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Journal ArticleDOI

A Comparison of the Effect of Universal Use of Gloves and Gowns with That of Glove Use Alone on Acquisition of Vancomycin-Resistant Enterococci in a Medical Intensive Care Unit

15 Sep 1996-Annals of Internal Medicine (American College of Physicians)-Vol. 125, Iss: 6, pp 448-456
TL;DR: An epidemiologic study and a controlled clinical trial comparing the efficacy of the universal use of gloves with that of theuniversal use of gowns and gloves in the prevention of colonization by vancomycin-resistant enterococci in a medical intensive care unit of a hospital in which vancomYcin- resistantEnterococci are endemic are conducted.
Abstract: Objective: To determine the efficacy of the use of gloves and gowns compared with that of the use of gloves alone for the prevention of nosocomial transmission of vancomycin-resistant enterococci. ...
Citations
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Journal ArticleDOI
TL;DR: The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis and provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health- Care settings.

2,882 citations

Journal ArticleDOI
TL;DR: The ability of hospital ventilation systems to filter Aspergillus and other fungi following a building implosion and the impact of bedside design and furnishing on nosocomial infections are investigated.

2,632 citations


Cites background from "A Comparison of the Effect of Unive..."

  • ...364, [746] [747] [748] [749] Isolation gowns are always worn in combination with gloves, and with other PPE when indicated....

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Journal ArticleDOI
TL;DR: The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health care settings.
Abstract: The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.

1,877 citations

Journal ArticleDOI
TL;DR: Active surveillance cultures are essential to identify the reservoir for spread of MRSA and VRE infections and make control possible using the CDC's long-recommended contact precautions, demonstrating consistency of evidence, high strength of association, reversibility, dose gradient, and specificity for control with this approach.
Abstract: patients with MRSA or VRE usually acquire it via spread. The CDC has long-recommended contact precautions for patients colonized or infected with such pathogens. Most facilities have required this as policy, but have not actively identified colonized patients with sur veillance cultures, leaving most colonized patients undetected and unisolated. Many studies have shown control of endemic and/or epidemic MRSA and VRE infections using surveillance cultures and contact precautions, demonstrating consistency of evidence, high strength of association, reversibility, a dose gradient, and specificity for control with this approach. Adjunctive control measures are also discussed. CONCLUSION: Active surveillance cultures are essential to identify the reservoir for spread of MRSA and VRE infections and make control possible using the CDC’s long-recommended contact precautions (Infect Control Hosp Epidemiol 2003;24:362-386).

1,432 citations


Cites background from "A Comparison of the Effect of Unive..."

  • ...The proportion of VRE-colonized patients who go unrecognized in the hospital in the absence of active surveillance cultures has been large in five studies.(105,125,149,195)'(196)...

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  • ...The recent emergence of VRSA, which has not yet been submitted to cost-effectiveness studies, will likely lead to even greater cost-effectiveness of controlling MRSA and VRE....

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  • ...The latter agent was restricted as part of most VRE control efforts, but efforts to control the use of vancomycin alone without effective measures to prevent transmission have not resulted in the control of VRE.86,105,116 This does not mean that antibiotics were not important contributing factors....

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  • ...Four of five other studies with epidemiologic data suggested that contact precautions with gowns and gloves worked better than gloves alone for preventing the spread of VRE.96105115135136 Additionally, a high rate of clothing contamination has been found122132134 that was prevented when gowns were worn.134 Of the various universal barrier options, universal gloving would cost the least but would be associated with a higher transmission rate than other options.96115135136 The highest cost of any universal barrier option would come from universal gown and glove isolation....

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  • ...After 2 more years without improvement, a SHEA task force was appointed to draft this evidence-based guideline on preventing nosocomial transmission of such pathogens, focusing on the two considered most out of control: MRSA and VRE....

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Journal ArticleDOI
TL;DR: This guideline is intended to provide a jumping-off point for scientists, clinicians, and policymakers to assess the appropriateness of using ultrasound for diagnosis and treatment of central nervous system disorders.

1,028 citations

References
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Journal ArticleDOI
TL;DR: Enterococci are important human pathogens that are increasingly resistant to antimicrobial agents, including resistance to cephalosporins, clindamycin, tetracycline, and penicillinase-resistant penicillins such as oxacillin, among others.
Abstract: Enterococci are important human pathogens that are increasingly resistant to antimicrobial agents. These organisms were previously considered part of the genus Streptococcus but have recently been reclassified into their own genus, called Enterococcus. To date, 12 species pathogenic for humans have been described, including the most common human isolates, Enterococcus faecalis and E. faecium. Enterococci cause between 5 and 15% of cases of endocarditis, which is best treated by the combination of a cell wall-active agent (such as penicillin or vancomycin, neither of which alone is usually bactericidal) and an aminoglycoside to which the organism is not highly resistant; this characteristically results in a synergistic bactericidal effect. High-level resistance (MIC, greater than or equal to 2,000 micrograms/ml) to the aminoglycoside eliminates the expected bactericidal effect, and such resistance has now been described for all aminoglycosides. Enterococci can also cause urinary tract infections; intraabdominal, pelvic, and wound infections; superinfections (particularly in patients receiving expanded-spectrum cephalosporins); and bacteremias (often together with other organisms). They are now the third most common organism seen in nosocomial infections. For most of these infections, single-drug therapy, most often with penicillin, ampicillin, or vancomycin, is adequate. Enterococci have a large number of both inherent and acquired resistance traits, including resistance to cephalosporins, clindamycin, tetracycline, and penicillinase-resistant penicillins such as oxacillin, among others. The most recent resistance traits reported are penicillinase resistance (apparently acquired from staphylococci) and vancomycin resistance, both of which can be transferred to other enterococci. It appears likely that we will soon be faced with increasing numbers of enterococci for which there is no adequate therapy.

1,817 citations


"A Comparison of the Effect of Unive..." refers background in this paper

  • ...Enterococcal infections traditionally have been attributed to strains from patients' endogenous flora (4), but several recent reports have shown that enterococci can be spread by carriage on the hands of personnel (5, 6) or by equipment (7)....

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Journal ArticleDOI
TL;DR: An estimated 2 million patients develop nosocomial infections in the United States annually and the growing number of antimicrobial agent-resistant organisms is troublesome, particularly vancomycin-resistant CoNS and Enterococcus spp.
Abstract: An estimated 2 million patients develop nosocomial infections in the United States annually. The increasing number of antimicrobial agent-resistant pathogens and high-risk patients in hospitals are challenges to progress in preventing and controlling these infections. While Escherichia coli and Staphylococcus aureus remain the most common pathogens isolated overall from nosocomial infections, coagulase-negative staphylococci (CoNS), organisms previously considered contaminants in most cultures, are now the predominant pathogens in bloodstream infections. The growing number of antimicrobial agent-resistant organisms is troublesome, particularly vancomycin-resistant CoNS and Enterococcus spp. and Pseudomonas aeruginosa resistant to imipenem. The active involvement and cooperation of the microbiology laboratory are important to the infection control program, particularly in surveillance and the use of laboratory services for epidemiologic purposes. Surveillance is used to identify possible infection problems, monitor infection trends, and assess the quality of care in the hospital. It requires high-quality laboratory data that are timely and easily accessible.

1,317 citations


"A Comparison of the Effect of Unive..." refers background in this paper

  • ...Enterococci have emerged as a prominent cause of nosocomial infection over the past two decades (1, 2)....

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Journal ArticleDOI
TL;DR: Major shifts in the etiology of nosocomial infection have occurred in the decade of the 1980s, and the shifts are away from more easily treated pathogens toward more resistant pathogens with fewer options for therapy.

1,115 citations


"A Comparison of the Effect of Unive..." refers background in this paper

  • ...Enterococci have emerged as a prominent cause of nosocomial infection over the past two decades (1, 2)....

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Journal ArticleDOI
TL;DR: A rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) has been reported from U.S. hospitals in the last 5 years, and the lack of available antimicrobials for therapy of infections due to VRE poses several problems.

806 citations

Journal ArticleDOI
TL;DR: Streptococci (206 cultures) previously identified as enterococci were retrieved from storage and reidentified by using tests designed to identify species of the genus Enterococcus by using DNA-DNA hybridizations to assure correct identification.
Abstract: Streptococci (206 cultures) previously identified as enterococci were retrieved from storage and reidentified by using tests designed to identify species of the genus Enterococcus. Of these 188, 91% were correctly identified as Enterococcus species. Of the remaining strains, nine (4%) were unidentified and six (3%) and 3 (1.5%) were identified as Leuconostoc sp. and Lactococcus sp., respectively. Two new Enterococcus species were discovered: E. raffinosus and E. solitarius. DNA-DNA hybridizations were performed on selected strains to assure correct identification. Cultures representing 10 of the 12 Enterococcus species were among the 188 strains identified. An identification system based on the grouping of key reactions of 20 phenotypic characteristics of Enterococcus species is described.

802 citations


"A Comparison of the Effect of Unive..." refers background in this paper

  • ..., Hazelwood, Missouri), the production of yellow pigment, and the 30 °C motility test (17)....

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