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At least 1,207 records · Page 67Linked to original sources

PubMed1995

An outbreak of needlestick injuries in hospital employees due to needles piercing infectious waste containers.

OBJECTIVES: To investigate the cause of an outbreak of needlestick injuries (NSIs) in hospital employees. SETTING: A 700-bed university hospital. DESIGN: Outbreak investigation, laboratory evaluation of a medical waste disposal device, cost analysis. METHODS: Employee health department records were reviewed of workers suffering sticks from needles piercing fiberboard-contaminated material containers (CMCs). A laboratory evaluation of needle-puncture resistance properties of the CMCs was performed using a testing apparatus. The cost of a hospital waste disposal program using fiberboard CMCs was compared with the cost of a program using rigid plastic (polypropylene) boxes. RESULTS: During 40 months of surveillance in 1986 and from 1989 to 1991, only one NSI had occurred from a needle piercing a CMC. During 9 months in 1993, 13 NSIs occurred due to needles piercing CMCs (P < .001). No clinical illness resulted from the NSIs. The outbreak was halted by a temporary change to plastic (polypropylene) boxes for sharps disposal ($4.92 to $23.33/cu ft) until receipt of a box with a newly designed solid fiberboard liner ($1.25/cu ft). CMC liners used during the epidemic had a mean needle puncture resistance of 527 g, as compared with 660 g for liners used before the outbreak (P < .001). The new solid fiberboard liner has a mean puncture resistance of 1,765 g. A program of waste disposal using fiberboard CMCs was found to cost approximately one-seventh the cost of a program using plastic boxes for disposal of infectious waste. CONCLUSION: A program for infectious waste disposal using fiberboard CMCs can be safe and cost-effective if appropriate standards for puncture resistance are met.

Containment of Biohazards↗

PubMed1995

Nosocomial outbreak caused by a multiresistant clone of Acinetobacter baumannii: results of the case-control and molecular epidemiologic investigations.

OBJECTIVE: To describe a nosocomial outbreak caused by multiresistant Acinetobacter baumannii. DESIGN: Descriptive and case-control study. Antibiotic susceptibilities and pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with SfiI and also with ApaI were used as markers of strain identity. SETTING: A large medical school-affiliated hospital in the city of Houston, Texas. RESULTS: During a 10-week period, A baumannii was isolated from 25 patients admitted to the intensive care unit (ICU). The attack rate was 14.3 per 100 ICU admissions. Case patients were intubated more frequently and for longer periods, and had longer ICU and hospital stays (P < 0.05 for each of these characteristics). Multivariate logistic regression analysis identified the length of ICU stay and the use of third-generation cephalosporins as associated with the acquisition of A baumannii. Patients infected with A baumannii had a higher mortality rate than colonized patients and control patients (P < 0.01). Sixteen isolates recovered from these 25 patients were susceptible only to imipenem/cilastatin, and PFGE confirmed that a single clone was the cause of this outbreak. Nine isolates of A baumannii from patients infected or colonized in two other hospitals in Houston during the same period, differed from the outbreak isolates by their susceptibility to ciprofloxacin. However, PFGE results were identical, indicating unsuscepted genetic relatedness among isolates from three different hospitals. CONCLUSIONS: A baumannii is an important nosocomial opportunistic pathogen and can adversely affect the outcome of ICU patients who acquire this organism. This outbreak was caused by a single clone that was isolated concurrently from three hospitals.

Acinetobacter↗

PubMed1995

Lessons from a nursing home outbreak of influenza A.

OBJECTIVE: To characterize risk factors for outbreak-associated influenza illness and death in a nursing home. DESIGN: Outbreak investigation with predetermined and concurrently determined risk information. SETTING: A nursing home service in a multiward chronic care hospital, Honolulu, Oahu, 1989 to 1990. PATIENTS: Elderly nursing home patients receiving long-term care. INTERVENTIONS: Influenza vaccination, amantadine administration, and infection control measures. RESULTS: Neither routine infection control measures nor vaccination prevented illness, complications, or death in a nursing home outbreak of influenza A. The 55% case-fatality rate resulted from severe pneumonia. Influenza transmission may have been mediated by staff via either contaminated hands or fomites. CONCLUSIONS: Data from this and other outbreaks suggest that recommendations for preventing nosocomial influenza in the nation's 1.5 million nursing home residents should be reconsidered.

Adult↗

PubMed1996

A prolonged outbreak of methicillin-resistant Staphylococcus aureus in the burn unit of a tertiary medical center.

OBJECTIVE: To report an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in our burn unit and the steps we used to eradicate the organism. DESIGN AND SETTING: Outbreak investigation in the burn unit of a 900-bed tertiary-care medical center. OUTBREAK: Between March and June 1993, MRSA was isolated from 10 patients in our burn unit. All isolates had identical antibiograms and chromosomal DNA patterns. CONTROL MEASURES: Infection control personnel encouraged healthcare workers to wash their hands after each patients contact. The unit cohorted all infected or colonized patients, placed each affected patient in isolation, and, if possible, transferred the patient to another unit. Despite these measures, new cases occurred. Infection control personnel obtained nares cultures from 56 healthcare workers, 3 of whom carried the epidemic MRSA strain. One healthcare worker cared for six affected patients, and one cared for five patients. We treated the three healthcare workers with mupirocin. Subsequently, no additional patients became colonized or infected with the epidemic MRSA strain. CONCLUSIONS: The outbreak ended after we treated healthcare workers who carried the epidemic strain with mupirocin. This approach is not appropriate in all settings. However, we felt it was justified in this case because of a persistent problem after less intrusive measures.

Burn Units↗

PubMed1996

Tracing the origin of an outbreak of methicillin-resistant Staphylococcus aureus infections in a Portuguese hospital by molecular fingerprinting methods.

Seventy-six methicillin-resistant Staphylococcus aureus (MRSA) isolates were collected from July 1992 to May 1995 at a 400-bed district hospital in the northeast of Portugal. During the second half of the surveillance period, in July of 1994, an outbreak was detected in the orthopedic ward. Thirty-three (out of the 76) MRSA strains were recovered only in this ward during the outbreak period. All strains were characterized by a variety of genomic fingerprints. Hybridization of ClaI and SmaI restriction digests with the mecA- and Tn554-specific DNA probes was used to identify polymorphism and determine chromosomal location of these determinants, and pulsed-field gel electrophoretic analysis of SmaI digests was used to determine chromosomal backgrounds. All strains recovered during the outbreak in the orthopedic ward were found to belong to a single clone that carried the mecA polymorph I, Tn554 type E in a macrorestriction background called H (clone I::E::H1), which was identified in 18 patients, and 5 health care personnel and from a fomite sample, and was traced to a single transfer patient admitted to the hospital at the beginning of the outbreak. The new clone I::E::H1 differed only in the macrorestriction profile from the MRSA clone previously dominant in this hospital, known as Iberian epidemic clone I::E::A, which has already been identified in several Spanish and Portuguese hospitals.

Blotting, Southern↗

PubMed1996

Nosocomial outbreak of gastroenteritis due to Salmonella senftenberg.

We describe a prolonged nosocomial outbreak of Salmonella senftenberg, an uncommon human pathogen. We detected 22 cases of infection due to S. senftenberg that occurred from March 1993 through November 1994 and involved 18 patients and four healthy employees. All infected persons had consumed food prepared by the hospital kitchen. The estimated attack rate for the period of the outbreak was 0.19-0.23 cases per 100,000 meals served. Infection control interventions included observation of food preparation, disinfection of kitchen devices, and education of food handlers. The consumption of lettuce (11 of 15 patients who could recount extended dietary histories vs. 4 of 20 controls; P = .005), cauliflower (5 of 15 vs. 0/20; P = .02), cottage cheese (4 of 15 vs. 0/20; P = .03), and deli turkey (8 of 15 vs. 0/20; P < .001) was associated with S. senftenberg infection. The isolates had identical antibiograms and pulsed-field gel electrophoretic patterns. Cultures of stool samples from food handlers as well as food items, kitchen devices, and kitchen surroundings were negative for S. senftenberg. Interruption of the outbreak occurred coincidentally with the institution of infection control measures. This prolonged outbreak of salmonellosis was probably related to contamination in the kitchen from turkey, with cross-contamination via equipment.

Adult↗

PubMed1996

Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci.

Infection control practices are not uniformly successful in limiting outbreaks of vancomycin-resistant enterococci (VRE). Despite the implementation of barrier precautions for VRE-infected patients, nearly one-half of the inpatients at our center were found to have gastrointestinal colonization by VRE. In an attempt to control the outbreak, we altered the antibiotic formulary by restricting the use of cefotaxime and vancomycin and adding beta-lactamase inhibitors to replace third-generation cephalosporins. The use of clindamycin was also restricted because of a concomitant outbreak of Clostridium difficile colitis. After 6 months, the average monthly use of cefotaxime, ceftazidime, vancomycin, and clindamycin had decreased by 84%, 55%, 34%, and 80%, respectively (P < .02). The point prevalence of fecal colonization with VRE decreased from 47% to 15% (P < .001), and the number of patients whose clinical specimens were culture positive also gradually decreased. A change in antibiotic use appears to have significantly affected our VRE outbreak when previous measures failed.

Ampicillin↗

PubMed1997

Emergence of antibody to capsular polysaccharides of Streptococcus pneumoniae during outbreaks of pneumonia: association with nasopharyngeal colonization.

Antibody to pneumococcal capsular polysaccharides (PPS) of Streptococcus pneumoniae plays a major role in protecting the host against pneumococcal infection. A variable proportion of healthy adults have antibody to PPS, often in the absence of recognized pneumococcal infection. To determine whether exposure to pneumococci or colonization by pneumococci, or both, stimulates the emergence of antibody to PPS, we studied outbreaks of pneumonia at two military camps. Of the men who were present at a military training camp during an outbreak of pneumonia due to S. pneumoniae serotype 1 but who did not develop pneumonia, 27.8% had IgG antibody to PPS 1, whereas only 3.6% of controls had this antibody. In another outbreak caused by S. pneumoniae serotypes 7F and 8, 35.9% of asymptomatic soldiers who had nasopharyngeal colonization by one of these strains had antibody to the relevant PPS, and another 30.8% who originally did not have antibody developed it within 30 days; thus, 66.7% of these soldiers had antibody to the relevant PPS. These data show that serotype-specific antibody promptly appears following exposure to an outbreak of pneumococcal pneumonia and is probably mediated through acquisition of nasopharyngeal pneumococcal carriage.

Adult↗

PubMed1997

Epidemiology of an unusually prolonged outbreak of typhoid fever in Terrassa, Spain.

An unusually prolonged outbreak of typhoid fever, from 1988 to 1994, in Terrassa (Barcelona, Spain), was caused by a casual food handler who was a carrier. The pattern of this outbreak suggested intermittent low-level exposure to Salmonella typhi. We found 70 patients with S. typhi infections, 52 of whom were available for study. Medical records were reviewed and patients were interviewed with use of a standard questionnaire. Phage typing and pulsed-field gel electrophoresis (PFGE) for strain subtyping were used to confirm the epidemiological data. The 27 outbreak strains shared the same phage type and the same PFGE pattern. Four sporadic strains shared the same phage type as the outbreak strain. PFGE was found to be useful for differentiating strains for epidemiological purposes.

Adult↗

PubMed1984

A common source foodborne outbreak of cholera in Singapore.

An epidemiological investigation of an outbreak of Vibrio cholerae 01, biotype El Tor, serotype Ogawa, phage type 1, confined to a group of foreign construction workers in Singapore is described. A total of 22 workers were confirmed to have cholera and another 15 had asymptomatic Vibrio cholerae 01 infection between 3 November and 11 November 1982. The source of infection was traced to contaminated seafood prepared at the construction site canteen where two food handlers were found to be infected with V. cholerae 01 (one symptomatic and the other asymptomatic). The incubation period of cholera in this outbreak ranged from 4 to 203 hours with a median of 38 hours. Only two workers had moderate to severe dehydration and required intravenous therapy. Early recognition of the outbreak and prompt implementation of control measures prevented the outbreak from spreading to other parts of Singapore.

Adolescent↗

PubMed1988

An outbreak of type A foodborne botulism in Taiwan due to commercially preserved peanuts.

Until recently, botulism was not recognized as an important public health problem in Taiwan. In 1986, an outbreak of type A foodborne botulism resulted in nine cases, two of them fatal. The vehicle in this outbreak was commercially preserved peanuts processed by an improperly equipped, unlicensed cannery. A single batch of peanuts was implicated; however, we could not determine why this particular batch was contaminated. Efforts to recall the product were hampered by a lack of distribution records. Mass media announcements were used to warn the public about the outbreak, and preliminary data suggest the ensuing publicity improved botulism surveillance. The local preference for low-acid preserved foods, increasing consumerism, the shortage of adequately trained inspectors are factors which probably contributed to this outbreak. Stricter enforcement of food sanitation policies are needed to meet the changing situation in Taiwan.

Adult↗

PubMed2005

Measles outbreak in the Republic of the Marshall Islands, 2003.

BACKGROUND: Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (>or=95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989-2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12-23 months varied widely (52-94%) between 1990 and 2000. METHODS: RMI is a Pacific island nation (1999 population: 50,840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control. RESULTS: Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged <1 year and 309 (37%) of cases in persons aged >or=15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1,000 infants). Among cases aged 1-14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years. Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. 'Islands' of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.

Adolescent↗

PubMed1977

Outbreak of pox disease among carnivora (felidae) and edentata.

An outbreak of pox disease in Carnivora of the family Felidae occurred in the Moscow Zoo. Two forms of the disease were found: (1) fatal, fulminant pulmonary without skin lesions and (2) dermal with rash. The severity of the dermal form varied from subclinical to lethal. The pulmonary form was characterized by pneumonia and exudative pleuritis, and large concentrations of virus were observed in the lungs and exudate. In addition to Carnivora of the family Felidae, two giant anteaters had a severe form of the disease (dermal with hemorrhages) and died. The agent of the outbreak appeared to be very closely related to cowpox virus; however, pocks developed at a lower temperature than do those that result from infection with cowpox virus. Strains isolated from sick animals were identical to the virus previously isolated from an outbreak of pox among elephants and okapi. The most probable sources of infection were rats that were fed to some of the animals. During the outbreak, a female attendant at the zoo became infected.

Animals↗

PubMed1989

Prevalence of respiratory syncytial virus subgroups over six consecutive outbreaks: 1981-1987.

Indirect immunofluorescence with strain-specific monoclonal antibodies was used to determine the phenotype of respiratory syncytial virus (RSV) isolates obtained from infants hospitalized in greater Boston over six successive outbreaks from 1981 to 1987. Of 981 isolates, 591 (60%) were classified as subgroup A and 383 (39%) as subgroup B. The prevalence of subgroups varied both between and within yearly outbreaks. In 1983-84 and 1984-85, both subgroups circulated concurrently and in almost equal proportions; in 1981-82, 1982-83, and 1985-86 subgroup A was dominant, accounting for 93% of all RSV isolates; and in 1986-87 subgroup B accounted for 89% of all RSV isolates. In some outbreaks both geographic and temporal clustering of subgroups occurred. No major differences in age, gender, or frequency of nosocomially acquired RSV between infants infected with either subgroup were seen, either overall or between or within yearly outbreaks. An expanded panel of monoclonal antibodies revealed further heterogeneity among subgroup A isolates. Comparison of these results with similar studies from other geographic locations indicated that the pattern of RSV subgroup prevalence is a localized phenomenon.

Disease Outbreaks↗

PubMed1990

Association between respiratory syncytial virus outbreaks and lower respiratory tract deaths of infants and young children.

The temporal patterns of respiratory virus isolations from 10 laboratories in the USA were compared with that of deaths of children less than 5 years old from July 1975 through June 1984. Isolations of respiratory syncytial virus (RSV) occurred as yearly winter outbreaks; parainfluenza virus 1 and 2 isolations occurred as well-defined outbreaks every other year in the autumn; parainfluenza virus 3 isolations occurred throughout the year with periodic, increased isolations suggestive of outbreaks; and influenza virus isolations (A, B, or A plus B) occurred as yearly winter outbreaks. After data were controlled for seasonal patterns, RSV isolations were strongly correlated with the winter peaks in lower respiratory tract illness (LRI) deaths of infants 1-11 months old; influenza virus isolations were correlated with the winter peak in LRI deaths of children 24-59 months old. The parainfluenza viruses were not correlated with respiratory deaths. This study supports the idea that RSV is a major contributor to winter peaks in LRI deaths of children 1-11 months old.

Child, Preschool↗

PubMed1991

A community outbreak of epidemic keratoconjunctivitis in central Australia due to adenovirus type 8.

A large outbreak of epidemic keratoconjunctivitis occurred in Alice Springs, Australia, between July and September 1989. Initially, there was a large outbreak within two child care centers, followed by a more prolonged outbreak within the community. A simultaneous outbreak occurred among staff at the local hospital. Infected children developed mild conjunctivitis, whereas adults developed typical keratoconjunctivitis. Conjunctival swabs from 30 cases were cultured and adenovirus was recovered from 18, all of which were typed by neutralization assay as adenovirus type 8. DNA restriction fragment analysis of the genomes of 5 isolates revealed they were identical, distinct from prototype adenovirus type 8, and nearly identical to adenovirus genome type 8C (Ad-8C), which was previously reported in the southern United States in the early 1970s. Ad-8C was present in another region of Australia greater than or equal to 1 year before the epidemic.

Adenovirus Infections, Human↗

PubMed1993

Direct inoculation of food as the cause of an outbreak of group A streptococcal pharyngitis.

An investigation was conducted of a food-related outbreak of group A streptococcal pharyngitis following an elementary school banquet. Of 166 surveyed banquet attendees, 71 (43%) reported outbreak-associated pharyngitis, and 21 (88%) of 24 tested attendees had evidence of group A streptococcus (GAS) in the throat. Attendees who ate macaroni and cheese were three times more likely to develop pharyngitis than those who did not (66/132 [50%] vs. 5/30 [17%], P = .002). None of the food handlers had GAS recovered by throat culture. However, the cook who prepared the macaroni and cheese had a hand wound; a wound culture grew GAS with the same T agglutination pattern and M- and/or opacity factor type as that of all available GAS strains from ill attendees. Under laboratory conditions, macaroni and cheese supported rapid growth of the outbreak-associated strain of GAS. To the authors' knowledge, this is the first documented foodborne outbreak of GAS pharyngitis in which the only apparent source of contamination was a food handler's skin lesion.

Disease Outbreaks↗

PubMed1994

Pseudomonas aeruginosa outbreak in a burn unit: role of antimicrobials in the emergence of multiply resistant strains.

An environmental survey and a cohort study were done to analyze an outbreak of infections in a burn unit caused by a serotype O:11 and a multidrug-resistant serotype O:12 Pseudomonas aeruginosa. The P. aeruginosa O:11 outbreak was controlled by eradicating an environmental source, contaminated hydrotherapy equipment. To assess risk factors for infections caused by P. aeruginosa O:12, 15 infected burn patients were compared with 32 noninfected burn patients hospitalized during the outbreak. Patients had similar extent, severity, location, and care of burn injuries, exposure to invasive procedures, and past history of P. aeruginosa infection. Prior treatment with ceftazidime (3 g/day) was the only independent risk factor for P. aeruginosa O:12 infection. The outbreak was controlled by increasing the daily administration of ceftazidime from 3 to 6 g and by a reinforcement of isolation precautions.

Adult↗