American journal of infection control
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Am J Infect Control · Jun 1995
Comparative StudyTuberculin skin test conversion in hospital employees vaccinated with bacille Calmette-Guérin: recent Mycobacterium tuberculosis infection or booster effect?
A rise in the incidence of purified protein derivative (PPD) skin test conversions among employees at our medical center between 1991 and 1993 prompted an examination of factors associated with PPD skin test conversion. We focused on the effect of bacille Calmette-Guérin (BCG) vaccination on PPD skin test conversion because of changes in employee health service policies in 1990 regarding testing of persons who had received BCG vaccination. ⋯ A large proportion of PPD skin test conversions at hospitals that employ large numbers of health care workers who have received BCG vaccination may not represent recently acquired tuberculosis. Rather, these conversions may be effects of previous BCG vaccination. Two-step initial PPD skin testing may help to eliminate nearly 80% of such false-positive conversions.
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Am J Infect Control · Apr 1995
The effects of circuit and humidifier type on contamination potential during mechanical ventilation: a laboratory study.
This study was undertaken because of concerns that ventilator humidifiers could be exacerbating the problem of nosocomial pneumonia in patients receiving mechanical ventilation. ⋯ Bubble-through humidifiers produce aerosols that readily contaminate both circuit condensate and effluent gas. Avoiding bubble-through humidifiers should improve patient safety while allowing changes in practice that can result in significant cost savings.
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Am J Infect Control · Dec 1994
Comparative StudyControl of methicillin-resistant Staphylococcus aureus in a pediatric burn unit.
Control of methicillin-resistant Staphylococcus aureus (MRSA) is particularly difficult in burn units, which are often cited as sources of hospital-wide MRSA outbreaks. We developed a successful MRSA control program and document here its apparent effectiveness in controlling MRSA transmission in a pediatric burn unit. ⋯ An MRSA control program including surveillance culturing, clinician feedback, flexible, site-specific isolation, and a list of known carriers is associated with a low rate of nosocomial MRSA in a pediatric burn unit.
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Am J Infect Control · Apr 1994
Comparative StudyEvaluation of single-use masks and respirators for protection of health care workers against mycobacterial aerosols.
The recent increase in multidrug-resistant tuberculosis has spawned a major controversy concerning the degree of respiratory protection needed by health care workers, particularly during sputum-inducing procedures. The objective of this study was to measure the filtration efficiencies of a single-use submicron surgical mask, two disposable dust/mist respirators, a dust/mist/fume respirator, and a high-efficiency particulate air respirator against aerosolized mycobacteria. Facial fit was not addressed. ⋯ Analysis of variance and Tukey's method for multiple comparisons indicated that the dust/mist/fume respirator and the HEPA respirator collected M. chelonae with significantly greater efficiency than did either the surgical mask or the dust/mist respirator. Even the least efficient mask tested, however, had a filter efficiency of more than 97% against particles averaging less than 1 micron in aerodynamic diameter.
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Am J Infect Control · Dec 1993
An effective continuous quality improvement approach to the prevention of ventilator-associated pneumonia.
In 1989, our medical center used continuous quality improvement concepts in the creation of a Nosocomial Pneumonia Prevention Team whose aim was to significantly reduce nosocomial ventilator-associated pneumonia. The team included representatives from nursing, respiratory therapy, pulmonary medicine, internal medicine, anesthesiology, education and training, and infection control. Because the majority of mechanically ventilated patients were located in the intensive care unit, this unit became the focus of the prevention efforts. ⋯ Fifteen cases of nosocomial ventilator-associated pneumonia were prevented and a cost saving of $105,000 was realized. Performance of traditional surveillance for outliers, coupled with literature-based thresholds, can lead to tolerance of inordinately high endemic rates. Infection control programs can significantly reduce endemic rates of nosocomial ventilator-associated pneumonia through continuous quality improvement methods and multidisciplinary interventions, with standard infection control procedures used for improvement.