bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Chlorhexidine in Ethanol and in Isopropanol on the Bacterial Colonization of the Umbilicus of Newborns
Authors: Nyström B. , Bygdeman S. , Henningsson A. , Tunell R. , Berg U.
Published: August 2016

The effect of daily treatment with 0.5% Chlorhexidine in 70% ethanol and in 70% isopropanol, respectively, on navel colonization and on rates of infection in newborns has been studied in 438 infants in two maternity wards during a 3-month period. In spite of isopropanol being reported as a more efficient skin disinfectant than ethanol in several experimental models, no significant differences were seen in the frequency of navel colonization or in infection rates between the two treatment groups. The colonization rate with S. aureus was lower in this than in an earlier investigation on navel disinfection with Chlorhexidine in ethanol performed in the same wards. This may reflect a progressive effectiveness of the treatment due to fewer S. aureus sources in the nursery. For practical reasons we continue to recommend daily navel disinfection with 0.5% Chlorhexidine in 70% ethanol on healthy newborns in hospital nurseries.
Amphotericin—How Safe and Effective?
Authors: Norris Sandra M.
Published: August 2016

Over a period of 35 days beginning July 23, 1984, the Infection Control Section of the Nassau Hospital, a 535-bed community teaching institution received reports of an unusually high number of PPD tuberculin skin test conversions among employees from Employee Health Service personnel.

The first case involved a registered nurse who, upon receiving a routine annual Mantoux skin test on July 23, converted from the previous year's negative reaction to a significant reaction (20 mm induration) with a greater than normal area of erythema. When she reported this to her private medical doctor prior to beginning INH prophylaxis, she was retested by the physician. This test was read as nonreactive.
The Rapidly Growing Mycobacteria—Mycobacterium fortuitumandMycobacterium chelonei
Authors: Brown Timothy H.
Published: August 2016

Recent clinical experience has addedMycobacterium fortuitumandMycobacterium cheloneito the expanding list of nosocomial pathogens. These rapidly growing mycobacteria were first isolated 80 years ago from frogs (M. fortuitum) and sea turtles (M. chelonei). Obtained occasionally from human sources as early as 1904, they were generally regarded as commensals in man. Friedmann was so convinced of the non-pathogenicity ofM. cheloneithat he introduced the “turtle vaccine” as a means of preventing and treating tuberculosis. Contemporary medical literature firmly establishes these organisms as human pathogens with particular importance in nosocomial infections.
Abbreviated Surveillance of Nosocomial Urinary Tract Infections: A New Approach
Authors: Costel Esther E. , Mitchell Sue , Kaiser Allen B.
Published: August 2016

An abbreviated method for the surveillance of nosocomial urinary tract infection is described. Combining desirable features of both active and passive surveillance, this new method involves concurrent review of microbiology reports. Compared to traditional active surveillance methods which require review of individual patient charts, the abbreviated method requires only one-fifth the time commitment while maintaining a 98% sensitivity. Although some degree of overestimation is inherent in this method, the primary goals of surveillance—monitoring infection rates and identifying clusters of infection—should be preserved.
Enterobacter
Authors: Ristuccia Patricia A. , Cunha Burke A.
Published: August 2016

The genus Enterobacter belongs to the tribe Klebsielleae found in the family Enterobacteriaceae. Members of this genus had previously been referred to as Aerobacter. The clinical importance of this genus as a separate entity was not fully appreciated until the 1960s. Until that time, the differentiation of Enterobacter from Klebsiella was not routinely performed, which resulted in many infections reported as being caused by the Klebsiella-Aerobacter group. Added confusion occurred at this time with the taxonomy change of Aerobacter to Enterobacter.
Implementing a Successful Hepatitis B Vaccination Program
Authors: Hanacik Linda J. , Franson Timothy R. , Gollup Jill D. , Rytel Michael W.
Published: August 2016

Health care personnel with frequent blood contact are at high risk for being exposed to and developing hepatitis B infection. Exposure to unidentified infectious patients may lead to personnel inadvertently foregoing appropriate, passive immunoprophylaxis. For these reasons, our hospital elected to conduct an aggressive program to administer hepatitis B vaccine to all employees at high risk for exposure to hepatitis B virus, thus protecting such employees from inadvertent occupational exposure. Administrators agreed to offer the vaccine as a free employee health benefit. “High-risk” employees attended mandatory inservice presentations covering hepatitis B disease, vaccine safety and efficacy, and related concerns. High-risk individuals were required to either receive vaccine or sign “informed refusal” forms. The vaccine clinic was organized to accommodate employee work schedules. Of high-risk employees eligible for vaccination, 90% completed a three-dose vaccine course. Extensive inservice education, financial and administrative support, and careful advance planning are all crucial in achieving high compliance with vaccination programs. A description of key steps in designing a successful vaccination program is outlined.
Klebsiella oxytoca Isolates in a General Hospital
Authors: Alvarez Salvador , Stinnett Joy A. , Shell Charles G. , Berk Steven L.
Published: August 2016

Primary infections caused by Klebsiella species are uncommon, but the organism is an important nosocomial pathogen. We report the predisposing factors, clinical features and outcome of 44 hospitalized patients in whom Klebsiella oxytoca was isolated. Twenty-one (48%) isolates were community-acquired and 23 (52%) were considered nosocomial in origin. Most of the patients were elderly males with serious underlying diseases. There were significant differences between those patients who acquired Klebsiella oxytoca in the hospital and in the community. Nosocomially acquired organisms were associated with a higher mortality (52% vs. 24%) (p<0.05), a higher incidence of infection vs. colonization (83% vs. 57%) (p<0.05), and a higher percentage of cases of pneumonia (43% vs. 19%) (p<0.05). The clinical features, the hospital service and the patients' underlying diseases were similar when patients who died and those who survived were compared. Patients who died were exposed to antibiotics more often prior to the positive culture with K. oxytoca (p<0.05). K. oxytoca is a significant pathogen in hospitalized elderly patients. It is likely to cause infections, especially pneumonia, and carry a high mortality. The organism can become endemic within the hospital setting with continued carriage and nosocomial spread.
Infection Control and Employee Health: Rubella Prevention Programs
Authors: Valenti William M.
Published: August 2016

In recent years, increased emphasis has been placed on immunization of adults. The reintroduction of the pneumococcal vaccine in 1976 seems to have begun a new era in adult medicine that targets certain vaccines toward adults. Prior to this, most of our efforts at immunization in the US were directed toward young children. Although the pneumococcal vaccine has been underutilized, publications from the CDC and the American College of Physicians suggest that this particular public health strategy will be with us for some time to come.
Topics in Clinical Microbiology:Francisella tularensis
Authors: Evans Martin E.
Published: August 2016

In 1911, McCoy discovered an unusual illness among ground squirrels in Tulare County, California. The illness resembled plague but was clearly different because a pathogen could not be isolated on the usual culture media. With the addition of egg yolk to the media, McCoy finally isolated an organism and named itBacterium tularensis. It was soon recognized thatB. tularensiscould cause disease in humans, and many investigators, especially Edward Francis, did much of the early work defining the bacteriology, pathology, and epidemiology of tularemia. The name of the organism was eventually changed toFrancisella tularensisin honor of Francis.

UnlikePseudomonas aeruginosaand the Enterobacteriaceae which are relatively non-pathogenic in the normal host,F. tularensiscan easily cause disease in previously healthy persons. In contrast,F. tularensishas not been implicated in nosocomial infections and person to person spread is rare. The organism is, however, extremely hazardous to workers in the clinical microbiology laboratory. Of all common bacterial and fungal pathogens isolated in the clinical laboratory,F. tularensisis second only toCoccidioides immitisin its potential to infect the laboratory worker. Many experienced investigators claim that it is impossible to work with the pathogen for any length of time without becoming infected. Currently it is highly recommended that persons who routinely work with the organism be immunized.
Host Factors in Whirlpool-AssociatedPseudomonas aeruginosaSkin Disease
Authors: Solomon Steven L.
Published: August 2016

Pseudomonas aeruginosafolliculitis is the most common recognizable infectious disease occurring after use of whirlpools and hot tubs. The factors that affect the host's susceptibility to whirlpool-related infection are the anatomic and physiologic defenses of normal skin, the microecology of the skin surface, factors intrinsic to the individual host, and behavioral factors. The structural components of the skin maintain an environment at the skin surface that makes human skin an inhospitable habitat for microflora. However, natural and experimental models ofP. aeruginosaskin infection suggest that immersion in whirlpools may negate many of the body's normal host defenses, especially the very low humidity at the skin surface. Transient colonization of skin withP. aeruginosamay lead to elaboration of toxins in vivo, resulting in the characteristic dermatitis.
Experiences With Bacteriological Monitoring of Pool Water
Authors: Schiemann Donald A.
Published: August 2016

A bacteriological study was completed on pools and whirlpools operated by hotels and private health clubs in the metropolitan area of Toronto, Ontario, Canada. Coliform bacteria, fecal coliform bacteria, and fecal streptococci were found only when other indices showed a drastic deterioration in water quality. Aerobic plate counts were higher, and staphylococci and Pseudomonas aeruginosa occurred more often in whirlpools than in swimming pools. There was a correlation between aerobic plate counts and the presence of staphylococci and P. aeruginosa. P. aeruginosa was rare in swimming pools in the absence of staphylococci; however, in whirlpools the organism was often found in the absence of staphylococci, and when aerobic plate counts were low. P. aeruginosa and plate counts in excess of 3,000 per ml occurred more frequently in whirlpools when the free chlorine residual was less than one part per million. The surface film showed concentrations of staphylococci far greater than the pool water. Whirlpools appear to present a different ecosystem that favors the establishment of P. aeruginosa. Staphylococci, but not Staphylococcus aureus, are useful in indicators of pool water quality but better laboratory methodology is required. Additional attention should be directed to the bacteriology of the water surface film, which presents a more direct hazard to bathers.
Evaluation of the Sterility and Stability of Insulin from Multidose Vials Used for Prolonged Periods
Authors: Rathod Minaxi , Saravolatz Louis , Pohlod Donald , Whitehouse Fred , Goldman Jose
Published: August 2016

Diabetic patients frequently use their insulin vials for prolonged periods, even though antibacterial preservatives used in multidose insulin vials are not required to be effective beyond 28 days. For this reason, we evaluated the antibacterial activity present in multidose insulin vials for up to 50 days. Multidose lente insulin vials were inoculated withS. aureusandP. aeruginosa. Vials incubated at room temperature (21°C) were sterile by 48 hours, whereas when they were incubated at refrigerator temperatures (4°C),S. aureuscontamination persisted up to the 17th day andP. aeruginosawere killed after 10 days. The same vials were serially contaminated on days 17, 30, and 50, and a similar antibacterial effect was maintained. Sixty-nine multidose insulin vials used for an average of 53 days were cultured. Eight vials demonstrated bacterial contamination with 1 cfu/ml ofS. epidermidisorPropionibacterium acnes. No endotoxin was detected in the multidose vials used for more than 28 days. Insulin assays on 40 multidose insulin vials used for more than 28 days showed an average insulin content of 101.6±1.9 units/ml. This study did not demonstrate significant bacterial contamination, endotoxin activity, or insulin degradation of multidose insulin in vials used for periods longer than 28 days. In addition, antibacterial preservatives were more effective at room temperature than at refrigerator temperature; thus, the practice of patients not refrigerating insulin vials is sensible.
Surveillance for Postoperative Infections in Outpatient Gynecologic Surgery
Authors: Garvey James M. , Buffenmyer Carol , Rycheck Russel Rule , Yee Robert , McVay Joanne , Harger James H.
Published: August 2016

Postoperative infection rates were determined for gynecologic outpatient surgical procedures performed in a traditional operating room environment and a separate, recently opened, surgicenter within the same hospital. Infections were self-reported by attending surgeons responding to computer-generated line listings of their recent surgical procedures. Responses were obtained on 97.9% (612/625) of women having surgery in the operating room and 99.5% (629/632) of women with surgicenter procedures. The overall infection rate for reported women was 0.9% (11/1,241). The difference between operating room and surgicenter rates was not statistically significant. Postoperative infections occurred in 2.5% (3/118) of diagnostic laparoscopies with tubal lavage and 1.4% (3/214) of voluntary abortions by dilatation and evacuation and curettage (D&E&C). The five other infections were scattered among the remaining 25 procedure categories. Ten of the 11 infections were limited to the “clean-contaminated” wounds. No serious or life-threatening infections were encountered. The computer-assisted surveillance system worked well and was easily incorporated into the existing infection surveillance system. The degree of ascertainment of postoperative wound infections is unknown due to reliance on physician self-reporting. However, no patients requiring readmission for infection went unreported by the attending surgeons.
Nosocomial Outbreak of Hand-Foot-and-Mouth Disease Among Operating Suite Personnel
Authors: Johnston Jeffrey M. , Burke John P.
Published: August 2016

In the fall of 1983 an outbreak of hand-foot-and-mouth disease occurred in a large urban hospital. The outbreak began among surgical nurses confined to one area of the operating suite and appeared to spread by direct contact to personnel working in the other areas. No cases were diagnosed among hospital patients. There was no evidence to support an ongoing community epidemic as only three of 98 physicians surveyed had seen hand-foot-and-mouth disease in their practices, and none occurred among family members of 94 unaffected employees. The outbreak resulted in 82 lost workdays at an estimated cost to the hospital of $5,676. Existing infection control guidelines do not address the issue of transmission of hand-foot-and-mouth disease from hospital personnel to patients; our experience suggests that the risk of transmission, at least in the operating suite environment, may be greater for other personnel than for patients.
Topics in Clinical Microbiology: Microbial Adherence and Infection—Clinical Relevance
Authors: Stratton Charles W. , Fishman Marlene
Published: August 2016

Adherence mechanisms have been described for some microbes, often in direct association with onset of infection. In other cases, the evidence is vague. This article will summarize modes of attachment, and will focus on each anatomical tract in an effort to outline the relationship between microbial adherence, host cells, foreign bodies, and infection.
The Nosocomial Colonization of T. Bear
Authors: Hughes Walter T. , Williams Bonnie , Williams Bobby , Pearson Ted
Published: August 2016

A national effort to reduce nosocomial infections includes a program developed at the National Institutes of Health to encourage handwashing in hospitals and day care centers. The program promotes a symbolic teddy bear (T. Bear) with slogans to remind hospital personnel and patients to practice handwashing. One of the items used is a stuffed toy T. Bear to be dispensed to the hospitalized child. Considering the manner in which children handle stuffed toys, we suspected the T. Bear might serve as a “fomite” for transmission of nosocomial microbes. A prospective study of 39 sterilized T. Bears revealed that all became colonized with bacteria, fungi, or both within 1 week of hospitalization. Hospital acquired organisms cultured from the T. Bear included Staphylococcus epidermidis, Staphylococcus aureus, alpha streptococci, Corynebacterium acnes, Micrococcus sp, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Bacillus sp, and species of Candida, Cryptococcus, Trichosporon, Aspergillus and others. Concomitant cultures of the patients revealed similar isolates. Although the T. Bear handwashing campaign should not be discredited, the promotional toy may pose an unnecessary expense and hazard and should not be used in hospitals or day care centers.
Reuse of Disposable Medical Devices: Historical and Current Aspects
Authors: Greene V.W.
Published: August 2016

The “plastics revolution” of the last quarter century disrupted a hospital tradition. Since the 1890s, hospitals processed, packaged, and sterilized most of the medical-surgical items they needed in their own sterile supply departments–a “cottage industry” developed specifically for recycling. Only those consumable items that were too difficult, expensive, or inconvenient to reprocess were purchased from outside manufacturers as presterilized, single-use “disposables.” Since the plastics revolution, however, the “disposables” started to displace the “reusables,” and while claiming to be an economical innovation, have become a significant item in the budget. Some hospitals feel that if disposables save money, reusing the disposable several times will save more. The practice is spreading. The manufacturers, in turn, claim that hospitals do not have adequate quality assurance programs or skills to reprocess their items properly. The debate is further complicated by legal and ethical ramifications, as well as commercial and economic arguments.
Suppurative Thrombophlebitis: Correlation Between Pathogen and Underlying Disease
Authors: Johnson Capt Robert A. , Zajac Capt Robert A. , Evans Maj Martin E.
Published: August 2016

We identified 29 episodes of suppurative thrombophlebitis in 27 patients admitted to a large general hospital between May 1980 and May 1984. In 25 patients, the intravenous cannulae had been in place for more than 3 days. Streptococcus faecalis, Pseudomonas aeruginosa or one of the Enterobacteriaceae were implicated in 14 patients. All these patients had recently undergone abdominal surgery or had a major intraabdominal inflammatory process at the time they developed thrombophlebitis. The remaining 13 patients were infected with Staphylococcus aureus, other grampositive cocci or Candida species. Only two of these had an active abdominal process at the time of their infection (x2 = 16.08, P<0.001). There is an apparent association between phlebitis caused by enteric organisms and active intra-abdominal pathology. There were two deaths related to delayed or deferred surgery. Suppurative thrombophlebitis is a lethal, preventable nosocomial infection that requires urgent surgical intervention.
Zero Infection Rate: An Achievable Irreducible Minimum in Clean Surgery?
Authors: Kaiser Allen B.
Published: August 2016

For clean elective surgery, the goal of nosocomial infection control is nothing less than an infection rate of zero. Although infection rates of less than 1% are being posted regularly in selected surgical operations today, infection rates of 2% to 6% persist in many procedures such as coronary artery bypass surgery and vascular surgery. Predictable achievement of a zero infection rate in all of clean surgery will require new directions in both basic and clinical research.

Research into the prevention of infection in clean surgery has, to date, focused upon 1) identifying and controllingthe routes of wound contamination, 2)decontamination of a contaminated woundthrough the prophylactic use of antimicrobials, and 3)modifying the host immune system. The latter is a fascinating area of new research which will not be discussed in detail here.

Routes of contaminationare often categorized as endogenous or exogenous. “Endogenous” generally refers to bacterial seeding of the wound from the flora of the patient's own skin, nose, perineum, and GI tract. “Exogenous” contamination has come to mean bacteria originating from the operating room environment or operating room personnel which reach the wound by direct inoculation (eg, improperly sterilized instruments, hands of the surgeon via torn gloves) or by the airborne route. These categories may not be broad enough to satisfy the complexities of the hospital environment, however. The addition of the category “acquired endogenous” may be of help in describing contamination which occurs when patients become colonized with resistant hospital flora and subsequently carry this newly acquired flora into the operating theater.
Endemic Nosocomial Filamentous Fungal Disease: A Proposed Structure for Conceptualizing and Studying the Environmental Hazard
Authors: Rhame Frank S.
Published: August 2016

Reducing the concentration of filamentous fungal spores in the air inhaled by immunosuppressed patients is an important goal. Although it is not clear that air is the exclusive vector of nosocomial filamentous fungal disease, it is quite likely that it is the most important vector. Uncertainties about this assertion are compounded by the great variety of fungal species involved. Aspergillus fumigatus, A. flavus, A. terreus, A. niger, Petriellidium boydii, Fusarium sp., Mucoraceae, Phoma sp., Alternaria, Penicillium, and others have caused invasive disease in immunosuppressed patients. But detailed studies of environmental correlates of nosocomial disease are largely restricted to A. flavus and A. fumigatus. Spores of all of these species may be recovered from unfiltered air. It is probably reasonable to extrapolate from Aspergillus to all of the species involved.
Infections in Hematologic Malignancy
Authors: Rogers Tom R.
Published: August 2016

Two decades have elapsed since the first detailed studies were undertaken to determine which factors were associated with an increased incidence of life-threatening sepsis during the treatment of leukemia and lymphoma. The state of granulocytopenia is now acknowledged to be the major factor predisposing to infection and accordingly, attention has focused on the merits of preventive measures applied during this risk period. A tremendous effort has been invested in the evaluation of different protocols and there is little doubt that major advances have been made even though a simultaneous improvement in survival rates as a result of more intensive chemotherapy has not always been in evidence. While it is appropriate to initiate prophylaxis before the treatment of most adult acute leukemias and for marrow transplantation, the reduced duration and severity of granulocytopenia during chemotherapy for both childhood acute leukemia and lymphoma generally obviate the need for this approach.

Progress in the development of potent broad-spectrum antibiotics coupled with better clinical awareness of the value of early treatment, as well as changing practices in supportive care have each contributed to the recent pattern of infection that has been observed. In addition, the impact of new technologies, as illustrated by recent innovative applications of bone marrow transplantation, further underlines the need to reappraise current infection control procedures.
Survey on Testing Criteria and Reporting Methods for Human Immunodeficiency Virus Serologic Tests in Veterans Administration Medical Centers
Authors: Mottice Susan , Matsumiya Sego , Reimer Larry
Published: August 2016

Guidelines for the indications for use, requirements for consent, and mechanisms for reporting of serologic tests for human immunodeficiency virus (HIV) infection are not standardized. In trying to establish such guidelines for our hospital, we surveyed all Veterans Administration Medical Centers regarding their current approach to testing both patients and employees. Infection control practitioners from 67 hospitals representing 37 states responded. Patients are likely to be tested for diverse reasons, unlikely to be counseled about the test or be required to consent to it, and test results are given no special precautions. Although 66% of the respondents do not use any extra precautions concerning patient confidentiality, 80% utilize more stringent criteria for testing and result-reporting with employees than patients. Thus, while the majority of hospitals maintain that current modes of confidentiality are acceptable for patients, practice suggests that these modes are considered inadequate for employees.
Construction Activity: An Independent Risk Factor for Invasive Aspergillosis and Zygomycosis in Patients with Hematologic Malignancy
Authors: Weems J. John , Davis Barry J. , Tablan Ofelia C. , Kaufman Leo , Martone William J.
Published: August 2016

Between November 1982 and July 1984, five patients at a 110-bed pediatric hospital were diagnosed with invasive filamentous fungal infection; three had invasive aspergillosis (IA) and two had invasive zygomycosis (IZ). All five had underlying hematologic malignancy (HM). In a case-control study, these five HM patients (cases) were compared to 10 autopsied HM patients without evidence of aspergillosis or zygomycosis (controls). Cases and controls did not differ in underlying disease or in the degree of immunosuppression, as measured by duration of granulocytopenia and number of platelet transfusions. However, case-patients were more likely than controls to have been hospitalized during the construction of a hospital addition (p<0.02, Fisher's exact test [FET]). Four (80%) of five HM patients autopsied during the period of construction had IA or IZ compared with one (5%) of 21 autopsied before construction began (p=0.001, FET). These findings suggest that, in a population of comparably immunosuppressed patients, construction activity may represent an independent risk factor for IA or IZ. Hospitals caring for such patients should take precautions which minimize exposure of these patients to construction or renovation activity.
Quantity of Soap as a Variable in Handwashing
Authors: Larson Elaine L. , Eke Paul I. , Wilder Mary P. , Laughon Barbara E.
Published: August 2016

The purposes of this study were to assess the effect of two quantities (1 mL or 3 mL) of four different handwashing products on reductions in log colony-forming units (CFU) from the hands and to determine the amount of liquid soap used for handwashing by personnel in one hospital. First, 40 subjects were assigned by block randomization to one of four handwashing products (4% chlorhexidine gluconate in a detergent base, two alcohol hand rinses, and a liquid, nonantimicrobial soap) to be used in either 1 mL or 3 mL amounts per wash. Each subject washed his or her hands 15 times per day for five days. After one and five days of handwashing there were significant reductions over baseline in log CFU between handwashing products (P<0.001). Additionally, subjects using 3 mL of antiseptic soap had significantly greater reductions in log CFU than those using 1 mL (P<0.001). Among subjects using control liquid soap there was no such dose response. Second, a survey of 47 members of a hospital nursing staff from nine specialty areas and ten individuals in the general population was conducted to measure amounts of two liquid soaps used for handwashing. Amount of soap ranged from 0.4 to 9 mL per handwash. Personnel working in clinical areas where patients were at high risk for nosocomial infection used significantly more soap than did others (P<0.05). We conclude that quantity of soap used for handwashing is one variable influencing the microbial counts on hands, and that the quantity of soap used by health care personnel varies considerably.
Handwashing Agents
Authors: Bjerke Nancy B.
Published: August 2016

Today's infection control practitioners (ICPs) bear a problem other than the one that faced Ignaz Semmelweis: not only do they attempt to get hospital personnel to wash their hands, they are bombarded by the choices of which soap to use. What type of soap is best? Towelette? Powder? Bar? Foam? Waterless? Lotion? Liquid? Should the agent be scented or unscented, medicated or nonmedicated, antimicrobial or antiseptic? Is a residual bacteriostatic effect more desirable than a fast-acting bactericidal effect? Can a ten-second cleansing yield a better handwash than a ten-minute scrub?
Brief Report: Distribution of the GenusAspergillusin Hospital Room Air Conditioners
Authors: Wadowsky Robert M. , Benner Susan M.
Published: August 2016

Aspergillus flavusandAspergillus fumigatusare important causes of invasive, often fatal, fungal disease in immuno-compromised patients. Sources of aspergilli for hospitalized patients may include window air conditioners, fireproofing materials, dust accumulated above false ceilings and acoustical ceiling tiles, and improperly functioning central ventilation systems. Renovation and construction projects, movement of heavy equipment, and demolition of nearby buildings often occur in or near hospitals. These events may aerosolize dust and soil laden withAspergillusspores. Immunocompromised patients may acquire invasive aspergillosis in the hospital by inhalation of spores or by direct contact with contaminated intravenous arm boards. We have recently recognized the occurrence of invasive aspergillosis in an area of our hospital that does not contain false ceilings or a central ventilation system. All of the patient rooms in this area contain air conditioners that are attached to ceilings rather than windows, recirculating room air rather than drawing air in from the outside.
Surveillance Strategies: A Primer
Authors: Abrutyn Elias , Talbot George H.
Published: August 2016

The Centers for Disease Control's Study on the Efficacy of Nosocomial Infection Control (SENIC) showed that infection surveillance and control activities are associated with a decrease in nosocomial infection rates. Moreover, the intensity of activity correlated with the magnitude of the fall in infection rates. These results, plus the guidelines of regulatory agencies, mandate that infection control programs conduct surveillance activities. However, absolute standards for the content and nature of surveillance programs have not been established, and many descriptions of different types of surveillance programs are available. In this primer, we describe the considerations involved in development of a surveillance program with emphasis on issues concerning data collection.

Langmuir considers surveillance when applied to disease as meaning the collection of data, the analysis of those data, and the distribution of the resulting information to those needing to know. The definition implies that surveillance is observational and that surveillance activities should be clearly separated from other related activities such as control measures. The latter activities, including their initiation, approval, and funding, are administrative matters underpinned by a scientific base that are undertaken by the recipients of the surveillance data and their analyses. They should be clearly separated from surveillance activities per se. There is also the implication that action results from surveillance; surveillance without action should be abandoned.
Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians
Authors: Fierro Julie L. , Prasad Priya A. , Localio A. Russell , Grundmeier Robert W. , Wasserman Richard C. , Zaoutis Theoklis E. , Gerber Jeffrey S.
Published: August 2016

Objective.

To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices.

Design.

Retrospective cohort study.

Setting.

All encounters to 25 pediatric primary care practices sharing an electronic health record.

Methods.

Streptococcal pharyngitis was defined by anInternational Classification of Diseases, Ninth Revisioncode for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation.

Results.

Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P< .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P≤ .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing.

Conclusions.

Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition.
Growing North Queensland? Challenges Confronting Social Policy
Authors: Riches Graham
Published: August 2016

The other day an economist friend told me that in Brisbane and commercial centres to the south, when discussion turned to financial and business considerations in the North, the key question asked was how to grow North Queensland? This market driven and profit seeking way in which southern entrepreneurs regard the beautiful and fragile environment in the north of this State, and its exploitation, was cause for concern but did not come as a surprise. After all, economic growth and international competitiveness is publicly endorsed by leading politicians and the captains of industry alike as the key to both material well being and social justice. Indeed it is central to today's conventional wisdom. Yet this belief must be challenged if there is to be creative discussion about social policy today.
You Can Trust Me — I'm With The Government
Authors: Kidd Ros
Published: August 2016

In Queensland today, a class action is being considered against the state government to recover and return to Aboriginal control, cash and assets which were acquired from Aboriginal earnings by the Aboriginal affairs department over a period of 60 odd years. In the process of three years' research into the workings of Queensland's Aboriginal department I have accumulated a range of information relevant to this matter. This summary provides a historical context within the constraints of incidental material which was available to me. I will canvass two separate, but interlocking, issues: the department's control of wages and savings accounts; and the government's handling of the trust funds built up from the accumulated, and compulsorily acquired, earnings of thousands of Aboriginal men and women.
'…the cheapest thing in Australia is the girls'
Authors: Hennessey Eileen M.
Published: August 2016

Australian foreign policy reached a watershed in late 1941/early 1942. As the Japanese continued their rapid advance through Southeast Asia and into New Guinea, apprehensive Australians believed their country could be next. The government also knew their traditional ally Britain would not come to their aid should the Japanese invade Australia, and as most of their own forces were already out of the country, the remainder would have provided a totally inadequate defence. For Prime Minister Curtin and his advisers it was America that had to provide protection for Australia; both for its own sake, and as the base from which the Japanese advance through the Eastern Pacific rim from North to South could be halted.
SEQ 2001, RPAG, PROP and other Alphabet Soup
Authors: Bird Neil
Published: August 2016

The lid of Pandora's Box has been lifted. Queensland, which takes pride in being different, is considering adopting a relatively conventional planning system — and in the process is raising issues which might never be adequately resolved. Until now, development in Queensland has been largely buffered against intervention by State planners, contributions towards social facilities and consultation with the public but all this could be about to change. In December 1990, a meeting at Parliament House convened by the then Minister for Housing and Local Government, Hon Tom Burns, set in train a process to investigate South East Queensland's needs for the coming decades — SEQ 2001. A Regional Planning Advisory Group (RPAG) was established which utilised a number of task forces and public consultation to canvass a wide range of topics while RPAG itself produced a ‘preferred pattern of urban development’ (PROP) and a complementary set of proposals for institutional change. The task force findings and the draft regional outline plan were presented to the public in July 1993 in a set of 19 reports with a request for comments by October 1993.
Journalism and Regional Identity
Authors: Cryle Denis
Published: August 2016

This discussion of George Loyau's prolific literary output will examine journalism in the wider context of literary production and raise questions about the role of journalists as entertainers as well as social and political commentators. Journalism remained Loyau's working profession for four decades (1860–1898). Yet it is easily overlooked because of his significant contribution to early Australian poetry and history. Loyau's verse and fiction were widely disseminated in the colonial press of the 1860s and 1870s, a time when he wrote for metropolitan and regional papers in all the mainland colonies except Western Australia. Regional Queensland, however, was the starting point and final location for a remarkable career which combined periods of public prominence with harrowing personal adversity. Indeed, the distinctive irony of Loyau's career is that adversity was never more acute than in those periods when his reputation as a poet and historian was being made. By contrast, regional journalism provided Loyau with the material means and social support he lacked in the large colonial centres. A recurring theme for the larger study of colonial journalists is the question of mobility. While metropolitan and political reporting were mostly highly prized by ambitious young journalists, Loyau's career confirms the role of regional networks in journalism and the existence of a class of readers who continued to crave popular fiction and entertainment as weekly staples. Although such journalism remained at odds with the political culture of the Fourth Estate, Loyau's literary persona proved both durable and complex, combining a deepseated sense of cultural inferiority with the celebration of the ephemeral through the practices of popular journalism.
Pulpit Socialist or Empire Wrecker?
Authors: Pear David
Published: August 2016

Once more let me say, for I have been criticised uphill and down for my attitude towards the strike, I cannot agree that the Church should stand aloof from such questions as those which concern us to-night.

These words express the heart of Farnham Edward Maynard's commitment to British seamen striking while in Australian ports during August to November 1925. Two principal issues arose to precipitate this strike. Uppermost was the poor level of pay provided by the shipping companies, and associated distress for the seamen's families when their principal ‘bread-winner’ was overseas. Their wages had been reduced from £10 per month to £9 by a board on which they believed they had inadequate representation. Such low wages were not, they maintained, adequate recompense for their work, particularly when coupled with the second issue: the living conditions aboard ship. Still angered by the waterside workers' industrial action at the end of 1924 and the following riots in Sydney during January 1925, local industry had little sympathy with the demands of overseas militants, however; nor had the Australian government, which made it clear that British seamen responsible for causing strike action in Australia would be deported. Not even the Waterside Workers' Federation, blamed for many of the recent troubles, supported the British seamen; declaring that the action proved the futility of a minority opposing the great majority', and provided ‘sufficient proof that no section of a union can accomplish success when attempting to achieve an objective against its executive, combined with majority rule’. The seamen were advised ‘to take their disputes to where they belong and rectify them there’.
'Working for the Duration?'
Authors: Oppenheimer Melanie
Published: August 2016

This paper will examine aspects of voluntarism and the voluntary principle on the home front in Australia during World War Two. The general assumptions which pervade historical texts and public consciousness consistently refer to voluntary work as simply knitting socks and balaclavas and little else. In fact the voluntary work carried out during World War Two was far more encompassing, complex and multifaceted. It may be surprising to some, although not, I suspect, to those who lived through the war, that voluntary work was extensive, crossed class and cultural boundaries, and had the overwhelming support of the community. Although this paper will focus on the state of Queensland, it is important to give a general outline of the types of voluntary work carried out on the home front, and what was involved.
'The Error of My Ways'. Edward Colless, Brisbane: Institute of Modern Art, 233 pp, 1995, $19.95
Authors: Petelin George
Published: August 2016

The Error of My Ways. Edward Colless, Brisbane: Institute of Modern Art, 233 pp, 1995, $19.95
Queensland Regional Radio
Authors: Anderson David
Published: August 2016

This is a transcript of the key-note address delivered by David Anderson at the ‘Beyond the Brisbane Line Conference’, Queensland Studies Centre, Griffith University, in collaboration with the University of Southern Queensland, Toowoomba, November 1994. David Anderson is the presenter of ABC Radio's Queensland Sunday program.
'Kie Daudai: Notes and Sketches from Cape York', E. E. Toohey, 324 pages, Ravenshoe, 1994, $16.50
Authors: Danaher P. A.
Published: August 2016

Kie Daudai: Notes and Sketches from Cape York, E. E. Toohey, 324 pages, Ravenshoe, 1994, $16.50
Metropolitan Policy and Regional Politics
Authors: Lee Christopher
Published: August 2016

The increasing inability of State and Federal governments to develop policy which articulates with the lived experiences of the many different regional communities has been a significant factor in electoral disenchantment with the political system and the subsequent rise of One Nation. The situation has not been helped by metropolitan intellectuals' penchant for resorting to patronising provincial stereotypes of the regional cultures so as to fashion themselves as an ethical, because multicultural, site of modernity. This article explores the tensions between local, State and Federal decision making processes and their reception in a regional community by examining the racially inflected controversy over the redevelopment of the Bridge Street quarry in the ‘conservative’ garden city of Toowoomba.
One Nation and Privatisation
Authors: Van Fossen Anthony
Published: August 2016

The rise of ethnic nationalism (as expressed by the political ascent of Pauline Hanson and her One Nation Party) has created divisions within the Right of Australian politics and impediments to a privatisation program which had been proceeding under the aegis of the Labor Party and the Liberal-National Party Coalition over the last fifteen years. This paper focuses on how Pauline Hanson's One Nation Party has opposed privatisation of government assets on the basis that privatisation offers opportunities for subversive foreign capital to weaken national solidarity, which is conceived in ethnic and racial terms. The One Nation Party, this new anti-privatisation movement, is interpreted on two levels:

as one of a growing number of ethnic nationalist movements across the globe which are recurrent outcomes of hegemonic decline and increasing multipolarity in the world-system (e.g., the current situation of declining American hegemony being similar to the crisis of British hegemony in the interwar period of the early twentieth century)

as the outcome of neo-liberal policies (including privatisation) which have failed to produce full employment or to arrest the decline of the petite bourgeoisie, which forms the primary basis of the support for Hanson and her One Nation party.
Union Strategy and the 1998 Waterfront Dispute
Authors: Bramble Tom
Published: August 2016

The four-month struggle between Patrick Stevedores and the Maritime Union of Australia (MUA) was the most significant industrial dispute of the 1990s and one of the most important since the 1960s. At stake were not just the jobs of 1,400 wharfies but the Howard Government's entire industrial relations agenda of union-busting. In every one of its key aims, the Government failed, and a gathering employer offensive against unionism was stopped in its tracks. Nonetheless, the wharfies took some important casualties in terms of jobs and working conditions. This article looks at both the inspiring elements of the struggle by Australian wharfies, but also asks the question, why, when the Government and the employers were on the ropes, did wharfies give up so much? The article argues that the terms of the final settlement cannot be divorced from the campaign strategy pursued by the union leadership, which was highly centralised and which looked not to industrial solidarity but to the courts and the ALP for salvation. This strategy was in turn the result of the union leadership seeking not to protect wharfies' jobs and working conditions, only to ensure reinstatement and a resumption of negotiated ‘waterfront reform’.