bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Surgical-Site Infections Diagnosed After Hospital Discharge A Prospective Cohort Study
Authors: Delgado-Rodríguez Miguel , Gómez-Ortega Antonio , Sillero-Arenas Maria , Llorca Javier 
Published: February 2006

AbstractObjective:To study postoperative infections in hospital and after discharge, and to identify the risk factors for such infections.Design:Prospective cohort study, with telephone follow-up for 1 month after hospital discharge.Setting:The general surgery service of a tertiary hospital in Spain.Main Outcome Measure:In-hospital and postdischarge surgical-site infection (SSI), always confirmed by a physician.Results:Of the 1,506 patients initially enrolled, 29 died during hospital stay, and 33 were lost to postdischarge follow-up. An SSI was identified prior to discharge in 123 patients and after discharge in 103. For several variables (age, serum albumin, glycemia, lengths of preoperative and postoperative hospital stay, etc), there were no differences between patients with postdischarge SSI and noninfected patients; however, there were differences detected between patients with postdischarge SSI and in-hospital SSI, as well as between patients with in-hospital SSI and noninfected patients. The analysis of risk factors showed that most predictors for in-hospital SSI did not behave in the same manner for postdischarge SSI. Stepwise logistic regression only identified chemoprophylaxis, age (advanced age was a preventive factor), and body mass index as independent risk factors for postdischarge SSI. Differences in risk factors between in-hospital and postdischarge SSIs remained even after controlling for time from operation to diagnosis.Conclusions:Most predictors of in-hospital SSI were not predictors of postdischarge SSI.
Converting Incidence and Prevalence Data of Nosocomial Infections Results From Eight Hospitals
Authors: Gastmeier Petra , Bräuer Helga , Sohr Dorit , Geffers Christine , Forster Dietmar H. , Daschner Franz , Rüden Henning 
Published: February 2006

AbstractObjective:To investigate the use of the formula of Rhame and Sudderth for the interconversion of prevalence and incidence data on the frequency of nosocomial infections.Design:Comparison of observed and calculated incidence data and prevalence data.Setting:One 8-week incidence investigation in the surgical and intensive care units of eight medium-sized hospitals; three separate point-prevalence studies in the same units.Results:The overall prevalence observed after the three prevalence studies in 2,169 patients was 6.8% (95% confidence interval [CI95], 5.7-8.0). In 2,882 discharged patients observed during the incidence study, the mean hospitalization was 9.8 days; patients with one or more nosocomial infection had a mean hospitalization time of 22.3 days and a mean interval of 8.2 days from admission to the first day of infection. Based on these data, the overall calculated incidence was 4.7%, whereas the observed incidence was 4.3% (CI95, 3.6-5.2). Vice versa, an overall prevalence of 6.2% was found when calculated from the observed incidence data.The incidence data calculated from prevalence data also were within the confidence interval of the incidences observed for urinary tract infections and surgical-site infections. (However, it was not possible to convert the data for two of the eight hospitals.)Conclusion:The approximate mathematical relationship between the prevalence and incidence data of nosocomial infection is confirmed by this study. However, although it is theoretically possible, we would not recommend the conversion of prevalence into incidence data or vice versa.
An Outbreak of Imipenem-ResistantAcinetobacter baumanniiin Critically Ill Surgical Patients
Authors: Fierobe Lisiane , Lucet Jean-Christophe , Decré Dominique , Muller-Serieys Claudette , Deleuze Arnaud , Joly-Guillou Marie-Laure , Mantz Jean , Desmonts Jean-Marie 
Published: February 2006

AbstractObjective:To describe an outbreak of imipenem-resistantAcinetobacter baumannii(IR-Ab) and the measures for its control, and to investigate risk factors for IR-Ab acquisition.Design:An observational and a case-control study.Setting:A surgical intensive care unit (ICU) in a university tertiary care hospital.Methods:After admission to the ICU of an IR-Ab-positive patient, patients were prospectively screened for IR-Ab carriage upon admission and then once a week. Environmental cleaning and barrier safety measures were used for IR-Ab carriers. A case-control study was performed to identify factors associated with IR-Ab acquisition. Cases were patients who acquired IR-Ab. Controls were patients who were hospitalized in the ICU at the same time as cases and were exposed to IR-Ab for a similar duration as cases. The following variables were investigated as potential risk factors: baseline characteristics, scores for severity of illness and therapeutic intervention, presence and duration of invasive procedures, and antimicrobial administration.Results:Beginning in May 1996, the outbreak involved 17 patients over 9 months, of whom 12 acquired IR-Ab (cases), 4 had IR-Ab isolates on admission to the ICU, and 1 could not be classified. Genotypic analysis identified two different IR-Ab isolates, responsible for three clusters. Ten of the 12 nosocomial cases developed infection. Control measures included reinforcement of barrier safety measures, limitation of the number of admissions, and thorough environmental cleaning. No new case was identified after January 1997. Eleven of the 12 cases could be compared to 19 controls. After adjustment for severity of illness, a high individual therapeutic intervention score appeared to be a risk factor for IR-Ab acquisition.Conclusion:The outbreak ended after strict application of control measures. Our results suggest that high work load contributes to IR-Ab acquisition.
A Nosocomial Outbreak of MultiresistantAcinetobacter baumanniiOriginating From an Intensive Care Unit
Authors: Ling Moi Lin , Ang Angela , Wee Molly , Wang Grace Chee Yang 
Published: February 2006

AbstractAn outbreak of a multiresistantAcinetobacter baumanniiin February through September 1996 affected 103 patients in a regional hospital in Singapore. We describe the effectiveness of closure of the outbreak area and the importance of good teamwork in the management of the outbreak.
An In-Use Evaluation of an Alcohol-Based Pre-Surgical Hand Disinfectant
Authors: Bryce Elizabeth A. , Spence Darlene , Roberts Frederick J. 
Published: February 2006

AbstractObjective:To determine whether alcohol hand disinfection is an effective alternative to traditional agents for the pre-surgical scrub.Design:A prospective clinical trial of a 70% isopropanol pre-surgical hand disinfectant.Setting:The operating room suites at two hospital sites in British Columbia.Methods:Cases were selected to evaluate both short and longer procedures. The hand disinfectant was compared to agents in current use as surgical scrubs (4% chlorhexidine and 7.5% povidone-iodine). Surgical technique and glove use were not modified. Pre- and postoperative fingertip impression and “glove-juice” cultures were used to determine microbial burden, and hands were evaluated for skin integrity.Results:There was no statistical difference between the microbial hand counts following use of the alcohol-based product or the current agents, for cases less than 2 hours' duration. Comparison of longer surgical cases revealed significantly better pre- and postoperative culture results with the alcohol hand rinse, but analysis of matched pairs showed no significant difference in microbial counts. The alcohol hand rinse was equivalent to the operative scrub in terms of skin integrity and user acceptability.Conclusion:An alcohol hand rinse was equivalently effective in reducing microbial hand counts as the traditional pre-surgical scrub, both immediately after hand disinfection and at the end of the surgical procedure.
Hospital Management of Tuberculosis in a Region With a Low Incidence of Tuberculosis and a High Prevalence of Nontuberculous Mycobacteria
Authors: Alexander Barbara D. , Stout Jason E. , Reller L. Barth , Hamilton Carol Dukes 
Published: February 2006

AbstractWe prospectively assessed the management of patients with suspected tuberculosis (TB) in an area with a high prevalence of nontuberculous mycobacteria (NTM) and a low incidence of TB. Clinicians' assessments were sensitive for TB but had poor predictive value. The acid-fast smear was a weak predictor of TB, owing to a high rate of isolation of NTM.
Hepatitis C Virus Infection in Employees of a Large University Hospital in Israel
Authors: Sermoneta-Gertel Simona , Donchin Milka , Adler Ruth , Baras Mario , Perlstein Tamar , Manny Noga , Shouval Daniel , Galun Eithan 
Published: February 2006

AbstractObjective:To assess whether hospital work constitutes a risk factor for hepatitis C virus (HCV) infection among employees of a large hospital in Israel.Design:Seroprevalence survey.Setting:A 1,006-bed, tertiary-care university hospital in Jerusalem.Participants:All 5,444 employees (18-65 years old) were eligible; 4,287 (79%) participated in the survey.Methods:Sera were tested for antibodies to HCV (anti-HCV) using a third-generation enzyme immunoassay. A third-generation strip immunoblot assay was used for confirmation. Participants were interviewed regarding their occupational history, and they completed a self-administered questionnaire covering history of non-occupational exposure to blood and country of birth. Other demographic information was obtained from the personnel department. Rates and odds ratios (ORs) were calculated, and multivariate logistic-regression analyses were performed to adjust for potential confounding variables.Results:Anti-HCV was found in 0.9% of employees (37/4,287; 95% confidence interval, 0.6-1.1), ranging from 0.1% among those born in Israel to 5.7% among those born in Central Asia. After age, gender, social status, country of birth, and history of blood transfusion were controlled for in a logistic regression, occupational exposure to blood ≥10 years was significantly associated with the presence of antibodies (OR, 2.6; P=.01). Presence of anti-HCV also was associated with country of birth (range: Israel OR, 1; West OR, 3.8 [P=.1]; Central Asia OR, 48.6 [P<.0001]) and history of blood transfusion (OR, 2.7; P=.01). No significant associations were found between anti-HCV and age, gender, social status, history of tattoo, acupuncture, current occupation, department, exposure to blood in current occupation, adherence to safety precautions, or history of percutaneous injury. The association with length of exposure was stronger (OR, 3.6; P=.01) when the same logistic regression was run excluding the outlier ethnic group of Central Asia.Conclusions:Hospital work does not seem to constitute a major risk factor for HCV infection in Israel today. A higher prevalence of anti-HCV among employees with longer versus shorter lengths of occupational exposure may be due to a cumulative effect of exposure over the years. Infection control efforts in recent years may have contributed to this association.
Nosocomial Infections in Pediatric Cardiac Surgery, Italy
Authors: Valera Mariangela , Scolfaro Carlo , Cappello Nazario , Gramaglia Elena , Grassitelli Sergio , Abbate Maria Teresa , Rizzo Alberta , Abbruzzese Piero , Valori Andrea , Longo Stefano , Tovo Pier Angelo 
Published: February 2006

AbstractObjective:To evaluate the incidence of nosocomial infection (NI) in pediatric patients who received cardiothoracic surgery and to identify possible associated risk factors.Design:Prospective observational study.Setting:The cardiac surgery and cardiac intensive care units at the Regina Margherita Children's Hospital, Turin, Italy.Patients:All patients who underwent surgery from July 20,1998, to July 19,1999, were enrolled, except patients with operative catheterization only.Methods:Clinical data were collected daily from July 20, 1998, to July 19, 1999. NIs were diagnosed according to US Centers for Disease Control and Prevention criteria.Results:104 patients were included in the present study, 80 (76.9%) of whom underwent extracorporeal circulation. The NI ratio was 48.1% (50/104); the percentage of patients with NI was 30.8% (32/104): 23.1% developed one infection, 7.7% two or more. The rate of NI was 2.17 per 100 days of hospitalization (50/2,304). The most common pathogen wasPseudomonas aeruginosa,Important risk factors were length of preoperative admission >5 days, total length of admission >10 days, open chest during postoperative phase, and cyanotic heart disease. There was a significant association between sepsis and central venous catheterization for 3 days or more. Rate of sepsis was 19 per 1,000 catheter days (16/852).Conclusion:NIs represent a frequent complication for children who undergo heart surgery. Based on our data, we suggest decreasing the preoperative stay as much as possible. The higher NI incidence in patients with an open chest postoperatively suggests that an alternative antibiotic strategy should be considered for these patients.
Nasal MRSA Colonization of AIDS Patients Cared for in a Brazilian University Hospital
Authors: Padoveze Maria Clara , Tresoldi Antonia Teresinha , vonNowakonski Angela , Aoki Francisco Hideo , Branchini Maria Luiza Moretti 
Published: February 2006

AbstractWeekly culture surveillance was conducted over a 2-year period to determine the incidence of methicillin-resistantStaphylococcus aureusnasal colonization among acquired immunodeficiency syndrome patients cared for in a day-care unit and in an infectious diseases unit. Analysis of genomic DNA profiles showed a predominant pattern in both units.
Impact of Nosocomial Infection on Length of Stay and Functional Improvement Among Patients Admitted to an Acute Rehabilitation Unit
Authors: Mylotte Joseph M. , Graham Robin , Kahler Lucinda , Young B. Lauren , Goodnough Susan 
Published: February 2006

AbstractObjective:To identify factors predictive of length of stay (LOS) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection.Setting:A 40-bed acute rehabilitation unit within a 300-bed, tertiary-care, public, university-affiliated hospital.Study Population:All patients admitted to the unit between January 1997 and July 1998.Design:Prospective cohort study in which demographic and clinical data, including occurrence of nosocomial infection, were collected during the entire unit admission of each patient. Multivariate linear regression analysis was used to identify factors predictive of unit LOS or improvement in functional status as measured by the change in the Functional Independence Measure (FIM) score between admission and discharge (ΔFIM).Results:There were 423 admissions to the rehabilitation unit during the study period, of which 91 (21.5%) had spinal cord injury (SCI) as a principal diagnosis. One hundred seven nosocomial infections occurred during 84 (19.9%) of the 423 admissions. The most common infections were urinary tract (31.8% of all infections), surgical-site (18.5%), andClostridium difficilediarrhea (15%). Only one patient died of infection. After controlling for severity of illness on admission, functional status on admission, age, and other clinical factors, the significant positive predictors of unit LOS were as follows: SCI (P&lt;.001), pressure ulcer (.002), and nosocomial infection (&lt;.001). Significant negative predictors of ΔFIM were age (P&lt;.001), FIM score on admission (&lt;.001), prior hospital LOS (.002), and nosocomial infection (.007).Conclusions:Several variables were identified as contributing to a longer LOS or to a smaller improvement in functional status among patients admitted for the first time to an acute rehabilitation unit Of these variables, only nosocomial infection has the potential for modification. Studies of new approaches to prevent infections among patients undergoing acute rehabilitation should be pursued.
Bacteriological Validation of a New Apparatus for Disinfection of Hospital Waste at the Point of Disposal
Authors: Eveillard Matthieu , Sarnel Claude , Fourniat Clotilde , Rivoal Florence , Daroukh Abla , Huchet Jacqueline , Chaty Michel , Hauss Serge , Bourlioux Pierre 
Published: February 2006

AbstractObjectives:To evaluate the ability of a new apparatus (Dipsys 25, Société SGN, Bagnols sur Cèze, France) to disinfect biomedical waste, including both potentially infectious agents and the normal saprophytic flora of the waste.Methods:Disinfection was assessed using standard methods (reference strains were fixed on reference carriers according to the French AFNOR methods) and nonstandard assays. Assays in conditions of hospital use, evaluations of bacterial survival during storage, sporicidal effect, and spore survival during storage were performed in parallel. Finally, bactericidal effect in extreme conditions (association of high contamination and high bacterial protection conditions) was tested with normal fecal flora. Bacterial counts were performed after treatment by the apparatus and without treatment (controls). All tests were carried out in triplicate.Results:In all treated carriers, a bacterial population decrease of at least 5 log10was obtained. Assays performed in hospital-use conditions did not show any bacterial growth. Concerning the evaluation of sporicidal effect and spore revival during conservation, a minimum reduction of 5 log10was observed in all assays performed, without survival. Finally, concerning assays in extreme conditions, the decrease of bacterial population was between 5 log10and 10 log10for vegetative anaerobes of normal fecal flora.Conclusion:Under our study conditions, the study apparatus reduced the tested microbial populations by a minimal factor of 5 log10. The main advantage of the apparatus is the opportunity to treat contaminated waste inside hospital wards, at the point of initial collection, without pulverization, by nonspecialized staff.
Multidrug-Resistant Bacteria Infection Control: Study of Compliance With Isolation Precautions in a Paris University Hospital
Authors: Vidal-Trecan Gwenaëlle M. , Delamare Natalie , Tcherny-Lessenot Stephanie , Lamory Jacqueline , Baudin François , de Prittwitz Michel , Salmon-Ceron Dominique 
Published: February 2006

Abstract
Isolation practices in a university hospital were analyzed for 137 patients with multidrug-resistant bacteria. Isolation was ordered in writing by physicians for 40% and instituted by nurses for 60%; 74% were isolated. Compliance depended on physician ordering in writing (odds ratio, 36.3; 95% confidence interval, 4.8-274.9). Nurses complied best with hand washing.
Hepatitis B Prevention Strategies Among Pediatric Hemodialysis Centers
Authors: Toma Michelle , Challapalli Malliswari 
Published: February 2006

Abstract
We surveyed pediatric hemodialysis centers (PHDCs) concerning their hepatitis B virus (HBV) prevention strategies. One hundred thirty-one patients were being dialyzed in these PHDCs in December 1996. Although all centers immunized HBV-susceptible hemodialysis patients and had infection control policies to curtail the spread of HBV infection, most centers were not in compliance with all of the Centers for Disease Control and Prevention recommendations for isolating hepatitis B surface antigen-positive patients.
Nosocomial Colonization of Premature Babies With Klebsiella oxytoca: Probable Role of Enteral Feeding Procedure in Transmission and Control of the Outbreak With the Use of Gloves
Authors: Berthelot Philippe , Grattard Florence , Patural Hugues , Ros Alain , Jelassi-Saoudin Hénia , Pozzetto Bruno , Teyssier Georges , Lucht Frédéric 
Published: February 2006

AbstractObjective:To investigate the persistence of colonization of premature babies byKlebsiella oxytoca, with special emphasis on the mode of transmission of the bacterium and evaluation of Standard Precautions to stop the epidemic.Design:Retrospective analysis of cases and prospective study of systematic bacteriological samples (stools and throat) from babies, healthcare workers (HCWs), and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction.Setting:A premature baby unit (PBU) and a neonatal intensive care unit in the university hospital of Saint-Etienne, France.Results:An outbreak ofK oxytocawas suspected in two pediatric wards after the occurrence of a fatal bacteremia in a newborn hospitalized in the PBU and the colonization of other babies 2 months later. Retrospective analysis showed that 24 babies' digestive tract had been colonized. No environmental reservoir was recovered in the units nor in enteral feeding. NoK oxytocawas isolated from HCW samples. Genotyping confirmed the presence of epidemic strains, although independent clones were responsible for infections or colonizations in each of the two units. The chronology and the site of babies' colonization (isolation ofK oxytocain stools before throat) were determined during a prospective study and suggested that enteral feeding procedures could be the source of contamination. Therefore, use of gloves during this practice by HCWs was recommended and, after readjustment of Standard Precautions, stopped the outbreak.Conclusion:To prevent cross-contamination among high-risk babies, careful attention must be paid to Standard Precautions. Bacteriological surveillance of the digestive tract of neonates could help to check compliance with these guidelines.
Reality Check: Should We Use Vancomycin for the Prophylaxis of Intravascular Catheter-Associated Infections?
Authors: Grohskopf Lisa A. , Maki Dennis G. , Sohn Annette H. , Sinkowitz-Cochran Ronda L. , Jarvis William R. , Goldmann Donald A. 
Published: February 2006

AbstractThe use of intravascular catheters is associated with increased risk of bloodstream infections, principally caused by coagulase-negative staphylococci. This “Reality Check” session, held at die 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, focused on the question of whether, and in what manner, vancomycin should be used for the prophylaxis of these infections.
Guidelines for the Management of Intravascular Catheter-Related Infections
Authors: Mermel Leonard A. , Farr Barry M. , Sherertz Robert J. , Raad Issam I. , O'Grady Naomi , Harris JoAnn S. , Craven Donald E. 
Published: February 2006

These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications.Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci,Staphylococcus aureus, aerobic gram-negative bacilli, andCandida albicansmost commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical iv antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen (s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed.