bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Predictors of Infection of Central Venous Catheters Used for Total Parenteral Nutrition
Authors: Armstrong Carl W. , Mayhall C. Glen , Miller Kathy B. , Newsome Heber H. , Sugerman Harvey J. , Dalton Harry P. , Hall Gaye O. , Hunsberger Sally 
Published: September 2009

AbstractTo identify predictors of infection in catheters used for total parenteral nutrition (TPN), clinical and microbiological data were prospectively collected on 169 catheter systems (88 patients). Based on semiquantitative catheter cultures, infection was associated with a positive insertion site skin culture taken close to the time of catheter removal (relative risk [RR] = 4.50), especially one yielding 250 colonies of an organism other than coagulase-negative staphylococci. Infection was also associated with erythema at the insertion site greater than 4 mm in diameter (RR = 2.93). In a subset of 67 catheters for which blood cultures were obtained, infection was also associated with a positive peripheral venous blood culture (RR = 5.90) and a positive central venous blood culture obtained through the catheter (RR = 5.44). Based on a logistic regression model, periodic cultures of the insertion site should be useful in evaluating subsequent fever in stable patients with indwelling central venous catheters. Another source of fever is likely if inflammation is absent and there is either no colonization or there is colonization by less than 50 colonies of coagulase-negative staphylococci at the insertion site. Conversely, the catheter should be removed and cultured semi-quantitatively if the site is colonized by an organism other than coagulase-negative staphylococci. We suggest that blood culture results add little to the risk estimate in these situations.
The Disinfectant Dilemma Revisited
Authors: Crow Sue , Gurevich Inge , Yannelli Barbara , Cunha Burke A. , Gurevich Znge 
Published: September 2009

Medical instruments that come in contact with patients' blood and body fluids during invasive procedures should be sterilized after use. Some instruments, however, are too delicate to tolerate auto-clave temperatures, even the lower temperature required by ethylene oxide sterilization. Chemical sterilants are an acceptable alternative but present a different problem because they require prolonged soaking time from six and three-quarters to ten hours. This long exposure to liquids may adversely affect the components of some instruments. Therefore, the manufacturer should always be consulted when prolonged soaking is contemplated.Another disadvantage to prolonged sterilization cycles is the increased number of instruments that may be required to compensate for the lag in availability. As an acceptable alternative, the Centers for Disease Control (CDC) and others have divided instruments into three categories: instruments that enter normally sterile tissue and the vascular system (these must be sterilized); instruments that contact nonintact skin and mucous membranes (these should receive high-level disinfection); and items that contact only intact skin such as blood pressure cuffs (these require a lower level of disinfection and will not be discussed here). Importantly, it should be noted that the Environmental Protection Agency (EPA), which registers chemical disinfectants/sterilants, does not recognize these categorizations. They register solutions for sterilization or disinfection.
Pseudomonas aeruginosa Revisited
Authors: Stratton Charles W. 
Published: September 2009

Pseudomonas aeruginosa previously has been reviewed in “Topics in Clinical Microbiology.” However, the increased importance of this micro-organism in nosocomial infections as well as new information on pathogenic mechanisms is such that this topic should be “revisited.” For example, the ubiquitous presence of this bacterium in nature and its ability to survive in hostile environments has been recently emphasized by episodes of P aeruginosa peritonitis, bacteremia and pseudobacteremia that have been linked to contaminated povidone-iodine. Clearly, P aeruginosa is an important pathogen and is deserving of careful and deliberate consideration.The role of P aeruginosa as a nosocomial pathogen in hospitalized patients with critical illness is rapidly increasing. Recent data from the Centers for Disease Control (CDC) have shown that while nosocomial infections from Escherichia coli and Klebsiella have remained relatively constant from 1975 to 1984, the proportion of such infections caused by Pseudomonas has risen from 6.3% in 1975 to 11.4% in 1984. The frightening aspect of this epidemiologic data is the extremely high rate of mortality associated with hospital-acquired Pseudomonas infections. For example, the mortality rate for Pseudomonas bacteremia often ranges from 67% to 90% for neutropenic cancer patients. Among more general hospital patient populations, the mortality rate for Pseudomonas bacteremia can be similar depending on the underlying condition of the host.
Contributions of Epidemiology to Quality Assessment and
Monitoring
Authors: Donabedian Avedis 
Published: September 2009

The contribution of epidemiology to quality assessment and monitoring: a
clear enough subject. But as I approached it, it slipped into ambiguity and
confusion. What was quality assessment? What was monitoring? For that
matter, what was quality? And the meaning of epidemiology was the deepest
mystery of all.
I must begin by defining my terms. Quality shall be taken to mean making
a judgment on the goodness of healthcare, based on one or more of the
following: the expected or realized ability of the care to achieve the
greatest improvement in health that the current science and technology of
healthcare can achieve; acceptability to patients (including their
families); and acceptability to the community (or the society at large).
There are three ways in which we can find out if healthcare has been good in
these respects. First is the examination of the process of care, which I
take to mean the degree to which what is done for and by patients
corresponds to what is known or believed to be most effective in improving
health, and most acceptable to patients and to society. Second is the
examination of the outcomes of care, meaning the degree to which the care
provided is acceptable and has attained achievable improvements in health.
Third is the examination of structural attributes, meaning the degree to
which the physical and organizational settings in which care is given are
conducive to the kind of care that can be expected to improve health and to
be acceptable to patients and to the community. So much for quality
assessment.
Hepatitis: B Perceptions, Knowledge and Vaccine Acceptance Among
Registered Nurses in High-Risk Occupations in a University Hospital
Authors: Spence Michael R. , Dash Georgia P. 
Published: September 2009

Abstract
We employed a questionnaire to survey 334 registered nurses regarding
their knowledge, perceptions and vaccine acceptance for Hepatitis B virus
(HBV) infections. The study population was those persons working in areas
considered at high-risk for contracting HBV. The nurses were asked to
provide information regarding blood and body fluid exposures and the
reporting of these exposures. The questionnaire was completed by 169 nurses
(50.6%). Less than half of the respondents (42%) had been vaccinated. We
found that 13 of 14 black nurses, compared to 85 of 154 nonblack nurses, had
not been vaccinated (p < .01). No other
demographic differences between recipients and nonrecipients were noted.
Partially or totally incorrect answers regarding transmittal knowledge were
given by 108 of 160 (68%) respondents. Reasons for failure to be vaccinated
were varied. Fear of side effects of the vaccine, contracting AIDS or
hepatitis from the vaccine, or doubt of efficacy of the vaccine were cited
by 50 of 88 (58%) respondents as reasons for not being vaccinated. Inability
to schedule an appointment or unawareness of the vaccine's availability were
expressed by 23% and 17% of the individuals, respectively. Our data allow us
to conclude that to improve vaccination compliance, the vaccine must be made
more readily available, possibly through workplace on-site administration.
Additionally, a concerted effort to educate our staff regarding HBV with
particular emphasis on minorities is needed.
Nosocomial Infection Caused by Xanthomonas maltophilia A
Case-Control Study of Predisposing Factors
Authors: Elting Linda S. , Khardori Nancy , Bodey Gerald P. , Fainstein Victor 
Published: September 2009

Abstract
Factors predisposing to clinically significant nosocomial infection with
Xanthomonas maltophilia were examined in a
matched case-control study using multivariate techniques. Sixteen cases
occurred among cancer patients in a six-month period, including an apparent
cluster of three cases in an intensive care unit. These infections were
unusually serious; eight patients had disseminated infection caused by
X maltophilia and six died as a result of
their infections.
Among the 64 factors that were examined, therapy with broad-spectrum
antibiotics and central venous catheterization were found to significantly
increase susceptibility to infection. Therapy with imipenem was more than
ten times more frequent among cases than among controls
(p < .001). All fatal infections occurred
in patients who had received imipenem, including two patients who died
before the organism could be identified and appropriate therapy
instituted.
Infection with X maltophilia should be
suspected in patients who develop superinfection while receiving imipenem,
and prompt therapy should be instituted to improve chances of survival.
Because a common environmental source of X
maltophilia was not identified, further study is necessary
to determine specific preventive measures.
Alcohol for Surgical Scrubbing?
Authors: Larson Elaine L. , Butz Arlene M. , Gullette Donna L. , Laughon Barbara A. 
Published: September 2009

Abstract
To test the effects of four surgical scrub products on colonizing hand
flora, 60 healthy adult volunteers were assigned by block randomization (12
subjects per group) to use one of the following formulations: 70% ethyl
alcohol with 0.5% chlorhexidine gluconate (ALC); a liquid detergent base
containing 1% triclosan (TRI); a liquid detergent base containing 4%
chlorhexidine gluconate (CHG); a liquid detergent base containing 7.5%
povidone-iodine (PI); or a nonantimicrobial liquid soap (control). Using
standard protocol, subjects performed a surgical scrub daily for five
consecutive days. Hand cultures were obtained at baseline and on test days 1
and 5 immediately after the scrub and following four hours of gloving. After
the first and last scrubs, ALC, CHG and PI resulted in significant
reductions in colonizing flora when compared to the control. Additionally,
by day 5 ALC was associated with an almost 3-log reduction as compared to an
approximate 1.5-log reduction for CHG and PI and less than a l-log reduction
of TRI and the control (p = .009). After four
hours of gloving on both days 1 and 5, microbial counts on hands of subjects
using ALC, TRI and CHG were significantly lower than counts for the control
(p < .001), whereas there was no
significant difference in counts between the PI and control groups (p =
.41). Skin assessment by study subjects rated products from least to most
harsh as follows: control, TRI, CHG, ALC and PI
(p = .00001). It was concluded that ALC could
be an efficacious and acceptable alternative for surgical
scrubbing.
Empiric Antimicrobial Therapy in the Febrile Granulocytopenic
Patient
Authors: Scheld Michael , Hughes Walter T. 
Published: September 2009

In the normal individual, about 100 billion polymorphonuclear leukocytes
(neutrophils) enter the bloodstream daily from the bone marrow. About half
of the intravascular neutrophils are adherent (marginated) to the
endothelium of small vessels and the remainder are circulating. Without
unusual disturbances, the half-life of the intravascular neutrophil is about
six hours. Although the number of circulating neutrophils seems enormous, it
represents only 5% of the total body content of these cells, the major
portion residing in the bone marrow.
It is remarkable that quantitation of polymorphonuclear leukocytes in a
drop of peripheral blood can be highly predictive of an individual's
resistance and response to infectious diseases, especially those caused by
bacteria. Neutrophil activity is complex and its role in host defense is
dependent upon factors other than quantity. Nevertheless, when the absolute
neutrophil count is maintained at values less than 1000/cu mm, increased
susceptibility to infection occurs and is at a rate that is inversely
proportional to the neutrophil count. When the count is decreased to values
of 500 neutrophils/cu mm or less, the frequency of serious bacterial
infection reaches a point where special attention must be directed to the
patient at the earliest sign of infection.
Emporiatrics The Study of Diseases in Travelers
Authors: Nettleman Mary D. 
Published: September 2009

This issue of the journal marks the introduction of a new column
“Emporiatrics”: the study of diseases in travelers. The editorial board
considers this an important aspect of the expanding role of the physician
epidemiologist and the infection control practitioner. We plan to put the
common issues into a perspective that will be useful for those who are
frequently asked questions about the prevention and control of illness in
travelers. We hope this will fill the current void and we invite your
response in letters to the editor.
How do you envision your ideal vacation? Relaxing on a sunny beach to
watch the sun sparkle on the water? Treading ancient streets of living
history? Hiking peacefully over hill and dale? Or are you more adventurous;
the kind of person who would consider Indiana Jones an ideal traveling
companion? The siren call of travel draws us and our patients to exotic
places filled with excitement-and disease. Indeed, many of the epidemics
that first gave birth to epidemiology are still in full swing in developing
countries. To protect the traveler from illness and to minimize the
importation of serious diseases, emporiatrics (from the Greek: emporos [one
who goes on shipboard as a passenger] and iatrke [medicine]) has been
developed.
Detection of HIV Antibody and Antigen (p24) in Residual Blood on Needles and Glass
Authors: Shirazian Djamshid , Herzlich Barry C. , Mokhtarian Foroozan , Grob David 
Published: September 2009

AbstractThere is a significant rate of percutaneous injury with needles during the care of patients with acquired immunodeficiency syndrome (AIDS). Following puncture injury, it is recommended that the source of the contaminating blood be checked, and if human immunodeficiency virus-type 1- (HIV-1)-seropositive, zidovudine prophylaxis be considered. As the source of contaminating blood may be unknown, we studied the detectability of HIV-1 antibody and circulating antigen (p24) in the residual blood from needles and pieces of glass at various intervals following exposure to blood. The residual volume of blood remaining in needles varied from 183 ±50 μ 1 for a 20 G needle to 7.8 ± 1 μ 1 for a 27 G needle, and the residual blood on small pieces of glass varied from 23 μ 1 for a piece weighing 558 mg to 2 μ 1 for a piece weighing 21 mg. Analysis of washed samples of residual blood from all 20 G through 26 G needles and from broken pieces of glass larger than 0.41 g that had been exposed to HIV-1-seropositive blood and left at room temperature for one hour, one day and one week resulted in positive tests for HIV-1 antibody by enzyme-linked immunosorbent assay (ELISA), immunofluorescence and Western blot assays. The circulating antigen was detected in residual blood of 20 G through 26 G needles, but not from contaminated pieces of glass. This technique could be applied to situations where a healthcare worker pricked him- or herself with a needle or with a piece of glass that had been contaminated with blood of unknown seroreactivity. If HIV-1 ELISA, immunofluorescence, Western blot and circulating antigen assays are negative, the individual can be reassured. Because only 0.4% of needlestick injuries with HIV-1-seropositive blood have resulted in seroconversion, there must be other factors, as yet unknown, that predispose to infection.
A Comparison of Infection Control Software for Use by Hospital Epidemiologists in Meeting the New JCAHO Standards
Authors: LaHaise Sharon 
Published: September 2009

AbstractTo choose a microcomputer software package for our hospital epidemiology division, the two leading commercial software packages for infection control, AICE (ICPA, Inc., Austin, Texas) and NOSO- (Epi Systematics, Inc., Ft. Meyers, Florida), were compared for the types of epidemiologic analysis likely to be required to satisfy new Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 1990 Infection Control Standards. The test dataset was a surgical database of 3,235 operations with 292 (9%) wound infections. Though NOSO- was more flexible in terms of the amount of data items one could record, it required seven times longer to learn, nine times more disk space to store and two times as long to enter cases than AICE. Six simple infection control reports (i.e., line listings, crosstabulations, stratified rates and graphs) required only seven computing steps and approximately 11 minutes to process with AICE, but 22 steps and over two hours with NOSO-3. All analytic results from AICE agreed with the results obtained with the Statistical Analysis System (SAS, SAS Institute, Inc., Cary, North Carolina), but analyses such as service-specific rates performed with NOSO- differed because of a design flaw in the NOSO- data structure.
Increasing ICU Staff Handwashing: Effects of Education and Group Feedback
Authors: Dubbert Patricia M. , Dolce Jeffrey , Richter William , Miller Mary , Chapman Stanley W. 
Published: September 2009

AbstractThis study provides an evaluation of the effectiveness of methods to increase hand-washing (HW) by nurses working in an intensive care unit. After baseline observations, two interventions were implemented in sequence: three series of classes conducted by the infection control nurse (ICN); and feedback to staff about handwashing errors on the previous day. Staff were aware that handwashing was being observed throughout the study. The educational intervention produced an immediate increase in HW that was followed by a decline to baseline rates over four weeks. Feedback produced an improvement to 97% compliance that was sustained until completion of the study. Improvement in HW compliance following specified critical procedures was also observed following interventions.
Toxoplasma gondii
Authors: Zygmunt Deborah J. 
Published: September 2009

Toxoplasma gondii is an obligate intracellular parasite that is a worldwide cause of infections in virtually all mammalian species, including humans. Although toxoplasmosis is extremely common in humans, most cases are subclinical and are revealed only by the presence of antibodies to this parasite. Prior to the use of immunosuppresive therapy and the recognition of the acquired immune deficiency syndrome (AIDS), the most devastating consequence of toxoplasmosis was seen in children of women who acquired acute toxoplasmosis in their first trimester of pregnancy.In the past two decades, this pathogen has become increasingly recognized in immunocompromised patients as a common cause of encephalitis. The tragedy of toxoplasmosis is that it is a preventable disease. French investigators, have clearly defined the risk and range of severity of congenital toxoplasmosis, the value of systemic screening and patient education, and the value of treatment of the mother during pregnancy to prevent transmission to the fetus. Prevention of a large portion of cerebral toxoplasmosis cases in immunocompromised patients might be possible if congenital toxoplasmosis was better controlled in the United States. The first step in controlling toxoplasmosis in the United States is a better appreciation of this infection.
Interaction of Granulocytopenia and Construction Activity as Risk Factors for Nosocomial Invasive Filamentous Fungal Disease in Patients With Hematologic Disorders
Authors: Weber Stephen F. , Peacock James E. , Do Kim-Anh , Cruz Julia M. , Powell Bayard L. , Capizzi Robert L. 
Published: September 2009

AbstractA clinicoepidemiologic study was undertaken to investigate an apparent increase in frequency of nosocomial invasive filamentous fungal disease (NIFFD) in adult patients with acute leukemia hospitalized during a period of hospital construction, and to determine if a relationship existed between the construction activity and the acquisition of NIFFD.The first study goal, to determine the incidence of NIFFD before and during construction, was approached by calculation of incidence rates of NIFFD in patients with acute leukemia, comparing 1982 and 1983 (a baseline period free of construction) to 1986 (a year when construction activity was at its peak). The second study goal, to identify risk factors for the development of NIFFD, was accomplished by reviewing the autopsy records of all patients with underlying hematologic disorders accompanied by granulocytopenia who died in our hospital from 1982 through 1986. Patients with and without autopsy evidence of NIFFD were then compared by univariate and multivariate (logistic regression) analysis to identify potential risk factors for the acquisition of NIFFD.The incidence of NIFFD in patients with acute leukemia hospitalized during the period of hospital construction was significantly increased when compared to a baseline period without construction (11 per 139 versus 4 per 333, p < .001). Review of all granulocytopenic patients autopsied over the five-year interval 1982 through 1986 revealed duration of granulocytopenia and hospitalization during construction to be risk factors for NIFFD by univariate analysis (p < .005). Logistic regression showed duration of granulocytopenia to be a highly significant independent risk factor (p < .01) and construction activity to be a probable independent risk factor (p = .09). The effect of construction on risk of NIFFD was most striking in those patients granulocytopenic for less than 40 days. The increased incidence of NIFFD occurred despite anticipation of this potential problem and compliance with published recommendations for infection control during periods of hospital construction.Given the potentiating effect of construction activity on the occurrence of NIFFD in granulocytopenic patients and the suboptimal impact of standard recommended preventive measures, additional risk-reduction methods (i.e., surveillance culturing, prophylactic antifungal therapy, use of portable high efficiency particulate air filters) may be appropriate for patients expected to experience prolonged granulocytopenia (> 14 days) while hospitalized during periods of major construction activity involving excavation. Further studies will be necessary to define the roles of each of these modalities.