bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Measles, Rubella, Mumps, and Varicella Antibodies Among Healthcare Workers in Japan
Authors: Hatakeyama Shuji , Moriya Kyoji , Itoyama Satoru , Nukui Yoko , Uchida Miho , Shintani Yoshizumi , Morisawa Yuji , Kimura Satoshi 
Published: April 2006

AbstractObjectives:To evaluate the immune status of healthcare workers (HCWs) against measles, rubella, mumps, and varicella in Japan, and to promote an adequate vaccination program among HCWs.Setting:University of Tokyo Hospital.Participants:Eight hundred seventy-seven HCWs.Design:Serologic screening for measles, rubella, mumps, and varicella was performed on HCWs. Antibodies against measles, rubella, and mumps were detected using hemagglutination inhibition (HI) assay ($4.20 per test). If serum was negative by HI assay, enzyme-linked immunosorbent assay (EIA) was performed ($12.60 per test). Anti-varicella antibodies were detected by EIA only.Results:Among tested HCWs, 98.5%, 90.4%, 85.8%, and 97.2% had immunity to measles, rubella, mumps, and varicella, respectively. All those born before 1970 were seropositive for measles. However, individuals susceptible to rubella, mumps, and varicella were present in all age groups. The sensitivities and negative predictive values of HI assay compared with EIA were 86.6% and 11.3% for measles, 99.1% and 92.2% for rubella, and 47.8% and 24.1% for mumps, respectively. For measles and mumps, prevaccination screening by HI assay in combination with EIA led to significant savings compared with EIA only. In contrast, it was estimated that prevaccination screening using only HI assay would be more economical for rubella.Conclusions:Aggressive screening and vaccination of susceptible HCWs was essential regardless of age. Prevaccination serologic screening using a combination of HI assay and EIA was more economical for measles and mumps.
Screening Healthcare Workers for Varicella-Zoster Virus: Can We Trust the History?
Authors: Almuneef Maha , Memish Ziad A. , Abbas Mostafa F. , Balkhy Hanan H. 
Published: April 2006

AbstractObjective:To determine the relationship between immunity and a history of chickenpox based on a self-administered questionnaire.Methods:We investigated immunity to varicella-zoster virus in a cohort of newly recruited employees with different job categories and different nationalities using enzyme-linked immunosorbent assay IgG.Results:There were 1,058 new recruits. Of these, 890 (84%) were immune and 168 (16%) were susceptible. The susceptibility rate was 23% (n = 77) for Asian, 15% (n = 14) for South African, 13% (n = 66) for Middle Eastern, and 9% (n = 11) for Western employees. Physicians were more likely to be immune (93%) than were nurses (85%), medical technicians (75%), or administrative clerks (84%). Seropositivity was not affected by age or gender. The positive predictive value of a history of chickenpox for the seropositivity was 89% (511 of 574); the negative predictive value was 22% (105 of 484). History of chickenpox had a sensitivity of 57% (511 of 890) and a specificity of 63% (105 of 168).Conclusions:The varicella-zoster virus seroprevalence among new employees was low, posing an important risk to existing employees and patients. Positive or negative history of chickenpox was an unreliable indicator of susceptibility among healthcare workers of different nationalities. Serologic screening of all employees and vaccination of those susceptible was recommended.
Postexposure Prophylaxis Against Varicella-Zoster Virus Infection Among Recipients of Hematopoietic Stem Cell Transplant: Unresolved Issues
Authors: Weinstock David M. , Boeckh Michael , Boulad Farid , Eagan Janet A. , Fraser Victoria J. , Henderson David K. , Perl Trish M. , Yokoe Deborah , Sepkowitz Kent A. 
Published: April 2006

AbstractRecent guidelines for the prevention of opportunistic infections have addressed a variety of issues germane to recipients of hematopoietic stem cell transplant. However, there are several issues regarding postexposure prophylaxis against varicella-zoster virus that remain unresolved. We address these questions and offer several consensus recommendations.
Implications of Postvaccination Hepatitis B Surface Antigenemia in the Management of Exposures to Body Fluids
Authors: Martín-Ancel Ana , Casas María Luisa , Bonet Bartolomé 
Published: April 2006

AbstractA neonate vaccinated against HBV was the source of an occupational exposure to blood. She was tested for hepatitis B surface antigen and found to be positive, leading to unnecessary treatment, retesting, and concern. Evaluation of the infectious status of HBV should rely on other means if vaccination has recently occurred.
Candida parapsilosis Bloodstream Infection in Pediatric Oncology Patients: Results of an Epidemiologic Investigation
Authors: Posteraro Brunella , Bruno Stefania , Boccia Stefania , Ruggiero Antonio , Sanguinetti Maurizio , Spica Vincenzo Romano , Ricciardi Gualtiero , Fadda Giovanni 
Published: April 2006

AbstractObjective:To investigate an outbreak of Candida parapsilosis bloodstream infections (BSIs) involving three patients admitted to a pediatric oncology unit between April and June 2002.Methods:After the third case was documented, cultures were performed of the hands of all medical and paramedical staff members in the pediatric oncology unit and of environmental surfaces in the rooms occupied by the three patients. Electrophoretic karyotyping with pulsed-field gel electrophoresis and arbitrarily primed polymerase chain reaction were used to assess the genetic relatedness among C. parapsilosis isolates.Results:The three cases of C. parapsilosis BSI were diagnosed based on blood cultures performed during a 38-day period. Evidence of prior C. parapsilosis colonization of the gastrointestinal tract was present in only the first case. Each patient had an indwelling central venous catheter (CVC), which was promptly removed, and semiquantitative catheter tip cultures also revealed C. parapsilosis. None of the 30 environmental cultures performed was positive for C. parapsilosis, but the fungus was isolated from the hands of 6 of the 20 nurses tested. Both molecular typing methods revealed identical DNA fingerprinting patterns for all 13 patient isolates (7 from blood, 3 from CVC tips, and 3 from the gastrointestinal tract) and for 5 of the 6 recovered from the nurses' hands.Conclusions:These findings suggest the possibility of cross-infection with a single C. parapsilosis strain that was transmitted (probably during CVC dressing changes) by nurses whose hands were colonized with it. The role of previous gastrointestinal colonization in the first case cannot be excluded.
Central Venous Catheter–Related Bacteremia Due to Gram-Negative Bacilli: Significance of Catheter Removal in Preventing Relapse
Authors: Hanna Hend , Afif Claude , Alakech Badie , Boktour Maha , Tarrand Jeffrey , Hachem Ray , Raad Issam 
Published: April 2006

AbstractObjective:To study the characteristics of catheter-related, gram-negative bacteremia (GNB) and the role of central venous catheter (CVC) removal.Design:This retrospective study involved a search of the microbiological department records of CVC and blood cultures and patients' medical records.Setting:University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas.Patients:Patients with cancer who had catheter-related GNB, defined as (1) a positive catheter tip culture with at least 15 colony-forming units semiquantitatively, (2) isolation of the same organism from the tip and peripheral blood cultures, (3) no other source for bacteremia except the CVC, and (4) clinical manifestations of infection (fever or chills).Results:Between January 1990 and December 1996, 72 cases of catheter-related GNB were available for review. Most of the patients (67; 93%) had their CVCs removed in response to the bacteremia. Few patients (5; 7%) retained their CVCs and were treated with appropriate antibiotics. When CVCs were removed, only 1 patient (1%) relapsed with the same organism, whereas all 5 patients with retained CVCs relapsed after having responded (P < .001). The most commonly isolated organisms were Enterobacter, Klebsiella, Stenotrophomonas, Pseudomonas, and Acinetobacter species. Catheter removal within 72 hours of the onset of the catheter-related GNB was the only independent protective factor against relapse of the infection (odds ratio, 0.13; 95% confidence interval, 0.02–0.75; P = .02).Conclusion:In patients with documented catheter-related GNB, CVCs should be removed within 48 to 72 hours to prevent relapse.
Application of Data Mining Techniques to Healthcare Data
Authors: Obenshain Mary K. 
Published: April 2006

AbstractA high-level introduction to data mining as it relates to surveillance of healthcare data is presented. Data mining is compared with traditional statistics, some advantages of automated data systems are identified, and some data mining strategies and algorithms are described. A concrete example illustrates steps involved in the data mining process, and three successful data mining applications in the healthcare arena are described.
An Outbreak of Methicillin-Resistant Staphylococcus aureus Infections Related to Central Venous Catheters for Hemodialysis
Authors: Lee Sai-Cheong , Chen Kuo-Su , Tsai Chi-Jen , Lee Ching-Chang , Chang Hung Yu , See Lai-Chu , Kao Yu-Chin , Chen Shu-Chu , Wang Cheng-Hsu 
Published: April 2006

AbstractObjectives:To determine risk factors for hemodialysis catheter-related bloodstream infections (HCRBSIs) and investigate whether use of maximal sterile barrier precautions would prevent HCRBSIs.Setting:Tertiary-care medical center hemodialysis unit.Design:Open trial with historical comparison and case-control study of risk factors for HCRBSIs.Methods:Prospective surveillance was used to compare HCRBSI rates for 1 year before and after implementation of maximal sterile barrier precautions. A case–control study compared 50 case-patients with HCRBSI with 51 randomly selected control-patients.Results:The HCRBSI rate was 1.6% per 100 dialysis runs (CI95, 1.1%–2.3%) in the first year and 0.77% (CI95, 0.5%–1.1%) in the second year (P = .0106). The most frequent cause of HCRBSI was MRSA in the first year (15 of 32) and MSSA in the second year (13 of 18). Ten MRSA blood isolates in the first year were identical by PFGE. Diabetes mellitus was a risk factor for HCRBSI. Age, gender, site of hemodialysis central venous catheter (CVC), other underlying diseases, coma score, APACHE II score, serum albumin level, and cholesterol level were not associated with HCRBSI and did not change between the 2 years. Hospital stay was prolonged for case-patients (32.78 ± 20.96 days) versus control-patients (22.75 ± 17.33 days), but mortality did not differ.Conclusions:Use of maximal sterile barrier precautions during the insertion of CVCs reduced HCRBSIs in dialysis patients and seemed cost-effective. Diabetes mellitus was associated with HCRBSI. An outbreak of MRSA in the first year was likely caused by cross-infection via medical personnel.
Influence of Selective Bowel Decontamination on the Organisms Recovered During Bacteremia in Neutropenic Patients
Authors: Daxboeck Florian , Rabitsch Werner , Blacky Alexander , Stadler Maria , Kyrle Paul A. , Hirschl Alexander M. , Koller Walter 
Published: April 2006

AbstractObjective:To assess the influence of prophylactic selective bowel decontamination (SBD) on the spectrum of microbes causing bloodstream infection (BSI).Design:The microbes causing BSI in neutropenic patients of a hematologic ward (HW) and a bone marrow transplantation unit (BMTU), respectively, were compared by retrospective analysis of blood culture results from January 1996 to June 2003.Setting:A 30-bed HW (no SBD) and a BMTU including a 7-bed normal care ward and an 8-bed intensive care unit (SBD used) of a 2,200-bed university teaching hospital.Results:The overall incidences of bacteremia in the HW and the BMTU were similar (72.6 vs 70.6 episodes per 1,000 admissions; P = .8). Two hundred twenty episodes of BSI were recorded in 164 neutropenic patients of the HW and 153 episodes in 127 neutropenic patients of the BMTU. Enterobacteriaceae (OR, 3.14; CI95, 1.67–5.97; P = .0002) and Streptococcus species (OR, 2.04; CI95, 1.14–3.70; P = .015) were observed more frequently in HW patients and coagulase-negative staphylococci more frequently in BMTU patients (OR, 0.15; CI95, 0.09–0.26; P< .00001). No statistically significant differences were found for gram-negative nonfermentative bacilli (P = .53), Staphylococcus aureus (P = .21), Enterococcus species (P = .48), anaerobic bacteria (P = .1), or fungi (P = .50).Conclusions:SBD did not lead to a significant reduction in the incidence of bacteremia, but significant changes in microbes recovered from blood cultures were observed. SBD should be considered when empiric antimicrobial therapy is prescribed for suspected BSI.
Molecular Epidemiology of Serratia marcescens Outbreaks in Two Neonatal Intensive Care Units
Authors: Milisavljevic Vladana , Wu Fann , Larson Elaine , Rubenstein David , Ross Barbara , Drusin Lewis M. , Della-Latta Phyllis , Saiman Lisa 
Published: April 2006

AbstractObjective:Serratia marcescens can cause serious infections in patients in neonatal intensive care units (NICUs), including sepsis, pneumonia, urinary tract infection, and conjunctivitis. We report the utility of genetic fingerprinting to identify, investigate, and control two distinct outbreaks of S. marcescens.Design:An epidemiologic investigation was performed to control two clusters of S. marcescens infections and to determine possible routes of transmission. Molecular typing by pulsed-field gel electrophoresis determined the relatedness of S. marcescens strains recovered from neonates, the environment, and the hands of healthcare workers (HCWs).Setting:Two geographically distinct level III-IV NICUs (NICU A and NICU B) in two university-affiliated teaching hospitals in New York City.Results:In NICU A, one major clone, “F,” was detected among isolates recovered from four neonates and the hands of one HCW. A second predominant clone, “A,” was recovered from four sink drains and one rectal surveillance culture from an asymptomatic neonate. In NICU B, four neonates were infected with clone “D,” and three sink drains harbored clone “H.” The attributable mortality rate from bloodstream infections was 60% (3 of 5 infants). The antimicrobial susceptibilities of clone F strains varied for amikacin, cefepime, and piperacillin/tazobactam.Conclusions:S. marcescens causes significant morbidity and mortality in preterm neonates. Cross-transmission via transient hand carriage of a HCW appeared to be the probable route of transmission in NICU A. Sinks did not harbor the outbreak strains. Antimicrobial susceptibility patterns did not prove to be an accurate predictor of strain relatedness for S. marcescens.
Handwashing Program for the Prevention of Nosocomial Infections in a Neonatal Intensive Care Unit
Authors: Won Sau-Pin , Chou Hung-Chieh , Hsieh Wu-Shiun , Chen Chien-Yi , Huang Shio-Min , Tsou Kuo-Inn , Tsao Po-Nien 
Published: April 2006

AbstractObjective:To evaluate the effects of a hand hygiene program on compliance with hand hygiene and the rate of nosocomial infections in a neonatal intensive care unit (NICU).Design:Open trial.Setting:A level-III NICU in a teaching hospital.Participants:Nurses, physicians, and other healthcare workers in the NICU.Interventions:A multimodal campaign for hand hygiene promotion was conducted beginning in September 1998. This program consisted of formal lectures, written instructions and posted reminders regarding hand hygiene and proper handwashing techniques, covert observation, financial incentives, and regular group feedback on compliance. Surveillance of handwashing compliance and nosocomial infections before and during the program was analyzed.Results:Overall compliance with hand hygiene improved from 43% at baseline to 80% during the promotion program. The rate of nosocomial infections decreased from 15.13 to 10.69 per 1,000 patient-days (P = .003) with improved handwashing compliance. In particular, respiratory tract infections decreased from 3.35 to 1.06 per 1,000 patient-days during the handwashing campaign (P = .002). Furthermore, the correlation between nosocomial infection of the respiratory tract and handwashing compliance also reached statistical significance (r = -0.385; P = .014).Conclusions:Improved compliance with handwashing was associated with a significant decrease in overall rates of nosocomial infection and respiratory infections in particular. Washing hands is a simple, economical, and effective method for preventing nosocomial infections in the NICU
Survey of Knowledge, Beliefs, and Practices of Neonatal Intensive Care Unit Healthcare Workers Regarding Nosocomial Infections, Central Venous Catheter Care, and Hand Hygiene
Authors: Kennedy Allison M. , Elward Alexis M. , Fraser Victoria J. 
Published: April 2006

AbstractObjective:To assess the knowledge, beliefs, and practices of neonatal intensive care unit (NICU) healthcare workers (HCWs).Design:Self-administered survey.Setting:A 55-bed NICU.Participants:NICU HCWs (N = 215).Results:The response rate was 68%. Ninety-two percent knew central venous catheters (CVCs) should be capped, clamped, or connected to running fluids at all times. Ninety-five percent knew when to change gloves. Thirty-one percent knew the recommended duration for handwashing. Most HCWs believed sterile technique in CVC care (96%), gloves (91%), and handwashing (99%) prevent nosocomial infection (NI). Sixty-seven percent used sterile barriers to insert CVCs, 76% reported wearing gloves, 81% reported routine handwashing, 35% knew that bacterial hand counts are higher with rings, 30% knew that long fingernails are associated with higher gram-negative bacterial hand contamination, and 35% knew that artificial fingernails are associated with higher gram-negative bacterial hand contamination. Most (93%) believed HCWs can affect outcomes of patients with NIs. Fewer believed rings (40%), artificial fingernails (61%), and long fingernails (48%) play a role in NIs, or that policies concerning number of rings (50%), cutting fingernails (35%), or prohibiting artificial fingernails (47%) would prevent NIs. Sixty-one percent of HCWs regularly wore at least one ring to work, 56% wore their fingernails shorter than the fingertip, and 8% wore artificial fingernails.Conclusions:A disconnect existed between CVC knowledge and beliefs and practice. HCWs did not know the relationship between bacterial hand counts and rings and fingernails, and did not believe rings or long or artificial fingernails increased the risk of NIs.
Pattern of Culture-Proven Neonatal Sepsis in a District General Hospital in the United Kingdom
Authors: Haque Khalid N. , Khan M. Ajaz , Kerry Sally , Stephenson Jim , Woods Gretta 
Published: April 2006

AbstractObjective:To determine the incidence, clinical characteristics, and risk factors associated with the first culture-proven episode of sepsis among neonates in a neonatal intensive care unit (NICU).Setting:Level-II NICU in the United Kingdom.Patients:Neonates with their first culture-proven sepsis between January 1, 1996, and December 31, 2000.Methods:Demographic data were obtained from the NICU database and chart review. Sepsis was considered early (EOS; < 72 hours old) or late (LOS; > 72 hours old). Data were also collected on potential risk factors.Results:Among 14,767 live births, 1,612 (11%) neonates were admitted to the NICU during the study period. Nine hundred eight were screened for sepsis. One hundred twenty-four had at least one positive culture (overall sepsis rate of 8.4 per 1,000 live births [1%] or 77 per 1,000 NICU admissions). Twenty-four neonates had EOS and 100 had LOS. Coagulase-negative staphylococci (CoNS) and group B Streptococcus were the most frequent organisms causing EOS, whereas CoNS and Escherichia coli most frequently caused LOS. Birth before 30 weeks' gestation and birth weight less than 1,500 g were risk factors for sepsis. Resuscitation at birth was the leading risk factor for EOS and respiratory support prior to sepsis, presence of a central or peripheral catheter, and total parenteral nutrition were leading risk factors for LOS.Conclusions:A strong inverse relationship existed between gestational age of 30 weeks or younger and birth weight of 1,500 g or less and LOS. Resuscitation and indwelling intravenous catheters were also risk factors.
Prevalence of Nosocomial Infections in Swiss Children's Hospitals
Authors: Mühlemann Kathrin , Franzini Christine , Aebi Christoph , Berger Christoph , Nadal David , Stähelin Jody , Gnehm Hanspeter , Posfay-Barbe Klara , Gervaix Alain , Sax Hugo , Heininger Ulrich , Bonhoeffer Jan , Eich Gerhard , Kind Christian , Petignat Christiane , Scalfaro Pietro 
Published: April 2006

AbstractObjective:To acquire data on pediatric nosocomial infections (NIs), which are associated with substantial morbidity and mortality and for which data are scarce.Design:Prevalence survey and evaluation of a new comorbidity index.Setting:Seven Swiss pediatric hospitals.Patients:Those hospitalized for at least 24 hours in a medical, surgical, intensive care, or intermediate care ward.Results:Thirty-five NIs were observed among 520 patients (6.7%; range per hospital, 1.4% to 11.8%). Bacteremia was most frequent (2.5 per 100 patients), followed by urinary tract infection (1.3 per 100 patients) and surgical-site infection (1.1 per 100 patients; 3.2 per 100 patients undergoing surgery). The median duration until the onset of infection was 19 days. Independent risk factors for NI were age between 1 and 12 months, a comorbidity score of 2 or greater, and a urinary catheter. Among surgical patients, an American Society of Anesthesiologists (ASA) score of 2 or greater was associated with any type of NI (P = .03). Enterobacteriaceae were the most frequent cause of NI, followed by coagulase-negative staphylococci; viruses were rarely the cause.Conclusions:This national prevalence survey yielded valuable information about the rate and risk factors of pediatric NI. A new comorbidity score showed promising performance. ASA score may be a predictor of NI. The season in which a prevalence survey is conducted must be considered, as this determines whether seasonal viral infections are observed. Periodic prevalence surveys are a simple and cost-effective method for assessing NI and comparing rates among pediatric hospitals.