bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Clostridium difficile Toxin-Associated Diarrhea
Authors: Brown Elizabeth , Talbot George H. , Axelrod Peter , Provencher Mary , Hoegg Cindy
Published: September 2009

The hospital-wide attack rate for Clostridium difficile-associated diarrhea at our tertiary-care university hospital was 0.02 per 100 patient discharges (0.02%) in 1982, but 0.41% and 1.47% in 1986 and 1987, respectively, with a peak incidence of 2.25% in the fourth quarter of 1987. Hospital antibiotic usage patterns showed concurrent increased use of third-generation cephalosporins, and intravenous vancomycin and metronidazole. Thirty-seven cases selected for study were older than 37 control patients, more likely to have an underlying malignancy and less likely hospitalized on the obstetrics/gynecology service. Their mean duration of hospitalization prior to diagnosis was 21 days, versus a mean total length of stay of eight days for controls. All cases received antibiotics, compared to 24 of the controls. Cases were given more antibiotics for longer periods, and more often received clindamycin, third-generation cephalosporins, aminoglycosides and vancomycin. Gender, race, duration of hospitalization, prior surgery and antiulcer therapy were not significant by logistic regression analysis. Epidemiologic variables with significantly different adjusted odds ratios (95% confidence intervals) were age greater than 65 years (14.1, 1.4-141), intensive care unit residence (39.2, 2.2-713), gastrointestinal procedure (23.2, 2.1-255) and more than ten antibiotic days (summation of days of each antibiotic administered) (16.1, 2.2-117). Control measures included encouraging earlier isolation and treatment of suspected cases and formulary restriction of clindamycin, with use of metronidazole for therapy of anaerobic infections. By the second half of 1988, the attack rate had dropped progressively to 0.74%.
Methicillin-Resistant Staphylococcus aureus Outbreak at a Veterans' Affairs Medical Center: Importance of Carriage of the Organism by Hospital Personnel
Authors: Reboli Annette C. , John Joseph F. , Platt Christel G. , Cantey J. Robert
Published: September 2009

The reported prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) by hospital personnel averages 2.5%. From August 1985 to September 1987, 155 patients at our Veterans' Affairs Medical Center (VAMC) were colonized or infected with MRSA. In December 1986, only two (2.1%) of 94 healthcare workers were identified as nasal carriers. Prompted by a sharp increase in the number of patients with MRSA in early 1987, contact tracing identified 450 employees, of whom 36 (8%) were nasal carriers. Thirty-five percent of surgical residents (7 of 20) were nasal carriers. Prior to being identified as a nasal carrier, one surgical resident was associated with the inter-hospital spread of the VAMC MRSA strain to the burn unit of the affiliated university hospital. Three family members of two employee carriers were also found to harbor the epidemic strain. All 36 carriers were decolonized with various antimicrobial combinations. Vigorous infection control measures were effective in controlling the epidemic. The frequency of MRSA carriage by hospital personnel at our medical center during the epidemic proved higher than previously appreciated. Thus, healthcare workers may comprise a sizable MRSA reservoir. During an MRSA epidemic, infection control should attempt to identify and decolonize this hospital reservoir, as these individuals can disseminate MRSA both within the hospital as well as into the community.
Intravascular Catheter Colonization and Related Bloodstream Infection in Critically III Neonates
Authors: Cronin Wendy A. , Germanson Teresa P. , Donowitz Leigh G.
Published: September 2009

Intravascular catheter tip colonization was prospectively evaluated in critically ill neonates to determine its relationship to the type of device used, duration of catheterization, insertion site and nosocomial bloodstream infection. Sixty-one percent (376 of 621) of all intravascular catheter tips were retrieved from 91 infants. Thirteen percent (41 of 310) of peripheral intravenous, 14% (6 of 42) of umbilical, 21% (3 of 11) of central venous, 36% (4 of 11) of peripheral arterial and 100% (2 of 2) of femoral catheters were colonized. Duration of catheterization was significantly longer for colonized lines (p < .001). Eight of 26 (30.8%) peripheral intravenous catheters remaining in place for more than three days were colonized, compared with 33 of 284 (11.6%) at three days or less (p = 0.012). Coagulase-negative staphylococcus was the organism most frequently isolated from catheter tips and bloodstream infections. Catheter colonization rates in this population were higher than those found in adults. Heavily manipulated devices and those in place for longer periods of time were the most frequently colonized.
Strategies for the Management of Varicella-Susceptible Healthcare Workers After a Known Exposure
Authors: Josephson Adele , Karanfil Lynne , Gombert Myles E.
Published: September 2009

Three different sequentially applied post-varicella zoster virus (VZV) exposure management strategies were employed over a 43-month period. We began by using a standard post-exposure protocol in which 50 susceptible healthcare workers (HCW) involved in hospital exposures were furloughed from work at a loss to the hospital of 424 workdays and $46,000. Of the eight nosocomial cases of VZV infection in HCWs, four (50%) caused future HCW and patient exposure. In trial I, we substituted a post-exposure screening procedure for the standard work furlough procedure. We screened 77 exposed staff resulting in one nosocomial VZV infection that was the source of another exposure incident. No secondary cases of varicella resulted from this exposure and only 20 days of furlough time were used during trial I. As VZV resulting from a home exposure source was responsible for most hospital exposures in which HCWs were the source, our trial II protocol added the Centers for Disease Control's (CDC) off-duty procedure, but limited its use to susceptibles exposed at home. The 43-month overall attack rate of nosocomial varicella was 4.7%, while the true home exposure attack rate was 79% (p < .00001). There was an average of 42.4 lost workdays charged to the hospital per incident under the standard protocol and three days per incident in the combined experience of trials I and II (p < .0001). Both trial protocol periods saved the hospital many potentially lost HCW days, 592 and 401, respectively, but the trial I protocol led to an observed increase in hospital exposure incidents. While the trial II protocol resulted in more lost workdays (120 of 521) than the trial I protocol, it prevented 18 additional HCW exposures. We conclude that the trial II protocol is safe and the most cost-effective of the three management strategies.
Human T-Cell Lymphotropic Virus-Type I
Authors: Larkin Julie , Sinnott John T. , Weiss Joshua , Holt Douglas A.
Published: September 2009

Human T-cell lymphotropic virus type-1 (HTLV-I) is a recently recognized retrovirus identified as the cause of adult T-cell leukemia-lymphoma (ATLL) and HTLV-I-associated myelopathy (TSPI HAM). HTLV-I, a member of the Retroviridae family of viruses, was first described in 1980 after the isolation of the virus from a patient with a T-cell lymphoma. These pathogenic retroviruses are typically divided into the Oncovirinae and Lentivirinae. The oncovirus group, including HTLV-I, HTLV-II and bovine leukemia virus (BLV), is generally associated with tumors. The lentiviruses are associated with immune deficiency and/or neurologic disease, and include agents such as the visna virus of sheep and the human immunodeficiency virus type-1 and -2 HIV-1 and HIV-2).
Pharmacodynamic Properties of Antibiotics: Application to Drug Monitoring and Dosage Regimen Design
Authors: Ebert Steven C. , Craig William A.
Published: September 2009

The goal of antimicrobial chemotherapy is to effectively eradicate pathogenic organisms while minimizing the likelihood of drug-related adverse effects. In this era of cost containment, consideration should also be given to performing this task with the smallest total dose of drug and the shortest duration of therapy. Determination of the appropriate dose and dosing interval of an antimicrobial requires knowledge and integration of both its pharmacokinetic and pharmacodynamic properties.
The Influenza Vaccination Demonstration Project: An Expanded Policy Goal
Authors: Fedson David S.
Published: September 2009

In 1980, the Public Health Service established an objective of immunizing 60% of high-risk persons with influenza vaccine annually by the year 1990. As no more than 32% of high-risk persons currently receive influenza vaccine each year, the Health Care Financing Administration (HCFA) has undertaken an influenza vaccination demonstration project for Medicare enrollees. Federally purchased vaccine is being distributed to physicians, health departments, hospitals, nursing homes and health maintenance organizations (HMOs). If the project is cost-effective, Congress has authorized HCFA reimbursement for influenza vaccination. Changing reimbursement policy alone, however, is unlikely to substantially improve influenza vaccine delivery; HCFA reimbursement for pneumococcal immunization since 1981 has not increased the use of pneumococcal vaccine. In contrast, federal purchase and distribution of vaccines to state and local health departments has helped maintain the remarkable success of childhood immunization programs. In addition, in Canada, provincial health departments purchase more than 80% of all influenza vaccine distributed, and from 1980 through 1988, per capita vaccine distribution increased 140%. These experiences suggest the need for an expanded policy goal for the influenza vaccination demonstration project that includes federal purchase and distribution of influenza vaccine. This approach, together with a change in reimbursement policy, offers greater promise for achieving our nation's objective for influenza vaccination.
Risky Business: Using Necessarily Imprecise Casualty Counts to Estimate Occupational Risks for HIV-1 Infection
Authors: Beekmann Susan E. , Fahey Barbara J. , Gerberding Julie L. , Henderson David K.
Published: September 2009

The emergence and widespread distribution of the acquired immunodeficiency syndrome (AIDS) have clearly signaled the most important epidemic of the 20th century. In responding to this epidemic in a compassionate and rational voice, the infection control practitioners-physicians, nurses and technologists-have played a crucial role in healthcare delivery. A great deal of information has resulted from numerous scientific studies. Because of the volume and complexity of data currently being generated, the Editorial Board of Infection Control and Hospital Epidemiology has invited Dr. David K. Henderson to initiate a new column on AIDS. He is an internationally recognized expert who has agreed to edit this column for the journal. We welcome your responses, and encourage your submissions to Dr. Henderson in this area.
Emporiatrics: Protecting Travelers From Malaria
Authors: Nettleman Mary D.
Published: September 2009

Although we think of malaria as a disease of the tropics, it is sobering to recall that in the beginning of this century, more than two-thirds of the earth's population lived in areas where malaria was endemic. The United States and Europe were both rife with malaria, and the disease changed the course of world history many times. Indeed, in Western Africa during 1942, the incidence of malaria was as high as 1,071 cases per 1,000 soldiers per year.
Practical Considerations in Designing Data Collection Forms
Authors: Wasek Patricia A.
Published: September 2009

The data collection form (also referred to as a questionnaire, case report form or interview guide) is the focal point of any research project. It contains the data used to test the research hypotheses. If errors are made in translating the questions of interest into items on the form, or in coding those items, the answers sought might not be available. Designing an excellent data collection form may be more art than science. However, there are certain principles that, if followed, will generally result in an easy-to-use, efficient and reliable instrument for gathering and coding data.
The Fifth Consensus Conference on Testing for Human Retroviruses
Authors: Hausler William J. , Getchell Jane P.
Published: September 2009

In late 1985, the Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) first recognized the need for standardization and uniformity of human immunodeficiency virus (HIV) test procedures, interpretation and reporting among public health laboratories. In 1986, the HIV Committee of ASTPHLD conducted its first Consensus Conference, with the objective of promoting quality and uniformity among laboratory programs through the exchange of data, sharing of expertise and formulation of consensus recommendations. There were 41 participants at this conference that addressed four topics: enzyme-linked immunosorbent assay (ELISA), Western blot, immunofluorescence and methods standardization.
Clostridium difficile -Associated Disease in Long-Term Care Facilities
Authors: Bentley David W.
Published: September 2009

Clostridium difficile is a major cause of gastrointestinal infections. In 1978, Bartlett and colleagues identified C difficile and its toxin as the cause of the antibiotic-associated pseudomembranous colitis (PMC). Within a few years, there was the development of a diagnostic assay, a description of a clinical and pathological spectrum of the disease, a definition of risk factors and characterization of the two toxins that account for the pathological event. Additional information regarding the microbiology, pathogenesis, clinical manifestations, diagnosis and treatment has rapidly developed. These features are beyond the scope of this report, and the reader is referred to several recent reviews.
Glutaraldehyde Nonbiologic Monitors
Authors: Kleier Donald J. , Averbach Robert E.
Published: September 2009

Glutaraldehyde was first synthesized by Harries and Tank in 1908, and first marketed as a chemosterilizer in 1963. Since that time, glutaraldehyde has been used extensively as a disinfectant and chemical sterilizing solution. Even though it is generally agreed that moist heat is the preferred method of sterilization for medical, dental and hospital instruments, glutaraldehyde is a relatively safe, simple-to-use and effective chemical solution that can sterilize heat-sensitive materials.

Glutaraldehyde (1,5-pentanedial) has two free aldehyde groups that combine irreversibly with bacterial cell membranes and enzyme systems. These properties give glutaraldehyde its biocidal effect. Contact time with glutaraldehyde is critical if sterilization, rather than disinfection, is to be achieved. Sterilization time ranges from minutes to ten hours, depending upon bacterial type and conditions of the test results. Sterilization with glutaraldehyde solutions usually requires prolonged contact times. Manufacturer instructions must be strictly followed.
An Outbreak of Acute Gastroenteritis Caused by a Small Round Structured Virus in a Geriatric Convalescent Facility
Authors: Gellert George A. , Waterman Stephen H. , Ewert Donnell , Oshiro Lyndon , Giles Marjorie P. , Monroe Stephen S. , Gorelkin Leo , Glass Roger I.
Published: September 2009

An outbreak of acute gastroenteritis (AGE) occurred in a 201-bed geriatric convalescent facility in Los Angeles County during December 1988 through January 1989. The attack rate was 55% among residents and 25% among employees. Illnesses were characterized by vomiting and diarrhea to a lesser extent, and the absence of fever. Bacterial and parasitic tests in a sample of patients were negative. A 27nm small round structured virus (SRSV) was identified in one of 30 stools studied by immune electron microscopy (IEM). While rotavirus and influenza A and B were found in three, one and three cases, respectively, no alternative etiologic agent could be demonstrated for most cases. The outbreak met Centers for Disease Control (CDC) clinical and epidemiologic criteria for Norwalk-like gastroenteritis. The death rate of residents was not elevated beyond baseline during the outbreak; however, one healthy employee had diarrhea and dehydration and died after developing an arrhythmia. An autopsy showed moderate, diffuse lymphocytic and neutrophilic myocarditis, and viral studies found influenza A in left ventricular tissue. Fourteen (25%) of 57 employee cases worked in occupations without routine stool or patient contact. At least nine of these employees lacked evidence of direct fecal contact, and transmission of infection in these cases may have been airborne. (Infect Control Hosp Epidemiol. 1990;11:459-464.)
Adoption of Guidelines for Universal Precautions and Body Substance Isolation in Canadian Acute-Care Hospitals
Authors: Birnbaum David , Schulzer Michael , Mathias Richard G. , Kelly Michael , Chow Anthony W.
Published: September 2009

The impact of recently recommended hospital infection control guidelines on Canadian acute-care hospitals is unknown. A confidential cross-sectional mailed survey of all acute-care Canadian hospitals was conducted to determine rates of receipt and adoption of published guidelines for Universal Precautions (UP) or Body Substance Isolation (BSI), rationale for adoption and knowledge of costs and benefits. Five hundred and seventy-nine of 943 sites (61%) responded (exceeding 80% in urban centers); 94% among hospitals with at least 300 beds and 57% among those under 300 beds. Seventy-four percent of responders claimed adoption of UP (65%) or BSI (9%), staff protection being their primary motivation. Adoption of either UP or BSI was associated with size (p<.001), increasing progressively from 45% in the smallest group (~25 beds) to 64% in the largest (2500 beds). Many hospitals introduced modifications and some substituted names other than UP or BSI in adopting a new strategy. In practice, UP and BSI now mean different things in different hospitals, and the distinction between them has become blurred. Furthermore, only 5% claiming adoption of a new strategy adopted all of the fundamental policies expected under UP or BSI. Receipt of guidelines was also correlated with size: one-third of hospitals under 200 beds had not received key publications defining UP and BSI. Only 19% claiming adoption of a new strategy indicated knowledge of cost implications. These results suggest a need for closer collaboration among hospitals and government agencies in developing uniform infection control policies, and for systematic evaluation of the cost and effectiveness of new strategies. (Infect Control Hosp Epidemiol. 1990;11:465-472.)
Influenza Outbreaks in Nursing Homes: How Effective Is Influenza Vaccine in the Institutionalized Elderly?
Authors: Cartter Matthew L. , Renzullo Philip O. , Helgerson Steven D. , Martin Stanley M. , Jekel James F.
Published: September 2009

During the 1984–1985 influenza season, outbreaks of influenza A (H3N2) occurred in three Connecticut nursing homes. Influenza vaccination rates were 67% (96 out of 144), 35% (30 out of 85) and 69% (332 out of 483), respectively. The relative risk of illness for vaccinated compared to unvaccinated residents was 1.8 (95% confidence interval, 0.6, 5.9), 1.6 (95% confidence interval, 0.8, 3.0) and 1.1 (95% confidence interval, 0.8, 1.7) for each of the three nursing homes, respectively. In the third outbreak, 22 vaccinated residents without clinical illness had a geometric mean titer of hemagglutination-inhibition (HI) antibody of 20. Although low, this titer was significantly higher than that of nine unvaccinated residents without clinical illness (12, p<.05); only three (14%) vaccinated residents had HI titers of 340. These results suggest that levels of HI antibody in vaccinated residents were not protective at the time of the third outbreak, four to five months after vaccination. In general, the study of vaccine effectiveness in nursing homes is limited by sample size and statistical power. Despite these limits, the retrospective investigation of influenza outbreaks in nursing homes is often the only practical way to evaluate influenza vaccine effectiveness in the elderly on a yearly basis.
Frequent Acquisition of Multiple Strains of Methicillin-Resistant Staphylococcus aureus by Healthcare Workers in an Endemic Hospital Environment
Authors: Opal Steven M. , Mayer Kenneth H. , Stenberg Marjorie J. , Blazek Julia E. , Mikolich Dennis J. , Dickensheets David L. , Lyhte Lisa W. , Trudel Ronald R. , Musser James M.
Published: September 2009

Methicillin-resistant Staphylococcus aureus (MRSA) has been an endemic nosocomial pathogen at the VA medical center (VAMC) in Providence, Rhode Island since 1981. From 1985 to 1987, more than 30% of all unique S aureus isolates were methicillin resistant. To evaluate the frequency of acquisition of MRSA isolates by healthcare workers, we compared the antimicrobial susceptibility patterns, multilocus enzyme genotypes and plasmid profiles of isolates recovered from nasal and hand cultures from VAMC nurses and house staff on rotation at the VAMC with those of clinical isolates from patients at the VAMC and four other affiliated hospitals. Fifty-six percent of ward nurses cultured (n = 112) were colonized with S aureus, of which 65% was methicillin resistant. Six isolates of MRSA were identified on the initial culturing of house staff (n=65); 16 MRSA isolates were recovered at the end of a four-week rotation (p<.02). Phenotypic and genotypic analyses demonstrated that numerous distinct MRSA strains were recovered in the study period. The incidence of MRSA among clinical isolates at the VAMC and affiliated institutions was remarkably constant throughout the three-year study period. Moreover, despite regularly sharing resident physicians, interns and medical students, MRSA isolates were uncommonly recovered at the other university-affiliated hospitals. Our study failed to reveal evidence of significant interhospital transmission of MRSA isolates by healthcare workers. While healthcare workers may contribute to the dissemination of MRSA within institutions, they appear to be less important in spreading MRSA between institutions (Infect Control Hosp Epidemiol. 1990;11:479-485.).
Aztreonam
Authors: Tunkel Allan R.
Published: September 2009

Aztreonam, the first licensed monobactam in the United States, is a β-lactam antimicrobial agent with a unique structure and in vitro spectrum of activity. The drug is active only against gram-negative aerobic bacteria in vitro, thus resembling the spectrum of aminoglycosides, but displays the safety profile typical of β-lactam agents. Due to these properties, aztreonam may prove useful in the therapy of various nosocomial infections. This review outlines the salient features of aztreonam and suggests areas of appropriate usage.
Single Preoperative Bladder Instillation of Povidone-Iodine for the Prevention of Postprostatectomy Bacteriuria and Wound Infection
Authors: Richter Santiago , Kotliroff Oscar , Nissenkorn Israel
Published: September 2009

Objective:

To study the effectiveness of preoperative bladder washing with povidone-iodine to prevent postprostatectomy wound infection.

Design:

Patients with an indwelling catheter and scheduled for prostatectomy were divided into two groups. In patients in group 1 (n = 76) the indwelling catheter was simply removed without bladder irrigation. Patients in group 2 (n = 80) had their bladder washed with a nondiluted solution of povidone-iodine before surgery.

Patients:

One hundred fifty-six consecutive patients with an indwelling catheter and bacteriuria. Mean age was 64 years. All patients had an open prostatectomy during the 12-month study period. Patients undergoing open prostatectomy during the first 6 months of the study had no bladder irrigation and served as the control group. Patients undergoing open prostatectomy during the following 6 months had a bladder instillation with povidone-iodine.

Results:

Wound infection appeared in 17 of 76 patients (22.4%) without bladder washing and in 4 of 80 patients (5%) when 50 to 60 ml of the solution was retained in the bladder for 10 to 13 minutes (p=.001). The incidence of postoperative bacteriuria remained unchanged in the control group (100%) but was reduced to 22.5% in the treated group (p= .001). Statistical comparisons of incidence were done using the chi square test.

Conclusions:

It has been demonstrated that the use of preoperative bladder instillation of povidone-iodine may be highly effective in the prevention of postprostatectomy wound infection and in reducing the incidence of bacteriuria in patients with an indwelling catheter and urine colonization.
Surveillance of Surgical Wound Infections Following Open Heart Surgery
Authors: Sellick John A. , Stelmach Marie , Mylotte Joseph M.
Published: September 2009

Objective:

To define accurate wound infection rates for the cardiac surgery service based on site of infection and characterization as “deep” or “incisional” and to determine whether a correctable cause for an apparent increase in deep wound infection rates existed.

Design:

Observational.

Setting:

Tertiary-care teaching hospital.

Participants:

All adults undergoing open heart surgery in 1988 and 1989.

Interventions:

Changed from razor to clipper preoperative hair removal in January 1989.

Results:

Deep sternotomy wound infections decreased significantly from 1.2% in 1988 to 0.2% in 1989 (p=.010) and deep venectomy (vein donor site) wound infections declined from 1.6% to 0.4% (p=.014) during the same time period. Incisional wound infection rates did not change. Patients with deep infections more likely required readmission or operation to treat their infection than those with incisional wound infections. The percentage of gram-negative organisms causing wound infections decreased from 56.3% in 1988 to 34.7% in 1989 (p= ,017).

Conclusions:

Preoperative hair removal using a clipper appears to have decreased the risk of deep wound infection compared with razor preparation. The dichotomous wound classification of “deep” and “incisional” distinguished between patients who required additional interventions for treatment of wound infections.
Noninfluenza Respiratory Virus Infection in Long-Term Care Facilities
Authors: Falsey Ann R.
Published: September 2009

Acute respiratory infections are a common problem in the general population, particularly during the winter months. Nonbacterial causes such as viruses, mycoplasma, and Chlamydia predominate,’ but with the exception of influenza virus, comprehensive studies are lacking that define the impact of these agents on the elderly. The institutionalized elderly represent a special subgroup of older persons who are prone to excess morbidity and mortality with respiratory infections. Each year, many residents of long-term care facilities become ill with respiratory illnesses not proven to be influenza, either by culture or serology. Recent studies have demonstrated the importance of a variety of viruses, including respiratory syncytial virus and parainfluenza, which can cause significant disease in this high-risk population. This article will review several of these epidemiologic studies and discuss in detail a number of viruses that are emerging as significant pathogens in the long-term care facility, with attention to modes of transmission and infection control.
Nosocomial Infection Rates for Interhospital Comparison: Limitations and Possible Solutions
Authors:   A Report From the National Nosocomial Infections Surveillance (NNIS) System
Published: September 2009

Improvement in quality of patient care has received increasing attention in the last decade, with emphasis in infection control and interhospital comparison of infection rates. One of the main objectives of the National Nosocomial Infections Surveillance (NNIS) system is to provide hospitals with comparative nosocomial infection data that at least partially adjust for patients' intrinsic and extrinsic risks for infection. This article summarizes the methods and results of analyses from the NNIS system and describes their application to future surveillance in US hospitals. We emphasize the importance of nosocomial infection surveillance data that adjust for specific infection risks in order to provide better interhospital comparison of infection rates. Traditional rates that do not provide such adjustment include the crude overall nosocomial infection rate of a hospital or service and site-specific infection rates by service. Because these inadequately adjusted rates are potentially misleading, they should not be used for interhospital comparison. This article describes several new infection rates, including device-associated, device-day infection rates for intensive care units and high-risk nurseries, and an NNIS surgical wound infection risk index. These rates appear to be better for interhospital comparison. NNIS data also suggest the importance of examining interventions (devices and operative procedures) that increase patient risk for infection. Failure to use appropriately adjusted rates and to examine the intervention experience may make interhospital comparisons meaningless or even misleading.
Validation of New Tests
Authors: Birnbaum David , Sheps Samuel B.
Published: September 2009

Tests may provide valuable information for identification or prediction functions. Examples include disease diagnosis and staging, therapeutic outcome prediction, outbreak detection, infection control policy compliance monitoring, and other quality assurance monitoring. However, the importance of information from specific tests depends on their validity and utility Thus, hospital epidemiologists who assess new or existing tests themselves should bear in mind “…a clear need for greater attention to accepted methodological standards on the part of researchers, reviewers and editors.”’ Poorly validated tests can produce harmful, misleading results.
Cost Improvements Through the Establishment of prudent Infection Control Practices in a Brazilian General Hospital, 1986–1989
Authors: Cavalcante M.D.A. , Braga O.B. , Teofilo C.H. , Oliveira E.N. , Alves A.
Published: September 2009

Objectives:

To review procedures currently practiced in a Brazilian general hospital and to eliminate ineffective and inefficient practices. To measure the resulting cost improvements based on rigid hospital financing control.

Design:

Implementation of surveillance and control programs and prevalence surveys to detect ineffective and inefficient practices.

Participants:

The study institution is a 130-bed general care facility affiliated with the Brazilian federal government. There were approximately 4,600 admissions per year during the study period (1986- 1989).

Results:

Instituting infection control measures and eliminating ineffective practices resulted in the following: an overall decrease in wound infection rates from 24.4% in 1987 to 3.45% in 1989; a 71% reduction in the global incidence of infection in the intensive care unit; a 74% reduction in the surgical prophylactic use of antibiotics; and a total savings of approximately $2 million (US dollars).

Conclusions:

During the period from 1986 to 1989, the infection control committee was able to decrease the overall wound infection rate from 24.4% in 1987 to 3.45% in 1989. This eliminated special health problems and improved patient care and cost-effectiveness for our hospital.
Failure of Bland Soap Handwash to Prevent Hand Transfer of Patient Bacteria to Urethral Catheters
Authors: Ehrenkranz N. Joel , Alfonso Blanca C.
Published: September 2009

Objective:

The study was designed to compare the efficacies of bland soap handwash and isopropyl alcohol hand rinse in preventing transfer of aerobic gram-negative bacilli to urinary catheters via transient hand colonization acquired from direct patient contact. Glove juice recovery of gram-negative bacteria was considered transient colonization; catheter recovery was considered transfer colonization.

Design:

The contact source for gram-negative bacteria was a single “high burden” groin skin carrier ( ≥ 104/ml cup scrub fluid). Using a two-period cross-over design, 6 healthcare workers had 2 15-second contacts for each hand followed by either soap handwash or alcohol hand rinse (12 experiments with each treatment). Between 4 to 5 minutes after contact, each hand manipulated a catheter; the catheter was then cultured and the hand was glove juice tested.

Results:

Soap handwash failed to prevent gram-negative bacteria transfer to the catheter in 11 of 12 (92%) experiments; alcohol hand rinse in 2 of 12 (17%) (p< .001). Soap handwash failed to prevent transient colonization in 12 of 12 (100%) experiments; alcohol in 5 of 12 (42%) (risk ratio 2.4,95% confidence interval 1.2-4.7). Single gram-negative bacteria species carried at source levels ≥ 5.5 × 103/ml (heavy contamination) established transient colonization in 23 of 30 (77%) exposures following soap handwash; single gram-negative bacteria species carried at levels ≤ 3.5 × 103/ml established colonization in 1 of 22 (5%) similar exposures (p<.001).

Conclusions:

Bland soap handwash was generally ineffective in preventing hand transfer of gram-negative bacteria to catheters following brief contact with a heavy-contamination patient source; alcohol hand rinse was generally effective.
Measles Immunity Among Community Hospital Employees
Authors: Houck Peter , Scott-Johnson Gay , Krebs Lylanne
Published: September 2009

Objective:

To define measles immunity rates among employees at 2 hospitals during a community outbreak in 1990.

Design:

Cohort survey using enzyme-linked immunosorbant assay (ELISA) and questionnaire.

Setting:

Two community hospitals.

Participants:

Seventy-six percent of 2,060 employees.

Results:

Seven percent (115/1566) of participants lacked ELISA-defined measles immunity. Among employees whose ages were known, 14% (64/467) of those born after 1956 and 5% (50/1086) of those born before 1957 lacked serologic evidence of immunity. Fifty-eight percent of the susceptible persons had substantial patient contact. With ELISA results as the reference for immunity, the predictive value of an undocumented positive history of measles disease or vaccination was 95%; the predictive value of a negative history of both was 52%. Measles developed in 7 employees.

Conclusions:

A substantial number of hospital employees lacked ELBA-defined measles immunity, including many who had patient contact or who had been born before 1957. Undocumented disease and vaccination histories were not adequate predictors of serologic status. This study supports the recommendations and suggestions of the Immunization Practices Advisory Committee that hospitals should require documented evidence of measles immunity from employees who have patient contact.
Evaluation of the Epidemiology of Hepatitis B Virus Cross-Infection in a Maternity Hospital
Authors: Puvacic Z. , Simic S. , Karlovac M. , Visnjevac V. , Simic M. , Nikulin B.
Published: September 2009

Objective:

To determine the hepatitis B infection risk in a university hospital of obstetrics and gynecology,

Setting:

The University Hospital of Obstetrics and Gynecology, The University of Sarajevo, Yugoslavia.

Design:

Staff members were divided into three groups: 73 doctors, 184 medical technicians working in delivery rooms, and 55 medical technicians working with postnatal care. The patients were 63 women, aged 17 to 39 years (mean = 26.11 years), pregnant for the first time and in the first stage of labor. Participants all had a negative history of hepatitis B and no known contact with the hepatitis B virus.

Results:

The incidence of hepatitis B infections among physicians, technicians, and postnatal care technicians was 1.36%, 3.8%, and 3.6%, respectively. The incidence among patients was 4.76%. The daily infection risk varied between 1% and 17% of all deliveries.

Conclusions:

The risks of transmission of the hepatitis B virus to hospital workers in this setting is indeed high enough to make a case for hepatitis B vaccination in susceptible staff members. Even if vaccination of staff members is carried out, hygienic measures to prevent the transmission of bloodborne infection between patients and from patients to staff are of the utmost importance.
Infection Control Violations
Authors: Homing Linda A. , Smith Philip W.
Published: September 2009

The Joint Commission on Accreditation of Healthcare Organizations UCAHO) mandates a hospital-wide infection control program.' National, state, and local healthcare guidelines and resources address infection control issues including asepsis, handwashing, isolation precautions, Universal Precautions (UP), and waste disposal. One important aspect of an infection control program is the monitoring of compliance with policies and procedures. We report a system of monitoring compliance with infection control policies and procedures through the use of confidential infection control violation reports.

Bishop Clarkson Memorial Hospital is a 550-bed tertiary care center that has an epidemiology services department consisting of a medical director, associate medical director, and two nurse epidemiologists. Hospital personnel have been encouraged through formal and informal educational sessions to report infection control violations to the service. Prior to 1986, infection control violations usually were noted through special studies such as isolation precautions monitors and surveillance activities. Occasionally, employees told Epidemiology Services about a witnessed violation but were very hesitant to document the incident because of fear of retaliation, harassment, and job loss. Peer pressure appeared to play a role in this hesitation.
The Nonexistent Problem
Authors: Davidhizar Ruth
Published: September 2009

It can be said that the greatest pitfall for the infection control practitioner lies in the realm of problem solving'; however, responding to potential problems is intrinsic to the role of the infection control practitioner. Potential problems are presented to the infection control practitioner not only by his or her employees and supervisors, but also from medical and other hospital staff. Not only do potential problems come from a variety of sources, but their significance may vary from unimportant to critical. In some cases, problems are minor and require little action. In other cases, problems represent critical emergencies and necessitate immediate and aggressive responses. Whether the infection control practitioner works in a small patient care unit or a large university hospital, correct assessment and response to a potential problem is a crucial aspect of effective management.

In most cases when a problem is presented, there is agreement by both presenter and infection control practitioner that a problem exists. For example, a patient may have methicillin-resistant Staphylococcus aureus (MRSA) infection. In other cases, while there is agreement that a problem exists, there may not be agreement on the importance of the problem. For example, what is seen by the infection control practitioner as a serious problem may be seen by a physician as a minor problem.
Salmonella and Shigella Gastroenteritis at a Public Teaching Hospital in Nairobi, Kenya
Authors: Paton S. , Nicolle L. , Mwongera M. , Kabiru P. , Mirza N. , Plummer F. , Wamola I.
Published: September 2009

Objective:

To measure the proportion of nosocomial diarrhea cases associated with Salmonella and Shigella species.

Design:

Prospective 6-month survey.

Setting:

Tertiary care center in a developing country.

Patient:

Pediatric and adult patients admitted within the previous 24 hours and all consenting adult or pediatric medical patients with nosocomial diarrhea.

Outcome Measures:

Prevalence of Salmonella and Shigella species isolated from rectal swabs at admission and among subjects with nosocomial diarrhea.

Results:

Salmonella species and Shigella species were isolated from 3.0% and 2.5%, respectively, of 667 patients screened on admission. All admission Salmonella isolates were identified in children under 13 years of age; Shigella prevalence was similar for children and adults. Children with Salmonella at admission were significantly older and more likely to have diarrhea, fever, and some indicators of malnutrition than those from whom Salmonella was not isolated. Salmonella and Shigella were isolated from rectal cultures in 36 (10%) and 9 (2.5%) of 360 nosocomial gastroenteritis cases, respectively. Nosocomial cases occurred equally in adults and children. In adults, nosocomial Salmonella acquisition was associated with sharing a room with a diarrhea patient and previous institutionalization. In children, it was associated with recent antimicrobial therapy, crowding at home, and age between 6 months and 6 years. Nine (41%) of 22 nosocomial Salmonella cases in adults occurred in patients with human immunodeficiency virus-type 1 (HIV-1) infection, while none of 79 HIV-1-positive patients had Salmonella isolated at admission.

Conclusions:

Salmonella is a frequent cause of nosocomial gastroenteritis in this tertiary care institution in a developing country Risk factors appear to differ for children and adults, and HIV-1-infected subjects may be at increased risk of acquisition. Control measures feasible for the limited resources available to such institutions require evaluation.
Collaborative Education Regarding Prevention of Human Immunodeficiency Virus Transmission in Healthcare Settings-Ghana
Authors: Cronin Wendy , Antwi Phyllis , Larson Elaine
Published: September 2009

Objective:

To evaluate the effectiveness of a collaborative and participatory approach to professional training to reduce the risk of human immunodeficiency virus (HIV) transmission.

Setting:

Healthcare settings in Ghana.

Methods:

Two 5-day workshops were conducted for high-level nurse educators and leaders who could contribute to national policy development A combination of didactics, skill development sessions, field experiences, and development of draft national guidelines and curriculum were used. Outcomes evaluated were pre-to-post training changes in HIV knowledge and attitudes and changes in practice within selected healthcare settings. One-month follow-up visits (times not specified to participants) were used to evaluate outcomes.

Results:

At post-test, significantly fewer participants thought HIV was transmitted by saliva, sweat, or tears (chi square, p<.0001), and significantly fewer reported hesitation to care for an HIV-infected patient because of lack of understanding about mode of transmission or because of lack of supplies, such as gloves (chi square, p<.01). In field observations, there was an overall 42% improvement in specific infection control practices.

Conclusions:

A collaborative and participatory approach to training can result in significant changes in infection control practices, even in settings with limited resources.
Amebiasis
Authors: Widmer A.F. , Nettleman M.D.
Published: September 2009

Amebiasis is an infection of the large intestine produced by the protozoan Entamoeba kistolytica. The disease occurs worldwide but is most prevalent in South and West Africa, Southeast Asia, Mexico, and the western part of Latin America.' More than 10% of the world's population is estimated to be infected. E kistolytica is the third leading parasitic cause of death in developing nations, after malaria and schistosomiasis. In the United States, the prevalence has declined from 5% to 10% in 1960 to approximately 1% to 4% currently. However, amebiasis is one of the most important pathogens to which travelers to endemic countries are exposed.

Other groups also are at higher risk of acquiring E kistolytica infection. Sixteen percent to 32% of homosexual men have been found to have E kistolytica in stool specimens. E kistolytica also has been reported as an occupational disease in flight personnel working for commercial airlines.” Because humans are virtually the exclusive reservoir of E kistolytica, appropriate control measures could result in a substantial reduction in the incidence of the disease.

Entamoeba has seven species including Entamoeba hartmanni, Entamoeba coli, Entamoeba colecki, and Entamoeba gingivalis; only E kistolytica causes disease in humans. The morphologic classification of Entamoeba is based on the number of nuclei in the mature cyst.' E kistolytica is further characterized by its unique antigens, DNA characteristics, and isoenzyme analyses. In contrast to the free-living amoeba, E kistolytica requires the presence of either bacteria or tissue substrates to satisfy its nutritional needs. It can be cultivated on artificial media, but the diagnostic value of culture remains uncertain.
Infected Urine as a Risk Factor for Postprostatectomy Wound Infection
Authors: Richter Santiago , Lang Ruth , Zur Fruma , Nissenkorn Israel
Published: September 2009

Objective:

To study the relation of preoperative infected urine and postprostatectomy wound infection in patients with and without indwelling bladder catheters.

Design:

Patients undergoing prostatectomy were evaluated for the presence of infected urine prior to prostatectomy and postoperative wound infection. They were further divided into patients with indwelling urinary catheter and catheter-free patients. All had received antibiotic prophylaxis.

Patients:

One hundred fifty consecutive patients undergoing open prostatectomy-mean age was 67 years; 100 patients with an indwelling catheter for a mean period of 50 days; 50 catheter-free patients.

Results:

Wound infection was found in 19 of 81 (23.5%) and in 6 of 69 (8.7%) patients with infected and sterile urine, respectively p = .028). In patients with indwelling catheters prior to operation, wound infection was 22.4% when urine was infected and 8.3% when it was not. In patients without catheters, infected urine was associated with 40% of wound infections, as compared with 8.9% of wound infections in patients with sterile urine. Organisms obtained from infected wound and urine were identical in 84% of cases. These results were obtained despite antibiotic prophylaxis.

Conclusions:

Wound infection has been demonstrated to be a postprostatectomy complication directly related to the presence of urinary infection at surgery; thus, elective prostatectomy should be deferred until urine becomes sterile.
Risk Factors for Nosocomial Bacteremia in a Large Spanish Teaching Hospital: A Case-Control Study
Authors: Trilla Antoni , Gatell Josep M. , Mensa Josep , Latorre Xavier , Almela Manuel , Soriano Eladio , Jimenez de Anta Maria T. , San Miguel Juan Garcia
Published: September 2009

Objective:

Identify independent risk factors associated with the development of nosocomial bacteremia.

Design:

Exploratory, unmatched, case-control study.

Setting:

A 970-bed Spanish university hospital.

Patients:

All non-neutropenic adult patients with nosocomial bacteremia admitted during a 12-month period were eligible as cases. All adult non-neutropenic patients without nosocomial bacteremia were eligible as controls.

Results:

The incidence of bacteremia in the study population was 6.9/1000 admissions/ year. One hundred eighty cases and 180 controls were analyzed. Multivariate analysis (stepwise logistic regression techniques) identified seven risk factors independently associated with nosocomial bacteremia: age above 65 years; prior admission (within six months) to the hospital; underlying diseases that were ultimately or rapidly fatal; indwelling urethral catheter in place for more than three days; intravenous central lines or peripheral venous lines (if in place for more than four days); “high-risk surgery” (i.e., lower abdominal, cardiac or thoracic); and admission to an intensive care unit.

Conclusions:

Although five variables are not modifiable, the remaining two relate to the use and duration of devices. Our data give strong support for the value of testing strict guidelines for limiting vascular catheters and evaluating the need for prolonged urethral catheterization. If effective infection control measures are identified, we could target hospital-wide surveillance to patients whose risk factors are amenable to intervention.