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Biomedical subjects

Jeannie P Cimiotti

Publications and source records attributed to Jeannie P Cimiotti.

8 recordsLinked to original sources
PubMed2006

Impact of staffing on bloodstream infections in the neonatal intensive care unit.

OBJECTIVE: To examine the association between registered nurse staffing and healthcare-associated bloodstream infections in infants in the neonatal intensive care unit (NICU). DESIGN: Prospective cohort study. SETTING: Two level III-IV NICUs in New York, NY, from March 1, 2001, through January 31, 2003. PARTICIPANTS: A total of 2675 infants admitted to the NICUs for more than 48 hours and all registered nurses who worked in the same NICUs during the study period. Intervention Hours of care provided by registered nurses. Main Outcome Measure Time to first episode of healthcare-associated bloodstream infection. RESULTS: A total of 224 infants had an infection that met the study definition of healthcare-associated bloodstream infection. In a multivariate analysis, after controlling for infants' intrinsic and extrinsic risk factors, a greater number of hours of care provided by registered nurses in NICU 2 was associated with a decreased risk of bloodstream infection in these infants (hazard ratio, 0.21; 95% confidence interval, 0.06-0.79). CONCLUSION: Our findings suggest that registered nurse staffing is associated with the risk of bloodstream infection in infants in the NICU.

Birth Weight↗
PubMed2005

Gram-negative bacilli associated with catheter-associated and non-catheter-associated bloodstream infections and hand carriage by healthcare workers in neonatal intensive care units.

OBJECTIVE: Bloodstream infections caused by Gram-negative bacilli are a substantial cause of morbidity and mortality in infants in neonatal intensive care units. This study describes the species of Gram-negative bacilli causing bloodstream infections in two neonatal intensive care units, compares characteristics of catheter-related and non-catheter-related bloodstream infections, and compares species and antibiotic resistance patterns of these organisms with those isolated from the hands of nurses working in the same neonatal intensive care units. DESIGN: Interventional study. SETTING: Two high-risk neonatal intensive care units. PATIENTS: Neonates hospitalized for >or =24 hrs. INTERVENTIONS: Prospective surveillance for bloodstream infections was performed in two neonatal intensive care units from March 2001 to January 2003. Hand cultures were obtained quarterly from participating nurses immediately after they performed hand hygiene. MEASUREMENTS AND MAIN RESULTS: There were 298 episodes of bloodstream infections among 2,935 admissions (5.75 episodes per 1,000 patient-days); 77 of 298 (26%) episodes were caused by Gram-negative bacilli. Among these, 47 (61.0%) were catheter-related bloodstream infections (2.61 episodes per 1,000 catheter-days). Eleven and 24 Gram-negative bacilli species were isolated from neonates and nurses, respectively. The most common Gram-negative bacilli causing bloodstream infections were Klebsiella pneumoniae (38.7%), Escherichia coli (21.2%), Enterobacter cloacae (11.2%), and Serratia marcescens (11.2%). In contrast, Acinetobacter lwoffi (18.1%), K. pneumoniae (11.7%), E. cloacae (10.6%), K. oxytoca (10.6%), and Pseudomonas spp. (7.4%) were most commonly isolated from hands of nurses. E. coli, P. aeruginosa, E. cloacae, and E. aerogenes were significantly more likely to cause bloodstream infections than to be isolated from nurses' hands (all p < .001). Although 39% of bloodstream infections were non-catheter-related, there were no significant differences in types of organisms or antimicrobial resistance patterns between catheter-related bloodstream infections and non-catheter-related bloodstream infections (all p > or = .35). Resistance patterns were similar between Gram-negative bacilli isolates from neonates and nurses' hands except for a significantly higher proportion of resistance to cefotaxime and gentamicin among neonatal isolates of K. pneumoniae (p < .05). CONCLUSIONS: Gram-negative bacilli species isolated from neonatal bloodstream infections and nurses' hands varied significantly. Clean hands of providers are an unlikely source of endemic Gram-negative bacilli, suggesting that prevention strategies should focus more on control of endogenous neonatal flora or environmental sources.

Bacteremia↗
PubMed2004

Emergence of resistant staphylococci on the hands of new graduate nurses.

OBJECTIVE: To describe the aerobic microbial flora on the hands of experienced and new graduate nurses over time. DESIGN: A prospective cohort design that examined the relationship between duration of employment in an intensive care unit (ICU) and the microbial flora on the hands of experienced and new graduate nurses during a 23-month period. SETTING: A 50-bed, level III-IV neonatal ICU in New York City. PARTICIPANTS: Twelve experienced nurses and 9 new graduate nurses working full time in the NICU. INTERVENTION: One hundred fifty samples were obtained from the clean, dominant hands of the nurses. Cultures were performed at baseline and then quarterly for each experienced and new graduate nurse. Baseline and final cultures of Staphylococcus epidermidis were further examined using pulsed-field gel electrophoresis. RESULTS: At baseline, a significantly larger proportion of the experienced nurses had methicillin-resistant, coagulase-negative staphylococci isolated from their hands compared with the new graduate nurses (95% and 33%, respectively; P = .0004). For a second culture, performed 1 to 4 months later, there were no longer significant differences between the two groups (82% and 54%, respectively; P = .12). By the last culture, all staphylococcal isolates were methicillin resistant in both groups of nurses; 3 were methicillin-resistant S. aureus. CONCLUSIONS: Colonization with methicillin-resistant staphylococci occurred after brief exposure to the hospital environment, despite the use of antiseptic hand hygiene agents. Furthermore, at final culture, the two groups shared one dominant hospital-acquired strain of S. epidermidis.

Cohort Studies↗
PubMed2003

Adverse reactions associated with an alcohol-based hand antiseptic among nurses in a neonatal intensive care unit.

BACKGROUND: Alcohol-based hand antiseptics are strongly recommended in the 2002 Centers for Disease Control and Prevention's hand-hygiene guideline. In a study comparing 2 hand-hygiene regimes, an alcohol-based (61% ethyl) antiseptic and a detergent containing 2% chlorhexidine gluconate in 2 neonatal intensive care units, we noted adverse reactions associated with the alcohol-based antiseptic. METHODS: A prospective study was conducted of the skin condition of 58 nurses using an alcohol-based product from March 2001 to January 2002. Adverse reactions to the alcohol-based product were noted and the Fisher exact test was used to determine factors associated with these reactions. Nurses with reactions to the alcohol product who were available to follow-up were patch tested to the product. RESULTS: Of 58 (1.1/100 nursing mo) nurses, 7 were evaluated by occupational health services for dermatologic symptoms that varied from mild to severe after use of the alcohol product, but 4 of 7 have resumed use. Nurses who had adverse reactions develop had been employed on the study unit and in the nursing profession for significantly less time than those with no reactions (P =.037 and P =.002, respectively), and were significantly more likely to report a history of itchy, sore skin (P =.047). A positive patch-test result was noted in 3 of 4 nurses with a previous reaction to the product. CONCLUSION: This case series will alert users in the United States and elsewhere to the nature of reactions to alcohol products and how these reactions differ from reactions to traditional hand antiseptic products.

Adult↗
PubMedDate not supplied

The magnet process and the perceived work environment of nurses.

BACKGROUND: Several studies have described the work environment of nurses from magnet and nonmagnet hospitals, but there have been no studies of nurses from hospitals in the magnet application process. OBJECTIVES: To compare the differences between characteristics of hospitals and nurses from three hospital types: magnet hospitals, hospitals in the process of applying for magnet certification, and nonmagnet hospitals, and how nurses from these hospitals perceive their work environment. METHODS: In a national, cross-sectional survey of critical care nurses, the Perceived Nursing Work Environment (PNWE) instrument was administered to measure nurses' perceptions of their work environment. RESULTS: Data were available from 2,092 nurse surveys. Over a third of the respondents were from in-process hospitals and almost half were from nonmagnet hospitals. The majority of nurses were female and from large hospitals in the Atlantic region. The mean age of nurses was 39.5 years and the mean years of work experience in the intensive care unit (ICU) was 10.2 years. Higher nurse scores were significantly associated with magnet certification on one subscale of the PNWE, nursing competence. DISCUSSION: Nurses from magnet hospitals had a positive perception of nursing competence in their work environment. Further research is necessary to examine the nurse work environment and to determine if the characteristics of magnet hospitals have changed.

Adult↗
PubMedDate not supplied

A cost comparison of hand hygiene regimens.

The cost and quality of two hand hygiene regimens were compared. A waterless alcohol-based rub was significantly less costly than traditional handwashing because of reduced time required, and was associated with significantly better quality.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Assessing nurses' hand hygiene practices by direct observation or self-report.

Methods of obtaining data on hand hygiene practices have not been well validated. The purpose of this study was to compare two methods of assessment of hand hygiene practices--direct observation and self-report using diaries. For 22 months, nursing staff (n = 119) from two neonatal ICUs recorded their hand hygiene practices on a diary card one shift/month (n = 1,071 diary cards). The same data were collected in monthly 1-hour direct observation sessions (n = 206 hours). Amount of time in gloves and total hand hygiene episodes/hour did not differ significantly by diary or observation, but four other specific parameters were significantly different. If hand hygiene practices are to be assessed over time, the same method must be used. Given these measurement limitations, more valid, practical, and less costly methods are needed.

Data Collection↗