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Biomedical subjects

E Larson

Publications and source records attributed to E Larson.

At least 91 records · Page 5Linked to original sources
PubMed1985

Effect of an expanded physical facility on nosocomial infections in a neonatal intensive care unit.

Fifty-two months' data were reviewed to assess the effect of a threefold increase in space per infant in a neonatal intensive care unit on rates of nosocomial infections (NIs) and colonization with Staphylococcus aureus (39 months in a crowded 18-bed unit and 13 months in a spacious 32-bed unit). Mean length of stay, survival rates, mean birth weights, and other parameters indicated that infant populations in the old and new units were similar. NI rates were not significantly different in the old and new units (11.7% and 9.6%, respectively; p = 0.17) nor were rates of colonization of anterior nares with S. aureus (11.7% and 10.7%; p = 0.5). NI rates, but not S. aureus colonization rates, were significantly higher during months of high patient turnover (p less than 0.01). Sites of infection were similar in the old and new units. There was, however, a significant change in bacterial species causing NI. Klebsiella pneumoniae and Pseudomonas aeruginosa caused 20.4% of NIs in the old unit, but only 2.1% in the new unit (p less than 0.001) and NIs caused by S. epidermidis increased from 4.7% to 14.9% (p = 0.02) in the new unit. There was also a marked decrease in the numbers of clusters of NI occurring in the new unit, indicating that cross-infections between infants were probably minimized.

Cross Infection↗
PubMed1985

Chlamydial infections.

Chlamydiae are small bacteria that have a unique life cycle. There are two species, Chlamydia psittaci and C. trachomatis, which cause a wide spectrum of clinical disease, including neonatal conjunctivitis and pneumonia, sexually transmitted disease, psittacosis, and trachoma. The importance of chlamydial disease in public health is being increasingly recognized, and the incidence in developed countries seems to be increasing. An understanding of chlamydial disease, its prevention and treatment, is essential for the infection control practitioner, who can play a significant role in patient education.

Chlamydia↗
PubMed1985

Handwashing and skin. Physiologic and bacteriologic aspects.

Handwashing practices are often based on tradition and belief. To develop sound rationale for handwashing practices, the physiologic and bacteriologic effects of handwashing must be examined. The purposes of this article are to review the three major microenvironments of the skin with their bacterial flora, to discuss physiologic and bacteriologic characteristics of the skin with particular reference to handwashing, and to describe current handwashing recommendations and practices.

Age Factors↗
PubMed1985

Evaluating handwashing technique.

Though standards for handwashing have been defined, little effort has been made to assess the quality of handwashing in clinical settings. This paper describes tests of reliability and validity of tools to evaluate two aspects of handwashing--appropriateness and technique. Based on these tests, methods to evaluate handwashing are recommended.

Attitude of Health Personnel↗
PubMed1985

Quality assurance. Evaluate thyself.

Quality assurance (qa) programs must be documented carefully, systematically, and completely to be of continued value. A literature review revealed that no tools had been developed to evaluate the effectiveness of qa programs. A tool was designed and tested to assess the reports of qa studies, as an initial step in establishing the benefits of qa. The tool was found to yield reproducible results and its use is recommended to others.

Hospital Bed Capacity, 500 and over↗
PubMed1985

Infection control issues in critical care: an update.

NIs continue to be a frequent and serious complication in the critically ill patient. Although not all NIs can be prevented, two essential components of health care practice that are aimed at protecting both patients and staff have been discussed--isolation techniques and handwashing. We have also discussed the infectious complications of intravascular therapy, one of the most essential and common treatments for the critically ill patient. An effective infection control program for critical care must have certain elements: established standards of infection control practice, continual surveillance and feedback regarding infection rates, adequate physical facilities including personnel to maintain a clean environment, orientation and continuing education for personnel, but most important, a staff with a high level of awareness about the need to prevent NI. This awareness is developed by a leader who communicates his/her concern about the issue of infection control.

Attitude of Health Personnel↗
PubMed1984

Bringing the new isolation guideline into focus.

In 1983 the Centers for Disease Control published a new Guideline for Isolation Precautions in Hospitals. This article briefly reviews some general principles of barrier techniques, compares the old and revised isolation guidelines, and discusses the difficulty in obtaining compliance with isolation practices.

Body Fluids↗
PubMed1984

Effects of handwashing agent, handwashing frequency, and clinical area on hand flora.

Six hundred twenty-two isolates from 554 samples taken from hands of 103 hospital personnel and 50 controls were obtained over a mean period of 35 days. Eighty-five were obtained immediately before and after handwashing (HW), the remainder after HW only. The relationship of HW agent used, clinical area and job, and frequency of HW to rates of bacterial colonization and numbers and types of organisms isolated, particularly gram-negative bacteria, were evaluated. The HW agent used ( nonantiseptic , hexachlorophene-based, chlorhexidine-based, or iodophor) was significantly correlated with the number of isolates obtained from each sample. Control subjects, all of whom used nonantiseptic soaps, had 1.42 mean isolates per sample; hospital personnel who used nonantiseptic soap had a mean of 1.00 isolates per sample. Other means were 1.25, hexachlorophene; 1.43, iodophor; 0.79, chlorhexidine; and 0.67 for those who used several different antiseptics, p less than 0.0001. The agent was also correlated with the type of organisms isolated (p = 0.002), but not with the counts of colony-forming units (CFU). Frequency of HW was significantly correlated with CFU counts before (p = 0.03) and after (p = 0.001) HW. In general, numbers decreased with increasing HW frequency, but at the higher HW frequencies there was a slight rise. There were significant differences in numbers of isolates per sample according to clinical area, with personnel working in obstetrics and nonpatient areas having the greatest number and those working on neonatal and medical-surgical units having the least (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Infective Agents, Local↗
PubMed1984

A decade of nosocomial Acinetobacter.

A review of nosocomial infections (NI) from January 1971 to April 1981 was conducted in a university-affiliated hospital to examine NI caused by Acinetobacter and to determine whether a rising trend in rates could be detected. Acinetobacter accounted for 85 of 6115 (1.4%) NI. Sites of infection were respiratory tract (42.2%), blood (17.8%), peritoneum (16.7%), urinary tract (10%), surgical wounds (7.8%), central nervous system (3.3%), and skin or eye (2.2%). All patients who developed NI from Acinetobacter were receiving systemic antimicrobial therapy; 58.8% were in the intensive care unit (ICU). The highest rates of Acinetobacter infection occurred in the early 1970s (2.3%); the lowest occurred from 1978 to 1981 (0.94%), p approximately 0.06. This decrease primarily resulted from two factors: a reduction in cross-infections, probably related to a structural change in the ICU from open-bed ward to single rooms, and the elimination of peritoneal infections traced to contamination of dialysate solution. We conclude that in this institution no rise in the proportion of NI caused by Acinetobacter has occurred over the past decade; if anything, there is a downward trend.

Acinetobacter↗
PubMed1984

A decentralized approach to maintenance of intravenous therapy.

A prospective experiment was conducted in a university-affiliated hospital to evaluate the effectiveness of a core of specially trained staff nurses in the maintenance of IV therapy. Five staff nurses for each of two experimental units were trained for 1 month by an IV nurse educator and were expected to perform venipuncture and monitor peripheral IV care on their units. On three control units, IV therapy continued to be a shared function of all medical house staff and nurses. During this study, 876 IV infusions on 707 patients were studied. There was a decrease in the phlebitis rate on experimental units from baseline to study periods of from 33.5% to 20.9% (relative risk, controlled for duration of the use of an IV device, 0.53, p = 0.05), whereas the rate on control units increased slightly (23.8% to 26.7%, p = greater than 0.5). Regardless of duration of use, steel needles were associated with lower phlebitis rates than were plastic catheters. The mean duration that each infusion device was in place was significantly shorter on experimental units than on control units (2.4 vs. 3.3 days, p = less than 0.001). However, bacterial colonization of IV devices occurred more often on experimental units than on control units both at baseline (12.7% vs. 7.1%; p = 0.25) and during the study phase (19.4% vs. 5.9%; p = less than 0.01). This increased colonization occurred with IV infusions started by both physicians and nurses. There were no septic complications of IV therapy in the patients studied. Patient comfort, measured by number of sticks for each venipuncture and patient interview, was significantly improved (p = less than 0.001) on experimental units during the study phase. Costs to start such a decentralized IV program on 10 clinical units was calculated to be about +10,000. This study provides information useful to those making administrative decisions regarding the value of IV teams or other methods for IV therapy maintenance. We concluded that a decentralized program can be successful with commitment of time and money resources and with a system of monitoring to ensure compliance with written IV guidelines.

Adult↗
PubMed1984

Storage of human breast milk.

The bacteriologic content of expressed breast milk was studied in 30 mothers at the time of expression and after 24 and 48 hours of refrigeration. There were no significant differences in colony counts between the three time intervals. All samples contained Staphylococcus epidermidis. In addition, eight other species were found, including four which were gram-negative. All samples contained less than 10(6) colonies/ml, and there were no significant differences in mean colony counts between samples expressed at home and at the hospital. We conclude that it is bacteriologically safe to refrigerate expressed breast milk for up to 48 hours.

Adult↗