bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of Germicidal Lamps to Control Tuberculosis in Healthcare Facilities
Authors: Tapper Michael L. , Macher Janet M. 
Published: September 2009

The transmission of tuberculosis in healthcare settings is a recognized hazard, and recent outbreaks involving multidrug-resistant strains of Mycobacterium tuberculosis have heightened workers' concerns. Much of the transmission of tuberculosis that occurs in healthcare settings is from patients with unrecognized active disease who are not on effective therapy or who are not isolated for the entire period–from admission until their infection is under control. This article discusses the use of environmental and engineering control measures, in particular germicidal lamps, to reduce healthcare worker exposure to mycobacteria.The Centers for Disease Control and Prevention (CDC) has described the use of germicidal lamps as controversial the American Thoracic Society has considered them supplemental interventions not intended to substitute for standard tuberculosis control practices, and some occupational health specialists have questioned their safety. On the other hand, some physicians believe that germicidal lamps are underused and the hazards associated with their use exaggerated. Given the constraints associated with many engineering controls and with respirators, it is clear we need to have available the widest choice of interventions to ensure the best protection for all workers and clients. This article discusses where germicidal lamps fit among tuberculosis control measures and addresses general questions about their use.
HIV Screening of Surgeons and Dentists: A Cost-Effectiveness Analysis
Authors: Sell Randall L. , Jovell Albert J. , Siegel Joanna E. 
Published: September 2009

AbstractObjective:To assess the cost-effectiveness of human immunodeficiency virus (HIV) screening strategies of surgeons and dentists.Design:We constructed a model to project costs and HIV transmissions prevented over 15 years for four screening scenarios: 1) one-time voluntary screening, 2) one-time mandatory screening, 3) annual voluntary screening, and 4) annual mandatory screening. One-time screening occurs only in the first year of the program; annual screening occurs once each year. Under mandatory screening, all practitioners are tested and risks of practitioner-to-patient transmission are eliminated for all practitioners testing positive. Voluntary screening assumes 90% of HIV-positive and 50% of HIV-negative practitioners are tested, and risks of transmission in the clinical setting are eliminated for 90% of HIV-positive surgeons and dentists. All costs and benefits are discounted at 5% per annum over 15 years.Results:Using “best-case” scenario assumptions, we find for surgeons that a one-time voluntary screening program would be most cost-effective, at $899,336 for every HIV transmission prevented. For dentists, the one-time voluntary program also is the most cost-effective, at $139,571 per transmission prevented. Annual mandatory programs were least cost-effective for both surgeons and dentists, at $63.3 million and $2.2 million per transmission prevented, respectively.Conclusions:HIV screening of surgeons and dentists ranks among the more expensive medical lifesaving programs, even using liberal assumptions about program effectiveness. Frequency of screening and whether testing is mandatory or voluntary dramatically affect cost per transmission prevented; these features should be considered carefully in designing specific HIV screening programs.
Methicillin-Resistant Staphylococcus aureus in Tertiary Care Institutions of the Canadian Prairies 1990-1992
Authors: Embil J. , Ramotar K. , Romance L. , Alfa M. , Conly J. , Cronk S. , Taylor G. , Sutherland B. , Louie T. , Henderson E. , Nicolle L.E. 
Published: September 2009

AbstractObjective:To review experience with methicillin-resistant Staphylococcus aureus (MRSA) in tertiary acute-care teaching hospitals on the Canadian prairies.Design:Retrospective review for a 36-month period, 1990 through 1992.Setting:Five tertiary acute-care teaching hospitals in three Canadian prairie provinces.Methods:MRSA isolates and susceptibility were identified through the clinical microbiology laboratory at each institution. For each patient, data collected included duration of institutional residence prior to isolation, patient ethnic background, age, sex, and antimicrobial susceptibility. Epidemiologic typing of strains used restriction fragment length polymorphism analysis by pulsed-field gel electrophoresis.Results:Two hundred fifty-nine MRSA isolates were identified in 135 patients during the 36 months, with substantial institutional variation in number of isolates. No consistent increase in yearly numbers of isolates was apparent. Patients usually had MRSA identified at admission (62%); only one of five centers had the majority of isolates acquired nosocomially. Patients with MRSA present at admission were more frequently of aboriginal (First Nations) ethnicity (62% compared with 14% of nosocomial; P<0.001). Pulsed-field gel electrophoresis of 167 isolates from 135 patients revealed 46 different strains with little interprovincial or inter-institutional identity of strains.Conclusions:MRSA isolated in patients in tertiary care institutions in these three Canadian provinces usually is acquired prior to admission. A disproportionate number of isolates are identified in aboriginal Canadians. Epidemiologic typing was consistent with a polyclonal origin of MRSA in this geographic area.
Investigation of a Pseudo-Outbreak of Orthopedic Infections Caused by Pseudomonas aeruginosa
Authors: Forman Wendy , Axelrod Peter , John Keith St. , Kostman Jay , Khater Christina , Woodwell John , Vitagliano Rose , Truant Allan , Satishchandran Vilas , Fekete Thomas 
Published: September 2009

AbstractObjectives:To report a pseudoepidemic of Pseudomonas aeruginosa infections discovered during an investigation of postoperative joint infections.Design:A retrospective review of case patients’ hospital charts, operative reports, and laboratory data, as well as environmental culturing, polymerase chain reaction (PCR) ribotyping of outbreak isolates, and in vitro analysis of P aeruginosa growth characteristics.Setting:A 510-bed, university-affiliated adult tertiary care hospital.Results:Between October 1 and December 1, 1992, seven postsurgical joint infections were diagnosed, including four caused by P aeruginosa. A bottle of “sterile” saline used to process tissue specimens was found to be contaminated with P aeruginosa. Further investigation revealed that P aeruginosa had grown from seven additional tissue cultures, all of which had been processed with the contaminated saline. PCR ribotypes of the contaminant matched those of the clinical isolates. In vitro, P aeruginosa strains were viable in commercial nonbacteriostatic saline, but never caused visible turbidity.Six patients received antibiotics for their presumed infections; four patients had peripherally inserted central catheters placed, and one experienced severe anaphylactic reactions to several antibiotics.Conclusions:Pseudoepidemics due to common organisms are often difficult to detect, and delayed recognition can result in substantial morbidity. This outbreak investigation illustrates the potential for contamination of diluents in the microbiology laboratory and emphasizes the need for meticulous quality control.
Relatedness of Coagulase-Negative Staphylococci Causing Bacteremia in Low-Birthweight Infants
Authors: Kacica Marilyn A. , Horgan Michael J. , Preston Karen E. , Lepow Martha , Venezia Richard A. 
Published: September 2009

AbstractObjective:To investigate coagulase-negative staphylococcus (CONS) causing bacteremia in a neonatal intensive care unit (NICU).Design:A 14-month retrospective review of 47 infants in the NICU with CONS bacteremia was undertaken to determine CONS glycocalyx production, plasmid pattern, total DNA restriction fragment polymorphism, and clinical risk factors.Results:The isolates included 32 Staphylococcus epidermidis, six Staphylococcus haemolyticus, four Staphylococcus warneri, four Staphylococcus saprophyticus, and one Staphylococcus hominis. Sixty-five percent of S epidermidis produced glycocalyx; other species did not. Oxacillin resistance (52%) and the antibiograms of the CONS were consistent with other units in the hospital. Five similar CONS plasmid patterns were found among 16 isolates; 31 isolates had unique patterns. Extractions of total DNA from these isolates were digested using HindIII, HaeIII, and BstEII. Those with similar restriction fragment length patterns could not be linked as nosocomially transmitted among infants with bacteremia.Conclusion:Our observations suggest that multiple strains of CONS infect infants in the NICU who have similar risk factors. Although current infection control practices limit transmission of a pathogen, they do not prevent CONS bacteremias.
Airborne Nosocomial Infection: A Contemporary Perspective
Authors: Eickhoff Theodore C. 
Published: September 2009

AbstractThe history of airborne nosocomial infections is reviewed, and current beliefs about such infections are placed into their historical context. Possible sources, both animate and inanimate, of airborne nosocomial infections in the hospital environment are identified. Viruses, bacteria, and fungi that have been important causes of airborne nosocomial infections in the past are discussed, and examples of key studies that have confirmed an airborne route of transmission are presented. Where relevant, measures that have been used to control airborne transmission of nosocomial pathogens are discussed. Although outbreaks of airborne nosocomial infection have been uncommon, airborne transmission appears to account for about 10% of all endemic nosocomial infections.
The Lone Ranger Rides Again, This Time Followed by a Federal Posse
Authors: Crow Sue 
Published: September 2009

AbstractThe Centers for Disease Control and Prevention proposed guidelines regarding the high-efficiency particulate air-filtered respirator have raised many questions that the healthcare worker has found difficult to answer. This product commentary addresses questions related to material that the respiratory protection program should include; provides information related to the physical exam before the use of the respirator; and explains the types of respirators. Cost issues also are discussed.
Nosocomial Pneumonia on General Medical and Surgical Wards in a Tertiary-Care Hospital
Authors: Greenaway Christina A. , Embil John , Orr Pamela H. , McLeod Judith , Dyck Brenda , Nicolle Lindsay E. 
Published: September 2009

AbstractObjective:To describe the demographic, clinical, and microbiologic characteristics of patients who develop nosocomial pneumonia on general medical and surgical wards of a tertiary-care hospital.Design:A one-year, prospective, descriptive study.Setting:a 1,100-bed, tertiary-care, urban hospital.Population:Patients experiencing nosocomial pneumonia were identified through surveillance on general medical and surgical wards, using a standard case definition.Results:92 pneumonias in 85 patients on general wards were identified. The mean age of patients was 63 ±? 17 years, 55 patients (65%) were male, and 75 cases of pneumonia (81%) were acquired on surgical wards. Bacteremia was identified in 8 (13%) of 62 episodes, and 48 (52%) grew potential pathogens from respiratory specimens. Twenty-six patients (28%) required transfer to the intensive-care unit (ICU), and 20 (22%) received mechanical ventilation. By multivariate analysis, patients with a thoracic surgical procedure or with Staphylococcus aureus isolated from respiratory secretions were more likely to require ICU admission. The overall mortality rate was 20% (17/85), with a directly associated mortality of 14% (12/85). Patients who died were older, more frequently resided on a medical ward, and had a greater mean number of comorbidities. These patients often were treated nonaggressively and were not considered candidates for ICU admission due to advanced age and poor underlying clinical status.Conclusions:Although the morbidity of nosocomial pneumonia in this population was high, as evidenced by high rates of transfer to ICU, the directly associated mortality was relatively low. Those requiring ICU admission require further study to identify preventive measures that could decrease the morbidity in this group. Interventions to prevent pneumonia or to improve prognosis may not be feasible for the majority of these patients who die from nosocomial pneumonia.
Risk Factors Associated with Permanent Access-Site Infections in Chronic Hemodialysis Patients
Authors: Bonomo Robert A. , Rice Dora , Whalen Christopher , Linn David , Eckstein Elizabeth , Shlaes David M. 
Published: September 2009

AbstractObjective:To determine the epidemiological risk factors associated with permanent access-site (PAS) infection in a population of chronic hemodialysis patients.Design:Retrospective cohort analysis.Seiting:Hemodialysis unit of a 400-bed Department of Veterans' Affairs hospital.Results:A cohort of 94 males (1,316 patient months) was studied. Fifty-one PAS infections in 31 patients were observed. SiX patients had two PAS infections, four patients had three infections, and two patients had four infections. Twenty-nine of the 31 patients with PAS infections were bacteremic at least once. Univariate analysis identified seven factors significantly associated with PAS infection in this population: location of PAS other than forearm, type of vascular access (poletrafluoroethylene [PTFE] versus endogenous arteriovenous [AV] fistula), limited ambulatory status, residence in a nursing home, bacterial infection at a distant site, number of access-site revisions, and number of hospitalizations. In a logistic regression analysis, only graft type and number of PTFE graft revisions were associated independently with PAS infection. The odds ratio for PAS infection in PTFE grafts compared to endogenous AV fistula was 7.8; the odds ratio for PAS infection with each PTFE graft revision was 1.5.Conclusions:PAS infections were associated independently with the type of graft and the number of PTFE graft surgical revisions.
Living With Methicillin-Resistant Staphylococcus aureus A 7-Year Experience With Endemic MRSA in a University Hospital
Authors: Adeyemi-Doro Folorunso A.B. , Scheel Olaf , Lyon Donald J. , Cheng Augustine F.B. 
Published: September 2009

AbstractA review of our infection control records revealed 3,159 new isolations of methicillin-resistant Staphylococcus aureus (MRSA) from 1988 to 1994. Prior to this period, our approach to MRSA had changed from eradication to containment measures. We found a decline in MRSA rates from 11.4 to 5.2 first isolations per 1,000 deaths and discharges over the study period.
Prescribing Pattern of Vancomycin in a Community Teaching Hospital With Low Prevalence of Vancomycin-Resistant Enterococci
Authors: Watanakunakorn Chatrchai 
Published: September 2009

AbstractA one-month prospective survey of all inpatients given vancomycin was performed in a community teaching hospital with a low prevalence of vancomycin-resistant enterococci. Only 20 of the 97 vancomycin orders written from August 1 to September 1, 1996, were consistent with Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines. Surgical prophylaxis accounted for 37 of the 77 orders inconsistent with HICPAC guidelines.
Ribotyping and Random Amplification of Polymorphic DNA for Nosocomial Enterobacter cloacae Isolates in a Pediatric Intensive-Care Unit
Authors: Hou Shih-Ting , Wang Chih-Chien , Chu Mong-Ling 
Published: September 2009

AbstractBetween 1987 and 1989, two sequential outbreaks of nosocomial infection caused by Enterobacter cloacae occurred in the pediatric intensive-care unit of a tertiary-care teaching hospital. Seventeen strains retrieved from the outbreaks and two control strains identified in other wards were typed by ribotyping and random amplification of polymorphic DNA (RAPD). The results indicated that the genomic pattern of strains identified between the first and second outbreaks was different. We conclude that both ribotyping and RAPD are highly discriminatory and reproducible methods for typing E cloacae. RAPD seems to be more efficacious and cost-effective.
Epidemiological Study of Hospital-Acquired Infection With Vancomycin-Resistant Enterococcus faecium Possible Transmission by an Electronic Ear-Probe Thermometer
Authors: Porwancher Richard , Sheth Anish , Remphrey Susan , Taylor Eileen , Hinkle Cynthia , Zervos Marcus 
Published: September 2009

AbstractClonal spread of vancomycin-resistant Enterococcus faecium among seven patients on one ward of a community teaching hospital was identified by contour-clamped homo-geneous electric-field gel electrophoresis. Environmental cultures isolated the same strain from the handle of a shared electronic ear-probe thermometer. Cross-contamination of the clonal strain between two geographically separate units on this ward, sharing equipment but not personnel, suggests the possibility of an environmental source.
A Cluster of Serious Escherichia coli Infections in a Neonatal Intensive-Care Unit
Authors: Diekema Daniel J. , Barr Joan , Boyken Linda D. , Buschelman Barry J. , Jones Ronald N. , Pfaller Michael A. , Herwaldt Loreen A. 
Published: September 2009

AbstractA cluster of serious Escherichia coli infections was identified among patients in a neonatal intensive-care unit. Infection control staff identified the outbreak because they realized that E coli rarely caused infections in this unit. Pulsed-field gel electrophoresis confirmed that one strain of E coli was transmitted among patients.
Cumulative Yield From Patient Surveillance Cultures for Methicillin-Resistant Staphylococcus aureus During a Hospital Outbreak
Authors: Forward Kevin R. , Arbique Judy C. 
Published: September 2009

AbstractThe cumulative yield from cultures of separate sites was determined during the investigation of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak. Surveillance cultures were submitted from clinical sites, nose, groin, and axilla of 421 patients on two different occasions. MRSA was recovered most often from various clinical sites, including lower respiratory tract, surgical wounds, urinary tract, and decubitus ulcers (total, 13 patients). Four additional patients were identified as positive from the first nasal swab, one patient from the second nasal swab, and two others from swabs of the groin. The submission of axillary swabs or a second groin swab did not identify additional MRSA-colonized patients and resulted in additional costs of $4,525.
Evaluation of Vancomycin Use in a Pediatric Teaching Hospital Based on CDC Criteria
Authors: Logsdon Beth A. , Lee Kelley R. , Luedtke Gary , Barrett Fred F. 
Published: September 2009

AbstractThis study was performed to determine whether van-comycin use at our pediatric hospital was consistent with modified Centers for Disease Control and Prevention guidelines. Vancomycin use was inappropriate in 54% of patients. Inappropriate use briefly decreased by 14% after educational efforts. Further education regarding van-comycin use was deemed necessary and is continuing.
Hospital-Acquired Pneumonia Perspectives for the Healthcare Epidemiologist
Authors: Craven Donald E. , Steger Kathleen A. 
Published: September 2009

AbstractNosocomial pneumonia is defined as an infection of lung parenchyma that was neither present nor incubating at the time of the patient's admission to the hospital. In the United States, hospital-acquired pneumonia is the second most common nosocomial infection and accounts for the most deaths from nosocomial infection. We describe how infection control personnel can use targeted surveillance to identify clusters of cases and to prevent pneumonia. We also discuss common pathogens that cause nosocomial pneumonia; ventilator-associated pneumonia; and strategies for prevention of hospital-acquired pneumonia.
More than 10 Years of Unrecognized Nosocomial Transmission of Legionnaires' Disease Among Transplant Patients
Authors: Kool Jacob L. , Fiore Anthony E. , Kioski Clare M. , Brown Ellen W. , Benson Robert F. , Pruckler Janet M. , Glasby Constance , Butler Jay C. , Cage Gary D. , Carpenter Joseph C. , Mandel Richard M. , England Bob , Breiman Robert F. 
Published: September 2009

AbstractObjective:To investigate a cluster of cases of legionnaires' disease among patients at a hospital.Setting:A university hospital that is a regional transplant center.Design:Retrospective review of microbiology and serology data from the hospital laboratories and prospective surveillance via the radiology department; a case-control study and environmental sampling within the hospital and from nearby cooling towers.Results:Diagnosis of seven cases of legionnaires' disease in the first 9 months of 1996 led to recognition of a nosocomial outbreak that may have begun as early as 1979. Review of charts from 1987 through September 1996 identified 25 culture-confirmed cases of nosocomial or possibly nosocomial legionnaires' disease, including 18 in bone marrow and heart transplant patients. Twelve patients (48%) died. During the first 9 months of 1996, the attack rate was 6% among cardiac and bone marrow transplant patients. For cases that occurred before 1996, intubation was associated with increased risk for disease. High-dose corticosteroid medication was strongly associated with the risk for disease, but other immunosuppressive therapy or cancer chemotherapy was not. Several species and serogroups of Legionella were isolated from numerous sites in the hospital's potable water system. Six of seven available clinical isolates were identical and were indistinguishable from environmental isolates by pulsed-field gel electrophoresis. Initial infection control measures failed to interrupt nosocomial acquisition of infection. After extensive modifications to the water system, closely monitored repeated hyperchlorinations, and reduction of patient exposures to aerosols, transmission was interrupted. No cases have been identified since September 1996.Conclusions:Legionella can colonize hospital potable water systems for long periods of time, resulting in an ongoing risk for patients, especially those who are immunocompromised. In this hospital, nosocomial transmission possibly occurred for more than 17 years and was interrupted in 1996, after a sudden increase in incidence led to its recognition. Hospitals specializing in the care of immunocompromised patients (eg, transplant centers) should prioritize surveillance for cases of legionnaires' disease. Aggressive control measures can interrupt transmission of this disease successfully.