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Biomedical subjects

E Creamer

Publications and source records attributed to E Creamer.

9 recordsLinked to original sources
PubMed2004

Implications of colonization of vancomycin-resistant enterococci (VRE) in renal dialysis patients. Learning to live with it?

Vancomycin-resistant enterococci (VRE) commonly colonize, but less frequently infect, debilitated patients, such as those on chronic renal dialysis. The emergence of VRE amongst our cohort of renal replacement therapy patients posed considerable challenges in our attempts to prevent spread. Although 60 of 451 (13%) patients became colonized, only two patients required systemic antibiotics for confirmed or suspected invasive infection. Mortality and inpatient stay was greater in VRE-positive compared with VRE-negative patients (50% versus 10%) and patients who were screened on three or more occasions were likely to remain positive (e.g. 56% of patients screened on six occasions were positive). The application of recommended guidelines for the control of VRE, however, severely disrupted our renal dialysis programme and therefore had to be abandoned. As patients on renal dialysis are more likely to acquire VRE, remain colonized, require antibiotics and require regular inpatient or outpatient care more frequently than other patients, control measures should be adapted to minimize spread but not disrupt important and essential medical services.

Adolescent↗
PubMed2004

A cluster of leptospirosis cases in canoeists following a competition on the River Liffey.

On 6 November 2001, a possible case of leptospirosis was notified in a canoeist following a white-water event on the River Liffey. It emerged that a second race participant was also a possible case. An outbreak control team coordinated the epidemiological investigation, laboratory investigation, environmental assessment, communication and control measures. A cluster of six laboratory-confirmed cases of leptospirosis, serologically Leptospira interrogans serogroup Icterohaemorrhagiae was found. The attack rate was 9.2% (6/65). Fever, chills, red eyes and shortness of breath were significantly associated with being a confirmed case. Five cases were hospitalized. Swallowing more than one mouthful of water was associated with an increased risk of developing leptospirosis. Increased rainfall and release of hydroelectric water may have contributed to this outbreak. A multidisciplinary approach and use of the Internet and e-mail facilitated rapid and effective communication.

Adolescent↗
PubMed2004

The epidemiology of infectious syphilis in the Republic of Ireland.

In response to the increasing numbers of syphilis cases reported among men having sex with men (MSM) in Dublin, an Outbreak Control Team (OCT) was set up in late 2000. The outbreak peaked in 2001 and had largely ceased by late 2003. An enhanced syphilis surveillance system was introduced to capture data from January 2000. Between January 2000 and December 2003, 547 cases of infectious syphilis were notified in Ireland (415 were MSM). Four per cent of cases were diagnosed with HIV and 15.4% of cases were diagnosed with at least one other STI (excluding HIV) within the previous 3 months. The mean number of contacts reported by male cases in the 3 months prior to diagnosis was 4 (range 0-8) for bisexual contacts and 6 for homosexual contacts (range 1-90). Thirty one per cent of MSM reported having had recent unprotected oral sex and 15.9% of MSM reported having had recent unprotected anal sex. Sixteen per cent of cases reported having had sex abroad in the three months prior to diagnosis. The results suggest that risky sexual behaviour contributed to the onward transmission of infection in Dublin. The outbreak in Dublin could be seen as part of a European-wide outbreak of syphilis. The rates of co-infection with HIV and syphilis in Ireland are comparable with rates reported from other centres. There is a need to improve surveillance systems in order to allow real time evaluation of interventions and ongoing monitoring of infection trends.

Adolescent↗
PubMed2000

Investigation of an outbreak of gastroenteritis caused by Norwalk-like virus, using solid phase immune electron microscopy.

In February 1993, 95 persons (47 patients and 48 staff members) were affected by an hospital outbreak of viral gastroenteritis. Using direct electron microscopy (EM) the causative agent was identified as a small round structured virus. This was confirmed as a Norwalk-like virus using solid phase immune electron microscopy (SPIEM). Of 94 stool samples examined, 12 (13%) samples containing small round structured viruses (SRSV) were SPIEM positive for Norwalk-like virus. A further 25 (27%) samples contained small round featureless virus (SRFV) identified by direct EM and were negative on SPIEM. The illness was characterized by preceding influenza-like symptoms in 76% of cases followed by vomiting (76%), diarrhoea (79%) and abdominal pain (79%). One fatality was recorded. The outbreak lasted for 15 days, with a peak incidence of new cases amongst patients and staff occurring on day 5. It was controlled through a combination of ward closures, patient cohorting, suspension of duties for affected staff and disinfection procedures. Difficulties were encountered in the education of staff and in the implementation of environmental control measures. Screening of hospital catering services and a case control study, carried out among affected staff members, failed to identify a foodborne source. Consumption of tap water in the hospital was commoner among affected staff members than among controls, but this did not reach significance (P = 0.1).

Aged↗
PubMed1996

Suction apparatus and the suctioning procedure: reducing the infection risks.

Serious infection has been related to the use of suction apparatus and to the suctioning procedure. Prevention of infection focuses on aseptic technique, handwashing, decontamination and sterilization of apparatus where appropriate. This article considers the infection risks arising from use of suction apparatus, the suctioning procedure and sets out recommendations for infection prevention.

Cross Infection↗
PubMedDate not supplied

Examining the care of patients with peripheral venous cannulas.

The purpose of this study was to examine nursing issues in the care of patients with peripheral venous cannulas (PVCs) with particular focus on duration of cannulation in order to minimize risk of infection. A tentative practice model evolved from this study. The research approach used involved qualitative methods utilizing grounded theory. Data analysis produced one tentative core category, 'effectiveness'. This allowed for the development of a 12-dimensional model explaining the nursing function against four interrelated models: development; practice; organizational support; effectiveness. Related to these four models were key professional aspects of 'autonomy-control' and 'knowledge-practice'. Interpretative findings from the study were plotted against this model, giving a graphic representation and highlighting strengths and weaknesses of nursing practice. Aspects requiring improvement included: PVC care as a syllabus subject; nursing practice; autonomy and control issues; shared responsibility problems; documentation systems; goal setting; outcomes. The policy, nurses' knowledge of PVC care and identification of critical issues were considered satisfactory. The model incorporates 12 important dimensions associated with effective practice that can be applied to nursing at different levels - clinical practice, education, management - and to other disciplines, providing a framework for narrowing the theory-practice gap and improving patient care.

Catheterization, Peripheral↗