In-use contamination of a hospital-grade disinfectant.

Background: Microbiological monitoring of disinfection of high-touch surfaces identified heavy growth of Serratia marcescens and Achromobacter xylosoxidans not present on surfaces before disinfection, suggesting contamination of the disinfectant used.

Methods: An investigation included interview of the housekeeper involved, level of bacterial contamination of the in-use quaternary ammonium (Quat) disinfectant, bactericidal activity of the contaminated disinfectant, pulsed field gel electrophoresis of S.marcescens and Achromobacter isolates, survival of S.

A multi-center outbreak of Candida tropicalis bloodstream infections associated with contaminated hemodialysis machine prime buckets.

Background: Outbreaks of fungal bloodstream infection (BSI) are uncommon among hemodialysis patients. We investigated an outbreak of Candida tropicalis BSIs involving patients at 3 of 4 affiliated hemodialysis units.

Methods: An investigation included a review of records of patients with C tropicalis BSI, a case-control study, and cultures of medications, hands of personnel, dialysis equipment, and water samples.

Challenges encountered and lessons learned during a trial of an electronic hand hygiene monitoring system.

Background: Automated hand hygiene monitoring systems (AHHMS) are being developed to supplement direct observations of hand hygiene (HH). We compared compliance rates generated by direct observations and by a badge-based AHHMS.

Methods: Observations of HH compliance were conducted in a surgical intensive care unit (SICU) and a general medical ward (GMW) during a 7-month baseline period and a 13-week intervention period, when compliance was also estimated using an AHHMS.

The PCOS Patients differ in Lipid Profile According to their Phenotypes.

Unlabelled: Polycystic ovary syndrome (PCOS) affects 4-18% of women of reproductive age. The number of reports exploring the lipid profiles among PCOS patients and number of studied patients are limited. The aim of our study was to assess the lipid profile separately in lean and non-lean women with polycystic ovary syndrome divided according to hyperandrogenemia, defined as free androgen index (FAI)≥5.

Examining Delivery Method and Infant Feeding Intentions between Women in Traditional and Non-Traditional Prenatal Care.

Introduction The purpose of the study is to evaluate delivery method and breastfeeding initiation in women enrolled in group prenatal care (CenteringPregnancy) and in traditional prenatal care. Methods Data were obtained from medical records of a hospital-based midwifery practice in south central Connecticut that offered both types of prenatal care programs. Medical information from 307 women enrolled in this practice was included in the analysis.

Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials.

Hypertension is a common complication of chronic kidney disease and persists among most patients with end-stage renal disease despite the provision of conventional thrice weekly hemodialysis (HD). We analyzed the effects of frequent HD on blood pressure in the randomized controlled Frequent Hemodialysis Network trials. The daily trial randomized 245 patients to 12 months of 6× ("frequent") vs.

Peritoneal dialysis in patients 75 years of age and older--a 22-year experience.

The role of peritoneal dialysis (PD) in the treatment of end-stage renal disease in elderly patients remains unclear. In the United States, PD is used only to a limited extent in that population. There are concerns about technique failure, including physical and psychosocial limitations and the risks of peritonitis.

Thrombosed cavernous hemangioma arising in cervical ectopic thymus tissue: a case report.

We report the case of a 35-year-old male presenting with a steadily growing, painful left-cervical neck mass. Final histopathologic diagnosis was consistent with a thrombosed cavernous hemangioma arising in cervical ectopic thymus tissue. This is the first description, to our knowledge, of such an entity.

Back to the basics.

The history and physical examination skills are being replaced by the tools of technology in establishing the actual cause of illness. We present a patient where the history and physical examination were essential in establishing the diagnosis. A 28-year-old female presented to the Emergency Department (ED) with an acute episode of epigastric pain radiating to the back associated with vomiting.

Treatment of athletic tendonopathy.

Tendinopathy is a general term that describes any painful condition that occurs in or around a tendon. Historically, treatments have been directed at inflammation, but an improved understanding of the pathophysiology of tendinopathy has led to redirecting the treatment toward methods that address the underlying pathophysiology. Anti-inflammatory treatments such as NSAIDs and corticosteroid injections are still in common use.

Prevention of central line-associated bloodstream infections in hemodialysis patients.

An increasing proportion of central line-associated bloodstream infections (CLABSIs) are seen in outpatient settings. Many of such infections are due to hemodialysis catheters (HD-CLABSIs). Such infections are associated with substantial morbidity, mortality, and excess healthcare costs.

Comparison of the microbiological efficacy of hydrogen peroxide vapor and ultraviolet light processes for room decontamination.

Objective: To compare the microbiological efficacy of hydrogen peroxide vapor (HPV) and ultraviolet radiation (UVC) for room decontamination.

Design: Prospective observational study.

Setting: 500-bed teaching hospital.

Natural history of the Sprint Fidelis lead: survival analysis from a large single-center study.

Purpose: The purposes of our study were to: (1) determine lead failure rate in a large single-center cohort of Sprint Fidelis 6949 (Fidelis) leads, (2) define the risk of lead failure over time, (3) assess the impact of the Lead Integrity Alert (LIA) on lead failure presentation, and (4) identify independent predictors of Fidelis lead failure.

Methods: All patients who underwent implantation of a Fidelis lead between September 2004 and July 2007 were included. Demographic, clinical, and device characteristics at the time of implant and prior to failure were collected and analyzed.

An expert panel report of a proposed scientific model demonstrating the effectiveness of antibacterial handwash products.

In 2005, a US Food and Drug Administration Nonprescription Drug Advisory Committee (NDAC) review of consumer antiseptic handwash product studies concluded that the data regarding existing products failed to demonstrate any association between specific log reductions of bacteria achieved by antiseptic handwashing and reduction of infection. The NDAC recommended that consumer antibacterial handwashing products should demonstrate a reduction in infection compared with non-antibacterial handwash products. In response to the NDAC review, a consumer product industry-sponsored expert panel meeting was held in October 2007 to review new methods for assessing the efficacy of antibacterial handwashes.

A case of idiopathic retroperitoneal fibrosis.

Retroperitoneal fibrosis is the presence of a fibrotic plaque in the prelumbar or presacral area. It can occur as a result of certain medications, fluid collections, inflammatory disease of various intra-abdominal organs, previous surgery or radiation therapy and various metastatic neoplasms. Most cases of retroperitoneal fibrosis are considered idiopathic.

Can moral reasoning predict general surgery residents' clinical competence?

Background: When selecting residents for residency programs, there has been little success using standard academic criteria to predict their clinical performance. However, numerous studies in the past have found linkages between the nonstandard variable moral reasoning as measured by the instrument Defining Issues Test (Version 2; DIT-2) and clinical decision making with higher levels of moral reasoning linked to better clinical performance. This study sought to determine whether this important linkage exists in surgery residents.

Imaging of acute head and neck infections.

Tonsillar infection is the most common cause of infections of the neck in children and young adults whereas odontogenic infection is the most common cause in older population groups. Other sources of neck infection include the salivary glands, nasal sinuses, middle ear and mastoids, cervical lymph nodes, and trauma. Computed tomography and magnetic resonance imaging have excellent sensitivity for the recognition of deep infections, particularly for the identification of abscess formation and its precise location and extension of disease.

Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices.

Objective: To compare fluorescent markers with aerobic colony counts (ACCs) and an adenosine triphosphate (ATP) bioluminescence assay system for assessing terminal cleaning practices.

Design: A prospective observational survey.

Setting: A 500-bed university-affiliated community teaching hospital.

Measuring healthcare worker hand hygiene activity: current practices and emerging technologies.

Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of multidisciplinary hand hygiene improvement programs. Observational surveys conducted by trained personnel are currently considered the "gold standard" method for establishing compliance rates, but they are time-consuming and have a number of shortcomings. Monitoring hand hygiene product consumption is less time-consuming and can provide useful information regarding the frequency of hand hygiene that can be used to give caregivers feedback.

Paratesticular leiomyosarcoma: case report and review.

Paratesticular leiomyosarcoma is a rare entity. Greater than 95% of tumors arising within the scrotal sac are testicular in origin. Of the paratesticular tumors, rhabdomyosarcoma accounts for nearly half of malignant masses.