William R. Jarvis, M.D.

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A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission?

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Abstract

OBJECTIVES: To describe an outbreak of Pseudomonas aeruginosa bloodstream infection (BSI) and endotracheal tube (ETT) colonization in a neonatal intensive care unit (NICU), determine risk factors for infection, and make preventive recommendations.

DESIGN: A 15-month cohort study followed by a case-control study with an environmental survey and molecular typing of available isolates using pulsed-field gel electrophoresis.… Read more

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Risk factors for radial artery harvest site infection following coronary artery bypass graft surgery

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Abstract

Radial arteries increasingly are used during coronary artery bypass graft (CABG) surgery. Although risk factors for saphenous vein harvest site infection (HSI) have been reported, rates of and risk factors for radial artery HSI are not well established. We compared rates of radial artery HSI that were detected by 2 surveillance methods, regular and heightened.… Read more

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Nosocomial tuberculosis prevention measures among two groups of US hospitals, 1992 to 1996

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Abstract

OBJECTIVE: To compare trends in nosocomial tuberculosis (TB) prevention measures and health-care worker (HCW) tuberculin skin test (TST) conversion of hospitals with HIV-related Pneumocystis carinii pneumonia (PCP) patients and other US hospitals from 1992 through 1996.

DESIGN AND SETTING: Surveys in 1992 and 1996 of 38 hospitals with PCP patients in four high-HIV-incidence cities and 136 other US hospitals from the American Hospital Association membership list.… Read more

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Vancomycin use in pediatric hematology-oncology patients

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Abstract

Across-sectional study was performed of pediatric hematology-oncology patients who received vancomycin; use was compared to the Centers for Disease Control and Prevention (CDC) recommendations for vancomycin use. Thirty-seven patients received 308 doses of vancomycin. AR patients initially received vancomycin as empirical therapy; 100% of this use was not consistent with the CDC recommendations.… Read more

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The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit

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Abstract

OBJECTIVES: To determine the risk factors for acquisition of nosocomial primary bloodstream infections (BSIs), including the effect of nursing-staff levels, in surgical intensive care unit (SICU) patients.

DESIGN: A nested case-control study.

SETTING: A 20-bed SICU in a 1,000-bed inner-city public hospital.… Read more

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Enterobacter cloacae bloodstream infections traced to contaminated human albumin

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Abstract

In August 1996, a patient in Kansas developed an Enterobacter cloacae bloodstream infection (BSI) shortly after receiving Albuminar, a brand of human albumin. Albuminar contamination was suspected. A case-control study of patients with primary gram-negative bacterial BSIs showed that patients with E.… Read more

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Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting

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Abstract

OBJECTIVE: Our objective was to identify risk factors for deep sternal site infection after coronary artery bypass grafting at a community hospital.

METHODS: We compared the prevalence of deep sternal site infection among patients having coronary artery bypass grafting during the study (January 1995-March 1998) and pre-study (January 1992-December 1994) periods.… Read more

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Epidemic transmission of human immunodeficiency virus in renal dialysis centers in Egypt

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Abstract

In 1993 an epidemic of human immunodeficiency virus (HIV) infection occurred among 39 patients at 2 renal dialysis centers in Egypt. The centers, private center A (PCA) and university center A (UCA) were visited, HIV-infected patients were interviewed, seroconversion rates at UCA were calculated, and relatedness of HIV strains was determined by sequence analysis; 34 (62%) of 55 patients from UCA and 5 (42%) of 12 patients from PCA were HIV-infected.… Read more

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Vancomycin use in pediatric neurosurgery patients

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Abstract

OBJECTIVE: The objective of this article is to describe a pediatric neurosurgery patient population receiving vancomycin and examine the indications for and appropriateness of vancomycin use.

METHODS: A cross-sectional study was performed on the pediatric neurosurgery patients at Egleston Children’s Hospital who received vancomycin from January 1 through December 31, 1996.… Read more

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Proficiency in detecting vancomycin resistance in enterococci among clinical laboratories in Santiago, Chile

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Abstract

Labarca JA, McDonald LC, Pinto ME, Palavecino E, González P, Cona E, Fernández A, Giglio MS, Jarvis WR

Emerging Infect. Dis. 1999 Nov-Dec;5(6):839-40

PMID: 10603228… Read more

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Satellite videoconferencing for healthcare workers: audience characteristics and the importance of continuing education credits

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Abstract

To assess the opinions of healthcare workers (HCWs) about a satellite videoconference as a means of earning continuing education credit, a telephone survey was conducted in September 1998, 1 month after a live interactive satellite videoconference on antimicrobial use and resistance.… Read more

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An outbreak of gram-negative bacteremia in hemodialysis patients traced to hemodialysis machine waste drain ports

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Abstract

OBJECTIVE: To investigate an outbreak of gram-negative bacteremias at a hemodialysis center (December 1, 1996-January 31, 1997).

DESIGN: Retrospective cohort study. Reviewed infection control practices and maintenance and disinfection procedures for the water system and dialysis machines. Performed cultures of the water and dialysis machines, including the waste-handling option (WHO), a drain port designed to dispose of saline used to flush the dialyzer before patient use.… Read more

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A multistate nosocomial outbreak of Ralstonia pickettii colonization associated with an intrinsically contaminated respiratory care solution

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Abstract

From 1 February through 30 April 1998, 4 hospitals reported a total of 34 patients colonized with Ralstonia pickettii. All but 1 had been exposed to 0.9% saline solution manufactured by 1 company (Modudose; Kendall, Mainsfield, MA), which was used during endotracheal suctioning.… Read more

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Seasonal variation of Acinetobacter infections: 1987-1996. Nosocomial Infections Surveillance System

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Abstract

To determine whether nosocomial infections due to Acinetobacter species have increased over the past 10 years and whether infections continue to have a pronounced seasonal variation, we analyzed infections reported by hospitals in the National Nosocomial Infections Surveillance System that performed adult and pediatric intensive care unit surveillance from 1987 through 1996.… Read more

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Reply

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Abstract

Kuehnert MJ, Jarvis WR

Clin. Infect. Dis. 1999 Nov;29(5):1358

PMID: 10525009… Read more

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Emerging Issues in Nosocomial Fungal Infections

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Abstract

Nosocomial fungal infections remain a serious cause of morbidity and mortality. As immunodeficient populations increase, the incidence of nosocomial fungal infections continues to rise. Although a wide variety of new and emerging fungi can cause nosocomial infections, Candida species remain the major etiologic agent.… Read more

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Reporting of vancomycin-resistant enterococci in Connecticut: implementation and validation of a state-based surveillance system

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Abstract

OBJECTIVE: To assess state-based surveillance for isolation from a sterile site of vancomycin-resistant enterococci (VRE) in Connecticut.

DESIGN: Clinical laboratory reporting (passive surveillance) of VRE isolates to the Connecticut Department of Public Health (CDPH) was followed by state-initiated validation, laboratory proficiency testing, and review of hospital demographic characteristics.… Read more

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Association between mucositis severity and vancomycin-resistant enterococcal bloodstream infection in hospitalized cancer patients

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Abstract

OBJECTIVE: To determine the role of mucositis severity in the development of vancomycin-resistant enterococcal (VRE) bloodstream infection (BSI).

SETTING: A tertiary-care university medical center.

PARTICIPANTS: Hematology-oncology-unit inpatients.

DESIGN: Patients with VRE BSI (case-patients) were compared with VRE-colonized (control) patients from September 1994 through August 1997.… Read more

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Unrecognised Mycobacterium tuberculosis bacteraemia among hospital inpatients in less developed countries

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Abstract

BACKGROUND: Nosocomial transmission of Mycobacterium tuberculosis is a global public-health concern. Although early clinical recognition of M. tuberculosis in hospital inpatients is critical for effective infection control, such recognition may be difficult in patients with HIV infection. To find out whether M.… Read more

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Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy

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Abstract

BACKGROUND: Intravenous therapy in the outpatient and home settings is commonplace for many diseases and nutritional disorders. Few data are available on the rate of and risk factors for bloodstream infection among patients receiving such therapy.

OBJECTIVE: To determine rates of and risk factors for bloodstream infection among patients receiving home infusion therapy.… Read more

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Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting

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Abstract

BACKGROUND: Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U. S. hospitals.

OBJECTIVE: To determine whether enhanced infection-control strategies reduce transmission of VRE in an endemic setting.

DESIGN: Prospective cohort study.

SETTING: Adult oncology inpatient unit.

PATIENTS: 259 patients evaluated during use of enhanced infection-control strategies and 184 patients evaluated during use of standard infection-control practices.… Read more

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Lessons from recent nosocomial epidemics

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Abstract

This review describes important examples of recent nosocomial infection epidemics. Current trends suggest that emerging problems in nosocomial infections include increased nosocomial epidemics in out-of-hospital settings, contamination of medical devices and products, and antimicrobial resistance. Increased attention should be focused on outbreak investigations in these areas.… Read more

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Antimicrobial resistance in Staphylococcus aureus

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Abstract

Recognized since 1883 as a common cause of infection, Staphylococcus aureus’ preantimicrobial-era bacteremia mortality rate was 82%. The mortality of that era threatens to return as evidence of growing vancomycin resistance undermines the utility of vancomycin therapy. Successful treatment of S.… Read more

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A pseudoepidemic of postoperative scleritis due to misdiagnosis

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Abstract

OBJECTIVE: To describe a pseudoepidemic of infectious scleritis following eye surgery.

METHODS: Retrospective cohort study with selected procedural and laboratory investigations.

RESULTS: Twenty-one patients with postoperative scleritis were identified during a 2-month outbreak. Neither an infectious etiology nor a causative pre-, intra-, or postoperative exposure was found.… Read more

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Regional dissemination of vancomycin-resistant enterococci resulting from interfacility transfer of colonized patients

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Abstract

During early 1997, the Siouxland District Health Department (SDHD; Sioux City, IA) reported an increased incidence of vancomycin-resistant enterococcal (VRE) isolates at area health care facilities. To determine the prevalence and risk factors for colonization with VRE strains at 32 health care facilities in the SDHD region, a prevalence survey and case-control study were performed.… Read more

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Proficiency of clinical laboratories in Spain in detecting vancomycin-resistant Enterococcus spp. The Spanish VRE Study Group

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Abstract

Studies in a variety of U.S. clinical laboratories have demonstrated difficulty in detecting intermediate and low-level vancomycin-resistant enterococci (VRE). The misclassification of “at least intermediate resistant isolates” as vancomycin susceptible may have both clinical implications and a negative impact on measures to control the spread of VRE.… Read more

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Fever and human immunodeficiency virus infection as sentinels for emerging mycobacterial and fungal bloodstream infections in hospitalized patients >/=15 years old, Bangkok

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Abstract

To determine the etiology of bloodstream infections (BSIs) in hospitalized patients /=15 years old in Thailand, prospectively enrolled, consecutive febrile (/=38 degrees C) patients were admitted to one hospital during February-April 1997. After a patient history was taken and a physical examination was performed, blood was obtained for comprehensive culture and human immunodeficiency virus (HIV) testing.… Read more

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Selected global health care activities of the Hospital Infections Program, Centers for Disease Control and Prevention

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Abstract

Manangan LP, Archibald LK, Pearson ML, Duffy RE, Garrett DO, Alonso-Echanove JA, Richet HM, Parvez FM, Jarvis WR

Am J Infect Control 1999 Jun;27(3):270-4

PMID: 10358231… Read more

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Trends in compliance with the guidelines for preventing the transmission of Mycobacterium tuberculosis among New Jersey hospitals, 1989 to 1996

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Abstract

OBJECTIVE: To determine trends in compliance with the guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare facilities among New Jersey hospitals from 1989 through 1996.

DESIGN: A voluntary questionnaire was sent to all 96 New Jersey hospitals in 1992.… Read more

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Increased risk of Mycobacterium tuberculosis infection related to the occupational exposures of health care workers in Chiang Rai, Thailand

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Abstract

SETTING: Chiang Rai, the northernmost province of Thailand.

OBJECTIVE: To evaluate the occupational risk for tuberculous infection of health care workers (HCWs) and the utility of tuberculin skin test (TST) in a developing country setting.

DESIGN: A cross-sectional TST survey, including a risk assessment questionnaire, of Chiang Rai Hospital HCWs.… Read more

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Postsurgical Candida albicans infections associated with an extrinsically contaminated intravenous anesthetic agent

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Abstract

From 16 to 30 April 1990, four of 364 (1%) postsurgical patients at one hospital developed Candida albicans fungemia or endophthalmitis. The case patients’ surgeries were clustered on two days. To identify risk factors for C. albicans infections, we conducted a cohort study comparing these 4 patients with 67 control patients who had surgeries on the same days but did not acquire C.… Read more

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Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee

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Abstract

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR

Infect Control Hosp Epidemiol 1999 Apr;20(4):250-78; quiz 279-80

PMID: 10219875… Read more

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Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee

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Abstract

EXECUTIVE SUMMARY The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)’s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1,2 Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs.… Read more

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Surgical-site complications associated with a morphine nerve paste used for postoperative pain control after laminectomy

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Abstract

OBJECTIVE: To identify risk factors that might explain a sudden increase in the rate of surgical-site complications following laminectomy.

DESIGN: Retrospective cohort study.

PATIENTS AND SETTING: Patients who underwent laminectomy at a 120-bed hospital from August 1 through October 15, 1996 (the epidemic period).… Read more

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The prevalence of colonization with vancomycin-resistant Enterococcus at a Veterans’ Affairs institution

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Abstract

OBJECTIVE: To study vancomycin-resistant Enterococcus (VRE) prevalence, risk factors, and clustering among hospital inpatients.

DESIGN: Rectal-swab prevalence culture survey conducted from February 5 to March 22, 1996.

SETTING: The Veterans’ Affairs Medical Center, Atlanta, Georgia.

PATIENTS: Hospital (medical and surgical) inpatients.… Read more

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The emergence of decreased susceptibility to vancomycin in Staphylococcus epidermidis

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Abstract

BACKGROUND: Coagulase-negative staphylococci (CNS) are the major cause of nosocomial bloodstream infection. Emergence of vancomycin resistance among CNS is a serious public health concern, because CNS usually are multidrug-resistant, and glycopeptide antibiotics, among which only vancomycin is available in the United States, are the only remaining effective therapy.… Read more

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Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group

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Abstract

BACKGROUND: Since the emergence of methicillin-resistant Staphylococcus aureus, the glycopeptide vancomycin has been the only uniformly effective treatment for staphylococcal infections. In 1997, two infections due to S. aureus with reduced susceptibility to vancomycin were identified in the United States.… Read more

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EMERGEncy ID NET: an emergency department-based emerging infections sentinel network

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Abstract

Talan DA, Moran GJ, Mower WR, Newdow M, Ong S, Slutsker L, Jarvis WR, Conn LA, Pinner RW

Clin. Infect. Dis. 1999 Feb;28(2):401-2

PMID: 10064261… Read more

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Control of vancomycin-resistant enterococci at a community hospital: efficacy of patient and staff cohorting

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Abstract

OBJECTIVE: To evaluate the efficacy of patient and staff cohorting to control vancomycin-resistant enterococci (VRE) at an Indianapolis community hospital.

DESIGN: To interrupt transmission of VRE, a VRE point-prevalence survey of hospital inpatients was conducted, and VRE-infected or -colonized patients were cohorted on a single ward with dedicated nursing staff and patient-care equipment.… Read more

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Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting

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Abstract

The influence of infection-control practices on bloodstream infection (BSI) risk was examined in a home health care setting in which three needleless devices were used consecutively. A case-control study and a retrospective cohort study were conducted. Risk factors for BSI included lower education level, younger age, having a central venous catheter (CVC) with multiple ports, or having a tunneled CVC.… Read more

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Immune determinants of organism and outcome in febrile hospitalized Thai patients with bloodstream infections

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Abstract

Opportunistic infections (OI) and the human immunodeficiency virus (HIV) cause significant morbidity and mortality in developing countries. Immune cell and cytokine profiles may be related to the type and course of OI and to the OI-HIV interaction. Examining cell-specific cytokine production ex vivo has only recently become feasible.… Read more

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Proficiency of clinical laboratories in and near Monterrey, Mexico, to detect vancomycin-resistant enterococci

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Abstract

Early detection of vancomycin-resistant enterococci is important for preventing its spread among hospitalized patients. We surveyed the ability of eight hospital laboratories in and near Monterrey, Mexico, to detect vancomycin resistance in Enterococcus spp. and found that although laboratories can reliably detect high-level vancomycin resistance, many have difficulty detecting low-level resistance.… Read more

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EMERGEncy ID NET: an emergency department-based emerging infections sentinel network. The EMERGEncy ID NET Study Group

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Abstract

Acute infectious disease presentations among many at-risk patient groups (eg, uninsured, homeless, and recent immigrants) are frequently seen in emergency departments. Therefore EDs may be useful sentinel sites for infectious disease surveillance. This article describes the background, development, and implementation of EMERGE ncy ID NET, an interdisciplinary, multicenter, ED-based network for research of emerging infectious diseases.… Read more

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Enterobacter cloacae and Pseudomonas aeruginosa polymicrobial bloodstream infections traced to extrinsic contamination of a dextrose multidose vial

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Abstract

OBJECTIVE: To identify risk factors for polymicrobial bloodstream infections (BSIs) in neonatal intensive care unit (NICU) patients during an outbreak of BSIs.

DESIGN: During an outbreak of BSIs, we conducted a retrospective cohort study, assessed NICU infection control practices and patient exposure to NICU healthcare workers (HCWs), and obtained cultures of the environment and HCW hands.… Read more

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Nocardia farcinica sternotomy site infections in patients following open heart surgery

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Abstract

Although Nocardia farcinica surgical site infection outbreaks have been reported (though rarely), no source for these has been identified. From May 1992 through June 1993, 5 patients contracted N. farcinica sternotomy site infections following open heart surgery at hospital A.… Read more

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Line-associated bloodstream infections in pediatric intensive-care-unit patients associated with a needleless device and intermittent intravenous therapy

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Abstract

OBJECTIVES: To determine risk factors for an increase in line-associated bloodstream infections (BSIs) in three pediatric intensive-care units at one hospital that recently had changed brands of needleless access device.

DESIGN: Retrospective case-control studies; review of the units’ infection control policies and procedures for accessing and replacing components of needleless access devices.… Read more

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Candida albicans endocarditis associated with a contaminated aortic valve allograft: implications for regulation of allograft processing

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Abstract

A patient developed Candida albicans endocarditis and fungemia after undergoing aortic valve replacement with an allograft. The allograft had been found during tissue bank processing to be contaminated with C. albicans, but it was culture-negative for C. albicans after routine disinfection with an antifungal-containing antimicrobial solution.… Read more