bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Handwashing on Mortality in Intensive Care: Examination of the Evidence
Authors: Nystrom Bertil 
Published: September 2009

AbstractOur highest priority should be to increase compliance with hand hygiene guidelines. It is food for thought that in several studies the group with the lowest compliance in intensive care settings is intensive care physicians. It is a reasonable assumption that they are role models for the rest of the ICU staff. Studies on practical and efficient means to increase compliance with hand hygiene guidelines and to influence behavior surely are needed more than are elaborate and sophisticated studies on the effects of handwashing.
Can Topical and Nonabsorbable Antimicrobials Prevent Cross-Transmission of Resistant Strains in ICUs?
Authors: Brun-Buisson Christian , Legrand Patrick 
Published: September 2009

AbstractTopical antimicrobials may complement traditional infection control measures and hasten the control of an outbreak. When a suitable nonabsorbable antimicrobial regimen can be found, its use during outbreaks caused by Enterobacteriaceae colonizing the digestive tract appears especially attractive, whether the infection occurs via primary endogenous colonization or exogenous colonization. In the latter circumstance, however, topical antimicrobials are not a substitute for isolation precautions and careful handwashing, which remain insufficiently adhered to in ICUs. Topical antimicrobials should be used as part of a global strategy in which isolation precautions remain of primary importance. It is likely, but unproven by well-designed studies, that nasal decontamination of patient carriers during outbreaks due to methicillin-resistant Staphylococcus aureus can be useful to control the outbreak. In this instance, however, skin and wound disinfection appears as an essential complementary measure, and careful attention should be given to extranasal sites of colonization with MRSA, where resistance to the topical agent can emerge. Whatever the circumstances and setting, prolonged use of topical antimicrobials during protracted outbreaks is less effective and carries a major risk of resistance to the topical agent(s) used against the outbreak strains. In such circumstances, careful microbiologic monitoring of colonization is mandatory.
Antimicrobial Prophylaxis in Surgery: General Concepts and Clinical Guidelines
Authors: Martin Claude ,   French Study Group on Antimicrobial Prophylaxis in Surgery,   French Society of Anesthesia and Intensive Care
Published: September 2009

AbstractBacteria are found in 90% of surgical incisions, regardless of surgical technique or environment. Initially, the number of pathogens is low, but proliferation is facilitated by favorable local conditions and weakened host defense mechanisms. The principles of presurgical administration of antibiotics are well defined, but a few controversies persist. An ideal antimicrobial agent would not induce bacterial resistance in pathogenic organisms, would penetrate tissues effectively, would have a long enough half-life so that a single injection could guarantee protection throughout the operation, would have a low toxicity, would not interfere with anesthetics, would be easy to administer, and would be cost-effective.
Antibiotic Resistance Is Selected Primarily in Our Patients
Authors: Pechere Jean-Claude 
Published: September 2009

AbstractThe potential for bacterial resistance probably existed prior to the arrival of humans on earth and bacterial populations isolated before the antibiotic era surely contained antibiotic-resistant organisms. Antibiotic resistance has undergone an explosive development following the introduction of antibiotics in medical practice and in agriculture, and there is no doubt that the higher prevalence of bacterial resistance is closely related to human activities. Strict infection control policies limit the risk of patient-to-patient transmission of resistant as well as susceptible bacteria.
Do Nonclinical Uses of Antibiotics Make a Difference?
Authors: Young Hilary-Kay 
Published: September 2009

AbstractAn increasing range of antibacterial compounds is being used for nonclinical purposes, especially in the fields of animal husbandry and fish farming. As in human medicine, exposure to antibiotics has lead to the emergence of antibiotic-resistant bacteria in animal populations. The potential impact of antibiotic use in animals on human health and the management of clinical infections in humans is discussed in light of growing evidence to suggest that “new” resistance genes and multiresistant pathogens with increased pathogenicity are emerging in food animals as a direct consequence of antibiotic exposure.
Pros and Cons of BCG Vaccination in Countries with Low Incidence of Tuberculosis
Authors: Tala Eero O. , Tala-Heikkila Marianna M. 
Published: September 2009

AbstractPreventive bacille Calmette-Guérin (BCG) vaccination, together with case finding and effective chemotherapy, has formed an integral part of the tuberculosis (TB) control program in most countries. In some low-incidence countries the balance of prevention has been more on the side of chemoprophylaxis than of BCG vaccination. The time clearly has come when the strategy of mass BCG vaccination no longer is indicated medically, nor is it cost-effective. The pros and cons of the programs need to be critically evaluated against the present epidemiological background, taking into account the facts that TB, the killer disease, is recovering strength, human immunodeficiency virus infection is on the increase, and multidrug-resistant TB has changed the outcome of this previously fully curable disease.Although no longer appropriate for mass programs, BCG vaccination still should be considered for the protection of selected risk groups in low-incidence countries. The overall efficacy may be of the order 50% to 80%, but the variation is great. Therefore, further research urgently is needed on the effectiveness of BCG as an intervention in local TB programs.
Usefulness of Molecular Epidemiology for Outbreak Investigations
Authors: Jarvis William R. 
Published: September 2009

AbstractWe conducted a retrospective review of nosocomial outbreak investigations conducted by the Hospital Infections Program, Centers for Disease Control and Prevention, from January 1991 through March 1994. Selected outbreaks have demonstrated the utility of molecular methods such as plasmid analysis, plasmid restriction endonuclease analysis, ribotyping, restriction fragment polymorphism, pulsed-field gel electrophoresis, and polymerase chain reaction in confirming the clonality of the outbreak and in confirming the source of the outbreak implicated in the epidemiologic investigation. These data show that molecular typing of isolates is particularly useful when combined with epidemiologic investigations of nosocomial outbreaks.
Real and Apparent Tuberculin Skin Test Conversions in a Group of Medical Students
Authors: Wurtz Rebecca , Fernandez Jose , Jovanovic Borko 
Published: September 2009

AbstractObjective:To evaluate tuberculin skin test (TST) conversions among a group of medical students.Design:Questionnaire sent to a medical school class in whom a cluster of TST conversions was noted, and interview and repeat TST of students with conversion.Setting:County hospital and associated medical school.Subjects:Medical students, after their third year in medical school.Results:Of 165 students in the class, 115 (70%) responded; 10 reported TST conversions between the beginning of the third and the fourth year. Seven of 10 were interviewed, and all 10 were retested. Five students, all in a cohort who tested each other during a clinical clerkship with a tuberculin material previously reported to be associated with a high rate of false-positive TSTs, were TST negative on repeat. Five had persistently positive TSTs. One was exposed during a psychiatry clerkship to a resident with pulmonary tuberculosis. Four students appeared to have converted their TST during their third year in medical school. All four did their medicine clerkship at a large county hospital (P<0.02; odds ratio = 16.4) that had few infection control measures in place for tuberculosis isolation during the time of their exposure.Conclusions:We recommend that medical students, as well as other healthcare professions students, be educated about infection control practices and skin tested at least annually during clinical training years.
A Common Source Outbreak of Gastroenteritis in a Teaching Hospital
Authors: Khatib Riad , Naber Mary , Shellum Nancy , Ashton Laura , Knowles Karen , Giardina Vickie , Wilson Francis M. 
Published: September 2009

Abstract:An outbreak of gastroenteritis at a large teaching hospital affected at least 52 workers. Investigation implicated a tuna salad, and the circumstances suggested Clostridium perfringens as the etiologic agent. The risk of such outbreaks may be reduced by cooling of ingredients prior to mixing and refrigeration in small steel containers.
Utility of the Hospital Tuberculosis Registry
Authors: Bryan Charles S. , Brenner Eric R. 
Published: September 2009

AbstractEmerging guidelines suggest that the management of tuberculosis and suspected tuberculosis in the hospital will become an increasingly costly enterprise. The local hospital registry can be a focal point for determining the extent to which such measures are necessary at individual institutions, that existing infection control recommendations are being carried out, and that patients released from the hospital are not lost to follow-up. Consideration might be given to inclusion of all patients begun on antituberculous therapy, regardless of the results of acid-fast bacilli cultures, in view of renewed concern about patient compliance.
Scabies Epidemic: Price and Prejudice
Authors: Pastenak Jacyr , Richtmann Rosana , Ganme Antonio P.P. , Rodrigues Edwal A.C. , Silva Fermina B.M. , Hirata Maria de Lurdes , Ciosak Suely 
Published: September 2009

AbstractScabies epidemics are not unusual, and the recommended way of stopping them is by simultaneous treatment of everybody in the facility; this has been known since the last century, when Norwegian scabies was a problem in Norway. When this is not done, scabies epidemics can smolder for months. Scabies should not spread with good infection control measures, but we learned that a good infection control service is not enough. Efforts have to be done to educate everybody in the hospital, including laundry workers, and to improve work conditions.
Bootstrapping
Authors: Gunter Bert 
Published: September 2009

Two questions confront data analysts: What's going on in the data? And how certain are the conclusions? One must deal with both questions to make rational decisions. John Tukey has called the two aspects of analysis exploratory and confirmatory. Consider, for example, a study in which patient data are analyzed for patterns that might identify causative agents for a particular disease. First, one should explore the data to reveal meaningful regularity (or perhaps irregularity might be a better way of saying it). For example, is there clustering in the geographic distribution of the patients that might indicate an environmental agent? After tentative pattern identification, confirmation is required to determine whether the patterns could simply be due to chance variation. That is, is the clustering strong enough to merit further detailed investigation or will the pattern disappear when further data are analyzed?Classical statistical methods approach these questions through the foundation of probabilistic inference. I believe that it is no exaggeration to say that development of such methods during the 20th century are among the most important achievements in the history of science. They have contributed to the scientific method a systematic way of discerning what A.S.C. Ehrenberg calls “lawlike relationships” in empirical data. Their application has been decisive to progress in fields as diverse as nuclear physics, engineering design, genetics, agriculture, and paleontology, as well as medical science.
Catheter-Associated Bacteriuria in Long-Term Care Facilities
Authors: Warren John W. 
Published: September 2009

AbstractCatheter-associated bacteriuria is the most common infection acquired in long-term care facilities. Complications include fever, acute pyelonephritis, bacteremia, catheter obstruction, urinary stones, chronic interstitial nephritis, renal failure, and death. The closed-catheter system has been the only innovation in this traditional method of care that has led to prevention of bacteriuria. Antimicrobial agents rarely are indicated to prevent or treat bacteriuria in long-term catheterized patients, except for those with symptomatic infection. Alternative devices are available and often may be preferable to the indwelling urethral catheter.These patients and their reservoirs of bacteriuric organisms are sources of nosocomial outbreaks. Such outbreaks can be prevented and controlled with attention to catheter hygiene, prevention of patient-to-patient transmission on the hands of caregivers, and possibly use of antimicrobials to diminish bacterial concentrations in the urine.
International Comparison of Results of Infection Surveillance: The Netherlands Versus Belgium
Authors: Mertens R. , Van den Berg J.M. , Veerman-Brenzikofer M.L.V. , Kurz X. , Jans B. , Klazinga N. 
Published: September 2009

AbstractObjective:To explore the potential benefit of comparing results from two national surveillance networks.Design:Two prospective multicenter cohort studies of surgical wound infections (SWI).Setting:Thirty-five and 62 acute-care hospitals in The Netherlands (NL) and Belgium (B), respectively, from October 1, 1991, to June 30, 1992.>Results:The participation was equivalent in the two countries: 27% (NL) and 28% (B) of all acute-care hospitals.Marked differences emerged between the Dutch and Belgian crude infection rates and the specific rates by wound class and other risk factors.Because the case-mix in the countries is quite different, comparisons can be made only by specific surgical category. The results for inguinal hernia repair and for appendectomy are compared as an example.In hemiorrhaphies, the difference in infection rate (0.4% [NL] versus 1.2% [B]) is not explained by differences in the distribution of risk factors. The shorter hospital stay in The Netherlands (4 days [NL] versus 6 days [B]), the more effective postdischarge surveillance in Belgium, and the fact that more than two thirds of the detected infections occurred after the first postoperative week probably can account for most of the difference. There was a striking difference in prophylaxis use (3.7% [ NL] versus 41.9% [B]).In appendectomies, the Dutch patient population shows on average a higher risk profile, and surgery is urgent much more often in The Netherlands (78.3%) than in Belgium (49.2%). The infection rate is higher in The Netherlands, especially among the patients without prophylaxis, which again is employed less frequently there.Conclusion:We conclude that international comparisons yield interesting insights regarding quality of care, reaching beyond the field of nosocomial infection prevention. This is an argument in favor of more harmonization between surveillance networks.
Comparative Risk of Bloodstream Infection in Organ Transplant Recipients
Authors: McClean K. , Kneteman N. , Taylor G. 
Published: September 2009

Abstract:To determine relative rates and sources of nosocomial bloodstream infection in solid organ transplant recipients, concurrently collected data on 277 consecutive patients were reviewed. Twenty-eight patients developed 40 infections. Liver recipients experienced a higher rate (28%) than either kidney (5%) or heart, heart-lung (10%). Primary infections (60% overall) caused by gram-positive bacteria (59% overall) predominated at all three sites.
Multidrug-Resistant Mycobacterium tuberculosis in an HIV Dental Clinic
Authors: Cleveland Jennifer L. , Kent Joseph , Gooch Barbara F. , Valway Sarah E. , Marianos Donald W. , Butler W. Ray , Onorato Ida M. 
Published: September 2009

AbstractObjective:To investigate possible transmission of multidrug-resistant tuberculosis (MDR-TB) in a dental setting.Design:A retrospective, descriptive study of dental workers (DWs), patients, and practice characteristics.Patients:Two dental workers (DW1 and DW2) with acquired immunodeficiency syndrome and MDR-TB.Setting:A hospital-based (Hospital X) human immunodeficiency virus (HIV) dental clinic in New York City.Methods:To identify dental patients with tuberculosis (TB), patients treated in the dental clinic at Hospital X during 1990 were cross-matched with those listed in the New York City Department of Health Tuberculosis Registry Mycobacterium tuberculosis isolates from both DWs and from dental patients with TB were tested for antimicrobial susceptibility and typed by restriction fragment length polymorphism (RFLP) analysis. Infection control practices were reviewed.Results:M tuberculosis isolates infecting DW1 and DW2 were resistant to isoniazid and rifampin and had identical RFLP patterns. DW1 and DW2 worked in close proximity to each other in a small HIV dental clinic in Hospital X during 1990. Of 472 patients treated in the dental clinic in 1990, 41 (8.7%) had culture-proven M tuberculosis infection. Of these 41, 5 had isolates with resistance patterns similar to both DWs; however, for four available isolates, the RFLP patterns were different from the patterns of the DWs. Sixteen of the 41 patients received dental treatment while potentially infectious. Dental patients were not routinely questioned about TB by dental staff, nor were all dental staff screened routinely for TB. No supplemental environmental measures for TB were employed in the dental clinic in 1990.Conclusions:Our investigation suggests that MDR-TB transmission may have occurred between two DWs in an HIV dental clinic. Opportunities for transmission of TB among dental staff and patients were identified. TB surveillance programs for DWs and appropriate infection control strategies, including worker education, are needed to monitor and minimize exposure to TB in dental settings providing care to patients at risk for TB.
The Evolving Epidemiology of Methicillin-Resistant Staphylococcus aureus at a University Hospital
Authors: Layton Marcelle C. , Hierholzer Walter J. , Patterson Jan Evans 
Published: September 2009

AbstractObjective:To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) at a university hospital during a 14-month period.Design:Prospective laboratory-based surveillance for MRSA with descriptive epidemiology based on medical chart review and characterization of strains by DNA typing, using pulsed-field gel electrophoresis (PFGE).Setting:An 850-bed tertiary care university hospital.Patients:Patients with clinical isolates of MRSA.Main Outcome Measure:Determination whether MRSA isolates were community- or hospital-related.Results:Among 87 patients with MRSA, 36 (41%) had community-acquired infections. Community acquisition was associated with recent hospitalization, previous antibiotic therapy, nursing home residence, and intravenous drug use. Greater than 3 months had elapsed from the time of discharge for 13 (62%) of the 21 patients with community-acquired isolates hospitalized within the last year. Eight patients (22%) with community-acquired MRSA had no discernible risk factors. PFGE allowed differentiation of 35 distinct whole-cell DNA patterns; heterogeneity was seen among both nosocomial and community-acquired isolates, with few instances of cross-transmission.Conclusions:Our data suggest an increase in community acquisition of MRSA. PFGE demonstrated heterogeneity of MRSA isolates from both the community and the hospital setting.
Interrepeat Fingerprinting of Third- Generation Cephalosporin-Resistant Enterobacter cloacae Isolated During an Outbreak in a Neonatal Intensive Care Unit
Authors: Verweij Paul E. , Van Belkum Alex , Melchers Willem J.G. , Voss Andreas , Hoogkamp-Korstanje Jacomina A.A. , Meis Jacques F.G.M. 
Published: September 2009

AbstractObjective:To investigate an outbreak in neonates of Enterobacter cloacae infection resistant to third-generation cephalosporins.Design:A retrospective study of an outbreak in the neonatal intensive care unit (NICU) and review of E cloacae isolates in pediatric wards and other intensive care units from June 1992 through March 1993.Setting:An academic tertiary care hospital.Patients:Six patients admitted to the NICU were colonized or infected with E cloacae resistant to third-generation cephalosporins. In the period preceding the outbreak, four E cloacae isolates were available from four patients in the pediatric surgical ward. Nine isolates from four patients in two other intensive care units (ICUs) also were collected during the outbreak. Isolates were biotyped by the API 50CH system and genotyped by polymerase chain reaction (PCR) fingerprinting.Results:Typing by interrepeat PCR showed that 21 isolates, which were obtained from five neonates, were identical. One neonate was colonized with a different strain. Some neonates were colonized with a single type of E cloacae for a relatively long period of time. Isolates of patients who were cared for in the pediatric surgical ward and the two other intensive care units (ICUs) showed different genotypes. One patient in an ICU was colonized with an E cloacae strain genetically identical to the outbreak strain. No predominant biotype could be established.Conclusions:E cloacae can colonize neonates for a long period of time and although colonization with E cloacae initially may arise endogenously, we were able to show further transmission by cross-contamination in a neonatal intensive care unit.
Recovery of Pseudomonas cepacia and Other Pseudomonas Species from the Environment
Authors: Mortensen Joel E. , Fisher Margaret C. , LiPuma John J. 
Published: September 2009

AbstractNine hundred sixteen cultures were obtained from homes of patients with cystic fibrosis, control homes, salad bars, and food markets, and analyzed for the presence of Pseudomonas cepacia and related bacteria. P cepacia was recovered from 5 (18%) of 27 homes, and from 20 (4%) of 509 cultures collected outside of homes. Relative to other pseudomonads, P cepacia is found infrequently in the environment. It is not clear how frequently these sources contribute to acquisition of this bacteria by persons with cystic fibrosis.
The Project to Monitor Indicators: A Collaborative Effort Between the Joint Commission on Accreditation of Healthcare Organizations and the Society for Healthcare Epidemiology of America
Authors: Kritchevsky Stephen B. , Simmons Bryan P. , Braun Barbara I. 
Published: September 2009

The Project to Monitor Indicators (PMI) will be a collaborative effort between the Society for Healthcare Epidemiology of America (SHEA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The goal of this collaboration is to create an intellectual infrastructure to support the effective use, development, understanding, and continuous improvement of clinical quality indicators through coordinated study by hospital epidemiologists.The Joint Commission is in the midst of an extensive effort to develop a set of indicators that reflect the performance of various aspects of clinical practice. These indicators will form the foundation of a national comparative measurement system called the Indicator Measurement System (IMSystem). It is the Joint Commission's plan that hospitals will be required to participate in the IMSystem as part of the accreditation process in the near future.