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Biomedical subjects

A Josephson

Publications and source records attributed to A Josephson.

At least 19 recordsLinked to original sources
PubMed1995

Meeting infection control standards in the OR.

Quality health care is associated with the absence of negative outcomes in patients. Institutions realize that quality cannot be assured but it can be assessed and methods can be developed to improve patient care. Many heath care institutions, therefore, have begun the conceptual transition from quality assurance model to principles of continuous quality improvement (CQI). This article describes a CQI project that was developed to enhance infection control standards in OR settings. The project involved three phases: development of a survey tool, implementation of an environmental assessment and monitoring model, and transfer of the model to OR staff members. Five months after implementation of the model, the chi-square test revealed there was a significant improvement in compliance (chi 2 = 5.0, P < .03). After 22 months of using the model, compliance to infection control standards remains high and OR staff members have taken ownership of the model by incorporating it into their departmental CQI process.

Hospitals, University↗
PubMed1993

The numbers game: sample-size determination.

Sample-size determination is a crucial component of study design. Estimates of sample size are influenced by the amount of change that must occur between study groups and the degree of risk that the investigator is willing to accept in evaluating the null hypothesis. A complete understanding of the impact of sample size on the interpretation of study data is therefore a prerequisite for quality, innovative, valid research.

Epidemiologic Factors↗
PubMed1993

Difficult parents. From adversaries to partners.

The pediatrician's job becomes frustrating when it is necessary to deal with difficult parents. Some physicians may not have the training or inclination to engage such parents in a therapeutic partnership. This paper discusses tools available to physicians which will help them develop an effective partnership that includes uncovering the hidden meaning behind a child's illness; understanding the reciprocal nature of partnerships; and the importance of determining each party's goals, roles, and expectations. Negotiating these steps enables physicians to develop a productive relationship with difficult parents of sick children. This strategy can facilitate the child's medical care and improve the parents' and physician's satisfaction with the services rendered. This paper also discusses steps to take when these attempts are not sufficient to handle the situation.

Adolescent↗
PubMed1992

A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit.

OBJECTIVE: To describe the epidemiology of a cluster of vancomycin-resistant Enterococcus faecium (VAREC) in a cardiothoracic surgery intensive care unit. DESIGN: A case series of patients identified through review of surveillance data on nosocomial infections, review of microbiologic records, and culture survey of patients in the unit. RESULTS: Six patients in the cardiothoracic surgery intensive care unit had VAREC with identical antimicrobic susceptibility patterns over a 6-month period. Four patients were identified with VAREC through prospective surveillance and 2 through retrospective review. Prior vancomycin use was seen more commonly in patients with VAREC (6/6, 100%) than in those without VAREC (3/12, 25%) (Fisher's exact test, p = .01). Six of the 7 patients with prior infection developed VAREC (85.7%). A prior nosocomial infection and prior exposure to vancomycin were found to be important variables in a logistic regression analysis. VAREC also was isolated from the environment. A combination of cohorting of patients and staff, and modifications of standard contact isolation practices eliminated the presence of VAREC from the cardiothoracic surgery intensive care unit. CONCLUSIONS: The results suggest that prior administration of vancomycin, especially in the patient who develops nosocomial infection, can influence the acquisition of vancomycin-resistant enterococci and that VAREC may be transmitted from patient to patient. Using a modification of the standard infection control practice of isolation, we were able to control the spread of this resistant strain of E faecium.

Cross Infection↗
PubMed1991

Risk-specific nosocomial infection rates.

Because nosocomial infection rates vary by hospital area and service, most infection control programs calculate area-specific rates to augment the reporting of their hospital-wide data. Rate development is often limited by the availability of appropriate specific denominator data to support important comparisons. Our university hospital reports a 20 month experience in which numerator data was collected as per the National Nosocomial Infections Surveillance System criteria for hospital-wide, high-risk nursery and ICU surveillance. These data were then combined with data in our hospital's patient-specific denominator file. This has enabled the development of risk-specific infection rates based on the analytic control of important variables available in both the numerator and denominator files. We found rate differences that were length of stay cohort specific, hospital day specific, age specific, birthweight specific, and survival cohort specific when examining our data by both the cumulative incidence and incidence density methods.

Adolescent↗
PubMed1990

Strategies for the management of varicella-susceptible healthcare workers after a known exposure.

Three different sequentially applied post-varicella zoster virus (VZV) exposure management strategies were employed over a 43-month period. We began by using a standard post-exposure protocol in which 50 susceptible healthcare workers (HCW) involved in hospital exposures were furloughed from work at a loss to the hospital of 424 workdays and $46,000. Of the eight nosocomial cases of VZV infection in HCWs, four (50%) caused future HCW and patient exposure. In trial I, we substituted a post-exposure screening procedure for the standard work furlough procedure. We screened 77 exposed staff resulting in one nosocomial VZV infection that was the source of another exposure incident. No secondary cases of varicella resulted from this exposure and only 20 days of furlough time were used during trial I. As VZV resulting from a home exposure source was responsible for most hospital exposures in which HCWs were the source, our trial II protocol added the Centers for Disease Control's (CDC) off-duty procedure, but limited its use to susceptibles exposed at home. The 43-month overall attack rate of nosocomial varicella was 4.7%, while the true home exposure attack rate was 79% (p less than .00001). There was an average of 42.4 lost workdays charged to the hospital per incident under the standard protocol and three days per incident in the combined experience of trials I and II (p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Chickenpox↗
PubMed1985

The relationship between intravenous fluid contamination and the frequency of tubing replacement.

Medical patients receiving IV therapy were randomly assigned to one of two IV tubing change groups. One group had a 48-hour tubing change and the other had no tubing change for the remainder of the cannula placement. A daily IV fluid specimen was processed microbiologically. To complete the study, a minimum of 3 continuous days of therapy and three fluid specimens was required. There were two contaminated specimens, one in each tubing change group. The contamination rate in the 48-hour change group was 0.87% and 0.96% in the no change group. The rate difference of 0.09% has a 95% confidence interval (-0.035 to +0.036) which includes zero. Survival analysis also revealed no significant difference in the cumulative probability of survival, however the mean duration of continuous tubing use of 4.3 days in the no change group and 1.8 days in the 48 hour change group were significantly different (p less than 0.05). The cumulative probability of surviving contamination free was 0.988 in the 48-hour group and 0.987 in the no-change group. We conclude that it is safe to change IV tubing at intervals up to but not exceeding 4 days.

Catheterization↗
PubMed1984

Cavitary Legionnaires' pneumonia: nosocomial infection in renal transplant recipients.

Cavitation is an unusual manifestation of legionnaires' pneumonia. Mortality rates range from 24 to 58 percent with effective therapy. Antibiotic therapy is not standardized and is largely based on anecdotal reports. This report has described nosocomially acquired cavitary legionnaires' pneumonia in five renal transplant recipients. The diagnosis was made by seroconversion and immunofluorescent staining of lung tissue or transtracheal aspirates. Frequently seen associated symptoms were not present. All patients were successfully treated with 2 to 4 g of erythromycin for at least 4 weeks.

Adult↗
PubMed1984

An epidemiologic study of postcesarean infection.

Cesarean section (CS) is associated with increased postpartum infectious morbidity, predominantly endometritis. In this prospective cohort study, endometritis was found in 28% of 229 patients who underwent consecutive CS from September 1979 to May 1980 at a university hospital. When the occurrence of bacteremia and wound infection was considered, the study found 31% of the patients were infected. Among the 20 potential epidemiologic and operative risk factors for infection that were studied, the most important were primary CS, membrane rupture, labor, and meconium staining (p = 0.0001). Failure to progress, breech presentation, and fetal distress were also significantly associated with infection (p = 0.001). Another factor correlated to the rate of infection was attendance by physician in training (p = 0.002). Discriminant function analysis was used to develop an equation that correctly classified, as infected or noninfected, 76% of a sample of CS patients (p = 0.004). This sample was not part of the original sample from which the discriminant function equation was developed. Finally toward the end of the study period, we observed a decrease in the infection rate among patients of house staff physicians. This decrease has resulted in similar infection rates for patients of attending physicians and patients of house staff physicians, which have continued to the present.

Bacterial Infections↗
PubMed1981

Infection complicating intrapericardial steroid instillation in uremic pericarditis.

Short-term, indwelling, percutaneous pericardiocentesis for drainage with local steroid instillation has been advocated for refractive uremic pericarditis. It is reported to be almost universally successful and to cause only minor complications. We describe a patient in whom this technique lead to purulent pericarditis (Staphylococcus aureus) requiring pericardiectomy.

Adult↗