bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microbial Contamination of Arterial Infusions Used for Hemodynamic Monitoring: A Randomized Trial of Contamination with Sampling Through Conventional Stopcocks versus a Novel Closed System
Authors: Crow Sue , Conrad Steven A. , Chaney-Rowell Cynthia , King John W. 
Published: September 2009

AbstractArterial catheters are now commonly used to monitor blood pressure and obtain blood samples for arterial blood gas and other laboratory determinations. Stopcocks inserted into the pressure monitoring circuit have been the primary means of obtaining blood from arterial catheters. However, these stopcock systems have been associated with nosocomial contamination and bacteremias. Because of the problems of bacterial contamination and blood wasting with the stopcock sampling systems, we compared the frequency and extent of contamination of external sampling ports and the monitoring tubing fluid in stopcocks with that of a novel closed needle-sampling system (Lab-Site, Migada Ltd, Rehovot, Israel), incorporated into pressure monitoring tubing (Abbott Laboratories Inc., North Chicago, Illinois). We found that use of the novel sampling system resulted in significantly fewer episodes of internal bacterial contamination of the arterial monitoring line (7%) than did the use of a stopcock system (61%). External contamination of the sampling port was also lower in the novel system (8%) than in the stopcock system (37%). This suggests that the closed system may reduce the risk of nosocomial infections in patients requiring arterial pressure monitoring.
Transmission and Control of Methicillin-Resistant Staphylococcus aureus in a Skilled Nursing Facility
Authors: Thomas J. Conley , Bridge Janis , Waterman Stephen , Vogt Jacqueline , Kilman Liga , Hancock Gary 
Published: September 2009

AbstractMethicillin-resistant Staphylococcus aureus (MRSA) is increasingly frequent in both acute care facilities (ACFs) and skilled nursing facilities (SNFs). Admissions to SNFs from ACFs with endemic MRSA are one likely source of infection in SNFs. The occurrence of MRSA in SNFs and the relative roles of ACFs and SNFs in MRSA transmission have not been well characterized. We conducted an epidemiologic investigation in an SNF reporting a high incidence of MRSA cases and found that the prevalence of MRSA exceeded that reported in acute care settings. Fifteen (9.1%) of the 164 residents were colonized or infected with MRSA. Risk factors for MRSA identified through a prevalence case-control study were nasogastric intubation (odds ratio = 5.5; 95% confidence interval = 1.2, 26.4), antibiotic therapy (OR= 3.9; CI = 1.2, 13.0), and hospitalization in an acute care facility within the previous six months (OR = 2.9; CI = 0.9, 9.7). During a three-month period, 6 of 100 new admissions were MRSA-positive; all positive patients were from ACFs. Five new cases also emerged from previously MRSA-negative residents. SNF residents are often discharged to ACFs. Transmission of MRSA within the SNF and the transfer of patients to ACFs increases the reservoir of potentially infective patients and the potential for MRSA infections in ACFs. Modest control measures, including targeted surveillance culturing and cohorting of colonized residents, may minimize MRSA transmission in the SNF and decrease the reservoir of MRSA in the community.
Coagulase-Negative Staphylococcal Infections in Vascular Surgery: Epidemiology and Pathogenesis
Authors: Edmiston Charles E. , Schmitt David D. , Seabrook Gary R. 
Published: September 2009

AbstractStaphylococcal infection of a vascular prosthesis is a relatively uncommon complication of peripheral vascular surgery; however, these infections and their sequelae can be catastrophic. The majority of prosthetic graft infections are caused by mucin-producing strains of Staphylococcus epidermidis, which express varying degrees of adherence to the synthetic substrates. Studies have demonstrated that the components and construction characteristics of the graft, implantation site, administration of antimicrobial agents, and endogenous microbial flora are all identifiable risk factors in vascular graft infections. Mucin production, a known virulence factor, has recently been shown to occur in endogenous coagulase-negative staphylococci (CNS) at the time of hospital admission. While mucin production plays an important role in the persistence of graft infections, there is no evidence that suggests a relationship between mucin and antimicrobial resistance.Identifying characteristics of (CNS) graft infections may include a draining wound sinus, poor graft incorporation, a perigraft exudate or a pseu-doaneurysm at the anastomotic site. The occult nature of these infections, in which the patient is often asymptomatic, makes diagnosis and treatment difficult. The graft or graft exudate may be negative when routine culture methods are employed. The recognition of CNS graft infections requires a high index of suspicion and the treatment of these infections requires understanding of the pathogenic process, individualized surgical management, and the judicious use of antimicrobial agents.
Brief Report: Primary and Recurrent Herpes Simplex Infection in a Pediatric Nurse Resulting from a Human Bite
Authors: Fuortes Laurence , Melson Enrico 
Published: September 2009

A case of primary and recurrent herpes simplex virus (HSV) infection resulting from a bite wound' occurring in a pediatric nurse is presented. HSV infection as an occupational hazard among hospital, personnel is briefly reviewed.Herpes simplex virus occurring as herpes whitlow is a well-known hazard among dentists and dental technicians. There is one report in the literature of a large series of nurses in a neurosurgical unit contracting herpetic whitlow. There is one case in the literature of a physician contracting primary herpes simplex infection from mouth-to-mouth resuscitation of a patient with herpes simplex pneumonia. Three days after performing mouth-to-mouth resuscitation, the physician developed painful papulovesicular lesions over the beard area, which subsequently ulcerated and crusted. One year after the resuscitation, the physician experienced cervical lymphadenop-and a recurrence of herpetic lesions in the same areas as the original infection. We report a case of primary and recurrent herpes simplex type 1 infection with disabling causalgia in a licensed practical nurse resulting from a bite wound received from a child hospitalized with pneumonia.
Shigellosis Occurring in Newborn Nursery Staff
Authors: Beers Lorraine M. , Burke Timothy L. , Martin David B. 
Published: September 2009

AbstractShigellosis is uncommon in the newborn nursery. We describe a case of Shigella sonnei gastroenteritis occurring in a newborn. Three of 32 health care providers caring for the infant acquired shigellosis. The neonate probably acquired the infection from its mother via vertical transmission. All six members of the infant's family had gastroenteritis and two siblings had stool cultures positive for Shigella. Transmission of Shigella in the newborn nursery is potentially great. Emphasis on handwashing and glove use, aggressive case finding, notification of contacts, and a liberal “forced paid sick time” policy may halt the spread.
Proteeae Groin Skin Carriage in Ambulatory Geriatric Outpatients
Authors: Ehrenkranz N. Joel , Eckert Debra G. , Alfonso Blanca C. , Moskowitz Lee B. 
Published: September 2009

AbstractAerobic gram-negative bacillus (AGNB) groin skin carriage was prospectively studied in ambulatory geriatric outpatients: 42 from three nursing homes and 44 from private homes. Initially, 12 (28.6%) Proteeae carriers were in the former group and 3 (6.8%) were in the latter (P =0.01). At one year, 6 of 7 surviving nursing home carriers remained Proteeae carriers while none from private homes remained carriers (P =0.007). The annual prevalence of Proteeae carriage was 14 (33.3%) in nursing homes and 4 (9.1%) in private homes (P =0.008); of non-Proteeae AGNB carriage, the annual prevalence was 2 (4.8%) and 4 (11.4%), respectively. Nursing home subjects had similar initial health characteristics; however, by one year, 5 of 12 carriers in contrast to 3 of 30 noncarriers were dead of chronic disease (P =0.03). These nursing homes included persons with chronic diseases that apparently facilitated Proteeae carriage. Urethral catheters, skin ulcers, and recent antibiotics were not factors.
Proteeae Groin Skin Carriage Among Nursing Home Resident—Resistance to Antiseptics
Authors: Eckert Debra G. , Ehrenkranz N. Joel , Alfonso Blanca C. , Moskowitz Lee B. 
Published: September 2009

AbstractProteeae carriage was evaluated in groin skin carriers following vigorous antiseptic application. Three Proteus mirabilis carriers were treated with 60% isopropyl alcohol or 4% chlorhexidine, observed to prevent skin contact, and then recultured; at four and eight hours P mirabilis numbers remained undiminished. Ten Proteeae carriers received a series of nine body baths with soap, chlorhexidine, and 0.75% povidone-iodine plus three cefazolin injections over 16 to 34 days; cumulative treatments failed to clear seven carriers. Within three months, all were again carriers. Proteeae carriers also had affinity for groin carriage of various aerobic gram-negative bacilli (AGNB) including cefazolin-resistant strains. In seven subjects, more than one AGNB species were recovered shortly after applying an antiseptic. Proteeae groin skin carriage appears to reflect a major change in the nature of resident bacteria on intact groin skin.
The Importance of Nosocomial Transmission of Measles in the Propagation of a Community Outbreak
Authors: Raad Issam I. , Sherertz Robert J. , Rains Caroline S. , Cusick Janet L. , Fauerbach Loretta L. , Reuman Peter D. , Belcuore Tom R. 
Published: September 2009

AbstractIn late January 1985, a measles outbreak occurred at a community hospital in Columbia county, Florida. The outbreak spread throughout the county and to two neighboring counties (Alachua and Marion), resulting in 79 cases with a 29% hospitalization rate. Hospitals represented the site with the highest frequency of transmission. At the Alachua county hospitals, where strict respiratory isolation measures were taken, no secondary cases occurred among hospitalized patients. Two independent risk factors existed for hospitalization: measles exposure in a hospital setting (P <0.05) and nonvaccination (P <0.00l). Of the total measles cases, 24% were under the age of 16 months and 47% of those aged 16 months or older had a history of appropriate vaccination. Columbia county, which experienced 86% of the cases, had a 5% frequency of unvaccinated students compared to 0.6% frequency at Alachua (P <0.00l) where only 10% of the cases occurred. This outbreak demonstrates the role of uncontrolled nosocomial transmission of measles in the propagation of a community outbreak.
Infection Control and Hospital Hygiene in Belgium
Authors: Reybrouck Gerald , Mertens Raf 
Published: September 2009

In 1972 the Council of Europe, in which most of the Western European countries are represented, adopted a resolution aimed at the improvement of hospital hygiene and the promotion of the prevention of nosocomial infections. The member states were invited to take the required measures, but each country was free to implement the resolution according to its own needs and particularities. In Belgium, the first legal regulations were issued in 1974—every hospital was obliged to set up a committee for hospital hygiene.Although similar regulations were issued in most other member states. the actual infection control policies adopted can vary. This article highlights some of the particularities for Belgium.
AIDS: Risk of HIV Infection to Health Care Workers
Authors: Schaffner William 
Published: September 2009

Dr. Jaffe presented an update on the risk of HIV infection to health care workers. He noted that information has come from three sources: 1) analysis of national AIDS surveillance data: 2) prospective studies of injuries and exposures of health care workers: and 3) anecdotal reports.The national AIDS surveillance data indicate that 5% of reported AIDS cases occur in health care workers; health care workers represent 5.7% of the US workforce. By itself, this would suggest that employment as a health care worker is not associated with a disproportionately large risk of AIDS. The health care workers with AIDS have an age and sex distribution that is similar to that of all AIDS patients; the health care workers with AIDS are more likely to be white, however. The health care workers with AIDS are more likely to he homosexual/bisexual men (73%) than are all AIDS patients (62%); conversely, they are less likely to admit to intravenous drug use.
Expanding Roles of Hospital Epidemiology: Severity of Illness Indicators
Authors: Gross Peter A. 
Published: September 2009

In recent years we have all been distressed by reports in the popular press of inaccurate hospital mortality data. We have been concerned when quality assurance programs attempt to compare infection rates among surgeons without adjusting for the differences in underlying illnesses of their patients. A similar concern arises when infection rates are compared among hospitals. And university hospital administrators have been concerned by the inadequate reimbursement given to referral hospitals compared with community hospitals.Congress has mandated that the Health Care Financing Administration (HCFA) adopt a severity adjuster for DRGs (Diagnosis Related Groups), the basis of Medicare's prospective payment system. A number of states are close to mandating the use of severity adjusters. These states include New Jersey, Colorado, Pennsylvania, Iowa and Washington. Finally, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is developing severity-adjusted clinical indicators to assess the quality of care.Dr. William Scheckler, when he was the president of the Society of Hospital Epidemiologists of America (SHEA), had the foresight to set up a task force so that SHEA could develop a position on the severity of illness indicators. The findings of the task force have been published previously in this journal (see volume 9, number 7, pp 309–316).
Expanding Role of Hospital Epidemiology: Employee Health—Chemical Exposure in the Health Care Setting
Authors: Rutala William A. , Hamory Bruce H. 
Published: September 2009

Health care workers are exposed to a vast array of health and safety hazards, unsurpassed by any other service industry and perhaps unequaled by industry in general. These hazards include exposure to biological agents, physical agents, stress, injury and chemical agents.The hospital environment abounds with hazardous chemical agents. A hospital survey conducted by the National Institute for Occupational Safety and Health (NIOSH) found at least 135 chemicals recognized as carcinogens, teratogens, mutagens, or which have some combination of these effects in humans or animals. Another 179 chemicals found in hospitals are primary irritants of the skin or eyes. Although employee risks associated with chemicals have been neglected all too frequently, attention finally is being directed to assessing and reducing these risks. Among the toxic substances that present health hazards to health care providers are disinfecting and sterilizing compounds, chemotherapeutic agents and anesthetic gases.
Infection Control: The Immunocompromised Host
Authors: Young Lowell S. 
Published: September 2009

I have two major concerns about the immunocompromised host field in 1989. The first relates to the tremendous impact that acquired immunodeficiency syndrome (AIDS) has had on nosocomial infections and the management of hospitalized patients. It is a major consideration in screening patients for organ transplants. Concern about AIDS influences all aspects of blood transfusion therapy.The second concern relates to the increasing demand for expensive technologically-oriented procedures involved in the management of immunocompromised hosts. I believe the demand for these approaches is irresistible and adds to the mounting problems that hospitals face in containing basic costs. Since there is a finite dollar available for medical expenses, 1 see these demands exacerbating the rationing of medical resources.
The Future of Hospital Epidemiology
Authors: Kunin Calvin M. 
Published: September 2009

It is not difficult to predict the future of hospital epidemiology. It will become increasingly important. The need to prevent and control hospital-acquired infections and to protect the staff from communicable diseases will grow. Hospitals will continue to be filled with patients, life-prolonging technical advances will continue to be introduced, resistance will emerge to the new antimicrobial agents, the number of patients with acquired immunodeficiency syndrome (AIDS) will increase and the population will continue to age. Concomitant increases in costs and demands for accountability and for quality assurance will occur (Table 1).The future for practitioners of hospital epidemiology is less assured. We will have to continue to convince hospital administrators that we are more than “bean counters” engaged mainly in surveillance. We must assure them that the benefits of our work justify the costs of maintaining effective infection control units and that we are dedicated to prevention and control.
Satellite Infection Control Committees within the Hospital: Decentralizing for Action
Authors: Ford-Jones E.L. , Mindorff C.M. , Gold R. 
Published: September 2009

The contemporary infection control program, whether independent or fully integrated into a hospital-wide quality assurance (QA) program, has a very broad scope including surveillance, outbreak management, education, policy/procedure development, environmental/construction surveillance, program evaluation and research (Table). The greatest problem organizing an infection control program has been identified as integration of its components so as to establish supervision and feedback among its participants, with the purpose of achieving steady progress.Programs have historically been “centralized” with the hospital epidemiologist, infection control practitioner and hospital infection control committee responsible directly or indirectly for the maintenance of the system.’
New Insights on the Genetic Basis for Resistance
Authors: Stratton Charles W. 
Published: September 2009

One of the more important aspects of nosocomial infections is that they often are caused by bacterial strains resistant to many antimicrobial agents. Despite over 50 years in the development and use of a wide variety of antibiotics, bacterial resistance mechanisms have not been defeated and are playing an increasingly important role in the therapy of infections.The mechanisms of bacterial resistance, moreover, are constantly changing, but our understanding of these resistance mechanisms at a molecular level is rapidly increasing.” Yet importantly, a detailed knowledge and understanding of the genetic basis for bacterial resistance is of great importance for the proper evaluation and control of nosocomial infections caused by resistant pathogens. The purpose of this discussion is to provide insights into the genetic basis for bacterial resistance and to describe some newer mechanisms of bacterial resistance that influence the therapeutic approach to nosocomial infections.
Surgeon-Specific Wound Surveillance: The Family or the Bean Counters?
Authors: Crow Sue , Bryan Charles S. 
Published: September 2009

I generally associate the “product commentary” section of this journal with such things as urethral catheters, vascular access devices and antiseptic solutions. Hence, the invitation to write about surgical wound surveillance seemed at first inappropriate. However, the gathering storm over who will supervise wound surveillance involves our own unique product: infection control data. My task is to address concerns common to all business enterprises:▪ What is the demand?▪ What does the consumer want?▪ Who should be the chief executive officer?▪ What should be our current strategy?More than 70 years ago, it was shown that making surgeons aware of infection rates can lower their incidence.’ It is now customary to cite a series of studies suggesting that surgeon-specific rate reporting lowers the incidence of postoperative wound infection. First, Cruse and Foord correlated this practice with a lowering of the infection rate from 2.6% to 0.6%. Next, Condon et al. and then Olson et al. reported similar successes. Finally, data from the Centers for Disease Control's SENIC project indicated that two factors clearly correlated with reduced wound infection rates: 1) strong surveillance and control programs; and 2) the presence of an effective infection control physician.” Having both elements in place reduced the infection rate by 41% or 35% for low-risk or high-risk patients, respectively. Having surveillance alone reduced the infection rate by 19% for low-risk patients and 20% for high-risk patients. These findings made the case for wound surveillance seem ironclad.
Enterobacter sakazakii Infections in Neonates Associated with Intrinsic Contamination of a Powdered Infant Formula
Authors: Simmons Bryan P. , Gelfand Michael S. , Haas Michael , Metts Linda , Ferguson John 
Published: September 2009

AbstractWe report an outbreak of Enterobacter sakazakii infection and colonization in neonates related to an infant formula contaminated during the manufacturing process. The outbreak occurred in a 2O-bed neonatal intensive care unit during a six-week period in 1988, and involved a total of four infants. Three infants had sepsis and three had bloody diarrhea; all patients responded to intravenous antibiotics and recovered without complications. The E sakazakii isolated from the formula had the same plasmid and multilocus enzyme profile as those isolated from patients. This outbreak demonstrates the significance of commercially contaminated formulas and emphasizes the need to limit contamination and multiplication of bacteria in enteral formulas.
Investigation of a Streptococcus viridans Pseudobacteremia Epidemic at a University Teaching Hospital
Authors: Church Deirdre L. , Bryant Heather E. 
Published: September 2009

AbstractFor several months in 1986, an outbreak of Streptococcus viridans pseudobacteremia occurred at a large teaching hospital. All sources of laboratory blood culture contamination were excluded. A retrospective epidemiological study indicated that one phlebotomist, “P,” collected a disproportionate number of the positive blood cultures. Further comparison of the paired blood culture results from the three months when the incidence was highest revealed a good concordance of results among all other phlebotomists (Kappa = 0.5), while P's results concurred with others less frequently than would be expected even by chance (Kappa < 0.0). Clinical follow-up showed that P did not routinely wear gloves while drawing blood and had eczema of the hands. Skin scrapings from the hands, right index finger/fingernail grew predominantly S viridans species that were compatible with those recovered from contaminated blood cultures. This epidemic demonstrated the need for early detection of this source as a cause of nosocomial pseudobacteremia.
On Using Microcomputers in Statistical Analysis
Authors: Lachenbruch Peter A. 
Published: September 2009

Over several years, I have used microcomputers for most of my statistical analyses. This article is a summary of some of my preferences and thoughts from this experience. Some of the ideas expressed here, of course, are distillations and re-expressions of the thoughts of others.When you use a microcomputer for your analyses, you assume all the roles traditionally associated with a computer center. You are responsible for the purchase of your machines, supplies and program selection. One problem that may arise is that you may not have a program you need or it may not exist in a version for your computer. If this is the case, you must either find a program that does the job you want or move the data set to a different computer. This problem is less severe now than it was a few years ago because many major statistical packages are available.