Orientation for new faculty members.
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Academies and Institutes↗
Biomedical subjects
J M Langley
Publications and source records attributed to J M Langley.
Surveillance methods for central venous access device-associated infections in Canadian pediatric hospitals.
The most common complication of central venous access device (CVAD) use is infection, which occurs in 3 to 48% of hospitalized patients. It is recommended that regular surveillance of adverse events with CVADs be conducted, expressed as a proportion of 1000 device days and reviewed and acted upon by the institution's infection control committee. In the process of developing a CVAD program the authors attempted to determine the standard of practice at other Canadian pediatric hospitals. A telephone survey of infection control practitioners (ICPS) or CVAD nurses in 15 university-affiliated Canadian pediatric hospitals was conducted using a standard questionnaire. Fourteen hospitals (93%) conduct surveillance for infections associated with CVADS. One program, a pilot project, follows mechanical complications of CVAD use. Eleven centres conduct comprehensive surveillance; in three, selected patients are followed. Only three programs have sufficient staff to follow out-patients. Definitions for CVAD infections varied widely. A positive blood culture from the catheter is sufficient for diagnosis in eight of the 14 centres (57%); the rest use Centers for Disease Control and Prevention (CDC) or modified CDC criteria. In the four centres where CVAD line days are collected on most or all patients, multiple personnel other than the ICP assist in data collection. Four hospitals report number of infections per 100 discharges, four report absolute number of infections and two use more than one denominator. Surveillance methods rely largely on paper-based chart and microbiology record review; no hospital had access to computerized patient data for direct data retrieval. Eight centres have CVAD committees for policy development, and all 15 have or are developing hospital-wide protocols for CVAD use. Canadian pediatric hospitals recognize the importance of CVAD infections, but it appears that insufficient resources are available to meet recommended data collection methods. Interhospital comparison of rates is not possible at present because of variation in definitions and denominators and in types of patients surveyed.
Catheterization, Central Venous↗
Demand for isolation beds in a pediatric hospital.
OBJECTIVE: To determine isolation bed use for community-acquired and nosocomial infections in a pediatric hospital. DESIGN: A prospective repeated point prevalence survey was conducted during a 14-month period. A questionnaire was sent to other free-standing Canadian children's hospitals to determine isolation practice and perceived needs. SETTING: A university-affiliated, 218-bed pediatric hospital in Halifax, Nova Scotia, Canada. PATIENTS: All inpatients on surveyed wards during the study period (n = 1634). RESULTS: Overall, 13.5% of patients required isolation (range 5.6% to 31% per month). Demand was seasonal, with 71% of isolation occurring from November to April. Demand exceeded supply by 2 to 22 beds (11% to 122%). Respiratory and enteric infections requiring contact isolation accounted for 80% of use (53% and 27%, respectively). Children younger than 24 months comprised 28% of admissions and used 57% of isolation beds. Of patients isolated, 25% had nosocomial infections and 75% had community-acquired infections. The percentage of infant rooms in Canadian children's hospitals that were single bed (considered optimal for infant isolation) varied: 0% to 20% for hospitals built before 1965 and 25% to 47% for newer hospitals. All hospitals with less than 33% single-bed infant rooms perceived this allocation to be inadequate (p < 0.01 Fisher Exact Test). CONCLUSIONS: Pediatric isolation bed use varies with patient age, season of year, and category-specific isolation requirements. An increasing need for single-bed rooms is identified. Isolation requirements must be considered during the design of new hospitals or renovation of existing ones.
Age Factors↗
Efficacy of antimicrobial prophylaxis in placement of cerebrospinal fluid shunts: meta-analysis.
The objective of this study was to determine if perioperative antimicrobial prophylaxis decreases the incidence of subsequent shunt infection in patients who require placement of internal CSF shunts. Data sources included a computerized search of two biomedical data bases, contact with colleagues, and a review of abstracts of meetings and of references of identified trials and reviews. Studies were chosen for detailed review if they involved human subjects who underwent CSF shunt placement, with random allocation of patients to groups receiving perioperative systemic antimicrobial agents or to a control group and an outcome measure of subsequent shunt infection. Twelve (32%) of 37 studies met selection criteria and were included. Features of trial design were extracted and trial quality was evaluated with use of a predetermined protocol by three independent investigators who were blinded to titles, authors, and institutions. Individually, only one of 12 trials achieved statistical significance favoring prophylaxis; in the aggregate, the use of prophylactic antibiotics was associated with a significant reduction in subsequent CSF shunt infection (Mantel-Haenszel weighted risk ratio: 0.52; 95% confidence interval: 0.37, 0.73; P = .0002; approximate risk reduction: 50%). This systematic overview of 12 trials of 1,359 randomized patients demonstrates that perioperative use of antimicrobial agents in CSF shunt placement significantly reduces the risk of subsequent infection.
Anti-Bacterial Agents↗
Evaluation of a tuberculosis screening program at a children's hospital.
Routine screening of patients for tuberculosis at the time of hospitalization and annual screening of hospital employees continue to be controversial. No data are available concerning tuberculosis screening programs at pediatric facilities. We reviewed the results of patient and employee tuberculosis screening programs in the last decade at the Izaak Walton Killam Hospital for Children. Four (11%) of 37 cases of tuberculosis were unsuspected until identified by the routine screening of all children at their admission to the hospital. No cases of tuberculosis were identified as a result of the employee screening program. Compliance with both screening programs was less than optimal. Review of programs at other Canadian pediatric centers demonstrated a range of practice. We conclude that routine screening of patients at the time of admission to the hospital and the annual screening of employees are unwarranted at present at our children's hospital. However, discontinuation of routine testing necessitates aggressive contact-tracing by public health authorities of patients with identified cases and periodic reevaluation of costs and benefits to determine whether reintroduction of screening is appropriate.
Hospital Bed Capacity, 100 to 299↗
Autosomal recessive inheritance of vasopressin-resistant diabetes insipidus.
We report on 2 intellectually normal sisters with vasopressin-resistant (nephrogenic) diabetes insipidus (NDI). The sex of the patients, the history of parental consanguinity, and the fact that both parents formed normally concentrated urine suggested that the NDI in the 2 sisters was the result of inheritance of an autosomal recessive mutation affecting renal tubular water reabsorption. The results of DNA analysis of the DXS52 locus with the use of St14 as probe, shown by Knoers et al. [1988] to be tightly linked to the NDI locus on the X-chromosome, showed that each girl inherited different Xq28 regions of the maternal X chromosomes, ruling out a diagnosis of classical X-linked NDI.
Consanguinity↗
Epidemiologic study of 4684 hospital-acquired infections in pediatric patients.
During a 4-year period 4684 nosocomial infections occurred in a university pediatric hospital which admitted 78,120 patients (nosocomial infection rate (NIR) = 6.0). NIR varied from 0.17 to 14.0 on different wards or services; the highest rates (greater than or equal to 5.6) were found in the Neonatal Intensive Care Unit, infant neurosurgery, hematology/oncology, neonatal surgery, cardiology/cardiovascular surgery, Pediatric Intensive Care Unit and infant/toddler medicine areas. Infections were most common in patients less than or equal to 23 months (NIR = 11.5), were less common in the 2- to 4-year age group (NIR = 3.6) and occurred least frequently in patients greater than or equal to 5 years (NIR = 2.6). The median day of onset of infections was 15.3 days. The proportional frequencies of infections were: 35% gastrointestinal; 21% bacteremia; 16% respiratory (10% upper, 6% lower); 7% postoperative wound; 6% urinary tract; 5% skin (32% of these skin infections were related to intravascular lines); 5% eye; 3% cerebrospinal fluid; and 2% other. A similar proportional frequency of 379 infections in patients hospitalized for more than 100 days was observed. The etiologic agents were Gram-positive bacteria (50%), viruses (23%), Gram-negative bacteria (18%), fungi (4%) and mixed/other (5%).
Adolescent↗
Poker players' pneumonia. An urban outbreak of Q fever following exposure to a parturient cat.
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Adult↗