bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recommendations for Preventing the Spread of Vancomycin Resistance
Authors:   Hospital Infection Control Practices Advisory Committee (HICPAC)
Published: September 2009

SummaryA rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (WE) has been reported from U.S. hospitals in the last 5 years. This increase poses several problems, including: a) the lack of available antimicrobials for therapy of infections due to VRE, since most VRE are also resistant to multiple other drugs, e.g., aminoglycosides and ampicillin, previously used for the treatment of infections due to these organisms, and b) the possibility that the vancomycin resistance genes present in VRE may be transferred to other gram-positive microorganisms such as Staphylococcus aureus.An increased risk of VRE infection and colonization has been associated with previous vancomycin and/or multi-antimicrobial therapy, severe underlying disease or immuno-suppression, and intra-abdominal surgery. Because enterococci can be found in the normal gastrointestinal or female genital tract, most enterococcal infections have been attributed to endogenous sources within the individual patient. However, recent reports of outbreaks and endemic infections due to enterococci, including VRE, have shown that patient-to-patient transmission of the microorganisms can occur either via direct contact or indirectly via hands of personnel or contaminated patientcare equipment or environmental surfaces.Prevention and control of the spread of vancomycin resistance will require coordinated, concerted effort from various departments of the hospital, and can only be achieved if each of the following elements is addressed: 1) prudent vancomycin use by clinicians, 2) education of hospital staff regarding the problem of vancomycin resistance, 3) early detection and prompt reporting of van-comycin resistance in enterococci and other gram-positive microorganisms by the hospital microbiology laboratory, and 4) immediate implementation of appropriate infection-control measures to prevent person-to-person transmission of VRE.
Occupational Risk of Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infections Among Funeral Service Practitioners in Maryland
Authors: Gershon Robyn R. M. , Vlahov David , Farzadegan Homayoon , Alter Miriam J. 
Published: September 2009

AbstractObjective:To estimate the risk of exposure and infection with bloodborne pathogens, a seroepidemiologic survey was conducted among funeral service practitioners (FSPs) in Maryland.Method:Of 262 members of the Maryland State Funeral Directors Association, 130 (49%) volunteered to participate in the study. In addition to a brief questionnaire, designed to assess both occupational and non-occupational risk factors for bloodborne pathogen infection, participants were screened for markers of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and past hepatitis B virus (HBV). Titers for antibodies to hepatitis B surface antigen (anti-HBs) also were examined and compared with history of hepatitis B vaccination.Results:Seroprevalence for HIV, HBV, and HCV infection was 0.8%, 4.6%, and 0%, respectively. Nearly 19% of participants reported at least one bloodborne exposure in the past 6 months. The one HIV infection and all but two of the HBV infections were correlated with well-established non-occupational risk behaviors. Disposable gloves were worn by 96%, and eating, drinking, or smoking during embalming were infrequent. Sixty-one percent of FSPs reported having received one or more doses of hepatitis B vaccine at some time in the past. Of those who reported having received all three doses of vaccine, 67% had adequate titers to hepatitis B surface antibody, the marker of protection related to vaccination.Conclusion:Compared with prior studies of FSPs, this study found a low rate of occupational exposures and a high rate of hepatitis B vaccination, suggesting improved compliance with recommendations for preventing transmission of bloodborne pathogens in the workplace.
An Outbreak of Handscrubbing-Related Surgical Site Infections in Vascular Surgical Procedures
Authors: Grinbaum Renato S. , de Mendonça Joao Silva , Cardo Denise M. 
Published: September 2009

AbstractObjective:To investigate an outbreak of surgical site infections (SSI) in a vascular surgery unit.Setting:A 60-bed unit of vascular surgery, where surgeons performed an average of 30 operations per month at the Hospital do Servidor Público Estadual, a 1,000-bed tertiary care hospital in São Paulo, Brazil.Design:We included in the case group nine patients who had limb amputations or arterial reconstructions, October 16 through 23, 1992. We included in the control group patients whose operations were performed within 30 days of the outbreak period. Control patients were matched for sex and type of operation.Results:Six of 9 case patients experienced SSI, as compared with 3 of 18 control patients (P= .026) and 28 of 244 patients in the pre-epidemic period (P= .0002). Risk factors were identical for case and control groups. Factors assessed were American Society of Anesthesiology (ASA) status, duration of surgery, wound class, emergency status, remote site infections, preoperative length of stay, use of prophylactic antibiotics, and underlying diseases. Possible common sources also were analyzed. No differences were observed concerning hair removal, preoperative shower, wound dressing, and surgical team present in the operating room. During the outbreak period, the operating room was not provided with povidone-iodine, used in our hospital for skin cleansing and handscrubbing. Surgeons from all departments, including vascular surgery, used 2% iodine with 70% alcohol for skin cleansing. Surgeons from other departments used this iodine solution for handscrubbing, but the vascular surgeons used plain soap for handscrubbing. No increases in SSI rates were reported in other services. Comparison of case and control groups for handscrubbing was statistically significant (P<.00001). After reinstitution of povidone-iodine, only one SSI was diagnosed in 13 vascular procedures.Conclusions:Although we could not demonstrate definitely that scrubbing with plain soap was related to SSI, we found a strong suggestion of this association
Conjunctivitis in a Long-Term Care Facility
Authors: Boustcha E. , Nicolle L. E. 
Published: September 2009

AbstractObjective:To determine the prevalence, incidence, and etiology of conjunctivitis in residents of a long-term care facility.Design:Prospective surveillance of episodes of conjunctivitis during two 6-month periods.Setting:Three-building, 319-bed, multipurpose, long-term care facility including units for personal care, chronic care, palliative care, rehabilitation, respiratory rehabilitation, and chronic ventilator patients.Results:The incidence of conjunctivitis on different units varied from 0.6 to 3.5 per 1,000 patient-days. One building had a significantly higher rate of acute conjunctivitis and, within that facility, the most highly impaired patients had significantly more disease. Patients with chronic conjunctivitis generally were admitted with conjunctivitis; institutionally acquired conjunctivitis proceeding to chronic conjunctivitis seldom was observed except on the chronic ventilator unit. Residents with chronic conjunctivitis were significantly more likely to have a diagnosis of glaucoma, ectropion, or entropion. Potential bacterial pathogens were isolated from 3 (21%) of 14 and 24 (38%) of 69 acute episodes for which cultures were available in the two study periods. Staphylococcus aureus was the most frequent pathogen isolated. Empiric therapy was usually with topical sodium sulamyd or gentamicin, with substantial interphysician variability in prescribing patterns. Symptom duration did not differ for episodes which did or did not receive topical antimicrobials.Conclusion:Conjunctivitis is common in this facility and occurs with increased frequency in more highly impaired residents. Most episodes may not be due to bacterial infection. Further study of optimal management approaches to conjunctivitis is necessary
Characterization of Nosocomial Strains of Enterobacter aerogenes by Arbitrarily Primed-PCR Analysis and Ribotyping
Authors: Grattard Florence , Pozzetto Bruno , Tabard Lionel , Petit Marianne , Ros Alain , Gaudin Odette G. 
Published: September 2009

AbstractObjective:To study the spread of strains of Enterobacter aerogenes in our hospital in 1992 and 1993 by using two genotypic markers, and to evaluate these methods for the epidemiological investigation of this species.Design:Ribotyping (using two endonucleases) and arbitrarily primed (AP)-PCR (using two different 10-mer primers) were applied to the epidemiological typing of clinical strains of E aerogenes isolated from hospitalized patients.Setting and Patients:The intensive care unit (ICU; 5 patients, 13 isolates), nephrology units (3 patients, 5 isolates), and surgery units (2 patients, 2 isolates) of the university hospital of Saint-Etienne (France).Results:Eight epidemiologically unrelated isolates, chosen as controls, exhibited distinct profiles, both by AP-PCR and ribotyping. Two clones of E aerogenes circulated in the ICU; both were isolated successively from samples of a single patient who stayed in the unit for almost 1 year. A third clone was recovered from patients of surgery units. A fourth clone was shown to have infected patients of nephrology units.Conclusions:Ribotyping and AP-PCR appear to be reliable methods for typing E aerogenes strains implicated in nosocomial infection. The spread of independent clones of E aerogenes in different units of our hospital in 1992 and 1993 was demonstrated by both methods. This study emphasizes the need to choose the endonucleases or primers with care to obtain high discriminatory results in genotypic investigations.
An Introduction to Utility Measurement in Health Care
Authors: Ferguson Beryl M. , Keown Paul A. 
Published: September 2009

AbstractKey decisions regarding the introduction and optimal use of health technologies often are made on an ad hoc basis. Quantitative information on effectiveness, if incorporated into the decision-making process, would establish a reasoned and defensible basis for the introduction and optimal use of therapeutic technologies. Utility measures provide a single summary score of effectiveness which, when combined with cost information, permits the calculation of cost-utility ratios for alternative technologies. A number of techniques have been developed to elicit utilities, including standard gamble, time trade-off, rating scales, the Quality of Well-Being Scale, and the Health Utility Index. No single method has been accepted yet as the gold standard. Selection therefore must be guided by the specific objectives of the assessment.
Molecular Epidemiology of Methicillin-Resistant Staphyloccocus aureus at a Low-Incidence Hospital over a 4-Year Period
Authors: Lugeon Catherine , Blanc Dominique S. , Wenger Aline , Francioli Patrick 
Published: September 2009

AbstractObjective:To study the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) over a prolonged period of time with the aid of a molecular typing method (ribotyping).Setting:A 1,000-bed tertiary university medical center.Patients and Methods:Defined epidemiological data were recorded for all patients culture-positive for MRSA between 1989 and 1992. Ribotyping of MRSA strains was performed using three restriction enzymes: EcoRv, HindHI, and KpnI.Results:From 1989 to 1992, MRSA was isolated from clinical specimens in 98 patients and from surveillance cultures in 27 patients. Among the 122 isolates available for typing, 26 different ribotypes were identified. In 20% of the cases, MRSA was community-acquired, and a third of these patients never had been hospitalized previously. Nine ribotypes were responsible for more than one case (2 to 64 patients); 17 appeared only once. Epidemiological data correlated with ribotyping results revealed 14 epidemiologic clusters involving six different ribotypes, whereas only three outbreaks were suspected initially. The median follow-up after the last isolation of a given ribotype was 14 months (range, 1 to 42) for clusters and 25 months (range, 1 to 46) for ribotypes that appeared only once. During clusters, only 16% of the cases occurred after the implementation of control measures in the ward (breakthrough cases).Conclusions:The high diversity of MRSA strains observed over 4 years suggested that new strains were introduced continuously in our hospital. Furthermore, that 17 ribotypes were isolated only once, that breakthrough cases represented only 16% of the cases in clusters, and that the follow-up duration after the last isolation of a given ribotype was more than 14 months suggest that infection control measures were effective in limiting the nosocomial spread of MRSA over a prolonged period of time.
Impact of the Bloodborne Pathogens Standard on Vaccination of Healthcare Workers with Hepatitis B Vaccine
Authors: Agerton Tracy B. , Mahoney Francis J. , Polish Louis B. , Shapiro Craig N. 
Published: September 2009

AbstractObjectives:To evaluate the impact of Occupational Safety and Health Administration (OSHA) regulations on the vaccination of healthcare workers (HCWs), to assess interpretation of these regulations, and to evaluate changes in hospital vaccination policies.Design:Between June 1, 1992, and August 15, 1992, a telephone survey was conducted among 150 hospitals selected randomly from participants in the American Hospital Association 1991 annual survey.Results:Of the 150 hospitals, 96 (64%) provided information on hepatitis B vaccination coverage of their employees. Of the 103,419 employees in these hospitals, 77,302 (75%) were eligible to receive the hepatitis B vaccine, and 38,850 (51%) of these were vaccinated completely (had received 3 doses of vaccine). Following issuance of the final regulations, 73% of hospitals reported greater employee acceptance of hepatitis B vaccine, and hospitals were more likely to offer hepatitis B vaccine to maintenance workers, security personnel, dietary staff, and clerical personnel. Seventy-five hospitals (59%) reported conducting postvaccination serologic testing on all hospital employees, 12 (8%) as a result of OSHA regulations. Twenty-three hospitals (16%) reported administering routine booster doses of hepatitis B vaccine at 3, 5, or 7 years.Conclusions:The new OSHA standard resulted in a greater awareness of risk for HBV infection among HCWs and an increase in the number of HCWs receiving hepatitis B vaccine; however, vaccination coverage remained suboptimal. Postvaccination serologic testing of employees with negligible risk and the routine administration of vaccine booster doses may be diverting resources and preventing comprehensive coverage of high-risk employees.
An Approach to the Evaluation of Quality Indicators of the Outcome of Care in Hospitalized Patients, With a Focus on Nosocomial Infection Indicators
Authors:   The Quality Indicator Study Group
Published: September 2009

AbstractThe Quality Indicator Study Group was created by the governing boards of three national professional organizations that have interest and experience in epidemiology, nosocomial infection control and prevention, and quality of care improvement. The Study Group has reviewed the existing literature concerning quality indicators (QIs), interviewed experts in the field, and focused on how best to evaluate such indicators, with an emphasis on nosocomial infection indicators as a paradigm for all QIs. In this report, we review pertinent issues and, where possible, provide specific advice on how to evaluate QIs and QI systems.
Application of CQI Tools to the Reduction in Risk of Needlestick Injury
Authors: Burnett Leslie , Chesher Doug 
Published: September 2009

AbstractObjective:To reduce the risk of needlestick injuries to laboratory workers.Design:Continuous Quality Improvement (CQI) tools were applied to data collected on the number of blood gas syringes that arrived in the laboratory with needles still attached and to the reasons for these occurrences.Setting:A clinical chemistry department within a 900-bed tertiary referral university teaching hospital.Participants:Clinical chemistry laboratory staff and medical staff responsible for sending syringes with needles still attached.Interventions:Changing to a preheparinized blood gas syringe that included a syringe cap within the packaging.Results:Fivefold reduction in the number of syringes arriving in the laboratory with needles still attached.Conclusion:The risk of needlestick injury to laboratory workers can be reduced by provision to clinical staff of preheparinized blood gas syringes that include a syringe cap within the packaging. The techniques of CQI provide powerful tools for the identification, solving, and monitoring of safety-related issues within the healthcare environment.
Subclavian Hemodialysis Catheter Infections: A Prospective, Randomized Trial of an Attachable Silver-impregnated Cuff for Prevention of Catheter-related Infections
Authors: Dahlberg Philip J. , Agger William A. , Singer James R. , Yutuc Wilfrido R. , Newcomer Kermit L. , Schaper Ana , Rooney Brenda L. 
Published: September 2009

AbstractObjective:To determine if an attachable silver-impregnated cuff is effective in reducing subclavian hemodialysis catheter-related infections.Design:Prospective, randomized, nonblinded study.Setting:Community teaching hospital.Patients:One hundred one acute and chronic renal failure patients requiring subclavian venipuncture and catheterization. After randomization, 47 patients underwent subclavian catheterization with a silver-impregnated cuff (Ag-CC), and 54 patients had routine catheter (RC) placements.Measurements:Multiple presumed predictor variables for catheter-related infections, exit site infection rate, bacteremia rates, and semiquantitative cultures of all catheters.Results:There were no significant differences between the AG-CC and the RC groups for catheter colonization, exit site infection, catheter sepsis, any catheter-related infections, or the incidence of infections within the first 7 or 14 days. Although the differences did not achieve statistical significance, the RC group was more likely to experience catheter colonization (20.4% versus 14.9%) and exit site infection (5.6% versus 2.1%). However, the RC group contained nearly twice as many intensive care (ICU) patients (44% versus 23%; P=.027), and ICU subjects were twice as likely to acquire catheter infection (P<.002).Conclusions:Although the sample size was insufficient to exclude Type 2 errors, it appears that the attachable silver-impregnated cuff did not reduce subclavian catheter-related infections in our patient population.
The Certification Board of Infection Control, Inc
Authors: Pirwitz Sandy 
Published: September 2009

AbstractThe Certification Board of Infection Control, Inc (CBIC), was created in 1981 by the Association for Professionals in Infection Control and Epidemiology, Inc, for the sole purpose of developing and administering an examination by which competent infection control professionals could become certified. This independent, voluntary board is multidisciplinary, representing all levels of professionals in the field of infection control, as well as a consumer member. CBIC certification is the only recognized certification for infection control professionals. Since the first examination was administered in 1983, over 3,000 persons have attained infection control certification (CIC) status and are permitted to use the CIC credential.
The Effect of Respirator Training on the Ability of Healthcare Workers to Pass a Qualitative Fit Test
Authors: Hannum Donna , Cycan Kerrie , Jones Linda , Stewart Melinda , Morris Steve , Markowitz Sheldon M. , Wong Edward S. 
Published: September 2009

AbstractObjectives:To determine the effect of different methods of training on the ability of hospital workers to wear respirators and pass a qualitative fit test, and to compare the direct cost of the training.Design:179 hospital employees were recruited for study and were stratified into three groups based on the type of training they received in the use of respirators. Employees in Group A received one-on-one training by the hospital's industrial hygienist and were fit tested as part of this training. Employees in Group B received classroom instruction and demonstration by infection control nurses in the proper use of respirators, but were not fit tested as part of training. Employees in Group C received no formal training. Each participant in our study underwent a subsequent qualitative fit test using irritant smoke to check for the employee's ability to adjust correctly the fit and seal of the respirator. The direct cost of each method of training was determined by accounting for the cost of trainers and the cost of employee-hours lost during training.Setting:775-bed Veterans' Affairs hospital.Results:94% of Group A participants (49 of 52) passed the qualitative fit test, compared to 91% of Group B participants (58 of 64) and 79% of Group C participants (50 of 63; P=.036, 2 × 3 chi-square). Group A had a significantly higher pass rate than Group C (P=.043), but Group B did not differ significantly from Group A or Group C. Location or professional status did not affect pass rate, but prior experience wearing respirators did. When the study groups were compared after stratifying for prior experience, we found no difference in pass rates, except when Groups A and B (those with any training) were combined and compared with Group C (107 of 116 versus 50 of 63, P=.05, Mantel-Haenszel chi-square).We estimate that the method of training involving individual instruction followed by fit testing took 20 minutes per employee to complete, compared to 10 minutes per six employee class for the method of classroom demonstration. The difference in direct cost between the two methods, applied to the training of 1,200 employees at our hospital, would be approximately $19,000 per year.Conclusion:Our study indicates that training in the proper use of respirators is important, but the method of training may not be, as the two methods we evaluated were nearly equivalent in their pass rates on fit testing (94% versus 91%). Fit testing as part of training may have enhanced the performance of our participants marginally, but was more time consuming and accounted for most of the excess cost.
Staphylococcus epidermidis Catheter-Related Infections in a Short-Bowel Patient. Persistence of a Single Strain Over a Two-Year Period
Authors: Voss Andreas , Melchers Willem J.G. , Bijl Diana , Hoogkamp-Korstanje Jacomina A.A. , Meis Jacques F.G.M. 
Published: September 2009

AbstractWe report the case of a patient with short-bowel syndrome, who lost multiple central venous devices over the course of 2 years while treating his catheter-related septicemia. Genotyping proved that all infectious episodes were caused by a single genotype of a Staphylococcus epidermidis strain, persisting over time