bluuebunny/crossref_metadata_2025_split huggingface dataset:
Focused Microbiological Surveillance and Gram-Negative Beta-Lactamase-Mediated Resistance in an Intensive Care Unit
Authors: Bryce E.A. , Smith J.A. 
Published: September 2009

AbstractObjective:To evaluate the use of focused surveillance in following resistance patterns within an intensive care unit (ICU).Design:Antibiograms of 167 gram-negative isolates from ICU patients were compared to the hospitalwide antibiograms. ICU isolates were examined for the newer forms of beta-lactamase resistance. An outbreak of multiresistant Pseudomonas aeruginosa during the survey illustrated the usefulness of focused surveillance in early intervention and containment.Setting:A 700-bed adult tertiary care hospital with a 16-bed medical and surgical ICU.Results:Hospitalwide and ICU antibiograms of the Enterobacteriaceae were similar. However, resistance of P aeruginosa in the ICU was underestimated by hospitalwide rates. Susceptibility of ICU isolates to ceftazidime, ciprofloxacin, and piperacillin was 54%, 54%, and 42%, compared with 81%, 77%, and 85%, respectively, in the hospital at large. Thirty-five percent of isolates exhibited one of the newer forms of beta-lactamase-mediated resistance, with 17% of isolates exhibiting Class I cephalosporinase production.Conclusion:Targeted survey of high antibiotic-use hospital units should be used to study bacterial epidemiology, rather than relying on general hospital data to evaluate patterns of antimicrobial resistance. Monitoring of potential problem areas leads to prompt identification of changes in resistance and allows early intervention.
A Cluster of Fever and Hypotension on a Surgical Intensive Care Unit Related to the Contamination of Plasma Expanders by Cell Wall Products of Bacillus stearothermophilus
Authors: Trilla Antoni , Codina Carles , Salles Montserrat , Gatell Josep M. , Zaragoza Magda , Marco Francesc , Navasa Miquel , Mulet Jaume , Ribas Josep , Jimenez de Anta Maria T. , Asenjo Miguel A. 
Published: September 2009

AbstractObjective:To evaluate an outbreak of fever and hypotension after cardiac surgical procedures and the role of polygeline, a plasma expander.Design:Unmatched case-control study.Setting:A six-bed cardiac surgery intensive care unit (SICU) of the Hospital Clinic of Barcelona (Spain), a 940-bed public teaching hospital.Patients:Eight cases and 25 control patients admitted to the SICU over a 4-week epidemic period.Main Outcome Measures:Development of hypotension (systolic blood pressure ≤ 90 mm Hg or a drop of 40 mm Hg from baseline systolic blood pressure) and fever (axillary temperature >38.5°C) within 24 hours of a cardiac surgical procedure.Results:The single risk factor significantly different between cases and controls was the total volume of polygeline used throughout the surgical procedure for extracorporeal circulation: a median of 1,250 mL (mean, 1,312.5 ± 842.5 mL) in cases versus 500 mL (mean, 566.0 ± 159.9 mL) in controls (P = .0029). By multiple logistic regression analysis, polygeline use was the single risk factor significantly related to the outcome (odds ratio, 8.75; CI95, 1.36 to 56.2; P= .01). Neither blood cultures from patients nor cultures of the polygeline used yielded growth of any microorganism. Stopping use of the implicated polygeline lot controlled the outbreak.Conclusions:Use of polygeline was associated with an outbreak of fever and hypotension in a SICU. Information from the manufacturer indicated the likelihood of contamination of the product with Bacillus stearothermophilus components. The manufacturer has since changed the production and control processes, and no further adverse events have been seen.
The Epidemiology of Colonization
Authors: Jarvis William R. 
Published: September 2009

AbstractColonization is the presence of a microorganism in or on a host, with growth and multiplication but without any overt clinical expression or detected immune response in the host at the time it is isolated. Normal colonization in humans begins during the birth process and through subsequent contacts with the inanimate or animate environments until a delicately balanced “normal” flora is established; subsequently, the precise components of this flora evolve. This normal flora, such as coagulase-negative Staphylococcus or Staphylococcus aureus on the skin or Candida albicansin the gastrointestinal tract, vagina, or perineal area, can result in infection when normal body defenses are impaired through underlying disease, immunomodulating therapy, or the use of invasive devices, or when the delicate balance of the normal flora is altered through antimicrobial therapy. Many, if not most, hospital-acquired infections result directly or indirectly from patient colonization; studies have shown that hospitalized patients are colonized rapidly with hospital flora. Recognizing this reservoir of patients colonized with epidemiologically important pathogens in our hospitals and improving barrier precaution measures or altering host susceptibility will be necessary if we are to reduce the incidence of infections with these organisms.
Follow-up Evaluation of Respiratory Isolation Rooms in 10 Midwestern Hospitals
Authors: Dahl Karen M. , L'Ecuyer Paul B. , Jones Marilyn , Fraser Victoria J. 
Published: September 2009

AbstractAs a follow-up to a 1992 study of respiratory isolation, we studied compliance with recommendations for respiratory isolation through smokestick testing (1993) and surveys (1994). Effective negative pressure was demonstrated in 80 of 156 rooms and was associated with the presence of anterooms (P<.001). The proportion of surveyed hospitals periodically testing isolation rooms increased from 0% (1992) to 30% (1993) to 100% (1994; P<.001).
Treatment and Control of Colonization in the Prevention of Nosocomial Infections
Authors: Mayhall C. Glen , Boyce John M. 
Published: September 2009

AbstractPatients frequently develop nosocomial infections that are caused by normal flora colonizing the patient at the time of admission, or by exogenous pathogens that are acquired and subsequently colonize the patient after admission to the hospital. To prevent nosocomial infections, a variety of strategies have been used either to prevent colonization from occurring, to eradicate colonizing organisms, or to prevent the progression from colonization to infection. These strategies include implementation of infection control measures designed to prevent acquisition of exogenous pathogens, eradication of exogenous pathogens from patients or personnel who have become colonized, suppression of normal flora, prevention of colonizing flora from entering sterile body sites during invasive procedures, microbial interference therapy, immunization of high-risk patients, and modification of antibiotic utilization practices. Because strategies that require widespread use of antimicrobial agents to suppress or eradicate colonizing organisms tend to promote emergence of multidrug-resistant pathogens, greater emphasis should be given to those strategies that prevent colonization from occurring or employ techniques other than administration of prophylactic antibiotics to eradicate colonization. Restricting inappropriate use of antibiotics should reduce the frequency with which patients become colonized and infected with multidrug-resistant organisms.
Nosocomial Infections in Surgical Patients: Comparison of Two Measures of Intrinsic Patient Risk
Authors: Delgado-Rodríguez Miguel , Sillero-Arenas María , Medina-Cuadros Marcelino , Martínez-Gallego Gabriel 
Published: September 2009

AbstractObjective:To compare, in subjects undergoing general surgery, two measures of intrinsic patient risk for nosocomial infection: the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance (NNIS) System index.Design:Prospective cohort study, with follow-up for 1 month after hospital discharge.Setting:The general surgery service of a tertiary hospital.Main Outcome Measure:Surgical-site infection.Patients:1,483 subjects aged 10 to 92 years.Results:During follow-up, 155 patients developed nosocomial infection, yielding a cumulative incidence of 10.5%. The NNIS index showed a linear trend with both crude and adjusted (for SENIC index) rates of surgicalwound infection. The SENIC index did not exhibit any linear trend with adjusted (for NNIS index) rates of surgical-wound infection. To delineate whether the SENIC index added explanatory information to the NNIS index (or vice versa), we regressed each variable on the other. Logistic regression analyses confirmed the results of stratified analysis: residuals of the NNIS index added discriminating ability to the SENIC index, whereas residuals of the SENIC index did not improve the predictive power of the NNIS index.Conclusions:The NNIS index had a better ability than the SENIC index for discriminating and predicting risk of surgical-wound infection
DNA Typing and Control of Methicillin-Resistant Staphylococcus aureus at Two Affiliated Hospitals
Authors: Hartstein Alan I. , LeMonte Ann M. , Iwamoto Pamela K.L. 
Published: September 2009

AbstractObjective:To describe control of endemic and outbreak-related methicillin-resistant Staphylococcus aureus (MRSA) at two affiliated hospitals.Design:Prospective surveillance of patients with MRSA. Disposable gloves were used by all staff having direct contact with the affected patient or his immediate environment, and patient isolates were typed by pulsedfield gel electrophoresis (PFGE) of genomic DNA. Surveillance and PFGE typing were used concurrently to identify possible nosocomial outbreaks, confirm or refute cross-infection, and support a need for additional outbreak control interventions.Setting:A university hospital (Hospital A) and a university-affiliated public hospital (Hospital B).Participants:Patients with MRSA colonization or infection over an 18-month interval (June 1993-November 1994).Intervention:Proper handwashing and gloving practices were reemphasized with staff following confirmation of outbreaks.Results:Hospital A had 60 community-acquired and 48 nosocomial cases of MRSA. Two small outbreaks (affecting a total of seven patients) and two pseudo-outbreaks were identified. Hospital B had 36 community-acquired and 22 nosocomial cases of MRSA. Only one outbreak affecting five patients occurred. All outbreaks ended shortly after staff meetings that emphasized ongoing and extremely careful handwashing and gloving when caring for identified patients. The majority of nosocomial cases at both hospitals were not related epidemiologically or had isolates with unique PFGE types. Pseudo-outbreaks were confirmed by demonstrating that isolates from epidemiologically related cases (by time and clinical service or hospital unit) had different PFGE types. Hospital A cases had 39 different PFGE types, and Hospital B cases had 31 different PFGE types.Conclusion:MRSA in hospitals, including outbreaks identified by prospective surveillance and confirmed by PFGE typing, can be controlled by minimal special precautions and interventions. This is possible despite the continuous admission of patients with MRSA from the community. PFGE typing is useful to confirm outbreaks and pseudo-outbreaks, demonstrate differences among epidemiologically unrelated isolates, and substantiate the efficacy of MRSA control programs within hospitals.
Evidence for the Genetic Unrelatedness of Nosocomial Alcaligenes xylosoxidans Strains in a Pediatric Hospital
Authors: Benaoudia Farida , Bingen Edouard 
Published: September 2009

AbstractRestriction fragment-length polymorphism of ribosomal DNA and random amplified polymorphic DNA analysis were used to study the relationships among nine isolates of Alcaligenes xylosoxidans obtained from seven children in a pediatric hospital. All the children harbored only genotypically unrelated strains, thus excluding a common source of exposure or patient-to-patient strain transfer.
No Time for Handwashing!? Handwashing Versus Alcoholic Rub Can We Afford 100% Compliance?
Authors: Voss Andreas , Widmer Andreas F. 
Published: September 2009

AbstractHandwashing is the most important and least expensive measure to prevent transmission of nosocomial infections. However, compliance rarely exceeds 40% under study conditions. Alcoholic hand disinfection (AHD) generally is used in Europe. In contrast, handwashing with medicated soap is practiced most frequently in the United States. Healthcare workers often explain the failure to comply with handwashing or AHD as due to the limited time available for this practice. We calculated a time consumption for handwashing and AHD in a representative model intensive-care unit with 12 healthcare workers, based on different compliance levels (40%, 60%, and 100%), duration of handwashing (40-80 seconds), and AHD (20 seconds). Comparing the extremes of our model, given 100% compliance, handwashing consumes 16 hours of nursing time per day shift, whereas AHD from a bedside dispenser requires only 3 hours (P=.01). We conclude that 100% compliance with handwashing may interfere with patient care and partly explains the low compliance. In contrast, AHD, with its rapid activity, superior efficacy, and minimal time commitment, allows 100% healthcare-worker compliance without interfering with the quality of patient care.
Removal of Mycobacterium Species by Breathing Circuit Filters
Authors: Aranha-Creado Hazel , Prince Daniel , Greene Kathryn , Brandwein Harvey 
Published: September 2009

AbstractBreathing circuit filters (BCFs) are used in respiratory and critical-care settings for humidification of air and to limit transmission of respiratory pathogens. Three types of BCFs (Pall BB 25A, BB 100, and HME 15-22) were evaluated (in triplicate) for removal of Mycobacterium species. Filters were challenged with aerosolized Mycobacterium bovis (a surrogate for Mycobacterium tuberculosis), at minimum total concentrations of 104 colony-forming units. No M bovis was recovered in the effluent, providing removal efficiencies of >99.99% to >99.999% for the filters tested.
Electronic Mail An Imperative for Healthcare Epidemiologists
Authors: Sellick John A. 
Published: September 2009

AbstractElectronic mail (e-mail) offers the potential for near-instantaneous transfer of messages and files across thousands of miles. The same message can be sent simultaneously to multiple recipients and for warded without retyping. Messages can be sent or read at any time, eliminating “telephone tag,” and, because the system is paperless, lost, blurred, and incomplete, facsimile transmissions can be minimized. Additionally, e-mail is less expensive than overnight letter ser vices or long-distance faxes. All healthcare epidemiologists should enter the information superhighway using e-mail. This article provides basic information needed to understand and begin using e-mail.
Association of Private Isolation Rooms with Ventilator-Associated Acinetobacter baumanii Pneumonia in a Surgical Intensive-Care Unit
Authors: Mulin Blandine , Rouget Claude , Clément Charles , Bailly Pascale , Julliot Maríe-Christine , Viel Jean-Françon F. , Thouverez Michelle , Vieille Isabelle , Barale Françon , Talon Daniel 
Published: September 2009

AbstractObjective:To determine the rates and routes of Acinetobacter baumanii colonization and pneumonia among ventilated patients in a surgical intensive-care unit (SICU) before and after architectural modifications.Design:A nonsequential study comparing two groups of patients. All isolates from systematic and clinical samples were genotyped by pulsed-field gel electrophoresis (PFGE). Records of patients hospitalized during the first and second periods were reviewed and findings were compared. Between the two periods, the SICU was remodeled from enclosed isolation rooms and open rooms to only enclosed isolation rooms with handwashing facilities in each room.Setting and Patients:All patients hospitalized and mechanically ventilated for more than 48 hours in the 15-bed SICU of the University Hospital of Besançon (France).Results:For the first and second periods, the rates of colonization were, respectively, 28.1% and 5.0% of patients (P<10−7; relative risk [RR], 2.23; 95% confidence interval [CI95], 1.8-2.75) and the specific rates of bronchopulmonary (BP) colonization were, respectively, 9.1 and 0.5 per 1,000 days of mechanical ventilation (P<10−5). Seven major PFGE isolate types were identified, 4 of which were isolated from 44 of the 47 colonized or infected patients. Logistic regression analysis showed that colonization was not associated with patient characteristics.Conclusion:Conversion from open rooms to isolation rooms may help control nosocomial BP tract acquisition of A baumanii in mechanically ventilated patients hospitalized in an SICU.
Controlling Varicella in the Healthcare Setting: The Cost Effectiveness of Using Varicella Vaccine in Healthcare Workers
Authors: Nettleman Mary D. , Schmid Marlene 
Published: September 2009

AbstractObjective:To determine if varicella vaccination of healthcare workers would result in a net cost savings.Design:A Markov-based decision analysis.Setting:The analysis was based on a hypothetical population of healthcare workers. Data were obtained from exposure records of a tertiary-care hospital and from the literature. Workers were considered potentially susceptible if they had no past history of varicella.Results:Vaccination of potentially susceptible workers would result in a net cost savings of $59 per person. Serological testing prior to vaccination resulted in smaller net savings. The results were robust across a wide range of assumptions. Importantly, however, the result was very dependent on infection control policy regarding work restrictions for vaccine recipients. If more than 3% of vaccinees were removed from work due to vaccine-associated rash, vaccination no longer would result in a net cost savings.Conclusion:Varicella vaccination of potentially susceptible healthcare workers can reduce costs and decrease morbidity. Infection control policy regarding work restrictions for vaccine recipients will play a key role in the feasibility of vaccination.
An Outbreak of Pseudomonas aeruginosa Related to Contaminated Urodynamic Equipment
Authors: Climo Michael W. , Pastor Antonio , Wong Edward S. 
Published: September 2009

AbstractInvestigation of an outbreak of multiresistant Pseudomonas aeruginosa urinary tract infections within our hospital identified the urodynamic laboratory as the point source. Disinfection procedures were inadequate, and transducers designated for single-patient use were used repeatedly and subsequently became contaminated. These improper procedures were part of a cost-containment effort.
A Pseudo-Outbreak of Respiratory Infection With Acinetobacter Species
Authors: Sule Olajumoke , Ludlam Hugo A. , Walker Colin W. , Brown Derek F.J. , Kaufmann Mary E. 
Published: September 2009

AbstractWe describe an apparent outbreak of respiratory infection with Acinetobacter species involving 14 patients over 8 days. Epidemiological investigation revealed two consecutive pseudo-outbreaks of infection caused by two consecutive, unrelated laboratory errors in the processing of sputum, nasopharyngeal, and endotracheal aspirates.
Reduction in Tuberculin Skin-Test Conversion Rate After Improved Adherence to Tuberculosis Isolation
Authors: Uyamadu Nathan , Ahkee Sunket , Carrico Ruth , Tolentino Arthur , Wojda Barbara , Ramirez Julio 
Published: September 2009

AbstractThe rate of purified protein derivative (PPD) conversion in workers at our hospital increased to 1.7% in 1991. After implementation of mandatory respiratory isolation of patients with community-acquired pneumonia, the rate dropped to 0.6%. This policy may protect workers in institutions where the majority of patients with pneumonia have risk factors for tuberculosis.
Bacterial Killing Ability of 10% Ethylene Oxide Plus 90% Hydrochlorofluorocarbon Sterilizing Gas
Authors: Alfa Michelle J. , DeGagne Pat , Olson Nancy 
Published: September 2009

AbstractObjectives:To use a serum and salt challenge in narrow-lumen carriers to evaluate a 10% ethylene oxide plus 90% hydrochlorofluorocarbon (EO-HCFC) sterilant mixture in a retrofitted 12/88 sterilizer as an alternative to the banned chlorofluorocarbon-ethylene oxide (EO) sterilant mixture.Design:An EO-HCFC sterilizing gas mixture in a retrofitted 12/88 sterilizer was compared to 100% ethylene oxide (100% EO) sterilizing gas to determine its relative ability to kill seven different bacteria (Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecalis, Bacillus subtilis spores, Bacillus stearothermophilus spores, Bacillus circulans spores, and Mycobacterium chelonei) in the presence or absence of a combined 10% serum and 0.65% salt challenge using both penicylinders (PC) and long narrowlumen (LU) carriers.Results:The EO-HCFC sterilant mixture (96% sterile carriers) was equivalent to the 100% EO sterilant (98% sterile carriers) for killing vegetative organisms, as well as spore suspensions, on the 27 PC and 27 LU carriers in the absence of serum and salt. In the presence of serum and salt, the EO-HCFC sterilant mixture was markedly better than the 100% EO sterilant at reducing the bacterial load on the 63 PC carriers (95% vs 62% sterile PC carriers, respectively), whereas both sterilizers were equivalent for the 63 LU carriers (49% vs 40% sterile LU carriers, respectively). Of the seven test organisms, E faecalis, B subtilis, B stearothermophilus, and B circulans were the most difficult to kill for both PC and LU carriers when serum and salt were present.Conclusions:The data presented in this report indicate that the EO-HCFC sterilant mixture is an effective alternative for gas sterilization. Indeed, the efficiency of bacterial killing for the EO-HCFC sterilant mixture was similar to that achieved by the 12/88 EO-CFC sterilant mixture.
Basics of Surgical-Site Infection Surveillance
Authors: Roy Marie-Claude , Perl Trish M. 
Published: September 2009

AbstractSurgical-site infections, the third most common class of nosocomial infections, cause substantial morbidity and mortality and increase hospital costs. Surveillance programs can lead to reductions in surgical-site infection rates of 35% to 50%. Herein, we will discuss the practical aspects of implementing a hospital-based surveillance program for surgical-site infections. We will review surveillance methods, patient populations that should be screened, and interventions that could reduce infection rates.
Risk Factors for Mortality in Staphylococcus aureus Bacteremia
Authors: Conterno Lucieni Oliveira , Wey Sergio Barsanti , Castelo Adauto 
Published: September 2009

AbstractObjective:To analyze risk factors for, and the role of methicillin resistance in, mortality in Staphylococcus aureus bacteremia.Design:Nested case-control study.Setting:General teaching hospital with a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains, in São Paulo, Brazil.Patients:136 patients over 14 years old with documented S aureus bacteremia. Those who died were compared with those who survived at least 14 days.Results:Mortality within 14 days of bacteremia was 39% (53/136). Mean age was 47 years. Hospital-acquired bacteremia represented 86% (117/136) of episodes. In 26% (35/136), infection was related to an intravascular catheter and in 13% (17/136) to the respiratory tract. Septic shock occurred in 22% (30/136) of cases. MRSA was isolated in 66% (90/136). Multivariate analysis identified three variables that were significantly and independently associated with mortality: site of entry (lung, odds ratio [OR], 17.0; unknown, OR, 12.3; others, OR, 6.6); occurrence of shock (OR, 8.9), and resistance of S aureus to methicillin (OR, 4.2).Conclusion:Our study shows that S aureus bacteremia has a high mortality, especially when the lung is the source of infection and when shock develops; resistance to methicillin may be another risk factor for poor outcome.