bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital Usage of Parenteral Antimicrobial Agents: A Gradated Utilization Review and Cost Containment Program
Authors: Pelletier Lawrence L. 
Published: August 2016

AbstractForty percent to 60% of antimicrobial agents administered in hospitals without effective antimicrobial review and control programs are not needed. Excessive use of antimicrobial agents in the hospital promotes colonization of patients with resistant organisms, needlessly exposes them to the risk of an adverse drug reaction, and increases the cost of care. A gradated antimicrobial utilization review program is presented that determines hospital usage, develops guidelines for appropriate cost-effective drug administration, provides several options for implementation, and monitors outcome so that measures can be modified for specific situations. The techniques used are basic epidemiologic measures currently used to assess hospital infections.
70% Alcohol Disinfection of Transducer Heads: Experimental Trials
Authors: Talbot George H. , Skros Maureen , Provencher Mary 
Published: August 2016

AbstractWe investigated the feasibility of transducer head disinfection with 70% alcohol wipes. In the initial trial, nine gas-sterilized transducers were inoculated with an estimated 5 × 106 organisms of a clinical isolate of Enterobacter cloacae, mimicking a contaminated fluid couple. A sterile disposable transducer dome was attached to each transducer. The units were allowed to sit for 24 hours at room temperature; the domes were then removed. Three transducer heads were cultured prior to disinfection to ensure that viable organisms remained. Each transducer head was wiped clean with a single alcohol wipe, allowed to dry, and then cultured. All nine cultures showed growth of E. cloacae. A second series of trials with 54 transducers employed an identical protocol, except that each transducer head received not one, but two, applications of alcohol. In addition to E. cloacae (26 runs), Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans were employed in nine, nine and ten runs, respectively. Cultures of 53 of 54 transducer heads showed no growth; the single positive culture was attributed to an error in technique. These preliminary results suggest that the double-alcohol-wipe technique may be an easy, cost-effective, alternative or supplemental method of transducer head disinfection. However, we do not advocate routine implementation of this technique in patient care settings until clinical trials confirm its safety and efficacy.
A Comparison of Pneumonia Caused by Gentamicin, Methicillin-Resistant and Gentamicin, Methicillin-SensitiveStaphylococcus aureus: Epidemiologic and Clinical Studies
Authors: Lentino Joseph R. , Hennein Hani , Krause Sally , Pappas Sharon , Fuller Gail , Schaaff Doris , DiCostanzo Mary Beth 
Published: August 2016

AbstractWe investigated an outbreak of nosocomial pneumonia due to gentamicin, methicillin-resistantStaphylococcus aureus(GMRSA). We compared the predisposing factors for pneunomia due to GMRSA to those for pneumonia due to gentamicin, methicillin-sensitiveStaphylococcus aureus(GMSSA). Seventeen of 29 patients with staphylococcal pneumonia were infected with GMRSA. Risk factors and associated diseases which selected for infection with GMRSA as opposed to GMSSA included prior antibiotic therapy for a prolonged period of time (p = 0.0001), number of risk factors per patient (p = 0.0001), days hospitalized prior to diagnosis of pneumonia (p = 0.002) and number of associated diseases per patient (p = 0.002).Despite the epidemiologic differences between GMSSA and GMRSA pneumonia, there were no differences in the clinical presentation, course of illness, complications, response to appropriate therapy or outcome between the two groups. Survival was adversely affected by age only among the GMSSA patients (p = 0.02) and by the number of associated diseases (p = 0.005).
Postoperative Infections Following Cardiac Surgery: Association with an Environmental Reservoir in a Cardiothoracic Intensive Care Unit
Authors: Dandalides Peter C. , Rutala William A. , Sarubbi Felix A. 
Published: August 2016

AbstractDuring 1981, 39 nosocomial infections occurred in 27 of 223 patients undergoing cardiac surgery in the North Carolina Memorial Hospital. The peak attack rate (23.7%) occurred in August and September compared to 10.1% in January through July. A case-control study demonstrated that the only risk factor common to poor and stable health groups compared to controls was duration of stay in the cardiothoracic intensive care unit (CTICU). Microbiologic studies of the environment, personnel and patients showed that colonization or infection of patients occurred 1 to 6 days after admission to the CTICU and that nosocomial pathogens were found: 1) in and around the unit's soiled utility sink, 2) in pooled handwashing cultures of unit personnel, and 3) on contaminated clean hands and air near the soiled utility sink, plus nearby bedside air only while the water in the sink was running. Environmental and personnel hand contamination by soiled utility sink aerosols likely contributed to these infections. Infection control measures, including discontinued use of the soiled utility sink, resulted in a significantly lower infection rate (5.6%).
Epidemic Keratoconjunctivitis: Report of an Outbreak in an Ophthalmology Practice and Recommendations for Prevention
Authors: Buehler James W. , Finton Robert J. , Goodman Richard A. , Choi Keewhan , Hierholzer John C. , Sikes R. Keith , Elsea William R. 
Published: August 2016

AbstractIn Fall 1981, an outbreak of acute infectious conjunctivitis with keratitis (EKC) occurred in patients who had visited a private ophthalmology clinic just prior to onset of illness. Among an estimated 2,200 patient visits to the office from August 10 to October 15, 1981 for problems unrelated to infectious conjunctivitis, 39 (1.8%) persons subsequently developed EKC. The median incubation period was 6.5 days (range, 1 to 14 days). A case-control study was done to identify risk factors associated with contracting EKC; patients with EKC were more likely than control patients to have been examined by one or the other of two of the four ophthalmologists at the clinic and to have undergone procedures such as tonometry or foreign body removal. Adenovirus was isolated from conjunctival swabs from four of five persons with conjunctivitis; three were type 8 and one was type 7. Recognition of the problem and improved handwashing practices were associated with terminating the outbreak. This outbreak illustrates the potential for transmission of adenovirus infection during the provision of eye care. Infection control practitioners should be familiar with measures for the prevention of such infections among ophthalmology patients.
A Multi-Hospital Hepatitis B Vaccine Program: Prevalence of Antibody and Acceptance of Vaccination Among High-Risk Hospital Employees
Authors: Klimek Joseph J. , Brettman Lee , Neuhaus Ellen , Garibaldi Richard A. 
Published: August 2016

AbstractIn July 1982, five Hartford hospitals embarked on a joint hospital-sponsored program to immunize high-risk employees against hepatitis B virus (HBV). The program included a questionnaire to characterize relative risk, serology for anti-HBs, vaccination and a follow-up survey of vaccine non-recipients.Of 2,065 employees who were considered to be at high-risk for infection with HBV, 1,894 (91.7%) responded to the screening questionnaire and 1,279 (67.5%) were tested for anti-HBs serology. The prevalence of antibody varied from hospital to hospital; the highest prevalence (10.9%) was observed at one of the urban university-affiliated community hospitals and the lowest prevalence (4.1%) was reported from the smaller, rural hospital. The prevalence of antibody also varied greatly within the high-risk groups; the highest prevalence of antibody was seen among surgical house officers (15%). The rate of acceptance of vaccine among hospitals ranged from 57.5% to 23.7%. Reasons for vaccine non-acceptance included fear of as yet unknown side effects, perceived low risk of hepatitis acquisition and possible effects on present or future pregnancies.Our experience illustrates some of the epidemiologic and practical aspects that must be addressed in administering a hospital-based HBV vaccine program. Among the five hospitals, we saw marked inter- and intra-hospital variations in the prevalence of anti-HBs among high-risk employees. More significantly, we observed unexpectedly low rates of vaccine acceptance among high-risk personnel.
Habitat Association ofKlebsiellaSpecies
Authors: Bagley Susan T. 
Published: August 2016

AbstractThe genusKlebsiellais seemingly ubiquitous in terms of its habitat associations.Klebsiellais a common opportunistic pathogen for humans and other animals, as well as being resident or transient flora (particularly in the gastrointestinal tract). Other habitats include sewage, drinking water, soils, surface waters, industrial effluents, and vegetation. Until recently, almost all theseKlebsiellahave been identified as one species, ie,K. pneumoniae.However, phenotypic and genotypic studies have shown that “K. pneumoniae” actually consists of at least four species, all with distinct characteristics and habitats. General habitat associations ofKlebsiellaspecies are as follows:K. pneumoniae—humans, animals, sewage, and polluted waters and soils;K. oxytoca—frequent association with most habitats;K. terrigena— unpolluted surface waters and soils, drinking water, and vegetation;K. planticola—sewage, polluted surface waters, soils, and vegetation; andK. ozaenae/K. rhinoscleromatis—infrequently detected (primarily with humans).
Klebsiella pneumoniae:Selected Virulence Factors that Contribute to Pathogenicity
Authors: Highsmith Anita K. , Jarvis William R. 
Published: August 2016

AbstractKlebsiella pneumoniaeinfections occur in humans of all ages, however the highest risk groups appear to be infants, the elderly and the immunocompromised. One or more virulence factors may contribute to pathogenicity in humans. In this article we review three factors that may mediate virulence: cell wall receptors, capsular polysaccharide, and endotoxin.First, the presence of cell wall receptors enablesK. pneumoniaeto attach to the host cell, thereby altering the bacterial surface so that phagocytosis by polymorphonuclear leukocytes and macrophages is impaired and invasion of the non-phagocytic host cell is facilitated. Second, invasion of the host cell is also facilitated by the large polysaccharide capsule surrounding the bacterial cell; in addition this capsule acts as a barrier and protects the bacteria from phagocytosis. Third,K. pneumoniaeproduces an endotoxin that appears to be independent of factors that determine receptors and capsular characteristics. Marked interspecies differences in endotoxin production may correlate with virulence. Although some or all of these factors may ultimately determine virulence, the interaction of these factors in vivo has made it difficult to assess the relative contribution of any one of these virulence factors. The pathogenic mechanisms ofK. pneumoniaethat ultimately determine virulence remain unclear and will require further study.
Genotypic Approaches to the Diagnosis of Bacterial Infections: Plasmid Analyses and Gene Probes
Authors: Wachsmuth Kaye 
Published: August 2016

AbstractPractical genetic approaches have been helpful in the diagnosis, epidemiology, and taxonomy of bacterial pathogens encountered in our laboratory at the Centers for Disease Control. There are many examples in which plasmid profiles have been used to define epidemic strains of enteric bacteria, staphylococci, pseudomonads, vibrios, and other pathogenic bacteria. Current methodologies should allow the microbiology laboratory to use plasmid profiles routinely and to identify plasmids associated with bacterial pathogenesis.Simplified DNA-DNA hybridization procedures have been used in our laboratory to survey or “probe” thousands ofEscherichia colicolonies for the presence of enterotoxin genes, eliminating traditional tissue culture or animal assays. Research scientists continue to develop gene probes for a number of bacterial toxins and hemolysins and for the identification of pathogens such as legionellae and salmonellae. These and other probes as well as hybridization “kits” may be commercially available to diagnostic laboratories within the next few years.
Acceptance of Hepatitis B Vaccine by Hospital Personnel
Authors: Crossley Kent B. , Gerding Dale N. , Petzel Robert A. 
Published: August 2016

AbstractPersonnel at high risk of acquiring hepatitis B in two university-affiliated teaching hospitals were offered immunization against this disease. Of the 1,193 employees, 454 (38%) requested immunization. Individuals who declined or deferred immunization were sent questionnaires requesting the reasons for their decisions. Responses to the questionnaire were received from 487 of 674 personnel (72%). Most respondents (>90%) indicated that they: 1) were aware of being at risk of acquiring hepatitis B, and 2) recognized the potential danger of the disease. A majority of respondents (56%) indicated that they had decided not to be immunized because they wanted to wait until more was known about the vaccine. Concern about specific side effects (eg, Guillain-Barré syndrome or acquired immunodeficiency syndrome) was cited much less often as a reason for declining immunization. Nearly one-fifth of questionnaire respondents either did not know the date of their last tetanus-diphtheria immunization or had not received a booster within the past decade.
A Comparison of Antibiotic Susceptibility Profiles Using Single and Multiple Isolates per Patient
Authors: Bennett William P. , O'Connor Michael L. , Wasilauskas Benedict L. 
Published: August 2016

AbstractWe compared the antibiogram statistics generated by including all clinical isolates to those obtained by tabulating no more than one isolate of a particular organism from a given patient. We found that 48.3% of the isolates presented multiple occurrences in individual patients but found no practical differences in the profiles obtained by the two methods. We also tabulated the occurrence of minimum inhibitory concentration (MIC)-distinct organisms among the sets of multiple isolates of E. coli and of S. aureus and found that only 20.9% of those isolates represented duplicate organisms by MIC profile. This heterogeneity of MIC sensitivity that occurs in multiple isolates from individual patients was not expected but provides an explanation for the lack of difference between the two methods of tabulating antibiotic susceptibility statistics.
Evaluation of a Skin Test for Chicken Pox
Authors: Florman Alfred L. , Umland Edith I , Ballou Denise , Cushing Alice H. , McLaren Leroy C. , Gribble T. John , Duncan Marilyn H. 
Published: August 2016

AbstractResults with a VZV skin test as a marker of past infection were compared with histories of chicken pox and specific antibody detected by ELISA in 100 individuals—25 of whom were pediatric patients with malignant diseases. A negative or uncertain history was not reliable, neither were the skin test results among the oncology patients. However, among the normal individuals, the skin test when compared with the ELISA had a sensitivity of 85%, a specificity of 100%, and a positive predictive value of 100%.
Product Commentary: Selecting an IV Tubing System
Authors: Chrystal Cynthia 
Published: August 2016

Intravenous (IV) therapy as a nursing specialty is based on principles of anatomy, physiology, pathophysiology, pharmacology, and infection control. Since IV therapy is an invasive procedure, it is germane that nurses strictly adhere to the fundamental principles that govern this area to assure patient protection. The focus of this article is to assimilate clinical expertise into a process for selecting IV tubing systems that are suitable for the delivery of the prescribed IV therapy.The first principle that governs the selection of IV tubings is to choose a system that will deliver the prescribed therapy and minimize the risk of infection. The National Intravenous Therapy Association (NITA) Standards of Practice states that 0.22 μm filters shall be utilized for the delivery of IV therapy unless contraindicated. The 0.22 μm filters provide the following four safeguards to patients: 1) they remove particulate matter than could impede circulatory flow through the pulmonary vascular system. 2) They eliminate air from the system and consequently protect patients from the risk of air embolism. The design of the 0.22 μm filter allows air to be automatically vented from the system; therefore, no entry into the sterile IV system is required to remove the air. Because every entry into the IV system may result in inadvertent contamination, the air-eliminating capabilities of the 0.22 μm filter may also be classified as an infection control measure. 3) They will retain virtually every pathogen bacterium or fungus that may have entered the system.
Needlecaps to Prevent Needlestick Injuries
Authors: Sumner Walton 
Published: August 2016

AbstractHospital employees are at risk for numerous possible complications of accidental needlesticks. The mechanisms of such accidents suggest that many are preventable. This article presents a simple but novel revision of the needlecap which facilitates resheathing of a used needle. With routine use the hospital environment could be made safer for virtually all employees at almost no additional cost. Ultimate hospital savings could be significant through prevention of injury.
Alteration of Normal Gastric Flora in Critical Care Patients Receiving Antacid and Cimetidine Therapy
Authors: Donowitz Leigh G. , Page M. Carol , Mileur Betty Lou , Guenthner Sharon H. 
Published: August 2016

AbstractOne hundred fifty-three critical care patients with documented cimetidine and antacid use were prospectively studied with serial gastric pH determinations and semiquantitative gastric fluid cultures. This study documents the abnormal gastric colonization of patients with therapeutically altered gastric acidity by hospital acquired gram negative rods (GNR). Three hundred twenty-four gastric fluid cultures from 153 patients revealed 152 (47%) positive cultures for GNR, 78 (24%) sterile specimens, and 94 (29%) positive for mixed oropharyngeal flora. One hundred forty (59%) of the 236 cultures at a pH of 4 or greater were positive for GNR. In contrast, only 12 (14%) of the 88 cultures at a pH of less than 4 were positive for GNR (p<.001). Forty-six (52%) of 88 cultures at a pH of less than 4 were sterile as compared to only 32 (14%) of 236 sterile cultures at a pH of 4 or greater (p<.001). At low pH, cultures are predominately sterile and at a pH of 4 or greater the flora dramatically changes to hospital acquired GNR. This artificially maintained reservoir of gram negative rods in the critically ill patient is a potential reservoir of organisms causing nosocomial bacteremia or pneumonia in this high risk population.
The Prevalence of Hepatitis B in Employees of Small, Rural Hospitals—Implications for Vaccine Administration
Authors: Martin David B. , Jannausch Marie , Skendzel Laurence P. 
Published: August 2016

AbstractThe Centers for Disease Control Advisory Committee on Immunization Practices has based recommendations for hepatitis B vaccine for hospital employees on studies done in large urban hospitals. Data on the prevalence of hepatitis B in employees of small hospitals have been lacking. We measured hepatitis B surface and core antibody in 422 employees of six small, rural hospitals who were exposed to blood. The overall prevalence among those “high-risk” employees was 5.5%. The highest prevalence was found in General Nursing, Intensive Care Nursing, Recovery Room, IV Therapy, Laboratory, and Respiratory Therapy, although differences were seen between hospitals. Results of such testing for individual hospitals may have a major impact on the cost-effectiveness of vaccination programs for their employees.
Increasing Handwashing in an Intensive Care Unit
Authors: Mayer Joni A. , Dubbert Patricia M. , Miller Mary , Burkett Paul A. , Chapman Stanley W. 
Published: August 2016

AbstractThe present study provides the first systematic evaluation of strategies for increasing handwashing of hospital staff. Nursing staff on two intensive care units (ICUs) were observed over a 3-month period. After baseline observations, two interventions were implemented on the experimental unit: 1) changing to an emollient handwashing agent, and 2) providing feedback to staff about the frequency of handwashing. Feedback focused on the previous day's handwashing following completed patient contacts, interrupted patient contacts, and critical procedures. No increase in handwashing was observed following introduction of the emollient soap. However, when feedback was provided on the experimental ICU, handwashing following completed patient contacts (the major dependent measure) increased to 92%, and was significantly higher than handwashing on the control unit. Follow-up observations suggested that compliance on the experimental unit appeared to return to baseline levels.
Prevalence of Measles Antibodies in Hospital Personnel
Authors: Chou Teresa , Weil Diane , Arnow Paul M. 
Published: August 2016

AbstractA community outbreak of measles prompted a serologic survey of personnel in a hospital serving that community. Two hundred sixty-six personnel, primarily physicians (129) and nurses (100), voluntarily participated. Serum specimens were initially tested by the immunofluorescent antibody and enzyme-linked immunosorbent assay (EIA) methods. Specimens with negative results by either test were further examined using the hemagglutination inhibition and plaque neutralization (PN) methods. If EIA and PN results were negative, an individual was considered susceptible. Only one of the 98 participants born during or after 1957 and none of the 168 participants born before 1957 were serosusceptible. The low rate of serosusceptibility, in contrast to previous studies of young adults, appears attributable to the sensitivity of the testing methods used. Based on our experience, institutions considering a measles serologic testing and immunization program should expect to identify very few serosusceptible personnel, even among those born during or after 1957.
Strict Versus Modified Isolation for Prevention of Nosocomial Transmission of Methicillin-ResistantStaphylococcus aureus
Authors: Ribner Bruce S. , Landry Martha N. , Gholson Gail L. 
Published: August 2016

AbstractPatients colonized or infected with methicillin-resistantStaphylococcus aureus(MRSA) in a Surgical Intensive Care Unit and Surgical Intermediate Care Unit were placed either in Strict Isolation or cared for with modified isolation precautions. The assignment was determined by the unit in which they were hospitalized. Units were changed from one form of isolation to the other and served as their own controls.Over a 4-month study period, the rate of MRSA transmission did not change when the type of isolation precautions were altered. The ratio of colonized to infected patients also remained constant. Infected patients were usually first detected by clinical specimens, while colonized patients were usually detected by surveillance cultures performed under the study protocol.Following the study, all hospitalized patients with MRSA were placed in modified isolation precautions. Total new acquisitions of MRSA in the hospital have decreased over the subsequent 6-month period.