A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections.

Objective: We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources.

Design: The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes.

[Perioperative thermal management].

Perioperative hypothermia can influence clinical outcome negatively. It triples the incidence of adverse myocardial outcomes, significantly increases perioperative blood loss, significantly augments allogenic transfusion requirements, and increases the incidence of surgical wound infections. The major causes are redistribution of heat from the core of the body to the peripheral tissues and a negative heat balance.

Evolving epidemiology of pediatric Staphylococcus aureus cutaneous infections in a Baltimore hospital.

Objectives: To examine the epidemiology, antibiotic susceptibility profiles, and outcomes in pediatric Staphylococcus aureus (SA) cutaneous infections at a time when community-associated (CA) methicillin-resistant SA (CA-MRSA) infections seemed to be increasing in our community.

Methods: The hospital microbiology database was searched for unique skin and wound SA isolates among pediatric patients between November 2002 and October 2003. Demographic and clinical data were abstracted from medical records.

Occupationally acquired infections and the healthcare worker.

Much of the recent research related to occupational infections in healthcare workers has focused on the evaluation of the effectiveness of preventive measures, the cost-effectiveness of such measures, and alternative approaches to preventing common occupational infections. This article reviews recent information on healthcare workers about occupationally acquired diseases and considers the risks from unusual or re-emerging pathogens. Among recent advances of note are effective post-exposure prophylaxis for HIV, approaches to achieving immunity to hepatitis B in vaccine non-responders, better diagnostic tests for hepatitis C and improved equipment for preventing blood exposure and tuberculosis.

Prevention of perioperative hypothermia with forced-air warming systems and upper-body blankets.

Forced-air warming is known as an effective procedure in prevention and treatment of perioperative hypothermia. Hypothermia is associated with disturbances of coagulation, raises postoperative oxygen consumption by shivering, increases cardiac morbidity, leads to a higher incidence of wound infection, and prolongs hospital stay. Additionally, preoperative local warming reduces the incidence of wound infection after clean surgery.

Epidemiology of community-acquired methicillin-resistant Staphylococcus aureus skin infections among healthcare workers in an outpatient clinic.

We describe an investigation of soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strains in 2 healthcare workers employed in an outpatient clinic for patients with human immunodeficiency virus infection. Cultures of environmental samples from multiple surfaces in the clinic grew toxin-producing CA-MRSA strains, suggesting fomites may play a role in the transmission of these strains of MRSA.

A multicenter intervention to prevent catheter-associated bloodstream infections.

Background: Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited.

Objective: To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections.

How will we know patients are safer? An organization-wide approach to measuring and improving safety.

Objective: Our institution, like many, is struggling to develop measures that answer the question, How do we know we are safer? Our objectives are to present a framework to evaluate performance in patient safety and describe how we applied this model in intensive care units.

Design: We focus on measures of safety rather than broader measures of quality. The measures will allow health care organizations to evaluate whether they are safer now than in the past by answering the following questions: How often do we harm patients? How often do patients receive the appropriate interventions? How do we know we learned from defects? How well have we created a culture of safety? The first two measures are rate based, whereas the latter two are qualitative.

Low prevalence of pertussis among children admitted with respiratory symptoms during respiratory syncytial virus season.

Pertussis may go unrecognized during respiratory syncytial virus (RSV) epidemics. Nosocomially transmitted pertussis can be severe in infants. Polymerase chain reaction (PCR) screening may identify infants with pertussis on admission, allowing for preemptive isolation.

Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port.

The technology of intravenous catheter access ports has evolved from open ports covered by removable caps to more-sophisticated, closed versions containing mechanical valves. We report a significant increase in catheter-related bloodstream infections after the introduction of a new needle-free positive-pressure mechanical valve intravenous access port at our institution.

A prospective trial of a novel, silicone-based, silver-coated foley catheter for the prevention of nosocomial urinary tract infections.

Objective: To evaluate the efficacy of silicone-based, silver ion-impregnated urinary catheters in the prevention of nosocomial urinary tract infections (NUTIs).

Design: Prospective, crossover study to compare the efficacy of a silicone-based, hydrogel-coated, silver-impregnated Foley catheter with that of a silicone-based, hydrogel-coated catheter in the prevention of NUTIs.

Setting: Adult medical and surgical wards of a university teaching hospital.

Preventing catheter-associated bloodstream infections: a survey of policies for insertion and care of central venous catheters from hospitals in the prevention epicenter program.

Objective: To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC insertion, use, and care.

Design: A 9-page written survey of practices and policies for nontunneled CVC insertion and care.

Setting: ICUs in 10 academic tertiary-care hospitals.

Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial.

Background: Central venous catheter-related infections are a significant medical problem. Improved preventive measures are needed.

Objective: To ascertain 1) effectiveness of a second-generation antiseptic-coated catheter in the prevention of microbial colonization and infection; 2) safety and tolerability of this device; 3) microbiology of infected catheters; and 4) propensity for the development of antiseptic resistance.

Handheld computer surveillance: shoe-leather epidemiology in the "palm" of your hand.

Background: Although urinary tract infections (UTIs) are the most common nosocomial infection, active UTI surveillance is often not feasible for infection control departments.

Methods: As part of an ongoing urinary catheter evaluation, we investigated the accuracy and cost-effectiveness of using handheld personal digital assistants (PDA) and computer-based UTI surveillance in comparison with traditional surveillance of UTIs among medical intensive care unit (MICU) patients. From September 22, 2000, to October 22, 2000, an infection control practitioner (ICP) actively surveyed all MICU patients who had a urinary catheter to determine criteria for a nosocomial UTI as defined by the Centers for Disease Control and Prevention (CDC).

Ability of physicians to diagnose and manage illness due to category A bioterrorism agents.

Background: Early recognition of a terrorist attack with biologic agents will rely on physician diagnosis. Physicians' ability to diagnose and care for patients presenting after a bioterror event is unknown. The role of online case-based didactics to measure and improve knowledge in the diagnosis and treatment of these patients is unknown.

Varying rates of Clostridium difficile-associated diarrhea at prevention epicenter hospitals.

Background: Clostridium difficile-associated diarrhea (CDAD) causes substantial healthcare-associated morbidity. Unlike other common healthcare-associated pathogens, little comparative information is available about CDAD rates in hospitalized patients.

Objectives: To determine CDAD rates per 10,000 patient-days and per 1,000 hospital admissions at 7 geographically diverse tertiary-care centers from 2000 to 2003, and to survey participating centers on methods of CDAD surveillance and case definition.

[The applicability of the ProSeal laryngeal mask airway for laparotomies].

Objective: The ProSeal laryngeal mask airway (PLMA) has some design features, which in contrast to the classic LMA allow separation of the respiration from the gastrointestinal canal, a higher leak pressure and a better position assessment. It can be debated if these instrumental improvements justify the application of the PLMA for elective abdominal surgery in cases without aspiration risk. Insertion of airway instruments and gastric tube with regard to insertion time and difficulties and frequency of side effects were to be compared for the tracheal tube and the PLMA.

Nosocomial malaria and saline flush.

An investigation of malaria in a US patient without recent travel established Plasmodium falciparum molecular genotype identity in 2 patients who shared a hospital room. P. falciparum can be transmitted in a hospital environment from patient to patient by blood inoculum if standard precautions are breached.

Age-related differences in multiple-object tracking.

Multiple-object tracking is the ability to attend (keep track of) the positions of multiple target items as they move among other items. The performance of young and older adults (M = 19 and 73 years old, respectively) was compared in two versions of a tracking task in which participants were required to monitor the positions of 1-4 moving targets in a field of 10 moving items. All participants were capable of tracking more than 1 item at once, but on average older participants tracked around 3 items at once whereas young adults tracked 4.

Methicillin-resistant Staphylococcus caprae in a neonatal intensive care unit.

Staphylococcus caprae, a hemolytic coagulase-negative staphylococcus that is infrequently associated with humans, was initially detected in specimens from six infants in our neonatal intensive care unit due to phenotypic characteristics common to methicillin-resistant Staphylococcus aureus. These isolates were subsequently identified as S. caprae by the Automated RiboPrinter microbial characterization system.

Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes.

Background: Recent worldwide reports of community-onset skin abscesses, outbreaks of furunculosis, and severe pneumonia associated with methicillin-resistant Staphylococcus aureus (MRSA) carrying Panton-Valentine leukocidin (PVL) genes and the staphylococcal cassette chromosome mec (SCCmec) type IV indicate that MRSA infections are evolving into a community-related problem. The majority of cases reported to date involve skin and soft-tissue infections, with severe pneumonia representing a relatively rare phenomenon. During a 2-month period in the winter of 2003-2004, four healthy adults presented to 1 of 2 Baltimore hospitals with severe necrotizing MRSA pneumonia in the absence of typical risk factors for MRSA infection.