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J A Sellick

Publications and source records attributed to J A Sellick.

11 recordsLinked to original sources
PubMed1997

Electronic mail: an imperative for healthcare epidemiologists.

Electronic mail (e-mail) offers the potential for near-instantaneous transfer of messages and files across thousands of miles. The same message can be sent simultaneously to multiple recipients and forwarded without retyping. Messages can be sent or read at any time, eliminating "telephone tag," and, because the system is paperless, lost, blurred, and incomplete, facsimile transmissions can be minimized. Additionally, e-mail is less expensive than overnight letter services or long-distance faxes. All healthcare epidemiologists should enter the information superhighway using e-mail. This article provides basic information needed to understand and begin using e-mail.

Computer Communication Networks↗
PubMed1995

Clinical and molecular epidemiology of Enterococcus faecalis bacteremia, with special reference to strains with high-level resistance to gentamicin.

The objective of this study was to characterize the clinical and molecular epidemiology of Enterococcus faecalis bacteremia, specifically that involving strains with high-level resistance to gentamicin (HLGR). Episodes of E. faecalis bacteremia at the Buffalo Veterans Affairs Medical Center from January 1986 to September 1989 were retrospectively identified. Of 94 episodes, 45 (48%) were due to strains with HLGR. Hemolytic activity was detected with greater frequency (85%) among the latter strains than among those without HLGR (P < .001). Of the 54 episodes for which medical charts were available for review, 94% were hospital acquired, and 46% were due to strains with HLGR. An examination of the plasmid DNA content of isolates revealed restriction-fragment-length polymorphism. One plasmid pattern was identified in 15 isolates with HLGR (P < .001), and chromosomal DNA digest patterns suggested a common clonality; there was no direct evidence for patient-to-patient spread of these strains. The use of antibiotics, the presence of invasive devices, surgery, and admission to an intensive-care unit were not significantly associated with HLGR bacteremia. Mortality during hospitalization was 65%, with no difference between figures for HLGR and non-HLGR infections. This high mortality regardless of gentamicin susceptibility status suggests that E. faecalis bacteremia is a marker for severe illness. In contrast to previous studies, this investigation identified no clinical factors associated with HLGR E. faecalis bacteremia.

Bacteremia↗
PubMed1992

Screening hospital employees for measles immunity is more cost effective than blind immunization.

OBJECTIVE: To examine alternative strategies in developing a cost-effective program to assure measles immunity among hospital employees. DESIGN: Observational. SETTING: Referral teaching hospital. PARTICIPANTS: Eighteen hundred "established" hospital employees with potential patient contact and 630 newly hired hospital employees. INTERVENTIONS: Established employees born after 1 January 1957 and all newly hired employees were screened for serologic evidence of measles immunity and immunized if necessary. MEASUREMENTS: Cost analysis. RESULTS: The cost of screening and directed immunization of established employees was $3.98 per employee compared with a potential cost of $10.03 to $42.80 per employee if all employees were "blindly" immunized with monovalent measles vaccine or trivalent mumps-measles-rubella vaccine. The cost of the screening and directed immunization of new employees was $2.42 per employee compared with potential costs of $8.30 to $39.34 per employee for blind immunization. These analyses assumed that varying percentages of employees would be able to produce documentation of having received a previous dose of vaccine or of having had measles. CONCLUSIONS: In a large referral hospital, screening for measles immunity followed by directed immunization was considerably less expensive than immunizing all potentially susceptible employees.

Cost-Benefit Analysis↗
PubMed1992

Occupational needlestick injuries: educational program and mechanical opening needle disposal boxes.

1. Needle recapping injuries, which individual employees have considerable ability to prevent, declined significantly following inservice education. 2. The problem of needles protruding into the opening of mechanical lids in needle disposal boxes persisted even after the inservice sessions. When clearlid, nonmechanical opening boxes were used, disposal injuries related to protruding needles declined significantly. 3. An educational program coupled with the appropriate placement of disposal boxes had a beneficial impact on some categories of needlestick injuries, although the total number of needlestick injuries did not decline.

Humans↗
PubMed1992

The varied clinical presentations of meningococcal infection.

The clinical presentation of Neisseria meningitidis may include bacteremia, septic shock, or meningitis. The polysaccharide capsule of the organism appears to be the major determinant and is necessary for specific immunity. Colonization of the nasopharynx is required for invasion, and persons with complement component deficiencies are particularly at risk of infection. The organism can be detected by culture of blood or spinal fluid, or by antigen detection in spinal fluid. Prompt therapy with penicillin G is necessary for a good outcome. The occurrence of secondary cases requires that prophylactic therapy be administered to close contacts of index cases. The cases presented herein illustrate a variety of manifestations of meningococcal infection, and all of the patients initially were seen in primary care settings. It is important for physicians to be vigilant for these infections so that appropriate therapy may be instituted rapidly.

Adolescent↗
PubMed1991

Surveillance of surgical wound infections following open heart surgery.

OBJECTIVE: To define accurate wound infection rates for the cardiac surgery service based on site of infection and characterization as "deep" or "incisional" and to determine whether a correctable cause for an apparent increase in deep wound infection rates existed. DESIGN: Observational. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: All adults undergoing open heart surgery in 1988 and 1989. INTERVENTIONS: Changed from razor to clipper preoperative hair removal in January 1989. RESULTS: Deep sternotomy wound infections decreased significantly from 1.2% in 1988 to 0.2% in 1989 (p = .010) and deep venectomy (vein donor site) wound infections declined from 1.6% to 0.4% (p = .014) during the same time period. Incisional wound infection rates did not change. Patients with deep infections more likely required readmission or operation to treat their infection than those with incisional wound infections. The percentage of gram-negative organisms causing wound infections decreased from 56.3% in 1988 to 34.7% in 1989 (p = .017). CONCLUSIONS: Preoperative hair removal using a clipper appears to have decreased the risk of deep wound infection compared with razor preparation. The dichotomous wound classification of "deep" and "incisional" distinguished between patients who required additional interventions for treatment of wound infections.

Cardiac Surgical Procedures↗
PubMed1991

Influence of an educational program and mechanical opening needle disposal boxes on occupational needlestick injuries.

OBJECTIVES: To determine whether an educational program had a beneficial impact on healthcare worker needlestick injuries, particularly those caused by recapping. Secondary goals were to evaluate the efficacy of in-room needle-boxes and to determine whether surveillance data were useful when evaluating new products. DESIGN: Survey of employee health department reports. SETTING: Tertiary care teaching hospital. PARTICIPANTS: Healthcare workers who reported needlestick injuries and other blood and body fluid exposures to the employee health department. INTERVENTIONS: Exposure data from the 10 months prior to institution of the educational program and installation of disposal boxes were compared with data from the following 27 months. Additionally, the type of disposal box was changed for the last 9 months of the survey. RESULTS: Needlestick injuries caused by recapping fell significantly following the educational program (p = .005). However, injuries caused by previously disposed needles protruding into the mechanical opening of the needleboxes increased significantly (p = .002). Following a change of needleboxes to a nonmechanical opening design, the latter type of injury declined (p = .052). Total needlestick injuries, most other categories of needlestick injury, and other exposures did not change significantly during the 37 months of the study. CONCLUSIONS: The educational programs appeared to have positive impact on reducing recapping injuries, but many other needlestick categories did not change significantly. Mechanical opening needle disposal boxes appear to present a hazard when compared with fixed opening boxes. Surveillance data appear to be useful in monitoring injuries as well as evaluating products.

Accidents, Occupational↗
PubMed1989

Epidural abscess and subdural empyema.

Epidural abscess and subdural empyema are serious intracranial infections that result in significant morbidity and mortality. Frequently, they are secondary to sinusitis or middle ear disease, and the bacteria involved are inhabitants of the upper respiratory tract. Symptoms may be mild and mimic the symptoms of the underlying infection. However, especially with subdural empyema, alteration in the level of consciousness and focal neurologic deficits are common. Morbidity and mortality are minimized by early diagnosis, which is best made with computed tomography scanning, and proper therapy, which consists of surgical drainage and administration of appropriate antimicrobials. It is important that primary care physicians be aware of the clinical features of these potentially fatal complications of common infections.

Adolescent↗