Seventy intensive care unit patients were admitted to a double-blind prospective study to determine the level of contamination associated with the admixture and administration of intravenous solutions and whether intravenous filtersets prevented bacteremia. Patients were randomly assigned a 0.22 micron filterset (real filter) or a filter cartridge without a 0.22 micron membrane (blank filter) on all possible intravenous lines. Forty-six (14.1 percent) real filtersets and 38 (11.3 percent) blank filtersets were found to be contaminated, and overall 30 patients (42.4 percent) were found to have extrinsically contaminated intravenous administration systems at least once during the study. Bacterial adherence to the plastic cartridge was demonstrated to be responsible for culture-positive blank filtersets. Staphylococcus epidermidis was the organism most frequently isolated from real and blank filtersets. Epidemiologic surveillance identified 10 patients with blank filtersets and three patients with real filtersets with clinically significant hospital-acquired bacteremias during the study period. It is concluded that a significant level of extrinsic contamination of intravenous infusion delivery systems occurred on the intensive care unit; documented clinically significant nosocomial bacteremias occurred less often in those patients who had a 0.22 micron bacterial retention filter on all possible intravenous lines.

Bacteriological Techniques↗

PubMed1986

Outbreak of bacterial endophthalmitis after cataract surgery and lens implantation: lack of direct evidence for exogenous contributing factors.

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Cataract Extraction↗

PubMed1986

Poor seroconversion rate after hepatitis B vaccination in high-risk institutionalized mentally retarded patients.

We studied the rate of seroconversion to positivity for antibody to hepatitis B surface antigen (anti-HBs) after immunization with hepatitis B vaccine in a group of mentally retarded institutionalized patients. Eight hundred sixty-eight individuals were screened for seromarkers of hepatitis B infection (hepatitis B surface antigen and anti-HBs), and 287 seronegative patients were vaccinated with the recommended schedule of hepatitis B virus vaccine (20 micrograms IM at 0, 1, and 6 months). Overall, 59% of patients responded to vaccination with detectable anti-HBs. We found a high correlation of lack of response with both intragluteal injection and increasing age (p less than 0.0008), although the design of the study did not allow these factors to be analyzed separately. We conclude that buttock injection and advancing age may be risk factors for poor immunogenicity of the hepatitis B vaccine in mentally retarded populations.

Adult↗

PubMed1986

Restriction policies for therapy with combination antibiotics.

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Anti-Bacterial Agents↗

PubMed1985

Treatment of wound infections.

Postoperative wound infections and infections linked to various traumatic and thermal injuries all contribute to patient morbidity and mortality, as well as to increased hospital costs. Standard practices of wound management include debridement of devitalized tissue, drainage, irrigation, and loose packing of the open wound. Antibiotics are usually effective as adjuncts to these procedures and to host resistance. Their choice, whenever possible, should be based on cultures of fresh pus (anaerobes must be obtained by airless syringe) to select an agent active against implicated pathogens. In rapidly developing infections, the choice must often be based on known probabilities until culture results are available. Specific management techniques are indicated for postoperative wounds, where brief prophylactic treatment may be needed. Traumatic wounds may require combination antibiotic therapy, and possible lack of immunity to tetanus should be considered. Most burn wound infections tend to be nosocomial; topical antiseptic agents often control burn infections while preventing the emergence of resistant bacteria.

Anti-Bacterial Agents↗

PubMed1985

A multi-hospital hepatitis B vaccine program: prevalence of antibody and acceptance of vaccination among high-risk hospital employees.

In July 1982, five Hartford hospitals embarked on a joint hospital-sponsored program to immunize high-risk employees against hepatitis B virus (HBV). The program included a questionnaire to characterize relative risk, serology for anti-HBs, vaccination and a follow-up survey of vaccine non-recipients. Of 2,065 employees who were considered to be at high-risk for infection with HBV, 1,894 (91.7%) responded to the screening questionnaire and 1,279 (67.5%) were tested for anti-HBs serology. The prevalence of antibody varied from hospital to hospital; the highest prevalence (10.9%) was observed at one of the urban university-affiliated community hospitals and the lowest prevalence (4.1%) was reported from the smaller, rural hospital. The prevalence of antibody also varied greatly within the high-risk groups; the highest prevalence of antibody was seen among surgical house officers (15%). The rate of acceptance of vaccine among hospitals ranged from 57.5% to 23.7%. Reasons for vaccine non-acceptance included fear of as yet unknown side effects, perceived low risk of hepatitis acquisition and possible effects on present or future pregnancies. Our experience illustrates some of the epidemiologic and practical aspects that must be addressed in administering a hospital-based HBV vaccine program. Among the five hospitals, we saw marked inter- and intra-hospital variations in the prevalence of anti-HBs among high-risk employees. More significantly, we observed unexpectedly low rates of vaccine acceptance among high-risk personnel.

Attitude of Health Personnel↗

PubMed1984

Treatment and prevention of oropharyngeal candidiasis.

As more potent antibacterial drugs are used to combat infections and as more patients with impaired defenses against infection are treated, other organisms, like fungi, have become important pathogens. Fungi of all types may appear in this setting, but Candida species are the most common, usually beginning as an infection in the oropharynx. Although oropharyngeal candidiasis usually remains localized, it may spread elsewhere, leading to a fatal outcome. Controversy still exists regarding the best drug to prevent or treat oropharyngeal candidiasis, but clotrimazole given as a troche may be the best choice at the moment owing to its high clinical success rate, safety, cost effectiveness, and high patient acceptability. There remains a need for more randomized and controlled studies comparing the efficacy of nystatin, ketoconazole, and clotrimazole in high-risk patients in whom invasive candidiasis remains a frequent problem.

Adolescent↗

PubMed1984

Effect of aging on the clinical significance of fever in ambulatory adult patients.

To study the effect of age on ultimate outcome of febrile illness, the authors prospectively studied 1,202 adult patients who came to an emergency room/walk-in clinic setting with temperatures of 101.0 degrees F (38.3 degrees C) or more. The patients were divided into four age categories: 17 to 40 years, 40 to 59 years, 60 to 79 years, and 80 years old or older. Advancing age was significantly (P less than 0.0005) associated with more serious disease, a higher rate of bacterial pathogen isolation, and a higher rate of life-threatening or deadly consequences. Of patients 17-39 years old, 58.2 per cent had viral syndromes, otitis media, or pharyngitis as the causes of fever. Of patients aged 40-59 years, only 20.7 per cent had one of these diseases. However, of patients 60 years old or older, only 4.1 per cent (15 of 370) had viral syndromes, otitis media, or pharyngitis, and the overall rate of hospitalization for this group was 92.5 per cent. The authors conclude that febrile patients 60 years old or older seen in emergency room/ambulatory care settings are extremely likely to have serious diseases. Caution should be exercised before concluding that their fevers are of benign origin.

Adolescent↗