bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nosocomial Infections in HIV-Infected Patients Preliminary Results from a Multicenter Surveillance System (1989-1995)
Authors: Stroud Leonardo , Srivastava Pamela , Culver David , Bisno Alan , Rimland David , Simberkoff Michael , Elder Harvey , Fierer Joshua , Martone William , Gaynes Robert 
Published: September 2009

AbstractObjective:To describe the characteristics of and trends in nosocomial infection among human immunodeficiency virus (HIV)-infected patients.Design:Multicenter prospective cohort study.Setting/Patients:HIV-infected patients were enrolled at time of first inpatient admission at five Veterans' Administration Medical Centers (VAMCs).Results:As of March 1995, 2,541 patients with 6,625 inpatient admissions had been monitored in the five VAMCs. A total of 530 nosocomial infections were detected using standard Centers for Disease Control and Prevention definitions. Overall distribution by infection site was 31% for primary bloodstream infections (BSIs), 28% for urinary tract infections, 15% for pneumonia, and 26% for all other sites. Of BSIs, 63% were central line-associated bloodstream infections (CLABs). The rate of CLABs per 1,000 central line days was 6.5 (range, 2.3-8.3) for all patients from participating hospitals, similar to the median CLAB rate of 6.0 for patients in medical intensive-care units (ICUs) of National Nosocomial Infections Surveillance (NNIS) System hospitals from January 1990 through September 1994. For ICU-specific CLABs, the rate from hospitals reporting at least one ICU CLAB was 12.7 (range, 12.1-13.1), comparable to the 90th percentile of NNIS hospital medical ICUs (13.1). Staphylococcus aureus, associated with 35% of BSIs, was the most common nosocomial BSI pathogen. Our data demonstrated the following: 13 (10%) of 134 patients with CD4 counts ≥200 cells/mm3 had a CLAB, compared with 61 (6%) of 1,011 patients with CD4 counts <200 cells/mm3, P=.08; the per-day risk of CLABs did not change with increased duration of catheterization (P=.4); and the per-day risk of a temporary (ie, short-term) CLAB was greater than that of a permanent CLAB (P<.001).Conclusions:The data suggest that HIV-infected patients were at higher risk of acquiring a BSI than were patients in the NNIS population; patients with CD4 counts ≥200 cell/mm3 and temporary central lines were at increased risk for BSI, perhaps reflecting widespread prophylaxis with trimethoprim-sulfamethoxazole among patients with CD4 counts <200 cells/mm3; and, in contrast to most studies, S aureus, not coagulase-negative Staphylococcus, was the most common BSI pathogen.
Automated Entry of Hospital Infection Surveillance Data
Authors: Smyth Edward T.M. , McIlvenny Gerard , Barr Jack G. , Dickson Lorna M. , Thompson Irene M. 
Published: September 2009

AbstractObjective:To assess the accuracy of an automated data entry system employing optical scanning technology and to provide an analysis of its costs as compared to manual data entry.Design:The accuracy and cost of automated data entry of 100 surgical-wound infection surveillance questionnaires was compared to manual entry.Setting:The Surgical Directorate, The Royal Hospitals, Belfast, Northern Ireland.Results:The use of optical scanning technology greatly improved the speed and accuracy of data entry. The time spent by the keyboard operator on data entry was reduced substantially.For each surgical-wound infection questionnaire automatically processed, there was a saving in clerical time equivalent to $0.63. The automated data entry process resulted in a 22-fold productivity increase compared to manual data entry with validation. After validation, an error rate of <0.2 errors per 1,000 responses was detected in automatically entered data compared to a rate of 12.4 errors per 1,000 responses for manually entered data. The automated system, including validation, provided a sevenfold productivity increase compared to “quick-and-dirty” manual data entry without validation.Conclusion:Hospital information technology systems may achieve total integration of data management, but realistically this would appear to be very much in the future. Until then, in view of the accuracy and substantial savings in time and money, we recommend the use of automated data entry technology. This system would be especially useful where data are transported from outlying hospitals to a central receiving center for collation and analysis.
Evidence of Interhospital Transmission of Extended-Spectrum β-Lactam-Resistant Klebsiella pneumoniae in the United States, 1986 to 1993
Authors: Monnet Dominique L. , Biddle James W. , Edwards Jonathan R. , Culver David H. , Tolson James S. , Martone William J. , Tenover Fred C. , Gaynes Robert P. ,   The National Nosocomial Infections Surveillance System
Published: September 2009

AbstractBackground:In addition to single-hospital outbreaks, interhospital transmission of extended-spectrum β-lactam-resistant (ESBLR) Klebsiella pneumoniae has been suspected in some reports. However, these studies lacked sufficient epidemiological information to confirm such an occurrence.Methods:We reviewed the surveillance data reported to the National Nosocomial Infections Surveillance (NNIS) System during 1986 to 1993 for K pneumoniae isolates and their susceptibility to either ceftazidime, cefotaxime, ceftriaxone, or aztreonam. Pulsed-field gel electrophoresis (PFGE) was used to study available ESBLR K pneumoniae isolates.Results:Among 8,319 K pneumoniae isolates associated with nosocomial infections, 727 (8.7%) were resistant or had intermediate-level resistance to at least one of these antibiotics. One hospital (hospital A) accounted for 321 isolates (44.2%) of ESBLR K pneumoniae. During 1986 to 1993, the percentage of K pneumoniae isolates that were ESBLR increased from 0 to 57.7% in hospital A, from 0 to 35.6% in NNIS hospitals 0 to 20 miles from hospital A (area B), and from 1.6 to 7.3% in NNIS hospitals more than 20 miles from hospital A, including hospitals located throughout the United States. Analysis of PFGE restriction profiles showed a genetic relationship between a cluster of isolates from hospital A and some isolates from one hospital in area B, and consecutive admission in these two hospitals was confirmed for two patients from whom isolates were available.Conclusions:These data provide evidence of interhospital transmission of ESBLR K pneumoniae in one region of the United States and stress the interrelationship between hospitals when trying to control antimicrobial resistance.
A Pseudo-Outbreak of Purified Protein Derivative Skin-Test Conversions Caused by Inappropriate Testing Materials
Authors: Grabau John C. , Burrows Daniel J. , Kern Michelle L. 
Published: September 2009

AbstractObjective:To investigate a cluster of newly identified tuberculosis infections.Design:A field study was conducted including interviews; medical record reviews; checking of bills and invoices, pharmacy records, and drug manufacturer information; and clinical retesting.Setting:Community residential facilities providing comprehensive services to retarded adults.Participants:Twenty residential facility staff (not previously known to be purified protein derivative [PPD] positive).Results:Staff had been tested with 250 TU of PPD, and 9 of 20 were tuberculin positive. Retesting with 5 TU yielded no reaction.Conclusions:Reactions were attributable to testing with a product not recommended for routine PPD screening. Healthcare workers planting PPD Mantoux tests always should check the vials to ensure that the appropriate strength solution is being used.
Infection Control Issues in Construction and Renovation
Authors: Carter Cheryl D. , Barr Brenda A. 
Published: September 2009

AbstractConstruction or renovation projects in hospitals pose special challenges. Infection control personnel should be involved in all phases of these projects to ensure that patients, visitors, and staff are protected from unnecessary exposure to infectious agents. Infection control personnel must identify the infection risks posed by each project and must plan ways to minimize the risk. Infection control personnel also must ensure that municipal, county, state, and federal infection control guidelines and regulations are met. This article will discuss basic infection control issues encountered during construction and renovation, offer practical suggestions for addressing these issues, discuss common questions that infection control personnel must address, and describe outbreaks related to construction and renovation.
Clostridium difficile-Associated Diarrhea: Epidemiology, Risk Factors, and Infection Control
Authors: Lai Kwan Kew , Melvin Zita S. , Menard Mary Jane , Kotilainen Helen R. , Baker Stephen 
Published: September 2009

AbstractObjectives:To evaluate the effectiveness of specific infection control measures on the incidence of Clostridium difficile-associated diarrhea (CDAD) and to identify risk factors for its development.Setting:370-bed, tertiary-care teaching hospital with approximately 12,000 to 15,000 admissions per year.Methods:Several infection control measures were implemented in 1991 and 1992, and the attack rates of CDAD were calculated quarterly. Antibiotic use for 1988 through 1993 was analyzed. A case-control study was conducted from January 1992 to December 1992 to identify risk factors for acquisition of CDAD.Results:From 1989 to 1992, the attack rate of CDAD increased from 0.49% to 2.25%. An increase in antibiotic use preceded the rise in the incidence of CDAD in 1991. Despite implementation of various infection control measures, the attack rate decreased to 1.32% in 1993, but did not return to baseline. Ninety-two cases and 78 controls (patients with diarrhea but with negative toxin assay) were studied. By univariate analysis, history of prior respiratory tract infections (odds ratio [OR], 3.6; 95% confidence interval [CI95], 1.2-10.4), the number of antibiotics, and the duration of exposure to second-generation cephalosporins (OR, 3.55; CI95, 1.47-9.41) and to ciprofloxacin (OR, 7.27; CI95, 1.13-166.0) were related significantly to the development of CDAD. By stepwise logistic regression analysis, only exposure to antibiotics and prior respiratory tract infections (P=.0001 and .0203, respectively) were found to be significant.Conclusion:Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline.
When the Biological Indicator Is Positive: Investigating Autoclave Failures
Authors: Bryce E.A. , Roberts F.J. , Clements B. , MacLean S. 
Published: September 2009

AbstractA series of positive biological indicators in steam autoclaves from different hospital departments within the same building were traced to blocked steam traps on building condensate lines. The steps taken during the investigation and a protocol for management of positive biological indicators are described.
Exclusion of Noninfectious Medical Waste From the Contaminated Waste Stream
Authors: Francis Michael C. , Metoyer Lana A. , Kaye Alan D. 
Published: September 2009

AbstractThe purpose of this study was to determine whether any waste was labeled incorrectly as infectious or contained material that could be recycled. Waste generated in preparation for surgery was separated and weighed. Of 530 lbs of operating room waste, 40 lbs were noninfectious, largely plastic and paper. The results of the present study suggest a segment of waste can be removed from the contaminated stream, potentially reducing hospital costs and improving our environment.
Surgical-Site Infection Rates in Patients Who Undergo Elective Surgery on the Same Day as Their Hospital Admission
Authors: Manian Farrin A. , Meyer Lynn 
Published: September 2009

AbstractObjective:To follow over time surgical-site infection (SSI) rates in patients admitted to the hospital on the same day as their elective surgery (group I), and to compare these rates with those of other surgical patients who also required postoperative hospitalization but either were hospitalized for 1 or more days immediately prior to surgery or underwent surgery on a nonelective basis (group II).Design:Observation of overall SSI rates over time for group I and II patients and study of risk factors associated with increased SSI rate among group I neurosurgical patients.Setting:A 900-bed, tertiary-care community hospital with >10,000 surgical procedures performed each year on patients requiring postoperative hospital stay.Patients:A total of 48,464 surgical procedures were performed on consecutive patients from 1990 to 1994, with 18,794 (39%) involving group I patients. In addition, 511 consecutive procedures performed on neurosurgical patients requiring postoperative hospitalization from July 1994 to May 1995 were analyzed.Results:In 1990, the overall SSI rate of group I patients was significantly lower than that of group II patients (0.4% vs 1.3%, relative risk [RR], 3.6; 95% confidence interval [CI95], 2-6.4; P<.0001), but, by 1994, there was no longer any significant difference between the SSI rates of group I and II patients (1.8% and 1.6%, respectively; P=.38). In 1994, the SSI rate in group I neurosurgical patients was significantly greater than that of group II patients (3.4% vs 0.4%; RR, 8.3; CI95, 1.05-66; P=.02). During the period April through September 1994 (warm months), group I neurosurgical patients were associated with a significantly lower American Society of Anesthesiologists score and SSI risk index (based on National Nosocomial Infection Surveillance System data) and a higher likelihood of having “clean-class” wounds, but significantly greater-than-expected SSI rate when adjusted for patient risk index and type of procedure (4.7% vs 1.4%; RR, 3.3; CI95, 1.3-8.6; P=.02). During the same period, the observed and expected SSI rates were not significantly different for group II neurosurgical patients.Conclusions:As a whole, the SSI rates among patients undergoing elective surgery on the same day of their hospital admission is no longer significantly lower than that of other patients who also require postoperative hospitalization. For certain procedures, such as those commonly performed on the neurosurgical service, elimination of preoperative hospital stay may be associated with greater-than-expected risk of SSI.
Increased Bloodstream Infection Rates in Surgical Patients Associated with Variation from Recommended Use and Care Following Implementation of a Needleless Device
Authors: Cookson Susan Temporado , Ihrig Melanie , O'Mara Edward M. , Denny Mark , Volk Helen , Banerjee Shailen N. , Hartstein Alan I. , Jarvis William R. 
Published: September 2009

AbstractObjective:To determine if an apparent increase in bloodstream infections (BSIs) in patients with central venous catheters (CVCs) was associated with the implementation of a needleless access device.Design:Retrospective cohort study using a derived CVC-days factor for estimating appropriate denominator data.Setting:A 350-bed urban, acute, tertiary-care hospital.Methods:BSI surveillance data were obtained, and high-risk areas for BSIs were determined. A random 5% sample of medical records was used to estimate CVC days, and a cohort study was conducted to compare BSI rates before and during needleless device use. A survey was conducted of nursing needleless-device practices.Results:The surgical intensive-care unit (SICU), the medical intensive-care unit, and the solid organ transplant unit (OTU) were identified as high-risk units. Using existing surveillance BSI data and the estimated CVC days, the catheter-related BSI rates in the high-risk surgical patients were significantly higher during the needleless-device period compared with the preneedleless-device period (SICU, 9.4 vs 5.0/1,000 CVC days; OTU, 13.6 vs 2.2/1,000 CVC days). A survey of the nurses revealed that 60% to 70% were maintaining the needleless devices correctly.Conclusion:We observed a significant increase in the BSI rate in two surgical units, SICU and OTU, associated with introduction of a needleless device. This increase occurred shortly after the needleless device was implemented and was associated with nurses' unfamiliarity with the device, and needless-device use and care practices different from the manufacturer's recommendations.
Mycobacterium avium Complex Common-Source or Cross-Infection in AIDS Patients Attending the Same Day-Care Facility
Authors: Carbonne Anne , Lemaitre Nadine , Bochet Marie , Truffot-Pernot Chantal , Katlama Christine , Grosset Jacques , Bricaire François , Jarlier Vincent 
Published: September 2009

AbstractTo delineate the epidemiology of Mycobacterium avium complex (MAC) infection in acquired immunodeficiency syndrome patients, we studied 32 case patients with disseminated MAC infection who attended the same daycare facility during a period of 13 months. Pulsed-field gel electrophoresis analysis showed very low similarity between MAC strains, suggesting that, despite close contacts between the patients, nosocomial cross-transmission or exposure to a common source of MAC did not occur
Central Venous Catheter-Related Corynebacterium minutissimum Bacteremia
Authors: Rupp Mark E. , Stiles Karen G. , Tarantolo Stefano , Goering Richard V. 
Published: September 2009

AbstractAlthough Corynebacterium minutissimum is well-known as the cause of erythrasma, it is noted as the etiologic agent of nondermatologic disease only rarely. We document this organism as a cause of central venous catheter-associated bacteremia and report the use of pulsed-field gel electrophoresis to characterize its molecular epidemiology
An Outbreak of Serratia marcescens Infections Related to Contaminated Chlorhexidine
Authors: Vigeant Patrice , Loo Vivian G. , Bertrand Céline , Dixon Catherine , Hollis Richard , Pfaller Michael A. , McLean A. Peter H. , Briedis Dalius J. , Perl Trish M. , Robson Hugh G. 
Published: September 2009

AbstractAn outbreak of Serratia marcescens infections occurred in a university tertiary-care hospital. Alcohol-free chlorhexidine solutions were contaminated with S marcescens. The majority of patient and chlorhexidine strains had similar pulsed field-gel electrophoresis banding patterns. Chlorhexidine was recalled, and the rate of S marcescens isolation returned to baseline. Chlorhexidine without alcohol should not be used as an antiseptic
Standardized Management of Patients and Employees Exposed to Pertussis
Authors: Haiduven Donna J. , Hench Carmen P. , Simpkins Sandy M. , Stevens David A. 
Published: September 2009

AbstractWaning pertussis immunity and spread of pertussis by asymptomatic adults contributes to increased pertussis exposures of vulnerable children. The Santa Clara Valley Medical Center had 49 pertussis exposures between July 1, 1989, and June 30, 1997, which originated in pediatric units or clinics and had an impact on the Employee Health Service (EHS) and Emergency Department (ED). We have developed a standardized protocol for management of employees and patients exposed to pertussis. The protocol includes a checklist for infection control staff; memoranda to exposed units conveying exposure information, instructions for employees to report to EHS or ED, and disease symptom information; written guidelines for physician management of patient exposures (prophylaxis and isolation) and EHS or ED management of employee exposures; and prophylaxis recommendations. We allow exposed employees to work while wearing a mask (worn until 5 days of prophylaxis are completed or for the entire potential contagious period if prophylaxis was refused). Employees who develop pertussis are restricted from work. Our protocol and standardized forms provide consistent management of pertussis exposures in both patients and employees.
Carriage of Methicillin-Resistant Staphylococcus Aureus at Hospital Admission
Authors: Troillet Nicolas , Carmeli Yehuda , Samore Matthew H. , Dakos Joanna , Eichelberger Karen , DeGirolami Paola C. , Karchmer Adolf W. 
Published: September 2009

AbstractObjectives:To measure the prevalence of, and to establish predictors for, the nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission. To evaluate mannitol-salt agar with oxacillin for the simultaneous detection and identification of MRSA from nasal swabs.Design:Three-month prospective case-control survey, with data collected from interviews and computerized databases. The criterion standard for MRSA detection was culture on Mueller-Hinton agar with oxacillin 6 μg/mL (National Committee for Clinical Laboratory Standards method).Setting:320-bed tertiary-care hospital.Patients:387 patients screened within 24 hours after admission, including 10 MRSA carriers (cases), 291 patients with no S aureus, and 86 patients with methicillin-susceptible S aureus.Results:The prevalence of MRSA nasal carriage was 2.6%, whereas the prevalence of carriage was 3.1% when both nasal and wound cultures were performed. The significant predictors of carriage were a prior detection of MRSA, open wounds, diabetes mellitus, treatments by injection, prior nursing home stays, visits at home by a nurse, and prior antibiotic treatments. Cases had stayed for longer periods in hospitals and had received longer antibiotic treatments within a year. Eighty patients (including the 10 cases) had diabetes, had been exposed to healthcare facilities within a year, and had antibiotics within 6 months. The sensitivity and negative predictive value of nasal swabs on mannitol-salt agar with oxacillin were 60% and 71%, respectively.Conclusion:MRSA carriage on admission to the hospital may be an increasing and underestimated problem. Further studies are needed to develop and validate a sensitive and specific prediction rule.
Colonization by Acinetobacter baumanii in Intensive–Care–Unit Patients
Authors: Lortholary Olivier , Fagon Jean-Yves , Hoi Annie Buu , Mahieu Geneviève , Gutmann Laurent 
Published: September 2009

AbstractWe prospectively studied the value of systematic rectal swabs performed for the detection of colonization and the prediction of infections by Acinetobacter baumanii in 751 consecutive patients admitted to five intensive-care units (ICUs) over an 8-month period. Gastrointestinal tract colonization was found in 8.7% of ICU admissions. The positive and negative predictive values of rectal swabs for the detection of subsequent infection were 17% and 99%, respectively. Sensitivity and specificity were 55% and 93%, respectively. We also determined the comparative values of rectal or nasal swabs and skin cultures for the detection of A baumanii colonization in 25 patients already colonized or infected with A baumanii. The combination of rectal and nasal swabs was positive in 20 (80%) of 25. The results of the present study suggest that detection of gastrointestinal tract A baumanii colonization is not an accurate predictor of subsequent A baumanii infection and that combined rectal and nasal swabs might be used for the detection of A baumanii colonization in ICU patients.