bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Three Methods to Recover Vancomycin-Resistant Enterococci (VRE) From Perianal and Environmental Samples Collected During A Hospital Outbreak of VRE
Authors: Reisner Barbara S. , Shaw Stephanie , Huber Mary E. , Woodmansee Carla E. , Costa Silvia , Falk Pamela S. , Mayhall C. Glen 
Published: February 2006

Objective:To establish an efficient and sensitive technique for recovering vancomycin-resistant enterococci (VRE) from perianal and environmental samples collected during implementation of control measures for an outbreak of VRE.Design:Perianal and environmental samples were collected in triplicate on sterile swabs. One swab was used to inoculate a selective broth medium containing 6 μg of vancomycin and 8 μg of ciprofloxacin per mL, one to inoculateCampylobacteragar containing 10 μg/mL of vancomycin, and one to inoculate Enterococcosel agar containing 8 μg/mL of vancomycin.Setting:Samples were collected in the intensive care units of a 600-bed university hospital over a period of 2 months.Sample Selection:Patients and their immediate environment were sampled if they resided in a ward with a patient known to be colonized or infected with VRE.Results:Of the 88 perianal samples obtained from 63 patients, 37 were positive for VRE by broth culture, with 36 also recovered on both types of solid media (sensitivity, 97.3%; negative predictive value, 98.1%). Of the initial samples collected from each of the 63 patients, 20 were positive for VRE by all methods. Of the 500 environmental samples cultured, 139 were positive for VRE in broth, with only 33 recovered onCampylobacteragar (sensitivity, 23.7%; negative predictive value, 77.2%) and 22 on Enterococcosel agar (sensitivity, 15.8%; negative predictive value, 75.2%).Conclusions:Our data indicate that, when performing surveillance cultures during an outbreak of VRE, use of an enrichment broth medium is required to recover VRE contaminating environmental surfaces; however, direct inoculation to selective solid medium is adequate to recover VRE in patient perianal specimens.
Experience of Healthcare Workers Taking Postexposure Prophylaxis After Occupational HIV Exposures: Findings of the HIV Postexposure Prophylaxis Registry
Authors: Weber David , Wang Susan A. , Panlilio Adelisa L. , Doi Peggy A. , White Alice D. , Stek Michael , Saah Alfred ,   HIV PEP Registry Group
Published: February 2006

Objective:To collect information about the safety of taking antiretroviral drugs for human immunodeficiency virus (HIV) postexposure prophylaxis (PEP).Design:A voluntary, confidential registry.Setting:Hospital occupational health clinics, emergency departments, private physician offices, and health departments in the United States.Results:492 healthcare workers (HCWs) who had occupational exposures to HIV, were prescribed HIV PEP, and agreed to be enrolled in the registry by their healthcare providers were prospectively enrolled in the registry. Three hundred eight (63%) of 492 of the PEP regimens prescribed for these HCWs consisted of at least three antiretroviral agents. Of the 449 HCWs for whom 6-week follow-up was available, 195 (43%) completed the PEP regimen as initially prescribed. Forty-four percent (n=197) of HCWs discontinued all PEP drugs and did not complete a PEP regimen. Thirteen percent (n=57) discontinued ≥1 drug or modified drug dosage or added a drug but did complete a course of PEP. Among the 254 HCWs who modified or discontinued the PEP regimen, the two most common reasons for doing so were because of adverse effects attributed to PEP (54%) and because the source-patient turned out to be HIV-negative (38%). Overall, 340 (76%) HCWs with 6-week follow-up reported some symptoms while on PEP: nausea (57%), fatigue or malaise (38%), headache (18%), vomiting (16%), diarrhea (14%), and myalgias or arthralgias (6%). The median time from start of PEP to onset of each of the five most frequently reported symptoms was 3 to 4 days. Only 37 (8%) HCWs with 6-week follow-up were reported to have laboratory abnormalities; review of the reported abnormalities revealed that most were unremarkable. Serious adverse events were reported to the registry for 6 HCWs; all but one event resolved by the 6-month follow-up visit. Fewer side effects were reported by HCWs taking two-drug PEP regimens than by HCWs taking three-drug PEP regimens.Conclusions:Side effects from HIV PEP were very common but were rarely severe or serious. The nature and frequency of HIV PEP toxicity were consistent with information already available on the use of these antiretroviral agents. Clinicians prescribing HIV PEP need to counsel HCWs about PEP side effects and should know how to manage PEP toxicity when it arises.
Does the Centers for Disease Control’s NNIS System Risk Index Stratify Patients Undergoing Cardiothoracic Operations by Their Risk of Surgical-Site Infection?
Authors: Roy Marie-Claude , Herwaldt Loreen A. , Embrey Richard , Kuhns Kristen , Wenzel Richard P. , Perl Trish M. 
Published: February 2006

AbstractBackground:In 1991, the Centers for Disease Control and Prevention devised the National Nosocomial Infection Surveillance (NNIS) System risk index to stratify populations of surgical patients by the risk of acquiring surgical-site infections (SSIs).Objective:To determine whether the NNIS risk index adequately stratifies a population of cardiothoracic surgery patients by the risk of developing SSI.Design:Casecontrol study.Setting:The University of Iowa Hospitals and Clinics, a 900-bed, midwestern, tertiary-care hospital.Patients:201 patients with SSIs identified by prospective infection control surveillance and 398 controls matched by age, gender, type of procedure, and date of procedure. All patients underwent cardiothoracic operative procedures between November 1990 and January 1994.Results:The SSI rate was 7.8%. Seventy-four percent of cases and 80% of controls had a NNIS risk index score of 1; 24% of cases and 16% of controls had a score of 2 (P=.05). Patients with a NNIS risk score ≥2 were 1.8 times more likely to develop an SSI than those with a NNIS score <2 (odds ratio, 1.83; 95% confidence interval, 1.14-2.94,P=.01). The duration of the procedure was the only component of the index that stratified the population by risk of SSI.Conclusions:The risk of SSI after cardiothoracic operations increases as the NNIS risk index score increases. However, this index only dichotomized the patient population on the basis of the procedure duration. More research is needed to develop a risk index that adequately stratifies the risk of SSI after cardiothoracic operations.
Identification of Factors That Disrupt Negative Air Pressurization of Respiratory Isolation Rooms
Authors: Pavelchak Nicholas , DePersis Ronald P. , London Matthew , Stricof Rachel , Oxtoby Margaret , DiFerdinando George , Marshall Elizabeth 
Published: February 2006

AbstractObjectives:To investigate the airflow characteristics of respiratory isolation rooms (IRs) and to evaluate the use of visible smoke as a monitoring tool.Methods:Industrial hygienists from the New York State Department of Health evaluated 140 designated IRs in 38 facilities within New York State during 1992 to 1998. The rooms were located in the following settings: hospitals (59%), correctional facilities (40%), and nursing homes (1%). Each room was tested with visible smoke for directional airflow into the patient room (ie, negative air pressure relative to adjacent areas). Information was obtained on each facility's policies and procedures for maintaining and monitoring the operation of the IRs.Results:Inappropriate outward airflow was observed in 38% of the IRs tested. Multiple factors were associated with outward airflow direction, including ventilation systems not balanced (54% of failed rooms), shared anterooms (14%), turbulent airflow patterns (11%), and automated control system inaccuracies (10%). Of the 140 tested rooms, 38 (27%) had either electrical or mechanical devices to monitor air pressurization continuously. The direction of airflow at the door to 50% (19/38) of these rooms was the opposite of that indicated by the continuous monitors at the time of our evaluations. The inability of continuous monitors to indicate the direction of airflow was associated with instrument limitations (74%) and malfunction of the devices (26%). In one facility, daily smoke testing by infection control staff was responsible for identifying the malfunction of a state-of-the-art computerized ventilation monitoring and control system in a room housing a patient infectious with drug-resistant tuberculosis.Conclusion:A substantial percentage of IRs did not meet the negative air pressure criterion. These failures were associated with a variety of characteristics in the design and operation of the IRs. Our findings indicate that a balanced ventilation system does not guarantee inward airflow direction. Devices that continuously monitor and, in some cases, control the pressurization of IRs had poor reliability. This study demonstrates the utility of using visible smoke for testing directional airflow of IRs, whether or not continuous monitors are used. Institutional tuberculosis control programs should include provisions for appropriate monitoring and maintenance of IR systems on a frequent basis, including the use of visible smoke.
NosocomialSerratia marcescensInfections Associated With Extrinsic Contamination of a Liquid Nonmedicated Soap
Authors: Sartor Catherine , Jacomo Véronique , Duvivier Cédric , Tissot-Dupont Hervé , Sambuc Roland , Drancourt Michel 
Published: February 2006

AbstractObjective:To determine the role of nonmedicated soap as a source ofSerratia marcescensnosocomial infections (NIs) in hospital units with endemicS marcescensNI and to examine the mechanisms of soap colonization.Setting:University-affiliated tertiary-care hospitals.Methods:A prospective case-control study and an environmental investigation were performed to assess the relationship betweenS marcescensNIs in hospital units andS marcescens-contaminated soap. Soap-bottle use and handwashing practices were reviewed. Cultures of healthcare workers’ (HCWs) hands were obtained before and after hand washing with soap.Results:5 of 7 hospital units withS marcescensNIs had soap bottles contaminated withS marcescens, compared to 1 of 14 other units (P=.006). After hand washing with anS marcescens-contaminated soap pump, HCWs' hands were 54 times more likely to be contaminated withS marcescens(P<.001).Conclusions:Extrinsic contamination of a non-medicated liquid soap byS marcescensresulted in handborne transmission ofS marcescensNIs by HCWs in our setting. This finding led to the application of strict guidelines for nonmedicated soap use and to the reinforcement of alcoholic hand disinfection.
Outbreak of Pseudomonas aeruginosa Ventriculitis Among Patients in a Neurosurgical Intensive Care Unit
Authors: Trick William E. , Kioski Clare M. , Howard Kathleen M. , Cage Gary D. , Tokars Jerome I. , Yen Bertina M. , Jarvis William R. 
Published: February 2006

AbstractObjective:To determine the cause of an outbreak of Pseudomonas aeruginosa cerebral ventriculitis among eight patients at a community hospital neurosurgical intensive care unit. All had percutaneous external ventricular catheters (EVCs) to monitor cerebrospinal fluid (CSF) pressure.Methods:Cohort study of all patients who had EVCs placed during the epidemic period (August 8-October 22, 1997). A case-patient was any patient with P aeruginosa ventriculitis during the epidemic period. Pulsed-field gel electrophoresis (PFGE) was performed on all isolates.Results:P aeruginosa was significantly more likely to be isolated from CSF per EVC placed in the epidemic than pre-epidemic (January 1-August 7, 1997) periods (8/61 [13%] vs 2/131 [1.5%], P = 002). During the epidemic period, ventriculitis was significantly more likely after EVC placement in the operating room than in other units (8/24 vs 0/22, P = .004). EVC placement technique differed for EVCs placed in the operating room (little hair was removed, preventing application of an occlusive dressing) versus other hospital units (more hair was removed, and an occlusive dressing was applied). Among patients who had operating room EVC placement, contact with one healthcare worker was statistically significant (7/13 vs 0/8, P = .02). Hand cultures of this worker were negative. All isolates had closely related PFGE patterns.Conclusions:These data suggest that a single healthcare worker may have contaminated EVC insertion sites, resulting in an outbreak of P aeruginosa ventriculitis. Affected patients were unlikely to have had an occlusive dressing at the EVC insertion site. Application of a sterile occlusive dressing may decrease the risk of ventriculitis in patients with EVCs.
Genotyping by Restriction Endonuclease Analysis Compared to Phenotyping by Antibiogram for Typing Methicillin-ResistantStaphylococcus aureusStrains Colonizing Patients in a Nursing Home
Authors: Lee Yee-Lean , Thrupp Lauri 
Published: February 2006

AbstractObjectives:To assist in defining patterns of methicillin-resistantStaphylococcus aureus(MRSA) colonization in a skilled nursing facility (SNF), we compared genotyping by field-inversion gel electrophoresis (FIGE) restriction endonuclease digestion analysis (REA) with phenotyping by antibiogram for defining strain relatedness among MRSA isolates from SNF patients.Design:Prospective screening culture surveillance for MRSA among patients in a community SNEMethods:Nares and stool swab cultures were obtained from newly admitted patients and from all patients quarterly. MRSA were isolated by oxacillin screening agar. Antibiograms were determined by the disk-diffusion method, and genotyping was by FIGE REA.Results:It was shown that, among isolates with the same genotypes, many had different antibiograms; among isolates with the same antibiograms, many had different genotypes; and the discriminatory indices for isolates of MRSA by FIGE REA and by antibiogram were 0.56 and 0.78, respectively.Conclusion:Our study demonstrated that, in patients from one SNF, genotyping by FIGE REA identified two prevalent REA DNA types, but with variability of antibiogram patterns within each DNA type; the antibiogram also identified prevalent patterns with variability of REA DNA type within each antibiogram pattern. The discriminatory index of antibiograms alone, or of genotypes alone as determined by FIGE REA, was poor for strains of MRSA isolated from the SNF patients in our study.
Increase in Community-Acquired Methicillin-Resistant Staphylococcus aureus at a Naval Medical Center
Authors: Kallen Alexander J. , Driscoll Timothy J. , Thornton Scott , Olson Patrick E. , Wallace Mark R. 
Published: February 2006

AbstractA retrospective review of methicillin-resistant Staphylococcus aureus isolates from the Naval Medical Center, San Diego, for the years 1994 through 1997, found that the annual number of community-acquired MRSA isolates increased during the period. These outpatient isolates were more likely than inpatient isolates to be sensitive to a greater number of antibiotics.
Control of Nosocomial Clostridium difficile Transmission in Bone Marrow Transplant Patients
Authors: Hanna Hend , Raad Issam , Gonzalez Virginia , Umphrey Jan , Tarrand Jeffrey , Neumann Joyce , Champlin Richard 
Published: February 2006

AbstractThis is a report of six cases of Clostridium difficile-associated diarrhea (CDAD) that occurred among cancer patients undergoing bone marrow transplantation in a tertiary-care cancer hospital. Specific infection control measures that were taken to minimize the nosocomial spread of CDAD also are discussed.
Practices to Improve Antimicrobial Use at 47 US Hospitals the Status of the 1997 SHEA/IDSA Position Paper Recommendations
Authors: Lawton Rachel M. , Fridkin Scott K. , Gaynes Robert P. , McGowan John E. ,   Intensive Care Antimicrobial Resistance Epidemiology (ICARE) Hospitals
Published: February 2006

Objective.To determine the status of programs to improve antimicrobial prescribing at select US hospitals.Design:Cross-sectional survey.Participants and Setting:Pharmacy and infection control staff at all 47 hospitals participating in phase 3 of Project Intensive Care Antimicrobial Resistance Epidemiology.Results:All 47 hospitals had some programs to improve antimicrobial use, but the practices reported varied considerably. All used a formulary, and 43 (91%) used it in conjunction with at least one of the other three antimicrobial-use policies evaluated: stop orders, restriction, and criteria-based clinical practice guidelines (CPGs). CPGs were reported most commonly (70%), followed by stop orders (60%) and restriction policies (40%). Although consultation with an infectious disease physician (70%) or pharmacist (66%) was commonly used to influence initial antimicrobial choice, few (40%) reported a system to measure compliance with these consultations.Conclusions:In most hospitals surveyed, practices to improve antimicrobial use, although present, were inadequate based on recommendations in a Society for Healthcare Epidemiology of America and Infectious Disease Society of America joint position paper. There is room to improve antimicrobial-use stewardship at US hospitals.
An Operating Surveillance System of Surgical-Site Infections in The Netherlands: Results of the PREZIES National Surveillance Network
Authors: Geubbels Eveline L.P.E. , Groot A. Joke Mintjes-de , Berg Jan Maarten J. van den , de Boer Annette S. 
Published: February 2006

AbstractObjectives:To describe the results of the first year of the Dutch national surveillance of surgical-site infections (SSIs) and risk factors, which aims to implement a standardized surveillance system in a network of Dutch hospitals, to collect comparable data on SSIs to serve as a reference, and to provide a basic infrastructure for further intervention research.Design:Prospective multicenter cohort study.Setting:Acute-care hospitals in The Netherlands from June 1996 to May 1997.Results:38 hospitals participated, with a slight overrepresentation of larger hospitals. Following a total of 18,063 operations, 562 SSIs occurred, of which 198 were deep. Multivariate analysis of pooled procedures shows that age, preoperative length of stay, wound contamination class, anesthesia score, and duration of surgery were independent risk factors for SSI. When analyzed by procedure, the relative importance of these risk factors changed. Bacteriological documentation was available for 56% of the SSIs; 35% of all isolates were Staphylococcus aureus. Multiple regression analysis computed the mean extra postoperative length of stay associated with SSI to be 8.2 days.Conclusion:The first year of national surveillance has shown that it is feasible to collect comparable data on SSI, which are already used for education, policy, and decision making in the network of participating hospitals. This gives room to effectuate the next aim, namely to use the network as an infrastructure for intervention research. Multivariate analysis shows that feedback on a procedure-specific level is important.
Nasal Carriage of Staphylococcus aureus: Is a Major Risk Factor for Surgical-Site Infections in Orthopedic Surgery
Authors: Kalmeijer Mathijs D. , Nieuwland-Bollen Ella van , Bogaers-Hofman Diane , Baere Gerard A.J. de , Kluytmans Jan A.J.W. 
Published: February 2006

AbstractObjective:To determine the relative importance of different risk factors for the development of surgical-site infections (SSIs) in orthopedic surgery with prosthetic implants.Design:In a cohort of 272 patients, the following possible risk factors were studied: age, gender, method of hair removal, duration of operation, surgeon, underlying illness, and nasal carriage of Staphylococcus aureus. Infections were recorded following the Centers for Disease Control criteria. The relation between risk factors and SSI was tested in univariate and multiple logistic regression analysis.Setting:Community hospital in Breda, The Netherlands.Results:18 (6.6%) of 272 patients experienced SSI: 11 superficial and 7 deep SSI. These infections led in three cases to removal of the prosthesis and caused 286 extra days in hospital. The main causative pathogen was S aureus. In multiple logistic regression analysis, the following factors were independent risk factors for the development of SSI: high-level nasal carriage of S aureus (P=.04), male gender (P=.005), and surgeon 1 (P=.006). The only independent risk factor for SSI with S aureus was high-level nasal carriage of S aureus (P=.002).Conclusion:High-level nasal carriage of S aureus was the most important and only significant independent risk factor for developing SSI with S aureus.
Identifying Outliers of Antibiotic Usage in Prevalence Studies on Nosocomial Infections
Authors: Gastmeier Petra , Sohr Dorit , Forster Dietmar , Schulgen Gabriele , Schumacher Martin , Daschner Franz , Rüden Henning 
Published: February 2006

AbstractObjective:To investigate whether the correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in each hospital department, described by Pearson's correlation coefficient (ρ) for binary data as a measure for adequate use of antibiotics, is an appropriate quality indicator.Design:Comparison of the results of repeated prevalence studies in different hospitals with the data of a national prevalence study, comparing the hospital (ρ) and reference (ρNIDHP[Nosokomiale Infektionen in Deutschland: Erfassung und Prävention]) correlation coefficients for “use of antibiotics/ presence of infections.”Setting:The data of 5,377 surgical patients were separated from the total data of a national prevalence study in 72 representative hospitals to create a reference correlation coefficient (ρNIDEP) with a reference range. Nine additional prevalence studies, involving a total of 4,984 patients, were repeatedly performed in the surgical departments of 8 other hospitals during a 12-month period, whereby the correlation coefficients ρn for every prevalence investigation were determined.Results:In the national prevalence study, 15.3% of the surgical patients received antibiotics on the study day. Surgical patients had a 3.8% prevalence of nosocomial infections and a 7.0% prevalence of community-acquired infections. Pearson's correlation coefficient ρNIDEP for correlation between patients' binary data use of antibiotics and presence of infection was 0.62. To compare the correlation coefficient of each department with the appropriate reference range, the coefficients of the single departments were plotted against the number of patients; in these plots, three lines indicated the value ρNIDEP and the upper and lower reference ranges, depending on the number of patients. Seven of eight surgical departments investigated during the repeated prevalence studies were found to be within the reference range, near the reference value, in the majority of prevalence studies; only one of the departments was identified as an outlier as regards antibiotic use.Conclusion:The correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in hospitals or departments, as described by Pearson's correlation coefficient ρ for binary data with a definitive reference range depending on the number of patients, is useful for quality management in identifying the overall necessity for evaluating the indications for antibiotic use in one's own hospital.
Nosocomial Malaria From Contamination of a Multidose Heparin Container With Blood
Authors: Al-Saigul Abdullah M. , Fontaine Robert E. , Haddad Qais 
Published: February 2006

AbstractA girl developed Plasmodium falciparum malaria in Riyadh, Saudi Arabia, a non-malarious area. Twelve to 18 days before onset, she had been hospitalized for asthma on the same ward as three malaria patients. The only link between the malaria patients and the asthma patient was a multidose heparin container used to fill syringes for use on heparin locks and intravenous devices. Contamination of the heparin with blood occurred on at least one occasion when a needle had been left in place through the septum of this container and was used to refill a used syringe.