bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunization with High-Dose Intradermal Recombinant Hepatitis B Vaccinein Healthcare Workers Who Failed to Respond to Intramuscular Vaccination
Authors: Levitz Robert E. , Cooper Brian W. , Regan Helen C. 
Published: September 2009

AbstractObjective:To achieve immunity to hepatitis B in healthcare workers who failed to respond to intramuscular vaccination and boosters.Design:An open prospective study of intradermal vaccination with recombinant hepatitis B vaccine.Setting:A large community hospital in Connecticut.Participants:Healthcare workers including physicians, nurses, and laboratory workers.Results:Immunization with high-dose intradermal recombinant hepatitis B vaccine, given in up to four doses, achieved immunity in 88% of healthcare workers who had previously been nonimmune.Conclusions:We conclude that intradermal vaccination is efficacious in the majority of healthcare workers who failed to respond to intramuscular vaccine. Further studies, including randomized comparisons with intramuscular vaccine as well as studies of cell-mediated immunity, appear warranted.
Nosocomial Outbreak Caused by a Multiresistant Clone of Acinetobacter baumannii: Results of the Case- Control and Molecular Epidemiologic Investigations
Authors: Scerpella E.G. , Wanger A.R. , Armitige L. , Anderlini P. , Ericsson C.D. 
Published: September 2009

AbstractObjective:To describe a nosocomial outbreak caused by multiresistant Acinetobacter baumannii.Design:Descriptive and case-control study. Antibiotic susceptibilities and pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with Sfil and also with Apal were used as markers of strain identity.Setting:A large medical school-affiliated hospital in the city of Houston, Texas.Results:During a 10-week period, A baumannii was isolated from 25 patients admitted to the intensive care unit (ICU). The attack rate was 14.3 per 100 ICU admissions. Case patients were intubated more frequently and for longer periods, and had longer ICU and hospital stays (P<0.05 for each of these characteristics). Multivariate logistic regression analysis identified the length of ICU stay and the use of third-generation cephalosporins as associated with the acquisition of A baumannii. Patients infected with A baumannii had a higher mortality rate than colonized patients and control patients [P<0.0l). Sixteen isolates recovered from these 25 patients were susceptible only to imipenem/ cilastatin, and PFGE confirmed that a single clone was the cause of this outbreak. Nine isolates of A baumannii from patients infected or colonized in two other hospitals in Houston during the same period, differed from the outbreak isolates by their susceptibility to ciprofloxacin. However, PFGE results were identical, indicating unsuspected genetic relatedness among isolates from three different hospitals.Conclusions:A baumannii is an important nosocomial opportunistic pathogen and can adversely affect the outcome of ICU patients who acquire this organism. This outbreak was caused by a single clone that was isolated concurrently from three hospitals.
Disposal-Related Sharps Injuries at a New York City Teaching Hospital
Authors: Weltman Andre C. , Short Louise J. , Mendelson Meryl H. , Lilienfeld David E. , Rodriguez Marge 
Published: September 2009

AbstractObjective:To characterize disposal-related sharps injuries.Design:A three-part study including (a) descriptive analysis of disposal-related injuries in a l-year period, (b) 4:l matched case-control study of nurses injured while using sharps disposal containers, and (c) survey to solicit opinions of users of containers.Setting:An 1,181-bed teaching hospital in New York City.Participants:For epidemiologic analyses, persons with self-reported injuries identified via New York State and Occupational Safety and Health Administration forms and control nurses without self-reported injuries. For survey, convenience sample of hospital nurses, laboratory workers, and maintenance workers.Main Outcome Measures:Circumstances of injuries determined by study questionnaires. Employee opinions obtained by questionnaires and discussions during small group sessions.Results:Three hundred sixty-one persons reported sharps injuries, of whom 72 (20%) had disposal-related injuries. Persons with disposal-related injuries included four hospital visitors and one patient. Of 67 disposal-related injuries among employees, 25 (37%) directly involved use of a sharps disposal container. Significant risk factors for injury included container height greater than 4 ft above the floor, distance less than 5 ft from site of sharp object use to nearest container, and lack of attendance at universal precautions inservice classes. Survey groups involved 69 employees who identified a variety of preferred features for sharps disposal containers.Conclusions:Disposal of sharp objects is an important cause of sharps injuries. Ergonomic factors, worker education, and appropriate container design should be considered in injury prevention strategies. Relevant guidelines and regulations are lacking and are needed.
Evaluation of a Rapid Readout Biological Indicator for 121°C Gravity and 132°C Vacuum-Assisted Steam Sterilization Cycles
Authors: Vesley Donald , Nellis Melissa A. , Allwood Paul B. 
Published: September 2009

AbstractObjective:A biological indicator (BI), based on fluorescent detection of a spore-associated enzyme, has been developed. We evaluated the new BI against five conventional self-contained BIs in a 121°C gravity-displacement sterilizer and, packaged in towel packs and disposable steam test packs, in a 132°C vacuum-assisted sterilizer.Design:In the 121°C gravity-displacement sterilizer, rapid readout BIs and conventional BIs were tested together in an otherwise empty chamber. Exposure times were 5, 10, and 15 minutes. In the 132°C vacuum-assisted steam sterilizer, BIs were contained in towel packs or disposable steam test packs. Surgical packs were added to represent a full load. Exposure times were 0, 1, and 2 minutes.Result:In gravity-displacement 5-minute cycles, the rapid readout BIs yielded 100% positive results within 30 minutes. The conventional BIs ranged from 72% to 100% positive in 48 hours. At 10 minutes, the rapid readout BIs were 83% positive after 3 hours, whereas the conventional BIs ranged from 0% to 37% positive after 48 hours. All indicators were negative after 15-minute exposures. In vacuum-assisted cycles, all indicators were negative after 3 minutes. After 1-minute exposures, the rapid readout BIs were 40% to 60% positive, whereas the conventional BIs were 15% to 20% positive.Conclusion:The rapid readout BIs are a more sensitive indicator of marginal steam sterilization cycles than conventional selfcontained BIs. They yield results within 3 hours, as compared to 24 to 48 hours for the conventional BIs.
Antimicrobial Use in Patients With Positive Intravascular Catheter Cultures A Six-Month Prospective Survey in a Teaching Hospital
Authors: Rello Jordi , Vallés Jordi , Fontanals Dionisia , Jubert Paola , Segura Ferran 
Published: September 2009

AbstractReview of medical records revealed that, of 190 intravascular catheters sent for culture during the study period, 50 were positive. Of these 50, 11 (22%) were sent for culture as a routine procedure without special clinical indications. Of the remaining 39 cultures, only 11 (28%) had clinical impact in the patient's management. Ten of the 50 therapeutic interventions were inappropriate. Restricting cultures to patients who may have catheter-related infection is likely to lead to significant cost savings.
Plasmid Analysis of 26 Staphylococcal Species by a Rapid Microscale Technique
Authors: Herchline Thomas , Maher William 
Published: September 2009

AbstractObjective:Evaluate a plasmid typing technique for a diverse group of staphylococci.Design:In vitro testing on known isolates.Setting:University hospital.Intervention:The plasmid content of 195 isolates representing 26 staphylococcal species was analyzed by agarose gel electrophoresis following lysostaphin-alkaline-SDS lysis, with and without acetone treatment.Results:Isolates yielded plasmid profiles with 0 to 7 extra-chromosomal bands (median, 1; 1.5); 171 (88%) had a profile with at least 1 band. Species with more than one isolate available for testing showed considerable diversity of plasmid profiles, except for Staphylococcus haemolyticus.Conclusions:The ease of the procedure and the diversity of plasmid profiles within each species examined suggests that plasmid profiling is an accessible and useful epidemiologic tool applicable to most staphylococcal species by epidemiologic units or clinical laboratories.
Prevention and Control of Varicella-Zoster Infections in Healthcare Facilities
Authors: Weber David J. , Rutala William A. , Hamilton Holli 
Published: September 2009

AbstractVaricella-zoster virus (VZV) is the causative agent of two diseases: varicella (chickenpox) and zoster (shingles). Although varicella generally is a mild disease in children, serious morbidity and mortality are common if infection occurs in neonates, pregnant women, adults, or immunocompromised patients. For this reason, the Centers for Disease Control and Prevention recommends that all the hospitals institute control measures. Healthcare workers should be screened for VZV immunity and, if susceptible, should receive the recently licensed Oka/Merck vaccine (unless contraindicated). This article reviews nosocomial outbreaks associated with VZV and provides detailed algorithms for preexposure immunization and postexposure management of healthcare workers exposed to VZV.
Percutaneous Feeding Tube Changes in Long-Term–Care Facility Patients
Authors: Graham Sylvia , Sim Gloria , Laughren Ruby , Chicoine Joyce , Stephenson Edith , Leche Gwen , McIntyre Margaret , Murray David , Aoki Fred Y. , Nicolle Lindsay E. 
Published: September 2009

AbstractObjective:To compare patient outcomes when percutaneous feeding tubes were changed routinely each month or only when necessary (prn).Design:Prospective, randomized, nonblinded crossover study of 6 months of routine monthly changes compared with 6 months of prn changes.Setting:416-bed long-term–care facility.Patients:26 permanent residents with nutrition managed through percutaneous gastrostomy or jejunosto-my feeding tubes. The median age was 61.5 years; 8 (31%) also had tracheostomies, and 3 (12%) had indwelling urinary catheters.Results:The frequency of feeding tube changes was 40 per 1,000 patient-days during the 6 months of routine tube changes and 14 per 1,000 when tubes were changed prn (P<.001). There were no differences between the two study periods in frequency of stoma site infections, fever, episodes of emesis, and total antibiotic courses. The median duration in situ of feeding tubes with prn changes was 104 days. For both periods, feeding tubes were significantly more likely to fall out and require replacement within 24 hours of previous tube replacement.Conclusion:There were no observed differences in clinical outcomes in long-term–care facility patients when feeding tubes were changed only as necessary as compared to routine monthly changes.
Gram-Negative Bacteremia in Open-Heart–Surgery Patients Traced to Probable Tap-Water Contamination of Pressure-Monitoring Equipment
Authors: Rudnick Judith R. , Beck-Sague Consuelo M. , Anderson Roger L. , Schable Barbara , Miller J. Michael , Jarvis William R. 
Published: September 2009

AbstractObjective: To determine the cause(s) of an outbreak of gram-negative bacteremia (GNB) in open-heart–surgery (OHS) patients at hospital A.Design: Case-control and cohort studies and an environmental survey.Results: Nine patients developed GNB with Enterobacter cloacae (6), Pseudomonas aeruginosa (5), Klebsiella pneumoniae (3), Serratia marcescens (2), or Klebsiella oxytoca (1) following OHS; five of nine patients had polymicrobial bacteremia. When the GNB patients were compared with randomly selected OHS patients, having had the first procedure of the day (8 of 9 versus 12 of 27, P=.02), longer cardiopulmonary bypass (median, 122 versus 83 minutes, P=.01) or cross-clamp times (median, 75 versus 42 minutes, P=.008), intraoperative dopamine infusion (9 of 9 versus 15 of 27, P=.01), or exposure to scrub nurse 6 (6 of 9 versus 4 of 27, P=.001) were identified as risk factors. When stratified by length of the procedure, only being the first procedure of the day and exposure to scrub nurse 6 remained significant. First procedures used pressure-monitoring equipment that was assembled before surgery and left open and uncovered overnight in the operating room, whereas other procedures used pressure-monitoring equipment assembled immediately before the procedure. At night, operating rooms were cleaned by maintenance personnel who used a disinfectant-water solution sprayed through a hose connected to an automatic diluting system. Observation of the use of this hose documented that this solution could have contacted and entered uncovered pressure-monitoring equipment left in the operating room. Water samples from the hose revealed no disinfectant, but grew P aeruginosa. The outbreak was terminated by setting up pressure-monitoring equipment immediately before the procedure and discontinuing use of the hose-disinfectant system.Conclusions: This outbreak most likely resulted from contamination of uncovered preassembled pressure-monitoring equipment by water from a malfunctioning spray disinfectant device. Pressure-monitoring equipment should be assembled immediately before use and protected from possible environmental contamination.
Basic Microbiologic Support for Hospital Epidemiology
Authors: Herwaldt Loreen A. , McGowan John E. , Metchock Beverly G. 
Published: September 2009

AbstractThe laboratory plays a major role in the epidemiology program's efforts to minimize nosocomial infections in healthcare institutions. This article will describe some of the interactions between the laboratory and the epidemiology program, and will identify resources and procedures that the laboratory needs to achieve epidemiologic goals.
The Effect of a Portable Hepa-Filtered Body Exhaust System on Airborne Microbial Contamination in a Conventional Operating Room
Authors: Bohn William W. , McKinsey David S. , Dykstra Mark , Koppe Susan 
Published: September 2009

AbstractObjective: To study the effect of a portable HEPA-filtered air exhaust system (Stackhouse Freedom Surgical Helmet System) on airborne microbial contamination in a modern conventional operating room.Design and Setting: Microbial air sampling was done with a two-stage Anderson sampler at the wound site during 46 total joint replacements. All operations were performed by the same surgeon in the same operating room at a large community hospital.Results: In 18 cases done without air exhaust hoods, the number of bacterial and fungal colony-forming units (CFU) ranged from 0.6 to 11.7 (mean, 3.6). Air sampling during 28 operations with the operating team in air exhaust hoods revealed a mean of 3.6 CFU (range, 0 to 11.4). Bacterial CFU averaged 3.4 without hoods and 3.2 with exhaust hoods. Coagulase-negative staphylococci were the most common isolates (48% of isolates with hood, 55% without hood). No infections occurred.Conclusion: We conclude that these air exhaust hoods did not lower airborne microbial contamination detectable with this air sampling method, as compared to standard head cover and mask, in a modern conventional operating room.
Influenza Vaccination of Medical Residents at the University of Virginia: 1986 to 1994
Authors: Fedson David S. 
Published: September 2009

AbstractDuring the 9-year period from 1986 to 1994, medical residents at the University of Virginia Health Sciences Center were offered free influenza vaccine in the General Medicine Clinic (GMC). Vaccination rates rose from 24% in 1986 to 99% in 1991. With changes in the GMC staff, the rates during the next 2 years dropped to 82% and 63%, respectively. Renewed attention to the vaccination program in 1994 led to a vaccination rate among eligible residents of 97%. Although the Employee Health Service also conducted its own vaccination programs for hospital personnel, the GMC accounted for most of the influenza vaccinations given to the medical residents throughout the 9-year period. The success of the GMC program demonstrates the importance of offering influenza vaccine to healthcare workers at their worksites and of focused responsibility to ensure that this is done.
Dissolving the Problem of Infectious Medical Waste
Authors: Crow Sue 
Published: September 2009

AbstractDecisions in purchasing healthcare products are based on fiscal responsibility, employee safety, regulatory agency guidelines, and environmental conservation. One of today's major dilemmas in health care is that of disposing of medical waste. The Isolyser Company of Norcross, Georgia, is one of the first to develop a biocycle system to reduce the problem of contaminated waste. A description of the system is provided, along with its advantages and disadvantages.
Emerging Infectious Diseases in the Institutional Setting: Another Hot Zone
Authors: Ostroff Stephen M. 
Published: September 2009

AbstractDuring the closing years of the 20th century, there has been an unprecedented number of newly recognized infectious agents and a resurgence of infectious diseases only recently thought to be conquered. These problems have been compounded by the increasing number of pathogens that have evolved resistance to antimicrobial agents. Hospitals and other institutional settings occupy a pivotal niche in the emergence of infectious agents due to factors such as the large concentrations of ill and immunocompromised persons, evolving technologies in healthcare settings, routine breeches of host defense mechanisms, and frequent use of antimicrobial agents. Any comprehensive strategy to address emerging infectious diseases must incorporate provisions for healthcare settings, including efforts to enhance surveillance, response capacity, training, education, applied research, and routine implementation of prevention measures.
Automatic Alerts for Methicillin-Resistant Staphylococcus aureus Surveillance and Control: Role of a Hospital Information System
Authors: Pittet Didier , Safran Edith , Harbarth Stephan , Borst François , Copin Pascale , Rohner Peter , Scherrer Jean-Raoul , Auckenthaler Raymond 
Published: September 2009

AbstractBackground: Methicillin-resistant Staphylococcus aureus (MRSA) is an escalating problem in hospitals worldwide. The hospital reservoir for MRSA includes recognized and unrecognized colonized or infected patients, as well as previously colonized or infected patients readmitted to the hospital. Early and appropriate infection control measures (ICM) are key elements to reduce MRSA transmission and to control the hospital reservoir.Objective: To describe the role of an expert system applied to the control of MRSA at a large medical center (1,600 beds) with high endemic rates.Methods: The University Hospital of Geneva has an extended hospital information system (HIS), DIOGENE, structured with an open distributed architecture. It includes administrative, medical, nursing, and laboratory applications with their relational databases. Among available patient databases, clinical microbiology laboratory and admission-discharge-transfer (ADT) databases are used to generate computer alerts. A laboratory alert (lab alert) is printed daily in the Infection Control Program (ICP) offices, listing all patients with cultures positive for MRSA detected within the preceding 24 hours. Patients might be either newly detected patients colonized or infected with MRSA, or previously recognized MRSA patients having surveillance cultures. The ICP nurses subsequently go to the ward or call the ward personnel to implement ICM. A second alert, the “readmission alert,” detects readmission to the hospital of any patient previously colonized or infected with MRSA by periodic queries (q 1 min) to the ADT database. The readmission alert is printed in the ICP offices, but also forwarded with added guidelines to the emergency room.Results: During the first 12 months of application (July 1994 to June 1995), the lab alert detected an average of 4.6 isolates per day, corresponding to 314 hospital admissions (248 patients); the use of this alert saved time for the ICP nurses by improving work organization. There were 438 readmission alerts (1.2 alerts per day) over the study period; of 347 patients screened immediately upon readmission, 114 (33%) were positive for MRSA carriage. Delayed recognition of readmitted MRSA carriers decreased significantly after the implementation of this alert; the proportion of MRSA patients recognized at the time of admission to the hospital increased from 13% in 1993 to 40% in 1995 (P<.001).Conclusions: Hospital information system-based alerts can play an important role in the surveillance and early prevention of MRSA transmission, and it can help to recognize patterns of colonization and transmission.
Host-Bacteria Interactions in Foreign Body Infections
Authors: François Patrice , Vaudaux Pierre , Foster Timothy J. , Lew Daniel P. 
Published: September 2009

AbstractPersistent staphylococcal infections are a major medical problem, especially when they occur on implanted materials or intravascular catheters. This review describes some of the recently discovered molecular mechanisms of Staphylococcus aureus attachment to host proteins coating biomedical implants. These interactions involve specific surface proteins, called bacterial adhesins, that recognize specific domains of host proteins deposited on indwelling devices, such as fibronectin, fibrinogen, or fibrin. Elucidation of molecular mechanisms of S aureus adhesion to the different host proteins may lead to the development of specific inhibitors blocking attachment of S aureus, which may decrease the risk of bacterial colonization of indwelling devices.
Operative Precautions in HIV and Other Bloodborne Virus Diseases
Authors: Raahave Dennis 
Published: September 2009

AbstractMathematical means have suggested that the surgical team is at particular risk of acquiring HIV (or other bloodborne viruses) from a source patient. To reduce this risk, it is mandatory to avoid accidental injuries during operative procedures. The surgeon must handle tissues with instruments and must minimize finger use. Sharp instruments should be passed through a neutral zone to ensure that the surgeon and nurse do not touch the same instrument at the same time. Instruments should not be handled blindly, but instead should be accompanied by eye and verbal contact. We find these changes in surgical technique are necessary for present and future generations of surgeons.
Prevention of Fungal Infections in Hematology Patients
Authors: Philpott-Howard John 
Published: September 2009

AbstractEndogenous infections such as candidiasis can be minimized by oral fluconazole prophylaxis, although oral or intravenous amphotericin, or itraconazole, are suitable for certain patients. Exogenous fungal infections most commonly are transmitted by the airborne route, but the benefits of high-efficiency particulate air-filtered room air probably are diminishing as broad-spectrum prophylaxis against Aspergillus species and other fungi improves. However, high-risk environmental sources such as construction work always must be avoided near neutropenic patients. Reactivation of quiescent pulmonary Aspergillus infection can be prevented by surgical resection during remission, or by systemic amphotericin prophylaxis during subsequent neutropenic episodes.