bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single Preoperative Bladder Instillation of Povidone-Iodine for the Prevention of Postprostatectomy Bacteriuria and Wound Infection
Authors: Richter Santiago , Kotliroff Oscar , Nissenkorn Israel 
Published: September 2009

AbstractObjective:To study the effectiveness of preoperative bladder washing with povidone-iodine to prevent postprostatectomy wound infection.Design:Patients with an indwelling catheter and scheduled for prostatectomy were divided into two groups. In patients in group 1 (n = 76) the indwelling catheter was simply removed without bladder irrigation. Patients in group 2 (n = 80) had their bladder washed with a nondiluted solution of povidone-iodine before surgery.Patients:One hundred fifty-six consecutive patients with an indwelling catheter and bacteriuria. Mean age was 64 years. All patients had an open prostatectomy during the 12-month study period. Patients undergoing open prostatectomy during the first 6 months of the study had no bladder irrigation and served as the control group. Patients undergoing open prostatectomy during the following 6 months had a bladder instillation with povidone-iodine.Results:Wound infection appeared in 17 of 76 patients (22.4%) without bladder washing and in 4 of 80 patients (5%) when 50 to 60 ml of the solution was retained in the bladder for 10 to 13 minutes (p=.001). The incidence of postoperative bacteriuria remained unchanged in the control group (100%) but was reduced to 22.5% in the treated group (p= .001). Statistical comparisons of incidence were done using the chi square test.Conclusions:It has been demonstrated that the use of preoperative bladder instillation of povidone-iodine may be highly effective in the prevention of postprostatectomy wound infection and in reducing the incidence of bacteriuria in patients with an indwelling catheter and urine colonization.
Surveillance of Surgical Wound Infections Following Open Heart Surgery
Authors: Sellick John A. , Stelmach Marie , Mylotte Joseph M. 
Published: September 2009

AbstractObjective:To define accurate wound infection rates for the cardiac surgery service based on site of infection and characterization as “deep” or “incisional” and to determine whether a correctable cause for an apparent increase in deep wound infection rates existed.Design:Observational.Setting:Tertiary-care teaching hospital.Participants:All adults undergoing open heart surgery in 1988 and 1989.Interventions:Changed from razor to clipper preoperative hair removal in January 1989.Results:Deep sternotomy wound infections decreased significantly from 1.2% in 1988 to 0.2% in 1989 (p=.010) and deep venectomy (vein donor site) wound infections declined from 1.6% to 0.4% (p=.014) during the same time period. Incisional wound infection rates did not change. Patients with deep infections more likely required readmission or operation to treat their infection than those with incisional wound infections. The percentage of gram-negative organisms causing wound infections decreased from 56.3% in 1988 to 34.7% in 1989 (p= ,017).Conclusions:Preoperative hair removal using a clipper appears to have decreased the risk of deep wound infection compared with razor preparation. The dichotomous wound classification of “deep” and “incisional” distinguished between patients who required additional interventions for treatment of wound infections.
Cost Improvements Through the Establishment of prudent Infection Control Practices in a Brazilian General Hospital, 1986–1989
Authors: Cavalcante M.D.A. , Braga O.B. , Teofilo C.H. , Oliveira E.N. , Alves A. 
Published: September 2009

AbstractObjectives:To review procedures currently practiced in a Brazilian general hospital and to eliminate ineffective and inefficient practices. To measure the resulting cost improvements based on rigid hospital financing control.Design:Implementation of surveillance and control programs and prevalence surveys to detect ineffective and inefficient practices.Participants:The study institution is a 130-bed general care facility affiliated with the Brazilian federal government. There were approximately 4,600 admissions per year during the study period (1986- 1989).Results:Instituting infection control measures and eliminating ineffective practices resulted in the following: an overall decrease in wound infection rates from 24.4% in 1987 to 3.45% in 1989; a 71% reduction in the global incidence of infection in the intensive care unit; a 74% reduction in the surgical prophylactic use of antibiotics; and a total savings of approximately $2 million (US dollars).Conclusions:During the period from 1986 to 1989, the infection control committee was able to decrease the overall wound infection rate from 24.4% in 1987 to 3.45% in 1989. This eliminated special health problems and improved patient care and cost-effectiveness for our hospital.
Failure of Bland Soap Handwash to Prevent Hand Transfer of Patient Bacteria to Urethral Catheters
Authors: Ehrenkranz N. Joel , Alfonso Blanca C. 
Published: September 2009

AbstractObjective:The study was designed to compare the efficacies of bland soap handwash and isopropyl alcohol hand rinse in preventing transfer of aerobic gram-negative bacilli to urinary catheters via transient hand colonization acquired from direct patient contact. Glove juice recovery of gram-negative bacteria was considered transient colonization; catheter recovery was considered transfer colonization.Design:The contact source for gram-negative bacteria was a single “high burden” groin skin carrier ( ≥ 104/ml cup scrub fluid). Using a two-period cross-over design, 6 healthcare workers had 2 15-second contacts for each hand followed by either soap handwash or alcohol hand rinse (12 experiments with each treatment). Between 4 to 5 minutes after contact, each hand manipulated a catheter; the catheter was then cultured and the hand was glove juice tested.Results:Soap handwash failed to prevent gram-negative bacteria transfer to the catheter in 11 of 12 (92%) experiments; alcohol hand rinse in 2 of 12 (17%) (p< .001). Soap handwash failed to prevent transient colonization in 12 of 12 (100%) experiments; alcohol in 5 of 12 (42%) (risk ratio 2.4,95% confidence interval 1.2-4.7). Single gram-negative bacteria species carried at source levels ≥ 5.5 × 103/ml (heavy contamination) established transient colonization in 23 of 30 (77%) exposures following soap handwash; single gram-negative bacteria species carried at levels ≤ 3.5 × 103/ml established colonization in 1 of 22 (5%) similar exposures (p<.001).Conclusions:Bland soap handwash was generally ineffective in preventing hand transfer of gram-negative bacteria to catheters following brief contact with a heavy-contamination patient source; alcohol hand rinse was generally effective.
Measles Immunity Among Community Hospital Employees
Authors: Houck Peter , Scott-Johnson Gay , Krebs Lylanne 
Published: September 2009

AbstractObjective:To define measles immunity rates among employees at 2 hospitals during a community outbreak in 1990.Design:Cohort survey using enzyme-linked immunosorbant assay (ELISA) and questionnaire.Setting:Two community hospitals.Participants:Seventy-six percent of 2,060 employees.Results:Seven percent (115/1566) of participants lacked ELISA-defined measles immunity. Among employees whose ages were known, 14% (64/467) of those born after 1956 and 5% (50/1086) of those born before 1957 lacked serologic evidence of immunity. Fifty-eight percent of the susceptible persons had substantial patient contact. With ELISA results as the reference for immunity, the predictive value of an undocumented positive history of measles disease or vaccination was 95%; the predictive value of a negative history of both was 52%. Measles developed in 7 employees.Conclusions:A substantial number of hospital employees lacked ELBA-defined measles immunity, including many who had patient contact or who had been born before 1957. Undocumented disease and vaccination histories were not adequate predictors of serologic status. This study supports the recommendations and suggestions of the Immunization Practices Advisory Committee that hospitals should require documented evidence of measles immunity from employees who have patient contact.
Evaluation of the Epidemiology of Hepatitis B Virus Cross-Infection in a Maternity Hospital
Authors: Puvacic Z. , Simic S. , Karlovac M. , Visnjevac V. , Simic M. , Nikulin B. 
Published: September 2009

AbstractObjective:To determine the hepatitis B infection risk in a university hospital of obstetrics and gynecology,Setting:The University Hospital of Obstetrics and Gynecology, The University of Sarajevo, Yugoslavia.Design:Staff members were divided into three groups: 73 doctors, 184 medical technicians working in delivery rooms, and 55 medical technicians working with postnatal care. The patients were 63 women, aged 17 to 39 years (mean = 26.11 years), pregnant for the first time and in the first stage of labor. Participants all had a negative history of hepatitis B and no known contact with the hepatitis B virus.Results:The incidence of hepatitis B infections among physicians, technicians, and postnatal care technicians was 1.36%, 3.8%, and 3.6%, respectively. The incidence among patients was 4.76%. The daily infection risk varied between 1% and 17% of all deliveries.Conclusions:The risks of transmission of the hepatitis B virus to hospital workers in this setting is indeed high enough to make a case for hepatitis B vaccination in susceptible staff members. Even if vaccination of staff members is carried out, hygienic measures to prevent the transmission of bloodborne infection between patients and from patients to staff are of the utmost importance.
Infection Control Violations
Authors: Homing Linda A. , Smith Philip W. 
Published: September 2009

The Joint Commission on Accreditation of Healthcare Organizations UCAHO) mandates a hospital-wide infection control program.' National, state, and local healthcare guidelines and resources address infection control issues including asepsis, handwashing, isolation precautions, Universal Precautions (UP), and waste disposal. One important aspect of an infection control program is the monitoring of compliance with policies and procedures. We report a system of monitoring compliance with infection control policies and procedures through the use of confidential infection control violation reports.Bishop Clarkson Memorial Hospital is a 550-bed tertiary care center that has an epidemiology services department consisting of a medical director, associate medical director, and two nurse epidemiologists. Hospital personnel have been encouraged through formal and informal educational sessions to report infection control violations to the service. Prior to 1986, infection control violations usually were noted through special studies such as isolation precautions monitors and surveillance activities. Occasionally, employees told Epidemiology Services about a witnessed violation but were very hesitant to document the incident because of fear of retaliation, harassment, and job loss. Peer pressure appeared to play a role in this hesitation.
The Nonexistent Problem
Authors: Davidhizar Ruth 
Published: September 2009

It can be said that the greatest pitfall for the infection control practitioner lies in the realm of problem solving'; however, responding to potential problems is intrinsic to the role of the infection control practitioner. Potential problems are presented to the infection control practitioner not only by his or her employees and supervisors, but also from medical and other hospital staff. Not only do potential problems come from a variety of sources, but their significance may vary from unimportant to critical. In some cases, problems are minor and require little action. In other cases, problems represent critical emergencies and necessitate immediate and aggressive responses. Whether the infection control practitioner works in a small patient care unit or a large university hospital, correct assessment and response to a potential problem is a crucial aspect of effective management.In most cases when a problem is presented, there is agreement by both presenter and infection control practitioner that a problem exists. For example, a patient may have methicillin-resistant Staphylococcus aureus (MRSA) infection. In other cases, while there is agreement that a problem exists, there may not be agreement on the importance of the problem. For example, what is seen by the infection control practitioner as a serious problem may be seen by a physician as a minor problem.
Salmonella and Shigella Gastroenteritis at a Public Teaching Hospital in Nairobi, Kenya
Authors: Paton S. , Nicolle L. , Mwongera M. , Kabiru P. , Mirza N. , Plummer F. , Wamola I. 
Published: September 2009

AbstractObjective:To measure the proportion of nosocomial diarrhea cases associated with Salmonella and Shigella species.Design:Prospective 6-month survey.Setting:Tertiary care center in a developing country.Patient:Pediatric and adult patients admitted within the previous 24 hours and all consenting adult or pediatric medical patients with nosocomial diarrhea.Outcome Measures:Prevalence of Salmonella and Shigella species isolated from rectal swabs at admission and among subjects with nosocomial diarrhea.Results:Salmonella species and Shigella species were isolated from 3.0% and 2.5%, respectively, of 667 patients screened on admission. All admission Salmonella isolates were identified in children under 13 years of age; Shigella prevalence was similar for children and adults. Children with Salmonella at admission were significantly older and more likely to have diarrhea, fever, and some indicators of malnutrition than those from whom Salmonella was not isolated. Salmonella and Shigella were isolated from rectal cultures in 36 (10%) and 9 (2.5%) of 360 nosocomial gastroenteritis cases, respectively. Nosocomial cases occurred equally in adults and children. In adults, nosocomial Salmonella acquisition was associated with sharing a room with a diarrhea patient and previous institutionalization. In children, it was associated with recent antimicrobial therapy, crowding at home, and age between 6 months and 6 years. Nine (41%) of 22 nosocomial Salmonella cases in adults occurred in patients with human immunodeficiency virus-type 1 (HIV-1) infection, while none of 79 HIV-1-positive patients had Salmonella isolated at admission.Conclusions:Salmonella is a frequent cause of nosocomial gastroenteritis in this tertiary care institution in a developing country Risk factors appear to differ for children and adults, and HIV-1-infected subjects may be at increased risk of acquisition. Control measures feasible for the limited resources available to such institutions require evaluation.
Collaborative Education Regarding Prevention of Human Immunodeficiency Virus Transmission in Healthcare Settings-Ghana
Authors: Cronin Wendy , Antwi Phyllis , Larson Elaine 
Published: September 2009

AbstractObjective:To evaluate the effectiveness of a collaborative and participatory approach to professional training to reduce the risk of human immunodeficiency virus (HIV) transmission.Setting:Healthcare settings in Ghana.Methods:Two 5-day workshops were conducted for high-level nurse educators and leaders who could contribute to national policy development A combination of didactics, skill development sessions, field experiences, and development of draft national guidelines and curriculum were used. Outcomes evaluated were pre-to-post training changes in HIV knowledge and attitudes and changes in practice within selected healthcare settings. One-month follow-up visits (times not specified to participants) were used to evaluate outcomes.Results:At post-test, significantly fewer participants thought HIV was transmitted by saliva, sweat, or tears (chi square, p<.0001), and significantly fewer reported hesitation to care for an HIV-infected patient because of lack of understanding about mode of transmission or because of lack of supplies, such as gloves (chi square, p<.01). In field observations, there was an overall 42% improvement in specific infection control practices.Conclusions:A collaborative and participatory approach to training can result in significant changes in infection control practices, even in settings with limited resources.
Amebiasis
Authors: Widmer A.F. , Nettleman M.D. 
Published: September 2009

Amebiasis is an infection of the large intestine produced by the protozoan Entamoeba kistolytica. The disease occurs worldwide but is most prevalent in South and West Africa, Southeast Asia, Mexico, and the western part of Latin America.' More than 10% of the world's population is estimated to be infected. E kistolytica is the third leading parasitic cause of death in developing nations, after malaria and schistosomiasis. In the United States, the prevalence has declined from 5% to 10% in 1960 to approximately 1% to 4% currently. However, amebiasis is one of the most important pathogens to which travelers to endemic countries are exposed.Other groups also are at higher risk of acquiring E kistolytica infection. Sixteen percent to 32% of homosexual men have been found to have E kistolytica in stool specimens. E kistolytica also has been reported as an occupational disease in flight personnel working for commercial airlines.” Because humans are virtually the exclusive reservoir of E kistolytica, appropriate control measures could result in a substantial reduction in the incidence of the disease.Entamoeba has seven species including Entamoeba hartmanni, Entamoeba coli, Entamoeba colecki, and Entamoeba gingivalis; only E kistolytica causes disease in humans. The morphologic classification of Entamoeba is based on the number of nuclei in the mature cyst.' E kistolytica is further characterized by its unique antigens, DNA characteristics, and isoenzyme analyses. In contrast to the free-living amoeba, E kistolytica requires the presence of either bacteria or tissue substrates to satisfy its nutritional needs. It can be cultivated on artificial media, but the diagnostic value of culture remains uncertain.
Infected Urine as a Risk Factor for Postprostatectomy Wound Infection
Authors: Richter Santiago , Lang Ruth , Zur Fruma , Nissenkorn Israel 
Published: September 2009

AbstractObjective:To study the relation of preoperative infected urine and postprostatectomy wound infection in patients with and without indwelling bladder catheters.Design:Patients undergoing prostatectomy were evaluated for the presence of infected urine prior to prostatectomy and postoperative wound infection. They were further divided into patients with indwelling urinary catheter and catheter-free patients. All had received antibiotic prophylaxis.Patients:One hundred fifty consecutive patients undergoing open prostatectomy-mean age was 67 years; 100 patients with an indwelling catheter for a mean period of 50 days; 50 catheter-free patients.Results:Wound infection was found in 19 of 81 (23.5%) and in 6 of 69 (8.7%) patients with infected and sterile urine, respectively p = .028). In patients with indwelling catheters prior to operation, wound infection was 22.4% when urine was infected and 8.3% when it was not. In patients without catheters, infected urine was associated with 40% of wound infections, as compared with 8.9% of wound infections in patients with sterile urine. Organisms obtained from infected wound and urine were identical in 84% of cases. These results were obtained despite antibiotic prophylaxis.Conclusions:Wound infection has been demonstrated to be a postprostatectomy complication directly related to the presence of urinary infection at surgery; thus, elective prostatectomy should be deferred until urine becomes sterile.
Risk Factors for Nosocomial Bacteremia in a Large Spanish Teaching Hospital: A Case-Control Study
Authors: Trilla Antoni , Gatell Josep M. , Mensa Josep , Latorre Xavier , Almela Manuel , Soriano Eladio , Jimenez de Anta Maria T. , San Miguel Juan Garcia 
Published: September 2009

AbstractObjective:Identify independent risk factors associated with the development of nosocomial bacteremia.Design:Exploratory, unmatched, case-control study.Setting:A 970-bed Spanish university hospital.Patients:All non-neutropenic adult patients with nosocomial bacteremia admitted during a 12-month period were eligible as cases. All adult non-neutropenic patients without nosocomial bacteremia were eligible as controls.Results:The incidence of bacteremia in the study population was 6.9/1000 admissions/ year. One hundred eighty cases and 180 controls were analyzed. Multivariate analysis (stepwise logistic regression techniques) identified seven risk factors independently associated with nosocomial bacteremia: age above 65 years; prior admission (within six months) to the hospital; underlying diseases that were ultimately or rapidly fatal; indwelling urethral catheter in place for more than three days; intravenous central lines or peripheral venous lines (if in place for more than four days); “high-risk surgery” (i.e., lower abdominal, cardiac or thoracic); and admission to an intensive care unit.Conclusions:Although five variables are not modifiable, the remaining two relate to the use and duration of devices. Our data give strong support for the value of testing strict guidelines for limiting vascular catheters and evaluating the need for prolonged urethral catheterization. If effective infection control measures are identified, we could target hospital-wide surveillance to patients whose risk factors are amenable to intervention.
Daily Meatal Care for Prevention of Catheter-Associated Bacteriuria Results Using Frequent Applications of Polyantibiotic Cream
Authors: Classen David C. , Larsen Robert A. , Burke John P. , Alling David W. , Stevens Lane E. 
Published: September 2009

AbstractObjective:To determine the efficacy of meatal treatment with a polyantibiotic cream in the prevention of bacteriuria during transurethral bladder catheterization.Design:Randomized controlled trial.Setting:Community teaching hospital.Intervention:Adult patients who underwent closed urinary catheter drainage for short and intermediate durations (two to 30 days).Intervention:Polyantibiotic cream containing polymyxin B sulfate, neomycin sulfate, and gramicidin was applied to the urethral meatus-catheter interface three times daily from the first day of catheterization until bacteriuria was found. The onset of bacteriuria was defined as the day the colonizing species first achieved a colony count of >1000 colonies/ml. Patients randomized to the control group received routine meatal care with cleansing of the meatal surface during daily bathing.Results:Among 2,923 patients who were randomly allocated to receive either the protocol meatal care or routine care, the evaluable study population consisted of 747 patients who were nonbacteriuric and who remained catheterized for more than two days. Overall, 26 (6.8%) of 383 patients given the polyantibiotic treatment acquired bacteriuria, as compared to 37 (10.1%) of 364 patients not given this treatment (p = .167). A Cox proportional hazards regression analysis showed that, among putative risk factors including lack of meatal care, only female gender, a meatal swab culture yielding gram-negative rods or enterococci, and lack of antibiotic use during catheterization were independently associated with the development of bacteriuria.Conclusions:The adverse effect of meatal care noted in earlier studies of a disinfectant ointment applied twice daily was not found in this study of an antimicrobial preparation in a cream vehicle applied three times daily. However, the results do not support meatal care as an efficacious method to prevent catheter-associated bacteriuria in all patients.