bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Prospective Randomized Trial Comparing Manual and Automated Endoscope Disinfection Methods
Authors: Fraser Victoria J. , Zuckerman Gary , Clouse Ray E. , O'Rourke Susan , Jones Marilyn , Klasner Jean , Murray Patrick 
Published: September 2009

AbstractObjective:To compare the efficacy of endoscope disinfection using automated and manual systems.Design:Prospective randomized trial.Setting:A 1,000-bed tertiary care referral center.Methods:All endoscopes underwent a three-stage decontamination process including brushing and cleaning with water and detergent, manual or automated disinfection with 2% glutaraldehyde, and 70% alcohol rinse with forced air drying. Cultures were obtained from endoscopes from both groups before and after alcohol rinse and then after overnight storage.Results:Cultures from 8/30 (27%) automated and 11/30 (37%) manually disinfected (P= 0.58) endoscopes grew gram-negative bacteria and/or nontuberculous mycobacteria before the alcohol rinse. After alcohol rinse, 3 (10%) of 30 automated and 8 (27%) of 30 manually disinfected endoscopes remained contaminated (P= 0.28). Manually disinfected endoscopes were contaminated more frequently with coliform bacteria, whereas endoscopes undergoing automated disinfection were more frequently contaminated with nontuberculous mycobacteria, but the differences were not statistically significant. After alcohol rinse and forced air drying, there was no difference in contamination rates between freshly disinfected endoscopes and those stored overnight (7/30 (23%) versus 4/30 (13%), P= 0.50). Colonoscopes and duodenoscopes were contaminated more often than gastroscopes (P=0.00001).Conclusion:The persistent endoscope contamination after manual and automated disinfection indicates the importance of developing more reliable and effective disinfection methods.
Evaluation of a Rapid Readout Biological Indicator for Flash Sterilization with Three Biological Indicators and Three Chemical Indicators
Authors: Rutala William A. , Gergen Maria F. , Weber David J. 
Published: September 2009

AbstractObjective:Flash sterilization is most commonly used for emergency sterilization of unwrapped items in a gravity displacement sterilizer for three minutes. Sterilization quality assurance is monitored by biological indicators that require a 24-hour incubation prior to reading. In this study, we compared a new biological indicator that provides results within 60 minutes with three conventional, 24-hour biological indicators for monitoring flash sterilization and three chemical indicators.Design:Conventional biological indicators tested included the conventional Attest 1261, Proof Flash and Assert, while the rapid readout indicator tested was Attest 1291. Attest Rapid Readout detects the presence of a Bacillus stearothermophilus enzyme by reading a fluorescent product that is produced by the enzymatic break-down of a nonfluorescent substrate. Chemical indicators tested included Comply, Incheque, and Thermalog S. Survival at 132°C in a gravity displacement sterilizer was measured by media color change after incubation for 24 hours at 56°C for the three conventional biological indicators, fluorescence at 60 minutes for the Attest Rapid Readout biological indicator, and color change for the chemical indicators. Each exposure time was replicated four times with 10 of each biological and chemical indicator per run.Results:The conventional biological indicators (Attest, Proof Flash, and Assert) had 90%, 48%, and 40% spore survival at two minutes exposure; 23%, 3%, and 0% at three minutes exposure; and 3%, 0%, and 0% at four minutes exposure respectively. The Attest Rapid Readout biological indicator had 88%, 33%, and 0% enzyme activity detectable at 2, 3, and 4 minutes exposure. The chemical indicators Comply, Incheque, and Thermalog S revealed sterilization failure rates of 100%, 100%, and 100% at 0 minutes exposure; 100%, 100%, and 45% at one minute; 0%, 0%, and 28% at two minutes exposure; 0%, 0%, and 18% at three minutes exposure; and 0%, 0%, and 0% at four minutes exposure, respectively.Conclusion:The sensitivity of the Attest Rapid Readout parallels the conventional biological indicators. These data suggest that a 60-minute rapid readout biological indicator is equivalent to the 24-hour biological indicators. If further studies demonstrate that a four-minute flash sterilization cycle provides a needed safety margin to ensure sterilization, then consideration should be given to requiring a four-minute flash sterilization cycle. Chemical indicators were too sensitive to the processing conditions (eg, steam) and are inadequate to ensure adequate sterilization.
Dissemination of Bacillus cereus in an Intensive Care Unit
Authors: Bryce E.A. , Smith J.A. , Tweeddale M. , Andruschak B.J. , Maxwell M.R. 
Published: September 2009

AbstractObjective:To report the contamination of ventilator equipment with Bacillus cereus and to outline the measures taken to trace the source of the organism.Design:A prospective survey of all intensive care unit patients who were culture-positive for B cereus and obtaining of environmental cultures of the cleaning and assembly area of the respiratory services division between October 1991 and September 1992.Setting And Patients:Ventilated patients from a 16-bed medical and surgical intensive care unit (ICU) in a 1,000-bed adult tertiary care hospital.Interventions And Results:From October 1991 to April 1992, B cereus colonized the ventilator circuitry of patients in the ICU. One of two washer/decontaminators in the cleaning and assembly area of the respiratory services division was found to yield the microorganism consistently from the water intake port. The design of the machine precluded easy decontamination of the port with 2% gluteraldehyde and a second outbreak occurred. Following the second outbreak, aqueous chlorhexidine in a final concentration of 0.05% was added to the first of two pasteurization cycles in an attempt to achieve sporicidal activity. This ended the outbreak. Sixty-two patients became colonized with the organism including two with nonfatal Bacillus sepsis and one death due to pneumonia associated with the organism.Conclusion:This experience emphasizes the importance of obtaining cultures of machine parts to identify the source of contamination and thereby direct control measures. Use of chlor-hexidine gluconate at high temperatures effectively eradicated B cereus from ventilator circuitry in a practical and cost-effective manner.
Prolonged and Multipatient Use of Prefilled Disposable Oxygen Humidifier Bottles: Safety and Cost
Authors: Henderson Elizabeth , Ledgerwood Donna , Hope Karen Myrthu , Hume Karen , Krulicki Walter , Ford Gordon , Golar Sandy , Sutherland Linda , Louie Thomas J. 
Published: September 2009

AbstractObjective:Multipatient use and prolonged use of prefilled disposable oxygen humidifier bottles (Aquapak 301, Respiratory Care, Inc., Arlington Heights, IL) were evaluated by performing microbiologic monitoring and a cost analysis on bottles used for varying numbers of patients and lengths of time.Methods:Humidifiers were hung for a maximum of one month. Monitoring was conducted in 6 different nursing areas. Quantitative cultures were done for aerobes and Legionella. Reusable humidifier bottles also were monitored.Results:Cultures were obtained from 1,311 disposable and 60 reusable humidifiers. No significant bacterial contamination was detected in the prefilled disposable oxygen humidifier units. Ten percent of the reusable bottles were contaminated by organisms associated with skin flora.Conclusions:Multipatient use and increased duration of use of disposable humidifiers result in cost savings without increasing patient risk. Restricted multipatient use of prefilled disposable oxygen humidifier bottles for a period of one month is a safe and cost-efficient practice.
Efficacy of Immunization with a Combination of Serum and Recombinant Hepatitis B Vaccines
Authors: Pearl Karlyn K. , Ortiz Ana A. , Pearl William 
Published: September 2009

AbstractObjective:To evaluate the efficacy of giving a third dose of recombinant hepatitis B vaccine to healthcare workers who already had received two doses of serum-derived vaccine, which is no longer available in the United States.Design:Volunteers who already had received two standard doses of serum-derived vaccine were given a third dose of either serum or recombinant vaccine in a double-blind fashion. Antibodies to hepatitis B surface antigen were measured at the time of the third immunization, three months later, and one year after the third immunization.Setting:U.S. Army Medical Center, El Paso, Texas.Patients:One hundred healthy healthcare workers.Results:Three months after receiving the third immunization, the serum vaccine group had significantly higher titers than the recombinant vaccine group (P= 0.018). One year after receiving the third immunization, those who received the combined regimen had a mean hepatitis B surface antibody titer less than half that of those who received three doses of serum-derived vaccine. However, both regimens resulted in titers that are considered to confer immunity.Conclusions:A regimen that combines serum and recombinant hepatitis B vaccines may not produce as high an antibody level as three doses of the same vaccine. Those who began immunization with serum vaccine and concluded with recombinant vaccine should be monitored for an accelerated drop in serum antibodies.
Computed Tomography Imaging in Children with Head Trauma: Utilization and Appropriateness from a Quality Improvement Perspective
Authors: Vera Montserrat , Fleisher Gary R. , Barnes Patrick D. , Bjornson Bruce H. , Allred Elizabeth N. , Goldmann Donald A. 
Published: September 2009

AbstractComputed tomography (CT) imaging plays an important role in the acute evaluation and management of children with head trauma. When routine quality improvement (QI) meetings with representatives from the Children’s Hospital radiology and emergency departments revealed disagreement regarding the utilization and appropriateness of CT in children presenting with head trauma, an interdepartmental QI team was formed to address this issue. Because formal criteria for obtaining CTs for head trauma were unavailable, internal institutional criteria were developed by consensus after literature review. Contrary to perceptions of some staff members, the majority (95%) of children who received CT met at least one of the established criteria over a one-year study period. There was little relationship between the presence of criteria and abnormal CT results, but decisions whether to admit patients to the hospital or to send them home were influenced by CT results. Follow-up studies suggested that patients who were discharged home with a normal CT or no CT had uniformly good outcomes.
Screening Surgeons for HIV Infection: Assessment of a Potential Public Health Program
Authors: Schulman Kevin A. , McDonald Robert C. , Lynn Lorna A. , Frank Ian , Christakis Nicholas A. , Schwartz J. Sanford 
Published: September 2009

AbstractObjective:To develop a model to assess the impact of a program of testing surgeons for human immunodeficiency virus (HIV) on the risk of HIV acquisition by their patients.Design:A Monte Carlo simulation model of physician-to-patient transmission of human immunodeficiency virus (HIV) infection using three different rates of physician-to-patient transmission per percutaneous exposure event (0.15%, 0.3%, 0.6%). Data from the model were developed from a review of the medical literature and from subjective probability estimates when data were not available. We used this model to estimate on a national basis the annual number of cases of HIV transmission from surgeons to patients with and without surgeon testing and practice limitations.Results:The annual number of transmitted cases would range from 0.5 ( 0.3), assuming a surgeon HIV prevalence of 0.1% and a surgeon-to-patient transmission rate of 0.15%, to 36.9 (±11.6), assuming a surgeon HIV prevalence of 2% and a surgeon-to-patient transmission rate of 0.6%. After one screening cycle, a mandatory screening program would be expected to reduce the annual transmissions to 0.05 (± 0.03) and 3.1 ( 1. 1), respectively.Conclusion:Patients are at low risk of acquiring HIV infection from an infected physician during an invasive procedure. The potential costs of such a program extended beyond the costs of testing and counseling. In communities with high HIV prevalence, screening surgeons and limiting their practices may decrease patient access to care. A disability insurance program also would be required to protect surgeons and trainees performing invasive procedures. Screening surgeons for HIV infection would be a costly undertaking that would reduce but not completely eliminate this risk.
Factors Affecting Mortality Outcome and Risk of Developing Nosocomial Bloodstream Infection
Authors: Jamulitrat Silom , Meknavin Ubolrat , Thongpiyapoom Somchit 
Published: September 2009

AbstractObjectives:To identify factors associated with developing nosocomial bloodstream infection (NBI) and to identify factors associated with fatal outcome of NBI.Design:Prospective matched and unmatched case-control studies.Seting:Songklanagarind Hospital, a 640-bed medical school and referral center in Songkla, Thailand.Patients:During a two-year study period, 277 patients of 17,829 total admissions in the hospital services of medicine, surgery, pediatrics, and orthopedics acquired bloodstream infections during hospitalization. For the purpose of identifying factors associated with mortality attributed to NBI, patients who died from NBI were assigned as cases; patients who survived the infections were assigned as controls. For the purpose of identifying risk factors for acquisition of NBI, patients with NBI were considered as cases; patients with the same primary diagnosis as a case but without NBI were eligible to be case-matched controls.Results:Case fatality rate was 37.2% based on deaths attributed specifically to bloodstream infection. Patients who died from NBI, compared with those who survived such infections, were associated with inappropriate antibiotic treatment, infection caused by Klebsiella pneumoniae, and the medicine service. When comparison was made between 239 patients with bloodstream infections and 598 diagnosis-matched controls with no bloodstream infection, infection was found to be associated with old age, number of comorbidities, number of prior infections, neutropenia, duration of immunosuppressive drugs, and duration of indwelling intravenous catheter.Conclusion:Awareness of the factors predisposing to NBI may permit better surveillance and better care. Although most of the factors associated with development of NBI or death from NBI are not subject to control, some factors are duration of immunosuppressive drugs, duration of indwelling intravenous lines, and choice of antibiotic treatment.
A Computerized Nationwide Network for Nosocomial Infection Surveillance in Belgium
Authors: Mertens Raf , Jans Beatrice , Kurz Xavier 
Published: September 2009

AbstractObjective:To assess the feasibility of computerized nationwide surveillance of nosocomial infections in Belgium, and to obtain preliminary national and hospital-specific incidence data.Design:Prospective multicenter cohort study of surgical wound infections (SWI).Setting:All 218 acute care hospitals in Belgium in the period October 14 to December 14, 1991.Results:Eighty-five of 218 acute care hospitals (39%) succeeded in collecting the required information and in completing this pilot study, although 50% of the participating hospitals had no previous experience in nosocomial infection surveillance. Seventy percent of the small-size hospitals (<200 beds) did not participate, mainly because of shortages of manpower. A lack of collaboration from clinicians was a problem in most participating hospitals.SWI postdischarge surveillance was most successful when based on information collected by the surgeons at the surgical outpatient clinic; by this method, postdischarge information was obtained on 43.9% of all surgical procedures.A total of 201 infections were observed among 10,537 operations, with a crude incidence rate of 1.91 per 100 operations or 1.51 per 1,000 person-days of observation. Infection rates by operation type and risk indicators are congruent with those of the literature. Survival analysis showed that the overall cumulative infection risk at 21 days postprocedure attained 8 1.6% of the 30-days risk.Conclusion:This nationwide network for nosocomial infection surveillance has introduced the practice of computerized surveillance of performance in a large number of hospitals. Still, several aspects of the surveillance demand to be improved: the collaboration of the clinicians, the quality of the data, and the postdischarge surveillance methodology.
Infection Control in the Russian Federation: Review of a Tertiary Care Hospital
Authors: Nettleman Mary D. , McIntosh Sandra L. , McIntosh Thomas J. , Wenger Jan , Geerdes Heidi 
Published: September 2009

As part of a project organized by the Iowa Council for International Understanding and funded by the Agency for International Development, healthcare workers from the United States visit the Russian Federation to review the status of infection control in selected Russian hospitals. In September of 1993, the United States team reviewed hospitals in Stavropol, a major city in the southwest part of the Russian Federation. This report summarizes issues and problems faced by an 810-bed tertiary care hospital in Stavropol.It is difficult to examine the development of Soviet/Russian healthcare without examining both ideological and political factors on one hand and reality on the other. After the Bolshevik Revolution in 1917, the victors did not acquire a problem-free system. On the contrary, it was politically corrupt and economically bankrupt. It faced serious shortages of medical personnel, equipment, supplies, and facilities. The lack of basic necessities such as soap and disinfectants further added to the crisis. Isolation hospitals were built in a vain attempt to eliminate epidemics. During this period, Russian health services lagged considerably behind Western Europe.
A Sustained Outbreak of Clostridium difficile in a General Hospital: Persistance of a Toxigenic Clone in Four Units
Authors: Nath Swapan K. , Thornley James H. , Kelly Mary , Kucera Bernadette , On Stephen L.W. , Holmes Barry , Costas Menelaos 
Published: September 2009

AbstractObjective:To evaluate the endemicity and epidemiology of toxigenic Clostridium difficile in a sustained outbreak of antibiotic-associated diarrhea.Setting:University-affiliated, 465-bed tertiary care teaching hospital with adjacent cancer clinic in Hamilton, Ontario.Design:From August 8, 1991, through August 31, 1993, a total of 187 cases were investigated for epidemiologic analysis of toxigenic C difficile from stool cultures, to identify the endemic clone(s). To assess the nature of contamination, cultures of inanimate surfaces in the patient environment from the four most affected units (medical teaching, nonteaching medical, hematologic oncology, and the intensive care unit) were processed for C difficile. The 229 clinical strains and 24 environmental strains isolated were typed by numerical analysis of SDS-PAGE protein patterns.Results:A majority (81%) of cases in the epidemiologic analysis were associated with a toxigenic electrophoretic (EP) type 1 C difficile that was identical to the strain first isolated from an index case that occurred 18 months before the start of this study. Culture and typing of the C difficile strains from the inanimate surfaces in the four most affected units showed that the patient environment was contaminated with the toxigenic EP type 1 organism. Six other strains that occurred infrequently among cases also were found in the environment.Conclusions:A single predominant toxigenic clone has been implicated in a sustained outbreak of antibiotic-associated diarrhea that affected elderly patients. The “endemic” clone transmitted for the 25-month study period was linked to an index case shedding a toxigenic EP type 1 strain that occurred 21 months prior to the initial outbreak on the medical teaching unit. The patient environment in the affected units was found to be contaminated with the same clone, possibly due to shedding of organisms by fecally incontinent symptomatic patients. The extrinsic factors contributing to the endemic transmission of this one clone still are not well understood
Nosocomial Transmission of Serratia odorifera Biogroup 2: Case Report Demonstration by Macrorestriction Analysis of Chromosomal DNA Using Pulsed-Field Gel Electrophoresis
Authors: Sader Helio S. , Perl Trish M. , Hollis Richard J. , Divishek Donna , Herwaldt Loreen A. , Jones Ronald N. 
Published: September 2009

AbstractObjectives:To investigate a cluster of Serratia odorifera in a cardiothoracic surgery unit (CTSU) and to evaluate the applicability of three typing methods for this species.Design:During a surveillance surgical wound study, S odorifera was isolated from two patients in the CTSU. The patients' hospital charts were reviewed for the details of surgery and for common personnel, procedures, or medications. Cultures were obtained of water, soap, and unit dose medications from the CTSU, the operating room, and the surgical intensive care unit. The isolates' antibiograms, biotypes (Vitek identification card and API 20E), and patterns of chromosomal DNA (chrDNA) by pulsed-field gel electrophoresis (PFGE) were examined. S odorifera isolates from our organism collection were used as controls.Setting:A 900-bed university hospital with a 22-bed CISU.Results:ChrDNA patterns of isolates from the two patients were identical, suggesting a possible nosocomial source. However, no source of organisms or mode of transmission was identified. Neither biotype nor antibiogram were useful for epidemiologically typing S odorifera, and PFGE was necessary to discriminate among isolates.Conclusions:Although rarely isolated, S odorifera and other non- marcescens Serratia species may cause nosocomial outbreaks. PFGE of chrDNA seems to be a reliable method for epidemiologically typing this species.
Profiling Physician Practice: A Potential for Misuse
Authors: Massanari R. Michael 
Published: September 2009

AbstractProfiling physician practice is not unfamiliar to hospital epidemiologists. Surgeon-specific postoperative wound infection rates have been used to monitor and improve the quality of surgical outcomes. However, concerns for small sample sizes, validity of methods for risk adjustment, and reliability of data collection methods along with other methodologic concerns have resulted in mixed opinions regarding physician profiling as a tool for improving quality of care. In light of pressures for healthcare reform and skepticism regarding physicians' decision making, it is unlikely that methodologic concerns will dissuade regulators and managers from expanding scrutiny of physician practice.
Itraconazole: A New Triazole Antifungal Agent
Authors: Zuckerman Jerry M. , Tunkel Allan R. 
Published: September 2009

AbstractThe azole antifungal agents represent a major advance in the management of superficial and systemic fungal infections. Itraconazole appears to have a broad spectrum of in vitro activity and is the first azole antifungal agent to have activity against Aspergillus species. Itraconazole acts primarily by impairing the synthesis of ergosterol, resulting in a defective fungal cell membrane with altered permeability and function. It is effective for a wide variety of mycotic infections and some fungal meningeal infections. Most adverse effects have been relatively minor and do not lead to discontinuation of therapy.