bluuebunny/crossref_metadata_2025_split huggingface dataset:
Joint Commission on Accreditation of Healthcare Organizations
Authors: Patterson Carole H. 
Published: September 2009

AbstractThe Joint Commission on Accreditation of Healthcare Organizations was founded in 1951 as a private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations. In 1987, the JCAHO launched its Agenda for Change to create a more modem and sophisticated accreditation process to place primary emphasis on actual performance. Coincident with this new emphasis, a number of task forces were established, including two for infection control standards.
An Outbreak of Needlestick Injuries in Hospital Employees Due to Needles Piercing Infectious Waste Containers
Authors: Anglim Anne M. , Collmer June E. , Loving T. Joel , Beltran Kenneth A. , Coyner Betty J. , Adal Karim , Jagger Janine , Sojka Nikolas J. , Farr Barry M. 
Published: September 2009

AbstractObjectives:To investigate the cause of an outbreak of needlestick injuries (NSIs) in hospital employees.Setting:A 700-bed university hospital.Design:Outbreak investigation, laboratory evaluation of a medical waste disposal device, cost analysis.Methods:Employee health department records were reviewed of workers suffering sticks from needles piercing fiberboard-contaminated material containers (CMCs). A laboratory evaluation of needle-puncture resistance properties of the CMCs was performed using a testing apparatus. The cost of a hospital waste disposal program using fiberboard CMCs was compared with the cost of a program using rigid plastic (polypropylene) boxes.Results:During 40 months of surveillance in 1986 and from 1989 to 1991, only one NSI had occurred from a needle piercing a CMC. During 9 months in 1993, 13 NSIs occurred due to needles piercing CMCs (P<.001). No clinical illness resulted from the NSIs. The outbreak was halted by a temporary change to plastic (polypropylene) boxes for sharps disposal ($4.92 to $23.33/cu ft) until receipt of a box with a newly designed solid fiberboard liner ($1.25/cu ft). CMC liners used during the epidemic had a mean needle puncture resistance of 527 g, as compared with 660 g for liners used before the outbreak (P<.001). The new solid fiberboard liner has a mean puncture resistance of 1,765 g. A program of waste disposal using fiberboard CMCs was found to cost approximately one-seventh the cost of a program using plastic boxes for disposal of infectious waste.Conclusion:A program for infectious waste disposal using fiberboard CMCs can be safe and cost-effective if appropriate standards for puncture resistance are met.
Recovery of Vancomycin-Resistant Enterococci on Fingertips and Environmental Surfaces
Authors: Noskin Gary A. , Stosor Valentina , Cooper Isabell , Peterson Lance R. 
Published: September 2009

AbstractObjective:To determine the recovery of vancomycin-resistant enterococci (VRE) on fingertips, gloved fingertips, and environmental surfaces commonly encountered in the healthcare setting, and to examine the importance of handwashing on the removal of these organisms.Design:Two clinical isolates of VRE (Enterococcus faecalis and Enterococcus faecium) were inoculated onto the hands of healthy human volunteers and the following environmental surfaces: countertops, bedrails, telephones, and stethoscopes. Following inoculation, samples were obtained at various time intervals to determine rates of recovery of organisms. To evaluate the effects of handwashing on enterococcal recovery, two different soap preparations were tested. Hands were washed with water alone or with one of the soaps and water. The soap and water studies were performed with a 5-second and a 30-second wash.Results:Both enterococcal strains survived for at least 60 minutes on gloved and ungloved fingertips. The E faecalis was recoverable from countertops for 5 days; the E faecium persisted for 7 days. For bedrails, both enterococcal species survived for 24 hours without significant reduction in colony counts. The bacteria persisted for 60 minutes on the telephone handpiece and for 30 minutes on the diaphragmatic surface of the stethoscope. A 5-second wash with water alone resulted in virtually no change in recovery of enterococci; a 30-second wash with water plus either soap was necessary to eradicate the bacteria from hands completely.Conclusion:VRE are capable of prolonged survival on hands, gloves, and environmental surfaces. Hands should be washed thoroughly and gloves removed following contact with patients infected or colonized with these multidrug-resistant bacteria. Finally, environmental surfaces may serve as potential reservoirs for nosocomial transmission of VRE and need to be considered when formulating institutional infection control policies.
Percutaneous Injury Analysis: Consistent Categorization, Effective Reduction Methods, and Future Strategies
Authors: Haiduven Donna J. , Phillips Esther S. , Clemons Karl V. , Stevens David A. 
Published: September 2009

AbstractObjective:To report the results of an 8-year analysis of percutaneous injuries (PI), to describe interventions to decrease these injuries, and to discuss future prevention strategies.Design:Using consistent methods, 881 percutaneous injury reports were reviewed, categorized, and analyzed from 1986 through 1993.Setting:A 620-bed acute-care county teaching hospital located in San Jose, California, that is affiliated with Stanford University Medical School, Palo Alto, California.Participants:Employees of Santa Clara Valley Medical Center who reported percutaneous injuries from 1986 through 1993.Interventions:Placement of needle disposal containers in all patient care areas, 1987; education, 1987 to present; communication of percutaneous injury analyses to all departments, 1988 to present; and safety product evaluation and purchases, 1991 to present.Results:The total number of PI decreased by 65% (P=.0007) from 1986 through 1993. Recapping injuries decreased from 1986 through 1993 by 88% (P<.0002); interventions that included convenient placement of needle disposal containers and consistent annual education may have contributed to this decrease. Injuries from manipulating intravenous lines or heparin locks decreased in 1992 (P<.03) after purchase of a needleless system for intravenous lines. Injuries from improper disposal or from abrupt patient movement did not decrease significantly over the 8-year period.Conclusions:This institution has conducted percutaneous injury analysis for 8 years, utilizing consistent reviewers and categorization methods. Successful interventions have reduced recapping injuries, injuries from manipulating intravenous lines/heparin locks, and the overall numbers of PI. The categories of “Improper Disposal” and “Patient Moved Abruptly” present challenges for future reductions, as well as the recently identified problem of staff not using available safety devices or using them improperly.
Molecular Heterogeneity of Acinetobacter baumanii Isolates During Seasonal Increase in Prevalence
Authors: Christie Celia , Mazon Dorothy , Hierholzer Walter , Patterson Jan Evans 
Published: September 2009

AbstractObjective:To study the epidemiology of Acinetobacter baumanii during a period of increased seasonal prevalence.Design:Descriptive molecular and clinical epidemiologic study of A baumanii isolates from 1990 through 1992.Setting:A 770-bed urban, acute, tertiary-care university hospital.Results:During 1990 through 1992, the rate of A baumanii isolations was 30.4 per 1,000 culture isolations during the summer, compared to 12.6 per 1,000 culture isolations during the fall, winter, and spring (P<.000001). There were 320 isolates identified among 260 patients during this time. Eighty-one patients with isolates available were identified for evaluation; they ranged in age from 2 months to 95 years. Pulsed-field gel electrophoresis (PFGE) typing showed that 59 (83%) of 71 typed isolates had distinct PFGE patterns. There were three small clusters of isolates with the same PFGE patterns, suggesting cross-transmission in those instances.Conclusions:A seasonally increased prevalence of A baumanii largely associated with device-related nosocomial infections in severely ill patients was noted over a 3-year period. Although there were isolated instances of cross-transmission, most isolates had distinct PFGE patterns. Clonal dissemination of a single strain was not responsible for the seasonal increased prevalence of A baumanii. PFGE typing was useful in directing control efforts.
Epidemiologic Investigation of an Outbreak of Coagulase-Negative Staphylococcus Primary Bacteremia in a Newborn Intensive Care Unit
Authors: Camargo Luis F.A. , Strabelli Tânia M.V. , Ribeiro Floracy G. , Iwahashi Eliza R. , Ebaid Munir , Filho Hélio H.H.C. , Sinto Sumiko I. , Mendes Caio M.F. , Uip David E. 
Published: September 2009

AbstractInfections due to coagulase-negative Staphylococcus (CNS) are an ever-increasing nosocomial problem, particularly in the pediatric population. The authors describe a cluster of three primary bloodstream infections due to CNS in a newborn intensive care unit that occurred between November 23 and December 2, 1992. Two children died as a direct consequence of the bacteremia; at autopsy, one had a large bacteria-containing thrombus extending from the insertion site of a central catheter to the superior vena cava. The children were placed in isolation, and the nursing and medical staff were given topical nasal mupirocin. Plasmid analysis performed later disclosed three different blood isolates that also were different from any of the staff's nasal isolates.The authors concluded that molecular methods such as plasmid analysis are important tools in identifying true outbreaks and can prevent needless interventions, such as those during this cluster.
Infections Caused by Staphylococcus aureus in a Veterans' Affairs Nursing Home Care Unit: A 5-Year Experience
Authors: Spindel Steven J. , Strausbaugh Larry J. , Jacobson Cleone 
Published: September 2009

AbstractObjectives:To describe the frequency and patterns of infection caused by methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S aureus (MRSA) infections in a single nursing home population and to determine the effect of MRSA's entry into the facility on subsequent experience with both MSSA and MRSA infections.Design:Observational and descriptive. Surveillance data on nursing home-acquired infections were reviewed to identify all patients with MSSA and MRSA infections occurring during the 5-year period from 1987 to 1991. The medical records of these patients were reviewed retrospectively to collect additional information about the patients and their infections.Setting and Patients:A 120-bed Veterans' Affairs nursing home care unit (NHCU) whose residents predominantly were elderly men with severe underlying diseases and functional impairments,Results:During the 5-year study period, 40 MSSA and 28 MRSA infections were acquired by NHCU residents. Twelve to 19 S aureus infections occurred each year. S aureus accounted for 13% to 17% of all NHCU-acquired infections during the years of study, occurring with a frequency of 0.29 to 0.47 infections per 1,000 resident-care days. MRSA infections, first detected in 1988, accounted for an increasing percentage of S aureus infections in subsequent years, but this increase had little effect on the facility's overall infection rates, the composite S aureus infection rates, or the types of infections observed. MSSA and MRSA infections acquired in the NHCU were comparable. Both affected patients with severe underlying diseases and functional impairments. Pneumonia, urinary tract infections, skin and soft tissue infections, and conjunctivitis were the types of infections observed most frequently, accounting for 28%, 25%, 22%, and 15% of all S aureus infections, respectively. Four bacteremic infections occurred in the MSSA group, and five in the MRSA group (P=.47). Four of the MSSA and three of the MRSA infections resulted in death (P= 1.0). Nine of the MSSA and 12 of the MRSA infections resulted in the patient's transfer to the associated acute care hospital for additional care (P= .13).Conclusions:In the NHCU setting, MSSA and MRSA infections were similar in terms of the types of residents affected, the sites involved, and the frequency of adverse outcomes. The entry of MRSA into the facility appeared to have no effect on the subsequent experience with NHCU-acquired infections caused by S aureus.
Preparing for and Surviving a JCAHO Inspection
Authors: Nettleman Mary D. 
Published: September 2009

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has been a major force in shaping the national approach to quality in the healthcare setting. In 1986, the JCAHO announced that it would establish an “Agenda for Change” designed to improve the measurement of quality. The result is that hospitals now are being held to a new set of standards, creating opportunity, uncertainty, and anxiety. This article is designed as a primer to help epidemiologists and infection control practitioners prepare for JCAHO visits.The best advice is to start early and work continuously to prepare for a JCAHO visit. Most standards require that compliance be documented for at least 1 year prior to the survey. Several resources are available to assist the epidemiologist (Table).The Comprehensive Accreditation Manual for Hospital, published annually by JCAHO, is an ideal place to begin preparing for a survey.' The accreditation manual contains standards that hospitals are expected to meet, as well as scoring guidelines and rules for accreditation. All sections that apply to the epidemiologist should be read. In some institutions, the epidemiologist's responsibilities are confined to infection control. In other institutions, the responsibilities have been broadened to include most of the functions described in the accreditation manual. It is helpful to go over each standard individually and consider how compliance will be documented.
Employee Health and Infection Control
Authors: Diekema Daniel J. , Doebbeling Bradley N. 
Published: September 2009

AbstractHospital employees are at risk for exposure to a variety of communicable diseases, which they may transmit to patients and other workers. The employee health service plays a critical role in an effective infection control program.In this article, we outline the major responsibilities of the employee health service and summarize key current recom-endations for management of exposures.
Quantitative Antibiogram as a Typing Method for the Prospective Epidemiological Surveillance and Control of MRSA Comparison with Molecular Typing
Authors: Blanc Dominique S. , Petignat Christiane , Moreillon Philippe , Wenger Aline , Bille Jacques , Francioli Patrick 
Published: September 2009

AbstractObjective:Evaluation of the quantitative antibiogram as an epidemiological tool for the prospective typing of methicillin-resistant Staphylococcus aureus (MRSA), and comparison with ribotyping.Methods:The method is based on the multivariate analysis of inhibition zone diameters of antibiotics in disk diffusion tests. Five antibiotics were used (erythromycin, clindamycin, cotrimoxazole, gentamicin, and ciprofloxacin). Ribotyping was performed using seven restriction enzymes (EcoRV, HindIII, KpnI, PstI, EcoRI, SfuI, and BamHI).Setting:1,000-bed tertiary university medical center.Results:During a 1-year period, 31 patients were found to be infected or colonized with MRSA. Cluster analysis of antibiogram data showed nine distinct antibiotypes. Four antibiotypes were isolated from multiple patients (2, 4, 7, and 13, respectively). Five additional antibiotypes were isolated from the remaining five patients. When analyzed with respect to the epidemiological data, the method was found to be equivalent to ribotyping.Among 206 staff members who were screened, six were carriers of MRSA. Both typing methods identified concordant of MRSA types in staff members and in the patients under their care.Conclusions:The quantitative antibiogram was found to be equivalent to ribotyping as an epidemiological tool for typing of MRSA in our setting. Thus, this simple, rapid, and readily available method appears to be suitable for the prospective surveillance and control of MRSA for hospitals that do not have molecular typing facilities and in which MRSA isolates are not uniformly resistant or susceptible to the antibiotics tested.
Occupational Hazards of Operating Opportunities for Improvement
Authors: Davis Mark S. 
Published: September 2009

AbstractThe emergence of hepatitis C virus compels us to refocus on protecting ourselves, our coworkers, and our families from potential illness, disability, or death. As bloodborne pathogens continue to evolve and mutate, the best option available is to prevent exposure. Surgeons have the opportunity to prevent the majority of exposures by utilizing currently available technology and knowledge. Surgeons should see, use, and evaluate a variety of safety-engineered devices, because their feedback can lead to improvements in technology. Education, communication, and access to safer technology will motivate surgeons to adopt safer behavior patterns. Provided with information and tools, we can change through self-motivation.
Infection Control Practices in the Home: A Survey of Households of HIV-Infected Persons with Hemophilia
Authors: Lobato Mark N. , Oxtoby Margaret J. , Augustyniak Linda , Caldwell M. Blake , Wiley Sarah D. , Simonds R.J. 
Published: September 2009

AbstractObjective:To assess infection control practices and risk for human immunodeficiency virus (HIV) transmission in households where home infusion for hemophilia is used.Design:Cross-sectional prospective survey from 1992 through 1994.Setting:Hemophilia treatment centers.Participants:Human immunodeficiency virus (HIV)-infected persons with hemophilia who receive home infusions of clotting factor concentrate and their household members.Main Outcome Measures:Frequency of specific infection control practices in the home and the risk of HIV transmission to household members.Results:We surveyed 235 persons from 75 families (79 HIV-infected persons with hemophilia and 156 household members) about infection control practices in the home. Forty-eight percent of household members surveyed helped with the infusion process. Of 74 members who assisted with infusion, 13 (18%) had sustained a needlestick injury, 11 of whom were injured during the past year. One hundred fifty household members tested for antibody to HIV were antibody negative. These household members had a total of 903 person-years of contact after HIV was diagnosed in the index case. Household members' adherence to recommended infection control measures was highest for washing hands after cleaning up infusion equipment and waste, and for using sharps disposal containers. Adherence was lowest for wearing gloves when helping with infusions and proper disposal of bloody waste from the infusion.Conclusions:No HIV transmission was found among persons living with HIV-infected persons with hemophilia, although there was a high rate of needlestick injuries during home infusion. Because persons who assisted with infusions often did not wear gloves and many households did not dispose of bloody waste properly, hemophilia treatment center personnel should emphasize these areas when training for home infusion. Adherence to appropriate infection control practices should help to keep the risk of HIV transmission in households extremely low.
Investigation of an Apparent Cluster of Klebsiella pneumoniae Bacteremias Using Random Amplified Polymorphic DNA Analysis
Authors: Hurley James C. , Russell Edward G. , Harrington Glenys , Spicer W. John 
Published: September 2009

AbstractA cluster of bacteremia episodes with Klebsiella pneumoniae was noted in patients in a hematology-oncology ward during a 3-week period. Random amplified polymorphic DNA (RAPD) analysis, a novel technique for generating chromosomal fingerprints from bacterial isolates, was used as an aid to the epidemiological investigation of this cluster. For each of the two patients from whom multiple isolates had been obtained, identical RAPD patterns were observed in the serial isolates, even for a patient where the isolates had different biotypes. Isolates from different patients gave distinct patterns. Random amplified polymorphic DNA was found to be a useful typing technique for this cluster of K pneumonia bacteremias.
An Outbreak of Multiresistant Acinetobacter baumanii in a University Hospital in São Paulo, Brazil
Authors: Levin Anna S.S. , Mendes Caio M.F. , Sinto Sumiko I. , Sader Helio S. , Scarpitta Candida R.M. , Rodrigues Edna , Sauaia Naim , Boulos Marcos 
Published: September 2009

AbstractA case-control (46 cases, 23 controls) study was done to determine risk factors for an outbreak of a multiresistant Acinetobacter baumanii (only susceptible to colistin) in a university hospital. The use of antecedent antibacterials and intubation were independent risk factors. No common source was found. With control measures, the outbreak resolved gradually.
Exploratory Data Analysis: Data Visualization or Torture?
Authors: Shelly Mark A. 
Published: September 2009

AbstractExploratory Data Analysis offers a set of graphical and statistical tools to find the full meaning from data sets. The user visualizes, analyzes, and transforms data distributions with these tools. Graphs reveal relationships between variables; the residuals left after fitting data show the adequacy of the model. Without this careful examination and understanding of the data, rote data analysis using standard statistical tests can give misleading results. Exploratory Data Analysis has its own set of pitfalls and must be used with confirmatory statistics and studies. Increasing power and resolution in personal computers enables modern statistical software to make these methods widely accessible. By easily moving between data and their graphic representation, analysis can be comprehensive without being tedious. Exploratory Data Analysis can add an exciting and useful tool to the epidemiologist's repertoire. This article illustrates several tools from an evolving list.
Noncompliance With Universal Precautions and the Associated Risk of Mucocutaneous Blood Exposure Among Danish Physicians
Authors: Nelsing Suzanne , Nielsen Thyge Lynghøj , Nielsen Jens Ole 
Published: September 2009

AbstractObjective:To study the compliance, and reasons for noncompliance, with Universal Precautions and the associated circumstances of mucocutaneous blood exposure (MCE) among Danish physicians.Design:A nationwide questionnaire survey.Setting:All Danish hospitals.Participants:All hospital-employed physicians.Results:Of 9,384 questionnaires, 6,256 (67%) were returned, and 6,005 were eligible for analysis. Only 35% of respondents were compliant with the basic principle of Universal Precautions. Compliance with specific barriers in the preceding week among “surgeons and pathologists” and “other physicians” was as follows: gloves, 63.0% and 23.4%; masks, 55.2% and 17.6%; and protective eyewear, 11.5% and 4.0%, respectively. Common arguments for non-compliance were “interferes with working skills,” “forget,” “wear spectacles,” “not available,” “too much trouble to get,” or “gloves do not fit.”Detailed descriptions of 741 MCEs were obtained. Blood splashes in the eyes (n=320) was the most common MCE in surgical specialties and pathology, whereas blood on the hands (n=290) was most common in other specialties. In 20% of MCEs of the eyes, the exposure occurred despite the use of spectacles. An estimated 84% to 98% of MCEs potentially would have been preventable had appropriate barriers been worn. More than one half of MCEs were preventable by two interventions only: compulsory use of protective eyewear during operations and use of gloves during insertion of peripheral intravenous catheters.Conclusion:Compliance with Universal Precautions is unacceptably low, as reflected by the circumstances of MCE. Increased efforts to ensure education in Universal Precautions, easy accessibility of protective barriers, and improved design of the barriers are necessary to improve compliance and reduce the risk of MCE.