bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nosocomial Bacteremia in HIV Patients: The Role of Peripheral Venous Catheters
Authors: Lambotte Olivier , Lucet Jean-Christophe , Fleury Laurent , Joly-Guillou Marie-Laure , Bouvet Elisabeth 
Published: February 2006

AbstractA retrospective case-control study compared 40 human immunodeficiency virus (HIV)-infected patients with 43 nosocomial bacteremias (NB) to 77 HIV-infected patients without NB. Presence of a peripheral venous catheter (PVC) was associated with occurrence of NB and was significantly more frequent in NB without an identified source. PVCs probably are an underestimated source of NB in HIV-infected patients.
Efficacy of a Washer-Pasteurizer for Disinfection of Respiratory-Care Equipment
Authors: Rutala William A. , Weber David J. , Gergen Maria F. , Gratta Albert R. 
Published: February 2006

AbstractWe evaluated the efficacy of a commercial washer-pasteurizer. Carriers were inoculated with 104 to 106 test organisms and pasteurized at 170°F for 30 minutes. Pasteurization eliminated all test organisms with the exception of Bacillus subtilis spores. Pasteurization appears efficacious for the disinfection of respiratory-care equipment and could result in a cost savings of approximately $30,000 per year.
Nosocomial Candida guilliermondii Fungemia in Cancer Patients
Authors: Mardani Masoud , Hanna Hend A. , Girgawy Essam , Raad Issam 
Published: February 2006

AbstractFrom 1988 to 1998, we identified nine patients with Candida guilliermondii fungemia. Four of the five patients with nosocomial infection died, while all of the non-nosocomial cases survived, even though one half of them (2/4) did not receive any treatment Nosocomial C guilliermondii fungemia is often associated with poor outcome despite aggressive antifungal therapy.
Compliance With National Recommendations for Tuberculosis Screening and Immunization of Healthcare Workers in a Children's Hospital
Authors: Bratcher Denise F. , Stover Beth H. , Lane Natalie E. , Paul Ronald I. 
Published: February 2006

AbstractPhysicians and clinical employees at a children's hospital were surveyed to compare their tuberculosis (TB) screening and immunization statuses. Failure to offer screening and immunization services to non-employee physicians was associated with lower rates of reported immunity to several vaccine-preventable diseases and with markedly lower rates of TB screening.
Control of Occupational Hepatitis B Among Healthcare Workers in the Czech Republic, 1982 to 1995
Authors: Helcl Jaroslav , Cástková Jitka , Benes Cestmir , Novotna Lenka , Sepkowitz Kent A , DeHovitz Jack A. 
Published: February 2006

AbstractOccupational hepatitis B remains a threat to healthcare workers (HCWs) worldwide, even with availability of an effective vaccine. Despite limited resources for public health, the Czech Republic instituted a mandatory vaccination program for HCWs in 1983. Annual incidence rates of acute hepatitis B were followed prospectively through 1995. Despite giving vaccine intradermally from 1983 to 1989 and intramuscularly as half dose from 1990 to 1995, rates of occupational hepatitis B decreased dramatically, from 177 cases per 100,000 workers in 1982 (before program initiated) to 17 cases per 100,000 in 1995. Among high-risk workers, the effect was even more dramatic (from 587 to 23 per 100,000). We conclude that strong public-health leadership led to control of occupational hepatitis B among HCWs in the Czech Republic, despite limited resources that precluded administering full-dose intramuscular vaccine for much of the program. Application of a similar program should be considered for other countries in regions that currently do not have a hepatitis B vaccination program.
SHEA Conference on Antimicrobial Resistance
Authors: Gerding Dale N. , Martone William J. 
Published: February 2006

AbstractAntimicrobial resistance is an increasing problem in healthcare institutions and in the community. Public concern about resistance is also increasing. The issue is broad and complex and not readily addressed by government, industry, or professional societies alone. On October 29-30,1998,19 representatives of various professional societies and governmental agencies met under the auspices of the Society for Healthcare Epidemiology of America (SHEA) at Brook Lodge Conference Center in Augusta, Michigan. The purpose of the meeting was to discuss the current status of antimicrobial resistance in the United States and Canada, including present society and governmental efforts to address the problem. Representatives exchanged experiences through presentations and discussions on the first day, then on the second day held a brainstorming session to address future needs and priorities in addressing the resistance problem. It was agreed that a national coordinated effort was needed. As part of this national effort, representatives called for the creation of a National Coalition on Antibiotic Resistance (NCAR) to combat antibiotic resistance through education, research, prevention, and advocacy. Priorities for NCAR were focused in four areas: (1) education of the public and professionals; (2) support of basic and applied research; (3) provision of an information resource and clearinghouse; and (4) advocacy initiatives. At the recommendation of the SHEA Board, discussions with the National Foundation for Infectious Diseases for the joint development of NCAR have begun.
Scheduled Replacement of Central Venous Catheters Is Not Necessary
Authors: Timsit Jean-François 
Published: February 2006

Although half of intensivists routinely replace their central venous catheters (CVCs), this practice is not supported by data from randomized control studies or by pathophysiology of CVC infection. The daily risk of CVC infection is considered to be a constant; the risk of catheter infection is directly related to the duration of catheter insertion. Consequently, the routine change of the catheter is able to decrease the number of infections per catheter but not to modify the number of infections per day of catheter insertion. This assertion is supported by evidence-based medicine: scheduled replacement every 3 or 7 days has not been shown to alter the infectious risks of CVCs in randomized studies or a meta-analysis.Moreover, routine replacement at a new site exposes the patient to an increased risk of mechanical complications. The overall rate of mechanical complications per catheter inserted is approximately 3%. Guidewire exchange of the catheters may reduce the risk of mechanical complications, but unfortunately is associated with a higher rate of catheter colonization and catheter-related bacteremia. Routine replacement of CVCs is not necessary.
Improving Compliance With Hand Hygiene in Hospitals
Authors: Pittet Didier 
Published: February 2006

Hand hygiene prevents cross-infection in hospitals, but compliance with recommended instructions often is poor among healthcare workers. Although some previous interventions to improve compliance have been successful, none has achieved lasting improvement. This article reviews reported barriers to appropriate hand hygiene and factors associated with poor compliance.Easy access to hand hygiene in a timely fashion and the availability of skin-care lotion both appear to be necessary pre-requisites for appropriate hand-hygiene behavior. In particular, in high-demand situations, hand rub with an alcohol-based solution appears to be the only alternative that allows a decent compliance. The hand-hygiene compliance level does not rely on individual factors alone, and the same can be said for its promotion. Because of the complexity of the process of change, it is not surprising that solo interventions often fail, and multimodal, multidisciplinary strategies are necessary. A framework that includes parameters to be considered for hand-hygiene promotion is proposed, based on epidemiologically driven evidence and review of the current knowledge. Strategies for promotion in hospitals should include reasons for noncompliance with recommendations at individual, group, and institutional levels. Potential tools for change should address each of these elements and consider their interactivity.
An Outbreak of Influenza A in a Neonatal Intensive Care Unit
Authors: Cunney Robert J. , Bialachowski Anne , Thornley Diane , Smaill Fiona M. , Pennie Ross A. 
Published: February 2006

Objectives:Investigation of an outbreak of influenza A in a neonatal intensive care unit (NICU) with examination of risk factors for infection and outcomes.Design:Retrospective cohort study of infants admitted to the unit during the outbreak period. Prospective survey of NICU staff and mothers of infants in the cohort study.Setting:Level III nursery in a university-affiliated tertiary referral center.Results:Nineteen infants in the NICU were infected with influenza A. There were six symptomatic cases and one death who had evidence of virus-associated hemophagocytic syndrome at autopsy. Amantadine prophylaxis was offered to the NICU staff, and amantadine therapy was given to five of the six symptomatic infants. Mechanical ventilation, gestational age, birth weight, Clinical Risk Index for Babies score, and twin pregnancy were associated with acquisition of influenza A on univariate analysis. Mechanical ventilation (odds ratio [OR], 6.2;P=.02) and twin pregnancy (OR, 7.0;P=.04) remained as significant risk factors for infection on multiple logistic regression analysis. Only 15% of respondents to the NICU staff survey were vaccinated against influenza. There was no association between a history of an influenza-like illness during pregnancy and acquisition of influenza A by infants of mothers who responded to the maternal survey (OR, 0.91;P=1.0).Conclusions:Influenza A is an important pathogen in the neonatal population and is readily transmissible in the NICU setting.
A Heterogeneous Outbreak ofEnterobacter cloacae and Serratia marcescensInfections in a Surgical Intensive Care Unit
Authors: Dorsey Grant , Borneo Hena T. , Sun Sumi J. , Wells Jennifer , Steele Lynn , Howland Kathryn , Perdreau-Remington Francoise , Bangsberg David R. 
Published: February 2006

Objective:To investigate an outbreak of invasive disease due toEnterobacter cloacaeandSerratia marcescensin a surgical intensive care unit (ICU).Design:Pulsed-field gel electrophoresis (PFGE) analysis of restriction fragments was used to characterize the outbreak isolate genotypes. A retrospective cohort study of surgical ICU patients was conducted to identify risk factors associated with invasive disease. Unit staffing data were analyzed to compare staffing levels during the outbreak to those prior to and following the outbreak.Setting:An urban hospital in San Francisco, California.Patients:During the outbreak period, December 1997 through January 1998, there were 52 patients with a minimum ICU stay of ≥72 hours. Of these, 10 patients fit our case definition of recovery ofE cloacaeorS marcescensfrom a sterile site.Results:PFGE analysis revealed a highly heterogeneous population of isolates. Bivariate analysis of patient-related risk factors revealed duration of central lines, respiratory colonization, being a burn patient, and the use of gentamicin or nafcillin to be significantly associated with invasive disease. Both respiratory colonization and duration of central lines remained statistically significant in a multivariate analysis. Staffing data suggested a temporal correlation between understaffing and the outbreak period.Conclusions:Molecular epidemiological techniques provided a rapid means of ruling out a point source or significant cross-contamination as modes of transmission. In this setting, patient-related risk factors, such as respiratory colonization and duration of central lines, may provide a focus for heightened surveillance, infection control measures, and empirical therapy during outbreaks caused by common nosocomial pathogens. In addition, understaffing of nurses may have played a role in this outbreak, highlighting the importance of monitoring staffing levels.
A Pseudo-Outbreak ofAureobasidiumSpecies Lower Respiratory Tract Infections Caused by Reuse of Single-Use Stopcocks During Bronchoscopy
Authors: Wilson Stephen J. , Everts Richard J. , Kirkland Kathryn B. , Sexton Daniel J. 
Published: February 2006

Objective:To investigate and control an apparent outbreak of lower respiratory tract infections due to Aureobasidium species.Design:Outbreak investigation.Setting:University-affiliated medical center.Patients:Nine patients who underwent bronchoscopy between June and August 1998.Results:Ten bronchoalveolar lavage (BAL) fluid cultures from nine patients grewAureobasidiumspecies during the outbreak period; whereas, respiratory specimens from only two patients grewAureobasidiumspecies during the preceding 6 years. No patient was judged to have true infection due toAureobasidiumspecies either before or after bronchoscopy. Nine of the 10 bronchoscopies that yieldedAureobasidiumspecies were performed in the outpatient bronchoscopy suite. TheAureobasidiumisolates were not associated with any one bronchoscope. Observation of bronchoscopy procedure revealed that plastic stopcocks labeled for single use were reused on different patients during BAL. There was no record of how many times each stopcock was being reused. After each use, the stopcocks were placed in an automated disinfection machine designed for bronchoscopes. Culture of the stopcocks after they had been “disinfected” yielded a heavy growth ofAureobasidiumspecies, while culture of fluid from the automated disinfection machine was negative. Reuse of the stopcocks was halted, and, during the following 6-month period,Aureobasidiumspecies were not isolated from any BAL specimen.Conclusions:Reuse of medical equipment labeled for single use is potentially hazardous, especially if no quality control system is in place to monitor sterility and function after reprocessing.
Cleaning of Blood-Contaminated Reprocessed Angiographic Catheters and Spinal Needles
Authors: Penna Thereza Christina Vessoni , Ferraz Carlos Augusto M. 
Published: February 2006

Objectives:To evaluate the efficacy of a multistep cleaning method using a cleaner and a chemical disinfectant on blood-contaminated angiographic catheters and spinal needles intended to be sterilized by hydrogen peroxide gas plasma.Method:A mixture of radiopaque iodine contrast, bovine blood (plus ethylenediaminetetraacetic acid), and a suspension of Bacillus subtilis spores was used to simulate catheterization and needle use. The mixture was a 1:1 proportion of contrast and blood, inoculated so that there was a final concentration of B subtilis spores of 1.0×106 colony-forming units (CFU)/mL. The inoculated devices were cleaned using a hydrogen peroxide solution at a concentration of 1.5±0.5 percent by weight, followed by distilled water with enzymatic detergent. After drying, the devices were sterilized with hydrogen peroxide gas plasma.Results:The initial B subtilis spore concentration inoculated into catheters and needles varied from 2.12×104 to 2.74×107 CFU/mL. The residual load of B subtilis spores after cleaning varied from zero (no count) to a maximum of 200 CFU/device. The multistep cleaning procedure was responsible for an average 5-log10 reduction of B subtilis spores in the catheter and needle lumens.Conclusions:The hydrogen peroxide and enzymatic detergent aqueous solutions were shown to be efficacious when used as part of a multistep cleaning method. The low level of microbial contamination prior to sterilization with hydrogen peroxide gas plasma assured that the intended sterility assurance level was reached.
Pathogenic Organisms Associated with Artificial Fingernails Worn by Healthcare Workers
Authors: Hedderwick Sara A. , McNeil Shelly A. , Lyons Michael J. , Kauffman Carol A. 
Published: February 2006

Objective:To determine differences in the identity and quantity of microbial flora from healthcare workers (HCWs) wearing artificial nails compared with control HCWs with native nails.Design:Two separate studies were undertaken. In study 1, 12 HCWs who did not normally wear artificial nails wore polished artificial nails on their nondominant hand for 15 days. Identity and quantity of microflora were compared between the artificial nails and the polished native nails of the other hand. In study 2, the microbial flora of the nails of 30 HCWs who wore permanent acrylic artificial nails were compared with that of control HCWs who had native nails. In both studies, nail surfaces were swabbed and subungual debris was collected to obtain material for culture.Staphylococcus aureus, gram-negative bacilli, enterococci, and yeasts were considered to be potential pathogens. All organisms were identified and quantified.Results:In study 1, potential pathogens were isolated from more samples obtained from artificial nails than native nails (92% vs 62%;P<.001). Colonization of artificial nails increased over time; by day 15, 71% of cultures yielded a pathogen compared with 21% on day 1 (P=.004). A significantly greater quantity of organisms (expressed as mean log10colony-forming units ± standard deviation) was isolated from the subungual area than the nail surface; this was noted for both artificial (5.0±1.4 vs 4.1 ±1.0;P<.001) and native nails (4.9±1.3 vs 3.7±0.8;P<.001). More organisms were found on the surface of artificial nails than native nails (P=.008), but there were no differences noted in the quantities of organisms isolated from the subungual areas. In study 2, HCWs wearing artificial nails were more likely to have a pathogen isolated than controls (87% vs 43%;P=.001). More HCWs with artificial nails had gram-negative bacilli (47% vs 17%;P=.03) and yeasts (50% vs 13%;P=.006) than control HCWs. However, the quantities of organisms isolated from HCWs wearing artificial nails and controls did not differ.Conclusions:Artificial fingernails were more likely to harbor pathogens, especially gram-negative bacilli and yeasts, than native nails. The longer artificial nails were worn, the more likely that a pathogen was isolated. Current recommendations restricting artificial fingernails in certain healthcare settings appear justified.
Nosocomial Infections in Combined Medical-Surgical Intensive Care Units in the United States
Authors: Richards Michael J. , Edwards Jonathan R. , Culver David H. , Gaynes Robert P. ,   National Nosocomial Infections Surveillance System
Published: February 2006

Objective:To describe the epidemiology of nosocomial infections in combined medical-surgical (MS) intensive care units (ICUs) participating in the National Nosocomial Infection Surveillance (NNIS) System.Design:Analysis of surveillance data on 498,998 patients with 1,554,070 patient-days, collected between 1992 and 1998 from 205 MS ICUs following the NNIS Intensive Care Unit protocol, representing 152 participating NNIS hospitals in the United States.Results:Infections at three major sites represented 68% of all reported infections (nosocomial pneumonia, 31%; urinary tract infections (UTIs), 23%; and primary bloodstream infections (BSIs), 14%: 83% of episodes of nosocomial pneumonia were associated with mechanical ventilation, 97% of UTIs occurred in catheterized patients, and 87% of primary BSIs in patients with a central line. In patients with primary BSIs, coagulase-negative staphylococci (39%) were the most common pathogens reported; Staphylococcus aureus (12%) was as frequently reported as enterococci (11%). Coagulase-negative staphylococcal BSIs were increasingly reported over the 6 years, but no increase was seen in candidemia or enterococcal bacteremia. In patients with pneumonia, S aureus (17%) was the most frequently reported isolate. Of reported isolates, 59% were gram-negative bacilli. In patients with UTIs, Escherichia coli (19%) was the most frequently reported isolate. Of reported isolates, 31% were fungi. In patients with surgical-site infections, Enterococcus (17%) was the single most frequently reported pathogen. Device-associated nosocomial infection rates for BSIs, pneumonia, and UTIs did not correlate with length of ICU stay, hospital bed size, number of beds in die ICU, or season. Combined MS ICUs in major teaching hospitals had higher device-associated infection rates compared to all other hospitals with combined medical-surgical units.Conclusions:Nosocomial infections in MS ICUs at the most frequent infection sites (bloodstream, urinary, and respiratory tract) almost always were associated with use of an invasive device. Device-associated infection rates were die best available comparative rates between combined MS ICUs, but the distribution of device-associated rates should be stratified by a hospital's major teaching affiliation status.
Prevalence and Determinants of Fecal Colonization with Vancomycin-ResistantEnterococcusin Hospitalized Patients in The Netherlands
Authors: Braak Nicole van den , Ott Alewijn , van Belkum Alex , Kluytmans Jan A.J.W. , Koeleman Johannes G.M. , Spanjaard Lodewijk , Voss Andreas , Weersink Annemarie J.L. , Vandenbroucke-Grauls Christina M.J.E. , Buiting Anton G.M. , Verbrugh Henri A. , Endtz Hubert P. 
Published: February 2006

Objective:To determine the prevalence and determinants of fecal carriage of vancomycin-resistant enterococci (VRE) in intensive care unit (ICU), hematology-oncology, and hemodialysis patients in The Netherlands.Design:Descriptive, multicenter study, with yearly 1-week point-prevalence assessments between 1995 and 1998.Population:All patients hospitalized on the testing days in ICUs and hematology-oncology wards in nine hospitals in The Netherlands were included.Methods:Rectal swabs obtained from 1,112 patients were screened for enterococci in a selective broth and subcultured on selective media with and without 6 mg/L vancomycin. Resistance genotypes were determined by polymerase chain reaction. Further characterization of VRE strains was done by pulsed-field gel electrophoresis (PFGE). We studied possible determinants of VRE colonization with a logistic regression analysis model. Determinants analyzed included gender, age, and log-transformed length of prior hospital stay.Results:The results showed that 614 (55%) of 1,112 patients were colonized with vancomycin-sensitive enterococci, and 15 (1.4%) of 1,112 carried VRE. No increase in VRE colonization was observed from 1995 to 1998. Eleven strains were identified asEnterococcus faeciumand four asEnterococcus faecalis. AllE faeciumand oneE faecaliscarried thevanAgene; the otherE faecalisstrains harbored thevanBgene. PFGE revealed that threevanBVRE isolated from patients hospitalized in one single ICU were related, suggesting nosocomial transmission. Though higher age seemed associated with VRE colonization, exclusion of patients with the nosocomial strain from the regression analysis decreased this relation to nonsignificant. Duration of hospital stay was not associated with VRE colonization.Conclusion:VRE colonization in Dutch hospitals is an infrequent phenomenon. Although nosocomial spread occurs, most observed cases were unrelated, which suggests the possibility of VRE acquisition from outside the hospital. Prolonged hospital stay, age, and gender proved unrelated to VRE colonization.