bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Computer-Based Patient Record: The Role of the Hospital Epidemiologist
Authors: Classen David C. , Burke John P. 
Published: September 2009

AbstractDespite advances in computers and software for data analysis, hospital epidemiologists still must use manual methods for data collection. To automate infection control surveillance fully, healthcare institutions need computerized medical records; however, very few institutions currently have such a system. Healthcare institutions appreciate the need for automation, but frequently do not see a clear path to the desired outcome. In this article, we outline the important issues that hospital epidemiologists must understand if they wish to help their institutions to computerize their medical records.
Tuberculosis Surveillance Practices in Long-Term Care Institutions
Authors: Naglie Gary , McArthur Margaret , Simor Andrew , Naus Monika , Cheung Angela , McGeer Allison 
Published: September 2009

AbstractObjecitves:To identify the tuberculosis (TB) skin-testing practices of long-term care facilities for the elderly in Toronto, Ontario.Design:A telephone survey using a 25-item questionnaire.Setting:Twenty-nine nursing homes (NHs) and 26 Homes for the Aged (HFAs) in metropolitan Toronto.Results:Thirty-one percent of facilities (17 of 55) had no formal tuberculin skin-testing program, including 52% of NHs (15 of 29) versus 8% of HFAs (2 of 26; P= 0.001). Ninety-two percent of HFAs (24 of 26) compared with 45% of NHs (13 of 29), obtained preadmission or admission skin-test status of residents (P= 0.0005). Annual testing was performed at 46% of HFAs (12 of 26) and 27% of NHs (8 of 29; P= 0.28). Of facilities that carried out any skin testing, 64% of HFAs (16 of 25) versus 32% of NHs (6 of 19) measured induration to establish test positivity (P=0.068). Fifty-two percent of HFAs (13 of 25), compared with 21% of NHs (4 of 19), recorded the actual size of induration in the patient record (P=0.085). Only 28% of HFAs (7 of 25) and 21% of NHs (4 of 19) correctly defined a positive tuberculin skin test.Conclusions:TB surveillance practices in long-term care institutions in Toronto are inadequate and often yield results that do not predict the risk of infection and cannot be used to investigate outbreaks. Tuberculin skin-testing practices were better at HFAs, which are subject to provincial legislation regarding TB surveillance, than at NHs, which are not subject to this legislation. Staff at HFAs and NHs require education regarding tuberculin skin-testing policies and procedures.
Impact of a Coordinated Tuberculosis Team in an Inner-City Hospital in New York City
Authors: Fazal Barkat A. , Telzak Edward E. , Blum Steve , Pollard Cathy L. , Bar Mordechai , Ernst Jerome A. , Turett Glenn S. 
Published: September 2009

AbstractObjective:To evaluate the impact of a coordinated approach for the isolation, diagnosis, and treatment of patients with tuberculosis.Design:Retrospective cohort study.Setting:Bronx-Lebanon Hospital Center, an inner-city hospital in the South Bronx, New York City.Patients:Patients with smear-positive, culture-confirmed pulmonary tuberculosis.Interventions:Institution of a coordinated tuberculosis team.Results:Admissions of 46 patients before and 39 patients after the formation of a tuberculosis team were reviewed. Before institution of the tuberculosis team, 35% of patients were isolated within 24 hours of presentation, 41% never were isolated, and the mean number of days patients were not isolated was 19. After implementation of the tuberculosis team, 59% of patients were isolated within 24 hours, only 5% were never isolated, and the mean number of days patients were not isolated was 3.5. These differences were statistically significant. There also was a corresponding decrease in length of hospitalization. In addition, there were noticeable improvements in patient and staff morale and attitudes.Conclusions:The tuberculosis team likely has decreased the risk of nosocomial tuberculosis transmission by increasing the proportion of infectious tuberculosis patients admitted into AFB isolation and by reducing (by 780) the number of days out of isolation while smear positive. There also were concomitant financial savings.
Respiratory Protection Standard: Comments on OSHA's Proposed Revision
Authors: Decker Michael D. 
Published: September 2009

AbstractOn November 15, 1994, the Occupational Safety and Health Administration (OSHA) published in the Federal Register (59:58884-58956) the draft of a proposed revision of the Respiratory Protection Standard. One of OSHA's oldest standards, the Respiratory Protection Standard defines the conduct of the employer (eg, hospital) with respect to respirator training, fit testing, medical examinations, use, storage, and so on. The proposed revision appears to have been drafted with no consideration for its effect on healthcare workers or the healthcare industry. SHEA has prepared the following comments to OSHA, which have been submitted to the docket and will be presented at public hearings later this month.
Prospective, Randomized Study of Ventilator-Associated Pneumonia in Patients With One Versus Three Ventilator Circuit Changes Per Week
Authors: Long Martha N. , Wickstrom Glenda , Grimes Anne , Benton Carol F. , Belcher Becky , Stamm Alan M. 
Published: September 2009

AbstractObjective:To assess the effect on the rate of ventilator-associated pneumonia (VAP) of decreasing the frequency of ventilator circuit changes from three times to once per week.Design:Prospective, randomized trial.Setting:Medical intensive care unit (MICU), a 12-bed, critical-care internal medicine unit, and neurosciences intensive care unit (NICU), a 21-bed, predominantly adult neurosurgical unit, of an urban university hospital.Patients:All 447 patients requiring mechanical ventilation during October 1992 through June 1993.Intervention:Patients were allocated randomly on the basis of permanent medical record numbers: those with odd numbers had circuits changed three times per week, those with even numbers once per week. Intensive-care-unit surveillance was conducted in accordance with definitions and methods of the National Nosocomial Infections Surveillance System.Results:In the MICU, the one-change-per-week group had a VAP rate of 7.3 per 1,000 ventilator days, versus 5.9 for the three-per-week group (P=.6). In the NICU, the one-change-per-week group had a rate of 12.2 per 1,000 ventilator days, versus 12.6 for the three-per-week group (P=.9). Considering patients in both units ventilated for no more than 7 days, the one-change-per-week group had a VAP rate of 5.9 per 1,000 ventilator days, versus 9.0 per 1,000 for the three-changes-per-week group (odds ratio [OR], 0.65; 95% confidence interval [CI95], 0.25 to 1.69). Including patients in the two units maintained on mechanical ventilation for more than 7 days, the one-change-perweek group had a VAP rate of 13.2 per 1,000 ventilator days, versus 9.6 per 1,000 for the three-changes-per-week group (OR, 1.37; CI95 0.71 to 2.65).Conclusions:Decreasing the frequency of ventilator circuit changes from three times to once per week had no adverse effect on the overall rate of VAP. Less frequent ventilator circuit changes may decrease the incidence of VAP among patients ventilated for no more than 1 week. However, the incidence of VAP may be higher among patients with once weekly circuit changes ventilated for more than 1 week.
Development of Mupirocin Resistance Among Methicillin-Resistant Staphylococcus aureus After Widespread Use of Nasal Mupirocin Ointment
Authors: Miller Mark A. , Dascal Andre , Portnoy Joseph , Mendelson Jack 
Published: September 2009

AbstractAll methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from colonized or infected patients in a 625-bed public teaching hospital during an epidemic, and for 3 years thereafter, underwent susceptibility testing to mupirocin. Mupirocin resistance among MRSA increased markedly over this period (1990, 2.7%; 1991, 8.0%; 1992, 61.5%; 1993, 65%) in association with increased use of mupirocin ointment as an adjunct to infection control measures.
Clostridium difficile Contamination of Blood Pressure Cuffs: A Call for a Closer Look at Gloving Practices in the Era of Universal Precautions
Authors: Manian Farrin A. , Meyer Lynn , Jenne Joan 
Published: September 2009

AbstractWe report an outbreak of Clostridium difficile-associated diarrhea at our medical center following adoption of Universal Precautions. Environmental cultures revealed unexpected contamination of blood pressure cuffs at a rate similar to that for bedside commodes (10% and 11.5%, respectively). An obser vational sur vey revealed that healthcare workers in the patient care areas not infrequently failed to remove their potentially stool-contaminated gloves prior to touching clean surfaces, which might have contributed to contamination of blood pressure cuffs.
Mathematical Models in Decision Analysis
Authors: Tom Eric , Schulman Kevin A. 
Published: September 2009

AbstractDecision analysis offers powerful techniques to understand and evaluate uncertain clinical situations better. Decision analytic models are appearing with increasing frequency in health policy planning, clinical information and decision-support computer systems, evaluations of clinical pathways, development of clinical practice or utilization review guidelines, and epidemiologic research. This article describes the structure, application, and limitations of the more popular decision analytic methods, including decision trees, Markov models, Monte Carlo simulation, survival and hazard functions, fuzzy logic, and sensitivity analysis. Understanding the nature of these methods will help readers to assess better the appropriateness of their use in published reports.
The Effect of High-Efficiency Particulate Air Respirator Design on Occupational Health: A Pilot Study Balancing Risks in the Real World
Authors: Eck Enid K. , Vannier Ann 
Published: September 2009

AbstractObjectives:To quantify specific factors believed to increase healthcare worker (HCW) risk for contaminated sharps injuries (eg, visibility, communication, and range of motion); to quantify the degree to which respirators of various designs impacted those same factors; and to assess HCW opinions about the suitability of selected respirators with respect to patient care and user compliance criteria.Design:Sharps injury data from seven hospitals were analyzed to determine the potential contribution of visibility, communication, and range of motion to reported injuries. Healthcare workers representing various clinical specialties and physical characteristics were examined at baseline and while wearing five different respirators to quantify the impact of respirator design on visibility, communication, and range of motion. Healthcare workers were inter viewed and completed a survey assessing each respirator.Setting:Hospital and ambulatory-care settings.Participants:Population-based and convenience sample.Results:Communication, visibility, and range of motion were found to affect contaminated sharps injuries significantly. Selected high-efficiency particulate air (HEPA) respirators were found to have a negative impact on each of these variables. Healthcare workers involved in the study also reported compliance criteria problems with selected HEPA respirators, which may effect implementation of respiratory precautions adversely.Conclusion:Current HEPA respirators, because of their design, potentially increase the risk of bloodborne pathogen exposure through sharps injuries. We conclude that mandating respirators without regard to the potential impact of their design to the sharps injuries may be counterproductive to HCW safety, because they may increase, rather than decrease, overall occupational risk to HCWs.
High Frequency of Pseudobacteremia at a University Hospital
Authors: Little J. Russell , Trovillion Ellen , Fraser Victoria 
Published: September 2009

AbstractA prospective survey of all positive blood cultures was performed during a 6-month period at a 390-bed, tertiary-care teaching hospital in St Louis, Missouri. Data were collected from the clinical microbiology laboratory, medical records, and physicians caring for patients with positive blood cultures. Of 5,732 blood cultures, 261 (4.6%) were positive, and approximately half of these (51.3%) were categorized as false positive. Positive cultures were significantly more likely to be true positives if obtained from patients with malignancies or if they became positive within the first 48 hours of incubation.
Impact of Changes in Catheter Management on Infectious Complications Among Children With Central Venous Catheters
Authors: Lange Beverly J. , Weiman Marjorie , Feuer Eric J. , Jakobowski Diane , Bilodeau Julia , Stallings Virginia A. , Hirschl Ronald , Bell Louis M. , Harper James , Cnaan Avital 
Published: September 2009

AbstractObjectives:To characterize and enumerate central venous catheter (CVC)-related complications among children with chronic illnesses, and to reduce the complication rate through changes in CVC management and education.Design:A prospective obser vational study followed by an educational program and a nonrandomized inter ventional trial.Setting:The Children's Hospital of Philadelphia, a tertiary, pediatric facility.Patients:268 children with Broviac, Hickman, or Infusaport catheters in place during 58,290 catheter days.Interventions:Development and implementation of protocols for cleaning insertion site and hub, use of nonocclusive dressings, and manipulation of access; formal staff and parental education about protocols.Results:CVC-related infections fell from 4.58/1,000 catheter-days preinter vention to 3.83 postintervention (risk ratio [RR], 0.20; 95% confidence interval [CI95], 0.89-1.622; P=.25); exit-site infections fell from 0.58 to 0.11 (CI95, 1.22-45.64; P=.02); rates among infants on the surgical service fell from 15.46 to 6.67 (RR, 2.31; CI95, 1.10-4.30; P=.02).Conclusions:Education and changes in management protocols reduced the incidence of exit-site infections among all patients and reduced the overall infectious complication rate among the infants receiving parenteral nutrition on the surgical ser vice. Other interventions are needed to decrease further the infectious complications in these children
The Cost of Selected Tuberculosis Control Measures at Hospitals with a History of Mycobacterium Tuberculosis Outbreaks
Authors: Kellerman Scott , Tokars Jerome I. , Jarvis William R. 
Published: September 2009

AbstractObjective:To determine the cost of nonrespirator-related tuberculosis (TB) control measures at several hospitals, following publication of the Centers for Disease Control and Prevention (CDC)'s revised TB infection control guidelines.Design:Infection control (IC) and TB coordinators obtained cost information on tuberculin skin-test (TST) programs, addition of IC and employee health service (EHS) personnel, and the retrofit or new construction of environmental controls.Setting:Four hospitals with, and one community hospital without, prior nosocomial multidrug-resistant TB transmission.Results:During the study period, the TST program costs remained constant at four of five hospitals and increased at one hospital (median 1994 TST program cost: $5,568; range, $2,393-$44,902). Additional IC or EHS personnel were hired at four of five hospitals (median cost increase, $125,500; range, $63,000-$228,000). The median cost of new construction or new equipment purchases (ie, sputum induction booths, ultraviolet lights, or portable high-efficiency particulate air filters) at study hospitals was $163,000 (range, $45,000-$524,000) and $70,000 (range, $31,000-$93,000), respectively.Conclusions:Costs associated with implementing control measures similar to those recommended in the CDC TB IC guidelines varied widely by hospital. Engineering controls involved the largest capital outlay, but increases in personnel were the largest continuing cost. These costs represent improvements made to upgrade selected aspects of hospital TB control programs, not the cost of an optimal TB control program.
Effect of Treatment on Contagiousness of Patients With Active Pulmonary Tuberculosis
Authors: Menzies Dick 
Published: September 2009

AbstractIn view of the important consequences with regard to policies for respiratory isolation of hospitalized patients with active tuberculosis, the duration of contagiousness after initiation of effective therapy was reviewed. All relevant English-language literature was reviewed to identify in vitro, animal experimental, and epidemiological evidence regarding contagiousness of patients with active tuberculosis after initiation of therapy.Based on in vitro evidence of numbers of tubercle bacilli initially present and rapidity of reduction with therapy, it can be predicted that patients whose respiratory secretions are initially smear-negative but culture-positive should no longer have viable bacilli detectable by culture within 2 weeks. Based on the same evidence, it can be predicted that, after 2 weeks of therapy, almost all smear-positive patients will remain culture-positive, and more than one half will remain smear-positive. There are few epidemiological studies of this issue, most of which have had major methodological weaknesses. None of the results from these studies can be considered relevant to the hospital environment, where the majority of workers are uninfected and patients are potentially immunocompromised.Animal and in vitro evidence suggest that patients with active tuberculosis remain contagious at least 2 weeks after the initiation of therapy. Patients with smear-positive disease are likely to be contagious much longer. There is no relevant and valid epidemiological evidence regarding this issue.
Outbreak Among HIV-Infected Patients of Staphylococcus aureus Resistant to Cotrimoxazole and Methicillin
Authors: Alonso Roberto , Padilla Belen , Sánchez-Carrillo Carlos , Muñoz Patricia , Rodríguez-Creixems Marta , Bouza Emilio 
Published: September 2009

AbstractObjective:To describe an outbreak of trimethoprim-sulfamethoxazole (cotrimoxazole)–resistant and methicillin-resistant Staphylococcus aureus (CMRSA) in a unit housing patients infected with the human immunodeficiency virus (HIV).Design:Prospective study involving patients colonized or infected with CMRSA.Patients:15 hospitalized patients with cultures positive for CMRSA.Methods:Isolates of CMRSA were collected and characterized. Molecular typing of the epidemic strains was carried out after total DNA extraction by restriction endonuclease analysis and random amplification of polymorphic DNA.Results:The epidemic was brought under control with the reinforcement of nosocomial transmission measures and with systematic nasal decontamination with mupirocin of all patients admitted to the HIV unit. Molecular typing techniques showed the existence of two epidemic strains: strain A was present in the 12 patients admitted to the HIV unit and strain B in the remaining 3 patients hospitalized elsewhere.Conclusions:Cotrimoxazole may no longer be a reliable and effective alternative for glycopeptides in patients with infection caused by MRSA strains, and HIV units should be particularly alert for CMRSA strains.
Nosocomial Legionellosis Traced to a Contaminated Ice Machine
Authors: Graman Paul S. , Quinlan Gail A. , Rank June A. 
Published: September 2009

AbstractObjective:To investigate a case of nosocomial legionellosis, identify pathways of transmission, and effect control of the environmental source.Design:Case investigation and environmental culture surveillance.Setting:A 720-bed university teaching hospital.Case Patient:A ventilator-dependent 66-year-old male developed nosocomial pneumonia due to Legionella pneumophila serogroup 6 after 3 months in an intensive-care unit (ICU). The patient had no intake of potable water except for ice chips from an ice machine in the ICU.Results:Cultures revealed L pneumophila serogroup 6 in the ice (4.3 colony-forming units/mL) and ice machine cold water (too numerous to count). Cultures from adjacent hot and cold taps, plus taps located near the patient, all were negative; ice machines and cold water on seven other patient units also were negative. Only sterile water had been used for tube feedings, mouth care, suctioning, and ventilator humidification. Hospital hot water previously had been colonized with L pneumophila serogroup 6, but all surveillance water cultures had been negative since chlorination of the hot-water system began the previous year; cold-water cultures had never before grown Legionella.The ice machine was disinfected with a 2-hour flush of 2.625% sodium hypochlorite. The supply line to the ice machine was replaced, and the cold-water pipe from the floor below was treated with 83 ppm sodium hypochlorite for 48 hours. All follow-up surveillance cultures of the ice machine remained negative through mid-1996. No additional cases of nosocomial legionellosis occurred.Conclusions:Ice machines may be reservoirs of L pneumophila in hospitals. Both ice and water dispensed from these machines may be contaminated, and nosocomial transmission may occur. Successful long-term decontamination and control can be accomplished with shock chlorination.
The Epidemiology of Hemorrhage Related to Cardiothoracic Operations
Authors: Herwaldt Loreen A. , Swartzendruber Sheri K. , Edmond Michael B. , Embrey Richard P. , Wilkerson Kim R. , Wenzel Richard P. , Perl Trish M. 
Published: September 2009

AbstractObjective:To define the epidemiology, risk factors, and unadjusted cost of hemorrhages related to cardiothoracic operations.Study Design:We conducted two case-control studies to evaluate the risk of hemorrhage following cardiothoracic operations. The definition of hemorrhage required one of the following: reoperation for bleeding, postoperative loss of greater than 800 mL of blood over 4 hours, or surgeon-diagnosed excessive intraoperative bleeding.Setting:The cardiothoracic surgery service of a university hospital.Results:Of 511 patients undergoing cardiothoracic operations, 93 (18%) met the definition of hemorrhage. In the first case-control study, 3 (14%) of 21 cases and 0 of 42 controls died (odds ratio [OR], 15.0; 95% confidence interval [CI95], 1.18-191.55). Compared with controls, cases received significantly more packed red blood cells intraoperatively (OR, 1.18/100 mL; CI95, 1.01-1.38), and significantly more platelets (OR, 3.26/100 mL; CI95, 1.47-7.26) and fresh frozen plasma (OR, 1.73/100 mL; CI95, 1.05-.84) in the intensive-care unit. Cases were more likely than controls to receive protamine postoperatively (OR, 3.74; CI95, 1.27-11.02). Previous sternotomy, preoperative aspirin or heparin, and preoperative laboratory values did not predict bleeding. The median unadjusted hospital cost was $3,458 higher for patients who suffered hemorrhage than for controls.To decrease costs, hetastarch (acquisition cost $45/500 mL) was substituted for albumin (acquisition cost $76/100 mL) in the pump priming solution (estimated possible cost savings, $7,000-$53,000/year). Because hemorrhage rates increased subsequently, we conducted a second case-control study that identified patient age (P=.02) and use of greater than 5 mL/kg of hetastarch (OR, 1.82) as risk factors for hemorrhage. The cost of treating hemorrhages exceeded all estimates of possible cost savings ($7,000-$53,000 per year).Conclusions:Our definition of hemorrhage identified patients who required increased volumes of blood products and who had an increased crude mortality rate and a higher unadjusted cost of hospitalization. Patient age and hetastarch use were risk factors for hemorrhage. Efforts to save money by substituting less expensive products inadvertently may increase costs by increasing the probability of perioperative adverse events.