Control of health care-associated infections (HAI): winning both the battles and the war.

At present, the United States (US) experiences its greatest life expectancy due mainly to improvements in mortality from cardiovascular diseases, which include coronary heart disease and stroke. These, in turn, are due largely to decreases in cigarette smoking as well as earlier and more aggressive diagnoses and treatments. These advances in health care delivery are, not surprisingly, accompanied by increasing numbers of complicating health care-associated infections (HAI).

Origin of the old testament plagues: explications and implications.

Analyses of past disasters may supply insights to mitigate the impact of recurrences. In this context, we offer a unifying causative theory of Old Testament plagues, which has present day public health implications. We propose the root cause to have been an aberrant El Niño-Southern Oscillation teleconnection that brought unseasonable and progressive climate warming along the ancient Mediterranean littoral, including the coast of biblical Egypt, which, in turn, initiated the serial catastrophes of biblical sequence - in particular arthropod-borne and arthropod-caused diseases.

Emergence of highly antibiotic-resistant Pseudomonas aeruginosa in relation to duration of empirical antipseudomonal antibiotic treatment.

Objective: This study examines antibiotic resistance in Pseudomonas aeruginosa in hospitalized patients in relation to prior empirical antibiotic therapy.

Design: Two retrospective case analyses comparing patients who manifested P aeruginosa with differing patterns of antibiotic resistance.

Setting And Participants: Patients acquiring P aeruginosa in a community hospital.

An apparent excess of operative site infections: analyses to evaluate false-positive diagnoses.

Objective: To investigate an apparent excess of operative site infections (OSI) reported according to doctor's diagnosis (presumptive OSI) by applying objective criteria for classification (documented OSI). To examine potential consequences of habitual overdiagnosis of OSI.

Design: A case-control design was used to examine the clinical course of 18 case patients (12 presumptive OSI, six documented OSI) and 18 matched controls.

Recorded criteria as a "gold standard" for sensitivity and specificity estimates of surveillance of nosocomial infection: a novel method to measure job performance.

Objectives: To compare the accuracy of infection control practitioners' (ICPs') classifications of operative site infection in Florida Consortium for Infection Control (FCIC) hospitals, in two time periods, 1990 to 1991 and 1991 to 1992, and to estimate the effect of duration of surveillance experience on that accuracy.

Methods: Medical record reviewers examined records of all patients classified by an ICP as infected, to distinguish false-positives from true infections based on evidence of standard infection criteria and the ICP's contemporaneous clinical observations. Reviewers also examined a random sample of 100 records from patients classified as noninfected for evidence of undetected infections (false-negatives).

Intervention to discontinue parenteral antimicrobial therapy in hospitalized patients with urinary tract infection, skin and soft tissue infection, or no evident infection.

Objectives: In a previous study, we found that unsolicited recommendations to physicians of medically stable patients with pneumonia to suspend parenteral antimicrobials shortened hospital length of stay (LOS) significantly. In this study, we made similar recommendations to physicians treating patients with different indications for parenteral antimicrobials, to examine the effect on LOS.

Methods: A nurse-interventionist presented randomly assigned physicians with nonconfrontational suggestions to discontinue parenteral antimicrobials by substituting comparable oral antimicrobials or stopping treatment.

Long term epidemiological analysis of Citrobacter diversus in a neonatal intensive care unit.

A prolonged outbreak of Citrobacter diversus central nervous system infection among hospitalized term infants, peaking in 1979, ceased with establishment of nurse-patient cohorting. The outbreak was attributed to dissemination of an epidemic strain among infants in an antiquated neonatal intensive care unit. When C.

Lack of evidence of efficacy of cohorting nursing personnel in a neonatal intensive care unit to prevent contact spread of bacteria: an experimental study.

Nurse cohorting was investigated in a modern neonatal intensive care unit (NICU). During 99 days bacterial infection and colonization rates were determined in 100 infants experimentally assigned cohort or noncohorted care. Colonizing isolate identity was determined by plasmid profile analyses and biotyping in weekly surveillance cultures.

Intervention to discontinue parenteral antimicrobial therapy in patients hospitalized with pulmonary infections: effect on shortening patient stay.

Objectives: Current efforts to contain anti-microbial costs in hospitals are based on restricting drugs. We explored the effects of unsolicited case-specific recommendations to physicians to discontinue parenteral antimicrobial therapy in medically stable patients with pneumonia, in order to shorten hospital length of stay.

Methods: A nurse-interventionist, working as an emissary of an appropriate committee in 3 nonteaching community hospitals, presented randomly assigned physicians with nonconfrontational suggestions to substitute comparable oral antimicrobials for parenteral antimicrobials.

Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters.

Objective: The study was designed to compare the efficacies of bland soap handwash and isopropyl alcohol hand rinse in preventing transfer of aerobic gram-negative bacilli to urinary catheters via transient hand colonization acquired from direct patient contact. Glove juice recovery of gram-negative bacteria was considered transient colonization; catheter recovery was considered transfer colonization.

Design: The contact source for gram-negative bacteria was a single "high burden" groin skin carrier (greater than or equal to 10(4)/ml cup scrub fluid).

Mediastinitis complicating cardiac operations: evidence of postoperative causation.

An excess rate of mediastinitis complicating cardiac operations occurred in one of two hospitals served by the same surgeons. The rates were 4% at hospital A and 0.48% at hospital B for the same period (P = .

Irrigation-aspiration for culturing draining decubitus ulcers: correlation of bacteriological findings with a clinical inflammatory scoring index.

Biopsy of infected decubitus ulcers for culture disrupts tissues and may disseminate infection. Antimicrobial prophylaxis to prevent dissemination of infection may adversely affect biopsy culture results. Irrigation-aspiration to obtain submarginal specimens from draining decubitus ulcers was studied as an atraumatic, noninvasive culturing technique to serve as an alternative to biopsy in research activities.

Infections complicating low-risk cesarean sections in community hospitals: efficacy of antimicrobial prophylaxis.

A prospective study of women with low-risk cesarean sections was conducted in four community hospitals to determine the frequency of postoperative infections and identify factors predisposing to endometritis and wound infection. Low-risk cesarean section was defined as a scheduled procedure without an urgent indication, with any duration of ruptured membranes being less than or equal to 12 hours. In a cohort of 1863 patients, 26 (1.

Containing costs of antimicrobials in the hospital: a critical evaluation.

Because reimbursement of hospitals from patient sources for the cost of antimicrobial agents varies considerably according to the nature of the patient population, the actual savings potential of cost-containment efforts is proportional to the extent that costs are not reimbursed. Meaningful cost estimations include calculations for drug preparation, administration, necessary laboratory tests, toxicity, and acquisition. Savings in surgical antimicrobial prophylaxis may be estimated according to the type and volume of operations, history of usage excesses, and anticipated degree of cooperation of surgeons.

Proteeae species bacteriuria accompanying Proteeae species groin skin carriage in geriatric outpatients.

There have been numerous reports of Proteeae species urinary tract infections among elderly individuals. To explore a possible urinary carrier source of Proteeae species in this population, the frequency of aerobic gram-negative bacillus (AGNB) bacteriuria at the greater than or equal to 10(2)/ml level was determined in 67 ambulatory elderly outpatients classified as to Proteeae group (Morganella, Proteus, Providencia) groin carriage by a set of two skin cultures obtained at least 1 week apart. None had urethral catheters, symptomatic infections, skin ulcers, or recent antibiotic therapy.

Indications for alcohol or bland soap in removal of aerobic gram-negative skin bacteria: assessment by a novel method.

A patient contact model was devised for health care workers (HCWs) to define heavy hand contamination with aerobic gram-negative bacilli (AGNB) that requires alcohol for complete removal. In patients, AGNB quantitation was per ml cup scrub fluid; in HCWs per ml glove juice. Following 15-second contact, two Proteeae groin carriers yielding greater than or equal to 4 log10 AGNB (high burden) transmitted greater than or equal to 3 log10 in 67% of 24 tests of six HCWs, and less than or equal to 2 log10 in 29%.

Proteeae groin skin carriage in ambulatory geriatric outpatients.

Aerobic gram-negative bacillus (AGNB) groin skin carriage was prospectively studied in ambulatory geriatric outpatients: 42 from three nursing homes and 44 from private homes. Initially, 12 (28.6%) Proteeae carriers were in the former group and 3 (6.

Sporadic bacteremia complicating central venous catheter use in a community hospital: a model to predict frequency and aid in decision-making for initiation of investigation.

Sporadic bacteremia complicating single-lumen central venous catheter (CVC) use was prospectively recorded in a community hospital in 1981 and 1982. Sixty-four of 1258 (5.1%) patients had definite bacteremia.

Proteeae groin skin carriage among nursing home residents--resistance to antiseptics.

Proteeae carriage was evaluated in groin skin carriers following vigorous antiseptic application. Three Proteus mirabilis carriers were treated with 60% isopropyl alcohol or 4% chlorhexidine, observed to prevent skin contact, and then recultured; at four and eight hours P mirabilis numbers remained undiminished. Ten Proteeae carriers received a series of nine body baths with soap, chlorhexidine, and 0.