bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suitability of the NNIS Index for Estimating Surgical-Site Infection Risk at a Small University Hospital in Brazil
Authors: Campos Maria Léa , Cipriano Zulmira Miotello , Freitas Paulo Fontoura 
Published: February 2006

AbstractObjectives:To detect the occurrence of surgical-site infection (SSI) in our study sample, using the traditional variables of the National Nosocomial Infection Surveillance (NNIS) index with a locally modified cut-off point for the “T time” defining length of surgical procedure; to compare the modified and the traditional NNIS index under the hypothesis that a cut-off point discriminating procedures of short and long duration, based upon the actual experience of the study sample, can adequately predict the risk of SSI.Design:A retrospective chart review of 9,322 patients undergoing surgical procedures in the period January 1993 to December 1998.Setting:A small university hospital (UH) in southern Brazil.Results:The composite index using the local sample procedure-duration cut-off point (UH-index) performed better than any of the individual components of the composite index (anesthesia risk index and surgical-wound class [SWC]). The UH-index also predicted adequately the risk of SSI when compared to the traditional NNIS index, particularly when stratifying by SWC.Conclusions:A modified NNIS index, using the sample cut-off point, can adequately predict the risk of SSI in a given population. Further studies are needed to compare and validate the NNIS index of risk for populations other than those of the NNIS-participating hospitals. Larger samples using different hospitals with similar characteristics are needed to investigate the risk of SSI associated with specific operations.
Persistence of Immunity to Varicella-Zoster Virus After Vaccination of Healthcare Workers
Authors: Saiman Lisa , LaRussa Philip , Steinberg Sharon P. , Zhou Juyan , Baron Keren , Whittier Susan , Della-Latta Phyllis , Gershon Anne A. 
Published: February 2006

AbstractObjective:Varicella-zoster virus (VZV) vaccine is recommended to protect susceptible healthcare workers (HCWs) from serious disease and to prevent nosocomial spread of VZV. We evaluated clinical outcomes and serological responses in HCWs after immunization with live attenuated VZV vaccine.Design:Vaccinees were immunized from 1979 to 1998 during VZV vaccine trials, as well as after licensure, and followed prospectively for 1 month to 20.6 (mean 4.6) years after vaccination. Sera were tested by fluorescent antibody to membrane antigen (FAMA), latex agglutination (LA), and enzyme-linked immunoassay (EIA) to detect VZV-specific antibodies.Study Participants:The median age of the 120 HCWs was 26 years; 51 (42%) were males.Interventions:Ninety eight (82%) of these study subjects received vaccine prepared by Merck and 22 (18%) by SmithKline Beecham; 25, 81, and 14 vaccinees received one dose, two doses, and three doses, respectively.Results:The crude attack rate was 10%; 12 of 120 HCWs developed chickenpox 6 months to 8.4 years after vaccination. The attack rates following household and hospital exposures were 18% (4/22) and 8% (6/72), respectively. All resulting illness was mild to moderate (mean 40 vesicles). Seroconversion after vaccination was documented by FAMA in 96% of HCWs, although 31% lost detectable antibodies. Compared with FAMA, LA and EIA were 82% and 74% sensitive and 94% and 89% specific, respectively.Conclusions:The VZV vaccine effectively protected HCWs from varicella, particularly from serious disease. Currently available serological tests are not optimal, and improved assays are needed.
Antibiotic Resistance Is a Major Risk Factor for Epidemic Behavior ofAcinetobacter baumannii
Authors: Koeleman Johannes G.M. , van der Bijl Madelon W. , Stoof Jeroen , Vandenbroucke-Grauls Christina M.J.E. , Savelkoul Paul H.M. 
Published: February 2006

AbstractObjective:To study the presence of bacterial factors in clinical isolates ofAcinetobacterspecies in order to identify markers of epidemic potential.Design:Case-control study.Methods:Forty-six isolates ofAcinetobacterspecies, including 23 epidemic and 23 sporadic strains from different outbreaks in nine European countries, were compared for the presence of the following factors: hemagglutination, presence of capsules and fimbriae, binding to salivary mucins, resistance to drying, and antibiogram typing. Genotyping of all strains was performed by amplified fragment-length polymorphism (AFLP).Results:All outbreak strains except two (91%) were identified asAcinetobacter baumannii. Binding to salivary mucins and resistance to antibiotics were significantly associated with epidemic behavior. Antibiogram typing showed clustering of predominantlyA baumanniistrains within one group, and these strains were significantly more resistant to antibiotics than sporadic strains. AFLP genotyping revealed a great heterogeneity among the different EuropeanAcinetobacterstrains. Cluster analysis of AFLP fingerprints showed several small clusters of differentA baumanniioutbreak strains. AFLP genotyping could not identify a common epidemic marker within the strains studied.Conclusions:Antibiogram typing can be used in routine clinical laboratories as a screening method to recognize potentially epidemicA baumanniistrains. Several other factors were found, both in different outbreaks as well as in sporadicAcinetobacterisolates. These characteristics were unable to predict epidemic behavior and therefore cannot be used as discriminative epidemic markers. AFLP genotyping demonstrated no common clonal origin of European epidemicA baumanniistrains. This indicates that any clinicalA baumanniiisolate with resistance to multiple antibiotics can be a potential nosocomial outbreak strain.
Outbreak ofSerratia marcescensInfection in a Neonatal Intensive Care Unit
Authors: Prasad G.A. , Jones Paula G. , Michaels Jacqueline , Garland Jeffery S. , Shivpuri Chandra R. 
Published: February 2006

AbstractWe report an outbreak ofSerratia marcescensinfection in the neonatal intensive care unit of a community hospital. The outbreak involved eight neonates, (five infected and three colonized), one of whom died. Pulsed-field gel electrophoresis confirmed that all isolates were identical strains. Cohorting and isolation of the infected neonates helped to control the outbreak. No environmental source of infection was found.
Routes and Sources ofStaphylococcus aureusTransmitted to the Surgical Wound During Cardiothoracic Surgery Possibility of Preventing Wound Contamination by Use of Special Scrub Suits
Authors: Tammelin Ann , Hambræus Anna , Ståhle Elisabeth 
Published: February 2006

AbstractObjectives:To trace the routes of transmission and sources ofStaphylococcus aureusfound in the surgical wound during cardiothoracic surgery and to investigate the possibility of reducing wound contamination, with regard to total counts of bacteria andS aureus, by wearing special scrub suits.Methods:A total of 65 elective operations for coronary artery bypass graft with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Bacteriological samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves and from the patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Bacteriological samples also were taken from the subcutaneous walls of the surgical wound just before closing the wound. Total counts of bacteria on sternal skin and wound walls (colony-forming units [CFUs//cm2) were calculated, as well as total counts of bacteria in the air (CFUs/m3). Strains ofS aureusrecovered from the different sampling sites were compared by pulsed-field gel electrophoresis (PFGE).Results:Special scrub suits significantly reduced total counts of bacteria in air compared to conventional scrub suits (P=.002). The number of air samples in whichS aureuswas found was significantly reduced by special scrub suits compared with conventional scrub suits (P=.016; relative risk, 4.4; 95% confidence interval [CI95], 1.3-14.9]). By use of PFGE, it was possible to identify two cases of possible airborne transmission ofS aureuswhen wearing conventional scrub suits, whereas no case was found when wearing special scrub suits. When exposed to airborneS aureus, the concomitant sternal carriage ofS aureuswas a risk factor for havingS aureusin the wound.Conclusions:Use of tightly woven special scrub suits reduces the dispersal of total counts of bacteria and ofS aureusfrom staff in the operating room, thus possibly reducing the risk of airborne contamination of surgical wounds. The importance of careful preoperative disinfection of the patient's skin should be stressed.
Anesthesia-Associated Carbon Monoxide Exposures Among Surgical Patients
Authors: Pearson Michele L. , Levine William C. , Finton Robert J. , Ingram Charles T. , Gay Kathleen B. , Tapelband Gerda , Smith J. David , Jarvis William R. 
Published: February 2006

AbstractObjective:To estimate the extent of, and evaluate risk factors for, elevated carboxyhemoglobin levels among patients undergoing general anesthesia and to identify the source of carbon monoxide.Design:Matched case-control study to measure carboxyhemoglobin levels.Setting:Large academic medical center.Participants:45 surgical patients who underwent general anesthesia.Results:Case-patients were more likely than controls to undergo surgery on Monday or Tuesday (10/15 vs 7/30; matched odds ratio [mOR], 7.7; 95% confidence interval [CI95], 1.8-34; P=.01), in one particular room (7/15 vs 4/30; mOR, 8.5; CI95, 1.5-48; P=.03) or in a room that was idle for ≥24 hours (11/15 vs 1/30; mOR, 95.5; CI95, 8.0-1,138; P≤.001). In a multivariate model, only rooms, and hence the anesthesia equipment, that were idle for ≥24 hours were independently associated with elevated intraoperative carboxyhemoglobin levels (OR, 22.4; CI95, 1.5-338; P=.025). Moreover, peak carboxyhemoglobin levels were correlated with the length of time that the room was idle (r=0.7; CI95, 0.3-0.9). Carbon monoxide was detected in the anesthesia machine outflow during one case-procedure. No contamination of anesthesia gas supplies or CO2 absorbents was found.Conclusions:Carbon monoxide may accumulate in anesthesia circuits left idle for ≥24 hours as a result of a chemical interaction between CO2-absorbent granules and anesthetic gases. Patients administered anesthesia through such circuits may be at increased risk for elevated carboxyhemoglobin levels during surgery or the early postoperative period.
Do New Surgeons Have Higher Surgical-Site Infection Rates?
Authors: Wurtz Rebecca , Wittrock Beth , Lavin Mary Alice , Zawacki Anne 
Published: February 2006

AbstractWe compared class I surgical-site infection (SSI) rates for new and experienced surgeons. Data showed that new surgeons in two surgical subspecialties associated with higher baseline SSI rates had rates higher than their experienced colleagues. They took longer in the operating room (OR), but did not operate on sicker patients. As the surgeons gained more experience (as measured by cumulative cases), their OR times and SSI rates decreased toward their colleagues'. New surgeons who perform infection-prone surgery may have higher SSI rates than more experienced colleagues until they gain experience. A new surgeon's SSI rate could be one factor considered in assessing competence.
Burkholderia cepaciaLower Respiratory Tract Infection Associated With Exposure to a Respiratory Therapist
Authors: Ramsey Alan H. , Skonieczny Patrice , Coolidge Diane T. , Kurzynski Terry A. , Proctor Mary E. , Davis Jeffrey P. 
Published: February 2006

AbstractObjective:To investigate and control a nosocomial outbreak ofBurkholderia cepacialower respiratory tract infection.Design:Outbreak investigation and case-control study.Setting:A 260-bed community hospital.Patients:Participants were mechanically ventilated intensive care patients without cystic fibrosis. A case was defined as a hospitalized patient with a sputum culture positive forB cepaciabetween January 1 and November 6, 1998.Methods:Respiratory therapy infection control policies and practices were reviewed; laboratory and environmental studies and a retrospective case-control study were conducted. Case-patients were matched with control-patients on age, gender, diagnosis, and type of intensive care unit.Results:Nine case-patients were identified;B cepacialikely caused pneumonia in seven and colonization in two. Two respiratory therapy practices probably contributed to the transmission ofB cepacia:multidose albuterol vials were used among several patients, and nebulizer assemblies often were not dried between uses.B cepaciawas grown from cultures of three previously opened multidose vials; pulsed-field gel electrophoresis patterns ofB cepaciafrom seven case-patients and two multidose vials were indistinguishable. Case-patients had longer durations of heated humidified mechanical ventilation (mean, 9.8 days vs 4.4 days;P=.03) and were more likely to have exposure to one particular respiratory therapist than controls (odds ratio, undefined; 95% confidence interval, 4.7-∞P=.001). The association with the respiratory therapist, a temporary employee, persisted after controlling for duration of heated humidified ventilation. No newB cepaciainfections were identified after control measures were implemented.Conclusions:B cepaciaprobably was transmitted among patients through use of extrinsically contaminated multidose albuterol vials. Respiratory therapy departments must pay close attention to infection control practices, particularly among new or temporary staff.
Costs and Savings Associated With Infection Control Measures That Reduced Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting
Authors: Montecalvo Marisa A. , Jarvis William R. , Uman Jane , Shay David K. , Petrullo Coleen , Horowitz Harold W. , Wormser Gary P. 
Published: February 2006

AbstractObjective:To determine the costs and savings of a 15-component infection control program that reduced transmission of vancomycin-resistant enterococci (VRE) in an endemic setting.Design:Evaluation of costs and savings, using historical control data.Setting:Adult oncology unit of a 650-bed hospital.Participants:Patients with leukemia, lymphoma, and solid tumors, excluding bone marrow transplant recipients.Methods:Costs and savings with estimated ranges were calculated. Excess length of stay (LOS) associated with VRE bloodstream infection (BSI) was determined by matching VRE BSI patients with VRE-negative patients by oncology diagnosis. Differences in LOS between the matched groups were evaluated using a mixed-effect analysis of variance linear-regression model.Results:The cost of enhanced infection control strategies for 1 year was $116,515. VRE BSI was associated with an increased LOS of 13.7 days. The savings associated with fewer VRE BSI ($123,081), fewer patients with VRE colonization ($2,755), and reductions in antimicrobial use ($179,997) totaled $305,833. Estimated ranges of costs and savings for enhanced infection control strategies were $97,939 to $148,883 for costs and $271,531 to $421,461 for savings.Conclusion:The net savings due to enhanced infection control strategies for 1 year was $189,318. Estimates suggest that these strategies would be cost-beneficial for hospital units where the number of patients with VRE BSI is at least see to nine patients per year or if the savings from fewer VRE BSI patients in combination with decreased antimicrobial use equalled $100,000 to $150,000 per year.
Use and Efficacy of Tuberculosis Infection Control Practices at Hospitals With Previous Outbreaks of Multidrug-Resistant Tuberculosis
Authors: Tokars Jerome I. , McKinley George F. , Otten Joan , Woodley Charles , Sordillo Emilia M. , Caldwell Joan , Liss Catherine M. , Gilligan Mary Ellen , Diem Lois , Onorato Ida M. , Jarvis William R. 
Published: February 2006

AbstractObjective:To evaluate the implementation and efficacy of selected Centers for Disease Control and Prevention guidelines for preventing spread ofMycobacterium tuberculosis.Design:Analysis of prospective observational data.Setting:Two medical centers where outbreaks of multidrug-resistant tuberculosis (TB) had occurred.Participants:All hospital inpatients who had active TB or who were placed in TB isolation and healthcare workers who were assigned to selected wards on which TB patients were treated.Methods:During 1995 to 1997, study personnel prospectively recorded information on patients who had TB or were in TB isolation, performed observations of TB isolation rooms, and recorded tuberculin skin-test results of healthcare workers. Genetic typing ofM tuberculosisisolates was performed by restriction fragment-length polymorphism analysis.Results:We found that only 8.6% of patients placed in TB isolation proved to have TB; yet, 19% of patients with pulmonary TB were not isolated on the first day of hospital admission. Specimens were ordered for acid-fast bacillus smear and results received promptly, and most TB isolation rooms were under negative pressure. Among persons entering TB isolation rooms, 44.2% to 97.1% used an appropriate (particulate, high-efficiency particulate air or N95) respirator, depending on the hospital and year; others entering the rooms used a surgical mask or nothing. We did not find evidence of transmission of TB among healthcare workers (based on tuberculin skin-test results) or patients (based on epidemiological investigation and genetic typing).Conclusions:We found problems in implementation of some TB infection control measures, but no evidence of healthcare-associated transmission, possibly in part because of limitations in the number of patients and workers studied. Similar evaluations should be performed at hospitals treating TB patients to find inadequacies and guide improvements in infection control.
Incidence and Predictors of Surgical-Site Infections in Vietnam
Authors: Nguyen Dao , MacLeod William Bruce , Phung Dae Cam , Cong Quyet Thang , Nguyen Viet Hung , Nguyen Van Hoa , Hamer Davidson Howes 
Published: February 2006

AbstractObjective:To determine the incidence of, and risk factors for, surgical-site infections (SSIs).Design:Prospective observational study of all patients undergoing surgery during a 3-month period.Setting:Two urban hospitals in Hanoi, Vietnam.Patients:All 697 patients admitted for emergent and elective surgery.Methods:Data were collected on all patients undergoing surgery during a 3-month period at each hospital. We stratified the data by type of surgery, wound class, and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk index. The analysis was done with the data sets from each hospital separately and with the combined data. The risk factors for SSI were identified using a logistic-regression model.Results:During the period of observation, 10.9% of 697 patients had SSI. The SSI rate was 8.3% for clean wounds, 8.6% for clean-contaminated, 12.2% for contaminated, and 43.9% for dirty wounds. The lowest rate of SSI (2.4%) was found in obstetric-gynecologic procedures and the highest rate (33.3%) in cardiothoracic operations. Using the SENIC risk index, the incidence of SSI in low-risk patients was 5.1%; for medium-risk patients, 13.5%, and high-risk patients, 24.2%. In a logistic-regression model, abdominal surgery (odds ratio [OR], 4.46;P&lt;.01) and wound class IV (OR, 5.67;P&lt;.01) were significant predictors of SSI. All patients were treated with prolonged courses of perioperative antibiotics. Overall infection control practices were poor as a result of deficient facilities, limited surgical instruments, and a lack of proper supplies for wound care and personal hygiene.Conclusions:There was a higher incidence of SSI in low-risk patients in Vietnam compared with developed countries. Excessive reliance on antimicrobial therapy as a means to limit SSI places patients at higher risk of adverse effects from treatment and also may contribute to worsening problems with antimicrobial resistance. Establishment of an infection control program with guidelines for antimicrobial use should improve the use of prophylactic antibiotics and attention to proper surgical and wound-care techniques. These interventions also should reduce the incidence of SSI and its associated morbidity and costs.
Incidence of, and Risk Factors for, Nosocomial Infections Among Hematopoietic Stem Cell Transplantation Recipients, With Impact on Procedure-Related Mortality
Authors: Marena Carlo , Zecca Marco , Carenini Maria Luisa , Bruschi Angela , Bassi Maria Luigia , Olivieri Pietro , Azzaretti Silvia , Locatelli Franco 
Published: February 2006

AbstractObjectives:To determine the incidence of, and risk factors for, nosocomial infections (NIs) occurring among hematopoietic stem cell transplantation (HSCT) recipients during hospitalization and to evaluate the impact of these NIs on patient outcome.Design:A two-year prospective observational study in two HSCT units.Patients:All patients admitted to the HSCT units between February 1997 and March 1999.Setting:A teaching hospital.Methods:After admission to the HSCT units, the patients were followed prospectively on a daily basis to collect all pertinent variables for the development of NIs.Results:49 NIs were identified in 34 of the 143 patients screened. The incidence of NIs and infected patients was 34.2% and 23.7%, respectively. The incidence density of NI was 8.96 per 1,000 patient-days. The most frequent NIs were bloodstream infections ([BSIs], 42.8%) and respiratory tract infections (28.6%). Other sites involved were as follows: eye (8.2%), urinary tract (6.1%), gastrointestinal tract (6.1%), skin (4.1%), ear (2%), and central venous catheter ([CVC], 2%). Because of the predominance and clinical relevance of BSIs, we examined both intrinsic and extrinsic risk factors associated with these infections. Independent risk factors for BSIs were allograft from matched unrelated or partially matched family donor, graft-versus-host disease (GVHD) prophylaxis without methotrexate (MTX), type of CVC, and duration of total parenteral nutrition. Four variables were independently associated with mortality occurring during hospitalization: culture-proven BSIs, advanced disease phase at transplant, type of transplant, and absence of MTX for GVHD prophylaxis.Conclusions:The study identified several factors associated with increased risk of BSIs among HSCT patients. Because BSIs are life-threatening complications for HSCT recipients, preventive measures aimed at reducing the incidence of these infections among patients given HSCT should be adopted.
Improved Compliance With Universal Precautions in the Operating Room Following an Educational Intervention
Authors: Kim Lynn E. , Jeffe Donna B. , Evanoff Bradley A. , Mutha Sunita , Freeman Brad , Fraser Victoria J. 
Published: February 2006

Abstract
Observation of surgical personnel in four specialties (cardio-thoracic, general, gynecologic, and orthopedic) in the operating room was performed prior to implementation of an educational intervention designed to improve compliance with Universal Precautions and at 1- and 2-years post-intervention. Use of protective eyewear and double gloving increased following the intervention, whereas the incidence of documented blood and body fluid exposures decreased.
Glove Reinforcement An Alternative to Double Gloving
Authors: Alrawi Sadir , Houshan Iyad , Satheesan Radhakrishnan , Raju Ramanathan , Cunningham Joseph , Acinapura Anthony 
Published: February 2006

Abstract
Gloves, worn by the surgical team to prevent transmission of infections from and to patients, are prone to tears and perforations. This study was done to determine the frequency and sites of unrecognized glove perforation during surgical procedures. The percentage of glove perforation was 14%. Of the punctures, 73% occurred in one of four contiguous locations on the glove. We recommend glove reinforcement at these locations to provide better protection, as well as to reduce the burden of double gloving.