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Biomedical subjects

L G Donowitz

Publications and source records attributed to L G Donowitz.

At least 37 records · Page 2Linked to original sources
PubMed1989

The high rate of blood donor exposure for critically ill neonates.

The purpose of this study was to determine the number and volume of red blood cell (RBC) transfusions and the number of donors a newborn is exposed to during his or her newborn intensive care unit (NICU) stay. On one day at the Medical University of South Carolina (MUSC) and two days at the University of Virginia Hospital (UVH) all babies who had or were receiving RBCs comprised the study group. Patient records were reviewed at discharge. Fifty-two (70%) of the 75 NICU babies had or were receiving RBCs and were enrolled. The average number of RBC transfusions was nine (range 1 to 28, median 7) and the average transfusion volume was 16.5 ml (range 5 to 60) for a total volume of 148 ml transfused during a NICU stay. Each baby was exposed to an average of 6.9 donors (range 1 to 25, median 6.5). The practice of splitting RBC packs to share among different infants and of giving multiple small volume transfusions maximizes donor exposure and transfusion-related infectious risks in this population.

Blood Donors↗
PubMed1989

The inanimate environment of an intensive care unit as a potential source of nosocomial bacteria: evidence for long survival of Acinetobacter calcoaceticus.

Environmental surface and personnel hand impression cultures were obtained during 13 sampling periods in the University of Virginia Pediatric Intensive Care Unit to document potential reservoirs of nosocomial pathogens. In 78 environmental cultures Staphylococcus aureus was found eight times and gram-negative bacilli ten times. The patient chart cover was the most commonly contaminated surface. Acinetobacter calcoaceticus was found in five of ten cultures positive for gram-negative bacilli. Thirty of 59 hand cultures were positive for S aureus and gram-negative bacilli; nurses and residents had both, respiratory therapists only gram-negative bacilli, and A calcoaceticus was the most commonly isolated bacterium of potentially nosocomial significance (14/30). Laboratory investigation of bacterial survival revealed that gram-negative bacilli survived on a dry formica surface from a few hours up to three days but Acinetobacter survived up to 13 days. Since A calcoaceticus has been implicated in many nosocomial infections, its long survival on a dry surface may be an additional factor in its transmission in hospitals and suggests that more attention be paid to environmental surfaces as a source of significant nosocomial pathogens.

Acinetobacter↗
PubMed1989

Hospital-acquired urinary tract infection.

From 16,534 admissions, 60 patients, 4 days to 15 years of age, with one or more hospital-acquired urinary tract infections were identified during a 5-year period by a prospective surveillance system. The patient charts were subsequently reviewed to characterize the population at risk for such infections and to describe the course and consequences of these infections. Infections in individual patients ranged from one to greater than 50. The hospital-acquired urinary tract infection rate for the study period was 14.2 infections per 1,000 admissions. In the patients in whom all urinary tract infections were well documented, the following characteristics were defined: (1) 92% (97 of 105) of the infections occurred in catheterized patients; (2) almost half (49 of 105) of the infections occurred in patients exposed to only intermittent catheterization; (3) 28% (29 of 105) of the infections were asymptomatic; (4) fever was the most frequent finding in the symptomatic patients and occurred in 66% (60 of 105); (5) pyuria was found in only 51% (35 of 69) of the urinalyses performed at diagnosis; (6) 85% (89 of 105) of the infections were single-organism infections; (7) 82% (101 of 123) of the causative organisms were Escherichia coli, Pseudomonas sp, coagulase-negative staphylococci, Enterococcus spp, Klebsiella spp, or Enterobacter sp. The urinary tract infections in the 60 patients were not complicated by bacteremia, and no direct relationship between the infections and the minimal mortality in our patients could be established.

Adolescent↗
PubMed1988

Infectious mononucleosis with pleural effusion.

We have described a 10-year-old child in whom a pleural effusion complicated an otherwise typical case of IM. Although rare, pleural effusions are a possible complication of infectious mononucleosis, and IM should be considered in the differential diagnosis of pleural effusions in children.

Acute Disease↗
PubMed1987

Handwashing technique in a pediatric intensive care unit.

A one-year prospective study of 454 patients in a pediatric intensive care unit was performed to determine whether the rate of breaks in handwashing technique was different between medical professionals and to determine whether these rates were altered by the use of the overgown. A handwashing break in technique was defined as not washing your hands after direct contact with either patients or support equipment before contact with another patient or departure from the unit. Ninety-four two-hour sessions were monitored by a research nurse during four cross-over periods of gown and no-gown use. Physicians did not wash their hands in 834 (79%) of 1056 contacts, nurses in 1073 (63%) of 1714 cases, occupational therapists in 21 (62%) of 34 cases, respiratory therapists in 269 (78%) of 346 cases, and radiology technicians in 59 (78%) of 76 cases. Nurses used significantly better technique when compared with physicians, respiratory therapists, and radiology technicians. Gown usage overall did not affect these breaks in handwashing technique rates. Physicians did not wash their hands 75% of the time when gowns were not used and 82% of the time when gowns were used. Handwashing rates were unaffected by gown use in all other professionals. Handwashing remains an important but neglected method of interrupting the transmission of hospital pathogens.

Adult↗
PubMed1987

Neonatal intensive care unit bacteremia: emergence of gram-positive bacteria as major pathogens.

An outbreak of nosocomial Staphylococcus epidermidis bacteremia in a neonatal intensive care unit in 1981 was epidemiologically linked to use of Broviac central venous catheters (p = 0.05) and prompted a review of nosocomial infection surveillance data for the previous 6 years, which indicated a striking shift from gram-negative to gram-positive bacteria, especially coagulase-negative staphylococci, as major bloodstream pathogens. In a case-control study with 68 patients with bacteremia between 1979 and September 1981 and 64 control patients, stratified by birth weight, three risk factors were identified: use of Broviac central venous catheters, surgical procedures, and intravenous hyperalimentation. The risk factors varied with the birth weight category. In the group of cases and controls with birth weights less than 1500 gm, only the use of Broviac catheters, which are usually left in the superior vena cava for several weeks, was associated with subsequent bacteremia (odds ratio = 7.1, p = 0.001). These observations, as well as the temporal association of the introduction of Broviac catheters with the subsequent shifts in causes to gram-positive organisms, suggest that the long-term indwelling vascular access devices contributed greatly to the changing pattern.

Catheters, Indwelling↗
PubMed1986

Overgown use for infection control in nurseries and neonatal intensive care units.

We surveyed 1824 physicians to determine current newborn nursery (NBN) and neonatal intensive care unit (NICU) gowning procedures and the gowning preferences of NBN and NICU physicians. A total of 712 questionnaires (39.0%) were returned from 453 hospitals. Of the 712 questionnaire respondents, 251 (35.3%) thought that gowns should be worn at all times. However, 319 (72.8%) of the 438 NBNs and 317 (71.6%) of the 443 NICUs surveyed continue to require gowns at all times. The difference between gown preference and practice was statistically significant. Gowns were worn only for handling infants in 96 NBNs (21.9%) and 109 NICUs (24.6%), while 344 physicians (48.3%) preferred this regimen. Gowns were worn in 16 NBNs (3.7%) and 15 NICUs (3.4%) only for isolated infants, but 67 respondents (9.4%) believed this to be the procedure of choice. At our institution, 100 and 300 gowns are worn daily in the NBN and NICU, respectively, at a cost of +0.28 per gown use, generating an estimated yearly expense of +40 880. In addition, the current literature does not support gowning as a means of infection control in this setting.

Health Maintenance Organizations↗
PubMed1986

Alteration of normal gastric flora in critical care patients receiving antacid and cimetidine therapy.

One hundred fifty-three critical care patients with documented cimetidine and antacid use were prospectively studied with serial gastric pH determinations and semiquantitative gastric fluid cultures. This study documents the abnormal gastric colonization of patients with therapeutically altered gastric acidity by hospital acquired gram negative rods (GNR). Three hundred twenty-four gastric fluid cultures from 153 patients revealed 152 (47%) positive cultures for GNR, 78 (24%) sterile specimens, and 94 (29%) positive for mixed oropharyngeal flora. One hundred forty (59%) of the 236 cultures at a pH of 4 or greater were positive for GNR. In contrast, only 12 (14%) of the 88 cultures at a pH of less than 4 were positive for GNR (p less than .001). Forty-six (52%) of 88 cultures at a pH of less than 4 were sterile as compared to only 32 (14%) of 236 sterile cultures at a pH of 4 or greater (p less than .001). At low pH, cultures are predominantly sterile and at a pH of 4 or greater the flora dramatically changes to hospital acquired GNR. This artificially maintained reservoir of gram negative rods in the critically ill patient is a potential reservoir of organisms causing nosocomial bacteremia or pneumonia in this high risk population.

Antacids↗
PubMed1986

High risk of nosocomial infection in the pediatric critical care patient.

During this one-year prospective study, 61 (13.7%) of 444 patients admitted to the pediatric ICU at the University of Virginia Hospital developed nosocomial infections. By comparison, general medical/surgical ward patients had an overall 4.8% risk of acquiring an infection during their hospital stay. Patients who had prolonged ICU stays and those on plastic surgery, neurosurgery, and pediatric surgery services were more likely to become infected. The four bloodstream pathogens isolated in five episodes of hospital-acquired bacteremia were Staphylococcus epidermidis, S. aureus, Escherichia coli, and Serratia liquifaciens.

Child↗
PubMed1986

Failure of the overgown to prevent nosocomial infection in a pediatric intensive care unit.

In a pediatric intensive care unit we conducted a 1-year prospective study of 454 patients to determine whether wearing a gown decreased the overall nosocomial infection rate, incidence of intravascular catheter colonization, breaks in handwashing technique, and traffic. The overall infection rate was 26 (13%) of 198 admissions during the gown-wearing periods v 23 (9%) of 256 admissions for the periods when gowns were not worn (P less than .25). Of 348 intravascular catheter tips cultured 16 (4.6%) were colonized during gown-wearing periods compared with 21 (6.3%) of 330 when no gowns were worn (P less than .25). Of 78 patient contacts 54 (69%) were followed by no handwashing during gown-wearing periods and 59 (70%) of 84 contacts were followed by no handwashing during periods when no gowns were worn. The mean occurrence of visits per patient per hour and total visits per hour differed between gown-wearing and no-gown-wearing periods by analysis of variance, P less than .01 and P less than .005, respectively. Although traffic was decreased during periods of gown use, overgowns are an expensive, ineffective method of decreasing nosocomial infection rates, vascular catheter colonization rates, and breaks in handwashing technique.

Clothing↗
PubMed1985

Consequences of candidemia for pediatric patients.

The hospital records of 45 infants and children with one or more blood cultures positive for Candida species were studied retrospectively in an attempt to define the risk of Candida-related complications. Death of eight of the patients (18%) was related to Candida infection, and five additional patients (11%) had metastatic foci of infection but survived. No characteristics were identified that would predict patients who were at high risk for complications of candidemia. Eleven patients were treated with amphotericin B for longer than a week and were examined for evidence of nephrotoxicity. None had persistent abnormalities of blood urea nitrogen or serum creatinine concentrations develop during treatment; two patients had hypokalemia.

Adolescent↗