Search PubMed⌕ Search

Biomedical subjects

R Wurtz

Publications and source records attributed to R Wurtz.

34 records · Page 2Linked to original sources
PubMed1995

Nosocomial infections in a burn intensive care unit.

Although many studies have reviewed burn wound infections (BWIs) in burn patients, few have prospectively surveyed other nosocomial infections. Seriously burned patients are clearly at increased risk for infection due to the nature of the burn injury itself, immunocompromising effects of burn injury, prolonged hospital stays, and invasive diagnostic and therapeutic procedures. Over 6 months, we prospectively reviewed all patients admitted to our burn intensive care unit (BICU) for nosocomial infections. We used standard CDC definitions of nosocomial infections (NIs). Because we had previously documented a high incidence of nosocomial pneumonias in these patients, we were particularly interested in determining risk factors for nosocomial pneumonia. The total census during the study period was 57. There were 40 discharges and deaths. Surveillance demonstrated 36 nosocomial infections in 26 patients, for a total of 90 nosocomial infections per 100 discharges and deaths, or 32.3 NIs/1000 patient days. Infections included 22 pneumonias, 10 urinary tract infections, two bacteraemias, one BWI and one episode of cellulitis. Intubation was strongly associated with nosocomial infection, particularly with pneumonia, BWI and bacteraemia. Sixty per cent of all patients were intubated at some time during their BICU stay, but 88 per cent of those who developed a nosocomial infection were intubated (P < 0.001). Inhalation injury was less significant than intubation in the development of nosocomial infection. All patients who developed pneumonia or a BWI were intubated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Infection control in public hospitals.

Public hospitals face challenging infection control problems that differ from those in other hospitals. This article reviews some of the unique aspects of infection control in public hospitals, including governance, physical plant, patient mix, communicable diseases, and employee issues, and suggests management strategies.

Facility Design and Construction↗
PubMed1994

Infection control instruction and screening for students.

Cook County Hospital is a large, municipal teaching hospital with multiple academic affiliations. We sought to provide uniform infection control orientation and screening for students because many had no previous training in body substance isolation systems or infection control and trainees may be more likely to be exposed to hospital-acquired infections because of their inexperience. Each student or visiting resident must complete an educational program once each year. The program consists of a pretest, a video, and group discussion, with examples of needle-disposal boxes and protective gear, information about ways to avoid needlesticks and mucosal splashes, what to do if a contact occurs, and information on isolation and tuberculosis. The session ends with a posttest, which is then retained on file. All trainees are also required to provide a "certificate of compliance" with the hospital's infectious disease serology screening program, which includes measles, rubella, and hepatitis B surface antigen testing, as well as tuberculin skin testing. Trainees must provide an updated form annually. The program is costly, both in dollars and in personnel time, for visiting students and the hospital. Tuberculin skin test screening detected a cluster of purified protein derivative skin test conversions in medical students.

Chicago↗
PubMed1994

Handwashing machines, handwashing compliance, and potential for cross-contamination.

Although handwashing is considered an important factor in the prevention of nosocomial infections, the optimal technique has not been determined and compliance is often difficult to obtain. Handwashing compliance is particularly important in intensive care areas of the hospital. In an effort to improve HW compliance, the surgical intensive care unit in our hospital purchased three handwashing machines. Four months after installation of the handwashing machines, an outbreak of methicillin-resistant Staphylococcus aureus occurred in the intensive care unit. As part of evaluating the outbreak, we cultured the handwashing machines, including the portholes and the paper towel dispenser. Cultures were positive for methicillin-resistant Staphylococcus epidermidis, Achromobacter species, and Streptococcus viridans. The design of the handwashing machines made contamination of sleeves and already-washed hands possible. An observational study revealed that handwashing compliance was poor but improved from 22% to 38% when the handwashing machines were in use. Nurses preferred handwashing at the sink and physicians preferred the handwashing machine. Handwashing machines may increase handwashing compliance because of their novelty, but they may also result in novel problems.

Cooperative Behavior↗
PubMed1994

Real and apparent tuberculin skin test conversions in a group of medical students.

OBJECTIVE: To evaluate tuberculin skin test (TST) conversions among a group of medical students. DESIGN: Questionnaire sent to a medical school class in whom a cluster of TST conversions was noted, and interview and repeat TST of students with conversion. SETTING: County hospital and associated medical school. SUBJECTS: Medical students, after their third year in medical school. RESULTS: Of 165 students in the class, 115 (70%) responded; 10 reported TST conversions between the beginning of the third and the fourth year. Seven of 10 were interviewed, and all 10 were retested. Five students, all in a cohort who tested each other during a clinical clerkship with a tuberculin material previously reported to be associated with a high rate of false-positive TSTs, were TST negative on repeat. Five had persistently positive TSTs. One was exposed during a psychiatry clerkship to a resident with pulmonary tuberculosis. Four students appeared to have converted their TST during their third year in medical school. All four did their medicine clerkship at a large county hospital (P < 0.02; odds ratio = 16.4) that had few infection control measures in place for tuberculosis isolation during the time of their exposure. CONCLUSIONS: We recommend that medical students, as well as other healthcare professions students, be educated about infection control practices and skin tested at least annually during clinical training years.

Chicago↗
PubMed1994

Cyclospora: a newly identified intestinal pathogen of humans.

A number of reports over the last several years have linked a previously unidentified acid-fast organism with prolonged diarrhea in humans. Initially thought to be a cyanobacterium, the organism has been identified as a coccidian protozoan of the genus Cyclospora, and the name Cyclospora cayetanensis has been proposed. Organisms that resemble Cyclospora protozoa have been discovered in human stool samples around the world and have been isolated from children, immunocompetent adults, and human immunodeficiency virus (HIV)-seropositive individuals. The apparently waterborne organisms cause disease predominantly in summer months. In wet mounts of fresh stool specimens, the organisms are wrinkled spheres of 8-9 microns in diameter, with well-defined nonrefractile external walls and internal granular material, and resemble large oocysts of Cryptosporidium species. Organisms fluoresce under ultraviolet illumination. Formalin-preserved oocysts are variably acid-fast, and the results of staining with the modified carbolfuchsin technique (which is used to stain Cryptosporidium species) range from no staining to deep-red staining. The clinical syndrome is characterized by watery diarrhea (approximately 6 stools/day), nausea, anorexia, abdominal cramping, fatigue, and weight loss. Diarrhea appears to be self-limiting in the immunocompetent host but may be prolonged in patients with advanced HIV infection. Symptoms have abated in a handful of people treated with trimethoprim-sulfamethoxazole. Many questions remain to be answered about this newly identified pathogen.

Animals↗
PubMed1994

Short report: gastric infection by Strongyloides stercoralis.

Strongyloides stercoralis ordinarily matures in the human proximal small intestine and embeds in the small intestine mucosal wall where eggs are produced. Although Strongyloides may infect many sites in hyperinfection syndromes, reports of gastric involvement are rare. We report a patient taking prednisone and an H2 blocker who developed hyperinfection syndrome, with mucosal Strongyloides larvae seen in a gastric biopsy.

Animals↗
PubMed1993

Cervical tuberculous vertebral osteomyelitis: case report and discussion of the literature.

We report a case of tuberculous vertebral osteomyelitis of the first and second cervical vertebrae with extensive adjacent soft-tissue involvement and extension into the mediastinum and bilateral flanks. The clinical presentation of tuberculous vertebral osteomyelitis depends on the vertebrae involved. The characteristic syndrome, Pott's disease, reflects the consequence of infection of the lower thoracic and lumbar spine, the most common site of tuberculous vertebral osteomyelitis. Cervical involvement is unusual: tuberculosis affects the cervical vertebrae in approximately 0.03% of all cases. Tuberculosis of the atlas and axis is even more rare. Characteristic symptoms reported on presentation include fever, weight loss, night sweats, and neck pain and stiffness. Patients may have no neurological manifestations, but findings can range from single nerve-root compression to quadriplegia. Abscess may extend into the retropharynx, mediastinum, and posterior triangles and along the epidural space. Computerized tomography and magnetic resonance imaging are the most useful imaging procedures. Therapy should consist of administration of antimycobacterial antibiotics and--if indicated by the degree of subluxation, by neurological signs, or by cervical instability--surgical debridement and stabilization.

Adult↗