bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Nosocomial Infection on Cost of Illness and Length of Stay in Intensive Care Units
Authors: Chen Yin-Yin , Chou Yi-Chang , Chou Pesus 
Published: April 2006

AbstractObjective:Economic evaluation has become increasingly important in healthcare and infection control. This study evaluated the impact of nosocomial infections on cost of illness and length of stay (LOS) in intensive care units (ICUs).Design:A retrospective cohort study.Setting:Medical, surgical, and mixed medical and surgical ICUs in a tertiary-care referral medical center.Patients:Patients admitted to adult ICUs between October 2001 and June 2002 were eligible for the study.Methods:Estimates of the cost and LOS for patients who acquired a nosocomial infection were computed using a stratified analysis and regression approach.Results:During the study period, 778 patients were admitted to the ICUs. Total costs for patients with and without nosocomial infections (median cost, $10,354 and $3,985, respectively) were significantly different (P < .05). The costs stratified by infection site (median differences from $4,687 to $7,365) and primary diagnosis (median differences from $5,585 to $16,507) were also significantly different (P < .05) except for surgical-site infection. After covariates were adjusted for in the multiple linear regression, nosocomial infection increased the total costs by $3,306 per patient and increased the LOS by 18.2 days per patient (P < .001). Each additional day spent in the ICU increased the cost per patient by $353 (P < .001).Conclusions:Nosocomial infections are associated with increased cost of illness and LOS. Prevention of nosocomial infections should reduce direct costs and decrease the LOS.
Effect of Pressure Ulcers on Length of Hospital Stay
Authors: Graves Nicholas , Birrell Frances , Whitby Michael 
Published: April 2006

AbstractObjective:To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not.Design:Cross-sectional, observational study.Setting:Tertiary-care referral and teaching hospital in Australia.Patients:Two thousand hospitalized patients 18 years and older who had a minimum stay in the hospital of 1 night and admission to selected clinical units.Methods:Two thousand participants were randomly selected from 4,500 patients enrolled in a prospective survey conducted between October 2002 and January 2003. Quantile median robust regression was used to assess risk factors for excess length of hospital stay.Results:Having a pressure ulcer resulted in a median excess length of stay of 4.31 days. Twenty other variables were statistically significant at the 5% level in the final model.Conclusions:Pressure ulcers make a significant independent contribution to excess length of hospitalization beyond what might be expected based on admission diagnosis. However, our estimates were substantially lower than those currently used to make predictions of the economic costs of pressure ulcers; existing estimates may overstate the true economic cost.
Knowledge of Standard and Isolation Precautions in a Large Teaching Hospital
Authors: Sax Hugo , Perneger Thomas , Hugonnet Stéphane , Herrault Pascale , Chraïti Marie-Noëlle , Pittet Didier 
Published: April 2006

AbstractObjective:To assess the level of knowledge regarding and attitudes toward standard and isolation precautions among healthcare workers in a hospital.Method:A confidential, self-administered questionnaire survey was conducted in a random sample of 1,500 nurses and 500 physicians in a large teaching hospital.Results:A total of 1,241 questionnaires were returned (response rate, 62%). The median age of respondents was 39 years; 71.9% were women and 21.2% had senior staff status. One-fourth had previously participated in specific training regarding transmission precautions for pathogens conducted by the infection control team. More than half (55.9%) gave correct answers to 10 or more of the 13 knowledge-type questions. The following reasons for noncompliance with guidelines were judged as “very important”: lack of knowledge (47%); lack of time (42%); forget-Mness (39%); and lack of means (28%). For physicians and healthcare workers in a senior position, lack of time and lack of means were significantly less important (P < .0005). On multivariate linear regression, knowledge was independently associated with exposure to training sessions (coefficient, 0.33; 95% confidence interval, 0.08 to 0.57; P = .009) and less professional experience (coefficient per increasing professional experience, -0.024; 95% confidence interval, -0.035 to -0.012; P < .0005).Conclusions:Despite a training effort targeting opinion leaders, knowledge of transmission precautions for pathogens remained insufficient. Nevertheless, specific training proved to be the major determinant of “good knowledge”.
Surveillance and Infection Control in an Intensive Care Unit
Authors: Orsi Giovanni Battista , Raponi Massimiliano , Franchi Cristiana , Rocco Monica , Mancini Carlo , Venditti Mario 
Published: April 2006

AbstractObjective:To evaluate the effect of an infection control program on the incidence of hospital-acquired infection (HAI) and associated mortality.Design:Prospective study.Setting:A 2,000-bed, university-affiliated hospital in Italy.Patients:All patients admitted to the general intensive care unit (ICU) for more than 48 hours between January 2000 and December 2001.Methods:The infection control team (ICT) collected data on the following from all patients: demographics, origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated microorganisms, and antibiotic susceptibility.Interventions:Regular ICT surveillance meetings were held with ICU personnel. Criteria for invasive procedures, particularly central venous catheters (CVCs), were modified. ICU care was restricted to a team of specialist physicians and nurses and ICU antimicrobial therapy policies were modified.Results:Five hundred thirty-seven patients were included in the study (279 during 2000 and 258 in 2001). Between 2000 and 2001, CVC exposure (82.8% vs 71.3%; P < .05) and mechanical ventilation duration (11.2 vs 9.6 days) decreased. The HAI rate decreased from 28.7% in 2000 to 21.3% in 2001 (P < .05). The crude mortality rate decreased from 41.2% in 2000 to 32.9% in 2001 (P < .05). The most commonly isolated microorganisms were nonfermentative gram-negative organisms and staphylococci (particularly MRSA). Mortality was associated with infection (relative risk, 2.11; 95% confidence interval, 1.72-2.59; P <.05).Conclusion:Routine surveillance for HAI, coupled with new measures to prevent infections and a revised policy for antimicrobial therapy, was associated with a reduction in ICU HAIs and mortality.
Impact of Severity of Illness Bias and Control Group Misclassification Bias in Case-Control Studies of Antimicrobial-Resistant Organisms
Authors: Harris Anthony D. , Carmeli Yehuda , Samore Matthew H. , Kaye Keith S. , Perencevich Eli 
Published: April 2006

AbstractBackground:Case-control studies often analyze risk factors for antibiotic resistance. Recently published articles have illustrated that randomly selected control-patients may be preferable to those with the susceptible phenotype of the organism. A possible methodologic problem with randomly selected control-patients is potential bias due to control group misclassification. This occurs if some control-patients did not have clinical cultures performed and thus might have been unidentified case-patients. If this bias exists, these studies might be expected to report lower odds ratios (ORs) because control-patients would be more like case-patients.Objective:To analyze potential biases that might arise due to control group misclassification and potentially larger selection biases that may be introduced if control-patients are required to have at least one clinical culture.Patients:One hundred twenty case-patients, 770 control-patients in group 1, and 510 control-patients in group 2.Methods:Two case-control studies. Case-patients had clinical cultures positive for imipenem-resistant Pseudomonas aeruginosa. The first group of control-patients were random. The second group of control-patients were identical to those in group 1 except being required to have at least one clinical culture.Results:Univariate analyses showed higher ORs for case-patients versus control-patients in group 1 (imipenem [OR, 12.5], piperacillin-tazobactam [OR, 3.7], and vancomycin [OR, 4.7]) as compared with case-patients versus control-patients in group 2 (imipenem [OR, 8.0], piperacillin-tazobactam [OR, 2.5], and vancomycin [OR, 3.0]).Conclusion:Requiring control-patients to have at least one clinical culture introduces a selection bias likely because it eliminates patients with less severe illness.
The Case-Case-Control Study Design: Addressing the Limitations of Risk Factor Studies for Antimicrobial Resistance
Authors: Kaye Keith S. , Harris Anthony D. , Samore Matthew , Carmeli Yehuda 
Published: April 2006

AbstractObjective:There are significant limitations of the standard case-control study design for identifying risk factors for resistant organisms. The objective of this study was to develop a study design to overcome these limitations.Design:Theoretical analysis of different types of study designs that can be used in risk factor studies for resistant organisms.Results:We developed the case-case-control study design, which uses two separate case-control analyses within a single study. The first analysis compares patients infected with resistant bacteria (resistant cases) with control-patients without infection caused by the target organism, who are therefore representative of the source population; and the second analysis compares patients infected with the susceptible phenotype of the target organism (susceptible cases) with the same controlpatients without infection caused by the target organism. These two analyses provide risk models for (1) isolation of the resistant phenotype of the target organism as compared with the source population and (2) isolation of the susceptible phenotype of the organism as compared with the source population. When these two risk models are compared and contrasted, risk factors specifically associated with isolation of the resistant phenotype can be identified.Conclusions:The case-case-control study design is an effective method for identifying risk factors for antimicrobial-resistant pathogens. Although the case-case-control study design has limitations, it is, in our opinion, more informative and less flawed than the standard case-control study design.
Isolation of Infectious Cystic Fibrosis Patients: Results of a Systematic Review
Authors: Vonberg Ralf-Peter , Gastmeier Petra 
Published: April 2006

AbstractObjective:Respiratory tract infections significantly contribute to morbidity and mortality among cystic fibrosis (CF) patients. Therefore, pathogen transmission needs to be prevented. There are several guidelines for the care of CF patients, but no transparent systematic literature review has been published.Methods:We conducted a systematic literature review (January 1966 to September 2004) dealing with segregation of CF patients colonized withBurkholderia cepaciaspecies,Pandoraeaspecies,Pseudomonas aeruginosa, Stenotrophomonas maltophilia,orAlcaligenesspecies. Quality of studies was evaluated by taking patient population size, existence of control-patients, patient randomization, diagnostic approach, and bacteria typing methods into account.Results:One hundred ninety-nine studies were found. Evidence and quality of 102 publications were evaluated. In 99 publications, recommendations concerning segregation measures for infectious CF patients were determined including a total of 11,576 patients. No randomized, controlled trials had been conducted. Fifty of 56 authors strongly recommended isolation of CF patients infected withB. cepaciaorPandoraeaspecies. In 31 of 39 studies, interpatient spread ofPseudomonas aeruginosawas documented or had been brought to an end by isolation of patients. Only five studies had addressed S.maltophiliaorAlcaligenesspecies.Conclusions:Patients colonized withB. cepaciaorPandoraeaspecies are to be separated from noncolonized patients in single rooms. Patients harboring multidrug-resistantPseudomonas aeruginosa, S. maltophilia,orAlcaligenesspecies may not share a room with immunocompromised patients, in intensive care units, or with other CF patients anywhere in the hospital.
Evaluation of Policies Regarding Physicians Infected With Blood-Borne Pathogens
Authors: Ng Cherie , Swartzberg John 
Published: April 2006

AbstractObjective:Formulating an effective approach to preventing surgeon-to-patient transmission of blood-borne pathogens has been controversial. The objective of our study was to evaluate current community hospital policies, if any, regarding restrictions on surgeons (general surgeons and obstetricians and gynecologists) infected with blood-borne pathogens operating on patients.Design:A survey on hospital policies regarding surgeons infected with blood-borne pathogens was sent to infection control officers at Northern California community hospitals (n = 113).Results:Forty-five hospitals responded to the survey. Of these, only 6 (13.3%) had a policy. Of the 39 (86.7%) that did not have a policy, only 3 hospitals were planning on implementing one.Conclusions:Many community hospitals are uninterested in instituting a policy regarding the practice of surgeons infected with blood-borne pathogens. Possible reasons include the lack of concern on the individual level, difficulty in defining exposure-prone procedures, and the nature of the relationship between medical staff and community hospitals.
Prerequisite Programs and Food Hygiene in Hospitals: Food Safety Knowledge and Practices of Food Service Staff in Ankara, Turkey
Authors: Bas Murat , Temel Mehtap Akçil , Ersun Azmi Safak , Kivanç Gökhan 
Published: April 2006

AbstractOur objective was to determine food safety practices related to prerequisite program implementation in hospital food services in Turkey. Staff often lack basic food hygiene knowledge. Problems of implementing HACCP and prerequisite programs in hospitals include lack of food hygiene management training, lack of financial resources, and inadequate equipment and environment.
Surgical-Site Infections Following Cesarean Section in an Estonian University Hospital: Postdischarge Surveillance and analysis of Risk Factors
Authors: Mitt Piret , Lang Katrin , Peri Aira , Maimets Matti 
Published: April 2006

AbstractObjectives:To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.Design:Cross-sectional survey.Setting:Academic tertiary-care obstetric and gynecology center with 54 beds.Patients:All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.Methods:Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System.Results:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95)], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P=.02).Conclusions:The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454).
Incidence of and Risk Factors for Surgical-Site Infections in a Peruvian Hospital
Authors: Hernandez Katherine , Ramos Elizabeth , Seas Carlos , Henostroza German , Gotuzzo Eduardo 
Published: April 2006

AbstractObjective:To determine the incidence of and risk factors for surgical-site infections (SSIs) after abdominal surgery.Design:A cohort study was conducted from January to June 1998. CDC criteria for SSI and the NNIS System risk index were used.Setting:A tertiary-care hospital in Peru.Patients:Adult patients undergoing abdominal surgery who consented were enrolled and observed until 30 days after surgery. Patients who had undergone surgery at another hospital or who died or were transferred to another hospital within 24 hours after surgery were excluded.Results:Four hundred sixty-eight patients were enrolled. Their mean age was 37.2 years. One hundred twenty-five patients developed SSIs, 18% of which were identified after discharge. The overall incidence rate (IR) was 26.7%. The IR was 13.9% for clean, 15.9% for clean-contaminated, 13.5% for contaminated, and 47.2% for dirty interventions. The IR was 3.6% for NNIS System risk index 0 and 60% for index 3. Risk factors for SSI on logistic regression analysis were dirty or infected wound (RR, 3.8; CI95, 1.7-8.4), drain use longer than 9 days (RR, 6.0; CI95, 2.5-12.5), and length of surgery greater than the 75th percentile (RR, 2.1; CI95, 1.0-4.4). Patients with SSI had a longer hospital stay than did non-infected patients (14.0 vs 6.1 days; P < .001).Conclusions:SSI is a major problem in this hospital, which has a higher IR (especially for clean interventions) than those of developed countries. In developing countries, prevention of SSI should include active surveillance and interventions targeting modifiable risk factors.
Peracetic Acid in the Disinfection of a Hospital Water System Contaminated With Legionella Species
Authors: Ditommaso Savina , Biasin Cinzia , Giacomuzzi Monica , Zotti Carla Maria , Cavanna Alberto , Moiraghi Angela Ruggenini 
Published: April 2006

AbstractObjective:To assess the efficacy of an alternative disinfection method for hospital water distribution systems contaminated with Legionella.Methods:Disinfection with peracetic acid was performed in a small hospital contaminated with L. pneumophila serotype 1. The disinfectant was used at concentrations of 50 ppm (first three surveillance phases) and 1,000 ppm (fourth surveillance phase) for 30 minutes.Results:Environmental monitoring revealed that disinfection was maintained 1 week after treatment; however, levels of recontamination surpassing baseline values were detected after approximately 1 month. Comparison of water temperatures measured at the distal outlets showed a statistically significant association between temperature and bacterial load. The circulating water temperature was found to be lower in the two wards farthest away from the hot water production plant than in other wards. It was thought that the lower water temperature in the two wards promoted the bacterial growth even after disinfection.Conclusion:Peracetic acid may be useful in emergency situations, but does not provide definitive protection even if used monthly.
Duration of Virus Shedding After Trivalent Intranasal Live Attenuated Influenza Vaccination in Adults
Authors: Talbot Thomas R. , Crocker Deidre D. , Peters Jody , Doersam Jennifer K. , Ikizler Mine R. , Sannella Edith , Wright Peter F. , Edwards Kathryn M. 
Published: April 2006

AbstractObjective:To characterize the probability and duration of viral shedding among adults given trivalent live attenuated influenza vaccine (LATV).Design:Prospective surveillance study.Methods:Nasal wash samples were collected from adult volunteers at baseline and on days 3, 7, and 10 and between days 17 and 21 following intranasal LAIV vaccination. The presence, titer, and identification of each specific strain of influenza virus shed were determined by standard methodology.Results:Twenty subjects received LATV. No samples were positive for influenza virus at baseline. After LAIV vaccination, influenza virus was recovered from 10 of 20 vaccinees on day 3, from 1 of 18 vaccinees on day 7, and from none of the samples on days 10 or 17 through 21. Vaccinees who shed vaccine virus were significantly younger than those who did not (mean age, 26.4 vs 38.6 years;P< .01). Although the presence of specific mucosal immunoglobulin A to influenza B was associated with significantly less shedding of influenza B after vaccination (P= .02), associations of shedding with other measures of immunity were not detected.Conclusion:The duration of shedding of vaccine virus after LAIV in adults is limited and may be associated with an individual's prior influenza vaccination history.
Clinical Outcomes and Costs Due toStaphylococcus aureusBacteremia Among Patients Receiving Long-Term Hemodialysis
Authors: Engemann John J. , Friedman Joëlle Y. , Reed Shelby D. , Griffiths Robert I. , Szczech Lynda A. , Kaye Keith S. , Stryjewski Martin E. , Reller L. Barth , Schulman Kevin A. , Corey G. Ralph , Fowler Vance G. 
Published: April 2006

AbstractObjective:To examine the clinical outcomes and costs associated withStaphylococcus aureusbacteremia among hemodialysis-dependent patients.Design:Prospectively identified cohort study.Setting:A tertiary-care university medical center in North Carolina.Patients:Two hundred ten hemodialysis-dependent adults with end-stage renal disease hospitalized withS. aureusbacteremia.Results:The majority of the patients (117; 55.7%) underwent dialysis via tunneled catheters, and 29.5% (62) underwent dialysis via synthetic arteriovenous fistulas. Vascular access was the suspected source of bacteremia in 185 patients (88.1%). Complications occurred in 31.0% (65), and the overall 12-week mortality rate was 19.0% (40). The mean cost of treatingS. aureusbacteremia, including readmissions and outpatient costs, was $24,034 per episode. The mean initial hospitalization cost was significantly greater for patients with complicated versus uncomplicatedS. aureusbacteremia ($32,462 vs $17,011;P= .002).Conclusion:Interventions to decrease the rate of S.aureusbacteremia are needed in this high-risk, hemodialysis-dependent population (Infect Control Hosp Epidemiol2005;26:534-539).