Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index.

Severity-of-illness scales have proven valuable in assessing clinical outcomes and resource consumption in adult and pediatric intensive care, but they have been less extensively developed for neonatal care. The National Therapeutic Intervention Scoring System (NTISS) was created by modifying the Therapeutic Intervention Scoring System (TISS). From the 76 original TISS items, 42 were deleted and 28 added to form the NTISS.

Transmission of infectious diseases in children.

A rational approach to the control of pediatric infectious diseases requires an appreciation of their epidemiology and mechanisms of transmission. The setting in which the exposure occurs may have a major influence on the risk of infection. Unfortunately, the epidemiology of many important pediatric pathogens is complex and incompletely understood.

A service chief model for general pediatric inpatient care and residency training.

Pediatric training programs are faced with rapid, fundamental changes in hospital practice and an increasingly rigorous regulatory and fiscal environment. Traditional models for providing care and teaching students and house officers may not be sufficiently responsive to these challenges. In 1986, the Department of Medicine at Children's Hospital, Boston, reorganized the general inpatient program and implemented a "service chief" system adapted from British hospital "firms.

Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities.

Purpose: The purpose of this investigation was to observe and assess the actual disinfection or sterilization of endoscopes in health care facilities.

Materials And Methods: A total of 22 hospitals and four ambulatory care centers in three states were studied. Facility protocols were reviewed, interviews conducted with relevant personnel, actual disinfection or sterilization procedures observed, and biologic tests performed to determine and assess disinfection/sterilization procedures.

Rapid detection of group A streptococci: comparative performance by nurses and laboratory technologists in pediatric satellite laboratories using three test kits.

Rapid tests for detecting group A streptococci in throat swabs are often performed outside hospitals or commercial laboratories by individuals with little or no technical training. We compared the abilities of nurses and technologists to perform and interpret three commercial kits (Directigen 1-2-3, ICON Strep A, and Culturette Brand 10-Minute Strep A ID) in three hospital satellite locations (the emergency department, a walk-in emergency clinic, and a general pediatric clinic). When the three tests were compared with culture, the sensitivities of the tests as performed by nurses and technologists, respectively, were 39 versus 44% for Directigen, 55 versus 51% for Culturette, and 72 versus 39% for ICON.

Protection against endocarditis due to Staphylococcus epidermidis by immunization with capsular polysaccharide/adhesin.

Background: Staphylococcus epidermidis is the principal pathogen in prosthetic valve endocarditis. The capsular polysaccharide adhesin (PS/A) has been shown to mediate attachment of bacteria to medical devices. In this study, we investigated the efficacy of active and passive immunization against PS/A in preventing S.

Contemporary challenges for hospital epidemiology.

According to conventional wisdom, it is time for hospital epidemiologists to look beyond traditional infection control responsibilities and to shoulder an "expanded role," including quality assurance, risk management, and pharmacoepidemiology. Some see this as a matter of survival as the profession reacts to potent external forces that seek to curb the cost of health care while assuring quality service. Infection control specialists, it is argued, have the epidemiologic skills to measure adverse outcomes of hospitalization, adjust for confounding variables, and evaluate the impact of targeted interventions.

Adaptation of the Centers for Disease Control guidelines for the prevention of nosocomial infection in a pediatric intensive care unit in Jakarta, Indonesia.

We attempted to implement a nosocomial infection control program based on the Centers for Disease Control (CDC) guidelines in an urban Indonesian public hospital at the request of Project Hope. Adoption of unmodified CDC guidelines was impeded by a substandard physical plant, absence of an infection control infrastructure, limited sterilization capabilities, lack of clinical microbiologic laboratory support, and the expense of single use medical devices. After on-site evaluations, CDC guidelines were extensively modified so that they were appropriate for local conditions and culture.

Blood proteins do not promote adherence of coagulase-negative staphylococci to biomaterials.

We studied the effects of in vitro and in vivo coating of catheters with human blood proteins on binding of coagulase-negative staphylococci. Coating resulted in no enhancement of binding. Catheters coated in vitro bound fewer organisms than uncoated catheters.

The role of barrier precautions in infection control.

Barrier precautions are a fundamental component of any infection control strategy and a critical aspect of all isolation systems. Because many infections are transmitted from patient-to-patient via the hands of personnel, gloves and gowns are widely recommended to provide an extra measure of protection against cross-infection. It is not clear whether gloves are superior to handwashing (if performed obsessionally) in this respect, and there is little evidence that gowns confer additional benefit.

False resistance to imipenem with a microdilution susceptibility testing system.

Routine monitoring of antibiotic resistance at Children's Hospital, Boston, detected a dramatic increase in the prevalence of imipenem-resistant strains of Pseudomonas aeruginosa. Further studies documented that false resistance to imipenem was due, in part, to the loss of imipenem potency in customized MIC microdilution trays supplied by Sensititre Ltd. (West Sussex, United Kingdom).

Chromosomally mediated beta-lactamase production and gentamicin resistance in Enterococcus faecalis.

We have analyzed four distinct strains of multiply resistant, beta-lactamase-producing enterococci isolated during an outbreak of colonization with these strains on an infant-toddler surgical ward at The Children's Hospital in Boston, Mass. All four strains were resistant to erythromycin, penicillin, and tetracycline and to high levels of gentamicin and streptomycin. One strain was also resistant to chloramphenicol.

Birth weight and length of stay as determinants of nosocomial coagulase-negative staphylococcal bacteremia in neonatal intensive care unit populations: potential for confounding.

Coagulase-negative staphylococci are the most common cause of bacteremia in the neonatal intensive care units of the Brigham and Women's Hospital and the Children's Hospital, Boston, Massachusetts. In 1982, nosocomial bacteremia with coagulase-negative staphylococci occurred in 45 of 882 (5.1%) infants admitted to these units who survived and remained in intensive care for more than 48 hours and were therefore at risk.

Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units.

Background And Methods: Coagulase-negative staphylococci are now the chief cause of bacteremia in neonatal intensive care units. To investigate potential risk factors for this nosocomial infection, we conducted a case--control study among 882 infants treated in two neonatal intensive care units during 1982.

Results: The 38 case patients and 76 controls were similar with respect to 27 indicators of the severity of the underlying illness.

Antibody to the capsular polysaccharide/adhesin protects rabbits against catheter-related bacteremia due to coagulase-negative staphylococci.

A rabbit model of catheter-related bacteremia was developed to study immunity to the capsular polysaccharide/adhesin (PS/A) of coagulase-negative staphylococci. Catheters colonized by coagulase-negative staphylococci were inserted into the right jugular vein and attached to a subcutaneous osmotic pump, and blood cultures were obtained over 14 days. Nonimmune rabbits were bacteremic for 6-8 days after infection, hypoglycemic, and hyperlipidemic and had strong immune responses to teichoic acid but not to PS/A.

Coagulase-negative staphylococci: interplay of epidemiology and bench research.

Coagulase-negative staphylococci (CNS) are major nosocomial pathogens in patients with prostheses and indwelling devices such as central venous catheters. For Staphylococcus epidermidis the unique association with foreign-body infections appears to be due in part to a capsular polysaccharide adhesin that mediates attachment to silicon elastomer and other biomedical materials. In addition, staphylococcal "slime" may promote persistent colonization of indwelling devices and protect staphylococci from clearance by host defense mechanisms.

Enzymatically labelled nucleic acid (NA) probe assays for detection of Campylobacter spp. in human faecal specimens and in culture.

Seventy-two stock clinical isolates of C. jejuni were tested with the SNAP Culture Identification Test Kit (Molecular Biosystems, Inc., San Diego, CA), an enzyme labelled nucleic acid probe colony blot assay, and with the Campyslide (BBL Microbiology Systems, Cockeysville, MD), a latex agglutination test.

Extra hospital stay and antibiotic usage with nosocomial coagulase-negative staphylococcal bacteremia in two neonatal intensive care unit populations.

Coagulase-negative staphylococci were the leading cause of nosocomial bacteremia in the neonatal intensive care units of the Brigham and Women's Hospital and Children's Hospital, Boston, Mass, in 1982. To determine the consequences of these nosocomial bacteremias, a cohort study was conducted in which two comparison subjects were matched with each of 38 bacteremic infants by hospital, birth weight within 100 g, and nearest date of discharge. To adjust for duration of stay in the hospital, it was also required that both comparison subjects have survived and remained in the hospital for as long as the time until bacteremia occurred in the bacteremic infant.

Microbial challenge of a blood cell separator outside-seal bowl system.

The ability to store platelets beyond 24 hours requires a functionally closed system. This study tested the ability of a cell separator bowl seal system to resist penetration of microbial contamination under normal running conditions and under extreme environmental stress. Three test organisms, Micrococcus luteus, Serratia marcescens, and Staphylococcus epidermidis, were applied directly to the bowl at the edge of the seal or aerosolized and passed through the centrifuge chamber while the cell separator was run through a simulated platelet collection.

[Surgical iridectomy following acute angle-closure glaucoma. A retrospective study of 107 patients].

In 69 of 107 patients with primary angle-closure glaucoma, it was possible to control intraocular pressure and visual fields by means of peripheral surgical iridectomy; in 17 of these patients topical glaucoma medication was required in addition. In 11 cases a second surgical operation other than iridectomy was necessary: 6 lensectomies for malignant glaucoma in 2 cases and lens subluxation or phacomorphic glaucoma in 4 and 5 filtering procedures. Among the 85 treated fellow eyes 68 were controlled by iridectomy alone and 17 eyes needed additional topical glaucoma medication.

Current issues in central venous catheter infection.

The majority of central venous line-associated infections are caused by organisms on the skin near the exit site gaining access to the intravascular segment of the catheter. A variety of strategies have been used in an effort to reduce catheter contamination, but one innovation--the semipermeable transparent dressing--may actually increase infection risk. On the other hand, new catheter materials and designs probably reduce the risk.

Prevention and management of neonatal infections.

The risk of nosocomial infection in full term neonates cared for in well-baby nurseries can be minimized if personnel adhere to fundamental infection control principles. Neonates who require intensive care face a much greater risk of infection, particularly if they have very low birthweights. Such babies have seriously impaired host defenses, require prolonged hospital stays, and are exposed to a variety of invasive diagnostic and therapeutic procedures.