bluuebunny/crossref_metadata_2025_split huggingface dataset:
Respiratory Distress and Sudden Death Associated with Receipt of a Peripheral Parenteral Nutrition Admixture
Authors: Shay David K. , Farm Lynda M. , Jarvis William R. 
Published: September 2009

AbstractObjective:To detect respiratory adverse reac¬tions potentially related to receipt of peripheral parenteral nutrition (PPN) in hospitalized patients and to determine risk factors for their occurrence.Design:Retrospective cohort study.Setting:Federal tertiary-care hospital.Patients:Medical and pharmacy records of all patients who received PPN from October 1992 to February 1994 were abstracted for demographics, diagnoses, medications received, indications for and formulation of PPN, and severity of illness as measured by Acute Physiology and Chronic Health Evaluation II scores.Results:A case-patient was defined as any patient who, while receiving PPN, had unexplained chest pain, dyspnea, cardiopulmonary arrest, or new interstitial infiltrates on chest radiograph. Patients who received PPN in which FreAmine was the amino acid source were more likely than those who received PPN made with Travasol to meet the case definition (5/11 vs 0/39; relative risk, >18; 95% confidence interval, 3.3->136; P<.001).Conclusions:A change in the amino acid source of a PPN admixture was associated with respiratory adverse events that ranged from interstitial infiltrates to sudden death. These events apparently resulted from the infusion of a calcium phosphate precipitate in an opaque admixture. Each new PPN admixture should be tested for stability before clinical use and infused into patients through an appropriate filter.
Infection Prevention and Control in the Long-Term-Care Facility
Authors: Smith Philip W. , Rusnak Patricia G. 
Published: September 2009

AbstractMore than 1.5 million residents reside in US nursing homes. In recent years, the acuity of illness of nursing home residents has increased. Long-term-care facility residents have a risk of developing nosocomial infection that is similar to acute-care hospital patients. A great deal of information has been published concerning infections in the long-term-care facility, and infection control programs are nearly universal.This position paper reviews the literature on infections and infection control programs in the long-term-care facility, covering such topics as tuberculosis, bloodborne pathogens, epidemics, isolation systems, immunization, and antibiotic-resistant bacteria. Recommendations are developed for long-term-care infection control programs based on interpretation of currently available evidence. The recommendations cover the structure and function of the infection control program, including surveillance, isolation, outbreak control, resident care, and employee health. Infection control resources also are presented.
A Mixed Foodborne Outbreak With Salmonella heidelberg and Campylobacter jejuni in a Nursing Home
Authors: Layton Marcelle C. , Calliste Susan G. , Gomez Thomas M. , Patton Charlotte , Brooks Steven 
Published: September 2009

AbstractObjective:To investigate a mixed Salmonella heidelberg and Campylobacter jejuni foodborne outbreak in a nursing home.Design:Retrospective cohort study with a nested case-control design. Cases were defined by positive stool-culture results. Controls needed to be both asymptomatic and culture-negative.Setting and Patients:Residents of a 580-bed nursing home in Brooklyn, New York.Results:Of the 580 residents, 119 (21%) developed illness. Of the 93 symptomatic patients who submitted specimens, cultures were positive for S heidelberg in 24 (26%), C jejuni in 14 (15%), and both microorganisms in 25 (27%).Only the pureed diet was associated highly with infection by either Salmonella (odds ratio [OR], 17.6; 95% confidence interval [CI95], 4.8-68.7; P<.001), Campylobacter (OR, 13.3; CI95, 3.2-59.2; P<.001), or both organisms (OR, 8.9; CI95, 2.7-30.3; P<.001). Among the 52 pureed foods served during the 5 days before the outbreak, five meat or poultry items were associated most strongly with culture positivity.Of these five meat items, only a chopped-liver salad was implicated by the two employees reporting illness. A reported food-handling error occurred when ground, cooked chicken livers were placed in a bowl containing raw chicken-liver juices.Intervention:Recommendations for proper cleaning and sanitizing of kitchen equipment to prevent cross-contamination between raw and cooked foods.Conclusions:Mixed foodborne outbreaks occur rarely. During this outbreak, contamination of a single food item with multiple bacterial pathogens was the likely source of transmission. Improper food-handling techniques that promote growth of one microorganism also allow growth of other pathogens that may be present. Because different sources and routes of transmission may be implicated for different pathogens, specific preventive measures may vary depending on the organisms involved.
Pseudo-Outbreak of Multiresistant Pseudomonas aeruginosa in a Hematology Unit
Authors: Verweij Paul E. , Bijl Diana , Melchers Willem J.G. , De Pauw Ben E. , Meis Jacques F.G.M. , Hoogkamp-Korstanje Jacomina A.A. , Voss Andreas 
Published: September 2009

AbstractObjective:To describe the investigation of a pseudo-outbreak of multiresistant Pseudomonas aeruginosa fecal colonization in a hematology unit.Design:Retrospective chart review; prospective environmental sampling and observation of stool culture technique; genotyping by random arbitrary primer polymorphic DNA polymerase chain reaction (RAPD-PCR).Setting:An academic tertiary-care hospital.Patients:Between August and October 1994, P aeruginosa resistant to imipenem, ceftazidime, ciprofloxacin, and all aminoglycosides was isolated from surveillance stool cultures from 10 neutropenic patients cared for in the hematology unit. P aeruginosa, with an identical susceptibility pattern, was isolated from three patients admitted to the same unit in the year before the “outbreak.” Two months before the outbreak, 12 healthcare workers had been added to the staff.Results:Observation of stool sampling techniques as performed by healthcare workers revealed that samples for surveillance cultures were taken from feces in the toilet. When the proper sampling technique was used, P aeruginosa was not isolated from stool samples from 8 of 10 patients with previously positive cultures. P aeruginosa also was isolated from two wash basins, toilet flushing water, and a toilet brush. Genotyping by RAPD-PCR showed that the isolate from the toilet flushing water was identical to the P aeruginosa strains of eight patients from the outbreak.Conclusions:This pseudo-outbreak emphasizes the importance of proper sampling techniques and that periodic observation may be necessary to verify proper sampling techniques.
Infection Risk and Cost-Effectiveness of Commercial Bags or Glass Bottles for Total Parenteral Nutrition
Authors: Durand-Zaleski Isabelle , Delaunay Laurent , Langeron Olivier , Belda Eric , Astier Alain , Brun-Buisson Christian 
Published: September 2009

AbstractObjective:To determine whether the greater daily expense of administering total parenteral nutrition (TPN) via plastic bags changed once daily, compared to glass bottles changed thrice daily, could be offset by savings from a reduction in nosocomial infections.Design:The costs and potential benefits of commercially available TPN bags and TPN in glass containers were compared. Costs were computed from the viewpoint of the hospital, first in a general model and then for two specific examples, Crohn's disease and intensive-care unit (ICU) patients. The extra cost of using bags was $20 per day. The total cost of nosocomial bacteremia was estimated at $6,000. The monetary benefits of using TPN bags were $6,000XT, where XT was the percentage of nosocomial infections averted. We also considered that reduction in intravenous (IV)-line manipulation could reduce bacteremia-related mortality and computed a cost-per-life-saved ratio.Results:Modeling showed that TPN in bags could yield a net benefit when the absolute reduction in the daily risk of nosocomial bacteremia reached the threshold value of 0.3%. Such a reduction could not be attained in patients with Crohn's disease, and corresponded to a 50% to 60% reduction of infection rates in ICU patients. Varying the risk of mortality attributable to IV-line-related infection from 1% to 13% resulted in a cost effectiveness of using TPN bags ranging from $90,000 to $7,000 per life saved in ICU, assuming a two-thirds reduction in IV-line infections, and from $180,000 to $14,000 if the infection rate was reduced by one third.Conclusion:The baseline cost-minimization analysis concluded that the extra cost of TPN bags was not justified by the extra savings. The cost-effectiveness analysis, however, found that the cost per life saved fell within the accepted range of public health interventions, provided a large fraction of infections are averted using TPN bags.
Varied Approaches to Tuberculosis Control in a Multihospital System
Authors: Woeltje Keith F. , L'Ecuyer Paul B. , Seiler Sondra , Fraser Victoria J. 
Published: September 2009

AbstractObjectives:To document the actual tuberculosis (TB) control policies and procedures in a nonoutbreak setting in a variety of hospitals. To determine if any particular practices are linked to higher rates of employee tuberculin skin-test conversion.Design:Survey of hospital occupational health and infection control practitioners for the year 1994 regarding hospital TB policies. Review of hospital records to verify the number of patients with TB at each hospital and to verify the number of employees with positive tuberculin skin tests. Smoke-stick testing of negative-pressure ventilation rooms.Setting:A 13-hospital health system in the Midwest.Results:Hospitals ranged in size from 40 to 1,208 beds (median 220) and employed 150 to 6,500 workers (median 875). There were seven rural and six urban centers, including four teaching hospitals. All 13 hospitals had TB control plans, and all performed annual tuberculin skin testing on employees. Annual skin-test positivity rates ranged from 0% to 1.0% (median 0.3%). Negative-pressure ventilation rooms were available in 11 hospitals. The percentage of negative-pressure rooms with effective negative pressure ranged from 44% to 100% (median 95%). Three of the 13 hospitals used high-efficiency particulate air (HEPA) masks as primary personal respiratory protection, and 8 used dust-mist or dust-mist-fume masks. We found no relation between the type of face mask used, number of functional negative-pressure rooms, or hospital TB risk category, and employee skin-test conversion rates.Conclusions:Considerable variation existed in the TB control policies and procedures between hospitals, but employee TB skin-test conversion rates were low in all settings.
Surgical Hand Disinfection With Alcohols at Various Concentrations: Parallel Experiments Using the New Proposed European Standards Method
Authors: Rotter Manfred L. , Simpson Rosemary A. , Koller Walter 
Published: September 2009

AbstractObjectives:To establish the concentration of isopropanol that exerts the same immediate and sustained effects as n-propanol 60% v/v in surgical scrubbing, and to assess the performance of the test method proposed as the European standard in parallel experiments.Design:Isopropanol at concentrations of 70%, 80%, and 90% v/v was tested in comparison with n-propanol 60%, the proposed reference preparation, in the draft method proposed by the European standard. A Latin square design was used with four balanced blocks of five volunteers each in four experimental runs that were spaced by intervals of 1 week each. Volunteers were allotted randomly to one of the four blocks. Independently, the volunteers' right and left hands also were randomized into two groups for the assessment of either immediate or sustained effects.Setting:Two laboratories supervised by two investigators, one from Vienna, Austria, and one from London, The United Kingdom.Method:The release of skin flora from the fingertips of clean hands was assessed before and after treatment by immediate sampling from one hand and by sampling of the other, gloved hand after 3 hours. The mean log10 reductions (RF) of bacterial release achieved by rubbing the alcoholic preparations for 3 minutes onto the hands were established.Results:For both experiments, the immediate effects of isopropanol 70% (RF, 2.0 and 2.1, respectively) were significantly smaller than those of the reference n-propanol 60% (RF, 2.4 and 2.6, respectively). This also was found with the sustained effects (RF, 0.7 and 1.1 vs 1.0 and 1.6, respectively). At 90%, isopropanol equalled the immediate effect of n-propanol 60%, whereas at 80% it proved slightly (although not significantly) less active. There were no significant differences in the results of both investigators. The sustained effects of isopropanol 80% and 90% were both larger than the reference in Vienna but were found smaller by the London investigator; none of the differences were significant. Mean RFs were significantly different between Vienna and London with n-propanol 60% and isopropanol 70%, but not with isopropanol at 80% or 90%.Conclusions:At 90%, isopropanol is as effective as n-propanol 60%, which was proposed by the European Committee for Standardization as a reference in testing :products for surgical hand disinfection. It could, therefore, serve as an alternative if the proposed agent is undesirable for any reason. In parallel experiments by two investigators, the proposed test method proved well workable; the results were very similar and the conclusions identical
Nosocomial Penicillin-Resistant Pneumococcal Infections at a Midwestern University Hospital
Authors: Little J. Russell , Miller James , Kahn Michael G. 
Published: September 2009

AbstractWe analyzed 333 isolates of Streptococcus pneumoniae from adult inpatients over a continuous 30-month period. Twenty-five percent of isolates were resistant to penicillin, and 18% of tested strains were not susceptible to ceftriaxone. For 29 (15%) of 199 evaluable patients, S pneumoniae was isolated from a culture first obtained >48 hours after admission, and chart review satisfied our case definition for nosocomial infection. S pneumoniae isolates were penicillin-resistant in 14 of 29 nosocomial and 34 of 170 community-acquired cases (odds ratio, 3.73; 95% confidence interval, 1.53-9.15; P =.01)
Mortality as an Outcome in Hospital-Acquired Pneumonia
Authors: Rello Jordi , Valles Jordi 
Published: September 2009

AbstractThe most common route of entry of pathogens into the lung in patients managed in the intensive-care unit is aspiration of contaminated oropharyngeal secretions or gastric contents. In intubated patients, the risk of this type of infection is particularly high. Knowledge of specific risk factors for specific microorganisms, along with the origin of acquisition (primary endogenous, secondary endogenous, or exogenous), will permit a more rational and effective method of prevention. Attributable mortality is highly dependent on the institution of a correct initial antibiotic choice, as well as the interaction between the virulence of the pathogen responsible and host defenses. However, survival in these patients is determined primarily by the degree of severity at the time of pneumonia diagnosis and the response to initial therapy. As a consequence, the number of preventable deaths is likely to be much smaller than the total. Therapy requires both supportive and specific measures. When diagnostic information becomes available, it permits the rescue of some patients with inadequate therapy or simplifies the spectrum of the empirical therapy. Initial antibiotic choice should be based on expected etiologic pathogens, while knowledge of local microbial epidemiology and susceptibility patterns is crucial.
Economic Consequences of Hospital Infections in a 1,000-Bed University Hospital in Norway
Authors: Andersen Bjørg Marit 
Published: September 2009

AbstractHospital infections were studied among 41,000 patients admitted to a 1,000-bed university hospital in Oslo, Norway. A prevalence rate of 8.5% in 1995 contributed to 14,500 days of extra stay in the hospital. The direct economic consequences of hospital infections was 40 to 50 million Norwegian kroner ($6-$7 million). The extra direct cost per infected patient was 14,300 Norwegian kroner ($2,200). Hospital infections are generating high extra costs and morbidity in countries with good general health care and with few problems with resistant bacteria.
Rates of Tuberculosis Infection in Healthcare Workers Providing Services to HIV-Infected Populations
Authors: Zahnow Karen , Matts John P. , Hillman David , Finley Elizabeth , Brown Lawrence S. , Torres Ramon A. , Ernst Jerome , El-Sadr Wafaa , Perez George , Webster Carol , Barber Beverly , Gordin Fred M. ,   Terry Beirn Community Programs for Clinical Research on AIDS
Published: September 2009

AbstractOBJECTIVE:To assess the prevalence of tuberculosis (TB) or a positive skin test in healthcare workers (HCWs) providing services to human immunodeficiency virus (HIV)-infected individuals and to determine prospectively the incidence of new infections in this population.DESIGN:This prospective cohort study enrolled 1,014 HCWs working with HIV-infected populations from 10 metropolitan areas. Purified protein derivative (PPD) tuberculin skin tests were placed at baseline and every 6 months afterwards on those without a history of TB or a positive PPD. Demographic, occupational, and TB exposure data also were collected.SETTING:Outpatient clinics, hospitals, private practice offices, and drug treatment programs providing HIV-related healthcare and research programs.PARTICIPANTS:A voluntary sample of staff and volunteers from 16 Community Programs for Clinical Research on AIDS units.RESULTS:Factors related to prior TB or a positive skin test at baseline included being foreign-born, increased length of time in health care, living in New York City, or previous bacille Calmette-Guerín vaccination. The rate of PPD conversion was 1.8 per 100 person years of follow-up. No independent relation was found between the amount or type of contact with HIV-infected populations and the risk of TB infection.CONCLUSION:These data provide some reassurance that caring for HIV-infected patients is not related to an increased rate of TB infection among HCWs in these settings.
Management and Outcome of Tuberculosis in Two St Louis Hospitals, 1988 to 1994
Authors: L'Ecuyer Paul B. , Woeltje Keith F. , Seiler Sondra M. , Fraser Victoria J. 
Published: September 2009

AbstractObjective:To describe management and outcome of tuberculosis (TB) and current practices for isolation in two urban hospitals in the Midwest.Design:Retrospective cohort study.Setting:Barnes Hospital and Jewish Hospital, tertiary-care and community hospitals affiliated with Washington University School of Medicine in St Louis, Missouri.Patients:All adult patients with a positive culture for Mycobacterium tuberculosis from 1988 to 1994.Results:We identified 122 cases at Barnes and Jewish Hospitals (36.5/100,000 hospital discharges), median age was 59.0 years, 61.5% were non-Caucasian, and 54.9% resided within the city limits. Underlying risk conditions were common: substance abuse (25%), recent TB contact (24%), and foreign birth (13%). Coexistent human immunodeficiency virus infection (8%) was uncommon. Of skin-tested cases, 22% were anergic; of the rest, 22% tested negative. Almost 20% of cases had prior positive skin tests, and thus were preventable, but had not received adequate prophylaxis. Of hospitalized patients with pulmonary TB, 70% received respiratory isolation. Antibiotic resistance was recognized in 16%; only 19% of cases initially received four-drug therapy. TB-related death occurred in 16%.Conclusions:In this area, TB cases primarily involve traditional risk groups without HIV coinfection. Current infection control practices, diagnostic strategies, and initial treatment regimens are suboptimal. Education about local disease epidemiology is needed to prevent nosocomial TB transmission.
A Randomized Crossover Study of Disposable Thermometers for Prevention of Clostridium difficile and Other Nosocomial Infections
Authors: Jernigan John A. , Siegman-Igra Yardena , Guerrant Richard C. , Farr Barry M. 
Published: September 2009

AbstractOBJECTIVE:To test the hypothesis that use of disposable thermometers would result in lower rates of nosocomial Clostridium difficile diarrhea and of total nosocomial infections, compared with electronic thermometers.DESIGN:Prospective randomized crossover trial.SETTING:A 700-bed university hospital providing primary and tertiary care.PATIENTS:All patients admitted to a group of 20 inpatient nursing units.INTERVENTIONS:20 nursing units were randomized into two groups. One group randomly was assigned exclusive use of single-use disposable thermometers for patient temperature measurement, and the other group was assigned exclusive use of electronic thermometers. After 6 months, the assignments were reversed.MAIN OUTCOME MEASURES:Rates of C difficile infections, total nosocomial diarrheal episodes, and total nosocomial infections were prospectively followed in each study unit over 11 months.RESULTS:26,350 patients were admitted to the study units and hospitalized for 120,529 patient days. There were 947 nosocomial infections (7.86 per 1,000 patient days). Nosocomial C difficile- associated diarrhea defined by positivity to both toxin B (titer ≥1:10) and toxin A was detected in 32 patients (3.4% of all nosocomial infections). A significantly lower rate of nosocomial C difficile-associated diarrhea was observed with disposable thermometer use (0.16 per 1,000 patient days) compared with electronic thermometer use (0.37 per 1,000 patient days, relative risk [RR]=0.44; 95% confidence interval [CI95], 0.21-0.93, P=.026). There was no difference in overall rates of nosocomial infection between the disposable and electronic groups (8.03 and 7.68 infections per 1,000 patient days, respectively; RR, 1.04; CI95, 0.92-1.19; P=.52) or in the overall rate of nosocomial diarrhea (3.34 and 3.40 per 1,000 patient days, respectively; RR, .98; CI95, 0.81-1.19; P=.87).CONCLUSIONS:The incidence of nosocomial C difficile diarrhea was reduced significantly by using single-use, disposable thermometers as compared with electronic thermometers, but there was no effect on either the overall rate of nosocomial diarrhea or the rate of total nosocomial infections.
Hepatitis B and Hemodialysis: The Impact of Universal Precautions in Preventing the Transmission of Bloodborne Viruses
Authors: Kroes Aloys C.M. , van Bommel Eric F.H. , Kluytmans Jan A.J.W. , Weimar Willem 
Published: September 2009

AbstractA detailed description is presented of the hemodialysis treatment for 6 weeks of a patient strongly positive for hepatitis B virus ([HBV], hepatitis B surface antigen, hepatitis B e antigen, HBV DNA), which was performed without any special precautions. All 59 patients potentially exposed to the HBV-positive patient, of whom 29 appeared fully unprotected by antibody, were followed for at least 9 months but remained negative. This illustrates the feasibility of following Universal Precautions instead of using exceptional procedures for one single agent
Handwashing Quality: Impact of a Special Program
Authors: Coignard Bruno , Grandbastien Bruno , Berrouane Yasmina , Krembel Christiane , Queverue Martine , Salomez Jean-Louis , Martin Guy 
Published: September 2009

AbstractTo evaluate the impact of a program on basic handwashing quality, a before-after audit was performed in a university hospital. We defined a 13-step protocol to describe a proper basic handwash (BHW). The proportion of BHW that satisfied this checklist increased significantly, from 4.2% before the program to 18.6% after, but these low proportions suggest that simpler alternatives to BHW should be studied