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W A Rutala

Publications and source records attributed to W A Rutala.

At least 19 recordsLinked to original sources
PubMed1992

Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks.

OBJECTIVE: To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters. DATA SOURCES: Meta-analysis of all studies published in the English literature, including abstracts, letters, and reports that examined the primary research question of infection risks associated with transparent compared with gauze dressings for use on central and peripheral venous catheters. Studies were identified by use of the MEDLINE database using the indexing terms occlusive dressings, transparent dressings, and infection and by review of referenced bibliographies. STUDY SELECTION: Seven of the 15 studies (47%) of central venous catheters and seven of 12 studies (58%) of peripheral catheters met our inclusion criteria for analysis. All studies used a prospective cohort design, utilized hospitalized patients, and reported at least one of our defined outcomes. EXTRACTION: Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome. DATA SYNTHESIS: Applying a Mantel-Haenszel chi 2 analysis, use of transparent dressings on central venous catheters was significantly associated with an elevated relative risk (RR) of catheter tip infection (RR = 1.78; 95% confidence interval [CI], 1.38 to 2.30). Catheter-related sepsis (RR = 1.69; 95% CI, 0.97 to 2.95) and bacteremia (RR = 1.63; 95% CI, 0.76 to 3.47) were both associated with an elevated RR. Use of transparent dressings on peripheral catheters was associated with an elevated RR of catheter-tip infection (RR = 1.53; 95% CI, 1.18 to 1.99) but not phlebitis (RR = 1.02; 95% CI, 0.86 to 1.20), infiltration (RR = 1.12; 95% CI, 0.92 to 1.37), or skin colonization (RR = 0.99; 95% CI, 0.90 to 1.09). CONCLUSION: The results demonstrated a significantly increased risk of catheter-tip infection with the use of transparent compared with gauze dressings when used with either central or peripheral catheters. An increased risk of bacteremia and catheter sepsis associated with the use of transparent compared with gauze dressings for use on central venous catheters was suggested.

Bacteremia↗
PubMed1992

Risk factors for nosocomial pneumonia in the elderly.

PURPOSE: Elderly patients have a disproportionate incidence of nosocomial pneumonia (NP) and a higher mortality rate, yet few studies have focused on this high-risk population. We undertook a study to examine risk factors for NP in elderly inpatients and to describe how these patients differ from younger patients with NP. METHODS: In a public teaching hospital, all cases of NP in patients aged 65+ were ascertained by prospective surveillance during a 2-year period (n = 59). These elderly cases were compared with 59 cases of NP in patients aged 25 to 50 to describe differences in risk factors and outcomes. Elderly cases were then matched to elderly control subjects who were admitted to the same hospital service but did not develop NP. Data were collected on known risk factors and on the potential risk factors of poor nutrition, neuromuscular disease, and dementia. Significant differences in risk factors were analyzed using univariate and multivariate comparisons of cases and controls. RESULTS: Elderly patients had twice the incidence of NP (RR = 2.1) as younger patients. Onset of infection was earlier for young than for older cases (6 versus 11 days, p less than or equal to 0.02), but mortality following NP was equal for the two age groups (42% versus 44%). No significant differences in risk factors were found for old and young cases, although older cases tended to have higher rates of poor nutrition, neuromuscular disease, and aspiration preceding their pneumonias. Comparison of elderly cases and elderly controls revealed significantly increased frequencies of poor nutrition, neuromuscular disease, pharyngeal colonization, aspiration, depressed level of alertness, intubation, intensive care unit admission, nasogastric tube use, and antacid use among cases. Cases were more severely ill on admission and had more pre-existing risk factors (2.8 versus 1.3, p less than or equal to 0.001) and more in-hospital risk factors (4.7 versus 1.6, p less than or equal to 0.001). Logistic regression analysis revealed low albumin, diagnosis of neuromuscular disease, and tracheal intubation to be strong independent predictors of risk for NP among elderly inpatients. CONCLUSIONS: We conclude that the specific risk factors of poor nutrition, neuromuscular disease, and tracheal intubation may prove useful to target future clinical interventions to prevent NP in the elderly.

Adult↗
PubMed1992

Relative frequency of nosocomial pathogens at a university hospital during the decade 1980 to 1989.

BACKGROUND: We compared the relative frequency of pathogens isolated from 1985 to 1989 (N = 4358) with those isolated from 1980 to 1984 (N = 5290) in a university hospital to determine trends in the relative importance of pathogens causing nosocomial infection. METHODS: Our study was based on surveillance data prospectively obtained between 1980 and 1989 from a 600-bed university hospital. Statistically significant trends occurring from 1980 to 1984 to 1985 to 1989 were determined by chi 2 tests with Bonferroni corrections (i.e., p less than [0.05/17]). RESULTS: Overall an increased frequency of isolation occurred for Candida and other yeasts and for Haemophilus species. A decreased frequency was noted for Proteus species, non-Bacteroides anaerobes, and Serratia species. Comparison of 1985 to 1989 with 1980 to 1984 revealed that the most significant change in nosocomial pathogens was the marked increase in infections with yeast, principally Candida species. Candida and other yeast infections increased 40%, from 7.6% (rank, 5) to 10.6% (rank, 3) of all pathogens isolated. Increases, which occurred in urine, blood, and wound isolates, were especially marked among surgical patients. In addition, a significant increase was noted among blood isolates in the isolation of yeast other than Candida albicans. CONCLUSIONS: We conclude that Candida and other yeasts are being isolated increasingly as causative agents of nosocomial infection.

Cross Infection↗
PubMed1992

Medical waste.

Explore the source record for details and available documents.

Humans↗
PubMed1991

Nosocomial infection rate as a function of human immunodeficiency virus type 1 status in hemophiliacs.

As part of a prospective cohort study initiated in 1983, the human immunodeficiency virus type 1 (HIV-1) status has been periodically determined for patients with clotting disorders (hemophilia A or B, von Willebrand's disease, miscellaneous). The University of North Carolina Hospitals has conducted comprehensive surveillance for nosocomial infections (NI) using modified Centers for Disease Control criteria since 1980 and entered this information in a computerized data base. Cross-matching of our NI data base and hemophiliac/HIV-1 study data base for the time period 1980-1989 revealed that 13 NI occurred in 11 patients during 659 hospitalizations (5,723 hospital days). NI rates per 100 admissions (per 1,000 hospital days) by HIV-1 status were as follows: HIV-1 negative = 0.91 (1.18), HIV-1 positive pre-AIDS = 1.65 (1.84), and AIDS = 6.67 (6.48). NI occurred with a similar frequency in HIV-1 positive pre-AIDS hemophiliacs and HIV-1 negative hemophiliacs (Fisher's exact test, p greater than 0.10). However, NI occurred more frequently in hemophiliacs with AIDS versus HIV-1 positive or negative hemophiliacs (Fisher's exact test, p less than 0.05). We conclude that HIV-1 infection does not appreciably alter the risk of developing a NI, but that patients who have progressed to AIDS are at significantly increased risk of developing a NI per hospital day or per hospitalization.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Inactivation of Mycobacterium tuberculosis and Mycobacterium bovis by 14 hospital disinfectants.

Epidemics of mycobacteria due to contamination of medical devices continue to occur. For this reason, we assessed the ability of disinfectants, generally used in hospitals for disinfecting noncritical and semicritical patient care items, to inactivate mycobacteria. A modified Association of Official Analytical Chemists' (AOAC) Tuberculocidal Activity Test, using Middlebrook 7H9 broth as the primary subculture medium and neutralization by dilution, was used to assess the ability of 14 hospital disinfectants to inactivate about 10(6) Mycobacterium tuberculosis and about 10(5) Mycobacterium bovis at 20 degrees C using 10- or 20-minute exposure. All products were tested for each organism using 10 penicylinders (P) and were prepared at the manufacturers' recommended use-dilution. Chlorine dioxide, 0.80% hydrogen peroxide plus 0.06% peroxyacetic acid, and an iodophor achieved complete inactivation (0 + P) of both M. tuberculosis and M. bovis. One quaternary ammonium compound with a tuberculocidal label claim, a quaternary ammonium compound without a tuberculocidal label claim, chlorine (approximately 100 ppm) and 0.13% glutaraldehyde/0.44% phenol/0.08% phenate were not effective (10 + P) against both M. tuberculosis and M. bovis. Another quaternary ammonium compound with a tuberculocidal label claim was tested against only M. bovis and found ineffective (10 + P). Glutaraldehydes (2% alkaline and 2% acid), a phenolic and chlorine (approximately 1,000 ppm) demonstrated complete inactivation of M. tuberculosis (0 + P) and good inactivation of M. bovis (1-3 + P). Two disinfectants, hydrogen peroxide and ethyl alcohol, provided differing results against M. tuberculosis and M. bovis. These studies have important implications for disinfecting semicritical patient care items.

Chlorine↗
PubMed1991

Infection risks associated with spirometry.

OBJECTIVES: Spirometry is a widely used pulmonary function test that allows measurement of forced vital capacity and time-related measures of dynamic pulmonary function. This study was designed to identify the risk of cross-transmission associated with two commonly used dryrolling seal spirometers. DESIGN: Using a prospective study design, we examined whether microbial contamination of spirometers occurred following use by patients with a heavily colonized or infected respiratory tract. Prior to spirometry evaluation, a patient's sputum culture and equipment samples (i.e., mouthpiece, proximal tubing, piston surface) were obtained. After patient evaluation, a sterile 2 L ventilation bag and sterile tubing were used to simulate the risk of infection of subsequent patients. Simulation 1 was performed immediately after patient testing and Simulation 2, representing a second patient was conducted approximately 18 hours later. SETTING: This study was conducted at the University of North Carolina Hospitals, a large university teaching facility. PATIENTS: Fourteen patients with underlying pulmonary disease were studied. RESULTS: Our study revealed that the mouthpieces became contaminated with the patients' oral flora and with the associated respiratory pathogen. Fourteen percent of the associated tubing after patient testing contained the respiratory pathogen. All other equipment samples (e.g., interior surfaces of the machine, Simulation 1, Simulation 2 samples) were negative for the respiratory pathogen. CONCLUSIONS: These data suggest that mouthpieces and spirometry tubing may become contaminated with microorganisms and should not be shared between patients. Since there is little or no bacterial contamination of the surfaces inside the spirometers and cross transmission is unlikely, it is unnecessary to routinely clean the interior surfaces of the spirometers.

Cross Infection↗
PubMed1991

Disinfection practices for endoscopes and other semicritical items.

OBJECTIVE: To determine the disinfection practices employed by North Carolina hospitals for endoscopes and other semicritical patient care items and to discuss minimally acceptable disinfection procedures for these items. DESIGN: A survey questionnaire was mailed to all North Carolina hospitals to identify their disinfection practices, and a literature review was conducted to ascertain studies that evaluated disinfection techniques for certain semicritical items. PARTICIPANTS: Questionnaires were returned by 107 of 167 (64%) North Carolina acute-care hospitals. RESULTS: Most hospitals (91%) used a glutaraldehyde-based disinfectant (59%, 2% glutaraldehyde; 29%, 0.13% glutaraldehyde-0.44% phenol-0.08% phenate; 3%, either); half (51%) of the hospitals immersed the endoscope into disinfectant for greater than or equal to 20 minutes, but 44% immersed for less than or equal to 10 minutes; nearly all hospitals (97%) disinfected endoscopes at room temperature. Hospitals rinsed the endoscope with sterile water (16%), tap water (54%), tap water followed by alcohol rinse (27%), or other (2%); 58% of the hospitals treated endoscopes from patients infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or Mycobacterium tuberculosis differently (81%, ethylene oxide [ETO] sterilization; 10%, increased exposure time; 10%, other). Twenty percent of the hospitals used an automated washer for processing endoscopic instruments. Rigid endoscopes (e.g., arthroscopes, laparoscopes) were primarily high-level disinfected (57%), ETO sterilized (17%), or either (13%). The disinfection strategies for other semi-critical items (e.g., applanation tonometers, cryosurgical instruments, and diaphragm fitting rings) were highly variable for the responding hospitals. CONCLUSIONS: This survey indicated the presence of a wide variety of practices for handling semicritical patient care items, many of which are inconsistent with current recommendations. To help establish minimally acceptable disinfection procedures for some patient care instruments (e.g., arthroscopes, laparoscopes, tonometers), the scientific literature was reviewed and recommendations were made.

Disinfection↗
PubMed1991

Gas and steam sterilization of assembled versus disassembled laparoscopic equipment. Microbiologic studies.

Current recommendations specify disassembly of most laparoscopic equipment prior to sterilization. Surgical technicians, however, are often unfamiliar with the proper assembly of laparoscopic instruments, resulting in possible patient injury from equipment malfunction. Therefore, we tested the hypothesis that disassembled laparoscopic equipment is sterilized more thoroughly than assembled equipment. We inoculated internal sites on laparoscopic instruments prior to assembly with bacterial spores resistant to ethylene oxide and steam sterilization. We also manually cleaned the equipment after inoculation prior to steam sterilization of both the assembled and disassembled instruments. The control instruments were stored at room temperature during test sterilization runs. No vegetative bacteria survived ethylene oxide or steam sterilization in assembled equipment, but despite a significant reduction, spore-forming bacteria could be cultured from the assembled equipment. If the instruments were washed before steam sterilization, there was similar spore clearance in the assembled and disassembled instruments, with both groups attaining a high level of disinfection. Our data suggest that disassembly, cleaning and proper assembly of equipment prior to sterilization present no more risk of infection transmission than does disassembly during prevacuum steam sterilization. The method provides properly assembled and functioning equipment at the time of surgery.

Clinical Protocols↗
PubMed1991

Infection control strategies relevant to employee health.

A well organized employee health service is a key component of an effective infection control program. All health care providers should be immune to mumps, measles, rubella, tetanus, and polio. Hepatitis B vaccine should be offered to all workers who have contact with blood. Employees with signs and symptoms of infectious diseases should be evaluated by Employee Health and follow work restrictions. Employees with exposure to communicable diseases should be evaluated for prophylaxis.

Communicable Disease Control↗
PubMed1990

Wound infection rates after invasive procedures in HIV-1 seropositive versus HIV-1 seronegative hemophiliacs.

One-hundred and two patients with hemophilia A, hemophilia B, or acquired antibody to factor VIII who had undergone invasive procedures were cross referenced with patients participating in an ongoing prospective natural history study of HIV-1 infection in hemophiliacs. Matching revealed that HIV-1 status was known for 83 patients (83%) who had undergone 169 procedures between July 1979 and April 1988. Invasive procedures were classified as clean in 108 patients (63.9%), clean-contaminated in 45 (26.6%), contaminated in 2 (1.2%), and infected in 14 (8.3%). Wound infection rates by HIV-1 status were as follows (95% confidence intervals): HIV+ 1.4% (0% to 5%), HIV- 0% (0% to 9%), and procedure before testing HIV+ 1.5% (0% to 6%). There were no significant differences between the wound infection rates of HIV-positive and HIV-negative hemophiliacs nor in the wound infection rate among all three subgroups of patients (p greater than 0.5, Fisher's Exact Test). We conclude that surgery in HIV-1-infected patients who have not progressed to AIDS does not entail an increased risk of postoperative wound infections.

HIV Seropositivity↗
PubMed1990

Effect of methodology, dilution, and exposure time on the tuberculocidal activity of glutaraldehyde-based disinfectants.

The Association of Official Analytical Chemists (AOAC) test for assessing the tuberculocidal activity of disinfectants has been shown to be variable. A modified AOAC test, which substituted Middlebrook 7H9 broth as the primary subculture medium and used neutralization by dilution, was compared with the standard AOAC method to assess the mycobactericidal activity of three glutaraldehyde-based disinfectants at 20 degrees C and various exposure times. These changes had a marked effect on results, with the modified AOAC test providing more positive penicylinders per 10 replicates in 12 of the 13 comparisons that provided positive results. These differences were observed with both Mycobacterium bovis (ATCC 35743) and a clinical isolate of Mycobacterium tuberculosis. The effects of various exposure times to and dilutions of the glutaraldehyde-based disinfectants were also examined. The minimum exposure time needed to inactivate reliably M. bovis or M. tuberculosis with 2% glutaraldehyde was 20 min at 20 degrees C. Diluting 2% glutaraldehyde caused a significant decline in mycobactericidal activity. Modification of the standard AOAC test to improve its sensitivity in detecting the failure of disinfectants to inactivate mycobacteria is indicated.

Aldehydes↗
PubMed1990

Manual ventilation bags as a source for bacterial colonization of intubated patients.

A group of 14 intensive care unit (ICU) patients were studied to determine if manual ventilation bags (MVB) could serve as a source of bacterial or fungal pathogens that could colonize the respiratory tract of intubated patients. A total of 51 cultures were simultaneously obtained of patient's sputum, the exterior MVB surface, MVB port, and MVB interior (postexhalation valve). Pathogens colonizing or infecting the respiratory tract of intubated ICU patients were frequently simultaneously present on the exterior surface of the MVB and inside the MVB port used to connect the MVB with the endotracheal tube. In addition, coagulase-negative staphylococci and yeast were frequently present on the exterior surface of the MVB. The interior of the MVB was usually sterile. In three instances pathogens were isolated from the MVB before isolation from the patient's sputum. MVB may serve as a source for colonizing the respiratory tract of intubated ICU patients and/or the hands of medical personnel. The exterior surface and port of MVB should be cleaned of visible debris and disinfected at least once a day.

Bacteria↗
PubMed1990

Disinfection in the OR.

1. Items that enter sterile tissue or the vascular system are considered critical items and must be sterile (eg, surgical instruments, cardiac catheters, implants). 2. Semicritical items are those objects that come in contact with mucous membranes or with skin that is not intact. Endoscopes, anesthesia breathing circuits, respiratory therapy equipment, and endotracheal tubes are included in this category. These items require high-level disinfection. 3. Noncritical items (eg, floors, blood pressure cuffs) come in contact with intact skin. These items require low-level disinfection. 4. Flash sterilization is overused in hospitals. Control measures should be used to minimize infections traced to sterilizer failure.

Disinfectants↗