bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention of Legionella Infections in a Bone Marrow Transplant Unit: Multifaceted Approach to Decontamination of a Water System
Authors: Matulonis Ursula , Rosenfeld Craig S. , Shadduck Richard K. 
Published: September 2009

AbstractObjective:To evaluate measures intended to reduce Legionella infections in patients undergoing bone marrow transplantation (BMT).Design:Ongoing clinical and microbiological surveillance for Legionella colonization or infection was undertaken. All neutropenic patients with pulmonary infiltrates and fever unresponsive to broad-spectrum antibiotics were tested for Legionella organisms.Setting:A 505-bed medical-surgical hospital with a designated BMT unit.Patients:Two hundred twenty-five patients underwent BMT; 201 were treated on a new BMT unit. The incidence of Legionella infections was compared to that seen in an estimated 150 neutropenic patients treated on other units.Intervention:A combined approach to decontamination of a hospital water supply was assessed. This included heating, particulate filtration, ultraviolet sterilization, and monthly pulse hyperchlorination of water supplied to the BMT unit. The incidence of Legionella infections was assessed on the BMT unit and compared with the frequency elsewhere in the hospital.Results:There were only three cases of Legionella pneumonia among 201 patients undergoing transplantation on a new BMT unit. In contrast, 33 cases of Legionella infections were detected from approximately 150 patients treated on general medical floors.Conclusion:A multifaceted approach to decontamination of a hospital water system led to a marked reduction in Legionella infections.
Infection with Methicillin-Resistant Staphylococcus aureus Among Hospital Employees
Authors: Muder Robert R. , Brennen Carole , Goetz Angella M. 
Published: September 2009

AbstractObjective:To describe the spectrum of clinical infection caused bymethicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers.Design:Case series.Setting:Two Veterans Affairs hospitals in which methicillin-resistant S aureus (MRSA) is endemic.Patients:Five employees presenting to employee health or infectious disease clinic.Results:All employees had had direct exposure to patients colonized with MRSA. Employee infections included cellulitis, impetigo, folliculitis, paronychia, and conjunctivitis. MRSA was isolated from all clinically infected sites and from the anterior nares of two employees. Three employees received a variety of ineffective oral antimicrobials before MRSA was recognized as the causative agent. All infections responded to appropriate therapy.Conclusions:Employees of hospitals with endemic MRSA may acquire MRSA infection. Presentation in our employees was that of relatively uncomplicated soft tissue infection, but several employees received inappropriate therapy before bacteriologic diagnosis. We recommend that culture and susceptibility testing be obtained prior to institution of therapy when hospital employees present with soft tissue infection.
Association Between Climate and Enterobacter Colonization in Swedish Neonatal Units
Authors: Fryklund Birgitta A. , Tullus Kjell , Burman Lars G. 
Published: September 2009

AbstractObjective:To study risk factors for the highly variable local colonization rates with unrelated Enterobacter species strains previously found in 22 Swedish neonatal units (0% to 32.4% of the infants).Patients and Setting:The fecal Enterobacter species carriage rates among 953 infants in the 22 special-care neonatal units were correlated with variables related to the ward (size, crowding, staffing, work load, antibiotic usage, level of care, hygienic precautions), and the hospital (temperature of water supplied, geographical location).Results:The average Enterobacter species carriage rate was highest at seven days of age (17% of the infants) and then declined to 3%. Only location of the hospital in an area with warmer climate according to horticultural zone showed an association with Enterobacter species carriage in multivariate analysis (P= 0.005).Conclusion:Although Enterobacter species mainly cause nosocomially acquired infections, the occurrence of the organism in special-care neonatal units seemed to be determined more by extrahospital than by intrahospital factors.
Nosocomial Outbreak of Pseudomonas cepacia Associated with Contamination of Reusable Electronic Ventilator Temperature Probes
Authors: Weems J. John 
Published: September 2009

AbstractObjective:The investigation and control of an outbreak of nosocomial Pseudomonas cepacia respiratory tract colonization and infection.Design:Epidemiologic investigation based on infection control surveillance data, including definition and characterization of case patients, environmental cultures based on epidemiologic information, and institution of control measures based on study results.Setting:A 1,171 -bed, university-affiliated tertiary care hospital.Results:Between January 1, 1988, and June 30, 1989, 127 patients were culture-positive for P cepacia, 117 (92%) of whom were culture-positive from sputum and were treated in the intensive care unit. Review of respiratory care procedures revealed that when mechanical ventilators were serviced between patients, the electronic temperature probes used with servo-controlled humidifiers were wiped with the same odor-counteractant cleaning solution used on ventilator cabinets, P cepacia was isolated from nine of 12 in-use temperature probe tips, three of which were from patients with negative sputum cultures for P cepacia, one of whom subsequently developed culture positivity for P cepacia.P cepacia also was isolated from the diluted odor-counteractant solution. Following the institution of a disinfection procedure for temperature probe tips, the incidence of P cepacia sputum culture positivity in ICU patients fell significantly compared to the outbreak period (138 of 5,225 discharges versus 52 of 3,678 discharges, P<0.01).Conclusions:This investigation identified contamination of reusable electronic temperature probes as a source of nosocomial respiratory infection due to P cepacia and emphasizes the need to carefully evaluate disinfection practices for reusable patient care equipment.
Outbreak of Candida tropicalis Fungemia in a Neonatal Intensive Care Unit
Authors: Finkelstein R. , Reinhertz G. , Hashman N. , Merzbach D. 
Published: September 2009

AbstractObjective:To describe an outbreak of Candida tropicalis fungemia in a neonatal intensive care unit (NICU), to evaluate the risk factors associated with this infection and the possible mode of nosocomial transmission.Design:Descriptive and case-control studyPatients and Methods:Surveillance cultures were taken from hospitalized patients, personnel, and inanimate objects in the NICU. Six patients with C tropicalis fungemia (cases) were compared with C tropicalis culture-negative patients matched for duration of exposure to the NICU (controls).Results:During a five-month period, C tropicalis was isolated from 29 blood cultures of six premature infants. The same organism also was isolated from fingernail samples taken from the ward housekeeper, who had a mild onychomycosis, and an asymptomatic nurse. Other potential reservoirs of C tropicalis were not identified among all the other infants or in the hospital environment. The six patients with C tropicalis fungemia were more likely to have received a larger number of antibiotics (4.0 versus 1.8, R<0.001) and to have been subjected to a longer duration of total parenteral nutrition (TPN) therapy (8.5 versus 2.67 days, P= 0.004) than the controls.Conclusions:The risk of fungemia in this outbreak can be attributed to a larger number of antibiotics and a longer period of TPN administered to the patients. Analysis of events suggests that the outbreak may have been the result of cross-infection between staff and patients.
Molecular Epidemiology of Nosocomial Infection: Analysis of Chromosomal Restriction Fragment Patterns by Pulsed-Field Gel Electrophoresis
Authors: Barg Neil L. , Goering Richard V. 
Published: September 2009

The epidemiological analysis of nosocomial pathogens is a subject of long-standing clinical interest. In recent years, molecular techniques have received increasing attention as a means of analyzing epidemiological interrelationships, thus leading to use of the term molecular epidemiology. Since chromosomal DNA represents a fundamental molecule of cellular identity, there has been particular interest in assessing chromosomal similarity as a measure of epidemiological relatedness.One attractive approach has been to digest chromosomal DNA with restriction enzymes, resulting in a series of different sized fragments that form patterns when comparatively analyzed by agarose gel electrophoresis. In this context, differences in fragment patterns commonly are referred to as restriction-fragment length polymorphisms (RFLPs). Enzymes commonly used to cleave DNA typically recognize numerous sites within the bacterial chromosome. With such enzymes, restriction digestion of DNA from different bacterial isolates results in fragments that are too numerous to compare accurately after conventional agarose gel electrophoresis.
Evaluation of Rooms with Negative Pressure Ventilation Used for Respiratory Isolation in Seven Midwestern Hospitals
Authors: Fraser Victoria J. , Johnson Krista , Primack Jonathan , Jones Marilyn , Medoff Gerald , Dunagan W.C. 
Published: September 2009

AbstractObjective:To determine the number and efficacy of respiratory isolation facilities in St. Louis hospitals and to assess the mechanisms in place for evaluating function of hospital ventilation systems.Design:A prospective multi-hospital surveillance study using direct observation and a standardized questionnaire.Setting:Seven hospitals (including university-affiliated large teaching, private community, private teaching, and private nonteaching adult hospitals, and one pediatric teaching hospital) in St. Louis, Missouri.Measurements:Actual direction of airflow in rooms designated for respiratory isolation was measured using smokesticks. Hospital demographic information, respiratory isolation policies, and frequency of ventilation tests were provided by infection control personnel.Results:One hundred twenty-one (3.4%) of 3,574 hospital rooms were designed to have negative pressure ventilation suitable for respiratory isolation. The percentage of isolation rooms in each institution ranged from 0.4% (92 of 486) to 93% (39 of 42). Only three (43%) of seven hospitals had intensive care respiratory isolation rooms, and none had isolation rooms in the emergency department. No hospital had tested routinely the efficacy of the negative pressure ventilation, and two (28%) of seven had tested airflow for the first time in the past year.We tested 115 (95%) of 121 isolation rooms. With the doors closed, 52 (45%) of 115 designated negative pressure rooms actually had positive airflow to the corridor. The number of negative pressure rooms and the presence or absence of anterooms did not predict correct direction of airflow. There was a significant difference among hospitals in the percentage of designated isolation rooms that had truly negative pressure (P<0.0001). Hospital age, size, and type corre-latedwith correct direction of airflow (R<.0001).Conclusion:In the hospitals studied, only a small number of rooms were designated for respiratory isolation, and the performance of these was not tested routinely. High-risk areas including intensive care units and emergency rooms were not equipped to provide respiratory isolation. The direction of airflow in respiratory isolation rooms was not always correct and should be evaluated frequently. (Infect Control Hosp Epidemiol 1993;14:623-628.)
A Case-Control Study of Nosocomial Ampicillin-Resistant Enterococcal Infection and Colonization at a University Hospital
Authors: Sexton Daniel J. , Harrell Lizzie J. , Thorpe Jackie J. , Hunt Debra L. , Reller L. Barth 
Published: September 2009

AbstractObjective:To assess risk factors for colonization and nosocomial infection with ampicillin-resistant enterococci (ARE).Design:Patients with ampicillin-resistant enterococci were compared retrospectively by logistic regression analysis with controls harboring susceptible strains. ARE were characterized by whole plasmid DNA analysis and restriction enzyme analysis of plasmid (REAP) DNA with EcoRI.Setting:The study was done at a 1,125 bed, tertiary-care teaching hospital in North Carolina with patients from whom enterococci were isolated from June 1, 1989, to March 30, 1991.Patients:The final study group comprised 44 cases with nosocomially-acquired colonization or infection with ARE and 100 controls with ampicillin-susceptible strains. Clinical and epidemiological risk factors for ARE were abstracted by chart review.Results:After controlling for age and site of infection, patients with ARE were more likely to have been admitted previously to our hospital and to have received third-generation cepha-losporins and clindamycin. However, only advanced age and clindamycin therapy were independently associatedwith presence of ARE. REAP with EcoRI showed 20 groups of enterococci on 19 different wards.Conclusions:These results suggest that ARE are endemic and multifocal in origin in our hospital and that advanced age and use of clindamycin are important selective risk factors for ARE colonization and infection (Infect Control Hosp Epidemiol 1993;14:629-635).
A Nosocomial Pseudo-Outbreak of Mycobacterium xenopi Due to a Contaminated Potable Water Supply: Lessons in Prevention
Authors: Sniadack David H. , Ostroff Stephen M. , Karlix Michael A. , Smithwick Ronald W. , Schwartz Benjamin , Sprauer Mary Ann , Silcox Vella A. , Good Robert C. 
Published: September 2009

AbstractObjectives:To determine risk factors for Mycobacterium xenopi isolation in patients following a pseudo-outbreak of infection with the organism.Design:Retrospective cohort analysis of mycobacteriology laboratory specimen records and frequency-matched case-control study of hospital patients.Setting:General community hospital.See also page 642Patients:For the case-control study, 13 case patients and 39 randomly selected controls with mycobacterial cultures negative for M xen-opi, frequency matched by specimen source, whose specimens were submitted from June 1990 through June 1991.Results:Between June 1990 and June 1991, M xenopi was isolated from 13 clinical specimens processed at a midwestern hospital, including sputum (n = 6), bronchial washings (2), urine (4), and stool (1). None of the patients with M xenopi- positive specimens had apparent mycobacterial disease, although five received antituberculosis drug therapy for a range of one to six months. Specimens collected in a nonsterile manner were more likely to grow the organism than those collected aseptically (3.1% versus 0, relative risk= infinity, P= 0.003). M xenopi isolation was attributed to exposure of clinical specimens to tap water, including rinsing of bronchoscopes with tap water after disinfection, irrigation with tap water during colonoscopy, gargling with tap water before sputum collection, and collecting urine in recently rinsed bedpans. M xenopi was isolated from tap water in 20 of 24 patient rooms tested, the endoscopy suite, and the central hot water mixing tank, but not from water in the microbiology laboratory. The pseudo-outbreak occurred following a decrease in the hot water temperature from 130°F to 120°F in 1989.Conclusions:Maintenance of a higher water temperature and improved specimen collection protocols and instrument disinfection procedures probably would have prevented this pseudo-outbreak (Infect Control Hosp Epidemiol 1993;14:636-641).
State Regulation of Hospital Water Temperature
Authors: Mandel Adam S. , Sprauer Mary Ann , Sniadack David H. , Ostroff Stephen M. 
Published: September 2009

AbstractObjective:The purpose of this study was to determine current regulations and policies in the United States concerning maximal water temperatures in acute care hospitals.Design:A standardized questionnaire administered by telephone to health department officials from 50 states and the District of Columbia.See also page 636Setting:State Health Departments in the 50 states and the District of Columbia.Results:All states responded to the survey. Respondents from 39 states (77%) reported regulating maximum allowable hospital water temperature at a mean of 116°F (median, 120°F; mode 110°F; range, 110°F to 129°F). Twelve states (23%) have no regulations for maximum water temperature. Of the 39 states regulating maximum water temperature, 30 (77%) routinely monitor hospital compliance. Nine states (23%) conduct inspections only in response to a complaint or incident.Conclusions:There is great variation among the states with respect to the existence, enforcement, and specific regulations controlling hospital water temperature. Risk-benefit and cost-effectiveness analyses would help to assess the risk of scald injuries at water temperatures that will inhibit microbial contamination (Infect Con-trol HOsp Epidemiol 1993;14:642-645).
The Use of Statistical Process Control Charts in Hospital Epidemiology
Authors: Sellick John A. 
Published: September 2009

Hospital epidemiologists rely on sound scientific and analytical principles in the conduct of surveillance, studies, investigations, etc. The demonstration of differences in occurrence of events (eg, nosocomial infections) in different time periods generally has used traditional hypothesis testing statistical models. However, repetitive hypothesis testing is impractical for frequent analysis of accumulating data, especially when there is no apparent outbreak. Clearly, a statistical procedure that simplifies hypothesis testing to detect acute variations in certain occurrences is desirable. Ongoing analysis of trends also would be desirable.Many United States hospitals have espoused continuous quality improvement (CQI) or similarly identified programs as a means to improve both patient care and operating efficiency. With this trend, the scientific method has become interjected into all aspects of patient management, and no longer is confined to formal research studies. Many scientific quality management techniques that long have been used in industrial settings have been applied to healthcare settings. Noteworthy is the use of statistical methods to describe the variation in processes, which is known as statistical process control (SPC). The term statistical quality control (SQC) often is used interchangeably, but some authors refer to SQC only when statistical methods also are used to improve a process. This article will describe the basic theory and simple application of SPC in hospital epidemiology.
Hantavirus: An Old Bug Learns New Tricks
Authors: Sinnott John T. , Greene John N. , Kim Evelyn , Gompf Sandra 
Published: September 2009

In the early summer of 1993, an enigmatic, catastrophic illness emerged in the southwestern United States. Previously healthy individuals suddenly developed symptoms of headache, fever, myalgia, and cough. This flu-like illness progressed to acute pulmonary insufficiency indistinguishable from adult respiratory distress syndrome. Within days of onset, death by respiratory failure occurred in at least two thirds of patients meeting the case definition. Such an unusual clinical scenario prompted a systematic quest to establish a pathogen responsible for this new and deadly illness.After eliminating the possibilities of plague and environmental toxins as causative agents, investigators evaluated a wide array of antibody titers on sera from patients fitting case criteria. They discovered rising titers of antibodies to hantavirus in paired sera of several patients. Furthermore, immunohistochemical staining revealed hantavirus antigen in the autopsy specimens of some cases. Thus, laboratory evidence implicated a hantavirus as the culprit of the illness in the Southwest, yet the clinical profile was incongruent with other known illnesses induced by this pathogen. Whereas outbreaks of hantavirus infection with high mortality normally are marked by extensive hemorrhagic and renal complications, none of the present cases in the Southwest exhibited such pathology. Moreover, hantavirus infection, although endemic to many regions throughout the world, never had surfaced previously in the United States as the cause of acute illness.
A Ventilation-Filtration Unit for Respiratory Isolation
Authors: Marier Robert L. , Nelson Tim 
Published: September 2009

AbstractObjective:The development of a new method for achieving respiratory isolation in hospitals, clinics, and residential facilities, in response to the increasing risk of transmission of tuberculosis and the limitations of the currently available isolation systems.Design:Ultraviolet (UV) light and ultra-low-penetration air filtration were combined with a ventilation unit and adapted for use in modular isolation rooms or for conversion of existing rooms.Results:The ventilation-filtration unit efficiently cleared bacterial aerosols and particles >0.2 μm from the air, maintained required negative pressures and airflows, and provided directional airflow within rooms.
Sporicidal Activity of Chemical Sterilants Used in Hospitals
Authors: Rutala William A. , Gergen Maria F. , Weber David J. 
Published: September 2009

AbstractObjective:The current study was designed to assess the sporicidal activity of chemical sterilants using the Association of Official Analytical Chemists (AOAC) sporicidal test. Chemical sterilants are used most commonly in the healthcare setting to disinfect medical instruments such as endoscopes. This study was undertaken to evaluate the efficacy of several newer formulations of glutaraldehydes and hydrogen peroxide as chemical sterilants.Design:Using the AOAC test the following agents were tested: two 2% alkaline glutaraldehydes (2% Alk-Glut), 2% acid glutaraldehyde (2% Acid Glut), 2% glutaraldehyde-7.05% phenol-1.20% sodium phenate, 10% glutaraldehyde-0.5% phenylphenol-0.1% tertiary amylphenol, and 6% hydrogen peroxide (H202). Growth in > 1 of 60 seeded penicylinders is considered by the AOAC to indicate failure of sporicidal activity,Results:Test results of the six disinfectants against Bacillus subtilis using the manufacturers' specified use-dilution and exposure time were: 0/60 with 2% Alk-Glut (product 1) at 10 hours, 0/60 with 2% Alk-Glut (product 2) at 8 hours, 0/60 with 2% Acid Glut at 10 hours, 2/60 with 2% glutaraldehyde-7.05% phenol-1 .20% sodium phenate at 6.75 hours, 0/60 with a 1:5 dilution (2.0% Glut) of 10% glutaraldehyde-0.5% phenylphenol-0. 1% amylphenol at 6 hours, 59/60 with a 1:20 dilution (0.5% Glut) of 10% glutaraldehyde-0.5% phenylphenol-0.1% tertiary amylphenol at 12 hours and 0/60 with 6% H202 at 6 hours. Test results against Clostridium sporogenes were: 2/60 with 2% Alk-Glut (product 1) at 10 hours, 1/60 with 2% Alk-Glut (product 2) at 8 hours, 1/60 with 2% Acid Glut at 10 hours, 2/60 with undiluted 2% glutaraldehyde-7.05% phenol-1.20% sodium phenate at 6.75 hours, 6/60 with a 1:5 dilution (2% Glut) of 10% glutaraldehyde-0.5% phenylphenol-0.1% amylpenol at 6 hours, 60/60 with a 1:20 dilution (0.5% Glut) of 10% glutaraldehyde-0.5% phenylphenol-0.1% amylpenol at 12 hours, and 0/60 with 6% H202 at 6 hours. Dilutions of 2% glutaraldehyde-7.05% phenol-1.20% sodium phenate yielded the following results against C sporogenes: 59/60 with a 1:8 dilution (0.25% Glut) at 6.75 hours, 60/60 with a 1:16 dilution (0.125% Glut) at 6.75 hours, 11/90 with a 1:8 (0.25% Glut) dilution at 12 hours, and 60/60 with a 1:16 dilution (0.125% Glut) at 12 hours.Conclusions:Both 2% acid and alkaline glutaraldehydes are effective chemical sterilants. Diluting glutaraldehyde-based sterilants below 2% glutaraldehyde resulted in failure to kill spores of B subtilis and C sporogenes.