bluuebunny/crossref_metadata_2025_split huggingface dataset:
Authors: Strausbaugh Larry J. , Pinner Robert W. , Rosen Hugo R. 
Published: August 2016

AbstractFirst identified in the late 1980s as the main causative agent of non-A, non-B hepatitis, hepatitis C virus (HCV) infection is now the most common chronic bloodborne infection in the United States. It is likely that the number of deaths attributable to HCV-related chronic liver disease will increase substantially during the next 2 decades, and the potential economic and clinical burden related to HCV is staggering. Accordingly, it is essential to identify risk factors for transmission of HCV and implement appropriate precautions to decrease the prevalence of this emerging infection. The relative importance of the two most common types of exposures associated with transmission of HCV, ie, blood transfusion and injection drug use, has evolved over time. Strict blood-donor selection and the use of reliable serological tests have led to a significant reduction in transfusion-associated risk. Injection drug use is currently the single most important risk factor for HCV infection in the United States.Transmission of HCV poses a serious threat to healthcare workers and patients if infection control techniques or disinfection procedures are inadequate. Potential exposures include contact of the eyes, mucous membranes, broken skin, or needlestick injury. Hospitalized patients may serve as a reservoir for transmission, and the prevalence of anti-HCV seropositivity among such patients can be as high as 20%.The infected healthcare worker is a potential source of transmission. A recent molecular phylogenetic analysis demonstrated that a cardiac surgeon likely transmitted HCV to five of his patients during open heart surgery. In summary, nosocomial transmission has been unequivocally confirmed and underscores the need for strict infection control practices.
Nosocomial Viral Infections: I. Epidemiology and Significance
Authors: Valenti William M. , Hall Caroline Breese , Douglas R. Gordon , Menegus Marilyn A. , Pincus Patricia H. 
Published: August 2016

AbstractViral illnesses in Strong Memorial Hospital were monitored over a 17-month period. Using criteria based primarily on the incubation periods for a number of common virus infections, the infections we found were classified as hospital- or community-acquired. Hospital-acquired viral infections occurred on most hospital services; the majority of infections occurred on the pediatric and psychiatric services. Infections due to herpesviruses were seen more frequently in a group of patients aged 14 years or older, while infections in patients aged three years or younger were more likely to be due to respiratory syncytial virus, influenzavirus, adenovirus, or parainfluenza virus. Patients with nosocomial infections due to viruses were hospitalized an average of 9.3 days longer than uninfected controls; thus nosocomial viral infections result in increased costs of hospitalization.
Nosocomial Viral Infections: II. Guidelines for Prevention and Control of Respiratory Viruses, Herpesviruses, and Hepatitis Viruses
Authors: Valenti William M. , Betts Robert F. , Hall Caroline Breese , Hruska Jerome F. , Douglas R. Gordon 
Published: August 2016

AbstractThis article reviews the most likely mechanisms of transmission of the commonly encountered respiratory viruses (influenza, respiratory syncytial virus, parainfluenza, rhinovirus), herpesviruses, and hepatitis viruses, and presents the guidelines used currently for prevention and control that are in use at Strong Memorial Hospital.
Successful Control of Hepatitis B Surface Antigenemia in a Dialysis Unit Without Geographic or Machine Isolation
Authors: Ostrower Victor S. , Lifschitz Meyer D. , Craven Philip C. , Williams Dwight M. 
Published: August 2016

AbstractPersistent hepatitis B infections among patients and frequent new hepatitis B infections among both patients and staff were a major problem in our dialysis unit during its first two and one-half years of operation. During this time the mean quarterly rate of conversion to HBsAg positivity among patients ranged from 0-60% (mean 12%); in staff it ranged from 0-13%. Control efforts, including strict temporal isolation, improved sanitary measures, and use of parallel plate dialyzers without geographic or machine isolation, were begun late in 1976. After a four-month lag, new HBsAg conversions ceased among the 30 patients and staff at risk, despite continued dialysis of eight HBsAg-positive patients (at least four of whom were HBeAg-positive). Over the succeeding three years the conversion rate was zero in both patients and staff. This experience suggests that conservative control measures without geographic separation of patients may be sufficient to control an established outbreak of hemodi-alysis-related hepatitis B. Controlled prospective trials of this hypothesis are warranted.
Pneumococcal Infections and Pneumococcal Vaccine: An Update
Authors: Rytel Michael W. 
Published: August 2016

AbstractPneumococcal pneumonia continues to be an important disease in terms of prevalence, morbidity and mortality. With the discovery of penicillin and its wide clinical use, the overall mortality of pneumococcal pneumonia has been significantly reduced, but problems remain. These include: 1) death rate is uninfluenced by the antibiotic in the first five days of illness; 2) death rate in certain high risk groups and in patients infectecd with type 3 pneumococcus exceeds 25%; and 3) penicillin resistant strains of pneumococci have emerged. Because of these and other considerations, a modern 14-valent pneumococcal vaccine has been developed by Robert Austrian and his co-workers. The vaccine has been found to be immunogenic and effective in a number of populations studied. Additional efficacy studies are needed, however, particularly in certain high risk groups, such as the elderly and immunocompromised patients.
Injection Site Abscesses Caused by Mycobacterium Chelonei
Authors: Gremillion David H. , Mursch Sara B. , Lerner Charles J. 
Published: August 2016

AbstractSubcutaneous abscesses occurred at hip and deltoid injection sites in 13 student nurse assistants following practice injections.Mycobacterium cheloneiwas isolated from three cases and was the presumptive pathogen in other temporally clustered cases with similar clinical findings. A 1,000 cc bottle of 0.9 N saline used as a source for practice injection solution was the apparent source of the organism.Presenting findings included tenderness (7), swelling (7), fever (3), adenopathy (1) and weight loss (1). All cases were characterized by long incubation periods (6 to 16 weeks) and delayed resolution (mean 8.8 months), and required surgical drainage or wedge excision for therapy. Antituberculous therapy was administered in three cases. Complications were limited to scarring in seven cases with keloid formation in two and persistent pain in three cases. This outbreak reinforces the importance of penetrating trauma in this cutaneous mycobacterial infection and emphasizes the emergence of this organism as an important nosocomial pathogen.
A Prospective Study of Infectious Diseases Following Bone Marrow Transplantation: Emergence ofAspergillusandCytomegalovirusas the Major Causes of Mortality
Authors: Peterson Phillip K. , McGlave Philip , Ramsay Norma K.C. , Rhame Frank , Cohen Eve , Perry Guy S. , Goldman Anne I. , Kersey John 
Published: August 2016

AbstractWe performed a prospective study of infections following bone marrow transplantation in 50 patients treated for aplastic anemia or hematologic malignancy. Early, continuous prophylaxis with trimethoprim/sulfamethoxazole and oral nystatin, and empiric intravenous antimicrobial therapy during febrile granulocytopenic episodes were standard treatment for all patients. The use of trimethoprim/sulfamethoxazole did not appear to adversely affect donor marrow engraftment. Serious gram-negative bacillary and systemicCandidainfections were uncommon. Although gram-positive bacterial infections were frequent, they were rarely associated with mortality. Aspergillosis emerged as the single most important infection, contributing to the death of nine patients. Cytomegalovirus diseases developed in 13 patients, seven of whom died. Patient age and chronic myelogenous leukemia were risk factors for the development of fatal infections. This study demonstrates that although certain serious infections can be controlled, there is a critical need for effective measures to prevent and treat aspergillosis and cytomegalovirus disease in these seriously compromised hosts.
Nafcillin Resistant Staphylococcus Aureus A Possible Community Origin
Authors: Hamoudi Ayser C. , Palmer Robert N. , King Timothy L 
Published: August 2016

AbstractAn increased incidence in nafcillin (semisynthetic penicillins) resistantStaphylococcus aureus(SR-SA), which peaked in January 1980, was noted in Columbus Children's Hospital (CCH), Columbus, Ohio. To investigate the source of this outbreak, we reviewed the susceptibility patterns ofS. aureusstrains isolated at CCH for a 12-month period (July 1979 to June 1980). A total of 773 isolates from 706 patients were investigated with a total of 40 patients colonized or infected with SR-SA, approximately 25% of which were diagnosed in the ambulatory clinics. These patients did not have any apparent previous contact with the inpatient unit or inpatient personnel. Eight nosocomial infections were also uncovered. The first appeared in December 1979. Our studies suggested that some SR-SA isolates may have originated in the community and these organisms may not be exclusive to the hospital environment, as was felt to be the case previously. We also determined that the baseline incidence for our hospital of SR-SA was approximately 2% of total S.aureusisolates. Only 35% of the SR-SA demonstrated resistance to multiple antibiotics. This report indicates that community and nosocomial 5.aureusisolates should be monitored for nafcillin resistance. Vancomycin susceptibility should be tested on all isolates and reported for SR-SA in life-threatening infections.
Surgical Scrub and Skin Disinfection
Authors: Ayliffe Graham A.J. 
Published: August 2016

AbstractThe role of pre-operative disinfection of the surgeon's hands and the skin of the operative site in the prevention of wound infection remains uncertain. The normal resident skin flora, consisting mainly of coagulase-negative staphylococci and aerobic and anaerobic diphtheroids, is an uncommon cause of infection except in prosthetic operations.Staphylococcus aureusis rarely a resident on normal skin other than the perineum, and is mostly present on the hands as a transient acquired from the nose. Nevertheless, it seems rational to kill or remove all transients on the hands of the surgeon and reduce residents to low levels.Surgical skin disinfection is usually assessed by measuring the reduction in organisms on the hands immediately after disinfection, after repeated applications of the disinfectant and after wearing gloves for two to three hours. The hands are commonly sampled in a bowl or plastic bag containing Ringer's or a similar solution and relevant neutralizers, or by the use of glove washings. A standardized technique is necessary to provide a statistical comparison between agents. Antiseptic detergents, chlorhexidine or povidone iodine show immediate reductions in bacterial counts of 70% to 80%, increasing to 99% after repeated application. Hexachloraphene and triclosan detergents show a lower immediate reduction but a good residual effect. Seventy percent ethyl or 60% propyl alcohol, with or without an antiseptic, show an immediate reduction of over 95%, and in excess of 99% on repeated application. Residual levels of organisms tend to be lower after repeated alcohol treatment than following the use of antiseptic detergents. A two to three-minute application of the antiseptic to the hands, without a scrubbing brush, is commonly recommended in the UK, but possibly in routine surgery an application time of 30 seconds is sufficient, killing or removing transients and superficial residents.
The Cost Implications of Clean Air Systems and Antibiotic Prophylaxis in Operations for Total Joint Replacement
Authors: Lidwell O.M. 
Published: August 2016

AbstractThe effect on sepsis of the use of prophylactic antibiotics and measures for reducing the level of airborne contamination in the operating room has been related to the costs of these measures and of dealing with a septic joint. While antibiotic prophylaxis is the most cost effective, the benefits that may be obtained from the introduction of cleaner air also appear to be worthwhile, even when considered solely in terms of hospital costs.
Legal Aspects of Antibiotic Audit
Authors: Nottebart Harry C. 
Published: August 2016

In first examining the legal aspects of an antibiotic audit, it might be well to consider the legal basis or reason to do such an audit.A hospital may be compelled to act in certain ways in order to comply with standards based on:1. Federal laws2. State laws, particularly those on hospital licensure.3. Joint Commission on Accreditation of Hospitals (JCAH) standards if the hospital is JCAH accredited.4. The hospital's own bylaws, rules and regulations, and policies and procedures.5. Certain actions are also based on duties perceived from reading opinions in lawsuits. This even may be reflected in changes in the hospital's bylaws, rules and regulations, or policies and procedures.
A Potential Infection Hazard Associated with the Use of Disposable Saline Vials
Authors: Rutala William A. , Stiegel Marsha M. , Sarubbi Felix A. 
Published: August 2016

AbstractNosocomial respiratory tract infections have occasionally been associated with contaminated respiratory therapy devices and techniques. In the past two years, our hospital purchased disposable saline squeeze vials for use during suctioning of intubated patients. These vials have a cap which must be flipped or twisted-off by the user before the contents can be instilled into the patient's respiratory tract. We observed use of this item in our intensive care units (ICU) and studied the potential for contamination. ICU nurses use ungloved hand(s) to flip or twist-off squeeze vial cups resulting in skin contact with the vial opening. Cultures of nurses' hands and squeeze vial contents were obtained in the ICU where 24 nurses opened 92 vials in the manner previously described. Twenty-three percent of vial contents were contaminated and cultures revealed S. epidermidis, S. aureus, Streptococcus viridans and enterococcus. On six occasions, organisms recovered from vial contents were believed to be identical to organisms isolated from the hands of the nurse who opened the vial. When nurses used care in removing the saline vial cap, cultures of vial contents were sterile.
Hospital-Acquired Infections in Intensive Care Unit Patients An Overview with Emphasis on Epidemics
Authors: Wenzel Richard P , Thompson Robert L. , Landry Sandra M. , Russell Brenda S. , Miller Patti J. , de Leon Samuel Ponce , Miller Grayson B. 
Published: August 2016

AbstractSurveillance activities for the detection of nosocomial infections at the University of Virginia Hospital (Charlottesville, Virginia) and at hospitals participating in the Virginia Statewide Infection Control Program have focused on outbreaks and device-related infections which are potentially preventable. Eleven outbreaks of nosocomial infections were identified at the University of Virginia Hospital between January 1, 1978 and December 31, 1982 (9.8 outbreaks/100,000 admissions). Ten of the 11 were centered in critical care units. The 269 patients involved in the epidemics represented 0.2% of all hospital admissions and 3.7% of all patients who developed nosocomial infections. Eight of the 11 outbreaks involved infection of the bloodstream, and the 90 patients who developed a bloodstream infection as part of an epidemic represented 8% of all patients with nosocomial bloodstream infections identified during the five-year study period. The reservoir of the 11 outbreaks involved devices (5), contaminated cocaine (1), probable blood products (1), other patients (3), and nursing personnel (1). Forty-one percent of all nosocomial bloodstream infections and 41% of all nosocomial pneumonias occurred in intensive care units (ICUs).In 38 hospitals in the state of Virginia with ICUs and practitioners who voluntarily reported surveillance data between June 1,1980 and May 31,1982, there were 264,757 patients admitted and a crude infection rate of 3%. Of note is that 1,867 of the 7,407 nosocomial infections (25%) occurred in the ICU patients. Several factors point to a compelling argument that the highest priority in infection control resources be assigned to the prevention and control of ICU infections: ICU patients often have serious device-related infections and may be identified as high risk prior to infection. Furthermore, they are at risk of being infected as part of a major outbreak. Such characteristics define a population of hospitalized patients, many of whose infections are preventable.
Optimal Design/Personnel for Control of Intensive Care Unit Infection
Authors: Nyström Bertil 
Published: August 2016

AbstractApart from the special mechanisms for spread of IV device and respiratory equipment-related infections, the mechanisms for spread of infections in the intensive care unit (ICU) are no different from other areas of the hospital. Control of transmission must emphasize the necessity of blocking the contact and airborne routes of spread.Hand disinfection with an alcoholic preparation and the use of patient-bound gowns for all direct patient contact are efficient measures against contact spread of infections.Airborne spread is best reduced by nursing patients in one-patient rooms with doors closed. A substantial part of the beds should be in such rooms. However, they are of little value if basic barrier nursing techniques are neglected. An ante-room to the one-patient room is practical for hand disinfection, gowning, etc., and if ventilated, offers added protection against airborne spread.Barriers against transmission of microorganisms must be created between patient rooms. Since basic barrier nursing techniques are the determining factors for infection control, the need for adequate numbers of well-trained and well-educated staff cannot be overestimated.
Staphylococcus epidermidis Bacteremia Associated With Vascular Catheters: An Important Cause of Febrile Morbidity in Hospitalized Patients
Authors: Sattler Fred R. , Foderaro Janet B. , Aber Robert C. 
Published: August 2016

AbstractSeventeen episodes of persistent Staphylococcus epidermidis bacteremia (one to nine days) occurred in 16 patients with vascular catheters during a 26-month period. Cases were statistically more likely to have a longer hospitalization (54 v 7.6 days, p < .0005), longer duration of antibiotic therapy (22 v 2.5 days, p = .002), presence of a central venous pressure (CVP) catheter (14 v 2, p < 3 × 10-8), and presence of an arterial catheter (4 v 1, p = 0.037) than randomly selected hospitalized patients matched for age, sex, and date of admission. However, when cases were compared with similarly matched non-bacteremic patients having CVP catheters, these characteristics were not significantly different in the two groups. Furthermore, exposure to total parenteral nutrition (TPN) and duration of TPN were not significantly different between cases and controls. Hence, the presence of a CVP catheter appeared to be the major risk factor for 5. epidermidis bacteremia. In 16 episodes, patients had temperature > 38.6°C without another identifiable cause, and the average white cell count for the case group was 19,400/mm. Seven patients also had diaphoresis, confusion, hypotension, or oliguria. Temperatures returned to normal in 13 within 24 hours after catheter removal, and all patients were afebrile and symptom-free within 72 hours. Thus, vascular catheter-associated S. epidermidis bacteremia was an important case of febrile morbidity in these patients.
Epidemic Bullous Impetigo in a Nursery Due to a Nasal Carrier ofStaphylococcus aureus:Role of Epidemiology and Control Measures
Authors: Nakashima Allyn K. , Allen James R. , Martone William J. , Plikaytis Brian D. , Storer Beth , Cook Larry M. , Wright Stephen P. 
Published: August 2016

AbstractFrom September 14, 1981 to February 28, 1982, an epidemic of bullous impetigo caused by a penicillin/tetracycline resistant strain ofStaphylococcus aureus,phage type 3A/3C, occurred in a newborn nursery in Louisville, Kentucky. Twenty of 1,181 (1.7%) infants at risk developed disease during the six-month epidemic period. Clinically all case-infants had bullous impetigo skin lesions. One infant developed staphylococcal septicemia. No infant died. An epidemiologic investigation identified a nurse as having significantly greater contact with case-infants than control-infants (p=0.0013). She was also found to be a nasal carrier of the epidemic strain. Infection control measures appeared to decrease infant-to-infant transmission via the hands of non-colonized nurses, but did not affect transmission from the nurse carrying the epidemic strain to infants. No cases of bullous impetigo have occurred since this nurse was temporarily removed from the nursery for treatment.
The Cephalosporin Antibiotic Agents — II. First- and Second-Generation Agents
Authors: Marsh T. Donald 
Published: August 2016

The first article in this series discussed the cephalosporin antibiotic agents as a class, including the similarities in their structure, antimicrobial action, and toxicity. Part II focuses on the difference between commercially available first- and second-“generation” agents.The cephalosporins are classified using various criteria, including vulnerability to beta-lactamase hydrolysis and antibacterial activity. The latter classification is based on the in vitro activity of the individual agents, with each succeeding “generation” possessing a greater spectrum of activity than the previous generation(s).
The Efficacy of Antibiotic Prophylaxis in the Prevention of Post-Cesarean Section Endometritis
Authors: Donowitz Leigh Grossman , Norris Sandra M. 
Published: August 2016

AbstractEndometritis is an infectious complication in 9% to 65% of patients delivered by cesarean section. The risk of developing endometritis is greater in the high-risk emergent patient as compared to routine repeat abdominal deliveries. This study describes the incidence of endometritis following cesarean section delivery in different patient groups at the University of Virginia Hospital during a 1-year period and reviews the literature on the efficacy and risks of prophylactic antibiotics in this setting. Of patients not receiving antibiotic prophylaxis, 11 (<1%) of 1,461 normal spontaneous vaginal delivery patients, 7 (16.7%) of 42 repeat and 39 (29.8%) of 131 emergent cesarean section patients developed endometritis. This contrasts to none of the 24 emergent patients who received antibiotic prophylaxis. The literature review shows multiple prospective well-designed and executed studies that demonstrate reliable decreases in the incidence of endometritis with short course antibiotic prophylaxis. Our conclusion is that short course antibiotic prophylaxis is a safe, reproducible, cost-effective and indicated method of reducing the incidence of this costly and serious postoperative infection.