bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Rate of Tuberculin Skin Test Conversion Among Workers at a University Hospital
Authors: Ramirez Julio A. , Anderson Pamela , Herp Sharon , Raff Martin J. 
Published: September 2009

AbstractObjectives:To summarize the results of an investigation of increased rates of tuberculin skin test conversion in employees at a university hospital.Design:The results of annual tuberculin skin tests performed on all 1,845 hospital employees from 1986 to 1991 were reviewed.Setting:A 450-bed acute tertiary care university hospital.Results:The rate of tuberculin skin test conversion was 0.35% (standard deviation ± 0.15) from 1986 to 1989 and increased to 1.7% during 1991. Investigation revealed deviations from the Centers for Disease Control (CDC) guidelines for tuberculosis control, which included the failure to consider tuberculosis as a probable cause of community-acquired pneumonia and the failure to initiate isolation precautions when tuberculosis was suspected.Conclusions:The epidemic appeared to be secondary to delays in diagnosis and isolation of patients with pulmonary tuberculosis. Future control measures should include isolation of all hospital patients admitted with pneumonia until tuberculosis has been excluded.
A Comparison of Clinical Virulence of Nosocomially Acquired Methicillin-Resistant and Methicillin-Sensitiye Staphylococcus aureus Infections in a University Hospital
Authors: Hershow Ronald C. , Khayr Walid F. , Smith Nina L. 
Published: September 2009

AbstractObjectives:To compare the clinical virulence of nosocomially acquired methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S aureus (MSSA) infections in 1989.Design:A retrospective comparison of host factors, in-hospital exposures, sites of infections, and outcomes of patients with nosocomial MRSA and MSSA infections.Setting:University of Illinois Hospital, Chicago, Illinois.Participants:Forty-four adult patients with nosocomial S aureus infections.Results:The 22 MRSA-infected and 22 MSSA-infected persons were similar regarding mean age, gender, underlying diseases, and exposure to surgery. Before developing infection, MRSA-infected persons were more likely to have received antibiotics (73% compared with 27%, odds ratio = 7.1, 95% confidence interval [CI95] = 2.0-25.8 p = .003) and to have stayed in the hospital >2 weeks (64% compared with 18%, odds ratio = 7.9, CI95 = 2.0-31.6, p = .002). Bacteremia was the most common presentation in the MRSA and MSSA groups (55% and 59%, respectively). Infectious complications and death were infrequent in both groups.Conclusions:MRSA and MSSA strains infect patients with similar demographic features and underlying diseases, but MRSA infections are significantly more common among patients with previous antibiotic therapy and a prolonged preinfection hospital stay. Clinical presentations and outcomes did not differ significantly between the 2 groups. Thus, similar to studies in the early 1980s, our findings do not suggest greater intrinsic virulence of MRSA.
Investigation of a Computer Virus Outbreak in the Pharmacy of a Tertiary Care Teaching Hospital
Authors: Bailey Thomas C. , Reichley Richard M. 
Published: September 2009

AbstractObjective:A computer virus outbreak was recognized, verified, defined, investigated, and controlled using an infection control approach. The pathogenesis and epidemiology of computer virus infection are reviewed.Design:Case-control study.Setting:Pharmacy of a tertiary care teaching institution.Results:On October 28, 1991, 2 personal computers in the drug information center manifested symptoms consistent with the “Jerusalem” virus infection. The same day, a departmental personal computer began playing ‘Yankee Doodle,” a sign of “Doodle” virus infection. An investigation of all departmental personal computers identified the “Stoned” virus in an additional personal computer. Controls were functioning virus-free personal computers within the department. Cases were associated with users who brought diskettes from outside the department (5/5 cases versus 5/13 controls, p = .04) and with College of Pharmacy student users (3/5 cases versus 0/13 controls, p = .012). The detection of a virus-infected diskette or personal computer was associated with the number of 5 1/4-inch diskettes in the files of personal computers, a surrogate for rate of media exchange (mean= 17.4 versus 152.5, p = .018, Wilcoxon rank sum test). After education of departmental personal computer users regarding appropriate computer hygiene and installation of virus protection software, no further spread of personal computer viruses occurred, although 2 additional Stoned-infected and 1 Jerusalem-infected diskettes were detected.Conclusions:We recommend that virus detection software be installed on personal computers where the interchange of diskettes among computers is necessary, that write-protect tabs be placed on all program master diskettes and data diskettes where data are being read and not written, that in the event of a computer virus outbreak, all available diskettes be quarantined and scanned by virus detection software, and to facilitate quarantine and scanning in an outbreak, that diskettes be stored in organized files.
Consensus Paper on the Surveillance of Surgical Wound Infections
Authors:   The Society for Hospital Epidemiology of America,   Association for Practitioners in Infection Control,   Centers for Disease Control,   Surgical Infection Society
Published: September 2009

AbstractA Surgical Wound Infection (SWI) Task Force was convened by The Society for Hospital Epidemiology of America (SHEA) to evaluate how SWI surveillance should be done and to identify where more information is needed. The Task Force reached consensus in the following areas. The Centers for Disease Control (CDC) definitions of SWI should be used for routine surveillance because of their current widespread acceptance and reproducibility. The CDC definitions have been clarified in an accompanying article (“Report From the CDC”). Direct observation of wounds and traditional infection control surveillance techniques are acceptable methods of case finding for hospitalized patients. The optimal method for case finding postdischarge or after outpatient surgery is unknown at this time. SWI rates should be stratified by surgical wound class plus a measure of patient susceptibility to infection, such as the American Society of Anesthesiology (ASA) class, and duration of surgery Surgeon-specific SWI rates should be calculated and reported to individual surgeons.
Seroprevalence of Antibodies to Hepatitis C Virus in High-Risk Hospital Personnel
Authors: Cooper Brian W. , Krusell Allan , Tilton Richard C. , Goodwin Randolph , Levitz Robert E. 
Published: September 2009

AbstractObective:To estimate seroprevalence of antibodies to hepatitis C virus in healthcare workers at high risk for blood exposure.Design:A prospective anonymous seroprevalence survey of 243 healthcare workers.setting:A large referral hospital and 2 community hospitals in Connecticut.Participants:Healthcare workers, including surgical personnel, dentists, hemodialysis workers, laboratory workers, and emergency room staff.Results:Antibody to hepatitis C virus was found in 1.6% (95% confidence interval [CI95] = 03.2%) of healthcare workers. None of the prevalent seropositives had a past history of clinical hepatitis or blood transfusion.Conclusions:We conclude that the sero-prevalence of hepatitis C virus in healthcare workers with a high degree of blood exposure is low and is similar to seroprevalence rates reported for volunteer blood donors. However, first-generation hepatitis C serologic tests may underestimate the true prevalence of infection. Further studies, including prospective cohort studies, will be required to determine if the low seroprevalence is from low risk of acquisition of disease or from loss of measurable humoral antibody response to the virus.
Molecular Epidemiology of Coagulase-Negative Staphylococci Isolated From Immunocompromised Patients
Authors: Herwaldt Loreen A. , Hollis Richard J. , Boyken Linda D. , Pfaller Michael A. 
Published: September 2009

Abstractobjective:To define the source of invasive coagulase-negative staphylococci (CNS) and the epidemiology of strain variation in immunocompromised patients.Design:Weekly microbial surveillance cultures were obtained from the nares, throat, skin, rectum, and urine. Plasmid pattern analysis was performed on all coagulase-negative staphylococci isolated from blood cultures and on selected strains from the surveillance sites.Setitng:A 902-bed, university-owned, tertiary-care referral hospital.Participants:Forty-four patients on the bone marrow transplant or hematologic malignancy services.Results:Plasmid pattern analysis was performed on 340 surveillance isolates (median = 7 per patient) and 201 bloodstream isolates (median = 3 per patient). Patients were colonized with numerous unique strains (median= 5 per patient) of coagulase-negative staphylococci. The 44 patients had 108 episodes of positive blood cultures, 20 of which were preceded by colonization with the same strain. Isolation of the matching strain from surveillance cultures preceded the positive blood culture by 1 to 8 days in 9 episodes and 18 to 389 days in 11 episodes. The matching strain was isolated from the skin in only 6 (30%) of those episodes and from mucosal sites in 70%. Of the 108 episodes of positive blood cultures, 21 were identified as nosocomial bloodstream infections. Four of the 21 nosocomial bloodstream infections were preceded by colonization with the same strain. In all 4 episodes, the infecting strain was cultured from the nares before the blood cultures were obtained.Conclusions:Our results suggest that mucous membranes might be sources for strains of CNS causing bacteremia.
Reduction in the Incidence of Clostridium difficile-Associated Diarrhea in an Acute Care Hospital and a Skilled Nursing Facility Following Replacement of Electronic Thermometers with Single-Use Disposables
Authors: Brooks Steven E. , Veal Rebecca O. , Kramer Martin , Dore Laura , Schupf Nicole , Adachi Masasumi 
Published: September 2009

AbstractObjective:To determine if the spread of Clostridium difficile-associated diarrhea is related to the use of electronic thermometers in an acute hospital and a chronic healthcare facility.Design:After finding that a significant percentage (20.8%) of electronic rectal thermometer handles were contaminated with C difficile, all electronic thermometers were replaced with disposables. A before/after trial was conducted to determine if the change to disposable thermometers would reduce the incidence of C difficile-associated diarrhea.Setting:The study took place in a 343-bed acute hospital and a 538-bed skilled nursing facility.Patients:All patients who underwent routine microbiological evaluation for nosocomially acquired diarrhea over a l-year period were included in the study. Nosocomial diarrhea was defined as 3 or more loose stools per day for 2 consecutive days and/or abdominal findings such as pain, distention, and ileus occurring 3 or more days after admission.Results:During the 6-month postintervention period, the incidence of C difficile-associated diarrhea was reduced from 2.71/ 1,000 patient days to 1.76/ 1,000 patient days in the acute hospital and from 0.41/1,000 patient days to 0.1 1/1,000 patient days in the skilled nursing facility The protective effect of the intervention was statistically significant for both facilities.Conclusions:Replacement of electronic thermometers with single-use disposables significantly reduced the incidence of C difficile-associated diarrhea in both acute care and skilled nursing care facilities. Data suggest that the rectal route may be important in the transmission of C difficile in these settings.
Ehrlichiosis
Authors: Taylor Eric , Sinnott John T. 
Published: September 2009

Ehrlichiosis, a potentially life-threatening disease, is becoming more frequently diagnosed, especially in the southern United States. Symptomatically, the clinical picture closely resembles Rocky Mountain Spotted Fever, with the development of headache and fever following a tick bite. The putative causative agent is a tickborne rickettsial-like organism that shares many antigenic determinants with Ehrlichia canis, a known canine pathogen. This tickborne organism may in fact be E canis.This bacterium is an obligate intracellular organism that preferentially infects lymphocytes, monocytes, and neutrophils. Ehrlichiosis probably accounts for a significant portion of what was previously diagnosed “seronegative Rocky Mountain Spotted Fever” cases.’Our understanding of this new disease has increased dramatically since the first case of human illness attributable to E canis was diagnosed in 1986. Treatment is curative, and therapy, typically with tetracyclines, must be instituted early to avoid disease progression and even death.
Peracetic Acid Sterilization: A Timely Development for a Busy Healthcare Industry
Authors: Crow Sue 
Published: September 2009

Peracetic acid is a component of an equilibrium mixture that includes acetic acid, hydrogen peroxide, and water. Although it was first reported in 1902, not until years later did Greenspan and MacKellar find it to be bactericidal at 0.001%, fungicidal at 0.003%, and sporicidal at 0.30%.’ There are no specific data explaining how peracetic acid actually destroys the cell; it has been speculated that it functions like other peroxides and oxidizing agents. Block suggests that it destroys the chemosmotic function of the lipoprotein cytoplasmic membrane through dislocation or rupture of the cell wall.Peracetic acid is sporicidal at low temperatures, and it remains effective in the presence of some organic material. Sprossig stated that peracetic acid has advantages for disinfection and sterilization not found in any other agent. Block states that, “It would be desirable to have a chemical with the attributes of hydrogen peroxide-effective germicidal and sterilizing capabilities, no harmful decomposition products, and infinite water solubility-but with greater lipid solubility and freedom from deactivation by catalases and peroxidases. Such a compound exists. It is peracetic acid.” Fraser adds that, “A prime advantage of peracetic acid is that it is a nonfoaming, water-soluble liquid that is fast acting and nonderivatising, as well as environmentally accepted.”
Risk Factors for Epidemic Xanthomonas Maltophilia Infection/Colonization in Intensive Care Unit Patients
Authors: Villarino Margarita E. , Stevens Lane E. , Schable Barbara , Mayers Gwendolyn , Miller J. Michael , Burke John P. , Jarvis William R. 
Published: September 2009

AbstractObjective:To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization.Design:Surveillance and cohort study.Setting:A 470-bed tertiary trauma-referral community hospital.Patients:From January 1, 1988 to March 17, 1989,106 intensive care unit patients developed X maltophilia infection/colonization. We defined a case as any intensive care unit patient who, from July 15, 1988, through March 17, 1989 (epidemic period), had X maltophilia infection/colonization ≥48 hours after intensive care unit admission. We identified 45 case patients and 103 control patients (persons in the shock-trauma intensive care unit for ≥72 hours during the epidemic period who had no X maltophilia-positive culture).Results:Cases were significantly more likely to occur in the shock-trauma intensive care unit than in all other intensive care units combined. Mechanical ventilation, tracheostomy, being transported to the hospital by airplane, and receipt of a higher mean number of antimicrobials were risk factors for X maltophilia infection/colonization. Risk of X maltophilia infection/colonization was significantly greater among cases exposed to a patient with a X maltophilia surgical wound infection than among those without such exposure (relative risk= 1.3, p= .03). Animate and inanimate cultures revealed X maltophilia contamination of the hospital room of a patient with an X maltophilia surgical wound infection, of respiratory therapy equipment in this patient% room, of respirometers shared between patients, and of shock-trauma intensive care unit personnel’s hands. Related environmental and clinical isolates were serotype 10.Conclusions:Mechanically ventilated patients receiving antimicrobials in the shock-trauma intensive care unit were at increased risk of X maltophilia infection/colonization. Patients with draining X maltophilia surgical wound infections served as reservoirs for X maltophilia, and contamination of the respirometers and the hands of shock-trauma intensive care unit personnel resulted in patient-to-patient transmission of X maltophilia.
Determinants of Clean Surgical Wound Infections for Breast Procedures at an Oncology Center
Authors: Rotstein Coleman , Ferguson Richard , Cummings K. Michael , Piedmonte Marion R. , Lucey Joyce , Banish Anne 
Published: September 2009

AbstractObjective:To determine the clean surgical wound infection rate for breast procedures and the risk factors predisposing patients to these infections.Design:A survey study.Setting:Oncology center.Patients:A consecutive sample of adult female patients who underwent surgical breast procedures for suspected carcinoma of the breast. Patients undergoing excisional biopsy, lumpectomy, or mastectomy from January 1985 to January 1987 were included in the study.Intervention:Clean surgical wound infection rates were derived overall and for each procedure type. The medical records of all patients were then reviewed to extract data on patient characteristics and operative information in order to assess the risk factors for infection.Results:Among the breast procedures performed on 448 patients, the overall clean surgical wound infection rate was 8.7% (39/448). The clean surgical wound infection rate for each procedure type was as follows: biopsy 2.3%, lumpectomy 6.6%, and mastectomy 19%. In addition to the type of procedure, factors significantly (p< .05) associated with the development of clean surgical wound infection in the univariate analysis included: presence of surgical drains (p<.01); closed suction drainage (odds ratio [OR] = 16.5, 95% confidence interval [CI95] = 5.0-54.7); location of the drain (OR = 3.3, CI95= 1.7-6.6); prolonged preoperative stay (OR= 1.2, CI,, = 1.0-1.5); length of surgery (OR=2.2, CI95= 1.7-3.0); and greater mean age (OR= 1.6, CI,, = 1.2-2.1).Conclusion:Clean surgical wound infections are not uncommon in patients undergoing breast procedures. Factors relating to both the patient and operative techniques contribute to the clean surgical wound infection rate. Further consideration should be given to perioperative antibiotic prophylaxis for selected breast procedures, and the role of surgical drains should be reassessed.
The Application of Continuous Quality Improvement to Healthcare
Authors: Decker Michael D. 
Published: September 2009

Last month,’ we described Continuous Quality Improvement (CQI), a general model for quality in any organized activity. CQI grew out of the concepts of Statistical Process Control developed in the 1930s by statistician Walter Shewhart. Shewhart believed that by measuring the outputs of any process, one could differentiate between variation from random fluctuations and variation that represented a loss of control over the process. Processes whose outputs remained within their control limits were considered to be under control. Processes that transgressed their control limits were out of statistical control, and adjustments were needed to return the process to control. The workers responsible for the processes could make the needed measurements and maintain the control charts themselves, allowing rapid detection and correction of unacceptable variation and enhancing the workers' sense of responsibility for the quality of the product.A number of theoreticians, particularly W. Edwards Deming, Joseph M. Juran, and Philip B. Crosby, built on these concepts to develop CQI (also known as total quality management, total quality control, or industrial quality control). In CQI, quality is achieved through “a continuous effort by all members of the organization to meet the needs and expectations of the customer.” The term “customer” includes every person or group, within or outside the organization, who depends on the efforts or outputs of workers within the organization.
Evaluation of a Mechanical/Chemical Infectious Waste Disposal System
Authors: Jetté L.P. , Lapierre S. 
Published: September 2009

AbstractObjectives:The mechanical/chemical infectious waste disposal system (IWDS), model Z-5000 HC, manufactured by Medical SafeTEC Inc. (Indianapolis, Indiana) was evaluated for its ability to disinfect biomedical waste.Methods:The IWDS was operated with a sodium hypochlorite solution and tested with loads consisting of microbial cultures and blood. During and after processing, samples of liquid, milled solid waste, and leachate were collected to determine the efficacy of disinfection and the chemical by-products released. An inactivation factor was calculated. Aerosol emission was studied. All tests were done in triplicate.Results:Our results showed the expected level of disinfection (inactivation factor >5 log,,) for all tests carried out with Bacillus subtilis, Enterococcus faecalis, Candida albicans, and Serratia marcescens, and for most of the tests with Mycobacterium fortuitum and bacteriophages 0X174 and f2. Further tests performed in the absence of blood resulted in an inactivation factor 35 log,, for all tests with M fortuitum, but not for those of the milled solids with bacteriophage f2. Aerosols were found to escape the apparatus when the IWDS was operated in the absence of chlorine. The liquid effluent contained an average of 17,600, and 15 mg/l of free chlorine, chloramines, and trihalomethanes (THM), respectively. The air effluent contained 1.1 mg/m3 of total chlorine and 1.4 kg/m3 of THM.Conclusions:Under our study conditions and except for certain tests with bacteriophage f2, the IWDS reduced the microbial populations tested by a factor of 5 log10. The aerosol dispersion problem remains to be solved, and the significance of the chemical by-products released will require further investigation.
Delayed Detection of an Increase in Resistant Acinetobacter at a Detroit Hospital
Authors: Johnson David R. , Love-Dixon Melinda A. , Brown William J. , Levine Donald P. , Downes Frances P. , Hall William N. 
Published: September 2009

AbstractObjective:To study an increase of antimicrobial-resistant Acinetobacter baumannii and to assess reasons for the delayed detection of this increase.Design:Review of medical, laboratory, and infection control records. Plasmid profile analysis of available A baumannii isolates.Setting:A 340-bed trauma and intensive care hospital in Detroit, Michigan.Results:The number of hospitalized patients with resistant A baumannii increased during late 1989 and early 1990: 4 in September, 10 in October, 12 in November, 18 in December, and 23 in January (chi square for trend = 14.6, p= .0001). Forty-four (66%) of the 67 patients culture-positive for resistant A baumannii had respiratory tract colonization or infection. Of 11 resistant isolates, 6 had a similar plasmid profile and 5 had no plasmids. Under the hospital's targeted surveillance system, only positive cultures from blood or wounds were investigated; this largely respiratory increase of resistant A baumannii went unrecognized until January 1990.Conclusions:Antimicrobial resistance in A baumannii is an important concern. Such resistance is not necessarily plasmid mediated. Tar geted surveillance for this and other agents of nosocomial infection should be used with caution, particularly in hospitals with many debilitated patients.