bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methicillin-Resistant Staphylococcus aureus in U.S. Hospitals, 1975–1991
Authors: Panlilio Adelisa L. , Culver David H. , Gaynes Robert P. , Banerjee Shailen , Henderson Tonya S. , Tolson James S. , Martone William J. ,   National Nosocomial Infections Surveillance System
Published: September 2009

AbstractObjectives:Analyze changes that have occurred among U.S. hospitals over a 17-year period, 1975 through 1991, in the percentage of Staphylococcus aureus resistant to b-lactam antibiotics and associated with nosocomial infections.Design:Retrospective review. The percentage of methicillin-resistant S aureus (MRSA) was defined as the number of S aureus isolates resistant to either methicillin, oxacillin, or nafcillin divided by the total number of S aureus isolates for which methicillin, oxacillin, or nafcillin susceptibility test results were reported to the National Nosocomial Infections Surveillance (NNIS) System.Setting:NNIS System hospitals.Results:Of the 66,132 S aureus isolates that were tested for susceptibility to methicillin, oxacillin, or nafcillin during 1975 through 1991, 6,986 (11%) were resistant to methicillin, oxacillin, or nafcillin. The percentage MRSA among all hospitals rose from 2.4% in 1975 to 29% in 1991, but the rate of increase differed significantly among 3 bed-size categories: <200 beds, 200 to 499 beds, and 2500 beds. In 1991, for hospitals with <200 beds, 14.9% of S aureus isolates were MRSA, for hospitals with 200 to 499 beds, 20.3% were MRSA; and for hospitals with >500 beds, 38.3% were MRSA. The percentage MRSA in each of the bed-size categories rose above 5% at different times: in 1983, for hospitals with 2500 beds; in 1985, for hospitals with 200 to 499 beds; and in 1987, for hospitals with <200 beds.Conclusions:This study suggests that hospitals of all sizes are facing the problem of MRSA, the problem appears to be increasing regardless of hospital size, and control measures advocated for MRSA appear to require re-evaluation. Further study of MRSA in hospitals would benefit our understanding of this costly pathogen.
A Cluster of Vancomycin-Resistant Enterococcus faecium in an Intensive Care Unit
Authors: Karanfil Lynne V. , Murphy Mary , Josephson Adele , Gaynes Robert , Mandel Laura , Hill Bertha C. , Swenson Jana M. 
Published: September 2009

AbstractObjective:To describe the epidemiology of a cluster of vancomycin-resistant Enterococcus faecium (VAREC) in a cardiothoracic surgery intensive care unit.Design:A case series of patients identified through review of surveillance data on nosocomial infections, review of microbiologic records, and culture survey of patients in the unit.Results:Six patients in the cardiothoracic surgery intensive care unit had VAREC with identical antimicrobic susceptibility patterns over a 6-month period. Four patients were identified with VAREC through prospective surveillance and 2 through retrospective review. Prior vancomycin use was seen more commonly in patients with VAREC (6/6,100%) than in those without VAREC (3/12, 25%) (Fisher’s exact test, p= .01). Six of the 7 patients with prior infection developed VAREC (85.7%). A prior nosocomial infection and prior exposure to vancomycin were found to be important variables in a logistic regression analysis. VAREC also was isolated from the environment. Acombination of cohorting of patients and staff, and modifications of standard contact isolation practices eliminated the presence of VAREC from the cardiothoracic surgery intensive care unit.Conclusions:The results suggest that prior administration of vancomycin, especially in the patient who develops nosocomial infection, can influence the acquisition of vancomycin-resistant enterococci and that VAREC may be transmitted from patient to patient. Using a modification of the standard infection control practice of isolation, we were able to control the spread of this resistant strain of E faecium.
Epidemiology of Measles Immunity in a Population of Healthcare Workers
Authors: Kim Mary , LaPointe Judith , Liu Francis J.G. 
Published: September 2009

AbstractObjective:To evaluate epidemiologic factors that can be used to predict lack of measles immunity in healthcare workers.Design:During mandatory screening of employees for measles antibody, a questionnaire was used to collect demographic information.Setting:Inpatient hospital, acute care clinics, and skilled nursing facility of a health maintenance organization.Participants:Employees of all ages and occupations.Results:Measles immunity could not be predicted from history of measles disease and vaccination, gender, or birthplace. Of nonimmune employees, 63.7% were in the 20- to 29-year-old age group and 26.5% were in the 30-to 39-year-old age group.Conclusions:Age is the most clinically Significant predictor of measles antibody, especially in persons born after 1950, who make up a large group susceptible to measles.
Aspects of Truth: Statistics, Bias, and Confounding
Authors: Burmeister Leon F. , Sheps Sam , Birnbaum David 
Published: September 2009

Conclusions drawn from research can be true, can be distortions resulting from bias or confounding, or can be untrue because of random chance. The essential role of epidemiology is to provide an approach to the appraisal of data concerning health and disease in order to discern the truth.The first article in this series discussed issues of validity and reliability in relation to diagnostic testing. A second article considered statistical concepts in the special case of inferring that a null hypothesis is true. This article will consider related aspects of research design, analysis, and the logic of scientific thought, while the next article in the series will discuss the role of confidence intervals in the analysis and interpretation of data.
Scabies in Long-Term Care Facilities
Authors: Bentley David W. , Degelau John 
Published: September 2009

The common parasitic infestation of scabies is an international microscopic terrorist, frequently occurring in long-term care facilities. Disruptive outbreaks have been reported in long-term care facilities throughout North America, Europe, and Israel. Once scabies is reported, the normal operations of a facility may be disrupted for several months at a time. Psychogenic scabies, threatened mass resignations of staff, and extensive local media coverage have been unwelcome sequelae of long-term care facility outbreaks.When confronted with an infestation, nursing staff and management are frequently left on their own to come up with a plan to eradicate the infestation. This may result in either inadequate treatment of infected individuals or excessive measures for the long-term care facility, such as closing admissions, banning visitors, and periodic mass “prophylaxis” treatment. Effective and efficient management of scabies outbreaks requires knowledge of the unique features of long-term care scabies and a systematic, yet practical, approach to treatment.
A Study of the Etiologies and Treatment of Nosocomial Pneumonia in a Community-Based Teaching Hospital
Authors: Schleupner Charles J. , Cobb David K 
Published: September 2009

AbstractObjective:To compare the frequency of the pathogens of nosocomial pneumonia in a community-based teaching hospital to the frequencies previously published, and to evaluate recommendations for the therapy of nosocomial pneumonia in this setting.Design:Retrospective review of prospectively acquired data accrued during 9 randomized single-blinded and 4 single-agent investigational antibiotic studies for the therapy of pneumonia in hospitalized patients between 1981 and 1989.Setting:The study was performed at a university affiliated, community-based teaching Department of Veterans Affairs Medical Center.Patients:Patients were hospitalized on the acute medical/surgical and intermediate medicine wards. Informed consent was obtained prior to enrolling patients into the respective antimicrobial studies. Pneumonia was documented radiographicahy and clinically for each patient.Results:Two hundred thirty-one episodes of nosocomial pneumonia were treated. Overall, 51% of pneumonias were caused by Streptococcus pneumoniae or Hemophilus influenzae with or without other organisms that were not gram-negative bacilli. Gram-negative bacilli, with or without other organisms, accounted for only 26% of all nosocomial pneumonias. Overall, monotherapy with a cephalosporin (usually a broad-spectrum agent) was equally efficacious compared with combination therapy (87% versus 81%, respectively). Cure rates for nosocomial pneumonias from gram-negative bacilli treated with these 2 therapies also were similar (70% versus 60%, respectively).Conclusions:In nontertiary care settings, gram-negative bacilli may cause fewer episodes of nosocomial pneumonia (26% in this study) than noted by previously published reports, which indicated that these organisms account for 50% of nosocomial pneumonias. Further, S pneumoniae and H influenzae may account etiologicahy for many of these nosocomial pneumonias. Monotherapy with an extended-spectrum cephalosporin may be more appropriate than combined treatment with a b-lactam and an aminoglycoside in a nontertiary care setting, thereby reducing potential toxicity in an older, hospitalized patient population.
The Merits of Confidence Intervals Relative to Hypothesis Testing
Authors: Burmeister Leon  F. , Bimbaum David , Sheps Samuel B. 
Published: September 2009

A variety of statistical tests of a null hypothesis commonly are used in biomedical studies. While these tests are the mainstay for justifying inferences drawn from data, they have important limitations. This report discusses the relative merits of two different approaches to data analysis and display, and recommends the use of confidence intervals rather than classic hypothesis testing.Formulae for a confidence interval surrounding the point estimate of an average value take the form: d= ±zσ/√n, where “d” represents the average difference between central and extreme values, “z” is derived from the density function of a known distribution, and “a/-∨n” represents the magnitude of sampling variability. Transposition of terms yields the familiar formula for hypothesis testing of normally distributed data (without applying the finite population correction factor): z = d/(σ/√n).
Secondary Measles Vaccine Failure in Healthcare Workers Exposed to Infected Patients
Authors: Ammari Linda K. , Bell Louis M. , Hodinka Richard L. 
Published: September 2009

AbstractObjective:To describe 4 healthcare workers who developed measles despite pre-existing antimeasles antibody levels.Design:Hospital employees working in patient care areas from July through November 1990 were screened for measles antibody levels using a commercially available enzyme immunoassay (EIA). The clinical course and laboratory evaluation of the 4 healthcare workers who developed measles were reviewed.Setting:An academic tertiary care children's hospital.Participants:A convenience sample of resident physicians, nurses, ward clerks, Child Life workers, physical and occupational therapists, radiology technicians, and housekeeping staff were screened regardless of age, immunization status, or history of measles infection.Results:Of 1,311 employees working in patient care areas, 900 (68.6%) had sera tested for measles antibody. Fourteen (1.5%) were negative, 338 (37.6%) had low-positive antibody levels, 372 (41.3%) were mid-positive, and 171 (19%) were high-positive; 5 (0.6%) showed equivocal results. Four healthcare workers vaccinated in the past developed measles. All had positive pre-illness measles antibody levels and all had a significant rise in measles-specific IgG following infection. Three of them had received at least 2 live measles vaccinations prior to caring for patients with measles.Conclusions:These cases raise concerns regarding detection of adequate protective measles immunity. We recommend that all healthcare workers observe respiratory precautions in caring for patients with measles.
The Affinity Between Continuous Quality Improvement and Epidemic Surveillance
Authors: Brewer Joseph H. , Gasser Carolyn S. 
Published: September 2009

AbstractObjective:To discuss the close affinity between the continuous quality improvement (CQI) concept of monitoring a process for the introduction of special causes and epidemic surveillance.Design:A case study of a CQI tool for infection control epidemic surveillance.Setting and Patients:A 668-bed acute care hospital with 5 intensive care units supporting heart, liver transplant, and trauma teams. The infection control department consists of 2.5 full-time employee nurse epidemiologists and a medical director who is an infectious disease specialist.Results:The outbreak investigation illustrates principles of CQI and their relationship to epidemic surveillance through the use of applied statistical methods.Conclusions:The expanding role of hospital epidemiology is enhanced by applying CQI concepts to improving health care. The application of epidemiologic tools and principles to the problems of nosocomial infections is strongly connected to the CQI concept of using dependable data to improve processes.
Validation of Surgical Wound Surveillance
Authors: Cardo Denise M. , Falk Pamela S. , Mayhall C. Glen 
Published: September 2009

AbstractObjective:To determine the sensitivity and specificity of standard infection control surveillance techniques for the identification of surgical wound infections.Design:Surveillance data collected by three infection control practitioners (ICPs) was compared to surveillance data collected simultaneously by a gold standard observer.Setting:University-affiliated, tertiary care hospital.Methods:Using standard infection control surveillance techniques (chart review and discussions with patients' nurses and physicians), ICPs collected surveillance data on patients on the General Surgery and Trauma Surgery Services on days 4 and 7 after surgery and then weekly for 30 days or until patients were discharged from the hospital. Simultaneously, a hospital epidemiologist collected surveillance data and examined each patient's wound daily.Results:Nine hundred twenty-five surgical patients including 537 trauma cases and 388 elective general surgery cases were followed postoperatively. The ICPs identified 67 surgical wound infections, and the hospital epidemiologist identified 80 surgical wound infections for a sensitivity of 83.8% with a 95% confidence interval (CI95) of 75.7% to 91.9%. Specificity was 99.8% with a CI95 of 99% to 100%. The sensitivity was the same for trauma surgery and general surgery, but incisional wound infections were more difficult to identify than deep wound infections. During a second validation period, sensitivity was 92.3% with a CI95 of 62% to 100%.Conclusions:Standard infection control surveillance techniques have the same sensitivity for detection of surgical wound infections as they do for identification of other nosocomial infections. Accurate data on surgical wound infections can be collected without direct examination of surgical wounds.
A Survey of Hospital Postpartum and Postabortion Rubella Vaccination Policies in Los Angeles County, 1992
Authors: Garcia Diana G. , Ewert Donnell P. , Mascola Laurene 
Published: September 2009

AbstractObjective:To determine the proportion of Los Angeles County (LAC) hospitals offering obstetrical services that have postpartum and postabortion rubella vaccination policies.Design:A survey was sent to the infection control practitioners (ICPs) of all operational acute care hospitals (N = 133) in LAC in 1992. A reminder and second survey was mailed to ICPs who did not respond to the first mailing.Results:Of 75 hospitals with obstetrical departments, 56 (75%) responded. Thirty-four (61%) of the 56 respondent hospitals had postpartum rubella vaccination policies. Of the 34 hospitals with policies, 30 (88%) accepted only a written record of rubella seropositivity as proof of immunity, 30 (88%) screened women with unknown immunity status before hospital discharge, and 32 (94%) vaccinated susceptible women before hospital discharge. Of the 32 hospitals that performed induced abortions, only two (6%) provided screening and vaccination services for these women.Conclusion:Only 61% of hospitals in LAC offering obstetrical services had postpartum rubella vaccination policies while only minimal screening and vaccination occurred in association with abortion services. Widespread implementation of postabortion screening and vaccination, and more stringent compliance with Advisory Committee on Immunization Practices recommendations for postpartum screening and vaccination in hospitals offering obstetrical services would reduce the number of rubella-susceptible women who have been missed by other prevention strategies.
Intervention to Discontinue Parenteral Antimicrobial Therapy in Hospitalized Patients with Urinary Tract Infection, Skin and Soft Tissue Infection, or No Evident Infection
Authors: Ehrenkranz N. Joel , Nerenberg Debra E. , Slater Kenneth C. , Shultz James M. 
Published: September 2009

AbstractObjectives:In a previous study, we found that unsolicited recommendations to physicians of medically stable patients with pneumonia to suspend parenteral antimicrobials shortened hospital length of stay (LOS) significantly. In this study, we made similar recommendations to physicians treating patients with different indications for parenteral antimicrobials, to examine the effect on LOS.Methods:A nurse-interventionist presented randomly assigned physicians with nonconfrontational suggestions to discontinue parenteral antimicrobials by substituting comparable oral antimicrobials or stopping treatment. Patients were being treated for urinary tract infection, skin infection, or no evident infection. Blinded observers evaluated in-hospital and 30-day postdischarge patient courses. Methodologies were identical to the previous study.Results:There were 70 physician-patient episodes (49 intervened episodes, 21 control episodes). In 44 episodes (90%), compliant physicians discontinued parenteral antimicrobials. Compared to a median postrandomization LOS of 2.5 days (range, 0 to 40.5) for 21 patients of control physicians, the corresponding LOS for 44 patients of compliant physicians was two days (range, 0 to 8; P= 1.0), and for five patients of noncompliant physicians, five days (range, 3 to 11; P= 0.04).The combined occurrence of all adverse events detected in this and the previous study was 11% for patients of control physicians, compared to 14% for patients of compliant physicians (P= 0.2), and 19% for patients of noncompliant physicians (P<0.05).Conclusions:For patients of compliant physicians hospitalized with urinary tract infection, skin and soft tissue infection, or no evident infection, cessation of parenteral antimicrobials did not significantly shorten LOS, due to brief LOS of patients of control physicians. Patients of noncompliant physicians experienced more adverse events and prolonged LOS. The appropriateness of routine continuous use of parenteral antimicrobials in medically stable inpatients is questioned.
The Epidemiology of Needlestick and Sharp Instrument Accidents in a Nigerian Hospital
Authors: Adegboye Ajibola A. , Moss Gregory B. , Soyinka Femi , Kreiss Joan K. 
Published: September 2009

AbstractObjectives:To characterize the epidemiology of percutaneous injuries of healthcare workers (HCWs) in Ile-Ife, Nigeria.Design:A cross-sectional survey of a randorn sample of HCWs regarding details of needle-stick and sharp instrument injuries within the previous yearSetting:University hospital and clinics in Ile-Ife, Nigeria.Participants:Hospital personnel with potential occupational exposure to patients' blood.Results:Needlestick accidents during the previous year were reported by 27% of 474 HCWs, including 100% of dentists, 81% of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff. The rate of needlestick injuries was 0.6 per person-year overall: 2.3 for dentists, 2.3 for surgeons, 0.4 for nonsurgical physicians, and 0.6 for nursing staff. Circumstances associated with needlestick injuries included unexpected patient movement in 29%, handling or disposal of used needles in 23%, needle recapping in 18%, accidental stick by a colleague in and needle disassembly in 10%. Sharp instrument injuries were reported by 15% of and most commonly involved broken glass patient specimen containers (39%). Almost all were aware of the potential risk of HIV transmission through percutaneous injuries, and 91% considered themselves very concerned about their occupational risk of HIV acquisition.Conclusions:The high frequency of percutaneous exposure to blood among HCWs in this Nigerian hospital potentially could be reduced by simple interventions at modest cost.
Effectiveness of Liquid Soap vs. Chlorhexidine Gluconate for the Removal of Clostridium difficile from Bare Hands and Gloved Hands
Authors: Bettin Kris , Clabots Connie , Mathie Pamela , Willard Keith , Gerding Dale N. 
Published: September 2009

AbstractObjective:To compare liquid soap versus 4% chlorhexidine gluconate in 4% alcohol for the decontamination of bare or gloved hands inoculated with an epidemic strain of Clostridium difficile.Design:C difficile (6.7 log10 colony-forming units [CFU], 47% spores), was seeded onto bare or latex gloved hands of ten volunteers and allowed to dry. Half the volunteers initially washed with soap and half with chlorhexidine, followed by the other agent 1 week later. Cultures were done with Rodac plates at three sites on the hand: finger/thumbtips, the palmar surfaces of the fingers, and the palm. Statistical comparison was by paired Student’s t test.Results:On bare hands, soap and chlorhexidine did not differ in residual bacterial counts on the finger/thumbtips (log10 CFU, 2.0 and 2.1, P= NS) and fingers (log10 CFU, 2.4 and 2.5, P=NS). Counts were too high on bare palms to quantitate. On gloved hands, soap was more effective than chlorhexidine on fingers (log10 CFU 1.3 and 1.7, P<.01) and palms (log10 CFU 1.5 and 2.0, P<.01), but not finger/thumbtips (log10 CFU 1.6 with each, P=NS). Residual C difficile counts were lower on gloved hands than bare hands (P<0.01 to <0.0001).Conclusions:The two agents did not differ significantly in residual counts of C difficile on bare hands, but on gloved hands residual counts were lower following soap wash than following chlorhexidine wash. These observations support the use of either soap or chlorhexidine as a handwash for removal of C difficile, but efficacy in the prevention of C difficile transmission must be determined by prospective clinical trials.
Surveillance for Surgical Site Infections: The Uses of Antibiotic Exposure
Authors: Yokoe Deborah S. , Platt Richard 
Published: September 2009

AbstractConventional methods of surveillance for surgical site infections are resource intensive, thus creating an incentive to develop simpler alternatives. Antibiotic exposure may serve as a satisfactory marker for a physician’s belief that infection is present and, therefore, may be a more efficient, and perhaps more accurate, measure than identification of an explicit diagnosis in the medical record. Surveillance strategies that use antibiotic exposure may provide resource-efficient adjuncts for surveillance of surgical site infections or be used in selected circumstances as substitutes for conventional surveillance methods.
Contaminated Collection Media as a Cause of Pseudoinfection
Authors: Schiappacasse Richard H. , Ritter Sharon , Schleis Cynthia , Backman Carole , Pierzchala Janis 
Published: September 2009

AbstractFollowing the appearance of positive Gram's stains from sterile surgical cases, an investigation was begun. Nonviable but stainable bacteria were found in the gel-based transport media. The use of a cause-and-effect diagram helped to show the numerous items that affected the problem.