bluuebunny/crossref_metadata_2025_split huggingface dataset:
staffTRAK-TB: Software for Surveillance of Tuberculosis Infection in Healthcare Workers
Authors: Burwen Dale R. , Seawright M. Franklin 
Published: February 2006

AbstractThe Centers for Disease Control and Prevention (CDC) recommends periodic tuberculin skin testing of healthcare workers with potential exposure to Mycobacterium tuberculosis. However, many healthcare facilities have neither a system to identify workers due for their skin test nor a means of analyzing aggregate data. To illustrate some of the complexities involved in tuberculin skin test (TST) tracking and analysis, and how these might be addressed, this report describes a software package called staffTRAK-TB, developed by the CDC to facilitate surveillance of tuberculosis infection in healthcare workers. staffTRAK-TB records data for each healthcare worker, including demographic information, occupation, work location, multiple TST results, and results of evaluations to determine if clinically active tuberculosis is present. Programmed reports include lists of workers due and overdue for skin tests, and skin test conversion rates by occupation or worksite. Standardization of types of occupations and locations allows data from multiple facilities to be aggregated and compared. Data transfer to the CDC can be performed via floppy diskettes. staffTRAK-TB illustrates important issues in software structure, standardization of occupation and work-location information, relevant data items, and reports and analyses that would be useful in practice. Developing software that adequately addresses the epidemiological issues is complex, and the lessons learned may serve as a model for hospital epidemiologists, infection control personnel, occupational health personnel, and computer programmers considering software development in this area or trying to optimize their facility's TST surveillance.
Satellite Videoconferencing for Healthcare Workers: Audience Characteristics and the Importance of Continuing Education Credits
Authors: Chen Ii-Lun , Eckhardt Joseph N. , Sinkowitz-Cochran Ronda L. , Jarvis William R. 
Published: February 2006

AbstractTo assess the opinions of healthcare workers (HCWs) about a satellite videoconference as a means of earning continuing education credit, a telephone survey was conducted in September 1998, 1 month after a live interactive satellite video-conference on antimicrobial use and resistance. There were 180 registered sites in 45 states surveyed, representing 1,589 viewers: 764 nurses (48.1%), 201 physicians (12.6%), and 624 other HCWs (39.3%). Continuing education credit was requested by 51% of nurses, 31% of physicians, and 27% of all other HCWs. Although preferred learning formats varied, 70% of respondents said it was important to offer continuing education credit. Furthermore, 31% of the respondents stated that the video-conference influenced institutional strategies. We concluded that satellite videoconferences are a method to reach audiences around the world efficiently and effectively, provide the latest information, facilitate interaction, and meet some of the demand for continuing education credit for HCWs.
Persistence ofLegionella Pneumophilain a Hospital's Water System: A 13-Year Survey
Authors: Rangel-Frausto M. Sigfrido , Rhomberg Paul , Hollis Richard J. , Pfaller Michael A. , Wenzel Richard P. , Helms Charles M. , Herwaldt Loreen A. 
Published: February 2006

AbstractObjective:To describe the molecular epidemiology ofLegionella pneumophilainfections in the University of Iowa Hospitals and Clinics (UIHC).Design:Molecular epidemiological study using pulsed-field gel electrophoresis (PFGE).Setting:A large university teaching hospital.Isolates:All surviving isolates obtained from culture-proven nosocomialL pneumophilainfections and all surviving isolates obtained from the University of Iowa Hospital and Clinics' water supply between 1981 and 1993.Results:Thirty-three isolates from culture-proven nosocomial cases ofL pneumophilapneumonia were available for typing. PFGE of genomic DNA from the clinical isolates identified six different strains. However, only strain C (16 cases) and strain D (13 cases) caused more than 1 case. Strain C caused clusters of nosocomial infection in 1981, 1986, and 1993 and also caused 4 sporadic cases. Strain D caused a cluster in 1987 and 1988 plus 4 sporadic cases. Of the six strains causing clinical infections, only strains C and D were identified in water samples. PFGE identified three strains in the water supply, of which strains C and D caused clinical disease and also persisted in the water supply during most of the study period.Conclusion:Specific strains ofL pneumophilacan colonize hospital water supplies and cause nosocomial infections over long periods of time.
Hospital Characteristics Associated With Colonization of Water Systems byLegionellaand Risk of Nosocomial Legionnaires' Disease: A Cohort Study of 15 Hospitals
Authors: Kool Jacob L. , Bergmire-Sweat David , Butler Jay C. , Brown Ellen W. , Peabody Deborah J. , Massi Daniel S. , Carpenter Joseph C. , Pruckler Janet M. , Benson Robert F. , Fields Barry S. 
Published: February 2006

AbstractObjective:To investigate an increase in reports of legionnaires' disease by multiple hospitals in San Antonio, Texas, and to study risk factors for nosocomial transmission of legionnaires' disease and determinants forLegionellacolonization of hospital hot-water systems.Setting:The 16 largest hospitals in the cities of San Antonio, Temple, and Austin, Texas.Design:Review of laboratory databases to identify patients with legionnaires' disease in the 3 years prior to the investigation and to determine the number of diagnostic tests forLegionellaperformed; measurement of hot-water temperature and chlorine concentration and culture of potable water forLegionella. Exact univariate calculations, Poisson regression, and linear regression were used to determine factors associated with water-system colonization and transmission ofLegionella.Results:Twelve cases of nosocomial legionnaires' disease were identified; eight of these occurred in 1996. The rise in cases occurred shortly after physicians started requestingLegionellaurinary antigen tests. Hospitals that frequently usedLegionellaurinary antigen tests tended to detect more cases of legionnaires' disease.Legionellawas isolated from the water systems of 11 of 12 hospitals in San Antonio; the 12th had just experienced an outbreak of legionnaires' disease and had implemented control measures. Nosocomial legionellosis cases probably occurred in 5 hospitals. The number of nosocomial legionnaires' disease cases in each hospital correlated better with the proportion of water-system sites that tested positive forLegionella (P=.07) than with the concentration ofLegionellabacteria in water samples (P=.23). Hospitals in municipalities where the water treatment plant used monochloramine as a residual disinfectant (n=4) and the hospital that had implemented control measures wereLegionella-free. The hot-water systems of all other hospitals (n=11) were colonized withLegionella. These were all supplied with municipal drinking water that contained free chlorine as a residual disinfectant. In these contaminated hospitals, the proportion of sites testing positive was inversely correlated with free residual chlorine concentration (P=.01). In all hospitals, hot-water temperatures were too low to inhibitLegionellagrowth.Conclusions:The increase in reporting of nosocomial legionnaires' disease was attributable to increased use of urinary antigen tests; prior cases may have gone unrecognized. Risk of legionnaires' disease in hospital patients was better predicted by the proportion of water-system sites testing positive forLegionellathan by the measured concentration ofLegionellabacteria. Use of monochloramine by municipalities for residual drinking water disinfection may help prevent legionnaires' disease.
The Impact of Multifocused Interventions on Sharps Injury Rates at an Acute-Care Hospital
Authors: Gershon Robyn R.M. , Pearse Lisa , Grimes Martha , Flanagan Patricia A. , Vlahov David 
Published: February 2006

AbstractObjective:To determine the impact of a multifocused interventional program on sharps injury rates.Design:Sharps injury data were collected prospectively over a 9-year period (1990-1998). Pre- and postinterventional rates were compared after the implementation of sharps injury prevention interventions, which consisted of administrative, work-practice, and engineering controls (ie, the introduction of an anti-needlestick intravenous catheter and a new sharps disposal system).Setting:Sharps injury data were collected from healthcare workers employed by a mid-sized, acute-care community hospital.Results:Preinterventional annual sharps injury incidence rates decreased significantly from 82 sharps injuries/1,000 worked full-time-equivalent employees (WFTE) to 24 sharps injuries/1,000 WFTE employees postintervention (P<.0001), representing a 70% decline in incidence rate overall. Over the course of the study, the incidence rate for sharps injuries related to intravenous lines declined by 93%, hollow-bore needlesticks decreased by 75%, and non-hollow-bore injuries decreased by 25%.Conclusion:The implementation of a multifocused interventional program led to a significant and sustained decrease in the overall rate of sharps injuries in hospital-based healthcare workers.
The Effect of Blood on the Antiviral Activity of Sodium Hypochlorite, a Phenolic, and a Quaternary Ammonium Compound
Authors: Weber David J. , Barbee Susan L. , Sobsey Mark D. , Rutala William A 
Published: February 2006

AbstractObjective:To assess the virucidal activity of three disinfectants (sodium hypochlorite, a phenolic, and a quaternary ammonium compound) in the presence and absence of blood.Methods:Disinfectants at varying concentrations (hypochlorite: 5,000, 500, or 50 ppm; phenolic: 1:10 or 1:128 dilution; quaternary ammonium compound: 1:10 or 1:128 dilution) were added to either saline or whole blood (final concentration, 80% or 20% blood) and mixed. Test organisms included an attenuated vaccine strain of poliovirus type 1 (prototype for relatively resistant hydrophilic viruses) and herpes simplex virus (HSV) type 1 (prototype for relatively susceptible lipophilic viruses). Virus was added to create a viral-blood suspension. Viral survival was tested at room temperature at the following times: 0, 15 seconds, 30 seconds, 1 minute, 2 minutes, 5 minutes, and 10 minutes. A neutralizer stopped the reaction, and virus was assayed using a plaque technique.Results:In the absence of blood, complete inactivation of HSV was achieved within 30 seconds with 5,000 (1:10 dilution of bleach) and 500 (1:100 dilution of bleach) ppm chlorine, 1:10 and 1:128 diluted phenolic (use dilution), and 1:10 and 1:128 diluted quaternary ammonium compound (use dilution). In the presence of 80% blood, only 5,000 ppm hypochlorite, 1:10 phenolic, and 1:10 or 1:128 quaternary ammonium compound were effective. In the absence of blood, complete inactivation of polio was achieved within 30 seconds by 5,000 and 500 ppm chlorine and 1:10 quaternary ammonium compound. In the presence of 80% blood, no solution tested was capable of completely inactivating poliovirus within 10 minutes.Conclusions:Our data suggest that, in the absence of visible blood, environmental surfaces may be disinfected with a diluted hypochlorite solution (1:10 or 1:100), a phenolic, or a quaternary ammonium compound. Based on our studies using HSV, which has similar susceptibilities to disinfectants as human immunodeficiency virus (HIV), phenolics at their use dilution and 1:100 diluted hypochlorite are unlikely to inactivate HIV or hepatitis B virus reliably in the presence of blood. Hypochlorite at a final concentration of 5,000 ppm (1:10 dilution) should be used to decontaminate blood spills, but, even after decontamination, care should be used to avoid sharps injuries.
Emergence of Vancomycin-Resistant Enterococci at a University Hospital in Taiwan: Persistence of Multiple Species and Multiple Clones
Authors: Hsueh Po-Ren , Teng Lee-Jene , Pan Hui-Ju , Chen Yu-Chi , Wang Li-Hua , Chang Shan-Chwen , Ho Shen-Wu , Luh Kwen-Tay 
Published: February 2006

AbstractObjectives:To describe the epidemiology of vancomycin-resistant enterococci (VRE) in a university hospital in Taipei, Taiwan.Design:Retrospective review over a 27-month period, from March 1996 to May 1998.Setting:A tertiary-care teaching hospital in Taiwan.Participants:Patients with VRE isolated from any body site.Methods:Patients were identified through hospital microbiology and infection control records. Patient charts were reviewed for clinical and epidemiology data, including age, gender, previous hospital admissions, underlying diseases, types of infection, and recent antibiotic use. VRE isolates were characterized by their typical biochemical reactions, cellular fatty acid profiles, and the presence ofvangenes. Antibiotypes using the E-test and randomly amplified polymorphic DNA (RAPD) patterns of these isolates were used to determine the clonality.Results:Twenty-five isolates of VRE recovered from 12 patients were identified. One patient with a perianal abscess had 12 isolates of VRE (4Enterococcus faecalis, 7Enterococcus faecium, and 1Enterococcus casseliflavus) recovered from perianal lesions. Among 3 patients who were hospitalized in the same room, 1 had a community-acquired cellulitis over the left leg caused byE faecalis, and the other 2 patients both had anal colonization with 2 isolates ofE faecalis. The other 8 patients had 1E faecalisisolate each from various clinical specimens. All isolates possessed vanA resistance phenotype andvanAgenes. Different antibiotypes and RAPD patterns of the isolates from different patients excluded the possibility of nosocomial spread at the hospital.Conclusions:Multiple species of VRE (E faecalis, E faecium, andE casseliflavus) and multiple clones ofE faeciumcould colonize or infect hospitalized patients. In addition, clones of VRE can persist long-term in patients' lower gastrointestinal tracts. These results extend our knowledge of the coexistence and the persistence of multiple species and multiple clones of VRE in hospitalized patients.
Selecting Respirators for Control of Worker Exposure to Infectious Aerosols
Authors: McCullough Nicole Vars , Brosseau Lisa M. 
Published: February 2006

AbstractA method for selecting respirators for protection in infectious aerosol environments was developed, building on a procedure used to choose respiratory protection for environments containing nonbiological contaminants. Modifications in the traditional respirator selection method are proposed for situations where information on occupational exposure limits, toxicity, and airborne concentrations is absent. Toxicity is determined from risk rankings proposed by a variety of organizations. The nature of the activity allows assessment of source generation, which is combined with room volume and airflow to obtain a ranking of airborne concentration. Finally, concentration and toxicity ranks determine a minimum assigned protection factor, which corresponds to a respirator class. Case studies are presented to illustrate the proposed decision logic. For each situation, the procedure yielded choices that were both protective and reasonable. These results suggest that the procedure will be applicable to a variety of settings for a range of infectious organisms.
The Prevalence of Colonization With Vancomycin-Resistant Enterococcus at a Veterans' Affairs Institution
Authors: Tokars Jerome I. , Satake Sachiko , Rimland David , Carson Loretta , Miller Elaine R. , Killum Edna , Sinkowitz-Cochran Ronda L. , Arduino Matthew J. , Tenover Fred C. , Marston Barbara , Jarvis William R. 
Published: February 2006

AbstractObjective:To study vancomycin-resistantEnterococcus(VRE) prevalence, risk factors, and clustering among hospital inpatients.Design:Rectal-swab prevalence culture survey conducted from February 5 to March 22,1996.Setting:The Veterans' Affairs Medical Center, Atlanta, Georgia.Patients:Hospital (medical and surgical) inpatients.Results:The overall VRE prevalence was 29% (42/147 patients). The VRE prevalence was 52% (38/73 patients) among patients who had received at least one of six specific antimicrobials during the preceding 120 days, compared with only 5% (4/74) among those who had not received the antimicrobials (relative risk, 9.6;P&lt;.001). The longer the period (up to 120 days) during which antimicrobial use was studied, the more closely VRE status was predicted. Among 67 hospital patients in 28 multibed rooms, clustering of VRE among current roommates was not found.Conclusions:At this hospital with relatively high VRE prevalence, VRE colonization was related to antibiotic use but not to roommate VRE status. In hospitals with a similar VRE epidemiology, obtaining cultures from roommates of VRE-positive patients may not be as efficient a strategy for identifying VRE-colonized patients as obtaining screening cultures from patients who have received antimicrobials.
Management of a Sabiá Virus-Infected Patient in a US Hospital
Authors: Armstrong Lori R. , Dembry Louise-Marie , Rainey Petrie M. , Russi Mark B. , Khan Ali S. , Fischer Steven H. , Edberg Stephen C. , Ksiazek Thomas G. , Rollin Pierre E. , Peters C.J. 
Published: February 2006

AbstractObjective:To describe the hospital precautions used to isolate a Sabiá virus (arenavirus: Arenaviridae)-infected patient in a US hospital and to protect hospital staff and visitors.Design:Investigation of a single case of arenavirus laboratory-acquired infection and associated case-contacts.Setting:A 900-bed, tertiary-care, university-affiliated medical center.Patients or other Participants:The case-patient became ill with Sabiá virus infection. The case-contacts consisted of healthcare workers, coworkers, friends, and relatives of the case-patient.Intervention:Enhanced isolation precautions for treatment of a viral hemorrhagic fever (VHF) patient were implemented in the clinical laboratory and patient-care setting to prevent nosocomial transmission. The enhanced precautions included preventing aerosol spread of the virus from the patient or his clinical specimens. All case-contacts were tested for Sabiá virus antibodies and monitored for signs and symptoms of early disease.Results:No cases of secondary infection occurred among 142 case-contacts.Conclusions:With the frequency of worldwide travel, patients with VHF can be admitted to a local hospital at any time in the United States. The use of enhanced isolation precautions for VHF appeared to be effective in preventing secondary cases by limiting the number of contacts and promoting proper handling of laboratory specimens. Patients with VHF can be managed safely in a local hospital setting, provided that appropriate precautions are planned and implemented.
Epidemiology of Device-Associated Infections Related to a Long-Term Implantable Vascular Access Device
Authors: Sotir Mark J. , Lewis Curtis , Bisher Edward W. , Ray Susan M. , Soucie J. Michael , Blumberg Henry M. 
Published: February 2006

AbstractObjective:To examine risk factors for, and determine the incidence of, device-associated infections among patients with an implantable vascular access device.Setting:Grady Health System, including a 1,000-bed, inner-city, public, teaching hospital and human immunodeficiency virus (HIV), oncology, and sickle cell clinics in Atlanta, Georgia.Patients:123 consecutive patients who received a PASPort implantable venous access device between January 1 and June 30, 1995.Design:Retrospective cohort study with follow-up ≥1 year following device implantation.Results:Underlying illnesses included HIV infection in 66 patients (median CD4 count, 24.4 cells/mm3), malignancy in 51, and sickle cell disease in 6. Mean age of patients was 43.7 years, 50% were male, and 74% were black. Thirty-one (25%) of 123 patients developed a primary or device-associated bloodstream infection (BSI), and 3 of the 31 patients experienced two separate episodes of infection. The overall rate of infection was 1.23 primary BSIs per 1,000 device days. Patients with cancer had a lower rate of infection than those with HIV infection, but the difference was not statistically significant (0.96 vs 1.50 BSIs/1,000 device days; relative risk, 0.58; 95% confidence interval, 0.27-1.26). Subgroup analysis of patients with different malignancies indicated that infection rates differed according to type of cancer, and there was a trend for heterogeneity across the different cancer strata (P=.06). Gram-positive pathogens accounted for 60% of the pathogens recovered. Six (19%) of 31 patients who developed an infection did so within the first 14 days after implantation. In 11 (32%) of the 34 BSIs, the port required removal; two patient deaths were attributed to device-associated bacteremias (0.072 deaths/ 1,000 device days).Conclusions:Approximately one fourth of patients who had a vascular access device implanted developed a primary BSI, but the overall infection rate (per 1,000 device days) was relatively low, even among those with HIV infection. Primary BSI rates in patients with vascular access devices appeared to differ according to the specific underlying illness.
Long-Lasting Contamination of a Vitrectomy Apparatus With Serratia marcescens
Authors: Kappstein Ines , Schneider Christian M. , Grundmann Hajo , Scholz Regina , Janknecht Peter 
Published: February 2006

AbstractObjective:To investigate the contamination of a vitrectomy apparatus withSerratia marcescens.Design:Descriptive microbiological and molecular environmental study.Setting:An 1,800-bed university hospital.Results:S marcescenswas found inside the vitrectomy apparatus at the pressure transducer. Molecular typing by randomly amplified polymorphic DNA-automated laser flourescence analysis and pulsed-field gel electrophoresis identified a single pattern for all strains isolated from the apparatus. Surprisingly, the contaminating strain was identical to two strains ofS marcescensisolated nearly 2 years earlier from two patients who were involved in a small outbreak of acute postoperative endophthalmitis following cataract surgery at another hospital. The emergency vitrectomies in these patients were performed at our hospital with the same apparatus that was found to be contaminated 2 years later.Conclusion:Performing a systematic environmental search for the assumed bacterial reservoir within the system of the vitrectomy apparatus finally made it possible to find and eliminate the nidus for the gram-negative rod. Molecular typing demonstrated that all isolates belonged to a single genotype, and revealed unexpectedly a link to two vitrectomies performed 2 years earlier. The data support the hypothesis that the source of the contamination was one of these patients, and thus contamination of the apparatus was present for almost 2 years.