bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatitis B Vaccine in Healthy Hospital Employees
Authors: Klotz S.A , Normand R. , Silberman R. 
Published: August 2016

AbstractA low rate of seroconversion to hepatitis B vaccine is reported. This occurred in healthy hospital employees from two separate institutions. A total of 236 individuals were evaluated in this study and only 53% or 124 persons developed protective levels of antibody to hepatitis B surface antigen following a complete vaccine series. In one hospital, 30% of the vaccine recipients developed antibody but not to a protective level. Employees who received the entire series in the arm or in the arm and buttock (mixed) had a significantly greater number of responders than employees who received the entire series in the buttock (P<.05). Recipients aged 50 to 59 years had a significantly lower response rate to the vaccine (P<.05). There was no correlation with the vaccinee's sex or the timing of the second injection. Vaccine was noted to have frozen in one hospital and accounted for some loss of antigenicity. This failure to respond to the vaccine has necessitated the use of booster injections of vaccine and continued antibody monitoring.
Increasing Handwashing Compliance With More Accessible Sinks
Authors: Kaplan Lois M. , McGuckin Maryanne 
Published: August 2016

AbstractThe frequency of handwashing in two intensive care units (ICUs) was observed. Handwashing after direct contact with patients or their support equipment was recorded. The ratio of beds to sinks was 1:1 in the medical ICU and 4:1 in the surgical ICU. Surveillance of physicians, nurses, and other personnel demonstrated a greater frequency of handwashing by nurses (63%) compared with physicians (19%) and other personnel (25%). The nurses in the unit with one sink per bed had a significantly greater number of handwashes (76%) than those in the unit with fewer sinks (51%).
Methicillin-ResistantStaphylococcus aureus(MRSA): Risk and Outcome of Colonized vs. Infected Patients
Authors: Longfield Jenice N. , Townsend Timothy R. , Cruess David F. , Stephens Maureen , Bishop Catherine , Bolyard Elizabeth , Hutchinson Elsie 
Published: August 2016

AbstractA retrospective study of 204 patients culture positive for methicillin-resistantStaphylococcus aureuscompared infected and colonized patients. Seventy-eight patients were colonized and never developed infection (C), 24 were colonized and subsequently infected (C➧I), and 102 patients had 1 or more nosocomial infections with MRSA at time of first culture (I). The most prevalent sites of infection were wound (26.5%) and bloodstream (20.7%), whereas the respiratory tract and surgical wounds were both frequent sites of colonization. Stepwise discriminant analysis found the most important factors in differentiating likelihood of colonization vs. infection were recent prior hospitalization, history of wound debridement, and number of invasive procedures. Ten percent of (C) died and 25.5% of (I) died. MRSA contributed to death in 57.6% of the (I) deaths (p<.05). These results underscore the importance of differentiating (C) vs. (I) in hospitals where MRSA is endemic so that early specific treatment may be initiated. Risk factors for infection should be discriminated from those for acquisition of the organism.
The Disinfectant Dilemma
Authors: Gurevich Inge 
Published: August 2016

In a recent communication, the manufacturer of a glutaraldehyde-based disinfectant described several important discoveries that became apparent during a recent review of claims of their product. Such updating of materials is an ongoing quality assurance mechanism for many reputable manufacturers.Manufacturer A maintains that the old Association of Official Analytical Chemists (AOAC) tuberculocidal testing procedure is prone to significant errors. Therefore, they developed a new, more reliable test (in their opinion), which has also been filed with the Environmental Protection Agency (EPA), and on which their new recommendations are based. Other manufacturers may use the old or new AOAC test methods to satisfy requirements of the EPA.
Types of Disposable Medical Devices Reused in Hospitals
Authors: Mayhall C. Glen 
Published: August 2016

AbstractRising health care costs have prompted hospitals to turn to reprocessing and reuse of disposable devices as a cost-saving measure. The safety, efficacy, and cost benefit of such a practice are largely unknown. Classification schemata are presented as a means of categorizing the reasons for reprocessing and the types of adverse effects that may result from reprocessing and reuse. The very limited literature on reuse of disposable devices is reviewed. Examples of the categories of reprocessing and adverse effects are provided from a review of the experience with reprocessing and reuse at a university medical center. With the rising pressure for containment of health care costs, it is likely that this practice will expand further. The practice of reprocessing and reuse should be subjected to scientific study.
Prevalence of Colonization with Antibiotic Resistant Gram-Negative Bacilli in a Nursing Home Care Unit: The Importance of Cross-Colonization as Documented by Plasmid Analysis
Authors: Shlaes David M. , Lehman Mary-Helen , Currie-McCumber Charlotte A. , Kim C.H. , Floyd Rachel 
Published: August 2016

AbstractA prevalence study was carried out on a 100-bed Veterans Administration nursing home care unit to determine the extent of colonization with gentamicin-resistant gram-negative bacilli (GRGNB). Hand cultures of 12 employees and 17 environmental cultures were negative. Twenty-six of 86 (30%) patients were colonized with 49 GRGNB. Sixteen patients (19%) had urinary colonization. Multivariate analysis revealed significant associations between rectal or perineal colonization (P<0.01), and the presence of a urinary device (82% condom catheters) (P<0.05), with urinary colonization. The most common isolates wereProvidencia stuartii(20),Escherichia coli(nine) andKlebsiella pneumoniae(nine). Twenty-six of 49 isolates carried plasmids. Restriction endonuclease digestion of plasmid DNA was performed for 21. Cross-colonization, as defined by the presence of the identical species with the identical restriction endonuclease digestion profile of purified plasmid DNA found in different patients, was observed for eight of 21 (38%) strains. All were geographically clustered. No strains could transfer gentamicin-resistance by conjugation and only two plasmids could transform ourE colirecipient to gentamicin resistance. OneE coliplasmid was identical to twoCitrobacter freundiiplasmids and aP stuartiiplasmid isolated from three different patients. This 105 kb plasmid is conjugative and encodes resistance to ampicillin, carbenicillin, tetracycline, and sulfonamides. Thus, 57% of strains were cross-colonizing or contained identical R-plasmids. Southern hybridization using a 1 kb TEM-1 gene probe demonstrated sequences homologous to this probe in five of five nursing home plasmids examined. These data demonstrate the utility of plasmid analysis in epidemiologic typing of multiple species of Enterobacteriaceae, and suggest wide dissemination of R-plasmids bearing the TEM-1β-lactamase gene among gram-negative bacilli colonizing patients residing in our nursing home.
Prevention of Nosocomial Infections in Marrow Transplant Patients: A Prospective Randomized Comparison of Systemic Antibiotics Versus Granulocyte Transfusions
Authors: Petersen Finn B. , Buckner C.D. , Clift Reginald A. , Nelson Nira , Counts George W. , Meyers Joel D. , Thomas E.D. 
Published: August 2016

AbstractOne hundred twelve patients with hematologic malignancies underwent marrow transplantation from HLA-matched sibling donors and were randomized to receive either prophylactic granulocyte transfusions (PG, 67 patients) or prophylactic systemic antibiotics (PSA, 45 patients) as prophylaxis against nosocomial infections. Patients were treated in conventional hospital rooms and studied until day 100 post-transplant. For the entire study period, 26 patients (39%) in the PG group developed septicemia compared to 15 patients (33%) in the PSA group. Twenty-eight patients (42%) in the PG group developed local major infections compared to 19 patients (42%) in the PSA group. Ten patients (15%) in the PG group developed viral interstitial pneumonitis compared to 6 patients (13%) in the PSA group. None of these differences were statistically significant. There was no difference in the incidence of bacterial or fungal infections or viral interstitial pneumonitis between the two groups during the granulocytopenic or post-engraftment period. There was no difference in the incidence and severity of graft-versus-host-disease (GVHD). Inability to carry out the prophylaxis was frequent in the PG group, with complications necessitating discontinuance of transfusion in 24% of the recipients and 13% of the donors. The use of PG as an infection prophylaxis modality in marrow transplantation is not supported by this study, as it is difficult to carry out and because PG did not show any advantage over the use of PSA in preventing nosocomial infections.
Skin as a Source for Hospital Infection
Authors: Noble William 
Published: August 2016

The skin is itself the site of infection by many different bacteria. Dermatologists may see primary skin infection due toStaphylococcus aureus, beta hemolytic streptococci and a host of less common pathogens including gonococci, mycobacteria and even enterobacteriaceae, or secondary infection which is mostly staphylococcal in eczema or weighted toward Proteus and Pseudomonas in venous stasis ulcers. Geriatricians see a mixed microbial flora in decubitus ulcers while those who insert plastic prostheses, intravenous or abdominal catheters can expect infection with coagulase-negative or positive cocci.The skin also forms a natural reservoir of organisms available to infect a variety of patients and it is with the skin as a reservoir that this article is concerned. The normal flora of the skin in healthy subjects is composed chiefly of coagulase-negative cocci and coryneforms with gram-negative bacilli chiefly, but not entirely, represented by Acinetobacter. Patients admitted to the hospital who are severely ill may become more heavily colonized by gram-negative bacilli while frank skin lesions constitute a more obvious source of potential pathogens.
Nosocomial Infection Prevalence, Risk and Control in Small Community and Rural Hospitals
Authors: Scheckler William E. , Peterson Patty J. 
Published: August 2016

Between 1972 and 1973, Britt and colleagues conducted 1-day infection prevalence surveys in 18 hospitals each with fewer than 75 beds and all located in the rural intermountain west. The lessons learned from that study were incorporated into a book chapter entitled “Infection Control in Small Hospitals” by Dr. Britt. Since that study no substantial nor systematic review of nosocomial infections in small community or rural hospitals has been reported. A recent editorial in Infection Control posed four questions that still needed to be answered for the smaller (less than 100-bed) hospital:1. Given the statistical realities of small hospitals, what types of surveillance methods—periodic prevalence surveys, general surveillance, focused surveillance, etc.—are the most reliable? Are any of them necessary?2. Which of the many infection control practices recommended by the CDC, the Joint Commission on Accreditation of Hospitals, and others are applicable to small hospitals?3. What resource sharing of existing expertise, from larger hospitals, health departments, groups such as the Association of Practitioners of Infection Control and the Society of Hospital Epidemiologists of America, and others can be developed for smaller hospitals in cost effective and realistic ways?4. Should smaller hospitals be required to have the same type of multidisciplinary infection control committees required of larger hospitals or can the responsibilities of the committee be delegated to a smaller group such as one nurse and one staff physician?The purpose of this report is to provide detailed infection control information obtained from 15 hospitals located in rural areas of Southwestern Wisconsin. This article will focus on data derived from an initial comprehensive prevalence survey that replicated the Britt study in the Wisconsin sites in 1983. Additional data were derived from ongoing bi-monthly prevalence studies done over 6 consecutive months in each of the 15 rural hospitals. Data from 6 months of ongoing comprehensive surveillance from each of the 15 hospitals and final conclusions from the project will be the subject of a subsequent paper.
In Vitro Activity of Cefixime and Six Other Agents Against Nosocomial Pathogens of the Enterobacteriaceae Family
Authors: Mulligan Maury E. , Kwok Y.Y. 
Published: August 2016

AbstractCefixime, a broad-spectrum, orally active cephalosporin, was more active in vitro than ampicillin, cefaclor, cephalothin, and trimethoprim/sulfamethoxazole against 194 nosocomial pathogens of the family Enterobacteriaceae. Activity was especially good against Klebsiella spp, Proteus spp, Serratia spp, and Providencia stuartii. Although gentamicin had equivalent or better activity against Citrobacter spp, Enterobacter spp, Escherichia coli, and Morganella morganii, all 23 of the gentamicin-resistant strains studied were susceptible to Cefixime. Isolates tested were from urinary tract infections, abdominal infections, wounds, vascular infections, and respiratory infections; they were sequentially collected nosocomial pathogens from a single institution. This orally active cephalosporin should be considered for therapy of a variety of nosocomial infections involving gram-negative bacillary pathogens.
The Incidence of Nosocomial Pneumonia Following Urgent Endotracheal Intubation
Authors: Lowy Franklin D. , Carlisle Penelope S. , Adams Audrey , Feiner Cheryl 
Published: August 2016

AbstractThe risk of nosocomial pneumonia following emergency or urgent endotracheal intubation was studied prospectively. Pneumonia developed in 35 of 78 (45%) patients within three days of intubation. No differences in age, sex, underlying illness, respiratory infection, or antibiotic use were found between those with or without pneumonia. There were also no differences in the frequency of complications occurring during intubation. Patients developing pneumonia tended to have the same organisms isolated from the sputum at the time of intubation and at the time of diagnosis of pneumonia (9 of 20 were identical, 5 differed by a single organism). Sputum cultures taken at the time of intubation were helpful in predicting the subsequent pathogens in patients who developed pneumonia. There were no differences in mortality between patients with (29%) and without (28%) pneumonia. Emergency endotracheal intubation appears to contribute to the overall incidence of nosocomial pneumonia.
Surgical Wound Infections: Prospective Study of 4,468 Clean Wounds
Authors: Gil-Egea M.J. , Pi-Sunyer M.T. , Verdaguer A. , Sanz F. , Sitges-Serra A. , Eleizegui L. Torre 
Published: August 2016

AbstractA prospective four-year study on the infection rate of clean operative wounds is presented. From January 1982 to June 1985, a nurse epidemiologist and a medical team assessed 4,468 operative procedures, from the day of surgery to the patients' discharge from the hospital. The infection rate was 3.2%. A higher incidence of wound infection was detected in patients requiring emergency operations (5.1%), in drained wounds (5.4%), and in patients with conditions thought to predispose to infection, such as advanced cancer, hepatic cirrhosis, diabetes, nephrotic syndrome, previous splenectomy, and treatment with immunosuppressive drugs (7.8%). Age over 65 did not influence infection rates. There were up to tenfold differences in infection indices between surgeons performing the same clean procedures. The continued monitoring of clean wound infection rates allowed the early detection and control of infection outbreaks. Providing periodic information on infection rates to the different surgical services was associated with decreasing infection rates over time.
The Analysis of the Impact of a Mild, Low-iodine, Lotion Soap on the Reduction of Nosocomial Methicillin-ResistantStaphylococcus aureus:A New Opportunity for Surveillance by Objectives
Authors: Onesko Kim M. , Wienke Eugene C. 
Published: August 2016

AbstractA significant unremitting increase in the incidence of nosocomial methicillin-resistantStaphylococcus aureus(MRSA) infections in a 500-bed acute care community teaching hospital prompted reevaluation of the efficacy of the infection control measures used. A well-accepted, low-iodine, antimicrobial soap was used to replace a liquid natural handsoap in two areas with the highest incidence of MRSA—the intensive care unit, and a medical division.Over a two-year period, an analysis was made of the effect of soap replacement on nosocomial infections and pathogens. Soap changeover occurred at the midpoint of the two-year period. From year to year, the nosocomial MRSA rate decreased 80% (ttest,P=0.005). Other pathogens that demonstrated a dramatic decrease included methicillin-sensitiveStaphylococcus aureus(MSSA), infections where no pathogens were isolated, and various gram-negative infections. Categories of nosocomial infections that decreased included surgical wound infections, primary bacteremias, and respiratory tract infections. The overall nosocomial infection rate of the two combined areas decreased 21.5%, representing a year-to-year savings of $109,500. As a result, the decision was made to install the low-iodine hand-soap permanently at all sinks within the hospital.
Cytomegalovirus
Authors: Sinnott John T. , Cancio Margarita R. 
Published: August 2016

Cytomegalovirus (CMV) has emerged as an important cause of human illness. Infection with this common virus can result in asymptomatic infection, an acute “mononucleosis-like” illness, or congenital disease. It is capable of persisting in a latent state and reactivating at a later date. It can be transmitted by blood transfusion, organ transplantation, oral or genital contact, intrauterine infection, perinatal infection and perhaps casually by children in day care centers.Historically, the first reports described “protozoan-like” cells in the organs of a fetus and a stillborn in 1904. In 1932, Farber reported the presence of inclusions in the nucleus and cytoplasm of cells in infants dying of various causes and coined the term cytomegalic inclusion disease. The urine was initially cultured in 1953 by Smith, and the subsequent development of serologic methods of diagnosis made its broad spectrum of disease more fully appreciated.
Use of Indwelling Urinary Tract Catheters in Swedish Hospitals
Authors: Burman Lars G. , Fryklund Birgitta , Nyström Bertil 
Published: August 2016

AbstractIn a survey of 67,774 patient days in 27 Swedish acute care hospitals, an indwelling urinary tract catheter (IUTC) was in place during 12% of patient days. There were marked differences between services (from 2% in rheumatology to 49% in urology), but also between hospitals for the same type of service (general surgery, internal medicine, gynecology, orthopaedic surgery) concerning proportion IUTC days, average duration of catheterization and the indications for IUTC use. The great local variation in IUTC usage for a particular service was usually not correlated with type of hospital (district, county, or regional/teaching), ie, with the mix of patients studied. We propose that the results mainly reflect a variable local impact of infection control and that a much more restrictive use of IUTCs is possible in many wards. This condition would imply a considerable potential for reducing the incidences of urinary tract infection and bacteremia and thus, mortality among hospitalized patients in Sweden.
Confounding and the Analysis of Multiple Variables in Hospital Epidemiology
Authors: Freeman Jonathan , Goldmann Donald A. , McGowan John E. 
Published: August 2016

AbstractMost information in hospital epidemiology comes from observational studies of hospitalized patients rather than planned experiments, and in such observational studies the characteristics of study patients may vary widely, even within a single hospital. Any comparison between hospital populations will usually contain additional, unintended contrasts among patients with varying degrees of health. Adult patients, for example, may have vastly different underlying diseases, and infants may be of substantially different birth weights. We used both underlying disease and birth weight as indices of the basic severity of illness in order to adjust for confounding by differences in underlying disease in reanalyses of several published studies. We give an example in which differing birth weights among groups of infants compared artifactually double the apparent effect of nosocomial infections as a cause of mortality, and another example in which differing degrees of severity of underlying illness artifactually halve the apparent effect of appropriate antibiotics in preventing death from bacteremia with gram-negative bacilli. We describe simple intuitive methods based on stratification, adapted from chronic disease epidemiology, to remove confounding effects during analyses.
Infectious Complications of Acute Myocardial Infarction
Authors: Alkan Michael , Cristal Natalio , Paran Esther 
Published: August 2016

AbstractFour cases of purulent complications in the heart following acute myocardial infarction are described. Fever occurred during the first week after coronary occlusion. In one case thrombophlebitis at an infusion site was followed by purulent pericarditis. One patient had an infected mural thrombus with peripheral septic embolic, and two suffered from streptococcal endocarditis. The association between these infections and recent acute myocardial infarction could be related to tissue necrosis and local thrombosis, but the increasing risk of bacteremia following invasive monitoring procedures in these patients is a risk factor that should not be ignored.