bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vancomycin-Resistant Enterococci in Stool Specimens Submitted for Clostridium difficile Cytotoxin Assay
Authors: Rafferty Mary Ellen , McCormick Malkanthie I. , Bopp Lawrence H. , Baltch Aldona L. , George Mary , Smith Raymond P. , Rheal Carol , Ritz William , Schoonmaker Diana 
Published: September 2009

AbstractThe prevalence of, and clinical risk factors associated with, vancomycin-resistant enterococcal colonization were investigated in patients suspected of having Clostridium difficile infection. Stools submitted for C difficile cytotoxin testing were screened for vancomycin-resistant enterococci (VRE). Isolates were speciated and characterized further by antibiotic susceptibility testing, DNA fingerprinting, and DNA:DNA hybridization for detection of specific vancomycin resistance genes. Of the 79 evaluable patients identified during a 3-month period, 16.5% were VRE-positive. The VRE isolates were genetically heterogeneous, although all carried the vanA gene. DNA fingerprinting data suggest that patient-to-patient transmission occurred, implicating colonized patients as potential reser voirs for VRE transmission. A positive C difficile cytotoxin assay and diabetes mellitus were the only identifiable risk factors associated with VRE colonization. Patients at risk for C difficile infection therefore may serve as reser voirs for VRE.
Activity of Disinfectants Against Vancomycin-Resistant Enterococcus faecium
Authors: Saurina Guillermo , Landman David , Quale John M. 
Published: September 2009

AbstractVancomycin-resistant enterococci (VRE) often contaminate the hospital environment. We examined the activity of commonly used disinfectants against eight strains of VRE, using a quantitative suspension test method. Isopropyl alcohol and sodium hypochlorite were highly effective. Hydrogen peroxide was ineffective for all strains. After 10 minutes of incubation (the manufacturers' recommended time of exposure), three phenolic and three quaternary ammonium compounds also were highly effective. After 3 minutes of exposure, however, occasional failures did occur. With the exception of 3% hydrogen peroxide, most disinfectants appear to be active against VRE.
Management of Healthcare Workers Infected With Hepatitis B Virus, Hepatitis C Virus, Human Immunodeficiency Virus, or Other Bloodborne Pathogens
Authors:   AIDS/TB Committee of the Society for Healthcare Epidemiology of America
Published: September 2009

AbstractThis article provides the current recommendations of the Society for Healthcare Epidemiology of America (SHEA) regarding the management of healthcare workers infected with hepatitis B virus (HBV), hepatitis C virus (HCV), or the human immunodeficiency virus (HIV). For the reasons cited in the article, SHEA now maintains that separate virus-specific management strategies are appropriate for healthcare workers who are infected with these unrelated viruses. SHEA emphasizes the use of appropriate infection control procedures to minimize exposure of patients or providers to blood, emphasizes that transfers of blood from patients to providers and from providers to patients should be avoided, and argues that infected health-care workers should not be prohibited from participating in patient-care activities solely on the basis of their blood-borne pathogen infection. SHEA recommends that hepatitis B e-antigen–positive healthcare workers routinely should double glove and should not perform those activities that have been identified epidemiologically as associated with a risk for provider-to-patient HBV transmission despite the use of appropriate infection control procedures. SHEA also recommends that HCV- and HIV-infected providers use double gloving for procedures, but recommends that these providers not be excluded from any aspect of patient care unless epidemiologically incriminated in the transmission of these infections despite adequate precautions. SHEA argues for comprehensive education concerning bloodborne pathogens for all healthcare providers and trainees and against mandatory pathogen-specific educational requirements for infected providers. SHEA recommends against specific competence-monitoring procedures directed at these healthcare workers infected with bloodborne pathogens, arguing for managing infected providers in the context of a comprehensive approach to the management of all impaired providers. SHEA emphasizes the importance of worker privacy and medical confidentiality. SHEA emphasizes the importance of offering employees who have disabilities reasonable accommodation for their disabilities. The article discusses exposure management in detail and, in general, recommends adherence to existing guidelines for managing exposures to these agents. Finally, SHEA recommends against routine mandatory testing of providers. Specific details and the rationale for these recommendations are included in the body of the article.
Intramural and Extramural Communication
Authors: Herwaldt Loreen A. , Lettau Ludwig A. 
Published: September 2009

AbstractEffective communication with hospital administrators, with medical staff, with the media, and with peers in healthcare epidemiology is a vital skill for hospital epidemiologists. This article will describe a number of practical ways to improve such communication based on the author's experience, on inter views with senior SHEA members, and on relevant articles from the literature.
Susceptibility of Antibiotic-Susceptible and Antibiotic-Resistant Hospital Bacteria to Disinfectants
Authors: Rutala William A. , Stiegel Marsha M. , Sarubbi Felix A. , Weber David J. 
Published: September 2009

AbstractObjective:To evaluate whether hospital strains of antibiotic-resistant bacteria exhibited altered susceptibility to disinfectants.Design:Antibiotic-susceptible bacteria were obtained from American Type Culture Collection: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Klebsiella pneumoniae, Salmonella choleraesuis, and Pseudomonas aeruginosa. Hospital strains of antibiotic-resistant bacteria were obtained from clinical isolates, including: S aureus, S epidermidis, E coli, Enterococcus species, K pneumoniae, and P aeruginosa. The Association of Official Analytical Chemist's use-dilution method was used to test these 12 strains of 7 bacterial pathogens for their susceptibility to a phenol and a quaternary ammonium compound. For five pathogens, we tested a susceptible and a more resistant strain in 20 comparative trials (5 pathogens, 2 disinfectants, 2 dilutions per disinfectant).Results:In our 20 comparative trials, the antibiotic-resistant strains exhibited an increased resistance to the disinfectant in only a single instance.Conclusions:Our data demonstrate that the development of antibiotic resistance does not appear to be correlated to increased resistance to disinfectants.
Nosocomial Transmission of Human Immunodeficiency Virus and Subsequent Transmission of Multidrug-Resistant Tuberculosis in a Healthcare Worker
Authors: Ridzon Renée , Kenyon Thomas , Luskin-Hawk Roberta , Schultz Carol , Valway Sarah , Onorato Ida M. 
Published: September 2009

AbstractA phlebotomist with nosocomially acquired human immunodeficiency virus infection developed tuberculosis 10 months after exposure to multidrug-resistant Mycobacterium tuberculosis during a nosocomial outbreak. Healthcare workers with immunosuppression are at increased risk of tuberculosis if infected and, if exposed, should be considered for preventive therapy regardless of tuberculin skin-test status.
Derivation and Validation of a Pulmonary Tuberculosis Prediction Model
Authors: Mylotte Joseph M. , Rodgers Jeanne , Fassl Maureen , Seibel Kathleen , Vacanti Angela 
Published: September 2009

AbstractObjective:To describe the derivation and validation of a pulmonary tuberculosis (TB) prediction model that would enable early discontinuation of unnecessary respiratory isolation.Design:Patients placed in isolation for suspected pulmonary TB were studied retrospectively (derivation cohort) and prospectively (validation cohort). Independent predictors of pulmonary TB in the derivation cohort (January 1992-March 1994) were identified by retrospective analysis. Predictors in the model were assigned weights on the basis of the results of the multivariate analysis in order to quantitate the risk of TB in an individual patient. The prospective validation consisted of application of the model to patients placed in isolation during the period April 1994 to June 1995. The predictability of the model in the derivation and validation cohorts was evaluated using receiver operating characteristics (ROC), curve analysis, and calculation of the area under the ROC curve (AUC).Setting:A university-affiliated, urban, public hospital with a large population of prison inmates and patients with human immunodeficiency virus infection.Interventions:Prospective application of the prediction model to patients placed in isolation during the validation period.Results:Four factors were found to be independent predictors of pulmonary TB among 296 isolation episodes in the derivation cohort: positive acid-fast sputum smear (odds ratio [OR], 5.8; 95% confidence interval [CI95], 3.0-11.0; weight=3 points), localized chest radiograph findings (OR, 2.5; CI95,1.3-4.9; weight=2 points), residence in a correctional facility (OR, 2.3; CI95, 1.2-4.4; weight=2 points), and history of weight loss (OR, 1.8; CI95, 1.0-3.2; weight=1 point). Infection control practitioners applied the model prospectively to 220 isolation episodes. The mean (土SE) AUCs of the ROC curve for the derivation and validation cohorts were not significantly different (.86±.04 vs.86±.07; P=.90). There was a significant decline in the mean duration of isolation from the onset of an automatic TB isolation policy in August 1992 to the end of the study (P=.045 by analysis of variance).Conclusions:A pulmonary TB prediction model was derived and validated prospectively in a hospital with a moderately high prevalence of TB. The model quantitated the risk of TB in an individual patient and aided infection control practitioners and primary-care physicians in their decisions to discontinue isolation during the validation period. Utilization of the model was responsible, in part, for a decrease in the mean duration of isolation during the study period. Although the model may not have general applicability due to the uniqueness of the patient population studied, this study illustrates how prediction models can be developed and used effectively to deal with a clinical problem.
Tuberculin Skin Testing of Hospitalized Patients
Authors: Woeltje Keith F. , Kilo Charles M. , Johnson Krista , Primack Jonathon , Fraser Victoria J. 
Published: September 2009

AbstractObjectives:We sought to define the prevalence of tuberculin skin test (TST) positivity in a group of newly hospitalized patients, to identify risk factors for positive tests, and to examine the impact of testing on infection control practices.Design:Unblinded cohort study over 5 days in July 1992.Setting:A 1,000-bed university-affiliated hospital.Patients:All patients admitted (excluding obstetric patients and newborns) were interviewed. Patients without a history of tuberculosis (TB) or a positive TST were offered a TST with Candida and tetanus controls.Results:Of 346 patients offered the test, 21 (6%) had a prior history of TB or a positive TST, and 36 (10%) declined to participate; 279 of the remaining 289 completed the study. Anergy was demonstrated in 94 (33.7%) of 279 patients. New positive TSTs were identified in 19 (10.3%) of 185 nonanergic patients. Of the 19 TST-positive patients, 6 (32%) had infiltrates on chest radiographs and were evaluated for active TB. One patient was treated empirically for active TB, and five received isoniazid prophylaxis. Risk factors for a new positive TST included age (odds ratio [OR], 1.56 per decade of life; P=.021), African American race (OR, 4.81; P=.008), alcohol abuse (OR, 5.53; P=.005), and peptic ulcer disease (OR, 4.53; P=.017). Risk factors for anergy included admission to a surgical service (OR, 2.1; P=.006), current use of steroids (OR, 2.65; P=.005), and human immunodeficiency virus (HIV) infection (OR, undefined; P=.034).Conclusions:Despite a high rate of anergy, routine tuberculin skin testing identified a substantial number of patients with TB infection who might otherwise have gone unrecognized.
Reduction in Tuberculin Skin-Test Conversions Among Medical House Staff Associated with Improved Tuberculosis Infection Control Practices
Authors: Bangsberg David R. , Crowley Kathleen , Moss Andrew , Dobkin Jay F. , McGregor Carlton , Neu Harold C. 
Published: September 2009

AbstractObjective:To assess the efficacy of an infection control program as measured by tuberculin skin-test (TST) conversion rates in medical house staff.Design:Observational study.Setting:University-based hospital in New York City serving a large indigent population.Participants:Medical house staff.Interventions:TST conversions were measured every 6 months in medical house staff from June 1992 to June 1994. Compliance with the isolation policy was measured by identifying room locations 24 hours after admission of patients who had Mycobacterium tuberculosis recovered from respiratory specimens.Results:The TST conversion rate decreased from 5.8 to 0, 2.3, and 0 per 100 person years of exposure in successive 6-month periods. The estimated annual TST conversion rate among interns fell from 7 per 100 person years in June 1992 to 0 per 100 person years in June 1993 and 0 per 100 person years in June 1994 (P=.029). The proportion of patients with pulmonary tuberculosis who were isolated in negative-pressure rooms increased from 38% to 75% over the study period (P=.01).Conclusion:Development of a multifaceted infection control program can decrease the risk of nosocomial tuberculosis infection in medical house staff.
Hospital Outbreak of Norwalk-Like Virus
Authors: Russo Philip L. , Spelman Denis W. , Harrington Glenys A. , Jenney Adam W.J. , Gunesekere Ishara C. , Wright Peter J. , Doultree Jennifer C. , Marshall John A. 
Published: September 2009

AbstractAn outbreak of gastroenteritis caused by Norwalk-like virus occurred in two areas of the hospital: area 1, consisting of three adjacent and interconnected wards, with mostly elderly patients; and area 2, an acute ward in a separate building with elderly patients. In area 1, 40 patients and 20 staff were affected; in area 2, 18 patients and 14 staff were affected. Infection control measures were instituted in consultation with the government health authority. These measures did not appear to affect the course of the outbreak, but may have prevented spread to other wards.
Bleeding After Cardiovascular Surgery Caused by Detergent Residues in Laparotomy Sponges
Authors: Geiss Heinrich K. , Schmitt Judith , Frank Stefan C. 
Published: September 2009

AbstractOn 2 successive days in July 1994, six patients who underwent coronary artery bypass grafting developed postoperative bleeding requiring reexploration. The cause was the use of reprocessed laparotomy sponges with retained detergents, inducing a bleeding disorder.
Primary Prevention and Rubella Immunity: Overlooked Issues in the Outpatient Obstetric Setting
Authors: Schoenhoff Deborah D. , Lane Timothy W. , Hansen Charles J. 
Published: September 2009

AbstractObjective:To determine the knowledge of rubella immune status among practicing obstetrician-gynecologists in the United States and of rubella immunity policies covering healthcare workers in the obstetric-care office setting.Design:Mailed survey questionnaire, August through December 1994.Setting:Physicians from multiple-practice sites including private office, public institution, university or teaching hospital, and closed panel health maintenance organization settings.Participants:3,302 practicing obstetrician-gynecologists, chosen by a systematic random sample from the AMA national physician database.Main Outcome Measures:Participants were defined as rubella immune if they reported knowledge of prior rubella vaccination or positive antibody titer. Knowledge of a policy for documenting rubella immunity among employees in the office-based practice setting also was assessed.Results:Questionnaires were returned from 50% (1,666) of the 3,302 surveyed, and 96% (1,599) were evaluable. Approximately 20% (304/1,599) of the responding obstetrician-gynecologists did not have knowledge of documented rubella immunity, and the majority of office-based practices did not require documentation of rubella immunity in the following groups: physicians, 66% (723/1,094); office nurses, 62% (666/1,070); and other office staff, 69% (728/1,063). Sixty-two percent (993/1,599) of responding physicians had individual rubella serologies performed, with 916 known to be positive, 53 reported negative, and 24 reported unknown. Fifty-seven percent (918/1,599) reported receiving monovalent rubella vaccine or trivalent measles-mumps-rubella vaccine. Multiple logistic regression analysis revealed the following to be independent predictors of positive immune status among respondents: female gender (odds ratio [OR], 2.4; 95% confidence interval [CI95], 1.8-3.1), medical school graduation since 1980 (OR, 2.6; CI95, 2.0-3.3), providing obstetric or fertility services (OR, 1.5; CI95, 1.2-1.9), and group practice setting ≥5 physicians; OR, 1.2; CI95, 1.1-14).Conclusions:Nationally, nearly one of every five practicing obstetricians may not have documented rubella immunity, and the majority of office-based practices have no system for assuring such immunity. Rubella immunity should extend beyond the hospital setting, with consideration for requiring rubella immunity as a condition for employment. Methods for effective implementation and documentation of current guidelines need to be addressed, particularly in the office setting.
An Evaluation of the AbTox Plazlyte Sterilization System
Authors: Bryce E.A. , Chia E. , Logelin G. , Smith J.A. 
Published: September 2009

AbstractObjective:To evaluate the efficacy of the AbTox Plazlyte Sterilization System against selected microbial species using inoculated carriers and surgical instruments.Setting:The microbiology laboratory of a 700-bed adult tertiary-care hospital.Design:The study was conducted in two phases. In phase 1, microorganisms were inoculated to various metal, paper, plastic, and glass carriers, as well as surgical equipment, and processed in cycle II of the AbTox sterilizer. Phase 2 compared AbTox cycle III with ethylene oxide sterilization using stainless steel washers, penicylinders, and surgical equipment. In both phases, cultures of equipment and carriers were obtained after processing. The phenotypic profiles and antibiograms of positive cultures were compared to the original inoculate to rule out the possibility of contamination.Results:Of a total of 350 paper carriers, 375 metal washers, and 234 pieces of equipment processed in cycle II and using trypticase soy broth as the inoculating medium, 123 metal washers (32%) and 8 instruments (3%) failed to be sterilized. Similar failures were noted with cycle III. The presence of either salt or protein adversely affected the system's ability to sterilize in either cycle.Conclusion:Further studies are needed to evaluate the extent to which salt or organic material compromise low-temperature gas-plasma sterilization. Meanwhile, users should exercise caution and use care in the cleaning of instruments that will be processed in the plasma-based sterilization technologies
Use of an Estimation Method to Derive an Appropriate Denominator to Calculate Central Venous Catheter-Associated Bloodstream Infection Rates
Authors: Cookson Susan Temporado , Ihrig Melanie , O'Mara Edward M. , Hartstein Alan I. , Jarvis William R. 
Published: September 2009

AbstractAn outbreak investigation was conducted to determine if an increase in bloodstream infections (BSIs) in patients with central venous catheters (CVC) had occurred. Because other methods of obtaining CVC days were not feasible, we used an estimation method based on a random 5% sample of medical records to determine the proportion of days that a CVC was present for each of three patient units. This calculated ratio was used to estimate the total CVC days for each unit. A cohort study was conducted in which the BSI rates before and during needleless device use were compared. This article describes the methods used to calculate this estimated denominator and discusses the need for such a denominator to be used by infection control practitioners when prospective collection of CVC days is not possible.
Infection Control in the Outpatient Setting
Authors: Herwaldt Loreen A. , Smith Shanon D. , Carter Cheryl D. 
Published: September 2009

AbstractThis article discusses aspects of ambulatory care that increase the difficulty of practicing infection control in this setting or that require infection control staff to use different methods than they would use in the inpatient setting. The article reviews basic infection control precautions that apply to the outpatient setting in general and specific precautions that apply to dialysis centers and physical therapy programs. The article also describes outbreaks that have occurred in the outpatient setting, defines the deficiencies in infection control practice that caused the outbreaks, and discusses methods to prevent transmission of pathogens in the outpatient setting.
Evaluation of a Room for Tuberculosis Patient Isolation Using Theatrical Fog
Authors: Gershey Edward L. , Reiman James , Wood William , Party Esmeralda 
Published: September 2009

AbstractObjective:To develop a method to evaluate directional airflow patterns, air dilution, and air mixing in facilities where tuberculosis patients are seen.Design:A tuberculosis patient isolation room was evaluated by analyzing pressure differential between the room and the corridor and by using theatrical fog to visualize room air movement and impact of dilution and exchange, as well as air capture and displacement. Tracer gas was compared to fog results and used to calculate air exchange rates.Setting:A small research hospital.Results:By adding theatrical fog to the patient room at several locations, we quickly learned that most of the air entering the room through the transom and around the door to the corridor was exhausted through the three exhaust vents. Little air appeared to move toward the exhaust fan.For comparison and to confirm the room air exchange rate, tracer gas was distributed and sampled. The kinetics of decay were very similar whether the tracer gas and room air were mixed during sampling or not.Conclusions:The fog procedure allowed good visual confirmation of air mixing and airflow patterns and provided quantitative data for evaluating the efficacy of air capture and displacement or dilution and exchange