bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decontaminated Single-Use Devices: An Oxymoron That May Be Placing Patients at Risk for Cross-Contamination
Authors: Heeg Peter , Roth Klaus , Reichl Rudolf , Cogdill C. Philip , Bond Walter W. 
Published: February 2006

AbstractObjective:To determine whether reprocessed single-use devices would meet regulatory standards for sterility and meet the same materials standards as a new device.Design:The study included single-use and reusable biopsy forceps and papillotomes and a reusable stone retrieval basket. The suitability of these devices for cleaning and disinfection or sterilization was examined.Methods:Testing of cleanability was conducted on devices contaminated with technetium 99-radiolabeled human blood. Instruments were cleaned using hospital recommended practices for manual cleaning. Gamma counts per second were determined before and after cleaning to localize contaminants, which were additionally visualized using light and scanning electron microscopy. X-ray phc-toelectron spectroscopy was used to quantify contamination elements on the materials tested. Residual bioburden testing on instruments contaminated with microorganisms suspended in coagulable sheep blood was carried out to establish the efficacy of disinfection and sterilization.Results:All devices remained contaminated after cleaning, but single-use devices and the stone basket tended to be more heavily contaminated than reusable forceps and papillotomes. Cleaning procedures facilitated distribution of contaminants further into the lumens of the disposable forceps. Decreased concentrations of silicon and increased concentrations of carbon and nitrogen suggested that layers of silicon lubricant had been removed and contaminants were organic material. Reusable devices were effectively disinfected, but single-use devices were not Sterilization could not eliminate the challenge microorganisms completely.Conclusions:None of the reprocessed single-use instruments were effectively cleaned, disinfected, or sterilized. This condition may provide an opportunity for the viability of non-resistant or nosocomial organisms and viruses. Additionally, reprocessing procedures may result in material destruction of fragile devices. Cost-saving initiatives that have inspired reprocessing of single-use devices, despite the absence of data establishing the efficacy of decontamination and the durability of materials throughout reprocessing, should be pushed into the background.
Comparison of Pulsed-Field Gel Electrophoresis and Amplified Fragment-Length Polymorphism for Epidemiological Investigations of Common Nosocomial Pathogens
Authors: D'Agata Erika M.C. , Gerrits Monique M. , Tang Yi-Wei , Samore M. , Kusters Johannes G. 
Published: February 2006

AbstractObjective:To compare molecular typing by amplified fragment-length polymorphism (AFLP) analysis with pulsed-field gel electrophoresis (PFGE) with respect to the ability to differentiate between epidemiologically related and unrelated isolates of common nosocomial pathogens recovered during a period of endemicity.Design:Retrospective laboratory analysis.Setting:Tertiary-care institution.Methods:17 isolates ofAcinetobacter baumannii,22 isolates ofPseudomonas aeruginosa,and 22 vancomycin-resistantEnterococcus faecium(VRE) were typed by both methods.Results:AFLP generated comparable results to PFGE forA baumanniiandP aeruginosaisolates; both methods identified epidemiologically related and unrelated isolates. However, strain typing of VRE isolates produced discordant results between the two methods. PFGE identified 10 different strain types and differentiated between all epidemiologically related and unrelated isolates. In contrast, AFLP generated only five different strain types, three of which contained both epidemiologically related and unrelated isolates.Conclusion:Molecular typing by AFLP is comparable to PFGE forA baumanniiandP aeruginosaisolates. For VRE isolates, however, PFGE remains the method of choice.
Correlates of Antibiotic Use in Taiwan Hospitals
Authors: McDonald L. Clifford , Yu Hui Tzu , Yin Hsiao Chun , Hsiung Chao Agnes , Hung Chien-Ching , Ho Monto ,   Antibiotic Use Working Group
Published: February 2006

AbstractObjective:To determine factors that correlate with increased antibiotic use among adult inpatients in Taiwan.Design:Retrospective survey of medical records.Setting:14 acute-care hospitals (8 regional hospitals, 6 medical centers) in Taiwan.Participants:A systematic probability sample from each hospital, totaling 663 adult inpatients who were discharged or had died in early 1999.Measurements:Infectious disease physicians at the 14 hospitals collected data from medical records regarding patient demographics, hospitalization, discharge diagnosis, and antibiotics received.Results:A total of 447 (67%) patients received antibiotics for an overall rate of 813 antibiotic-days (number of days patients received each antibiotic)/1,000 patient-days. Both the proportion of beds in intensive care units ([ICUs] Pearson correlation coefficient [r], 0.67; 95% confidence interval [CI95], 0.36-0.89;P<.01) and the proportion of patients admitted to surgical services (r,0.66; CI95, 0.20-0.88;P=.01) correlated with the mean patient rate of antibiotic-days/hospital-day (MPAUD). In contrast, we found no correlation between the proportion of patients who received antibiotics and the MPAUD. Using multiple linear regression, medical center status was the only independent predictor for increased MPAUD (regression coefficient [b], 0.15; CI95, 0.05-0.24;P<.01). There was no correlation between pooled rates of antibiotic-days/hospital-day and any hospital demographic factors. First-generation cephalosporin (39%) and aminoglycoside (24%) use accounted for the majority of antibiotic-days.Conclusions:Antibiotic use is greater in medical centers than in regional hospitals and appears to be independent of surgical case mix or the proportion of ICU beds. Determination of multiple, independent measures of antibiotic use may be necessary to understand the relation between antibiotic use and resistance in hospitals.
Topical Mupirocin for Eradication of MRSA Colonization With Mupirocin-Resistant Strains
Authors: Semret Makeda , Miller Mark A. 
Published: February 2006

AbstractTopical mupirocin was able to interrupt colonization of 52% and 68% of methicillin-resistantStaphylococcus aureus(MRSA)-colonized patients carrying mupirocin-resistant and -sensitive strains, respectively, including 44.4% and 85.7% of those colonized only in the nares. Although a trend to decreased effectiveness was seen for clearing mupirocin-resistant MRSA this agent can decolonize many patients with resistant strains.
Experience in the Field: Assessing Quality of Health Care Reform in Canada
Authors: Birnbaum David , Millar John 
Published: February 2006

AbstractThe Canadian Institute for Health Information (CIHI) maintains databases to report independently on the health of Canadians and the performance of their healthcare system. CIHI recently received funding to improve indicator development for tracking quality, because in Canada we really have very few data that allow us to make comparable observations down to a regional or institution-specific interest level. We have a long way to go, and we recognize that collaboration and partnership is the only way that this development will move ahead.
Controlling Methicillin-Resistant Staphylococcus aureus: A Feedback Approach Using Annotated Statistical Process Control Charts
Authors: Curran Evonne T. , Benneyan James C. , Hood John 
Published: February 2006

AbstractObjectives:To investigate the benefit of a hospitalwide feedback program regarding methicillin-resistant Staphylococcus aureus (MRSA), using annotated statistical process control charts.Design:Retrospective and prospective analysis of MRSA rates using statistical process control charts.Participants:Twenty-four medical, medical specialty, surgical, intensive care, and cardiothoracic care wards and units at four Glasgow Royal Infirmary hospitals.Methods:Annotated control charts were applied to prospective and historical monthly data on MRSA cases from each ward and unit during a 46-month period from January 1997 through September 2000. Results were fed back from December 1999 and then on a regular monthly basis to medical staff, ward managers, senior managers, and hotel services.Results:Monthly reductions in the MRSA acquisition rate started 2 months after the introduction of the feedback program and have continued to the present time. The overall MRSA rate currently is approximately 50% lower than when the program began and has become more consistent and less variable within departments throughout Glasgow Royal Infirmary. The control charts have helped to detect rate changes and manage resources more effectively. Medical and nursing staff and managers also report that they find this the most positive form of MRSA feedback they have received.Conclusions:Feedback programs that provide current information to front-line staff and incorporate annotated control charts can be effective in reducing the rate of MRSA.
Stool Colonization With Vancomycin-Resistant Enterococci in Healthcare Workers and Their Households
Authors: Baran Joseph , Ramanathan Jambunathan , Riederer Kathleen M. , Khatib Riad 
Published: February 2006

AbstractObjective:To determine the prevalence of stool colonization with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) and their families.Design:Prospective assessment of fecal colonization with VRE.Setting:A 603-bed, tertiary-care teaching hospital.Participants:Healthy volunteers recruited from hospital employees and their households were screened to exclude pregnancy, diabetes mellitus, immunosuppressive disorders, and recent use of antimicrobials.Intervention:Self-obtained stool swabs were used to obtain cultures. Isolated enterococci were screened for vancomycin resistance and species were identified. Intra-household isolates were genotyped using pulsed-field gel electrophoresis (PFGE).Results:The participants (n = 228; age range, 28 days to 80 years) were from 137 households with and 91 without employees who had contact with patients.Enterococcusspecies were isolated from 127 stool specimens (55.7%). VRE were detected in 12 individuals, representing 6E. casseliflavus, 5E. faecium, and 1E. gallinarum. VRE were more commonly isolated in employees who had contact with patients (5 of 52 vs 0 of 40; relative risk [RR], 1.9; 95% confidence interval [CI95], 1.5 to 2.2;P= .07) and their household members (10 of 137 vs 2 of 91; RR, 3.3; CI95, 0.7 to 14.8;P= .13). In 2 households (2 adults in a physician's household and an adult plus a child in a nurse's household) PFGE analysis demonstrated identical intra-household strains of vancomycin-resistantE. faecium.Conclusions:VRE colonization was found in 5.3% of screened stools and was more prevalent in HCWs who had contact with patients and their households. Identical PFGE patterns between 2 employees who had contact with patients and their household members demonstrated probable intra-household spread. Although the mode of acquisition was uncertain, the association with employees who had contact with patients suggests possible occupational sources. These findings demonstrate the spread of VRE within the household and implicate occupational risk for its acquisition.
Sensor-Operated Faucets: A Possible Source of Nosocomial Infection?
Authors: Assadian Ojan , El-Madani Nadja , Seper Edith , Mustafa Stefan , Aspöck Christoph , Koller Walter , Rotter Manfred L. 
Published: February 2006

AbstractRecently, contamination of sensor-operated faucets (SOFs) withPseudomonas aeruginosawas observed. To evaluate odds ratios, we conducted a case–control study in which handle-operated faucets served as controls. No statistically significant difference inP. aeruginosacounts was observed between SOFs and regular faucets in our study (odds ratio, 0.0; 95% confidence interval, 0.0 to 39.0; two-sidedPexact = .99).
Intradermal Recombinant Hepatitis B Vaccine for Healthcare Workers Who Fail to Respond to Intramuscular Vaccine
Authors: Playford E. Geoffrey , Hogan Patrick G. , Bansal Amolak S. , Harrison Kareena , Drummond David , Looke David F. M. , Whitby Michael 
Published: February 2006

Objective:To study the humoral immune responses, safety, and tolerability of intradermal recombinant hepatitis B vaccination in healthcare workers (HCWs) nonresponsive to previous repeated intramuscular vaccination.Design:An open, prospective, before–after trial.Setting:A tertiary referral hospital and surrounding district health service in Queensland, Australia.Participants:Hospital and community HCWs nonresponsive to previous intramuscular hepatitis B vaccination.Methods:Intradermal recombinant hepatitis B vaccine was administered every second week for a maximum of 4 doses. Hepatitis B surface antibody (anti-HBs) responses were assessed 2 weeks after each dose.Results:Protective anti-HBs levels developed in 17 (94%) of 18 study subjects. Three doses resulted in seroconversion of all responding subjects and the highest geometric mean antibody concentration. The vaccine was well tolerated.Conclusion:More than 90% of previously nonresponsive HCWs responded to intradermal recombinant hepatitis B vaccine with protective anti-HBs levels.
Central Venous Catheter-Associated Bloodstream Infections in Pediatric Oncology Home Care
Authors: Shah Samir S. , Manning Mary Lou , Leahy Elizabeth , Magnusson Mark , Rheingold Susan R. , Bell Louis M. 
Published: February 2006

AbstractFifty-two pediatric oncology patients with central venous catheters (CVCs) who received home care services were studied. Gram-negative organisms were responsible for a greater proportion of CVC-associated bloodstream infections in pediatric oncology patients receiving home care than in hospitalized pediatric oncology patients.
The Cost of Antibiotic Resistance: Effect of Resistance Among Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa on Length of Hospital Stay
Authors:   The Brooklyn Antibiotic Resistance Task Force
Published: February 2006

AbstractTo assess the effect of antimicrobial resistance on length of hospital stay, a case–control study compared infections due to four nosocomial pathogens. Significantly increased lengths of stay were associated with infections due to methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase–producing Klebsiella pneumoniae, and carbapenem-resistant Acinetobacter baumannii or Pseudomonas aeruginosa. Infections with resistant pathogens are associated with prolonged hospitalization.
A Nursery Outbreak of Staphylococcus aureus Pyoderma Originating From a Nurse With Paronychia
Authors: Lo Wen-Tsung , Wang Chih-Chien , Chu Mongling 
Published: February 2006

AbstractAn outbreak of methicillin-susceptible Staphylococcus aureus pyoderma occurred in the nursery of a tertiary-care referral center. All strains retrieved from the outbreak, including one from a nurse's infected finger, were typed by arbitrarily primed polymerase chain reaction and automated ribotyping. The results indicated that the spread of the outbreak was probably facilitated by contamination of the nurse with paronychia.
Surveillance for Nosocomial Infections and Fever of Unknown Origin Among Adult Hematology–Oncology Patients
Authors: Engelhart Steffen , Glasmacher Axel , Exner Martin , Kramer Michael H. 
Published: February 2006

Objective:To determine the incidence of nosocomial infections (NIs) and fever of unknown origin among adult hematology–oncology patients.Design:Prospective surveillance study.Setting:The 18-bed hematology–oncology unit at the University Hospital Bonn, Bonn, Germany.Patients:All hematology–oncology patients admitted during a total of 8 months in 1998 and 1999.Methods:Standardized surveillance system based on the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance system. Rates of NI and fever of unknown origin were calculated for patient-days and patient-days at risk (ie, days with neutropenia of < 500/mm3 or leukopenia of < 1,000/mm3).Results:Of 116 patients hospitalized for a total of 4,002 days (172 admissions; mean length of stay, 25.2 days), 32 (27.6%) had a total of 44 documented NIs (19 bloodstream infections, 15 pneumonias, 7 urinary tract infections, and 3 others). In addition, 33 fevers of unknown origin were documented in 28 patients. No patient had thrush while receiving antifungal prophylaxis. The overall rates for NI and fever of unknown origin were 11.0 and 8.2 per 1,000 patient-days (25.3 and 15.4 per 1,000 patient-days at risk), respectively. The risks for NI and fever of unknown origin were significantly higher during neutropenic days, with 34 (77.3%) of the 44 NIs and 22 (66.7%) of the 33 fevers of unknown origin occurring during 1,345 patient-days at risk.Conclusions:Prospective surveillance for NIs on hematology–oncology units should include fever of unknown origin as the single most common and clinically important entity. For a meaningful comparison of surveillance data for hematology–oncology patients, the reported infection rates should include rates based on days with neutropenia, for which days with leukopenia could serve as a surrogate marker under routine conditions.
Peripheral Teflon Catheters: Factors Determining Incidence of Phlebitis and Duration of Cannulation
Authors: Cornely Oliver A. , Bethe U. , Pauls Regina , Waldschmidt D. 
Published: February 2006

Background:Catheter-related phlebitis is a frequent problem in the clinical setting. Risk factors for catheter-related phlebitis were assessed at a single tertiary-care institution where no routine change policy for peripheral intravenous catheters is in place.Methods:In a nonrandomized, observational trial, peripheral intravenous Teflon catheters were inserted in patients with a diagnosis of leukemia, lymphoma, solid tumor, acquired immunodeficiency syndrome, other serious infection, or autoimmune disorder. Underlying disease, age, white blood cell count at the time of insertion, physician placing the catheter, catheter bore, duration of cannulation, reason for removal of the catheter, and visual inspection of the insertion site were recorded.Results:Four hundred twelve catheters were inserted in 175 patients. The number of catheterizations per episode varied between 1 and 7. Three hundred sixty-four (88.3%) catheter placements were evaluable. The mean duration of cannulation was 4.2 days. The overall incidence of phlebitis was 12.9%. Catheters in leukopenic patients showed a longer duration of cannulation compared with catheters in nonleukopenic patients, but no difference regarding the phlebitis rate.Conclusion:Findings in this study partly contrast with data reported in the literature. In particular, leukopenia, female gender, prolonged duration of cannulation, antibiotics, and choice of insertion site could not be shown to be risk factors.
Extended-Spectrum β-Lactamase–ProducingEscherichia coliandKlebsiellaSpecies: Risk Factors for Colonization and Impact of Antimicrobial Formulary Interventions on Colonization Prevalence
Authors: Bisson Gregory , Fishman Neil O. , Patel Jean Baldus , Edelstein Paul H. , Lautenbach Ebbing 
Published: February 2006

Objective:The incidence of extended-spectrum β-lactamase (ESβL)–mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESβL-producingEscherichia coliand Klebsiella species(ESβL-EK) remain unclear, as do methods to control their further emergence.Design:Case–control study.Setting:Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.Patients:Thirteen patients with ESβL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.Results:Duration of hospitalization was the only independent risk factor for ESβL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a singleK. oxytocaclone. Finally, the prevalence of ESβL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P= .51).Conclusions:ESβL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESβL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.
Trauma Severity Scoring Systems as Predictors of Nosocomial Infection
Authors: Jamulitrat Silom , Narong Montha Na , Thongpiyapoom Somchit 
Published: February 2006

Objectives:To describe the patterns of nosocomial infections in patients with traumatic injuries and to compare the associations between injury severity, derived from various severity scoring systems, and subsequent nosocomial infections.Design:Prospective observational study.Setting:A 750-bed university hospital serving as a medical school and referral center for the southern part of Thailand.Participants:All trauma patients admitted to the hospital for more than 3 days during 1996 to 1999 were eligible for this study.Methods:The severity of injuries was measured in terms of injury severity score (ISS), revised trauma score (RTS), new injury severity score (NISS), and trauma injury severity score (TRISS). Infections acquired during hospitalization were categorized using Centers for Disease Control and Prevention criteria. The association between severity of injury and nosocomial infection was examined with Poisson regression models.Results:There were 222 nosocomial infections identified among 146 patients, yielding an infection rate of 0.8 infections per 100 patient-days. Surgical-site infection was the most common site-specific infection, accounting for 31.1% of all infections. The incidence of intravenous catheter–related bloodstream infection was 1.6 infections per 100 catheter-days. The bladder catheter–related urinary tract infection rate was 2.8 infections per 100 catheter-days. The rate of ventilator-associated pneumonia was 3.2 infections per 100 ventilator-days. The incidence of infection correlated well with injury severity. The infection incidence rate ratios for one severity category increment of ISS, NISS, RTS, and TRISS were 1.65 (95% confidence interval [CI95, 1.42 to 1.92), 1.79 (CI95, 1.55 to 2.05), 1.64 (CI95, 1.43 to 1.88), and 1.32 (CI95, 1.14 to 1.52), respectively.Conclusions:Surgical-site infection was the most common site-specific nosocomial infection. The NISS might be the most appropriate severity scoring system for adjustment of infection rates in trauma patients.