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Hilary M Babcock

Publications and source records attributed to Hilary M Babcock.

8 recordsLinked to original sources
PubMed2006

Is influenza an influenza-like illness? Clinical presentation of influenza in hospitalized patients.

BACKGROUND: Early recognition of influenza virus infection in hospitalized patients can prevent nosocomial transmission. OBJECTIVE: To determine the clinical presentation of influenza in hospitalized patients. DESIGN: Case series. Data were collected retrospectively from medical records and included demographic information, comorbidities, clinical symptoms and signs, microbiologic test results, and outcomes (including pneumonia and intensive care unit [ICU] admission). SETTING: A 1,400-bed teaching hospital. PATIENTS: A total of 207 inpatients who received a diagnosis of influenza virus infection during 3 seasons from 2000 to 2003. RESULTS: Over the course of 3 seasons, 207 patients received a diagnosis of influenza (186 were infected with influenza A virus, and 21 were infected with influenza B virus). The most commonly reported symptoms were cough (186 patients [90%]) and subjective fever (137 patients [66%]); 124 patients (60%) had a documented temperature of 37.8 degrees C or greater before influenza was diagnosed. Sore throat was uncommon (44 patients [21%]). Centers for Disease Control and Prevention (CDC) criteria for influenza-like illness (ILI)--temperature 37.8 degrees C or greater and either cough or sore throat--were met by 107 patients (51%). There were no differences in the proportion of patients who met ILI criteria with respect to age, sex, season, influenza virus type, or time to diagnosis in the hospital. Most patients (150 [72%]) received acetaminophen. Only 41 patients (20%) had positive results of clinical cultures; 178 patients (86%) received antibiotic therapy. Fifty-six patients (27%) had pneumonia: 36 (17%) required admission to the ICU, and 25 (12%) required ventilatory support. Patients with pulmonary disease were more likely to require ventilatory support (12 [26%] vs 13 [8%]; P =.003). CONCLUSIONS: Only half of hospitalized patients with influenza met CDC criteria for ILI. These criteria may be more appropriate in outpatient settings. A high index of suspicion is needed to recognize influenza in hospitalized patients.

Adolescent↗
PubMed2004

An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects.

STUDY OBJECTIVES: To determine whether an educational initiative could decrease rates of ventilator-associated pneumonia in a regional health-care system. SETTING: Two teaching hospitals (one adult, one pediatric) and two community hospitals in an integrated health system. DESIGN: Preintervention and postintervention observational study. PATIENTS: Patients admitted to the four participating hospitals between January 1, 1999, and June 30, 2002, who acquired ventilator-associated pneumonia. INTERVENTION: An educational program for respiratory care practitioners and ICU nurses emphasizing correct practices for the prevention of ventilator-associated pneumonia. The program included a self-study module on risk factors for, and strategies to prevent, ventilator-associated pneumonia and education-based in-services. Fact sheets and posters reinforcing the information were posted throughout the ICU and respiratory care departments. MEASUREMENTS AND RESULTS: Completion rates for the module were calculated by job title at each hospital. Rates of ventilator-associated pneumonia per 1,000 ventilator days were calculated for all hospitals combined and for each hospital separately. Overall 635 of 792 ICU nurses (80.1%) and 215 of 239 respiratory therapists (89.9%) completed the study module. There were 874 episodes of ventilator-associated pneumonia at the four hospitals during the 3.5-year study period out of 129,527 ventilator days. Ventilator-associated pneumonia rates for all four hospitals combined dropped by 46%, from 8.75/1,000 ventilator days in the year prior to the intervention to 4.74/1,000 ventilator days in the 18 months following the intervention (p < 0.001). Statistically significant decreased rates were observed at the pediatric hospital and at two of the three adult hospitals. No change in rates was seen at the community hospital with the lowest rate of study module completion among respiratory therapists (56%). CONCLUSIONS: Educational interventions can be associated with decreased rates of ventilator-associated pneumonia in the ICU setting. The involvement of respiratory therapy staff in addition to ICU nurses is important for the success of educational programs aimed at the prevention of ventilator-associated pneumonia.

Adult↗
PubMed2003

Surgical site infections after arthroscopy: Outbreak investigation and case control study.

PURPOSE: The goal of this study was to determine the causes of increased post-arthroscopy surgical site infections (SSIs) and to define risk factors for infection. TYPE OF STUDY: Outbreak investigation and case control study at a university-affiliated community hospital from 1994 to 1996, with surveillance through 1999. METHODS: Demographic, clinical, and microbiological data were collected on 27 post-arthroscopy SSIs from 1994 through 1999. Risk factors for SSI were identified by case-control analysis and presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Initial investigation revealed an increased annual rate of post-arthroscopy SSIs in 1995 (1.3%). Infection control deficiencies were identified, and feedback was provided to surgeons and staff. Instrument sterilization was standardized, flash sterilization prohibited, and preoperative shaving discouraged. Case-control analysis of 10 cases (from 1994 to 1996) found a statistically significant increase in risk of SSI with intra-articular corticosteroid joint injection (OR, 9.33; 95% CI, 1.6 to 64.9); other risk factors did not reach statistical significance. SSI rates dropped after feedback and education (0.34% in 1996). Continued surveillance revealed 2 smaller outbreaks, in December 1997 (1997 rate, 1.13%) and September 1998 (1998 rate, 1.09%). Case-control analysis of the 17 cases occurring in 1997 through 1999 was also performed. The 1997 outbreak appeared to be related to preoperative razor shaving (P =.003), which was then prohibited by hospital policy. One scrub nurse was also associated with 75% of these cases, which were culture-positive for coagulase-negative Staphylococcus. The cases in the 1998 outbreak shared prolonged procedure duration and conversion to arthrotomy. Of 27 cases, 24 required repeat hospitalization and repeat surgery, at an average excess cost of $9,154.84 per case. All received prolonged courses of intravenous or oral antibiotics. CONCLUSIONS: Post-arthroscopy SSIs are associated with significant morbidity and cost. Although small numbers make finding statistical significance difficult in case-control studies, infection control and CDC-recommended interventions can lower SSI rates. Careful definitions, ongoing surveillance, and long-term follow-up are helpful in reporting results of infection control interventions.

Adrenal Cortex Hormones↗
PubMed2003

Differences in percutaneous injury patterns in a multi-hospital system.

OBJECTIVE: Determine differences in patterns of percutaneous injuries (PIs) in different types of hospitals. DESIGN: Case series of injuries occurring from 1997 to 2001. SETTING: Large midwestern healthcare system with a consolidated occupational health database from 9 hospitals, including rural and urban, community and teaching (1 pediatric, 1 adult) facilities, ranging from 113 to 1,400 beds. PARTICIPANTS: Healthcare workers injured between 1997 and 2001. RESULTS: Annual injury rates for all hospitals decreased during the study period from 21 to 16.5/100 beds (chi-square for trend = 22.7; P = .0001). Average annual injury rates were higher at larger hospitals (22.5 vs 9.5 PIs/100 beds; P = .0001). Among small hospitals, rural hospitals had higher rates than did urban hospitals (14.87 vs 8.02 PIs/100 beds; P = .0143). At small hospitals, an increased proportion of injuries occurred in the emergency department (13.7% vs 8.6%; P = .0004), operating room (32.3% vs 25.4%; P = .0002), and ICU (12.3% vs 9.4%; P = .0225), compared with large hospitals. Rural hospitals had higher injury rates in the radiology department (7.7% vs 2%; P = .0015) versus urban hospitals. Injuries at the teaching hospitals occurred more commonly on the wards (28.8% vs 24%; P = .0021) and in ICUs (11.4% vs 7.8%; P = .0006) than at community hospitals. Injuries involving butterfly needles were more common at pediatric versus adult hospitals (15.8% vs 6.5%; P = .0001). The prevalence of source patients infected with HIV and hepatitis C was higher at large hospitals. CONCLUSIONS: Significant differences exist in injury rates and patterns among different types of hospitals. These data can be used to target intervention strategies.

Database Management Systems↗
PubMed2003

Ventilator-associated pneumonia in a multi-hospital system: differences in microbiology by location.

OBJECTIVE: To determine whether there were differences in the microbiologic etiologies of ventilator-associated pneumonia in different clinical settings. DESIGN: Observational retrospective cohort study of microbiologic etiologies of ventilator-associated pneumonia from 1998 to 2001 in a multi-hospital system. Microbiologic results were compared between hospitals and between different intensive care units (ICUs) within hospitals. SETTING: Three hospitals--one pediatric teaching hospital, one adult teaching hospital, and one community hospital--in one healthcare system in the midwestern United States. PATIENTS: Patients at the target hospitals who developed ventilator-associated pneumonia and for whom microbiologic data were available. RESULTS: Seven hundred fifty-three episodes of ventilator-associated pneumonia had culture data available for review. The most common organisms at all hospitals were Staphylococcus aureus (28.4%) and Pseudomonas aeruginosa (25.2%). The pediatric hospital had higher proportions of Escherichia coli (9.5% vs 2.3%; P < .001) and Klebsiella pneumoniae (13% vs 3.1%; P < .001) than did the adult hospitals. In the pediatric hospital, the pediatric ICU had higher P aeruginosa rates than did the neonatal ICU (33.3% vs 17%; P = .01). In the adult hospitals, the surgical ICU had higher Acinetobacter baumannii rates (10.2% vs. 1.7%; P < .001) than did the other ICUs. CONCLUSIONS: Microbiologic etiologies of ventilator-associated pneumonia vary between and within hospitals. Knowledge of these differences can improve selection of initial antimicrobial regimens, which may decrease mortality.

Cohort Studies↗
PubMed2001

Postarthroscopy surgical site infections: review of the literature.

The use of arthroscopy for both diagnosis and operative intervention has been increasing steadily since its introduction in the 1970s. It is generally associated with fewer complications and shorter times to mobilization than are open procedures. Overall reported rates of complications are low (0.1%-0.6% of procedures). This review focuses on infectious complications of arthroscopy, which are rare (0.01%-0.48% of procedures) but result in significant morbidity for the patient when they occur. The most commonly reported causative organisms are staphylococci. Several outbreaks have been reported related to breaks in infection control or to contaminated instruments. Suggested risk factors include use of intra-articular corticosteroids, prolonged tourniquet time, patient's age >50 years, failure to prepare the surgical site again before conversion to arthrotomy, procedure complexity, and a history of previous procedures. However, most reports use variable and unclear definitions of infection, which makes it difficult to draw firm conclusions.

Arthroscopy↗