bluuebunny/crossref_metadata_2025_split huggingface dataset:
Klebsiella oxytoca Isolates in a General Hospital
Authors: Alvarez Salvador , Stinnett Joy A. , Shell Charles G. , Berk Steven L. 
Published: August 2016

AbstractPrimary infections caused by Klebsiella species are uncommon, but the organism is an important nosocomial pathogen. We report the predisposing factors, clinical features and outcome of 44 hospitalized patients in whom Klebsiella oxytoca was isolated. Twenty-one (48%) isolates were community-acquired and 23 (52%) were considered nosocomial in origin. Most of the patients were elderly males with serious underlying diseases. There were significant differences between those patients who acquired Klebsiella oxytoca in the hospital and in the community. Nosocomially acquired organisms were associated with a higher mortality (52% vs. 24%) (p<0.05), a higher incidence of infection vs. colonization (83% vs. 57%) (p<0.05), and a higher percentage of cases of pneumonia (43% vs. 19%) (p<0.05). The clinical features, the hospital service and the patients' underlying diseases were similar when patients who died and those who survived were compared. Patients who died were exposed to antibiotics more often prior to the positive culture with K. oxytoca (p<0.05). K. oxytoca is a significant pathogen in hospitalized elderly patients. It is likely to cause infections, especially pneumonia, and carry a high mortality. The organism can become endemic within the hospital setting with continued carriage and nosocomial spread.
Topics in Clinical Microbiology:Francisella tularensis
Authors: Evans Martin E. 
Published: August 2016

In 1911, McCoy discovered an unusual illness among ground squirrels in Tulare County, California. The illness resembled plague but was clearly different because a pathogen could not be isolated on the usual culture media. With the addition of egg yolk to the media, McCoy finally isolated an organism and named itBacterium tularensis. It was soon recognized thatB. tularensiscould cause disease in humans, and many investigators, especially Edward Francis, did much of the early work defining the bacteriology, pathology, and epidemiology of tularemia. The name of the organism was eventually changed toFrancisella tularensisin honor of Francis.UnlikePseudomonas aeruginosaand the Enterobacteriaceae which are relatively non-pathogenic in the normal host,F. tularensiscan easily cause disease in previously healthy persons. In contrast,F. tularensishas not been implicated in nosocomial infections and person to person spread is rare. The organism is, however, extremely hazardous to workers in the clinical microbiology laboratory. Of all common bacterial and fungal pathogens isolated in the clinical laboratory,F. tularensisis second only toCoccidioides immitisin its potential to infect the laboratory worker. Many experienced investigators claim that it is impossible to work with the pathogen for any length of time without becoming infected. Currently it is highly recommended that persons who routinely work with the organism be immunized.
Host Factors in Whirlpool-AssociatedPseudomonas aeruginosaSkin Disease
Authors: Solomon Steven L. 
Published: August 2016

AbstractPseudomonas aeruginosafolliculitis is the most common recognizable infectious disease occurring after use of whirlpools and hot tubs. The factors that affect the host's susceptibility to whirlpool-related infection are the anatomic and physiologic defenses of normal skin, the microecology of the skin surface, factors intrinsic to the individual host, and behavioral factors. The structural components of the skin maintain an environment at the skin surface that makes human skin an inhospitable habitat for microflora. However, natural and experimental models ofP. aeruginosaskin infection suggest that immersion in whirlpools may negate many of the body's normal host defenses, especially the very low humidity at the skin surface. Transient colonization of skin withP. aeruginosamay lead to elaboration of toxins in vivo, resulting in the characteristic dermatitis.
Experiences With Bacteriological Monitoring of Pool Water
Authors: Schiemann Donald A. 
Published: August 2016

AbstractA bacteriological study was completed on pools and whirlpools operated by hotels and private health clubs in the metropolitan area of Toronto, Ontario, Canada. Coliform bacteria, fecal coliform bacteria, and fecal streptococci were found only when other indices showed a drastic deterioration in water quality. Aerobic plate counts were higher, and staphylococci and Pseudomonas aeruginosa occurred more often in whirlpools than in swimming pools. There was a correlation between aerobic plate counts and the presence of staphylococci and P. aeruginosa. P. aeruginosa was rare in swimming pools in the absence of staphylococci; however, in whirlpools the organism was often found in the absence of staphylococci, and when aerobic plate counts were low. P. aeruginosa and plate counts in excess of 3,000 per ml occurred more frequently in whirlpools when the free chlorine residual was less than one part per million. The surface film showed concentrations of staphylococci far greater than the pool water. Whirlpools appear to present a different ecosystem that favors the establishment of P. aeruginosa. Staphylococci, but not Staphylococcus aureus, are useful in indicators of pool water quality but better laboratory methodology is required. Additional attention should be directed to the bacteriology of the water surface film, which presents a more direct hazard to bathers.
Evaluation of the Sterility and Stability of Insulin from Multidose Vials Used for Prolonged Periods
Authors: Rathod Minaxi , Saravolatz Louis , Pohlod Donald , Whitehouse Fred , Goldman Jose 
Published: August 2016

AbstractDiabetic patients frequently use their insulin vials for prolonged periods, even though antibacterial preservatives used in multidose insulin vials are not required to be effective beyond 28 days. For this reason, we evaluated the antibacterial activity present in multidose insulin vials for up to 50 days. Multidose lente insulin vials were inoculated withS. aureusandP. aeruginosa. Vials incubated at room temperature (21°C) were sterile by 48 hours, whereas when they were incubated at refrigerator temperatures (4°C),S. aureuscontamination persisted up to the 17th day andP. aeruginosawere killed after 10 days. The same vials were serially contaminated on days 17, 30, and 50, and a similar antibacterial effect was maintained. Sixty-nine multidose insulin vials used for an average of 53 days were cultured. Eight vials demonstrated bacterial contamination with 1 cfu/ml ofS. epidermidisorPropionibacterium acnes. No endotoxin was detected in the multidose vials used for more than 28 days. Insulin assays on 40 multidose insulin vials used for more than 28 days showed an average insulin content of 101.6±1.9 units/ml. This study did not demonstrate significant bacterial contamination, endotoxin activity, or insulin degradation of multidose insulin in vials used for periods longer than 28 days. In addition, antibacterial preservatives were more effective at room temperature than at refrigerator temperature; thus, the practice of patients not refrigerating insulin vials is sensible.
Surveillance for Postoperative Infections in Outpatient Gynecologic Surgery
Authors: Garvey James M. , Buffenmyer Carol , Rycheck Russel Rule , Yee Robert , McVay Joanne , Harger James H. 
Published: August 2016

AbstractPostoperative infection rates were determined for gynecologic outpatient surgical procedures performed in a traditional operating room environment and a separate, recently opened, surgicenter within the same hospital. Infections were self-reported by attending surgeons responding to computer-generated line listings of their recent surgical procedures. Responses were obtained on 97.9% (612/625) of women having surgery in the operating room and 99.5% (629/632) of women with surgicenter procedures. The overall infection rate for reported women was 0.9% (11/1,241). The difference between operating room and surgicenter rates was not statistically significant. Postoperative infections occurred in 2.5% (3/118) of diagnostic laparoscopies with tubal lavage and 1.4% (3/214) of voluntary abortions by dilatation and evacuation and curettage (D&E&C). The five other infections were scattered among the remaining 25 procedure categories. Ten of the 11 infections were limited to the “clean-contaminated” wounds. No serious or life-threatening infections were encountered. The computer-assisted surveillance system worked well and was easily incorporated into the existing infection surveillance system. The degree of ascertainment of postoperative wound infections is unknown due to reliance on physician self-reporting. However, no patients requiring readmission for infection went unreported by the attending surgeons.
Nosocomial Outbreak of Hand-Foot-and-Mouth Disease Among Operating Suite Personnel
Authors: Johnston Jeffrey M. , Burke John P. 
Published: August 2016

AbstractIn the fall of 1983 an outbreak of hand-foot-and-mouth disease occurred in a large urban hospital. The outbreak began among surgical nurses confined to one area of the operating suite and appeared to spread by direct contact to personnel working in the other areas. No cases were diagnosed among hospital patients. There was no evidence to support an ongoing community epidemic as only three of 98 physicians surveyed had seen hand-foot-and-mouth disease in their practices, and none occurred among family members of 94 unaffected employees. The outbreak resulted in 82 lost workdays at an estimated cost to the hospital of $5,676. Existing infection control guidelines do not address the issue of transmission of hand-foot-and-mouth disease from hospital personnel to patients; our experience suggests that the risk of transmission, at least in the operating suite environment, may be greater for other personnel than for patients.
Topics in Clinical Microbiology: Microbial Adherence and Infection—Clinical Relevance
Authors: Stratton Charles W. , Fishman Marlene 
Published: August 2016

AbstractAdherence mechanisms have been described for some microbes, often in direct association with onset of infection. In other cases, the evidence is vague. This article will summarize modes of attachment, and will focus on each anatomical tract in an effort to outline the relationship between microbial adherence, host cells, foreign bodies, and infection.
The Nosocomial Colonization of T. Bear
Authors: Hughes Walter T. , Williams Bonnie , Williams Bobby , Pearson Ted 
Published: August 2016

AbstractA national effort to reduce nosocomial infections includes a program developed at the National Institutes of Health to encourage handwashing in hospitals and day care centers. The program promotes a symbolic teddy bear (T. Bear) with slogans to remind hospital personnel and patients to practice handwashing. One of the items used is a stuffed toy T. Bear to be dispensed to the hospitalized child. Considering the manner in which children handle stuffed toys, we suspected the T. Bear might serve as a “fomite” for transmission of nosocomial microbes. A prospective study of 39 sterilized T. Bears revealed that all became colonized with bacteria, fungi, or both within 1 week of hospitalization. Hospital acquired organisms cultured from the T. Bear included Staphylococcus epidermidis, Staphylococcus aureus, alpha streptococci, Corynebacterium acnes, Micrococcus sp, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Bacillus sp, and species of Candida, Cryptococcus, Trichosporon, Aspergillus and others. Concomitant cultures of the patients revealed similar isolates. Although the T. Bear handwashing campaign should not be discredited, the promotional toy may pose an unnecessary expense and hazard and should not be used in hospitals or day care centers.
Reuse of Disposable Medical Devices: Historical and Current Aspects
Authors: Greene V.W. 
Published: August 2016

AbstractThe “plastics revolution” of the last quarter century disrupted a hospital tradition. Since the 1890s, hospitals processed, packaged, and sterilized most of the medical-surgical items they needed in their own sterile supply departments–a “cottage industry” developed specifically for recycling. Only those consumable items that were too difficult, expensive, or inconvenient to reprocess were purchased from outside manufacturers as presterilized, single-use “disposables.” Since the plastics revolution, however, the “disposables” started to displace the “reusables,” and while claiming to be an economical innovation, have become a significant item in the budget. Some hospitals feel that if disposables save money, reusing the disposable several times will save more. The practice is spreading. The manufacturers, in turn, claim that hospitals do not have adequate quality assurance programs or skills to reprocess their items properly. The debate is further complicated by legal and ethical ramifications, as well as commercial and economic arguments.
Suppurative Thrombophlebitis: Correlation Between Pathogen and Underlying Disease
Authors: Johnson Capt Robert A. , Zajac Capt Robert A. , Evans Maj Martin E. 
Published: August 2016

AbstractWe identified 29 episodes of suppurative thrombophlebitis in 27 patients admitted to a large general hospital between May 1980 and May 1984. In 25 patients, the intravenous cannulae had been in place for more than 3 days. Streptococcus faecalis, Pseudomonas aeruginosa or one of the Enterobacteriaceae were implicated in 14 patients. All these patients had recently undergone abdominal surgery or had a major intraabdominal inflammatory process at the time they developed thrombophlebitis. The remaining 13 patients were infected with Staphylococcus aureus, other grampositive cocci or Candida species. Only two of these had an active abdominal process at the time of their infection (x2 = 16.08, P<0.001). There is an apparent association between phlebitis caused by enteric organisms and active intra-abdominal pathology. There were two deaths related to delayed or deferred surgery. Suppurative thrombophlebitis is a lethal, preventable nosocomial infection that requires urgent surgical intervention.
Zero Infection Rate: An Achievable Irreducible Minimum in Clean Surgery?
Authors: Kaiser Allen B. 
Published: August 2016

For clean elective surgery, the goal of nosocomial infection control is nothing less than an infection rate of zero. Although infection rates of less than 1% are being posted regularly in selected surgical operations today, infection rates of 2% to 6% persist in many procedures such as coronary artery bypass surgery and vascular surgery. Predictable achievement of a zero infection rate in all of clean surgery will require new directions in both basic and clinical research.Research into the prevention of infection in clean surgery has, to date, focused upon 1) identifying and controllingthe routes of wound contamination, 2)decontamination of a contaminated woundthrough the prophylactic use of antimicrobials, and 3)modifying the host immune system. The latter is a fascinating area of new research which will not be discussed in detail here.Routes of contaminationare often categorized as endogenous or exogenous. “Endogenous” generally refers to bacterial seeding of the wound from the flora of the patient's own skin, nose, perineum, and GI tract. “Exogenous” contamination has come to mean bacteria originating from the operating room environment or operating room personnel which reach the wound by direct inoculation (eg, improperly sterilized instruments, hands of the surgeon via torn gloves) or by the airborne route. These categories may not be broad enough to satisfy the complexities of the hospital environment, however. The addition of the category “acquired endogenous” may be of help in describing contamination which occurs when patients become colonized with resistant hospital flora and subsequently carry this newly acquired flora into the operating theater.
Infections in Hematologic Malignancy
Authors: Rogers Tom R. 
Published: August 2016

Two decades have elapsed since the first detailed studies were undertaken to determine which factors were associated with an increased incidence of life-threatening sepsis during the treatment of leukemia and lymphoma. The state of granulocytopenia is now acknowledged to be the major factor predisposing to infection and accordingly, attention has focused on the merits of preventive measures applied during this risk period. A tremendous effort has been invested in the evaluation of different protocols and there is little doubt that major advances have been made even though a simultaneous improvement in survival rates as a result of more intensive chemotherapy has not always been in evidence. While it is appropriate to initiate prophylaxis before the treatment of most adult acute leukemias and for marrow transplantation, the reduced duration and severity of granulocytopenia during chemotherapy for both childhood acute leukemia and lymphoma generally obviate the need for this approach.Progress in the development of potent broad-spectrum antibiotics coupled with better clinical awareness of the value of early treatment, as well as changing practices in supportive care have each contributed to the recent pattern of infection that has been observed. In addition, the impact of new technologies, as illustrated by recent innovative applications of bone marrow transplantation, further underlines the need to reappraise current infection control procedures.
Survey on Testing Criteria and Reporting Methods for Human Immunodeficiency Virus Serologic Tests in Veterans Administration Medical Centers
Authors: Mottice Susan , Matsumiya Sego , Reimer Larry 
Published: August 2016

AbstractGuidelines for the indications for use, requirements for consent, and mechanisms for reporting of serologic tests for human immunodeficiency virus (HIV) infection are not standardized. In trying to establish such guidelines for our hospital, we surveyed all Veterans Administration Medical Centers regarding their current approach to testing both patients and employees. Infection control practitioners from 67 hospitals representing 37 states responded. Patients are likely to be tested for diverse reasons, unlikely to be counseled about the test or be required to consent to it, and test results are given no special precautions. Although 66% of the respondents do not use any extra precautions concerning patient confidentiality, 80% utilize more stringent criteria for testing and result-reporting with employees than patients. Thus, while the majority of hospitals maintain that current modes of confidentiality are acceptable for patients, practice suggests that these modes are considered inadequate for employees.
Construction Activity: An Independent Risk Factor for Invasive Aspergillosis and Zygomycosis in Patients with Hematologic Malignancy
Authors: Weems J. John , Davis Barry J. , Tablan Ofelia C. , Kaufman Leo , Martone William J. 
Published: August 2016

AbstractBetween November 1982 and July 1984, five patients at a 110-bed pediatric hospital were diagnosed with invasive filamentous fungal infection; three had invasive aspergillosis (IA) and two had invasive zygomycosis (IZ). All five had underlying hematologic malignancy (HM). In a case-control study, these five HM patients (cases) were compared to 10 autopsied HM patients without evidence of aspergillosis or zygomycosis (controls). Cases and controls did not differ in underlying disease or in the degree of immunosuppression, as measured by duration of granulocytopenia and number of platelet transfusions. However, case-patients were more likely than controls to have been hospitalized during the construction of a hospital addition (p<0.02, Fisher's exact test [FET]). Four (80%) of five HM patients autopsied during the period of construction had IA or IZ compared with one (5%) of 21 autopsied before construction began (p=0.001, FET). These findings suggest that, in a population of comparably immunosuppressed patients, construction activity may represent an independent risk factor for IA or IZ. Hospitals caring for such patients should take precautions which minimize exposure of these patients to construction or renovation activity.
Quantity of Soap as a Variable in Handwashing
Authors: Larson Elaine L. , Eke Paul I. , Wilder Mary P. , Laughon Barbara E. 
Published: August 2016

AbstractThe purposes of this study were to assess the effect of two quantities (1 mL or 3 mL) of four different handwashing products on reductions in log colony-forming units (CFU) from the hands and to determine the amount of liquid soap used for handwashing by personnel in one hospital. First, 40 subjects were assigned by block randomization to one of four handwashing products (4% chlorhexidine gluconate in a detergent base, two alcohol hand rinses, and a liquid, nonantimicrobial soap) to be used in either 1 mL or 3 mL amounts per wash. Each subject washed his or her hands 15 times per day for five days. After one and five days of handwashing there were significant reductions over baseline in log CFU between handwashing products (P<0.001). Additionally, subjects using 3 mL of antiseptic soap had significantly greater reductions in log CFU than those using 1 mL (P<0.001). Among subjects using control liquid soap there was no such dose response. Second, a survey of 47 members of a hospital nursing staff from nine specialty areas and ten individuals in the general population was conducted to measure amounts of two liquid soaps used for handwashing. Amount of soap ranged from 0.4 to 9 mL per handwash. Personnel working in clinical areas where patients were at high risk for nosocomial infection used significantly more soap than did others (P<0.05). We conclude that quantity of soap used for handwashing is one variable influencing the microbial counts on hands, and that the quantity of soap used by health care personnel varies considerably.
Surveillance Strategies: A Primer
Authors: Abrutyn Elias , Talbot George H. 
Published: August 2016

The Centers for Disease Control's Study on the Efficacy of Nosocomial Infection Control (SENIC) showed that infection surveillance and control activities are associated with a decrease in nosocomial infection rates. Moreover, the intensity of activity correlated with the magnitude of the fall in infection rates. These results, plus the guidelines of regulatory agencies, mandate that infection control programs conduct surveillance activities. However, absolute standards for the content and nature of surveillance programs have not been established, and many descriptions of different types of surveillance programs are available. In this primer, we describe the considerations involved in development of a surveillance program with emphasis on issues concerning data collection.Langmuir considers surveillance when applied to disease as meaning the collection of data, the analysis of those data, and the distribution of the resulting information to those needing to know. The definition implies that surveillance is observational and that surveillance activities should be clearly separated from other related activities such as control measures. The latter activities, including their initiation, approval, and funding, are administrative matters underpinned by a scientific base that are undertaken by the recipients of the surveillance data and their analyses. They should be clearly separated from surveillance activities per se. There is also the implication that action results from surveillance; surveillance without action should be abandoned.