bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serial Survey of Methicillin-Resistant Staphylococcus aureus Nasal Carriage Among Residents in a Nursing Home
Authors: Hsu Clement C.S. 
Published: September 2009

AbstractObjective:To study the natural course of nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA) among residents in a nursing home.Design:A cohort study with eight surveys of nasal cultures over 15 months.Setting:A community nursing home in Chicago, Illinois.Participants:Between 117 and 129 residents of the nursing home in each survey.Results:MRSA carriers were present throughout the study period. On the average, 24.4% (range: 17.1% to 34.2%) of the residents carried S aureus, and 35.3% (range: 20% to 62.5%) of the isolates were methicillin resistant at each survey. The carrier state was persistent or transient and was affected little by a roommate's carrier status. Approximately 70% to 80% of residents who were bedridden or who had decubitus ulcers or foreign bodies carried MRSA at least once during the study period. Residents' prior hospitalization was not associated with MRSA carriage.Conclusion:This study demonstrated that MRSA was perpetuated in the nursing home by persistently or intermittently colonizing debilitated residents who required more intensive nursing care and that the prior hospitalization of the residents was not an important cause of its perpetuation. (Infect Control Hosp Epidemiol. 1991;12:416-421.)
Clinical Significance of Neutropenia in Patients With Human Immunodeficiency Virus Infection
Authors: Farber Bruce F. , Lesser Martin , Kaplan Mark H. , Woltmann Jeanine , Napolitano Barbara , Armellino Donna 
Published: September 2009

AbstractObjective:To determine the incidence of infection in human immunodeficiency virus (HIV)-infected patients during periods of neutropenia and non-neutropenia. To compare the infection rates in patients with HIV disease to those in a group hospitalized with neutropenia and hematologic malignancy.Design:Prospective observational study conducted between December 1985 and December 1987 at a university teaching hospital. Thirty patients with documented acquired immunodeficiency syndrome (AIDS) and absolute T-helper cells <200 mm/mm3. All patients had a period of non-neutropenia following a neutropenic period (neutrophils <1000 cells/mm3).Results:The rate of first infection during neutropenic and non-neutropenic periods for opportunistic infection and nonopportunistic infections were compared. There were no differences between infection rates for the two time periods for both types of infections. A subgroup of patient care days in which non-neutropenic days followed neutropenic days also was studied to eliminate selection bias. In this group, a comparison of infection rates also revealed no difference between neutropenic and non-neutropenic periods. An alternate analysis of the time until first infection during periods of neutropenia or non- neutropenia was done using the Kaplan-Meier product limit method. There was a longer infection-free period for the neutropenic group for opportunistic infections, but it was not statistically significant (p<.1). In addition, we compared HIV-infected patients with a group of 37 patients with neutropenia from hematologic malignancy. There was a significantly higher rate of all infections, particularly bacteremias (p<.001), in the group of patients with hematologic malignancies when compared with all subsets of patients with HIV disease.Conclusion:We conclude that patientswith HIV disease and modest neutropenia do not have an increased risk of bacterial infection. The incidence of all infections is significantly greater in patients with neutropenia secondary to hematologic malignancy, (Infect Control Hosp Epidemiol. 1991;12:429-434.)
Efficacy of Glove Combinations in Reducing Cell Culture Infection After Glove Puncture With Needles Contaminated With Human Immunodeficiency Virus Type 1
Authors: Johnson Gregory K. , Nolan Timothy , Wuh Hank C. , Robinson William S. 
Published: September 2009

AbstractObjective:To study the effect of various latex and treated glove combinations in reducing the frequency of human immunodeficiency virus (HIV) infection of tissue culture cells after puncture by surgical needles contaminated with infectious human immunodeficiency virus type 1 (HIV 1).Design:One, two, or three layers of sterile latex glove material, or two latex layers with intermediate cotton or Kevlar (with or without the virucidal compound nonoxynol-9) were used to cover 24-well cell culture dishes containing MT2 cells in cell culture medium. Surgical needles wet with cell culture medium containing HIV- 1 (HTLV IIIA strain) were passed through the glove materials into the culture medium in the wells of the culture dishes. The culture medium in each well was then assayed biweekly for HIV-1 p24 antigen as a test for infection of cells in the well.Results:The rate of HIV-1 infection of cell cultures after glove puncture was greater than 90% with a single latex surgical glove barrier, 23% to 60% with double or triple layers of latex gloves, less than 8% with an intermediate cotton glove impregnated with 4% nonoxynol-9, 6% with an intermediate Kevlar glove, and 0% with an intermediate Kevlar glove impregnated with non-oxynol-9.Conclusions:An intermediate glove of Kevlar or of Kevlar or cotton impregnated with virucidal compound nonoxynol-9 between standard latex gloves may improve surgical glove safety, compared with latex gloves alone with respect to needlestick transmission of HIV 1. The experimental model used may permit rapid investigation of other glove systems as barriers to the transfer of infectious agents through gloves by needlestick. (Infect Control Hosp Epidemiol. 1991;12:435-438.)
The Hospital Epidemiologist in Long-Term Care: Practical Considerations
Authors: Mylotte Joseph M. 
Published: September 2009

Infection control practices in long-term care facilities have been the subject of an increasing number of reports in the past few years. A recent review by Smith in this series outlined important problems regarding infection surveillance in long-term care facilities including: the lack of standard definitions of infection and the difficulty of applying Centers for Disease Control (CDC) definitions in long-term care facilities: the lack of a consensus on the best approach to infection surveillance in long-term care facilities; the lack of full-time commitment to infection control among long-term care facilities; and the lack of risk stratification of patients. For reasons mentioned previously, the effective solution to these problems will require the input of hospital-based infection control professionals. It would be ideal if, prior to this effort, these professionals could gain some experience regarding the important differences between the long-term care facility and the acute hospital setting.In this article, the observations of a hospital epidemiologist who has consulted for several years with long-term care facilities will be discussed. Specifically, I will deal with experiences and problems I have dealt with in long-term care facilities that were either new to me or variations of hospital-based experience.
Expected Costs of Implementing a Mandatory Human Immunodeficiency Virus and Hepatitis B Virus Testing and Restriction Program for Healthcare Workers Performing Invasive Procedures
Authors: Gerber-ding Julie Louise 
Published: September 2009

Healthcare personnel injured by needles or other sharps contaminated with blood from infected patients are at risk for infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens.’ When such injuries also result in blood contamination of a patient's wound, mucous membrane, or skin lesion, transmission of infection in the opposite direction, from provider to patient, may occur.Although HBV transmission from HBeAg- positive providers to patients during invasive procedures where the opportunity for injury and contamination coexists was documented as early as 1974, the hazard was not deemed large enough to warrant widespread changes in infection control practices or mandatory testing. Recent reports suggesting that HIV infection in three patients of a dentist with acquired immunodeficiency syndrome (AIDS) were acquired in the dental office have had a much more dramatic impact.
Bactericidal Action of Modulated Ultraviolet Light on Six Groups of Salmonella
Authors: Bank H.L. , John J.F. , Atkins L.M. , Schmehl M.K. , Dratch R.J. 
Published: September 2009

Previous studies on the bactericidal effects of ultraviolet (UV) lamps have focused on the effects of specific wavelengths and the time and intensity of exposure. Virtually all of these studies have used continuous wave UV. Exposure to UV can induce abnormal ion flow or increased membrane permeability, or it can depolarize the membrane, induce DNA, RNA, and protein alterations, and inhibit oxidative phosphorylation. Any periodic alteration in the modulation of the intensity alters the biological effectiveness. If the waveform and pulse repetition rate are chosen carefully, the bactericidal effects of the UV light may be greatly enhanced.We tested a prototype UV-C lamp modulated by a series of complex waveforms designed to enhance bactericidal activity. These experiments evaluated the effectiveness of the modulated WC in a series of in vitro experiments on six serogroups of Salmonella.
Lyme Borreliosis
Authors: Holt Douglas A. , Pattani Namrata J. , Sinnott John T. , Bradley Elizabeth 
Published: September 2009

Lyme borreliosis (also known as Lyme disease) has become the most commonly reported tick-transmitted disease in the United States.’ The diverse clinical manifestations of the disease make diagnosis difficult, but Lyme borreliosis is quite responsive to treatment if recognized in the early stages.In the early part of the century, Afzelius in Sweden and Lipschutz in Austria described a distinctive skin lesion, erythema chronicum migrans (ECM), which developed at the site of a previous tick bite. Later, Garin and Bujadoux in France, Hellerström in Sweden, and Bannwarth in Germany described the association of ECM with neurological diseases, including neuropathies, radiculopathies, and cranial nerve palsies. Lyme disease was first recognized as a separate syndrome in the United States by Dr. Allen Steere and his colleagues in 1976, after a homemaker, MS Polly Murray, brought an outbreak of arthritis to their attention. Epidemiological studies of this unusual geographical clustering of children in Lyme, Connecticut, who were thought to have juvenile rheumatoid arthritis, suggested another process. The illness was eventually found to be caused by a vectorborne spirochete,Borrelia burgdorferi, which is capable of infecting the cardiovascular, dermatologic, neurologic, and musculoskeletal systems.
Microbial Growth and Endotoxin Production in the Intravenous Anesthetic Propofol
Authors: Arduino Matthew J. , Bland Lee A. , McAllister Sigrid K. , Aguero Sonia M. , Villarino Margarita E. , McNeil Michael M. , Jarvis William R. , Favero Martin S. 
Published: September 2009

AbstractObjective:In this study, we measured microbial growth and endotoxin production in the intravenous anesthetic propofol using 10 different microbial strains; 6 isolated from outbreak cases and 4 from laboratory stock cultures.Design:In each trial, endotoxin-free glass tubes containing 10 ml propofol were inoculated with 10°-103 CFU/ml of the test organism and incubated at 30°C for 72 hours.Setting:In May and June 1990, the Centers for Disease Control received reports of 5 outbreaks in 5 states of postsurgical patient infections and/or pyrogenic reactions. Epidemiologic and laboratory investigations implicated extrinsic contamination of an intravenous anesthetic, propofol, as the probable source of these outbreaks.Results:After 24 hours, 9 of the 10 cultures increased in viable counts by 3 to 6 logs. At least 1 ng/ml of endotoxin was produced within 24 hours by Escherichia coli, Enterobacter cloacae, and Acinetobacter calcoaceticus subspecies anitratus.Conclusions:Propofol can support rapid microbial growth and endotoxin production. To avoid infectious complications, scrupulous aseptic technique should be used when preparing or administering this anesthetic.
Migration to Rural Areas by HIV Patients Impact on HIV-Related Healthcare Use
Authors: Davis Kristine , Stapleton Jack 
Published: September 2009

AbstractObjective:To evaluate the impact of patient migration on human immunodeficiency virus (HIV)-related healthcare use in a rural setting.Design:Data were collected on all patients seeking medical care related to HIV infection at The University of Iowa HIV/acquired immunodeficiency syndrome (AIDS) clinic. Information was collected related to patient care, stage of illness, prior and current residence, and clinic and hospital use.Setting:An outpatient clinic in a university hospital offering primary and consultative medical care for persons with HIV infection.Patients:All patients scheduled into clinic reported a previous positive HIV serologic test.Results:Forty-five percent (81 of 181) of patients reported moving to Iowa, yet no more than 11% (n = 20) moved out of the state during the same period of observation. Of patients meeting the centers for Disease control criteria for AIDS, 24% were diagnosed prior to moving to Iowa (18 of 74). Twenty-seven percent of AIDS-related inpatient days of hospitalization and 19% of AIDS-related outpatient clinic visits were used by persons diagnosed in another state. Lifetime charges totalled for eight patients ranged from $24,873 to $232,556, with a mean of $109,934.Conclusions:A substantial portion of HIV related healthcare in our rural area was used by individuals who had migrated to or back to Iowa. Further understanding of the reasons for and the extent of HIV patient migration to rural areas is needed.
Complications Associated With Central Venous Catheters Inserted in Critically III Neonates
Authors: Hruszkewycz Victoria , Holtrop Paul C. , Batton Daniel G. , Morden Robert S. , Gibson Peter , Band Jeffrey D. 
Published: September 2009

AbstractObjective:To assess the incidence and spectrum of complications associated with central venous catheter (CVC) placement in the critically ill infant.Design:A prospective study of all babies hospitalized in a neonatal intensive care unit (NICU) from January 1989 to December 1989. Potential risk factors associated with infection were evaluated by a case-control comparison.Setting:Conducted at a university-affiliated, tertiary care community hospital.Patients:Neonates requiring intensive care and a central venous catheter. Controls consisted of noninfected babies.Results:Of 263 critically ill neonates, only 13 (4.9%) required a CVC insertion. Seventeen CVCs were placed in these 13 neonates for a total duration of 600 days (median, 32 days/cannula). Fifteen (88%) of these cannulas had one or more complications during its catheter life including dislodgement or leakage (53%), occlusion or thrombosis (47%), infections (29%), or minor bleeding (12%). Five babies (29%) developed 6 episodes of bloodstream infection including 3 sporadic cases due to Staphylococcus epidermidis and a cluster of fungemia due to Malassezia furfur associated with lipid emulsion therapy Infants with a CVC-associated infection were a younger gestational age (24 weeks versus 32 weeks, p=.04) and weighed less at birth (580 g versus 1285 g, p =.02). The overall rate of bloodstream infection was one episode per 100 days of catheter use.Conclusions:CVCs may be lifesaving to a critically ill neonate, but complications occur frequently Use must be restricted to infants in whom alternate delivery routes of intravenous therapy or support are otherwise unavailable.
Cholera, Travel, and Infection Control
Authors: Nettleman Mary D. 
Published: September 2009

Recent outbreaks of cholera in South America and a handful of imported cases in the United States have transformed the disease from a third-world curiosity to an important issue for our daily American newspapers. Although cholera often is considered one of the classic plagues of humankind, we now know that the disease can be contained with modern sanitation and that, with proper hydration, mortality rates are less than 1%. The role of epidemiologists and infection control practitioners should be to provide information, reassure the public, and prevent harmful attempts at infection control based on “cholera hysteria.”It is surprising to realize that cholera is a relative newcomer to the global pestilence scene. In fact, pandemics were not reported before the 18th century..’ As cholera spread from Asia to Europe, panic outran the disease and was exacerbated by futile attempts to limit the epidemic. Cholera victims were placed in strict quarantine, and their houses were burned. In some instances, military troops encircled towns or fortified borders in a vain attempt to confine the disease. Public officials would deny that cholera had invaded their cities until the graveyards were filled with indisputable evidence. In the early 1800s, during the height of the epidemic in the United States, 1,000 people died daily in Philadelphia, Pennsylvania, alone.2 Virtually all those deaths could have been prevented with proper rehydration and replacement of electrolytes.
Resistance to Imipenem Among Selected Gram-Negative Bacilli in the United States
Authors: Gaynes Robert P. , Culver David H. ,   The National Nosocomial Infections Surveillance System
Published: September 2009

AbstractObjectives:Identification of imipenem resistance among selected gram-negative bacilli, especially Pseudomonas aeruginosa and Enterobacter species.Methods:We analyzed 1986-1990 National Nosocomial Infection Surveillance (NNIS) data from 3,316 P aeruginosa isolates and 1,825 Enterobacter species isolates for which susceptibility results to imipenem were reported.Results:For P aeruginosa, 11.1% of the isolates were resistant to imipenem; 16.1% were either intermediate-susceptible or resistant to the drug. A logistic regression model found that resistance was more common among P aeruginosa isolated from the respiratory tract, patients in intensive care units, and in teaching hospitals. Additionally, resistance to imipenem increased by 25% in teaching hospitals from 1986-1988 to 1989-1990. For Enterobacter species, 1.3% of the isolates were resistant to imipenem; 2.3% were either intermediate-susceptible or resistant to the drug. However, imipenem resistance for these isolates did not differ between the two periods and was not more common in patients in an intensive care unit or infections at any specific site.Conclusions:The frequency of resistance to imipenem is greater among P aeruginosa than among Enterobacter species. Resistance to imipenem among the P aeruginosa isolates is more common from strains isolated from patients with nosocomial infections in an intensive care unit, from the respiratory tract, and from teaching hospitals. Resistance appears to be increasing among nosocomial P aeruginosa isolated in teaching hospitals.
Cross-Sectional Epidemiology of Phlebitis and Catheter-Related Infections
Authors: Ena Javier , Cercenado Emilia , Martinez David , Bouza Emilio 
Published: September 2009

AbstractObjectives:To describe the characteristics and the problems arising from the use of vascular catheterization in a general hospital and to identify avoidable risk factors associated with catheter-related infections.Design:Cross-sectional, including the entire hospitalized population.Setting:A university-affiliated hospital.Results:Three-hundred fifty-three intravascular catheters were implanted in 315 of a total of 1,838 hospitalized patients (17.1%, confidence interval [CI] = 15.7-18.5). Of the 353 intravascular catheters, 26 (7.3%) were intraarterial, 273 (77.3%) were peripheral, and 54 (15.3%) were central. The median (range) duration of the catheterization was 3 (1-1 1) days for arterial catheters, 1 (1-24) for peripheral catheters, and 5 (1- 130) for central catheters. Fifty-three (15%, CI = 11.5-19.5) showed signs of infection. Independent risk factors associated with infection were the presence of infection located elsewhere (odds ratio [OR]=8.7, CI=4.13-18.3, p<.0001), inappropriate catheter care (OR= 5.3, CI = 2.5-11.2, p<.0001), inappropriate length of catheter use (OR= 3.5, CI = 1.4-9.02, p<.01), and duration of hospitalization exceeding 14 days (OR=2.6, CI=O.9-7.83,p=.07).Conclusion:The risk factors associated with catheter-related infections suggest that many are preventable by improved protocols for management. This hypothesis can easily be tested.
Intervention to Discontinue Parenteral Antimicrobial Therapy in Patients Hospitalized with Pulmonary Infections: Effect on Shortening Patient Stay
Authors: Ehrenkranz N. Joel , Nerenberg Debra E. , Shultz James M. , Slater Kenneth C. 
Published: September 2009

AbstractObjectives:Current efforts to contain antimicrobial costs in hospitals are based on restricting drugs. We explored the effects of unsolicited case-specific recommendations to physicians to discontinue parenteral antimicrobial therapy in medically stable patients with pneumonia, in order to shorten hospital length of stayMethods:A nurse-interventionist, working as an emissary of an appropriate committee in 3 nonteaching community hospitals, presented randomly assigned physicians withnonconfrontational suggestions to substitute comparable oral antimicrobials for parenteral antimicrobials. Blinded observers evaluated in-hospital and30-day postdischarge courses of patients of physicianswhohad been contacted by the nurse (cases) and those who had not (controls).Results:Eighty-two patient episodes (47 physicians) met study criteria. There were 53 cases and 29 controls. In 42 of 53 (79%) case episodes, physicians discontinued parenteral antimicrobials; patients' mean length of stay was 2.4 days less than for 29 control episodes (estimated cost savings was$884/patient). In 11 (21%) episodes, case physicians continuedparenteraltherapy; patients' mean length of stay was 1.9 days longer than for controls (estimated cost excess was$704/patient). Education, training and practice characteristics were comparable in physician groups. Severity of illness indicators and postdischarge outcomes were comparable in patient groups.Conclusions:The major cost-saving potential for shifting from par-enter-al to oral antimicrobial therapy is shortened length of stay. Timely information about alternative drug therapies, offered on a patient-specific basis, appears to modify the treating behavior of physicians. The program as currently conducted is cost-effective, with an estimated net savings of $50,000 per 100 interventions.