bluuebunny/crossref_metadata_2025_split huggingface dataset:
Work-Site-Based Influenza Vaccination in Healthcare and Non-Healthcare Settings
Authors: D'Heilly Sarah J. , Nichol Kristin L. 
Published: April 2006

AbstractObjective:To better understand work-site–based programs for influenza vaccination.Design:Self-administered, mailed questionnaire.Setting:Healthcare and non-healthcare companies.Participants:Random sample of 2,000 members of the American Association of Occupational Health Nurses.Results:The response rate was 55%, and 88% of the respondents were employed by companies sponsoring work-site influenza vaccination. Thirty-two percent of respondents worked for healthcare and healthcare-related services companies. Healthcare companies were more likely to sponsor worksite-based vaccination (94% vs 85%; P < .0001) compared with non-healthcare companies. Healthcare companies were also more likely to encourage vaccination of high-risk employees (70% vs 55%; P < .0001) and cover its cost (86% vs 61%; P < .0001). Multivariate logistic regression was used to determine factors associated with highly successful vaccination. Being a healthcare-related company (OR, 2.1; CI95 1.4–3.2; P < .0001), employers covering the vaccination cost (OR, 3.1; CI95, 1.4–6.6; P = .004), having more experience with work-site vaccination (OR, 1.6; CI95, 1.0–2.4; P = .036), and management encouraging vaccination (OR, 2.6; CI95, 1.4–4.9; P = .002) were associated with highly successful programs.Conclusions:Most of the occupational health nurses surveyed work for employers sponsoring work-site vaccination, and 32% were employed by healthcare and related services companies. Healthcare companies were more likely to sponsor worksite–based vaccination and to vaccinate most of their employees; however, only 18% had vaccination rates higher than 50%. Strategies need to be developed to increase vaccination rates so that benefits of vaccination can be realized by employers and employees.
Cockroaches as Potential Vectors of Nosocomial Infections
Authors: Pai Hsiu-Hua , Chen Wei-Chen , Peng Chien-Fang 
Published: April 2006

AbstractObjective:To determine the possible role of cockroaches in the epidemiology of nosocomial infections.Design:Epidemiologic investigation of bacteria and fungi in cockroaches and evaluation of the antibiotic resistance of the bacteria isolated from the insects.Setting:Ninety hospitals in Kaohsiung City and Kaohsiung County in Taiwan.Methods:Cockroaches were collected in clinical and nonclinical areas and microorganisms were isolated from their external surface and alimentary tract. The susceptibilities of Staphylococcus aureus, Enterococcus species, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Serratia marcescens, and Proteus species to 17 antibiotics were tested.Results:Cockroach infestation was found in 46.7% of the hospitals studied. Two hundred three cockroaches were collected (139 Periplaneta americana and 64 Blattella germanica). Periplaneta americana was found more often in nonclinical areas (64.5%) and B. germanica in clinical areas (78.1%). There was no statistically significant difference between Periplaneta americana (98.6%) and B. germanica (96.9%) regarding overall isolation rate (P > .05). However, 33 species of bacteria and 16 species of fungi were isolated from Periplaneta americana and only 23 and 12, respectively, from B. germanica. Resistance to ampicillin (13.7% to 100%), chloramphenicol (14.3% to 71.4%), tetracycline (14.3% to 73.3%), and trimethoprim-sulfamethoxazole (14.3% to 57.1%) was found in two gram-positive and five gram-negative bacteria.Conclusion:Because cockroach infestation occurred in more than 40% of the hospitals and nearly all of the cockroaches harbored bacteria with multidrug resistance and fungi, cockroaches may play a potential role in the epidemiology of nosocomial infections in those hospitals.
Pneumococcal Immunization in Older Adults: Implications for the Long-Term–Care Setting
Authors: Loeb Mark , Stevenson Kurt B. ,   SHEA Long-Term-Care Committee
Published: April 2006

AbstractObjectives:To compare the efficacy of the polysaccharide pneumococcal vaccine in older adults between clinical trial and observational studies and to discuss the implications for long-term–care facilities (LTCFs).Data Source:A Medline search (to April 2003).Study Selection:All meta-analyses of randomized and quasi-randomized trials of pneumococcal vaccines with placebo or no treatment were sought. All cohort or case–control studies were sought.Data Synthesis:Of the 16 individual randomized clinical trials included in the reviews, 8 compared pneumococcal vaccine in individuals 55 years and older individuals. Only one study specifically addressed LTCF residents. Although no significant protective effect of the vaccine in elderly subpopulations was found, on the basis of wide confidence intervals and small subpopulation sample sizes, beneficial effects, particularly for pneumococcal bacteremia, could not be ruled out. Of the individual observational studies, 11 specifically evaluated vaccine efficacy in older adults. Vaccine efficacy was demonstrated in 9 of the 11 studies with no protective effect was shown in 2 studies.Conclusion:Although the pooling of clinical trial data does not demonstrate significant efficacy of the pneumococcal polysaccharide vaccine in subgroups of older adults, these subgroup studies lacked power to show significant differences. Observational studies repeatedly demonstrate efficacy in older adults, and the vaccine has been demonstrated to be cost-effective and safe. It is strongly promoted by U.S. and Canadian advisory committees. On the basis of this available evidence, the pneumococcal polysaccharide vaccine should currently be recommended for older adults, especially those who are residents of LTCFs.
Foundations of the Severe Acute Respiratory Syndrome Preparedness and Response Plan for Healthcare Facilities
Authors: Srinivasan Arjun , McDonald Lawrence C. , Jernigan Daniel , Helfand Rita , Ginsheimer Kathleen , Jernigan John , Chiarello Linda , Chinn Raymond , Parashar Umesh , Anderson Larry , Cardo Denise ,   SARS Healthcare Preparedness and Response Plan Team
Published: April 2006

AbstractObjective:To help facilities prepare for potential future cases of severe acute respiratory syndrome (SARS).Design and Participants:The Centers for Disease Control and Prevention (CDC), assisted by members of professional societies representing public health, healthcare workers, and healthcare administrators, developed guidance to help facilities both prepare for and respond to cases of SARS.Interventions:The recommendations in the CDC document were based on some of the important lessons learned in healthcare settings around the world during the SARS outbreak of 2003, including that (1) a SARS outbreak requires a coordinated and dynamic response by multiple groups; (2) unrecognized cases of SARS-associated coronavirus are a significant source of transmission; (3) restricting access to the healthcare facility can minimize transmission; (4) airborne infection isolation is recommended, but facilities and equipment may not be available; and (5) staffing needs and support will pose a significant challenge.Conclusions:Healthcare facilities were at the center of the SARS outbreak of 2003 and played a key role in controlling the epidemic. Recommendations in the CDC's SARS preparedness and response guidance for healthcare facilities will help facilities prepare for possible future outbreaks of SARS.
An Outbreak of Bacteremias Associated With Mycobacterium mucogenicum in a Hospital Water Supply
Authors: Kline Susan , Cameron Sarah , Streifel Andrew , Yakrus Mitchell A. , Kairis Frank , Peacock Keith , Besser John , Cooksey Robert C. 
Published: April 2006

AbstractObjective:To investigate and determine the cause of an outbreak of Mycobacterium mucogenicum bacteremias in bone marrow transplant (BMT) and oncology patients.Design:Case–control study and culturing of hospital water sources. Isolates were typed using molecular methods.Setting:University-affiliated, tertiary-care medical center.Patients:Case-patients were adult and pediatric BMT patients or hematopoietic stem cell transplant (BMT) (n = 5) and oncology (n = 1) patients who were diagnosed as having M. mucogenicum bacteremia during the study period of August through November 1998. Two control-patients were selected for each case-patient matched by age, time of hospitalization, inpatient unit, and type of patient (BMT or oncology).Results:There were no significant differences between case-patients and control-patients regarding intravenous products received or procedures performed, frequency of bathing, neutropenia, or steroid use. Nontuberculous mycobacteria were isolated from several water sources at the medical center including tap water from sinks and showerheads, the hospital hot water source, and the city water supply to the hospital. Analysis by multilocus enzyme electrophoresis and randomly amplified polymorphic DNA showed a match between one patient's blood isolate and an isolate from shower water from that patient's prior hospital room.Conclusions:The cause of the outbreak seemed to be water contamination of central venous catheters (CVCs) during bathing. A recommendation in early 2001 that CVCs be protected from water during bathing was followed by no M. mucogenicum bacteremias during the second half of 2001, only one in 2002, and none at all during 2003.
Screening and Treatment of Latent Tuberculosis Among Healthcare Workers at Low, Moderate, and High Risk for Tuberculosis Exposure: A Cost-Effectiveness Analysis
Authors: Salpeter Shelley R. , Salpeter Edwin E. 
Published: April 2006

AbstractObjective:To evaluate cost-effective screening and treatment strategies for healthcare workers (HCWs) at risk for tuberculosis exposure.Design:A Markov model was developed to track three hypothetical cohorts of HCWs at low, moderate, and high risk for tuberculosis exposure. For those found to be tuberculin reactors at entry, the choice was for isoniazid treatment or no treatment. For those without tuberculin reactivity, the choice of screening intervals was 6 months, 1 year, 2 years, or 5 years. Outcomes measured were tuberculosis cases, death, life expectancy, and cost. Assumptions were derived from published data and analyses.Results:Treatment of initial reactors with isoniazid in all three risk groups was associated with a net savings of $14,800 to $15,700 for each tuberculosis case prevented. For those without evidence of infection at entry, the most cost-effective screening interval was 1 year for high-risk groups, 2 years for moderate-risk groups, and 5 years for low-risk groups, with a net savings $0.20 to $26 per HCW per year. Screening at a more frequent interval was still cost-effective.Conclusions:For HCWs found to be tuberculin reactors, treatment of their latent infection is to their benefit and is associated with a net cost-savings. Regular tuberculin screening of HCWs can be cost-effective or result in a net cost-savings. Each institution could use its own skin test surveillance data to create an optimum screening program for its employees. However, for most HCWs, a 1-year screening interval would be a cost-effective and safe choice.
Tuberculosis in Healthcare Workers Caring for a Congenitally Infected Infant
Authors: Mouchet Françoise , Hansen Valérie , Van Herreweghe Inge , Vandenberg Olivier , Van Hesse Régine , Gérard Michèle , Toppet Michèle , Wanlin Maryse , Toppet Véronique , Casimir Georges , Haumont Dominique , Levy Jack 
Published: April 2006

AbstractObjective:To assess the extent of nosocomial transmission of tuberculosis among infants, family members, and healthcare workers (HCWs) who were exposed to a 29-week-old premature infant with congenital tuberculosis, diagnosed at 102 days of age.Design:A prospective exposure investigation using tuberculin skin test (TST) conversion was conducted. Contacts underwent two skin tests 10 to 12 weeks apart. Clinical examination and chest radiographs were performed to rule out disease. Isoniazid prophylaxis was administered to exposed infants at higher risk.Setting:A neonatal intensive care unit in an urban hospital in Brussels, Belgium.Participants:Ninety-seven infants, 139 HCWs, and 180 visitors.Results:Newly positive TST results occurred in HCWs who had been in close contact with the infant. Six (19%) of 32 primary care nurses and physicians had TST conversions and received treatment. Among the 97 exposed infants, 85 were screened and 34 were identified as at higher risk of infection. Of these, 27 received preventive isoniazid. None of the infants and none of the 93 other infants' family members evaluated were infected.Conclusions:Congenital tuberculosis in an infant poses a risk for nosocomial transmission to HCWs. Delayed diagnosis of this rare disease and close proximity are the most important factors related to transmission.
Risk of Tuberculous Infection Among Healthcare Workers in a Tertiary-Care Hospital in Ankara, Turkey
Authors: Keskiner Ramazan , Ergönül Önder , Demiroglu Ziya , Eren Sebnem , Baykam Nurcan , Dokuzoguz Basak 
Published: April 2006

AbstractObjective:To determine risk factors for tuberculin skin test (TST) positivity among healthcare workers (HCWs).Design:Two-step TST was performed in 2002.Setting:Tertiary-care hospital in Ankara, Turkey.Participants:A sample of 491 hospital HCWs were included. Information related to demographics, profession, work duration, department, and individual and family history of tuberculosis (TB) was obtained by a structured questionnaire.Results:Four hundred eight (83%) had two-step TST positivity. On multivariate analysis, male physicians (relative risk [RR], 1.5; 95% confidence interval [CI95], 1.23–1.69; P = .001), nurses (RR, 1.5; CI95, 1.29–1.66; P = .005), radiology technicians (RR, 1.7; CI95, 1.35–1.73; P = .002), laboratory technicians (RR, 1.6; CI95, 1.3–1.74; P = .007), and male housekeepers (RR, 1.6; CI95, 1.38–1.7; P < .001) had a higher risk than did female physicians. Among laboratory technicians, radiology technicians had the highest TST positivity (85%). HCWs working for less than 1 year (RR, 0.8; CI95, 0.72–0.98; P = .027) had a lower risk of infection. The HCWs having bacille Calmette–Guérin vaccination (RR, 1.12; CI95, 1.08–1.45) had higher TST positivity.Conclusion:Male physicians, nurses, and laboratory technicians had increased risk of Mycobacterium tuberculosis infection in this setting, but community exposure likely accounted for most infections.
Periodically Changing Ventilator Circuits Is Not Necessary to Prevent Ventilator-Associated Pneumonia When a Heat and Moisture Exchanger Is Used
Authors: Lorente Leonardo , Lecuona María , Galván Ramón , Ramos María J. , Mora María L. , Sierra Antonio 
Published: April 2006

AbstractObjective:To analyze the efficacy of periodically changing ventilator circuits for decreasing the rate of ventilator-associated pneumonia when a heat and moisture exchanger (HME) is used for humidification. The Centers for Disease Control and Prevention recommended not changing the circuits periodically.Design:Randomized, controlled trial conducted between April 2001 and August 2002.Setting:A 24-bed, medical–surgical intensive care unit in a 650-bed, tertiary-care hospital.Patients:All patients requiring mechanical ventilation during more than 72 hours from April 2001 to August 2002.Interventions:Patients were randomized into two groups: (1) ventilation with change of ventilator circuits every 48 hours and (2) ventilation with no change of circuits. Throat swabs were taken on admission and twice weekly until discharge to classify pneumonia as endogenous or exogenous.Results:Three hundred four patients (143 from group 1 and 161 from group 2) with similar characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, diagnostic group, and mortality) were analyzed. There was no significant difference in the rate of pneumonia between the groups (23.1% vs 23.0% and 15.5 vs 14.8 per 1,000 ventilator-days). There was no significant difference in the incidence of exogenous pneumonia per 1,000 days of mechanical ventilation (1.71 vs 1.25). There was no difference in the distribution of microorganisms causing pneumonia.Conclusions:Circuit change using an HME for humidification does not decrease pneumonia and represents an unnecessary cost.
An Outbreak of Pseudomonas aeruginosa Pneumonia and Bloodstream Infection Associated With Intermittent Otitis Externa in a Healthcare Worker
Authors: Zawacki Anne , O'Rourke Edward , Potter-Bynoe Gail , Macone Ann , Harbarth Stephan , Goldmann Donald 
Published: April 2006

ArstractObjectives:To investigate an outbreak of Pseudomonas aeruginosa pneumonia and bloodstream infection among four neonates, determine risk factors for infection, and implement preventive strategies.Design:Retrospective case finding; prospective surveillance cultures of patients, personnel, and environmental sites; molecular typing by pulsed-field gel electrophoresis; and a matched case-control study.Patients and Setting:Neonates in the level-III neonatal intensive care unit of a tertiary-care pediatric institution.Interventions:Cohorting of patients with positive results for P. aeruginosa, work restrictions for staff with positive results, implementation of an alcohol-based hand product, review of infection control policies and procedures, and closure of the unit until completion of the investigation.Results:Seven (4%) of 190 environmental cultures and 5 (3%) of 178 cultures of individual healthcare workers' hands grew P. aeruginosa. All four outbreak isolates and one previous bloodstream isolate were genotypically identical, as were the P. aeruginosa isolates from the hands and external auditory canal of a healthcare worker with intermittent otitis externa. Four of 5 case-patients versus 5 of 15 matched control-patients had been cared for by this healthcare worker (P = .05). The healthcare worker was treated and no further cases occurred.Conclusions:These findings suggest that a healthcare worker with intermittent otitis externa may have caused this cluster of fatal P. aeruginosa infections, adding the external ear to the list of colonized body sites that may serve as a source of potentially pathogenic organisms.
Booster Effect of Two-Step Tuberculin Skin Testing Among Hospital Employees From Areas With a High Prevalence of Tuberculosis
Authors: Al Mazrou Abdulrahman M. 
Published: April 2006

AbstractDuring a baseline survey of TST, 236 nurses underwent a two-step TST. Overall, 29 (12%) showed boosting. All age groups showed boosting; the rate was 9.7% in those younger than 35 years. Subjects older than 45 years were more likely to have a booster effect than younger individuals (29% vs 10.1%).
Patterns of Handwashing Behavior and Visits to Patients on a General Medical Ward of Healthcare Workers
Authors: Raboud Janet , Saskin Refik , Wong Kurt , Moore Christine , Parucha Grace , Bennett Jocelyn , Green Karen , Low Don , Loeb Mark , Simor Andy , McGeer Allison 
Published: April 2006

AbstractObjective:To obtain accurate data regarding the handwashing behavior and patterns of visits to patients by healthcare workers (HCWs).Methods:All visits by HCWs to selected patient rooms were recorded for 3 days and 2 nights. Additionally, 5 nurses were observed for 1 day each and 2 nurses were observed for 1 night each. Nurses were observed for their entire shifts and all of their activities were recorded.Setting:A general medical ward in a tertiary-care hospital.Participants:Convenience samples of HCWs and patients.Results:Patients were visited every 25 minutes on average. Monitoring rooms and observing nurses resulted in similar rates of patient visits. The highest level of risk was contact with body fluids in 11% of visits and skin in 40% of visits. The overall rate of handwashing was 46%; however, the rate was higher for visits involving contact with body fluids (81%) and skin (61%). Nurses returned immediately to the same patient 45% of the time. The rate of handwashing was higher for the last of a series of visits to a patient's room (53% vs 30%, P < .0001).Conclusions:Nurses adjusted their handwashing rates in accordance with the risk level of each visit. Monitoring patient rooms and observing nurses yielded similar estimates of patient visits and proportions of visits involving contact with skin or body fluids. Education programs about hand hygiene may be more effective if patterns of care and levels of risk are incorporated into recommendations.
Alcohol-Based Handrub: Evaluation of Technique and Microbiological Efficacy with International Infection Control Professionals
Authors: Widmer Andreas F. , Dangel Marc 
Published: April 2006

AbstractBackground And Objective:The Centers for Disease Control and Prevention has published a new guideline on hand hygiene promoting the use of the alcohol-based handrub, but the technique was not addressed. The goal of this study was to evaluate the influence of technique on the efficacy of the alcohol-based handrub.Participants:Healthcare workers (HCWs) attending a course in hospital epidemiology.Methods:A fluorescent dye was added to a hand antiseptic, and hands were checked under ultraviolet light after antiseptic cleansing. Data regarding the numbers of predefined fluorescent areas on the skin were collected in addition to demographic data such as age, gender, job description, and job experience. Results of the visualization test were compared with the data from microbiological samples before and after the procedure by the hand plate technique.Results:Sixty HCWs were tested, 63% of whom had worked in infection control for more than 10 years. Sixty-six percent of all participants still had detectable bacteria after antisepsis. The mean log10 CFU reduction was 2.0 (range, 0–3.85). Twenty-five percent of all HCWs achieved less than 1.1 log10 CFU. Staphylococcus aureus was isolated from 13% (one of them being methicillin resistant) and gram-negative bacilli from 6.7%. After using the alcohol handrub, one subject still remained positive for S. aureus. Years of experience was the single most important factor predicting antimicrobial efficacy.Conclusions:Technique is of crucial importance in hand antisepsis. Major deficiencies were detected among even highly trained HCWs. Training should be provided before switching from handwashing to the alcohol handrub.
Ineffectiveness of Handwashing With Lotion Soap to Remove Nosocomial Bacterial Pathogens Persisting on Fingertips: A Major Link in Their Intrahospital Spread
Authors: Bottone Edward J. , Cheng Mark , Hymes Saul 
Published: April 2006

AbstractThe effectiveness of five 30-second handwashes with a non-antiseptic lotion soap to remove nosocomial pathogens (108CFU) applied to fingertips was studied. CFU for all species dropped rapidly after the first handwash; persistence (10 to 15 CFU) was maintained thereafter. Wiping hands with an antiseptic (70% isopropyl or 10% povidone-iodine) sponge removed persisters.