50 results on '"Tokars, J I"'
Search Results
2. Sampling for Collection of Central Line–Day Denominators in Surveillance of Healthcare-Associated Bloodstream Infections
- Author
-
Klevens, R. M., Tokars, J. I., Edwards, J., and Horan, T.
- Published
- 2006
3. Automated monitoring of clusters of falls associated with severe winter weather using the BioSense system
- Author
-
Dey, A. N., primary, Hicks, P., additional, Benoit, S., additional, and Tokars, J. I., additional
- Published
- 2010
- Full Text
- View/download PDF
4. The Changing Face of Surveillance for Health Care--Associated Infections
- Author
-
Tokars, J. I., primary, Richards, C., additional, Andrus, M., additional, Klevens, M., additional, Curtis, A., additional, Horan, T., additional, Jernigan, J., additional, and Cardo, D., additional
- Published
- 2004
- Full Text
- View/download PDF
5. Predictive Value of Blood Cultures Positive for Coagulase-Negative Staphylococci: Implications for Patient Care and Health Care Quality Assurance
- Author
-
Tokars, J. I., primary
- Published
- 2004
- Full Text
- View/download PDF
6. Enterobacter cloacae Bloodstream Infections Traced to Contaminated Human Albumin
- Author
-
Wang, S. A., primary, Tokars, J. I., additional, Bianchine, P. J., additional, Carson, L. A., additional, Arduino, M. J., additional, Smith, A. L., additional, Hansen, N. C., additional, Fitzgerald, E. A., additional, Epstein, J. S., additional, and Jarvis, W. R., additional
- Published
- 2000
- Full Text
- View/download PDF
7. Vascular access in patients receiving hemodialysis
- Author
-
Tokars, J. I., primary
- Published
- 1997
- Full Text
- View/download PDF
8. U.S. hospital mycobacteriology laboratories: status and comparison with state public health department laboratories
- Author
-
Tokars, J I, primary, Rudnick, J R, additional, Kroc, K, additional, Manangan, L, additional, Pugliese, G, additional, Huebner, R E, additional, Chan, J, additional, and Jarvis, W R, additional
- Published
- 1996
- Full Text
- View/download PDF
9. A Survey of Occupational Contact and HIV Infection Among Orthopedic Surgeons
- Author
-
TOKARS, J. I., primary, CHAMBERLAND, M. E., additional, SCHABLE, C. A., additional, CULVER, D. H., additional, JONES, M., additional, McKIBBEN, P. S., additional, and BELL, D. M., additional
- Published
- 1993
- Full Text
- View/download PDF
10. Current practices in mycobacteriology: results of a survey of state public health laboratories
- Author
-
Huebner, R E, primary, Good, R C, additional, and Tokars, J I, additional
- Published
- 1993
- Full Text
- View/download PDF
11. A survey of occupational blood contact and HIV infection among orthopedic surgeons. The American Academy of Orthopaedic Surgeons Serosurvey Study Committee
- Author
-
Tokars, J. I., primary
- Published
- 1992
- Full Text
- View/download PDF
12. Percutaneous injuries during surgical procedures
- Author
-
Tokars, J. I., primary
- Published
- 1992
- Full Text
- View/download PDF
13. Mycobacterium gordonae pseudoinfection associated with a contaminated antimicrobial solution
- Author
-
Tokars, J I, primary, McNeil, M M, additional, Tablan, O C, additional, Chapin-Robertson, K, additional, Patterson, J E, additional, Edberg, S C, additional, and Jarvis, W R, additional
- Published
- 1990
- Full Text
- View/download PDF
14. Description of a new surveillance system for bloodstream and vascular access infections in outpatient hemodialysis centers.
- Author
-
Tokars, Jerome I. and Tokars, J I
- Subjects
- *
PUBLIC health surveillance , *HEMODIALYSIS - Abstract
Bloodstream and vascular access infections are a threat to hemodialysis patients. However, there are few studies of rates of such infections and there are no standardized methods for ongoing data collection. Because of frequent hospitalizations and receipt of antimicrobials, hemodialysis patients are at high risk for infection with drug-resistant bacteria. This article describes a new voluntary national surveillance system. Each month participating dialysis center personnel will record the number of chronic hemodialysis patients that they treat (broken down into four types of vascular access). A one-page form will be completed for each hospitalization or in-unit IV antimicrobial start among these patients. These data will allow calculation, stratified by type of vascular access, of several rates, including hospitalizations, in-unit IV antimicrobial starts, and vascular access infections. For individual dialysis centers, this surveillance system will provide a simple and standardized method for recording data, calculating rates, and comparing rates over time. It is hoped that collection and examination of these data will lead to quality improvement measures. For government and the medical and public health communities, aggregation of these data from many dialysis centers will provide a wealth of information that is not currently available. For further information, or to receive a protocol for this study, contact Elaine R. Miller, RN, MPH, at (404)639-6422 (telephone), (404)639-6459 or 6458 (fax), or erm4@cdc.gov (e-mail:). Information is also available on the CDC website at http:@www.cdc.gov/ncidod/hip/Dialysis/dialysis.+ ++htm. [ABSTRACT FROM AUTHOR]
- Published
- 2000
- Full Text
- View/download PDF
15. National surveillance of dialysis-associated diseases in the United States, 1997.
- Author
-
Tokars, Jerome I., Miller, Elaine R., Alter, Miriam J., Arduino, Matthew J., Tokars, J I, Miller, E R, Alter, M J, and Arduino, M J
- Subjects
HEMODIALYSIS complications - Abstract
Reports on the results of the United States Centers for Disease Control and Prevention's national survey of hemodialysis-associated diseases in 1997. Dialysis practices and reuse of disposables; Frequency of hemodialysis-associated complications and diseases; Recommended measures to prevent complications and diseases in hemodialysis patients and staff.
- Published
- 2000
- Full Text
- View/download PDF
16. Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy.
- Author
-
Tokars JI, Cookson ST, McArthur MA, Boyer CL, McGeer AJ, Jarvis WR, Tokars, J I, Cookson, S T, McArthur, M A, Boyer, C L, McGeer, A J, and Jarvis, W R
- 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.Design: Prospective, observational cohort study.Setting: Cleveland, Ohio, and Toronto, Ontario, Canada.Patients: Patients receiving home infusion therapy through a central or midline catheter.Measurements: Primary laboratory-confirmed bloodstream infection.Results: Among 827 patients (988 catheters), the most common diagnoses were infections other than HIV (67%), cancer (24%), nutritional and digestive disease (17%), heart disease (14%), receipt of bone marrow or solid organ transplants (11%), and HIV infection (7%). Sixty-nine bloodstream infections occurred during 69,532 catheter-days (0.99 infections per 1000 days). In a Cox regression model with time-dependent covariates, independent risk factors for bloodstream infection were recent receipt of a bone marrow transplant (hazard ratio, 5.8 [95% CI, 3.0 to 11.3]), receipt of total parenteral nutrition (hazard ratio, 4.1 [CI, 2.3 to 7.2]), receipt of therapy outside the home (for example, in an outpatient clinic or physician's office) (hazard ratio, 3.6 [CI, 2.2 to 5.9]), use of a multilumen catheter (hazard ratio, 2.8 [CI, 1.7 to 4.7]), and previous bloodstream infection (hazard ratio, 2.5 [CI, 1.5 to 4.2]). Rates of bloodstream infection per 1000 catheter-days varied from 0.16 for patients with none of these 5 risk factors to 6.77 for patients with 3 or more risk factors. Centrally inserted venous catheters were associated with a higher risk than implanted ports were, but the difference was not statistically significant.Conclusion: Bloodstream infections seem to be infrequent among outpatients receiving infusions through central and midline catheters. However, the rate of infection increases with bone marrow transplantation, parenteral nutrition, infusion therapy in a hospital clinic or physician's office, and use of multilumen catheters. Compared with implanted ports or peripherally inserted catheters, centrally inserted venous catheters may confer greater risk for bloodstream infection. [ABSTRACT FROM AUTHOR]- Published
- 1999
- Full Text
- View/download PDF
17. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. The CDC Cooperative Needlestick Surveillance Group.
- Author
-
Tokars JI, Marcus R, Culver DH, Schable CA, McKibben PS, Bandea CI, Bell DM, Tokars, J I, Marcus, R, Culver, D H, Schable, C A, McKibben, P S, Bandea, C I, and Bell, D M
- Abstract
Objective: To study the risk for human immunodeficiency virus (HIV) infection and the patterns of use and associated toxicity of zidovudine among health care workers after an occupational exposure to HIV.Design: An ongoing, prospective surveillance project conducted by the Centers for Disease Control and Prevention.Participants: Exposed workers voluntarily reported by 312 U.S. health care facilities from August 1983 to June 1992.Results: Four of 1103 enrolled workers with percutaneous exposure to HIV-infected blood seroconverted (HIV seroconversion rate, 0.36%; upper limit of the 95% Cl, 0.83%); no enrolled workers with mucous membrane (n = 75) or skin (n = 67) contact seroconverted. During October 1988 to June 1992, 31% of 848 enrolled workers used zidovudine after exposure; this proportion increased from 5% during October through December 1988 to 43% during January through June 1992. Despite using zidovudine after exposure, one worker became infected with a strain of HIV that was apparently sensitive to zidovudine. Adverse symptoms, most commonly nausea, malaise or fatigue, and headache, were reported by 75% of workers using zidovudine; 31% of workers did not complete planned courses of zidovudine because of adverse events.Conclusions: The risk for HIV seroconversion after percutaneous exposure to HIV-infected blood is 0.36%, which is similar to previous estimates. Zidovudine is used after exposure by a sizable proportion of health care workers enrolled in the project despite frequent, minor, associated symptoms. Documented failures of postexposure zidovudine prophylaxis, including in one worker enrolled in this study, indicate that if zidovudine is protective, any protection afforded is not absolute. Postexposure zidovudine, if used, requires careful consideration of possible risks and benefits. [ABSTRACT FROM AUTHOR]- Published
- 1993
- Full Text
- View/download PDF
18. Study to Determine the Ability of Clinical Laboratories to Detect Antimicrobial-resistant Enterococcus spp. in Buenos Aires, Argentina
- Author
-
Cookson, S. T., Lopardo, H., Marin, M., Arduino, R., Rose, M. J., Altschuler, M., Galanternik, L., Swenson, J. M., Tokars, J. I., and Jarvis, W. R.
- Published
- 1997
- Full Text
- View/download PDF
19. Vancomycin-resistant enterococci colonization in patients at seven hemodialysis centers.
- Author
-
Tokars JI, Gehr T, Jarvis WR, Anderson J, Armistead N, Miller ER, Parrish J, Qaiyumi S, Arduino M, Holt SC, Tenover FC, Westbrook G, and Light P
- Subjects
- Humans, Middle Aged, Prevalence, Risk Factors, United States, Cross Infection epidemiology, Enterococcus physiology, Gram-Positive Bacterial Infections epidemiology, Renal Dialysis, Vancomycin Resistance
- Abstract
Background: Vancomycin-resistant enterococci (VRE) are increasing in prevalence at many institutions, and are often reported in dialysis patients. We studied the prevalence of and risk factors for VRE at seven outpatient hemodialysis centers (three in Baltimore, MD, USA, and four in Richmond, VA, USA)., Methods: Rectal or stool cultures were performed on consenting hemodialysis patients during December 1997 to April 1998. Consenting patients were recultured during May to July 1998 (median 120 days later). Clinical and laboratory data and functional status (1 to 10 scale: 1, normal function; 9, home attendant, not totally disabled; 10, disabled, living at home) were recorded., Results: Of 478 cultures performed, 20 (4.2%) were positive for VRE. Among the seven centers, the prevalence of VRE-positive cultures varied from 1.0 to 7.9%. Independently significant risk factors for a VRE-positive culture were a functional score of 9 to 10 (odds ratio 6.9, P < 0.001), antimicrobial receipt within 90 days before culture (odds ratio 6.1, P < 0.001), and a history of injection drug use (odds ratio 5.4, P = 0.004)., Conclusions: VRE-colonized patients were present at all seven participating centers, suggesting that careful infection-control precautions should be used at all centers to limit transmission. In agreement with previous studies, VRE colonization was more frequent in patients who had received antimicrobial agents recently, underscoring the importance of judicious antimicrobial use in limiting selection for this potential pathogen.
- Published
- 2001
- Full Text
- View/download PDF
20. Infection control in hemodialysis units.
- Author
-
Tokars JI, Arduino MJ, and Alter MJ
- Subjects
- Humans, Renal Dialysis instrumentation, Water Supply, Hemodialysis Units, Hospital standards, Infection Control, Infections etiology, Renal Dialysis adverse effects
- Abstract
Infectious complications of hemodialysis include bacterial infections caused by contaminated water or equipment, other bacterial infections (including vascular access infections), and bloodborne viruses (primarily the hepatitis B and C viruses). Infections caused by contaminated water and equipment can be prevented by a well-designed water-treatment system, routine cleaning and disinfection of system components, and routine bacteriologic monitoring of dialysis water and dialysis fluid. Standard precautions with additional measures recommended specifically for dialysis centers will prevent transmission of bacteria and viruses from patient to patient. These precautions include routine use of gloves, handwashing, and cleaning and disinfection of the external surface of the dialysis machine and other environmental surfaces. In addition, preventing transmission of hepatitis B virus infection requires vaccination of susceptible patients and staff, avoiding dialyzer reuse, and use of a dedicated room, dialysis machine, and staff members when treating patients chronically infected with this virus.
- Published
- 2001
- Full Text
- View/download PDF
21. Use and efficacy of tuberculosis infection control practices at hospitals with previous outbreaks of multidrug-resistant tuberculosis.
- Author
-
Tokars JI, McKinley GF, Otten J, Woodley C, Sordillo EM, Caldwell J, Liss CM, Gilligan ME, Diem L, Onorato IM, and Jarvis WR
- Subjects
- Adolescent, Adult, Aged, Centers for Disease Control and Prevention, U.S., Child, Child, Preschool, Cross Infection epidemiology, Disease Outbreaks, Florida epidemiology, HIV Infections epidemiology, Humans, Middle Aged, Mycobacterium tuberculosis genetics, Mycobacterium tuberculosis isolation & purification, New York epidemiology, Patient Isolation statistics & numerical data, Personnel, Hospital, Polymorphism, Genetic genetics, Prospective Studies, Respiratory Protective Devices statistics & numerical data, Tuberculin Test statistics & numerical data, Tuberculosis, Multidrug-Resistant epidemiology, United States epidemiology, Cross Infection prevention & control, Guideline Adherence statistics & numerical data, Infection Control standards, Tuberculosis, Multidrug-Resistant prevention & control
- Abstract
Objective: To evaluate the implementation and efficacy of selected Centers for Disease Control and Prevention guidelines for preventing spread of Mycobacterium tuberculosis., Design: Analysis of prospective observational data., Setting: Two medical centers where outbreaks of multidrug-resistant tuberculosis (TB) had occurred., Participants: All hospital inpatients who had active TB or who were placed in TB isolation and healthcare workers who were assigned to selected wards on which TB patients were treated., Methods: During 1995 to 1997, study personnel prospectively recorded information on patients who had TB or were in TB isolation, performed observations of TB isolation rooms, and recorded tuberculin skin-test results of healthcare workers. Genetic typing of M tuberculosis isolates was performed by restriction fragment-length polymorphism analysis., Results: We found that only 8.6% of patients placed in TB isolation proved to have TB; yet, 19% of patients with pulmonary TB were not isolated on the first day of hospital admission. Specimens were ordered for acid-fast bacillus smear and results received promptly, and most TB isolation rooms were under negative pressure. Among persons entering TB isolation rooms, 44.2% to 97.1% used an appropriate (particulate, high-efficiency particulate air or N95) respirator, depending on the hospital and year; others entering the rooms used a surgical mask or nothing. We did not find evidence of transmission of TB among healthcare workers (based on tuberculin skin-test results) or patients (based on epidemiological investigation and genetic typing)., Conclusions: We found problems in implementation of some TB infection control measures, but no evidence of healthcare-associated transmission, possibly in part because of limitations in the number of patients and workers studied. Similar evaluations should be performed at hospitals treating TB patients to find inadequacies and guide improvements in infection control.
- Published
- 2001
- Full Text
- View/download PDF
22. A prospective study of vascular access infections at seven outpatient hemodialysis centers.
- Author
-
Tokars JI, Light P, Anderson J, Miller ER, Parrish J, Armistead N, Jarvis WR, and Gehr T
- Subjects
- Aged, Anti-Bacterial Agents pharmacology, Bacteremia drug therapy, Bacteremia etiology, Bacteria drug effects, Bacteria isolation & purification, Bacterial Infections complications, Bacterial Infections drug therapy, Cohort Studies, Female, Humans, Kidney Failure, Chronic therapy, Male, Middle Aged, Prospective Studies, Risk Factors, Ambulatory Care Facilities statistics & numerical data, Bacterial Infections microbiology, Kidney Failure, Chronic microbiology, Renal Dialysis instrumentation
- Abstract
Vascular access infections are a major cause of morbidity and mortality in hemodialysis patients, and the use of antimicrobials to treat such infections contributes to the emergence and spread of antimicrobial-resistant bacteria. To determine the incidence of and risk factors for vascular access infections, we studied hemodialysis patients at 7 outpatient dialysis centers (4 in Richmond, VA, and 3 in Baltimore, MD) during December 1997 to July 1998. Vascular access infections were defined as local signs (pus or redness) at the vascular access site or a positive blood culture with no known source other than the vascular access; and hospitalization or receipt of an intravenous (IV) antimicrobial. A total of 796 patients were followed for 4,134 patient-months. The vascular access infection rate was 3.5/100 patient-months, ie, patients had a 3.5% risk of infection each month. Independent risk factors were the specific dialysis unit where the patient was treated (relative hazard varying from 1.0 to 4.1 among the 7 centers), catheter access (relative hazard, 2.1 v implanted access), albumin level (relative hazard, 2.4 for lowest v highest quartile), urea reduction ratio (relative hazard, 2.2 for lowest v highest quartile), and hospitalizations during the previous 90 days (relative hazard, 4.9 for >/=6 v zero hospitalizations). These data confirm that vascular access infections are common in hemodialysis patients and that infection rates differ substantially among different centers. Catheter use should be minimized to reduce these infections. Additionally, the possibility that improved serum albumin and urea reduction ratio could reduce vascular access infections should be evaluated.
- Published
- 2001
- Full Text
- View/download PDF
23. Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center.
- Author
-
Grohskopf LA, Roth VR, Feikin DR, Arduino MJ, Carson LA, Tokars JI, Holt SC, Jensen BJ, Hoffman RE, and Jarvis WR
- Subjects
- Adult, Aged, Aged, 80 and over, Ambulatory Care Facilities, Bacteremia epidemiology, Bacteremia microbiology, Cohort Studies, Colorado epidemiology, Cosmetics, Cross Infection epidemiology, Cross Infection microbiology, Data Collection, Epoetin Alfa, Female, Fever etiology, Humans, Male, Middle Aged, Odds Ratio, Recombinant Proteins, Renal Dialysis, Serratia classification, Serratia isolation & purification, Serratia Infections epidemiology, Serratia Infections microbiology, Soaps, United States, Bacteremia etiology, Cross Infection etiology, Disease Outbreaks prevention & control, Drug Contamination economics, Drug Contamination prevention & control, Erythropoietin administration & dosage, Serratia Infections etiology
- Abstract
Background: In a one month period, 10 Serratia liquefaciens bloodstream infections and 6 pyrogenic reactions occurred in outpatients at a hemodialysis center., Methods: We performed a cohort study of all hemodialysis sessions on days that staff members reported S. liquefaciens bloodstream infections or pyrogenic reactions. We reviewed procedures and cultured samples of water, medications, soaps, and hand lotions and swabs from the hands of personnel., Results: We analyzed 208 sessions involving 48 patients. In 12 sessions, patients had S. liquefaciens bloodstream infections, and in 8, patients had pyrogenic reactions without bloodstream infection. Sessions with infections or reactions were associated with higher median doses of epoetin alfa than the 188 other sessions (6500 vs. 4000 U, P=0.03) and were more common during afternoon or evening shifts than morning shifts (P=0.03). Sessions with infections or reactions were associated with doses of epoetin alfa of more than 4000 U (multivariate odds ratio, 4.0; 95 percent confidence interval, 1.3 to 12.3). A review of procedures revealed that preservative-free, single-use vials of epoetin alfa were punctured multiple times, and residual epoetin alfa from multiple vials was pooled and administered to patients. S. liquefaciens was isolated from pooled epoetin alfa, empty vials of epoetin alfa that had been pooled, antibacterial soap, and hand lotion. All the isolates were identical by pulsed-field gel electrophoresis. After the practice of pooling epoetin alfa was discontinued and the contaminated soap and lotion were replaced, no further S. liquefaciens bloodstream infections or pyrogenic reactions occurred at this hemodialysis facility., Conclusions: Puncturing single-use vials multiple times and pooling preservative-free epoetin alfa caused this outbreak of bloodstream infections in a hemodialysis unit. To prevent similar outbreaks, medical personnel should follow the manufacturer's guidelines for the use of preservative-free medications.
- Published
- 2001
- Full Text
- View/download PDF
24. Outbreak of Pseudomonas aeruginosa ventriculitis among patients in a neurosurgical intensive care unit.
- Author
-
Trick WE, Kioski CM, Howard KM, Cage GD, Tokars JI, Yen BM, and Jarvis WR
- Subjects
- Cohort Studies, Disease Outbreaks, Hospitals, Community, Humans, Infection Control methods, Neurosurgery, Cerebral Ventricles, Encephalitis epidemiology, Intensive Care Units, Pseudomonas Infections epidemiology, Pseudomonas aeruginosa isolation & purification
- Abstract
Objective: To determine the cause of an outbreak of Pseudomonas aeruginosa cerebral ventriculitis among eight patients at a community hospital neurosurgical intensive care unit. All had percutaneous external ventricular catheters (EVCs) to monitor cerebrospinal fluid (CSF) pressure., Methods: Cohort study of all patients who had EVCs placed during the epidemic period (August 8-October 22, 1997). A case-patient was any patient with P aeruginosa ventriculitis during the epidemic period. Pulsed-field gel electrophoresis (PFGE) was performed on all isolates., Results: P aeruginosa was significantly more likely to be isolated from CSF per EVC placed in the epidemic than pre-epidemic (January 1-August 7, 1997) periods (8/61 [13%] vs 2/131 [1.5%], P=.002). During the epidemic period, ventriculitis was significantly more likely after EVC placement in the operating room than in other units (8/24 vs 0/22, P=.004). EVC placement technique differed for EVCs placed in the operating room (little hair was removed, preventing application of an occlusive dressing) versus other hospital units (more hair was removed, and an occlusive dressing was applied). Among patients who had operating room EVC placement, contact with one healthcare worker was statistically significant (7/13 vs 0/8, P=.02). Hand cultures of this worker were negative. All isolates had closely related PFGE patterns., Conclusions: These data suggest that a single healthcare worker may have contaminated EVC insertion sites, resulting in an outbreak of P aeruginosa ventriculitis. Affected patients were unlikely to have had an occlusive dressing at the EVC insertion site. Application of a sterile occlusive dressing may decrease the risk of ventriculitis in patients with EVCs.
- Published
- 2000
- Full Text
- View/download PDF
25. Risk factors for radial artery harvest site infection following coronary artery bypass graft surgery.
- Author
-
Trick WE, Scheckler WE, Tokars JI, Jones KC, Smith EM, Reppen ML, and Jarvis WR
- Subjects
- Aged, Case-Control Studies, Confidence Intervals, Coronary Artery Bypass methods, Female, Graft Rejection epidemiology, Graft Survival, Humans, Infection Control standards, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Population Surveillance, Risk Factors, Wisconsin epidemiology, Coronary Artery Bypass adverse effects, Coronary Disease surgery, Radial Artery transplantation, Surgical Wound Infection epidemiology, Tissue and Organ Harvesting adverse effects
- 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. Risk factors were determined by a case-control study. We identified 35 radial artery HSIs ("case sites") in 26 case patients. The radial artery HSI rate was significantly higher during heightened surveillance than during routine surveillance (12.3% vs. 3.1%, respectively; P=.002). Multivariate analysis showed that diabetes mellitus with a preoperative glucose level >/=200 mg/dL (odds ratio [OR], 4.4; P=. 01) and duration of surgery >/=5 h (OR, 3.1; P=.02) were independent risk factors for radial artery HSI. Infection is a common complication of radial artery harvesting for CABG surgery, and infection rates are dependent on the intensity of surveillance. We identified preoperative hyperglycemia and surgery duration as independent risk factors for radial artery HSI.
- Published
- 2000
- Full Text
- View/download PDF
26. Infections due to antimicrobial-resistant pathogens in the dialysis unit.
- Author
-
Tokars JI
- Subjects
- Bacterial Infections microbiology, Bacterial Infections transmission, Humans, Practice Guidelines as Topic, Quality Control, Renal Dialysis adverse effects, Bacterial Infections prevention & control, Drug Resistance, Microbial, Hemodialysis Units, Hospital standards
- Published
- 2000
- Full Text
- View/download PDF
27. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting.
- Author
-
Trick WE, Scheckler WE, Tokars JI, Jones KC, Reppen ML, Smith EM, and Jarvis WR
- Subjects
- Aged, Case-Control Studies, Cefuroxime administration & dosage, Cefuroxime adverse effects, Cephalosporins administration & dosage, Cephalosporins adverse effects, Chi-Square Distribution, Diabetes Complications, Female, Humans, Hyperglycemia complications, Logistic Models, Male, Middle Aged, Obesity complications, Prevalence, Reoperation, Risk Factors, Statistics, Nonparametric, Surgical Wound Infection epidemiology, Sutures adverse effects, Coronary Artery Bypass, Sternum surgery, Surgical Wound Infection etiology
- 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. We compared any patient having a deep sternal site infection after coronary artery bypass graft surgery during the study period (case-patients) with randomly selected patients who had coronary artery bypass graft surgery but no deep sternal site infection during the same period (control-patients)., Results: Deep sternal site infections were significantly more common during the study than during the pre-study period (30/1796 [1.7%] vs 9/1232 [0.7%]; P =.04). Among 30 case-patients, 29 (97%) returned to the operating room for sternal debridement or rewiring, and 2 (7%) died. In multivariable analyses, cefuroxime receipt 2 hours or more before incision (odds ratio = 5.0), diabetes mellitus with a preoperative blood glucose level of 200 mg/dL or more (odds ratio = 10.2), and staple use for skin closure (odds ratio = 4.0) were independent risk factors for deep sternal site infection. Staple use was a risk factor only for patients with a normal body mass index., Conclusions: Appropriate timing of antimicrobial prophylaxis, control of preoperative blood glucose levels, and avoidance of staple use in patients with a normal body mass index should prevent deep sternal site infection after coronary artery bypass graft operations.
- Published
- 2000
- Full Text
- View/download PDF
28. Tuberculosis in hemodialysis patients in New Jersey: a statewide study.
- Author
-
Simon TA, Paul S, Wartenberg D, and Tokars JI
- Subjects
- Allied Health Personnel, Humans, Incidence, New Jersey epidemiology, Population Surveillance, Surveys and Questionnaires, Tuberculin Test, Tuberculosis diagnosis, Hemodialysis Units, Hospital, Infection Control standards, Tuberculosis epidemiology
- Abstract
Objective: To study the incidence of tuberculosis (TB), tuberculin skin testing (TST) practices, and infection control practices at outpatient hemodialysis centers., Design: Mail surveys performed in December 1994 and 1995., Main Outcome Measures: The numbers of patients with incident active TB during 1994 and 1995, TST policies during 1994, and TB infection control policies in 1994., Setting: All outpatient dialysis centers in New Jersey., Patients or Participants: Healthcare workers and patients in dialysis centers in New Jersey., Results: Of 47 centers, 41 provided information on TST and TB infection control policies and practices. TSTs were performed on newly hired healthcare workers at all 41 centers and on established workers at 39 centers. In contrast, only 1 center reported performing TSTs on hemodialysis patients; 5 other centers reported screening of patients for TB using chest radiographs. Active TB was reported in 3 of 4,550 chronic hemodialysis patients in 1994 (rate, 66/100,000 patient-years) and in 4 of 4,831 patients in 1995 (rate, 83/100,000 patient-years). Both rates were several times higher than the rate in the New Jersey general population during this period (10.7-10.8/100,000)., Conclusion: Although based on small numbers of patients with TB, we found a relatively high incidence of TB among hemodialysis patients in New Jersey. Most centers reported performing TSTs on workers but not on patients. These results suggest the need for improved TB screening and infection control precautions at outpatient dialysis centers.
- Published
- 1999
- Full Text
- View/download PDF
29. The prevalence of colonization with vancomycin-resistant Enterococcus at a Veterans' Affairs institution.
- Author
-
Tokars JI, Satake S, Rimland D, Carson L, Miller ER, Killum E, Sinkowitz-Cochran RL, Arduino MJ, Tenover FC, Marston B, and Jarvis WR
- Subjects
- Aged, Bacteremia microbiology, Bacteremia transmission, Cross Infection microbiology, Cross Infection transmission, Disease Transmission, Infectious, Drug Resistance, Microbial, Electrophoresis, Gel, Pulsed-Field, Enterococcus drug effects, Female, Georgia epidemiology, Gram-Positive Bacterial Infections microbiology, Gram-Positive Bacterial Infections transmission, Humans, Long-Term Care, Male, Middle Aged, Prevalence, Risk Factors, Anti-Bacterial Agents pharmacology, Bacteremia epidemiology, Cross Infection epidemiology, Enterococcus isolation & purification, Gram-Positive Bacterial Infections epidemiology, Hospitals, Veterans statistics & numerical data, Vancomycin pharmacology
- 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., Results: The overall VRE prevalence was 29% (42/147 patients). The VRE prevalence was 52% (38/73 patients) among patients who had received at least one of six specific antimicrobials during the preceding 120 days, compared with only 5% (4/74) among those who had not received the antimicrobials (relative risk, 9.6; P<.001). The longer the period (up to 120 days) during which antimicrobial use was studied, the more closely VRE status was predicted. Among 67 hospital patients in 28 multibed rooms, clustering of VRE among current roommates was not found., Conclusions: At this hospital with relatively high VRE prevalence, VRE colonization was related to antibiotic use but not to roommate VRE status. In hospitals with a similar VRE epidemiology, obtaining cultures from roommates of VRE-positive patients may not be as efficient a strategy for identifying VRE-colonized patients as obtaining screening cultures from patients who have received antimicrobials.
- Published
- 1999
- Full Text
- View/download PDF
30. Protective effect of hepatitis B vaccine in chronic hemodialysis patients.
- Author
-
Miller ER, Alter MJ, and Tokars JI
- Subjects
- Adult, Aged, Aged, 80 and over, Case-Control Studies, Female, Hepatitis B etiology, Humans, Male, Middle Aged, Risk, Time Factors, Treatment Outcome, Hepatitis B prevention & control, Hepatitis B Vaccines therapeutic use, Renal Dialysis adverse effects
- Abstract
Hepatitis B virus (HBV) infection is a well-recognized risk in chronic hemodialysis patients. Although the risk has declined dramatically since the 1970s, outbreaks of HBV infection among these patients continue to occur. The Centers for Disease Control and Prevention (CDC) has recommended hepatitis B vaccination of hemodialysis patients since 1982; however, by 1996, only 36% of the approximately 200,000 US chronic hemodialysis patients had received the vaccine, perhaps in part because of doubts among dialysis personnel of its efficacy. We performed a case-control study to determine whether receipt of hepatitis B vaccine was associated with a decreased risk of acquiring HBV infection. We determined the vaccination status of all chronic hemodialysis patients at 98 US hemodialysis centers that reported patients with acute HBV infection on a nationwide mailed survey in 1995. A total of 111 hepatitis B surface antigen (HBsAg) positive case patients were compared with 12,500 control patients. Case patients were significantly less likely than control patients to have received hepatitis B vaccine (10.8% v 23.6%; odds ratio, 0.39; 95% confidence interval, 0.22-0.72). After stratifying by dialysis center to control for differing community and dialysis center risks of HBV infection, we found that the risk for HBV infection was 70% lower in vaccinated patients (adjusted odds ratio, 0.30; 95% confidence interval, 0.18-0.50). These results suggest that hepatitis B vaccine has a significant protective effect against acquiring HBV infection in chronic hemodialysis patients, and efforts should be expanded to increase the use of hepatitis B vaccine in this patient population.
- Published
- 1999
- Full Text
- View/download PDF
31. Outbreak of sterile peritonitis among continuous cycling peritoneal dialysis patients.
- Author
-
Mangram AJ, Archibald LK, Hupert M, Tokars JI, Silver LC, Brennan P, Arduino M, Peterson S, Parks S, Raymond A, McCullough M, Jones M, Wasserstein A, Kobrin S, and Jarvis WR
- Subjects
- Adult, Ambulatory Care, Colony Count, Microbial, Dialysis Solutions chemistry, Dialysis Solutions standards, Drug Contamination, Drug and Narcotic Control, Endotoxins analysis, Female, Hospitals, University, Humans, Male, Middle Aged, Pennsylvania epidemiology, Peritonitis microbiology, Quality Control, Sterilization, United States epidemiology, Dialysis Solutions adverse effects, Disease Outbreaks, Peritoneal Dialysis, Continuous Ambulatory adverse effects, Peritonitis epidemiology, Peritonitis etiology
- Abstract
Background: Approximately 30,000 patients receive peritoneal dialysis in the United States. In August 1996, several dialysis centers from different states reported sterile peritonitis among CCPD patients using sterile peritoneal dialysis solution (PDS) from a single manufacturer. The manufacturer recalled 53 lots of PDS that had passed established industry guidelines and Food and Drug Administration (FDA) approved quality control tests [including endotoxin levels <0.5 endotoxin units (EU)/ml], but had pre-sterilization bacterial colony counts >1 cfu/ml., Methods: At one outpatient dialysis center, Hospital of the University of Pennsylvania (HUP), we conducted a retrospective cohort study of all CCPD patients treated during July 15 to August 30, 1996. A case-patient was defined as any HUP patient with culture-negative peritoneal fluid with a white blood cell count >100/mm3, cloudy peritoneal fluid, and/or abdominal pain. PDS and tubing were cultured for bacteria and assayed for endotoxin., Results: Overall, 14 of 28 patients had sterile peritonitis. The only risk factor identified was exposure to > or =1 lot of recalled PDS (14 of 22 vs. 0/6, P = 0.02); the more recalled lots received, the higher the attack rate (P = 0.0001). Five of 47 PDS bags had detectable endotoxin; recalled lots were more likely to have measurable endotoxin than nonrecalled lots (5/19 vs. 0/17, P = 0.05). When case-patients resumed CCPD using PDS from non-recalled lots, no further cases were reported., Conclusions: Our results suggest that this outbreak was caused by intrinsic PDS contamination with endotoxin. Pre-sterilization colony counts may be an important quality control indicator for CCPD fluids in conjunction with endotoxin levels.
- Published
- 1998
- Full Text
- View/download PDF
32. The costs of healthcare worker respiratory protection and fit-testing programs.
- Author
-
Kellerman SE, Tokars JI, and Jarvis WR
- Subjects
- Cross Infection prevention & control, Disease Outbreaks economics, Disease Outbreaks prevention & control, Equipment and Supplies, Hospital economics, Florida, Hospitals, Rural economics, Hospitals, Urban economics, Humans, Infection Control methods, Nebraska, New York City, Occupational Health Services economics, Purchasing, Hospital statistics & numerical data, Retrospective Studies, Hospital Costs statistics & numerical data, Infection Control economics, Inservice Training economics, Occupational Exposure prevention & control, Personnel, Hospital education, Purchasing, Hospital economics, Respiratory Protective Devices economics, Tuberculosis, Pulmonary prevention & control
- Abstract
Objective: We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB)., Design: The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study., Setting: Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB., Results: During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526)., Conclusions: Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB.
- Published
- 1998
- Full Text
- View/download PDF
33. Vancomycin use and antimicrobial resistance in hemodialysis centers.
- Author
-
Tokars JI
- Subjects
- Drug Resistance, Microbial, Humans, Anti-Bacterial Agents therapeutic use, Bacterial Infections drug therapy, Renal Dialysis, Vancomycin therapeutic use
- Published
- 1998
- Full Text
- View/download PDF
34. National surveillance of dialysis associated diseases in the United States, 1995.
- Author
-
Tokars JI, Miller ER, Alter MJ, and Arduino MJ
- Subjects
- Arteriovenous Shunt, Surgical, Catheters, Indwelling, Equipment Reuse, HIV Infections epidemiology, HIV Infections etiology, Hepatitis B epidemiology, Hepatitis B etiology, Hepatitis C epidemiology, Hepatitis C etiology, Humans, Incidence, Staphylococcal Infections epidemiology, Staphylococcal Infections etiology, Surveys and Questionnaires, Tuberculosis epidemiology, Tuberculosis etiology, United States epidemiology, Population Surveillance, Renal Dialysis adverse effects
- Abstract
Chronic hemodialysis centers in the United States were surveyed in 1995 regarding a number of hemodialysis associated diseases and practices. A total of 2,647 centers, representing 224,954 patients and 54,194 staff members, responded. Seventy-seven percent of centers reported that they reused disposable dialyzers. At the end of 1995, 65% of patients were treated with an arteriovenous graft, 22% an arteriovenous fistula, and 13% a temporary or permanent central catheter. By the end of 1995, at least three doses of hepatitis B vaccine had been administered to 35% of patients and to 82% of staff members. Acute infection with the hepatitis B virus (HBV) occurred in 0.06% of patients, and was more likely to be reported by centers with lower proportions of patients vaccinated against HBV. The prevalence of antibody to hepatitis C virus (HCV) was 10.4% among patients and 2.0% among staff. At least one patient with vancomycin resistant enterococci (VRE) was reported by 11.5% of centers, more commonly by hospital (vs freestanding centers not located in hospitals) and government centers, and centers located in certain geographic areas. Vancomycin was received by 7.2% of patients in December 1995. The percentage of centers reporting patients with other pathogens was 7.9% for active tuberculosis, 39% for human immunodeficiency virus (HIV), and 40% for methicillin resistant Staphylococcus aureus (MRSA).
- Published
- 1998
- Full Text
- View/download PDF
35. A cluster of bloodstream infections and pyrogenic reactions among hemodialysis patients traced to dialysis machine waste-handling option units.
- Author
-
Jochimsen EM, Frenette C, Delorme M, Arduino M, Aguero S, Carson L, Ismaïl J, Lapierre S, Czyziw E, Tokars JI, and Jarvis WR
- Subjects
- Adult, Aged, Bacteremia epidemiology, Case-Control Studies, Enterobacteriaceae Infections epidemiology, Female, Fever epidemiology, Hemodialysis Units, Hospital, Humans, Male, Medical Waste Disposal instrumentation, Middle Aged, Quebec epidemiology, Bacteremia etiology, Cross Infection epidemiology, Disease Outbreaks, Enterobacter cloacae isolation & purification, Enterobacteriaceae Infections transmission, Equipment Contamination, Fever etiology, Renal Dialysis adverse effects
- Abstract
From June 17 through November 15, 1995, ten episodes of Enterobacter cloacae bloodstream infection and three pyrogenic reactions occurred in patients at a hospital-based hemodialysis center. In a case-control study limited to events occurring during October 1-31, 1995, seven dialysis sessions resulting in E. cloacae bacteremia or pyrogenic reaction without bacteremia were compared with 241 randomly selected control sessions. Dialysis machines were examined, dialysis fluid and equipment were cultured, and E. cloacae isolates were genotyped by pulsed-field gel electrophoresis. Each dialysis machine had a waste-handling option (WHO) through which dialyzer-priming fluid was discarded before each dialysis session; in 7 of 11 machines, one-way check valves designed to prevent backflow from the WHO into patient bloodlines were dysfunctional. In the case-control study, case sessions were more frequent when machines with >/=1 dysfunctional check valves were used. E. cloacae with identical pulsed-field gel electrophoresis patterns were isolated from case patients, dialysis fluid, station drains, and WHO units. Our investigation shows that bloodstream infections and pyrogenic reactions were caused by backflow from contaminated dialysis machine WHO units into patient bloodlines. The outbreak was terminated when WHO use was discontinued, check valves were replaced, and dialysis machine disinfection was enhanced.
- Published
- 1998
- Full Text
- View/download PDF
36. Secular trends in bloodstream infection caused by antimicrobial-resistant bacteria in New Jersey hospitals, 1991 to 1995.
- Author
-
Tokars JI, Paul SM, Crane GL, Cetron MS, Finelli L, and Jarvis WR
- Subjects
- Data Collection, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections epidemiology, Hospitals, Private statistics & numerical data, Humans, Imipenem administration & dosage, Microbial Sensitivity Tests, New Jersey epidemiology, Penicillin Resistance, Pneumococcal Infections drug therapy, Pneumococcal Infections epidemiology, Prevalence, Species Specificity, Streptococcus pneumoniae drug effects, Vancomycin administration & dosage, Bacteremia epidemiology, Bacteremia microbiology, Cross Infection epidemiology, Cross Infection microbiology, Drug Resistance, Microbial, Drug Resistance, Multiple, Enterococcus drug effects, Gram-Negative Bacteria drug effects
- Abstract
Introduction: Antimicrobial resistance among bacteria is an increasing public health problem. In 1991, New Jersey was the first state to establish statewide, hospital-based surveillance for antimicrobial-resistant bacteria., Methods: Each month, all 96 nonfederal New Jersey hospital laboratories complete a form listing the species identity and drug susceptibility results for selected antimicrobial-resistant bacteria isolated from blood cultures from hospital inpatients. Penicillin-resistant Streptococcus pneumoniae and aminoglycoside-resistant gram-negative rods were studied from 1991 to 1995. Vancomycin-resistant enterococci and imipenem-resistant gram-negative rods were studied from 1992 through 1995., Results: From 1992 to 1995, the vancomycin-resistant enterococci bloodstream infection prevalence rate increased from 11 to 29 per 100,000 hospital admissions (p < 0.001); the rate was higher at larger hospitals, urban and inner-city hospitals, and teaching hospitals. From 1991 to 1995, the penicillin-resistant S. pneumoniae bloodstream infection rate increased from 1.1 to 9.9 per 100,000 admissions (p < 0.001). In contrast, bloodstream infection rates did not change significantly for imipenem-resistant (12.5 during 1992 and 14.1 during 1995, p = 0.4) or aminoglycoside-resistant (8.0 during 1991 and 6.8 during 1995, p = 0.4) gram-negative rods., Conclusions: We found that vancomycin-resistant enterococci and penicillin-resistant S. pneumoniae, but neither of two groups of antimicrobial-resistant gram-negative rods, are increasing rapidly in prevalence in New Jersey. Continued monitoring and interventions to slow these increases are needed.
- Published
- 1997
- Full Text
- View/download PDF
37. Tuberculin skin testing of ESRD patients.
- Author
-
Tokars JI and Miller B
- Subjects
- Humans, Kidney Failure, Chronic complications, Tuberculin Test
- Published
- 1997
- Full Text
- View/download PDF
38. The cost of selected tuberculosis control measures at hospitals with a history of Mycobacterium tuberculosis outbreaks.
- Author
-
Kellerman S, Tokars JI, and Jarvis WR
- Subjects
- Cross Infection epidemiology, Disease Outbreaks, Hospitals, Community economics, Humans, Infection Control standards, Practice Guidelines as Topic, Tuberculosis, Multidrug-Resistant epidemiology, Tuberculosis, Pulmonary epidemiology, United States epidemiology, Cross Infection prevention & control, Hospital Costs statistics & numerical data, Infection Control economics, Tuberculosis, Multidrug-Resistant prevention & control, Tuberculosis, Pulmonary prevention & control
- Abstract
Objective: To determine the cost of nonrespirator-related tuberculosis (TB) control measures at several hospitals, following publication of the Centers for Disease Control and Prevention (CDC)'s revised TB infection control guidelines., Design: Infection control (IC) and TB coordinators obtained cost information on tuberculin skin-test (TST) programs, addition of IC and employee health service (EHS) personnel, and the retrofit or new construction of environmental controls., Setting: Four hospitals with, and one community hospital without, prior nosocomial multidrug-resistant TB transmission., Results: During the study period, the TST program costs remained constant at four of five hospitals and increased at one hospital (median 1994 TST program cost: $5,568; range, $2,393-$44,902). Additional IC or EHS personnel were hired at four of five hospitals (median cost increase, $125,500; range, $63,000-$228,000). The median cost of new construction or new equipment purchases (ie, sputum induction booths, ultraviolet lights, or portable high-efficiency particulate air filters) at study hospitals was $163,000 (range, $45,000-$524,000) and $70,000 (range, $31,000-$93,000), respectively., Conclusions: Costs associated with implementing control measures similar to those recommended in the CDC TB IC guidelines varied widely by hospital. Engineering controls involved the largest capital outlay, but increases in personnel were the largest continuing cost. These costs represent improvements made to upgrade selected aspects of hospital TB control programs, not the cost of an optimal TB control program.
- Published
- 1997
- Full Text
- View/download PDF
39. An outbreak of Enterobacter hormaechei infection and colonization in an intensive care nursery.
- Author
-
Wenger PN, Tokars JI, Brennan P, Samel C, Bland L, Miller M, Carson L, Arduino M, Edelstein P, Aguero S, Riddle C, O'Hara C, and Jarvis W
- Subjects
- Follow-Up Studies, Humans, Infant, Newborn, Infant, Premature, Intensive Care Units, Neonatal, Disease Outbreaks, Enterobacter isolation & purification, Enterobacteriaceae Infections epidemiology
- Abstract
Enterobacter hormaechei was first identified as a unique species in 1989. Between 29 November 1992 and 17 March 1993, an outbreak of E. hormaechei occurred among premature infants in the intensive care nursery (ICN) at The Hospital of the University of Pennsylvania. The 10 infants whose cultures were positive for E. hormaechei (six were infected and four were colonized) had a lower median estimated gestational age and birth weight than did other ICN infants; other risk factors for infection or colonization with E. hormaechei were not identified. Cultures from three isolettes and a doorknob in the ICN were positive for E. hormaechei. Pulsed-field gel electrophoresis of isolates from six patients and two isolettes were identical. Observations of health care workers revealed breaks in infection control techniques that may have allowed transmission of this organism. We found that E. hormaechei is a nosocomial pathogen that can infect vulnerable hospitalized patients and that can be transmitted from patient to patient when infection control techniques are inadequate.
- Published
- 1997
- Full Text
- View/download PDF
40. National surveillance of dialysis associated diseases in the United States--1994.
- Author
-
Tokars JI, Alter MJ, Miller E, Moyer LA, and Favero MS
- Subjects
- Fever epidemiology, HIV Infections epidemiology, Hepatitis B epidemiology, Hepatitis B Vaccines immunology, Hepatitis C epidemiology, Humans, Incidence, Sepsis epidemiology, Time Factors, United States epidemiology, Renal Dialysis adverse effects
- Abstract
Dialysis centers in the United States were surveyed in 1994 regarding a number of hemodialysis associated diseases and practices. A total of 2,449 centers, representing 206,884 patients and 50,314 staff members, responded. In 1994, 99% of centers used bicarbonate dialysate as the primary method of dialysis, 45% used high flux dialysis, and 75% reused dialyzers. Hepatitis B vaccine had been administered to 31% of patients and to 80% of staff members. Acute infection with hepatitis B virus occurred in 0.1% of patients and was more likely to be reported by centers with lower proportions of patients vaccinated against hepatitis B virus and those not using a separate room and dialysis machine to treat hepatitis B surface antigen positive patients. The prevalence of antibody to hepatitis C virus was 10.5% among patients and 1.9% among staff members and varied according to geographic region. Pyrogenic reactions in the absence of septicemia were reported by 22% of centers and were most highly associated with dialyzer reuse. Human immunodeficiency virus infection was reported to be present in 1.5% of patients; 37% of centers provided hemodialysis to one or more patients infected with human immunodeficiency virus.
- Published
- 1997
41. Use of the hepatitis-B vaccine and infection with hepatitis B and C among orthopaedic surgeons. The American Academy of Orthopaedic Surgeons Serosurvey Study Committee.
- Author
-
Shapiro CN, Tokars JI, and Chamberland ME
- Subjects
- Adult, Algorithms, Female, Humans, Male, Middle Aged, Occupational Exposure, Prevalence, Seroepidemiologic Studies, Hepatitis B epidemiology, Hepatitis B Vaccines, Hepatitis C epidemiology, Occupational Diseases epidemiology, Orthopedics
- Abstract
We used a questionnaire, with a guarantee of anonymity to the respondents, and conducted serological testing of 3411 attendees at the 1991 Annual Meeting of The American Academy of Orthopaedic Surgeons to evaluate the prevalences of infection with the hepatitis-B and C viruses and the use of the hepatitis-B vaccine among orthopaedic surgeons. There was evidence of infection with hepatitis B in 410 (13 per cent) of 3239 participants who had reported having no non-occupational risk factors; 2103 (65 per cent) reported that they had been immunized with the hepatitis-B vaccine. Of 3262 participants who reported having no non-occupational risk factors and who were evaluated for infection with hepatitis C, twenty-seven (less than 1 per cent) tested positive for the antibody to the hepatitis-C virus. The prevalence of previous infection with hepatitis B increased with increasing age; four (3 per cent) of 136 surgeons who were twenty to twenty-nine years old had evidence of infection, whereas ninety-six (27 per cent) of 360 surgeons who were sixty years old or more had evidence of infection. The prevalence of infection with hepatitis C also increased with increasing age; none of 135 surgeons who were twenty to twenty-nine years old had evidence of infection, and five (1 per cent) of 360 surgeons who were sixty years old or more had evidence of the virus. The prevalence of vaccination decreased steadily with age: 123 (90 per cent) of 136 surgeons who were twenty to twenty-nine years old reported that they had received the hepatitis-B vaccine, whereas 127 (35 per cent) of 360 surgeons who were sixty years old or more reported that they had received the vaccine. The prevalence of infection with hepatitis B or hepatitis C was not associated with the measured indices of exposure to the blood of patients (the number of cutaneous or mucosal contacts with blood that had occurred within the previous month or the number of percutaneous injuries that had occurred within the previous month or year, as recalled by the participants). In conclusion, the prevalence of immunization with the hepatitis-B vaccine was high among the orthopaedic surgeons studied. Although the prevalence of infection with the hepatitis-C virus was several times greater in the current investigation than has been reported in studies of blood donors in the United States, infection with this virus was not associated with the indices of occupational exposure to blood measured in this study.
- Published
- 1996
- Full Text
- View/download PDF
42. National surveillance of dialysis associated diseases in the United States, 1993.
- Author
-
Tokars JI, Alter MJ, Favero MS, Moyer LA, Miller E, and Bland LA
- Subjects
- Centers for Disease Control and Prevention, U.S., Data Collection, Dialysis Solutions standards, Disposable Equipment statistics & numerical data, Equipment Reuse statistics & numerical data, Fever epidemiology, HIV Infections etiology, HIV Infections immunology, Hepacivirus immunology, Hepatitis B etiology, Hepatitis B immunology, Hepatitis B Antibodies analysis, Hepatitis B Surface Antigens analysis, Hepatitis B Vaccines administration & dosage, Hepatitis C etiology, Hepatitis C immunology, Hepatitis C Antibodies analysis, Humans, Incidence, Personnel, Hospital, Prevalence, Regression Analysis, Renal Dialysis economics, Renal Dialysis statistics & numerical data, Risk Factors, Sepsis etiology, Syndrome, United States epidemiology, HIV Infections epidemiology, Hepatitis B epidemiology, Hepatitis C epidemiology, Renal Dialysis adverse effects, Sepsis epidemiology
- Abstract
To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention, in collaboration with the Health Care Financing Administration, performed a mail survey of 2,304 chronic hemodialysis centers in the United States in 1993. By the end of 1993, at least three doses of hepatitis B vaccine were administered to 29% of patients and 76% of staff at responding centers. Hepatitis B surface antigen was present at low frequency in patients (incidence = 0.1%, prevalence = 1.2%) and staff members (incidence = 0.2%, prevalence = 0.3%). The 1993 incidence of hepatitis B virus infection among patients was higher at centers that accepted hepatitis B surface antigen positive patients but did not use a separate room and dialysis machine for treatment of these patients, government and profit (versus nonprofit) centers, and centers in four End Stage Renal Disease Networks. The prevalence of antibody to hepatitis C virus was 9.7% among patients and 1.6% among staff members. Pyrogenic reactions in the absence of septicemia were reported by 21% of centers and associated with use of high flux dialysis. Human immunodeficiency virus infection was known to be present in 1.5% of patients; 34% of centers reported providing hemodialysis to one or more human immunodeficiency virus infected patients.
- Published
- 1996
43. Skin and mucous membrane contacts with blood during surgical procedures: risk and prevention.
- Author
-
Tokars JI, Culver DH, Mendelson MH, Sloan EP, Farber BF, Fligner DJ, Chamberland ME, Marcus R, McKibben PS, and Bell DM
- Subjects
- Adult, Chicago, Conjunctiva, Face, Gloves, Surgical, Hand, Humans, Logistic Models, Mucous Membrane, New York City, Protective Clothing statistics & numerical data, Skin, Blood-Borne Pathogens, Infectious Disease Transmission, Patient-to-Professional prevention & control, Surgical Procedures, Operative
- Abstract
Objective: To study the epidemiology and preventability of blood contact with skin and mucous membranes during surgical procedures., Design: Observers present at 1,382 surgical procedures recorded information about the procedure, the personnel present, and the contacts that occurred., Setting: Four US teaching hospitals during 1990., Participants: Operating room personnel in five surgical specialties., Main Outcome Measures: Numbers and circumstances of contact between the patient's blood (or other infective fluids) and surgical personnel's mucous membranes (mucous membrane contacts) or skin (skin contacts, excluding percutaneous injuries)., Results: A total of 1,069 skin (including 620 hand, 258 body, and 172 face) and 32 mucous membrane (all affecting eyes) contacts were observed. Surgeons sustained most contacts (19% had > or = 1 skin contact and 0.5% had > or = 1 mucous membrane-eye contact). Hand contacts were 72% lower among surgeons who double gloved, and face contacts were prevented reliably by face shields. Mucous membrane-eye contacts were significantly less frequent in surgeons wearing eyeglasses and were absent in surgeons wearing goggles or face shields. Among surgeons, risk factors for skin contact depended on the area of contact: hand contacts were associated most closely with procedure duration (adjusted odds ratio [OR], 9.4; > or = 4 versus < 1 hour); body contacts (arms, legs, and torso) with estimated blood losses (adjusted OR, 8.4; > or = 1,000 versus < 100 mL); and face contacts, with orthopedic service (adjusted OR, 7.5 compared with general surgery)., Conclusion: Skin and mucous membrane contacts are preventable by appropriate barrier precautions, yet occur commonly during surgery. Surgeons who perform procedures similar to those included in this study should strongly consider double gloving, changing gloves routinely during surgery, or both.
- Published
- 1995
- Full Text
- View/download PDF
44. Evaluation of infection control measures in preventing the nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in a New York City hospital.
- Author
-
Stroud LA, Tokars JI, Grieco MH, Crawford JT, Culver DH, Edlin BR, Sordillo EM, Woodley CL, Gilligan ME, and Schneider N
- Subjects
- AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections prevention & control, Centers for Disease Control and Prevention, U.S., Cohort Studies, Cross Infection epidemiology, Disease Outbreaks, Guidelines as Topic, Humans, Infection Control methods, New York City epidemiology, Personnel, Hospital, Retrospective Studies, Tuberculosis, Multidrug-Resistant epidemiology, United States, Cross Infection prevention & control, Hospitals, Urban standards, Infection Control standards, Tuberculosis, Multidrug-Resistant prevention & control
- Abstract
Objective: To evaluate the efficacy of Centers for Disease Control and Prevention (CDC)-recommended infection control measures implemented in response to an outbreak of multidrug-resistant (MDR) tuberculosis (TB)., Design: Retrospective cohort studies of acquired immunodeficiency syndrome (AIDS) patients and healthcare workers. The study period (January 1989 through September 1992) was divided into period I, before changes in infection control; period II, after aggressive use of administrative controls (eg, rapid placement of TB patients or suspected TB patients in single-patient rooms); and period III, while engineering changes were made (eg, improving ventilation in TB isolation rooms)., Setting: A New York City hospital that was the site of one of the first reported outbreaks of MDR-TB among AIDS patients in the United States., Participants: All AIDS patients admitted during periods I and II. Healthcare workers on nine inpatient units with TB patients and six without TB patients., Results: The epidemic (38 patients) waned during period II and only one MDR-TB patient presented during period III. The MDR-TB attack rate among AIDS patients hospitalized on the same ward on the same days as an infectious MDR-TB patient was 8.8% (19 of 216) during period I, decreasing to 2.6% (5 of 193; P = 0.01) during period II. In a small group of healthcare workers with tuberculin skin test data, conversions during periods II through III were higher on wards with than without TB patients (5 of 29 versus 0 of 15; P = 0.15), although the difference was not statistically significant., Conclusions: Transmission of MDR-TB among AIDS patients decreased markedly after enforcement of readily implementable administrative measures, ending the outbreak. However, tuberculin skin-test conversions among healthcare workers may not have been prevented by these measures. CDC guidelines for prevention of nosocomial transmission of TB should be implemented fully at all US hospitals.
- Published
- 1995
- Full Text
- View/download PDF
45. National surveillance of dialysis associated diseases in the United States, 1992.
- Author
-
Tokars JI, Alter MJ, Favero MS, Moyer LA, Miller E, and Bland LA
- Subjects
- Antibodies, Viral analysis, Catheterization, Central Venous statistics & numerical data, Dialysis Solutions, Fever epidemiology, Fever etiology, HIV Infections etiology, HIV Infections prevention & control, Hepatitis B etiology, Hepatitis B prevention & control, Hepatitis B Vaccines administration & dosage, Hepatitis C etiology, Hepatitis C prevention & control, Humans, Incidence, Logistic Models, Mass Screening, Occupational Diseases epidemiology, Prevalence, Renal Dialysis instrumentation, Risk Factors, Surveys and Questionnaires, United States epidemiology, HIV Infections epidemiology, Hepatitis B epidemiology, Hepatitis C epidemiology, Population Surveillance, Renal Dialysis adverse effects, Renal Dialysis statistics & numerical data
- Abstract
To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention, in collaboration with the Health Care Financing Administration, completed a mail survey of chronic hemodialysis centers in the United States in 1992. Of 2,321 centers surveyed, 2,170 (93%) representing 170,028 patients and 43,535 staff members responded. In 1992, 2,049 (94%) centers used bicarbonate dialysate as the primary method of dialysis, 765 (35)% used high flux dialysis, and 1,569 (72%) reused dialyzers, continuing the trends toward increased use of these methods. Central (subclavian or jugular) venous catheters were used in > or = 1 patient as permanent vascular access for hemodialysis at 69% of dialysis centers. Hepatitis B surface antigen was present at low frequency in patients (incidence = 0.1%, prevalence = 1.2%) and staff members (incidence - 0.03%, prevalence = 0.3%). Among centers that had > or = 1 hepatitis B surface antigen positive patient, the incidence of hepatitis B virus infection was lower in those centers that used a separate room for dialysis of patients positive for hepatitis B surface antigen. From 1991 to 1992, reported hepatitis B vaccine coverage increased from 17% to 24% among patients and from 56% to 69% among staff members; in absolute terms, these were the largest single year increases since introduction of hepatitis B vaccine. The prevalence of antibody to hepatitis C virus was 8.1% among patients and 1.6% among staff members. Pyrogenic reactions in the absence of septicemia were reported by 19% of centers and associated with use of high flux dialysis. New dialyzer syndrome was reported by 24% of centers, most frequently by centers using regenerated cellulose or cuprophan membranes. Human immunodeficiency virus was known to be present in 1.5% of patients; 34% of centers reported providing hemodialysis to one or more patients infected with HIV.
- Published
- 1994
46. Bacterial contamination of platelets at a university hospital: increased identification due to intensified surveillance.
- Author
-
Zaza S, Tokars JI, Yomtovian R, Hirschler NV, Jacobs MR, Lazarus HM, Goodnough LT, Bland LA, Arduino MJ, and Jarvis WR
- Subjects
- Adult, Aged, Aged, 80 and over, Blood Banking methods, Blood Specimen Collection methods, Cluster Analysis, Female, Humans, Male, Middle Aged, Prevalence, Risk Factors, Bacteremia epidemiology, Bacteremia etiology, Blood Platelets microbiology, Cross Infection epidemiology, Cross Infection etiology, Disease Outbreaks, Hospitals, University, Infection Control, Platelet Transfusion adverse effects
- Abstract
Background: A cluster of bacterial contamination of platelets occurred at a university hospital in a one-month period. This unusual clustering allowed us to examine the likely mechanism of contamination and clinical sequelae., Methods: We reviewed medical records of patients receiving random donor platelet transfusions to determine numbers of platelets transfused, reactions reported, and episodes of bacterial contamination. We also reviewed procedures at the collecting blood agencies and the hospital blood bank., Results: Four patients received bacterially contaminated platelets during June and July 1991. The rates of reported platelet transfusion reactions increased significantly (P < 0.001) from September 1989 through July 1991 (study period); in addition, the rate of contamination of platelets during June and July 1991 was 23-fold higher than during the previous 21 months (P < 0.001). Surveillance methodology changed dramatically during the study period, contributing to the recognition of the current cluster. Pathogens isolated from the contaminated platelet pools were Bacillus cereus, Staphylococcus epidermidis, or Pseudomonas aeruginosa in titers ranging from 10(6) to 10(8) colony forming units/mL. Four constituent individual platelet units identified as the probable cause of the outbreak (including one postepidemic episode) were significantly older (mean age, 4.8 days) than 106 randomly selected individual platelet units (mean age, 3.7 days; P = 0.04). Platelet pools were transfused an average of 2.5 hours after pooling. Review of blood collection and platelet preparation practices did not identify breaks in procedure or technique that could have caused contamination., Conclusions: Increased awareness of platelet transfusion reactions by clinical staff and routine culturing of all platelets associated with transfusion reactions will identify contaminated platelets. Identification of contaminated platelets is necessary to treat affected patients appropriately and to determine the prevalence of and risk factors for contaminated platelets (Infect Control Hosp Epidemiol 1994;15:82-87).
- Published
- 1994
- Full Text
- View/download PDF
47. National surveillance of dialysis associated diseases in the United States, 1991.
- Author
-
Tokars JI, Alter MJ, Favero MS, Moyer LA, and Bland LA
- Subjects
- Fever etiology, HIV Infections epidemiology, Health Surveys, Hepatitis B epidemiology, Hepatitis B Antibodies blood, Hepatitis B Vaccines immunology, Hepatitis C epidemiology, Humans, Incidence, Prevalence, United States epidemiology, Renal Dialysis adverse effects
- Abstract
To determine trends in a number of hemodialysis associated diseases and practices, the Centers for Disease Control and Prevention in collaboration with the Health Care Financing Administration performed a mail survey of chronic hemodialysis centers in the United States in 1991. Of 2,123 centers surveyed, 2,046 (96%), representing 155,877 patients and 40,298 staff members, responded. The 1991 survey found that certain hemodialysis practices are increasing in frequency, including use of bicarbonate dialysate and high-flux dialysis and reuse of disposable dialyzers (in 1991, 71% of centers reused dialyzers). Hepatitis B surface antigen (HBsAg) was present at low frequency in patients (incidence = 0.2%, prevalence = 1.3%) and staff (incidence = 0.04%, prevalence = 0.3%). Among centers that had > or = HBsAg positive patient, the incidence of hepatitis B virus (HBV) infection was lower in those centers that used a separate room for dialysis of HBsAg positive patients. Reuse of dialyzers, blood lines, transducer filters, or dialyzer caps was not associated with an increased risk of acquiring HBV infection among either patients or staff. Antibody to HBsAg was present in 21% of patients and 53% of staff, and was significantly related to levels of hepatitis B vaccine coverage. Pyrogenic reactions in the absence of septicemia were reported by 20% of centers and associated with the reuse of dialyzers. Human immunodeficiency virus (HIV) was known to be present in 1.2% of patients; 29% of centers reported providing hemodialysis to one or more HIV infected patients.
- Published
- 1993
48. National surveillance of hemodialysis associated diseases in the United States, 1990.
- Author
-
Tokars JI, Alter MJ, Favero MS, Moyer LA, and Bland LA
- Subjects
- Ambulatory Care Facilities statistics & numerical data, Centers for Disease Control and Prevention, U.S., Centers for Medicare and Medicaid Services, U.S., HIV Infections epidemiology, HIV Infections etiology, Hepatitis B etiology, Hepatitis B Vaccines, Hepatitis C epidemiology, Hepatitis C etiology, Humans, Occupational Exposure statistics & numerical data, Population Surveillance, Renal Dialysis instrumentation, Renal Dialysis statistics & numerical data, Sepsis epidemiology, United States epidemiology, Disposable Equipment statistics & numerical data, Hemodialysis Units, Hospital statistics & numerical data, Hepatitis B epidemiology, Renal Dialysis adverse effects
- Abstract
To determine trends in several hemodialysis associated diseases and practices, the Centers for Disease Control (CDC), in collaboration with the Health Care Financing Administration (HCFA), performed a mail survey of chronic hemodialysis centers in the United States in 1990. Of 1,995 centers surveyed, 1,882 (94%) representing 140,608 patients and 36,907 staff members responded. As in recent years, the 1990 survey found that certain hemodialysis practices are increasing in frequency, including treatment of water with reverse osmosis and deionizer units; use of bicarbonate dialysate and high-flux dialysis; and reuse of disposable dialyzers (in 1990, 70% of centers reused dialyzers). Hepatitis B surface antigen (HBsAg) was present at low frequency in patients (incidence, 0.2%; prevalence, 1.2%) and staff (incidence, 0.04%; prevalence, 0.3%). Antibody to hepatitis B surface antigen was present in 20% of patients and 58% of staff, and was significantly related to levels of hepatitis B vaccine coverage. Pyrogenic reactions in the absence of septicemia were reported by 20% of centers and were associated with use of high-flux dialyzer membranes and reuse of dialyzers (particularly in centers where the maximum number of reuses was 40 or more). Septicemia among hemodialysis patients was reported by 49% of centers. Twenty-six percent of centers reported providing hemodialysis for patients infected with human immunodeficiency virus (HIV), and 1.1% of dialyzed patients had known HIV infection.
- Published
- 1993
49. Tuberculin skin testing of hospital employees during an outbreak of multidrug-resistant tuberculosis in human immunodeficiency virus (HIV)-infected patients.
- Author
-
Tokars JI, Jarvis WR, Edlin BR, Dooley SW, Grieco MH, Gilligan ME, Schneider N, Montonez M, and Williams J
- Subjects
- Animals, Drug Resistance, Microbial, Tuberculosis epidemiology, Tuberculosis transmission, Disease Outbreaks, HIV Infections complications, Personnel, Hospital, Tuberculin Test, Tuberculosis microbiology
- Published
- 1992
- Full Text
- View/download PDF
50. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome.
- Author
-
Edlin BR, Tokars JI, Grieco MH, Crawford JT, Williams J, Sordillo EM, Ong KR, Kilburn JO, Dooley SW, and Castro KG
- Subjects
- Adult, Air Movements, Case-Control Studies, Cluster Analysis, Drug Resistance, Microbial, Female, Hospital Bed Capacity, 500 and over, Hospital Design and Construction, Humans, Inpatients, Isoniazid pharmacology, Length of Stay, Male, Mycobacterium tuberculosis drug effects, Mycobacterium tuberculosis isolation & purification, New York epidemiology, Streptomycin pharmacology, Tuberculosis transmission, Acquired Immunodeficiency Syndrome complications, Cross Infection epidemiology, Hospitals, Voluntary statistics & numerical data, Tuberculosis epidemiology
- Abstract
Background: Since 1990 several clusters of multidrug-resistant tuberculosis have been identified among hospitalized patients with the acquired immunodeficiency syndrome (AIDS). We investigated one such cluster in a voluntary hospital in New York., Methods: We compared exposures among 18 patients with AIDS in whom tuberculosis resistant to isoniazid and streptomycin was diagnosed from January 1989 through April 1990 (the case patients) with exposures among 30 control patients who had AIDS and tuberculosis susceptible to isoniazid, streptomycin, or both. We also compared exposures among the 14 case patients hospitalized during the six months before the diagnosis of tuberculosis (the exposure period) with those among 44 control patients with AIDS matched for duration of hospitalization. Mycobacterium tuberculosis isolates were typed with analysis of restriction-fragment-length polymorphism (RFLP)., Results: Case patients with drug-resistant tuberculosis were significantly more likely than controls with drug-susceptible tuberculosis to have been hospitalized during their exposure periods (14 of 18 vs. 10 of 30) (odds ratio, 7.0; 95 percent confidence interval, 1.6 to 36; P = 0.006). Case patients hospitalized during their exposure periods were significantly more likely to have been hospitalized on the same ward as a patient with infectious drug-resistant tuberculosis than were either controls with drug-susceptible tuberculosis hospitalized during their exposure periods or controls matched for duration of hospitalization (13 of 14 vs. 2 of 10 and 23 of 44) (odds ratio, 52; 95 percent confidence interval, 3.1 to 2474; P less than 0.001; and odds ratio, infinity; 95 percent confidence interval, 2.4 to infinity; P = 0.005, respectively). Among those hospitalized on the same ward, the rooms of case patients were closer to that of the nearest patient with infectious tuberculosis than were the rooms of controls matched for duration of hospitalization. M. tuberculosis isolates from 15 of 16 case patients had identical patterns on RFLP analysis. Of 16 patients' rooms tested with air-flow studies, only 1 had the recommended negative-pressure ventilation., Conclusions: Multidrug-resistant tuberculosis is readily transmitted among hospitalized patients with AIDS. Physicians must be alert to this danger and must enforce adherence to the measures recommended to prevent nosocomial transmission of tuberculosis.
- Published
- 1992
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.