bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sixteen Years' Surveillance of Surgical Sites in an Irish Acute-Care Hospital
Authors: Creamer Eilish , Cunney Robert J. , Humphreys Hilary , Smyth Edmond G. 
Published: February 2006

AbstractObjective:To report a program of continuous surveillance of surgical-site infections (SSIs) using basic surveillance methods.Design:Analysis of routine prospective surveillance data.Setting:Two hospitals in Ireland (300 and 350 beds) that merged and moved to a new 650-bed hospital in 1987.Patients:59,335 surgical sites of postoperative patients.Interventions:Surgical sites were surveyed by one infection control nurse and SSI rates were produced for selected operations and surgical services. The program was conducted in general accordance with the 1999 HICPAC guidelines, but differed in surveillance strategy. Operations were limited to two to three risk classifications, assigned by the infection control nurse.Results:The overall SSI rate was 4.5%, with 2.4% in clean surgery. Apart from increases in the 3rd, 4th, 13th, and 14th years, rates remained relatively stable during the 16 years. Few significant decreases in SSI rates in surgical services or specific operations were shown, apart from the following: vascular surgery, 8.1% to 5% between the first 8 years and the last 8 years; general surgery services, 9% to 5%, and gynecology, 15.8% to 1.7%, both in the first year compared with in subsequent years; and gastric operations, 21% to 4.3% between the first year and the second year. Organ/space infection was identified in 0.5% of 17,804 operations, including 0.4% meningitis after neurosurgical procedures, 3% graft infections after vascular bypass operations, and 0.2% intra-abdominal infections after abdominal surgery.Conclusions:With the use of basic principles of surveillance and modest resources, procedure-specific SSI rates were produced, with little significant change during the 16 years. Despite limitations in case-finding, risk stratification, feedback, and surveillance methods, the overall SSI rates were comparable with other published data.
A Quality Management Project in 8 Selected Hospitals to Reduce Nosocomial Infections: A Prospective, Controlled Study
Authors: Gastmeier Petra , Bräuer Helga , Forster Dietmar , Dietz Eckehard , Daschner Franz , Rüden Henning 
Published: February 2006

Objective:To reduce the number of nosocomial infections (NIs) in surgical patients by a quality management approach.Design:Prospective, controlled study in 8 medium-sized hospitals during a 26-month period.Setting:Four study hospitals and 4 control hospitals.Methods:In two 10-month intervention periods, 4 external physicians introduced quality circles and ongoing surveillance in the 4 study hospitals. There were three 8-week observation periods in all 8 hospitals with the same physicians before, during, and after the intervention periods.Results:During the first observation period, almost identical overall incidence densities were found for the study hospitals and the control hospitals. During the course of the study, the overall incidence density decreased significantly in the study hospitals (risk ratio [RR], 0.74; 95% confidence interval [CI95], 0.59 to 0.94) and nonsignificantly in the control hospitals (RR, 0.90; CI95 0.70 to 1.16). With the use of a Cox regression model to evaluate the impact of the intervention periods while taking into account the distribution of risk factors for NI in both groups, a significant risk reduction (RR, 0.75; CI95, 0.58 to 0.97) was observed after the first intervention period when comparing study and control hospitals. At the end of the study (ie, after the second intervention period), the difference between the study hospitals and the control hospitals was not significant (RR, 0.78; CI95, 0.60 to 1.01). This was due to no further improvement at the end of the study in the study hospitals and a decrease in the control hospitals.Conclusion:This study demonstrates that NI rates can be significantly reduced by appropriate intervention methods in hospitals that are interested in quality management activities. However, continuous intense efforts are necessary to maintain these improvements.
Risk Factors for Vancomycin-ResistantEnterococcus(VRE) Infection in Colonized Patients With Cancer
Authors: Husni Rola , Hachem Ray , Hanna Hend , Raad Issam 
Published: February 2006

AbstractTo determine the risk factors for vancomycin-resistantEnterococcus(VRE) infection in colonized patients with cancer, we conducted a case–control study. According to multivariate analysis, the only significant factors were neutropenia (< 500 cells/mm3) for more than 1 week and the use of oral vancomycin. Therefore, colonized neutropenic patients with cancer who have previously used oral vancomycin are most prone to VRE infection.
Limited Impact of Sustained Simple Feedback Based on Soap and Paper Towel Consumption on the Frequency of Hand Washing in an Adult Intensive Care Unit
Authors: Bittner Marvin J. , Rich Eugene C. , Turner Paul D. , Arnold William H. 
Published: February 2006

Objective:To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption.Design:Prospective trial with a nonequivalent control group.Setting:Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU).Subjects:Unit staff.Intervention:Every weekday from May 26 through December 8,1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks.Results:Directly counted hand washing fell in the SICU from a baseline of 2.68 ± 0.72 (mean ± standard deviation) episodes per occupied bed per hour to 1.92 ± 1.35 in the follow-up period. In the MICU, episodes fell from 2.58 ± 0.95 (baseline) to 1.74 ± 0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36 ± 0.49 at baseline to 1.01 ± 0.36, with a return to 1.16 ± 0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r= -0.35 for the MICU,r= -0.46 for the SICU).Conclusions:Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.
Morbidity, Mortality, and Healthcare Burden of NosocomialClostridium Difficile-Associated Diarrhea in Canadian Hospitals
Authors: Miller Mark A. , Hyland Meagan , Ofner-Agostini Marianna , Gourdeau Marie , Ishak Magued ,   Canadian Hospital Epidemiology Committee,   Canadian Nosocomial Infection Surveillance Program
Published: February 2006

Objective:To assess the healthcare burden, morbidity, and mortality of nosocomialClostridium difficile-associated diarrhea (N-CDAD) in Canadian hospitals.Design:Laboratory-based prevalence study.Setting:Nineteen acute-care Canadian hospitals belonging to the Canadian Hospital Epidemiology Committee surveillance program.Patients:Hospitalized patients in the participating centers.Methods:Laboratory-based surveillance was conducted forC. difficiletoxin in stool among 19 Canadian hospitals from January to April 1997, for 6 continuous weeks or until 200 consecutive diarrhea stool samples had been tested at each site. Patients with N-CDAD had to fulfill the case definition. Data collected for each case included patient demographics, length of stay, extent of diarrhea, complications of CDAD, CDAD-related medical interventions, patient outcome, and details of death.Results:We found that 371 (18%) of 2,062 tested patients had stools with positive results forC. difficiletoxin, of whom 269 (13%) met the case definition for nosocomial CDAD. Of these, 250 patients (93%) had CDAD during their hospitalization, and 19 (7%) were readmitted because of CDAD (average readmission stay, 13.6 days). Forty-one patients (15.2%) died, of whom 4 (1.5% of the total) were considered to have died directly or indirectly of N-CDAD. The following N-CDAD-related morbidity was noted: dehydration, 3%; hypokalemia, 2%; gastrointestinal hemorrhage requiring transfusion, 1%; bowel perforation, 0.4%; and secondary sepsis, 0.4%. The cost of N-CDAD readmissions alone was estimated to be a minimum of $128,200 (Canadian dollars) per year per facility.Conclusion:N-CDAD is a common and serious nosocomial infectious complication in Canada, is associated with substantial morbidity and mortality, and imposes an important financial burden on healthcare institutions.
Scissors: A Potential Source of Nosocomial Infection
Authors: Embil John M. , Zhanel George G. , Plourde Pierre J. , Hoban Daryl 
Published: February 2006

AbstractThis point-prevalence survey of healthcare workers' scissors demonstrates that of 232 scissors sampled, 182 (78.4%) were colonized with bacteria. The scissors of nurses and those for communal use were most frequently contaminated. Cleaning of scissors occurred infrequently, but wiping scissors with an alcohol swab effectively disinfected them. The suspicion that scissors may harbor and potentially transmit microorganisms, including antibiotic-resistant bacteria, has been confirmed.
A Survey of Reprocessing Methods, Residual Viable Bioburden, and Soil Levels in Patient-Ready Endoscopic Retrograde Choliangiopancreatography Duodenoscopes Used in Canadian Centers
Authors: Alfa Michelle J. , Olson Nancy , DeGagne Pat , Jackson Michele 
Published: February 2006

Objectives:To obtain information about current reprocessing practices and to obtain samples from the biopsy channel to quantitate soil levels and bioburden in patient-ready flexible duodenoscopes used for endoscopic retrograde choliangiopancreatography (ERCP).Design:Participating centers were sent a questionnaire and a kit for on-site collection of samples from the biopsy channel of the duodenoscope.Setting:Thirty-seven hospitals from across Canada participated. The only criterion was that they currently used and reprocessed flexible duodenoscopes for ERCP procedures.Methods:The questionnaire obtained information on reprocessing practices. The kit included a detailed instruction booklet outlining sample collection and all of the tubes, sterile water, and brushes needed for it. Samples were collected on-site from all ERCP scopes in each center on Monday morning and shipped by overnight courier on ice to the research center. Each sample was assayed by routine microbiologic methods for total viable count and protein, blood, carbohydrate, and endotoxin levels.Results:Microbial overgrowth was present in 7% of 119 scope samples. Cleaning appeared to be reasonably well done in most of the centers, and 43% of the centers were in total compliance with basic national guidelines. The data from the scope samples indicated that there was significantly greater buildup of protein, carbohydrate, and endotoxin associated with ERCP scopes from centers using glutaraldehyde, compared with those using peracetic acid. Carbohydrate was the soil component detected most frequently and in the highest concentration in scope channels.Conclusions:Although cleaning was generally well done, areas for improvement included ensuring the availability of written reprocessing protocols, immersion of scopes during manual cleaning, use of adequate fluid volume for rinsing, adequate drying of scopes prior to storage, and the separation of ERCP valves from scopes during storage.
Skin Colonization byMalasseziain Neonates and Infants
Authors: Ashbee H. Ruth , Leck Astrid K. , Puntis John W. L. , Parsons Wendy J. , Evans E. Glyn V. 
Published: February 2006

Objective:To identify the timing, pattern, and determinants of colonization of neonates byMalassezia.Design:Prospective observational study.Setting:A neonatal medical and surgical unit consisting of 10 special care, 10 high-dependency, 10 intensive care, and 10 surgical cots.Participants:All neonates (≤ 28 days of age) or infants (> 28 days of age) admitted to the unit during the 20-week period from October 1995 to March 1996.Methods:All infants or neonates were swabbed on the day of admission and every third day thereafter and risk factors were collected for every day on the unit.Results:During the study period, 245 neonates and 42 infants were sampled for their entire duration of stay on the unit. Of these, 41 infants (97.6%) were colonized withMalasseziaon admission to the unit and thereafter, as assessed by subsequent samples. Within the neonate population, 78 (31.8%) became colonized, but none were colonized immediately after birth. Univariate analysis showed that many factors appeared to be significantly associated with colonization in the neonates, including use of ventilation, presence of central venous catheters, use of parenteral nutrition, and use of antibacterial or antifungal drugs. However, when the data were analyzed by multivariate logistic regression to control for confounding variables, only gestational age and length of stay on the unit were found to be significantly associated with colonization.Conclusion:Colonization of infants is not as unusual as previously thought and many infants have established a cutaneousMalasseziacommensal flora by the age of 3 to 6 months. Factors that predispose to colonization in neonates may not be the same as those that predispose to infection.
Temporal Trends in Tuberculosis Hospitalization Rates Before and After Implementation of Directly Observed Therapy: New York City, 1988–1995
Authors: Terry Mary Beth , Desvarieux Moïse , Short Margaret 
Published: February 2006

AbstractNew York City hospitalization rates were analyzed to investigate whether tuberculosis (TB) hospitalizations declined after implementation of directly observed therapy QOOT) for TB. TB hospitalization rates mirrored incidence rates in pattern but not in magnitude. Rates have declined significantly following widespread implementation of DOT in 1993.
Occlusive Scrub Suits in Operating Theaters During Cataract Surgery: Effect on Airborne Contamination
Authors: Andersen Bjørg Marit , Solheim Nette 
Published: February 2006

AbstractThe effect of wearing occlusive scrub suits on bacterial contamination of air was studied during cataract operations. All personnel regularly wore cotton scrub suits. During the intervention period, all wore occlusive scrub suits, which, compared with cotton scrub suits, were associated with more than a 50% reduction in the load of airborne bacteria during operations.
Bloodstream Infections in Pediatric Oncology Outpatients: A New Healthcare Systems Challenge
Authors: Smith Theresa L. , Pullen Gregg T. , Crouse Vonda , Rosenberg Jon , Jarvis William R. 
Published: February 2006

Objective:To investigate a perceived increase in central venous catheter (CVC)–associated bloodstream infections (BSIs) among pediatric hematology–oncology outpatients.Design:A case–control study.Setting:A pediatric hematology–oncology outpatient clinic at Fresno Children's Hospital.Patients:Pediatric hematology–oncology clinic outpatients with CVCs at Fresno Children's Hospital between November 1994 and October 1997.Methods:A case-patient was defined as any hematology–oncology outpatient with a CVC-associated BSI at Fresno Children's Hospital from November 1996 to October 1997 (study period) without a localizable infection. To identify case-patients, we reviewed Fresno Children's Hospital records for all hematology–oncology clinic patients, those with CVCs and those with CVCs and BSIs. Control-patients were randomly selected hematology–oncology outpatients with a CVC but no BSI during the study period. Case-patient and control-patient demographics, diagnoses, caretakers, catheter types, catheter care, and water exposure were compared.Results:Twenty-five case-patients had 42 CVC-associated BSIs during the study period. No significant increase in CVC-associated BSI rates occurred among pediatric hematology–oncology patients. However, there was a statistically significant increase in nonendogenous, gram-negative (eg, Pseudomonas species) BSIs during summer months (May–October) compared with the rest of the year. Case-patients and control-patients differed only in catheter type; case-patients were more likely than control-patients to have a transcutaneous CVC. Summertime recreational water exposures were similar and high in the two groups.Conclusions:Hematology–oncology clinic patients with transcutaneous CVCs are at greater risk for CVC-associated BSI, particularly during the summer. Caretakers should be instructed on proper care of CVCs, particularly protection of CVCs during bathing and recreational summer water activities, to reduce the risk of nonendogenous, gram-negative BSIs.
Bacterial Contamination of Hospital Pagers
Authors: Singh Deepjot , Kaur Hanspreet , Gardner William G. , Treen Lisa B. 
Published: February 2006

AbstractWe assessed the bacterial contamination of the pagers of healthcare personnel and the efficacy of disinfection with 70% isopropyl alcohol. Microorganisms were isolated from all pagers; 21% yielded Staphylococcus aureus, of which 14% were methicillin resistant. Cleaning with alcohol reduced the total colony count by an average of 94%. Bacterial load varied by healthcare worker group and service assignment.
Control of Transmission of Norwegian Scabies
Authors: Zafar Abdul B. , Beidas Sary O. , Sylvester Linda K. 
Published: February 2006

AbstractSeven staff members developed scabies after exposure to a patient with acquired immunodeficiency syndrome (AIDS) dementia and hyperkeratotic skin lesions. They were treated and prophylaxis was given to 11 staff members in September 1998. The hospital has had no nosocomial scabies since then despite the admission of 11 patients with AIDS and Norwegian scabies.
Genotypic Analysis by 27A DNA Fingerprinting ofCandida albicansStrains Isolated During an Outbreak in a Neonatal Intensive Care Unit
Authors: Boccia Stefania , Posteraro Brunella , Sorda Marilena La , Vento Giovanni , Matassa Piero Giuseppe , Tempera Alessia , Petrucci Stefano , Fadda Giovanni 
Published: February 2006

AbstractWe describe an outbreak ofCandida albicanssystemic infection involving five premature infants in a neonatal intensive care unit. Molecular and epidemiologic characterization of allC. albicansisolates was performed by DNA fingerprinting with the 27A probe. This genotypic analysis demonstrated that the isolates were identical, providing evidence for the circulation of a uniqueC. albicansstrain.
Application of Environmental Sampling to Flexible Endoscope Reprocessing: The Importance of Monitoring the Rinse Water
Authors: Muscarella Lawrence F. 
Published: February 2006

AbstractThe routine sampling of environmental surfaces within a healthcare facility is generally not recommended by the Centers for Disease Control and Prevention (CDC), the Association for the Advancement of Medical Instrumentation (AAMI), and several other healthcare organizations. There are a few circumstances, however, for which some organizations do recommend this practice. For instance, the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC) recommend environmental sampling as clinically required during an outbreak investigation. The CDC and AAMI also recommend routine sampling of the rinse water used during hemodialyzer (but not endoscope) reprocessing. The rationale for this recommendation is based in part on reports of pyrogenic responses, patient infections, and bacteremia due to waterborne, gram-negative bacteria during hemodialysis. To determine whether the basis for this rationale might similarly apply to the rinse water used during endoscope reprocessing, the Food and Drug Administration's medical device reporting database, the endoscope reprocessing literature, and other sources were reviewed. The results of this review indicate that nosocomial outbreaks linked to endoscopes contaminated with gram-negative bacteria have been frequently reported. As a result, for several reasons, including to minimize the risk of patient infection due to gram-negative bacteria following endoscopy, this article recommends routine microbiologic sampling of the rinse water used during endoscope reprocessing.
Blue light‐induced association of phototropin 2 with the Golgi apparatus
Authors: Kong Sam‐Geun , Suzuki Tomomi , Tamura Kentaro , Mochizuki Nobuyoshi , Hara‐Nishimura Ikuko , Nagatani Akira 
Published: February 2006

SummaryPhototropins 1 and 2 (phot1 and phot2) function as blue light (BL) photoreceptors for phototropism, chloroplast relocation, stomatal opening and leaf flattening in Arabidopsis thaliana. Phototropin consists of two functional domains, the N‐terminal photosensory domain and the C‐terminal Ser/Thr kinase domain. However, little is known about the signal transduction pathway that links the photoreceptors and the physiological responses downstream of BL perception. To understand the mechanisms by which phot2 initiates these responses, we transformed the phot1phot2 double mutant of Arabidopsis with constructs encoding translationally fused phot2:green fluorescent protein (P2G). P2G was fully functional for the phot2‐specific physiological responses in these transgenic plants. It localized strongly to the plasma membrane and weakly to the cytoplasm in the dark. Upon illumination with BL, punctate P2G staining was formed within a few minutes in addition to the constitutive plasma membrane staining. This punctate distribution pattern matched well with that of the Golgi‐localized KAM1ΔC:mRFP. Brefeldin A (BFA), an inhibitor of vesicle trafficking, induced accumulation of P2G around the perinuclear region even in darkness, but the punctate pattern was not observed. After treatment of these cells with BL, P2G exhibited the punctate distribution pattern that matched with that of the Golgi marker. Hence, the light‐dependent association of P2G with the Golgi apparatus was BFA‐insensitive. A structure/function analysis indicated that the kinase domain was essential for the Golgi localization of phot2. The BL‐induced Golgi localization of phot2 may be one of important signaling steps in the phot2 signal transduction pathway.
Hypocomplementemic urticarial vasculitis: a rare presentation of systemic lupus erythematosus
Authors: Aydogan Kenan , Karadogan Serap Koran , Adim Saduman Balaban , Tunali Şukran 
Published: February 2006

AbstractBackground Urticarial vasculitis is a small‐vessel vasculitis, presenting clinically as persistent urticarial skin lesions and microscopically as leucocytoclastic vasculitis. Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a distinct type of urticarial vasculitis with multiorgan involvement, whose etiology and link with other diseases are still unknown. Some authors have suggested that HUVS can be accompanied by systemic lupus erythematosus (SLE), and others believe that it is a rare subtype of SLE. Urticarial vasculitis is seen in 7–8% of SLE, while 50% of HUVS patients are diagnosed with SLE.Observations and results We report a case of HUVS associated with SLE with fatal outcome unresponsive to the combination of systemic corticosteroids and azathioprine.Conclusions SLE and HUVS share both clinical and laboratory features and are probably not separate entities. It is mostly likely that HUVS and SLE fall into the same spectrum of autoimmune diseases. HUVS is probably a subset of SLE. As both diseases can fatally, it should be kept in mind that the overlap of SLE and HUVS may exhibit a relatively rapid progression and poor prognosis.