scholarly journals Comparison of Tuberculosis Infection Control Programs in Canadian Hospitals Categorized by Size and Risk of Exposure to Tuberculosis Patients, 1989 to 1993 – Part 2

1997 ◽  
Vol 8 (4) ◽  
pp. 195-201
Author(s):  
Donna Holton ◽  
Shirley Paton ◽  
Helen Gibson ◽  
Geoffrey Taylor ◽  
Carol Whyman ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Low Risk ◽  
Respiratory Protection ◽  
Hospital Size ◽  
Screening Programs ◽  
Environmental Controls ◽  
Hospital Infection Control ◽  
Mdr Tb ◽  
Risk Of Exposure

OBJECTIVE: To analyze tuberculosis (TB) programs in acute care hospitals (hospitals) categorized by size and risk of exposure to TB patients from 1989 to 1993.DESIGN: Retrospective survey.PARTICIPANTS: Members of the Community and Hospital Infection Control Association-Canada and l’Association des professionnels pour la prévention des infections who worked in Canadian hospitals received questionnaires. One questionnaire per hospital was completed.OUTCOME: Hospitals reported the number of respiratory TB and human immunodeficiency virus (HIV) cases admitted, the engineering and environmental controls available, and the type of occupational TB screening programs available. Data were stratified by hospital size and risk of exposure to TB patients.RESULTS: Thirty-four (10.9%) hospitals with at least 500 beds admitted more than 50% of the TB cases, more than 40% of the multidrug-resistant TB (MDR-TB) cases and more than 65% of the HIV cases. Thirty-six (11.6%) facilities classified as high risk hospitals reported more than 70% of the TB cases, more than 58% of the MDR-TB cases and more than 75% of the HIV cases. A significantly higher pooled average tuberculin test conversion rate was found in individuals working in high risk (4.4%) than in low risk hospitals (1.5%). Significantly more high risk than low risk hospitals had an isolation room with air exhausted outside, negative air pressure and at least six air changes per hour. Only 13 high risk hospitals had all three engineering characteristics. Surgical masks were used for respiratory protection in 18 (50%) high risk and 186 (77.8%) low risk hospitals.CONCLUSIONS: Nosocomial transmission ofMycobacterium tuberculosismay have occurred because TB programs available in many Canadian hospitals were inadequate.

scholarly journals Status of Tuberculosis Infection Control Programs in Canadian Acute Care Hospitals, 1989 to 1993 – Part 1

1997 ◽  
Vol 8 (4) ◽  
pp. 188-194 ◽  
Author(s):  
Donna Holton ◽  
Shirley Paton ◽  
Helen Gibson ◽  
Geoffrey Taylor ◽  
Carol Whyman ◽  
...  
Keyword(s):  
Infection Control ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Respiratory Protection ◽  
Care Hospital ◽  
Screening Programs ◽  
Control Programs ◽  
Environmental Controls ◽  
Hospital Infection Control

OBJECTIVE: To document tuberculosis (TB) prevention and control activities in Canadian acute care hospitals from 1989 to 1993.DESIGN: Retrospective questionnaire.PARTICIPANTS: All members of the Community and Hospital Infection Control Association-Canada and l’Association des professionnels pour la prévention des infections who lived in Canada and worked in an acute care hospital received a questionnaire. One questionnaire per hospital was completed.OUTCOME: The study documented the number of respiratory TB cases admitted to the hospital, the type of engineering and environmental controls available, and the type of occupational tuberculin skin test (TST) screening programs offered by the hospital.RESULTS: Questionnaires were received from 319 hospitals. Ninety-nine (32%) hospitals did not admit a respiratory TB case during the study. Thirty-one (10%) hospitals averaged six or more TB cases per year. TST results were reported for 47,181 health care workers, and 819 (1.7%) were reported as TST converters; physicians had a significantly higher TST conversion rate than other occupational groups. Most hospitals did not have isolation rooms with air exhausted outside the building, negative air pressure and six or more air changes per hour. Surgical masks were used as respiratory protection by 74% of staff.CONCLUSIONS: Canadian hospitals can expect to admit TB patients. Participating hospitals did not meet TB engineering or environmental recommendations published in 1990 and 1991. In addition, occupational TB screening programs in 1989 to 1993 did not meet Canadian recommendations published in 1988.

Assessment of occupational exposure to leptospirosis in a sheep-only abattoir

2010 ◽  
Vol 139 (5) ◽  
pp. 797-806 ◽  
Author(s):  
S. DORJEE ◽  
C. HEUER ◽  
R. JACKSON ◽  
D. M. WEST ◽  
J. M. COLLINS-EMERSON ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
High Risk ◽  
Occupational Exposure ◽  
Low Risk ◽  
Risk Modelling ◽  
Spreadsheet Model ◽  
Risk Period ◽  
Daily Risk ◽  
Risk Of Exposure ◽  
Stochastic Risk

SUMMARYThis study estimated the frequency of exposure of meat workers to carcasses infected with Leptospira serovars Hardjobovis or Pomona in a sheep-only abattoir in New Zealand. A stochastic spreadsheet model was developed to assess the daily risk of exposure of eviscerators, meat inspectors and offal handlers to live leptospires in sheep carcasses from May to November 2004 (high-risk period), and from December 2004 to June 2005 (low-risk period). The average sheep processed per day were 225 for an eviscerator, 374 for a meat inspector, and 1123 for an offal handler. The median daily exposures during high- and low-risk periods were 11 [95% distribution interval (DI) 5–19] and three (95% DI 1–8) infected carcasses/day for eviscerators, 18 (95% DI 9–29) and six (95% DI 2–12) for meat inspectors, and 54 (95% DI 32–83) and 18 (95% DI 8–31) for offal handlers, respectively. Stochastic risk modelling provided evidence that processing of sheep carcasses exposed meat workers regularly to live leptospires with substantial seasonal variation.

scholarly journals Determining the source of transmission of SARS-CoV-2 infection in a healthcare worker

2020 ◽  
Author(s):  
Nasia Safdar ◽  
Gage K. Moreno ◽  
Katarina M. Braun ◽  
Thomas C. Friedrich ◽  
David H. O’Connor
Keyword(s):  
Infection Control ◽  
Healthcare Worker ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Total Population ◽  
Protective Equipment ◽  
Hospital Infection Control ◽  
Risk Of Exposure ◽  
N95 Respirators ◽  
Cumulative Prevalence

BackgroundHealthcare workers (HCWs) are at the frontlines of the COVID-19 pandemic and are at risk of exposure to SARS-CoV-2 infection from their interactions with patients and in the community (1, 2). Limited availability of recommended personal protective equipment (PPE), in particular N95 respirators, has fueled concerns about whether HCWs are adequately protected from exposure while caring for patients. Understanding the source of SARS-CoV-2 infection in a HCW – the community or the healthcare system – is critical for understanding the effectiveness of hospital infection control and PPE practices. In Dane County, Wisconsin, community prevalence of SARS-CoV-2 is relatively low (cumulative prevalence of ~0.06% – positive cases / total population in Dane county as of April 17). Although SARS-CoV-2 infections in HCWs are often presumed to be acquired during the course of patient care, there are few reports unambiguously identifying the source of acquisition.ObjectiveTo determine the source of transmission of SARS-CoV-2 in a healthcare worker.

scholarly journals Genomic Surveillance of Acinetobacter baumannii in the Philippines, 2013-2014

2021 ◽  
Author(s):  
Jeremiah Chilam ◽  
Silvia Argimon ◽  
Marilyn T. Limas ◽  
Melissa L. Masim ◽  
June M. Gayeta ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Carbapenem Resistance ◽  
The Philippines ◽  
Genotypic Resistance ◽  
Carbapenem Resistant ◽  
Genomic Study ◽  
Hospital Infection Control ◽  
Control And Prevention ◽  
Infection Control And Prevention

Acinetobacter baumannii is an opportunistic nosocomial pathogen that has increasingly become resistant to carbapenems worldwide. In the Philippines, carbapenem resistance and multi-drug resistance (MDR) rates are above 50%. We undertook a genomic study of carbapenem resistant A. baumannii in the Philippines to characterize the population diversity and antimicrobial resistance (AMR) mechanisms. We sequenced the whole genomes of 117 A. baumannii isolates recovered by 16 hospitals in the Philippines between 2013 and 2014. We determined the multi-locus sequence type (MLST), presence of acquired AMR determinants and relatedness between isolates from the genome sequences. We also compared the phenotypic and genotypic resistance results. Carbapenem resistance was mainly explained by the acquisition of class-D beta-lactamase gene blaOXA-23. The concordance between phenotypic and genotypic resistance to imipenem was 98.15% and 94.97% overall for the seven antibiotics analysed. Twenty-two different sequence types (ST) were identified, including 7 novel STs. The population was dominated by high-risk international clone 2 (i.e., clonal complex 92), in particular by ST195 and ST208 and their single locus variants. With WGS we identified local clusters representing potential undetected nosocomial outbreaks, as well as multi-hospital clusters indicating inter-hospital transmission. Comparison with global genomes suggested that the establishment of carbapenem-resistant IC2 clones in the Philippines is likely the result of clonal expansion and geographical dissemination and at least partly explained by inadequate hospital infection control and prevention. This study is the first extensive genomic study of carbapenem-resistant A. baumannii in the Philippines and underscores the importance of hospital infection control and prevention to contain high-risk clones.

A Statewide Characterization of Hospital Infection Control Practices and Practitioners

1980 ◽  
Vol 1 (4) ◽  
pp. 227-232 ◽  
Author(s):  
Anita L. Booth ◽  
R. Mark Weeks ◽  
Robert H. Hutcheson ◽  
William Schaffner
Keyword(s):  
Infection Control ◽  
Rural Areas ◽  
Medical Specialty ◽  
Hospital Infection ◽  
Modest Improvement ◽  
Hospital Size ◽  
Control Programs ◽  
Infection Control Practitioner ◽  
Hospital Infection Control ◽  
Control Resource

AbstractSelected features of infection control programs among the 163 general hospitals in Tennessee were surveyed in 1976 and 1979. Each hospital but one had a designated infection control practitioner. Three-fourths of the hospitals had fewer than 200 beds and most were in rural areas. The practitioners in these small hospitals worked in an isolated professional milieu: few (4%) had attended a basic training course or were members of a national (11%) or local (16%) infection control association. They also had significantly less access to standard infection control resource publications than did practitioners in large hospitals. Use of aqueous quaternary ammonium compounds for disinfection was reported by 37% of all hospitals in 1979; 68% of hospitals routinely performed bacteriologic cultures of personnel or the environment. In contrast, only 3% of hospitals did not have a policy specifying the use of sterile closed-system drainage of indwelling bladder catheters. Although these practices varied somewhat by hospital size, the differences were not statistically significant. Modest improvement in each parameter was noted since 1976. Pathology was the most common medical specialty (34%) among chairman of infection control committees; internal medicine and pediatrics accounted for only 13%. The practice of routine microbiologic monitoring was significantly more common among hospitals with chairmen who were pathologists. The implications of these findings for national priorities in hospital infection control are discussed.

Nosocomial Tuberculosis: An Outbreak of a Strain Resistant to Seven Drugs

1995 ◽  
Vol 16 (3) ◽  
pp. 152-159
Author(s):  
Robin M. Ikeda ◽  
Guthrie S. Birkhead ◽  
George T. DiFerdinando ◽  
Donald L. Bornstein ◽  
Samuel W. Dooley ◽  
...  
Keyword(s):  
New York ◽  
Infection Control ◽  
Skin Test ◽  
Exposure Period ◽  
Multidrug Resistant ◽  
Correctional Officer ◽  
Direct Care ◽  
Nosocomial Transmission ◽  
Environmental Controls ◽  
Mdr Tb

AbstractObjective:To evaluate nosocomial transmission of multidrug-resistant (MDR) tuberculosis (TB).Design:Outbreak investigation: review of infection control practices and skin test results of healthcare workers (HCWs); medical records of hospitalized TB patients and mycobacteriology reports; submission of specimens for restriction fragment length polymorphism (RFLP) typing; and an assessment of the air-handling system.Setting:A teaching hospital in upstate New York.Results:Skin-test conversions occurred among 46 (6.6%) of 696 HCWs tested from August through October 1991. Rates were highest on two units (29% and 20%); HCWs primarily assigned to these units had a higher risk for conversion compared with HCWs tested following previous incidents of exposure to TB (relative risk [RR] = 53.4, 95% confidence interval [CI95] =6.9 to 411.1; and RR=37.4, CI95= 5.0 to 277.3, respectively). The likely source patient was the only TB patient hospitalized on both units during the probable exposure period. This patient appeared clinically infectious, was associated with a higher risk of conversion among HCWs providing direct care (RR = 2.37; CI95 = 1.05 to 5.34), and was a prison inmate with TB resistant to seven antituberculosis agents. The MDR-TB strain isolated from this patient also was isolated from other inmate and noninmate patients, and a prison correctional officer exposed in the hospital. Mycobacterium tuberculosis isolates from all of these patients had matching RFLP patterns. Infection control practices closely followed established guidelines; however, several rooms housing TB patients had marginal negative pressure with variable numbers of air changes per hour, and directional airflow was disrupted easily.Conclusions:These data strongly suggest nosocomial transmission of MDR-TB to HCWs, patients, and a prison correctional officer working in the hospital. Factors contributing to transmission apparently included prolonged infectiousness of the likely source patient and inadequate environmental controls. Continued urgent attention to TB infection control is needed.

SHEA-CDC TB Survey, Part I: Status of TB Infection Control Programs at Member Hospitals, 1989-1992

1995 ◽  
Vol 16 (3) ◽  
pp. 129-134
Author(s):  
Scott K. Fridkin ◽  
Lilia Manangan ◽  
Elizabeth Bolyard ◽  
William R. Jarvis ◽  
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Tuberculin Skin Testing ◽  
Respiratory Protection ◽  
Mdr Tb ◽  
Reported Data ◽  
Tb Infection Control

AbstractObjective:To determine trends in Mycobacterium tuberculosis infection in healthcare workers, tuberculosis (TB) control measures, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) guideline for preventing transmission of TB in healthcare facilities.Design:Voluntary questionnaire sent to all members of the Society for Healthcare Epidemiology of America, representing 359 hospitals.Results:Respondents’ hospitals (210 [58%]) had a median of 2,400 healthcare workers (range, 396 to 13,745), 437 beds (range, 48 to 1,250), 5.6 patients with TB per year (range, 0 to 492), and 0 multidrug-resistant (MDR) TB patients per year (range, 0 to 33). Of 166 respondents’ hospitals for which data were provided for 1989 through 1992, the number caring for MDR-TB patients increased from 10 (6%) in 1989 to 49 (30%) in 1992. Reported policies for routine healthcare worker tuberculin skin testing varied. The median skin-test positivity rate for healthcare workers at the time of hire increased from 0.54% in 1989 to 0.81% in 1992, but the median conversion rate during routine testing remained similar: 0.35% in 1989 and 0.33% in 1992. Among 196 hospitals with reported data on respiratory protection use for 1989 through 1992, the use of either surgical submicron, dust-mist, or dust-fume-mist respirators for healthcare workers increased from 9 (5%) in 1989 to 85 (43%) in 1992. Of 181 hospitals with reported data, 113 (62%) had acid-fast bacilli isolation facilities consistent with the 1990 CDC guideline (ie, a single patient room, negative air pressure relative to the hallway, air exhausted directly outside, and ≥ 6 air exchanges per hour).Conclusions:While the number of surveyed hospitals caring for TB and MDR-TB patients increased during 1989 through 1992, TB infection control measures at many hospitals still did not meet the 1990 CDC guideline recommendations.

scholarly journals Endometriosis, hormonal therapy and oncological risks

2021 ◽  
pp. 61-65
Author(s):  
A.M. Grigorenko
Keyword(s):  
Ovarian Cancer ◽  
High Risk ◽  
Risk Group ◽  
Transvaginal Ultrasound ◽  
Low Risk ◽  
Moderate Risk ◽  
Screening Programs ◽  
Positive Effects ◽  
Pelvic Organs ◽  
Gynecological Examination

Endometriosis is now considered as benign disease. However, a correlation was found between endometriosis and several types of cancer. Endometriomas are found in 17–44% of patients with endometriosis and can be frequent precursors of ovarian cancer (endometrioid and clear cell ovarian tumors are more common). This process can be realized through several mechanisms: predominance of certain cytokines, oxidative stress and local hyperestrogenia, genetic mutations including PTEN, PIK3CA, ARID1A, Wnt/β-catenin, microsatellite instability, Src and KRAS.There are no generally accepted approaches to non-invasive early diagnosis of ovarian cancer, especially in borderline tumors and early stages of malignancy. The lack of accurate screening programs for ovarian cancer emphasizes the importance of identifying high-risk, moderate-risk, and low-risk groups. Screening is not recommended in the general population in the low-risk group. Annual CA125 evaluation and transvaginal pelvic ultrasound with general and special gynecological examination are recommended in the moderate-risk group in postmenopause. Transvaginal ultrasound of the pelvic organs with CA125 evaluation is performed every 6 months in the high-risk group, starting from 30 years or 5–10 years before the youngest age of ovarian cancer onset in relatives. The main method of diagnosing tumors is expert ultrasound of the pelvic organs (simultaneously with transabdominal ultrasound). The main tumor markers are CA125 (single evaluation has low diagnostic value), risk malignancy index (RMI) and HE4.Clinical trials are going on and various methods of prevention, screening and treatment of these diseases are being developed. Probably, dienogest can help to solve the problem. Existing results of research are promising, but insufficient since they show both the positive effects of progestin therapy and minor cases of cancer detection during therapy that are not related to the use of progestins, but probably indicate unknown mechanisms of transformation in endometriosis.

scholarly journals Human papillomaviruses: are we ready to type?

1989 ◽  
Vol 2 (2) ◽  
pp. 166-190 ◽  
Author(s):  
A Roman ◽  
K H Fife
Keyword(s):  
High Risk ◽  
Genital Tract ◽  
Large Scale ◽  
Precancerous Lesions ◽  
Clinical Specimen ◽  
Prognostic Indicator ◽  
Human Papillomaviruses ◽  
Low Risk ◽  
Screening Programs ◽  
Hpv Types

The issue of determining which human papillomavirus (HPV) is present in a clinical specimen (typing specimens for HPVs) is receiving attention because HPVs cause condyloma acuminata and are associated with the continuum of disease which ranges from dysplasia to invasive genital cancer. Morphological inspection of precancerous lesions is not sufficient to determine which lesions will progress and which will not. A number of research tools based primarily on deoxyribonucleic acid hybridization have been developed. These permit identification and typing of HPV in genital tract scrapings or biopsies. Some HPV types (e.g., HPV-16 and HPV-18) have been identified in high-grade dysplasias and carcinomas more commonly than other types (e.g., HPV-6) and have been designated "high risk" types for cervical cancer. Thus, the question arises whether HPV typing would improve patient management by providing increased sensitivity for detection of patients at risk or by providing a prognostic indicator. In this review, the available typing methods are reviewed from the standpoint of their sensitivity, specificity, and ease of application to large-scale screening programs. Data implicating HPVs in the genesis of genital tract cancers are reviewed, as is the association of specific HPV types with specific outcomes. We conclude that there is currently no simple, inexpensive assay for HPV types, although such assays may be developed in the future. Analysis of the typing data indicates that, while HPV types can be designated high risk and low risk, these designations are not absolute and thus the low-risk group should not be ignored. In addition, interpretation of the data is complicated by finding high-risk types in individuals with no indication of disease. Insufficient data exist to indicate whether knowledge of the presence of a given HPV type is a better prognostic indicator than cytological or histological results. Thus, more research is needed before it can be determined whether typing information will augment the method currently in use for deciding treatment regimen and whether it warrants widespread use.

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