bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of a Novel Approach to Evaluate the Outcome of Endoscope Reprocessing
Authors: Sciortino C. V. , Xia Eric L. , Mozee Alberta 
Published: April 2006

AbstractObjective:To investigate and evaluate the use of a portable luminometer system for detecting contamination following the reprocessing and high-level disinfection of flexible endoscopes.Design:Random sampling of endoscopes spaced at 1- to 2-week intervals following normal use in patients.Methods:Portable luminometer system testing of 31 endoscopes undergoing reprocessing, 63 stored endoscopes, and 15 reprocessed endoscopes that underwent in-depth microbiological analysis. For testing with the portable luminometer system, samples were collected by swabbing a 100-cm2 shank surface area and the internal tip end orifice. Standardization of portable luminometer system results was performed in vitro by comparison of serial dilutions of known quantities of microorganisms and blood, tested before and after sterilization by autoclave. Microbiological analysis included Gram stain, culture for aerobic bacteria, and gene probes for Mycobacterium tuberculosis, herpes simplex viruses 1 and 2, and Cytomegalovirus. Trichrome and calcofluor white stains were used to detect parasites and fungi. Legionella was detected by stain with fluorescent-labeled monoclonal antibody.Setting:The gastroendoscopy unit of a Veterans Affairs hospital.Results:The portable luminometer system was capable of detecting microbial and cellular contamination of flexible endoscopes following high-level disinfection and reprocessing. The sensitivity of the assay was sufficient for detecting low-level contamination.Conclusions:The system provided a rapid microbiological outcome monitor for the cleaning and disinfection process. The system was easy to use and relatively accurate.
Burkholderia cepacia Infections Associated With Intrinsically Contaminated Ultrasound Gel: The Role of Microbial Degradation of Parabens
Authors: Hutchinson Jim , Runge Wendy , Mulvey Mike , Norris Gail , Yetman Marion , Valkova Nelly , Villemur Richard , Lepine Francois 
Published: April 2006

AbstractObjective:To describe an outbreak of serious nosocomial Burkholderia cepacia infections occurring after transrectal prostate biopsy associated with ultrasound gel intrinsically contaminated with paraben-degrading microorganisms.Methods:A retrospective chart review prompted by a blood culture isolate of B, cepacia. Identification of microorganisms in ultrasound gel in two Canadian centers and characterization by pulsed-field gel electrophoresis and assays for paraben degradation.Setting:Two Canadian university-affiliated, tertiary-care centers in Newfoundland and Alberta.Results:Six serious B. cepacia infections were identified at the two centers. Isolates of B. cepacia recovered from the blood of patients from both centers and the ultrasound gel used during the procedures were identical, confirming intrinsic contamination. Strains of Enterobacter cloacae isolated from ultrasound gel at the two centers were also identical. The ability to degrade parabens was proven for both B. cepacia and E. cloacae strains recovered from the ultrasound gel.Conclusions:Ultrasound gel is a potential source of infection. Contamination occurs at the time of manufacture, with organisms that degrade parabens, which are commonly used as stabilizing agents. There are far-reaching implications for the infection control community.
Compliance With Guidelines on Antibiotic Prophylaxis in Total Hip Replacement Surgery: Results of a Retrospective Study of 416 Patients in a Teaching Hospital
Authors: Bedouch Pierrick , Labarère José , Chirpaz Emmanuel , Allenet Benoit , Lepape Alain , Fourny Magali , Pavese Patricia , Girardet Pierre , Merloz Philippe , Saragaglia Dominique , Calop Jean , Francois Patrice 
Published: April 2006

AbstractObjective:To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines.Design:Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis.Setting:Orthopedic surgery wards in a 2,200-bed French teaching hospital.Patients:A random sample of 416 patients undergoing THR from January 1999 to December 2000.Results:Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P < .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95,1.02-2.38).Conclusion:The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.
Rapid Monitoring by Quantitative Polymerase Chain Reaction for Pathogenic Aspergillus During Carpet Removal From a Hospital
Authors: Neely Alice N. , Gallardo Vince , Barth Ed , Haugland Richard A. , Warden Glenn D. , Vesper Stephen J. 
Published: April 2006

AbstractMonitoring for pathogenic Aspergillus species using a rapid, highly sensitive, quantitative polymerase chain reaction technique during carpet removal in a burn unit provided data that allowed patients to be safely returned to the refloored area sooner than if only conventional culture monitoring had been used.
Prevalence and Fluconazole Susceptibility of Candida Species Recovered From the Oropharynx of Healthcare Workers (HCWs) and Non-HCWs
Authors: Klein Joel D. , Levin S. 
Published: April 2006

AbstractWe compared oropharyngeal cultures and fluconazole susceptibility for Candida in 100 healthcare workers (HCWs) and 100 non-HCWs. Isolates were identified using standard microbiological methods. Susceptibility was determined by Etest and microliter method. There was no significant difference in prevalence or species of oropharyngeal Candida between HCWs and non-HCWs. Fluconazole resistance was infrequent.
Increased Susceptibility to Vancomycin-Resistant Enterococcus Intestinal Colonization Persists After Completion of Anti-Anaerobic Antibiotic Treatment in Mice
Authors: Stiefel Usha , Pultz Nicole J. , Helfand Marion S. , Donskey Curtis J. 
Published: April 2006

AbstractBackground:Antibiotic-associated disruption of the indigenous intestinal microflora may persist beyond the treatment period. Although piperacillin/tazobactam inhibits the establishment of vancomycin-resistant Enterococcus (VRE) stool colonization in mice during treatment, we hypothesized that this agent and other anti-anaerobic antibiotics would increase susceptibility to colonization during the period of recovery of the intestinal microflora.Design:Mice received 104 colony-forming units of vancomycin-resistant E. faecium by orogastric inoculation 2, 5, or 10 days after completing 5 days of subcutaneous antibiotic treatment, or both during and 2 days after the completion of treatment. Denaturing gradient gel electrophoresis (DGGE) was performed to assess changes in the intestinal microflora.Results:Anti-anaerobic antibiotics (ie, piperacillin/tazobactam, cefoxitin, and clindamycin) caused significant disruption of the indigenous microflora (mean DGGE similarity indices ≤ 27% in comparison with saline controls) and promoted the establishment of high-density colonization when VRE was inoculated 2 or 5, but not 10, days following treatment (P < .001). Piperacillin/tazobactam exhibited a biphasic effect on the establishment of colonization (ie, inhibition when exposed to VRE during treatment and promotion when exposed to VRE after discontinuation of treatment), resulting in greater overall promotion of colonization than did agents with minimal anti-anaerobic activity (ie, levofloxacin, cefepime, and aztreonam) when VRE was inoculated both during and 2 days after treatment (P< .001).Conclusion:Patients receiving anti-anaerobic antibiotics, including piperacillin/tazobactam, may be susceptible to the establishment of high-density VRE colonization during the period of recovery of the anaerobic microflora.
Impact of Surveillance for Vancomycin-Resistant Enterococci on Controlling a Bloodstream Outbreak Among Patients With Hematologic Malignancy
Authors: Hachem Ray , Graviss Linda , Hanna Hend , Arbuckle Rebecca , Dvorak Tanya , Hackett Brenda , Gonzalez Virginia , Perego Cheryl , Tarrand Jeffrey , Raad Issam 
Published: April 2006

AbstractObjective:To determine the impact of stool surveillance cultures of critically ill patients on controlling vancomycin-resistant enterococci (VRE) outbreak bacteremia.Design:Stool surveillance cultures were performed on patients who had hematologic malignancy or were critically ill at the time of hospital admission to identify those colonized with VRE. Hence, contact isolation was initiated.Setting:A tertiary-care cancer center with a high prevalence of VRE.Participants:All patients with hematologic malignancy who were admitted to the hospital as well as all of those admitted to the intensive care unit were eligible.Results:Active stool surveillance cultures performed between 1997 and 2001 decreased the incidence density of VRE bacteremias eightfold while vancomycin use remained constant. In fiscal year (FY) 1997 and FY 1998, there were five and three VRE outbreak bacteremias, respectively. The outbreak clones were responsible for infection in 69% of those patients with VRE bacteremia. However, the stool surveillance program resulted in the complete control of VRE bacteremia by FY 1999 until the end of the study.Conclusion:Despite the steady use of vancomycin, the active surveillance program among high-risk patients with hematologic malignancy and those who were critically ill resulted in the complete control of VRE outbreak bacteremia at our institution.
Failure to Develop Vancomycin-Resistant Enterococcus With Oral Vancomycin Treatment of Clostridium difficile
Authors: Salgado Cassandra D. , Giannetta Eve T. , Farr Barry M. 
Published: April 2006

AbstractObjective:Oral vancomycin therapy has been a risk factor for turning culture positive for vancomycin-resistant Enterococcus (VRE). VRE colonization status was reviewed for all patients who received oral vancomycin and underwent prospective cultures.Methods:Data were extracted from the medical records of all patients receiving oral vancomycin between August 1995 and February 2001 regarding history, hospital course, and perirectal VRE cultures. Hospital policy required contact isolation for patients receiving oral vancomycin until colonization with VRE was excluded.Results:Twenty-six courses of oral vancomycin were given to 22 patients. VRE colonization status after completion of therapy was evaluated for 23 courses in 20 (91%) of these patients. None of these patients became VRE culture positive during a median follow-up of 18 days (range, 9 to 39 days), with a median duration of treatment of 10 days (range, 3 to 58 days), and with a median total dose of 6,500 mg (range, 1,250 to 29,000 mg). All patients received other antibiotics within 30 days prior to therapy with oral vancomycin, during therapy with oral vancomycin, or both; 95% had received anti-anaerobic therapy and 35% had received parenteral vancomycin.Conclusions:Even when other risk factors were present, no patient receiving oral vancomycin at our facility subsequently became culture positive for VRE. This suggests that oral vancomycin therapy or other antibiotic use, including anti-anaerobic therapy, may not be a significant independent risk factor for turning culture positive for VRE among patients not previously exposed to the microbe.
A Cost-Benefit Analysis of Gown Use in Controlling Vancomycin-Resistant Enterococcus Transmission Is It Worth the Price?
Authors: Puzniak Laura A. , Gillespie Kathleen N. , Leet Terry , Kollef Marin , Mundy Linda M. 
Published: April 2006

AbstractObjective:To determine the net benefit and costs associated with gown use in preventing transmission of van-comycin-resistant Enterococcus (VRE).Design:A cost-benefit analysis measuring the net benefit of gowns was performed. Benefits, defined as averted costs from reduced VRE colonization and infection, were estimated using a matched cohort study. Data sources included a step-down cost allocation system, hospital informatics, and microbiology databases.Setting:The medical intensive care unit (MICU) at Barnes-Jewish Hospital, St. Louis, Missouri.Patients:Patients admitted to the MICU for more than 24 hours from July 1, 1997, to December 31, 1999.Interventions:Alternating periods when all healthcare workers and visitors were required to wear gowns and gloves versus gloves alone on entry to the rooms of patients colonized or infected with VRE.Results:On base-case analysis, 58 VRE cases were averted with gown use during 18 months. The annual net benefit of the gown policy was $419,346 and the cost per case averted of VRE was $1,897. The analysis was most sensitive to the level of VRE transmission.Conclusions:Infection control policies (eg, gown use) initially increase the cost of health services delivery. However, such policies can be cost saving by averting nosocomial infections and the associated costs of treatment. The cost savings to the hospital plus the benefits to patients and their families of avoiding nosocomial infections make effective infection control policies a good investment.
Emergence of Resistant Staphylococci on the Hands of New Graduate Nurses
Authors: Cimiotti Jeannie P. , Wu Fann , Della-Latta Phyllis , Nesin Mirjana , Larson Elaine 
Published: April 2006

AbstractObjective:To describe the aerobic microbial flora on the hands of experienced and new graduate nurses over time.Design:A prospective cohort design that examined the relationship between duration of employment in an intensive care unit (ICU) and the microbial flora on the hands of experienced and new graduate nurses during a 23-month period.Setting:A 50-bed, level III-IV neonatal ICU in New York City.Participants:Twelve experienced nurses and 9 new graduate nurses working full time in the NICU.Intervention:One hundred fifty samples were obtained from the clean, dominant hands of the nurses. Cultures were performed at baseline and then quarterly for each experienced and new graduate nurse. Baseline and final cultures of Staphylococcus epidermidis were further examined using pulsed-field gel electrophoresis.Results:At baseline, a significantly larger proportion of the experienced nurses had methicillin-resistant, coagulase-negative staphylococci isolated from their hands compared with the new graduate nurses (95% and 33%, respectively; P = .0004). For a second culture, performed 1 to 4 months later, there were no longer significant differences between the two groups (82% and 54%, respectively; P = .12). By the last culture, all staphylococcal isolates were methicillin resistant in both groups of nurses; 3 were methicillin-resistant S. aureus.Conclusions:Colonization with methicillin-resistant staphylococci occurred after brief exposure to the hospital environment, despite the use of antiseptic hand hygiene agents. Furthermore, at final culture, the two groups shared one dominant hospital-acquired strain of S. epidermidis.
Surgical-Site Infection Due to Staphylococcus aureus Among Elderly Patients Mortality, Duration of Hospitalization, and Cost
Authors: McGarry Sarah A. , Engemann John J. , Schmader Kenneth , Sexton Daniel J. , Kaye Keith S. 
Published: April 2006

AbstractObjectives:To examine the impact of surgical-site infection (SSI) due to Staphylococcus aureus on mortality, duration of hospitalization, and hospital charges among elderly surgical patients and the impact of older age on these outcomes by comparing older and younger patients with S. aureus SSI.Design:A nested cohort study.Setting:A 750-bed, tertiary-care hospital and a 350-bed community hospital.Patients:Ninety-six elderly patients (70 years and older) with S. aureus SSI were compared with 2 reference groups: 59 uninfected elderly patients and 131 younger patients with S. aureus SSI.Results:Compared with uninfected elderly patients, elderly patients with S. aureus SSI were at risk for increased mortality (odds ratio [OR], 5.4; 95% confidence interval [CI95], 1.5-20.1), postoperative hospital-days (2.5-fold increase; CI95, 2.0-3.1), and hospital charges (2.0-fold increase; CI95, 1.7-2.4; $41,117 mean attributable charges per SSI). Compared with younger patients with S. aureus SSI, elderly patients had increased mortality (adjusted OR, 2.9; CI95, 1.1-7.6), hospital-days (9 vs 13 days; P = .001), and median hospital charges ($45,767 vs $85,648; P < .001).Conclusions:Among elderly surgical patients, S. aureus SSI was independently associated with increased mortality, hospital-days, and cost. In addition, being at least 70 years old was a predictor of death in patients with S. aureus SSI.
Risk Factors for Surgical-Site Infection Following Primary Total Knee Arthroplasty
Authors: Minnema Brian , Vearncombe Mary , Augustin Anne , Gollish Jeffrey , Simor Andrew E. 
Published: April 2006

AbstractObjective:To identify risk factors associated with the development of surgical-site infection (SSI) following total knee arthroplasty (TKA).Design:A case-control study.Setting:A 1,100-bed, university-affiliated, tertiary-care teaching hospital.Methods:Case-patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospectively by infection control practitioners using National Nosocomial Infections Surveillance (NNIS) System methods. Three control-patients were selected for each case-patient, matched by date of surgery. Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection.Results:Twenty-two patients with infections (6 superficial and 16 deep) were identified. Infection rates per year were 0.95%, 1.07%, and 1.19% in 1999, 2000, and 2001, respectively. Logistic regression analysis identified two variables independently associated with the development of infection: the use of closed suction drainage (odds ratio [OR], 7.0; 95% confidence interval [CI95], 2.1-25.0; P = .0015) and increased international normalized ratio (INR) (OR, 2.4; CI95, 1.1-5.7; P = .035). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various comorbidities, surgeon, duration of procedure or tourniquet time, type of bone cement or prosthesis used, or receipt of blood product transfusions.Conclusions:The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.
Preoperative Risk Factors for Nasal Carriage of Staphylococcus aureus
Authors: Herwaldt Loreen A. , Cullen Joseph J. , French Pamela , Hu Jianfang , Pfaller Michael A. , Wenzel Richard P. , Perl Trish M. 
Published: April 2006

AbstractBackground:Staphylococcus aureus nasal carriage is a risk factor for surgical-site infections (SSIs) caused by S. aureus, and eradication of carriage reduces postoperative nosocomial infections caused by it. No study has compared large groups of preoperative carriers and non-carriers to identify factors that are linked to S. aureus nasal carriage.Methods:While conducting a clinical trial evaluating whether mupirocin prevented S. aureus SSIs, we prospectively collected data on 70 patient characteristics that might be associated with S. aureus carriage. We performed stepwise logistic regression analysis.Results:Of the 4,030 patients, 891 (22%) carried S. aureus. Independent risk factors for S. aureus nasal carriage were obesity (odds ratio [OR], 1.29; 95% confidence interval [CI95], 1.11-1.50), male gender (OR, 1.29; CI95,1.11-1.51), and a history of a cerebrovascular accident (OR, 1.53; CI95, 1.03-2.25) for all patients. Factors associated with nasal carriage varied somewhat by surgical specialty. In all groups, preoperative use of antimicrobial agents was independently associated with a lower risk of carrying S. aureus in the nares. Previously identified risk factors were not significantly associated with S. aureus nasal carriage in this large group of surgical patients.Conclusion:Male gender, obesity, and a history of a cerebrovascular accident were identified as risk factors for S. aureus nasal carriage. It remains to be seen whether preoperative weight loss would reduce the rate of nasal carriage. In addition, the value of screening this patient population for S. aureus nasal carriage merits further investigation.
Prevention of Infections Associated With Permanent Cardiac Antiarrhythmic Devices by Implementation of a Comprehensive Infection Control Program
Authors: Borer Abraham , Gilad Jacob , Hyam Eytan , Schlaeffer Francisc , Schlaeffer Pnina , Eskira Seada , Aloni Phany , Wagshal Abraham , Katz Amos 
Published: April 2006

AbstractObjective:To implement a comprehensive infection control (IC) program for prevention of cardiac device-associated infections (CDIs).Design:Prospective before-after trial with 2 years of follow-up.Setting:A tertiary-care, university-affiliated medical center.Patients:A consecutive sample of all adults undergoing cardiac device implantation between 1997 and 2002.Intervention:An IC program was implemented during late 2001 and included staff education, preoperative modification of patient risk factors, intraoperative control of strict aseptic technique, surgical scrubbing and attire, control of environmental risk factors, optimization of antibiotic prophylaxis, postoperative wound care, and active surveillance. The clinical endpoint was CDI rates.Results:Between 1997 and 2000, there were 7 CDIs among 725 procedures (mean annual CDI incidence, 1%). During the first 9 months of 2001, there were 7 CDIs among 167 procedures (4.2%; P = .007): CDIs increased from 7 among 576 to 3 among 124 following pacemaker implantation (P = .39) and from 0 among 149 to 4 among 43 following cardioverter-defibrillator implantation (P = .002). Of the 14 CDIs, 5 involved superficial wounds, 7 involved deep wounds, and 2 involved endocarditis. Following intervention, there were no cases of CDI among 316 procedures during 24 months of follow-up (4.2% reduction; P = .0005).Conclusions:We observed a high CDI rate associated with substantial morbidity. IC measures had an impact on CDI. Although the relative weight of each measure in the prevention of CDI remains unknown, our results suggest that implementation of a comprehensive IC program is feasible and efficacious in this setting.