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An outbreak due to multiresistant Acinetobacter baumannii in a burn unit: risk factors for acquisition and management.

https://arctichealth.org/en/permalink/ahliterature190091
Source
Infect Control Hosp Epidemiol. 2002 May;23(5):261-7
Publication Type
Article
Date
May-2002
Author
Andrew E Simor
Mark Lee
Mary Vearncombe
Linda Jones-Paul
Clare Barry
Manuel Gomez
Joel S Fish
Robert C Cartotto
Robert Palmer
Marie Louie
Author Affiliation
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, North York, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 2002 May;23(5):261-7
Date
May-2002
Language
English
Publication Type
Article
Keywords
Acinetobacter Infections - epidemiology - etiology - prevention & control
Acinetobacter baumannii
Blood Component Transfusion - adverse effects
Burn Units
Burns - complications
Case-Control Studies
Cross Infection - epidemiology - etiology - prevention & control
Disease Outbreaks - prevention & control - statistics & numerical data
Drug Resistance, Multiple, Bacterial
Environmental Monitoring - standards
Epidemiological Monitoring
Female
Hand Disinfection - standards
Hospitals, Teaching
Housekeeping, Hospital - standards
Humans
Hydrotherapy - adverse effects
Infection Control - methods
Logistic Models
Male
Middle Aged
Multivariate Analysis
Ontario - epidemiology
Risk factors
Abstract
To describe the investigation and management of an outbreak due to multiresistant Acinetobacter baumannii and to determine risk factors for acquisition of the organism.
A 14-bed regional burn unit in a Canadian tertiary-care teaching hospital.
Case-control study with multivariate analysis of potential risk factors using logistic regression analysis. Surveillance cultures were obtained from the hospital environment, from noninfected patients, and from healthcare providers.
A total of 31 (13%) of 247 patients with acute burn injuries acquired multiresistant A. baumannii between December 1998 and March 2000; 18 (58%) of the patients were infected. The organism was recovered from the hospital environment and the hands of healthcare providers. Significant risk factors for acquisition of multiresistant A. baumannii were receipt of blood products (odds ratio [OR], 10.8; 95% confidence interval [CI95], 3.4 to 34.4; P
PubMed ID
12026151 View in PubMed
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[Avoiding emergencies: a study confirms the risks associated with elderly nursing home residents].

https://arctichealth.org/en/permalink/ahliterature122473
Source
Perspect Infirm. 2012 Jul-Aug;9(4):44
Publication Type
Article

Change in practice patterns in the management of diabetic cardiac surgery patients.

https://arctichealth.org/en/permalink/ahliterature169780
Source
Can J Cardiovasc Nurs. 2006;16(1):20-7
Publication Type
Article
Date
2006
Author
Cheryl A Kee
Julia A Tomalty
Jennifer Cline
R J Novick
Larry Stitt
Author Affiliation
London Health Sciences Centre, University Hospital, 339 Windemere Road, London, Ontario, N6A 5A5. Cheryl.kee@lhsc.on.ca
Source
Can J Cardiovasc Nurs. 2006;16(1):20-7
Date
2006
Language
English
Publication Type
Article
Keywords
Aged
Blood Glucose - metabolism
Cardiac Surgical Procedures - adverse effects
Clinical Protocols
Cross Infection - epidemiology - etiology - prevention & control
Diabetes Complications - complications
Drug Monitoring
Female
Hospitals, Teaching
Humans
Hyperglycemia - etiology - metabolism - prevention & control
Hypoglycemic agents - therapeutic use
Infusions, Intravenous
Insulin - therapeutic use
Intensive Care - organization & administration
Male
Middle Aged
Ontario - epidemiology
Organizational Innovation
Outcome Assessment (Health Care)
Physician's Practice Patterns - organization & administration
Postoperative Care - methods
Practice Guidelines as Topic
Risk factors
Abstract
Diabetes and elevated blood glucose (BG) levels > 11.1 mmol/L in the acute post-operative period have been identified as risk factors for surgical site infections (SSI) and nosocomial infections (Furnary, Zerr, Grunkemeir, & Starr, 1999; American College of Endocrinology consensus guidelines for glycemic control, 2002). Some studies have suggested that intensive insulin therapy reduced in-hospital mortality and that a continuous insulin infusion should be a standard of care for diabetic cardiac surgery patients (Furnary et al., 2003; Brown & Dodek, 2001). Our urban tertiary care teaching hospital initiated an insulin nomogram in the intensive care unit intending to more effectively control blood glucose (BG) levels in cardiac surgical patients. This cohort study compared glucose control and clinical outcomes in 53 diabetic cardiac surgery patients prior to the initiation of the insulin infusion and 50 patients following the implementation between October 2002 and April 2003. Results demonstrated target glucose control in the ICU was improved by 20% (p
PubMed ID
16615261 View in PubMed
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Construction-related nosocomial infections in patients in health care facilities. Decreasing the risk of Aspergillus, Legionella and other infections.

https://arctichealth.org/en/permalink/ahliterature192970
Source
Can Commun Dis Rep. 2001 Jul;27 Suppl 2:i-x, 1-42, i-x, 1-46
Publication Type
Article
Date
Jul-2001
Source
Can Commun Dis Rep. 2001 Jul;27 Suppl 2:i-x, 1-42, i-x, 1-46
Date
Jul-2001
Language
English
French
Publication Type
Article
Keywords
Aspergillosis - etiology - prevention & control
Canada - epidemiology
Cross Infection - epidemiology - etiology - prevention & control
Disease Outbreaks - prevention & control
Facility Design and Construction - standards
Humans
Infection Control - organization & administration
Institutional Management Teams
Legionnaires' Disease - epidemiology - etiology - prevention & control
Risk Assessment - methods
Risk factors
Abstract
Construction and renovation projects in health care facilities are a risk for certain patients, particularly those who are immunocompromised. A proactive approach must be taken to limit construction-related nosocomial infections. This requires having a multidisciplinary team, supported by administration, to plan and implement preventive measures throughout the duration of the construction project. The ICP should be an active team member in all phases of the project. The ICP plays a major role by providing education to personnel; ensuring that preventive measures are identified, initiated, and maintained; and carrying out surveillance for infections in patients. By ensuring that the appropriate preventive measures are in place and clear lines of communication exist among the personnel, patient safety will be enhanced.
PubMed ID
11593827 View in PubMed
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Control of methicillin-resistant Staphylococcus aureus outbreak involving several hospitals.

https://arctichealth.org/en/permalink/ahliterature177792
Source
J Hosp Infect. 2004 Nov;58(3):180-6
Publication Type
Article
Date
Nov-2004
Author
S. Pastila
K T Sammalkorpi
J. Vuopio-Varkila
S. Kontiainen
M A Ristola
Author Affiliation
Kanta-Häme Central Hospital, 13530 Hämeenlinna, Finland. satu.pastila@welho.com
Source
J Hosp Infect. 2004 Nov;58(3):180-6
Date
Nov-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Cross Infection - epidemiology - etiology - prevention & control
Disease Outbreaks
Female
Finland - epidemiology
Humans
Incidence
Infection Control - methods
Male
Medical Records
Medical Staff
Methicillin Resistance
Middle Aged
Registries
Retrospective Studies
Staphylococcal Infections - epidemiology - etiology - prevention & control
Staphylococcus aureus - isolation & purification
Abstract
This population-based, retrospective, cohort study describes a large methicillin-resistant Staphylococcus aureus (MRSA) epidemic caused by one strain (E1) in the greater Helsinki region. The epidemic comprised 210 cases at several hospitals, but was finally controlled. The study period ranged from June 1991 to December 2000. The epidemic peaked in 1993-1995 with 143 cases (68% of total cases). From August 1993, all MRSA-positive cases at the eight municipal hospitals were isolated and barrier nursed. Contacts were cohorted and screened for MRSA colonization. Decolonization treatment was administered to some chronic carriers. MRSA cases and contacts were identified in the joint patient register of the municipal hospitals from August 1993. The annual incidence of MRSA E1 in Helsinki City area per 100,000 inhabitants rose from 0.2 in 1991 to 13.6 in 1994. It decreased from 1995, reaching 0.7 per 100,000 in 2000. A jointly agreed policy on MRSA and timely co-operation between all units were essential for control of this epidemic.
PubMed ID
15501331 View in PubMed
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Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates.

https://arctichealth.org/en/permalink/ahliterature229735
Source
Am J Infect Control. 1989 Dec;17(6):330-9
Publication Type
Article
Date
Dec-1989
Author
J M Conly
S. Hill
J. Ross
J. Lertzman
T J Louie
Author Affiliation
Infection Control Unit, University of Manitoba, Winnipeg, Canada.
Source
Am J Infect Control. 1989 Dec;17(6):330-9
Date
Dec-1989
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cross Infection - epidemiology - etiology - prevention & control
Female
Hand Disinfection
Humans
Inservice training
Intensive Care Units - standards
Male
Manitoba - epidemiology
Middle Aged
Personnel, Hospital - education
Abstract
Handwashing is the single most important procedure in the prevention of nosocomial infections and yet it remains the most violated of all infection control procedures. With a sequential intervention study in an intensive care unit we have demonstrated that poor handwashing practices are associated with a high nosocomial infection rate, whereas good handwashing practices are associated with a low nosocomial infection rate. An educational and enforcement program designed to improve handwashing procedures can significantly reduce endemic nosocomial infection rates.
PubMed ID
2596730 View in PubMed
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Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients.

https://arctichealth.org/en/permalink/ahliterature180029
Source
Am J Infect Control. 2004 May;32(3):155-60
Publication Type
Article
Date
May-2004
Author
Geoffrey Taylor
Denise Gravel
Lynn Johnston
John Embil
Donna Holton
Shirley Paton
Author Affiliation
2E4.11 Walter McKenzie Center, University of Alberta Hospital, Edmonton, Alberta T6G 2B7, Canada.
Source
Am J Infect Control. 2004 May;32(3):155-60
Date
May-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Bacteremia - epidemiology - etiology - prevention & control
Canada - epidemiology
Case-Control Studies
Cohort Studies
Cross Infection - epidemiology - etiology - prevention & control
Female
Humans
Incidence
Infection Control - methods
Male
Middle Aged
Renal Dialysis - adverse effects - statistics & numerical data
Abstract
To assess incidence of and identify risk factors for bloodstream infection in patients starting hemodialysis or starting a new means of vascular access for hemodialysis.
Two cohorts of patients, 1 initiating hemodialysis (new patients) and a 1:1 matching group of patients continuing hemodialysis but starting a new vascular access (continuing patients), were enrolled from 9 Canadian hemodialysis units and followed for 6 months. Bloodstream infection was defined using established criteria. A nested case-control study was carried out, using as cases those cohort patients diagnosed with infection. Each case was matched with a control having the same means of access and new or continuing status.
A total of 527 patients (258 new, 269 continuing), were recruited and underwent 31,268 hemodialysis procedures during this 6-month follow-up. There were 96 bloodstream infections in 93 patients (11.97/10,000 days, 28.81/10,000 hemodialysis procedures), yielding a relative risk of infection of 3.33 (95% CI, 2.12-5.24) for patients with a previous bloodstream infection and 1.56 (95% CI, 1.02-2.38) for patients continuing hemodialysis by a new means of access. Survival analysis revealed that compared to arteriovenous fistula vascular access, the relative risk of bloodstream infection in patients was 1.47 (95% CI, 0.36-5.96) for arteriovenous grafts, 8.49 (95% CI, 3.03-23.78) for cuffed central venous catheters, and 9.87 (95% CI, 3.46-28.20) for uncuffed central venous catheters. The regression model of the case-control study identified earlier bloodstream infection (OR, 6.58), poor patient hygiene (OR, 3.48), and superficial access-site infection (OR, 4.36) as additional risk factors.
During the first 6 months there is a high rate of bloodstream infection in patients starting hemodialysis either for the first time or by a new means of vascular access. Previous hemodialysis bloodstream infection and continuing hemodialysis by a new means of vascular access are markers for an increased risk of infection, as is poor patient hygiene. Central venous catheter vascular access, whether cuffed or uncuffed, has a much higher infection risk. In this study, there was no difference in infection rate between cuffed and uncuffed central catheters.
PubMed ID
15153927 View in PubMed
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Multi-centre research surveillance project to reduce infections/phlebitis associated with peripheral vascular catheters.

https://arctichealth.org/en/permalink/ahliterature196677
Source
J Hosp Infect. 2000 Nov;46(3):194-202
Publication Type
Article
Date
Nov-2000
Author
E T Curran
J E Coia
H. Gilmour
S. McNamee
J. Hood
Author Affiliation
Glasgow Royal Infirmary, Glasgow, UK. evonne.curran@glasgow-hb.scot.nhs.uk
Source
J Hosp Infect. 2000 Nov;46(3):194-202
Date
Nov-2000
Language
English
Publication Type
Article
Keywords
Catheterization, Peripheral - adverse effects
Cross Infection - epidemiology - etiology - prevention & control
England - epidemiology
Equipment Contamination
Female
Humans
Infection Control - methods
Ireland - epidemiology
Logistic Models
Male
Middle Aged
Phlebitis - epidemiology - etiology - prevention & control
Risk factors
Sentinel Surveillance
Sweden - epidemiology
Abstract
A surveillance project was undertaken on 37 surgical wards by infection control nurses with the aim of reducing phlebitis/infections associated with peripheral vascular catheters, and to identify risk factors. Data on 2934 catheters in situ longer than 24h was collected in two separate surveillance periods and results were fed back after each surveillance period. Four significant risk factors were identified; what the catheters were used for, the duration the catheters were in situ, the surveillance period (the first surveillance period had a higher phlebitis rate than the second) and whether an infusion pump was used. Logistic regression analysis showed that each of these had a significant effect after adjusting for the effects of the other three factors.
PubMed ID
11073728 View in PubMed
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Nosocomial infection following cardiovascular surgery: comparison of two periods, 1987 vs. 1992.

https://arctichealth.org/en/permalink/ahliterature203210
Source
Crit Care Med. 1999 Jan;27(1):104-8
Publication Type
Article
Date
Jan-1999
Author
O. Dagan
P N Cox
L. Ford-Jones
J. Ponsonby
D J Bohn
Author Affiliation
Department of Critical Care, Hospital for Sick Children, and University of Toronto, Canada.
Source
Crit Care Med. 1999 Jan;27(1):104-8
Date
Jan-1999
Language
English
Publication Type
Article
Keywords
Cardiovascular Surgical Procedures - adverse effects - standards
Child
Cross Infection - epidemiology - etiology - prevention & control
Female
Hospitals, Pediatric
Humans
Intensive Care Units, Pediatric - standards - statistics & numerical data
Male
Ontario - epidemiology
Prospective Studies
Quality Control
Risk factors
Sensitivity and specificity
Surgical Wound Infection - epidemiology - etiology - prevention & control
Abstract
To evaluate whether changes have occurred at our center in the rate of nosocomial infections and in the infectious organisms consequent to changes in policy and procedure as of 1987.
Multidisciplinary pediatric intensive care unit (PICU) in a major tertiary care center.
Prospective comparative study.
Four-hundred and fifty-five consecutive patients who underwent cardiac surgery within a 10-month period.
Changes related to antibiotic use and invasive device management were introduced after the 1987 survey. To determine the effect of these changes, all patients undergoing cardiac surgery between July 1991 and April 1992 were followed daily from PICU admission to 2 months after hospital discharge for signs of infection. Each infectious episode was reviewed by the nosocomial infection control committee. A weighted scoring system was used to determine risk.
In the 1987 study, 40 of 310 patients had 78 infections for a nosocomial infection ratio (NIR) of 25.2. Of the 455 patients surveyed in 1992, 72 had 91 episodes of infection. The nosocomially infected patient rate was 15.8 and the NIR was 20. The frequency of wound infection decreased from 7% in 1987 to 4.3% in this study, and no episode of mediastinitis was observed. In the bacteriological spectrum, the absence of candidal infection was significant, and there was a decrease in the proportional frequency of pseudomonas infection from 21% to 15%.
The comparison between the two time periods demonstrates that an aggressive approach to managing intravascular catheters and urinary catheters and limiting the use of antibiotics probably affects the spectrum of nosocomial infections.
PubMed ID
9934902 View in PubMed
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Nosocomial outbreak of ampicillin resistant Enterococcus faecium: risk factors for infection and fatal outcome.

https://arctichealth.org/en/permalink/ahliterature52469
Source
J Hosp Infect. 2000 Jun;45(2):135-44
Publication Type
Article
Date
Jun-2000
Author
S. Harthug
G E Eide
N. Langeland
Author Affiliation
Institute of Medicine, Haukeland University Hospital, Bergen, N-5021, Norway. sig.harthung@haukeland.no
Source
J Hosp Infect. 2000 Jun;45(2):135-44
Date
Jun-2000
Language
English
Publication Type
Article
Keywords
Aged
Ampicillin Resistance
Case-Control Studies
Cross Infection - epidemiology - etiology - prevention & control
Disease Outbreaks - prevention & control
Enterococcus faecium
Female
Gram-Positive Bacterial Infections - epidemiology - etiology - prevention & control
Humans
Logistic Models
Male
Mortality
Norway - epidemiology
Odds Ratio
Prospective Studies
Research Support, Non-U.S. Gov't
Risk factors
Abstract
A nosocomial outbreak caused by ampicillin resistant Enterococcus faecium (ARE) was detected at a Norwegian university hospital in January 1995. Prior to this outbreak, ARE were not common in this hospital or other hospitals in Norway. During 1995 and 1996, a total of 149 cases with clinical ARE infection were detected prospectively. A case control study was performed by allocating controls matched for gender, age and ward of admission. Altogether, 123 case control pairs with mean age 70.1 years were included. Isolates from 89 (72. 4%) of the cases were identical or related to the defined outbreak strain as determined by pulsed-field gel electrophoresis (PFGE). In 75 of the patients (60.9%), ARE caused urinary tract infection, five (4.1%) had bacteraemia, 33 (26.8%) had wound infection and 10 (8.1%) had other infections. In a logistic regression model for 1:1 matched samples, the following factors were identified as significant risk factors for ARE infection: underlying neurological disease (OR=33.5), prescription of antimicrobial agents for more than 10 days (OR=8. 99), prescription of cephalosporins (OR=4.69), underlying gastrointestinal disease (OR=3.36) and length of hospital stay per day (OR=1.04). The intrahospital death rate for the cases was 18.7% compared with 8.9% for the controls, corresponding to an excess mortality attributable to ARE infection of 9.8%. A history of carbapenem prescription was the only independent factor contributing to death (OR=5.64) when comparing ARE patients dying in hospital to those surviving.
PubMed ID
10860690 View in PubMed
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18 records – page 1 of 2.