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Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices

Abstract

OBJECTIVE: The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees.

METHODS: A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups).… Read more

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The Roles of Epidemiologists, Laboratorians, and Public Health Agencies in Preventing Invasive Cronobacter Infection

Abstract

BACKGROUND: Cronobacter can cause severe, invasive infection in very young infants. These bacteria can also colonize or cause insignificant infections in immunocompromised, elderly, and/or hospitalized adults.

METHODS: This editorial review highlights key points addressed in the Frontiers Research Topic on Cronobacter, discusses the clinical presentation and epidemiology of Cronobacter infections, and examines the responses of public health agencies to this problem.… Read more

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Meta-analysis on central line-associated bloodstream infections associated with a needleless intravenous connector with a new engineering design

Abstract

BACKGROUND: Intravenous needleless connectors (NCs) with a desired patient safety design may facilitate effective intravenous line care and reduce the risk for central line-associated bloodstream infection (CLA-BSI). We conducted a meta-analysis to determine the risk for CLA-BSI associated with the use of a new NC with an improved engineering design.… Read more

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Multicenter cohort study to assess the impact of a silver-alloy and hydrogel-coated urinary catheter on symptomatic catheter-associated urinary tract infections

Abstract

PURPOSE: The purpose of this study was to determine the effect of a silver-alloy hydrogel catheter on symptomatic catheter-associated urinary tract infections (CAUTIs).

DESIGN: Multicenter before-after non-randomized cohort study.

SUBJECTS AND SETTING: Seven acute care hospitals ranging in size from 124 to 607 beds participated in this study.… Read more

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Comparison of central line-associated bloodstream infection rates when changing to a zero fluid displacement intravenous needleless connector in acute care settings

Abstract

This was a multicenter, quasiexperimental, 140-month, acute care study comparing central line-associated bloodstream infection rates associated with positive or negative intravenous connectors to a zero fluid displacement connector. A decrease in central line-associated bloodstream infections was found after changing from either negative or positive intravenous connectors to the zero fluid displacement connector (P = .004) with total cost savings of over $3 million.… Read more

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Community-acquired, non-occupational needlestick injuries treated in US Emergency Departments

Abstract

BACKGROUND: The escalating number of persons self-injecting medications, predominantly insulin, has generated concerns that the public is at risk of acquiring blood-borne infections from discarded needles/syringes. Communities have developed disposal guidelines but a debate continues over the need for further legislation and/or at-home safety devices.… Read more

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Prevention of invasive Cronobacter infections in young infants fed powdered infant formulas

Abstract

BACKGROUND: Invasive Cronobacter infection is rare, devastating, and epidemiologically/microbiologically linked to powdered infant formulas (PIFs). In 2002-2004, the US Food and Drug Administration advised health care professionals to minimize PIF and powdered human milk fortifier (HMF)’s preparation, feeding, and storage times and avoid feeding them to hospitalized premature or immunocompromised neonates.… Read more

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Socioeconomic impact on device-associated infections in pediatric intensive care units of 16 limited-resource countries: international Nosocomial Infection Control Consortium findings

Abstract

OBJECTIVES: We report the results of the International Nosocomial Infection Control Consortium prospective surveillance study from January 2004 to December 2009 in 33 pediatric intensive care units of 16 countries and the impact of being in a private vs. public hospital and the income country level on device-associated health care-associated infection rates.… Read more

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National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010

Abstract

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most prevalent multidrug-resistant organisms causing health care-associated infections. Limited data are available about how the prevalence of MRSA has changed over the past several years and what MRSA prevention practices have been implemented since the 2006 Association for Professionals in Infection Control and Epidemiology, Inc, MRSA survey.… Read more

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Health care-associated infection outbreak investigations by the Centers for Disease Control and Prevention, 1946-2005

Abstract

Since 1946, Centers for Disease Control and Prevention (CDC) personnel have investigated outbreaks of infections and adverse events associated with delivery of health care. CDC Epidemic Intelligence Service officers have led onsite investigations of these outbreaks by systematically applying epidemiology, statistics, and laboratory science.… Read more

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Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC

Abstract

PURPOSE: To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs).

METHODS: Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries.… Read more

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Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States

Abstract

BACKGROUND: The economic impact of adding chlorhexidine gluconate (CHG)-impregnated sponge dressing to standard care (ie, chg-impregnated sponge dressing + skin preparation and transparent film dressing vs skin preparation and transparent film dressing) for the prevention of central-line infections was evaluated.… Read more

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Risk factors and risk adjustment for surgical site infections in pediatric cardiothoracic surgery patients

Abstract

BACKGROUND: The complexity of congenital cardiac defects and the aggressive medical management required to support patients through their recovery place children at high risk for surgical site infection (SSI).

METHODS: We conducted a retrospective review of children undergoing cardiothoracic surgery at a tertiary care referral center between January 1, 2000, and June 30, 2001.… Read more

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Guidelines on blood cultures

Abstract

Just over one-third of sepsis patients have positive blood cultures, mainly due to inadequate sampling volumes (50% of adults have < 1.0 CFU/mL blood) and the prior use of antibiotics. However, 20-30% of sepsis patients are given inappropriate empirical antibiotics. The Clinical and Laboratory Standards Institute guidelines recommend paired culture sets to help discriminate between contaminant organisms and true pathogens; four 10-mL bottles (2 sets) should be used for the initial evaluation to detect about 90-95% of bacteremias and six 10-mL bottles (3 sets) should be used to detect about 95-99% of bacteremias. It has also been shown that the positivity rate increased by 15-35% with resin-based media in patients on antibiotics. For diagnosing catheter-related bloodstream infections, differential time-to-positivity is one method recommended to help determine whether the catheter is truly the source of infection. The proper training of personnel with regard to drawing an appropriate blood volume and the importance of clear labeling of culture bottles is also of critical importance. Furthermore, if the contamination rate is relatively high, hiring dedicated staff who are well-trained in order to get a lower blood culture contamination rate may be cost-effective. It is because high false-positive blood culture rates due to contamination are associated with significantly increased hospital and laboratory charges.

Towns ML, Jarvis WR, Hsueh PR

J Microbiol Immunol Infect 2010 Aug;43(4):347-9

PMID: 20688297

Guidelines on blood cultures was last modified: August 1st, 2010 by Towns ML, Jarvis WR, Hsueh PR… Read more
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Prevention of surgical-site infections

Abstract

Farr BM, Jarvis WR

N. Engl. J. Med. 2010 Apr;362(16):1541; author reply 1542-4

PMID: 20414961

Prevention of surgical-site infections was last modified: April 22nd, 2010 by Farr BM, Jarvis WR… Read more
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Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors

Abstract

BACKGROUND: Health care-associated, central venous catheter-related bloodstream infections (HA-BSIs) are a major cause of morbidity and mortality. Needleless connectors (NCs) are an important component of the intravenous system. NCs initially were introduced to reduce health care worker needlestick injuries, yet some of these NCs may increase HA-BSI risk.… Read more

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Healthcare-associated infection in Italy: annual point-prevalence surveys, 2002-2004

Abstract

OBJECTIVE: Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality worldwide. During the period from 2002 through 2004, a group of Italian hospitals was recruited to conduct HAI point-prevalence surveys.

DESIGN: Three point-prevalence surveys.

METHODS: A total of 9,609 patients were surveyed.… Read more

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Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative

Abstract

OBJECTIVE: The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.

METHODS: An observational study was conducted in 26 freestanding children’s hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative.… Read more

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Gram-negative bloodstream infections in hematopoietic stem cell transplant patients: the roles of needleless device use, bathing practices, and catheter care

Abstract

BACKGROUND: Between August 1 and October 30, 1998 (outbreak period), an increased incidence of central venous catheter (CVC)-associated gram-negative bacterial bloodstream infection (GN-BSI) was detected in hematopoietic stem cell transplantation (HSCT) candidates and recipients in an outpatient HSCT unit. The objectives of the present study were to determine strategies for controlling the outbreak and identify risk factors for GN-BSI.… Read more

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National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006

Abstract

BACKGROUND: Despite methicillin-resistant Staphylococcus aureus (MRSA) being endemic in virtually all US health care facilities, there are no data on the prevalence of MRSA in US health care facilities.

METHODS: We conducted a national prevalence survey of MRSA in inpatients at US health care facilities.… Read more

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The Lowbury Lecture. The United States approach to strategies in the battle against healthcare-associated infections, 2006: transitioning from benchmarking to zero tolerance and clinician accountability

Abstract

Approximately 2,000,000 healthcare-associated infections (HAIs) annually occur in US healthcare facilities and lead to approximately 60,000 90,000 deaths and cost $17 29 billion dollars. Such HAIs are an equal, if not more common problem, worldwide. Many evidence-based HAI prevention guidelines exist.… Read more

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Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam

Abstract

OBJECTIVE: We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam.

DESIGN: A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention).… Read more

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Infectious diseases physicians’ preferences for continuing medical education on antimicrobial resistance and other general topics

Abstract

A 19-item survey instrument was designed and mailed by the Infectious Diseases Society of America to its membership to determine the media preferred by infectious diseases physicians for continuing medical education on general topics and on antimicrobial resistance. The objective of the survey was to offer the developers of educational programs knowledge on which to base more-effective ways to deliver educational materials to physicians in this specialty.… Read more

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Incidence of pediatric and neonatal intensive care unit-acquired infections

Abstract

OBJECTIVE: To compare the cumulative incidence of infections acquired in the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU).

DESIGN: Estimation of the cumulative incidence of infections with data obtained from the Pediatric Prevention Network (PPN) point-prevalence survey and observed rates from the National Nosocomial Infections Surveillance (NNIS) system.… Read more

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The state of the science of health care epidemiology, infection control, and patient safety, 2004

Abstract

Being aware and implementing the latest and best scientific evidence in infection control and health care epidemiology is critical to enhancing patient outcomes. In this review, the latest published scientific data in health care epidemiology and patient safety were reviewed for the period May 2003-May 2004.… Read more

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HIV-1 and HCV infections among antibody-negative blood donors

Abstract

Kainer MA, Jarvis WR

N. Engl. J. Med. 2004 Nov;351(21):2232-5; author reply 2232-5

PMID: 15559958

HIV-1 and HCV infections among antibody-negative blood donors was last modified: September 28th, 2015 by Kainer MA, Jarvis WR… Read more
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Clostridium infections associated with musculoskeletal-tissue allografts

Abstract

BACKGROUND: Allografts are commonly used in orthopedic reconstructive surgery. In 2001, approximately 875,000 musculoskeletal allografts were distributed by U.S. tissue banks. After the death from Clostridium sordellii sepsis of a 23-year-old man who had received a contaminated allograft from a tissue bank (Tissue Bank A), the Centers for Disease Control and Prevention initiated an investigation, including enhanced case finding, of the methods used for the recovery, processing, and testing of tissue.… Read more

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Emergence of vancomycin-resistant enterococci in San Francisco Bay area hospitals during 1994 to 1998

Abstract

OBJECTIVE: To determine the magnitude of vancomycin-resistant enterococci (VRE) in three counties in the San Francisco Bay area.

DESIGN: Active laboratory-based surveillance for VRE from January 1995 through December 1996 and a laboratory-based and hospital-based questionnaire survey for 1993 to 1994 and 1997 to 1998.… Read more

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Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001

Abstract

We reviewed Clostridium difficile-associated disease (CDAD) data from the intensive care unit (ICU) and hospital-wide surveillance components of the National Nosocomial Infections Surveillance System hospitals during 1987-2001. ICU CDAD rates increased significantly only in hospitals with 500 beds (P… Read more

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Klebsiella pneumoniae bloodstream infections among neonates in a high-risk nursery in Cali, Colombia

Abstract

OBJECTIVES: To determine the cause of an outbreak of Klebsiella pneumoniae bloodstream infections (BSIs) among neonates in a high-risk nursery and to institute control measures.

DESIGN: During the on-site investigation, a cohort study to identify risk factors for K. pneumoniae BSI, a point-prevalence study to assess K.… Read more

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Clinical predictors of bloodstream infections and mortality in hospitalized Malawian children

Abstract

BACKGROUND: In sub-Saharan Africa, bloodstream infections (BSI) are a major cause of pediatric mortality. Because of limited resources and facilities in these developing countries, treatment often must be based solely on clinical observations and patient history and includes the use of broad spectrum antimicrobials, a factor in the emergence of antibiotic resistance.… Read more

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Controlling healthcare-associated infections: the role of infection control and antimicrobial use practices

Abstract

Healthcare-associated infections are a major cause of morbidity and mortality in pediatric patients in the United States and throughout the world. Overall rates of infection range widely depending on the pediatric population, with the highest rates being in patients in neonatal intensive care units, followed by those in pediatric intensive care units, immunocompromised patients, and those undergoing surgical procedures.… Read more

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Benchmarking for prevention: the Centers for Disease Control and Prevention’s National Nosocomial Infections Surveillance (NNIS) system experience

Abstract

Healthcare-associated infections are a major cause of morbidity and mortality at hospitals in the United States. Surveillance of these infections identifies secular trends and provides data upon which prevention interventions can be based in order to improve patient safety. National surveillance of healthcare-associated infections was initiated in the United States in 1970.… Read more

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Epidemiology of bloodstream infections in a bacille Calmette-Guérin-vaccinated pediatric population in Malawi

Abstract

The risk of Mycobacterium bovis bloodstream infection (BSI) in bacille Calmette-Guérin (BCG)-vaccinated children with human immunodeficiency virus (HIV) infection remains uncharacterized. We studied pediatric inpatients during the 1998 dry season in Malawi. After a detailed clinical evaluation, blood was drawn for culture and HIV testing.… Read more

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Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission

Abstract

OBJECTIVES: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among patients presenting for hospital admission and to identify risk factors for MRSA colonization.

DESIGN: Surveillance cultures were performed at the time of hospital admission to identify patients colonized with S.… Read more

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Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus in an outpatient clinic population

Abstract

OBJECTIVES: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in an outpatient population and to identify risk factors for MRSA colonization.

DESIGN: Surveillance cultures were performed during outpatient visits to identify S. aureus colonization. A case-control study was performed to identify risk factors for MRSA colonization.… Read more

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SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus

Abstract

BACKGROUND: Infection control programs were created three decades ago to control antibiotic-resistant healthcare-associated infections, but there has been little evidence of control in most facilities. After long, steady increases of MRSA and VRE infections in NNIS System hospitals, the Society for Healthcare Epidemiology of America (SHEA) Board of Directors made reducing antibiotic-resistant infections a strategic SHEA goal in January 2000.… Read more

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Are there regional variations in the diagnosis, surveillance, and control of methicillin-resistant Staphylococcus aureus?

Abstract

OBJECTIVE: To assess the way healthcare facilities (HCFs) diagnose, survey, and control methicillin-resistant Staphylococcus aureus (MRSA).

DESIGN: Questionnaire.

SETTING: Ninety HCFs in 30 countries.

RESULTS: Evaluation of susceptibility testing methods showed that 8 laboratories (9%) used oxacillin disks with antimicrobial content different from the one recommended, 12 (13%) did not determine MRSA susceptibility to vancomycin, and 4 (4.5%) reported instances of isolation of vancomycin-resistant S.… Read more

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Epidemiological and microbiological characterization of infections caused by Staphylococcus aureus with reduced susceptibility to vancomycin, United States, 1997-2001

Abstract

Infections caused by Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS; minimum inhibitory concentration [MIC], or=4 microg/mL), including vancomycin-intermediate S. aureus (VISA; MIC, 8 microg/mL), are a new clinical and public health dilemma. Prospective surveillance and a nested case-control study of patients in the United States infected with SA-RVS was conduced from March 1999 through December 2000.… Read more

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Peripheral blood cell-specific cytokines in persons with untreated HIV infection in Malawi, Africa

Abstract

Human immunodeficiency virus (HIV) infection is the primary cause of morbidity and mortality in Malawi, Africa, because of its many effects on the immune system. Immune cells communicate through cytokines; therefore, we examined the relationships between HIV serostatus and cell-specific cytokine production for 40 asymptomatic, employed adults and 312 acutely ill, hospitalized patients in Malawi.… Read more

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Demographic and immune correlates of human herpesvirus 8 seropositivity in Malawi, Africa

Abstract

BACKGROUND: In the USA, human herpesvirus 8 (HHV-8) is associated with Kaposi’s sarcoma (KS) and HIV infection. We examined HHV-8 seroprevalence in a Malawian cohort, and assessed its relationship with HIV, KS, demographic characteristics, and immune findings.

METHODS: In 1997 and 1998, blood samples were obtained from 272 hospitalized Malawian patients, for whom demographic information was obtained, and 24 healthy volunteers without demographic data.… Read more

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Clinical and immune impact of Mycobacterium bovis BCG vaccination scarring

Abstract

The World Health Organization recommends Mycobacterium bovis BCG vaccination in areas of high tuberculosis prevalence. BCG’s clinical and immune effects, not necessarily Mycobacterium tuberculosis specific, are unclear. BCG vaccine scarring often is used as a surrogate marker of vaccination or of effective vaccination.… Read more

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Automated Evaluation of AIDS Messages with High‐Risk, Low‐Literacy Audiences

Abstract

A series of televised public service announcements (PSAs) about acquired immune deficiency syndrome (AIDS) was evaluated with 100 black participants attending a Sexually Transmitted Diseases Clinic in Atlanta, Georgia. Since the literacy level of the participants was suspected to be low, questions were administered orally and an electronic data collection technique was used which permitted the participants to push buttons, as opposed to speaking or writing responses.… Read more

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Evaluation and treatment of neonates with suspected late-onset sepsis: a survey of neonatologists’ practices

Abstract

OBJECTIVE: To ascertain current diagnostic and treatment practices for suspected late-onset sepsis in infants in neonatal intensive care units (NICUs) and identify areas that may benefit from clinical practice guidelines.

METHODS: During June 2000, we conducted a multicenter survey of neonatologists and infection control professionals regarding practices related to late-onset sepsis in NICUs at children’s hospitals participating in the Pediatric Prevention Network.… Read more

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Spontaneous cytokine production and its effect on induced production

Abstract

Cytokines regulate cellular immune activity and are produced by a variety of cells, especially lymphocytes, monocytes, and macrophages. Multiparameter flow cytometry is often used to examine cell-specific cytokine production after in vitro phorbol 12-myristate 13-acetate and ionomycin induction, with brefeldin A or other agents added to inhibit protein secretion.… Read more

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Prevalence of surgical-site infections and patterns of antimicrobial use in a large tertiary-care hospital in Ho Chi Minh City, Vietnam

Abstract

BACKGROUND: Few studies have been conducted in Vietnam on the epidemiology of healthcare-associated infections or antimicrobial use. Thus, we sought to determine the prevalence of and risk factors for surgical-site infections (SSIs) and to document antimicrobial use in surgical patients in a large healthcare facility in Vietnam.… Read more

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Vitamin A levels and immunity in humans

Abstract

In animal studies, vitamin A deficiency induces a shift from type 2 (humoral, Th2) to type 1 (cellular, Th1) cytokines; there are no similar data for humans. Control of human immunodeficiency virus (HIV) and Mycobacterium tuberculosis infections requires type 1 cytokine (cellular) immunity.… Read more

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Bloodstream infections in pediatric oncology outpatients: a new healthcare systems challenge

Abstract

OBJECTIVE: To investigate a perceived increase in central venous catheter (CVC)-associated bloodstream infections (BSIs) among pediatric hematology-oncology outpatients.

DESIGN: A case-control study.

SETTING: A pediatric hematology-oncology outpatient clinic at Fresno Children’s Hospital.

PATIENTS: Pediatric hematology-oncology clinic outpatients with CVCs at Fresno Children’s Hospital between November 1994 and October 1997.… Read more

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Age-related differences in cell-specific cytokine production by acutely ill Malawian patients

Abstract

Age-related changes in human cell-specific cytokine responses to acute illness have not been well examined. We therefore evaluated age-related differences in T, B and natural killer (NK) peripheral blood lymphocyte cytokine responses of 309 acutely ill hospitalized people in Malawi, Africa, < 1 month-61 years of age.… Read more