PubMed · 8610933
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L E Asbel, C C Johnson. 1996-05-15. Ventilator circuit changes.. https://doi.org/10.7326/0003-4819-124-10-199605150-00024
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OBJECTIVE: To determine if compliance with annual tuberculosis skin testing correlated with the number of cases of tuberculosis seen in patients and healthcare workers. DESIGN: Survey using a written questionnaire. SETTING AND PARTICIPANTS: 159 Veterans' Administration facilities. RESULTS: Hospitals that reported that > 80% of their healthcare workers received annual skin tests saw 12.7 patient cases per 10,000 admissions and 4.0 healthcare worker cases per 10,000 personnel. Facilities in which < 20% of their healthcare workers were given annual skin tests saw 4.5 cases per 10,000 admissions and 1.6 cases in healthcare workers per 10,000 personnel (P < .001 for patients and P = .31 for healthcare workers). The ratio of the median number of patients placed in acid-fast bacilli (AFB) isolation to the median number of patients with confirmed tuberculosis was 12. There was no correlation of this ratio with the number of cases of tuberculosis in patients or healthcare workers seen in each facility. CONCLUSION: Compliance with annual tuberculosis skin testing was related directly to the rate of tuberculosis seen in patients. More standardized policies for placing patients in AFB isolation are needed to control for potentially costly variation among facilities. These measures should have highest priority in the control of tuberculosis in the healthcare setting, before implementing still more expensive interventions.
OBJECTIVE: To describe control of endemic and outbreak-related methicillin-resistant Staphylococcus aureus (MRSA) at two affiliated hospitals. DESIGN: Prospective surveillance of patients with MRSA. Disposable gloves were used by all staff having direct contact with the affected patient or his immediate environment, and patient isolates were typed by pulsed-field gel electrophoresis (PFGE) of genomic DNA. Surveillance and PFGE typing were used concurrently to identify possible nosocomial outbreaks, confirm or refute cross-infection, and support a need for additional outbreak control interventions. SETTING: A university hospital (Hospital A) and a university-affiliated public hospital (Hospital B). PARTICIPANTS: Patients with MRSA colonization or infection over an 18-month interval (June 1993-November 1994). INTERVENTION: Proper handwashing and gloving practices were reemphasized with staff following confirmation of outbreaks. RESULTS: Hospital A had 60 community-acquired and 48 nosocomial cases of MRSA. Two small outbreaks (affecting a total of seven patients) and two pseudo-outbreaks were identified. Hospital B had 36 community-acquired and 22 nosocomial cases of MRSA. Only one outbreak affecting five patients occurred. All outbreaks ended shortly after staff meetings that emphasized ongoing and extremely careful handwashing and gloving when caring for identified patients. The majority of nosocomial cases at both hospitals were not related epidemiologically or had isolates with unique PFGE types. Pseudo-outbreaks were confirmed by demonstrating that isolates from epidemiologically related cases (by time and clinical service or hospital unit) had different PFGE types. Hospital A cases had 39 different PFGE types, and Hospital B cases had 31 different PFGE types. CONCLUSION: MRSA in hospitals, including outbreaks identified by prospective surveillance and confirmed by PFGE typing, can be controlled by minimal special precautions and interventions. This is possible despite the continuous admission of patients with MRSA from the community. PFGE typing is useful to confirm outbreaks and pseudo-outbreaks, demonstrate differences among epidemiologically unrelated isolates, and substantiate the efficacy of MRSA control programs within hospitals.
In recent years, enterococci have become increasingly resistant to a broad range of antimicrobial agents. The development of high-level resistance to aminoglycosides, penicillins, and glycopeptides singly and in combination has important clinical implications. Strains of Enterococcus faecium that are resistant to every useful available antibiotic have been described. Resistance to penicillin can be due to overproduction of penicillin-binding protein (which has low affinity for penicillins) or to production of beta-lactamase. High-level resistance of enterococci to gentamicin is due to the synthesis of a modifying enzyme. In this case, the synergistic activity of the combination of penicillin with any aminoglycoside (except for streptomycin) is totally abolished. Acquired resistance to glycopeptides is often plasmid-mediated and is associated with a major epidemic potential since certain plasmids are self-transferable from E. faecium to a variety of gram-positive organisms, including Staphylococcus aureus.