bluuebunny/crossref_metadata_2025_split huggingface dataset:
Refinements of Environmental Assessment During an Outbreak Investigation of Invasive Aspergillosis in a Leukemia and Bone Marrow Transplant Unit
Authors: Thio Chloe L. , Smith Dottie , Merz William G. , Streifel Andrew J. , Bova Greg , Gay Lora , Miller Carole B. , Perl Trish M. 
Published: February 2006

AbstractObjectives:To investigate an outbreak of aspergillosis in a leukemia and bone marrow transplant (BMT) unit and to improve environmental assessment strategies to detectAspergillus.Design:Epidemiological investigation and detailed environmental assessment.Setting:A tertiary-care university hospital with a 37-bed leukemia and BMT unit.Participants:Leukemic or BMT patients with invasive aspergillosis identified through prospective surveillance and confirmed by chart review.Interventions:We verified the diagnosis of invasive fungal infection by reviewing medical charts of at-risk patients, performing a case-control study to determine risk factors for infection, instituting wet mopping to clean all floors, providing N95 masks to protect patients outside high-efficiency particulate air (HEPA)-filtered areas, altering traffic patterns into the unit, and performing molecular typing of selectedAspergillus flavusisolates. To assess the environment, we verified pressure relationships between the rooms and hallway and between buildings, and we compared the ability of large-volume (1,200 L) and small-volume (160 L) air samplers to detectAspergillusspores.Results:Of 29 potential invasive aspergillosis cases, 21 were confirmed by medical chart review. Risk factors for developing invasive aspergillosis included the length of time since malignancy was diagnosed (odds ratio [OR], 1.0;P=.05) and hospitalization in a patient room located near a stairwell door (OR, 3.7;P=.05). Two of fiveA flavuspatient isolates were identical to one of the environmental isolates. The pressure in most of the rooms was higher than in the corridors, but the pressure in the oncology unit was negative with respect to the physically adjacent hospital; consequently, the unit acted essentially as a vacuum that siphoned non-HEPA-filtered air from the main hospital. Of the 78 samples obtained with a small-volume air sampler, none grew anAspergillusspecies, whereas 10 of 40 cultures obtained with a large-volume air sampler did.Conclusions:During active construction,Aspergillusspores may have entered the oncology unit from the physically adjacent hospital because the air pressure differed. Guidelines that establish the minimum acceptable pressures and specify which pressure relationships to test in healthcare settings are needed. Our data show that large-volume air samples are superior to small-volume samples to assess forAspergillusin the healthcare environment.
Antimicrobial Activity of Home Disinfectants and Natural Products Against Potential Human Pathogens
Authors: Rutala William A. , Barbee Susan L. , Aguiar Newman C. , Sobsey Mark D. , Weber David J. 
Published: February 2006

AbstractObjective:To assess the efficacy of both natural products (vinegar, baking soda) and common commercial disinfectants (Vesphene Ilse, TBQ, Clorox, Lysol Disinfectant Spray, Lysol Antibacterial Kitchen Cleaner, Mr. Clean Ultra, ethanol) designed for home or institutional use against potential human pathogens, including selected antibiotic-resistant bacteria.Design:A quantitative suspension test was used to assess the efficacy of selected disinfectants following exposure times of 30 seconds and 5 minutes. Activity was assessed againstStaphylococcus aureus, Salmonella choleraesuis, Escherichia coli0157:H7, andPseudomonas aeruginosa. Selected disinfectants were also tested against poliovirus, vancomycin-susceptible and -resistantEnterococcusspecies, and methicillin-susceptible and -resistantS aureus.Results:The following compounds demonstrated excellent antimicrobial activity (>5.6-8.2 log10reduction) at both exposure times: TBQ, Vesphene, Clorox, ethanol, and Lysol Antibacterial Kitchen Cleaner. Mr. Clean eliminated 4 to >6 logs10and Lysol Disinfectant ~4 logs10of pathogenic microorganisms at both exposure times. Vinegar eliminated <3 logs10ofS aureusandE coli, and baking soda <3 logs10of all test pathogens. All tested chemical disinfectants completely inactivated both antibiotic-resistant and -susceptible bacteria at both exposure times. Only two disinfectants, Clorox and Lysol, demonstrated excellent activity (>3 log10reduction) against poliovirus.Conclusions:A variety of commercial household disinfectants were highly effective against potential bacterial pathogens. The natural products were less effective than commercial household disinfectants. Only Clorox and Lysol disinfectant were effective against poliovirus
Microbiological Evaluation of Central Venous Catheter Administration Hubs
Authors: Lucet Jean-Christophe , Hayon Jan , Bruneel Fabrice , Dumoulin Jean-Louis , Joly-Guillou Marie-Laure 
Published: February 2006

AbstractWe compared, in three intensive care units, colonization of hubs with hub protection boxes or hubs with needleless closed connectors; 137 central venous catheters and 451 hubs were randomized in two groups with similar characteristics. Catheter and hub colonization were not different between the two groups. Among 30 colonized catheters, the same isolate was found in only two hubs; hub contamination rarely is responsible for catheter colonization in short-term catheters. Further studies are required to evaluate the benefit of protected hubs compared with unprotected hubs.
The Threat of Biological Terrorism: A Public Health and Infection Control Reality
Authors: Leggiadro Robert J. 
Published: February 2006

AbstractBioterrorism is an emerging public health and infection control threat. Potential biological agents include smallpox, anthrax, plague, tularemia, botulinum toxin, brucellosis, Q fever, viral encephalitis, hemorrhagic fever, and staphylococcal enterotoxin B. An understanding of the epidemiology, clinical manifestations, and management of the more likely candidate agents is critical to limiting morbidity and mortality from a biological event. Effective response requires an increased index of suspicion for unusual diseases or syndromes, with prompt reporting to health authorities to facilitate recognition of an outbreak and subsequent intervention. Hospital epidemiology programs will play a crucial role in this effort.
Excessive Use of Vancomycin: A Successful Intervention Strategy at an Academic Medical Center
Authors: Hamilton Carol Dukes , Drew Richard , Janning Stephen W. , Latour Joanne Kure , Hayward Shelly 
Published: February 2006

AbstractThe project goal was to decrease excessive vancomycin use. Interventions included an educational chart note the first day of therapy, followed by pharmacists discussing the need for continued therapy with patients' physicians. Empirical vancomycin use improved from 20% to 90% compliance with guidelines within 6 months of the intervention
Outbreak of Nosocomial Multidrug-ResistantEnterobacter aerogenesin a Geriatric Unit: Failure of Isolation Contact, Analysis of Risk Factors, and Use of Pulsed-Field Gel Electrophoresis
Authors: Piagnerelli Michaël , Kennes Bernard , Brogniez Yvette , Deplano Ariane , Govaerts Danielle 
Published: February 2006

AbstractWe describe herein an outbreak ofEnterobacter aerogenesin a geriatric acute unit with failure of contact isolation that necessitated the temporary closure of the department. We emphasize the need for guidelines for the management of multiresistant bacteria.
Applicability of Two Surgical-Site Infection Risk Indices to Risk of Sepsis in Surgical Patients
Authors: Fariñas-Álvarez Concepción , Fariñas M. Carmen , Prieto Dolores , Delgado-Rodríguez Miguel 
Published: February 2006

AbstractObjective:To compare the ability of the Study of the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infection Surveillance (NNIS) indices to predict the development of nosocomial sepsis in subjects undergoing surgery.Design:1-year prospective case-control study.Setting:A tertiary-care center in Spain.Patients:Cases were surgical patients with nosocomial sepsis defined using the criteria of the Consensus Conference on Sepsis, identified by daily prospective surveillance.Methods:Controls were randomly selected from the daily list of surgical inpatients. Data were prospectively collected. To determine whether either index added explanatory information to the other, two methods were used. The first method involved computing a set of residuals for both variables. Residuals and primary variables were introduced in logistic regression models. The second method evaluated both indices with the Goodman-Kruskal (G) nonparametric coefficient.Results:99 cases and 97 controls were included. After controlling for confounders, both the SENIC index (P<.001) and the NNIS index (P=.04) showed a significant trend. Residuals of the SENIC index added discriminating ability to the NNIS index, whereas residuals of the NNIS index did not improve the prediction ability of the SENIC index. Similar results were yielded by the G statistic: the SENIC index showed higher predictive power than the NNIS index (G=0.56 vs G=0.41).Conclusions:Both indices performed about equally well for discriminating risk of nosocomial sepsis. The SENIC index had a somewhat better ability than the NNIS index only when the number of discharge diagnoses (not truly a predictive factor) were involved in the calculation of the SENIC index.
Clinical Infection Control in Gene Therapy: A Multidisciplinary Conference
Authors: Evans Martin E. , Jordan Craig T. , Chang Stephen M.W. , Conrad Carol , Gerberding Julie L. , Kaufman Howard L. , Mayhall C. Glen , Nolta Jan A. , Pilaro Anne M. , Sullivan Sean , Weber David J. , Wivel Nelson A. 
Published: February 2006

AbstractGene therapy is being studied for the treatment of a variety of acquired and inherited disorders. Retroviruses, adeno-viruses, poxviruses, adeno-associated viruses, herpesviruses, and others are being engineered to transfer genes into humans. Treatment protocols using recombinant viruses are being introduced into clinical settings. Infection control professionals will be involved in reviewing the safety of these agents in their clinics and hospitals. To date, only a limited number of articles have been written on infection control in gene therapy, and no widely available recommendations exist from federal or private organizations to guide infection control professionals. The goals of the conference were to provide a forum where gene therapy experts could share their perspectives and experience with infection control in gene therapy and to provide an opportunity for newcomers to the field to learn about issues specific to infection control in gene therapy. Recommendations for infection control in gene therapy were proposed.
Antibiotic Use in Long-Term–Care Facilities: Many Unanswered Questions
Authors: Loeb Mark 
Published: February 2006

AbstractThe extensive use of antibiotics in long-term–care facilities has led to increasing concern about the potential for the development of antibiotic resistance. Relatively little is known, however, about the quantitative relation between antibiotic use and resistance in this population. A better understanding of the underlying factors that account for variance in antibiotic use, unexplained by detected infections, is needed. To optimize antibiotic use, evidence-based standards for empirical antibiotic prescribing need to be developed. Limitations in current diagnostic testing for infection in residents of long-term–care facilities pose a substantial challenge to developing such standards.
Reintroduction of Influenza A to a Nursing Building
Authors: Drinka Paul J. , Gravenstein Stefan , Krause Peggy , Nest Lori , Dissing Margaret , Shult Peter 
Published: February 2006

AbstractWe report an outbreak of influenza A from a four-building veterans' facility in King, Wisconsin. Influenza was isolated in 154 of 721 residents over a 121-day period. Building A had 2 cases, no isolates for 40 days, followed by 27 cases. Building B had 25 cases, no isolates for 75 days, followed by 4 cases. Building C had 23 cases, no isolates for 14 days, followed by 17 cases. Influenza A may be reintroduced to a nursing building. Surveillance with contingency plans for restarting of prophylaxis must continue for the duration of influenza in the community.
Outbreak of NosocomialBurkholderia cepaciaInfection and Colonization Associated With Intrinsically Contaminated Mouthwash
Authors: Matrician Linda , Ange Gretehen , Burns Sonia , Fanning W. Lee , Kioski Clare , Cage Gary D. , Komatsu Kenneth K. 
Published: February 2006

AbstractFrom August 1996 through June 1998, 69 ventilated, intensive care unit patients at two Arizona hospitals had nosocomial respiratory tract cultures positive forBurkholderia cepacia.Intrinsically contaminated alcohol-free mouthwash was identified by pulsed-field gel electrophoresis as the source of the outbreak
Should We Routinely Use Mupirocin to Prevent Staphylococcal Infections?
Authors: Roth Virginia R. , Murphy Cathryn , Perl Trish M. , DeMaria Alfred , Sohn Annette H. , Sinkowitz-Cochran Ronda L. , Jarvis William R. 
Published: February 2006

AbstractRoutine use of mupirocin to prevent staphylococcal infections is controversial. We assessed attitudes and practices of healthcare professionals attending the Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections regarding mupirocin prophylaxis. Eighty percent of participants did not use mupirocin routinely. At the end of the session, 58% indicated they would consider increased use of mupirocin.
Influenza Vaccination Status of Healthcare Workers and the Extent of their Domestic Contact With Individuals at High Risk for Influenza-Related Complications
Authors: Ong Adrian K.Y. , Srimanunthiphol Jun , Frankel Richard I. 
Published: February 2006

AbstractMany healthcare workers have frequent household contact with persons at high risk for influenza-related complications. Educating healthcare workers about the risk of domestic transmission of influenza may improve their acceptance of influenza vaccination. Concerns regarding vaccine efficacy and safety also need to be addressed.
Increasing Pneumococcal Vaccination Rates Among Residents of Long-Term–Care Facilities: Provider-Based Improvement Strategies Implemented by Peer-Review Organizations in Four Western States
Authors: Stevenson Kurt B. , McMahon John W. , Harris Jan , Hillman J. Richard , Helgerson Steven D. 
Published: February 2006

AbstractObjective:To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs.Design:Prospective, before-after quality improvement project.Setting:133 LTCFs in Alaska, Idaho, Montana, and Wyoming.Patients:All residents of participating LTCFs.Methods:Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF.Results:133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy.Conclusions:Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.
Program Overview: The Reality Check Sessions at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections
Authors: Sohn Annette H. , Sinkowitz-Cochran Ronda L. , Jarvis William R. 
Published: February 2006

AbstractThe 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections provided a unique forum to assess opinions regarding current infection control controversies. The “Reality Check” sessions were a special portion of the conference where attendees expressed their opinions on these issues and heard varying viewpoints from noted experts. Using an Audience Response System (ARS), individual audience members cast their votes during seven different sessions. Although systems such as the ARS have been used during other conferences, there are no published accounts to date describing audience viewpoints on infection control topics. An overview of the “Reality Check” sessions follows.
Influenza Vaccination Levels and Influenza-Like Illness in Long-Term-Care Facilities for Elderly People in Niigata, Japan, During an Influenza A (H3N2) Epidemic
Authors: Oshitani Hitoshi , Saito Reiko , Seki Nao , Tanabe Naohito , Yamazaki Osamu , Hayashi Seiji , Suzuki Hiroshi 
Published: February 2006

AbstractSurveys on influenza vaccination and illness in long-term-care facilities in Niigata Prefecture during an influenza A (H3N2) epidemic revealed that >20% of facilities had outbreaks and >10% of residents experienced influenza. Outbreaks and number of cases were significantly reduced by vaccination, which should be strongly recommended for institutionalized elderly people.
Control of Influenza A on a Bone Marrow Transplant Unit
Authors: Weinstock David M. , Eagan Janet , Malak Sharp Abdel , Rogers Maureen , Wallace Holly , Kiehn Timothy E. , Sepkowitz Kent A. 
Published: February 2006

AbstractIn January 1998, an outbreak of influenza A occurred on our adult bone marrow transplant unit. Aggressive infection control measures were instituted to halt further nosocomial spread. A new, more rigorous approach was implemented for the 1998/99 influenza season and was extremely effective in preventing nosocomial influenza at our institution.
Heat-and-Moisture Exchangers Used With Biweekly Circuit Tubing Changes: Effect on Costs and Pneumonia Rates
Authors: Salemi Charles , Padilla Sally , Canola Teresa , Reynolds David 
Published: February 2006

AbstractIn 1991, heat-and-moisture exchangers were introduced with biweekly ventilator circuit tubing changes, resulting in elimination of multiple pieces of respiratory equipment and reduced labor costs. The annual savings were $157,000, totalling $1.5 million since the onset of the program. There have been no increases in rates of ventilator-associated pneumonia.
An Outbreak of Pyodermas Among Neonates Caused by Ultrasound Gel Contaminated With Methicillin-SusceptibleStaphylococcus Aureus
Authors: Weist Klaus , Wendt Constanze , Petersen Lyle R. , Versmold Hans , Rüden Henning 
Published: February 2006

Objective:To investigate an outbreak of methicillin-susceptibleStaphylococcus aureus(MSSA); infections in a neonatal clinic.Design:Prospective chart review, environmental sampling, and genotyping by two independent methods: pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). A case-control study was performed with 31 controls from the same clinic.Setting:A German 1,350-bed tertiary-care teaching university hospital.Results:There was a significant increase in the incidence of pyodermas with MSSA 10 neonates in good physical condition with no infection immediately after birth developed pyodermas. A shared spatula and ultrasound gel were the only identified infection sources. The gel contained MSSA and was used for hip-joint sonographies in all neonates. PFGE and RAPD-PCR patterns from 6 neonates and from the gel were indistinguishable and thus genetically related clones. The case-control study revealed no significant risk factor with the exception of cesarean section (P=.006). The attack rate by days of hip-joint sonography between April 15 and April 27, 1994, was 11.8% to 40%.Conclusions:Inappropriate hygienic measures in connection with lubricants during routine ultrasound scanning may lead to nosocomialS aureusinfections of the skin. To our knowledge this source ofS aureusinfections has not previously been described.
Pyrogenic Reactions Associated With Single Daily Dosing of Intravenous Gentamicin
Authors: Buchholz Udo , Richards Chesley , Murthy Rekha , Arduino Matthew , Pon Doreen , Schwartz Wayne , Fontanilla Elsie , Pegues Clare , Boghossian Noemy , Peterson Carol , Kool Jacob , Mascola Laurene , Jarvis William R. 
Published: February 2006

Objective:To identify risk factors associated with an unexpected outbreak of pyrogenic reactions (PR) following intravenous gentamicin.Design:We conducted two cohort studies. PRs were defined as chills, rigors, or shaking within 3 hours after initiating the gentamicin infusion during the preepidemic (December 1, 1997-January 15,1998) or epidemic (May 1-June 15,1998) periods. We tested gentamicin vials for endotoxin using the limulus amebocyte lysate assay.Setting:Inpatient services of a large community hospital in Los Angeles, California.Results:During the epidemic period, 22 (15%) of 152 patients developed documented PRs following intravenous gentamicin. PRs were more likely among patients receiving single daily dosing (SDD) than multiple daily dosing gentamicin (20/73 [27%] vs 2/79 [3%]; relative risk, 10.8; 95% confidence interval, 2.644.7). Laboratory analysis of gentamicin vials found endotoxin levels that were higher among Fujisawa-brand gentamicin (implicated brand) than gentamicin used after the outbreak terminated (non-implicated brand). Although endotoxin levels in the vials did not exceed US Pharmacopeia limits (1.7 endotoxin units/mg gentamicin), the use of SDD gentamicin may place patients at greater risk of receiving doses of endotoxin above the threshold for PRs in humans.Conclusions:Reassessment of the acceptable amounts of endotoxin in gentamicin and other parenteral products should be considered when dosing intervals used in clinical practice change.