bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital
Authors: Christiansen Keryn J. , Tibbett Patricia A. , Beresford William , Pearman John W. , Lee Rosie C. , Coombs Geoffrey W. , Kay Ian D. , O'Brien Frances G. , Palladino Silvano , Douglas Charles R. , Montgomery Philip D. , Orrell Terri , Peterson Allison M. , Kosaras Frank P. , Flexman James P. , Heath Christopher H. , McCullough Cheryll A. 
Published: April 2006

AbstractObjective:To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.Interventions:Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistant Enterococcus faecium despite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection of vanA and vanB resistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).Results:A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistant E. faecium. Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).Conclusion:Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.
Intervention to Reduce the Incidence of Methicillin-Resistant Staphylococcus aureus Skin Infections in a Correctional Facility in Georgia
Authors: Wootton Susan H. , Arnold Kathryn , Hill Holly A. , McAllister Sigrid , Ray Marsha , Kellum Molly , LaMarre Madie , Lane Mary Ellen , Chaitram Jasmine , Lance-Parker Susan , Kuehnert Matthew J. 
Published: April 2006

AbstractBackground and Objective:In August 2001, a cluster of MRSA skin infections was detected in a correctional facility. An investigation was conducted to determine its cause and to prevent further MRSA infections.Design:Case-control study.Setting:A 200-bed detention center.Patients:A case was defined as a detainee with a skin lesion from which MRSA was cultured from July 24 through December 31, 2001. Case-patients were identified by review of laboratory culture results and by skin lesion screening through point-prevalence survey and admission examination. Controls were randomly selected from an alphabetized list of detainees.Intervention:Medical staff implemented measures to improve skin disease screening, personal hygiene, wound care, and antimicrobial therapy.Results:Sixteen cases were identified: 11, 5, and 0 in the preintervention, peri-intervention, and postintervention periods, respectively. Seven case-patients and 19 controls were included in the case-control study. On multivariable analysis, working as a dormitory orderly (OR, 9.8; CI95, 0.74-638; P= .10) and a stay of longer than 36 days (OR, 6.9; CI95, 0.65-128.2; P = .14) were the strongest predictors for MRSA skin infection. The preintervention, peri-intervention, and postintervention MRSA infection rates were 11.6, 8.8, and 0 per 10,000 detainee-days, respectively. The rate of MRSA skin infections declined significantly between both the preintervention and peri-intervention periods and the postintervention period (P < .01 for both comparisons).Conclusions:MRSA skin disease can become an emergent problem in a correctional facility. Interventions targeted at skin disease screening, appropriate antimicrobial treatment, and hygiene may decrease the risk of acquiring MRSA infection in correctional facilities.
Emergence of Vancomycin-Resistant Enterococci in San Francisco Bay Area Hospitals During 1994 to 1998
Authors: Rosenberg Jon , Jarvis William R. , Abbott Sharon L. , Vugia Due J. ,   California Emerging Infections Program
Published: April 2006

AbstractObjective:To determine the magnitude of van-comycin-resistant enterococci (VRE) in three counties in the San Francisco Bay area.Design:Active laboratory-based surveillance for VRE from January 1995 through December 1996 and a laboratory-based and hospital-based questionnaire survey for 1993 to 1994 and 1997 to 1998.Setting:All 33 general acute care hospitals in three counties in the San Francisco Bay area.Participants:Laboratories and infection control professionals serving these hospitals, and staff of the California Emerging Infections Program.Results:The number of hospitals reporting 1 or more patient clinical VRE isolates was 1 (3%) in 1993, 7 (21%) in 1994, 31 (94%) in 1995, and 33 (100%) in 1996 to 1998. The number of patient isolates increased from 1 in 1993 to 24 in 1994, 176 in 1995,429 in 1996, 730 in 1997, and 864 in 1998. Most VRE isolates in 1995 and 1996 were from urine and were not associated with serious clinical disease. However, the number of isolates from blood increased from 9 (6% of total) in 1995 to 44 (12% of the total) in 1996, 90 (14%) in 1997, and 100 (13%) in 1998.Conclusions:Our data document the rapid emergence and increase of VRE in all hospitals in three counties in the San Francisco Bay area during 1994 to 1998. Infection control measures for VRE together with antibiotic utilization programs should be implemented to limit further spread.
Control of Nosocomial Acquisition of Vancomycin-Resistant Enterococcus Through Active Surveillance of Hemodialysis Patients
Authors: Axon R. Neal , Engemann John J. , Butcher James , Lockamy Kathy , Kaye Keith S. 
Published: April 2006

AbstractHemodialysis-dependent patients are an important VRE source. After implementation of active surveillance for VRE targeting hemodialysis patients, the hospital-wide nosocomial VRE rate increased by 41%, but decreased by 41% among non-hemodialysis patients (P = .05). To assess the effectiveness of active surveillance, patients undergoing active surveillance should be analyzed separately from other patients.
Surgical-Site Infection Rates and Risk Factor Analysis in Coronary Artery Bypass Graft Surgery
Authors: Harrington Glenys , Russo Philip , Spelman Denis , Borrell Sue , Watson Kerrie , Barr Wendy , Martin Rhea , Edmonds Diedre , Cocks Joanne , Greenbough John , Lowe Jill , Randle Leesa , Castell Jan , Browne Elizabeth , Bellis Kaye , Aberline Melissa 
Published: April 2006

AbstractBackground:The Victorian Infection Control Surveillance Project (VICSP) is a multicenter collaborative surveillance project established by infection control practitioners. Five public hospitals contributed data for patients undergoing coronary artery bypass graft (CABG) surgery.Objective:To determine the aggregate and comparative interhospital surgical-site infection (SSI) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group.Method:Each institution used standardized definitions of SSI, risk adjustment, and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Data on potential risk factors were prospectively collected.Results:For 4,474 patients undergoing CABG surgery, the aggregate SSI rate was 7.8 infections per 100 procedures (95% confidence interval [CI95], 7.0-8.5), with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures. Multivariate risk factor analysis demonstrated age (odds ratio [OR], 1.02; CI95, 1.01-1.04; P < .001), obesity (OR, 1.8; CI95, 1.4-2.3; P < .001), and diabetes mellitus (OR, 1.6; CI95, 1.2-2.1; P < .001) as independent predictors of SSI. Three hundred thirty-four organisms were isolated from 296 SSIs. Of the total SSIs, methicillin-resistant Staphylococcus aureus was isolated from 32%, methicillin-sensitive S. aureus from 24%, gram-negative bacilli (eg, Enterobacter and Escherichia colt) from 18%, and miscellaneous organisms from the remainder.Conclusion:We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI. VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery.
Staphylococcus aureus Nasal Carriage in a Student Community Prevalence, Clonal Relationships, and Risk Factors
Authors: Bischoff Werner E. , Wallis Michelle L. , Tucker Keith B. , Reboussin Beth A. , Sherertz Robert J. 
Published: April 2006

AbstractObjective:To evaluate the prevalence and risk factors of nasal Staphylococcus aureus (SA) in the community.Design:Cross-sectional study.Setting:Wake Forest University, Winston-Salem, North Carolina.Participants:Four hundred fifty students were screened for nasal SA carriage during the fall of 2000, 2001, and 2002.Methods:Students were screened by nose swabs. A self-administered questionnaire collected information on demographics and medical history. Antibiotic testing and PFGE were performed on isolates. Risk factors were determined by logistic regression analysis.Results:Of 450 volunteers, 131 (29%) were SA carriers. Antibiotic resistance was high for azithromycin (26%) and low for ciprofloxacin (1%), tetracycline (5%), mupirocin (1%), and methicillin (2%). PFGE patterns were not associated with carriage. Age, male gender, white race, medical student, allergen injection therapy, chronic sinusitis, rheumatoid arthritis, hospitalization for 6 months or less, and use of antibiotics were associated with carrier status by univariate analysis. Stepwise multivariate logistic regression led to a best fitting model with older age (OR, 1.04; CI95, 1.005-1.079), male gender (OR, 1.50; CI95, 0.982-2.296), and chronic sinusitis (OR, 2.71; CI95, 0.897-8.195) as risk factors. Antibiotic use (< 4 weeks) (OR, 0.41; CI95, 0.152-1.095) and allergen injection therapy (OR 0.41; CI95, 0.133-1.238) were protective. Analyses of carriers revealed candidate factors for persistent carriage to be nasal SA colonization rate and male gender. Factors for azithromycin resistance were non-medical students and antibiotic use in the past 6 months.Conclusion:Older male volunteers suffering from chronic sinusitis and not taking antibiotics were at higher risk for carrying SA.
Airborne Dispersal as a Novel Transmission Route of Coagulase-Negatwe Staphylococci Interaction Between Coagulase-Negative Staphylococci and Rhinovirus Infection
Authors: Bischoff Werner E. , Bassetti Stefano , Bassetti-Wyss Barbara A. , Wallis Michelle L. , Tucker Brian K. , Reboussin Beth A. , D'Agostino Ralph B. , Pfaller Michael A. , Gwaltney Jack M. , Sherertz Robert J. 
Published: April 2006

AbstractObjective:To investigate whether rhinovirus infection leads to increased airborne dispersal of coagulase-negative staphylococci (CoNS).Design:Prospective nonrandomized intervention trial.Setting:Wake Forest University School of Medicine, Winston-Salem, North Carolina.Participants:Twelve nasal Staphylococcus aureus-CoNS carriers among 685 students screened for S. aureus nasal carriage.Interventions:Participants were studied for airborne dispersal of CoNS in a chamber under three conditions (street clothes, sterile gown with a mask, and sterile gown without a mask). After 2 days of pre-exposure measurements, volunteers were inoculated with a rhinovirus and observed for 14 days. Daily quantitative nasal and skin cultures for CoNS and nasal cultures for rhinovirus were performed. In addition, assessment of cold symptoms was performed daily, mucous samples were collected, and serum titers before and after rhinovirus inoculation were obtained. Sneezing, coughing, and talking events were recorded during chamber sessions.Results:All participants had at least one nasal wash positive for rhinovirus and 10 developed a symptomatic cold. Postexposure, there was a twofold increase in airborne CoNS (P = .0004), peaking at day 12. CoNS dispersal was reduced by wearing a gown (57% reduction, P < .0001), but not a mask (P = .7). Nasal and skin CoNS colonization increased after rhinovirus infection (P<.05).Conclusions:We believe this is the first demonstration that a viral pathogen in the upper airways can increase airborne dispersal of CoNS in nasal S. aureus carriers. Gowns, gloves, and caps had a protective effect, whereas wearing a mask did not further reduce airborne spread.
The Value of Bacterial Culture During Clean Orthopedic Surgery a Prospective Study of 1,036 Patients
Authors: Bernard Louis , Sadowski Christophe , Monin Daniel , Stern Richard , Wyssa Blaise , Rohner Peter , Lew Daniel , Hoffmeyer Pierre ,   Groupe d'Etude sur l'Osteite
Published: April 2006

AbstractObjective:To determine whether bacterial cultures of the wounds of patients undergoing clean orthopedic surgery would help predict infection.Methods:During 1 year, 1,256 cultures were performed for 1,102 patients who underwent clean orthopedic surgery. Results were analyzed to evaluate their ability to predict postoperative infection.Results:The sensitivity, specificity, positive predictive value, and negative predictive value of the cultures were 38%, 92%, 7%, and 99%, respectively.Conclusions:Cultures performed during clean orthopedic surgery were not useful for predicting postoperative infection.
Prevalence of Methicillin-Resistant Staphylococcus aureus Nasal Carriage Among Patients With Femoral Neck Fractures Implication for Antibiotic Prophylaxis
Authors: Merrer Jacques , Pisica-Donose Georges , Leneveu Michel , Pauthier François 
Published: April 2006

AbstractFifteen (8.4%) of 179 patients admitted with femoral neck fractures carried MRSA Among 96 patients admitted from their homes, only 2 (2%) were carriers, whereas 13 (15.6%) of 83 patients from nursing or residential homes or long-term-care facilities were colonized (P = .001). Routine prophylaxis with vancomycin is recommended in the latter group.
Is It Necessary to Shave the Pubic and Genital Regions of Patients Undergoing Endoscopic Urological Surgery?
Authors: Menéndez Violeta , Galán Juan Antonio , Elia Matilde , Collado Argimiro , Lioréns Francisco , Fernández Carlos , Garciá-López Francisco 
Published: April 2006

AbstractTo determine whether postoperative urinary infections were related to shaving before undergoing endoscopic urological surgery, 90 patients were randomly assigned to shaving or not shaving. Urinary cultures revealed infection in 10 patients. Half of them had been shaved, suggesting that this practice does not affect the incidence of urinary infections.
Factors Promoting Consistent Adherence to Safe Needle Precautions Among Hospital Workers
Authors: Vaughn Thomas E. , McCoy Kimberly D. , Beekmann Susan E. , Woolson Robert F. , Torner James C. , Doebbeling Bradley N. 
Published: April 2006

AbstractObjective:To examine organizational factors and occupational characteristics associated with adherence to occupational safety guidelines recommending never recapping needles.Design:Mail surveys were conducted with healthcare workers (HCWs) and infection control professionals (ICPs).Setting:The surveys were conducted at all non-federal general hospitals in Iowa, except one tertiary-care hospital. Survey data were linked to annual survey data of the American Hospital Association (AHA).Participants:HCWs were sampled from statewide rosters of physicians, nurses, and laboratory workers in Iowa. Eligible HCWs worked in a setting and position in which they were likely to routinely handle needles. ICPs at all hospitals in the state were surveyed.Results:Ninety-nine ICPs responded (79% response rate). AHA data were available for all variables from 84 (85%) of the hospitals. Analyses were based on 1,454 HCWs who identified one of these hospitals as their primary hospital (70% response rate). Analyses were conducted using multiple logistic regression. Positive predictors of consistent adherence included infection control personnel hours per full-time–equivalent employee (odds ratio [OR], 1.03), frequency of standard precautions education (OR, 1.11), facilities providing personal protective equipment (OR, 1.82), facilities using needleless intravenous systems (OR, 1.42), and management support for safety (OR, 1.05). Negative predictors were use of “blood and body fluid precautions” isolation category (OR, 0.74) and increased job demands (OR, 0.90).Conclusion:Healthcare organizations can improve staff safety by investing wisely in educational programs regarding approaches to minimize these risks, providing protective equipment, and eliminating the use of blood and body fluid precautions as an isolation policy.
Cost-Effectiveness of Hepatitis A–B Vaccine Versus Hepatitis B Vaccine for Healthcare and Public Safety Workers in the Western United States
Authors: Jacobs R. Jake , Gibson Gene A. , Meyerhoff Allen S. 
Published: April 2006

AbstractObjective:To determine the cost-effectiveness of substituting hepatitis A–B vaccine for hepatitis B vaccine when healthcare and public safety workers in the western United States are immunized to protect against occupational exposures to hepatitis B.Participants:A cohort of 100,000 hypothetical healthcare and public safety workers from 11 western states with hepatitis A rates twice the national average.Design:A Markov model of hepatitis A was developed using estimates from U.S. government databases, published literature, and an expert panel. Added costs of hepatitis A–B vaccine were compared with savings from reduced hepatitis A treatment and work loss. Cost-effectiveness was expressed as the ratio of net costs to quality-adjusted life-years (QALYs) gained.Results:Substituting hepatitis A–B vaccine would prevent 29,796 work-loss–days, 222 hospitalizations, 6 premature deaths, and the loss of 214 QALYs. Added vaccination costs of $5.4 million would be more than offset by $1.9 million and $6.1 million reductions in hepatitis A treatment and work loss costs, respectively. Cost-effectiveness improves as the time horizon is extended, from $232,600 per QALY after 1 year to less than $0 per QALY within 11 years. Estimates are most sensitive to community-wide hepatitis A rates and the degree to which childhood vaccination may reduce future rates.Conclusion:For healthcare and public safety workers in western states, substituting hepatitis A–B vaccine for hepatitis B vaccine would reduce morbidity, mortality, and costs.
A Large Nosocomial Outbreak of Hepatitis C and Hepatitis B Among Patients Receiving Pain Remediation Treatments
Authors: Comstock R. Dawn , Mallonee Sue , Fox Jan L. , Moolenaar Ronald L. , Vogt Tara M. , Perz Joseph F. , Bell Beth P. , Crutcher James M. 
Published: April 2006

AbstractBackground and Objective:In August 2002, the Oklahoma State Department of Health received a report of six patients with unexplained hepatitis C virus (HCV) infection treated in the same pain remediation clinic. We investigated the outbreak's extent and etiology.Design, Setting, and Participants:We conducted a retrospective cohort study of clinic patients, including a serologic survey, interviews of infected patients, and reviews of medical records and staff infection control practices. Patients received outpatient pain remediation treatments one afternoon a week in a clinic within a hospital. Cases were defined as HCV or hepatitis B virus (HBV) infections among patients who reported no prior diagnosis or risk factors for disease or reported previous risk factors but had evidence of acute infection.Results:Of 908 patients, 795 (87.6%) were tested, and 71 HCV-infected patients (8.9%) and 31 HBV-infected patients (3.9%) met the case definition. Multiple HCV genotypes were identified. Significantly higher HCV infection rates were found among individuals treated after an HCV-infected patient during the same visit (adjusted odds ratio [AOR], 6.2; 95% confidence interval [CI95], 2.4–15.8); a similar association was observed for HBV (AOR, 2.9; CI95, 1.3–6.5). Review of staff practices revealed the nurse anesthetist had been using the same syringe–needle to sequentially administer sedation medications to every treated patient each clinic day.Conclusions:Reuse of needles–syringes was the mechanism for patient-to-patient transmission of HCV and HBV in this large nosocomial outbreak. Further education and stricter oversight of infection control practices may prevent future outbreaks.
Confirmation of Nosocomial Hepatitis C Virus Infection in a Hemodialysis Unit
Authors: Furusyo Norihiro , Kubo Norihiko , Nakashima Hisashi , Kashiwagi Kenichiro , Etoh Yoshitaka , Hayashi Jun 
Published: April 2006

AbstractObjectives:To investigate a hepatitis C virus (HCV) outbreak in a hemodialysis unit and determine the source of transmission.Methods:We have prospectively investigated the epidemiology of hemodialysis-related HCV infection in a single unit since 1989. In September 2000, acute hepatitis C (AH-C) was diagnosed in 5 patients by alanine aminotransferase elevation and HCV genotype lb viremia without antibody to HCV. We surveyed the epidemiologic situation and performed polymerase chain reaction sequence analysis of the HCV 5'-noncoding (5'NC) region in the patients for comparison with 9 patients with chronic HCV genotype 1b viremia.Results:Sequence analysis of the 5'NC region showed the consistency in the 5 independent clones from each AH-C patient and those from each chronic HCV viremia patient and no quasispecies over time in the clones of any of 14 analyzed patients. All AH-C patients had the same sequencing of the 6 variations in the region with the only other patient. A saline ampoule, used for heparin solution during hemodialysis, had a recap function. It was difficult to determine whether the ampoule was new or had already been used. The source-patient often underwent hemodialysis before the AH-C patients and most of their hemodialysis-related medicine was prepared during the source-patient's treatment. These findings suggested a high possibility that the AH-C patients shared a single heparin–saline solution ampoule contaminated by HCV from the source-patient.Conclusion:Nosocomial HCV infection occurred as a result of poor infection control practice when a patient with chronic HCV viremia received treatment prior to other hemodialysis patients.