bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of the Healthcare Worker Infected With Human Immunodeficiency Virus Lessons From Nosocomial Transmission of Hepatitis B Virus
Authors: Weber David J. , Hoffmann Karen K. , Rutala William A. 
Published: September 2009

Since acquired immunodeficiency syndrome (AIDS) was first recognized and reported in 1981, more than 175,000 persons with AIDS have been reported to public health departments in the United States.’ Despite advances in therapy, the median survival following the diagnosis of AIDS is approximately two years.” The dramatic increase in AIDS cases and their continued poor prognosis has resulted in great public concern regarding the risks of transmission of human immunodeficiency virus (HIV) from infected healthcare workers to patients.The report of probable transmission of HIV infection from a dentist to five patients”” has lead in part to the recent publication of recommendations by the Centers for Disease Control (CDC) for the prevention of nosocomial transmission of HIV during exposure-prone invasive procedures from infected healthcare workers to patients.” In brief, these recommendations entail the following: all healthcare workers should adhere to Universal Precautions (UP); healthcare workers who perform exposure-prone invasive procedures should know their HIV status but testing should be on a voluntary basis; and healthcare workers testing positive for HIV or hepatitis B surface antigen (HBsAg) and hepatitis B “e” antigen (HBeAg) should not perform exposure-prone procedures unless cleared by an expert panel, and then only with informed consent of their patients.
Malassezia furfur Infections
Authors: Teglia Osvaldo , Schoch Paul E. , Cunha Burke A. 
Published: September 2009

Malassezia furfur, previously known as Pityrosporum obiculare, is a lipophilic saprophytic yeast that preferentially colonizes the skin of the scalp, chest, and back. Three clinical syndromes have been associated with M furfur infections: intravenous line sepsis associated with lipid infusions; folliculitis, most often in patients with acquired immunodeficiency syndrome (AIDS) and less commonly in steroid-treated patients with diabetes mellitus; and tinea versicolor, a superficial dermatosis seen in healthy young adults. Most cases of M furfur seen in the hospital are AIDS patients with folliculitis and intravenous line sepsis in neonates receiving lipid emulsions.The genus Malassezia consists of two saprophytic yeast-like organisms: M furfur and Malassezia pachydermatitis. M furfur, predominantly a yeast, is a fastidiously lipophylic member of the normal skin flora in 90% of humans. It is present as filamentous structures in the skin where the organism is associated with tinea versicolor and folliculitis. M pachydermatitis is a yeast most often associated with dogs, where it has been reported to cause otitis externa. Recent reports have implicated this organism in human infections as well.
Influence of an Educational Program and Mechanical Opening Needle Disposal Boxes on Occupational Needlestick Injuries
Authors: Sellick John A. , Hazamy Peggy Ann , Mylotte Joseph M. 
Published: September 2009

AbstractObjectives:To determine whether an educational program had a beneficial impact on healthcare worker needlestick injuries, particularly those caused by recapping. Secondary goals were to evaluate the efficacy of in-room needle-boxes and to determine whether surveillance data were useful when evaluating new products.Design:Survey of employee health department reports.Setting:Tertiary care teaching hospital.Participants:Healthcare workers who reported needlestick injuries and other blood and body fluid exposures to the employee health department.Interventions:Exposure data from the 10 months prior to institution of the educational program and installation of disposal boxes were compared with data from the following 27 months. Additionally, the type of disposal box was changed for the last 9 months of the survey.Results:Needlestick injuries caused by recapping fell significantly following the educational program (p=.005). However, injuries caused by previously disposed needles protruding into the mechanical opening of the needle-boxes increased significantly (p=.002). Following a change of needleboxes to a nonmechanical opening design, the latter type of injury declined (p=.052). Total needlestick injuries, most other categories of needlestick injury, and other exposures did not change significantly during the 37 months of the study.Conclusions:The educational programs appeared to have positive impact on reducing recapping injuries, but many other needlestick categories did not change significantly. Mechanical opening needle disposal boxes appear to present a hazard when compared with fixed opening boxes. Surveillance data appear to be useful in monitoring injuries as well as evaluating products.
Contaminated Commercial Charcoal as a Source of fungi in the Respiratory Tract
Authors: George David L. , McLeod Rima , Weinstein Robert A. 
Published: September 2009

AbstractObjective:To investigate the possibility that contaminated commercial activated charcoal may serve as a source for fungal colonization or infection of the lower respiratory tract.Design:The clinical course of a patient who aspirated commercial activated charcoal was reviewed. Fungal cultures were performed for 2 samples of an activated charcoal in sorbitol product from separate lots produced by a single manufacturer. Details of the manufacturing process were obtained from a representative of the manufacturer.Setting:An intensive care unit in a large community teaching hospital.Patients:A single patient with steroid-treated lung disease who developed a fatal pulmonary illness after aspirating a commercial activated charcoal product.Results:After aspirating the charcoal product, the patient developed respiratory tract colonization and possible infection with Aspergillus niger, Paecilomyces variotii, and Penicillium species. Similar fungal species were isolated from cultures of samples obtained from two separate lots of the same commercial activated charcoal product. Several opportunities for contamination during the manufacturing process were identified.Conclusions:Physicians caring for immuno-compromised patients should be aware that commercial activated charcoal products can be a source of fungal respiratory tract colonization that may mimic or cause pneumonia.
Protecting Travelers from Typhoid Fever
Authors: Rao Nalini 
Published: September 2009

Typhoid fever is unique to humans. It remains a significant health problem in many developing countries, and poses a risk to travelers who visit such endemic regions. The proportion of cases acquired in foreign countries has continued to rise, reaching 70% in 1984. The risk of typhoid fever should not be underestimated as a travel-related illness.The incidence of typhoid fever in the united states has decreased from one case per 100,00 population in 1955 to about 0.2 cases per 100,000 in 1966, and has since remained the same. However, international travelers account for more than two-thirds of the reported cases. The percentage of imported cases increased from 33% during 1967 through 1972, to 70% during 1983 through 1984. The majority of the imported cases were from mexico (39%) and india (15%). During the decade 1975 through 1984, 43% of travel-associated cases were non-U.S. citizens. the risk of acquiring typhoid varied from country to country and was the highest for travelers to india and pakistan, with over 400 cases per million, compared with mexico, with 34 per million, and europe, with 0.6 cases per million travelers.
Duration of Response to Intramuscular Versus Low Dose Intradermal Hepatitis B Booster Immunization
Authors: McKinney W. Paul , Russler Susan K. , Horowitz Mary M. , Battiola Richard J. , Lee Martha Bi-Fong 
Published: September 2009

AbstractObjective:To determine the duration of the immune response to plasma-derived hepatitis B vaccine among healthcare workers responding to booster doses of intradermal (ID) or intramuscular (IM) vaccine in 1986 and those with protective levels of antibody to hepatitis B surface antigen (anti-HBs) in 1986 without booster vaccine. Both groups received a primary hepatitis B vaccine series 24 to 36 months earlier.Design:Cross-sectional follow-up study two years later of an inception cohort defined in 1986.Setting:An academically affiliated metropolitan county hospital.Participants:Group 1: Hospital employees responding to booster doses of hepatitis B vaccine given ID or IM in 1986 due to low anti-HBs levels. Forty-one (82%) of 50 eligible persons were evaluated. Group 2: Persons not receiving booster vaccine in 1986 due to protective levels of anti-HBs. A random sample of 95 persons was drawn from a pool of 152 participants with protective levels in 1986. sixty-five (68%) of 95 contacted persons were restudied.Results:In 1988, 14 (64%) of 22 previous ID responders had anti-HBs levels ≥ 10 milli-international units (mIU)/mL, compared with 17 (89%) of 19 IM responders (p= .055). The 1988 geometric mean titer of IM recipients was 66.4 ±4.5 mIU/mL and of ID recipients was 20.7 ±7.4 (p= .04). None of 65 Group 2 subjects' anti-HBs titers dropped below 10 mIU/mL by 1988.Conclusions:plasma-derived hepatitis B vaccine recipients with anti-HBs levels ≥ 10 mIU/mL at 24 to 36 months after primary immunization are likely to maintain these levels two years later. The diminished durability of the antibody response together with the increased rate of local side effects associated with the ID injection route may limit its applicability as an alternative to using IM booster doses of hepatitis B vaccine.
An Attempt To Make an Issue Less Murky: A Comparison of Four Systems for Infection Precautions
Authors: Jackson Marguerite M. , Lynch Patricia 
Published: September 2009

Birnbaum and others' recently published an article about adoption of guidelines for Universal Precautions (UP) and Body Substance Isolation (BSI) in Canadian acute-care hospitals. The authors pointed out that terminology was used inconsistently among the Canadian hospitals and that there was considerable confusion about the meaning of different terms.As two of the developers of the BSI system, we have been impressed that the philosophical differences among the isolation systems are also misinterpreted by many. The primary purpose of an isolation system, and why and when and it is implemented, form the bases for the philosophical differences among the different systems. Failing to understand the fundamental differences leads practitioners incorrectly to apply the methods of the system in use at their facilities and also leads to inconsistency in practice among healthcare workers.The primary purpose of BSI is to reduce risks to patients of cross-transmission of microorganisms via hands of healthcare workers. A secondary benefit of BSI is to protect the healthcare worker from microorganisms harbored by patients. The system is based on three fundamental premises.
The Sixth Annual Conference on Human Retrovirus Testing
Authors:   ASTPHLD Committee on Human Retrovirus Testing
Published: September 2009

The constant evolution of testing methodologies for the human retroviruses demands that periodic reviews of the capabilities of these methodologies used in the public health laboratories be conducted. To this end, the Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) sponsored the Sixth Conference on Human Retrovirus Testing March 57, 1991, in Kansas City, Missouri. Approximately 285 conference participants viewed 36 poster presentations, heard 12 plenary session speakers discuss a variety of topics relevant to retrovirus testing, and participated in six panel sessions concentrating on the most relevant topics of human retrovirus testing.Panel Session 1 was entitled ‘Testing for HIV-1.” Topics discussed included rapid testing methods, western blots, testing of nontraditional samples, surrogate markers, recombinant/synthetic-based assays, western blot interpretation criteria, indirect fluorescent antibody methods, and viral detection methods.
Infection and Antibiotic Use in a Community Hospital, 1971-1990
Authors: Huth Thomas S. , Burke John P. 
Published: September 2009

AbstractObjective:To determine the prevalence of infections and antibiotic use at a community hospital in 1990 and to compare the results with those from previous surveys in 1971, 1979, and 1984.Design:Point prevalence survey.Setting:Community teaching hospital.Participants:All hospitalized patients, excluding those on the nursery, psychiatry, and short-stay wards.Intervention:Medical records were reviewed and a pertinent physical examination was performed on each patient.Results:Overall, 46 (20.1%) of 229 patients had infection in 1990. Community-acquired and hospital-acquired infections were present in 26 (11.4%) and 24 (10.5%) of the patients, respectively. The most common site of community-acquired infection was the deep abdomen in 8 (25.8%) of 32 sites, while hospital-acquired infection most frequently involved the lower respiratory tract in 8 (25.0%) of 32 sites. Antimicrobial agents were being administered to 88 (38.4%) of the patients. Cephalosporins (particularly newer, broad-spectrum agents) were the most frequently used antibiotics, comprising 53 (45.3%) of the 117 total antimicrobial prescriptions. seven (18.4%) of the 38 antibiotics used for surgical prophylaxis were given for more than 48 hours. Trend analysis revealed no significant changes in the proportions of patients with community-acquired, hospital-acquired, or total infection over the last 20 years (p=.18, p=.12, and p=.O7, respectively). While the overall use of antibiotics increased p<.ool), the administration of prophylactic perioperative antibiotics for greater than 48 hours decreased p=.009).Conclusions:Despite major shifts in factors associated with an increased risk of infection, the overall prevalences of hospital-acquired and community-acquired infections remained remarkably constant during the last 20 years. Although total antibiotic use increased, the duration of surgical prophylaxis decreased and the pattern of use of therapeutic antibiotics also changed with increased use of broad-spectrum agents
Clonal Diversity of Methicillin-ResistantStaphylococcus aureusin an Acute-Care Institution
Authors: Nicolle L.E. , Bialkowska-Hobrzanska H. , Romance L. , Harry VS. , Parker S. 
Published: September 2009

AbstractObjective:To evaluateplasmidandchromosomal typing methods for differentiation ofmethicillin-resistant Staphylococcusaureus(MRSA).Design:Comparison of relatedness of strains using epidemiologic features, phage typing, and antimicrobial susceptibility with blinded assessment by molecular typing methods. Molecular typing methods includedAccIandClalrestriction endonuclease fingerprinting of chromosomal DNA andplasmidtyping.Setting:Tertiary-care teaching hospital.Methods:Convenience sample of 10MRSAstrains, including 4 outbreak-associated and 6 sporadic strains of diverse epidemiologic origins without evidence of nosocomial transmission.Results:Only 2 strains were phagetypeable. The epidemic strain was distinguishable by its susceptibility pattern. Theotherstrains were not consistently separable by phenotyping orplasmid typing methods but were distinct by chromosome typing.Conclusions:Theseobservations document the diversity of origins of MRSA strains introduced into an acute-care institution.Chromosomaltyping may be the preferred method for the determination of clonal origin of MRSA.
Prevention and Control of Influenza A Outbreaks in Long-Term Care Facilities
Authors: Bentley David W. , Gravenstein Stefan , Miller Barbara A. , Drinka Paul 
Published: September 2009

No single virus has the health impact of influenza. Influenza has remained epidemiologically important because it escapes host immune pressure through antigenic variation, is highly contagious, and can cause pneumonia and death in the most susceptible hosts. Viral transmission is most efficient where contact between susceptible hosts is greatest. For humans, this includes institutional settings such as daycare centers, schools, hospitals, and long-term care facilities.Of the three types of influenza, influenza C is relatively nonvirulent. Influenza B is most virulent in children; its antigenic stability presumably allows the adult population to benefit from acquired immunity. Influenza A is virulent in people of all ages, especially in those at the extremes of age or with immunocompromising disease; the attack rate in persons over 70 years of age is four times that of adults under 40 years of age. A major factor accounting for recurrent influenza A epidemics is change in the virus (antigenic drift and shift) that renders the vaccine less efficacious. Influenza epidemics cost billions of dollars and result in thousands of deaths annually. This discussion will focus on the prevention and treatment of influenza A in the long-term care facility.
Yersinia Enterocolitica Infections in
Hospitalized Patients The Problem of Hospital-Acquired
Infections
Authors: Cannon Constance G. , Linnemann Calvin C. 
Published: September 2009

AbstractObjective:To study the epidemiology of Yersinia enterocolitica infections in
hospitalized patients and to determine the frequency of hospital-acquired
infection and the modes of transmission within the hospital.Design:Descriptive study in which the clinical microbiology laboratory reported
all positive Yersinia cultures to the infection control department; each
case was investigated to determine the source of infection.Setting:A 700-bed university teaching hospital.Participants:All patients who were culture-positive for Y enterocolitica after
admission to the University of Cincinnati Hospital during the 4-year
period between 1987 and 1990.Results:Of 18 patients who were diagnosed with Yersinia infections, 8 (44%) were
community-acquired. These patients were admitted with gastrointestinal
symptoms and had their first positive cultures between days 1 and 5 of
their hospitalizations. Five patients (28%) had hospital-acquired
infections, having developed diarrhea after admission for unrelated
problems, and became culture-positive between days 18 and 66. The
remaining 5 patients could not be classified as either community- or
hospital-acquired. These patients had gastrointestinal symptoms at the
time of admission, but these could have been explained by other diseases.
Their first positive stool cultures were not obtained until the second
week or later during hospitalization, and 3 of these patients had
negative stool cultures prior to a positive culture.Conclusions:Although Y enterocolitica has not previously been
recognized as a common hospital problem, at least 28% of our patients
acquired their Yersinia infections in the hospital. In some cases, cross
infections, transmitted by healthcare workers, occurred between patients.
Four of the 18 infections occurred in patients with acquired
immunodeficiency syndrome.
Increased Use of Pneumococcal Vaccination in a Medicine Clinic
Following Initiation of a Quality Assessment Monitor
Authors: Tobacman Joanne K. 
Published: September 2009

AbstractObectives:To determine the use of pneumococcal vaccination in a general medicine
ambulatory clinic and the effect of a quality assessment monitor on
use.Design:A prospective 8-month (October 1990 through May 1991) survey and 8-month
(October 1989 through May 1990) retrospective survey of use of
pneumococcal vaccination in the clinic.Setting:A general medicine clinic where patients are seen for their first
internal medicine clinic visit at The University of Iowa Hospitals and
Clinics, Iowa City, Iowa.Patients:One thousand sixty adult patients who presented to the clinic during the
study interval.Interventions:The use of the form constituted an intervention.Results:Use of pneumococcal vaccination was increased more than 5 times over the
baseline level following implementation of the quality assessment
monitor.Conclusions:Underuse of pneumococcal vaccination occurred in this general medicine
clinic, and the introduction of a quality assessment monitor constituted
an intervention that significantly increased the use of pneumococcal
vaccination.
Clustered Bacteremias in a Hemodialysis Unit Cross-Contamination
of Blood Tubing From Ultrafiltrate Waste
Authors: Longfield Robert N. , Wortham William G. , Fletcher Linda L. , Nauscheutz William F. 
Published: September 2009

AbstractObjectve:To determine the cause of clustered bacteremias occurring among chronic
hemodialysis patients.Design:A retrospective investigation of clinical and laboratory records with
direct observation of dialysis facilities and technique. Bacterial blood
isolates were identified and compared with environmental isolates.Setting:The 1 1-station chronic hemodialysis unit that serves approximately 50
patients in a 450-bed military hospital.Patients:Hemodialysis unit patients with aerobic gram-negative bacillus or
Enterococcus casseliflavus blood isolates between
April 1988 and February 1990.Results:The recovery and species identification of the unique isolate, E
casseliflavus, from 2 index cases of bacteremia in
February 1990 helped identify the cluster and demonstrated its protracted
course. Dialysis blood tubing was contaminated with ultrafiltrate waste
during dialyzer setup.Intervention:Bacteremias were controlled by halting the practice of attaching the
venous tubing directly to a waste container while priming the membrane,
by emphasizing glove changes and handwashing after contact with
ultrafiltrate waste and by daily decontamination of ultrafiltrate waste
bags.Conclusions:We recommend that other hemodialysis units institute these
interventions.
Nosocomial Human Parovirus B19 Infection: Lack of Transmission From a Chronically Infected Patient to Hospital Staff
Authors: Koziol Deloris E. , Kurtzrnan Gary , Ayub Jamshed , Young Neal S. , Henderson David K. 
Published: September 2009

AbstractObjective:To assess the potential for nosocomial spread of parvovirus B19 from a chronically infected patient.Design:Employees exposed to the index case and control (unexposed) employees were evaluated by baseline and follow up parvovirus B19 serologies and hematologic assessments, and completed baseline and follow up epidemiologic questionnaires.Setting:A chronically infected patient was hospitalized on a hematology ward in a research referral hospital for 3.5 weeks prior to a diagnosis of parvovirus B19 infection and the institution of isolation precautions.Methods:Sera were screened for parvovirus B19 DNA (dot blot analysis), and IgG and IgM anti-B19 antibodies (capture immunoassay). Hematologic assessment included CBC, differential, and reticulocyte count.Results:The index case had parvovirus B19 DNA at approximately lo6 genome copies per ml of serum, elevated IgM and low levels of IgG B19 antibodies. Of the 21 exposed staff, 11 (52%) had IgG B19 antibodies and were immune; of the 8 unexposed staff, 6 (75%) had IgG B19 antibodies. No employees developed IgM B19 antibodies, B19 DNA, hematologic abnormalities, or clinical symptoms.Conclusions:In contrast to reports of documented nosocomial transmission of B19 parvovirus from patients in transient aplastic crisis, nosocomial transmission did not occur-even in the absence of isolation precautions-presumably from the lower level of B19 viremia in our chronically infected (rather than acutely infected) patient.