bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nosocomial Methicillin-ResistantStaphylococcus aureusBacteremia: Is It Any Worse Than Nosocomial Methicillin-SensitiveStaphylococcus aureusBacteremia?
Authors: Selvey Linda A. , Whitby Michael , Johnson Barbara 
Published: February 2006

AbstractObjective:To determine the comparative virulence of methicillin-resistantStaphylococcus aureus(MRSA) and methicillin-sensitiveS aureus(MSSA) by consideration of predisposing factors and outcomes in patients infected with these organisms in the healthcare setting.Design:Analysis of an historical cohort of 504 bacteremic patients (316 MSSA and 188 MRSA), examining factors associated with mortality.Setting:A 916-bed, university-affiliated, tertiary referral hospital.Results:Risk factors for the development of MRSA include male gender, admission due to trauma, immunosuppression, presence of a central vascular line or an indwelling urinary catheter, and a past history of MRSA infection. Overall mortality was 22%. Death due to bacteremia was significantly greater in the MRSA group (risk ratio, 1.68;P<.05), although these patients were not found to be more likely to die due to underlying disease during treatment of bacteremia. In those patients who recovered from bacteremia, no significant differences for the outcome of death could be determined between the MRSA and MSSA groups.Conclusions:There is a general consensus in the published literature that MRSA bacteremia is more likely to be associated with death, and we confirm this conclusion. However, in contrast to other studies, our MRSA cohort does not appear to be more at risk of death due to underlying disease during treatment for bacteremia. Similarly, the general consensus that MRSA patients have an increased overall mortality was not confirmed in our study. Differences in comorbidities of patients may provide some explanation of these conflicting results, while an alternate explanation is that MRSA strains are more virulent than MSSA in some centers. Perhaps the most plausible explanation is that treatment is provided earlier and in a more aggressive fashion in some centers, leading to an overall lower mortality rate in all staphylococcal bacteremias in these institutions.
Comparison of Blood-Culture Contamination Rates in a Pediatric Emergency Room: Newly Inserted Intravenous Catheters Versus Venipuncture
Authors: Ramsook Chris , Childers Kim , Cron Stanley G. , Nirken Milton 
Published: February 2006

AbstractWe compared contamination rates of blood cultures obtained either from newly inserted intravenous catheters or via venipuncture. Of 2,431 blood cultures, the overall contamination rate was 2.7% (intravenous catheter, 3.4%; venipuncture, 2.0%;P=.043). The site of lowest contamination was the antecubital fossa, making this the optimal choice for blood-culture sampling.
The Utility of Polysporin Ointment in the Eradication of Methicillin-Resistant Staphylococcus aureus Colonization: A Pilot Study
Authors: Fung Scott , O'Grady Sharon , Kennedy Catharine , Dedier Helen , Campbell Iivi , Conly John 
Published: February 2006

AbstractWe evaluated the efficacy of an ointment containing bacitracin, polymyxin B, and gramicidin for the eradication of colonization by methicillin-resistant Staphylococcus aureus in 11 medical patients, 10 (91%) of whom had previously failed a 1-week course of topical mupirocin. Mupirocin resistance was documented in 5 (45%) of 11 patients. Successful decolonization was achieved in 9 (82%) of 11 patients (based on 2 months of follow-up).
Analysis of Sharp-Edged Medical-Object Injuries at a Medical Center in Taiwan
Authors: Wang Fu-Der , Chen Yin-Yin , Liu Cheng-Yi 
Published: February 2006

AbstractA total of 733 incidents by sharp-edged objects occurred among healthcare workers between 1995 and 1998. Injuries occurred most frequently among interns. The workplace location with the highest incidence of injury was the patient ward, and the object that most frequently inflicted injury was a needle. The most frequent work practice was recapping of syringes. One healthcare worker demonstrated seroconversion for hepatitis C.
The Burden of Infection in Long-Term Care
Authors: Strausbaugh Larry J. , Joseph Carol L. 
Published: February 2006

AbstractAvailable data, although fragmentary, indicate that infections impose a large burden on long-term–care facilities (LTCFs) in the United States. Endemic infections occur with frequencies estimated to range between 1.64 and 3.83 million per year. These estimates rival or exceed the annual tally for nosocomial infections in acute-care settings. Infections associated with outbreaks caused by respiratory, gastrointestinal, and antimicrobial-resistant pathogens burden LTCFs even further. As judged by antimicrobial use, transfers to hospital, and mortality figures, infections in LTCFs are not trivial. Moreover, annual costs associated with these infections appear to exceed $1 billion. Recognition of the burden associated with infection in LTCFs helps to identify research priorities for this rapidly growing area of healthcare.
Streptococcus pneumoniaeSerotype 4 Outbreak in a Home for the Aged: Report and Review of Recent Outbreaks
Authors: Gleich Sheldon , Morad Yosef , Echague Ramon , Miller James R. , Kornblum John , Sampson Jacquelyn S. , Butler Jay C. 
Published: February 2006

AbstractObjective:To describe a pneumonia outbreak caused byStreptococcus pneumoniaeamong residents of a home for the aged and to review contemporary pneumococcal outbreaks.Design:Epidemiological investigation.Methods:Spneumoniaeisolates were serotyped and analyzed by pulsed-field gel electrophoresis. Paired sera were tested for antibodies to pneumococcal surface adhesin A protein (PsaA, a 37-kDa cell-wall protein). Pneumococcal outbreaks reported in the last decade in English were reviewed.Results:Pneumonia developed in 18 of 200 residents. In 11 (61%), a pneumococcal etiology was demonstrated.S pneumoniae,serotype 4, was isolated from the blood cultures of 3 patients; all isolates were indistinguishable by pulsed-field gel electrophoresis. Pneumococcal involvement was established in 2 by sputum culture and latex agglutination of parapneumonic fluid and in 6 others by a twofold rise in optical density of serum antibody reactive to PsaA. Pneumococcal immunization had not previously been received by any patient; mortality was 22%. No additional cases were noted following administration of pneumococcal vaccine and antibiotic prophylaxis with penicillin or erythromycin. Twenty-six outbreaks of invasive pneumococcal disease since 1990 were reviewed. Twelve occurred in the United States, and serotypes 23F, 14, and 4 accounted for 8 (67%) of 12 outbreaks. All confirmed serotypes in US outbreaks are included in the 23-valent vaccine. More than one half of pneumococcal outbreaks worldwide involved elderly persons in hospitals or long-term-care facilities.Conclusions:A pneumococcal pneumonia outbreak occurred among unvaccinated residents of a residential facility for the aged. Institutionalized elderly persons are at risk of outbreaks of pneumococcal disease and should be vaccinated.
Hospital- and Community-Based Surveillance of Methicillin-Resistant Staphylococcus aureus: Previous Hospitalization is the Major Risk Factor
Authors: Warshawsky Bryna , Hussain Zafar , Gregson Daniel B. , Alder Robert , Austin Marilyn , Bruckschwaiger Debra , Chagla Abdul H. , Daley Jackie , Duhaime Cam , McGhie Kathy , Pollett Graham , Potters Harriet , Schiedel Lorraine 
Published: February 2006

AbstractObjective:The purpose of the study was to determine the incidence and risk factors for the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in our community.Design:This study used a cross-sectional design to assess patients colonized or infected with MRSA.Patients:The study population consisted of residents of London, Ontario, Canada, who were identified as MRSA-positive for the first time in 1997.Setting:All acute- and chronic-care hospitals, long-term healthcare facilities, and community physicians' offices in the city of London participated in the study.Main Outcome Measure:Incidence of MRSA in the community, risk factors for acquisition, especially previous hospitalization over a defined period, and strain type were evaluated.Results:In 1997, 331 residents of London were newly identified as MRSA-positive, representing an annual incidence of 100/100,000 persons (95% confidence interval, 88.8-110.7). Thirty-one (9.4%) individuals were not healthcare-facility patients in the previous month, and 11 (3.3%), 10 (3.0%), and 6 (1.8%) individuals had no such contact in the previous 3, 6, and 12 months, respectively. One hundred seventy-seven strains, including five of the isolates from patients with no healthcare-facility contact in the previous year, were typed. One hundred sixty (90.3%) of these isolates, including all typed strains from patients with no healthcare facility contact, belonged to a single clone.Conclusion:These findings demonstrate that the incidence of MRSA is higher than previously reported and that hospital contact is the single most important risk factor for the acquisition of MRSA in our community. Screening for MRSA in previously hospitalized patients at the time of hospitalization may reduce nosocomial spread and indirectly reduce the incidence of MRSA in the community.
“Colonization Pressure” and Risk of Acquisition of Methicillin-Resistant Staphylococcus aureus in a Medical Intensive Care Unit
Authors: Merrer Jacques , Santoli François , Vecchi Corinne Appéré-De , Tran Beatrice , De Jonghe Bernard , Outin Hervé 
Published: February 2006

AbstractObjective:To determine the roles of “colonization pressure,” work load or patient severity in patient acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs).Design:Prospectively collected data from October 1996 through December 1998.Setting:A 12-bed medical ICU in a university-affiliated general hospital.Patients:Patients with risk factors for MRSA admitted to the ICU were screened within 72 hours of admission and weekly thereafter. MRSA was considered imported if detected during the first 72 hours of admission and nosocomial if detected only thereafter. Three screening strategies were used on admission during three consecutive periods.Interventions:The unit of time chosen for measurements was the week. Weekly colonization pressure (WCP) was defined as the number of MRSA-carrier patient-days/total number of patient-days. Patient severity (number of deaths, Simplified Acute Physiologic Score [SAPS] II), work load (number of admissions. Omega score), and colonization pressure (number of MRSA carriers at the time of admission, WCP) were compared with the number of MRSA-nosocomial cases during the following week.Results:Of the 1,016 patients admitted over 116 weeks, 691 (68%) were screened. MRSA was imported in 91 (8.9%) admitted patients (13.1% of screened patients) and nosocomial in 46 (4.5%). The number of MRSA-nosocomial cases was correlated to the SAPS II (P=.007), the Omega 3 score (P=.007), the number of MRSA-imported cases (P=.01), WCP (P<.0001), and the screening period (P<.0001). In multivariate analysis, WCP was the only independent predictive factor for MRSA acquisition (P=.0002). Above 30% of WCP, the risk of acquisition of MRSA was approximately fivefold times higher (relative risk, 4.9;95% confidence interval, 1.2-19.9; P<.0001).Conclusion:Acquisition of MRSA in ICU patients is strongly and independently influenced by colonization pressure.
Zanamivir Use During Transmission of Amantadine-Resistant Influenza A in a Nursing Home
Authors: Lee Christine , Loeb Mark , Phillips Anne , Nesbitt Judy , Smith Karen , Fearon Margaret , McArthur Margaret A. , Mazzulli Tony , Li Yan , McGeer Allison 
Published: February 2006

AbstractObjective:To describe the use of zanamivir during an influenza A outbreak.Population:Residents of a 176-bed long-term-care facility for the elderly in Newmarket, Ontario, Canada, 90% of whom received influenza vaccine in the fall of 1998.Outbreak:When respiratory illness due to influenza A was confirmed, infection control measures and amantadine prophylaxis were initiated. Despite these measures, transmission of influenza A continued.Intervention:Zanamivir inhalations, 10 mg daily for prophylaxis and 10 mg twice daily for treatment of influenza.Results:There were 13 definite and 66 probable outbreak-associated cases of influenza A. Twelve (15%) cases developed pneumonia, 7 (9%) were hospitalized, and 2 (2.6%) died. All 12 culture-positive cases yielded influenza A/Sydney/H3N2/05/97-like virus, a 1998/99 vaccine component. The three isolates obtained prior to the initiation of amantadine were amantadine-susceptible; all nine obtained after prophylaxis was instituted were amantadine-resistant. One hundred twenty-nine (92%) of 140 residents who were offered zanamivir accepted it and were able to attempt inhalations. Of these 129, 78% (100) had no difficulty in complying with inhalations. Difficulty with inhalations was associated with decreased functional and mental status. Fifteen (58%) of 26 residents fully dependent in activities of daily living had difficulty compared to 14 (14%) of 100 others (P<.001). Twenty-two (45%) of 49 residents not oriented to person, place, or time had difficulty compared to 7 (10%) of 77 others (P<001). In the 2 weeks after zanamivir prophylaxis, only 2 new cases of respiratory illness occurred, neither confirmed as influenza. No side effects were identified in 128 zanamivir-treated residents.Conclusion:A minority of nursing home residents have difficulty following instructions for zanamivir inhalations. Zanamivir was well tolerated, and its use was temporally associated with termination of an outbreak that amantadine had failed to control.
The Nature and Frequency of Blood Contacts Among Home Healthcare Workers
Authors: Beltrami Elise M. , McArthur Margaret A. , McGeer Allison , Armstrong-Evans Maxine , Lyons Demie , Chamberland Mary E. , Cardo Denise M. 
Published: February 2006

Objective:To estimate the frequency of, and assess risk factors for, percutaneous, mucous membrane, and cutaneous blood contacts sustained by healthcare workers (HCWs) during the delivery of infusion therapy and the performance of procedures involving sharp instruments in the home setting.Design:Prospective surveillance of percutaneous, mucous membrane, and cutaneous blood contacts.Setting:Eleven home healthcare agencies in the United States and Canada from August 1996 through June 1997.Participants:HCWs who provided home infusion therapy or performed procedures using hollow-bore needles and other sharp instruments in the home setting.Methods:Each participating worker recorded information about the procedures performed and blood contacts experienced during each of his or her home visits for a 2- to 4-week period using standard questionnaires. HCWs also completed questionnaires regarding job duties, reporting of previous occupational blood contacts, and their use of protective barriers in the home setting.Results:Participating HCWs provided information about 33,606 home visits. A total of 19,164 procedures were performed during 14,744 procedure visits. Fifty-three blood contacts occurred during these visits, for a blood-contact rate of 2.8 blood contacts per 1,000 procedures and 0.6 percutaneous injuries per 1,000 procedures with needles or lancets. Gloves were worn for 52%, masks for 5%, gowns for 3%, and protective glasses or goggles for 2% of all procedure visits. HCWs used barriers for 53% of visits during which at least 1 procedure was performed and for 27% of other visits.Conclusions:HCWs involved in home health care are at risk for blood contact. Infection control barrier use was low in our study. The majority of skin contacts could have been prevented by glove use.
A Prolonged Outbreak ofPseudomonas Aeruginosain a Neonatal Intensive Care Unit Did Staff Fingernails Play a Role in Disease Transmission?
Authors: Moolenaar Ronald L. , Crutcher J. Michael , Joaquin Venusto H. San , Sewell Lucille V. , Hutwagner Lori C. , Carson Loretta A. , Robison Denise A. , Smithee Lauri M.K. , Jarvis William R. 
Published: February 2006

AbstractObjectives:To describe an outbreak ofPseudomonas aeruginosabloodstream infection (BSD and endotracheal tube (ETT) colonization in a neonatal intensive care unit (NICU), determine risk factors for infection, and make preventive recommendations.Design:A 15-month cohort study followed by a case-control study with an environmental survey and molecular typing of available isolates using pulsed-field gel electrophoresis.Setting and Patients:Neonates in the NICU of a university-affiliated children's hospital.Interventions:Improved hand washing and restriction of use of long or artificial fingernails.Results:Of 439 neonates admitted during the study period, 46 (10.5%) acquiredP aeruginosa; 16 (35%) of those died. Fifteen (75%) of 20 patients for whom isolates were genotyped had genotype A and 3 (15%) had genotype B. Of 104 healthcare workers (HCWs) from whom hand cultures were obtained,P aeruginosawas isolated from three nurses. Cultures from nurses A-1 and A-2 grew genotype A and cultures from nurse B grew genotype B. Nurse A-1 had long natural fingernails, nurse B had long artificial fingernails, and nurse A-2 had short natural fingernails. On multivariate logistic regression analysis, exposure to nurse A-l and exposure to nurse B were each independently associated with acquiring a BSI or ETT colonization withP aeruginosa, but other variables, including exposure to nurse A-2, were not.Conclusion:Epidemiological evidence demonstrated an association between acquiringP aeruginosaand exposure to two nurses. Genetic and environmental evidence supported that association and suggested, but did not prove, a possible role for long or artificial fingernails in the colonization of HCWs' hands withP aeruginosa. Requiring short natural fingernails in NICUs is a reasonable policy that might reduce the incidence of hospital-acquired infections.
Standardized Surveillance of Hemodialysis Vascular Access Infections 18-Month Experience at an Outpatient, Multifacility Hemodialysis Center
Authors: Stevenson Kurt B. , Adcox Michael J. , Mallea Michael C. , Narasimhan Nagraj , Wagnild Jon P. 
Published: February 2006

AbstractObjective:To develop a standardized surveillance system for monitoring hemodialysis vascular-access infections in order to compare infection rates between outpatient sites and to assess the effectiveness of infection control interventions.Design:Prospective descriptive analysis of incidence infection rates.Setting:An outpatient hemodialysis center with facilities in Idaho and Oregon.Patients:All outpatients receiving chronic outpatient hemodialysis.Results:There were 38,096 hemodialysis sessions (31,603 via permanent fistulae or grafts, 5,060 via permanent tunneled central catheters, and 1,433 via temporary catheters) during an 18-month study period in 1997 to 1998. We identified 176 total infections, for a rate of 4.62/1,000 dialysis sessions (ds). Of the 176, 80 involved permanent fistulae or grafts (2.53/1,000 ds), 69 involved permanent tunneled central catheter infections (13.64/1,000 ds), and 27 involved temporary catheter infections (18.84/1,000 ds). There were 35 bloodstream infections (0.92/1,000 ds) and 10 episodes of clinical sepsis (0.26 /1,000 ds). One hundred thirty-one vascular-site infections without bacteremia were identified (3.44/1,000 ds), including 65 permanent fistulae or graft infections (2.06/1,000 ds), 42 permanent tunneled central catheter infections (8.3/1,000 ds), and 24 temporary catheter infections (16.75/1,000 ds).Conclusions:Infection rates were highest among temporary catheters and lowest among permanent native arteriovenous fistulae or synthetic grafts. This represents the first report of extensive incidence data on hemodialysis vascular access infections and represents a standardized surveillance and data-collection system that could be implemented in hemodialysis facilities to allow for reliable data comparison and benchmarking.
Prevalence of Hepatitis C Antibodies in a Large Sample of Belgian Healthcare Workers
Authors: Moens Guido , Vranckx Robert , De Greef Liesbeth , Jacques Pierre 
Published: February 2006

AbstractObjective:To assess the risk of hepatitis C virus (HCV) infection among Belgian (Flemish) healthcare workers.Design:A seroprevalence survey of HCV IgG antibodies.Setting and Participants:A systematic sample of 5,064 employees from 22 general hospitals in Flanders and Brussels, Belgium, was tested at the annual occupational medical examination. Together with demographic and occupational data, information was collected on the frequency of blood contact, needlestick injuries, and medical and surgical history. The blood samples were tested using the third-generation Abbott Screen Kit test, with confirmation by Matrix, LIA, and an in-house polymerase chain reaction and the Quantiplex-HCV b-DNA test.Results:21 persons were found to be positive for HCV markers. The overall prevalence was 0.41% (95% confidence interval [CI95], 0.24-0.59). A statistically significant association was found with a history of blood transfusion (odds ratio [OR], 4.14; CI95, 1.67-10.31) and with history of a clinically apparent hepatitis (OR, 3.98; CI95,1.60-9.90). Although the ORs for the frequency of blood contact were slightly elevated (between 1.17 and 2.73), this association was not significant. Moreover, a history of needlestick injuries showed a nonsignificant OR of 1.28 (CI95, 0.53-3.09), and no statistically significant difference was found with a variety of duties and tasks. The ORs for potential occupational risk factors were adjusted according to age, gender, antecedents, and other confounders using a logistic regression analysis. Based on this procedure, the ORs decreased slightly.Conclusions:Flemish healthcare workers showed a lower HCV seropositivity than is seen in the general population; a history of blood transfusion and of clinically apparent hepatitis was most strongly associated with the presence of HCV markers. We concluded that employees in Flemish regional general hospitals are not at an overall increased risk for HCV infection, although occasional transmission through percutaneous injuries is possible, and prevention therefore remains imperative.