Biomedical subjects
Publications and source records attributed to K H Chavigny.
As nursing rises to meet the challenges of change, it is increasingly important to present the claims of nursing in terms that are morally and scientifically accountable. The challenge to balance the interests of the professions with the interests of patients will continue as healthcare issues are determined.
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An historical cohort study of risk factors associated with nosocomial infection was conducted in two university hospitals on the East and West Coast of the USA. The purpose of the study was to estimate the relative risk ratios (RR) associated with antibiotic therapy, instrumentation, surgical operations and age with nosocomial infection, and to establish the hierarchical relationship of these factors to each other. A high risk cohort of long-staying patients (average length of stay = 30 days), was selected and each patient's chart was analysed retrospectively for infection occurrence and for risk factors. There was no significant difference between hospitals in rates of nosocomial infections, diagnostic categories and utilization of risk factors. Categorical linear regression analysis showed that a four factor model consisting of antibiotic therapy, instrumentation, surgical operations and age accounted for 95 per cent of the variation in nosocomial infection rates. Length of stay was treated as a co-dependent variable. Multivariable stratification analysis yielded aetiologic fractions of 63 per cent attributable to antibiotic therapy, 26 per cent to surgical operations, and 13 per cent to instrumentation. About half the antibiotic therapy was given on admission or at least 4 days before the first hospital-acquired infection. These data support careful assessment of prophylactic antibiotic therapy and infection control policies to reduce risk of nosocomial infection in university hospitals.
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If n different analytical procedures are applied to a culture of a pathogen, then that pathogen is characterized by an ordered sequence or vector of length n. A group of such sequences (or 'susceptibility patterns' as they are called in this context) can be generated by applying this process to cultures taken from infected individuals in an epidemic. This paper introduced statistical tests that can be used to determine whether a pattern obtained from the culture of a single case differs from those patterns obtained from cultures of a group of infected individuals. The methods are applied to come nosocomial epidemics. These taxonomic techniques extend beyond the present application to other classification problems in the biological and medical sciences.
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A descriptive study comparing the use of the gram-positive skin cleansers Zephiran and hexachlorophene to Prepodyne, a gram-negative cleanser, was performed upon 1, 469 specimens from patients attending the prenatal clinic of a large university hospital. The period prevalence rate of symptomatic and asymptomatic bacteriuria in 1, 350 patients was 11.5 per cent. Group teaching compared to individualized teaching of the patients to collect their own aliquots did not appear to have a measurable effect upon the levels of bacteriuria. Significant differences were found at p equals 0.05 between all the serially sampled groups using the different cleansers. No significant difference was found between the two groups using only hexachlorophene when compared for differences between patient-collected and nurse-collected specimens; nevertheless, the patient-collected specimens had greater proportions of low bacterial counts than those collected by the nurses. This study indicates that carefully instructed patients in large clinic populations are more efficient than the nurses when they collect their own midstream specimens, using an adequate cleansing agent. An analysis of the rates disclosed that Zephiran cleansing had high contamination levels, whereas Prepodyne significantly reduced contamination of the specimens. However, the possible reduction of the rate of 10-5 specimens to 9.1 per cent in the group using Prepodyne did not rule out the possibility of reduced specificity, and the hazard of false-negative results occuring with the use of gram-negative skin cleansers requires further study.
Four fatal cases of neonatal herpes simplex infection occurred during a two-month period in the perinatal intensive care unit of a hospital. Virus isolation or serologic studies, or both, implicated herpesvirus hominis type 2 in all four cases. Three of the infants developed symptoms in the first week of life and were probably infected in utero or at delivery. The fourth infant did not develop signs of illness until age 6 weeks, an interval much longer than that expected with disease acquired at birth. An epidemiologic investigation indicated that the most likely source of this fourth infant's herpes infection was by indirect contact with one of the other three infected neonates. Nosocomial spread of herpes simplex virus within a hospital nursery, although uncommon, may pose an added risk to the newborn infant if nursery techniques among infants are compromised.
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Patients in two acute care university hospitals were entered into the study using the following method: twenty patients were selected each day from all floors/units in each hospital until the hospital communities had been surveyed only once. A total of 762 hospital patients were identified for the study, and the history of each patient was then abstracted from their charts. The data were analyzed as an historical cohort study design. The two hospital samples were compared to show the effects of the nonrandom sampling method using one hospital as a comparison group for the other. Expected associations between nosocomial infection and known risk factors were compared and contrasted between the hospitals using cumulative incidence rates and relative risk ratios. The average length of stay of the group of patients in each hospital was extended from a mean of ten days to a mean of 30 days. The only significant difference between the two hospital cohorts was an age effect. The advantages and disadvantages of this method for selecting a long staying cohort at high risk for nosocomial infection in acute care facilities are detailed.