bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occupational Exposure and Voluntary Human Immunodeficiency Virus Testing: A Survey of Maryland Hospitals
Authors: Solomon Liza , Thompson Charlotte , Squiers Linda , Wulff Karen , Benjamin Georges 
Published: February 2006

AbstractA survey was conducted to estimate how often healthcare providers were exposed to patients' blood and the percentage of incidents in which patients agreed to human immunodeficiency virus (HIV) testing. Data from 38 hospitals with 53,508 employees revealed 2,244 exposures. Of 1,732 requests for information regarding the HIV status of the source patient, only 77 (6%) resulted in the patient's refusal to consent to an HIV test.
Implementation of an Interactive Computer-Assisted Infection Monitoring Program at the Bedside
Authors: Heininger Alexandra , Niemetz Adolf H. , Keim Martin , Fretschner Reinhold , Döring Gerd , Unertl Klaus 
Published: February 2006

AbstractA new computer-assisted infection monitoring (CAI) software program has been developed for use in an intensive-care unit (ICU). By means of an interactive dialogue with physicians at the bedside, infection diagnoses and therapeutic decisions were recorded prospectively during a 3-month test period. By linking epidemiological data with information about therapeutic decisions, CAI could assess the quality of the therapeutic decisions. Antibiotics chosen empirically before the availability of any culture results, matched the antibiotic susceptibility patterns of the subsequently identified pathogens in 74% of the cases. Therapy chosen in collaboration with the computer after the pathogen was known, but before sensitivity results were available, corresponded with the eventual antibiograms of the microorganisms in 90% of the cases. Data analysis by CAI allowed us to assess critically the diagnostic and therapeutic habits in our ICU. Using the query-by-example method, CAI automatically calculated device-associated infection rates.
The Presterilization Microbial Load on Used Medical Devices and the Effectiveness of Hydrogen Peroxide Gas Plasma AgainstBacillus SubtilisSpores
Authors: Penna Thereza Christina Vessoni , Ferraz Carlos Augusto M. , Cassola Maria Águida 
Published: February 2006

Objectives:To determine the microbial load found on used critical medical devices (5 spinal anesthesia needles, 21 catheters, and 28 sheaths) prior to sterilization and to evaluate the effectiveness of hydrogen peroxide gas plasma against inoculatedBacillus subtilisvargiobigii(American Type Culture Collection 9372) spores.Methods:Membrane filter and pour-plate methods were applied to estimate total microbial loads (aerobic and anaerobic, mesophilic and thermophilic, vegetative and spore forms). Spinal anesthesia needles (102 units) and sheath components (61 units) were inoculated with a suspension ofB subtilisspores. After drying, the devices were sterilized with hydrogen peroxide gas plasma.Results:Higher counts of aerobic, mesophilic, and fungal organisms were recovered when the drying period was insufficient. Anaerobic spores were not found in any analyzed presterilization items. The hydrogen peroxide gas plasma effected a 5 to 7 log10-fold reduction inB subtilisspore counts in well-dried needles and sheath components.Conclusions:The success of hydrogen peroxide gas plasma sterilization depends mostly on educating the staff to assure well-cleaned and dried reusable medical devices, allowing penetration of the hydrogen peroxide gas plasma into the critical points of the items and providing a reduction in organisms.
Screening High-Risk Patients for Methicillin-ResistantStaphylococcus Aureuson Admission to the Hospital Is It Cost Effective?
Authors: Papia Giuseppe , Louie Marie , Tralla Arnold , Johnson Claudette , Collins Veronica , Simor Andrew E. 
Published: February 2006

Objectives:To determine the cost-effectiveness of a policy of screening high-risk patients for methicillin-resistantStaphylococcus aureus(MRSA) colonization on admission to hospital.Setting:980-bed university-affiliated tertiary-care hospital.Patients:Between June 1996 and May 1997, patients directly transferred from another hospital or nursing home, or who had been hospitalized in the previous 3 months, were screened for MRSA within 72 hours of hospital admission.Design:Nasal, perineal, and wound swabs were obtained for MRSA screening using standard laboratory methods. Laboratory and nursing costs associated with screening patients for MRSA on admission to hospital were calculated. The costs associated with the implementation of recommended infection control measures for patients with MRSA also were determined.Results:3,673 specimens were obtained from 1,743 patients. MRSA was found on admission in 23 patients (1.3%), representing 36% of the 64 patients with MRSA identified in the hospital during the year. MRSA-colonized patients were more likely to have been transferred from a nursing home (odds ratio [OR], 6.4;P=.04) or to have had a previous history of MRSA colonization (OR, 13.1;P=.05). Laboratory and nursing costs were found to be $8.34 per specimen, for a total cost of $30,632 during the year. The average cost of implementing recommended infection control measures for patients colonized with MRSA was approximately $5,235 per patient.Conclusion:If early identification of MRSA in colonized patients prevents nosocomial transmission of the organism to as few as six new patients, the screening program would save money.
Methicillin-ResistantStaphylococcus Aureusin French Hospitals: A 2-Month Survey in 43 Hospitals, 1995
Authors:   The Hôpital Propre II Study Group
Published: February 2006

Objective:To estimate the incidence of methicillin-resistantStaphylococcus aureus(MRSA) in patients hospitalized in French public hospitals.Design:A 2-month survey that included 163,573 patients and 140,114 admissions.Setting and Patients:Forty-three public or public-affiliated hospitals throughout France, including 12 university-affiliated hospitals. Information was recorded on all patients having MRSA recovered from culture of any clinical sample.Results:The overall median incidence rate (per 1,000 admissions) of clinically detected MRSA was 5.9 (range, 1.8-15.8); median rates were similar in hospitals affiliated or not affiliated to universities (6.4 and 5.9, respectively). Smaller unaffiliated hospitals (<500 beds) had higher MRSA incidence rates (mean, 7.2) than larger (>500 beds) unaffiliated hospitals or university hospitals (mean, 6.7 and 6.1, respectively). The incidence density (per 1,000 patient-days) of MRSA was higher in intensive-care units [ICUs] 2.39/1,000) than in surgical (0.80/1,000) and medical (0.70/1,000) wards, respectively; comparable rates were recorded in rehabilitation units (0.67/1,000), whereas in long-term-stay units, the incidence density of MRSA was 0.27/1,000 patient-days. Of 958 MRSA isolates, 660 (69%) also were resistant to all aminoglycosides. In 411 (43%) of 958 patients, the MRSA isolate was considered imported (ie, first recovered within 72 hours of the patient's admission to the unit). More than one half (53%) of imported cases were transfer patients from other hospitals, and 17% originated from ICUs.Conclusion:MRSA is extensive in French hospitals. All categories of hospitals are involved to a similar extent, and there is intense circulation of patients colonized or infected with MRSA between units and hospitals. Containment of MRSA would mandate increasing resources devoted to infection control, especially in smaller hospitals, and control programs should involve notification of carriers and screening of patients at risk of MRSA carriage on admission to detect carriers and to implement isolation precautions rapidly.
Long-Term Central Venous Catheter Infection in HIV-infected and Cancer Patients: A Multicenter Cohort Study
Authors: Astagneau Pascal , Maugat Sylvie , Tran-Minh Tuan , Douard Marie-Cécile , Longuet Pascale , Maslo Caroline , Parte Régis , Macrez Annick , Brücker Gilles 
Published: February 2006

Objectives:To evaluate and compare the risk of long-term central venous catheter (CVC) infection in human immunodeficiency virus (HIV)-infected and cancer patients.Design:Prospective multicenter cohort study based on active surveillance of long-term CVC manipulations and patient outcome over a 6-month period.Setting:Services of infectious diseases and oncology of 12 university hospitals in Paris, France.Participants:In 1995, all HIV and cancer patients with solid malignancy were included at the time of long-term CVC implantation.Results:Overall, 31.6% of long-term CVC infections were identified in 32% of 201 HIV and 5% of 255 cancer patients. Most were associated with bacteremia, most commonly coagulase-negative staphylococci. The long-term CVC time-related infection risk was greater in HIV than in cancer patients (3.78 vs 0.39 infections per 1,000 long-term CVC days; P<.001). The independent risk factors of long-term CVC infection were as follows: in HIV patients, frequency of long-term CVC handling and neutropenia; in cancer patients, poor Karnofsky performance status; in both HIV and cancer patients, recent history of bacterial infection. The risk of long-term CVC infection was similar for tunneled catheters and venous access ports in each population.Conclusions:Prevention of long-term CVC infection should focus first on better sterile precautions while handling long-term CVC, especially in HIV patients who have frequent and daily use of the long-term CVC.
Seroconversion Rates in Healthcare Workers Using a Latex Agglutination Assay After Varicella Virus Vaccination
Authors: Weinstock David M. , Rogers Maureen , Lim Suzanne , Eagan Janet , Sepkowitz Kent A. 
Published: February 2006

Objectives:To determine the seroconversion rate after varicella immunization of healthcare workers (HCWs) and the effect of seroconversion rate on current cost-based recommendations for universal vaccination.Methods:A voluntary vaccination program for HCWs was performed at a tertiary-care cancer center in New York City. A commercial latex agglutination assay was used to test postvaccination antibody response. Costs for vaccination and postvaccination serological testing were compared to potential costs of postexposure employee furloughs.Results:Of 263 seronegative HCWs, 96 (36.5%) began the vaccine program. Thirty-nine HCWs received only one dose of vaccine. Seven returned for follow-up antibody testing, of whom 4 were seropositive. Of the 57 HCWs who received two doses, 38 returned for follow-up serology. Thirty-one (81.6%) HCWs were seropositive for varicella-zoster virus antibodies, and seven HCWs (18.4%) remained seronegative. Total cost of vaccination for all 263 seronegative HCWs was estimated and compared to the cost of varicella-related furloughs at our institution.Conclusions:We found a considerably lower rate of vaccine-induced seroconversion at our hospital compared to that of the published literature. Despite this finding, universal varicella vaccination remained an extremely cost-effective alternative to the furloughing of exposed, seronegative HCWs. Projected hospital savings exceeded $53,000 in the first year after vaccination alone.
Sporicidal Activity of a New Low-Temperature Sterilization Technology: The Sterrad 50 Sterilizer
Authors: Rutala William A. , Gergen Maria F. , Weber David J. 
Published: February 2006

AbstractThis study was undertaken to evaluate the efficacy of a new low-temperature sterilization system that recently has been cleared by the Food and Drug Administration, the Sterrad 50. Flat stainless steel carriers were inoculated with approximately 106 Bacillus stearothermophilus spores. These carriers were placed aseptically in the middle of 40-cm–long stainless steel-lumened test units of varying diameters (1 mm, 2 mm, and 3 mm). After inoculation, the test units were processed in the Sterrad 50. After sterilization, the carriers were assayed for growth of the B stearothermophilus spores. Our data demonstrated that the Sterrad 50 was highly effective in killing the B stearothermophilus spores (no positive carriers with 30 tests of each lumen-diameter test unit). The Sterrad 50 is likely to be clinically useful for the sterilization of heat-sensitive medical equipment.
Results of a Comprehensive Infection Control Program for Reducing Surgical-Site Infections in Coronary Artery Bypass Surgery
Authors: McConkey Samuel J. , L'Ecuyer Paul B. , Murphy Denise M. , Leet Terry L. , Sundt Thoralf M. , Fraser Victoria J. 
Published: February 2006

AbstractObjective:To evaluate the efficacy of a comprehensive infection control program on the reduction of surgical-site infections (SSIs) following coronary artery bypass graft (CABG) surgery.Design:Prospective cohort study.Setting:1,000-bed tertiary-care hospital.Patients:Persons undergoing CABG with or without concomitant valve surgery from April 1991 through December 1994.Interventions:Prospective surveillance, quarterly reporting of SSI rates, chlorhexidene showers, discontinuation of shaving, administration of antibiotic prophylaxis in the holding area, elimination of ice baths for cooling of cardioplegia solution, limitation of operating room traffic, minimization of flash sterilization, and elimination of postoperative tap-water wound bathing for 96 hours. Logistic regression models were fitted to assess infection rates over time, adjusting for severity of illness, surgeon, patient characteristics, and type of surgery.Results:2,231 procedures were performed. A reduction in infection rates was noted at all sites. The rate of deep chest infections decreased from 2.6% in 1991 to 1.6% in 1994. Over the same period, the rate of leg infections decreased from 6.8% to 2.7%, and of all SSI from 12.4% to 8.9%. The adjusted odds ratio (OR) for all SSIs for the end of 1994 compared to December 31,1991, was 0.37 (95% confidence interval [CI95], 0.22-0.63). For deep chest and mediastinal infections, the adjusted OR comparing the same period was 0.69 (CI95, 0.28-1.71).Conclusions:We observed significant reductions in SSI rates of deep and superficial sites in CABG surgery following implementation of a comprehensive infection control program. These differences remained significant when adjusted for potential confounding covariables
Nosocomial Pertussis in Healthcare Workers From a Pediatric Emergency Unit in France
Authors: Gehanno Jean-François , Pestel-Caron Martine , Nouvellon Michèle , Caillard Jean-François 
Published: February 2006

AbstractObjective:After pertussis was diagnosed in July 1997 in a 55-year-old nurse (case) from a pediatric emergency unit who had a respiratory illness and paroxysmal cough for 5 weeks, an epidemiological investigation was initiated to determine if other healthcare workers (HCWs) from the same unit also had pertussis.Design:Interviews were conducted to assess symptoms occurring in the previous months. Two sera were collected 2 to 3 months apart for 59 of 61 HCWs of the unit. The IgG response to pertussis toxin was determined using Western blot assay.Setting:Pediatric emergency unit (61 HCWs) of a 2,500-bed university hospital.Results:There was a total of 10 (5 confirmed and 5 probable) cases of pertussis identified in this outbreak. Nine HCWs (15%) had results suggesting recent or acute pertussis. To avoid transmission to patients and other HCWs, all HCWs with cough were treated for 14 days with erythromycin, and those having acute cough were given a 5-day sick leave. Despite these measures, a new acute pertussis case was identified in a 41-year-old nurse, with a positive culture from nasopharyngeal aspirates. Thus, all HCWs in the unit were prescribed spiramycin for 10 days to prevent any further spread of pertussis.Conclusion:Pertussis should be considered a threat to HCWs who are in contact with children. For HCWs, diagnosis of pertussis should be made on a clinical basis, giving greater importance to sensitivity of diagnosis criteria, and on early bacterial identification by culture of the organism or by polymerase chain reaction.Recommendations:In case of pertussis in an HCW, all staff in the unit who have had unprotected and intensive contact with that person should be provided with macrolide treatment to stop any transmission to colleagues and to young patients. Furthermore, the possibility of providing these HCWs with acellular pertussis vaccines warrants further investigation.
Two Consecutive Outbreaks ofStenotrophomonas Maltophilia (Xanthomonas Maltophilia)in an Intensive-care Unit Defined by Restriction Fragment-Length Polymorphism Typing
Authors: Alfieri Nancy , Ramotar Karam , Armstrong Pamela , Spornitz Mary E. , Ross Glenda , Winnick James , Cook D. Roy 
Published: February 2006

AbstractObjective:To investigate and control consecutive outbreaks ofStenotrophomonas maltophiliainfections in intensive-care–unit (ICU) patients.Design:Epidemiological investigation; restriction fragment-length polymorphism typing by pulsed-field gel electrophoresis (PFGE) of genomic DNA of outbreak strains; institution of infection control measures to limit spread.Setting:The medical-surgical ICU in an 800-bed tertiary-care center in Calgary, Alberta, Canada.Results:S maltophiliawas recovered from 14 ICU patients (12 infected, 2 colonized) between February 1993 and February 1994. Ten of the 14 patient isolates and 1 environmental isolate were available for PFGE typing. Patient isolates from 6 of the first 10 patients were identical. Isolates from the next 3 of 4 patients and an isolate recovered from a ventilator being used by a patient not infected withS maltophiliaalso were identical, but different from the first 6. The ventilator isolate was temporally associated with the latter 4 patients.Conclusion:Molecular typing allowed us to determine that there were two separate consecutiveS maltophiliaoutbreaks rather than a single protracted outbreak. Recovery ofS maltophiliafrom patient ventilators and an in-line suction catheter suggests that the organism may have been spread by cross-contamination from contaminated equipment or from an environmental source.
Vancomycin in Oregon: Who's Using It and Why
Authors: Cieslak Paul R. , Strausbaugh Larry J. , Fleming David W. , Ling Julia M. 
Published: February 2006

AbstractObjective:To determine the proportion of vancomycin orders that are appropriate according to national guidelines and to identify targets for educational messages.Design:Population-based study of vancomycin use in Oregon during a 3-week period. Survey of pharmacists, prospective flagging of vancomycin orders, and data abstraction from patient charts using standardized forms.Setting:Nonpsychiatric hospitals in Oregon.Results:Four (6%) of the 66 Oregon hospitals had pharmacy restrictions on initial vancomycin orders. Sixty-four (97%) of the hospitals participated in the study of indications for use; 293 vancomycin orders were reported; 3.8 courses were initiated per 1,000 patient-days. Indications for use were determined for 266 (91%); of these, 159 (60%) were deemed appropriate. Of uses for prophylaxis, empirical treatment of suspected gram-positive infection, and treatment of documented gram-positive infection, 57%, 56%, and 65%, respectively, were appropriate. Of hospitals with <250, 251-475, and >475 licensed beds, 65%, 58%, and 57% of vancomycin orders were appropriate. No single medical specialty accounted for >16% of inappropriate vancomycin use.Conclusions:Vancomycin was used inappropriately by physicians of many different specialties, in hospitals of all sizes, and in sundry clinical situations. The problem of inappropriate vancomycin use does not lend itself to solution by educational strategies targeted at specific subgroups; restrictions by hospital pharmacies may be required.
Varicella-Zoster Screening and Management Programs in Healthcare Facilities in Canada
Authors: Lussier Nathalie , Weiss Karl , Laverdière Michel 
Published: February 2006

AbstractA 24-question survey on varicella-zoster screening programs and control measures for varicella-zoster infections was sent to 170 Canadian healthcare facilities. The results indicated that 60% of Canadian healthcare facilities have well-established preemployment varicella-zoster screening programs for healthcare workers. Overall, 30% of healthcare facilities impose work restrictions for susceptible healthcare workers, 49% use negative-pressure rooms for varicella-zoster management, and 28% have a policy to discharge susceptible exposed patients. Large variations exist among Canadian healthcare facilities in their varicella-zoster infection control policies.
Nosocomial Meningococcemia in a Physician
Authors: Gehanno Jean-François , Kohen-Couderc Laure , Lemeland Jean-François , Leroy Jacques 
Published: February 2006

AbstractWe report the case of a pediatrician who developed meningococcal meningitis after performing endotracheal intubation without protection on a child who was suspected of having meningoencephalitis. This case emphasizes the necessity for healthcare workers who perform high-risk procedures to use personal protection devices (ie, respirators and protective goggles). Unprotected healthcare workers with high exposure toNeisseria meningitidisshould receive chemoprophylaxis.
The Emergence of Resistant Strains of Acinetobacter baumannii: Clinical and Infection Control Implications
Authors: Dy Marie Eve , Nord Jill A. , LaBombardi Vincent J. , Kislak Jay W. 
Published: February 2006

AbstractA prospective study was undertaken to determine colonization rates, susceptibility profiles, and outcomes in patients with clinical isolates of Acinetobacter baumannii. Fifty percent of patients became colonized with A baumannii, and 29% of these patients had clinical and colonizing isolates with discordant susceptibility profiles, without apparent relation to antibiotic use. Barrier infection control measures are necessary to prevent nosocomial transmission.
Infection Control in Gene Therapy
Authors: Evans Martin E. , Lesnaw Judith A. 
Published: February 2006

AbstractGene therapy is now being studied for the treatment of a wide variety of acquired and inherited diseases. Viruses used as vectors for gene transfer include retroviruses, adenoviruses, vaccinia viruses, adeno-associated viruses, and herpesviruses. These vectors, developed in the laboratory and in animal studies, are now being introduced into the clinical arena. Infection control practitioners will be involved invariably in reviewing the use of these agents in their clinics and hospitals. This review summarizes key aspects of the more common vectors and makes recommendations for infection control.