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Biomedical subjects

E L Larson

Publications and source records attributed to E L Larson.

49 records · Page 3Linked to original sources
PubMed1986

Composition and antimicrobic resistance of skin flora in hospitalized and healthy adults.

The aerobic bacterial flora of the skin of the anterior nares, axilla, perineum, and toe web in a group of 37 patients hospitalized for at least 2 weeks was compared with the flora of 30 healthy adults. Colony counts were significantly higher for flora of the perineum and toe web in both groups (P less than 0.05). Patients had significantly higher carriage rates of Proteus, Pseudomonas, and Candida spp. (P less than 0.01). Staphylococcus haemolyticus was isolated more frequently from patients, and S. hominis was isolated more frequently from controls (P less than 0.01). Patient microflora, including gram-positive cocci, gram-negative bacilli, large-colony diphtheroids, and lipophilic diphtheroids, showed a high degree of resistance to multiple antimicrobial agents. The gram-positive coccal flora of patients was significantly more resistant than that of controls for 8 of 10 antimicrobial agents tested. Methicillin resistance occurred in only 2.9% of isolates from controls, but in 44.3% from patients (P less than 0.01). This extensive survey identifies qualitative and quantitative differences in skin flora and confirms that significantly higher levels of antimicrobial resistance are present in all types of organisms from a number of skin sites in hospitalized patients.

Adolescent↗
PubMed1986

Infection.

Explore the source record for details and available documents.

Aged↗
PubMed1981

The effect of private isolation rooms on patient care practices, Colonization and infection in an intensive care unit.

Conversion of an intensive care unit (ICU) from an open unit to isolation rooms permitted study of patient care practices, colonization and infection in both settings. Air sampling and observation of patient care practices included 99 of 410 open unit patients (168 patient-hours during nine months) and 68 of 1,022 isolation room patients matched on the basis of risk factors for infection and staff contact (113 patient-hours during 12 months). Number and type of interactions between staff and patients, and frequency of handwashing and its relationship to patient-staff interactions were recorded. All ICU patients were monitored daily for signs of and selected risk factors for infection, and material for culture for six surveillance organisms was obtained every four days. Numbers of persons interacting with a patient hour were 6.1 +/- 3.5 in the open units and 4.9 +/- 2.8 in the isolation rooms (0.05 less than P less than 0.10). Frequency of handwashing did not increase significantly in the unit providing convenient sinks, occurring in an observed to expected ratio of only 24 percent. Over-all rates of infection in the open unit and isolation rooms were 15.0 and 13.4, respectively. Half of the infections occurring in patients with complete cultures obtained on admission were caused by organisms colonizing the patient upon admission to the ICU. The isolation rooms did not appear to reduce nosocomial acquisition (P = 0.168, Mantel-Haenszel) of the six surveillance organisms. We conclude that many patient-staff interactions in an ICU are not followed by handwashing, and that the new unit design had no apparent effect upon the frequency of handwashing or over-all incidence of colonization and infection in the ICU.

Air Microbiology↗
PubMed1981

Persistent carriage of gram-negative bacteria on hands.

The hand floras of 103 hospital personnel and 50 controls were studied over a mean of 35 days. One or more of 22 species of gram-negative bacteria (GNB) were found to be carried persistently on the hands of 22 (21%) hospital personnel and 40 (80%) controls (age-adjusted relative risk (RR) 3.2; p less than 0.001). Males were significantly more often carriers than females (age-adjusted RR 1.8; p less than 0.01), and persons who washed hands less than eight times per day were significantly more likely to persistently carry the same species of GNB on the hands than those who washed more than eight times per day (group-adjusted RR 2.4: p less than 0.001). Predominant organisms from both groups were species of Acinetobacter (45%) and Klebsiella-Enterobacter (39%). Twenty-one percent of 541 nosocomial infections over a 7-month period in the study institution were caused by species found on personnel hands. The same distribution of species types between hospital personnel and controls indicated that handwashing regimens used by hospital personnel were reducing numbers of organisms without shifting the ecologic balance of bacterial populations on the hands. It was concluded that such organisms are much more prevalent on normal skin than generally thought.

Cross Infection↗
PubMed1980

Analysis of three variables in sampling solutions used to assay bacteria of hands: type of solution, use of antiseptic neutralizers, and solution temperature.

Tests were performed using the sterile bag technique to determine the effects of type of sampling solution, use of antiseptic neutralizers, and solution temperature on the detection and quantitation of bacteria on hands. Using paired hand cultures, three sampling solutions were compared: quarter-strength Ringer solution, a phosphate buffer containing Triton X-100, and the same buffer containing antiseptic neutralizers. The phosphate buffer containing Triton X-100 was significantly better than quarter-strength Ringer solution in mean bacterial yield; the neutralizer-containing sampling solution was slightly better than Triton X-100-containing solution, although differences were not significant at the P = 0.05 level. Temperature (6 or 23 degrees C) of the sampling solution showed no consistent effect on bacterial yield from hands tested with the fluid containing neutralizers.

Adult↗
PubMedDate not supplied

Differences in skin flora between inpatients and chronically ill outpatients.

BACKGROUND: Changes in skin flora have been reported among hospitalized and critically ill patients, but little is known about whether these changes are associated with hospitalization or with chronic, serious illness. The purpose of this survey was to compare skin flora of chronically ill outpatients and inpatients. METHODS: Aerobic skin flora of forearm and midsternum of 250 patients in an intensive care unit and 251 outpatients was sampled by contact plates. RESULTS: Mean colony-forming units were 160.6, forearm; 229. 4, sternum (P <.000). In logistic regression analysis, patients in the medical intensive care unit were significantly more likely to have high counts on the arm (odds ratio, 2.48; 95% confidence interval: 1.34-4.43; P =.004), and blacks were significantly more likely to have higher counts on the sternum when compared with other ethnic groups (odds ratio, 1.92; confidence interval: 1.18-3.11; P =. 009). No differences were noted between inpatients or outpatients in prevalence of methicillin-sensitive Staphylococcus aureus, but inpatients were more likely to carry methicillin-resistant Staphylococcus aureus (arm, P =.007; sternum, P =.02). Outpatients had a higher prevalence of micrococci and gram-negative bacteria at both skin sites (all P <.01) and yeast at the sternal site (P =.007). CONCLUSIONS: This comparison provides data to differentiate between effects of hospitalization and effects of chronic illness on skin flora.

Aged↗
PubMedDate not supplied

Increasing clinical use of pulse oximetry.

Changing the system from measuring blood gases through invasive measures to using noninvasive pulse oximetry is a challenge in the Critical Care Unit where invasive techniques are taken for granted. The authors report a project that was successful in increasing the use of noninvasive monitoring techniques by critical care nurses in a Surgical Intensive Care Unit. This clinical project became an important aspect of incorporating the staff in a change to more extensive use of pulse oximetry. This study defines the change in nursing practice with the use of pulse oximetry. The authors discuss three areas: (1) demonstration of the correlation between O2Sat as measured by the pulse oximeter and arterial blood gas saturations; (2) introduction of the pulse oximeter as a reliable alternative to ABGs when monitoring oxygenation; and (3) the establishment of guidelines for using pulse oximetry within the clinical setting.

Blood Gas Analysis↗
PubMedDate not supplied

A comparison of the auscultated acceleration test and the nonstress test as predictors of perinatal outcomes.

In this prospective study, the predictive ability of the nonstress test (NST), the most widely used antepartum screening test to assess fetal well-being, was compared with that of the auscultated acceleration test (AAT) in predicting perinatal outcomes. The AAT is a more easily administered test than the NST, and, unlike the NST, does not use electronic fetal monitors. Study subjects were 205 women with singleton pregnancies greater than 34 weeks' gestation, whose delivery occurred within 7 days of receiving antepartum testing by NST at Johns Hopkins Hospital. The AAT yielded better prediction of poor perinatal outcomes than the NST. The NST, however, was a significantly better predictor of favorable outcomes than the AAT. The AAT has the potential to affect perinatal care if false positive results can be decreased through further research.

Adult↗
PubMedDate not supplied

In vitro survival of skin flora in heparin locks and needleless valve infusion devices.

OBJECTIVE: To determine the extent to which two types of infusion devices, the heparin lock and a needleless valve device, allowed the persistence of inoculated microorganisms. DESIGN: Experiment. SETTING: Clinical microbiology laboratory. OUTCOME MEASURES: Bacterial counts in infusion devices. INTERVENTION: Five of each type of device were inoculated with approximately 10(5) colony-forming units of a strain of Staphylococcus epidermidis and Enterobacter aerogenes and tested for growth at seven time intervals, from 10 minutes to 72 hours after inoculation. RESULTS: Both strains of bacteria were present in each device at every time interval tested, including 72 hours after inoculation. CONCLUSIONS: Bacteria introduced into a heparin lock or valve device may be isolated for prolonged periods of time. This suggests that if such devices are contaminated during use, they may be a potential source of infection. The risk of infection should be one major consideration in risk and benefit deliberations when choosing new products.

Catheters, Indwelling↗