bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing Occupational Exposures to HIV-1 in the Healthcare Workplace
Authors: Fahey Barbara J. , Beekmann Susan E. , Schmitt James M. , Fedio Joan M. , Henderson David K. 
Published: September 2009

Managing occupational exposures to human immunodeficiency virus type 1 (HIV-1) in the healthcare workplace remains both controversial and complex. Healthcare workers' perceptions of risk for occupational transmission of HIV-1, their knowledge of risk-reduction strategies, and their perceptions about appropriate postexposure management are all derived from an intricate interplay of scientific, political, social, and emotional sources. Following an occupational exposure to blood or blood-containing body fluids, a healthcare worker's immediate emotional response may be extreme gut-wrenching anxiety, with perceptions often biased by ignorance, uncertainty, and fear. The healthcare worker's postinjury emotional and psychological stress can be extraordinary; postinjury therapy, of necessity, must integrate medical, physical, psychological, and psychosocial aspects of care. Clinical decisions regarding HIV-1 injury management, therefore, are based not only on available scientific and medical information but also on measured actions designed to manage and presumably to diminish the profound anxiety almost invariably associated with an occupational exposure to HIV-1. In stark contrast to this common and extreme emotional reaction, the likelihood of disease transmission from such occupational exposures is relatively small.In this article, we will discuss a series of questions and issues typically encountered when a healthcare worker sustains an occupational exposure to HIV-1.
Risk Factors for Urinary Lithotripsy-Associated Sepsis
Authors: Orenstein Robert , Bross James E. , Dahlmann Mary 
Published: September 2009

AbstractObjectives:To identify risk factors for sepsis following urinary extracorporeal shock wave lithotripsy (ESWL).Design:Retrospective case-control study with two control groups.Setting:A rural, 570-bed, regional referral center.Results:Six cases (four bacteremias and two fungemias) were compared with two sets of 18 controls. Cases had a higher frequency and number of urinary tract infections prior to the procedure and tended to have larger stone size.Conclusions:Patients undergoing ESWL who are at high risk for infectious complications may be identified by preprocedure evaluation. Such patients may require alternative prophylactic regimens and close postprocedure follow-up.
Hand Dexterity in Hospital Personnel with Multiple Needlestick Injuries
Authors: Casanova J.E. , Barnas G.P. , Gollup J. , Schmitt S. , Casanova J.S. 
Published: September 2009

AbstractObjective:To test the hypothesis that multiple needlestick injuries in hospital employees may he due to intrinsic deficits in hand dexterity.Design:A case-control study comparing employees with multiple reported needlestick injuries to those with none. Hand dexterity was tested using the Purdue Pegboard Test, a standardized validated test of hand dexterity.Setting:A 300-bed, acute care teaching hospital.Participants:Fifteen hospital employees who sustained four or more injuries were compared to 19 controls.Results:No differences were detected in hand dexterity between the case and control groups.Conclusions:While employees with multiple needlestick injuries accounted for 85% of reported injuries, underlying factors responsible for injuries in this high-risk subgroup do not include measurable deficits in hand dexterity.
Epidemiology of Antiobiotic Use in a Neonatal Intensive Care Unit
Authors: Fonseca Silvia N.S. , Ehrenkranz Richard A. , Baltimore Robert S. 
Published: September 2009

AbstractObjective:To determine the incidence and pattern of antibiotic use in a neonatal intensive care unit (NICU).Design:Prospective study of a one-month NICU cohort. Investigators visited each subject, checking nursing notes, antibiotic flow sheets, and laboratory data at each daily visit.Setting:The NICU at Yale-New Haven Hospital, New Haven, Connecticut; a regional care, level 3 unit in a tertiary care medical center.Patients:All infants admitted to the NICU for one month (n = 63) who resided in the unit for ≥ 24 hours.Results:75% of the infants had antibiotic treatment begun in the first 48 hours of life. The highest rate of antibiotic treatment starts was in premature infants with birthweight less than 1,500 g, 92% of whom received antibiotics in the first 48 hours. In the subsequent days of life the incidence of starting antibiotic treatment was low and sporadic and the prevalence of antibiotic treatment by day of life showed a sharp decline between the third and fourth days of life. Five cross-sectional studies in the nursery showed point-prevalence rates of antibiotic use to be 27% to 43% of the whole NICU population, highest in the intensive care sector of the unit and in those <72 hours of age.Conclusions:The high incidence of antibiotic starts in this NICU was largely the result of universal treatment of premature infants beginning on the first day of life. The risk of infection in these infants is quite low; more information is needed concerning how to distinguish infants who do not require treatment. This study provides comparison data for NICUs compiling data on incidence and prevalence of antibiotic use and developing programs to limit antibiotic use.
Ten Years of Prospective Clostridium difficile-Associated Disease Surveillance and Treatment at the Minneapolis VA Medical Center, 1982–1991
Authors: Olson Mary M. , Shanholtzer Carol J. , Lee James T. , Gerding Dale N. 
Published: September 2009

AbstractObjectives:To understand the epidemiology, risks, and management of Clostridium difficile -associated disease (CDAD) and to establish and evaluate reliable methods of surveillance.Design:Case finding was done by daily ward and laboratory rounds. The criteria for CDAD diagnosis were: at least four unformed stools per day for 2 days and a positive culture or cytotoxin for C difficile, or positive endoscopy or autopsy for pseudomembranes.Setting:The surveillance covered all patients from 1982 through 1991 in the 820-bed Minneapolis Veterans Affairs Medical Center.Participants:The criteria were met by 908 patients. Medical service patients numbered 488; surgical patients, 420. Frequencies ranged from a high of 149 cases in 1982 to a low of 50 cases in 1989.Results:Stool specimens were obtained on 898 (99%) of the 908 CDAD patients. Stools were culture-positive in 864 (96%) of 898, cytotoxin-positive in 569 (63%) of 898. Endoscopy was performed on 196 (22%) of the 908 patients, and 80 (41%) of 196 patients had pseudomembranes. Ten (1%) of the 908 patients were diagnosed by endoscopy without a stool specimen, or at autopsy. No treatment was needed for 135 (15%) of the 908 CDAD patients, and 19 (2%) of the 908 died before treatment was started. Oral metronidazole was the treatment for 632 (70%) of 908 patients (1% intolerance, 2% failure, 7% relapse) and oral vancomycin was given to 122 (13%) of 908 patients (1% intolerance, 1% failure, 10% relapse). Twelve patients had pseudomembranous colitis at autopsy, and it was the primary cause of death in 5 (0.6%) of 908.Conclusions:CDAD usually responds to oral metronidazole or vancomycin but is nonetheless responsible for a high morbidity and occasional mortality in patients even when the diagnosis and treatment are pursued aggressively.
Management of Healthcare Workers Exposed to Pertussis
Authors: Rutala William A. , Weber David J. 
Published: September 2009

AbstractThe epidemiology of pertussis has changed in recent years. First, pertussis in adults is far more common than previously thought. Second, in many instances, the disease in adults is atypical or asymptomatic. Third, adult pertussis occurs despite a prior history of full immunization and, indeed, in persons with a prior history of natural disease.Large outbreaks of pertussis have occurred in healthcare facilities through failure to recognize and isolate infected infants and children, failure to recognize and treat disease in staff members, and failure to institute control measures rapidly. Appropriate use of work restriction and erythromycin prophylaxis may decrease the likelihood of institutional outbreaks
Mortality Attributable to Nosocomial Infections in the ICU
Authors: Fagon Jean-Yves , Novara Ana , Stephan François , Girou Emmanuelle , Safar Michel 
Published: September 2009

AbstractAlthough a direct relationship between nosocomial infection and mortality in intensive care unit (ICU) patients has not always been demonstrated formally, it is possible to conclude that nosocomial infections increase the risk of death in critically ill patients. A more precise analysis indicates that: 1) this effect is highly probable for pneumonia, doubtful for bacteremia, and uncertain for urinary tract infection; 2) risk increases with duration of stay in the ICU; 3) bacterial etiology modifies the risk; and 4) this effect is stronger in less severely ill patients, probably because the severity of underlying disease remains the most significant factor.
Viewpoint: Survival Benefit by Selective Decontamination of the Digestive Tract (SDD)
Authors: van Saene H.K.F. , Nunn A.J. , Petros A.J. 
Published: September 2009

AbstractMorbidity and mortality due to infection acquired either before or after admission to the intensive care unit is still a major problem. A limited range of potentially pathogenic microorganisms (PPM) are involved, and infection with these PPM usually follows a predictable pattern. Selective decontamination of the digestive tract (SDD) should be investigated further in patients with primarily curable diseases who are not infected on admission to intensive care but become infected there.
Infectious Risk Factors Related to Operating Rooms
Authors: Pittet Didier , Ducel Georges 
Published: September 2009

AbstractRisk factors related to operating rooms include patient-associated risks, the operating room environment, ventilation systems, cleansing and sterilization, and operating room personnel. Although constantly debated, surgical wound infection surveillance with appropriate feedback to surgeons is one of the few effective measures that helps reduce surgical infection rates, and we strongly recommend its use. We also recommend the further study of other potential components of effective infection control programs for surgical patients.
Do Intensive Hospital Antibiotic Control Programs Prevent the Spread of Antibiotic Resistance?
Authors: McGowan John E. 
Published: September 2009

AbstractThe relation between antibiotic control and resistance was assessed by review of selected journal articles from 1988 through 1994. Most studies of control or monitoring do not report susceptibility pattern as an outcome measure. Several aspects of bias and confounding prevent more than analysis of temporal association between antibiotic use restriction and resistance pattern. However, in a few institutions there has been an increase in susceptibility to antimicrobials following intensive control or monitoring. Moreover, in a few hospitals, intensive antibiotic control for selected drug-organism pairs was associated with a high prevalence of susceptibility, and the proportion susceptible fell abruptly when control or monitoring was relaxed or removed. These examples, coupled with the recent emergence of new resistant organisms, justify attempts to determine the value of intensive antibiotic control as a preventive practice. Because these studies were performed in single institutions, their power to distinguish associations was poor. Cooperative multicenter studies are needed in which selection and classification biases are addressed prospectively, and in which confounding factors are controlled.
Applications of Molecular Methods to Epidemiologic Investigations of Nosocomial Infections in a Pediatric Hospital
Authors: Bingen Edouard 
Published: September 2009

AbstractMolecular typing methods are highly discriminatory for strains that cannot be separated by phenotypic methods. They are especially suited to monitoring outbreaks in children's hospitals. In many cases, molecular typing has improved the understanding of the mechanism of nosocomial acquisition of organisms by allowing distinction between endogenous and exogenous infections. Among exogenous infections, it has distinguished between individual and epidemic strains, thus differentiating cross-infection from independent acquisition.
Infectious Diseases and Death Among Nursing Home Residents: Results of Surveillance in 13 Nursing Homes
Authors: Beck-Sague Consuelo , Villarino Elsa , Giuliano Diane , Welbel Sharon , Latts Lisa , Manangan Lilia M. , Sinkowitz Ronda L. , Jarvis William R 
Published: September 2009

AbstractAn increasing proportion of the U.S. population resides in nursing homes (NHs). No surveillance system exists for infections in these facilities. To determine the incidence and types of infections in NH residents, and to identify predictors of death among residents with infections, we initiated a surveillance system at 13 NHs in California during a 6-month period from October 1989 through March 1990. The study included 1,754 residents, among whom 835 infections were identified during the study period. The most common infections were urinary tract infections (UTIs; 286, 34.2%), respiratory tract infections (RTIs; 259, 31%), and skin infections (150,17.9%). Of the 259 residents with respiratory tract infections, 69 (27%) had pneumonia. Antimicrobials were prescribed for 646 (77%) of the infectious episodes. Residents with pneumonia were more likely to die than residents with other infections (4 of 69 versus 12 of 766; P=0.04). Symptoms of altered body temperature (fever, hypothermia, chills) and change in mental status also were associated with an increased risk of a fatal outcome (10 of 260 versus 6 of 575; P= 0.01) and (7 of 127 versus 9 of 708; P= 0.004). This study suggests that the most common infections among NH residents are UTIs, RTIs, and skin infections. Pneumonia, symptoms of fever, and mental status changes all were associated with increased mortality. The frequency of infections among NH residents and their impact on resident outcome highlights the need for infectious disease surveillance in this population.
Changing Patterns of Mycobacterial Disease at a Teaching Community Hospital
Authors: Cox Jeffrey N. , Brenner Eric R. , Bryan Charles S. 
Published: September 2009

AbstractObjectives:To evaluate trends in the occurrence and diagnosis of mycobacterial disease.Design:Prospective surveillance study using a central tuberculosis registry at a 611-bed teaching community hospital.Results:Data pertaining to 715 patients were entered into the registry between 1976 and 1991 on the basis of positive smears or cultures for acid-fast bacilli (AFB). Over time, the ratio of isolates of Mycobacterium tuberculosis to isolates of nontuberculous mycobacteria reversed (from 3.2 to 1 between 1976 and 1981 to 1 to 1.6 between 1986 and 1991). The sensitivity of the sputum AFB smear for diagnosis of pulmonary tuberculosis increased (from 0.73 to 0.96), but the positive predictive value of the sputum AFB smear declined (from 0.72 to 0.59). The acquired immunodeficiency syndrome epidemic accounted for these changes only to a small extent.Conclusions:The increasing occurrence of non-tuberculous mycobacterial disease and the declining positive predictive value of the sputum AFB smear at this hospital imply that respiratory isolation and antituberculous therapy will be used inappropriately for many patients. The development and use of newer tests for early isolation and specific identification of M tuberculosis should be accelerated.
Plasmid DNA Profiles of Acinetobacter Baumannii: Clinical Application in a Complex Endemic Setting
Authors: Seifert Harald , Boullon Bertil , Schulze Andrea , Pulverer Gerhard 
Published: September 2009

AbstractObjective:To study the epidemiological, microbiological, and clinical features of infections due to Acinetobacter baumannii in a complex endemic situation over an 18-month period and to determine the clinical usefulness of plasmid DNA analysis of A baumannii in epidemiological investigations.Design:Review of medical and laboratory records. Antibiotic resistance patterns, biotyping, and plasmid profile analysis were used to characterize clinical and environmental isolates. Pulsed-field gel electrophoresis (PFGE) of chromosomal DNA was performed to verify results obtained with the other typing methods.Setting:Four different intensive care units of an 800-bed tertiary care center in Cologne, Germany.Results:240 patients were colonized or infected with A baumannii during the study period. No seasonal variations were observed. The majority of isolates (53%) were recovered from the respiratory tract. Major infections occurred in 61 patients; these included 48 bacteremias and eight pulmonary infections. Five different epidemic strains were identified: one each was A baumannii biotype 2 and 6, and three were biotype 9. A baumannii biotype 9 accounted for the vast majority of isolates (88%), which were clustered into three epidemic strains demonstrating distinct plasmid profiles. Two of these were considered genetically related as shown by PFGE. Epidemic strains were multidrug resistant, being uniformly susceptible to imipenem only. An epidemiological investigation failed to identify any point source of infection. Barrier precautions and improved handwashing were instituted in three of the four units and significantly reduced the incidence of colonization and infection in these units. Attack rates remained unchanged, however, in the burn unit where control measures were not implemented.Conclusion:Acinetobacter strains representing multiple biotypes and plasmid types were present in this endemic setting. Multidrug resistance in A baumannii is an important concern. Plasmid DNA analysis proved to be useful in epidemiological typing of A baumannii strains and may serve as a complementary typing system to traditional epidemiological methods.
Nosocomial Legionellosis Associated with Aspiration of Nasogastric Feedings Diluted in Tap Water
Authors: Venezia Richard A. , Agresta Marjorie D. , Hanley Eileen M. , Urquhart K. , Schoonmaker D. 
Published: September 2009

AbstractProblem:Two cases of nosocomial legionellosis due to Legionella pneumophila serogroup 6 (Lp6) were identified in the intensive care unit. Both patients had a history of aspiration of nasogastric tube feedings, developed pulmonary infiltrates, had positive cultures for Lp6, had serological titer rises to Legionella, were treated, and recovered.Method:Isolates of Lp6 from the potable water system and patients were characterized by DNA restriction enzyme analyses using pulsed-field gel electrophoresis (PFGE).Results:Water samples grew >1O4 CFU/L of Lp6, and the same PFGE pattern was observed with the patient and water isolates. Potable water was used only for delivering medications and diluting feeding solutions given through the nasogastric tubes of the patients. Heat shock of the hot water system (140° to 160°F or 60° to 7O°C, 4 hours) was performed and the temperature was maintained between 131° to 140°F (55° to 60°C). Surveillance over 18 months revealed a reduction in Legionella to <102 CFU/L.Conclusion:We speculate that nosocomial Legionella pneumonia occurred due to aspiration of nasogastric tube solutions diluted with tap water. A nursing practice change to use only sterile water to dilute feedings and flush medications for nasogastric administration was instituted. The hot water temperature at the faucet was increased to ≥131°F (≥60°C) to control Legionella. No further nosocomial cases have occurred.
The Use of Molecular Typing Techniques in the Epidemiologic Investigation of Resistant Enterococci
Authors: Willey Barbara M. , McGeer Allison J. , Ostrowski Mario A. , Kreiswirth Barry N. , Low Donald E. 
Published: September 2009

The Enterococcus has become an important nosocomial pathogen despite its low virulence. From 1986 to 1989, the National Nosocomial Infections Surveillance System (NNIS) reported enterococci to be the third most common pathogen associated with bloodstream infections and the second most commonly isolated pathogen overall. This is due in part to the organism's ubiquitous nature and inherent antimicrobial resistance.Enterococcus faecalis is found in the stool of virtually all adults at concentrations in excess of 106 colony-forming units/g. Enterococcus faecium, the second most common species causing human infection, is found at lesser concentrations in the stool of approximately 25% of healthy adults. Enterococci also can be isolated from the mouth, anterior urethra, groin, and vagina.
Improving Hepatitis B Vaccination Rates Among Surgeons
Authors: Manian Farrin A. 
Published: September 2009

Abstract:To improve hepatitis B vaccination among surgeons at our medical center, we instituted a program by which the surgeons were updated regarding vaccine safety and efficacy, and the cost of the vaccine and its administration at “strategic” locations was underwritten by the hospital. The rate of hepatitis B vaccination among surgeons increased from 62% to 89% based on pre- and postintervention surveys.
Contaminated Disinfectants in Health Clinics in Ilorin, Nigeria
Authors: Olayemi A.B. , Obayan Y. 
Published: September 2009

Abstract:Five of 18 samples of working dilutions of disinfectants used in the University of Ilorin Teaching Hospital, the University Clinic, and three other urban medical centers were found to be contaminated with bacteria. The results confirmed that disinfectants in storage support the growth of infectious agents, underlining the need to use fresh preparations of disinfectants.
Influenza and Pneumococcal Vaccination and Tuberculin Skin Testing Programs In Long-Term Care Facilities: Where Do We Stand?
Authors: McArthur Margaret A. , Simor Andrew E. , Campbell Beverly , McGeer Allison 
Published: September 2009

AbstractObjectives:1) To compare policies and procedures for distribution of influenza and pneumococcal vaccines to long-term care facilities for the elderly in Canada, 2) to determine vaccination rates of residents and staff, and 3) to describe vaccination and tuberculin skin testing programs in these facilities.Design:A cross-sectional survey consisting of telephone interviews and a mailed questionnaire was conducted in the spring of 1991. Telephone interviews were conducted with provincial/territorial epidemiologists. The questionnaire was sent to all (N = 1,520) Canadian long-term care facilities for the elderly with ≥ 25 beds.Results:There were 1,270 responding facilities (84%). The mean overall influenza vaccination rate for residents was 78.5%. The mean vaccination rate was higher in those provinces in which the vaccine was paid for by the government (79% versus 71%; P= 0.002). Only 19% of facilities reported staff vaccination rates >25%; rates again were higher in those provinces in which vaccine for staff was provided by the government. Pneumococcal vaccine was offered to residents in 12% of the facilities. The proportions of facilities with >10% and >75% of residents vaccinated were significantly higher in the provinces where the pneumococcal vaccine was recommended and paid for as compared with those where it was not (P<0.001 for both). Tuberculin skin testing programs for residents existed in 360 long-term care facilities (28%) across the country.Conclusion:In 1990, the number of residents living in Canadian long-term care facilities who were vaccinated against influenza and Streptococcus pneumoniae was suboptimal. Staff influenza vaccination rates were very low across the country. Most facilities did not have a baseline tuberculin skin test status for their residents. Vaccination rates are higher in jurisdictions in which governments provide the vaccine without charge.