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Nosocomial transmission of Mycobacterium tuberculosis: role of health care workers in outbreak propagation

Abstract

To investigate an outbreak of tuberculosis (TB) among health care workers (HCWs) at a county hospital, all patients with culture-confirmed TB on wards A and B and all HCWs working at least one shift on these wards from January 1991 through March 1992 were studied.… Read more

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Evidence for a shift from a type I lymphocyte pattern with HIV disease progression. Hemophilia Growth and Development Study

Abstract

Whether a shift from a type I (cell mediated) immune profile occurs with progressive HIV-related immune dysfunction is a matter of heated debate.

We analyzed data for 333 HIV antibody-positive (HIV+) and -negative (HIV-) hemophilic children/adolescents, to examine whether the relationships among immunologic parameters and vaccine-related serology supported a shift with advancing HIV infection.… Read more

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Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections

Abstract

Risk factors for vancomycin-resistant enterococcal (VRE) bloodstream infection (BSI) were studied at a tertiary-care hospital by comparing 46 patients with VRE-BSI with 46 randomly selected patients with vancomycin-susceptible enterococcal (VSE) BSI. Among patients with an enterococcal BSI, risk factors for mortality were determined.… Read more

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Nosocomial outbreak of Candida albicans sternal wound infections following cardiac surgery traced to a scrub nurse

Abstract

From August 1988 through October 1989, 15 patients at 1 hospital developed Candida albicans sternal wound infections after cardiac surgery. An investigation found that case-patients were more likely than cardiac surgery patients without sternal wound infections to have surgeries lasting 165 min (11/15 vs.… Read more

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Tuberculosis infection-control practices in United States emergency departments

Abstract

STUDY OBJECTIVE: To determine the frequency with which patients with suspected tuberculosis (TB) or TB risk factors present to US emergency departments and to describe current ED TB infection-control facilities and practices.

DESIGN: Mailed survey of a sample of EDs in US acute care facilities.… Read more

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Epidemic aluminum intoxication in hemodialysis patients traced to use of an aluminum pump

Abstract

This study was designed to identify the source, risk factors, and clinical consequences of an outbreak of aluminum intoxication in hemodialysis patients using case-control and cohort studies. In 1991, a dialysis center in Pennsylvania [Dialysis Center A (DCA)] identified a number of patients with elevated serum aluminum levels.… Read more

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Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy

Abstract

OBJECTIVE: To determine risk factors for bloodstream infections (BSIs) in an outbreak among patients receiving home intravenous infusion therapy.

DESIGN: Case-control and retrospective cohort studies.

SETTING: Home health agency.

PATIENTS: Patients receiving home intravenous infusion therapy from Rhode Island Home Therapeutics (RIHT) from January through December 1993.… Read more

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Epidemiology of nosocomial fungal infections, with emphasis on Candida species

Abstract

Currently, about 180 hospitals participate in the National Nosocomial Infections Surveillance (NNIS) system. From January 1980 through April 1990, 27,200 fungal isolates causing nosocomial infections were reported from these hospitals; Candida species accounted for 19,621 (72.1%) of these isolates. Immunocompromised patients are at particularly high risk for candidemia.… Read more

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Reducing the spread of antimicrobial-resistant microorganisms. Control of vancomycin-resistant enterococci

Abstract

Strategies to reduce the spread of hospital-acquired microorganisms resistant to multiple antimicrobial agents are discussed. Because hospitals have experienced a rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) in the past 5 years, the Hospital Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention has issued recommendations for preventing the spread of vancomycin resistance.… Read more

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Magnetic phase diagram, static properties, and relaxation of the insulating spin glass CoCl2

Abstract

DeFotis GC, Coffey GA, Cinquina CC, Chandarlapaty S, Brubaker WW, Krovich DJ, Chamberlain RV, Jarvis WR

Phys. Rev., B Condens. Matter 1995 Jun;51(21):15113-15124

PMID: 9978465

Magnetic phase diagram, static properties, and relaxation of the insulating spin glass CoCl2 was last modified: June 1st, 1995 by DeFotis GC, Coffey GA, Cinquina CC, Chandarlapaty S, Brubaker WW, Krovich DJ, Chamberlain RV, Jarvis WR… Read more
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Tuberculosis in health care workers at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis

Abstract

OBJECTIVE: Investigate reports of tuberculosis in health care workers employed at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis.

DESIGN: Case series of tuberculosis in health care workers, January 1, 1989, through May 31, 1992. Antimicrobial susceptibility testing and restriction fragment length polymorphism analysis of M tuberculosis isolates.… Read more

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An outbreak of pyrogenic reactions in chronic hemodialysis patients associated with hemodialyzer reuse

Abstract

In February 1992, 22 patients undergoing chronic hemodialysis at an outpatient dialysis center experienced pyrogenic reactions (PR). The PR rate was significantly greater (p < 0.001) during the epidemic (February 3-5) than the pre-epidemic period (November 1, 1992-February 1, 1992). All patients with PR used dialyzers that had been manually reprocessed either on February 1 or 3. These dialyzers contained up to 120.8 EU/ml of endotoxin in the blood compartment. The only dialyzer reprocessed before February 1 that was available for analysis was found to contain no detectable endotoxin, while dialyzers reprocessed during the epidemic period contained a median endotoxin concentration of 52.8 EU/ml. The bioburden of water used to prepare dialysate was in excess of the Association for the Advancement of Medical Instrumentation (AAMI) standard for water, < or = 200 colony forming units (CFU)/ml. Samples of treated water collected in the reuse area were within AAMI standards at the time of the investigation (February 11 and February 26), but before the investigation, water samples were assayed with a culture method that could not detect microbial concentrations below 10(3) CFU/ml. In addition, the treated water feed line to the disinfectant container may never have been disinfected. However, no samples were collected from this line during the investigation. This outbreak emphasizes the need to use water that meets the AAMI bacteriologic and endotoxin standards of < or = to 200 CFU/ml and/or 5 EU/ml, respectively, for reprocessing hemodialyzers nad to ensure that appropriate culture techniques are used for treated water dialysate.

Rudnick JR, Arduino MJ, Bland LA, Cusick L, McAllister SK, Aguero SM, Jarvis WR

Artif Organs 1995 Apr;19(4):289-94

PMID: 7598647

An outbreak of pyrogenic reactions in chronic hemodialysis patients associated with hemodialyzer reuse was last modified: April 1st, 1995 by Rudnick JR, Arduino MJ, Bland LA, Cusick L, McAllister SK, Aguero SM, Jarvis WR… Read more
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SHEA-CDC TB survey, Part I: Status of TB infection control programs at member hospitals, 1989-1992. Society for Healthcare Epidemiology of America

Abstract

OBJECTIVE: To determine trends in Mycobacterium tuberculosis infection in healthcare workers, tuberculosis (TB) control measures, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) guideline for preventing transmission of TB in healthcare facilities.

DESIGN: Voluntary questionnaire sent to all members of the Society for Healthcare Epidemiology of America, representing 359 hospitals.… Read more

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SHEA-CDC TB survey, Part II: Efficacy of TB infection control programs at member hospitals, 1992. Society for Healthcare Epidemiology of America

Abstract

OBJECTIVE: To assess the efficacy of current Mycobacterium tuberculosis control measures.

DESIGN: Voluntary questionnaire to members of the Society for Healthcare Epidemiology of America.

RESULTS: Healthcare worker (HCW) tuberculin skin-test (TST) conversion rates were significantly higher in larger hospitals (or = 437 beds) (0.9% versus 0.6%; P < 0.05), or in hospitals reporting > or = 6 TB patients in 1992 (1.2% versus 0.6%; P < 0.05). Among larger hospitals or those hospitals surveyed reporting > or = 6 TB patients, those without at least three of the four criteria suggested in the 1990 Centers for Disease Control and Prevention (CDC) TB guidelines for acid-fast bacilli (AFB) isolation (specifically, a single-patient room; negative pressure; and air exhausted directly outside) had significantly higher annual TST conversion rates than those with these criteria (1.8% versus 0.6%; P < 0.05). Respiratory therapist or bronchoscopist TST conversion rates were significantly lower in hospitals compliant with the exhaust criteria (1.2% versus 2.8%; P < 0.05). Regardless of hospital characteristic, HCW TST conversion rates did not differ between hospitals in which HCWs used surgical masks or used disposable particulate respirators.

CONCLUSION: Among larger hospitals or hospitals reporting or = 6 TB patients per year, failure to comply with the 1990 CDC TB recommendations for AFB isolation room guidelines was associated with higher HCW TST conversion rates.… Read more

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Epidemic nosocomial pneumonia in the intensive care unit

Abstract

The changing and expanding spectrum of pathogens associated with nosocomial pneumonia (NP) will require modification in our approach to both endemic and epidemic NP in the ICU. Knowledge of specific pathogens, modes of transmission, and sources or reservoirs of epidemic NP is crucial to the recognition, control, and prevention of these infections in ICU patients.… Read more

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Control of nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among healthcare workers and HIV-infected patients

Abstract

From 1988 to 1990, an outbreak of multidrug-resistant tuberculosis (MDR-TB) among patients, and an increased number of tuberculin-skin-test conversions among healthcare workers, occurred on the HIV ward of Jackson Memorial Hospital, Miami, Florida, USA. Measures similar to those subsequently recommended in the 1990 Centers for Disease Control and Prevention guidelines were implemented on the HIV ward by June, 1990, and in September, 1992, we evaluated the efficacy of these control measures.… Read more

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Respirators, recommendations, and regulations: the controversy surrounding protection of health care workers from tuberculosis

Abstract

Recent nosocomial outbreaks of tuberculosis have increased concern about the occupational acquisition of tuberculosis by health care workers. The Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, and the Occupational Safety and Health Administration, Department of Labor, have issued recommendations and regulations in an effort to decrease health care workers’ risk for exposure to patients with infectious tuberculosis.… Read more

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Efficacy of control measures in preventing nosocomial transmission of multidrug-resistant tuberculosis to patients and health care workers

Abstract

OBJECTIVE: To assess the efficacy of control measures in decreasing nosocomial transmission of multidrug-resistant tuberculosis.

DESIGN: Retrospective cohort study.

SETTING: A teaching hospital in New York City.

POPULATION: 40 patients hospitalized with multidrug-resistant tuberculosis (case-patients) and health care workers receiving tuberculin skin testing.… Read more

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An outbreak of gram-negative bloodstream infections in chronic hemodialysis patients

Abstract

Six chronic hemodialysis patients acquired bloodstream infections (BSIs) with Klebsiella pneumoniae of the same serotype and similar plasmid profile during an 11-day period. The 6 case-patients were more likely than noncase-patients to have received dialysis during the fourth shift (p < 0.05) and to have their dialyzers reprocessed for reuse after those of the noncase-patients (p = 0.05). Investigation identified a patient during the same shift with an arteriovenous fistula infected with K. pneumoniae. The dialyzer reprocessing technician did not change gloves between contacting patients and their dialyzers in the treatment area and reprocessing the case-patients' dialyzers at the end of the fourth shift. We conclude that the outbreak of BSIs was caused by cross-contamination of the case-patients' dialyzers with bacteria from the gloves of the reprocessing technician and by inadequate dialyzer disinfection. After revised dialyzer reprocessing techniques and glove-changing policies were instituted, no further clusters of BSIs occurred.

Welbel SF, Schoendorf K, Bland LA, Arduino MJ, Groves C, Schable B, O’Hara CM, Tenover FC, Jarvis WR

Am.… Read more