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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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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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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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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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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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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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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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Vancomycin use in hospitalized pediatric patients

Abstract

OBJECTIVES: To assess vancomycin utilization at children’s hospitals, to determine risk factors for vancomycin use and length of therapy, and to facilitate adapting recommendations to optimize vancomycin prescribing practices in pediatric patients.

METHODS: Two surveys were conducted at Pediatric Prevention Network hospitals.… 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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Serratia marcescens bacteremia traced to an infused narcotic

Abstract

BACKGROUND: From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak.

METHODS: A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic.… Read more

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Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey

Abstract

To assess risk factors for development of candidal blood stream infections (CBSIs), a prospective cohort study was performed at 6 sites that involved all patients admitted to the surgical intensive care unit (SICU) for 48 h over a 2-year period.… Read more

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Use and efficacy of tuberculosis infection control practices at hospitals with previous outbreaks of multidrug-resistant tuberculosis

Abstract

OBJECTIVE: To evaluate the implementation and efficacy of selected Centers for Disease Control and Prevention guidelines for preventing spread of Mycobacterium tuberculosis.

DESIGN: Analysis of prospective observational data.

SETTING: Two medical centers where outbreaks of multidrug-resistant tuberculosis (TB) had occurred.… Read more

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Anesthesia-associated carbon monoxide exposures among surgical patients

Abstract

OBJECTIVE: To estimate the extent of, and evaluate risk factors for, elevated carboxyhemoglobin levels among patients undergoing general anesthesia and to identify the source of carbon monoxide.

DESIGN: Matched case-control study to measure carboxyhemoglobin levels.

SETTING: Large academic medical center.… Read more

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Emerging healthcare-associated problem pathogens in the United States

Abstract

Healthcare-associated infections are a major cause of morbidity and mortality. Dramatic changes in the delivery of healthcare during the past decade have changed the definition of healthcare-associated infections. Healthcare delivery changes include a reduction in the number of general hospital beds, an increase in the proportion of patients who are in intensive care units, a larger proportion of surgical procedures performed as outpatient procedures, a marked increase in patients cared for in outpatient settings, and an increase in the delivery of healthcare in the home setting.… Read more

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An epidemic of corneal destruction caused by plasma gas sterilization. The Toxic Cell Destruction Syndrome Investigative Team

Abstract

BACKGROUND: Toxic endothelial cell destruction (TECD) syndrome after intraocular ophthalmic surgery is rare and can result from exposure to a variety of toxins. During January 8 to 14, 1998, 6 patients developed TECD with corneal edema associated with unreactive or dilated pupils at Hospital A.… Read more

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Nosocomial tuberculosis prevention measures among two groups of US hospitals, 1992 to 1996

Abstract

OBJECTIVE: To compare trends in nosocomial tuberculosis (TB) prevention measures and health-care worker (HCW) tuberculin skin test (TST) conversion of hospitals with HIV-related Pneumocystis carinii pneumonia (PCP) patients and other US hospitals from 1992 through 1996.

DESIGN AND SETTING: Surveys in 1992 and 1996 of 38 hospitals with PCP patients in four high-HIV-incidence cities and 136 other US hospitals from the American Hospital Association membership list.… Read more

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The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit

Abstract

OBJECTIVES: To determine the risk factors for acquisition of nosocomial primary bloodstream infections (BSIs), including the effect of nursing-staff levels, in surgical intensive care unit (SICU) patients.

DESIGN: A nested case-control study.

SETTING: A 20-bed SICU in a 1,000-bed inner-city public hospital.… Read more

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Vancomycin use in pediatric neurosurgery patients

Abstract

OBJECTIVE: The objective of this article is to describe a pediatric neurosurgery patient population receiving vancomycin and examine the indications for and appropriateness of vancomycin use.

METHODS: A cross-sectional study was performed on the pediatric neurosurgery patients at Egleston Children’s Hospital who received vancomycin from January 1 through December 31, 1996.… Read more

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A pseudoepidemic of postoperative scleritis due to misdiagnosis

Abstract

OBJECTIVE: To describe a pseudoepidemic of infectious scleritis following eye surgery.

METHODS: Retrospective cohort study with selected procedural and laboratory investigations.

RESULTS: Twenty-one patients with postoperative scleritis were identified during a 2-month outbreak. Neither an infectious etiology nor a causative pre-, intra-, or postoperative exposure was found.… Read more

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Trends in compliance with the guidelines for preventing the transmission of Mycobacterium tuberculosis among New Jersey hospitals, 1989 to 1996

Abstract

OBJECTIVE: To determine trends in compliance with the guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare facilities among New Jersey hospitals from 1989 through 1996.

DESIGN: A voluntary questionnaire was sent to all 96 New Jersey hospitals in 1992.… Read more

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Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee

Abstract

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR

Infect Control Hosp Epidemiol 1999 Apr;20(4):250-78; quiz 279-80

PMID: 10219875

Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee was last modified: April 1st, 1999 by Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR… Read more
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Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee

Abstract

EXECUTIVE SUMMARY The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)’s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1,2 Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs.… Read more

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Surgical-site complications associated with a morphine nerve paste used for postoperative pain control after laminectomy

Abstract

OBJECTIVE: To identify risk factors that might explain a sudden increase in the rate of surgical-site complications following laminectomy.

DESIGN: Retrospective cohort study.

PATIENTS AND SETTING: Patients who underwent laminectomy at a 120-bed hospital from August 1 through October 15, 1996 (the epidemic period).… Read more

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The prevalence of colonization with vancomycin-resistant Enterococcus at a Veterans’ Affairs institution

Abstract

OBJECTIVE: To study vancomycin-resistant Enterococcus (VRE) prevalence, risk factors, and clustering among hospital inpatients.

DESIGN: Rectal-swab prevalence culture survey conducted from February 5 to March 22, 1996.

SETTING: The Veterans’ Affairs Medical Center, Atlanta, Georgia.

PATIENTS: Hospital (medical and surgical) inpatients.… Read more

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Nocardia farcinica sternotomy site infections in patients following open heart surgery

Abstract

Although Nocardia farcinica surgical site infection outbreaks have been reported (though rarely), no source for these has been identified. From May 1992 through June 1993, 5 patients contracted N. farcinica sternotomy site infections following open heart surgery at hospital A.… Read more

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Are US hospitals making progress in implementing guidelines for prevention of Mycobacterium tuberculosis transmission?

Abstract

BACKGROUND: Outbreaks of tuberculosis (TB) in hospitals have occurred when the Centers for Disease Control and Prevention (CDC) guideline recommendations for preventing the transmission of Mycobacterium tuberculosis were not fully implemented.

OBJECTIVE: To determine whether US hospitals are making progress in implementing the CDC guidelines for preventing TB.… Read more

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Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device

Abstract

OBJECTIVE: To determine if an apparent increase in bloodstream infections (BSIs) in patients with central venous catheters (CVCs) was associated with the implementation of a needleless access device.

DESIGN: Retrospective cohort study using a derived CVC-days factor for estimating appropriate denominator data.… Read more

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Detecting pediatric nosocomial infections: how do infection control and quality assurance personnel compare?

Abstract

OBJECTIVE: To compare how well infection control (IC) and quality assurance (QA) personnel in a specialty setting identify the presence, type (nosocomial or community-acquired), and (if nosocomial) site of infection.

METHODS: In 1994, we mailed a survey that included 21 pediatric case histories to IC and QA personnel in pediatric settings in the United States (children’s hospitals and medical school-affiliated hospitals with pediatric wards of 30 beds).… Read more

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Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention

Abstract

Approximately 2 million nosocomial infections occur annually in the United States. These infections result in substantial morbidity, mortality, and cost. The excess duration of hospitalization secondary to nosocomial infections has been estimated to be 1 to 4 days for urinary tract infections, 7 to 8.2 days for surgical site infections, 7 to 21 days for bloodstream infections, and 6.8 to 30 days for pneumonia.… Read more

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Status of tuberculosis infection control programs at United States hospitals, 1989 to 1992. APIC. Association for Professionals in Infection Control and Epidemiology

Abstract

BACKGROUND: Recent nosocomial outbreaks have raised concern about the risk of Mycobacterium tuberculosis transmission in United States hospitals.

METHODS: To determine current tuberculosis (TB) infection control practices, we surveyed a sample of approximately 3000 acute care facilities about the number of patients with drug-susceptible or multidrug-resistant TB (MDR-TB), health care worker (HCW) tuberculin skin test (TST) results, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) TB guidelines.… Read more

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Risk factors for ventilator-associated pneumonia in surgical intensive-care-unit patients

Abstract

Patients admitted during the study period to the Sharp Memorial Hospital intensive-care units who required mechanical ventilation were followed prospectively; 15 (10.4%) of 145 acquired ventilator-associated pneumonia (VAP). Duration of prior oral or nasal intubation and H2 receptor antagonists use were longer among patients who developed VAP than among those who did not.… Read more

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The role of understaffing in central venous catheter-associated bloodstream infections

Abstract

OBJECTIVE: To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.

DESIGN: Case-control and cohort studies of surgical intensive care unit (SICU) patients.

SETTING: A university-affiliated Veterans Affairs medical center.

PATIENTS: Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls.… Read more

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Acremonium kiliense endophthalmitis that occurred after cataract extraction in an ambulatory surgical center and was traced to an environmental reservoir

Abstract

During October and November 1993, four patients contracted Acremonium kiliense endophthalmitis at one ambulatory surgical center. We hypothesized that the source was environmental and conducted a matched case-control study, environmental evaluation, and observational studies. Case and control patients were similar in clinical characteristics.… 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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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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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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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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How common is latex allergy? A survey of children with myelodysplasia

Abstract

To estimate the prevalence of latex allergy among children with myelodysplasia, describe the spectrum of associated clinical symptoms and evaluate potential risk factors for the development of latex sensitization, the authors conducted a survey at a regional spina bifida center.… Read more

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Nosocomial infections in surgical patients in the United States, January 1986-June 1992. National Nosocomial Infections Surveillance (NNIS) System

Abstract

OBJECTIVES: To describe the distribution of nosocomial infections among surgical patients by site of infection for different types of operations, and to show how the risk of certain adverse outcomes associated with nosocomial infection varied by site, type of operation, and exposure to specific medical devices.… Read more

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CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections

Abstract

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG

Infect Control Hosp Epidemiol 1992 Oct;13(10):606-8

PMID: 1334988

CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections was last modified: October 1st, 1992 by Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG… Read more
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CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections

Abstract

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG

Am J Infect Control 1992 Oct;20(5):271-4

PMID: 1332552

CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections was last modified: October 1st, 1992 by Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG… Read more
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Outbreak of surgical wound infections associated with total hip arthroplasty

Abstract

OBJECTIVES: Describe an outbreak of surgical wound infections associated with total hip arthroplasty; identify risk factors for surgical wound infection during the pre-outbreak and outbreak periods.

SETTING: A 100-bed hospital. From May 1 to September 30, 1988, 7 of 15 patients who underwent total hip arthroplasty developed surgical wound infections from Staphylococcus aureus (5), Enterobacter cloacae (1), beta-hemolytic streptococci (1), enterococci (1), coagulase-negative staphylococci (1), and Escherichia coli (1) (attack rate = 46.7%).… Read more

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Antimicrobial susceptibility patterns of common and unusual species of enterococci causing infections in the United States. Enterococcal Study Group

Abstract

We collected 705 isolates of enterococci (1 per patient) from cultures of a variety of anatomic sites from patients at eight tertiary-care hospitals in six geographic regions of the United States. A total of 632 (90%) Enterococcus faecalis, 58 (8%) E.… Read more

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A cluster of severe postoperative bleeding following open heart surgery

Abstract

OBJECTIVE: To investigate a cluster of postoperative bleeding following open heart surgery.

DESIGN: A cohort and case/control study.

SETTING: Palo Alto Veterans Administration Medical Center, Palo Alto, California.

PARTICIPANTS: Six (21.4%) of 28 patients undergoing open heart surgery who developed severe, nonsurgical, postoperative bleeding from July 1 through August 30, 1988 (outbreak period).… Read more

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Predominant pathogens in hospital infections

Abstract

To determine the distribution of pathogens causing nosocomial infections in United States hospitals, we analysed data from the National Nosocomial Infections Surveillance (NNIS) System. From October 1986 to December 1990, amongst hospitals conducting hospital-wide surveillance, the five most commonly reported pathogens were Escherichia coli (13.7%), Staphylococcus aureus (11.2%), enterococci (10.7%), Pseudomonas aeruginosa (10.1%), and coagulase-negative staphylococci (9.7%).… Read more

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Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients

Abstract

OBJECTIVE: To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization.

DESIGN: Surveillance and cohort study.

SETTING: A 470-bed tertiary trauma-referral community hospital.

PATIENTS: From January 1, 1988 to March 17, 1989, 106 intensive care unit patients developed X maltophilia infection/colonization.… Read more

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Aspergillus fumigatus sternal wound infections in patients undergoing open heart surgery

Abstract

During a 21-month period (July 1986-April 1988), six patients who underwent open heart surgery at Holston Valley Hospital and Medical Center in Kingsport, Tennessee, developed sternal would infections caused by Aspergillus fumigatus. All patients required sternectomy, reconstructive surgery, and long term amphotericin B therapy; no patient died.… Read more

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Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System

Abstract

To determine which intensive care unit (ICU) infection rate may be best for interhospital and intrahospital comparisons and to assess the influence of invasive devices and type of ICU on infection rates, we analyzed data from the National Nosocomial Infections Surveillance System.… Read more

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Serratia marcescens surgical wound infection following breast reconstruction

Abstract

Surgical wound infections due to gram-negative bacilli have been rarely reported following breast implant surgery. From April to November 1989, four patients from one plastic surgeon’s practice developed Serratia marcescens surgical wound infection (SWI) following breast reconstruction procedures with implantation of six expandable mammary implants.… Read more