bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative Epidemiology
Authors: Freeman Jonathan 
Published: September 2009

AbstractWe provide guidance for new practitioners in the vocabulary of modern epidemiology and the application of quantitative methods. Most hospital epidemiology involves surveillance (observational) data that were not part of a planned experiment, so the rubric and logic of controlled experimental studies cannot be applied. Forms of incidence and prevalence often are confused. The names “cohort study” and “case-control study” are unfortunate, as cohort studies rarely involve cohorts and case-control studies allow no active control by the investigator. Either type of study can be prospective or retrospective. Results of studies with discrete outcomes (infected or not, lived or died) often are represented best by a form of the risk ratio with 95% confidence intervals. The potential distorting effects of selection bias, misclassification, and confounding need to be considered.
Capture-Recapture Methods in Epidemiological Studies
Authors: Stephen Craig 
Published: September 2009

AbstractMedical researchers often are faced with the challenge of estimating the total number of cases in a population based on incomplete samples. Because of a lack of explicit methods for determining if all cases have been counted, indirect methods for estimating the abundance of disease have been developed. Capture-recapture models are an indirect method of estimating population sizes that have been employed in recent epidemiological studies. These methods, derived from techniques developed for studies of animal abundance, estimate the true population size by evaluating the degree of overlap among incomplete lists of cases from existing data sources. Although intuitively appealing, the successful application of these methods is dependent upon a clear understanding of the biology of the disorder involved, the dynamics of the reference population, and the assumptions and robustness of the specific models used. Failure to address these issues can lead to inaccurate and sometimes misleading results. This article describes some of the strengths and limitations of recapture techniques and provides the reader with a foundation from which to explore the methods in further detail.
Does a Cheaper Mask Save Money? The Cost of Implementing a Respiratory Personal Protective Equipment Program
Authors: Rivera Pedro , Louther Joyce , Mohr James , Campbell Angela , DeHovitz Jack , Sepkowitz Kent A. 
Published: September 2009

AbstractObjective:To determine the annual cost of implementing and maintaining a respiratory personal protective equipment (PPE) program at an urban hospital.Setting:St Clare's Hospital and Health Center, a 250-bed hospital in Manhattan that treats 60 to 100 cases of tuberculosis annually.Methods:Review of Purchasing Department records for all masks acquired by the hospital from 1992 to 1995, and an estimate of administrative time spent developing and implementing the guidelines recommended by various agencies during the study interval.Results:Respiratory isolation was provided for 6,360 to 10,883 days annually during the 4-year interval. Yearly costs for the PPE program ranged from $86,560 to $175,690. Of note, the daily cost for a respiratory isolation day decreased dramatically between 1994 and 1995 ($25/day to $13/day), when the high-efficiency particulate air-filter (HEPA) respirator was used by all staff. The decrease occurred because of lower administrative costs and a sharp decrease in the numbers of HEPA units purchased. Objective measures of worker compliance with HEPA respirators demonstrated the decrease was not due to less HEPA use but rather that employees were using each HEPA unit for several weeks, as recommended.Conclusion:We found a significant decrease in cost in the second year of our HEPA program due to increasing employee familiarity with the program. Newly approved, cheaper, but less durable, N-95 masks are unlikely to withstand multiple wearings and may be discarded after a few uses. Thus, cheaper masks may result in a more expensive PPE program.
Implementation of Consensus Guidelines for the Follow-Up of Positive Blood Cultures
Authors: Herchline Thomas , Gros Sheila 
Published: September 2009

AbstractObjective:Assess the effect and use of resources associated with implementation of a program for the systematic follow-up of positive blood cultures.Design:Prospective epidemiologic study.Setting:Tertiary-care military medical center.Intervention:All positive blood cultures (BC) were reported via E-mail to an infectious disease specialist as soon as growth was noted. This individual reviewed all Gram stains, clinical data, and antibiotic information on these patients.Results:From June 26, 1994, through January 25, 1995, there were 3,121 BCs drawn, of which 199 (6.4%) were positive from 145 episodes. Sixty-three episodes involved probable contaminants, and 82 episodes were considered true bacteremias. Six patients with true bacteremia died, two were transferred, and three were discharged within 24 hours of drawing the positive BC. Of the remaining 71 true bacteremias, 9 patients were on inadequate empiric therapy, as judged by the final organism susceptibilities. Changes in empiric therapy were recommended for five of the nine episodes and were implemented by the primary physicians in each case. Each of the changes resulted in improved coverage (as judged by the final identification and susceptibilities).Conclusions:This program has improved the quality of care at Keesler Medical Center at the cost of one additional hour of consultant time per week.
Nosocomial Infection in an Intensive-Care Unit Identification of Risk Factors
Authors: Fernandez-Crehuet Rafael , Diaz-Molina Carmen , de Irala Jokin , Martinez-Concha Diego , Salcedo-Leal Inmaculada , Masa-Calles Josefa 
Published: September 2009

AbstractObjective:To identify risk factors predictive of nosocomial infection in an intensive-care unit (ICU) and to identify patients with a higher risk of nosocomial infection using a predictive model of nosocomial infection in our ICU.Design:Prospective study; daily concurrent surveillance of intensive-care-unit patients.Setting/Patients:All patients admitted for at least 24 hours to the ICU of a tertiary-level hospital from February to November 1994 were followed daily.Methods:Variables measuring extrinsic and intrinsic risk factors for nosocomial infection were collected on each patient during their ICU stay, and the Cox Proportional Hazards multivariable technique was used to identify the variables significantly associated with infection.Results:The population studied consisted of 944 patients. The main risk factors identified were intrinsic; the significant extrinsic risk ofactors identified were head of the bed in a horizontal (<30°) position (this variable presented the highest increase of the infection hazard ratio) and the use of sedative medication. Patients presenting the highest risk scores using the predictive model are those with the highest risk of nosocomial infection.Conclusion:The important preventive measures derived from our results are that underlying conditions suffered by the patient at the ICU admission should be corrected promptly, the depression of the patient's level of consciousness with sedatives should be monitored carefully, and the horizontal position of the head of the bed should be avoided totally. Patients with a high risk of infection can be the target of special preventive measures.
Exposure Workups
Authors: Herwaldt Loreen A. , Pottinger Jean M. , Carter Cheryl D. , Barr Brenda A. , Miller Elyse D. 
Published: September 2009

AbstractExposure workups are an important responsibility for infection control personnel. A well-designed plan for investigating exposures, which includes appropriate algorithms, will enable infection control personnel to evaluate exposures rapidly and consistently so that nosocomial transmission is minimized. Infection control personnel should use their own data to develop policies and procedures that suit the needs of their facility. After they have imple-merited the plan, infection control personnel should continue to collect data on exposures so they can continuously improve their performance.
A Pseudo-Outbreak of Mycobacterium chelonae Infections Related to Bronchoscopy
Authors: Cox Ronald , deBorja Karen , Bach Michael C. 
Published: September 2009

AbstractMycobacterium gordonae and rapidly growing “atypical” mycobacteria including Mycobacterium chelonae are commonly found in tap water. This article describes a pseudooutbreak of M chelonae infections related to bronchoscopy. Because patients may be treated and isolated unnecessarily when positive with acid-fast bacilli before the species are known, the financial burden for patients and hospitals may be great.
Decision Analysis: Balancing Quality and Cost
Authors: Brasel Karen J. , Weigelt John A. 
Published: September 2009

AbstractHealthcare reform is a topic consuming the time and energy of many healthcare professionals, administrators, and politicians. One goal of reform is to improve value—better quality health care for less cost. Unfortunately, much of the current debate proceeds without clear definitions of quality or cost. To have profitable discussion, we must have precise definitions. With these definitions in hand, the technique of decision analysis provides a unique opportunity to evaluate quality and costs of healthcare decisions simultaneously. We believe it is imperative for physicians to become familiar with this important and powerful tool.
Susceptibility of Vancomycin-Resistant Enterococci to Environmental Disinfectants
Authors: Anderson Roger L. , Carr Janice H. , Bond Walter W. , Favero Martin S. 
Published: September 2009

AbstractObjective:To determine the susceptibilities of vancomycin-resistant and -sensitive enterococci (VRE and VSE) to various concentrations of commonly used, commercial, hospital-grade disinfectants.Design:A microbial suspension test using inocula of 108 cells per mL in a disinfectant test dilution was used to determine inactivation kinetics of the test strains. In each test, 1-mL aliquots were removed from the cell-disinfectant mixtures at 15 and 30 seconds and then at 1-minute intervals for 5 minutes and neutralized. Appropriate serial dilutions were plated on agar medium for enumeration of survivors.Results:VRE and VSE challenge inocula (in the absence of any additional protein or serum challenge) were below the limit of detection (5 colony-forming units/mL) after 15 seconds' exposure to the manufacturers' suggested use-dilutions of quaternary ammonium, phenolic, or iodophor germicidal detergents. In subsequent tests, when the disinfectants were diluted far beyond the recommended use-dilutions (extended dilution), no differences were demonstrated between the susceptibilities of VRE and VSE.Conclusions:VRE and VSE are sensitive to a spectrum of commonly used environmental disinfectants and have parallel inactivation rates when challenged with extended dilutions of these products. Our findings did not demonstrate a relationship between antibiotic and germicide resistance. Routine disinfection and housekeeping protocols presently used in hospitals need not be altered due to concerns about the potential for environmentally mediated transmission of antibiotic-resistant microorganisms.
Changing the Infection Control Paradigm From Off-Line to Real Time The Experience at Millard Fillmore Health System
Authors: Carr James R. , Fitzpatrick Paul , Izzo Joseph L. , Cumbo Thomas J. , Birmingham Mary C. , Adelman Martin H. , Paladino Joseph A. , Hanson Stephen C. , Schentag Jerome J. 
Published: September 2009

AbstractIn 1993, several departments at Millard Fillmore Health System joined efforts to initiate a new approach to infection control. The main emphasis of this program is to move infection control to a real-time mode to manage patient outcomes daily. The principal objective was to decrease the number of nosocomial infections by 10%, with a particular emphasis on surgical-site infections. Besides real-time surveillance, we are critically evaluating several aspects of the management of nosocomial infections.High-level computer support has been the framework upon which this program was built. We have micro-computers that are linked directly to microbiology, pharmacy, billing, and admissions, downloading data several times daily. An expert software system merges all of the data, and from this we can target patients for real-time interventions. The computer system allows all inpatients to be screened for either infection control or antibiotic management inter ventions on a daily basis, with minimal time being spent on data collection and maximal efforts devoted to inter ventions at the bedside.Additionally, the infection management program will assist in maintaining the extraordinarily low expenditures on antimicrobial agents. During 1993, the Millard Fillmore Health System spent $924,884 on antibiotics, an amount approximately 50% that of comparably sized hospitals.
An Introduction to Time-Trend Analysis
Authors: Birnbaum David , Ely John W. , Dawson Jeffrey D. , Lemke Jon H. , Rosenberg Jon 
Published: September 2009

AbstractHealthcare professionals often are presented with data that appear to indicate an upward or downward trend over time. For example, admissions of acquired immunodeficiency syndrome (AIDS) patients appear to be increasing, cesarean section rates appear to be decreasing, or nosocomial pneumonia rates appear to be increasing. Critical decisions sometimes are based on such trends, which often are presented without a statistical analysis. Those responsible for decision making may be left wondering whether these apparent trends represent only chance variation. Graphs showing trends over time generally present one of three kinds of outcome data: counts (eg, three AIDS admissions), proportions (eg, 10 cesarean sections per 100 total deliveries), or person-time data (eg, 13 cases of nosocomial pneumonia per 10,000 patient days). Using familiar examples and a minimum of technical language, we illustrate the analysis of time trends.
Nosocomial Transmission of Trichophyton tonsurans Tinea Corporis in a Rehabilitation Hospital
Authors: Lewis Steven M. , Lewis Barbara G. 
Published: September 2009

AbstractObjective:Investigate the nosocomial transmission of Trichophyton tonsurans tinea corporis.Design:Descriptive study of a nosocomial epidemic of tinea corporis.Setting:A free-standing inpatient rehabilitation facility.Participants:Patients and healthcare workers present on an inpatient rehabilitation ward at the time of transmission of tinea corporis.Results:T tonsurans tinea corporis was transmitted from one patient to four healthcare workers despite early diagnosis and treatment. Infection rates for healthcare workers having major, moderate, and minor contact with the index case were 30%, 17%, and 0%, respectively (overall rate, 25%).Conclusions:This study identifies rehabilitation inpatients as another population in which nosocomial transmission of T tonsurans tinea corporis can occur. The high attack rate and transmission, despite early diagnosis and treatment, emphasizes the need for isolation precautions.
Intravascular Catheter Colonization in Critically Ill Children
Authors: Schlager Theresa A. , Hidde Markley , Rodger Pamela , Germanson Teresa P. , Donowitz Leigh G. 
Published: September 2009

AbstractIn a prospective study, cultures were obtained of all intravascular catheters removed from children in an intensivecare unit. Of 366 catheters removed from 217 children, 110 (30%) were found to be colonized, most commonly with coagulase-negative staphylococci. Despite the high rate of colonization, there were only nine instances (2%) of catheter-related bacteremia.
A Survey of Policies at Children's Hospitals Regarding Immunity of Healthcare Workers: Are Physicians Protected?
Authors: Lane Natalie E. , Paul Ronald I. , Bratcher Denise F. , Stover Beth H. 
Published: September 2009

AbstractObjective:To determine policies at children's hospitals regarding immunizations, annual tuberculosis (TB) screening, and blood or body fluid exposure follow-up, particularly as they apply to physicians.Design and Participants:A three-page survey was sent to infection control practitioners (ICPs) in April 1994 at hospitals affiliated with the National Association of Children's Hospitals and Related Institutions. One follow-up mailing was sent to nonresponding ICPs.Results:Responses were received from 62 (67%) of 93 ICPs. Thirty-five (66%) of 53 children's hospitals had an immunity policy that applied to medical students, 42 (79%) of 53 to resident physicians, 32 (52%) of 62 to hospital-based physicians, and 18 (29%) of 62 to private or community physicians (who admit patients to one hospital). Physicians were required to show evidence of an annual TB screen at 36 hospitals (58%). Immunity policies or TB screening were provided for the following physician groups: medical students, 13 (21%); resident physicians, 43 (69%); hospital-based physicians, 50 (81%); and private or community physicians, 23 (37%). Infection control practitioners reported that the following diseases had been identified within the past 5 years at their hospitals: measles, 82%; mumps, 40%; rubella, 31%; TB, 94%; hepatitis B, 94%; pertussis, 90%; varicella, 98%; and influenza, 94%. Physicians in these institutions were reported to have contracted the following diseases from patient exposure: measles, hepatitis B, TB, pertussis, varicella, and influenza.Conclusion:Children's hospitals vary widely in their policies regarding healthcare-worker immunity, and, in many cases, physicians may not be protected from nosocomial transmission of community infections.
Varicella Vaccination for Healthcare Workers at a University Hospital An Analysis of Costs and Benefits
Authors: Tennenberg Alan M. , Brassard Juanita E. , Van Lieu Jaclyn , Drusin Lewis M. 
Published: September 2009

AbstractObjective:To demonstrate the costs and benefits of vaccinating varicella-susceptible healthcare workers at a university hospital with live, attenuated varicella-zoster virus vaccine.Design:Retrospective review of employee medical records and data on the cost of special paid absence for susceptible healthcare workers after exposure to varicella or herpes zoster.Setting:A 988-bed tertiary-care university hospital.Results:In 1994, 224 hospital employees (3.4%) were susceptible to the varicella-zoster virus. There were 40 exposures to varicella and herpes zoster in that year, involving 29 of the susceptible employees. Nine (31%) of the exposed susceptibles became varicella immune by indirect fluorescent antibody testing subsequent to exposure. Seventeen (59%) have had multiple varicella exposures and special paid absences while employed by the hospital. In 1994, wages paid to healthcare workers while furloughed for the communicable period following varicella exposure totaled $38,463.93. An additional $24,748.74 was paid to replacement workers during that same time. Varicella vaccine to immunize all 224 susceptibles in 1994 would have cost $17,920. Absences due to varicella and herpes zoster exposure also result in disruptions to patient care.Conclusions:Varicella vaccination for varicella-susceptible healthcare workers at a university hospital would result in financial savings and improved patient care. We recommend that other institutions consider the costs and benefits of adopting a varicella immunization program for their susceptible employees.
Evaluation of Integrity of Gloves Used in a Flow Cytometry Laboratory
Authors: Cappuccio William R. , Lees Peter S.J. , Breysse Patrick N. , Margolick Joseph B. 
Published: September 2009

AbstractThis study was conducted to evaluate the effect of normal use on latex glove integrity in a flow cytometry laboratory. The gloves were tested using the 1,000 μL watertight test and met industrial standards (less than 4% leakage) before, but not after, use. More durable gloves, or more frequent changes of gloves, may be needed to ensure adequate barrier protection for laboratory workers during routine procedures.
The Challenge of Postoperative Infections Does the Surgeon Make a Difference?
Authors: Holzheimer René G. , Haupt Werner , Thiede Arnulf , Schwarzkopf Andreas 
Published: September 2009

AbstractPostoperative infections remain a challenge in many surgical procedures despite improved surgical technique and powerful antibiotics. The number of sepsis cases has tripled from 1979 to 1992 due to increased invasive procedures in older and immune-suppressed patients. Increasingly, in recent years, outbreaks of resistant pathogens have been published, provoking the question of how postoperative infections and resistant pathogens should be dealt with.Wound classification and risk stratification were developed to identify patients at risk for postoperative infection. However, other important intrinsic factors of the patient were not included, and further attempts have been made to increase sensitivity and specificity (eg, Study on the Efficacy of Nosocomial Infection Control project, National Nosocomial Infection Surveillance System score); the American Society of Anesthesiologists preoperative assessment score and the operation duration for specific procedures were introduced into the system as risk stratifiers.Advances in immunology have identified new ways in which the surgeon can moderate the immune response (eg, hemorrhage and blood transfusion-induced immune suppression). The increased rate of resistance in enterococci and staphylococci has refocused attention on infection control in surgery. However, there are recent reports from both sides of the Atlantic indicating that guidelines for infection control and antibiotic policy have not become reflected in standard procedures in many hospitals.New antibiotics may be developed, but resistance soon may follow. Sound techniques in surgery, with careful infection control and antibiotic policies, may be the only strategy to prevent further increases in resistance of pathogens in postoperative infections.