bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Surveillance of Central Catheter-Related Bloodstream Infection in an ICU in Korea
Authors: Yoo Sunmi , Ha Mina , Choi Daeok , Pai Hyunjoo 
Published: February 2006

AbstractObjective:To determine whether surveillance and infection control interventions decrease the incidence of catheter-related (CR) bloodstream infections (BSIs) in Korea.Setting:A medical-surgical intensive care unit (ICU) of a university hospital in Korea.Design:The CR infection rate of the intervention period was compared to that of historical controls for a 4-month period.Patients:All patients with a central venous catheter in the intensive care unit (ICU) from October 1998 to January 1999.Methods:Active infection control programs were initiated during the intervention period. Data collected included patient characteristics, risk factors of CR infection, and the microbiology laboratory results. Laboratory-proven CR infection rates were compared between the intervention group and control group.Results:304 catheters were inserted into 248 patients. The intervention group and the control group showed similar characteristics, but more patients in the intervention group received steroid therapy, and subclavian insertion was more common in the intervention group. CR BSI occurred in 1.3 per 1,000 catheter-days in the intervention group and 4.2 in the control group (binomial test, P=.14). CR infections were associated with the duration of ICU admission by multivariate logistic regression.Conclusions:The data suggested that an active infection surveillance and control program could reduce the rate of CR BSI in an ICU.
Evaluating Sharps Safety Devices Meeting OSHA's Intent
Authors: Pugliese Gina , Germanson Teresa P. , Bartley Judene , Luca Judith , Lamerato Lois , Cox Jack , Jagger Janine 
Published: February 2006

AbstractThe Occupational Safety and Health Administration (OSHA) revised the Bloodborne Pathogen Standard and, on July 17, 2001, began enforcing the use of appropriate and effective sharps devices with engineered sharps-injury protection. OSHA requires employers to maintain a sharps-injury log that records, among other items, the type and brand of contaminated sharps device involved in each injury. Federal OSHA does not require needlestick injury rates to be calculated by brand or type of device. A sufficient sample size to show a valid comparison of safety devices, based on injury rates, is rarely feasible in a single facility outside of a formal research trial. Thus, calculations of injury rates should not be used by employers for product evaluations to compare the effectiveness of safety devices. This article provides examples of sample-size requirements for statistically valid comparisons, ranging from 100,000 to 4.5 million of each device, depending on study design, and expected reductions in needlestick injury rates.
Etiology of Fever and Opportunities for Reduction of Antibiotic Use in a Pediatric Intensive Care Unit
Authors: Toltzis Philip , Rosolowski Bonnie , Salvator Ann 
Published: February 2006

Abstract

Objective:

To determine the cause of fever in critically ill children and to identify opportunities for reducing antibiotic use in this population.

Design:

Prospective case series.

Setting:

A tertiary-care medical-surgical pediatric intensive care unit (PICU).

Patients:

Children admitted to the PICU who experienced fever (axillary temperature &gt;38.3°C).

Measurements:

Consecutive children who were febrile at any point in their PICU stay were investigated over two winter seasons. Etiology of the fever was determined by physical examination and routine microbiology and radiographic tests. Three subgroups were reviewed to approximate the number of antibiotic-days that could have been reduced; namely, those with an indeterminate source, those with a documented viral infection, and those receiving a prolonged course of antibiotics. A set of standards reflecting common antibiotic use then was applied to these three patient groups.

Results:

Of 211 subjects, the majority (83.3%) had either a definitive or suspected focus for their fever, and nearly all of these patients were judged to have an infectious etiology. The study population received a total of 2,036 antibiotic-days. Despite the high incidence of infectious causes of fever in our subjects, however, approximately 15% of total antibiotic-days could have been reduced by applying common-use standards.

Conclusions:

Fever in the PICU was usually of defined focus and infectious in origin. However, among febrile patients in the PICU, substantial opportunity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously.
Negative-Pressure Monitoring of Tuberculosis Isolation Rooms Within New York State Hospitals
Authors: Pavelchak Nicholas , Cummings Karen , Stricof Rachel , Marshall Elizabeth , Oxtoby Margaret , London Matthew 
Published: February 2006

Abstract
A previously published study recommended the daily use of visible smoke to test for negative air pressure in isolation rooms occupied by potentially infectious tuberculosis cases. Continuous monitoring devices were found to have poor reliability. Findings from our survey of engineering controls in acute-care hospitals within New York State support this recommendation.
Using Epidemiology to Target Staff Influenza Vaccination Programs
Authors: Russell Margaret L. , Ferguson Cheryl A. 
Published: February 2006

Abstract
We examined staff influenza vaccination rates in rural hospitals that had both acute- and long-term-care (LTC) units. After controlling for hospital, acute-care staff were less likely to be vaccinated than LTC staff. There was no consistent association between type of worker and vaccination after controlling for both hospital and type of care.
Infection Control Practices Among Correctional Healthcare Workers: Effect of Management Attitudes and Availability of Protective Equipment and Engineering Controls
Authors: Green-McKenzie Judith , Gershon Robyn R.M. , Karkashian Christine 
Published: February 2006

AbstractObjectives:To determine the relation of the availability of personal protective equipment (PPE) and engineering controls to infection control (IC) practices in a prison healthcare setting, and to explore the effect on IC practices of a perceived organizational commitment to safety.Design:Cross-sectional survey.Setting:The study population was drawn from the 28 regional Correctional Health Care Workers Facilities in Maryland.Participants:All full-time Maryland correctional healthcare workers (HCWs) were surveyed, and 225 (64%) of the 350 responded.Method:A confidential, self-administered questionnaire was mailed to all correctional HCWs employed in the 28 Maryland Correctional Health Care Facilities. The questionnaire was analyzed psychometrically and validated through extensive pilot testing. It included items on three major constructs: IC practices, safety climate (defined as the perception of organizational commitment to safety), and availability of IC equipment and supplies.Results:A strong correlation was found between the availability of PPE and IC practices. Similarly, a strong correlation was found between IC practices and the presence of engineering controls. In addition, an equally strong association was seen between the adoption of IC practices and employee perception of management commitment to safety. Those employees who perceived a high level of management support for safety were more than twice as likely to adhere to recommended IC practices. IC practices were significantly more likely to be followed if PPE was always readily available. Similarly, IC practices were more likely to be followed if engineering controls were provided.Conclusion:These findings suggest that ready availability of PPE and the presence of engineering controls are crucial to help ensure their use in this high-risk environment. This is especially important because correctional HCWs are potentially at risk of exposure to bloodborne pathogens such as human immunodeficiency virus and hepatitis B and C viruses. Commitment to safety was found to be highly associated with the adoption of safe work practices. There is an inherent conflict of “custody versus care” in this setting; hence, it is especially important that we understand and appreciate the relation between safety climate and IC practices. Interventions designed to improve safety climate, as well as availability of necessary IC supplies and equipment, will most likely prove effective in improving employee compliance with IC practices in this healthcare setting.
The Prevalence of Fecal Colonization With VRE Among Residents of Long-Term–Care Facilities in Melbourne, Australia
Authors: Padiglione Alexander A. , Grabsch Elizabeth , Wolfe Rory , Gibson Kimberly , Grayson M. Lindsay 
Published: February 2006

AbstractA point-prevalence survey performed among residents of eight nursing homes in Melbourne, Australia, found a rate of fecal VRE colonization of 3.1% (9/292; 95% confidence interval, 1.1-5.1), allvanBEnterococcusfaecium.This is a higher rate than in the general community (3.1% vs 0.2%). Many residents (16%) had been inpatients in acute-care hospitals in the previous 3 months.
Models and Mechanisms for Building and Funding Partnerships
Authors: Bisby Mark 
Published: February 2006

AbstractThe Canadian Institutes of Health Research (CIHR) recently replaced two former federal agencies, the Medical Research Council and the National Health Research and Development Program. CIHR has attracted widespread international attention as a grand experimental model that emphasizes excellence, interdisciplinarity, networking, partnership, and a collective process for priority setting, alongside continuing support for the best ideas of the most talented investigators. CIHR identified four cross-cutting health research themes (biomedical research; clinical research; health service; systems research; and research into the societal, cultural, and environmental determinants of health) across its 13 virtual institutes. Each institute is required to bring together investigators working in specific aspects of health research, as they relate to the mandate of the institute, in order to stimulate novel interdisciplinary research approaches. The challenge to Canadian members of the Society for Healthcare Epidemiology of America and their collaborators from other countries is to engage in partnership with CIHR, so that together we can ensure unparalleled quality, safety, and efficacy of healthcare systems in Canada and around the world.
The Direct Costs of Nosocomial Catheter-Associated Urinary Tract Infection in the Era of Managed Care
Authors: Tambyah Paul A. , Knasinski Valerie , Maki Dennis G. 
Published: February 2006

AbstractObjective:To determine the additional direct costs of hospitalization attributable to catheter-associated urinary tract infection (CAUTI) in 1,497 newly catheterized patients.Design:Prospective observational and laboratory study.Setting:University hospital.Methods:Data were collected on risk factors for CAUTI (defined as > 103 colony-forming units [CFU]/mL), severity of illness, and diagnostic and therapeutic interventions in consenting newly catheterized patients. Daily urine cultures were obtained from each newly catheterized patient, but the results of these cultures were not revealed to his or her physician. During the study, one of the investigators (DGM) reviewed each patient's record and made a judgment as to which of the diagnostic tests and treatments ordered and what incremental length of stay could reasonably be ascribed to his or her CAUTI. The total hospital costs for each patient were also obtained.Results:Overall, 235 patients acquired CAUTIs during the study; most of the CAUTIs were completely asymptomatic, and only 52% were diagnosed by the patients' physicians using the hospital laboratory. Only 1 patient with a CAUTI had a secondary bloodstream infection. Thirty-three (13%) of the CAUTIs were caused by Escherichia coli; 63 (25%) by Klebsiella, Enterobacter, Citrobacter, Pseudomonas aeruginosa, or other antibiotic-resistant, gram-negative bacilli; 87 (35%) by enterococci or staphylococci; and 67 (27%) by Candida species. The 123 CAUTIs diagnosed by the hospital laboratory were judged to have been responsible for an additional $20,662 in extra costs of diagnostic tests and $35,872 in extra medication costs, a mean of $589 (median, $356) per CAUTI. CAUTIs caused by E. coli cost considerably less than infections caused by other gram-negative bacilli ($363.3 ± $228.2 vs $690.4 ± $783.7; P = .02) or yeasts ($821.2 ± $2,169.9). There were less striking differences in the costs per CAUTI caused by staphylococci or enterococci ($387.1 ± $434.8).Conclusions:The extra direct costs associated with nosocomial CAUTI found in this prospective study, which was done in the era of managed care during the late 1990s, are substantially lower than those reported in the largest comparable studies done more than 15 years ago, most of which were retrospective, reflecting the powerful impact of cost-containment measures that are now implemented in managed care.
Hand Washing and Physicians: How to Get Them Together
Authors: Salemi Charles , Canola M. Teresa , Eck Enid K. 
Published: February 2006

AbstractObjective:To determine the motivating and behavioral factors responsible for improving compliance with hand washing among physicians.Design:Five unobtrusive, observational studies recording hand washing after direct patient contact, with study results reported to physicians.Setting:A 450-bed hospital in a health maintenance organization with an 18-bed medical-surgical intensive care unit (ICU) and a 12-bed cardiac care unit.Methods:An infectious disease physician met individually with participants to report study results and obtain a commitment to hand washing guidelines. Follow-up interviews were conducted to evaluate behavioral factors and educational programs. Hand washing study results were presented to all staff physicians by live and videotaped inservice presentations and electronic mail (e-mail) newsletters. The importance of influencing factors and the educational effectiveness of the hand washing program were evaluated.Results:Five observational hand washing studies were conducted in the ICU between April 1999 and September 2000. Rates of physician compliance with hand washing were 19%, 85%, 76%, 74%, and 68%, respectively. There were 71 initial encounters and 55 follow-up interviews with the same physicians. Physician interviews revealed that 73% remembered the initial encounter, 70% remembered the hand washing inservice presentations, and 18% remembered the e-mail newsletters. Personal commitment and meeting with an infectious disease physician had the most influence on hand washing behavior. Direct inservice presentations (either live or videotaped) had more influence than did e-mail information. Rates of ventilator-associated pneumonia did not significantly change before and during the study periods. A decrease in the rate of central-line–related bloodstream infections from 3.2 to 1.4 per 1,000 central-line days was found, but could not be solely attributed to improved physician compliance with hand washing.Conclusions:Physician compliance with hand washing can improve. Personal encounters, direct meetings with an infectious disease physician, and videotaped presentations had the greatest impact on physician compliance with hand washing at our medical center, compared with newsletters sent via e-mail. Local data on compliance with hand washing and physician involvement are factors to be considered for physician hand washing compliance programs in other medical centers.
Masking of Neutropenic Patients on Transport From Hospital Rooms Is Associated With a Decrease in Nosocomial Aspergillosis During Construction
Authors: Raad Issam , Hanna Hend , Osting Cheryl , Hachem Ray , Umphrey Jan , Tarrand Jeffrey , Kantarjian Hagop , Bodey Gerald P. 
Published: February 2006

AbstractTo prevent nosocomial pulmonary aspergillosis during hospital construction, neutropenic patients with hematologic malignancy were required to wear high-efficiency masks when leaving their rooms. The rate of nosocomial aspergillosis decreased from 0.73 per 1,000 hospital patient-days during fiscal years 1993 to 1996 to 0.24 per 1,000 hospital patient-days during fiscal years 1996 to 1999 (P < .001). High-efficiency masks reduced nosocomial aspergillosis during hospital construction.
Failure of Oral Antimicrobial Agents in Eradicating Gastrointestinal Colonization With Vancomycin-Resistant Enterococci
Authors: Hachem Ray , Raad Issam 
Published: February 2006

AbstractEradication of gastrointestinal colonization with vancomycin-resistant enterococci (VRE) using a combination of oral bacitracin and gentamicin was evaluated. Twenty-eight evaluable treated patients were matched with 28 control patients. After 3 months of follow-up, 5 patients (18%) in the treatment group versus 1 patient (4%) in the control group (P= .2) had negative results on stool cultures, with a similar frequency of VRE bacteremia (P= .8). The use of oral bacitracin plus gentamicin did not reduce VRE colonization or bacteremia.
The Best Hospital Practices for Controlling Methicillin-Resistant Staphylococcus Aureus: On the Cutting Edge
Authors: Arnold Meredith S. , Dempsey Jane M. , Fishman Marlene , McAuley Patricia J. , Tibert Cynthia , Vallande Nancy C. 
Published: February 2006

Objective:A performance improvement task force of Rhode Island infection control professionals was created to develop an epidemiologic model of statewide consistent infection control practices that could reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA).Design:This model encompasses screening protocols, isolation techniques, methods of cohorting positive patients, decolonization issues, postexposure follow-up, microbiology procedures, and standardized surveillance methodologies. These “best practice guidelines” include three categories of recommendations that define priority levels based on the availability of scientific data.Setting:From 1995 through 2000, several Rhode Island hospitals experienced a fivefold increase in nosocomial acquisition of MRSA.Participants:Rhode Island infection control professionals are a highly interactive group in the unique position of sharing patients and ultimately experiencing similar trends and problems.Intervention:The task force collaborated on developing the best hospital infection control practices to prevent and control the spread of MRSA in Rhode Island.Results:The task force met with local infectious disease physicians and representatives from the Rhode Island Department of Health, the Hospital Association of Rhode Island, and Rhode Island Quality Improvement Partners. Discussions identified numerous and diverse MRSA control practices, issues of consensus, and approaches to resolving controversial methods of reducing the spread of MRSA The guidelines regarding the best hospital practices for controlling MRSA were finalized 8 months later.Conclusion:These guidelines were distributed to all chief executive officers of Rhode Island hospitals by the Rhode Island Department of Health in December 2001. They were issued separate and apart from any regulations, with the intent that hospitals will adopt them as best hospital practices in an attempt to control MRSA.
An Outbreak ofStaphylococcus aureusin a Pediatric Cardiothoracic Surgery Unit
Authors: Weber Stefan , Herwaldt Loreen A. , McNutt Louise-Anne , Rhomberg Paul , Vaudaux Pierre , Pfaller Michael A. , Perl Trish M. 
Published: February 2006

Objective:To investigate an outbreak ofStaphylococcus aureussurgical-site infections.Design:Case–control study.Setting:Pediatric cardiothoracic surgery service of a tertiary-care university medical center.Method:Molecular typing was used to identify healthcare workers who carried the epidemic strain.Results:Three children acquired surgical-site infections caused by a single strain ofS. aureus. Fourteen (25%) of the staff members in the operating room and 17 (11%) on nursing units carried the epidemic strain (P= 01). A case–control study identified 4 healthcare workers who were associated statistically with the outbreak, 2 of whom (a cardiothoracic surgeon and a perfusionist) carried the epidemic strain in their nares. The surgeon also carried the epidemic strain on his hands. Each staff member who carried the epidemic strain was treated with mupirocin; those carrying the strain on their hands were required to wash their hands with chlorhexidine. The surgeon was not allowed to perform surgery until 2 of his hand cultures did not growS. aureus.Conclusions:Only three children were infected with the epidemic strain, but it was disseminated widely among staff who cared for children who underwent cardiothoracic surgery. No additional cases were identified after staff members who carried the epidemic strain were decolonized. Both classic epidemiologic methods and molecular typing techniques were necessary to identify the source and extent of this outbreak.
The Effectiveness of Influenza Vaccine Against Influenza A (H3N2) Virus Infections in Nursing Homes in Niigata, Japan, During the 1998-1999 and 1999-2000 Seasons
Authors: Saito Reiko , Suzuki Hiroshi , Oshitani Hitoshi , Sakai Takatsugu , Seki Nao , Tanabe Naohito 
Published: February 2006

Objective:To evaluate the effectiveness of influenza vaccines against influenza-like illness (ILI) among nursing home residents.Design:Prospective, nonrandomized, cohort study.Setting:Nine nursing homes during the 1998-1999 influenza season and 11 nursing homes during the 1999-2000 influenza season in Niigata Prefecture, Japan.Participants:Six hundred ninety-nine residents and 440 healthcare workers (HCWs) during the first season, and 930 residents and 517 HCWs during the second season, with vaccination rates ranging from 0% to 97.7%.Results:Overall, ILI decreased from 24.3% during the 1998-1999 season to 8.8% during the 1999-2000 season. Multivariate analysis adjusted for several factors, including gender, age, underlying diseases, and resident and HCW vaccination rates, failed to demonstrate clear individual protection of residents (relative risk [RR], 1.42; P = .2 for the first season; RR, 0.95; P = .9 for the second season). However, vaccination rates of 60% or greater for residents and HCWs reduced the risk of ILI, and also could prevent outbreaks during the 2 seasons. Highly impaired activities of daily living and chronic respiratory diseases were significantly associated with increased ILI.Conclusions:A high vaccination rate for both residents and HCWs may reduce the risk of ILI and institutional outbreaks in nursing homes