bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Colonization With Vancomycin-Resistant Enterococci in a Melbourne Hospital
Authors: MacIntyre C. Raina , Empson Marianne , Boardman Claire , Sindhusake Doungkamol , Lokan Julie , Brown Graham V. 
Published: February 2006

AbstractObjective:To determine risk factors for colonization with vancomycin-resistant enterococci (VRE) in a hospital outbreak.Design:Outbreak investigation and case-control study.Setting:A referral teaching hospital in Melbourne, Australia.Participants:Cases were inpatients colonized (with or without clinical disease) with VRE between July 26 and November 28, 1998; controls were hospitalized patients without VRE.Methods:Five cases of VRE were identified between July 26 and November 8, 1998, by growth of VRE from various sites. Active case finding by cultures of rectal swabs from patients surveyed in wards was commenced on July 26, after the first isolate of VRE.Results:There were 19 cases and 66 controls. All the VRE identified werevanB, and all wereEnterococcus faecium.One molecular type predominated (18/19 cases). In a logistic-regression model, being on the same ward as a VRE case was the highest risk factor (odds ratio [OR], 82; 95% confidence interval [CI95], 5.7-1,176;P=.001). Having more than five antibiotics (OR 11.9; CI95, 1.1-129.6;P<.05), use of metronidazole (OR 10.9; CI95, 1.7-69.8;P=.01), and being a medical patient (OR 8.1; CI95,1.4-47.6;P<.05) also were significant. Intensive care unit admission was associated with decreased risk (OR, 0.1; CI95, 0.01-0.8;P<.05).Conclusion:Our findings are consistent with an acute hospital outbreak. Monitoring and control of antibiotic use, particularly metronidazole, may reduce VRE in our hospital. Ongoing surveillance and staff education also are necessary.
In Vitro and In Vivo Efficacy of Catheters Impregnated With Antiseptics or Antibiotics: Evaluation of the Risk of Bacterial Resistance to the Antimicrobials in the Catheters
Authors: Sampath Lester A. , Tambe Suhas M. , Modak Shanta M. 
Published: February 2006

AbstractObjective:To compare the efficacy of a new antiseptic catheter containing silver sulfadiazine and chlorhexidine on the external surface and chlorhexidine in the lumens to an antibiotic catheter impregnated with minocycline and rifampin on its external and luminal surfaces.Design:Experimental trial.Methods:Antimicrobial spectrum of catheters was determined by zones of inhibition. Resistance to luminal colonization was tested in vitro by locking catheter lumens withStaphylococcus epidermidisorStaphylococcus aureusculture after 7 days of perfusion. In vitro development of resistance to the antiseptic or antibiotic combination used in catheters was investigated. In vivo efficacy was tested (rat subcutaneous model) by challenge with sensitive or antibiotic-resistant bacteria.Results:Antiseptic and antibiotic catheters exhibited broad-spectrum action. However, antibiotic catheters were not effective againstCandidaspecies andPseudomonas aeruginosa.Both catheters prevented luminal colonization. Compared to controls, both test catheters resisted colonization when challenged withS aureus7 and 14 days' postimplant (P<.05).Repeated in vitro exposure ofS epidermidisculture to the antibiotic and antiseptic combinations led to small increases in the minimum inhibitory concentration (15 times and 2 times, respectively). Unlike the antibiotic catheter, the in vitro and in vivo activity of the antiseptic catheter was unaffected by the resistance profile of the test organism. Antiseptic catheters were more effective than antibiotic catheters in preventing colonization by rifampin-resistantS epidermidisin vivo (P<.05).Conclusions:Antiseptic and antibiotic catheters exhibit similar efficacy; however, when challenged with a rifampin-resistant strain, the antibiotic catheter appeared to be more susceptible to colonization than the antiseptic device.
Appropriateness of Use of Indwelling Urinary Catheters in Patients Admitted to the Medical Service
Authors: Munasinghe Rajika L. , Yazdani Habeeb , Siddique Mohamed , Hafeez Wasif 
Published: February 2006

AbstractOf 836 medical admissions evaluated over a 1-month period, 89 (10.7%) had a urinary catheter placed within 24 hours; 34 placements (38%) had no justifiable indication. Risk for inappropriate catheterization was independent of age, gender, functional status, and mental status at admission. Preventive measures should focus on increasing awareness among healthcare providers.
Transmission of Hepatitis C in a Pharmacologic Study
Authors: Saginur Raphael , Nixon Judith , Devries Barbara , Bruce Natalie , Carruthers Christopher , Scully Linda , Berger Rachel , Leech Judy , Nicolle Lindsay , Mackenzie Andrew 
Published: February 2006

AbstractObjective:To describe an outbreak of hepatitis C in a clinical research study.Design:Observational study.Setting:Tertiary-care hospital.Patients:Healthcare workers who volunteered to be subjects in a study of the metabolic effects of inhaled and oral corticosteroids who were unwittingly exposed to hepatitis C virus (HCV).Methods:Epidemiological investigation and serological analyses.Results:One chronic carrier of HCV was identified. Four fellow workers volunteering in the studies became infected with HCV, with 96% homology among strains. There was no evidence of spread from infected healthcare workers to patients on whom they had performed arterial punctures (2 of 214 positive, unrelated to each other and to the outbreak strain).Conclusion:Infection control standards in clinical research must be maintained vigorously to prevent transmission of blood-borne pathogens such as HCV.
Environmental Contamination by Multidrug-ResistantAcinetobacter baumanniiin an Intensive Care Unit
Authors: Levin Anna S. , Gobara Satiko , Mendes Caio M.F. , Cursino M. Rosa , Sinto Sumiko 
Published: February 2006

AbstractContamination in an intensive care unit caused by mul-tidrug-resistantAcinetobacter baumanniicomplex (MRAB)-colo-nized patients was evaluated using environmental and patient cultures. MRAB occurred in 21% of patients' cultures, 2.1% of 513 areas surrounding MRAB-patients, and one of 372 common areas. No transmission to other patients occurred. Barrier precautions and ethanol disinfection may prevent dissemination.
Nasal Carriage ofStaphylococcus aureusAmong Patients Receiving Allergen-Injection Immunotherapy: Associated Factors and Quantitative Nasal Cultures
Authors: Bassetti Stefano , Dunagan Donnie P. , D'Agostino Ralph B. , Sherertz Robert J. 
Published: February 2006

AbstractObjective:To compare the prevalence of nasalStaphylococcus aureuscarriage among outpatients receiving allergen-injection immunotherapy with the prevalence among healthy controls and to determine predictors of nasalS aureuscarriage.Design:Survey.Setting:Allergy clinic of a university hospital.Participants:A volunteer sample consisting of 45 outpatients undergoing desensitization therapy and 84 first- and second-year medical students.Results:The nasalS aureuscarriage rate was significantly higher among patients (46.7%) than among students (26.2%;P=.019). In a multivariate model adjusted for age and gender, the presence of atopic dermatitis or eczema was the only independent predictor of nasal Saureuscarriage (odds ratio [OR], 4.4; 95% confidence interval [CI95], 1.2-16.0;P=.02). The only other participant characteristic associated with nasalS aureuscarriage was immunotherapy with allergen injections (OR, 1.98; CI95, 0.7-6.0), but this association did not reach statistical significance (P=.23). The probability of nasalS aureuscarriage was 88.9% for patients receiving allergen injections and having atopic dermatitis or eczema, and 36.1% for patients receiving allergen injections without atopic dermatitis or eczema.Conclusions:Patients undergoing desensitization have a higher nasal carriage rate ofS aureus.However, factors other than the regular use of needles, and in particular abnormalities related to the atopic constitution of these patients, may predispose this population forS aureuscarriage.
Azithromycin Prophylaxis During a Hospitalwide Outbreak of a Pertussis-Like Illness
Authors: Martinez Shay M. , Kemper Carol A. , Haiduven Donna , Cody Sara H. , Deresinski Stanley C. 
Published: February 2006

AbstractA questionnaire regarding tolerability and adherence was administered for 5 days to hospital employees who received azithromycin prophylaxis during a hospitalwide outbreak of a pertussis-like illness. Analysis of the 239 responses from those having received prophylactic azithromycin determined that it was well tolerated and accounted for a minimal loss of days worked; 81.5% were fully adherent with the regimen.
Nosocomial Infections in Geriatric Long-Term-Care and Rehabilitation Facilities: Exploration in the Development of a Risk Index for Epidemiological Surveillance
Authors: Golliot Franck , Astagneau Pascal , Cassou Bernard , Okra Nicole , Rothan-Tondeur Monique , Brücker Gilles 
Published: February 2006

AbstractObjective:To compute a risk index for nosocomial infection (NI) surveillance in geriatric long-term-care facilities (LTCFs) and rehabilitation facilities.Design:Analysis of data collected during the French national prevalence survey on NIs conducted in 1996. Risk indices were constructed based on the patient case-mix defined according to risk factors for NIs identified in the elderly.Setting:248 geriatric units in 77 hospitals located in northern France.Participants:All hospital inpatients on the day of the survey were included.Results:Data from 11,254 patients were recorded. The overall rate of infected patients was 9.9%. Urinary tract, respiratory tract, and skin were the most common infection sites in both rehabilitation facilities and LTCFs. Eleven risk indices, categorizing patients in 3 to 7 levels of increasing NI risk, ranging from 2.7% to 36.2%, were obtained. Indices offered risk adjustment according to NI rate stratification and clinical relevance of risk factors such as indwelling devices, open bedsores, swallowing disorders, sphincter incontinence, lack of mobility, immunodeficiency, or rehabilitation activity.Conclusion:The optimal index should be tailored to the strategy selected for NI surveillance in geriatric facilities in view of available financial and human resources.
Factors Associated With Tuberculin Reactivity in Two General Hospitals in Mexico
Authors: García-García María de Lourdes , Jiménez-Corona Aida , Jiménez-Corona María Eugenia , Ferreyra-Reyes Leticia , Martínez Kenneth , Rivera-Chavira Blanca , Martínez-Tapia María Elena , Valenzuela-Miramontes Emilio , Palacios-Martínez Manuel , Juárez-Sandino Luis , Valdespino-Gómez José Luis 
Published: February 2006

Abstract

Objective:
To identify risk factors associated with tuberculin reactivity in healthcare workers (HCWs).

Design:
Cross-sectional survey of tuberculin reactivity (2 TU of purified protein derivative (PPD) RT23, using the Mantoux two-step test).

Setting:
Two general hospitals located in a region with a high prevalence of tuberculosis and high bacille Calmette-Guérin (BCG) coverage.

Participants:
Volunteer sample of HCWs.

Results:
605 HCWs were recruited: 71.2% female; mean age, 36.4 (standard deviation [SD], 8.2) years; 48.9% nurses, 10.4% physicians, 26.8% administrative personnel; mean time of employment, 10.9 (SD, 6.7) years. PPD reactivity (≥10 mm) was found in 390 (64.5%). Multivariate analysis revealed an association of tuberculin reactivity with occupational exposure in the hospital: participation in autopsies (odds ratio [OR], 9.3; 95% confidence interval [CI95], 2.1-40.5; P=.003.), more than 1 year of employment (OR, 2.4; CI95, 1.1-5.0; P=.02), work in the emergency or radiology departments (OR, 2.0; CI95,1.03-3.81; P=.04), being physicians or nurses (OR, 1.5; CI95, 1.04-2.11; P=.03), age (OR, 1.04; CI95, 1.02-1.07 per year of age; P&lt;.001), and BCG scar (OR, 2.1; CI95, 1.2-3.4; P=.005).

Conclusions:
Although the studied population has a high baseline prevalence of tuberculosis infection and high coverage of BCG vaccination, nosocomial risk factors associated with PPD reactivity were identified as professional risks; strict early preventive measures must be implemented accordingly.
Effectiveness of Hand-Cleansing Agents for Removing Methicillin-Resistant Staphylococcus aureus From Contaminated Hands
Authors: Guilhermetti Marcio , Hernandes Silvio Evandro Daniel , Fukushigue Yoshiaki , Garcia Lourdes Botelho , Cardoso Celso Luíz 
Published: February 2006

AbstractObjective:The effectiveness of hand-cleansing agents in removing a hospital strain of methicillin-resistantStaphylococcus aureusfrom artificially contaminated hands of five volunteers was studied.Design:The products used were plain liquid soap, ethyl alcohol 70% (by weight), 10% povidone-iodine liquid soap (PVP-I), and chlorhexidine gluconate (4%) detergent. The experiments were performed using a Latin square statistical design, with two 5×4 randomized blocks. The removal rates ofS aureuscells from contaminated fingertips were estimated by analysis of variance, the response variable being the log10reduction factor (RF), ie, log10of the initial counts minus log10of the final counts. In the first and second blocks, the fingertips of the volunteers were contaminated in mean with 3.76 log10colony-forming units ([CFU] light-contamination hand) and 6.82 log10CFU (heavy-contamination hand), respectively.Results:In the first block, there were significant differences between treatments (P&lt;.05). The 10% PVP-I (RF, 3.76) and 70% ethyl alcohol (RF, 3.51) had significantly higher removal rates than plain liquid soap (RF, 1.96) and 4% chlorhexidine (RF, 1.91). In the second block, 10% PVP-I (RF, 4.39) and 70% ethyl alcohol (RF, 3.27) also were significantly more effective than plain liquid soap (RF, 1.77) and 4% chlorhexidine (RF, 1.37;P&lt;.05). Plain liquid soap was significantly more effective than chlorhexidine (4%) detergent.Conclusions:The results suggest that 10% PVP-I and 70% ethyl alcohol may be the most effective hand-cleansing agents for removing methicillin-resistantS aureusstrain from either lightly or heavily contaminated hands.
Reality Check: Should We Try to Detect and Isolate Vancomycin-Resistant Enterococci Patients?
Authors: Ostrowsky Belinda , Steinberg James T. , Farr Barry , Sohn Annette H. , Sinkowitz-Cochran Ronda L. , Jarvis William R. 
Published: February 2006

AbstractAntimicrobial resistance, including vancomycin resistance in enterococci (VRE), is a growing problem in healthcare facilities. This “Reality Check” session focused on the question of whether we should try to detect and isolate patients colonized or infected with VRE.
Optimal Frequency of Changing Intravenous Administration Sets: Is It Safe to Prolong Use Beyond 72 Hours?
Authors: Raad Issam , Hanna Hend A. , Awad Abeer , Alrahwan Amin , Bivins Carol , Khan Asma , Richardson Deborah , Umphrey Jan L. , Whimbey Estella , Mansour Georganne 
Published: February 2006

AbstractObjective:To determine the safety and cost-effectiveness of replacing the intravenous (TV) tubing sets in hospitalized patients at 4- to 7-day intervals instead of every 72 hours.Design:Prospective, randomized study of infusion-related contamination associated with changing IV tubing sets within 3 days versus within 4 to 7 days of placement.Setting:A tertiary university cancer center.Patients and Methods:Cancer patients requiring IV infusion therapy were randomized to have the IV tubing sets replaced within 3 days (280 patients) or within 4 to 7 days of placement (232 patients). Demographic, microbiological, and infusion-related data were collected for all participants. The main outcome measures were infusion- or catheter-related contamination or colonization of IV tubing, determined by quantitative cultures of the infusate, and infusion- or catheter-related bloodstream infection (BSI), determined by quantitative culture of the infusate in association with blood cultures in febrile patients.Results:The two groups were comparable in terms of patient and catheter characteristics and the agents given through the IV tubing. Intent-to-treat analysis demonstrated a higher level of tubing colonization in the 4- to 7-day group versus the 3-day group (median, 145 vs 50 colony-forming units;P=.02). In addition, there were three episodes of possible infusion-related BSIs, all of which occurred in the 4- to 7-day group (P=.09). However, when the 84 patients who received total parenteral nutrition, blood transfusions, or interleukin-2 through the IV tubing were excluded, the two groups had a comparable rate of colonization (0.4% vs 0.5%), with no catheter- or infusion-related BSIs in either group.Conclusion:In patients at low risk for infection from infusion- or catheter-related infection who are not receiving total parenteral nutrition, blood transfusions, or interleukin-2, delaying the replacement of IV tubing up to 7 days may be safe, as well as cost-effective.
A Hospital Epidemic of Vancomycin-Resistant Enterococcus Risk Factors and Control
Authors: Byers Karin E. , Anglim Anne M. , Anneski Cynthia J. , Germanson Teresa P. , Gold Howard S. , Durbin Lisa J. , Simonton Barbara M. , Farr Barry M. 
Published: February 2006

AbstbactObjective:To determine risk factors for vancomycin-resistantEnterococcus(VRE) colonization during a hospital outbreak and to evaluate Centers for Disease Control and Prevention (CDC)-recommended control measures.Design:Epidemiological study involving prospective identification of colonization and a case-control study.Setting:A university hospital.Participants:Patients on eight wards involved in outbreak from late 1994 through early 1995.Methods:Cases were matched by ward and culture date with up to two controls. Risk factors were evaluated with four multivariate models using conditional logistic regression. The first evaluated proximity to other VRE patients and isolation status. The second evaluated proximity to unisolated VRE cases and three variables independently predictive after adjustment for proximity. The third evaluated seven significant univariate predictors in addition to proximity to unisolated VRE in backward, stepwise logistic regression. The fourth assessed proximity to VRE with all other variables collected, clustered in a principal components analysis. Pulsed-field gel electrophoresis was performed to assess clonality of two outbreak strains.Results:The incidence of transmission declined significantly after CDC guidelines were implemented. Proximity to unisolated VRE cases during the prior week was a significant predictor of acquisition in each of four multivariate models. Other significant risk factors in multivariate models included a history of major trauma and treatment with metronidazole. Pulsed-field gel electrophoresis confirmed the clonality of two outbreak strains.Conclusions:VRE was transmitted between patients during a hospital epidemic, with proximity to previously unisolated VRE patients being an important risk factor. Weekly surveillance cultures and contact isolation of colonized patients significantly reduced spread.
Surveillance of Nosocomial Infections in Icus: Is Postdischarge Surveillance Indispensable?
Authors: Geffers Christine , Gastmeier Petra , Bräuer Helga , Daschner Franz , Rüden Henning 
Published: February 2006

Abstract

Objective:

To determine how many infections are missed if the postdischarge surveillance (PDS) follow-up of intensive care unit (ICU) patients that is required by the National Nosocomial Infection Surveillance System method is not done.

Design:

ICU patients were followed up and surveillance results with PDS (gold standard) and without PDS were compared.

Setting:

Surgical or interdisciplinary ICUs in eight German acute-care hospitals.

Patients:

All 1,857 patients within a 6-month period in the participating ICUs (a total of 9,129 ICU-patient–days).

Results:

Without PDS, 45 urinary tract infections (UTIs) were diagnosed, compared with 53 with PDS; thus, 15% of the UTIs were missed if no postdischarge follow-up was performed. Three nosocomial pneumonias (4%) and one bloodstream infection (8%) also were missed if surveillance was carried out without PDS. A total of 198 nosocomial infections (NIs) were recorded with PDS, compared to 175 NIs without PDS. Approximately 12% of all ICU-associated NIs were missed if no follow-up was done.

Conclusions:

Since it is very time-consuming to follow patients after their transfer from the ICU, we do not perform a postdischarge follow-up of patients in the course of routine surveillance.
Risk of Exposure to Bloodborne Infection for Italian Healthcare Workers, by Job Category and Work Area
Authors: Puro Vincenzo , De Carli Gabriella , Petrosillo Nicola , Ippolito Giuseppe ,   Studio Italiano Rischio Occupazionale da HIV Group
Published: February 2006

AbstractObjective:To analyze the rate of occupational exposure to blood and body fluids from all sources and specifically from human immunodeficiency virus (HIV)-infected sources among hospital workers, by job category and work area.Design:Multicenter prospective study. Occupational exposure data (numerator) and full-time equivalents ([FTEs] denominator) were collected over a 5-year period (1994-1998) and analyzed.Setting:18 Italian urban acute-care hospitals with infectious disease units.Results:A total of 10,988 percutaneous and 3,361 mucocutaneous exposures were reported. The highest rate of percutaneous exposure per 100 FTEs was observed among general surgery (11%) and general medicine (10.6%) nurses, the lowest among infectious diseases (1.1%) and laboratory (1%) physicians. The highest rates of mucocutaneous exposure were observed among midwives (5.3%) and dialysis nurses (4.7%), the lowest among pathologists (0%). Inadequate sharps disposal and the prevalence of sharps in the working unit influence the risk to housekeepers. The highest combined HIV exposure rates were observed among nurses (7.8%) and physicians (1.9%) working in infectious disease units. The highest rates of high-risk percutaneous exposures per 100 FTE were again observed in nurses regardless of work area, but this risk was higher in medical areas than in surgery (odds ratio, 2.1; 95% confidence interval, 1.9-2.5; P<.0001).Conclusion:Exposure risk is related to job tasks, as well as to the type and complexity of care provided in different areas, whereas HIV exposure risk mainly relates to the prevalence of HIV-infected patients in a specific area. The number of accident-prone procedures, especially those involving the use of hollow-bore needles, performed by job category influence the rate of exposure with high risk of infection. Job- and area-specific exposure rates permit monitoring of the effectiveness of targeted interventions and control measures over time.