bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of Multilocus Enzyme Electrophoresis to Epidemiologic Investigations of Xanthomonas Maltophilia
Authors: Schable Barbara , Villarino Margarita E. , Favero Martin S. , Miller J. Michael 
Published: September 2009

AbstractObjective:To test the utility of a newly developed multilocus enzyme electrophoresis typing method for Xanthomonas maltophilia.Design:Isolates were first screened by slide agglutination, which served as the standard to characterize the outbreak strains. All isolates were then subjected to multilocus enzyme elec-trophoresis and the results analyzed based on epidemiological data.Setting:This outbreak occurred in a shock-trauma intensive care unit of a large general community hospital.Patients:Patients admitted to the shock-trauma intensive care unit who had X maltophilia isolated from any site > 24 hours after admission met the case definition. Specimens from patients who fit the case definition were characterized, as were specimens from other patients that were used as controls for nonoutbreak isolates. Environmental samples were also evaluated for X maltophilia.Results:Most of the 64 isolates received during this outbreak were serotype 10, and when they were subjected to multilocus enzyme electro-phoresis, one electrophoretic type predominated and correlated to most outbreak isolates. Unrelated isolates of serotype 10 from other institutions all exhibited unique electrophoretic types.Conclusion:Application of multilocus enzyme electrophoresis to X maltophilia outbreaks is a valuable addition to the characterization of suspected outbreak strains.
Effect of Educational Programs, Rigid Sharps Containers, and Universal Precautions on Reported Needlestick Injuries in Healthcare Workers
Authors: Linnemann Calvin C. , Cannon Constance , DeRonde Martha , Lanphear Bruce 
Published: September 2009

AbstractObjective:To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital.Design:Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially.Setting:A 700-bed general hospital that serves as the main teaching hospital of the University of cincinnati.Participants:All employees of University Hospital who reported to personnel health for management of needlestick injuries.Interventions:In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice.Results:Surveillance identified 1,602 needlestick injuries (320/year) or 104/1 ,000/ year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers.Conclusions:The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.
Needlestick Injury: Impact of a Recapping Device and an Associated Education Program
Authors: Whitby Michael , Stead Pat , Najman Jake M. 
Published: September 2009

AbstractObjective:To determine the impact of the introduction of a plastic shield-shaped device (Needleguard, Biosafe, Auckland, New Zealand) and education program designed to allow safer recapping, on recorded rates of needlestick injury.Design:A before-after trial with a two-year duration of follow-up.Setting:Tertiary referral hospital.Participants:Nursing and other hospital personnel.Results:Prospectively collected baseline data, together with the results of an anonymous questionnaire of 25% of the hospital nursing staff, defined a reported needlestick injury rate of 6.9 per hundred full-time nursing staff per year. In the pre-intervention period, there were 6.7 needlestick injuries per 100 nursing staff members per year reported. This increased to 15.4 (p<.0001) needlestick injuries per 100 nursing staff members per year after the intervention. An anonymous survey undertaken at both time periods suggests that the apparent increase in officially reported needlestick injuries is due to an increase in the willingness of nurses to now report previously unreported needlestick injuries.Conclusions:The impact of the safety device and education program was the more accurate reporting of needlestick injuries; many nursing staff continued to resheath needles contrary to hospital policy. Many staff simply did not use the newly designed safety device. Approaches to improving compliance with such safety devices are considered.
A Survey of Nosocomial Respiratory Viral Infections in a Children's Hospital: Occult Respiratory Infection in Patients Admitted During an Epidemic Season
Authors: Goldwater Paul N. , Martin A. James , Ryan Brownwyn , Morris Sylvia , Thompson Jill , Kok T.W. , Burrell Christopher J. 
Published: September 2009

AbstractObjective:To define the extent of shedding of respiratory viruses and Mycoplasma pneumoniae among a population of pediatric patients admitted to the hospital during a winter epidemic period and to identify nosocomial infections within this population.Design:An open, prospective survey of patients admitted to three wards (General Medical, Respiratory Infectious, and Infectious Diseases) of a pediatric hospital during a defined three-month period.Patients:All patients with medical, respiratory, and infectious conditions admitted to three wards of the Adelaide Children's Hospital had nasopharyngeal aspirations performed at the time of admission with the purpose of documenting viral and M pneumoniae shedding. Patients were monitored daily for the development of symptoms of respiratory infection or new symptoms of respiratory disease. Such patients underwent a further nasopharyngeal aspiration for the purpose of diagnosing hospital-acquired infection.Results:Nasopharyngeal aspirations were obtained from 601 patients. Forty-seven percent of asymptomatic patients were positive for a respiratory virus or M pneumoniae, and 61% of patients with respiratory symptoms were also positive. Gastroenteritis patients shed viruses in 66% of cases. Respiratory symptoms were initially overlooked by admitting physicians but subsequently identified in 110 cases, and 46% of these were found to be positive for a respiratory virus or M pneumoniae. There were 18 possible hospital acquired infections among the 293 initially virus-negative patients. Multiple isolates were obtained from a substantial number of patients, especially those with respiratory symptoms.Conclusions:A substantial proportion of all patients admitted to a pediatric hospital during winter represent a potential source of infection, and strict infection control measures should be enacted to limit the spread of these infections.
Disinfection Practices for Endoscopes and Other Semicritical Items
Authors: Rutala William A. , Clontz Eva P. , Weber David J. , Hoffmann Karen K. 
Published: September 2009

AbstractObjective:To determine the disinfection practices employed by North Carolina hospitals for endoscopes and other semicritical patient care items and to discuss minimally acceptable disinfection procedures for these items.Design:A survey questionnaire was mailed to all North Carolina hospitals to identity their disinfection practices, and a literature review was conducted to ascertain studies that evaluated disinfection techniques for certain semicritical items.Participants:Questionnaires were returned by 107 of 167 (64%) North Carolina acute-care hospitals.Results:Most hospitals (91%) used a glutaraldehyde-based disinfectant (59%, 2% glutaraldehyde; 29%, 0.13% glutaraldehyde-0.44% phenol-0.08% phenate; 3%, either); half (51%) of the hospitals immersed the endoscope into disinfectant for >20 minutes, but 44% immersed for <10 minutes; nearly all hospitals (97%) disinfected endoscopes at room temperature. Hospitals rinsed the endoscope with sterile water (16%), tap water (54%), tap water followed by alcohol rinse (27%), or other (2%); 58% of the hospitals treated endoscopes from patients infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or Mycobacterium tuberculosis differently (81%, ethylene oxide [ETO] sterilization; 10%, increased exposure time; 10%, other). Twenty percent of the hospitals used an automated washer for processing endoscopic instruments. Rigid endoscopes (e.g., arthroscopes, laparoscopes) were primarily high-level disinfected (57%), ET0 sterilized (17%), or either (13%). The disinfection strategies for other semicritical items (e.g., applanation tonometers, cryosurgical instruments, and diaphragm fitting rings) were highly variable for the responding hospitals.Conclusions:This survey indicated the presence of a wide variety of practices for handling semicritical patient care items, many of which are inconsistent with current recommendations. To help establish minimally acceptable disinfection procedures for some patient care instruments (e.g., arthroscopes, laparoscopes, tonometers), the scientific literature was reviewed and recommendations were made.
Investigations of Intrinsic Pseudomonas cepacia Contamination in Commercially Manufactured Povidone-Iodine
Authors: Anderson Roger L. , Vess Robert W. , Carr Janice H. , Bond Walter W. , Panlilio Adelisa L. , Favero Martin S. 
Published: September 2009

AbstractObjective:Laboratory investigations were initiated with a povidone-iodine antiseptic solution that was intrinsically contaminated with Pseudomonas cepacia. These investigations were helpful in understanding the microbicidal and chemical properties of iodophor solutions and the mechanism by which P cepacia can survive in iodine-containing antiseptics.Design:Included in these studies were: prolonged survival of P cepacia; available and free iodine determinations; microbial challenge studies; and scanning electron microscopic examination of contaminated antiseptic.Results:P cepacia survived in this iodophor antiseptic up to 68 weeks from the date of manufacture. A uniform concentration of 1% available iodine was found in all lots of povidone-iodine tested as specified on the product label, but free iodine (I,) values varied greatly. Low free iodine levels of 0.23 to 0.46 ppm were associated with the contaminated lot of povidone-iodine. Solutions of povidone-iodine with varying levels of free iodine were rapidly microbicidal when challenged with cells of P cepacia derived from culture broth and washed or adapted to growth in water. P cepacia cells taken directly from contaminated povidone-iodine survived for significantly longer periods of time. Large numbers of P cepacia were found embedded in extracellular material and among strands of glycocalyx between cells as shown by scanning electron microscopy.Conclusions:The physical thickness of cellular and extracellular material that forms on surfaces could protect embedded organisms from the microbicidal action of disinfectants and antiseptics and subsequently allow for extended microbial survival times. Manufacturers should be aware that distribution piping surfaces colonized with bacteria may be a source of product contamination and resistant organisms.
Epidemiology of Isolation Precautions
Authors: Pettinger Ann , Nettleman Mary D. 
Published: September 2009

AbstractObjective:To investigate compliance with isolation precautions.Design:A prospective observational study carried out during ten weeks of 1989. Participants were unaware of the study.Setting:The isolation bay of a 24-bed surgical intensive care unit in a 900-bed university tertiary care facility.Participants:Study participants included any healthcare worker or visitor entering the patient room during designated 15-minute intervals.Results:We observed 467 subjects entering patient rooms. Compliance with strict isolation (65%) was better than with wound/skin (40%) or excretion/secretion (36%) isolation (p<.01). Visitors were more compliant than healthcare workers (88% versus 41%; p<.01). Spending more time in the room was associated with improved compliance (p<.01). Compliance was higher for subjects entering with a group compared with those entering alone (51% versus 41%; p<.05). The compliance rate for nurses improved as the nurse/patient ratio improved (p= .14). Compliance was independent of severity of illness. Multivariate analysis revealed that the amount of time spent in the room, being a visitor, and use of strict isolation were independent predictors of compliance.Conclusions:Noncompliance was wide-spread. When increased demands are placed on the time of physicians and nurses in the name of cost containment, unperceived consequences, such as those resulting from decreased compliance, must be considered.
Monitoring and Evaluation
Authors: Decker Michael D. 
Published: September 2009

The development of this section of Infection Control and Hospital Epidemiology was stimulated by the opportunity and the need to expand the activities of those practicing epidemiology in the hospital “beyond nosocomial infections to the rates, distributions, preventive measures, and cost benefit studies of all adverse events in patients.” Some of the most compelling opportunities to do so involve the hospital's quality assessment (QA) and utilization review (UR) activities.The hospital can reap considerable benefits from the involvement of an epidemiologist in the QA/UR program. Assistance in study design, sampling techniques, data management, and statistically sound analysis can be invaluable. Furthermore, in the process of providing consultation, the epidemiologist is training the QA staff in the epidemiologic approach to data. Involvement of an epidemiologist (particularly a physician epidemiologist) in the QA program can increase the confidence of the medical staff in the validity of the data presented to them and enhance their willingness to act in response.Although QA programs must be responsive to the requirements of many external entities, for the majority of hospitals, the most detailed and demanding applicable standards are those set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and published annually in the Accrediting Manual for Hospitals. Fundamental to many of these standards is the process known as “monitoring and evaluation.”
Risk Factors for the Development of Clostridium difficile-Associated Diarrhea During a Hospital Outbreak
Authors: Thibault Alain , Miller Mark A. , Gaese Christina 
Published: September 2009

AbstractObjective:To evaluate the risk factors associated with a nosocomial outbreak of Clostridium difficile-associated diarrhea.Design:Case-control study with two control groups.Setting:University-affiliated urban hospital.Patients:A convenience sample of 26 patients was chosen out of a total of 78 hospitalized patients with C difficile-associated diarrhea, defined as the presence of diarrhea and a positive C difficile cytotoxin assay or stool culture. Twenty-six controls were matched for age, gender, ward, and date of admission; 18 additional controls were matched to surgical patients for date and ward of admission, as well as for the type of surgical procedure performed.Results:Significant risk factors for the development of C difficile-associated diarrhea were gastrointestinal surgery (exposure odds ratio [EOR] = 7.9, p= .004, 95% confidence interval [CI]= 1.9, 35), use of neomycin (EOR= 15.6, p=.012, 95% CI=1.7, 92), clindamycin (EOR=15.6, p=.005, 95% CI=1.7, 92), metronidazole (EOR=5.7,p=.02,95%CI= 1.4, 25), and excess antibiotic use (mean number of antibiotics = 4.2 versus 1.4, p<.00005). The presence of systemic disease and the use of antacids or immunosuppressive drugs were similar in cases and controls. In surgical patients, no specific antibiotic could be linked to C difficile-associated diarrhea because of uniform perioperative antibiotic use. There was a significant difference in the number of antibiotics administered to cases and controls (mean = 3.1 versus 1.9, p< .005).Conclusions:The results suggest that control of nosocomial C difficile-associated diarrhea may be attained by minimizing the administration of antibiotics, avoidance of high-risk antibiotics, and having a high index of suspicion of C difficile-associated diarrhea in patients who develop diarrhea after gastrointestinal surgery. Perioperative administration of metronidazole, when given with other antibiotics, failed to protect against the development of C difficile-associated diarrhea.
Hospital-Acquired Diarrhea in Adults: A Prospective Case-Controlled Study in Mexico
Authors: Zaidi Mussaret , de Leon Samuel Ponce , Ortiz Rosa Maria , de Leon Sergio Ponce , Calva Juan J. , Ruiz-Palacios Guillermo , Camorlinga Margarita , Cervantes Luz Elena , Ojeda Francisco 
Published: September 2009

AbstractObjective:To know the incidence, etiology, risk factors, morbidity, and mortality of nosocomial diarrhea in adults.Design:Nested case-control study, matched by service, length of stay, date of admission, and presence of leukopenia and/or the acquired immunodeficiency syndrome (AIDS). Cases were those who developed nosocomial diarrhea. Controls were those who did not develop nosocomial diarrhea during a comparative period nor during the next ten days. Stool samples were processed in search for parasites, yeasts, bacteria, and rotavirus.Setting:Third-level referral center, in Mexico City, Mexico, for general internal medicine and surgical problems.Patients:Eligible subjects were all new admissions to the hospital from November 1987 to September 1988. Reasons for exclusion were presence of chronic diarrheal disease or melena. There were 115 cases and 111 controls.Results:Overall risk of acquiring nosocomial diarrhea was 5.5%, or 1.8 episodes per 100 patient-weeks. A potential pathogen was found in 59%. Yeasts and Entamoeba histolytica were the most frequently isolated pathogens. Mortality in cases was 18%, as compared with 5% in controls (p<.01). Multivariate analysis showed enteral feeding, recent enemas, presence of Candida species, use of antacids/Hz-blockers, and presence of nasogastric tubes as significant risk factors for nosocomial diarrhea.Conclusions:Diarrhea is a common complication in hospitalized patients. It occurs more often than previously suspected and is linked with a substantial mortality, The spectrum of etiologic agents is different from that reported in pediatric hospitals. Given that nosocomial diarrhea may constitute, at least, a marker of severity of illness, it should receive more attention in general hospitals.
Policy for Managing a Community Infectious Disease Outbreak
Authors: Frace Ruth M. , Jahre Jeffrey A. 
Published: September 2009

AbstractObjective:To identify guidelines for the management of an infectious disease emergency.Setting:In February 1990, the discovery of hepatitis A in three foodhandlers prompted city and state health officials to offer mass immunization to residents of several counties in eastern Pennsylvania. In an attempt to facilitate the immunization effort, local hospitals were asked to establish and staff clinics to supplement the efforts of the health bureaus.Results:Over a four-week period, combined efforts resulted in approximately 10,000 people receiving immunization with immune serum globulin (IgG).Conclusions:This was one of several infectious disease emergencies the community has faced in the recent past. Recognizing that future incidents of this nature are likely to occur, one 435-bed community teaching hospital devised an infectious disease emergency policy that allows for rapid deployment of personnel and services in the event of an infectious disease outbreak.
Biological Warfare and Infection Control
Authors: Nettleman Mary D. 
Published: September 2009

Though biological weapons were outlawed in 1925 by the Geneva Convention and though research, development, and stockpiling of such weapons were forbidden by the Biological Weapons Convention in 1972, the threat of biological warfare has not been eradicated. A wide variety of agents have been considered as possible weapons. In addition to their devastating effect on the battlefield, some have potential for nosocomial spread in US hospitals that care for victims of biological warfare. The following is a brief review of the history of germ warfare, a description of selected agents under consideration, and a discussion of the potential impact of biological weapons on hospital infection control.Biological warfare has been attempted many times in past centuries and is not a concept unique to the war in the Persian Gulf. Poisoning wells by throwing dead bodies into them was not uncommon in the Middle Ages. During the 14th century conflict in Crimea, plague victims were catapulted into the besieged city of Kaffa by the Tartar army. Whether aided by this or not, plague soon broke out and the city surrendered. Escaping citizens and returning soldiers soon spread the disease to much of Europe. In another example, blankets from smallpox victims were considered as potential weapons against American Indians by British colonial commanders in the 18th century. More recently, Japan purportedly investigated biological weapons to spread plague, cholera, yellow fever, and anthrax during World War II. Attempts in earlier centuries usually were unsuccessful due to the lack of knowledge about disease vectors and etiological agents. Only with the advent of modern microbiological techniques has intentional biological warfare been possible on an organized and vast scale.
Problems Resulting from Multiple Tests
Authors: Burmeister Leon F. 
Published: September 2009

The consequences of multiple tests within a study have received much attention in recent years. In spite of many detailed considerations, there remains controversy concerning the seriousness of these consequences.To appreciate fully the arguments that abound in this controversy, it is necessary to be aware of several different definitions of errors that can occur in hypothesis testing. The definitions of Type I error (rejection of a true null hypothesis) and Type II error (failure to reject a false null hypothesis) remain basic. Consider initially the Type I error, which receives the major emphasis of arguments concerning the effects of multiple testing. Its usual definition is based on the fact that for a single variable and a single comparison, there is a probability (α) that the hypothesis of no effect erroneously can be rejected. If all studies consisted of only one variable and if only one comparison were of interest (for example, only two treatments or two groups were studied), there would be no multiple testing controversy. Of course, few, if any, studies are so limited in their intent. Thus, the consequences of multiple testing apply to nearly all studies.