摘要:

The risk of human immunodeficiency virus (HIV) transmission after a hollow needlestick injury contaminated with HIV-infected blood is 0.4%. The HIV seroprevalence of patients in many urban hospitals is significant, and surgeons are frequently exposed to patients' blood in the course of their work. HIV infection is an occupational disease. Strict barrier precautions significantly reduce but do not eliminate the risk of exposure to patients' blood, and routine HIV testing of surgical patients remains controversial. The risk of HIV transmission from a health care worker to a patient during an invasive procedure is unknown; routine HIV testing of health care workers is under discussion. State Workers' Compensation is inadequate to provide supplemental income to resident physicians with occupationally acquired HIV infection who are unable to work. Both HIV-positive and HIV-negative patients deserve the highest quality of surgical care.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Current surgical practice proscribes prophylactic antimicrobial agents for clean operations not associated with a prosthesis or cardiac surgery. A large, prospective, randomized study challenged this by finding an improved outcome in hernia and breast surgery when antibiotics were given preoperatively. Serious flaws in this study mandate further investigation of the problem. Another challenge was directed at the efficacy of cefazolin in the prophylaxis of staphylococcal infections. Refinements in the definition and stratification of abdominal infection according to localization of infection, etiology, and degree of physiologic impairment have brought clinical studies of abdominal infection to a new level of sophistication and clinical validity.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Enterococci have established themselves as important nosocomial pathogens and have recently acquired a number of novel antimicrobial resistances. Available evidence suggests that the hospital epidemiology of antimicrobial-resistant enterococci is likely to resemble that of other recognized nosocomial pathogens such as methicillin-resistantStaphylococcus aureus. Speciation and screening of “significant” isolates for novel resistances is important for prevalence studies and selection of antimicrobial therapy and prophylaxis. Simple and widely applicable typing schemes are required for epidemiologic surveillance. Cross-infection may occur, and when complicated by multiple antimicrobial resistance, control of infection measures may need to be reinforced.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Methicillin-resistantStaphylococcus aureus(MRSA) outbreaks continue in several countries and appear to be endemic in many. Certain MRSA can be as virulent as methicillin-sensitiveS. aureusisolates. The complexity of the genetic basis of the different types of phenotypic expression of methicillin resistance continues to be unraveled. Broth enrichment of screening swabs can improve sensitivity of MRSA detection but should be used with caution. Typing methods have been reassessed and new ones developed; there is much room for improvement and a less expensive typing system. We also need good markers for virulence and epidemicity. Guidelines have been revised for the control of MRSA outbreaks in the United Kingdom and may be more applicable elsewhere in the world than previous recommendations. The emergence of resistance to additional antibiotics, in particular ciprofloxacin and mupirocin, is a disturbing development, and prescribing habits need to be watched closely.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Many problems relating to the diagnosis and epidemiology of nosocomial candidiasis remain unsolved. Antemortem diagnosis of invasive candidiasis has always been problematic. Antigen detection systems also appear to be of low sensitivity and specificity. Good epidemiology of nosocomial candidiasis has been handicapped by the relatively poor typing methods available forCandida albicans. Genotyping methods, particularly those based on DNA probes, appear to be major improvements. Using genotyping, two previously described single-strain outbreaks have been reported to be due to multiple-strain types. Nevertheless, studies of nosocomial candidiasis have suggested that cross-infection does occur and can be controlled. There have been several reports from developed countries showing that nosocomial mycobacterial disease still occurs. Nosocomial viral infections remain a major problem, particularly in pediatrie hospitals. These infections may be due to cross-infection from other patients or members of staff. Control measures can be successful if rigorously applied. This includes ensuring that medical staff are adequately vaccinated.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The treatment of end-stage renal failure by continuous ambulatory peritoneal dialysis has proven less successful than anticipated due to the high incidence of infective peritonitis. Essentially, peritoneal host defenses are critically immunocompromised by the presence of two foreign bodies: dialysate and Tenckhoff catheter. Thus, infection is readily established and is frequently impossible to eradicate despite appropriate antibiotic therapy. It follows that the prevention of infective peritonitis is of supreme importance to the success of the technique. Recent research into the epidemiology and pathogenesis of infections caused by the most important groups of infecting microorganisms has demonstrated that this goal is achievable.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Clostridium difficile and rotaviruses remain the most common recognized causes of nosocomial diarrhea. Nosocomial diarrhea predisposes to nosocomial infections. Stool softeners and antacids are risk factors associated withC. difficilecarriage, while older age, severe underlying disease, antibiotics, gastrointestinal stimulants, stool softeners, and enemas are risk factors related toC. difficilediarrhea.C. difficile-colonized patients may be a source for infections in other hospitalized patients. Vinyl gloves can decrease hand carriage and transmission ofC. difficile. Excretion of the organism or cytotoxin may occur even after treatment and clinical response. Nosocomial rotavirus spread in children is related to infected roommates and hospital staff with contaminated hands. Using the proved effective disinfectants and educating staff and parents of the need for and techniques of handwashing are important. Routine stool culture and ova and parasite examination are inappropriate for most patients with nosocomial diarrhea.Helicobacter pylori, Yersinia enterocolitica, Shigella sonnei, andCryptosporidium parvumare additional etiologies sometimes seen in nosocomial diarrhea. Irrespective of the cause, all hospitalized patients with diarrhea should be promptly placed in enteric precaution to prevent spread of fecal organisms to other hospitalized patients.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Computer usage in hospital epidemiology has grown rapidly in recent years. In fact, among the departments concerned with measuring and improving quality, infection control leads the way in applying microcomputers to its information management needs. An obvious use of computers is to help manage surveillance databases. Other compelling reasons to collect and analyze data using computers include 1) newer methods to detect outbreaks; 2) classifying patient risks using indices specific to each type of infection; 3) decision analysis as a method of addressing cost-benefit questions; and 4) the future potential of expert computer systems.

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0951-7375    

出版商:OVID    

年代:1991

数据来源: OVID