bluuebunny/crossref_metadata_2025_split huggingface dataset:
Finding a Method for Optimizing Risk Adjustment When Comparing Surgical-Site Infection Rates
Authors: Brandt Christian , Hansen Sonja , Sohr Dorit , Daschner Franz , Rüden Henning , Gastmeier Petra 
Published: April 2006

AbstractObjective:To investigate whether stratification of the risk of developing a surgical-site infection (SSI) is improved when a logistic regression model is used to weight the risk factors for each procedure category individually instead of the modified NNIS System risk index.Design and Setting:The German Nosocomial Infection Surveillance System, based on NNIS System methodology, has 273 acute care surgical departments participating voluntarily. Data on 9 procedure categories were included (214,271 operations).Methods:For each of the procedure categories, the significant risk factors from the available data (NNIS System risk index variables of ASA score, wound class, duration of operation, and endoscope use, as well as gender and age) were identified by multiple logistic regression analyses with stepwise variable selection. The area under the receiver operating characteristic (ROC) curve resulting from these analyses was used to evaluate the predictive power of logistic regression models.Results:For most procedures, at least two of the three variables contributing to the NNIS System risk index were shown to be independent risk factors (appendectomy, knee arthroscopy, cholecystectomy, colon surgery, herniorrhaphy, hip prosthesis, knee prosthesis, and vascular surgery). The predictive power of logistic regression models (including age and gender, when appropriate) was low (between 0.55 and 0.71) and for most procedures only slightly better than that of the NNIS System risk index.Conclusion:Without the inclusion of additional procedure-specific variables, logistic regression models do not improve the comparison of SSI rates from various hospitals.
Preliminary Assessment of an Automated Surveillance System for Infection Control
Authors: Wright Marc-Oliver , Perencevich Eli N. , Novak Christopher , Hebden Joan N. , Standiford Harold C. , Harris Anthony D. 
Published: April 2006

AbstractBackground and Objective:Rapid identification and investigation of potential outbreaks is key to limiting transmission in the healthcare setting. Manual review of laboratory results remains a cumbersome, time-consuming task for infection control practitioners (ICPs). Computer-automated techniques have shown promise for improving the efficiency and accuracy of surveillance. We examined the use of automated control charts, provided by an automated surveillance system, for detection of potential outbreaks.Setting:A 656-bed academic medical center.Methods:We retrospectively reviewed 13 months (November 2001 through November 2002) of laboratory-patient data, comparing an automated surveillance application with standard infection control practices. We evaluated positive predictive value, sensitivity, and time required to investigate the alerts. An ICP created 75 control charts. A standardized case investigation form was developed to evaluate each alert for the likelihood of nosocomial transmission based on temporal and spatial overlap and culture results.Results:The 75 control charts were created in 75 minutes and 18 alerts fired above the 3-sigma level. These were independently reviewed by an ICP and associate hospital epidemiologist. The review process required an average of 20 minutes per alert and the kappa score between the reviewers was 0.82. Eleven of the 18 alerts were determined to be potential outbreaks, yielding a positive predictive value of 0.61. Routine surveillance identified 5 of these 11 alerts during this time period.Conclusion:Automated surveillance with user-definable control charts for cluster identification was more sensitive than routine methods and is capable of operating with high specificity and positive predictive value in a time-efficient manner.
Bone Wax as a Risk Factor for Surgical-Site Infection Following Neurospinal Surgery
Authors: Gibbs Laurel , Kakis Anthony , Weinstein Philip , Conte John E. 
Published: April 2006

AbstractSurgical-site infection occurred in 6 of 42 neurospinal cases in which bone wax was used and in 1 of 72 cases in which it was not used during a 3-month period (P < .01). Increased risk of infection should be considered when using bone wax as a hemostatic agent.
Effect of the Increasing Use of Piperacillin/Tazobactam on the Incidence of Vancomycin-Resistant Enterococci in Four Academic Medical Centers
Authors: Stiefel Usha , Paterson David L. , Pultz Nicole J. , Gordon Steven M. , Aron David C. , Donskey Curtis J. 
Published: April 2006

AbstractBackground:The substitution of piperacillin/tazobactam, ampicillin/sulbactam, or both for third-generation cephalosporins has been associated with reduced vancomycin-resistant enterococci (VRE). However, piperacillin/tazobactam came into widespread use during a period in which the prevalence of VRE increased. We hypothesized that the increasing use of piperacillin/tazobactam and other agents with relatively enhanced anti-enterococcal activity (ie, piperacillin, ampicillin/sulbactam, and ampicillin) has been associated with increased or unchanged rates of VRE in some hospitals.Design:We retrospectively evaluated the correlation between hospital antibiotic use (defined daily doses per 10,000 patient-days of care) and incidence of stool or non-stool VRE isolation. We assessed whether a high or increasing proportion of use of beta-lactam agents with relatively enhanced versus minimal (ie, third-generation cephalosporins and ticarcillin/clavulanate) anti-enterococcal activity would prevent increased VRE.Setting:Four academic medical centers.Results:With the increasing use of piperacillin/tazobactam, the use of beta-lactam agents with enhanced activity against enterococci surpassed the combined use of third-generation cephalosporins and ticarcillin/clavulanate in each hospital. In one hospital, the incidence of VRE was positively correlated with the use of piperacillin/tazobactam or beta-lactam agents with enhanced anti-enterococcal activity (P< .0001). The incidence of VRE rose steadily in another hospital despite relatively high use of beta-lactam agents with enhanced versus minimal anti-enterococcal activity. A negative correlation between VRE and piperacillin/tazobactam or beta-lactam agents with enhanced anti-enterococcal activity was observed in one hospital, but this correlation was not statistically significant.Conclusion:Increasing the hospital use of piperacillin/tazobactam and other beta-lactams with relatively enhanced anti-enterococcal activity may not be an effective control measure for VRE.
Do Infection Control Measures Work for Methicillin-Resistant Staphylococcus aureus?
Authors: Boyce John M. , Havill Nancy L. , Kohan Cynthia , Dumigan Diane G. , Ligi Catherine E. 
Published: April 2006

AbstractObjective:To review evidence regarding the effectiveness of control measures in reducing transmission of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals.Design:Literature review and surveillance cultures of hospitalized patients at high risk for MRSA colonization or infection.Setting:A 500-bed, university-affiliated, community teaching hospital.Results:The percentage of nosocomial S. aureus infections caused by MRSA increased significantly between 1982 and 2002, despite the use of various isolation and barrier precaution policies. The apparent ineffectiveness of control measures may be due to several factors including the failure to identify patients colonized with MRSA For example, cultures of stool specimens submitted for Clostridium difficile toxin assays at one hospital found that 12% of patients had MRSA in their stool, and 41% of patients with unrecognized colonization were cared for without using barrier precautions. Other factors include the use of barrier precaution strategies that do not account for multiple reservoirs of MRSA, poor adherence of healthcare workers (HCWs) to recommended barrier precautions and handwashing, failure to identify and treat HCWs responsible for transmitting MRSA, and importation of MRSA by patients admitted from other facilities. Control programs that include active surveillance cultures (ASCs) of high-risk patients and use of barrier precautions have reduced MRSA prevalence rates and have been cost-effective. Using a staged approach to implementing ASCs can minimize logistic problems.Conclusion:MRSA control programs are effective if they include ASCs of high-risk patients, use of barrier precautions when caring for colonized or infected patients, hand hygiene, and treating HCWs implicated in MRSA transmission.
Risk Factors and Costs Associated With Methicillin-Resistant Staphylococcus aureus Bloodstream Infections
Authors: McHugh Carolyn Guertin , Riley Lee W. 
Published: April 2006

AbstractObjectives:To compare the cost of hospitalization of patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) versus patients with methicillin-sensitive S. aureus (MSSA) BSI, controlling for severity of underlying illness; and to identify risk factors associated with MRSA BSI.Design:Retrospective case-control study based on medical chart review.Setting:A 640-bed, tertiary-care hospital in Seattle, Washington.Patients:All patients admitted to the hospital between January 1,1997, and December 31,1999, with S. aureus BSI confirmed by culture.Results:Twenty patients with MRSA BSI were compared with 40 patients with MSSA BSI. Univariate analysis identified 5 risk factors associated with MRSA BSI. Recent hospital admission (P = .006) and assisted living (P = .004) remained significant in a multivariate model. Costs were significantly higher per patient-day of hospitalization for MRSA BSI than for MSSA BSI ($5,878 vs $2,073; P = .003). When patients were stratified according to severity of illness as measured by the case mix index, a difference of $5,302 per patient-day was found between the two groups for all patients with a case mix index greater than 2(P<.001).Conclusion:These observations suggest that MRSA BSI significantly increases hospitalization costs compared with MSSA BSI, even when controlling for the severity of the patient's underlying illness. As MRSA BSI was also found to be significantly associated with a group of patients who have repeated hospitalizations, such infections contribute substantially to the increasing cost of medical care.
Sternal Surgical-Site Infection Following Coronary Artery Bypass Graft Prevalence, Microbiology, and Complications During a 42-Month Period
Authors: Sharma Mamta , Berriel-Cass Dorine , Baran Joseph 
Published: April 2006

AbstractObjective:Surgical-site infection (SSI) is a serious and costly complication following coronary artery bypass graft (CABG). We analyzed surgical factors, microbiology, and complications at a 608-bed community teaching hospital to identify opportunities for prevention.Methods:All patients undergoing CABG procedures from June 1997 through December 2000 were analyzed. Hospital records and postdischarge surveillance data were reviewed for demographics, surgical information, timing and classification of infection, microbiology, and bacteremic events.Results:Of 3,443 patients undergoing CABG, sternal SSI developed in 122 (3.5%); 71 (58.2%) were classified as superficial SSI and 51 (41.8%) as deep SSI. Surgical antimicrobial prophylaxis was employed in all cases. On average, infection occurred 21.5 days (range, 4 to 315) after CABG. Most cases were diagnosed on readmission (59%); 20 cases (16%) were identified by postdischarge surveillance. Microbiological data were positive in 109 (89.3%), with a single pathogen implicated in most (86.2%). Gram-positive cocci were most frequently recovered (81%); gram-negative bacilli (17%), gram-positive bacilli (1%), and yeast (1%) were less common. Staphylococcus aureus was the most frequently isolated pathogen (49%). Bacteremia was noted in 22 instances (18%). It was significantly associated with deep SSI (P =. 002) and identified only in S. aureus cases.Conclusions:SSI complicated 3.5% of the procedures. S. aureus was implicated in most of the cases and was significantly associated with deep SSI. It was the only pathogen associated with secondary bacteremia. In addition to standard guidelines, targeted methods against S. aureus should help reduce the overall rate of SSI.
Effect of Implementing Safety-Engineered Devices on Percutaneous Injury Epidemiology
Authors: Sohn SeJean , Eagan Janet , Sepkowitz Kent A. , Zuccotti Gianna 
Published: April 2006

AbstractObjective:To assess the effect of implementing safety-engineered devices on percutaneous injury epidemiology, specifically on percutaneous injuries associated with a higher risk of blood-borne pathogen exposure.Design:Before-and-after intervention trial comparing 3-year preintervention (1998–2000) and 1-year postintervention (2001–2002) periods. Percutaneous injury data have been entered prospectively into CDC NaSH software since 1998.Setting:A 427-bed, tertiary-care hospital in Manhattan.Participants:All employees who reported percutaneous injuries during the study period.Intervention:A “safer-needle system,” composed of a variety of safety-engineered devices to allow for needle-safe IV delivery, blood collection, IV insertion, and intramuscular and subcutaneous injection, was implemented in February 2001.Results:The mean annual incidence of percutaneous injuries decreased from 34.08 per 1,000 full-time–equivalent employees preintervention to 14.25 postintervention (P < .001). Reductions in the average monthly number of percutaneous injuries resulting from both low-risk (P < .01) and high-risk (P was not significant) activities were observed. Nurses experienced the greatest decrease (74.5%, P < .001), followed by ancillary staff (61.5%, P = .03). Significant rate reductions were observed for the following activities: manipulating patients or sharps (83.5%, P < .001), collisions or contact with sharps (73.0%, P = .01), disposal-related injuries (21.41%, P = .001), and catheter insertions (88.2%, P < .001). Injury rates involving hollow-bore needles also decreased (70.6%, P < .001).Conclusions:The implementation of safety-engineered devices reduced percutaneous injury rates across occupations, activities, times of injury, and devices. Moreover, intervention impact was observed when stratified by risk for blood-borne pathogen transmission.
Cost–Benefit Analysis of Chlorhexidine Gluconate Dressing in the Prevention of Catheter-Related Bloodstream Infections
Authors: Crawford Albert G. , Fuhr Joseph P. , Rao Bhaskar 
Published: April 2006

AbstractObjectives:To compare the costs with the benefits of using chlorhexidine gluconate dressings on central venous catheters and to determine the effectiveness of these dressings in reducing local infections and catheter-related bloodstream infections (CRBSIs), costs, and mortality.Design:Cost–benefit analysis using randomized, controlled trial data on chlorhexidine dressing prevention of local infection and CRBSI, data on cost of chlorhexidine dressing versus standard treatment, data on averted cost of treating local infection and CRBSI, and data on mortality attributable to CRBSI. Decision analysis evaluated averted CRBSI treatment cost per patient resulting from chlorhexidine dressing use. Sensitivity analyses demonstrated net benefit of chlorhexidine dressing, varying baseline rate of CRBSI, incremental cost of treating CRBSI, and number of catheters, and evaluated mortality preventable through chlorhexidine dressing use, varying baseline rate of CRBSI, number of catheters, and mortality attributable to CRBSI.Patients and Setting:Patients of all Philadelphia area hospitals and one Philadelphia academic medical center.Results:Estimated potential annual U.S. net benefits from chlorhexidine dressing use ranged from $275 million to approximately $1.97 billion. Cost–benefit findings persisted in sensitivity analyses varying baseline rate of CRBSI, incremental cost of treating CRBSI, and overall number of catheters used. Preventable mortality analyses showed potential decreases of between 329 and 3,906 U.S. deaths annually as a result of nationwide use of chlorhexidine dressing.Conclusions:Chlorhexidine dressings would reduce costs, local infections and CRBSIs, and deaths. Use of chlorhexidine dressings should be considered to prevent infections among patients with catheters.
Clustering of Serratia marcescens Infections in a Neonatal Intensive Care Unit
Authors: Sarvikivi Emmi , Lyytikäinen Outi , Salmenlinna Saara , Vuopio-Varkila Jaana , Luukkainen Päivi , Tarkka Eveliina , Saxén Harri 
Published: April 2006

AbstractObjectives:To study clusters of infections caused by Serratia marcescens in a neonatal intensive care unit (NICU) and to determine risk factors for S. marcescens infection or colonization.Design:Genotyping of S. marcescens isolates was performed by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted.Setting:A tertiary-care pediatric hospital with a 16-bed NICU.Patients:All neonates with at least one culture positive for S. marcescens in the NICU during December 1999 to July 2002. Case-patients (n = 11) treated in the NICU during December 1999 to February 2000 were included in the case-control study. Neonates treated in the NICU for at least 72 hours during the same period with cultures negative for S. marcescens were used as control-patients (n = 27).Results:S. marcescens was cultured from 19 neonates; 9 were infected and 10 were colonized. PFGE analysis identified three epidemic strains; each cluster consisted of identical isolates, except one isolate in the first cluster that was different. The risk factors identified were low birth weight, prematurity, prolonged respiratory therapy, prolonged use of antibiotics, and maternal infection prior to delivery. Overcrowding and understaffing were recorded simultaneously with the clusters.Conclusions:PFGE analysis showed three independent clusters. Several factors contributed to spread of the epidemic strains: (1) there were many severely premature and susceptible neonates, (2) the NICU was overcrowded during the clusters, and (3) transmission was likely to occur via the hands of staff. Cohorting and improvement of routine infection control measures led to the cessation of each cluster.
Rapid Eradication of a Cluster of Serratia marcescens in a Neonatal Intensive Care Unit: Use of Epidemiologic Chromosome Profiling by Pulsed-Field Gel Electrophoresis
Authors: Lai Kwan Kew , Baker Stephen P. , Fontecchio Sally A. 
Published: April 2006

AbstractObjective:To investigate a cluster of patients infected and colonized with Serratia marcescens in a neonatal intensive care unit (NICU).Methods:In June 2001, two neonates in the NICU had clinical infections with S. marcescens and one died. Infection control surveillance data for the NICU revealed that S. marcescens was rarely isolated from clinical specimens. Surveillance and environmental cultures were performed and isolates were typed using pulsed-field gel electrophoresis. Staff and neonates were cohorted and a waterless, alcohol-based handwashing agent was introduced. A case-control study was performed.Results:From June 2 through August 20, 2001, 11 neonates with S. marcescens infection and colonization were identified. The incidence of S. marcescens infections increased from 0.19 per 1,000 patient-days in 2000 to 0.52 per 1,000 patient-days in 2001 (P < .0001). In the first 3 weeks of the investigation, there were 2 sets of patients and sinks with indistinguishable strains; however, in subsequent weeks, all isolates were of unique strains, signifying no further transmission of the two initial predominant strains. Neonates with S. marcescens were more likely to have a lower gestational age and birth weight. There was no association between cases and healthcare workers (HCWs).Conclusions:A cluster of S. marcescens was quickly terminated after the introduction of preventive measures including cohorting of infected and colonized neonates and HCWs, contact precautions, surveillance cultures, and a waterless, alcohol-based hand antiseptic. Chromosomal typing determined that strains with an indistinguishable pattern were no longer present in the unit after control measures were implemented.
Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit in Saudi Arabia: A 30-Month Prospective Surveillance
Authors: Almuneef Maha , Memish Ziad A. , Balkhy Hanan H. , Alalem Hala , Abutaleb Abdulrahman 
Published: April 2006

AbstractObjective:To describe the rate, risk factors, and outcome of ventilator-associated pneumonia (VAP) in pediatric patients.Methods:This prospective surveillance study of VAP among all patients receiving mechanical ventilation for 48 hours or more admitted to a pediatric intensive care unit (PICU) in Saudi Arabia from May 2000 to November 2002 used National Nosocomial Infections Surveillance (NNIS) System definitions.Results:Three hundred sixty-one eligible patients were enrolled. Most were Saudi with a mean age of 28.6 months. Thirty-seven developed VAP. The mean VAP rate was 8.87 per 1,000 ventilation-days with a ventilation utilization rate of 47%. The mean duration of mechanical ventilation was 21 days for VAP patients and 10 days for non-VAP patients. The mean PICU stay was 34 days for VAP patients and 15 days for non-VAP patients. Among VAP patients, Pseudomonas aeruginosa was the most common organism, followed by Staphylococcus aureus. Other gram-negative organisms were also encountered. There was no significant difference between VAP and non-VAP patients regarding mortality rate. Witnessed aspiration, reintubation, prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were associated with VAP. On multiple logistic regression analysis, only prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were independent predictors of VAP.Conclusions:The mean VAP rate in this hospital was higher than that reported by NNIS System surveillance of PICUs. This study has established a benchmark for future studies of VAP in the pediatric intensive care population in Saudi Arabia. Additional studies from the region are necessary for comparison and development of preventive measures.
Transmission of Methicillin-Resistant Staphylococcus aureus to Preterm Infants Through Breast Milk
Authors: Behari Priya , Englund Janet , Alcasid Grace , Garcia-Houchins Sylvia , Weber Stephen G. 
Published: April 2006

AbstractObjective:To determine a potential source of MRSA colonization and infection among preterm infants in a neonatal intensive care unit (NICU) using molecular analysis of breast milk samples.Design:Case report, outbreak investigation.Results:Preterm triplets were delivered at 26 weeks' gestation via cesarean section when routine active surveillance for MRSA was performed for all infants in a NICU. Surveillance consisted of swabbing the throat, nose, and umbilicus (TNU) weekly. Although infants A and B initially had negative TNU swabs, repeat cultures were positive for MRSA on day of life (DOL) 10 and DOL 18, respectively. Surveillance and clinical cultures for infant C were negative. Infant A developed sepsis, and multiple blood cultures were positive for MRSA beginning on DOL 14. Infant B developed conjunctivitis and a conjunctival exudate culture was positive for MRSA on DOL 70. Both infants were fed breast milk via nasogastric tube. Cultures of breast milk samples for infants A and B dated prior to either infant's first positive surveillance culture were positive for MRSA. All MRSA isolates had identical results on antibiotic susceptibility testing. PFGE demonstrated identical banding patterns for the MRSA isolates from the blood culture of infant A, breast milk for infants A and B, and a surveillance swab from infant B. At no time did the mother develop evidence of mastitis or other local breast infection.Conclusions:MRSA can be passed from mother to preterm infant through contaminated breast milk, even in the absence of maternal infection. Colonization and clinical disease can result.