bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nosocomial Respiratory Tract Colonization and Infection with Aminoglycoside-Resistant Acinetobacter calcoaceticus var anitratus: Epidemiologic Characteristics and Clinical Significance
Authors: Peacock James E. , Sorrell LuAnne , Sottile Frank D. , Price Loraine E. , Rutala William A. 
Published: September 2009

AbstractDuring the period July 1983 through December 1984, aminoglycoside-resistant Acinetobacter calcoaceticus var anitratus (ACA) were isolated from 98 patients in a university hospital. Eighty-seven percent of patients (85/98) acquired aminoglycoside-resistant ACA in the intensive care unit (ICU) and 92% (90198) of all initial isolates were from sputum. ICU patients with respiratory colonization/infection with aminoglycoside-resistant ACA were compared with matched ICU controls with other gram-negative rods in sputum. Compared with controls, the duration of ICU stay prior to colonization/infection with aminoglycoside-resistant ACA was significantly longer for cases (14.7 days υ 5.9 days, P = 0.002). Although exposures to devices and procedures were not significantly different for the two groups, cases received respiratory therapy significantly longer than did controls (14.7 days υ 6.6 days, P = 0.006). Prior to isolation of aminoglycoside-resistant ACA in sputum, cases received more cephalosporins than did controls (1.9 υ 1.2, P = 0.018); aminoglycoside usage in the two groups was comparable but cases tended to have received aminoglycoside for longer durations before colonization/infection than had controls (9.0 days υ 6.1 days, P = 0.08). Following sputum isolation of ACA, 6 of 22 cases developed ACA bacteremia compared with bacteremia in 2 of 22 controls. We conclude that factors predisposing to colonization/infection with aminoglycoside-resistant ACA were extended ICU care, prolonged respiratory therapy, and prior therapy with cephalosporins and aminoglycoside. In addition, ACA may be a more common cause of secondary bacteremia than previously appreciated.
Description of Case-Mix Adjusters by the Severity of Illness Working Group of The Society of Hospital Epidemiologists of America (SHEA)
Authors: Gross Peter A. , Beyt B. Eugene , Decker Michael D. , Garibaldi Richard A. , Hierholzer Walter J. , Jarvis William R. , Larson Elaine , Simmons Bryan , Scheckler William E. , Harkavy Lorraine M. 
Published: September 2009

AbstractHospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs). However, reimbursement under the DRG system is not acceptable for all patients in all hospitals because it is neither an accurate predictor of costs nor of clinical outcome. This deficiency poses significant problems for hospitals because DRGs are used nationwide as the prospective payment system for inpatients covered by Medicare. Several case-mix adjusters have been proposed to modify DRGs to improve their accuracy in predicting costs and outcome. We reviewed five of the most widely available indices: Acute Physiologic and Chronic Health Evaluation (APACHE II), Coded Disease Staging, Computerized Severity Index (CSI), Medical Illness Severity Group System (MEDISGROUPS), and Patient Management Categories (PMC). Recommendations for the use of a single case-mix adjuster cannot be made at this time because all indices have not been compared in sufficiently diverse settings and because some are better predictors of costs while others are better predictors of clinical outcome. Hospital epidemiologists and other infection control practitioners should be informed about these indices and their potential applications as they expand their role beyond infection control problems to issues concerning cost containment, quality assurance, and reimbursement.
Introduction of a Plasmid Encoding the OHIO-l β -Lactamase to an Intermediate Care Ward by Patient Transfer
Authors: Shlaes David M. , Currie-McCumber Charlotte A. , Lehman Mary-Helen 
Published: September 2009

AbstractA prospective study of 147 intermediate care ward (ICW) patients for acquisition of gentamicin-resistant Enterobacteriaceae (GRE) was carried out. Fifty (34%) were colonized or infected with one or more strains of GRE. Fifteen of these patients and one nurse were colonized with 22 strains (including ten species) of GRE bearing identical 60 kb plasmids encoding a novel β-lactamase determinant, OHIO-l and ANT (2“). Analysis of the time course of colonized patients on the ICW revealed one probable episode of cross-transmission. Five colonized patients had been residing in the ICW from one to four months prior to study initiation. Eight patients were admitted to the ICW from other hospital areas already colonized and one additional patient acquired colonization on the ICW from an unknown source. Thus, eight of ten patients admitted to the ICW during the prospective study were already colonized on admission to the ICW. To control this level of colonization it would therefore be necessary to direct efforts at limiting admission of colonized patients or attempting to eliminate the strain from persistently colonized patients, rather than trying to limit transmission within the ward.
Handwashing, Semmelweis, and Chlorine
Authors: Beck William C. 
Published: September 2009

When I went to medical school, I was taught that asepsis had its beginnings with Oliver Wendell Holmes, Lord Joseph Lister, and Ignaz Semmelweis. Holmes introduced the concept that puerperal sepsis was spread from patient to patient by physicians. Lister developed the concept that surgical infection was of bacterial origin. Semmelweis proved that childbed fever was transmitted on the contaminated hands of the attendant. In 1846 he effectively used a chloride as an antiseptic for the first time.Moreover, Semmelweis, on hearing of the death of Professor Kolletschka following a finger pinprick by a scalpel that had been used in an autopsy, noted that the symptoms and outcome were identical to puerperal sepsis. Thus, he established that “cadaverous particles” had lethal potential.
Bacillus Species Pseudomeningitis
Authors: Lettau Ludwig A. , Benjamin Dean , Cantrell H. Furman , Potts David W. , Boggs J. Michael 
Published: September 2009

AbstractA cluster of cerebrospinal fluid Gram's stains showing gram-positive bacilli and of cerebrospinal fluid cultures growing Bacillus species in a large community teaching hospital prompted an epidemiologic and microbiologic investigation. Pseudomeningitis was suspected and confirmed when cultures of uninoculated commercial trypticase soy broth with 5% Fildes enrichment grew Bacillus species. Secondary contamination of the pipettes used for inoculation accounted for the positive cerebrospinal fluid Gram's stains. The costs of this pseudo-outbreak included unnecessary antibiotic therapy, lumbar punctures, and hospitalization. Such adverse effects can be minimized by increased physician awareness of pseudoinfections and by prompt investigation of such occurrences.
An Epidemic of Adenovirus 7a Infection in a Neonatal Nursery: Course, Morbidity, and Management
Authors: Finn Adam , Anday Endla , Talbot George H. 
Published: September 2009

AbstractAn epidemic of adenovirus 7a in our neonatal intensive care nursery and intermediate care nursery in July and August 1987 caused the death of two patients. Significant symptomatic infection possibly due to the virus occurred in nine patients, ten staff, and three parents, of whom three patients, three staff, and one parent were positive by culture. As a direct consequence of the outbreak, 58 staff days of work were lost; the intensive care nursery had to be closed to admissions for 19 days and the intermediate care nursery for 14 days. Seventeen newborns were transferred to other hospitals and four mothers were sent elsewhere for delivery. Control measures, which included cohorting of patients, use of gloves, gowns and goggles, and exclusion of symptomatic staff from the unit, appeared effective. Rapid immunofluorescence testing of virological specimens was of little use in monitoring the outbreak, largely because of poor specimen quality. This outbreak further underlines the ease of transmission and high morbidity of neonatal adenovirus infection.
Nosocomial Infection in Adult Patients with Sickle Cell Anemia
Authors: Crowe Helen M. , Lichtenberg Deborah A. , Craven Donald E. 
Published: September 2009

AbstractAlthough the vulnerability of patients with sickle cell disease to infection with encapsulated organisms is well recognized, nosocomial transmission of infection has not been studied in this population. We describe eight serious, nosocomially transmitted infections in four adult patients hospitalized for complications of sickle cell disease, which led to death in one patient and prolonged hospital stays in three others. Although we have not surveyed all patients with sickle cell disease for rates of nosocomial infection, the cases presented suggest that these patients may be at increased risk. Risk can be reduced if health care workers are especially vigilant in adhering to handwashing and other infection control measures when caring for these patients. Additionally, we recommend that a patient with sickle cell disease not share a room with a patient known to have or suspected of having a nosocomial or community-acquired infectious disease.
Safe and Cost-Effective Cleaning of Pressure-Monitoring Transducers
Authors: Platt Richard , Lehr John L. , Marino Susan , Munoz Alvaro , Nash Barbara , Raemer Daniel B. 
Published: September 2009

AbstractThe CDC category I recommendation for high-level disinfection of pressure-monitoring transducers between uses imposes substantial costs. This practice has not been shown to be useful when disposable transducer domes are used. A prospective, randomized, double-blind study assessed the consequences of wiping transducers with alcohol between uses rather than sterilizing with ethylene oxide. We studied 5,197 transducer courses with disposable domes involving 2,202 patients in intensive care units during 15 months. There was no significant difference between the two treatment regimens in the risk of positive cultures of fluids from monitored lines, of cultures of cannula tips or of a positive blood culture. We conclude that under normal conditions, ie, in the absence of a cluster of transducer-related bacteremias, wiping transducers with alcohol between uses is sufficient when disposable domes are used.
Do Antibiotic Combinations Prevent the Emergence of Resistant Organisms?
Authors: Craig William A. 
Published: September 2009

Antibiotic combinations are often used in the therapy of infectious diseases to broaden the antibacterial spectrum and to enhance antimicrobial activity. Another potential reason for combination therapy is to reduce or prevent the emergence of resistant organisms during therapy. Antituberculous chemotherapy provides a classic example in which drug combinations have successfully prevented the emergence of drug-resistant organisms and improved clinical outcome. The purpose of this brief report is to review the success of combination therapy in preventing resistance in more common bacterial infections.The emergence of resistance during single-drug therapy is a well-documented clinical phenomenon, especially with the broad-spectrum ß-lactams against gram-negative bacilli. As with Mycobacterium tuberculosis, the resistant organisms are generally thought to be naturally occurring mutants selected by drug exposure. Because mutation frequencies appear to vary from 10-6 to 10-8, it is not surprising that emergence of resistant organisms observed clinically occurs primarily at sites of high organism density, such as the respiratory and urinary tracts.
Epidemic of Serratia marcescens Bacteremia and Meningitis in a Neonatal Unit in Mexico City
Authors: Zaidi Mussaret , Sifuentes José , Bobadilla Miriam , Moncada David , de León Samuel Ponce 
Published: September 2009

AbstractA case-control study was conducted on an epidemic of bacteremia and meningitis caused bySerratia marcescensin the neonatal intensive care unit and special care nursery of a general hospital in Mexico City, Mexico. A 19.9% incidence of bacteremia and meningitis was recorded in contrast to 1.4% and 3.7% during pre-epidemic and postepidemic periods; a 69% mortality rate was observed. Peripheral IV catheters and the use of mixed IV fluids prepared in the wards were the major risk factors (P&lt; 0.001). Rectal and nasopharyngeal cultures were positive in 68% of asymptomatic neonates and hand cultures were positive in 16.7% of personnel. Strains were resistant to all aminoglycosides and broad-spectrum penicillins, and belonged to the A5/8 bio-group. Containment of this outbreak was difficult because of failure to identify colonized infants early in the epidemic and because of persistent carriage ofS marcescensby personnel. Comparisons between this hospital and tertiary care centers in Mexico suggest that in developing countries nosocomial infections could be of greater magnitude in secondary than in tertiary level centers.
Urinary Tract Infection Following Instrumentation for Urodynamic Testing
Authors: Hamill Richard J. , Wright Charles E. , Andres Nita , Koza Maureen A. 
Published: September 2009

AbstractAfter identifying a temporal cluster of urinary tract infections in patients who had undergone urodynamic procedures, we examined the techniques within the urodynamic laboratory and retrospectively reviewed charts of all 155 patients tested in the previous six months. The rate of acquired urinary tract infections was 18.7%. Risk factors for infection included undergoing cystometrograms and being subject to the first procedure performed in a day. Technical errors in the performance of the urodynamic studies included failure to completely disassemble the apparatus upon completion of a procedure, failure to use sterile components, and lapses in aseptic technique. Bacteria implicated in the outbreak were isolated from tubing, transducers, and flush solutions. After the institution of appropriate technique, all patients tested in the subsequent six months were followed. The rate of acquired urinary tract infection dropped to 5%. Urodynamic apparatus should be completely disassembled following the completion of a procedure; reassembly using sterile components should occur immediately prior to the next procedure; aseptic technique should be maintained; and patients should undergo routine urine screening before a procedure. Surveillance of urodynamic procedures may reveal correctable flaws in technique.
Regulation of Topical Antimicrobials: History, Status and Future Perspective
Authors: Bruch Mary K. , Larson Elaine 
Published: September 2009

AbstractAntimicrobial agents used as disinfectants and antiseptics are increasing in epidemiologic importance. The regulation of topical antiseptics has ranged from nonexistent, lax and confusing to inclusion in the Food and Drug Administration (FDA) over-the-counter (OTC) review of drug ingredients. This article simplifies the complex history, current status and future possibilities for the hospital use of topical antiseptic products.
The High Rate of Blood Donor Exposure for Critically III Neonates
Authors: Donowitz Leigh G. , Turner Ronald B. , Searcy Mary Ann M. , Luban Naomi L.C. , Hendley J. Owen 
Published: September 2009

AbstractThe purpose of this study was to determine the number and volume of red blood cell (RBC) transfusions and the number of donors a newborn is exposed to during his or her newborn intensive care unit (NICU) stay. On one day at the Medical University of South Carolina (MUSC) and two days at the University of Virginia Hospital (UVH) all babies who had or were receiving RBCs comprised the study group. Patient records were reviewed at discharge. Fifty-two (70%) of the 75 NICU babies had or were receiving RBCs and were enrolled. The average number of RBC transfusions was nine (range 1 to 28, median 7) and the average transfusion volume was 16.5 ml (range 5 to 60) for a total volume of 148 ml transfused during a NICU stay. Each baby was exposed to an average of 6.9 donors (range 1 to 25, median 6.5). The practice of splitting RBC packs to share among different infants and of giving multiple small volume transfusions maximizes donor exposure and transfusion-related infectious risks in this population.
Pseudoepidemic of Rhodotorula rubra in Patients Undergoing Fiberoptic Bronchoscopy
Authors: Hoffmann Karen K. , Weber David J. , Rutala William A. 
Published: September 2009

AbstractBetween March and June 1988, Rhodotorula rubra was isolated from the bronchial washings of 30 of 56 (54%) patients undergoing bronchoscopy at a North Carolina community hospital. Pulmonary disease consistent with invasive fungal pneumonia was not apparent for any patient. Repeat sputum cultures were performed on 11 patients, none of whom were positive for R rubra. Investigation revealed fungal contamination of two brushes used to clean the bronchoscope channels and one positive sample of the tub water used to test the integrity of the bronchoscope prior to cleaning and disinfection. Control measures instituted were high-level disinfection of all equipment used to clean the bronchoscopes, including the brushes, complete air drying of the bronchoscopes before storing and storage of equipment in closed cabinets. An additional case one month after instituting these measures prompted the addition of a final 70% ethyl alcohol rinse of the bronchoscopes immediately prior to storage. Over a six-month period no additional cases have been identified.Despite published disinfection guidelines, pseudoepidemics and infections from contaminated equipment continue to appear. This pseudoepidemic investigation revealed a site for contaminating bronchoscopes that has not been previously reported, the inner cannula cleaning brushes. This emphasizes the need for stringent adherence to recommended cleaning and disinfection guidelines.
Evaluation of a New Method of Detection of Nosocomial Infection in the Pediatric Intensive Care Unit: The Infection Control Sentinel Sheet System
Authors: Ford-Jones E.L. , Mindorff C.M. , Pollock E. , Milner R. , Bohn D. , Edmonds J. , Barker G. , Gold R. 
Published: September 2009

AbstractTo improve the efficiency of nosocomial infection detection, a highly structured system combining initial reporting by the bedside night nurse of symptoms possibly related to infection with follow-up by the infection control nurse (ICN) was developed: The Infection Control Sentinel Sheet System (ICSSS).Between July 1, 1987 and February 28, 1988, a prospective comparison of results obtained through ICSSS and daily bedside observation/chart review by a full-time trained intensivist was undertaken in the pediatric intensive care unit (PICU). Ratios of nosocomial infections and nosocomially-infected patients were 15.8 and 7.0 respectively among 685 admissions; included are seven infections identified only through the ICSSS so that the “gold standard” became an amalgamation of the two systems. The sensitivity for detection of nosocomially-infected patients by bedside observation/chart review and ICSSS was 100% and 87% respectively. The sensitivity for detection of standard infections (blood, wound and urine) was 88% and 85% respectively. The sensitivity for detection of nosocomial infections at all sites was 94% and 72% respectively. Missed infections were minor (e.g., drain, skin, eye), required physician diagnosis (e.g., pneumonia), were not requested on the sentinel sheet (SS) (e.g., otitis media), related to follow-up of deceased patients or were minor misclassifications or failures to associate with device (e.g., central-line related). Daily PICU surveillance by the ICN required only 20 minutes a day. The ICSSS appears highly promising and has many unmeasured benefits.
Evaluation of Rigid Container Systems for Sterilization
Authors: Ryan Peggy 
Published: September 2009

The packaging of surgical instruments, medical devices and procedure trays for sterilization is indeed important. There are three choices for packaging.The first two methods use traditional over-wrap packaging, with either reusable flat wraps of muslin or tightly woven textiles, or one of several types of nonwoven disposable wraps. Reusable wrappers must be monitored by labor-intensive inspection, delinting and frequent patching, and are easily contaminated. In addition, disposable wraps can develop tears and holes compromising the sterility of the contents. Thus, both reusable and disposable wrappers have drawbacks.
Epidemic Keratoconjunctivitis in a University Medical Center Ophthalmology Clinic; Need for Re-evaluation of the Design and Disinfection of Instruments
Authors: Koo Denise , Bouvier Brenda , Wesley Michele , Courtright Paul , Reingold Arthur 
Published: September 2009

AbstractDuring the period from early December 1987 to late January 1988, an outbreak of epidemic keratoconjunctivitis (EKG) caused by adenovirus type 8 occurred at a university medical center eye clinic. A telephone survey of patients revealed an attack rate of 17% among patients seen during the epidemic period. A case-control study demonstrated that development of EKC was associated with exposure to pneumotonometry and to three caregivers. After controlling for exposure to pneumo-tonometry, however, only exposure to one caregiver was significantly associated with risk of the disease. On January 19, 1988, after recognition of the outbreak, the eye clinic instituted additional infection control measures. A survey of patients seen the following week showed a substantial decrease in the attack rate (1.9%). Before these control measures were implemented, clinic personnel had followed the manufacturer's recommendations and disinfected pneumotonometer tips with 70% isopropyl alcohol, fearing that other disinfectants would corrode the instrument metal. Isopropyl alcohol, shown to have limited activity against adenovirus in vitro, also was being used to “disinfect” pneumotonometer tips between uses at six other area eye clinics polled by telephone. The results of this study demonstrate the need for changes in the design and manufacture of equipment used in the eye clinic.
What is Leaky Can be Risky: A Study of the Integrity of Hospital Gloves
Authors: Yangco Bienvenido G. , Yangco Nathaniel F. 
Published: September 2009

AbstractOne thousand six-hundred and eighteen medical gloves were tested to determine whether, with current increased demands, these gloves are of high quality, i.e., free of leaks. The risk of exposure to potentially infected fluids when using leaky gloves was also estimated. Using a four-stage leak test, no significant difference was found between 64 of 790 (8.1%, range 0% to 44.4%) unsterile latex gloves and 11 of 210 (5.2%, range 1.7% to 21.7%) unsterile vinyl gloves (p=.21). Sterile surgical gloves (7 of 618, 1.13% [range 0% to 3%]) had fewer leaks compared to unsterile latex and vinyl gloves combined p<.OOOl). The safranin test was positive in 27 of 28 (96.4%) leaky gloves tested, indicating a high risk of exposure to potentially infected fluids when leaky gloves are used. Because of these findings, elements of “universal precautions” such as changing gloves after each patient contact and good handwashing after using gloves should be carefully observed. There is a need for the Food and Drug Administration to establish more stringent guidelines for manufacturing gloves and to verify compliance with these guidelines.