bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes, Practices, and Infection Risks of Hemophilia Treatment Center Nurses Who Teach Infection Control for the Home
Authors: Lobato Mark N. , Hannan Judith , Simonds R.J. , Riske Brenda , Evatt Bruce L. 
Published: September 2009

AbstractObjective:To examine the practices toward infection control training and to assess the attitudes about, and risks for, exposures to blood among hemophilia treatment center (HTC) nurses who teach home infusion therapy (HIT).Design and Population:Written and telephone interview surveys of the 153 nurses who teach HIT at federally funded HTCs.Main Outcome Measures:Hemophilia treatment center nurses' teaching practices and infection control messages taught, and frequency of exposures to blood.Results:The response rate to the written nurses' survey was 60% and to the telephone interview 88%. Nurses taught patients a median of three HIT sessions totaling 4 hours of instruction. Reevaluation of patients' HIT practices took place every 6 months by 22% and every 12 months by 59% of nurses. Nurses frequently reported teaching proper use of a sharps disposal container (99%) and gloves (93%), but less often reported teaching patients to wash hands after infusions (26%) and to report needlestick injuries to HTCs (11%). The respondents identified several barriers to effective infection control as it is practiced in the home by patients. Although at least 30% of HTC nurses recalled having had percutaneous exposure to blood, they considered their risk for hepatitis B infection low but greater than for infection with the human immunodeficiency virus (HIV).Conclusions:While some important infection control messages are stressed during HIT teaching, others may be underemphasized. Failure to instruct patients about all infection control precautions may be related to nurse educators' perception of low to moderate personal risk for hepatitis B and HIV infection. Patients receiving HIT, and those who assist them, need to be fully aware of, and to have reinforced periodically, universal infection control strategies in the home.
Three-Year Outbreak of Pseudobacteremia With Burkholderia cepacia Traced to a Contaminated Blood Gas Analyzer
Authors: Gravel-Tropper Denise , Sample Mary Lee , Oxley Catherine , Toye Baldwin , Woods Donald E. , Garber Gary E. 
Published: September 2009

ABSTRACTBetween November 1990 and June 1993, Burkholderia cepacia was isolated from the blood cultures of 13 neonates born at the Ottawa General Hospital. Eight of the 13 neonates appeared symptomatic, and only 4 were treated with appropriate antimicrobial therapy, but all improved clinically. In August 1993, the blood gas analyzer in the neonatal intensive-care unit was found to be contaminated heavily with B cepacia. Eight available patient isolates were identical to the isolates recovered from the blood gas analyzer by ribotyping analysis. Infection control measures were implemented to prevent future contamination of the analyzer, and no further cases have been identified.
An Outbreak of Burkholderia cepacia Lower Respiratory Tract Infection Associated With Contaminated Albuterol Nebulization Solution
Authors: Reboli A.C. , Koshinski R. , Arias K. , Marks-Austin K. , Stieritz D. , Stull T.L. 
Published: September 2009

AbstractAn outbreak of Burkholderia cepacia lower respiratory tract colonization and infection occurred in the adult intensive-care units in various geographic locations throughout our hospital. Forty-four patients became colonized or infected over an 11-month period, whereas B cepacia had been isolated from only 13 patients in the preceding 48 months. Environmental cultures revealed the source to be extrinsically contaminated albuterol nebulization solution. Polymerase chain reaction-ribotyping confirmed the genetic relatedness of the B cepacia patient isolates and the contaminated albuterol. After extensive infection control training for the respiratory therapy staff, including attention to nebulization technique, washing and drying the nebulizer cup, and good handwashing, there have not been any new cases.
Management of Healthcare Workers With Pharyngitis or Suspected Streptococcal Infections
Authors: Weber David Jay , Rutala William A. , Denny Floyd W. 
Published: September 2009

AbstractThe group A streptococcus may cause pharyngitis, rheumatic fever, streptococcal toxic shock syndrome, and serious skin and soft-tissue infections. More than 50 nosocomial outbreaks have been reported since 1966. For this reason, healthcare facilities should develop policies for the diagnosis and treatment of symptomatic hospital employees, and for the recognition and management of potential outbreaks. The clinical diagnosis of streptococcal pharyngitis is unreliable. Rapid streptococcal tests may be used for initial screening, but a negative rapid test should be confirmed with a properly obtained culture. Penicillin remains the treatment of choice, but new alternatives now include a 5-day course of either azithromycin or cefpodoxime.
Pediatric Primary Gram-Negative Nosocomial Bacteremia: A Possible Relationship With Infusate Contamination
Authors: Macías-Hernández Alejandro E. , Hernández-Ramos Isabel , Muñoz-Barrett Juan M. , Vargas-Salado Enrique , Guerrero-Martínez Francisco J. , Medina-Valdovinos Humberto , Hernández-Hernández Jesus , Ponce-de-León-Rosales Samuel 
Published: September 2009

AbstractObjective: To evaluate the potential contribution of “extrinsic” contamination of intravenous fluids in hospital bacteremia and infection.Design: Prospective cross-sectional survey of infusate contamination, December 1992 to December 1993.Setting: A pediatric department (1,500 admissions per year) in a general, urban teaching hospital, serving low-income patients.Samples and Patients: Infusate samples (0.5 to 1.0 mL) from the injection port used by the staff were taken for cultures from all febrile or septic patients in hospital wards. At least four samples were taken each day; if no febrile or septic patients were available, other patients were sampled at convenience.Results: A 6.8% positive culture rate (87 contaminates in 1,277 infusates) was obtained, without significant differences among the wards. Gram-negative organisms were recovered from 56 samples (62.9%), mainly of the tribe Klebsielleae (56.1%). Coagulase-negative staphylococci were isolated in 30 samples (33.7%). There was no significant difference between the febrile-septic group and the asymptomatic group in the rate of infusate contamination (P=.59). In eight patients, the same organisms were recovered from infusate and blood culture. The overall bacteremia rate was 2.5 per 100 discharges.Conclusions: Compared to previous reports, higher infusate contamination rates and different organisms (mainly gram-negative) were observed. In hospitals of underdeveloped countries, nosocomial infection control frequently is disregarded. Infusate contamination may be common and could lead to gram-negative bacteremia. In such settings, it seems advisable to perform surveillance studies to identify infusate contamination, because a single infusate contamination could be a signal for an epidemic.
Control of Endemic Glycopeptide-Resistant Enterococci
Authors: Dembry Louise M. , Uzokwe Keke , Zervos Marcus J. 
Published: September 2009

AbstractObjective: To evaluate the epidemiology of, and control measures for, vancomycin-resistant Enterococcus (VRE) in a renal unit.Design: A 3-month, prospective, prevalence culture survey of patients on a 24-bed renal unit.Setting: A 975-bed community teaching hospital.Patients: Patients admitted to the renal unit over a 3-month period. Patients identified with VRE were each matched with four patients without VRE isolated over the study period.Interventions/Control Measures: Resistant-organism barrier precautions. To eradicate carriage of VRE, two patients with VRE stool colonization were treated with 5 days of oral doxycycline (100 mg twice per day) and rifampin (300 mg/day).Results: Seven patients with VRE (8 isolates) were identified. Five isolates were Enterococcus faecium (vancomycin MIC=16 to 256 μg/mL), two were Enterococcus faecalis (MICs=16 and 124 μg/mL), and one was Enterococcus gallinarum (MIC=8.0 μg/mL). Eradication of carriage with VRE was accomplished in two patients treated with doxycycline and rifampin. In the final 30 days of the culture survey and at 9 months, there were no further patients with VRE identified.Conclusions: Resistant-organism precautions and elimination of patient carriage may be useful measures for controlling the spread of low-prevalence endemic vancomycin-resistant Enterococcus.
Nosocomial Infections in Spain: Results of Five Nationwide Serial Prevalence Surveys (EPINE Project, 1990–1994)
Authors: Vaqué Josep , Rosselló José , Trilla Antoni , Monge Vicente , García-Caballero Juan , Arribas José L. , Blasco Pedro , Sáenz-Domínguez José R. , Albero Inma , Calbo Francisco , Barrio Josep , Herruzo Rafael , Sáenz-González Carmen , Arévalo José M. ,   EPINE Working Group
Published: September 2009

AbstractObjective: To determine trends in rates of nosocomial infections in Spanish hospitals.Design: Prospective prevalence studies, performed yearly from 1990 through 1994.Setting: A convenience sample of acute-care Spanish hospitals.Participants and Patients: The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately.Results: The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P=.0001). Patients admitted to intensive care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis.Conclusions: The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicate that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.
Vancomycin Use in a University Medical Center: Comparison With Hospital Infection Control Practices Advisory Committee Guidelines
Authors: Evans Martin E. , Kortas Kenneth J. 
Published: September 2009

AbstractObjective: To compare actual vancomycin use in a hospital with the guidelines proposed by the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention.Design: One-month prospective survey of all patients given vancomycin. Data were collected from patient and laboratory records and discussions with prescribing physicians.Setting: Four hundred sixty-one–bed tertiary-care university hospital.Results: Only 35% of the 101 vancomycin orders written during the audit were consistent with HICPAC guidelines. Twenty-eight patients were begun on vancomycin for the treatment of documented infections due to β-lactam–resistant gram-positive bacteria or because preliminary culture results suggested such bacteria were present. Seven methicillin-resistant Staphylococcus aureus, two ampicillin-resistant enterococci, and 10 coagulase-negative staphylococci were recovered. Vancomycin use was judged inappropriate in 66 patients. The drug was used empirically without obtaining appropriate cultures (44 patients), as surgical prophylaxis (6 patients), for primary treatment of antibiotic-associated colitis (3 patients), for convenience in a hemodialysis patient (1 patient), or for other reasons not recommended by HICPAC (12 patients).Conclusions: Vancomycin use in our teaching center often was inconsistent with HICPAC guidelines. Information from the audit will be useful for designing strategies to improve vancomycin use.
Control of Construction-Associated Nosocomial Aspergillosis in an Antiquated Hematology Unit
Authors: Loo Vivian G. , Bertrand Céline , Dixon Catherine , Vityé Debbie , DeSalis Beverley , McLean A.P.H. , Brox Alan , Robson Hugh G. 
Published: September 2009

AbstractObjective: To determine the incidence of aspergillosis in patients with leukemia or bone marrow transplants during a construction-associated outbreak, and the effect of an environmental control program for Aspergillus.Design: Clinical, microbiological, and pathological records were reviewed retrospectively once the outbreak was appreciated, and prospectively thereafter, to determine the presence or absence of aspergillosis and duration of neutropenia.Setting: A university tertiary-care center with a single designated hematology-oncology unit.Patients: From January 1988 to September 1993, there were 141 patients with leukemia or bone marrow transplants identified as being neutropenic during 231 admissions to this specialized unit.Interventions: Installation of wall-mounted portable high-efficiency particulate air (HEPA)-filter air purifiers, application of copper-8-quinolinolate–formulated paint, replacement of perforated ceiling tiles with nonperforated type, sealing of all windows, replacement of horizontal, dust-accumulating blinds with vinyl, opaque, roller shades, and systematic and regular cleaning of surfaces.Results: Thirty-six cases of nosocomial aspergillosis were diagnosed during this period. The incidence density (ID) in the preconstruction period was 3.18 per 1,000 days at risk. During construction activity—before the implementation of a control strategy—the ID increased dramatically to 9.88 per 1,000 days at risk. With infection control measures implemented and continued construction work, the ID decreased to 2.91 per 1,000 days at risk, comparable to the preconstruction baseline rate.Conclusions: An environmental control strategy incorporating widely available technology may have played an important role in controlling this outbreak of construction-associated invasive aspergillosis.
Primary Cutaneous Aspergillosis: Case Report and Review of the Literature
Authors: Larkin Julie A. , Greene John N. , Sandin Ramon L. , Houston Sally H. 
Published: September 2009

AbstractPrimary cutaneous aspergillosis is an uncommon entity that may occur in immunosuppressed hosts, usually resulting from contact with contaminated medical devices used in patient care. The infection spreads locally with subsequent skin necrosis due to angioinvasion and thrombosis. We report primary cutaneous aspergillosis following contact with contaminated gauze, and we review the relevant literature.
Nosocomial Infection Due to Vibrio cholerae in Two Referral Hospitals in Guatemala
Authors: Hernández Jaime E. , Mejía Carlos R. , Cazali Iris L. , Arathoon Eduardo G. 
Published: September 2009

AbstractWe report nosocomial infection with Vibrio cholerae 01, in four seriously ill individuals and one infant in Guatemala. Nosocomial cholera occurs in developing countries in Latin America and should be suspected in hospitalized patients with diarrhea, especially during community outbreaks, in order to institute appropriate diagnostic, therapeutic, and control measures.
Trends in the Prevalence of Methicillin-Resistant Staphylococcus aureus Associated With Discontinuation of an Isolation Policy
Authors: Fazal Barkat A. , Telzak Edward E. , Blum Steve , Turett Glenn S. , Petersen-Fitzpatrick Frances E. , Lorian Victor 
Published: September 2009

AbstractThe number of patients with methicillin-resistant Staphylococcus aureus (MRSA) before and after discontinuing placement of patients into private rooms was determined. The mean monthly number of patients with MRSA decreased from 34 to 22, and the proportion of S aureus isolates that were MRSA decreased from 34% to 20%. We found no evidence that failure to isolate patients with MRSA resulted in an increased prevalence of MRSA.
Risk Factors for Ventilator-Associated Pneumonia in Surgical Intensive-Care–Unit Patients
Authors: Beck-Sague Consuelo M. , Sinkowitz Ronda L. , Chinn Raymond Y. , Vargo Judy , Kaler Wendy , Jarvis William R. 
Published: September 2009

AbstractPatients admitted during the study period to the Sharp Memorial Hospital intensive-care units who required mechanical ventilation were followed prospectively; 15 (10.4%) of 145 acquired ventilator-associated pneumonia (VAP). Duration of prior oral or nasal intubation and H2 receptor antagonists use were longer among patients who developed VAP than among those who did not. Prior cefazolin use was associated with a higher rate of VAP (11 of 63 [17%] versus 4 of 82 [5%], P=.01).
Disinfection and Sterilization of Patient-Care Items
Authors: Herwaldt Loreen A. , Rutala William A. 
Published: September 2009

AbstractThis article provides recommendations on the preferred method for disinfection and sterilization of patient-care items based on the intended use of the item (ie, critical, semicritical, noncritical). The chemical disinfectants recommended for patient-care items and instruments include glutaraldehyde, hydrogen peroxide, peracetic acid, sodium hypochlorite, alcohol, iodophors, phenolics, and quaternary ammonium compounds. The choice of disinfectant, concentration, and exposure time is based on the risk of infection associated with the use of the item. The sterilization methods briefly discussed include steam sterilization, ethylene oxide, dry heat, and the new low-temperature sterilization technologies. When properly used, these disinfection and sterilization processes can ensure the safe use of invasive and noninvasive medical devices. However, this requires strict adherence to current cleaning, disinfection, and sterilization guidelines.
Comparison of a Rapid Readout Biological Indicator for Steam Sterilization With Four Conventional Biological Indicators and Five Chemical Indicators
Authors: Rutala William A. , Jones Suzanne M. , Weber David J. 
Published: September 2009

AbstractObjective: In this study, we compare a new biological indicator that provides results within 3 hours with four conventional, 48-hour biological indicators and five chemical indicators.Design: Biological indicators tested included the conventional Attest 1262, Proof Plus, Assert, and Biosign, and the new Attest 1292 Rapid Readout biological indicator. Chemical indicators tested included Comply, Propper, Chemdi, Sterigage, and Thermalog S. Spore survival following 121°C in a gravity displacement sterilizer was measured by media color change after incubation for 24 and 48 hours at 56°C for the conventional biological indicators, fluorescence at 3 hours for the Attest 1292 Rapid Readout biological indicator, and color change for the chemical indicators. Each exposure time was replicated 12 times with five samples of each indicator per run (ie, 60 replicates per indicator).Results: At 48 hours, the conventional biological indicators Attest 1262, Proof Plus, Assert, and Biosign showed 100%, 95%, 88%, and 93% spore survival at 5 minutes' exposure; 0%, 0%, 0%, and 8% at 10 minutes; and all showed 0% survival at 15 minutes' exposure. Following a 3hour incubation, the Attest 1292 Rapid Readout biological indicator showed fluorescence at 100%, 72%, and 0% at 5, 10, and 15 minutes, respectively. The chemical indicators Comply, Propper, Chemdi, Sterigage, and Thermalog S revealed sterilization failure rates of 100%, 100%, 100%, 100%, and 100% at 5 minutes' exposure; 0%, 0%, 0%, 92%, and 100% at 10 minutes; and, 0%, 0%, 0%, 3%, and 27% at 15 minutes' exposure, respectively.Conclusions: The sensitivity of the Attest 1292 Rapid Readout biological indicator parallels that of conventional biological indicators. These data suggest that a 3hour rapid readout biological indicator is equivalent to a standard 48-hour biological indicator. Some chemical indicators (eg, Thermalog S) failed to indicate adequate sterilization at 15 minutes' exposure. These chemical indicators have the potential of causing unnecessary recall of adequately sterilized items.
Sixteenth-Century Paduan Annotations to the First Edition of Vasari'sVite(1550)*
Authors: Ruffini Marco 
Published: September 2009

AbstractThe discovery of annotations to a copy of Vasari'sVite(1550) in the Beinecke Library at Yale University gives us a rare insight into how the book and contemporary art literature were read and how the information they provided circulated in the Veneto. This article traces the origin of the annotations to the circle of artists and amateurs around the painter Domenico Campagnola in Padua. In polemical reaction to the Florentinism of theVite,the annotations repeat the major anti-Vasarian arguments elaborated by art writers, but also offer new information about Veneto art. There is also a biographical note on Titian, which precedes the publication of the artist's biography in the second edition of theVite(1568).
Piety, Patriotism, and Empire: Lessons for England, Spain, and the New World in the Works of Richard Hakluyt*
Authors: Boruchoff David A. 
Published: September 2009

AbstractThis essay examines the didactic intent of historical works that modern critics, under the influence of a later, especially Victorian, view of English history, have construed as unalloyed propaganda for Protestant England in the pursuit of empire and in its rivalry with Catholic Spain. Careful analysis of the editorial practices of Richard Hakluyt (ca. 1552–1616) reveals that he and others of his generation instead employed patriotic conceits, such as the claim to God's Providence and protection, in a more complex and circumspect manner: as both encouragement and a corrective to national endeavor and as a yardstick against which to measure what was actually done.
Methicillin-Resistant Staphylococcus aureus Control in Hospitals: The French Experience
Authors: Richet Hervé , Wiesel Michel , Le Gallou Florence , André-Richet Béatrice , Espaze Eric ,   Association des Pays de la Loire pour l'Eviction des Infections Nosocomiales
Published: September 2009

AbstractThe first cases of isolation of Staphylococcus aureus resistant to methicillin in France were published in 1962. However, until recently, very few epidemiological studies or attempts to control the epidemic have been done in France. In this article, we present the results of a prospective study performed during a 3-month period in 27 hospitals of the Région des Pays de la Loire. Among the 94,605 hospitalized patients included in the study, 0.45% (427) developed methicillin-resistant Staphylococcus aureus (MRSA) infections, the incidence rate ranging from 0% to 1.2%. Thirty-four percent of MRSA-infected patients were 80 years old or older, 30% had been transferred from another service and 19% from another hospital, 56% were hospitalized at least once during the previous year, MRSA had been isolated at least once previously in 18% of MRSA-infected patients, 19% died, 16% were transferred to another service and 11% to another hospital, and only 32% were discharged to their homes. A poor compliance to contact isolation precautions was observed in all hospitals: 46% of MRSA-infected patients were hospitalized in a private room; gloves, masks, and gowns were worn for the care of 63.4%, 14%, and 42.5% of MRSA-infected patients, respectively; and handwashing was feasible in the rooms of 52% of the patients.