bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Cumulative Probability of Occupationally-Acquired HIV Infection: The Risks of Repeated Exposures During a Surgical Career
Authors: McKinney W. Paul , Young Mark J. 
Published: September 2009

AbstractThe cumulative risk of human immunodeficiency virus (HIV) infection over a healthcare career has rarely been estimated, but is more relevant to the description of an occupational hazard than the risk of seroconversion from a single exposure. We describe a model for assessing the individualized risk for HIV infection after multiple potential exposures over many years for surgeons and other operating room personnel, a high-risk group. For the average surgeon operating over a 30-year career on patients with an HIV seroprevalence of 0.01, the cumulative risk is estimated at 1%. The same surgeon operating on patients with a seroprevalence of 0.10 has an estimated cumulative risk of 10%. These risks may vary dramatically depending on the assumed rate of skin punctures during surgery. Healthcare workers need to be aware of the cumulative risk from multiple exposures to infectious blood and body fluids, to follow proposed suggestions for the reduction of percutaneous blood exposures and to assist in developing new technology to further reduce these risks. Failure to protect these professionals could result in the reduction of services for the approximately 1 to 1.5 million HIV-infected persons in the United States.
Physicians' Perceptions About Increased Glove-Wearing in Response to Risk of HIV Infection
Authors: Linn Lawrence S. , Kahn Katherine L. , Leake Barbara 
Published: September 2009

AbstractGlove-wearing attitudes of 375 physicians, representing 56% of all physicians surveyed, were ascertained. Although the majority were comfortable with their current glove use, 33% preferred wearing them more frequently. The most common reasons for not wearing gloves were a low likelihood of disease transmission and fear of offending patients. Many physicians felt that more frequent glove use in examining human immunodeficiency virus- (HIV)-positive patients might reduce rapport and diminish the adequacy of physical examination procedures, but only 11% felt that increased glove use would compromise overall care of HIVpositive patients. With regard to all patients, 33% felt that increased glove use in examinations would compromise care. Additionally, 56% of physicians stated that they were somewhat concerned about HIV infection. Glove-wearing preferences were significantly associated with greater concern about infection, a younger age and more frequent exposure to blood and body secretions. Contact with high-risk patient groups was not associated with glove-wearing preferences.
Brief Report: A Scheme to Review Infection Control Guidelines for the Purpose of Implementation in the Hospital
Authors: Seto W.H. , Ching T.Y. , Chu Y.B. , Ong S.G. 
Published: September 2009

Infection control guidelines are now widely used in controlling nosocomial infection. For instance, the guidelines published by the Centers for Disease Control (CDC) are now successfully diffused and available in over 80% of the hospitals in the United States.Before introducing any guideline, it should be carefully reviewed and evaluated. Because guidelines can only benefit patients after they are successfully implemented, the review should focus on the implementation process. A review scheme focusing on implementation was developed. In this scheme, an attempt was made to identify the guideline recommendations already being practiced in the hospital, recommendations requiring extra resources before they could be implemented and recommendations resisted by the hospital staff. We describe the review scheme and a study to assess its validity when used by infection control nurses (ICNs) in Hong Kong
Using Decision Analysis to Assess the Quality of Quality Assurance
Authors: Nettleman Mary D. 
Published: September 2009

The recent emphasis on outcome assessment has required hospitals not only to practice high quality care but also to prove that they do so. In search of leadership, many hospitals have turned to epidemiologists and infection control practitioners (ICPs), arguing that there are strong parallels between their activities and those of quality assurance. Both have the same ultimate goal of improving the health of the patient. The principles of surveillance, data management and problem solving used in epidemiology apply also to quality assurance. As advisers, participants or leaders, epidemiologists and ICPs are being drawn irresistibly into the field of quality assurance.The need for leadership has arisen because the assessment of quality is a surprisingly complex task. Initial approaches are often unstructured and designed to fulfill the requirements of various regulatory agencies rather than to improve the delivery of care. In addition, quality assurance is costly, and financial restrictions on medicine are increasing. It is time to take a serious look at the cost-effectiveness of quality assurance and apply the techniques of medical decision analysis to combat the inefficiency and ineffectiveness that often dominate the field.
Criticism: A By-Product of Controlling Infection
Authors: Crow Sue , Davidhizar Ruth , Boonstra Connie 
Published: September 2009

Many hospital epidemiologists (HE) and infection control practitioners (ICPs) find criticism a product of controlling infection because as change agents, these healthcare workers are often perceived as being highly critical. Criticism of epidemiologists and ICPs may appear in a number of ways. Staff may perceive the HE/ICP in a criticizing role because monitoring duties usually require investigative behavior that can be misinterpreted as spying. Staff may feel that epidemiologists do not understand the real work situation, because HEs and ICPs often do not actively care for patients and sometimes dictate that familiar routines be replaced by new procedures. This is especially true when the new procedures appear to take more time and effort than the familiar routine. In addition, the HE/ICP may be seen as picking on certain staff members when follow-up evaluation flags staff deficiencies that must be corrected.Criticism is a subjective perception, but staff who perceive the change agent as critical may impede the change process. All too often, staff who feel criticized get angry and defensive, and become less willing to cooperate. Instead of quickly being able to modify unacceptable staff behavior, the HE/ICP may find that staff resistance and negativism will obstruct the implementation of even a minor change. Staff energy will be spent justifying the undesired behavior. Some staff even fantasize about eliminating the roles of the epidemiologist and ICPs, and may be heard to say, “We got our work done before they came. Besides, how does all this monitoring really help patient care? With this nursing shortage, the ICP could help us more by taking part in real patient care.” The ICP and HE do not generate known income for the hospital and many times they create additional work and advocate that extra monies be spent. Consequently, even an administrator might become critical of these change agents.
Risk Factors for Clostridium difficile Toxin-Associated Diarrhea
Authors: Brown Elizabeth , Talbot George H. , Axelrod Peter , Provencher Mary , Hoegg Cindy 
Published: September 2009

AbstractThe hospital-wide attack rate for Clostridium difficile-associated diarrhea at our tertiary-care university hospital was 0.02 per 100 patient discharges (0.02%) in 1982, but 0.41% and 1.47% in 1986 and 1987, respectively, with a peak incidence of 2.25% in the fourth quarter of 1987. Hospital antibiotic usage patterns showed concurrent increased use of third-generation cephalosporins, and intravenous vancomycin and metronidazole. Thirty-seven cases selected for study were older than 37 control patients, more likely to have an underlying malignancy and less likely hospitalized on the obstetrics/gynecology service. Their mean duration of hospitalization prior to diagnosis was 21 days, versus a mean total length of stay of eight days for controls. All cases received antibiotics, compared to 24 of the controls. Cases were given more antibiotics for longer periods, and more often received clindamycin, third-generation cephalosporins, aminoglycosides and vancomycin. Gender, race, duration of hospitalization, prior surgery and antiulcer therapy were not significant by logistic regression analysis. Epidemiologic variables with significantly different adjusted odds ratios (95% confidence intervals) were age greater than 65 years (14.1, 1.4-141), intensive care unit residence (39.2, 2.2-713), gastrointestinal procedure (23.2, 2.1-255) and more than ten antibiotic days (summation of days of each antibiotic administered) (16.1, 2.2-117). Control measures included encouraging earlier isolation and treatment of suspected cases and formulary restriction of clindamycin, with use of metronidazole for therapy of anaerobic infections. By the second half of 1988, the attack rate had dropped progressively to 0.74%.
Methicillin-Resistant Staphylococcus aureus Outbreak at a Veterans' Affairs Medical Center: Importance of Carriage of the Organism by Hospital Personnel
Authors: Reboli Annette C. , John Joseph F. , Platt Christel G. , Cantey J. Robert 
Published: September 2009

AbstractThe reported prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) by hospital personnel averages 2.5%. From August 1985 to September 1987, 155 patients at our Veterans' Affairs Medical Center (VAMC) were colonized or infected with MRSA. In December 1986, only two (2.1%) of 94 healthcare workers were identified as nasal carriers. Prompted by a sharp increase in the number of patients with MRSA in early 1987, contact tracing identified 450 employees, of whom 36 (8%) were nasal carriers. Thirty-five percent of surgical residents (7 of 20) were nasal carriers. Prior to being identified as a nasal carrier, one surgical resident was associated with the inter-hospital spread of the VAMC MRSA strain to the burn unit of the affiliated university hospital. Three family members of two employee carriers were also found to harbor the epidemic strain. All 36 carriers were decolonized with various antimicrobial combinations. Vigorous infection control measures were effective in controlling the epidemic. The frequency of MRSA carriage by hospital personnel at our medical center during the epidemic proved higher than previously appreciated. Thus, healthcare workers may comprise a sizable MRSA reservoir. During an MRSA epidemic, infection control should attempt to identify and decolonize this hospital reservoir, as these individuals can disseminate MRSA both within the hospital as well as into the community.
Intravascular Catheter Colonization and Related Bloodstream Infection in Critically III Neonates
Authors: Cronin Wendy A. , Germanson Teresa P. , Donowitz Leigh G. 
Published: September 2009

AbstractIntravascular catheter tip colonization was prospectively evaluated in critically ill neonates to determine its relationship to the type of device used, duration of catheterization, insertion site and nosocomial bloodstream infection. Sixty-one percent (376 of 621) of all intravascular catheter tips were retrieved from 91 infants. Thirteen percent (41 of 310) of peripheral intravenous, 14% (6 of 42) of umbilical, 21% (3 of 11) of central venous, 36% (4 of 11) of peripheral arterial and 100% (2 of 2) of femoral catheters were colonized. Duration of catheterization was significantly longer for colonized lines (p < .001). Eight of 26 (30.8%) peripheral intravenous catheters remaining in place for more than three days were colonized, compared with 33 of 284 (11.6%) at three days or less (p = 0.012). Coagulase-negative staphylococcus was the organism most frequently isolated from catheter tips and bloodstream infections. Catheter colonization rates in this population were higher than those found in adults. Heavily manipulated devices and those in place for longer periods of time were the most frequently colonized.
Strategies for the Management of Varicella-Susceptible Healthcare Workers After a Known Exposure
Authors: Josephson Adele , Karanfil Lynne , Gombert Myles E. 
Published: September 2009

AbstractThree different sequentially applied post-varicella zoster virus (VZV) exposure management strategies were employed over a 43-month period. We began by using a standard post-exposure protocol in which 50 susceptible healthcare workers (HCW) involved in hospital exposures were furloughed from work at a loss to the hospital of 424 workdays and $46,000. Of the eight nosocomial cases of VZV infection in HCWs, four (50%) caused future HCW and patient exposure. In trial I, we substituted a post-exposure screening procedure for the standard work furlough procedure. We screened 77 exposed staff resulting in one nosocomial VZV infection that was the source of another exposure incident. No secondary cases of varicella resulted from this exposure and only 20 days of furlough time were used during trial I. As VZV resulting from a home exposure source was responsible for most hospital exposures in which HCWs were the source, our trial II protocol added the Centers for Disease Control's (CDC) off-duty procedure, but limited its use to susceptibles exposed at home. The 43-month overall attack rate of nosocomial varicella was 4.7%, while the true home exposure attack rate was 79% (p < .00001). There was an average of 42.4 lost workdays charged to the hospital per incident under the standard protocol and three days per incident in the combined experience of trials I and II (p < .0001). Both trial protocol periods saved the hospital many potentially lost HCW days, 592 and 401, respectively, but the trial I protocol led to an observed increase in hospital exposure incidents. While the trial II protocol resulted in more lost workdays (120 of 521) than the trial I protocol, it prevented 18 additional HCW exposures. We conclude that the trial II protocol is safe and the most cost-effective of the three management strategies.
The Influenza Vaccination Demonstration Project: An Expanded Policy Goal
Authors: Fedson David S. 
Published: September 2009

AbstractIn 1980, the Public Health Service established an objective of immunizing 60% of high-risk persons with influenza vaccine annually by the year 1990. As no more than 32% of high-risk persons currently receive influenza vaccine each year, the Health Care Financing Administration (HCFA) has undertaken an influenza vaccination demonstration project for Medicare enrollees. Federally purchased vaccine is being distributed to physicians, health departments, hospitals, nursing homes and health maintenance organizations (HMOs). If the project is cost-effective, Congress has authorized HCFA reimbursement for influenza vaccination. Changing reimbursement policy alone, however, is unlikely to substantially improve influenza vaccine delivery; HCFA reimbursement for pneumococcal immunization since 1981 has not increased the use of pneumococcal vaccine. In contrast, federal purchase and distribution of vaccines to state and local health departments has helped maintain the remarkable success of childhood immunization programs. In addition, in Canada, provincial health departments purchase more than 80% of all influenza vaccine distributed, and from 1980 through 1988, per capita vaccine distribution increased 140%. These experiences suggest the need for an expanded policy goal for the influenza vaccination demonstration project that includes federal purchase and distribution of influenza vaccine. This approach, together with a change in reimbursement policy, offers greater promise for achieving our nation's objective for influenza vaccination.
Glutaraldehyde Nonbiologic Monitors
Authors: Kleier Donald J. , Averbach Robert E. 
Published: September 2009

Glutaraldehyde was first synthesized by Harries and Tank in 1908, and first marketed as a chemosterilizer in 1963. Since that time, glutaraldehyde has been used extensively as a disinfectant and chemical sterilizing solution. Even though it is generally agreed that moist heat is the preferred method of sterilization for medical, dental and hospital instruments, glutaraldehyde is a relatively safe, simple-to-use and effective chemical solution that can sterilize heat-sensitive materials.Glutaraldehyde (1,5-pentanedial) has two free aldehyde groups that combine irreversibly with bacterial cell membranes and enzyme systems. These properties give glutaraldehyde its biocidal effect. Contact time with glutaraldehyde is critical if sterilization, rather than disinfection, is to be achieved. Sterilization time ranges from minutes to ten hours, depending upon bacterial type and conditions of the test results. Sterilization with glutaraldehyde solutions usually requires prolonged contact times. Manufacturer instructions must be strictly followed.
An Outbreak of Acute Gastroenteritis Caused by a Small Round Structured Virus in a Geriatric Convalescent Facility
Authors: Gellert George A. , Waterman Stephen H. , Ewert Donnell , Oshiro Lyndon , Giles Marjorie P. , Monroe Stephen S. , Gorelkin Leo , Glass Roger I. 
Published: September 2009

AbstractAn outbreak of acute gastroenteritis (AGE) occurred in a 201-bed geriatric convalescent facility in Los Angeles County during December 1988 through January 1989. The attack rate was 55% among residents and 25% among employees. Illnesses were characterized by vomiting and diarrhea to a lesser extent, and the absence of fever. Bacterial and parasitic tests in a sample of patients were negative. A 27nm small round structured virus (SRSV) was identified in one of 30 stools studied by immune electron microscopy (IEM). While rotavirus and influenza A and B were found in three, one and three cases, respectively, no alternative etiologic agent could be demonstrated for most cases. The outbreak met Centers for Disease Control (CDC) clinical and epidemiologic criteria for Norwalk-like gastroenteritis. The death rate of residents was not elevated beyond baseline during the outbreak; however, one healthy employee had diarrhea and dehydration and died after developing an arrhythmia. An autopsy showed moderate, diffuse lymphocytic and neutrophilic myocarditis, and viral studies found influenza A in left ventricular tissue. Fourteen (25%) of 57 employee cases worked in occupations without routine stool or patient contact. At least nine of these employees lacked evidence of direct fecal contact, and transmission of infection in these cases may have been airborne. (Infect Control Hosp Epidemiol. 1990;11:459-464.)
Adoption of Guidelines for Universal Precautions and Body Substance Isolation in Canadian Acute-Care Hospitals
Authors: Birnbaum David , Schulzer Michael , Mathias Richard G. , Kelly Michael , Chow Anthony W. 
Published: September 2009

AbstractThe impact of recently recommended hospital infection control guidelines on Canadian acute-care hospitals is unknown. A confidential cross-sectional mailed survey of all acute-care Canadian hospitals was conducted to determine rates of receipt and adoption of published guidelines for Universal Precautions (UP) or Body Substance Isolation (BSI), rationale for adoption and knowledge of costs and benefits. Five hundred and seventy-nine of 943 sites (61%) responded (exceeding 80% in urban centers); 94% among hospitals with at least 300 beds and 57% among those under 300 beds. Seventy-four percent of responders claimed adoption of UP (65%) or BSI (9%), staff protection being their primary motivation. Adoption of either UP or BSI was associated with size (p<.001), increasing progressively from 45% in the smallest group (~25 beds) to 64% in the largest (2500 beds). Many hospitals introduced modifications and some substituted names other than UP or BSI in adopting a new strategy. In practice, UP and BSI now mean different things in different hospitals, and the distinction between them has become blurred. Furthermore, only 5% claiming adoption of a new strategy adopted all of the fundamental policies expected under UP or BSI. Receipt of guidelines was also correlated with size: one-third of hospitals under 200 beds had not received key publications defining UP and BSI. Only 19% claiming adoption of a new strategy indicated knowledge of cost implications. These results suggest a need for closer collaboration among hospitals and government agencies in developing uniform infection control policies, and for systematic evaluation of the cost and effectiveness of new strategies. (Infect Control Hosp Epidemiol. 1990;11:465-472.)
Influenza Outbreaks in Nursing Homes: How Effective Is Influenza Vaccine in the Institutionalized Elderly?
Authors: Cartter Matthew L. , Renzullo Philip O. , Helgerson Steven D. , Martin Stanley M. , Jekel James F. 
Published: September 2009

AbstractDuring the 1984–1985 influenza season, outbreaks of influenza A (H3N2) occurred in three Connecticut nursing homes. Influenza vaccination rates were 67% (96 out of 144), 35% (30 out of 85) and 69% (332 out of 483), respectively. The relative risk of illness for vaccinated compared to unvaccinated residents was 1.8 (95% confidence interval, 0.6, 5.9), 1.6 (95% confidence interval, 0.8, 3.0) and 1.1 (95% confidence interval, 0.8, 1.7) for each of the three nursing homes, respectively. In the third outbreak, 22 vaccinated residents without clinical illness had a geometric mean titer of hemagglutination-inhibition (HI) antibody of 20. Although low, this titer was significantly higher than that of nine unvaccinated residents without clinical illness (12, p<.05); only three (14%) vaccinated residents had HI titers of 340. These results suggest that levels of HI antibody in vaccinated residents were not protective at the time of the third outbreak, four to five months after vaccination. In general, the study of vaccine effectiveness in nursing homes is limited by sample size and statistical power. Despite these limits, the retrospective investigation of influenza outbreaks in nursing homes is often the only practical way to evaluate influenza vaccine effectiveness in the elderly on a yearly basis.
Frequent Acquisition of Multiple Strains of Methicillin-Resistant Staphylococcus aureus by Healthcare Workers in an Endemic Hospital Environment
Authors: Opal Steven M. , Mayer Kenneth H. , Stenberg Marjorie J. , Blazek Julia E. , Mikolich Dennis J. , Dickensheets David L. , Lyhte Lisa W. , Trudel Ronald R. , Musser James M. 
Published: September 2009

AbstractMethicillin-resistant Staphylococcus aureus (MRSA) has been an endemic nosocomial pathogen at the VA medical center (VAMC) in Providence, Rhode Island since 1981. From 1985 to 1987, more than 30% of all unique S aureus isolates were methicillin resistant. To evaluate the frequency of acquisition of MRSA isolates by healthcare workers, we compared the antimicrobial susceptibility patterns, multilocus enzyme genotypes and plasmid profiles of isolates recovered from nasal and hand cultures from VAMC nurses and house staff on rotation at the VAMC with those of clinical isolates from patients at the VAMC and four other affiliated hospitals. Fifty-six percent of ward nurses cultured (n = 112) were colonized with S aureus, of which 65% was methicillin resistant. Six isolates of MRSA were identified on the initial culturing of house staff (n=65); 16 MRSA isolates were recovered at the end of a four-week rotation (p<.02). Phenotypic and genotypic analyses demonstrated that numerous distinct MRSA strains were recovered in the study period. The incidence of MRSA among clinical isolates at the VAMC and affiliated institutions was remarkably constant throughout the three-year study period. Moreover, despite regularly sharing resident physicians, interns and medical students, MRSA isolates were uncommonly recovered at the other university-affiliated hospitals. Our study failed to reveal evidence of significant interhospital transmission of MRSA isolates by healthcare workers. While healthcare workers may contribute to the dissemination of MRSA within institutions, they appear to be less important in spreading MRSA between institutions (Infect Control Hosp Epidemiol. 1990;11:479-485.).