Biomedical subjects

B N Doebbeling

Publications and source records attributed to B N Doebbeling.

At least 37 records · Page 2Linked to original sources

PubMed1996

Blood and body fluid exposures during clinical training: relation to knowledge of universal precautions.

To investigate the relation between knowledge of universal precautions and rates of exposure to blood and body fluid during clinical training, a cohort of 155 students was surveyed following training in universal precautions and 18 months later. A total of 127 students (82%) participated; 58 (46%) experienced at least one exposure during the first clinical training year. Knowledge of universal precautions was inversely associated with the frequency of mucous membrane exposures (p .001); an apparent "dose-response" effect was evident (one-way analysis of variance; F = 5.2, p - 0.007). Students are frequently exposed to blood and body fluid during clinical training. Higher levels of retained knowledge about universal precautions are associated with a decreased risk of mucous membrane exposure.

Health Knowledge, Attitudes, Practice↗

PubMed1996

Student health policies of U.S. medical schools.

BACKGROUND: Medical students are at risk of exposure to bloodborne pathogens, yet few data are available about U.S. medical schools' policies to protect students. METHOD: A cross-sectional survey of the student affairs deans at the 126 U.S. medical schools was conducted in May 1994. A confidential questionnaire inquired about policies regarding vaccination for hepatitis B virus (HBV), blood and body-fluid exposures, universal precautions training, and health and disability insurance for students. RESULTS: A total of 108 (86%) of the schools participated in the survey. Most (99, 92%) required either HBV vaccination, evidence of immunity, or a signed waiver refusing vaccination. Nearly all (94, 87%) required health insurance, and almost all (101, 94%) offered a plan (at a mean cost of $690 annually), but fewer schools (69, 64%) offered disability insurance. The schools frequently held students responsible for the costs of HBV vaccination (73, 68%), postexposure serologic testing (22, 20%), and treatment of training-related medical problems (43, 40%). CONCLUSION: Most medical schools comply with current recommendations for preventing training-related exposures to bloodborne pathogens, illness, and injury, but students face a substantial financial responsibility for these services at a time when many have large debts. Many schools do not have disability insurance readily available for students. Medical schools should review their student health policies to protect students adequately.

Blood-Borne Pathogens↗

PubMed1996

Predictors of hepatitis B vaccine acceptance in health care workers.

This article examines the relative importance of occupational, epidemiologic, and attitudinal factors in hepatitis B vaccine acceptance. A stratified random sample of 1,018 health care workers at risk for occupational blood exposure at our university hospital were contacted in 1992 and 919 (90%) participated. Potential reasons for vaccine acceptance or refusal were evaluated with factor analysis. Logistic regression models were calibrated on a stratified random subsample to identify independent predictors of initiating and completing the series, then validated on the remaining subjects. Fifty-four percent (482 of 898) of previously nonimmune workers had completed the series, while 70% (626) had received one or more doses. Hepatitis B vaccine acceptance was related strongly to social influence (physicians, supervisors, role models, friends, and spouse) and knowledge of the disease and vaccine, whereas refusal was primarily related to concern about vaccine side effects and problems with vaccine access. Independent predictors of initiating the vaccine series included younger age (odds ratio [OR] 0.98 per year, 95% confidence interval [CI95] 0.96-0.997), occupation (housestaff: OR 2.9, CI95 1.1-7.9; nurses: OR 2.1, CI95 1.0-4.3 versus housekeepers), increased blood exposure frequency (OR 2.4, CI95 1.6-3.5 for 1-6 versus 0 exposures in past year), and increased frequency of recent influenza vaccination (OR 3.3, CI95 2.0-5.3 for 1 versus 0 doses in prior 3 years). Occupation (increased acceptance among housestaff, nurses, nursing assistants, laboratory technicians), increased frequency of blood exposure, and recent influenza vaccination also were predictors of series completion. Factors such as occupation, blood exposure frequency and acceptance of other preventive services may help identify health care worker groups with low vaccine acceptance most likely to benefit from targeted vaccine delivery. Hepatitis B vaccine should be offered routinely during evaluation for occupational blood exposure. Future vaccine implementation efforts should emphasize the involvement of physicians and supervisors and education about occupational disease risk, liability, and the safety of the vaccine.

Adult↗

PubMed1995

Universal precautions training of preclinical students: impact on knowledge, attitudes, and compliance.

BACKGROUND: Little information exists regarding the impact of universal precautions training programs on preclinical students' knowledge, attitudes, and behavior. METHODS: We developed, implemented, and assessed an educational program in universal precautions for 2nd-year medical and preclinical physician assistant students. Students (n = 170) completed pre- and post-training questionnaires to assess universal precautions knowledge and to evaluate attitudes about their perceived risk for bloodborne pathogen infection, the importance of universal precautions procedures, and their willingness to provide care for human immunodeficiency virus (HIV)-positive or acquired immune deficiency syndrome (AIDS) patients. Phlebotomy, intravenous catheter insertion, and arterial blood gas sampling techniques were demonstrated, practiced, and evaluated during practical training sessions. Outcome measures included changes in pre- and posttraining knowledge scores and attitudes, as well as observed compliance with universal precautions during practical training. RESULTS: Universal precautions knowledge scores increased significantly after training (P < 0.0001). Personal assessments of the risk of developing HIV due to patient care significantly decreased (P < 0.0001) and willingness to provide care for AIDS patients increased (P = 0.004) following training. Importantly, students reported that high expected rates of contact with HIV-positive and other patient groups would not significantly affect their specialty choice. Observed compliance with universal precautions procedures during practical training ranged from 95 to 99% for glove use, 76 to 77% for direct sharps disposal without needle recapping, and 56 to 78% for handwashing after glove removal during phlebotomy and intravenous catheter insertion. CONCLUSIONS: This program is effective in increasing students' knowledge of universal precautions. Training favorably affects students' willingness to care for HIV-positive patients and their assessed risk of developing occupational bloodborne infection.

Blood Specimen Collection↗

PubMed1995

Motivation for hepatitis B vaccine acceptance among medical and physician assistant students.

PURPOSE: To evaluate the acceptance rate and motivation for acceptance of hepatitis B virus (HBV) vaccine among preclinical medical and physician assistant (PA) students in comparison with similar data obtained from resident and staff physicians. METHODS: A cross-sectional survey of all second-year medical and PA students (n = 170) at the University of Iowa College of Medicine was conducted in Spring 1992, requesting demographic data, preventive health measure use, and reasons for HBV vaccine acceptance. Responses were compared with data obtained from resident and staff physicians during a concurrent hospital-wide survey. Rates of vaccine acceptance and use of other preventive health measures were compared across the physician groups. Factor analysis was performed to examine reasons for vaccine acceptance among the students. RESULTS: The questionnaire was completed by 162 of the 170 students (95%). Nearly all (99%) of the eligible students had received at least one dose of the HBV vaccine. Vaccine acceptance rates were significantly higher among the students than among either the resident or the staff physicians (p = 0.003, p < 0.0001, respectively). Influenza vaccine acceptance and seat belt use were significantly higher among the resident and staff physicians than they were among the students. The students attributed their high HBV vaccine acceptance rate to the recommendations of authority figures. Threat of illness and issues of vaccine safety and efficacy were relatively unimportant among the students, though the residents and staff physicians reported threat of illness to be an important motivator for vaccination. CONCLUSIONS: Excellent HBV vaccine acceptance rates may be achieved among preclinical medical and PA students. Recommendations of authority figures are important motivators for HBV vaccine acceptance among students.

Adult↗

PubMed1995

Employee health and infection control.

Hospital employees are at risk for exposure to a variety of communicable diseases, which they may transmit to patients and other workers. The employee health service plays a critical role in an effective infection control program. In this article, we outline the major responsibilities of the employee health service and summarize key current recommendations for management of exposures.

Bacterial Infections↗

PubMed1995

Familial carriage of methicillin-resistant Staphylococcus aureus and subsequent infection in a premature neonate.

During routine surveillance of patients in a Neonatal Intensive Care Unit (NICU), an alert infection-control practitioner confirmed the relationship of the index patient (sibling 3) who had a methicillin-resistant Staphylococcus aureus (MRSA) infection to an infant sibling (sibling 2) who had been admitted to the hospital 7 months previously with an MRSA infection. Cultures of nasal specimens obtained from the index patient's parents and two other siblings also yielded MRSA for two of the family members, the mother and sibling 1. The strains were typed by antibiogram, plasmid analysis, and genomic DNA typing. The isolates from sibling 1, sibling 2, the mother, and one isolate from sibling 3 were found to be identical by all techniques. The other isolates from sibling 3 shared the same genomic type but had no detectable plasmids. These findings suggest that transmission of this strain occurred at least three times within this family and that at least one family member was colonized with the same strain for 7 months or more. Recognition that family members may serve as reservoirs for nosocomial infections with MRSA raises important issues for infection control.

Adult↗

PubMed1995

Investigation of Candida albicans transmission in a surgical intensive care unit cluster by using genomic DNA typing methods.

An apparent outbreak of serious Candida albicans infections (n = 6) occurred in a surgical intensive care unit over a 4-week period. Four patients developed C. albicans bloodstream infections. An additional patient developed catheter-related C. albicans infection; the sixth patient developed an infection of cerebrospinal fluid. C. albicans was isolated from the hands of five health care workers (17%) and the throat of one health care worker (3%) during the outbreak investigation. Karyotyping and restriction endonuclease analysis of genomic DNA with BssHII of 23 C. albicans isolates from patients and the 6 health care worker isolates revealed 9 and 12 different patterns, respectively. Three of six patients appeared to be infected with the same C. albicans strain (two bloodstream infections and one cerebrospinal fluid infection). The hands of a health care worker were colonized with strain that appeared identical to an isolate from a patient prior to infection of the patient. However, restriction endonuclease analysis with SfiI found differences among the isolates determined to be identical by the other two methods. Karyotyping alone does not appear to be sufficient to differentiate between outbreak and control isolates. Restriction endonuclease analysis typing may be a more sensitive method than karyotyping alone in the investigation of a cluster of C. albicans infections. Furthermore, the use of more than one restriction enzyme may be necessary for optimal strain discrimination in restriction endonuclease analysis of genomic DNA.

Candida albicans↗

PubMed1995

The epidemiology of methicillin-resistant Staphylococcus aureus colonisation and infection.

Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common nosocomial pathogen in health care facilities throughout the world. Overall, approximately two-thirds of nosocomial cases and outbreaks have occurred in critical care units. Major risk factors for colonisation and infection in nursing homes include age, underlying conditions, nasal colonisation and the presence of indwelling devices such as catheters, tracheostomies and nasogastric tubes. In general, patients with MRSA infections in an acute care facility are more likely to have had a prolonged hospital stay, to have received prior antibiotics and to have severe underlying disease, than patients infected with methicillin-susceptible S. aureus. Risk factors for MRSA bacteraemia include: a higher frequency of severe underlying disease, poorer underlying prognosis, prior antibiotic therapy, prolonged hospitalisation, intravascular catheterisation, and intensive care unit location. Risk factors for developing MRSA postoperative wound infections include: prior antimicrobial therapy, prolonged hospitalisation and severity of underlying disease. Little data are available to identify specific risk factors for colonisation or infection of burn wounds by MRSA.

Cross Infection↗

PubMed1994

Long-term efficacy of intranasal mupirocin ointment. A prospective cohort study of Staphylococcus aureus carriage.

BACKGROUND: We investigated the long-term effect of a single 5-day application of intranasal mupirocin calcium ointment on Staphylococcus aureus nasal and hand colonization. The subjects were 68 healthy volunteers who were health care workers with stable S aureus nasal carriage and who had participated in a randomized, double-blind placebo-controlled clinical trial of intranasal mupirocin ointment. METHODS: A 1-year prospective cohort study of S aureus nasal carriers after treatment with active drug or placebo was performed. Cultures were obtained from all subjects 6 and 12 months after therapy. All subjects returned for the 6-month visit; 63 (93%) were examined at 1 year. The major outcome measure was the relative proportion of any S aureus cultured at either site at 6 and 12 months. The S aureus isolates were typed by restriction endonuclease analysis of plasmid DNA and by antibiotic susceptibility tests; the similarity of nasal and hand isolate "fingerprints" was compared. RESULTS: At 6 months, nasal carriage was 48% in the treatment group vs 72% in controls (relative risk, 0.68; 95% confidence interval, 0.45 to 1.02; P = .054); at 1 year, nasal carriage was 53% vs 76%, respectively (relative risk, 0.70; 95% confidence interval, 0.48 to 1.02; P = .056). Hand carriage at 6 months was significantly reduced among mupirocin recipients relative to controls (15% and 48%; P = .04, adjusted for the baseline rate of hand carriage). Thirty-six percent of treated subjects were recolonized in the nares with a new strain at 1 year, whereas 34% had reisolation of the original strain after initially negative posttherapy cultures. During the year of follow-up, hand carriage was observed at least once in two thirds of the subjects. Nearly all of the hand isolates (87%) exactly matched the subjects' coincident nasal plasmid fingerprint and antibiogram type. CONCLUSIONS: A single brief treatment course of intranasal mupirocin was effective in reducing nasal S aureus carriage for up to 1 year. When S aureus was recovered after nasal decolonization, the new isolate was as likely to represent colonization with a new strain as reisolation of the original strain. Staphylococcus aureus hand carriage was significantly decreased 6 months after therapy, further implicating the nares as the primary reservoir site for hand carriage.

Administration, Intranasal↗

PubMed1994

Candida tropicalis vertebral osteomyelitis: a late sequela of fungemia.

Two adult patients who had undergone bone marrow transplantation had transient fungemia due to Candida tropicalis during the posttransplantation neutropenic period and later (at 5 and 14 months post-transplantation) developed vertebral osteomyelitis due to the same organism. The courses of all adult patients who underwent bone marrow transplantation at our center during this time were reviewed for determining the frequency of this problem. Molecular typing techniques were used to establish the relationship between the organisms isolated during the initial fungemia and those causing the subsequent osteomyelitis. Only two of 532 adults who received transplants at our center from 1980 to 1993 developed candidal osteomyelitis. Moreover, they are part of a subset of 13 patients (2.4% of the total) whose cultures were positive for C. tropicalis; five of the 13 had fungemia. The study of fungal isolates from prior sites of colonization and from blood sampled during the original fungemia and of subsequently recovered vertebral bone isolates by means of DNA restriction fragment analysis (with use of standard agarose gel electrophoresis or pulsed-field gel electrophoresis) showed that the colonizing, bloodstream, and bone isolates were identical in each case. Transient C. tropicalis fungemia in severely immunocompromised patients may cause important late infectious complications, including osteomyelitis. Although these initial septic events may appear to resolve easily, the outcome in the two cases in this report suggests that special treatment considerations, such as immediate removal of the central venous catheter and intensive treatment with amphotericin B, may be required in selected cases for prevention of late sequelae.

Adult↗

PubMed1994

Investigation of the sequence of colonization and candidemia in nonneutropenic patients.

Among neutropenic patients with hematologic malignancies, candidemia has been shown to arise typically from autoinfection after colonization. In patients without neutropenia, we examined the similarities of strains colonizing or infecting various body sites and those subsequently causing Candida bloodstream infections. Strain similarity was examined by karyotyping and restriction endonuclease analysis of genomic DNA (REAG) by using two restriction enzymes (SfiI and BssHII). The banding patterns of 42 isolates from 19 patients were independently evaluated in a blinded fashion by three observers. The interobserver reliability measured with a generalized kappa statistic was 0.59 for karyotyping, 0.84 for REAG with SfiI, and 0.88 for REAG with BssHII (P < 0.001 for each). REAG classified the initial colonizing or infecting isolate and subsequent blood isolates as identical in 16 patients (84%). The mean duration of colonization or infection prior to a positive blood culture was 5 and 23 days in patients infected with related and unrelated isolates, respectively (P = 0.14; 95% confidence interval = -14.5 to 50.5). Karyotyping results matched the REAG results for isolates from 14 of the 19 patients (74%). In patients infected with identical isolates, the initial isolate was most frequently recovered from the urine (n = 5) or vascular catheter tips (n = 4). In the five subjects with organisms showing disparate results between the methods, karyotyping revealed different banding patterns, whereas REAG suggested that the isolates were identical. Candida colonization or infection with an identical strain frequently precedes bloodstream infection in nonneutropenic patients. Future studies should evaluate whether patients at high risk for candidemia and who have vascular catheter or urine samples that are positive for a Candida on culture should be treated empirically.

Adult↗

PubMed1994

Nasal and hand carriage of Staphylococcus aureus in healthcare workers.

Six double-blind, randomised placebo-controlled clinical trials in the United States have evaluated the elimination of Staphylococcus aureus carriage in healthcare workers with mupirocin ointment. Consistent data from the six centres demonstrated that calcium mupirocin ointment administered intranasally for five days is safe and effective in eliminating nasal carriage of S. aureus. Hand cultures were also performed at one centre, showing that hand carriage rates were significantly decreased 72 hours post-therapy and at six months. Additionally, molecular typing of all isolates obtained from the nares and hands found identical strains at both sites in the majority of subjects, implicating the nares as the primary reservoir of S. aureus colonisation.

Adolescent↗

PubMed1994

Mental health treatment in primary care: physician treatment choices and psychiatric admission rates.

OBJECTIVE: To evaluate how primary care physician characteristics, patient characteristics, and adequacy of local specialty resources influenced 1) primary care physician mental health treatment practices, and 2) inpatient psychiatric admission rates. METHODS: A mailed survey was conducted of a stratified sample of 107 primary care physicians in six rural and urban locations. Small area variation data were examined for the six areas to relate survey findings to psychiatric admission rates. We compared characteristics and specialty resources to treatment practices and admission rates through linear and logistic regression analyses. RESULTS: Survey responses were received from 52% of physicians (n = 56). Respondents and nonrespondents had similar demographic characteristics. Physician characteristics, particularly self-rated confidence, were related to referral, prescription, and on-site counseling practices. Primary care treatment practices were associated with admission rates, especially for substance abuse and dependence. CONCLUSIONS: Attention to studies of physician confidence is indicated, as is attention to studies of providing mental health training and treatment guidelines to primary care physicians, especially for substance abuse.

Ambulatory Care↗

PubMed1993

Outbreak of Pseudomonas aeruginosa infections in a surgical intensive care unit: probable transmission via hands of a health care worker.

Pseudomonas aeruginosa was isolated from nine patients (16.2 isolations/1,000 patient-days) in a surgical intensive care unit during an outbreak in November 1990; this rate of isolation was three times higher than that noted previously on this unit. Three patients were infected with the same strain, as defined by identical serotypes, pyocin types, and contour-clamped homogeneous electric field (CHEF) electrophoresis patterns of digested genomic DNA. The hands of 80 health care workers were cultured, and a strain of P. aeruginosa identical to that infecting the three patients was isolated from the hands of a nurse providing care to all three. Environmental surfaces, medical devices, and ward stock supplies were cultured; none of these cultures yielded this strain. No clusters of infection with this strain or other strains of P. aeruginosa were observed after compliance with hand-washing and universal precautions was reemphasized. Thus this outbreak was linked to the carriage of P. aeruginosa on the hands of a health care worker. It could not be determined definitively whether this carriage was the source of the cluster or a consequence of it. However, the geographic and temporal clustering of carriage with an outbreak due to a strain of an apparently identical molecular type underlines the importance of routine hand washing between contacts with different patients.

Adult↗

PubMed1993

Comparison of pulsed-field gel electrophoresis with isoenzyme profiles as a typing system for Candida tropicalis.

Candida species are important nosocomial pathogens, particularly in immunocompromised and critically ill patients. A variety of methods have been used to differentiate strains, but an optimal system has not been established. We compared methods for typing a panel of nine related isolates of Candida tropicalis from an outbreak of sternal wound infections as well as four unrelated control isolates of this species. (The genetic relationships of the nine isolates in the panel had been confirmed previously by restriction fragment analysis.) Typing was undertaken without knowledge of an isolate's origin. Karyotyping by contour-clamped homogeneous electric field (CHEF) gel electrophoresis failed to distinguish between outbreak and control isolates. However, when chromosome-sized DNA was digested with SfiI, EagI, SacII, or NaeI and the fragments were separated by CHEF electrophoresis, the outbreak isolates were readily identified. The isoenzyme profiles of the outbreak isolates were identical and were distinctly different from those of the control isolates. While both isoenzyme profiles and the modified CHEF procedure were discriminatory, the latter is recommended as a relatively convenient and reproducible technique for comparison of types of C. tropicalis.

Acid Phosphatase↗

PubMed1993

Elimination of Staphylococcus aureus nasal carriage in health care workers: analysis of six clinical trials with calcium mupirocin ointment. The Mupirocin Collaborative Study Group.

Six double-blind, independently randomized studies evaluated the efficacy and safety of calcium mupirocin ointment in eliminating nasal carriage of Staphylococcus aureus among health care workers. Healthy volunteers with stable nasal carriage of S. aureus (n = 339) received either calcium mupirocin ointment (n = 170) or an identical placebo ointment (n = 169) intranasally for 5 days. Nasal carriage was eliminated 48-96 hours after completion of treatment in 130 (91%) of 143 evaluable volunteers receiving mupirocin but in only 8 (6%) of 142 evaluable volunteers receiving placebo. The 85% crude difference represents a 90% pooled (adjusted) estimate of the risk difference (95% confidence interval, 0.86-0.95) and a risk ratio of 16 (P < .0001). This effect of treatment with mupirocin was observed consistently (risk ratio, 8-32) in all six centers. In addition, 96 of the 130 mupirocin-treated volunteers and 1 of the 8 placebo-treated volunteers who were culture-negative at the end of therapy remained free of S. aureus 4 weeks after treatment. Adverse events in each treatment arm were mild and equally frequent. These data, consistent across six institutions, demonstrate that calcium mupirocin ointment administered intranasally for 5 days is safe and effective in eliminating stable nasal carriage of S. aureus.

Administration, Intranasal↗

PubMed1993

Transferrin and lactoferrin undergo proteolytic cleavage in the Pseudomonas aeruginosa-infected lungs of patients with cystic fibrosis.

Bacterium- and neutrophil-derived proteases have been suggested to contribute to tissue injury at sites of Pseudomonas aeruginosa infection. Pseudomonas elastase cleavage of transferrin enhances in vitro iron removal from this protein by the P. aeruginosa siderophore pyoverdin. This cleavage also generates new iron chelates which, in contrast to iron bound to transferrin, are able to catalyze formation of the highly cytotoxic hydroxyl radical from neutrophil-derived superoxide and hydrogen peroxide via the Haber-Weiss reaction. In order to determine whether this cleavage occurs in vivo, a chemiluminescence immunoblot system was developed to detect the presence of proteolysis products of transferrin or the related iron-binding protein, lactoferrin. Using this immunoblot system, we detected transferrin and lactoferrin cleavage products in bronchoalveolar lavage (BAL) samples from 21 of 22 and 20 of 21 cystic fibrosis (CF) patients, respectively. Three of eleven and two of nine BAL samples from individuals with other forms of chronic inflammatory lung disease had transferrin and lactoferrin cleavage products, respectively. Each patient in whom such products were detected was also infected with P. aeruginosa. No such products were detected in normal individuals. In the CF patients, there was no clear correlation between the extent of transferrin or lactoferrin cleavage and BAL neutrophil or P. aeruginosa concentration or the disease status of the patient. In contrast, in the non-CF patients with chronic inflammatory lung disease, transferrin and lactoferrin cleavage products were detected only in those BAL samples which contained the greatest concentration of both neutrophils and P. aeruginosa. These data provide evidence that P. aeruginosa- and/or human-derived protease cleavage of transferrin and lactoferrin occurs in vivo in the airways of individuals with CF and other forms of chronic lung disease, suggesting that this process could contribute to P. aeruginosa-associated lung injury in these patients.

Adult↗