Antimicrobial catheters: value and safety.
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
Biomedical subjects
B M Farr
Publications and source records attributed to B M Farr.
Protecting long-term care patients from antibiotic resistant infections: ethics, cost-effectiveness, and reimbursement issues.
Explore the source record for details and available documents.
Aged↗
Accuracy and cost-effectiveness of new tests for diagnosis of catheter-related bloodstream infections.
Explore the source record for details and available documents.
Adult↗
Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: A consensus panel report. Society for Healthcare Epidemiology of America.
The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.
Accreditation↗
Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Society for Healthcare Epidemiology of America.
The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.
Accreditation↗
Disinfection of hospital rooms contaminated with vancomycin-resistant Enterococcus faecium.
Sixteen percent of hospital room surfaces remained colonized by vancomycin-resistant enterococci (VRE) after routine terminal disinfection. Disinfection with a new "bucket method" resulted in uniformly negative cultures. Conventional cleaning took an average of 2.8 disinfections to eradicate VRE from a hospital room, while only one cleaning was required with the bucket method.
Anti-Bacterial Agents↗
A randomized crossover study of disposable thermometers for prevention of Clostridium difficile and other nosocomial infections.
OBJECTIVE: To test the hypothesis that use of disposable thermometers would result in lower rates of nosocomial Clostridium difficile diarrhea and of total nosocomial infections, compared with electronic thermometers. DESIGN: Prospective randomized crossover trial. SETTING: A 700-bed university hospital providing primary and tertiary care. PATIENTS: All patients admitted to a group of 20 inpatient nursing units. INTERVENTIONS: 20 nursing units were randomized into two groups. One group randomly was assigned exclusive use of single-use disposable thermometers for patient temperature measurement, and the other group was assigned exclusive use of electronic thermometers. After 6 months, the assignments were reversed. MAIN OUTCOME MEASURES: Rates of C difficile infections, total nosocomial diarrheal episodes, and total nosocomial infections were prospectively followed in each study unit over 11 months. RESULTS: 26,350 patients were admitted to the study units and hospitalized for 120,529 patient days. There were 947 nosocomial infections (7.86 per 1,000 patient days). Nosocomial C difficile-associated diarrhea defined by positivity to both toxin B (titer > or = 1:10) and toxin A was detected in 32 patients (3.4% of all nosocomial infections). A significantly lower rate of nosocomial C difficile-associated diarrhea was observed with disposable thermometer use (0.16 per 1,000 patient days) compared with electronic thermometer use (0.37 per 1,000 patient days, relative risk [RR] = 0.44; 95% confidence interval [CI95], 0.21-0.93, P = .026). There was no difference in overall rates of nosocomial infection between the disposable and electronic groups (8.03 and 7.68 infections per 1,000 patient days, respectively; RR, 1.04; CI95, 0.92-1.19; P = .52) or in the overall rate of nosocomial diarrhea (3.34 and 3.40 per 1,000 patient days, respectively; RR, .98; CI95, 0.81-1.19; P = .87). CONCLUSIONS: The incidence of nosocomial C difficile diarrhea was reduced significantly by using single-use, disposable thermometers as compared with electronic thermometers, but there was no effect on either the overall rate of nosocomial diarrhea or the rate of total nosocomial infections.
Clostridioides difficile↗
Frequency of percutaneous injuries requiring postexposure prophylaxis for occupational exposure to human immunodeficiency virus.
New recommendations regarding prophylaxis of healthcare workers exposed to human immunodeficiency virus (HIV) prompted us to examine the frequency and nature of percutaneous injuries at this hospital. Four previously defined risk factors for transmission of HIV were evaluated. Between 1993 and 1995, 1,070 percutaneous injuries were reported, including 11 in which the source patient had acquired immunodeficiency syndrome (AIDS). Five of these injuries involved at least one risk factor for transmission. No source patient was found to have AIDS as a result of testing following exposure. We conclude that high-risk injuries are infrequent and that postexposure prophylaxis will not increase costs greatly at this medical center.
Cross Infection↗
Hospital wards spreading vancomycin-resistant enterococci to intensive care units: returning coals to Newcastle.
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
Effect of a vancomycin restriction policy on ordering practices during an outbreak of vancomycin-resistant Enterococcus faecium.
BACKGROUND: With the development of nosocomial pathogens that are resistant to multiple antimicrobial agents, reasonable restriction of antibiotic use has become a priority. METHODS: During an outbreak of vancomycin-resistant enterococcal infections, an audit of vancomycin hydrochloride use was conducted during October 3 through 21, 1994, and January 24 through February 2, 1995. During these periods, all orders for vancomycin were reviewed by clinical pharmacists. Use was classified as either appropriate or inappropriate based on recommendations by the Hospital Infection Control Practice Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention, Atlanta, Ga. A policy restricting the use of vancomycin was adopted in November 1994. RESULTS: During the first audit in October 1994, 61% of vancomycin orders were considered inappropriate according to HICPAC criteria. At the time of this audit, the first cases of an outbreak of nosocomial vancomycin-resistant Enterococcus faecium had been detected. The follow-up audit showed that 30% of vancomycin orders were inappropriate by HICPAC criteria (P < .001). Overall use of vancomycin decreased by 50% and remained at this lower level for the following year. CONCLUSION: The institution of a vancomycin restriction policy was associated with a reduction of both inappropriate drug orders and total use.
Anti-Bacterial Agents↗
Zinc gluconate lozenges for treating the common cold.
Explore the source record for details and available documents.
Common Cold↗
Prognosis and decisions in pneumonia.
Explore the source record for details and available documents.
Community-Acquired Infections↗
Emerging evidence of selection of fluconazole-tolerant fungi in surgical intensive care units.
OBJECTIVE: To determine whether increased use of fluconazole has coincided with a shift in the relative proportion of fluconazole-tolerant species isolated from critically ill surgical patients in 2 university hospitals. DESIGN: Microbiological data and fluconazole administration frequencies were reviewed among patients treated in the surgical intensive care units (SICUs) from January 1, 1990, through December 31, 1995. SETTING: The SICUs of the University of Virginia Medical Center, Charlottesville, and the Hospital of the University of Pennsylvania, Philadelphia. MAIN OUTCOME MEASURES: The number and species types of all fungal isolates and the number of patients treated with fluconazole for each of the 6 years were determined. RESULTS: A sharp increase in the use of fluconazole among critically ill surgical patients has occurred at both medical centers from 1990-1995. The culture results of most patients treated with fluconazole were negative for fungi (73% and 63% at the University of Virginia Medical Center and the Hospital of the University of Pennsylvania, respectively); there was a greater tendency to use fluconazole at the University of Virginia Medical Center compared with the Hospital of the University of Pennsylvania (2.2% vs 1.8% of patients admitted to the SICU received it, respectively; P = .007). There was a significant increase in the proportion of Candida glabrata isolated at the University of Virginia Medical Center (P < .01) from 1990-1995, but a similar change was not detectable at the Hospital of the University of Pennsylvania. CONCLUSIONS: These data justify concern that the increased use of fluconazole in SICUs may be promoting a shift in the fungal flora that cause nosocomial infections toward species that are more difficult to treat. Prospective studies about the use of fluconazole for prophylaxis and empirical therapy among SICU patients are warranted before its widespread use in these settings continues.
Antifungal Agents↗
Urbs in rure redux: changing risk factors for rural HIV infection.
The purpose was to ascertain risk factors for HIV infection in a predominantly rural population using descriptive epidemiologic studies performed at a university health sciences center. Participants included adult patients with HIV infection or AIDS who were cared for between January 1982 and January 1993. The relative frequency of cases in minority and female heterosexual patients increased significantly. The male to female ratio among blacks with HIV infection declined to 1.1:1 during the final 3 years of the study. Patients who believed they had acquired infection in Virginia were more likely to cite a rural area of acquisition and to have had multiple heterosexual partners but were less likely to have had male homosexual contact than patients who believed they had been infected in other states. HIV continued to spread into rural areas of Virginia, and the gender ratio among blacks with HIV declined throughout the study. Having multiple heterosexual partners, the main risk factor for HIV transmission worldwide, may now result in HIV infection in rural Virginia.
Acquired Immunodeficiency Syndrome↗
Diagnosis of vascular catheter-related bloodstream infection: a meta-analysis.
Catheter-related bloodstream infections increased in incidence during the past decade, causing significant morbidity, mortality, and excess hospital costs. Absence of inflammation at the catheter site in most cases makes clinical diagnosis uncertain. The relative accuracy and cost-effectiveness of different microbiologic tests for confirming that bloodstream infection is catheter related have remained unclear. A meta-analysis of published studies was conducted regarding the accuracy of diagnostic test methods using pooled sensitivity and specificity and summary receiver operating characteristic (ROC) curve analysis. The cost for each test was estimated by methods published by the College of American Pathologists. Costs of catheter replacement and antibiotic therapy for false positive results were included in the cost per accurate test result. Twenty-two studies evaluating six test methods met inclusion criteria for the meta-analysis. Accuracy increased in ROC analysis for catheter segment cultures with increasing quantitation (P = 0.03) (i.e., quantitative > semiquantitative > qualitative) largely due to an increase in specificity. The highest Youden index (mean = 0.85) was observed with quantitative catheter segment culture, the only method with pooled sensitivity and specificity above 90%. For blood culture methods, there was no statistically significant trend toward increased accuracy. The unpaired quantitative catheter blood culture offered the lowest cost per accurate test result but was only 78% sensitive. In conclusion, quantitative culture was the most accurate method for catheter segment culture, and unpaired quantitative catheter blood culture was the single most cost-effective test, especially for long-term catheters.
Bacteremia↗
Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus.
Contact isolation has been recommended by the Centers for Disease Control and Prevention for the prevention of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA), but there are few data which prospectively quantitate the effectiveness of contact isolation for this purpose. During an outbreak of MRSA in a neonatal intensive care unit between July 18, 1991 and January 30, 1992, weekly surveillance cultures were performed on all patients. Sixteen of 331 admissions became colonized with MRSA, and 3 (19%) developed infections: bacteremia, conjunctivitis, and dialysis catheter site infection. The isolates from all 16 patients were submitted to plasmid profile analysis and restriction enzyme analysis of whole cell DNA. All of the patients had identical chromosomal patterns and plasmid profiles, which differed from control isolates from other wards, indicating that the outbreak resulted from spread of a unique strain. None of 144 personnel who were cultured after recent contact with newly colonized patients during the outbreak were found to carry MRSA, which suggests that patients were the reservoir for transmission rather than caregivers. The most probable source for each individual transmission was determined based on proximity in time and space and shared exposure to caregivers. The rate of transmission of MRSA from patients on contact isolation was significantly lower (0.009 transmissions per day on isolation) than the rate for patients not on isolation (0.140 transmissions per day unisolated, relative risk = 15.6, 95% confidence interval 5.3-45.6, p < 0.0001). The authors conclude that the risk of nosocomial transmission of MRSA was reduced 16-fold by contact isolation during the outbreak in this neonatal intensive care unit. These data confirm the results of previous studies which have suggested that contact isolation was effective in controlling the epidemic spread of methicillin-resistant Staphylococcus aureus.
Contact Tracing↗
Central venous catheter-related infections: a review.
Catheter-associated bloodstream infections remain an important cause of nosocomial infection, with an estimated 50,000-100,000 cases occurring each year in the United States. Central venous catheters are believed to be responsible for 90% of such infections. The cumulative risk of acquiring a catheter-related bloodstream infection has ranged between 1 and 10% for central venous catheters in general and 6% for total parenteral nutrition catheters. The skin is the most common source of organisms causing catheter-related infections. Recent prospective studies have shown that the incidence density per catheter day does not increase with duration of catheterization and that routine changes, either over a guidewire or by new site puncture, do not appear to lower the risk of infection. Diagnosis of infection can be difficult in intensive care patients but is usually easier in less ill patients with a central venous catheter. Quantitative or semiquantitative laboratory techniques can be used to confirm the diagnosis in the appropriate clinical setting. A variety of preventive measures have been shown to minimize the risk of development of catheter-related bloodstream infection, including use of maximal aseptic technique for insertion, use of special teams for care of the catheter, limiting manipulation of the catheter, use of povidone-iodine ointment and cotton gauze dressings for recently inserted catheters, a silver-impregnated collagen cuff and antiseptic-impregnated catheters.
Bacteremia↗
Prevention of nosocomial influenza.
OBJECTIVE: To study compliance with preventive strategies at a university hospital during an outbreak of nosocomial influenza A during the winter of 1988, and the rates of vaccination of healthcare workers and of nosocomial influenza following changes in vaccine practices after the outbreak. DESIGN: Retrospective review of employee health, hospital epidemiology, hospital computing; and clinical microbiology records. SETTING: A university hospital. INTERVENTIONS: Unvaccinated personnel with exposure within the previous 72 hours to an unisolated case of influenza were offered influenza vaccine and 14 days of amantadine hydrochloride prophylaxis. Personnel with exposure more than 72 hours before evaluation were offered vaccine. A mobile cart was introduced for vaccinating personnel after the 1988 outbreak. RESULTS: An outbreak of influenza with 10 nosocomial cases occurred in 1988. Only 4% of exposed employees had been vaccinated previously and 23% of exposed, unvaccinated employees agreed to take vaccine, amantadine, or both. A mobile-cart vaccination program was instituted, and annual vaccination rates steadily increased from 26.3% in 1989 to 1990 to 38% in 1993 to 1994 (P < .0001). The relative frequency of documented cases of influenza in employees with symptoms of influenza decreased significantly during this period (P = .025), but nosocomial influenza rates among patients did not change significantly. CONCLUSION: A mobile-cart influenza vaccination program was associated with a significant increase in compliance among healthcare workers, but a majority still remained unvaccinated. The rate of nosocomial influenza among patients was not reduced by the modest increase in the vaccination rate, but influenza rates remained acceptably low, perhaps due to respiratory isolation of patients and furlough of employees with influenza.
Adolescent↗