bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inactivation of Human Immunodeficiency Virus by a Medical Waste Disposal Process Using Chlorine Dioxide
Authors: Farr R. Wesley , Walton Cheryl 
Published: September 2009

AbstractObjective:To study the ability of a medical waste disposal process using chlorine dioxide to inactivate human immunodeficiency virus type 1 (HIV 1).Design:Stock HIV-1 (HTLV-IIIB strain) was treated with chlorine dioxide under the following settings: cell culture medium alone, culture medium with 25% blood, culture medium with medical supplies treated by the Condor machine (Winfield Environmental Corp., Escondido, CA). MT-2 cells in 96-well tissue culture plates were inoculated with serial tenfold dilutions of treated and untreated HIV-1. Cytopathic effect was read on day five, and the TCID50 (50% tissue culture infectious dose) was calculated.Results:Treatment of HIV-1 with chlorine dioxide in culture medium alone resulted in a 5.25 log10 reduction in TCID50. Treatment of HIV-1 with chlorine dioxide in the presence of 25% blood caused a 6.25 log10 reduction in HIV-1 infectivity Treatment of HIV-1 with chlorine dioxide in the presence of medical supplies treated in the Condor machine resulted in a 4.75 log10 reduction in HIV infectivity.Conclusions:Chlorine dioxide inactivated HIV-1 in vitro. Chlorine dioxide inactivated HIV-1 in the presence of blood and in the presence of medical supplies under conditions that simulated the conditions existing in the Condor machine.
Pharmacodynamics of Antiretroviral Chemotherapy
Authors: Drusano George L. 
Published: September 2009

Most clinicians are both familiar and comfortable with antibacterial chemotherapy. In large part, this is due to the relatively broad therapeutic-toxic window presented by most antibacterial agents, especially the beta-lactam class of drugs. Except for the occasional patient, little thought is given to overdosage, even (inappropriately) when organ function is impaired. Rather, the focus has been on providing demonstrably effective concentrations of drug as early in the course of the infection as possible. This has the rational aim of maximizing therapy from the very beginning, in order to minimize mortality and infectious morbidity. This is possible because of the paucity of drug-related morbidity in this setting.Antiretroviral therapy sometimes has been compared with oncologic chemotherapy, mostly because of the more toxic nature of antiviral agents. This is a mistake. The aim of oncologic chemotherapy is to reduce the number of malignant cells in the body to as close to zero as possible. This is best accomplished by the largest tolerable dose of oncolytic agent. These two linked ideas have driven virtually all of oncologic drug development. Indeed, the explicit aim of Phase 1 and Phase 2 trials in oncolytics is to identify the largest tolerable dose of drug. In contrast to anti-infective chemotherapy, the focus is almost exclusively on the relationship between drug exposure and the development of toxicities.
CQI Tools Sentinel Events, Warning, and Action Limits
Authors: Birnbaum David 
Published: September 2009

Sentinel events, that is, events whose single occurrence is of sufficient concern to trigger systematic response, recently were advocated as an important component in managing quality under Continuous Quality Improvement (CQI). Ideally, sentinel events are exceedingly rare and invariably indicate preventable deficiencies (eg, operation on the wrong patient, which should never occur, denotes a lack of management control requiring corrective action). However, although single cases of nosocomial group A streptococcal surgical wound infection or of tuberculosis are harbingers of worse to come unless prompt intervention is initiated, sentinel events generally have not served infection surveillance programs adequately. This is because nosocomial infection is the result of multifactorial chains of events that produce a probability, not a certainty, of infection, and our knowledge is incomplete. Without detailed knowledge of these probabilistic chains, the absolute minimum rates of infection that may be attained, and the optimal statistical approaches to define predictive outbreak “warning” or “action” levels, we will not be able to define meaningful sentinel events. How, then, can we best assure health services quality?Nearly 30 years ago, Drucker suggested that three elements comprise effective management decisions. They involve determining 1) whether a specific situation is generic or an exception, 2) clear specification of what the decision has to accomplish, and 3) what is right rather than simply what is acceptable.
Measles Immunity in Employees of a Multihospital Healthcare Provider
Authors: Wright Larry J. , Carlquist John F. 
Published: September 2009

AbstractObjective:To assess the potential for nosocomial measles transmission by measuring seropositivity among healthcare workers in Utah.Design:Blood specimens were collected for measurement of measles IgG antibody by enzyme immunoassay (EIA). Individuals with undetectable or equivocal antibody levels were considered at risk for infection. Employees were grouped according to the decade of their birth, and analyses of serological findings were done by the Mantel-Haenszel chi-square test for trend.Setting:The study was performed in a healthcare organization comprised of six urban and 10 rural hospitals.Participants:Employees (n = 5825) were tested regardless of age, history of disease, or immunization.Results:There were 599 employees (10.3%) who were nonimmune. A trend showing age-related differences in immunity was not noted among employees born prior to 1957 (4.7% nonimmune). However, for employees born after that time, there was a significant age-associated increase in the percentage of susceptible individuals (P= 0.00001). The rate of susceptibility was 8.1% for individuals born between 1957 and 1959, 16.3% for individuals born during the 1960s, and 33.7% for those born in the 1970s.Conclusions:We concluded that employees born after 1960 represent a material risk for transmission of measles in the hospital setting. Despite the low percentage of susceptibility among those born before 1957, the 144 susceptible individuals in this group also are at risk for measles transmission. Thus, during periods of increased measles prevalence, we would recommend screening all healthcare workers regardless of age and vaccinating those who are susceptible.
Measles Immunity in a Population of Healthcare Workers
Authors: Willy Mary E. , Koziol Deloris E. , Fleisher Thomas , Koo Sylvia , McFarland Henry , Schmitt James , Wesley Robert , Hurwitz Eugene S. , Henderson David K. 
Published: September 2009

AbstractObjectives:To evaluate measles seroprev-among cohorts of new employees and to evaluate vaccine responses of susceptible adult healthcare workers.Design:New employees were screened for measles susceptibility as part of employee evaluations. Anti-IgG measles antibody tests were completed on 2,473 workers. Demographic, measles history, and measles vaccination information was collected using a short questionnaire. Susceptible workers were vaccinated and screened for vaccine responses following vaccination.Results:Ninety-three workers (4%) were seronegative, and 56 (2%) were equivocal. Individuals in the youngest cohort (born after 1956) were significantly more likely to be susceptible than those in the middle cohort (born 1951 to 1956) and those in the oldest cohort (born before 1951) (P<0.01). The middle cohort included eight (5%) of the 149 seronegative or equivocal workers. Among the members of the youngest cohort, those from the United States were more likely to be susceptible (P<0.01) than those from outside the United States.Of the 106 vaccinated susceptible workers whose follow-up serologies were determined, 90 (85%) developed positive IgG serologies, six had equivocal results, and 10 were seronegative. Eleven of the 16 non- or hyporesponders were revaccinated and re-evaluated; nine developed low positive IgG antimeasles levels, one exhibited an equivocal response, and one failed to respond.Conclusions:A small but important proportion of healthcare workers are susceptible to measles. Whenever feasible, measles immunity programs for healthcare workers should include workers born before 1957. Of workers born after 1956, those from outside the United States are more likely to be immune than workers from inside the United States. Using the currently available vaccine, revaccination of initial non- or hyporesponders appears to be effective.
Attitudes of Internal Medicine Residents Regarding Influenza Vaccination
Authors: Nafziger Daniel A. , Herwaldt Loreen A. 
Published: September 2009

AbstractObjective:To survey the attitudes of internal medicine residents regarding the influenza vaccine and their reasons for accepting or refusing the vaccine during a hospitalwide immunization campaign.Design and Participants:Internal medicine residents responded to a written survey.Setting:A university-owned, 891-bed, tertiary referral hospital and a 278-bed Veterans Administration hospital in Iowa.Results:Immediately following the immunization campaign, 51% of residents had received the vaccine. Of those residents who were not vaccinated, 42% never had time to go to the vaccine clinic, but only 8% worried about side effects of the vaccine. Residents whose clinics were staffed by infectious disease subspecialists were significantly more likely to be vaccinated (odds ratio = 2.55; CI95 = 1.01 to 6.42) than residents working with general internists or other subspecialists.Conclusions:Knowledge, vaccine availability, and social pressure all increase the likelihood that residents will be vaccinated. Faculty, particularly those interested in infectious diseases, may influence residents to accept the vaccine.
Analysis of Epidemic and Endemic Isolates of Xanthomonas maltophilia by Contour-Clamped Homogeneous Electric Field Gel Electrophoresis
Authors: VanCouwenberghe Carolyn , Cohen Stuart 
Published: September 2009

AbstractBackground:Xanthomonas maltophilia is increasingly a cause of nosocomial infections. The mode of transmission of this organism is not well known.Objective:To investigate clonality of X maltophilia isolates in epidemic and endemic settings.Methods:An outbreak of X maltophilia was noted in the Intensive Care Nursery (ICN). Over the ensuing 9 months, hospitalwide isolates of X maltophilia were analyzed using contour-clamped homogeneous electric field (CHEF) gel electrophoresis of chromosomal DNA. This method was compared with the antibiogram for detecting differences and similarities among strains.Results:X maltophilia was recovered from 76 sites in 72 patients; 65 isolates from 61 patients and the hands of one nurse were available for analysis. CHEF demonstrated differences between most epidemiologically unrelated strains and similarity between most epidemiologically related strains. Several strains, initially presumed to be related because of temporal and spatial proximity of the patients involved, were determined by CHEF analysis to be independent infections. One pair of isolates whose Xbal CHEF patterns differed by a single band were differentiated clearly by Sspl. There was enough variation in the minimum inhibitory concentrations of selected antibiotics to allow typing of some strains. The antibiogram, however, did not group all of the ICN outbreak isolates with others found to be genetically identical by CHEF and it grouped 39 of 56 isolates with others not genetically the same.Conclusions:Although it is a convenient and economical tool, the antibiogram has limitations. Analysis by CHEF should help to elucidate the epidemiological spread of X maltophilia in the hospital.
Colonization and Transmission of High-Level Gentamicin-Resistant Enterococci in a Long-Term Care Facility
Authors: Chenoweth Carol E. , Bradley Suzanne F. , Terpenning Margaret S. , Zarins Lidija T. , Ramsey Mary A. , Schaberg Dennis R. , Kauffman Carol A. 
Published: September 2009

AbstractObjectives:To assess the prevalence of high-level gentamicin-resistant enterococcus (HGRE) colonization, transmission patterns, and spectrum of illness among residents of a long-term care facility.Design:Monthly surveillance for HGRE colonization of wounds, rectum, and perineum over a 1-year period.Setting:A Veterans Affairs long-term care facility attached to an acute-care facility.Patients:All 341 patients in the facility during the observation period.Results:Over the 1-year period, 120 patients (35.2%) were colonized with HGRE at least once, with an overall monthly colonization rate of 20± 1.5%. HGRE were isolated from rectum (12.8%), wounds (11.7%), and perineum (9.3%). Patients with the poorest functional status had the highest rate of colonization (P<0.0005). HGRE-colonized patients were more likely to be colonized with methicillin-resistant Staphylococcus aureus (51% versus 25%; P<0.0005). Seventy-four patients (21.7%) were colonized at admission or at the start of the study. Another 46 patients (13.5%) acquired HGRE during the study, including 36 who acquired HGRE while in the long-term care facility and 10 who were positive when transferred back from the acute-care hospital. Based on plasmid profiles, only two patients appeared to have isolates similar to those of current or previous roommates. Carriage of HGRE was transient in most cases. Only 20 patients were colonized for 4 or more months, and those patients usually carried different strains intermittently. Infections were infrequent, occurring in only 4.1% of total patients.Conclusions:In our long-term care facility, HGRE were endemic, and new acquisition of HGRE occurred frequently. However, only two patients had evidence of acquisition from a roommate, suggesting that cross-infection from a roommate was not a major route of spread of HGRE.
Drug Use Evaluation of Antibiotics in a Pediatric Teaching Hospital
Authors: Lee Kelley R. , Leggiadro Robert J. , Burch Kelly J. 
Published: September 2009

AbstractObjective:To determine the incidence and type of antibiotic use variances at our institution.Design:Inpatient bacterial culture and susceptibility results were reviewed for 1 week per month. Medication administration records were evaluated to determine whether antibiotic selection was appropriate, given the susceptibility of the organism. Process indicators included use of the least costly antibiotic. as well as appropriate dose, interval, and route of administration. The complete medical record was reviewed for all patients if management did not appear to meet criteria.Setting:A 225-bed. tertiary-care children’s teaching hospital.Results:Thirty-five (8.2%) of 428 patients reviewed over 12 months had a total of 49 variances: failure to treat (3), treatment of contaminant/colonizer (2), use of more costly agent (10), failure to revise therapy (8), inappropriate route (2), inappropriate empiric antibiotic (4), incorrect dose (3), unnecessary multiple antibiotics (6), inappropriate drug (8), and prolonged prophylaxis (3).Conclusions:Thirty-five patients with 10 types of variances were identified during the study. Follow-up monitoring will assess the impact of educational efforts on the incidence of variances. Specific problem antibiotics have been identified for further audits.
Gowns: Selection on a Procedure-Driven Basis
Authors: Belkin Nathan L. 
Published: September 2009

AbstractThe Occupational Safety and Health Administration requires that the types and characteristics of personal protective equipment used “depend upon the task and degree of exposure anticipated.” The level of protection required, therefore, is logically contingent upon the operative site, estimated blood loss, and duration of the procedure. However, more recent studies provide data that specifically identify the personnel and areas of the body that are most likely to become contaminated. This adds a new dimension to the procedure-oriented selection process that is worthy of consideration.
Glutaraldehyde: Current Status and Uses
Authors: Russell A.D. 
Published: September 2009

AbstractGlutaraldehyde (pentanedial) is a dialdehyde that displays potent bactericidal, fungicidal, mycobactericidal, sporicidal, and virucidal activity. Pertinent to its activity is its interaction with amino groups in proteins and enzymes, but this simplistic statement masks the manner in which it inactivates various types of microorganisms. Notwithstanding its toxicity for medical staff, glutaraldehyde remains an invaluable compound for high-level disinfection purposes in endoscopy units.
Hepatitis C Virus Infection in Healthcare Workers: Risk of Exposure and Infection
Authors: Lanphear Bruce P. , Linnemann Calvin C. , Cannon Constance G. , DeRonde Martha M. , Pendy Luann , Kerley Lisa M. 
Published: September 2009

AbstractObjectives:To determine the incidence of hepatitis C virus (HCV) infection among healthcare workers (HCWs) at a university hospital, the proportion of HCWs having non-A, non-B hepatitis (NANBH) who were anti-HCV positive, and the rate of HCV transmission following a HCV-positive needlestick injury.Design:Longitudinal analysis of a dynamic (cohort) population.Measurements:From 1980 through 1989, HCWs who had clinical NANBH were identified, and from 1987 through 1989, HCWs who reported a blood or body fluid exposure and the patients who were the source of the exposure were screened for antibodies to HCV.Setting:A 732-bed, university hospital and outpatient clinics.Results:Over the 10-year period, six cases of occupationally acquired NANBH were observed, for an incidence of 21 cases per 100,000 HCWs per year (standardized incidence ratio, 2.96; 95% confidence interval [CI95], 1.83 to 4.36). Four of the six cases were confirmed to be HCV infection. From 1987 through 1989, 176 (12.7%) of 1,387 patients who were the source of an exposure were anti-HCV positive. Exposures that occurred in the emergency department were more likely to be anti-HCV positive than were exposures from all other locations (relative risk [RR] = 1.7; P= 0.009). Of HCWs who had an HCV-positive needlestick injury and whose serum had been tested for anti-HCV at least 5 months after the exposure, 3 (6.0%) of 50 seroconverted. From 1987 through 1989, the incidence of HCV infection among HCWs was 54 cases per 100,000 HCWs per year.Conclusion:The incidence of clinical NANBH among HCWs in this study is approximately three times higher than that of non-HCWs. HCWs are at significant risk for exposure to and acquisition of HCV.
Interruption of Rotavirus Spread Through Chemical Disinfection
Authors: Sattar Syed A. , Jacobsen Heather , Rahman Hasina , Cusack Timothy M. , Rubino Joseph R. 
Published: September 2009

AbstractIntroduction:Rotaviruses, which are among the most important infectious causes of acute diarrhea, frequently cause outbreaks in hospitals, daycare centers, schools, and nursing homes. These viruses can remain viable on inanimate surfaces for many days and infectious rotavirus particles have been recovered from hands and a variety of surfaces and objects. Casual contact can lead to the transfer of these viruses from contaminated to clean surfaces. Therefore, animate and inanimate surfaces may play a complementary role in the spread of these viruses.Objective:In this study, we compared the capacity of a disinfectant spray (0.1% o-phenylphenol and 79% ethanol), a domestic bleach (6% sodium hypochlorite diluted to give 800 ppm free chlorine), a quaternary ammonium (quat)-based product (7.05% quat diluted 1:128 in tap water), and a phenol-based product (14.7% phenol diluted 1:256 in tap water) to interrupt the transfer of a human rotavirus (DS-1) from stainless steel disks to fingerpads of volunteers with a 10-second contact at a pressure of 1 kg/cm2.Design:Each disk received a 10 μL inoculum containing 1.0 × 104 to 7.0 × 104 plaque-forming units (PFU) of the virus suspended in 10% feces. The inoculum was dried for 1 hour and overlaid with 20 μL of either tap water or the test product.Results:A 10-minute exposure to tap water reduced the virus titer by 52.3% ± 11.7%. The disinfectant spray was able to reduce virus infectivity by >99.99% after a contact of 3 to 10 minutes. The loss in virus infectivity after a 10-minute treatment with the quat was almost the same (54.7% ± 17.8%) as seen with tap water. The activities of the bleach and the phenolic were very similar with losses in PFU of 97.9% ± 0.4% and 95% ± 5.36%, respectively. No detectable virus was transferred to fingerpads from disks treated with disinfectant spray, the bleach, and the phenolic. Contact of the fingerpads with tap water- or quat-treated disks resulted in the transfer of 5.6% ± 1.1% and 7.6% ± 2.5% of the remaining infectious virus, respectively.Conclusion:These findings emphasize the care needed in the selection of environmental surface disinfectants in preventing the spread of rotaviral infections.
A Pseudo-Epidemic Involving Bone Allografts
Authors: Mermel Leonard A. , Josephson Stephen L. , Giorgio Christina 
Published: September 2009

AbstractPre-implantation cultures of four sterile bone allograft specimens grew Comomonas acidovorans and Pseudomonas species. An epidemiological investigation, including molecular subtyping methods, revealed that the allograft specimens were contaminated in a microbiology laboratory sonicator water bath.
Tuberculin Testing in a Tertiary Hospital: Product Variability
Authors: Shands Joseph W. , Boeff Deborah , Fauerbach Loretta , Gutekunst Richard R. 
Published: September 2009

AbstractNine percent of 2,721 hospital employees, previously tuberculin negative, were PPD positive when tested with 5 TU of PPD (Aplisol, Parke-Davis). Seventy percent of the positive reactions were found to be erroneous on retesting with Tubersol (Connaught). The excessive potency of Aplisol led to excessive expenditures of time and money investigating a nonexistent outbreak.
Bacterial Contamination of Platelets at a University Hospital: Increased Identification Due to Intensified Surveillance
Authors: Zaza Stephanie , Tokars Jerome I. , Yomtovian Roslyn , Hirschler Nora V. , Jacobs Michael R. , Lazarus Hillard M. , Goodnough Lawrence T. , Bland Lee A. , Arduino Matthew J. , Jarvis William R. 
Published: September 2009

AbstractBackground:A cluster of bacterial contamination of platelets occurred at a university hospital in a one-month period. This unusual clustering allowed us to examine the likely mechanism of contamination and clinical sequelae.Methods:We reviewed medical records of patients receiving random donor platelet transfusions to determine numbers of platelets transfused, reactions reported, and episodes of bacterial contamination. We also reviewed procedures at the collecting blood agencies and the hospital blood bank.Results:Four patients received bacterially contaminated platelets during June and July 1991. The rates of reported platelet transfusion reactions increased significantly (P<0.001) from September 1989 through July 1991 (study period); in addition, the rate of contamination of platelets during June and July 1991 was 23-fold higher than during the previous 21 months (P< 0.00 1). Surveillance methodology changed dramatically during the study period, contributing to the recognition of the current cluster. Pathogens isolated from the contaminated platelet pools were Bacillus cereus, Staphylococcus epidermidis, or Pseudomonas aeruginosa in titers ranging from 106 to 108 colony forming units/ml. Four constituent individual platelet units identified as the probable cause of the outbreak (including one postepidemic episode) were significantly older (mean age, 4.8 days) than 106 randomly selected individual platelet units (mean age, 3.7 days; P = 0.04). Platelet pools were transfused an average of 2.5 hours after pooling. Review of blood collection and platelet preparation practices did not identify breaks in procedure or technique that could have caused contamination.Conclusions:Increased awareness of platelet transfusion reactions by clinical staff and routine culturing of all platelets associated with transfusion reactions will identify contaminated platelets. Identification of contaminated platelets is necessary to treat affected patients appropriately and to determine the prevalence of and risk factors for contaminated platelets.