bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Clinical Experience Affect Medical Students' Knowledge, Attitudes, and Compliance With Universal Precautions?
Authors: Jeffe Donna B. , Mutha Sunita , Kim Lynn E. , Evanoff Bradley A. , L'Ecuyer Paul B. , Fraser Victoria J. 
Published: September 2009

AbstractObjective:To investigate differences in second-, third-, and fourth-year medical students' knowledge of bloodborne pathogen exposure risks, as well as their attitudes toward, and intentions to comply with, Universal Precautions (UP).Design:Cross-sectional survey.Participants And Setting:Surveys about students' knowledge, attitudes, and intentions to comply with UP were completed by 111 second-year (preclinical), 80 third-year, and 60 fourth-year medical students at Washington University School of Medicine in the spring of 1996.Results:Preclinical students knew more than clinical students about the efficacy of hepatitis B vaccine, use of antiretroviral therapy after occupational exposure to human immunodeficiency virus, and nonvaccinated healthcare workers' risk of infection from needlestick injuries (P<.001). Students' perceived risk of occupational exposure to bloodborne pathogens and attitudes toward hepatitis B vaccine did not differ, but preclinical students agreed more strongly that they should double glove for all invasive procedures with sharps (P<.001). Clinical students agreed more strongly with reporting only high-risk needlestick injuries (P = .057) and with rationalizations against using UP (P = .008). Preclinical students more frequently reported contemplating or preparing to comply with double gloving, wearing protective eyewear, reporting all exposures, and safely disposing of sharps, whereas students with clinical experience were more likely to report compliance. Clinical students also were more likely to report having “no plans” to practice the first three of these precautions (P<.001).Conclusions:Differences in knowledge, attitudes, and intentions to comply with UP between students with and without clinical experience may have important implications for the timing and content of interventions designed to improve compliance with UP.
Clinical Effectiveness of Low-Temperature Sterilization Technologies
Authors: Rutala William A. , Weber David J. 
Published: September 2009

AbstractThe elimination of chlorofluorocarbons by the Clean Air Act has led to the development of alternative technologies for low-temperature sterilization in the healthcare setting, including 100% ethylene oxide, ethylene oxide with other stabilizing gases, immersion in peracetic acid, and gas plasmas. The ideal sterilant does not exist, and infection control professionals should understand the advantages and disadvantages of these processes. However, when combined with adherence to standard cleaning protocols, the available data suggest that the currently available Food and Drug Administration-cleared low-temperature sterilization technologies can inactivate a clinically relevant inoculum of highly resistant organisms
Risk Factors for Death in Patients With Candidemia
Authors: Nucci Marcio , Colombo Arnaldo L. , Silveira Fernanda , Richtmann Rosana , Salomão Reinaldo , Branchini Maria Luiza , Spector Nelson 
Published: September 2009

AbstractObjective:To analyze possible risk factors for death among patients with nosocomial candidemia. To identify risk factors for death in patients with candidemia, we analyzed demographic, clinical, and microbiological data.Setting:Six tertiary hospitals in Brazil.Patients:A cohort of 145 patients with candidemia.Design:26 possible risk factors for death, including age, underlying disease, signs of deep-seated infection, neutropenia, number of positive blood cultures, removal of a central venous catheter, etiologic agent of the candidemia, susceptibility pattern of the isolate to amphotericin B, and antifungal treatment were evaluated by univariate stepwise logistic regression analysis.Results:Non-albicans species accounted for 63.4% of the candidemias. Risk factors for death in univariate analysis were older age, catheter retention, poor performance status, candidemia due to species other than Candida parapsilosis, hypotension, candidemia due to species other than Candida parapsilosis, and no antifungal treatment. In multivariate analysis, older age and non-removal of a central venous catheter were the only factors associated with an increased risk for death.Conclusions:These data suggest that patients with candidemia and a central venous catheter should have the catheter removed.
Streptococcus pneumoniae Transmission in Chronic-Care Facilities: Description of an Outbreak and Review of Management Strategies
Authors: Sheppard Donald C. , Bartlett Kathleen A. , Lampiris Harry W. 
Published: September 2009

AbstractWe report an outbreak of invasive Streptococcus pneumoniae disease in a chronic-care facility with a documented immunization rate of only 2.5%. We describe and discuss the infection control strategies used in prevention and management of such outbreaks, highlighting the role of immunization and presumptive chemotherapy.
An Outbreak of Bacillus Species in a Cancer Hospital
Authors: Thuler Luiz Claudio Santos , Velasco Eduardo , Martins Carlos Alberto de Souza , de Faria Lúcia Maria Dias , da Fonseca Nereida Proença , Dias Leda Maria de Castro , Gonçalves Vania Maria da Silva e Castro 
Published: September 2009

AbstractBacillus species were recovered from the blood cultures of 39 oncology patients over 14 weeks. A matched case-control study showed a strong association of Bacillus species bacteremia with use of calcium gluconate solution (odds ratio=25.0) and of central venous lines (odds ratio=8.8). Stopping use of the implicated calcium gluconate vials controlled the outbreak.
Caveats Regarding the Use of Control Charts
Authors: Humble Charles 
Published: September 2009

AbstractControl charts are essential tools in the statistical process control armamentarium. Although designed for ease of use in highly structured production settings, they are in fact quite complex in nature; their proper use depends on numerous conditions that may not be clear to newer users. This article briefly contrasts the use of control charts in production and healthcare settings and highlights common sources of problems among novice users. These include misunderstandings of the type of data being charted, non-independence of samples, the influence of natural cycles, ignoring known special influences, overlooking clear signals that a process is out of control, and calculating control limits before adequate data are available.
Low Risk for Tuberculosis in a Regional Pediatric Hospital: Nine-Year Study of Community Rates and the Mandatory Employee Tuberculin Skin-Test Program
Authors: Christie Celia D.C. , Constantinou Panayiota , Marx Mary L. , Willke Mary Jane , Marot Kathleen , Mendez Fernando L. , Donovan James , Thole Julia 
Published: September 2009

AbstractObjective:To assess the risk of Mycobacterium tuberculosis infection and disease among patients and workers in a regional pediatric hospital.Design:Descriptive epidemiological study of the mandatory tuberculin skin testing program of hospital employees at hire and during annual reevaluation, pediatric patients with tuberculosis (TB), efficacy of hospital infection control measures, and community rates of TB.Setting:361-bed, university, pediatric hospital serving Cincinnati (1.7 million population).Results:During 1986 through 1994, 2,275 to 4,356 employees were compliant with Mantoux skin testing and screening each year. This represented >97% of the population who were eligible for screening. The cumulative rate of M tuberculosis infection from a previous positive tuberculin skin test was 10% to 12% per year during 1986 through 1994. Among new Mantoux skin-test converters in employees at annual reevaluation, the risk of TB infection was 0.3% in 1993 and 1994. There were no active cases of TB identified during new employee screening or annual reevaluation. Of 62 new Mantoux skin-test converters in 9 years, 23% were foreign-born, 13% were Asian, 23% were African American, 11% received the bacillus of Calmette-Guerin vaccine, and 60% had direct patient care or indirect patient contact. A cluster of five converters occurred in a department with no patient care or contact. Mantoux conversion rates were 1.9 per 1,000 employee patient-care or contact-years and 2.2 per 1,000 employee non-patient-contact years. Twenty pediatric patients with active TB were identified during 1991 to 1994, with ≤6 cases per year, placing this hospital in the low-risk category for M tuberculosis disease. Three children with pulmonary TB were admitted without immediate respiratory isolation, possibly exposing 9 patients and 42 employees; none converted their Mantoux skin tests on retesting. Rates of active TB in Cincinnati were stable during the period (eg, 8/100,000 population in 1994).Conclusions:Despite intense active surveillance among thousands of hospital employees with >97% annual compliance, tuberculin conversion rates were low, and no cases of active TB were identified during 9 years of follow-up. There was no evidence of transmission of M tuberculosis from infected patients to employees during uncontrolled exposures. Rates of TB in the community were low. These data suggest that rigorous application of the Centers for Disease Control and Prevention guidelines and Occupation Safety and Health Administration regulations for preventing nosocomial TB in pediatric hospitals may be excessive and costly. Special provisions should be made for pediatric hospitals with a proven low risk of transmission of M tuberculosis
Risk Factors Associated With the Acquisition of Amikacin-Resistant Gram-Negative Bacilli in Central New Jersey Hospitals
Authors: Jessop Amy B , John Joseph F. , Paul Sindy M. 
Published: September 2009

AbstractA case-control study was performed in central New Jersey hospitals to evaluate the potential patient factors associated with the acquisition of amikacin-resistant gram-negative bacilli (ARGNB).Univariate analysis revealed an association between numerous patient factors, and multivariate analysis revealed four factors to be associated independently with ARGNB: the number of hospital admissions during the prior year, previous aminoglycoside exposure, intubation, and intensive–care–unit admission
In Support of Bacillus of Calmette and Guérin for Healthcare Workers
Authors: Jenney Adam W.J. , Spelman Denis W. 
Published: September 2009

AbstractAlthough widely used outside the United States, bacillus of Calmette and Guerin (BCG) immunization generally is given scant consideration in the US literature. We believe that the recent resurgence of tuberculosis, including multidrug-resistant tuberculosis, is a compelling argument for the use of BCG in healthcare workers and that BCG given to those at risk of exposure could be more effective than routine tuberculin skin testing and isoniazid prophylaxis.
Use of Antibiotic Exposure to Detect Postoperative Infections
Authors: Yokoe Deborah S. , Shapiro Mervyn , Simchen Elisheva , Platt Richard 
Published: September 2009

ABSTRACTOBJECTIVE: To assess the utility of postoperative antibiotic exposure as an indicator of postoperative infection after coronary artery bypass graft surgery.DESIGN: We determined an optimal antibiotic exposure threshold by creating receiver operating characteristic curves.SETTING: Tertiary healthcare institution (United States); national sample (Israel).PATIENTS: 5,887 patients undergoing coronary artery bypass graft surgery.RESULTS: Postoperative antibiotic exposure with at least 9 days between the first and last dates of antibiotic administration, excluding the first postoperative day, had a sensitivity of 95% (261/276) and specificity of 85% (3,944/4,628) for identifying surgical-site infection, using as a gold standard surgical-site infections identified by conventional prospective surveillance or extrapolated from review of a sample of medical records. In contrast, using the same gold standard for surgical-site infections, the sensitivity of routine prospective surveillance alone was only 60%. The predictive value positive of the defined antibiotic exposure was 28% (261/945) for surgical-site infection and 60% (563/945) for any nosocomial infection. In the Israeli cohort, the sensitivity was 87% (74/85) and the specificity was 82% (735/898).CONCLUSION: Antibiotic exposure of sufficient duration and timing was more sensitive than conventional methods in detecting nosocomial infection and required substantially less effort to collect. Although the predictive value positive for surgical-site infection was only moderate, the majority of individuals identified this way had a nosocomial infection
Stability and Bactericidal Activity of Chlorine Solutions
Authors: Rutala William A. , Cole Eugene C. , Thomann Charlotte A. , Weber David J. 
Published: September 2009

ABSTRACTOBJECTIVES: To determine the stability of sodium hypochlorite (diluted household bleach) when stored for 30 days in various types of containers and to determine the efficacy of low concentrations of free available chlorine to inactivate test bacteria.DESIGN: Laboratory-based study. Solutions of standard household bleach were prepared using tap water or sterile distilled water at dilutions of 1:100, 1:50, and 1:5. Chlorine concentrations were measured, and then the solutions were placed into five polyethylene containers and left at room temperature (20°C) under various conditions (translucent containers with light exposure and with or without air; brown opaque container without light or air exposure). Samples for chlorine and pH determinations were taken at time 0 and on days 7, 14, 21, 30, and 40. Bactericidal activity of chlorine solutions was assessed using the Association of Official Analytical Chemists Use-Dilution Method. Test bacteria included Pseudomonas aeruginosa, Staphylococcus aureus, and Salmonella choleraesuis.RESULTS: Chlorine concentrations at 30 days varied from the 40% to 50% range for 1:50 or 1:100 dilutions stored in containers other than closed brown containers to 83% to 85% for the 1:5 dilution stored in closed but non-opaque containers to 97% to 100% for 1:50 or 1:5 solutions stored in closed brown containers. The lowest concentration of sodium hypochlorite solution that reliably inactivated all the test organisms was 100 ppm.CONCLUSIONS: These data suggest that chlorine solutions do not need to be prepared fresh daily, as is recommended currently, and the lowest concentration of chlorine that reliably inactivates S aureus, S choleraesuis, and P aeruginosa is 100 ppm
Reduction in Vancomycin-Resistant Enterococcus and Clostridium Difficile Infections Following Change to Tympanic Thermometers
Authors: Brooks Steven , Khan Ashraf , Stoica Dorin , Griffith Jennylyn , Friedeman Les , Mukherji Rajat , Hameed Rizwanullah , Schupf Nicole 
Published: September 2009

ABSTRACTOBJECTIVE: To contain a nosocomial outbreak of vancomycin-resistant Enterococcus (VRE).DESIGN: Intervention study, with comparison of incidence rates before and after intervention to assess whether changes in incidence followed the intervention and were greater than expected based on trends observed before the intervention.SETTING: A 343-bed acute-care hospital serving a predominantly elderly population referred from nursing homes, as well as patients admitted from the community.METHODS: Interventions strategies were tested on three high-risk nursing stations. These included enhanced environmental sanitation; intensive staff retraining in Universal Precautions, body substance isolation, and proper use of gloves; and the use of tympanic thermometers to avoid possible rectal or oral VRE transmission during temperature taking.RESULTS: Nosocomial VRE infections were reduced by 48% 9 months after switching to tympanic thermometers; incidence of Clostridium difficile infections also was reduced. As a result, tympanic thermometers were introduced facilitywide; additional observation for 20 months showed a risk reduction of 60% for VRE and 40% for C difficile.CONCLUSION: Cross-transmission of VRE and C difficile during temperature taking may result in bowel colonization, placing the patient at increased risk for infection. This risk may be reduced by the use of tympanic thermometers
Nursing Home Infection Control: A Status Report
Authors: Smith Philip W. 
Published: September 2009

ABSTRACTInfection control in the long-term–care facility has expanded substantially since “Topics in Long-Term Care” debuted in this journal in 1989. This section has been on hiatus, but now, after a 4-year lag, resumes its exploration of these topics.In the first article, endemic and epidemic infections in long-term care are discussed and compared to nosocomial infections in the hospital. The basic elements of an infection control program in this setting, as well as the recent advances in the field, are reviewed
Frequency of Percutaneous Injuries Requiring Postexposure Prophylaxis for Occupational Exposure to Human Immunodeficiency Virus
Authors: Sistrom Maria Gilson , Coyner Betty Joe , Gwaltney Jack M. , Farr Barry M. 
Published: September 2009

AbstractNew recommendations regarding prophylaxis of healthcare workers exposed to human immunodeficiency virus (HIV) prompted us to examine the frequency and nature of percutaneous injuries at this hospital. Four previously defined risk factors for transmission of HIV were evaluated. Between 1993 and 1995, 1,070 percutaneous injuries were reported, including 11 in which the source patient had acquired immunodeficiency syndrome (AIDS). Five of these injuries involved at least one risk factor for transmission. No source patient was found to have AIDS as a result of testing following exposure. We conclude that high-risk injuries are infrequent and that postexposure prophylaxis will not increase costs greatly at this medical center.
High Rates of Discitis Following Surgery for Prolapsed Intervertebral Discs at a Hospital in Pakistan
Authors: Siddiqui Amna R. , Luby Stephen P. 
Published: September 2009

AbstractOBJECTIVES:To confirm the presence of an outbreak of postoperative infections following laminectomy and to determine the infection rate after interventions were instituted.DESIGN:Retrospective cohort study. Medical records were reviewed, personnel interviewed, and premises examined.SETTING:Surgical unit of hospital A in Pakistan.SUBJECTS:Patients who had surgical laminectomy between January 1993 and July 1994.INTERVENTION:Instructive program for nursing and medical staff in December 1993.RESULTS:From January to December 1993, 6 (15%) of 41 laminectomy patients developed postoperative discitis. The risk of discitis varied significantly by surgeon (P=.016); patients who had one particular surgeon, surgeon A, were nine times more likely to develop postoperative infections than patients who did not have surgeon A. Patients were not consistently cleaned or shaved before coming to the operating room, and personnel moved back and forth between the operation theater and other parts of the hospital without changing their gowns or slippers. After the instructional intervention, between January and July 1994, 2 (6%) of 31 laminectomy patients developed postoperative discitis, a rate not significantly lower than in the preceding 12 months (P=.45). Overall, from January 1993 through July 1994, female patients were more likely to develop discitis than males (31% vs 7%; relative risk, 4.4; 95% confidence interval, 1.3-15.6; P<.032).CONCLUSION:Endemic conditions require that laminectomy at hospital A be limited to those situations where the benefits of the surgery exceed the considerable risk of postoperative discitis.
The Costs of Healthcare Worker Respiratory Protection and Fit-Testing Programs
Authors: Kellerman Scott E. , Tokars Jerome I. , Jarvis William R. 
Published: September 2009

AbstractObjective:We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB).Design:The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study.Setting:Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB.Results:During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526).Conclusions:Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB
Failure to Eradicate Vancomycin-Resistant Enterococci in a University Hospital and the Cost of Barrier Precautions
Authors: Lai Kwan Kew , Kelley Anita L. , Melvin Zita S. , Belliveau Paul P. , Fontecchio Sally A. 
Published: September 2009

AbstractObjective:To describe the effect of infection control interventions on the incidence of vancomycin-resistant enterococci (VRE), the utility of pharyngeal cultures for surveillance for VRE colonization, and the cost of barrier precautions.Design:Evaluation of the occurrence of VRE infection or colonization, rates of vancomycin use, results of surveillance cultures before and after interventions, and the cost of increased barrier precautions.Setting:University of Massachusetts Medical Center, a 347-bed tertiary-care teaching hospital with eight intensive-care units, one burn unit, and one bone marrow transplant unit.Participants:Patients in the intensive-care units and staff who were involved with patients colonized or infected with VRE.Methods:Infection control interventions included placement of patients with VRE in private rooms, strict contact isolation, cohorting of patient and nursing staff, prohibiting of equipment sharing, and monitoring of compliance with the vancomycin restriction policy, with hand washing, and of the adequacy of environmental cleaning. Both rectal and pharyngeal cultures were obtained from patients at the beginning of the outbreak, and the utility of pharyngeal cultures was evaluated. The cost of barrier precautions was estimated by comparing the cost of glove and gown use before and after the outbreak began.Results:The interventions decreased the number of new cases of VRE, but total eradication of VRE was not achieved. Compliance with the room-cleaning protocol was 91% (141/155 observations). Hand washing following interaction with patients who were not in isolation was 51%, vs 100% for patients in isolation. Overall, handwashing compliance was 71% (319/449): 56% (130/231) for physicians and 86% (187/218) for nurses (P<.0001). The mean number of doses of vancomycin dispensed per 1,000 patient days decreased from 145 to 114 per 1,000 patient days (P<.001). Compliance with vancomycin-use guidelines was 85%. Forty-six (77%) of 60 surveillance rectal swabs yielded enterococci, as compared to only 4 (11%) of 36 pharyngeal cultures (P<.0001). Expenses on glove and gowns alone increased by over $11,000 per year since the epidemic began.Conclusions:Implementation of the various infection control measures did not eradicate VRE cases from the hospital. Rectal cultures were more useful than pharyngeal cultures for surveillance of VRE. Controlling VRE epidemics can be costly.