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Biomedical subjects

S L Solomon

Publications and source records attributed to S L Solomon.

48 records · Page 3Linked to original sources
PubMed1985

Mechanism of cross-contamination of blood culture bottles in outbreaks of pseudobacteremia associated with nonsterile blood collection tubes.

Several studies have identified nonsterile blood collection tubes as the reservoir for contaminating microorganisms in outbreaks of pseudobacteremia. Microorganisms are thought to be transferred from the nonsterile tubes to the blood culture tubes when blood is drawn for cultures, but the validity of this hypothesis has not previously been tested. We recently investigated an outbreak of Ewingella americana pseudobacteremia in which an epidemiological association was found between pseudobacteremia and the practice of drawing blood for culturing at the same time that blood for coagulation studies is drawn. The nonsterile coagulation tubes, prepared in the hospital, were contaminated with E. americana. We studied three different procedures that personnel reported using to inoculate blood culture tubes after dispensing blood into the coagulation tubes. Although the failure to change or remove the needle before inoculating the blood culture tubes resulted in the highest percentage of cross-contamination, we found that all the techniques we simulated carried some risk of cross-contamination when coagulation tubes were filled first.

Blood↗
PubMed1985

Nosocomial Pseudomonas pickettii colonization associated with a contaminated respiratory therapy solution in a special care nursery.

Pseudomonas pickettii caused respiratory tract colonization in five infants in the special care nursery of a Chicago hospital. All organisms had the same antimicrobial susceptibilities. Endotracheal suctioning with saline from 5-ml unit-dose vials was identified by epidemiologic investigation as a risk factor for colonization. The vials of saline were contaminated with a strain of P. pickettii having the same antimicrobial susceptibility pattern as the isolates from patients. As part of an investigation of the manufacturing plant where the saline solution was produced, P. pickettii was recovered from deionized water used to make the product and from several sites in the processing line. Bypassing of a 180 degrees F (ca. 82 degrees C) water-holding tank appeared to be temporally related to product contamination. The ability of P. pickettii to survive and grow in this solution has been demonstrated in the laboratory. This outbreak demonstrates that, despite pertinent Food and Drug Administration regulations and company programs for identifying such contamination, intrinsically contaminated solutions can occasionally reach the bedside of the patient.

Cross Infection↗
PubMed1984

An outbreak of Candida parapsilosis bloodstream infections in patients receiving parenteral nutrition.

From July to September 1981, five patients at one hospital had bloodstream infections or colonization of an intravascular cannula with Candida parapsilosis. All five cases, but none of 34 controls, were receiving parenteral nutrition at the onset of infection or colonization (P less than 0.01; Fisher's exact test, one-tailed). Epidemiologic investigation showed that human serum albumin was more frequently added to parenteral nutrition solutions during the epidemic period than during a comparable period a year earlier. The increase in human serum albumin use coincided with the more frequent use of an electrically powered vacuum pump to assist in compounding parenteral nutrition solutions. Cultures from the vacuum pump showed heavy growth of C parapsilosis from multiple sites. Laboratory investigation demonstrated that sterile solutions could be contaminated by use of the vacuum pump. Use of the vacuum pump was stopped, and no further cases occurred.

Candidiasis↗
PubMed1983

Exercise-induced right ventricular tachycardia and arrhythmogenic right ventricular dysplasia: electrophysiologic and therapeutic considerations.

Three cases of exercise-induced ventricular tachycardia with associated right ventricular dysplasia are described. In each case, patients experienced ventricular tachycardia during treadmill tests. In all three patients, echocardiography or nuclear scintigraphy revealed a dilated right ventricle with reduced ejection fraction; cardiac catheterization with angiography also showed a dilated and hypokinetic right ventricle in each case. Two patients underwent electrophysiology studies that showed an inducible ventricular tachycardia originating from the right ventricular outflow tract. All three patients were treated with single agent antiarrhythmic drugs that controlled their ventricular tachycardia.

Journal Article↗
PubMedDate not supplied

Health and economic impacts of antimicrobial resistance.

For comparison of the impacts of infections due to antimicrobial-resistant bacteria with those of infections due to antimicrobial-susceptible strains of the same bacteria, data were evaluated from 175 published and unpublished reports of investigations of nosocomial and community-acquired infections with selected bacteria. The evaluation of outcomes of hospital-acquired infections with resistant organisms was often confounded by risk factors also associated with poor outcomes. Nevertheless, for both nosocomial and community-acquired infections, the mortality, the likelihood of hospitalization, and the length of hospital stay were usually at least twice as great for patients infected with drug-resistant strains as for those infected with drug-susceptible strains of the same bacteria. Poor outcomes could be attributed both to the expected effects of ineffective antimicrobial therapy and to the unexpected occurrence of drug-resistant infections complicated by prior antimicrobial therapy for other medical problems. Although the adverse economic and health effects of drug-resistant bacterial infections can only be roughly quantified, it is concluded that antimicrobial resistance is an important health problem and an economic burden to society.

Bacterial Infections↗
PubMedDate not supplied

Viral meningitis in child care center staff and parents: an outbreak of echovirus 30 infections.

OBJECTIVE: A report of five cases of viral meningitis among adults with children enrolled in a child care center prompted an investigation of risk factors for viral transmission from children to adult household members. METHODS: To determine recent echovirus 30 (E30) infections, the authors conducted a serologic survey. To determine risk factors for infection among adult household members, they conducted a retrospective cohort study using written questionnaires. RESULTS: Recent E30 infections were found in 84% of children tested, 57% of adult household members tested, and 47% of staff members tested. Infected adults were more likely than infected children to have clinical meningitis. Among adult household members, changing diapers was a risk factor for recent infection. Women who changed > or = 90 diapers per month had a higher infection rate than women who changed fewer diapers; in contrast, men who changed > or = 90 diapers per month had a lower infection rate than men who changed fewer diapers. Handwashing was protective: there was a negative correlation between handwashing after diaper changes and E30 infection among adults with infected children in diapers. CONCLUSIONS: Because child care centers can be a source of enteroviral infections among adult household members, adults with viral meningitis should be questioned about their children's day care or preschool attendance. The importance of handwashing should be stressed to adults with children in day care.

Adult↗
PubMedDate not supplied

Nosocomial fungemia in neonates associated with intravascular pressure-monitoring devices.

In the period from January, 1982, to March, 1983, eight infants in the neonatal intensive care unit at one hospital had blood cultures positive for Candida parapsilosis; six cases had occurred after December, 1982. Epidemiologic investigation included a case-control study comparing the 8 cases with 29 birth weight-matched controls. Logistic regression analysis indicated that the model that best fit the observed data included the following risk factors for fungemia: duration of umbilical artery catheterization; duration of receipt of parenteral nutrition; and estimated gestational age. Parenteral nutrition therapy was often administered through the umbilical artery catheters, which were also used for monitoring arterial pressure; transducer domes thus contained parenteral nutrition fluid. Transducers were usually disinfected with alcohol. Laboratory investigation showed that the heads of 6 of 11 in-use blood pressure transducers and 1 of 4 transducers in storage after cleaning were culture-positive for C. parapsilosis. After control measures were instituted no further cases occurred.

Blood↗
PubMedDate not supplied

Impact of hospital care on incidence of bloodstream infection: the evaluation of processes and indicators in infection control study.

The Evaluation of Processes and Indicators in Infection Control (EPIC) study assesses the relationship between hospital care and rates of central venous catheter-associated primary bacteremia in 54 intensive-care units (ICUs) in the United States and 14 other countries. Using ICU rather than the patient as the primary unit of statistical analysis permits evaluation of factors that vary at the ICU level. The design of EPIC can serve as a template for studies investigating the relationship between process and event rates across health-care institutions.

Bacteremia↗
PubMedDate not supplied

Applying economic principles to health care.

Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering health care in a hospital. Health-care markets lack the characteristics needed to determine a "market" price that reflects the economic value of resources used. However, resource allocation in a hospital can be analyzed by using production theory to determine efficient resource use. The information provided by hospital epidemiologists is critical to understanding health-care production processes used by a hospital and developing economic incentives to promote antibiotic effectiveness and infection control.

Anti-Bacterial Agents↗
PubMedDate not supplied

School-based screening for tuberculous infection. A cost-benefit analysis.

OBJECTIVE: To compare tuberculin screening of all kindergartners and high school entrants (screen-all strategy) vs screening limited to high-risk children (targeted screening). DESIGN: Decision, cost-effectiveness, and cost-benefit analyses. SETTING AND SUBJECTS: Students in a large urban and rural county. DEFINITIONS: High risk of tuberculosis infection was defined as birth in a county with a high prevalence of tuberculosis. Low risk was defined as birth in the United States. OUTCOME MEASURES: Tuberculosis cases prevented for 10, 000 children screened. Net costs, net cost per case prevented, benefit-cost ratio, and incremental cost-effectiveness. RESULTS: The screen-all strategy would prevent 14.9 cases per 10,000 children screened; targeted screening would prevent 84.9 cases per 10,000 children screened. The screen-all strategy is more costly than no screening; the benefit-cost ratio is 0.58. Targeted screening would result in a net savings; the benefit-cost ratio is 1.2. Screening all children is cost saving only if the reactor rate is 20% or greater. The cost per additional case prevented for screening all children compared with targeted screening (+34 666) is more than twice as high as treatment and contact tracing for a case of tuberculosis (+16 392). CONCLUSIONS: Targeted screening of schoolchildren is much less costly than mass screening and is more efficient in prevention of tuberculosis.

Adolescent↗