Showing papers by "Richard P. Wenzel published in 1976"

Hospital-acquired infections i. surveillance in a university hospital

Abstract: A new system of surveillance is described for detecting hospital-aquired infections. Surveillance begins on the ward where a weekly review of the nursing care plan (Kardex) is used to select high risk patients (approximately 65% of the total population) for a subsequent chart review. A nurse-epidemiologist required 16-25 hr per week to perform surveillance and 4 more hr to organize line listings of infected patients. The Kardex review was 82 to 94 percent accurate in detecting nosocomial infections when compared to prospective reviews of the charts of all hospitalized patients. The new surveillance method was more accurate than a system based on weekly chart reviews of all patients receiving systemic antibiotics and/or of all patients with fever (temperature less than or equal to 37.8 C orally). In addition, it was more accurate and offered advantages over a system in which surveillance depended primarily on the bacteriology laboratory. Over a 12-month period 1154 hospital-acquired infections were identified for a 7% annual infection rate. Data from ongoing surveillance are used to record accurate infection rates by service, to define the risk of various hospital procedures, and to monitor for common source outbreaks of infection.

Hospital-acquired infections: ii. infection rates by site, service and common procedures in a university hospital

Abstract: Over a three-year period, 3432 nosocomial infections occurred in a university hospital admitting 55,476 patients over a three-year period (6/100 admissions). A single system of surveillance was used, and overall monthly rates varied from 4-9/100 admissions with particularly high rates in the Newborn Intensive Care Unit (24/100). Annual rates greater than or equal to 10/100 admissions were found in major surgical services of Gneral Surgery, Neuro-Surgery, Thoracic Cardiovascular Surgery (TCV), Plastic Surgery and Urology; 1243 urinary tract infections (2.24/100 admissions/ accounted for 36% of the problem. The rate of urinary tract infections after catheterization was 13/100 procedures overall with unusually high rates for patients in Neuro-Surgery (37/100), Orthopedics (23/100), and Plastic Srugery (18/100). There were 524 nosocomial pneumonias (.94/100 admissions), and the rate was especially high (3.7/100) for patients admitted to the TCV service or for those placed on a respirator (3.4/100 patients). Identifying high risk areas and high risk procedures in a hospital is a practical starting point for infection control.

Providencia stuartii, a hospital pathogen: potential factors for its emergence and transmission

Abstract: The emergence of Providencia stuartii as a hospital pathogen in a burn unit was demonstrated by routine infection surveillance. The organism was initially recognized in a burn wound and subsequently in urine or sputum. Compared to controls, those patients harboring P. stuartii were similar in age and percentage of body surface burned and were more likely to have been in one of the two burn unit rooms, (p less than 0.02). Infection with P. stuartii was independent of duration in the Intensive Care Unit or Burn Unit, and of number of visits to hydrotherapy or operating rooms (OR). Once patients were colonized with P. stuartii they had greater morbidity than non-colonized patients as evidenced by longer stays in the unit and increased visits to the OR for debridement. P. stuartii was isolated from air samples (5/14) more commonly than from the hands of personnel. In vitro tests suggested that extensive use of parenteral gentamicin and replacement of the antibacterial topical cream sulfamylon by silver sulfadiazine favored the emergence of P. stuartii over Pseudomonas aeruginosa as the predominant colonizing organism.

Field Trial of an Inactivated Mycoplasma pneumoniae Vaccine. I. Vaccine Efficacy

Abstract: The efficacy of an inactivated Mycoplasma pneumoniae vaccine was evaluated in a double-blind study of 7,861 Marine Corps recruits at Parris Island, South Carolina. Vaccine was administered to half for the volunteers in a 1-ml dose by a jet-injection device, and phosphate-buffered saline was administered similarly to control subjects. Twenty-one vaccinees (5.3 per 1,000) and 43 recipients of placebo (10.9 per 1,000) were hospitalized with pneumonia; the incidence of illness among the two groups indicated a 51% overall protective efficacy for the vaccine (x2 = 7.49; P less than 0.01). The refined data for pneumonia due to M. pneumoniae showed 67% protective efficacy when serologic data were employed (x2 = 7.84; P = 0.005) and a 42% protective efficacy (x2 = 1.80; P greater than 0.10) when data from cultures for M. pneumoniae were employed. Vaccinees with pneumonia due to M. pneumoniae suffered no increased illness compared to controls, suggesting no hypersensitization with natural illness following the inactivated vaccine. Only when serologic data were analyzed did it appear that the M. pneumoniae vaccine protected against M. pneumoniae specific bronchitis (35% efficacy) but the difference was not statistically significant (x2 = 1.28; P greater than 0.20).

Swine-influenza infection in civilians. Report of two cases.

Abstract: The recent outbreak of influenza due to A/New Jersey/8/76 (HswN1) in a number of recruits at Fort Dix, New Jersey,1 has aroused concern that a new influenza pandemic similar to that of 1918 may be imminent. Only persons living before 1923 have a high prevalence of hemagglutination-inhibition antibody to swine-influenza viruses.2 , 3 No large-scale outbreaks of swine-influenza infection in man have been recognized since 1920, although sporadic transmission of the virus from swine to man has been suspected. The HswN1, strain has remained prevalent among swine, with as many as 50 per cent . . .

Comparison of Josamycin and Erythromycin in the Therapy of Mycoplasma pneumoniae Pneumonia

Abstract: A controlled, double-blind study was performed to compare the efficacy of two macrolide antibiotics, erythromycin and josamycin, in the therapy of Mycoplasma pneumoniae pneumonia. Marine Corps recruit volunteers received one of the two antibiotics in a dosage of 2 g daily for 7 days. Twelve of 21 men treated with josamycin and 9 of 25 men treated with erythromycin had confirmed M. pneumoniae pneumonia. The josamycin-treated group remained hospitalized for 5.4 ± 1.2 days compared to 5.1 ± 2.0 days for the erythromycin-treated group (0.60 > P > 0.50). Fever days were similar for the josamycin-treated (1.4 ± 0.4) and erythromycin-treated (1.2 ± 0.3) groups (P = 0.95). There was no difference in resolution of signs and symptoms of illness in the two study populations. Thus, josamycin is as efficacious as erythromycin in the therapy of M. pneumoniae pneumonia.

Comparison of the sensitivity of two methods for isolation of Mycoplasma pneumoniae.

Abstract: Throat swab specimens from 1,494 Marine Corps recruits were inoculated into vials containing diphasic (broth/agar) mycoplasma medium and also onto PPLO agar plates, which were subsequently overlayed with sheep erythrocytes in saline agar. Strains of Mycoplasma pneumoniae were isolated from 89 (6%) of the specimens by one or both of the methods. Eight-one of the 89 (91%) positive specimens were cultured with diphasic medium, whereas only 42 (47%) were cultured with the overlay method (x2 = 7.44, P less than 0.01). The diphasic system for isolation of M. pneumoniae should be the method of choice in clinical and research application.