bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applying a Standard of Care to the Quality Assessment of Bacteremia
Authors: Gross Peter A. , Saul Zane K. , Kuyumcu Arpi 
Published: September 2009

AbstractObjective:To identify an indicator of appropriate antibiotic use for bacteremia that is scientifically sound, that is noncontroversial, and that can be broadly applied as an index of the quality of care.Design:Retrospective review of consecutive cases of significant documented bacteremias.Setting:Suburban tertiary-care hospital.Results:Two hundred ninety-one of 300 (97%) patients received appropriate antibiotics within 48 hours after the final antibiotic sensitivity report was placed on the hospital chart. Therapy was not appropriate in 6 patients with methicillin-resistant Staphylococcus aureus and in 3 patients with enterococcal bacteremia.Interventions:Following this study, we instituted a program to prospectively monitor antibiotic use in bacteremias. During the most recent 1-year period, the infectious disease fellow or pharmacist called the attending physician to change antibiotics in 84 of 731 (11.5%) patients with bacteremia. The program was well-accepted by attending physicians.Conclusions:A scientifically sound, non-controversial standard of care was identified and used to evaluate the appropriateness of antibiotic use. When this standard was applied prospectively and incorporated into the hospital's routine operations, the quality of care was improved.
AIDS: Is It an Ill Wind?
Authors: Beck WC. , Meyer Kenneth 
Published: September 2009

Historically, infection control can, we believe, be divided into three eras, each lasting about a half century. We wonder whether we are now seeing the beginning of a fourth.The first era, which we call the nascent period, began roughly in the middle of the last century. It arose from the discoveries of Ignaz Semmelweis and Florence Nightingale. The benefits of each of their contributions on hospital mortality were so spectacular that they would qualify for the “lead ball” award. (Del Gurchio quoted Lloyd MacLean as saying, “If you hold a lead ball out of the window and when you let it go it goes up, you do not need a statistician to tell you it was a significant event.” Hence, the “lead ball” award.)The second era would be the aseptic period. It dates from the acceptance of the findings of Pasteur, Lister, and Koch. Their concepts achieved general acceptance, after a hard fight, at the beginning of the 20th century.
When Your Patient Complains
Authors: Davidhizar Ruth , Vance Anna 
Published: September 2009

Being the recipient of complaints is a common experience for healthcare workers. Complaints are often surprising for the novice caregiver who expects to be appreciated for services provided. In reality, most patients are grateful for the attention and assistance from caregivers. However, complaints, for a variety of reasons, are a frequent and regular occurrence in the healthcare arena. Whether caregivers are physicians, nurses, infection control practitioners, or support staff, few caregivers can avoid encountering the patient who complains.Complaining is defined by Webster-l as an expression of pain, grief, or discomfort and a way to make an accusation or charge. While the definition may appear simple and straightforward, complaints from patients often are complex. A complaint may have a variety of meanings. The most significant meaning is frequently not apparent in the verbalized complaint. Furthermore, the verbalized complaint is frequently not the most significant concern of the patient.” For the caregiver to respond effectively, it is important to identify and understand the meaning behind the patient's complaint.
Outbreak of Surgical Wound Infections Associated With Total Hip Arthroplasty
Authors: Beck-Sague Consuelo M. , Chong Wang H. , Roy Connie , Anderson Roger , Jarvis William R 
Published: September 2009

AbstractObjectives:Describe an outbreak of surgical wound infections associated with total hip arthroplasty; identify risk factors for surgical wound infection during the pre-outbreak and outbreak periods.Setting:A 100-bed hospital. From May 1 to September 30, 1988, 7 of 15 patients who underwent total hip arthroplasty developed surgical wound infections from Staphylococcus aureus (5), Enterobacter cloacae (1), b-hemolytic streptococci (1), enterococci (1), coagulase-negative staphylococci (1), and Escherichia coli (1) (attack rate = 46.7%).Design:Retrospective cohort studies comparing surgical wound infection rates by patient-and procedure-related risk factors during the pre-outbreak and outbreak periods were conducted. Drop plate quantitative air culturing was conducted in 10 consecutive total hip artbroplasties in the subsequent 6 months.Results:Rates of surgical wound infection were significantly higher for arthroplasties in which no intraoperative prophylactic antimicrobials were given (44% versus 8%, relative risk [RR] = 5.4, p= .01), or in which the posterior approach (20% versus 3%, RR= 6.7, p = .04) or a specific prosthesis (39% versus 5%, RR=6.3, p = 0.01) was used. The surgical wound infection rate was highest when one circulating nurse, Nurse A, assisted (47% versus 4%, RR= 12.8, p<.001). Logistic regression analysis identified use of the posterior approach (RR= 1.8, p= .04) and Nurse A's participation (RR= 5.0, p <.001) as independent risk factors for surgical wound infection. Interviews of the nursing supervisor indicated that Nurse A had recurrent dermatitis on her bands. During 6 months following Nurse A's reassignment, the rate declined significantly (from 7/15 to 0/10, p=.01). Drop plate culturing yielded 2 to 10 colonies per plate of organisms that did not match outbreak organisms.Conclusions:Outbreaks associated with personnel generally involve only 1 species. In this outbreak, Nurse A (possibly because of her dermatitis), technique, the posterior approach, and/or other undetermined factors were the primary predictors of surgical wound infection.
Infections and Infection Risks in Home Care Settings
Authors: White Mary C. 
Published: September 2009

AbstractObjectives:To describe the characteristics of home healthcare clients with respect to infection risks and the presence of infections.Design:Descriptive survey of client charts using a point prevalence design.Setting:A private San Francisco, California, Bay area home care agency.Participants:A random sample of 175 clients (28%) was taken from the active client list for a single day; demographic data and clinical data from the last visit prior to the selection day were collected from each chart.Results:The clients were predominantly elderly (mean= 68.6) with an average of 3.6 comorbid conditions; 12% had an invasive device. Over 20% had an infection on the day surveyed. Five percent had an infection that occurred during home care deliveryConclusions:A substantial proportion of home health clients have infections, and they represent persons with a number of the risks associated with infections. Guidelines for defining and monitoring infections in home care need to be developed. Hospital-based surveillance methods are not altogether appropriate in this setting; redesigning methods such as targeted surveillance, monitoring rehospitalization, or immunization practices are discussed as potential ways to measure quality of care in the home setting.
Needlestick Injury in Hospital Personnel: A Multicenter Survey From Central Italy
Authors: Albertoni Francesco , Ippolito Giuseppe , Petrosillo Nicola , Sommella Lorenzo , Nardo Vincenzo Di , Ricci Carlo , Franco Elisabetta , Perucci Carlo A. , Rapiti Elisabetta , Zullo Gennaro ,   The Latium Hepatitis B Prevention Group
Published: September 2009

AbstractObjectives:To assess the rate of needlestick injury in hospital personnel in an Italian region. To identify risk factors potentially amenable to correction.Design:Hospital workers undergoing hepatitis B prevaccination testing in 1985 through 1986 were interviewed regarding needlestick injury in the previous year, job category, area of work, years of employment, and other pertinent information.Setting:Of the 98 public hospitals of the Latium region, 68 participated in the survey: 32 of 55 with less than 200 beds, 20 of 25 with 200 to 300 beds, 11 of 13 with 400 to 900 beds, and all of the 5 with more than 1,000 beds.Participants:All healthcare workers providing direct patient care or environmental services as well as student nurses were invited by the hospital directors to undergo hepatitis B prevaccination testing and vaccination, if eligible.Results:Of 30,226 hospital workers of the 68 participating hospitals, 20,055 were interviewed (66.3%): 47.7% of the 7,172 doctors, 71% of the 14,157 nurses, 55.9% of the 2,513 technicians, and 71.9% of the 6,384 ancillary workers. Needlestick injury was recalled by 29.3%; the rates were 54.9%, 35.3%, 33.8%, 26.5%, 18.7%, and 14.7% in surgeons, registered and unskilled nurses, physicians, ancillary workers, and technicians, respectively. The recalled injury rate was 39.7% and 34.0% in surgical and intensive care areas; in infectious diseases, it was 16.7%. Bates were lower in hospitals with 200 to 300 beds (25.6%). The needlestick injury rate declined from 32% in those with less than 5 years of employment to 28% in those with more than 20 years (p<.01). Prevalence of HBV infection was higher in student nurses and young workers recalling a needlestick exposure (14.3% and 15.8%, respectively), versus 10.1% and 12.8% in those not exposed (p<.01 and <.05, respectively).Conclusions:Parenteral exposure to bloodborne infectious agents is a relevant risk among healthcare workers in our region, particularly in defined job categories and hospital areas (surgeons, nurses, surgical, and intensive care areas). Immunization and educational efforts should be made along with better designs of devices to reduce the risk of infection.
Nosocomial Infections in Surgical Patients in the United States, January 1986-June 1992
Authors: Horan Teresa C. , Culver David H. , Gaynes Robert P. , Jarvis William R. , Edwards Jonathan R. , Reid Casetta R. ,   National Nosocomial Infections Surveillance (NNIS) System
Published: September 2009

AbstractObjectives:To describe the distribution of nosocomial infections among surgical patients by site of infection for different types of operations, and to show how the risk of certain adverse outcomes associated with nosocomial infection varied by site, type of operation, and exposure to specific medical devices.Design:Surveillance of surgical patients during January 1986-June 1992 using standard definitions and protocols for both comprehensive (all sites, all operations) and targeted (all sites, selected operations) infection detection.Setting and Patients:Acute care US hospitals participating in the National Nosocomial Infection Surveillance (NNIS) System: 42,509 patients with 52,388 infections from 95 hospitals using comprehensive surveillance protocols and an additional 5,659 patients with 6,963 infections from 11 more hospitals using a targeted protocol.Results:Surgical site infection was the most common nosocomial infection site (37%) when data were reported by hospitals using the comprehensive protocols. When infections reported from both types of protocols were stratified by type of operation, other sites were most frequent following certain operations (e.g., urinary tract infection after joint prosthesis surgery [52%]). Among the infected surgical patients who died, the probability that an infection was related to the patient's death varied significantly with the site of infection, from 22% for urinary tract infection to 89% for organ/space surgical site infection, but was independent of the type of operation performed. The probability of developing a secondary bloodstream infection also varied significantly with the primary site of infection, from 3.1% for incisional surgical site infection to 9.5% for organ/space surgical site infection (p<.001). For all infections except pneumonia, the risk of developing a secondary bloodstream infection also varied significantly with the type of operation performed (p<.00l) and was generally highest for cardiac surgery and lowest for abdominal hysterectomy. Surgical patients who developed ventilator-associated pneumonia were more than twice as likely to develop a secondary bloodstream infection as nonventilated pneumonia patients (8.1% versus 3.3%, p<.001).Conclusions:For surgical patients with nosocomial infection, the distribution of nosocomial infections by site varies by type of operation, the frequency with which nosocomial infections contribute to patient mortality varies by site of infection but not by type of operation, and the risk of developing a secondary bloodstream infection varies by type of primary infection and, except for pneumonia, by type of operation.
An Outbreak of Acute Nonbacterial Gastroenteritis in a Nursing Home
Authors: Pegues David A. , Woernle Charles H. 
Published: September 2009

AbstractObjective:To determine risk factors for and modes of transmission of an outbreak of acute nonbacterial gastroenteritis among residents and staff in a nursing home.Design:Cohort study of residents and questionnaire survey of employees.Setting:One hundred twenty-bed nursing home in Alabama.Patients:From July 11,1991, through July 25,1991,77 of 120 residents (attack rate = 64%) and at least 14 of 49 employees (minimum attack rate = 29%) developed acute gastroenteritis characterized by vomiting and diarrhea; few residents developed fever > 100°F. Nine residents required intravenous rehydration, and 2 residents died.Results:The risk of developing illness was greater for female residents (64/92 versus 13/28; relative risk [RR] = 1.5; 95% confidence interval [CI95 ]=1.0-2.3) and for employees who reported handling residents' soiled linen, stools, or vomitus more frequently (>5 times a shift versus = 5 times a shift: 7/13 versus 7/31; RR=2.4; CI95 = 1.1-5.4). Direct transmission of infection, probably via person-to-person spread, sustained the outbreak. Temporal clustering analysis demonstrated that the risk of becoming ill 1 or 2 days after a roommate became ill was significantly greater than that of becoming ill at other times during the outbreak (RR= 2.2; CI95 = 1.3-3.8). No Salmonella or Shigella species, ova, or parasites were identified from 12 fecal specimens obtained from ill residents.Conclusions:Although stool and serum specimens were not available for viral studies, the clinical symptoms and incubation period were consistent with illness due to Norwalk-like viral agents. This outbreak emphasizes the severity of acute nonbacterial gastroenteritis among elderly and debilitated residents of nursing homes and the need for prompt use of enteric precautions in controlling outbreaks of gastroenteritis in these facilities.
Ethical Considerations in the Use of Subliminal Stimulation to Improve Handwashing Compliance Scientific Utility Versus Autonomy of the Individual
Authors: Edmond Michael B. , Wenzel Richard P. 
Published: September 2009

Nosocomial infections remain a significant problem for the healthcare system in the United States. At least 5% of patients will acquire an infection during their hospital stay, extending hospitalization by four days per infection, directly accounting for an estimated 60,000 deaths per year and an additional $10 billion of the amount spent on healthcare.Previous studies have demonstrated that pathogenic bacteria can be recovered from the hands of healthcare workers and transmitted to patients. Moreover, a recent study has shown that hand carriage of organisms and subsequent contact may be the most important mechanism of nosocomial infection transmission in the intensive care unit setting.
Selective Surveillance for Nosocomial Infections in a Brazilian Hospital
Authors: Lima Noelia L. , Pereira Claudia R.B. , Souza Isabel C. , Facanha Monica C. , Lima Aldo A.M. , Guerrant Richard L. , Farr Barry M. 
Published: September 2009

AbstractObjective:To devise a system for surveying the frequency of nosocomial infections in a tertiary care hospital in a developing country.Design:Prospective selective surveillance by nurses of the charts of patients at high risk for nosocomial infections, as identified by a form completed by resident physicians. The sensitivity, specificity, and predictive value of this method of selective surveillance were compared with those for total prospective chart review by two infectious disease specialists.Setting:A university hospital in northeastern Brazil.Patients:All patients hospitalized for more than 72 hours with an identified risk factor for nosocomial infection.Results:The ratio of nosocomial infections to 100 discharges was 13.4 and the incidence density was 11.2/1,000 patient days. The surveillance method demonstrated a sensitivity of 74% and a specificity of 99.7%. Positive predictive value was 93%, negative predictive value was 99%, and overall accuracy was 98%.Conclusions:This method of selective surveillance for nosocomial infections based on risk factors identified by physicians demonstrated excellent predictive value and overall accuracy and may be of use to other hospitals that lack a nursing care plan book such as the Kardex. The relative frequency of nosocomial infections significantly exceeded the rates reported from hospitals in developed countries.
Klebsiella Pneumoniae Infection on a Rehabilitation Unit: Epidemiologic Typing Methods
Authors: Thompson W. , Romance L. , Bialkowska-Hobrazanska H. , Rennie R.P. , Ashton F. , Nicolle L.E. 
Published: September 2009

AbstractObjective:To identify factors associated with an increased occurrence of Klebsiella pneumoniae isolation in urine cultures and infected wounds on a rehabilitation unit and to compare typing methods for K pneumoniae isolates.Design:Retrospective review of laboratory reports and patient records with case-control study. Analysis of K pneumoniae isolates using capsular serotyping, enzyme electrophoretic typing, ribotyping, and DNA typing.Setting:48-bed rehabilitation unit in an 1,100-bed tertiary care teaching hospital in Winnipeg, Manitoba.Results:In 1988, 20 (19%) of 106 patients admitted to the rehabilitation unit had K pneumoniae isolated from urine or wound, and in 1989 31 (28%) of 111 patients had Klebsiella isolated. Review of ward practices revealed appropriate written policies but evidence of failure in execution leading to multiple opportunities for transmission among patients. Substantial environmental contamination was not identified, although a common urine graduate may have contributed to some transmission. Individuals with K pneumoniae isolated had a significantly longer duration of stay. Many of these were spinal cord-injured patients and were maintained on intermittent catheterization.One outbreak strain was identified in epidemiologic typing. Other strains were generally identified in individuals with nonnosocomial acquisition of infection. Comparison of epidemiologic typing methods suggests ribotyping may be the optimal method for typing K pneumoniae strains.Conclusions:K pneumoniae was acquired frequently by spinal cord-injured patients with extended admissions, re-emphasizing the importance of both patients and stalf following appropriate infection control practices on rehabilitation wards. Ribotyping was the optimal method for typing K pneumoniae isolates.
Comparison of Patient Telephone Survey with Traditional Surveillance and Monthly Physician Questionnaires in Monitoring Surgical Wound Infections
Authors: Manian Farrin A. , Meyer Lynn 
Published: September 2009

AbstractObjective:To evaluate the utility of patient telephone surveys in further improving the detection of surgical wound infections (SWIs) postdischarge in the setting of ongoing traditional surveillance system and monthly physician surveys.Design:Prospective surveillance study of randomly selected patients undergoing surgery in inpatient or outpatient settings.Setting:Tertiary care suburban hospital.Results:Five hundred one patients were randomly selected for telephone contact, of whom 189 (38%) were successfully contacted after three attempts. Eighteen (9.5%) patients reported one or more signs or symptoms of possible SWI. However, none of these patients required antibiotic therapy, was hospitalized with an SWI, or reported by his or her physician (based on the monthly questionnaire) to have had an SWI. Total time spent contacting patients was 47 hours and 48 minutes, or 15 minutes per each successful telephone contact.Conclusions:Patient telephone surveys as conducted in this study were inefficient and failed to substantially improve the rate of detection of over traditional surveillance system and monthly physician questionnaires.
Urinary Tract Infections in Long-Term Care Facilities
Authors: Nicolle L.E. 
Published: September 2009

Urinary tract infection, or bacteriuria, is common in residents of long-term care facilities (LTCFs). The prevalence of bacteriuria in noncatheterized residents of LTCFs has been reported to be 15% to 50% in studies performed in several different countries (Table). As with most other age groups, the prevalence is greater for women than men. The female to male ratio is, however, lower than in younger populations.The incidence of bacteriuria is also extremely high. In one group of severely functionally disabled elderly men, 45 new infections/100 patient years were observed, with 10% of nonbacteriuric residents becoming bacteriuric in each three-month period. An institutionalized population in Greece had initial prevalences of bacteriuria of 19% for men and 27% for women, with an additional 11% and 23% of the non-bacteriuric population, respectively, developing a positive urine culture at 6 or 12 months from admission.4 A nursing home population of elderly women in Philadelphia, with an initial prevalence of bacteriuria of 25%, had an additional 8% of the initially nonbacteriuric subjects identified with a positive urine culture each six-month period of follow-up.
Choosing Appropriate Criteria for Tuberculin Positivity and Conversion in a Long-Term Care Facility
Authors: Muder Robert R. , Brennen Carole , Yu Kwan Ting 
Published: September 2009

AbstractObjectives:The Centers for Disease Control and Prevention has issued new criteria for conversion of the tuberculin skin test; in persons over 35 years of age, an increase in induration of at least 15 mm is considered indicative of new tuberculous infection. We reviewed our experience in a tuberculosis control program in a long-term care facility to assess the applicability of the new criteria to our patient population.Design:Retrospective review of seven years of tuberculosis control records and outbreak investigation.Setting:Long-term care Veterans Affairs hospital.Patients:All patients in the facility between 1985 and June 1992 who received routine admission and annual tuberculin skin testing or who were evaluated for possible exposure to active tuberculosis. A total of 2,342 skin tests were performed.Results:Mean increase in skin test diameter in patients with at least two prior negative tests and known exposure to active tuberculosis was 13.9 ± 4.7 mm. Frequency distribution histograms of skin test sizes of initial tuberculin testing in the entire population indicated 10 mm induration as a reasonable criterion for initial positivity.Conclusions:In our long-term care population, an increase in skin test induration of 10 mm may indicate new tuberculous infection. Criteria for skin test conversion derived from ambulatory populations in other geographic areas may not apply in all situations. Prevalence of infection with Mycobacterium tuberculosis and prevalence of skin test reactivity due to nontuberculous mycobacteria are likely to influence the predictive value of criteria for tuberculin conversion in a given population.