bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nosocomial Infection in a High Risk Cohort: An Illustration of a Sampling Method
Authors: Chavigny Katherine Hill , Fischer Janet 
Published: August 2016

AbstractPatients in two acute care university hospitals were entered into the study using the following method: twenty patients were selected each day from all floors/units in each hospital until the hospital communities had been surveyed only once. A total of 762 hospital patients were identified for the study, and the history of each patient was then abstracted from their charts. The data were analyzed as an historical cohort study design. The two hospital samples were compared to show the effects of the non-random sampling method using one hospital as a comparison group for the other. Expected associations between nosocomial infection and known risk factors were compared and contrasted between the hospitals using cumulative incidence rates and relative risk ratios. The average length of stay of the group of patients in each hospital was extended from a mean of ten days to a mean of 30 days. The only significant difference between the two hospital cohorts was an age effect. The advantages and disadvantages of this method for selecting a long staying cohort at high risk for nosocomial infection in acute care facilities are detailed.
The Source of Biliary Infections Associated with T-Tube Drainage
Authors: Agger William A. , Glasser James E. , Boyd William C. , Melby Neil 
Published: August 2016

AbstractThe purpose of this study was to determine the source of organisms responsible for biliary infection associated with T-tube placement. Two groups of patients who had had T-tubes placed following common bile duct exploration were studied. In one group of 34 patients, bacterial cultures were taken daily from the drainage bag and the lumen of the T-tube. In the second group of patients, paired daily bacterial cultures were taken from the T-tube lumen and the skin tract surrounding the T-tube. Results of the first group showed the drainage bag to be the initial site of infection in seven cases, with “descending” infection from the patient's skin occurring in 27 cases, 14 in whom the organism was initially present in the bile while in the other 13 the organism appeared later. In the second group, of 32 isolates only five were found extraluminally before they appeared within the lumen, these five being allStaphylococcus epidermidis.Thus the majority of bile infections occurring after T-tube placement were found to originate from the patient's own biliary tree or skin.
Endemic Resistance to Amikacin Among Hospital Isolates of Gram-Negative Bacilli: Implications for Therapy
Authors: Wormser Gary P. , Tatz Joseph , Donath Joseph 
Published: August 2016

AbstractWe reviewed the records of the microbiology laboratory of the Veterans Administration Medical Center, Bronx, New York in order to determine the prevalence, epidemiology and complete antibiotic susceptibility profile of amikacin-resistant aerobic and facultative gram-negative bacilli isolated from clinical specimens submitted for culture between January 1,1980 and May 1,1981. Of more than 5000 gram-negative rods isolated during this 16-month period, 2.8% were determined to be resistant to amikacin by the disc diffusion method. Eighty-eight of the amikacin-resistant organisms were unique isolates derived from cultures on 74 patients located throughout the hospital. Urine (51%) and sputum (27%) were the predominant sources of specimens yielding resistant strains. These organisms represented seven different genera of Enterobacteriaceae (58%) orPseudomonas aeruginosa(31%) and other glucose non-fermenting species (11%). Resistance to amikacin was usually associated with resistance to gentamicin, tobramycin and most of the other antimicrobials tested. Twenty percent of isolates were susceptible to only a single antimicrobial, and another 5% were resistant to every agent routinely tested. Although geographic clustering of a small number of amikacin-resistant organisms occurred twice (a strain ofProteus mirabilison the spinal cord injury service and a strain ofP. aeruginosaon one medical ward), the vast majority of isolations were consistent with a pattern of endemic resistance.
Nursing Care of the Immunosuppressed Patient
Authors: Crow Sue 
Published: August 2016

AbstractThe primary objectives of nurses caring for the immunosuppressed patient are to create a safe, peaceful environment and to promote the quality of the patient's life. Strengthening the patient's defense mechanisms is inherent in these nursing objectives, and the nurse must have certain competencies to reinforce these defense mechanisms. One competency is a thorough understanding of the immunosuppressed patient. The infection control practitioner (ICP) should assist the nurse in understanding what an immunosuppressed patient is, what his risk of infection is, what his reaction to infection might be, and what isolation practices are appropriate. Another necessary nursing skill is proficiency in patient assessment, not only when the patient is admitted, but on a continuous basis since the patient's status can change so rapidly.Finally the nurse must have the ability to implement appropriate nursing measures. The nurse must use the principles of asepsis in all patient care activities, recognize risk factors of infection, and understand the importance of such details as proper nutrition, oral hygiene, and skin care. Psychological support is also an essential part of the nursing care plan.Nursing care affects the well-being of the immunosuppressed patient and infection control practitioners have a role in ascertaining that nurses know how to treat such patients appropriately.
Nosocomial Endocarditis
Authors: Friedland Gerald , von Reyn C. Fordam , Levy Barry , Arbeit Robert , Dasse Priscilla , Crumpacker Clyde 
Published: August 2016

AbstractWe analyzed 14 cases of nosocomial infective endocarditis which occurred over a seven-year period at the Beth Israel Hospital in Boston, and compared them with 90 cases of community-acquired endocarditis. Patients with nosocomial endocarditis were older, more often female, and had a greater incidence of underlying valvular heart disease and bacteremia precipitating invasive procedures (93% v 50%, P < .05). Forty-three percent of patients had infection at the site of prosthetic valves or intracardiac prosthetic material. The disease carried a significantly higher mortality than community-acquired endocarditis (43% v 11%, P < .01). The clinical presentation was acute and the infecting organisms reflected the site of origin of bacteremia, with staphylococci from skin and enterococci from urinary sources. Half of the cases in this series may have been prevented by the application of currently recommended preventive and therapeutic practices. Nosocomial endocarditis occurs in a definable sub-population of hospitalized patients and is potentially preventable.
Caring for the Infectious Patient: Risk Factors During Pregnancy
Authors: Gurevich Inge , Tafuro Patricia 
Published: August 2016

AbstractHealth care personnel are exposed to infectious diseases in the community as well as in the health care setting when they care for patients with transmissible conditions. Pregnant nurses, physicians and others face an additional risk—that of exposing their unborn children to some of these infections. Risk factors vary greatly between diseases and it is, therefore, important that each be evaluated and acted upon realistically. We will discuss and compare the risk of infections such as hepatitis, cytomegalovirus, tuberculosis, chickenpox, and others. With this knowledge, administrators and personnel involved will be able to make decisions about which patients should not be cared for by pregnant personnel, and which areas pose too high a risk for the mother and child so that a temporary transfer may be advisable. We address the multiplicity of preventive measures available for the prevention of maternal infections.
A Hospital Contingency Plan for Exotic Communicable Diseases
Authors: Campbell Beverly A. , Pequegnat M. Dorothy , Clayton Alastair J. 
Published: August 2016

AbstractThe exotic communicable diseases are highly virulent, transmissible, conditions which occur most often in tropical areas. Since the late 1960s, there have been occasions when these diseases have been exported to the US and Canada. Advance planning will facilitate the care of patients infected with these diseases in health care facilities. Hospitals should develop a contingency plan which addresses the management of patients that present themselves to the emergency department as well as patients diagnosed after admission. The plan should address such topics as the isolation room, protective clothing, disinfection of the environment and equipment as well as the management of waste and handling of corpses. A well thought out plan will prevent subsequent transmission of infection to attending personnel, other patients and the surrounding community.
Antibody Response to Somatic Antigen ofSalmonella typhiin Areas Endemic and Non-Endemic for Typhoid Fever
Authors: Hirschl Alexander , Stanek Gerold , Rotter Manfred L. , Chau Pak Y. , Niemetz Adolf H. 
Published: August 2016

AbstractIn sera obtained between the 6th and the 30th day from 16 Austrian and 26 Hong Kong patients with culturally verified typhoid fever, agglutinating antibodies (microagglutination test) at significant titers were detected in 93% of the Austrian (median titer: 640) but in only 50% of the Hong Kong patients (median titer: 240). Similar results (93% and 54% positive sera respectively) were obtained for specific IgM as assessed by the enzyme-linked immunosorbent assay (ELISA) using lipopolysaccharide ofS. typhias antigen (median relative titer: 0.32 and 0.21 respectively). In contrast, specific IgG at significant concentrations were found in only 69% of the Austrian (median relative titer: 0.16) but 88% of the Hong Kong sera (median relative titer: 0.71). The (IgM-detecting) microagglutination test may be sufficiently diagnostic for typhoid fever in nonendemic areas such as Austria. In endemic regions like Hong Kong, however, tests indicative for early specific IgG are indispensable for serological diagnosis of the disease. The ELISA proved useful and is an example for such tests.
The Efficacy of Several New Handwashing Agents for Removing Non-Transient Bacterial Flora from Hands
Authors: Morrison Allan J. , Gratz Jean , Cabezudo Ignacio , Wenzel Richard P. 
Published: August 2016

AbstractForty subjects participated in a study of four handwashing agents evaluated for their efficacy in removing non-transient bacteria: 70% isopropanol, 0.05% stabilized iodine, 4% chlorhexidine gluconate, and 1% para-chloro-meta-xylenol. Each subject performed a non-medicated handwash to remove transient flora. Afterwards, three consecutive experimental handwashes were performed using a 10-second contact time, and a fourth handwash employed a 1-minute contact time. Quantitative post-handwash cultures were obtained using the sterile bag technique incorporating an effective agent neutralizer. Significant mean log10reductions were documented for chlorhexidine gluconate, but only after the third (P=.05) and fourth (p=.004) handwash; however, the total log10reduction was less than 1.0 for any single agent.Subsequently, three evaporative handwash agents, including 70% isopropanol, 0.5% chlorhexidine in 70% isopropanol, and a 60% isopropanol formulation containing evaporative retardants, were tested in 14 subjects. Contact time was prolonged to the point of evaporation prior to culturing. Four consecutive post-handwash cultures were obtained after performing a baseline pre-handwash culture. When compared with the other two evaporative agents, the 60% isopropanol formulation demonstrated significant mean log10reductions for each handwash (p ≤ .03), with a total log10 reduction of 2.9 over all four handwashes (p=.0001). The brief contact time incorporated in our handwashing technique reflects clinical usage patterns. The marked bacterial reduction demonstrated by the 60% isopropanol formulation warrants further study.
Nosocomial Infections in 15 Rural Wisconsin Hospitals—Results and Conclusions from 6 Months of Comprehensive Surveillance
Authors: Scheckler William E. , Peterson Patty J. 
Published: August 2016

AbstractFifteen rural Wisconsin acute care community hospitals with an average approved bed size of 55 and an average daily census of 28 patients participated in a nosocomial infection control project. Each hospital Infection Control Practitioner (ICP) was trained and conducted prospective nosocomial infection surveillance on all patients admitted to the hospital for 6 consecutive months between May 1,1984 and April 30, 1985. Two hundred twenty nosocomial infections were reported among 13,420 discharged patients for an incidence rate of 1.64 infections per 100 discharged patients. One hundred sixty-four patients had one nosocomial infection. Twenty-three patients had two or more. Infection rates were highest among gynecology— 4.9% and general surgery patients— 4.0%, and lowest among newborns—0.3% and pediatric patients—0%. 39.7% of the infections were of the urinary tract, 27.9% of surgical wounds, 16% pneumonia, and 1.4% primary bacteremia. The other infections were in seven additional sites. Risk factors associated with acquisition of infections included old age, urinary catheterization, and/or a surgical procedure. The overall nosocomial surgical wound infection incidence for inpatient procedures was 1.9%, with incidences of 0.4% for hernia repair, 1.3% for cholecystectomy, 3.3% for appendectomy, 4.0% for total abdominal hysterectomy, and 3.9% for cesarean sections; The incidence of nosocomial infections was 2.7 infections per 100 discharged patients age 65 years or over and 0.9 infections per 100 discharged patients less than 65 years. Two hundred thirty-six microorganisms were cultured from 175 of the infections. Staphylococcus aureus, coagulase-negative Staphylococcus, and Enterococcus were the most common gram-positive organisms. E. coli, Pseudomonas, Proteus, and Klebsiella were the most common gram-negative organisms cultured. The overall nosocomial infection incidence was much lower than reported rates for other groups of hospitals. These data have implications for the review and potential modification of complex guidelines and requirements for infection control in smaller rural hospitals.
A Hospital Cafeteria-Related Food-Borne Outbreak Due to Bacillus cereus: Unique Features
Authors: Baddour Larry M. , Gaia Shelia M. , Griffin Ronald , Hudson Richard 
Published: August 2016

AbstractAlthough Bacillus cereus is a well-known cause of food-borne illness, hospital-related outbreaks of food-borne disease due to B. cereus have rarely been documented. We report a hospital employee cafeteria outbreak due to foods contaminated with B. cereus in which an outside caterer was employed to prepare the suspect meals. Data were collected from 249 of 291 employees who had eaten either of the two meals. With a mean incubation period of 12.5 hours, 64% (160 of 249) of employees manifested illness. Symptoms, which averaged 24.3 hours in duration, included diarrhea (96.3%), abdominal cramps (90%), nausea (50.6%), weakness (24.7%), and vomiting (13.8%). Eighty-seven employees sought medical attention, 84 of whom were seen in an emergency room. Although a significant difference was not demonstrated in food-specific attack rates, B. cereus was cultured from both rice and chicken items that were served at both meals. Sixty-three employees submitted stools for culture that grew no enteric pathogens, but none were examined for B. cereus. This food-borne outbreak demonstrates: (1) the need for hospital kitchen supervisors to ensure proper handling of food when outside caterers are employed; (2) that significant differences in food-specific attack rates may not be demonstrated in outbreaks, which may be related to several factors; and (3) the importance of notifying microbiology laboratory personnel when B. cereus is a suspect enteric pathogen, since many laboratories do not routinely attempt to identify this organism in stool specimens.
Selective Screening of Hospitalized Patients for the Presence of Asymptomatic Hepatitis B Virus Carriage: Predictability Based on Census Tract Data
Authors: Baddour Larry M. , Jennings Billy R. , Osborne Pamela T. , Rendtorff Robert C. , Moffatt Marge C. , Luther Ginger M. , Holcomb Jamie L. 
Published: August 2016

AbstractReview of all hepatitis B surface antigen-positive patients reported to the county health department over the past 3 years showed that 60% of patients had been diagnosed at our hospital, which serves an inner city, predominantly black, indigent population. Sera from 524 adult patients admitted to the hospital were prospectively collected and tested for hepatitis B surface antigen, eight (1.5%) of which were antigen-positive. Census tract data allowed us to perform selective screening of sera from 95 other patients who were subsequently hospitalized and deemed “high risk” for hepatitis B infection. Nine of 95 (9.5%) selectively screened samples were positive for hepatitis B surface antigen, which represented a significantly higher rate of antigen carriage (P<0.0001) in hospitalized patients from “high risk” areas than that found in the general population screen. The methodology presented herein may be useful in providing a means of identifying hepatitis B surface antigen-positive patients from adult, urban, indigent care populations.
Nosocomial Dermatophytosis Caused by Microsporum canis in a Newborn Department
Authors: Mossovitch M. , Mossovitch B. , Alkan M. 
Published: August 2016

AbstractSeven nurses working in a newborn unit were infested by Microsporum canis, involving the skin of the left forearm. One infant who was treated in the same unit suffered from a similar lesion on the occipital region. Transmission during bottle feeding was suspected. After the introduction of long sleeves for all nurses, no further cases occurred. Data collected on the nurses in the unit suggested that infection correlated with direct
exposure to infants.
Systemic and Topical Antimicrobial Agents in the Prevention of Catheter-Associated Bacteriuria and its Consequences
Authors: Simpson Rosemary A. 
Published: August 2016

Infection of the urinary tract is acknowledged to be the most common hospital infection, associated closely with the presence of an indwelling catheter. Patients are catheterized for a variety of reasons and for different periods of time, ranging from postoperative catheterization of a few days following urological surgery to the long-term catheterization over many months or years of patients who are unfit for operation, with spinal injuries or neuropathic bladders. The extent of the problem includes patients returning home infected, requiring catheterization before readmission to the hospital or needing nursing at home with a long-term catheter. The risks of infection and its complications as well as methods of control may differ between each group.It is of fundamental importance to distinguish between patients who came to surgery with an existing infection and those with sterile preoperative urine. Other factors include recent previous catheterization and, importantly, the length of time the catheter is inserted. For the patient with sterile preoperative urine, postoperative bacteriuria seldom causes severe symptoms and can be treated with antibiotics or left to clear spontaneously after removal of the catheter. A minority of patients suffer consequences of their infection especially when bacteriuria starts before the catheter is removed postoperatively. Catheter removal often causes transient bacteremia, also induced by instrumentation or operation on infected urine, which may lead to serious complications, particularly of septicemia. In our experience in Bristol, about 1 in 4 patients admitted for urological surgery already has infected urine as defined by the presence of ≥105 bacteria/ml midstream urine or ≥=104 bacteria/ml catheter urine. Of those admitted with infected urine, 3 in 4 have a catheter already inserted compared with only 1 catheterized patient in 4 admitted to operation with sterile urine.
Emergence of Nosocomial Methicillin-ResistantStaphylococcus aureusand Therapy of Colonized Personnel during a Hospital-Wide Outbreak
Authors: Bacon Alfred E. , Jorgensen Karen A. , Wilson Kenneth H. , Kauffman Carol A. 
Published: August 2016

AbstractAt the Ann Arbor Veterans Administration Medical Center, 30 patients over a 6-month period became nosocomially infected or colonized by methicillin-resistantStaphylococcus aureus. Immediate institution of strict infection control measures, in conjunction with surveillance cultures of personnel and treatment of carriers, did not limit spread of the outbreak strain of MRSA. Multiple nonoutbreak strains, phenotypically exhibiting heteroresistance, were also uncovered. Thirteen hospital personnel were identified as MRSA carriers. Trimethoprim-sulfamethoxazole (TMP-SMX) and rifampin initially eradicated the carrier state, documented by anterior nares cultures in 13 courses of treatment in 11 employees. However, three employees were recolonized, one at one month, one at both one and four months, and one at four months. Treatment of the carrier state reservoir among personnel appeared to have no effect on the emergence and spread of nosocomial MRSA.
Variation in Methicillin-ResistantStaphylococcus aureusOccurrence by Geographic Location and Hospital Characteristics
Authors: Wakefield Douglas S. , Pfaller Michael , Massanari R. Michael , Hammons Glenn T. 
Published: August 2016

AbstractA survey of 162 Veterans Administration Medical Center (VAMC) laboratories performing antimicrobial susceptibility testing was performed to determine variation in reported rates of methicillin-resistantStaphylococcus aureus(MRSA) isolation by geographic location and hospital characteristics. Of the 162 VAMC laboratories surveyed, 136 (84%) provided usable data. The percentage ofS aureusisolates reported as resistant to methicillin ranged from 0% to 52% with a mean value of 10% among the 136 survey respondents. MRSA were isolated in every VA Medical District and 96% of all respondent laboratories reported isolating at least one MRSA isolate during the preceding year. These data are considered an underestimate of the time MRSA rate in the VA system due to the fact that many laboratories failed to follow key methodologic guidelines for optimal detection of MRSA. A positive correlation was found between MRSA isolation rate and several measures of hospital size and activity including total beds, total admissions, and total antimicrobial susceptibility tests performed. Geographic clustering of MRSA isolation was observed with distinct areas of very high and very low percentages ofS aureusisolates reported as MRSA. The data suggest that the geographic distribution of MRSA within the VA system should be monitored closely for evidence of spread from areas with high-MRSA rates to areas of mid- or low-MRSA rates. Evidence of increased MRSA isolation within these areas may necessitate increased caution in patient referral and transfer patterns within the VA system.