New-onset rhinitis symptoms among hospitalized patients: are flowers a culprit?

New-onset rhinitis symptoms following admission to the hospital were reported by 12.7% of surveyed patients. Presence of flower arrangements in the proximity of patients' beds was highly associated with the development of new rhinitis (odds ratio, 9.7; 95% confidence interval, 4.3-21.7), or what may be more aptly referred to as "florocomial" rhinitis.

Potential role of famciclovir for prevention of herpetic whitlow in the health care setting.

Oral famciclovir was initiated in a health care worker immediately after an accidental percutaneous injury involving a needle freshly removed from a patient's herpes labialis vesicles. In follow-up, the health care worker remained seronegative for herpes simplex I and II antibodies (IgG and IgM) and did not develop herpetic whitlow, supporting the potential role of famciclovir in the prevention of herpetic whitlow in a health care setting.

Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: a Consensus Panel report.

In 1997 the Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in out-of-hospital settings. The following report represents the Consensus Panel's best assessment of requirements for a healthy and effective out-of-hospital-based infection control and epidemiology program. The recommendations fall into 5 categories: managing critical data and information; developing and recommending policies and procedures; intervening directly to prevent infections; educating and training of health care workers, patients, and nonmedical caregivers; and resources. The Consensus Panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee.

Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: a consensus panel report. Association for Professionals in Infection Control and Epidemiology and Society for Healthcare Epidemiology of America.

In 1997 the Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in out-of-hospital settings. The following report represents the Consensus Panel's best assessment of requirements for a healthy and effective out-of-hospital-based infection control and epidemiology program. The recommendations fall into 5 categories: managing critical data and information; developing and recommending policies and procedures; intervening directly to prevent infections; educating and training of health care workers, patients, and nonmedical caregivers; and resources. The Consensus Panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee.

Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis.

BACKGROUND: Human ehrlichiosis is a recently recognized tick-borne infection. Four species infect humans: Ehrlichia chaffeensis, E. sennetsu, E. canis, and the agent of human granulocytic ehrlichiosis. METHODS: We tested peripheral-blood leukocytes from 413 patients with possible ehrlichiosis by broad-range and species-specific polymerase-chain-reaction (PCR) assays for ehrlichia. The species present were identified by species-specific PCR assays and nucleotide sequencing of the gene encoding ehrlichia 16S ribosomal RNA. Western blot analysis was used to study serologic responses. RESULTS: In four patients, ehrlichia DNA was detected in leukocytes by a broad-range PCR assay, but not by assays specific for E. chaffeensis or the agent of human granulocytic ehrlichiosis. The nucleotide sequences of these PCR products matched that of E. ewingii, an agent previously reported as a cause of granulocytic ehrlichiosis in dogs. These four patients, all from Missouri, presented between May and August 1996, 1997, or 1998 with fever, headache, and thrombocytopenia, with or without leukopenia. All had been exposed to ticks, and three were receiving immunosuppressive therapy. Serum samples obtained from three of these patients during convalescence contained antibodies that reacted with E. chaffeensis and E. canis antigens in a pattern different from that of humans with E. chaffeensis infection but similar to that of a dog experimentally infected with E. ewingii. Morulae were identified in neutrophils from two patients. All four patients were successfully treated with doxycycline. CONCLUSIONS: These findings provide evidence of E. ewingii infection in humans. The associated disease may be clinically indistinguishable from infection caused by E. chaffeensis or the agent of human granulocytic ehrlichiosis.

Lack of agreement between tympanic and oral temperature measurements in adult hospitalized patients.

BACKGROUND: The purpose of this study was to compare temperature measurements obtained by tympanic thermometers with those obtained by oral electronic or mercury-glass thermometers in adult hospitalized patients. METHODS: A prospective study of 406 nonintensive care unit adult patients hospitalized during an 8-month period in a tertiary care community medical center. RESULTS: Poor agreement was observed between tympanic versus electronic thermometer reading, with 95% limits of agreement of -2.11 degrees F to +2.81 degrees F. Similarly, poor agreement was observed between tympanic versus oral mercury-glass temperatures, with 95% limits of agreement of -1.72 degrees F and +2.64 degrees F oral electronic temperatures 100 degrees F (37.7 degrees C) or higher, 10 (37%, 95% confidence interval 19% to 58%) readings were 99.5 degrees F (37.5 degrees C) or lower, and six (22%, 95% confidence interval 9% to 42%) measured lower than 98.6 degrees F by tympanic thermometers. CONCLUSIONS: Temperatures measured by tympanic thermometers generally have poor agreement with those measured by oral electronic or mercury-glass thermometers in adult hospitalized patients. We recommend the tympanic thermometers not by used for routine screening for fever in this patient population.

Surgical-site infection rates in patients who undergo elective surgery on the same day as their hospital admission.

OBJECTIVE: To follow over time surgical-site infection (SSI) rates in patients admitted to the hospital on the same day as their elective surgery (group I), and to compare these rates with those of other surgical patients who also required postoperative hospitalization but either were hospitalized for 1 or more days immediately prior to surgery or underwent surgery on a nonelective basis (group II). DESIGN: Observation of overall SSI rates over time for group I and II patients and study of risk factors associated with increased SSI rate among group I neurosurgical patients. SETTING: A 900-bed, tertiary-care community hospital with >10,000 surgical procedures performed each year on patients requiring postoperative hospital stay. PATIENTS: A total of 48,464 surgical procedures were performed on consecutive patients from 1990 to 1994, with 18,794 (39%) involving group I patients. In addition, 511 consecutive procedures performed on neurosurgical patients requiring postoperative hospitalization from July 1994 to May 1995 were analyzed. RESULTS: In 1990, the overall SSI rate of group I patients was significantly lower than that of group II patients (0.4% vs 1.3%, relative risk [RR], 3.6; 95% confidence interval [CI95], 2-6.4; P<.0001), but, by 1994, there was no longer any significant difference between the SSI rates of group I and II patients (1.8% and 1.6%, respectively; P=.38). In 1994, the SSI rate in group I neurosurgical patients was significantly greater than that of group II patients (3.4% vs 0.4%; RR, 8.3; CI95, 1.05-66; P=.02). During the period April through September 1994 (warm months), group I neurosurgical patients were associated with a significantly lower American Society of Anesthesiologists score and SSI risk index (based on National Nosocomial Infection Surveillance System data) and a higher likelihood of having "clean-class" wounds, but significantly greater-than-expected SSI rate when adjusted for patient risk index and type of procedure (4.7% vs 1.4%; RR, 3.3; CI95, 1.3-8.6; P=.02). During the same period, the observed and expected SSI rates were not significantly different for group II neurosurgical patients. CONCLUSIONS: As a whole, the SSI rates among patients undergoing elective surgery on the same day of their hospital admission is no longer significantly lower than that of other patients who also require postoperative hospitalization. For certain procedures, such as those commonly performed on the neurosurgical service, elimination of preoperative hospital stay may be associated with greater-than-expected risk of SSI.

Adjunctive use of monthly physician questionnaires for surveillance of surgical site infections after hospital discharge and in ambulatory surgical patients: report of a seven-year experience.

We report our experience with the use of monthly physician questionnaires, in conjunction with traditional in-house monitoring, for surveillance of surgical site infections (SSIs) in inpatients after hospital discharge and in ambulatory surgical patients (i.e., those not requiring perioperative hospitalization) over a 7-year period (July 1988 to June 1995) involving 156,977 surgical procedures. The mean annual response rate was 73% and did not change significantly from year to year (range, 71% to 75%), but the proportion of surgical procedures covered by returned surveys increased during the study period from 75% to 81% in inpatients and from 78% to 86% in ambulatory surgical patients (p < 0.0001 for both comparisons). Of 1051 SSIs identified, 231 (22%) were identified solely by the survey: 16% of SSIs in inpatients after discharge and 66% of SSIs in ambulatory surgical patients. Of 787 cases meeting the criteria for SSI on the basis of in-house surveillance and listed on returned questionnaires, 366 (47%) were not marked as SSIs by the responding surgeons. We conclude that since its implementation in 1988, monthly physician surveys at our medical center continue to contribute significantly to identification of otherwise undetected SSIs. However, monthly questionnaires should only complement, not replace, traditional in-house surveillance.

Prevalence of use of infection control rituals and outdated practices: Education Committee survey results.

BACKGROUND: To better serve APIC membership, the National APIC Education Committee periodically conducts educational needs assessments. METHODS: In the July/August 1995 issue of APIC News, the committee published a survey on the prevalence of infection control "sacred cows," practices considered to be outdated and ritualistic. A response was requested only from ICPs working in inpatient facilities. We asked ICPs which of the listed practices were part of their facility's infection control program, and whether they were interested in changing those that were. We also asked about the certification status of the program's manager (CIC vs non-CIC). RESULTS: A total of 506 survey forms were completed and returned, with 74% from acute care only, 7% from long-term care only, 10% from acute and long-term care, and 8% from other types of facilities. Mean number of beds was 226. Infection control programs had existed for a mean of 15 years. Most respondents' facilities still engaged in infection control rituals. Fifty-eight percent of respondents were still doing total surveillance, 43% were still using reverse or protective isolation, and 11% were still subjecting employees with positive reactions to purified protein derivative of tuberculin testing to annual chest radiographs, to name a few. Certified respondents were significantly less likely to include outdated practices than were non-CICs for 11 of 15 practices (73%). CICs were no more likely than non-CICs, however, to be interested in changing any current rituals. CONCLUSION: The Education Committee will use this information to plan future educational offerings.

Cellulitis associated with an oral source of infection in breast cancer patients: report of two cases.

We present 2 patients with prior lumpectomy, axillary node dissection and radiation therapy for treatment of breast cancer, who subsequently developed arm and chest cellulitis associated with an oral infection (gingivitis with bacteremia in one patient, and dental abscess in another). Our findings suggest that hematogeneous seeding of the compromised extremity and/or breast from the oral cavity should be considered as a possible cause of cellulitis in breast cancer patients.

Loss of antimicrobial susceptibility in aerobic gram-negative bacilli repeatedly isolated from patients in intensive-care units.

OBJECTIVE: To study the loss of antimicrobial susceptibility in repeat (same patient, same bacterial species, and same site) aerobic gram-negative bacilli (AGNB) isolated from individual patients during their stay in the intensive-care unit (ICU). SETTING: A 792-bed, tertiary-care community hospital with a total of 107 adult, pediatric, and neonatal ICU beds. METHOD: An observational prospective study performed November 1992 through mid-July 1993. RESULTS: Of 594 consecutive AGNB from 287 ICU patients, 117 isolates (20%) from 55 patients (19%) were repeat isolates, with the majority obtained from respiratory secretions (83%). Pseudomonas aeruginosa and Enterobacter species accounted for 61% of the isolates. Forty-two (36%) of the repeat isolates from 24 patients (44%) had > or = 4-fold increase in minimum inhibitory concentration to at least one antibiotic and no longer were considered fully susceptible based on National Committee on Clinical Laboratory Standards criteria. Loss of antimicrobial susceptibility often developed within several (median 8) days and was associated only infrequently with simultaneous transition from colonization to infection in the individual patient. Use of certain beta-lactam antibiotics was associated with increasing resistance to several other antibiotics in the same class. Concurrent use of beta-lactams and aminoglycosides did not prevent loss of antimicrobial susceptibility to the former in repeat isolates. CONCLUSION: We conclude that loss of antimicrobial susceptibility in repeat AGNB isolated from ICU patients is common, usually is not associated with transition from colonization to infection, and often is associated with prior use of antibiotics. Minimizing antibiotic use in ICU patients should help reduce the risk of antimicrobial resistance in repeat AGNB isolates.

Blood and body fluid exposures among surgeons: a survey of attitudes and perceptions five years following Universal Precautions.

A mail survey of surgeons at our medical center 5 years following adoption of Universal Precautions revealed that 29% estimated having > or = 1 potentially serious blood or body fluid exposures (BBEs) per month. Failure to report BBEs (usually needlesticks) to the employee health department was common, and the majority of surgeons in practice for > or = 10 years never reported such exposures. The most commonly cited reason for not reporting BBEs was perceived low risk of acquiring bloodborne infections.

Clostridium difficile contamination of blood pressure cuffs: a call for a closer look at gloving practices in the era of universal precautions.

We report an outbreak of Clostridium difficile-associated diarrhea at our medical center following adoption of Universal Precautions. Environmental cultures revealed unexpected contamination of blood pressure cuffs at a rate similar to that for bedside commodes (10% and 11.5%, respectively). An observational survey revealed that healthcare workers in the patient care areas not infrequently failed to remove their potentially stool-contaminated gloves prior to touching clean surfaces, which might have contributed to contamination of blood pressure cuffs.