Use of a patient empowerment tool for hand hygiene.

Background: Patient empowerment is recognized as an important component of a multimodal strategy to improve hand hygiene adherence. We examined the attitudes of adult patients and parents of pediatric patients toward a new patient empowerment tool (PET) at our hospital. We also surveyed physicians to determine their perceptions about the PET.

Multidisciplinary performance improvement team for reducing health care-associated Clostridium difficile infection.

Clostridium difficile is the most frequent cause of health care-associated diarrhea and is a significant cause of morbidity and mortality. It is also associated with a considerable financial burden. A concerted multidisciplinary approach is required for prevention.

Comparison of immune response to the influenza vaccine in obese and nonobese healthcare workers.

Objective: To determine whether there is a difference in antibody titers and functionality after receipt of the influenza vaccine for obese versus nonobese healthcare workers (HCW).

Design: Prospective observational study.

Setting: Tertiary medical center.

Knowledge and attitudes of visitors to patients in contact isolation.

In this study, conducted at a tertiary care center, we surveyed visitors to patients in contact isolation to assess their knowledge and attitudes about contact isolation. Although response rates were low, we found that visitors had an overall positive perception and understanding of contact isolation. We think this is likely attributable to the communication and education provided by health care providers to the visitors.

Nontuberculous mycobacterial cutaneous infections: an updated review.

Nontuberculous mycobacteria (NTM) cause cutaneous infections more commonly than Mycobacterium tuberculosis, and the incidence of infection with these organisms is increasing with the use of immunosuppressive agents. Diagnosis of NTM cutaneous infections is not always straightforward. Therefore, a high index of clinical suspicion is needed to make a diagnosis of NTM cutaneous infection.

Measurements of airborne influenza virus in aerosol particles from human coughs.

Influenza is thought to be communicated from person to person by multiple pathways. However, the relative importance of different routes of influenza transmission is unclear. To better understand the potential for the airborne spread of influenza, we measured the amount and size of aerosol particles containing influenza virus that were produced by coughing.

Left knee prosthesis-related Mycobacterium goodii infection.

Non-tuberculous mycobacteria are increasingly being recognized as important human pathogens. We present the case of a 44-year-old non-diabetic male who underwent left total knee arthroplasty for degenerative arthritis after trauma. He developed left knee swelling and progressively worsening pain over the next 4 weeks.

Distribution of airborne influenza virus and respiratory syncytial virus in an urgent care medical clinic.

Background: Considerable controversy exists with regard to whether influenza virus and respiratory syncytial virus (RSV) are spread by the inhalation of infectious airborne particles and about the importance of this route, compared with droplet or contact transmission.

Methods: Airborne particles were collected in an urgent care clinic with use of stationary and personal aerosol samplers. The amounts of airborne influenza A, influenza B, and RSV RNA were determined using real-time quantitative polymerase chain reaction.

Prospective comparison of tuberculin skin test and QuantiFERON-TB Gold In-Tube assay for the detection of latent tuberculosis infection among healthcare workers in a low-incidence setting.

We compared the results of the tuberculin skin test with the results of the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay among 182 low-risk healthcare workers. Overall agreement and specificity were high, but the tests did not agree on positive results. Only 2 of 5 positive QFT-GIT assay results could be confirmed with repeat analyses.

Measurement of airborne influenza virus in a hospital emergency department.

Size-fractionated aerosol particles were collected in a hospital emergency department to test for airborne influenza virus. Using real-time polymerase chain reaction, we confirmed the presence of airborne influenza virus and found that 53% of detectable influenza virus particles were within the respirable aerosol fraction. Our results provide evidence that influenza virus may spread through the airborne route.

Teaching scholars programs: faculty development for educators in the health professions.

Objective: This article 1) provides an overview of formal Health Sciences Teaching Scholars Programs as presented in medical education literature and 2) presents information about an innovative multidiscipline Teaching Scholars Program.

Method: Health Sciences Teaching Scholars Programs and similar programs were reviewed in the medical education literature to identify similar and dissimilar characteristics. The WVU Teaching Scholars Program highlighted in this article is presented with a discussion of goals, objectives, target audiences, course length, session frequency, program topics, learning methods, and assessments of the programs.

Candida endophthalmitis: focus on current and future antifungal treatment options.

Candida endophthalmitis is a sight-threatening manifestation of disseminated candidiasis. The occurrence of endogenous candida endophthalmitis in patients with candidemia has ranged from 0-45% in the published literature. In critically ill patients, it has even been associated with increased mortality.

An assessment of influenza vaccination among health profession students.

Health profession students work in close proximity to patients and could be a source of nosocomial influenza. We studied the proportion of health profession students presenting for immunization at an influenza immunization campaign. This assessment is useful to guide future campaigns as we prepare for pandemic influenza.

Mycobacterium fortuitum infection masquerading as an orbital mass.

Orbital infection with nontuberculous mycobacteria is rare and usually presents as an inflammatory process. We report a case of a 34-year-old male hospital worker with a positive purified protein derivative skin test who had Mycobacterium fortuitum infection that presented as an orbital mass causing diplopia. This presentation is unlike previously published reports and demonstrates the importance of orbital biopsy and tissue culture.

Association of hemochromatosis with infectious diseases: expanding spectrum.

Withholding iron from potential pathogens is a host defense strategy. There is evidence that iron overload per se compromises the ability of phagocytes to kill microorganisms. Several hypotheses exist to explain the association of hemochromatosis with infection.

Hand hygiene practices in adult versus pediatric intensive care units at a university hospital before and after intervention.

Observations of hand hygiene practices of the health care workers (HCWs) were carried out at a tertiary care center by a single observer in all adult and pediatric intensive care units (ICUs) before and after educational programs. Access to alcohol-based hand rub was also increased. A survey of HCWs was carried out to determine knowledge of hand hygiene.

Managing embolic myocardial infarction in infective endocarditis: current options.

Systemic embolization is common in infective endocarditis and is known to occur in 45-65% of cases. Coronary artery embolism has been seen in as many as 60% of cases at necropsy. However, it only rarely has been described as resulting in transmural myocardial infarction.

Effect of high-dose vitamin C on the steady-state pharmacokinetics of the protease inhibitor indinavir in healthy volunteers.

Study Objective: To determine whether daily high-dose vitamin C alters the steady-state pharmacokinetics of indinavir, a protease inhibitor indicated for treatment of the human immunodeficiency virus type 1.

Design: Prospective, open-label, longitudinal, two-period time series.

Setting: University medical center.

Computerized antimicrobial decision support: an offline evaluation of a database-driven empiric antimicrobial guidance program in hospitalized patients with a bloodstream infection.

Introduction: We developed a computerized antimicrobial guidance program based on the last 5 years of our laboratory culture data augmented by expert infectious disease logic. The program is designed to assist physicians with the targeting of empiric antimicrobials for hospitalized patients by tracking pathogenic bacteria and their evolving antimicrobial resistance profiles. Costs, toxicities, and environmental impact of antimicrobial use also influence the final recommendations.

Computerized antimicrobial decision support for hospitalized patients with a bloodstream infection.

We developed a computerized antimicrobial decision support program founded on our local bacterial susceptibility data. In a retrospective analysis of patients with a bloodstream infection, we compared the actual antimicrobials prescribed to the antimicrobials recommended by the program. We found the computer-guided therapy to be clinically and statistically more effective than the therapy initiated by the physicians.

Infrequent occurrence of amphotericin B lipid complex-associated nephrotoxicity in various clinical settings at a university hospital: a retrospective study.

Background: Lipid-based formulations of amphotericin B (AMB) have been shown to significantly lessen the occurrence of nephrotoxicity associated with the conventional form of AMB. A MEDLINE search of literature published from 1983 to 2002, using the search terms amphotericin B and nephrotoxicity, identified only 1 large, randomized, prospective trial that has tried to compare the nephrotoxicity rates among lipid-based AMB formulations. Using the nephrotoxicity surrogate marker of doubling of serum creatinine (SCr) level, the investigators reported a high rate of AMB lipid complex (ABLC)-associated nephrotoxicity (42.

Malaria in West Virginia: forty cases seen at West Virginia University Hospital.

In the U.S., malaria predominately occurs in travelers and immigrants.