bluuebunny/crossref_metadata_2025_split huggingface dataset:
SHEA-CDC TB Survey, Part II: Efficacy of TB Infection Control Programs at Member Hospitals, 1992
Authors: Fridkin Scott K. , Manangan Lilia , Bolyard Elizabeth ,   The Society for Healthcare Epidemiology of America, Jarvis William R. 
Published: September 2009

AbstractObjective:To assess the efficacy of current Myco-bacterium tuberculosis control measures.Design:Voluntary questionnaire to members of the Society for Healthcare Epidemiology of America.Results:Healthcare worker (HCW) tuberculin skin-test (TST) conversion rates were significantly higher in larger hospitals ( ≥ 437 beds) (0.9% versus 0.6%; P < 0.05), or in hospitals reporting ≥ 6 TB patients in 1992 (1.2% versus 0.6%; P < 0.05). Among larger hospitals or those hospitals surveyed reporting ≥ 6 TB patients, those without at least three of the four criteria suggested in the 1990 Centers for Disease Control and Prevention (CDC) TB guidelines for acid-fast bacilli (AFB) isolation (specifically, a single-patient room; negative pressure; and air exhausted directly outside) had significantly higher annual TST conversion rates than those with these criteria (1.8% versus 0.6%; P < 0.05). Respiratory therapist or bronchoscopist TST conversion rates were significantly lower in hospitals compliant with the exhaust criteria (1.2% versus 2.8%; P < 0.05). Regardless of hospital characteristic, HCW TST conversion rates did not differ between hospitals in which HCWs used surgical masks or used disposable particulate respirators.Conclusion:Among larger hospitals or hospitals reporting ≥ 6 TB patients per year, failure to comply with the 1990 CDC TB recommendations for AFB isolation room guidelines was associated with higher HCW TST conversion rates. These data suggest that complete implementation of the 1990 CDC TB guidelines would decrease HCWs’ risk of nosocomial transmission of TB in larger hospitals or those reporting more TB patients. However, in nonoutbreak situations, disposable particulate respirators or submicron surgical masks may not offer significantly greater protection to HCWs than surgical masks.
Studies of Ventilation Efficiency in a Protective Isolation Room by the Use of a Scale Model
Authors: Marshall John W. , Vincent James H. , Kuehn Thomas H. , Brosseau Lisa M. 
Published: September 2009

AbstractObjective:To assess the ability of a protective isolation room ventilation system to reduce patient exposure to airborne infectious agents, using a small-scale model that permits cost-effective and unobtrusive study of relevant indices of performance.Design:A one-half scale model of a protective isolation room at the University of Minnesota Hospital was constructed and equipped for tracer gas experiments to assess ventilation efficiency.Measurements:Tracer gas (SF6) was injected into the model supply air. Tracer gas concentration was recorded over time and analyzed to determine local and room mean age of air. Age of air is a direct measurement of ventilation efficiency and can be used to predict patient exposure to contamination.Results:Although for the room taken as a whole, ventilation efficiency was close to 50% (a value corresponding to perfect mixing), the experimental results for the local mean age of air indicate that some parts of the model were ventilated much better than others.Conclusion:Room air exchange rate is only one parameter useful in assessing ventilation in patient areas. Effective distribution of ventilation air also is critical to the control of airborne contamination. Areas of the room with poor ventilation would be expected to have higher concentrations of airborne infectious agents and other contaminants. Patient exposure can be minimized by placing the patient in well-ventilated areas of the room. Improved ventilation designs may reduce patient exposure further without increasing actual airflow rate.
Resistant Enterococci: A Prospective, Study of Prevalence, Incidence, and Factors Associated With Colonization in a University Hospital
Authors: Weinstein Jeffrey W. , Roe Matthew , Towns Michael , Sanders Linda , Thorpe Jackie J. , Corey G. Ralph , Sexton Daniel J. 
Published: September 2009

AbstractObjective:To determine the prevalence of gastrointestinal tract colonization with antibiotic-resistant enterococci at ward entry and to study the incidence and risk factors for nosocomial acquisition of colonization with resistant enterococci.Design:A prospective cohort study conducted between February 1 and March 15, 1993.Methods:Rectal cultures were obtained within 24 hours of admission or transfer onto the study wards and repeated at weekly intervals and at the time of discharge. Patients harboring antibiotic-resistant enterococci at the time of admission or after admission were compared to patients who were not colonized with these organisms. Clinical and epidemiologic risk factors for colonization were abstracted prospectively by daily chart review. Following a univariate analysis of risk factors associated with colonization, a multivariate statistical analysis using three separate models was done.Setting:A 1,125-bed, tertiary-care teaching hospital in North Carolina.Patients:A total of 350 patients admitted to two general medical wards and the medical intensive care unit during the study period.Results:Antibiotic-resistant enterococci were isolated from 52 patients: 19 were colonized at admission to the study, and 33 later acquired resistant strains. At the time of admission, 5.4% of the patients were colonized with ampicillin-resistant enterococci (ARE), including 1.1% that were colonized with vancomycin-resistant enterococci. Prior hospitalization was associated with colonization with ARE at admission (P=.01). Independent risk factors for nosocomial acquisition of ARE included treatment with more than three antibiotics, empiric use of antibiotics, use of third-generation cephalosporins, and the use of enteral tube feedings. Antibiotics used prophylactically were not associated with resistant enterococcal colonization.Conclusions:Our data help to elucidate the epidemiology of gastrointestinal tract colonization with resistant enterococci. We hypothesize that surveillance and control programs will be more likely to succeed if targeted at patients receiving more than three antibiotics, empiric antibiotics, and enteral tube feedings.
The Infection Control Committee
Authors: Wiblin R Todd , Wenzel Richard P. 
Published: September 2009

AbstractHospital epidemiologists translate their expertise into institutional policy and gain the support of administrators through the infection control committee. Committee members have the important task of helping to disseminate information to all important hospital constituencies. The infection control team can facilitate its goals by properly preparing committee members for the meeting. A well-educated committee will approve policies efficiently. The committee periodically should reassess its accomplishments and goals. This article will explore the workings of the infection control committee and will suggest strategies that the hospital epidemiologist can use to make the committee an asset rather than a hindrance.
Cost-Effectiveness of Perioperative Mupirocin Nasal Ointment in Cardiothoracic Surgery
Authors: VandenBergh Marjolein F.Q. , Kluytmans Jan A.J.W. , van Hout Ben A. , Maat Alexander P.W.M. , Seerden Rob J. , McDonnel Joseph , Verbrugh Henri A. 
Published: September 2009

AbstractObjective:To assess the cost-effectiveness of perioperative intranasal application of mupirocin calcium ointment in cardiothoracic surgery.Design:Cost-effectiveness analysis based on results of an intervention study with historical controls.Setting:University Hospital Rotterdam, a tertiary referral center for cardiac and pulmonary surgery.Patients:Consecutive patients undergoing cardiothoracic surgery between August 1, 1989, and February 1, 1991 (control group, n=928), and between March 1, 1991, and August 1, 1992 (intervention group, n=868).Intervention:Perioperative nasal application of mupirocin calcium ointment started on the day before surgery, continued for 5 days, twice daily.Results:Postoperative costs were increased significantly in patients with a surgical-site infection (SSI), compared with uninfected patients (P<.001). Mean SSI-attributable costs were estimated at $16,878 (95% confidence interval, $15,575-$18,181). The incidence of SSIs was 7.3% in the control group and 2.8% in the intervention group, mupirocin effectiveness being 62%. The costs of mupirocin were $11 per patient. Thus, the savings per SSI prevented were $16,633. To validate this comparative estimate of SSI-attributable costs, a noncomparative analysis of the postoperative length of stay (POLS) was performed, according to the Appropriateness Evaluation Protocol. Approximately 50% of the comparative SSI-attributable POLS were judged SSI-attributable in the noncomparative analysis. Sensitivity analyses, testing for the robustness of our conclusions, indicated that the presented model is rather insensitive to variations in the incidence of SSIs and for the effectiveness and costs of mupirocin. SSI-attributable costs were shown to be the only variable with substantial effect on the cost-effectiveness ratio. Perioperative mupirocin would result in net costs instead of savings only if SSI-attributable costs were less than $245.Conclusions:SSIs in patients undergoing cardiothoracic surgery are associated with a substantial increase in postoperative costs. Provided that perioperative mupirocin reduces the SSI rate, this measure will be highly cost-effective in most centers providing cardiothoracic surgical services.
Elimination of Nasal Carriage of Staphylococcus aureus in Hemodialysis Patients
Authors: Kluytmans Jan A.J.W. , Manders Marie-Jose , van Bommel Erik , Verbrugh Henri 
Published: September 2009

AbstractObjective:To study the efficacy of mupirocin for the elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients.Design:The efficacy of mupirocin was studied in a prospectively followed cohort. The effect of this intervention on the rate of S aureus bacteremia was evaluated using a historic control group.Setting:Patients on the hemodialysis unit of the University Hospital Rotterdam, a tertiary referral center.Patients:The study group consisted of consecutive patients on hemodialysis from February 1, 1992, until November 1, 1993. They were screened by taking nasal cultures monthly during their time on hemodialysis. If S aureus was isolated, treatment with mupirocin nasal ointment was initiated. The control group consisted of patients treated on the same hemodialysis unit from January 1, 1990, until January 1, 1992.Results:The study group consisted of 226 patients, of whom 172 were evaluated to determine the efficacy of mupirocin. Sixty-seven (39%) were identified as nasal carriers. Following the initial treatment, 66 nasal cultures (98.5%) became negative. After 3 months and 6 months, respectively, 63 (94%) and 61 (91%) of the treated carriers had negative cultures. The rate of bacteremia (defined as the number of episodes of 5 aureus bacteremia per patient-year on hemodialysis) was significantly lower among the 226 patients in the study group (0.04 per patient-year) than among the 273 patients in the control group (0.25 per patient year; P <.001). Development of resistance and adverse effects were not observed.Conclusions:Mupirocin nasal ointment effectively eliminates nasal carriage of 5 aureus in patients on hemodialysis. This was associated with a significant reduction of the incidence of 5 aureus bacteremia, as compared to historic controls.
A Prolonged Outbreak of Methicillin-Resistant Staphylococcus aureus in the Burn Unit of a Tertiary Medical Center
Authors: Meier Patricia A. , Carter Cheryl D. , Wallace Sarah E. , Hollis Richard J. , Pfaller Michael A. , Herwaldt Loreen A. 
Published: September 2009

AbstractObjective:To report an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in our burn unit and the steps we used to eradicate the organism.Design And Setting:Outbreak investigation in the burn unit of a 900-bed tertiary-care medical center.Outbreak:Between March and June 1993, MRSA was isolated from 10 patients in our burn unit. All isolates had identical antibiograms and chromosomal DNA patterns.Control Measures:Infection control personnel encouraged healthcare workers to wash their hands after each patient contact. The unit cohorted all infected or colonized patients, placed each affected patient in isolation, and, if possible, transferred the patient to another unit. Despite these measures, new cases occurred. Infection control personnel obtained nares cultures from 56 healthcare workers, 3 of whom carried the epidemic MRSA strain. One healthcare worker cared for six affected patients, and one cared for five patients. We treated the three healthcare workers with mupirocin. Subsequently, no additional patients became colonized or infected with the epidemic MRSA strain.Conclusions:The outbreak ended after we treated healthcare workers who carried the epidemic strain with mupirocin. This approach is not appropriate in all settings. However, we felt it was justified in this case because of a persistent problem after less intrusive measures.
The Role of Understaffing in Central Venous Catheter-Associated Bloodstream Infection
Authors: Fridkin Scott K. , Pear Suzanne M. , Williamson Theresa H. , Galgiani John N. , Jarvis William R. 
Published: September 2009

AbstractObjective:To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.Design:Case-control and cohort studies of surgical intensive care unit (SICU) patients.Setting:A university-affiliated Veterans Affairs medical center.Patients:Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993).Measurements:CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio.Results:When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence inter val, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the out-break period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients.Conclusions:Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (ie, nosocomial infection) needs to be critically assessed.
Tuberculosis in the Workplace: OSHA's Compliance Experience
Authors: McDiarmid Melissa , Gamponia Melissa J. , Ryan Margaret A.K. , Hirshon Jon Mark , Gillen N.A. , Cox Maureen 
Published: September 2009

AbstractObjective:Inspections of 272 facilities were performed between May 1992 and October 1994 to determine compliance with applicable Occupational Safety and Health Administration (OSHA) requirements for prevention of tuberculosis (TB) transmission.Design:Retrospective record review of two data sources: (1) OSHA's Computerized Integrated Management Information System and (2) an inspector-completed questionnaire on inspection results.Setting/Participants:Inspections of five types of facilities: healthcare institutions, correctional facilities, homeless shelters, long-term–care facilities for the elderly, and others, including drug treatment centers that the Centers for Disease Control and Prevention (CDC) identified as having a higher than expected rate of TB.Methods:The OSHA Compliance Memorandum, based on the 1990 CDC Guidelines, which outlined elements of a TB prevention program, was used in performing 272 inspections of facilities between May 1992 and October 1994. Elements of compliance were recorded and reviewed from the IMIS database and inspectors' questionnaires.Results:Regulated facilities were not fully compliant with OSHA guidance. Generally, healthcare facilities performed better than other facilities. Most facilities (79%) were compliant with administrative elements of a comprehensive TB control program, such as early identification of known or suspected infectious TB patients and skin testing of workers. Only 29% of inspected facilities were found to have acceptable respiratory protection programs for the prevention of occupational TB.Conclusion:Facilities have not been fully compliant with the OSHA memorandum describing protection of workers from TB. Facility compliance was better with some traditionally recognized TB infection control elements, but was weaker in the area of respiratory protection programs. This may reflect a lack of familiarity with the latter type of hazard protection.
An Outbreak of Cutaneous Aspergillosis in a Tertiary-Care Hospital
Authors: Bryce E.A. , Walker M. , Scharf S. , Lim A.T. , Walsh A. , Sharp N. , Smith J.A. 
Published: September 2009

AbstractA cluster of four cases of surgical and burn wound aspergillosis occurred in a 900-bed, adult, tertiary-care hospital. The source was traced to the outside packages of dressing supplies, which had become contaminated during construction in the central Inventory Control area. This resulted in patients with large exposed surface areas being inoculated directly with Aspergillus spores.
Comparative Killing Kinetics of Methicillin-Resistant Staphylococcus aureus by Bacitracin or Mupirocin
Authors: Chapnick Edward K. , Gradon Jeremy D. , Kreiswirth Barry , Lutwick Larry I. , Schaffer Benjamin C. , Schiano Thomas D. , Levi Michael H. 
Published: September 2009

AbstractThe in vitro activities of bacitracin and mupirocin were compared for seven different strains of methicillin-resistant Staphylococcus aureus. Six of seven strains showed bacitracin minimum inhibitory concentrations (MICs) of 0.5 to 1.0 units/mL, and all seven had mupirocin MICs of 0.5 to 2 μg/mL. Time-kill studies revealed 2.6- to 4.5-log reduction in 24 hours with strains susceptible to bacitracin (4 units/mL) and 0 to 2.2 reduction with mupirocin (16 μg/mL). Bacitracin should be considered further for in vivo studies because of enhanced bacteriocidal effect and lower cost.
Educational Needs and Opportunities for the Hospital Epidemiologist
Authors: Dembry Louise M. , Hierholzer Walter J. 
Published: September 2009

AbstractThe role of the hospital epidemiologist has changed substantially over the last 30 years as medical care has become more complex. The hospital epidemiologist needs training in methods for sur veillance, prevention, and control of nosocomial infections. The hospital epidemiologist also must know how to apply these methods to other areas, including the epidemiology of noninfectious adverse out-comes of medical care. Training in hospital epidemiology should be a defined part of every infectious disease fellowship training program. Ancillary and additional training is available from several sources.
Loss of Antimicrobial Susceptibility in Aerobic Gram-Negative Bacilli Repeatedly Isolated From Patients in Intensive-Care Units
Authors: Manian Farrin A. , Meyer Lynn , Jenne Joane , Owen Amy , Taff Terry 
Published: September 2009

AbstractObjective:To study the loss of antimicrobial susceptibility in repeat (same patient, same bacterial species, and same site) aerobic gram-negative bacilli (AGNB) isolated from individual patients during their stay in the intensive-care unit (ICU).Setting:A 792-bed, tertiary-care community hospital with a total of 107 adult, pediatric, and neonatal ICU beds. METHOD: An obser vational prospective study performed November 1992 through mid-July 1993.Results:Of 594 consecutive AGNB from 287 ICU patients, 117 isolates (20%) from 55 patients (19%) were repeat isolates, with the majority obtained from respiratory secretions (83%). Pseudomonas aeruginosa and Enterobacter species accounted for 61% of the isolates. Forty-two (36%) of the repeat isolates from 24 patients (44%) had >4-fold increase in minimum inhibitory concentration to at least one antibiotic and no longer were considered fully susceptible based on National Committee on Clinical Laboratory Standards criteria. Loss of antimicrobial susceptibility often developed within several (median 8) days and was associated only infrequently with simultaneous transition from colonization to infection in the individual patient. Use of certain β-lactam antibiotics was associated with increasing resistance to several other antibiotics in the same class. Concurrent use of β-lactams and aminoglycosides did not prevent loss of antimicrobial susceptibility to the former in repeat isolates.Conclusion:We conclude that loss of antimicrobial susceptibility in repeat AGNB isolated from ICU patients is common, usually is not associated with transition from colonization to infection, and often is associated with prior use of antibiotics. Minimizing antibiotic use in ICU patients should help reduce the risk of antimicrobial resistance in repeat AGNB isolates.
Risk Factors Associated With Clostridium difficile Diarrhea in Hospitalized Adult Patients: A Case-Control Study—Sucralfate Ingestion is Not a Negative Risk Factor
Authors: Watanakunakorn Paul W. , Watanakunakorn Chatrchai , Hazy John 
Published: September 2009

AbstractObjectives:To assess risk factors associated with Clostridium difficile diarrhea in hospitalized adult patients, and to test the hypothesis that sucralfate ingestion is associated with nondetection of C difficile cytotoxin in stool specimens.Design:A retrospective case-control study of hospitalized adult patients who had stool specimens assayed for C difficile cytotoxin. For each patient who had positive C difficile cytotoxin, a patient who had negative C difficile cytotoxin was used as a control. The study period was January to December 1993.Setting:A community teaching hospital affiliated with a medical school in northeastern Ohio.Results:There were 91 case patients and 91 control patients. Cephalosporin exposure was identified as a risk factor in patients with C difficile diarrhea. The number of patients who had sucralfate ingestion was comparable in both groups of patients.Conclusions:Administration of cephalosporins was identified as a risk factor in patients with C difficile diar-rhea. We were not able to confirm a recent report of the association between ingestion of sucralfate and nondetection of C difficile cytotoxin in stool specimens. Our findings suggest that sucralfate ingestion is not associated with nondetection of C difficile cytotoxin in stool specimens. Assay of C difficile cytotoxin in stool specimens remains a valid method of diagnosing C difficile diarrhea, even in patients who ingest sucralfate.