bluuebunny/crossref_metadata_2025_split huggingface dataset:
Readers:' Forum: Nosocomial Rubella—Consequences of an Outbreak and Efficacy of a Mandatory Immunization Program
Authors: Heseltine Peter N.R. , Ripper Marie , Wohlford Patricia 
Published: August 2016

AbstractAn outbreak of rubella in a large metropolitan hospital is described. Nineteen cases among employees and three secondary cases in family members occurred. Nosocomial cases occurred among the 3,900 employees of an adult medical-surgical unit where a voluntary program of rubella immunization was in effect. No cases occurred among the 1,400 employees of the women's and pediatric units with mandatory policies, despite interfacility and community exposure. Ten pregnant women were among the 377 contacts of the cases. Five were sero-negative to rubella. Two who developed clinical rubella, one asymptomatic sero-conversion and one other, all elected to terminate their pregnancies. The remaining woman, exposed in her third trimester delivered a normal infant. We conclude a policy requiring new employees to be rubella immune is more effective in preventing nosocomial rubella than a voluntary program and is desirable in view of the potential consequences of an outbreak to pregnant employees.
Cost Containment in Infection Control: Ethical Problems in Rationing Medical Care
Authors: Macklin Ruth 
Published: August 2016

The era of cost containment is upon us. Bureaucrats and regulators, politicians and insurance administrators have begun to devise schemes for reducing the costs of hospital care and medical services in a country justly proud of the quality of its health care. The term “cost containment” has a neutral ring to it, a tone deliberately chosen by policy makers to soften the impact of its effects. The concept has an aura of virtue, conjuring an image of overflowing expenditures that must be put back into the container. But let us recognize the harsh reality that cost containment is simply another term for rationing, a notion that has somewhat unsavory connotations.The need to embark on rationing arises when a crisis of available goods or services is imminent. We are told that too much money is being spent today on health care in the US. Since spending too much on anything is considered wasteful, and since wastefulness is at least an inefficient, if not an unethical way to treat resources, the conclusion seems inescapable that there is a moral imperative to cut costs in the health care sector. To be sure, the goals of eliminating waste and reducing excessive costs should be pursued by hospitals and physicians alike. But let us not hide behind these noble goals and accept uncritically the idea that to increase efficiency in delivering health care, it is necessary to embark on rationing schemes.
Characteristics ofPseudomonas aeruginosaIsolated From Whirlpools and Bathers
Authors: Highsmith Anita K. , Le Phuong Nhan , Khabbaz Rima F. , Munn Van P. 
Published: August 2016

AbstractPseudomonas aeruginosais the most frequently isolated microorganism from whirlpool water and lesions associated with outbreaks of dermatitis and folliculitis related to whirlpool exposure. Strains were selected from 19 outbreaks ofP. aeruginosainfections (1977 to 1983) associated with whirlpool use; they were examined to determine if the strains possessed unique virulence factors or characteristics that might aid in their selection in the environment.P. aeruginosa, 011, was the predominant serotype isolated from whirlpool water as well as from bathers with dermatitis or folliculitis, followed by serotypes 09, 04, and 03. Antimicrobial susceptibility patterns were similar for all strains. Strains ofP. aeruginosafrom bathers and water demonstrated statistically significant differences in extracellular enzyme production compared with control strains.P. aeruginosa, serotypes 09 and 011, were found to be sensitive to low levels of chlorine. These data suggest that, if adequate levels of free available chlorine are maintained,P. aeruginosashould have little opportunity to persist in whirlpools.A bather's risk ofP. aeruginosadermatitis or folliculitis appears to be affected primarily by three factors: 1) immersion in water colonized byP. aeruginosa, 2) skin hydration with altered skin flora, and 3) toxic reactions to extracellular enzyme or exotoxins produced byP. aeruginosa. Although a single virulence factor was not identified from the results of this study, there are some indications that the enzymes produced by these microorganisms play an important role in the pathogenesis of disease associated with whirlpool use.
Epidemiology and Clinical Significance of Blood Cultures Positive for Coagulase-Negative Staphylococcus
Authors: Kirchhoff Louis V. , Sheagren John N. 
Published: August 2016

AbstractCoagulase-negative staphylococci are frequently isolated from blood cultures. As these organisms may occasionally cause serious disease, differentiating bacteremia from contamination is very important but often difficult. Over a 26-month period, of 29,542 blood cultures processed at the University of Michigan Medical Center, 2,875 (9.7%) were positive, and of those, 694 (from 527 patients) grew coagulase-negative staphylococci. Isolates from the 439 patients with only one blood culture positive for coagulase-negative staphy-lococci and those from the 18 patients with two positive cultures 10 days or more apart were deemed contaminants. Review of the records of the remaining 70 patients with multiple isolates indicated that 33 had had an episode of true bacteremia, 29 (87.9%) of which were associated with intravascular catheters or prosthetic valves. Overall, 85% of all coagulase-negative staphylococci isolated during the study period were judged to be contaminants. Seventy-one percent of the blood cultures drawn during the episodes of bacteremia were positive for coagulase-negative staphylococci as opposed to only 34% in the patients with contaminated cultures (p < 0.01). Moreover, coagulase-negative staphylococci grew in both aerobic and anaerobic bottles in 85% of blood culture sets drawn during episodes of bacteremia, but in only 30% of the cultures thought to be contaminated (p < 0.001). Growth of coagulase-negative staphylococci in less than 48 hours was also significantly associated with bacteremia (p < 0.01). Antibiotic sensitivity patterns were not useful in differentiating bacteremia from contamination. Thus, clinicians should consider coagulase-negative staphylococci as true blood pathogens in patients with intravascular devices who have a high proportion of blood cultures positive for this organism over a short period of time, and whose cultures became positive in less than 48 hours, with a high percent positive in both bottles. Microbiology laboratories can conserve considerable resources by limiting sensitivity studies to isolates from such patients.
Immunity of Hospital Personnel Against Polio Virus
Authors: Alkan M. , Morag R. , Rubinstein E. , Derazne E. 
Published: August 2016

AbstractSera from 275 employees of three hospitals were tested for the presence of antibodies to polio virus. Immunity was found to increase with age, and was higher in personnel directly involved in patient care than in the others. Previous exposure to poliomyelitis as well as a history of previous immunization did not correlate with the immunological status of the employee. When antibodies against one of the three polio types or more could not be demonstrated, the employee was vaccinated by an inactivated polio virus vaccine.
All-inclusive Concurrent Antibiotic Usage Review: A Way to Reduce Misuse Without Formal Controls
Authors: Heineman Herbert S. , Watt Valerie S. 
Published: August 2016

AbstractDuring an 11-week period, all antibiotic usage on a 113-bed medical teaching service was reviewed concurrently in weekly sessions between house staff and a review team. Recommendations for change, based on accepted criteria, were communicated by the house officer to the attending physician. In one-half of the patients no change was suggested; in one-third, a recommended change was made; and in only one-sixth was a recommendation not followed. Cost savings were conservatively estimated to approach $10,000 in this pilot study; this extrapolates to almost $300,000 per year for the 714-bed medical center, or more than 18% of the antibiotic expenditures.This program achieves its objective in a nonthreatening, noncontrolling manner, provides continuing education, and contributes to improved patient care.
The Efficacy of a Florida Hospital Consortium for Infection Control: 1975-1982
Authors: Ehrenkranz N. Joel 
Published: August 2016

AbstractFrom 1975 through 1982, the South Florida Hospital Consortium for Infection Control provided consultative and educational services to personnel of 20 community hospitals. To evaluate program efficacy, outbreak frequencies were compared at 11 hospitals with 5 to 8 years of experience through 1982. Annual outbreak rates during the first 4 membership years were compared with those of subsequent years, by service. Each hospital served as its own control. Outbreaks were most frequent in critical care and orthopedic-general surgery patients, and among hospital personnel. Critical care outbreaks occurred more often in hospitals classified as oncology centers (P<.05); their frequency did not decrease significantly after 4 years of membership. However, surgical outbreak rates did decrease from .36 annually in the first years to .03 thereafter (P<.01). This was not attributable to a secular decrease and is taken to indicate program efficacy. No change in frequency of hospital personnel outbreaks was evident.
Gentamicin-Resistance Plasmids in an Intensive Care Unit
Authors: Shlaes David M. , Currie-McCumber Charlotte , Eanes Mabel , Rotter Grace , Floyd Rachel 
Published: August 2016

AbstractTo better understand the role of plasmids and their importance in the endemic antibiotic resistance of Enterobacteriaceae, we began a prospective study of our combined medical intensive care/coronary care unit. An initial culture survey of the patients, ward staff, and environment was followed by a prospective sampling of 139 consecutive new admissions at the time of admission to the unit, and at regular intervals thereafter for the remainder of their stay. All cultures were planted on agar-containing gentamicin. Of the 147 patients studied, 12 (8.2%) were colonized with 20 strains of gentamicin-resistant gram-negative bacilli (GRGNB) at 29 sites. An additional four GRGNB were isolated from the environment. Of the 24 GRGNB strains, 7 (29%) Enterobacteriaceae carried plasmids shown to carry the gentamicin-resistance determinant. Plasmids were further characterized by restriction endonuclease digestion profiles of plasmid DNA purified fromE. coliC600 transconjugants or transformants. A 93 kb plasmid introduced to the unit by aSerratia liquefacienscolonizing a patient transferred from another area in the hospital was identical to 93 kb plasmids carried by aC. amalonaticusand anE. aerogenessubsequently colonizing another patient on the unit. A 60 kb plasmid, first isolated from aS. marcescenscolonizing a sink drain was later isolated from anE. cloacaecolonizing a patient. Our results indicate that spread of specific R-plasmids may be one mechanism for dissemination of antibiotic resistance on our MICU/CCU.
Viability of Staphylococci in Various Diluents
Authors: Essiain Razmick , Flournoy D.J 
Published: August 2016

AbstractStandardized suspensions of 78 staphylococci and micrococci were stored in different diluents and tested periodically for 3 weeks to determine their ability to maintain viability. In 92% of the tests, diluent suspensions yielded viable organisms for at least 21 days. Organism survival was maintained in the following order, from best to worst: skim milk, tap water, 0.9% NaCl, deionized water, Dianeal (peritoneal dialysis) fluid, 0.2% bovine serum albumin and 5% glycerol. In 81% of the instances, oxacillin-susceptible staphylococci survived better than oxacillin-resistant staphylococci.
Adapting Disease-Specific Isolation Guidelines to a Hospital Information System
Authors: Jacobson Julie T. , Johnson Dickey S. , Ross Carol A. , Conti Marlyn T. , Evans R. Scott , Burke John R 
Published: August 2016

AbstractThe authors modified the Centers for Disease Control's guideline for disease-specific isolation precautions to a hospital computerized information system. Entering a suspected diagnosis selected from the isolation option on computer terminals generated: 1) a printout listing the isolation instructions, infective material(s), and persons who should avoid exposure; 2) an order for the appropriate supplies; 3) a patient charge based on the supplies required; and 4) an option for stopping, changing, or listing the orders. In order to implement this system, both extensive in-service training for nurses and efforts to change ordering practices of physicians were necessary.Prevalence surveys before and after computerization were used to evaluate the new system. Combined surveys showed that isolation was ordered for only 21% of patients when indicated. Failure to isolate was identified as a significant problem. As a consequence, continuous surveillance and consultation of all infected patients were instituted, resulting in isolation orders for 81% when indicated. The computerized disease-specific system has resulted in better and more accurate use of isolation, probably due to in service education and surveillance efforts.
Biological Sterilization Monitors: A Four-Year In-Use Evaluation of Two Systems
Authors: Kotilainen Helen Rosen , Gantz Nelson M. 
Published: August 2016

AbstractBiological monitors (BI) are considered to be the best monitor of the sterilization process yet false positives may result in recalls and quality assurance difficulties. To assess the frequency, type and reasons for questionable results, we undertook a 4-year in-use study of two commonly used BI types—spore strips (Spordi®) and a self-contained crushable ampule (Attest®)—for both steam and ethylene oxide (EO). After laboratory verification of time/kill ratios for a portion of each involved lot, 2 BI of each type were placed in test pack within a randomly selected load run at standard time and temperature. All resulting positive BI were subcultured. Steam cycle positives were uncommon (32/1,1710 positive Spordi, 1.9%; 20/1,710 positive Attest, 1.2%) and could be related to chamber temperature or steam quality. All of the 4 BI per load were positive in only three loads; physical monitors indicated gross malfunction. Five positive Spordi were due to either contaminants or a malfunctioning incubator. EO-related positives were more common (53/1,109 positive Spordi, 4.8%; 25/1,109 positive Attest, 2.3%). One-half of the Spordi tests became positive after 48 hours of incubation. Organisms other thanB. subtiliswere recovered from 49.1% of the positive tests (26/53). The Attest was remarkable for its lack of contamination; 1/25 was positive forPseudomonas stutzerionly. More positives were observed during the winter months when relative humidity was below 20%. This finding was more commonly observed with the EO Attest. In summary, we found no significant difference in the performance of either BI. Subculturing of positives and maintenance of proper humidity during storage should be emphasized.
Susceptibility to Varicella-Zoster Virus Among Adults at High Risk for Exposure
Authors: Alter Sherman J. , Hammond Jeanne A. , McVey Carol J. , Myers Martin G. 
Published: August 2016

AbstractThe adult health care provider who is susceptible to varicella zoster virus (VZV) represents a risk to her or himself and to patients. Nineteen percent of employees at this Children's Hospital had no or uncertain prior experience with VZV, and of these, 28% were found to be VZV susceptible, representing 5% of the total population of 2,730 hospital employees. During the 12 months of study, six of the potential 135 to 137 VZV-susceptible individuals acquired varicella. VZV-susceptible health care providers should be aware of their potential to both acquire and transmit VZV.
Is Primary Cytomegalovirus Infection an Occupational Hazard for Obstetric Nurses? A Serological Study
Authors: Hatherley Lawrence I. 
Published: August 2016

AbstractThe results are reported of a 4-year prospective study of the incidence of primary cytomegalovirus (CMV) infection in the nursing staff of a specialist obstetric hospital. The absence of seroconversion found in personnel attending patients with confirmed CMV-infection justifies reassuring staff members in “high-risk” areas of the adequacy of the methods used to combat cross-infection . On the other hand, a low rate of seroconversion (1.2% per annum) in the staff who nurse normal mothers and “rooming-in” babies emphasizes the need for die rigorous observance of hygienic precautions by all personnel in all areas. The results of this Australian investigation are discussed in relation to the northern hemisphere experience of CMV-seroconversion in pediatric nurses.
Effects of Ultra High Speed Floor Burnishing on Air Quality in Health Care Facilities
Authors: Schmidt Edward A. , Cannan Bernard M. , Mulhall Richard C. , Coleman David L. 
Published: August 2016

AbstractEffects of ultra high speed (UHS) floor burnishing upon air quality in health care facilities were evaluated. A 2,000-rpm burnisher can disseminate high-velocity (190 km/hr) dust and microbial particles. A UHS burnisher used with either inadequate or no air restraint produced significant increases (P<0.05) in the levels of airborne dust particles and microorganisms. A UHS burnisher equipped with an air restraint assembly specifically designed for use in health care facilities produced no significant increase (P>0.05) in the levels of airborne dust particles or microorganisms when compared to ambient air levels. The types and distribution of airborne microorganisms isolated from microbial air samples were not unusual nor were they directly influenced by the floor burnishing processes. Furthermore, the UHS floor burnishing process produced a significant reduction (P<0.05 ) in microbial floor contaminants (96%). When the use of UHS floor burnishing is contemplated for productivity improvement and esthetic enhancement, the possible adverse effects on air quality should also be considered.
High Incidence of Subclavian Dialysis Catheter-Related Bacteremias
Authors: Pezzarossi Hugo E. , de León R Samuel Ponce , Calva Juan J. , Lazo de la Vega Sergio A. , Ruiz-Palacios Guillermo M. 
Published: August 2016

AbstractThis retrospective cohort study reviews the incidence of bacteremia in 48 patients undergoing hemodialysis using subclavian vein dialysis catheters (SDC) as temporary vascular access. Twelve (25%) of these patients had catheter-related bacteremia, and the most frequently isolated organisms were coagulase-negative staphylococci. Three patients developed right-sided endocarditis and one of diem died due to pulmonary embolism. The presence of possible risk factors for SDC-related bacteremia, including duration of catheterization and number of hemodialysis procedures, were not statistically different when patients with and without bacteremia were compared, with the exception of a significantly lower incidence of bacteremia among those patients receiving antibiotic therapy at the time of catheter insertion. The use of resterilized catheters was not a risk factor. Specific guidelines for SDC insertion and care were established and followed, after which the infection frequency was reduced to 7.5% (1 episode per 45.5 patient-weeks of catheter use) in this high-risk population
The Enterococcus
Authors: Gullberg Robert M. 
Published: August 2016

In 1899, Thiercilin used the term “enterococcus” to describe microscopic organisms seen in pairs or short chains in feces. Later (in the 1930s) the name was used in a more restrictive sense for streptococci that had the hardy capacity to survive under extreme conditions.Enterococci belong to a group D family of streptococci, as characterized by Lancefield in 1938. In contrast to other groups of streptococci, the group D antigen is not a wall carbohydrate but a glycerol teichoic acid containing glucose and D-alanine. This antigen appears to be related directly to the cytoplasm or plasma membrane.
Clinical Review of Ribavirin
Authors: Eggleston Mark 
Published: August 2016

AbstractThe recent approval of ribavirin aerosol for the treatment of severe respiratory syncytial virus (RSV) in infants and young children is a significant addition to the antiviral drugs available today. When administered as an aerosolized form by face mask or mist tent for 20 to 21 hours per day, ribavirin effectively decreases the symptoms of RSV infection and the shedding of RSV virus.Studies of other viral infections such as viral hepatitis, influenza A and B, Lassa fever, genital herpes, and herpes zoster have demonstrated promising, but inconclusive results. Further studies are needed to justify ribavirin therapy for these indications.
The Impact of Postdischarge Infection on Surgical Wound Infection Rates
Authors: Reimer K. , Gleed C. , Nicolle L.E. 
Published: August 2016

AbstractWe undertook a study of postdischarge infections to assess the reliability of a surgical wound surveillance program in a 930-bed teaching hospital. During a six-month period, a subset of operations performed each day was randomly selected and patients interviewed by telephone one month postsurgery using a standard set of questions. The infection rate for all patients contacted directly postdischarge was 5.4%, whereas the surgical wound infection rate determined for all procedures through the standard hospital program was 1.5%. For day-surgery patients, who are not routinely followed in the hospital surveillance program, 8 (7.8%) of 103 patients contacted had infection. Thus, the overall surgical infection rate determined in this study was over three times higher than that calculated using standard surveillance. A reliable method for identifying postdischarge wound infections is necessary to ensure accurate surgical wound infection rates.
Recurrent Pseudobacteremias Traced to a Radiometric Blood Culture Device
Authors: Bradley Suzanne F. , Wilson Kenneth H. , Rosloniec Michael A. , Kauffman Carol A. 
Published: August 2016

AbstractFive clusters of pseudobacteremias over a seven-month period were traced to a BACTEC® radiometric device. Four episodes were due to enterococcus and one involvedStaphylococcus aureus.Each cluster began with multiple positive blood cultures from a patient with clinical evidence of bacteremia. On subsequent days each bottle in sequence yielded growth of the identical organism, as shown by phage typing and antibiograms. Cultures from patients believed to be infected with the organisms tested positive earlier (mean = 1.4 days) than those patients believed to be pseudobacteremic (mean = 4.8 days). Investigation pointed toward the BACTEC device as the most likely source. Resin beads were found in the needle on several occasions and were shown to be transferred from bottle to bottle. We postulated that contaminated resin beads or liquid from a positive bottle remained in the needle above the portion that was heat-sterilized, contaminating the next bottle when it was sampled.