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Biomedical subjects

Anne Matlow

Publications and source records attributed to Anne Matlow.

15 recordsLinked to original sources
PubMed2006

Sustained endemicity of Burkholderia cepacia complex in a pediatric institution, associated with contaminated ultrasound gel.

OBJECTIVE: To determine whether contaminated ultrasound gel is the source of intermittent outbreaks of nosocomial infection due to Burkholderia cepacia complex in patients without cystic fibrosis since 1992. DESIGN: A prospective clinical and in vitro study of all in-use bottles of ultrasound gel, as well as a retrospective analysis of archived bacterial strains, were performed. Handling of gel for clinical purposes throughout the hospital was evaluated. Gel and archived clinical isolates of B. cepacia complex were speciated to genomovar level and characterized by pulsed-field gel electrophoresis, and the pulsed-field gel electrophoresis patterns were compared. SETTING: The Hospital for Sick Children, a 300-bed, tertiary care, pediatric academic health sciences center in Toronto, Canada. PATIENTS: All patients without cystic fibrosis from whom B. cepacia complex was recovered at the Hospital for Sick Children since 1992. RESULTS: No standardized protocol for storage or handling of ultrasound gel was found. Gel from 39% of bottles grew either B. cepacia (genomovar I) or Burkholderia stabilis (genomovar IV). These isolates had pulsed-field gel electrophoresis patterns identical to 2 of the 7 clinical pulsed-field gel electrophoresis types that are responsible for 88% of clinical isolates. CONCLUSIONS: Contaminated ultrasound gel contributed to nosocomial infection due to B. cepacia complex in this institution over the course of 10 years. Suggested guidelines for the handling of ultrasound gel are provided.

Academic Medical Centers↗
PubMed2006

Enteral tube hub as a reservoir for transmissible enteric bacteria.

Enteral feeding is a risk factor for cross transmission of microbes. Administration set tubing can be colonized by organisms present in the enteral tube hub; molecular typing has demonstrated genetic relatedness of enteric bacteria isolated from both sites. Strict attention to infection control measures is imperative when handling enteral feed apparatuses.

Bacteria↗
PubMed2006

Disclosure of medical errors.

The 1999 release of the Institute of Medicine's document To Err is Human was akin to removing the lid of Pandora's box. Not only were the magnitude and impact of medical errors now apparent to those working in the health care industry, but consumers or health care were alerted to the occurrence of medical events causing harm. One specific solution advocated was the disclosure to patients and their families of adverse events resulting from medical error. Knowledge of the historical perspective, ethical underpinnings, and medico-legal implications gives us a better appreciation of current recommendations for disclosing adverse events resulting from medical error to those affected.

Disclosure↗
PubMed2006

Blueprint for patient safety.

This article outlines a plan called the Blueprint for Patient Safety, which one organization has used to implement a comprehensive patient safety program. The blueprint starts with a graphic that depicts the basic objectives of patient safety and clarifies the sometimes misunderstood relationship between patient safety and more traditional quality-improvement activities. A second schematic outlines the key elements of the plan, including the concepts of continuous learning and the encompassing role of leadership. Finally, the 10 components of the plan and specific elements that could fall under each component are described.

Humans↗
PubMed2006

A 24-hour screening protocol for identification of vancomycin-resistant Enterococcus faecium.

We describe a 24-h protocol for the identification of patients who are positive for vancomycin-resistant Enterococcus faecium (VRE), using stool and rectal swab samples and VRE screening broth, automated DNA extraction, and real-time PCR for vanA and vanB genes. Compared to conventional screening methods, this protocol had a high sensitivity and specificity and a negative predictive value.

Automation↗
PubMed2006

Patient safety in a pediatric centre: partnering with families.

Patient Centred Care (PCC) is a recognized pillar of quality healthcare. According to the Institute of Medicine (Kohn et al. 2000), PCC respects and is responsive to individual patient preferences, needs and values, and ensures they guide all clinical decisions. In a pediatric setting, both the child and family's preferences and values are critical; as a result, the concept of PCC is broadened to include the entire family, and is termed Family Centred Care (FCC). True FCC requires transparent and ongoing collaboration between the child, family, and all members of the healthcare team. An institution's commitment to Family Centred Care must be explicit and permeate all aspects of healthcare provisions. At Toronto's Hospital for Sick Children (SickKids), the Families as Partners in Patient Safety Committee has proven to be a successful initiative based on Family Centred Care principles. This interdisciplinary committee includes healthcare providers, parents and representatives from our hospital's Children's Council. The mandate of the group is to: (1) identify patient safety (PS) issues, (2) make recommendations to improve PS and (3) increase awareness and promote the partnership between parents and staff in PS. Key initiatives to date include developing PS information for families, a combined hand hygiene campaign and a campaign to make the hospital 100% smoke-free. A task-oriented partnership between families and healthcare workers has proven to be a productive model for advancing pediatric patient safety.

Cooperative Behavior↗
PubMed2004

Nosocomial transmission of congenital tuberculosis in a neonatal intensive care unit.

Congenital tuberculosis is uncommon, and nosocomial transmission from a congenitally infected infant to another infant has not been reported in the English literature. We report an investigation of 2 infants with tuberculosis who were cared for in the same neonatal intensive care unit. Isolates from both infants were genetically indistinguishable. Transmission between the 2 infants was likely due to contaminated respiratory equipment.

Cross Infection↗
PubMed2003

Microbial contamination of enteral feed administration sets in a pediatric institution.

BACKGROUND: Enteral feeding tubes have been associated with outbreaks of antimicrobial-resistant organisms, but the pathogenesis of this association has not been investigated. We hypothesized that the enteral feed administration sets become colonized externally by microbes grown from the enteral tube hub, and therefore serve as a reservoir of organisms that can be crosstransmitted. METHODS: We conducted a prospective observational cohort pilot study, obtaining bacterial cultures from the external enteral feed administration set and from the hub of nasogastric, gastric, or gastrojejunal tubes in children receiving enteral feeding while hospitalized in a tertiary care pediatric hospital. RESULTS: Thirty-six of 37 hubs cultured had bacterial growth. Twenty-nine of 36 administration sets (78%) sampled had at least 1 microbe isolated that was also cultured from the hub. No significant risk factors for colonization were identified. CONCLUSIONS: Enteral feed administration sets are frequently colonized by organisms in the enteral tube hub. These sets can serve as a reservoir of organisms that can be crosstransmitted between patients. Adherence to Standard Precautions is critical when handling enteral feeding apparatuses.

Bacteria↗
PubMed2003

Children hospitalized with severe acute respiratory syndrome-related illness in Toronto.

OBJECTIVE: An outbreak of severe acute respiratory syndrome (SARS) occurred in the greater Toronto area between February and June 2003. We describe the clinical, laboratory, and epidemiologic features of children who were admitted to the Hospital for Sick Children, Toronto, with a presumptive diagnosis of suspect or probable SARS. METHODS: A prospective investigational study protocol was established for the management of children with a presumptive diagnosis of suspect or probable SARS. All were ultimately classified as having probable SARS, suspect SARS, or another cause on the basis of their epidemiologic exposure, clinical and radiologic features, and results of microbiologic investigations. RESULTS: Twenty-five children were included; 10 were classified as probable SARS and 5 were classified as suspect SARS, and in 10 another cause was identified. The exposure consisted of direct contact with at least 1 adult probable SARS case in 11 children, travel from a World Health Organization-designated affected area in Asia in 9 children, and presence in a Toronto area hospital in which secondary SARS spread had occurred in 5 children. The predominant clinical manifestations of probable cases were fever, cough, and rhinorrhea. With the exception of 1 teenager, none of the children developed respiratory distress or an oxygen requirement, and all made full recoveries. Mild focal alveolar infiltrates were the predominant chest radiograph abnormality. Lymphopenia; neutropenia; thrombocytopenia; and elevated alanine aminotransferase, aspartate aminotransferase, and creatine kinase were present in some cases. Nasopharyngeal swab specimens were negative for the SARS-associated coronavirus by an in-house reverse transcriptase-polymerase chain reaction in all 25 children. CONCLUSIONS: Our results indicate that SARS is a relatively mild and nonspecific respiratory illness in previously healthy young children. The presence of fever in conjunction with a SARS exposure history should prompt one to consider SARS as a possible diagnosis in children irrespective of the presence or absence of respiratory symptoms. Reverse-transcriptase polymerase chain reaction analysis of nasopharyngeal specimens seems to be of little utility for the diagnosis of SARS during the early symptomatic phase of this illness in young children.

Adolescent↗
PubMed2002

Do in-line respiratory filters protect patients? Comparing bacterial removal efficiency of six filters.

With all pulmonary function diagnostic and respiratory therapy equipment, cross-infection has always been a concern, especially in the cystic fibrosis population, in whom pulmonary function tests are done routinely. The aim of this study was to identify and compare the bacterial removal efficiency (BRE, ability of a filter to remove microorganisms) of six different filters used in hospital settings: Microgard (MG), Spirobac (SB), PALL (PL), and KOKO (KK), used in the pulmonary function laboratory; and Clear-Guard (CG) and Respigard (RG), used in ventilator circuits. Filters were tested in both saturated and nonsaturated conditions. A Pseudomonas aeruginosa suspension of 1 x 10(4) to 1 x 10(8) CFU/mL was nebulized onto each filter. A blood agar plate was held immediately downstream from the filter. Colony-forming units (CFU) were then counted after 24 hr of incubation. A peak flow was applied across the spirometry filters. Bacterial thresholds of the filters were also identified (concentration of bacteria at which a filter no longer has 100% BRE). There was a significant difference in BRE among the six filters in saturated states when challenged with 1 x 10(4) CFU/mL (MG, KK, CG, and RG, 100%; SB, 98.8%; PL, 42.7%; P = 0.003). There was no significant difference between saturated and nonsaturated states, or after application of a peak flow. Filter thresholds were significantly different (KK 1 x 10(8), MG 1 x 10(7), CG 1 x 10(6), RG 1 x 10(5), and SB and PL <1 x 10(4) CFU/mL). In conclusion, when all filters are exposed to the same extreme challenges, significant differences exist in their ability to remove bacteria.

Cross Infection↗
PubMed2002

The role of nurse understaffing in nosocomial viral gastrointestinal infections on a general pediatrics ward.

OBJECTIVE: To examine the relationship between nurse staffing levels and the rate of nosocomial viral gastrointestinal infections (NVGIs) in a general pediatrics population. DESIGN: Retrospective descriptive study. SETTING: A general pediatrics ward at The Hospital for Sick Children in Toronto, Ontario, Canada, a 320-bed, tertiary-care pediatric institution. RESULTS: Forty-three NVGIs were detected in 37 patients of 2,929 admissions (1.3%). The monthly NVGI rate correlated significantly with the monthly night patient-to-nurse ratio (r = 0.56) and the monthly day patient-to-nurse ratio (r = 0.50). The nursing hours per patient-day during the preinfection period (PIP) were significantly lower than those during the nonpreinfection period (NPIP; 12.5 vs 13.0). There was no difference between the PIP and the NPIP day patient-to-nurse ratios (3.31 vs 3.32), but there was a significant difference between the PIP and the NPIP night patient-to-nurse ratios (3.26 vs 3.16). The incidence of NVGIs in the 72-hour period after any day when the nursing hours per patient-day were less than 10.5 was 6.39 infections per 1,000 patient-days, compared with 2.17 infections per 1,000 patient-days in periods with more than 10.5 nursing hours per patient-day (rate ratio, 2.94; 95% confidence interval, 2.16 to 4.01). CONCLUSION: Nurse understaffing contributed to an increased NVGI rate in our general pediatrics population, and should be assessed as a risk factor in outbreak investigations.

Child↗