bluuebunny/crossref_metadata_2025_split huggingface dataset:
Local Antibiotic Prophylaxis in Surgery
Authors: Martin Claude , Viviand Xavier , Potié Frédéric 
Published: September 2009

AbstractThe perioperative use of antibiotics is an established and accepted technique for the prevention of postoperative infection. Intravenous administration often is preferred, and intramuscular administration is possible, although it has certain drawbacks. This article examines a variety of other routes of administration for delivering antibiotics locally to the surgical site. These techniques merit further study in prospectively randomized trials.
Selected Aspects of the Socioeconomic Impact of Nosocomial Infections: Morbidity, Mortality, Cost, and Prevention
Authors: Jarvis William R. 
Published: September 2009

AbstractApproximately 2 million nosocomial infections occur annually in the United States. These infections result in substantial morbidity, mortality, and cost. The excess duration of hospitalization secondary to nosocomial infections has been estimated to be 1 to 4 days for urinary tract infections, 7 to 8.2 days for surgical site infections, 7 to 21 days for bloodstream infections, and 6.8 to 30 days for pneumonia. The estimated mortalities associated with nosocomial bloodstream infections and pneumonia are 23.8% to 50% and 14.8% to 71% (overall), or 16.3% to 35% and 6.8% to 30% (attributable), respectively. The estimated average costs of these infections are $558 to $593 for each urinary tract infection, $2,734 for each surgical site infection, $3,061 to $40,000 for each bloodstream infection, and $4,947 for each pneumonia. Even minimally effective infection control programs are cost-effective. In countries with prospective payment systems based on diagnosis-related groups, hospitals lose from $583 to $4,886 for each nosocomial infection. As administrators focus on cost containment, increased support should be given to infection control programs so that preventable nosocomial infections and their associated expenditures can be averted.
Risk Factors for Mortality Associated With Enterococcal Bloodstream Infections
Authors: Stroud Leonardo , Edwards Jonathan , Danzig Lisa , Culver David , Gaynes Robert 
Published: September 2009

AbstractObjective:To determine risk factors for mortality in patients with a nosocomial enterococcal primary bloodstream infection (EPBI) and to assess whether vancomycin resistance placed a patient at increased risk of death.Design/Setting:A retrospective cohort study was conducted in four National Nosocomial Infection Surveillance System hospitals.Results:Of 145 patients identified with EPBIs, 74 (51%) died, and 26 (18%) had a vancomycin-resistant isolate. Upon comparing patients with EPBIs who survived to those who died, no associations were found between mortality and prior invasive device use, procedure history, type or number of prior nosocomial infections, length of hospitalization before infection, or receipt of vancomycin. Independent predictors of mortality were indices of severity of illness (APACHE II score and comorbidity weighted index), age, the use of third-generation cephalosporins or metronidazole during the week prior to infection, and female gender.Conclusions:Vancomycin resistance was not an independent predictor of death, and its role was difficult to establish, because cohort patients were among the most severely ill of all hospitalized patients. Enterococcal primary bloodstream infections appear to indicate severe, life-threatening disease processes. The pathogenicity of enterococci and the role of vancomycin resistance as a cause of mortality in patients with EPBIs need to be assessed further.
Rapid Identification of Respiratory Viruses: Impact on Isolation Practices and Transmission Among Immunocompromised Pediatric Patients
Authors: Beekmann Susan E. , Engler Howard D. , Collins Amy S. , Canosa Jeanne , Henderson David K. , Freifeld Alison 
Published: September 2009

AbstractObjective:To determine whether empiric isolation of patients with acute respiratory virus infection symptoms could be discontinued when preliminary shell vial cultures were negative, and the impact of this approach on hospital resources.Design:In 1993, we retrospectively reviewed respiratory virus test results from 1992 to 1993 and extended data collection prospectively through the 1993 to 1994 season. The rapid test and 48-hour shell vial results were compared to a standard of rapid test plus 5-day shell vial culture results to determine the sensitivity and specificity of these “preliminary” results.Setting:A 400-bed tertiary referral research hospital.Patients:Patients from any inpatient unit or clinic with acute respiratory virus infection symptoms who had a specimen submitted for respiratory virus culture. Patients were placed on empiric respiratory isolation pending culture results.Results:The overall sensitivity of the combined rapid and 48-hour culture results in adults and children was 97%. All 15 pediatric patients with respiratory syncytial virus infection who had specimens submitted on first suspicion of respiratory virus infection were positive by rapid test. Culture results were positive within 48 hours for 100% of patients with influenza A (15 patients), influenza B (6), and parainfluenza (18) viruses. Of 59 pediatric inpatients who were isolated empirically awaiting 5-day culture results, 31 (52%) ultimately were determined to be culture negative.Conclusions:Empiric isolation of symptomatic children can be discontinued at 48 hours when both the rapid test and the early culture results are negative. Our institution would have saved 93 days of unnecessary isolation over 2 years had such a policy been in place.
An Outbreak of Viral Gastroenteritis in a Nursing Home: Importance of Excluding Ill Employees
Authors: Rodriguez Evelyn M. , Parrott Colleen , Rolka Henry , Monroe Stephan S. , Dwyer Diane M. 
Published: September 2009

AbstractBackground:In May 1994, 43 persons in a nursing home were reported with gastroenteritis. An outbreak investigation was conducted to determine risk factors for gastroenteritis among residents and staff.Methods:Data were analyzed using contingency tables; relative risks (RR) and statistical significance were determined with Fisher's Exact Test. The chi-squared statistic to perform a goodness of fit test for the binomial distribution was used to determine whether cases occurred randomly and independently of each other. Stools were tested for bacterial enteric pathogens, ova, and parasites and were examined by electron microscopy, Southern hybridization, and reverse transcription-polymerase chain reaction. Paired sera were collected to detect fourfold rises in antibody titer by enzyme immunoassay against Norwalk viruses.Results:Of 121 residents, 62 (51%) had gastroenteritis, as did 64 (47%) of the 136 staff. The index case was a nurse who became ill at work and continued to work, while symptomatic, for another 2 days. Only residents who had received medications from this nurse between May 17 and May 20 became ill on the first day of the outbreak (13 of 35 versus 0 of 5). Nurses and nurse aides were more likely than employees without direct resident contact to be cases (46 of 68 versus 18 of 58; RR, 2.18;P<.001). Bacterial stool cultures and parasite examinations were negative. Results of electron microscopy, polymerase chain reaction with Southern hybridization, and enzyme immunoassay indicated the causative agent was a small, round, structured virus similar to the Snow Mountain Agent.Conclusion:To minimize outbreaks in nursing homes, we recommend that ill staff be excluded from work until symptoms resolve.
Epidemiologic Typing Systems
Authors: Maslow Joel , Mulligan Maury Ellis 
Published: September 2009

AbstractMicrobial strain typing is a useful adjunct to clinical epidemiology. Phenotypic typing systems examine expressed characteristics, whereas genotypic systems, including recent PCR-based systems, examine chromosomal or plasmid DNA. Typing systems have evaluated bacteria, fungi, and viruses successfully. The criteria used to assess the utility of each system include typeability, reproducibility, and discriminatory power.
Prevention and Control of Nosocomial Infections in Spain: Current Problems and Future Trends
Authors: Trilla Antoni , Vaqué Josep , Roselló Jose , Salles Montserrat , Marco Francesc , Prat Andreu , Bayas Jose M. , de Anta Maria Teresa Jimenez , Asenjo Miguel A. 
Published: September 2009

AbstractSpain is a state member of the European Union, with more than 180,000 hospital beds and 800 public and private institutions. Only 6.9% of our gross national product is devoted to health expenditures. All citizens receive free health care through the National Health System. This system has given increasing attention to the prevention and control of nosocomial infections since 1986. In this article, results of serial prevalence surveys of antibiotic use and resistance patterns of microorganisms isolated from nosocomial infections are discussed. The needs for future development of infection control and quality assurance training programs in Spain also are discussed. Overall, a clinically and epidemiologically oriented approach to infection control is preferred, with greater emphasis in the role of infection control practitioners and infection control committees.
Cost-Effectiveness of Hepatitis A Vaccination in Healthcare Workers
Authors: Smith Shanon , Weber Stefan , Wiblin Todd , Nettleman Mary 
Published: September 2009

AbstractObjective:To study the cost-effectiveness of vaccination for hepatitis A.Setting:Hypothetical analysis of students currently enrolled in medical school in the United States.Method:A Markov-based model was developed using data from the literature, actual hospital costs, and an annual discount rate of 5%. The incidence rate was based on the lowest annual rate for the US population during the past decade.Results:Over the lifetimes of students currently in medical school, the model estimated that there would be 286 hepatitis A cases with four deaths and 107 lost years of life. With routine vaccination, these numbers would decrease to 17, 0.3, and 6, respectively. The costs per life-year saved and quality adjusted life-year saved were $58,000 and $47,000, respectively. Serologic screening prior to vaccination was less cost-effective than universal vaccination. If the incidence of hepatitis A was underestimated by a factor of 5, the cost per life-year saved would decrease to $5,500. If the incidence of hepatitis was underestimated by a factor of 10, vaccination would result in a net cost savings.Conclusion:We conclude that the cost per life-year saved by routine hepatitis A vaccination was similar to many other standard medical modalities. For routine vaccination of medical students to be cost-saving, the incidence rate for hepatitis A must be at least 10 times higher than the rate presently reported for the general population. Serological screening prior to vaccination was not cost-effective.
The Infection Control Practices of General Dental Practitioners
Authors: McCarthy Gillian M. , MacDonald John K. 
Published: September 2009

AbstractObjectives:To investigate the infection control practices of general dentists in Ontario in 1994.Design:Confidential coded questionnaires were mailed to all general dental practitioners in Ontario (n=5,176), with three follow-up attempts. Data were analyzed using Pearson's chi-squared test and multiple logistic regression.Setting:Offices of general dental practitioners in Ontario.Participants:General dental practitioners actively involved in treating patients.Results:The response rate adjusted for nondelivery was 70%. A high proportion of respondents reported using gloves (always, 91.8%; sometimes, 7.8%), masks (always, 74.8%; sometimes, 21.1%), or protective eyewear (always, 83.6%; sometimes, 13%); heat sterilization of hand-pieces (83.9%); and hepatitis B (HBV) vaccination of dentists (92.3%). However, only 61.4% of respondents reported HBV vaccination of all clinical staff, and 87.7% used additional precautions for patients with human immunodeficiency virus (HIV). Significant predictors of the use of recommended infection control procedures (ie, always using gloves, masks, and eye protection; heat sterilization of handpieces; HBV vaccination for dentist and staff; and no extra precautions for patients with HIV) were age ?40 years (odds ratio [OR], 2.6), lack of concern regarding increased personal risk (OR, 2.0) or costs of infection control procedures (OR, 1.5), and knowledge of the low infectivity of HIV after a needlestick injury (OR, 2.0) and that infection control procedures for HBV are adequate for HIV (OR, 2.7).Conclusion:Additional education is required to promote a more realistic perception of risk of HIV transmission in the dental office and the use of all recommended infection control practices, including Universal Precautions.
Serratia Marcescens Outbreak Associated With Extrinsic Contamination of 1% Chlorxylenol Soap
Authors: Archibald Lennox K. , Corl Ann , Shah Bhavesh , Schulte Myrna , Arduino Matthew J. , Aguero Sonia , Fisher Donna J. , Stechenberg Barbara W. , Banerjee Shailen N. , Jarvis William R. 
Published: September 2009

AbstractObjectives:To determine risk factors for Serratia marcescens infection or colonization, and to identify the source of the pathogen and factors facilitating its persistence in a neonatal intensive-care unit (NICU) during an outbreak.Design:Retrospective case-control study; review of NICU infection control policies, soap use, and hand-washing practices among healthcare workers (HCWs); and selected environmental cultures.Setting:A university-affiliated tertiary-care hospital NICU.Patients:All NICU infants with at least one positive culture for S marcescens during August 1994 to October 1995. Infants who did not develop S marcescens infection or colonization were selected randomly as controls.Results:Thirty-two patients met the case definition. On multivariate analysis, independent risk factors for S marcescens infection or colonization were having very low birth weight (<1,500 g), a patent ductus arteriosus, a mother with chorioamnionitis, or exposure to a single HCW. During January to July 1995, NICU HCWs carried their own bottles of 1% chlorxylenol soap, which often were left standing inverted in the NICU sink and work areas. Cultures of 16 (31%) of 52 samples of soap and 1 (8%) of 13 sinks yielded S marcescens. The 16 samples of soap all came from opened 4-oz bottles carried by HCWs. DNA banding patterns of case infant, HCW soap bottle, and sink isolates were identical.Conclusions:Extrinsically contaminated soap contributed to an outbreak of S marcescens infection. Very-low-birth-weight infants with multiple invasive procedures and exposures to certain HCWs were at greatest risk of S marcescens infection or colonization.
Mycobacterium tuberculosis Specimen Contamination Revisited: The Role of Laboratory Environmental Control in a Pseudo-outbreak
Authors: Segal-Maurer Sorana , Kreiswirth Barry N. , Burns Janice M. , Lavie Sol , Lim Mimi , Urban Carl , Rahal James J. 
Published: September 2009

AbstractObjective:To investigate suspected pseudo-outbreaks of Mycobacterium tuberculosis (MTB) during August 1994 and July 1995 among patients who did not have clinical findings consistent with tuberculosis.Design:Retrospective and prospective surveys of all clinical and laboratory data using standard epidemiological tools and DNA fingerprinting.Setting:A university-affiliated community hospital.Patients:Those with positive MTB cultures during periods when we noted that the number of MTB positive cultures greatly outnumbered the usual monthly average (retrospective analysis, 1994) and patients with positive MTB cultures without clinical findings consistent with tuberculosis (prospective survey, 1995).Results:Epidemiological and molecular studies revealed specimen cross-contamination in the laboratory due to a faulty exhaust hood. Improvement in laboratory ventilation and change of the implicated hood prevented further specimen contamination.Conclusions:The identification of positive MTB cultures from patients without clinical evidence of tuberculosis should be a signal to suspect laboratory contamination and implement control measures. These should include a thorough epidemiological investigation, DNA fingerprint analysis, and an environmental inspection.
True Community-Acquired Methicillin-Resistant Staphylococcus aureus Bacteremia
Authors: Akram Javed , Glatt Aaron E. 
Published: September 2009

AbstractMethicillin-resistant Staphylococcus aureus (MRSA) recently has been reported as an outpatient pathogen. We assessed this and found our institution's frequency quite low. Only 16 patients (4%) had true community-acquired MRSA bacteremia. Ten had no recorded previous hospitalization; twelve (75%) had significant underlying medical problems. Substance abuse and prior outpatient antibiotic use were not identified as major risks for community-acquired MRSA bacteremia.
Absence of Rectal Colonization With Vancomycin-Resistant Enterococci Among High-Risk Pediatric Patients
Authors: Trabulsi Adnan , Glover Anne-Marie , Reising Shirley F. , Christie Celia D. C. 
Published: September 2009

AbstractWe prospectively surveyed for rectal colonization with vancomycin-resistant Enterococcus among 93 high-risk pediatric patients who were hospitalized at least 5 (median, 20) days. Fifty-two patients (56%) had enterococcal colonization; none had active infection with Enterococcus. All enterococci were vancomycin-susceptible (minimum inhibitory concentration ≤4 μg/mL). Associated exposures included recent antibiotics (50, 96%), surgical procedures (26, 58%), and immunosuppression (15, 29%).
Requirements for Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report
Authors: Scheckler William E. , Brimhall Dennis , Buck Alfred S. , Farr Barry M. , Friedman Candace , Garibaldi Richard A. , Gross Peter A. , Harris Jo-Ann , Hierholzer Walter J. , Martone William J. , McDonald Linda L. , Solomon Steven L. 
Published: September 2009

AbstractThe scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.
Nosocomial Infections in a Rural Regional Hospital in a Developing Country: Infection Rates by Site, Service, Cost, and Infection Control Practices
Authors: Orrett Fitzroy A. , Brooks Phyllis J. , Richardson Elizabeth G. 
Published: September 2009

AbstractObjective:To assess the prevalence of nosocomial infections at a rural government hospital from 1992 to 1995.Design:Retrospective review of data from 1992 to 1995 regarding rates of nosocomial infections, cost to government, and infection control practices.Setting:653-bed rural hospital providing primary and tertiary care.Patients:Patients admitted to the hospital between 1992 and 1995 who were found with hospital-acquired infections during their stay.Interventions:None.Results:Over the 4-year period, 7,158 nosocomial infections were identified from 72,532 patients (10.0/100 admissions). High nosocomial infection rates were found on the intensive-care unit (67/100 admissions), urology (30/100 admissions), neurosurgery (29.5/100 admissions), and newborn nursery (28.4/100 admissions). Urinary tract infections (4.1/100 admissions) accounted for most nosocomial infections (42%), followed by postoperative wound infections (26.8%) with a rate of 2.6/100 admissions. Nosocomial pneumonias and bloodstream infections also were common with 13.2% and 8.0%, respectively. The highest rates occurred on the intensive-care unit for both pneumonia (26.4/100 admissions) and bloodstream infection (7.0/100 admissions). The cost to the government for nosocomial infections was estimated at US $697,000 annually (US $1=$6 Trinidad and Tobago). Poor infection control practices, inadequate handwashing facilities, lack of supplies, and nonexistent garbage cans on most wards were quite evident.Conclusions:Strict adherence to proper infection control practices, such as handwashing techniques, and improvement of facilities are crucial steps in preventing cross-infections in the hospital environment. Implementing these measures may substantially reduce the massive drain on the hospital budget in treating nosocomial infections. The saved revenue could go toward improvement of ward facilities and reduction of over-crowding, thus further reducing cross-infection.