bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a Urinary Catheter with a Preconnected Closed Drainage Bag
Authors: DeGroot-Kosolcharoen Jane , Guse Rhonda , Jones Jeffrey M. 
Published: September 2009

AbstractThe incidence of hacteriuria, significant urinary tract infection, and cost associated with the use of two urinary catheter drainage systems were evaluated in a population of hospitalized adult males. A commercially available device comprised of a Foley catheter attached with a heat-shrunk plastic seal to the tubing of a closed drainage hag (preconnected system) was compared with a standard system that had the Foley catheter attached to the closed drainage hag after it had been inserted. Using a randomized prospective design, the performance of the preconnected system in 97 patients was compared with that of the standard system in 105 patients. Catheters were left in place a mean of 6.4 and 7.6 days in the respective groups. Bacteriuria occurred after catheter insertion in 11.3% of patients receiving the preconnected system and 13.3% of patients receiving the standard system (not statistically significant). When bacteriuria developed, it occurred within seven days of catheter insertion in 50% of instances, irrespective of drainage system employed, suggesting that manipulations related to catheter insertion were important in initiating bacteriuria. Significant urinary tract infections occurred in only 2% of all patients studied. The higher cost for purchasing the preconnected system was not warranted for the population of patients studied.
Nosocomial Pseudomonas aeruginosa Conjunctivitis in a Pediatric Hospital
Authors: King Susan , Devi Shashi P. , Mindorff Cathy , Patrick Mary Lou , Gold Ronald , Ford-Jones E. Lee 
Published: September 2009

AbstractConjunctivitis accounted for 5% of nosocomial infections occurring in a university-affiliated pediatric hospital between January 1984 and April 1986. Pseudomonas aeruginosa was recovered from the conjunctiva of 30 patients. The primary diseases of these patients were chronic and debilitating. Eighty percent of patients were under 18 months of age although only 30% of admissions are represented in this age group. Seventy percent of cases occurred in pediatric intensive care unit/neonatal intensive care unit patients. Seventy percent of patients who had antecedent nasopharyngeal/ endotracheal cultures obtained were colonized with P aeruginosa. All patients except one had one or more of the following interventions prior to the onset of conjunctivitis: tracheostomy, endotracheal tube, oxygen by hood, or suctioning. Two children (7.4%) have residual corneal scars. Improvements in eye care including protection of the eye during suctioning, other respiratory care, and nasogastric tube procedures are warranted.
The Impact of Preoperative Skin Disinfection on Preventing lntraoperative Wound Contamination
Authors: Garibaldi Richard A. , Skolnick Deborah , Lerer Trudy , Poirot Andrea , Graham Jeffrey , Krisuinas Edward , Lyons Robert 
Published: September 2009

AbstractThe efficacy of total body showering and incision site scrub with disinfectant agents was evaluated in a randomized, prospective study of 575 patients undergoing selected surgical procedures. Patients who showered twice with 4% chlorhexidine gluconate had lower mean colony counts of skin bacteria at the surgical incision site in the operating room prior to the final scrub than patients who showered twice with povidone-iodine solution or medicated bar soap. Patients in the chlor-hexidine group had no growth on 43% of the incision site skin cultures compared with 16% in the povidone-iodine group and 6% in the soap and water group. Patients who showered and who were scrubbed with chlorhexidine also had lower rates of intraoperative wound contamination. Bacteria were recovered from the wounds of 4% of patients using this regimen compared with 9% for patients who used povidone-iodine and 15% for patients who showered with medicated soap and water and were scrubbed with povidone-iodine. We noted no difference in surgery-specific infection rates among patients in the three treatment groups; however, our sample sizes were too small to evaluate this outcome parameter adequately.These data suggest that preoperative showering and scrubbing with chlorhexidine is an effective regimen to reduce extrinsic intraoperative contamination of the surgical wound from skin bacteria. The efficacy of this regimen to prevent postoperative wound infection needs to be evaluated in a well-designed, carefully controlled prospective trial with adequate numbers of patients to achieve statistically valid conclusions.
Effect of Bedside Needle Disposal Units on Needle Recapping Frequency and Needlestick Injury
Authors: Edmond Michael , Khakoo Rashida , McTaggart Bonny , Solomon Rose 
Published: September 2009

AbstractNeedle recapping has been shown to be one of the leading causes of needlestick injuries. Frequency of recapping has not been reported. This study was designed to determine the frequency of needle recapping by nursing personnel and the effect of bedside needle disposal units on the frequency of recapping and needlesticks. Seventy-four nurses carrying out 312 activities involving use of needles were observed. The subjects were not aware of the nature of the study. The recapping frequency was 93.9%. The study was repeated after educational programs and following installation of a hospital-wide bedside needle disposal system. Fifty-three nurses performing 151 activities with needles were observed. Frequency of recapping was 94%. There was no significant difference in the rate of recapping or needlestick injuries after installation of the new needle disposal system. Educational programs regarding recapping, a very common practice, may be ineffective. Alternate methods for preventing nee-dlesticks may be necessary.
Brief Report: Tuberculin Testing, BCG in Pregnancy
Authors: Gillum Michael D. , Maki Dennis G. 
Published: September 2009

The issue of tuberculin skin testing in pregnant health care workers of third-world ethnicity who may have previously received bacille Calmette-Guerin (BCG) immunization is complex and multifaceted. The relevant issues are:• Is tuberculin skin testing safe in the pregnant female?• Is tuberculin skin testing indicated in the pregnant female?• Is tuberculin skin testing accurate and reliable in the pregnant female?• Does previous BCG vaccination alter the diagnostic utility of tuberculin skin testing?• Finally, is tuberculin skin testing safe in the BCG-immunized pregnant female?Is tuberculin skin testing safe in the pregnant female?When purified protein derivative (PPD) tuberculin is injected locally into the skin, most of it is removed within hours by lymphocytes. The remainder is engulfed by macrophages, and a mild brief local inflammatory reaction develops in both nonsensitive and hypersensitive patients. The reaction goes no further in the nonsen-sitized patient. In the sensitized patient-who has had Mycobacterium tuberculosis infection in the past-the area becomes heavily infiltrated by mononuclear cells, and an inflammatory reaction continues to increase for several days.
Butoconazole Nitrate
Authors: Tatum Demetris M. , Eggleston Mark 
Published: September 2009

Imidazoles and their derivatives have been proven very effective in the treatment of fungal infections. Butoconazole nitrate is an important addition to this class of antifungal agents. It was introduced to the market in for the short-term management of vaginal infections caused by Candida species. It has high activity, against Candida albicans in vitro and is very effective clinically.Butoconazole nitrate is an imidazole derivative with potent antifungal activity in vivo and in vitro (Figure). When synthesized, it exists as a racemic mixture in which both components are optical isomers and equally active.
The Trach Care™ Closed Tracheal Suction System: A New Medical Device to Permit Tracheal Suctioning Without Interruption of Ventilatory Assistance
Authors: Mayhall C. Glen 
Published: September 2009

Many new medical devices have been introduced into the market over the last two decades with the aim of improving medical care. Recently, a new device, Trach Care’”, has been introduced by Ballard Medical Products. device has been designed to allow endotracheal suctioning of intubated patients on ventilatory support without having to disconnect the patient from the ventilator.‘The Trach Care’” device has three major components. The T-piece is the component nearest the patient. It has a limb for connection to the endotracheal tube or tracheos-torny, a limb for connection to the ventilator, and a limb for introduction of the catheter. The remaining limb is covered by a plastic cap. On the limb through which the catheter is introduced, there is a port for infection of irrigation fluid. The second component is the catheter with its protective sheath. The third component, a control valve, is connected to the opposite end of the catheter and sheath. Opposite the insertion of the catheter on the control valve there is a port for connection to the wall suction tubing. When the control valve is opened, the vacuum from the wall suction tubing is applied to the catheter. The control valve may be locked in the “off position. When the Trach Care™ device is placed into the ventilator circuit, the trachea can be suctioned without interruption of ventilatory support.
Legal Comment, Part I: Basics of Liability Law
Authors: Hesson William W. , Thu Cynthia W. 
Published: September 2009

This article, the first in a series that will explore the legal implications of hospital infection control, outlines the basic legal principles applicable to infection control. Future articles will discuss the issue of confidentiality and apply general principles to the specific issues surrounding AIDS.In order to succeed in a medical malpractice action, the plaintiff must demonstrate by a preponderance of the evidence that: (1) the defendant(s) had a duty to act in a particular manner; (2) the defendant(s) negligently breached that duty; (3) the plaintiff suffered some “harm” or injury; and (4) the harm suffered by the plaintiff was causally related to the breach of duty.'Physicians and hospitals have a duty, once a patient care provider relationship has been created, to provide care to the best of their skill, training, and experience.' A significant aspect of that duty for hospitals is the creation and maintenance of an environment that is safe from unnecessary risk of infection or harm.
Malassezia furfurSkin Colonization in Infancy
Authors: Bell Louis M. , Alpert Gershon , Slight Paula Horton , Campos Joseph M. 
Published: September 2009

AbstractMalassezia furfur, a lipophilic yeast, has become recognized as a cause of sepsis in infants receiving parenteral fat emulsions via indwelling deep venous catheters. Colonization of infants' skin may be a prerequisite to colonization of the intravascular catheter and subsequent infection withM furfur. Three hundred ninety-three surveillance cultures were performed on 146 infants during their first 12 weeks of hospitalization in the intensive care unit (ICU) or the neonatal transitional unit (NTU). In addition, 47 full-term newborn infants and 38 healthy infants in the well-baby clinic were cultured. Colonization rates were greatest (48%) during the second month of hospitalization for the infants in the ICU/NTU group. In contrast, 0 of 47 newborn infants and 2 of 38 healthy infants were colonized. Prematurity and a prolonged length of stay were identified as risk factors for colonization.
Infection Rate for Single Lumen v Triple Lumen Subclavian Catheters
Authors: Yeung Carole , May John , Hughes Roger 
Published: September 2009

AbstractAn infection rate was calculated for all subclavian catheters inserted during a 12-month period. The overall, single lumen, and triple lumen infection rates were 1.7% (42/2,431), 0.4% (8/1,936), and 6.9% (34/495), respectively. After excluding single lumen catheters in patients in a surgical cardiovascular unit who appeared to have a decreased risk of infection, the overall, single lumen, and triple lumen rates were 3.7% (42/1,140), 1.2% (8/645), and 6.9% (34/495), respectively. Within this group, 11.8% (281237) of the catheters used for total parenteral nutrition (TPN) were infected, whereas 1.6% (14/903) of the non-TPN catheters were infected. Of patients receiving total parental nutrition through a triple lumen catheter, 14.5% (25/172) became infected, whereas 4.6% (3/65) of the patients receiving total parental nutrition through a single lumen catheter became infected. Single and triple lumen patient groups appeared comparable based on average age, death rate, immunosuppression, underlying disease, and duration of catheterization, but the risk of infection was approximately three times greater for patients receiving total parental nutrition through a triple lumen catheter.
Infection Control in Maryland Nursing Homes
Authors: Khabbaz Rima F. , Tenney James H. 
Published: September 2009

AbstractWe surveyed 53 randomly chosen Maryland nursing homes for infection control policies and practices. The majority had written infection control policies, an infection control committee, and a designated practitioner for infection control; in most facilities, however, the infection control practitioner had other major duties, spent little time on infection control, and had no specific training in the field. Thirty-four percent of homes in the survey performed routine environmental cultures, and more than half had insufficient or no isolation policies for infected decubiti and acute diarrhea. In general, the intensity of infection surveillance and the extent of infection control measures increased with the level of care provided, from domiciliary homes to homes providing chronic care. Employee health care fared generally well: 60% of homes offered influenza vaccine to employees and 66% had restriction policies for employees with upper respiratory infections. While the majority of homes offered the influenza vaccine to residents, acceptance of other vaccines recommended for the elderly was less widespread. We conclude that infection control efforts are made in most Maryland nursing homes; however, appropriate guidelines and more effort to educate nursing home personnel in proper infection control practices are badly needed.
A Survey of SHEA Members on Universal Precautions and HIV Screening
Authors: Miller Patti J. , Farr Barry M. 
Published: September 2009

The Centers for Disease Control (CDC) have recommended that health care workers use appropriate barriers, referred to as universal precautions, to protect themselves against exposure to the blood and body fluids of all patients. The CDC has suggested that the use of universal precautions eliminates the need for the isolation category blood and body fluid precautions (BBFP). There has been discussion concerning the feasibility of applying these precautions to all patients. Tangential issues involving screening of all hospitalized patients and whether or not informed consent should be required before such testing occurs are also being debated.The purpose of the current study was to survey those attending a meeting of The Society of Hospital Epidemiologists of America (SHEA) in October 1987 to determine their opinions on these issues and their hospitals' actual practices with regard to universal precautions, human immunodeficiency virus (HIV) screening, and informed consent.
The Israeli Study of Surgical Infections (ISSI): I. Methods for Developing a Standardized Surveillance System for a Multicenter Study of Surgical Infections
Authors: Simchen Elisheva , Wax Yohanan , Pevsner Bella , Erdal Mary , Michel Jacques , Modan Michaela , Rubinstein Eitan , Sacks Theodore , Shapiro Mervyn , Tevaglioglo Bilha 
Published: September 2009

AbstractThe postoperative wound infection experience in 11 Israeli hospitals was investigated with two objectives: (1) to utilize the variability among hospitals for a better understanding of the determinants of these infections, and (2) to present surgeons and infection control teams with information upon which they can take action. This article summarizes the methods that were applied to maximize the uniformity of information obtained from hospitals. (1) The same kind of patients were sampled in every hospital. (2) The data collection system was standardized, and analyzed for errors. The overall error rate was small (2%) but there were potential problem areas, such as missing information on underlying diagnoses (12%). Few errors (1%) were found in the nurses' observations of the wounds. (3) All wound infections were diagnosed in a uniform manner by convening a panel of four specialists at the central Israeli Study of Surgical Infections (ISSI) office. (4) The definition of infection that was finally chosen for this multicenter study had to be broadened to include, in addition to pus, “discharge other than pus,” because of the higher reliability among panel members. This definition was also clinically valid in terms of morbidity. (5) The rate of postdischarge infections was estimated and was not found to be related to the discharge policies in the various hospitals.
The Israeli Study of Surgical Infections (ISSI): II. Initial Comparisons Among Hospitals with Special Focus on Hernia Operations
Authors: Simchen Elisheva , Wax Yohanan , Pevsner Bella 
Published: September 2009

AbstractIn a study of 5,571 patients from the general surgery departments of 11 Israeli hospitals, the crude overall wound infection rates showed interhospital heterogeneity. The rates ranged from 6.3% to 12.4% (P(X2) = 0.039). Controlling for the different distributions of procedures performed in the various institutions did not reduce this variability. None of the hospitals had either consistently high or consistently low infection rates. A hospital could have low rates for one procedure and high rates for another. Therefore, the decision was made to proceed with procedure-specific analyses. This article details results of the analysis of 1,487 hernia operations. Four variables (old age, infection at another site, incarceration, and introduction of drains) accounted for almost all the differences in infection rates among the institutions. Of the four, presence of drains had the strongest association with infection (P derived from the logistic model <0.001). The risk was consistent in all hospitals and was unconfounded by other measurable factors. In contrast, the pattern of using drains seemed arbitrary and inconsistent, ranging from 9% of patients in one hospital to 41% in another. These findings were used as a basis for discussion with the surgical teams and for the initiation of a randomized clinical trial on the use of drains in hernia operations.
Surgical Complications Related to Insertion of Penile Prostheses with Emphasis on Infection and Cost
Authors: Goetz Angella , Yu Victor L. , O'Donnell Walter F. 
Published: September 2009

AbstractWe initiated a prospective study of penile prosthesis implant surgery to evaluate risk factors for infection and other complications. Twenty-one patients admitted for surgery or related complications were evaluated over a seven-month period. The two types of penile prostheses implanted were (1) inflatable and (2) semirigid. Nine of 21 patients (43%) developed postoperative complications. Although cephapirin and gentamicin were given prophylactically, four of nine patients had four wound infections and one case of pneumonia. One case of Bacteroides fragilis bacteremia was due to stool incontinency during surgery. In two of the wound infections, removal and reinsertion of the prosthesis was necessary. Other complications included hypotension during surgery, prosthesis malfunction and malposition, and urethral tears. There were no significant associations between infection and age, length of surgery, or type of prosthesis used. These complications contributed to prolonged hospital stay and readmission (87 extra days for the infected patients at a cost of $44,000). Antibiotic costs to treat the infections totaled $1,900. Prospective evaluation by infection control practitioners of various elective surgeries can be useful in quantitating the complication rate and targeting patients at risk, with the goal of minimizing hospital costs.
Cost-Effective Eradication of an Outbreak of Methicillin-Resistant Staphylococcus aureus in a Community Teaching Hospital
Authors: Rao Nalini , Jacobs Sharon , Joyce Linda 
Published: September 2009

AbstractDuring an eight-month period, 25 hospitalized patients became infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) in a 464-bed acute care, medical-surgical teaching hospital. There were only five cases during the eight months prior to the outbreak period (P < 0.0001). Initial measures, including category-specific isolation and education, did not limit the spread of the outbreak of a strain of MRSA. This prompted institution of additional measures including (1) strict isolation of all infected and colonized cases; (2) prospective microbiological surveillance to detect additional cases; (3) multiple site cultures of identified cases to determine the extent of colonization; (4) employee and environment surveillance; (5) antibiotic decolonization of patients and employees; and (6) educational efforts. The highest number of personnel carriers were noted in one of the critical care units where most of the cases occurred. The decolonization protocol was 100% effective for personnel carriers. The incidence of nosocomial cases of MRSA fell to zero in the five months following the implementation of the strategy. The cost of the entire eradication process was approximately half that of treating a single MRSA bacteremia.
Legal Comment, Part 2: Confidentiality: A Legal Cornerstone in Infection Control Programs
Authors: Hesson William W. , Thu Cynthia W. 
Published: September 2009

This is the second in a series of articles addressing legal issues in infection control. The first article (Infect Control Hosp Epidemiol 1988: 9(3):127-129) discussed the basic elements of liability law as it relates to infection control in the hospital setting. This article will focus on confidentiality in the infection control process.Infection monitoring and control, as it occurs in most hospital settings, depends on ready access to relevant information, careful evaluation of the data, and appropriate communication of conclusions and recommendations. Equally obvious, however, is the risk associated with free-floating information of this significance. Infection control programs produce a multitude of documents that are of potential interest to outsiders such as fellow staff members, other health care institutions, and attorneys. Without specific attention to mechanisms for protecting its confidentiality, information gathered in the infection control process may well become available to some or all of those interested parties.
General Design and Analysis Questions
Authors: Woolson Robert F. , McNutt Louise-Anne 
Published: September 2009

Much of clinical and hospital epidemiology involves the identification and enumeration of cases or the comparison of case frequencies between two or more groups of interest. Because both of these activities involve the use of statistics, it is important to pay careful attention to biostatistical issues involved in the collection and the analysis of such data.In this article, the first in a series of biostatistical papers, we discuss some general issues that are important in the design, analysis, and interpretation of clinical epidemiologic data. Subsequent papers in this series will deal with specific methods of analysis, examples of these methods of analysis, and limitations and interpretations of the methods.