bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation Between Frequency of Tuberculosis and Compliance With Control Strategies
Authors: Roy Marie-Claude , Fredrickson Mary , Good Natalie L. , Hunter S. Ann , Nettleman Mary D. 
Published: September 2009

AbstractObjective:To determine if compliance with annual tuberculosis skin testing correlated with the number of cases of tuberculosis seen in patients and healthcare workers.Design:Survey using a written questionnaire.Setting and Participants:159 Veterans' Administration facilities.Results:Hospitals that reported that >80% of their healthcare workers received annual skin tests saw 12.7 patient cases per 10,000 admissions and 4.0 healthcare worker cases per 10,000 personnel. Facilities in which <20% of their healthcare workers were given annual skin tests saw 4.5 cases per 10,000 admissions and 1.6 cases in healthcare workers per 10,000 personnel (P<.001 for patients and P=.31 for healthcare workers). The ratio of the median number of patients placed in acid-fast bacilli (AFB) isolation to the median number of patients with confirmed tuberculosis was 12. There was no correlation of this ratio with the number of cases of tuberculosis in patients or healthcare workers seen in each facility.Conclusion:Compliance with annual tuberculosis skin testing was related directly to the rate of tuberculosis seen in patients. More standardized policies for placing patients in AFB isolation are needed to control for potentially costly variation among facilities. These measures should have highest priority in the control of tuberculosis in the healthcare setting, before implementing still more expensive interventions.
Use of Electrophoretic Karyotyping in the Evaluation of Candida Infections in a Neonatal Intensive-Care Unit
Authors: Vazquez Jose A. , Boikov Dina , Boikov Sergei G. , Dajani Adnan S. 
Published: September 2009

AbstractObjective:To evaluate a possible commonsource outbreak of Candida infections in the neonatal intensive-care unit. Systemic Candida infections increased from 6 to 11 cases (0.71 to 1.34 per 1,000 patient-days). In addition, Candida parapsilosis infections increased from 1 in 1992 to 10 in 1993.Design and Setting:Tertiary-care, teaching, pediatric institution with a 40-bed neonatal intensive-care unit (NICU). Clinical characteristics, associated conditions, and antimicrobial therapy were obtained from the medical records of all NICU patients with positive blood cultures for Candida during 1992 and 1993. Nineteen Candida isolates from 15 infants were studied retrospectively using contour-clamped homogeneous electric-field (CHEF) electrophoresis.Results:CHEF revealed eight karyotypes of C parapsilosis. Five isolates recovered from four patients shared one karyotype. The remaining isolates from seven infants all had distinctly different karyotypes.Conclusions:The evidence was insufficient to implicate a single source of infection, even though four patients in the same unit had identical strain types. However, identical strains of C parapsilosis were associated geographically, suggesting that nosocomial acquisition of C parapsilosis through indirect patient contact in the NICU was possible. The CHEF technique yields unique patterns that may be used to delineate clinical isolates and to study the molecular epidemiology of candidal infections.
The Evolution of the Surgical Mask: Filtering Efficiency Versus Effectiveness
Authors: Belkin Nathan L. 
Published: September 2009

AbstractWhen originally introduced for use at the turn of the century, the primary function of the surgical mask was to prevent the migration of microorganisms residing in the nose and mouth of members of the operating team to the open wound of the patient. As technology developed new materials and designs, their filtering efficiencies gradually improved. However, there is no standard test method for assessing that capability, and its influence on the rates of surgical-wound infection has yet to be demonstrated. Quite to the contrary, both in-vitro and in-vivo studies indicate that a mask may not be universally necessary in today's surgical environment.
Sentinel System for Nosocomial Infections in the Netherlands A Pilot Study
Authors: Severijnen A.J. , Verbrugh H.A. , Groot A.J. Mintjes-de , Vandenbroucke-Grauls C.M.J.E. , van Pelt W. 
Published: September 2009

AbstractObjective:To determine the feasibility of stan¬dardized surveillance of nosocomial infections (NI) in The Netherlands, using local data on patients with NI collected by infection control practitioners (ICPs) and denominator data on all patients under surveillance obtained from the Dutch National Medical Registry (LMR).Design:A prospective, multicenter study.Setting:Eight hospitals in the Utrecht region, and the National Institute of Public Health and the Environment.Patients:ICPs traced NI in gynecological and orthopedic patients for 9 to 16 months. Denominator data on all patients under surveillance were obtained from the LMRResults:Data from 8,922 patients were collected; the ICPs registered 470 patients with 526 N1. Overall, the NI incidence was 5.9 per 100 patients, or 6.3 per 1,000 patient days. Urinary tract infections (UTI) were most frequent (3.3%), followed by surgical-wound infections (SWI; 2.0%) and bloodborne infections (0.12%). The incidence of both SWI and UTI differed markedly between hospitals, only partially on account of differences in patient mix (age, type of operations), antibiotic prophylaxis, and intensity of tracing methods for NI. Delay in the availability of denominator data hampered the timely feedback of incidence figures.Conclusions:Surveillance of NI in a network of sentinel hospitals offered valuable information on the occurrence of NI and on factors influencing the incidence of NI. It revealed situations in which both NI surveillance and infection control methods in individual hospitals should be improved. Obtaining denominator data on all patients from electronically registered patient discharge data greatly reduces the workload of ICPs and enables surveillance on all types of NI (all body sites and all pathogens). For timely feedback, numerator and denominator data within hospitals must be linked.
Modeling the Spread of Resistant Nosocomial Pathogens in an Intensive-Care Unit
Authors: Sébille Véronique , Chevret Sylvie , Valleron Alain-Jacques 
Published: September 2009

AbstractObjectives:To show the value of mathematical modeling in simulating the spread of nosocomial pathogens in an intensive-care unit (ICU), to provide a framework for listing available knowledge; to predict the benefits of various control measures; and to supplement the epidemiological assessment of these measures.Design:Simulated outbreak of a nosocomial pathogen in an ICU, based on a deterministic compartmental model describing both person-to-person spread and indirect spread between patients through staff members.Interventions:Simulation of three typical colonization control measures: effective handwashing compliance among staff members, ICU antimicrobial policy, and curtailing ICU admission of colonized patients.Results:In controlling colonization, effective handwashing compliance reduced staff member colonization, but only moderately limited patient colonization unless the ICU was isolated strictly by curtailing the admission of colonized patients. The impact of antibiotic policy was very slight.Conclusions:In the field of nosocomial infection, mathematical modeling appears to be a valuable tool that can be used to evaluate the magnitude of the expected effects of control strategies and to guide the selection of the best randomized clinical trials to pursue.
Nosocomial Infections in Neonates Receiving Extracorporeal Membrane Oxygenation
Authors: Coffin Susan E. , Bell Louis M. , Manning MaryLou , Polin Richard 
Published: September 2009

AbstractObjective:To determine the incidence of, and risk factors for, nosocomial infections in neonates during and after treatment with extracorporeal membrane oxygenation (ECMO).Design:A retrospective cohort study of all infants treated with ECMO during a 4-year period.Patients:26 neonates experiencing 32 nosocomial infections, and 54 neonates with no nosocomial infections.Setting:A large, urban children's hospital.Results:30% of neonates treated with ECMO experienced at least one nosocomial infection. The rate of nosocomial infections was 10.3 per 1,000 patient-days. Risk factors significantly associated with nosocomial infection included duration of ECMO >7 days (mean, 12 vs 7 days; odds ratio [OR], 2.84; 95% confidence interval [CI95], 0.96-8.56); neonatal intensive care-unit stay >21 days (mean, 44 vs 19 days; OR, 8.73; CI95, 2.49-31.94); hospitalization >50 days (mean, 63 vs 29 days; OR, 5.44; CI95, 1.47-20.87); and surgical procedure before or during ECMO (46% vs 22%; OR, 4.58; CI95, 1.25 to 17.38).Conclusions:Nosocomial infections occurred in 30% of patients undergoing ECMO. Although nosocomial infections were not associated with an increase in mortality, hospitalization was prolonged.
Handwashing and Glove Use in a Long-Term–Care Facility
Authors: Thompson Betsy L. , Dwyer Diane M. , Ussery Xilla T. , Denman Susan , Vacek Pam , Schwartz Benjamin 
Published: September 2009

AbstractObjectives:To determine glove use and handwashing practices, the factors associated with infection control practices, and the frequency of potential microbial transmission in a long-term–care facility (LTCF).Design:Observational study of 230 staff-resident interactions in an LTCF. We recorded resident characteristics, type of activity, staff credentials, and movements of the staff member's hands, then used the LTCF's guidelines to judge appropriateness of glove use and handwashing.Setting:255-bed, university-based LTCF in Baltimore, Maryland.Participants:A systematic sample of staff-resident interactions.Results:Gloves were worn in 139 (82%) of 170 interactions when indicated, but changed appropriately in only 21 (16%) of 132. Hands were washed when needed before an interaction in 27%, during an interaction in 0%, and after an interaction in 63%. Gloves were less likely to be used when caring for residents with gastrostomy tubes compared with other residents (relative risk, 0.85; 95% confidence interval, 0.73-0.98). Guidelines were followed more frequently during wound care than during other activities. Microbial transmission potentially could have occurred in 158 (82%) of 193 evaluable interactions.Conclusions:We documented marked deficiencies in glove use and handwashing, demonstrated the possible impact of these deficiencies, and identified factors associated with inadequate handwashing and glove use. This information can be used in future educational and research efforts to improve infection control practices.
Hospital Epidemiologic Surveillance for Invasive Aspergillosis: Patient Demographics and the Utility of Antigen Detection
Authors: Patterson Jan Evans , Zidouh Ahmed , Miniter Peggy , Andriole Vincent T. , Patterson Thomas F. 
Published: September 2009

AbstractObjective:To monitor the epidemiology of invasive aspergillosis at a university hospital during a period of hospital construction. To compare the efficacy of active epidemiologic surveillance for invasive aspergillosis using Aspergillus cultures with the efficacy of surveillance using Aspergillus antigen detection.Design:A prospective surveillance study.Setting:An 850-bed, tertiary-care, university-based hospital.Patients:A convenience sample of 153 patients with Aspergillus antigen testing and culture.Results:24 cases were identified over a 12-month period; 7 were nosocomial, and 17 were community-acquired. Cases occurred primarily in patients with hematologic malignancy, but also occurred in patients with solid tumor, steroid treatment, cardiac transplant, and acquired immunodeficiency syndrome. Culture techniques identified only 14 (58%) of 24 cases, whereas Aspergillus antigen was positive in 19 (79%) of 24 cases tested. Epidemiological surveillance using either antigen or culture positivity detected 22 (92%) of 24 cases. In addition, antigen detection was 98% specific for the detection of aspergillosis, as compared to 91% for culture and 88% for antigen and culture combined.Conclusions:Hospital surveillance for aspergillosis should include determination of whether cases are nosocomial or community-acquired, because many may be the latter. Patients at risk for aspergillosis include patients without hematologic malignancies. Enhanced case detection occurred with active surveillance of patients considered to be at risk using both fungal serology and traditional microbiological techniques. Antigen detection was more sensitive and specific for the detection of invasive aspergillosis and may improve epidemiological surveillance for aspergillosis.
Nosocomial Exposure to Parvovirus B19: Low Risk of Transmission to Healthcare Workers
Authors: Ray Susan M. , Erdman Dean D. , Berschling Jeffrey D. , Cooper Joan E. , Török Thomas J. , Blumberg Henry M. 
Published: September 2009

AbstractObjective:To evaluate the risk of nosocomial transmission of parvovirus B19 (B19) infection to healthcare workers (HCWs) exposed to patients with transient aplastic crisis (TAC) caused by acute B19 infection.Design:Cohort study.Setting:1,000-bed, urban teaching hospital in Atlanta, Georgia.Participants:Eighty-seven exposed HCWs who cared for two patients with TAC prior to the time they were isolated and a comparison group of 88 unexposed HCWs from wards or clinics where the patients did not receive care.Intervention:Self-administered questionnaire on hospital contact with index patients, B19 community risk factors, and signs and symptoms suggestive of B19 disease. Serology for B19-specific IgM and IgG antibodies measured by antibody-capture enzyme-linked immunosorbent assay.Results:1 (3.1%) of the 32 nonimmune exposed HCWs had serologic evidence of recent B19 infection compared to 3 (8.1%) of the 37 nonimmune HCWs in the comparison group (P=.6). In a subgroup analysis of exposed HCWs who cared for index patients during the time when the virus load was expected to be greatest, a recent infection rate of 5.8% (1/17) was found among nonimmune HCWs.Conclusions:The finding of similar rates of recent infection in nonimmune exposed and unexposed HCWs suggests that transmission to HCWs did not occur, despite failure to place the patients in isolation at the onset of hospitalization.
Nosocomial Infections and Pseudoinfections From Contaminated Bronchoscopes: Two-Year Follow Up Using Molecular Markers
Authors: Blanc D.S. , Parret T. , Janin B. , Raselli P. , Francioli P. 
Published: September 2009

AbstractDuring a 6-month period, two genetically distinct clones were isolated from 65% of patients with Pseudomonas aeruginosa isolated from bronchial specimens obtained during or after bronchoscopy. This epidemic was due to contamination of bronchoscopes by washing machines. After reintroduction of manual disinfection of endoscopes, a significant decrease in the incidence of the epidemic clones was observed, but the incidence of nonepidemic P aeruginosa did not change. The distinction between sporadic and epidemic cases was possible only with the use of a molecular typing method (ribotyping).
Outbreak Investigations
Authors: Beck-Sague Consuelo , Jarvis William R. , Martone William J. 
Published: September 2009

AbstractEpidemic nosocomial infections are defined as hospital-acquired infections that represent an increase in incidence over expected rates. Epidemic-associated infections usually are clustered temporally or geographically, suggesting that the infections are from a common source or are secondary to increased person-to-person transmission. Epidemics are important, because they account for a substantial percentage of nosocomial infections. Furthermore, if infection control personnel thoroughly investigate outbreaks of nosocomial infections, they may identify new agents, reservoirs, or modes of transmission.
Possible Nosocomial Transmission of Psittacosis
Authors: Hughes Carolyn , Maharg Pat , Rosario Peter , Herrell Michael , Bratt Donna , Salgado Jose , Howard David 
Published: September 2009

AbstractObjectives:To investigate a cluster of seven pneumonia cases among persons exposed to a pet-shop worker hospitalized with psittacosis.Design:Epidemiological study of the outbreak, sero-diagnostic evaluation of exposed persons with pneumonia; and retrospective review of the pneumonia cases.Setting:450-bed teaching community hospital.Participants:Employees of the nursing unit where the patient with psittacosis was hospitalized.Results:The index case had laboratory and clinical evidence of psittacosis. Four of the seven exposed persons who developed pneumonia had serologic results that met criteria for a diagnosis of psittacosis, and three met criteria for Chlamydia pneumoniae infection, possibly reflecting cross-reactivity between the microimmunofluo-rescence assays for the two diseases. The epidemiological graph suggested a relationship between the index case and the cluster of pneumonias in exposed individuals.Conclusions:Psittacosis may have been transmitted person to person in a hospital setting.
Influenza Vaccination of Healthcare Workers
Authors: Nichol Kristin L. , Hauge Meri 
Published: September 2009

AbstractObjective:To assess factors associated with influenza vaccination of healthcare workers.Design:Cross-sectional survey.Setting:University-affiliated Veterans' Affairs medical center.Participants:Staff physicians and nurses employed by the medical center.Methods:A mailed, self-administered questionnaire.Results:The response rate was 38.0%. The mean age of the respondents was 43.6 years, 71.5% were females, and 26.2% were physicians. Nearly all of the practitioners had daily or weekly contact with elderly or high-risk patients. The influenza vaccination rate of the respondents was 61.2%. More than 50% of vaccine recipients indicated that avoiding illness, protecting patients, and being able to receive the vaccine conveniently and free of charge all were very important factors influencing their decisions to receive the vaccine. Avoiding illness was rated the most important factor by 58.8% of vaccine recipients. Among vaccine nonrecipients, concern about side effects was identified as a very important factor by 36.2% and as the most important factor by 30.9%.Vaccine recipients were significantly more likely than were vaccine nonrecipients to indicate that influenza and its complications are very serious for high-risk patients. They also were more likely to report that the vaccine is very effective, that influenza vaccination is uncommonly associated with side effects, that healthcare workers' risk for contracting influenza is higher than the general public's risk, and that it is very important for healthcare workers to receive the vaccine to decrease risk for transmission to high-risk patients. After stepwise logistic regression, variables independently associated with receipt of vaccine were age, prior receipt of vaccine, being a physician, considering the vaccine to be very effective, believing that systemic side effects are uncommon, and indicating that it is very important for healthcare workers to receive vaccine for the protection of their patients.Conclusion:Many healthcare workers fail to receive influenza vaccine each year. Strategies to improve immunization levels should address concerns about vaccine safety and efficacy, barriers to vaccination including inconvenience and cost, and the reasons for targeting healthcare workers.
Negotiating With Administration—Or How to Get Paid for Doing Hospital Epidemiology
Authors: Deery H. Gunner 
Published: September 2009

AbstractMany hospital administrators acknowledge the value of a hospital epidemiologist. However, many hospital epidemiologists are not being paid for their work. To eliminate this inequity, hospital epidemiologists must negotiate contractual relationships successfully with their hospitals or healthcare systems. This article reviews an approach to rectifying this problem that is based on practical experience.
The Risk of Peripheral Vein Phlebitis Associated With Chlorhexidine-Coated Catheters A Randomized, Double-Blind Trial
Authors: Sherertz Robert J. , Stephens Jeffrey L. , Marosok Randy D. , Carruth William A. , Rich H. Anne , Hampton Kenneth D. , Motsinger Sandy M. , Harris Lynnette C. , Scuderi Philip E. , Pappas James G. , Felton Steven C. , Solomon Donald D. 
Published: September 2009

AbstractObjective:To evaluate the risk of phlebitis associated with chlorhexidine-coated polyurethane catheters in peripheral veins.Design:A randomized, double-blinded trial comparing chlorhexidine-coated polyurethane catheters with uncoated polyurethane catheters.Setting:A university hospital.Patients:Adult medicine and surgery patients.Interventions:Certified registered nurse anesthetists or an infusion team consisting of nurses and physicians inserted the catheters. Catheter insertion sites were scored twice daily for evidence of phlebitis. At the time catheters were removed, a quantitative blood culture was performed, and catheters were sonicated for quantitative culture.Results:Of 221 evaluable catheters, phlebitis developed in 18 (17%) of 105 coated catheters, compared to 27 (23%) of 116 uncoated catheters (relative risk [RR], 0.74; 95% confidence interval [CI95], 0.43-1.26; P=.32). By survival analysis, chlorhexidine-coated catheters had a lower risk of phlebitis during the first 3 days (P=.06), but not when all catheters were considered in both patient groups (P=.31). In the absence of catheter colonization, the incidence of phlebitis was 21% (16/76) and 24% (20/86) for coated and uncoated catheters, respectively (P=.85), whereas in the presence of catheter colonization, the incidence of phlebitis was 14% (1/7) and 80% (4/5) for coated and uncoated catheters, respectively (RR, 0.18; CI95, 0.03-1.15; P=.07).Conclusion:The risk of phlebitis in the presence of catheter colonization was 82% lower for chlorhexidinecoated polyurethane catheters compared to otherwise identical uncoated catheters.
Accidental Blood Contact During Orthopedic Surgical Procedures
Authors: Folin Ann C. , Nordström Gun M. 
Published: September 2009

AbstractA questionnaire study was carried out of all orthopedic surgical procedures in the operating rooms of a teaching hospital over an 8-week period to describe the frequency and circumstances of accidental blood contact. Blood exposure occurred in 11% of the procedures. Contamination of intact skin was the most common incident (79%); percutaneous injury occurred in 13%. The majority of the incidents were believed to be preventable.
Skin Testing for Tuberculosis in University Teaching Hospitals—Is There a Problem?
Authors: Mabon Barbara L. , Ciardi Beth , Nouri Kathi , Ruben Frederick L. 
Published: September 2009

AbstractWe performed four annual audits of tuberculin tests performed on hospitalized patients at a university teaching hospital complex. Each audit assessed if tests were performed and read correctly. House staff performed skin testing in years 1 to 3. Despite inter ventions of teaching and then of written instructions on skin testing, performance was poor. When testing was turned over in year 4 to trained infection control practitioners, performance approached 100%. We conclude that university teaching hospitals should assess skin-testing performance