bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatitis B Vaccine: Persistence of Antibody Following Immunization
Authors: Barnas Gary P. , Hanacik Linda J. 
Published: September 2009

AbstractWe examined the persistence of hepatitis B surface antibody following hepatitis B vaccination in a group of health care workers. Of the 187 vaccine recipients screened, 39 were found to be antibody negative. Life table analysis showed the proportion retaining antibody at one, two, three, and four years from the first dose of vaccine was 92%, 84%, 73%, and 55% respectively. The likelihood of retaining antibody was significantly decreased as the age of the vaccine recipient increased. These results indicate that a large proportion of vaccine recipients no longer had detectable antibody four years after receipt of the vaccine. It remains to be shown if such individuals who have lost antibody are susceptible to the development of clinical hepatitis.
Hospital Infection Surveillance in the United Kingdom
Authors: Ayliffe G.A.J. 
Published: September 2009

Surveillance methods vary in different hospitals, but are mainly based on laboratory reports, as in Sweden. These reports are supplemented by ward visits by the infection control nurse and by the usual epidemiologic methods in the investigation of outbreaks.An increasing interest in surveillance of hospital infection occurred in the 1950s when outbreaks of staphylococcal infection were causing problems throughout the world. The appointment of an MD as infection control officer in every hospital was suggested in 1955 by Colebrook in the Birmingham Accident Hospital, but no full-time officer has so far been appointed in the United Kingdom (UK). The task was taken on by medical microbiologists, who are usually physicians and, currently in England and Wales, make up 82% of infection control officers.”In the early days, the recording of the incidence of infection was usually confined to surgical wounds, as in the US. The problem of collecting a large amount of data by the microbiologist was recognized by Moore who appointed the first infection control nurse.” He also described the importance of laboratory reports in the early detection of outbreaks.Surveillance was a major topic for discussion at the international Conference on Nosocomial Infections in 1970, and Moore suggested that incidence rates were of little value for determining changes in a hospital or for comparisons between hospitals. The number of infections in individual hospitals was too small for statistical comparison, particularly if rates were low and infections influenced bv many factors were not corrected for in the overall rates.
A Quality Assurance Program for Human Immunodeficiency Virus Seropositivity Screening of Dried-Blood Spot Specimens
Authors: Hannon W. Harry , Lewis D. Sue , Jones Wanda K. , Powell Mary K. 
Published: September 2009

AbstractEpidemiologic projects have been implemented for using dried-blood spot (DBS) specimens routinely collected on filter paper from neonates as a seroepidemiologic resource to monitor seroprevalence of human immunodeficiency virus (HIV) among child-bearing women. To ensure the quality of the data base produced from the national and other epidemiologic surveys, a quality assurance program was developed to interact with all the neonatal screening laboratories. The focus of the Centers for Disease Control's quality assurance program for HIV seropositivity testing of neonatal blood specimens is to maintain a national program to produce, certify, and provide external quality control materials as DBSs on filter paper, to monitor the filter paper matrix, to operate an external performance surveillance program, and to provide other special and consultative services. The dried-blood control and surveillance materials are certified by rigorous testing for accuracy, stability, and homogeneity. Preliminary results from the first performance evaluation of screening laboratories indicated excellent performance.
Impact of a Recapping Device on Venepuncture-Related Needlestick Injury
Authors: Goldwater Paul N. , Law R. , Nixon A.D. , Officer J.A. , Cleland J.F. 
Published: September 2009

AbstractIn a 33-month prospective analysis of needlestick injuries, venepuncturists working under Centers for Disease Control (CDC) guidelines for handling used needles were shown to incur a needlestick injury for every 3,175 to 4,006 needle-handling procedures. On the other hand, users of a simple device designed to reduce the risk of injury when recapping used needles were shown to incur a needlestick only once in every 16,100 venepunctures performed (P&lt;0.00l). This represents a fourfold reduction in the rate of needlestick injuries. We thus question the effectiveness of the CDC nonrecapping policy.
Pneumococcal Endophthalmitis after Corneal Transplantation Control by Modification of Harvesting Techniques
Authors: Moore Peggy J. , Linnemann Calvin C. , Sanitato James J. , Binnion Beth 
Published: September 2009

AbstractBetween January and September 1986, 61 patients underwent corneal transplantation at a university hospital, and three (4.9%) of the patients developed endophthalmitis. Cultures of the donor cornea were positive for Streptococcus pneumoniae. The transplant program was stopped and an investigation begun. Review of corneal transplants in 1985 showed that S pneumoniae was recovered from only 1 (1.5%) of 66 donor corneas compared with 6 (9.8%) of 61 in 1986 (P = 0.045; Fisher's exact test). Investigation showed that major changes had occurred in the corneal transplant program in 1986 as a result of a new state law. Coroner's cases had become the source of most corneas; younger donors were available, and corneas, instead of whole eyes, were collected in the coroner's office, often by part-time technicians. All of the infected corneas had been harvested by part-time technicians, instead of the regular eye bank technician, and came from younger donors (mean age 11.8 years v 27.2; P ≤ 0.02). Based on these observations, collection techniques were modified to reduce contamination of corneas during harvesting. This included the use of surgical drapes and gloves, collecting the cornea without interruption, saline irrigation of the eye, and inversion of the eye chamber to ensure complete contact of the cornea with the antibiotic-containing media. The program was restarted, and there were no corneal infections with S pneumoniae during a one-year follow-up period. The study indicates that techniques sufficient to prevent infection when whole eyes were taken and the cornea harvested by experienced technicians were not effective for direct harvesting of corneas in a coroner's office by less experienced technicians. The use of younger donors may also increase the risk of S pneumoniae contaminating the cornea and require additional measures for control.
Infection Control in Canada
Authors: Campbell Beverly 
Published: September 2009

The Canadian health care system serves a population of approximately 25 million people spread out over a very large geographic area (9,960,000 km2). Canada is a federal state consisting of ten provinces and two territories. It was formally created in 1867 when the British North America Act (BNA Act) was passed by the British Parliament, uniting several of the British North American colonies.The BNA Act grants the provincial governments primary jurisdiction over most health services. The federal government has jurisdiction over quarantine, the establishment and maintenance of marine hospitals, and the quality of food and drugs, and until recently provided health care services to the territories. The federal government also helps to finance provincial health care services and, therefore, the provincial governments have been persuaded to establish hospital and medical care insurance programs. The shared-cost federal programs require each province to meet certain conditions in order to obtain federal funding. This division of powers has resulted in ten distinct, although related, health systems.
The Inanimate Environment of an Intensive Care Unit as a Potential Source of Nosocomial Bacteria: Evidence for Long Survival of Acinetobacter calcoaceticus
Authors: Getchell-White Sandra I. , Donowitz Leigh G. , Groschel Dieter H.M. 
Published: September 2009

AbstractEnvironmental surface and personnel hand impression cultures were obtained during 13 sampling periods in the University of Virginia Pediatric Intensive Care Unit to document potential reservoirs of nosocomial pathogens. In 78 environmental cultures Staphylococcus aureus was found eight times and gram-negative bacilli ten times. The patient chart cover was the most commonly contaminated surface. Acinetobacter calcoaceticus was found in five of ten cultures positive for gram-negative bacilli. Thirty of 59 hand cultures were positive for S aureus and gram-negative bacilli; nurses and residents had both, respiratory therapists only gram-negative bacilli, and A calcoaceticus was the most commonly isolated bacterium of potentially nosocomial significance (14/30). Laboratory investigation of bacterial survival revealed that gramnegative bacilli survived on a dry formica surface from a few hours up to three days but Acinetobacter survived up to 13 days. Since A calcoaceticus has been implicated in many nosocomial infections, its long survival on a dry surface may be an additional factor in its transmission in hospitals and suggests that more attention be paid to environmental surfaces as a source of significant nosocomial pathogens.
Legionella pneumophila Grows Adherent to Surfaces in vitro and in situ
Authors: Wright J.B. , Ruseska I. , Athar M.A. , Corbett S. , Costerton J.W. 
Published: September 2009

AbstractLegionella pneumophila continues to play a role in both community- and nosocomially-acquired pneumonia. We investigated the ability of L pneumophila to adhere to various types of materials such as those found in the hospital air-cooling and potable water distribution systems. Through the use of a unique sampling apparatus, we were able to regularly acquire planktonic and sessile samples and determine the numbers of bacteria present in both populations, in vitro and in situ.Portions of these apparatuses could be aseptically removed for examination by scanning electron microscopy, or for the determination of the number of viable adherent L pneumophila. The number of bacteria present in each sample was determined by direct plate count, with presumptive L pneumophila colonies being positively identified by direct fluorescent antibody staining techniques.The results demonstrated that not only are legionellae capable of colonizing various metallic and nonmetallic surfaces but that they are preferentially found on surfaces. Surface-adherent bacteria may play a profound role as a reservoir of these potential pathogens in aquatic environments. Furthermore, these results suggest that any comprehensive legionella monitoring program must include not only water samples but also an examination of the adherent populations.
The Epidemiology of Cytomegalovirus Infection Among Patients with Burns
Authors: Bale James F. , Kealey G. Patrick , Massanari R. Michael , Strauss Ronald G. 
Published: September 2009

AbstractTo determine the epidemiology of cytomegalovirus (CMV) infections among patients with burns, we prospectively studied 120 burn patients admitted to the University of Iowa Burn Center over a two-and-one-half year period. At the time of their admission, 44% of the patients had serologic evidence of prior CMV infection. Among 44 seropositive patients, 23 (52%) had four-fold or greater rises in CMV antibody titers. These patients had more severe burns (mean body surface area burn [BSAB] 26.8%) than those who did not exhibit titer rises (mean BSAB 16.2%, p=.04). Among 43 seronegative patients observed for at least 65 days after discharge from the center, eight (18.6%) seroconverted. Patients who seroconverted had longer hospital stays (p=.03), trends toward more severe burns p = .08) and a younger age (p = .15) than patients who remained seronegative. Despite frequent serologic evidence of CMV infection, CMV did not contribute, either directly or indirectly, to the morbidity or mortality of burns in these patients.
Comprehensive Surveillance of Surgical Wound Infections in Outpatient and Inpatient Surgery
Authors: Manian Farrin A. , Meyer Lynn 
Published: September 2009

AbstractA surgeon-specific computer-generated monthly questionnaire was used to improve surveillance of surgical wound infections in outpatients as well as inpatients following discharge. From July 1988 through June 1989, 20,536 surgical procedures were performed at our medical center, of which 53% were for outpatients. The total wound infection rate was 0.63%: 0.13% in outpatients and 1.2% in inpatients (p<.005). Of the infected wounds, 20% were reported by the survey alone and would have gone undetected by conventional surveillance methods (71.4% of outpatient and 13.8% of inpatient wound infections). As a whole, clean and clean-contaminated wounds in outpatients were much less likely to become infected than those in inpatients. Wound cultures were not obtained in 85% of infections reported by the survey alone, and were less likely to be obtained in outpatients. The average time spent by the infection control department on the survey was approximately two hours per week.
The Role of Handwashing in Prevention of Endemic Intensive Care Unit Infections
Authors: Simmons Bryan , Bryant Jerri , Neiman Kim , Spencer Linda , Arheart Kris 
Published: September 2009

AbstractHandwashing is believed to be the most important means of preventing nosocomial infections. Previous studies of healthcare workers (HCWs) have shown that handwashing practices are poor. No one has shown that handwashing practices can be easily improved and that this prevents endemic (non-epidemic) nosocomial infection. Handwashing and infection rates were studied in two intensive care units (ICUs) of a community teaching hospital. Handwashing rates were monitored secretly throughout the study. After six months of observation, we started interventions to increase handwashing. Handwashing increased gradually, but overall rates before (22.0%) and after (29.9%) interventions were not significantly different (p = .071). Handwashing never occurred before intravenous care, whereas it occurred 67.5% for all other indications (p<.0001). When questioned, nurses felt they were washing appropriately nearly 90% of the time. Infection rates seemed unrelated to handwashing throughout the study, and no clusters of infection were detected. We conclude that handwashing rates, when measured against arbitrary but reasonable standards, are suboptimal, difficult to change and not closely related to evidence of cross-infection. Further, nurses wash hands selectively, depending on the indication for handwashing, and generally believe they are washing much more frequently than an objective observer believes they are.
Evaluating the Sterility of Disposable Wall Oxygen Humidifiers, During and Between Use on Patients
Authors: Seto W.H. , Ching T.Y. , Yuen K.Y. , Lam W.K. 
Published: September 2009

Oxygen wall humidifiers are used regularly in the hospital. Although the humidifiers in mechanical ventilators have been extensively investigated, oxygen wall humidifiers are often neglected in the literature. Both reusable and disposable humidifiers are available, and according to the recommendation from the Centers for Disease Control (CDC), both types of humidifiers are acceptable. For reusable humidifiers however, it is crucial that they be washed daily as recommended and that water left in the reservoir be discarded before refilling.In the CDC guideline for the prevention of nosocomial pneumonia, it is stated that disposable humidifiers for wall oxygen outlets “may be safe for long periods.” However, studies that actually assess the efficacy of these humidifiers on patients are rarely reported, and, to the best of our knowledge, only one such study has been published.
Control of Epidemic Methicillin-Resistant Staphylococcus aureus
Authors: Murray-Leisure Katherine A. , Geib Sandra , Graceley Diane , Rubin-Slutsky Arline B. , Saxena Narendra , Muller H. Arnold , Hamory Bruce H. 
Published: September 2009

AbstractWe controlled the spread of epidemic methicillin-resistant Staphylococcus aureus (MRSA) infection in an 884-bed veterans' facility by cohorting known active MRSA carriers and MRSA-infected patients on one nursing unit. Simultaneously, all previously-institutionalized transfers into the veterans' facility were screened with swab cultures for MRSA at the time of admission. All MRSA patients were maintained on contact (gown and glove) or strict isolation and treated aggressively with topical and enteral antibiotics with the assistance of the infectious disease consultant. The monthly incidence of new MRSA patients dropped from a maximum of 16 per month to three or less per month within six months of instituting these infection control measures. There were no further MRSA bacteremias after the establishment of the MRSA cohort in a single unit. Aggressive cohort management of known MRSA patients and screening of previously-institutionalized patients on admission for MRSA controlled epidemic MRSA in this large institution.
Adverse Exposures and Universal Precautions Practices Among a Group of Highly Exposed Health Professionals
Authors: Willy Mary E. , Dhillon Gita L. , Loewen Nancy L. , Wesley Robert A. , Henderson David K. 
Published: September 2009

AbstractAn anonymous national survey of a representative population of healthcare workers who were thought likely to have frequent and intensive exposures to blood and other body fluids (certified nurse-midwives [CNMs]), was conducted to assess the type and frequency of self-reported occupational exposures to blood and body fluids experienced, the extent to which barrier precautions and other infection control measures were used, whether or not reported use of barriers was associated with a lower perceived rate of exposures and factors that influenced the use of infection control procedures.Of those responding, 74% had soiled their hands with blood at least one time in the preceding six months, 51% had splashed blood or amniotic fluid in their faces and 24% reported one or more needlestick injuries during that same period. Our study also found evidence of an association between the practice of needle recapping and the occurrence of needlestick injury (p = .003). Despite a high level of training and knowledge, only 55% reported routinely practicing universal precautions (UPs).Several factors that potentially influenced the use of UPS were studied, including healthcare worker perceptions of risk of occupational bloodborne infection, knowledge of routes of transmission of bloodborne pathogens and rationale for not using appropriate barriers. Our data suggest that occupational exposures occur frequently and that healthcare workers' (HCWs') perceptions of risk for occupational infection play an important role in influencing use of UPS. This study emphasizes the importance of developing new strategies for UP training.
An Analysis of Blood and Body Fluid Exposures Sustained by House Officers, Medical Students, and Nursing Personnel on Acute-Care General Medical Wards: A Prospective Study
Authors: Stotka Jennifer L. , Wong Edward S. , Williams Denise S. , Stuart C. Geri , Markowitz Sheldon M. 
Published: September 2009

AbstractObjective:To prospectively examine the epidemiology of blood and body fluid exposures sustained by medicine housestaff, medical school students, registered nurses (RNs), licensed practical nurses (LPNs), and nurses' aides (NAs) on general medicine wards and to define problem areas that may be amenable to change.Design:Daily data collection during 9 months using a self-reporting questionnaire.Setting:General medical wards in 2 tertiary referral hospitals.Participants:Medicine housestaff/students and nursing personnel.Results:Physicians reported 644 exposures, of which 98 (15.2%), 296 (46.0%), and 250 (38.8%) were sustained by medicine residents, interns, and students, respectively. Blood contact occurred with 591 (91.8%) exposures. For physicians, 575 (89.3%) exposures occurred during venipuncture, intravenous catheter manipulation, and arterial punctures. Interns and students most commonly incurred exposures during venipunctures and intravenous manipulations; residents commonly were exposed during emergent intravenous catheter placements. Five-hundred-twenty-two (8 1%) exposures occurred between 7 A.M. and 7 P.M. During 524 (81.4%) exposures, physicians were not using barrier devices. Nurses reported 235 exposures, of which 140 (59.6%), 23 (9.8%), and 72 (30.6%) were sustained by RNs, LPNs, and NAs, respectively. RN exposures commonly occurred during intravenous manipulations and glucometer fingersticks. LPNs and NAs incurred a higher percentage of exposures during nonprocedural patient care. Blood contact and wound drainage accounted for 167 (71.1%) and 31 (13.2%) exposures, respectively.Conclusions:Exposures to blood and body fluids frequently are incurred by healthcare workers on general medical wards. Efforts to reduce these exposures should be directed not only at improving procedural skills of healthcare workers for venipunctures, intravenous catheter insertions, and glucometer fingersticks, but also in increasing barrier use during procedural and nonprocedural tasks.
Monitoring Universal Precautions A New Assessment Tool
Authors: Gauthier Dorothy K. , Turner Joan G. , Langley Lisa G. , Neil Clayton J. , Rush Patricia L. 
Published: September 2009

AbstractObjectives:Two pilot studies were conducted to produce efficacy data on an observational tool designed to assess the use of Universal Precautions (UP) in patient care settings. The instrument addresses barrier precautions, hand-washing, handling of sharps, and avoidance of unprotected mouth to mouth resuscitation.Design:The Universal Precautions Assessment Tool was submitted to a panel of 3 experts to establish consensual validity. It was pilot tested by 2 simultaneous observers to establish interrater reliability.Setting:Pilot Study I was conducted in 3 different units within a 100-bed U.S. Army hospital. Pilot Study II was conducted in the emergency department of a large university-based hospital.Participants:Subjects observed were registered nurses providing acute patient care.Results:Two simultaneous raters calculated UP compliance rates of 76.4% and 78.6%, respectively, for 9 nurses in Pilot Study I, and 62% and 65%, respectively, for 5 nurses in Pilot Study II. The intraclass correlation coefficient for the raters' scores in Pilot Study I was 0.992 with a 95% confidence interval (0.979, 0.997). Consensual validity was established.Conclusions:The instrument has acceptable interrater reliability under the conditions used. Limitations to use include the possibility of a Hawthorne effect and the fact that assessing proper implementation of UP occasionally relies on a “judgment call” by the observer. With test conditions adjusted to minimize these limitations and with proper consideration of sample size, the tool can be used by researchers and by monitors of hospital quality control to measure UP compliance of caregivers individually or collectively.