Biomedical subjects
I Gurevich
Publications and source records attributed to I Gurevich.
Varicella zoster and herpes simplex virus infections.
There are six herpes viruses, three of which, the varicella-zoster virus and the herpes simplex viruses types 1 and 2, are of particular concern to patients and staff in critical care units. These viruses, especially in their reactivated states, may present atypically in critically ill and immune-suppressed patients, and, by the time the diagnosis is made, exposures of other patients and clinicians may have occurred. Pregnancy and immunosuppressed states can result in severe, even life-threatening varicella-zoster virus infections in susceptible adults. Similarly, nosocomial herpes simplex virus infections can have serious consequences for exposed patients and staff. An additional problem after herpes simplex virus infection is the potential of lifelong and possibly frequent recurrences. In this article, the manifestations, modes of transmission, and treatment will be discussed. Special emphasis will be placed on describing the types of patients who are at high risk of presenting with varicella-zoster virus or herpes simplex virus infection so that physicians and nurses can use appropriate preventive measures to avert nosocomial infections in patients and staff.
Fifth disease and other parvovirus B19 infections.
Parvovirus B19 is the etiologic agent in three diseases with clinically different presentations and implications. The first and most common disease is erythema infectiosum or fifth disease. Symptoms may vary somewhat between affected children and adults. A second type of presentation occurs in infected people who require a greater than normal replacement of red blood cells, and a third infection may affect a developing fetus. Because there is no effective treatment or vaccine, physicians and nurses should conscientiously observe universal precautions to avoid acquisition of B19 infection from patients.
Significance of fever in hospital employees.
Hospital employees are exposed to a variety of occupationally related hazards that can be categorized as infectious or noninfectious. Lost work time often results from these problems. Infection control practitioners receive many telephone calls of inquiry about these employees in terms of their transmissible infections. Little has been written concerning fever in the employee health setting. To determine the frequency of febrile illness in hospital employees, we conducted a prospective study of the employee health service from January to December 1987. Winthrop-University Hospital is a 533-bed community teaching hospital with approximately 2400 employees. During 1987, 2974 visits were made to the employee health service. Of these, 879 (30%) were for occupationally related illness or injury. Oral temperatures of greater than or equal to 100 degrees F were noted in 25 (2.8%) of the 879 visits. Fever occurred predominantly in employees with infections. Upper respiratory tract infection accounted for 268 of 544 (49%) visits for infection. In addition, 11 of 22 (50%) febrile episodes were related to upper respiratory tract infections. A total of 963 work days were lost because of illness or injury. Of these, 743 (77%) were related to an infectious illness; 67 sick days (7%) were attributed to infections with a febrile response. We conclude that fever is uncommon in our employee health care population and that upper respiratory tract infections were the single most common cause of fever. When an employee had a febrile illness, the lost work time was 9% of the total time loss because of infection.
Colonization and bacteremia related to duration of triple-lumen intravascular catheter placement.
The increased use of triple-lumen catheters has brought with it an increase in sepsis. We undertook a study to determine whether this increase was related to the length of time a catheter was in place. Culture of the fluid in each of the three lumens of all triple-lumen catheters in the medical intensive care units was done daily for a 6-month period. In 14 of 31 catheters, 28 of 93 lumens showed bacterial or fungal growth. A temporal relationship between the time a catheter was placed and the onset of catheter colonization and patient sepsis was established (p less than 0.01). Catheter colonization preceded sepsis in three of four patients who became bacteremic with the same organisms that were cultured from the lumens and the catheter tips. As a result of this study, centrally placed intravascular lines are now changed every 7 days in our institution with a noticeable decrease in line-related sepsis.
The disinfectant dilemma revisited.
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Chickenpox in apparently 'immune' hospital workers.
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Counseling the patient with herpes.
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Survey of techniques used for sterilization of facial implants.
Policies need to be developed in each institution to ensure that OR personnel alert the CSS when implants are sent to CSS for sterilization so that a spore test can be processed with each implant regardless of the method of sterilization (steam, gas, or other). Implants should be quarantined for a 48-hour negative test result when possible. It is advisable to keep a log in CSS for items that require premature release with prior notification of the physician. In situations when implants and materials must be customized during surgery, OR personnel may sterilize the unwrapped implants and materials with a spore test. Under special circumstances, such materials may be released for use before obtaining the results of the 48-hour spore test, if the special circumstances are recorded in a log in the OR. If a spore test is subsequently found to show positive results, the physician and infection control personnel should be notified by telephone by OR personnel. Opposition to these policies in institutions that have implemented them has gradually diminished as surgeons have become used to the requirements and realize the rationale. OR nurses and infection control personnel need to understand that the procedures constitute safer patient care practices and that they are in full compliance with CDC guidelines.
Acquired immunodeficiency syndrome: realistic concerns and appropriate precautions.
Few topics generate as much misinformation and fear as the acquired immunodeficiency syndrome. As a result, many physicians and nurses believe that universal testing of hospitalized patients would decrease their risk of inadvertent exposure to undiagnosed carriers of the human immunodeficiency virus (HIV). Quite the contrary may be the case. Therefore, in this article the advantages and disadvantages of routine testing are examined in relationship to established risk factors for health care personnel. Realistic concerns are discussed and appropriate precautions are stressed, while some of the myths are dispelled. These include potential transmission of HIV by saliva and mosquito bites, and the superiority of one glove material over another.
Preventing the spread of infectious disease. Precautionary measures for the office setting.
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Yield of stool cultures, ova and parasite tests, and Clostridium difficile determinations in nosocomial diarrheas.
Stool cultures for bacterial pathogens, ova and parasites, and Clostridium difficile are usually ordered for patients with nosocomial diarrhea. In the interest of cost containment we undertook an 18-month retrospective study to assess the cost/benefit of performing each of these three tests. During the study period nosocomial diarrhea developed in 118 patients. Of 452 bacterial stool cultures ordered, only one was positive for Campylobacter jejuni and none for ova and parasites. However, of 126 cultures examined for C. difficile, 47 showed positive results. We conclude that bacterial stool culture and ova and parasite identification are not indicated for patients with nosocomial diarrhea. Elimination of these unnecessary stool tests (bacterial/ova and parasite) would have saved the hospital approximately +7530 in the 18-month study period.
Infection control in critical care.
Most common nosocomial infections in the intensive care setting are nosocomial urinary tract infections, nosocomial pneumonia, and intravascular line-related infections. Patients in the intensive care setting rapidly become colonized by nosocomial gram-negative organisms. The colonization of the patient precedes actual infection and provides some indicator of the microflora of the intensive care unit as well as early warning of the potential for outbreaks in the unit. Infection control in the intensive care unit is of vital importance in preventing colonization of microbes as well as in the recognition and interruption of outbreaks of nosocomial infections. In this article are discussed nosocomial infections in patients in the intensive care unit from the infection control standpoint.
Transmissible infections in critical care.
Personnel caring for critically ill patients in emergency or trauma care settings, or in adult and pediatric intensive care units, face considerable risk of acquiring infections from their patients. Obvious infections are less hazardous than obscure, unsuspected, or unreported ones. Although postexposure prophylaxis is available in some cases, it can add its own risks for uninformed persons. Examples of inadvertent but unnecessary exposures, with their consequences, are discussed in this article. Emphasis is on how ethical and considerate behavior toward others, along with clinical awareness, diagnostic clues, and early communication with the infection control service, could have prevented these exposures and might do so in other instances.
Staphylococcus aureus bacteremia.
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An appropriate category of isolation for antibiotic resistant organisms.
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Group B streptococcal bacteraemia associated with a triple lumen intravenous catheter.
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