1/17. Nosocomial meningococcemia in a physician.We report the case of a pediatrician who developed meningococcal meningitis after performing endotracheal intubation without protection on a child who was suspected of having meningoencephalitis. This case emphasizes the necessity for healthcare workers who perform high-risk procedures to use personal protection devices (i.e., respirators and protective goggles). Unprotected healthcare workers with high exposure to neisseria meningitidis should receive chemoprophylaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/17. The use of guidelines for the empirical treatment of hospital-acquired pneumonia.BACKGROUND: Several practice guidelines for the empirical antimicrobial treatment of hospital-acquired pneumonia (HAP) have been developed, but the acceptance and use of such guidelines are unknown. OBJECTIVE: To assess physicians' use of empirical HAP guidelines published by the American Thoracic Society (ATS) and by The University Health Network, Toronto, ontario. DESIGN: A retrospective assembly and chart review. SETTING: A university teaching hospital. PATIENTS: One hundred fifteen consecutive patients who had been diagnosed with pneumonia more than 48 h after admission to hospital over a 10-month period. RESULTS: The charts of 115 patients were reviewed. Seventy-five patients (65%) were treated empirically. Forty patients (35%) were treated based on microbiological data that were available before the initiation of antibiotics. Patients who received nonempirical treatment for HAP had a significantly greater acuity of illness than the empirically treated group. Thirty-seven patients (49%) who received empirical therapy were treated according to either ATS or hospital guidelines for HAP. The use of guideline-concordant antimicrobial therapy had no measurable effect on in-hospital mortality (eight of 37 patients [21.6%] versus seven of 38 patients [18.4%], P=0.96) or median length of stay (19 days versus 21 days, P=0.30). Patients whose treatment did not follow guideline recommendations tended to receive appropriate antimicrobial coverage more often than did those patients whose treatment was guideline concordant (15 of 18 patients [83%] versus six of 11 patients [55%], P=0.49). CONCLUSIONS: Institutional and ATS guidelines for the empirical treatment of HAP are less widely used than would be predicted by chance at The University Health Network. The clinical utility of these guidelines remains to be proven.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
3/17. severe acute respiratory syndrome from the trenches, at a singapore university hospital.The epidemiology and virology of severe acute respiratory syndrome (SARS) have been written about many times and several guidelines on the infection control and public health measures believed necessary to control the spread of the virus have been published. However, there have been few reports of the problems that infectious disease clinicians encounter when dealing with the protean manifestations of this pathogen. This is a qualitative account of some of the issues faced by an infectious disease physician when identifying and treating patients with SARS as well as protecting other healthcare workers and patients, including: identification of the chain of contagion, early recognition of the disease in the absence of a reliable and rapid diagnostic test, appropriate use of personal protective equipment, and the use of isolation to prevent super-spreading events. Many issues need to be addressed if clinicians are to be able to manage the virus should it reappear.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
4/17. tuberculosis in healthcare workers caring for a congenitally infected infant.OBJECTIVE: To assess the extent of nosocomial transmission of tuberculosis among infants, family members, and healthcare workers (HCWs) who were exposed to a 29-week-old premature infant with congenital tuberculosis, diagnosed at 102 days of age. DESIGN: A prospective exposure investigation using tuberculin skin test (IST conversion was conducted. Contacts underwent two skin tests 10 to 12 weeks apart. Clinical examination and chest radiographs were performed to rule out disease. isoniazid prophylaxis was administered to exposed infants at higher risk. SETTING: A neonatal intensive care unit in an urban hospital in Brussels, belgium. PARTICIPANTS: Ninety-seven infants, 139 HCWs, and 180 visitors. RESULTS: Newly positive TST results occurred in HCWs who had been in close contact with the infant. Six (19%) of 32 primary care nurses and physicians had TST conversions and received treatment. Among the 97 exposed infants, 85 were screened and 34 were identified as at higher risk of infection. Of these, 27 received preventive isoniazid. None of the infants and none of the 93 other infants' family members evaluated were infected. CONCLUSIONS: Congenital tuberculosis in an infant poses a risk for nosocomial transmission to HCWs. delayed diagnosis of this rare disease and close proximity are the most important factors related to transmission.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
5/17. Reducing the risk of health care-associated infections by complying with CDC hand hygiene guidelines.BACKGROUND: The joint commission on accreditation of healthcare organizations has made the reduction of health care-associated infections one of its National patient safety goals for 2005. CASE STUDY: A 57-year-old man who underwent coronary artery bypass graft surgery was discharged from the hospital without any complications. During his routine follow-up surgery clinic visit two weeks later, his sternal wound was found to be infected. Wound and blood cultures were positive for methicillin-resistant staphylococcus aureus (MRSA). IMPLEMENTING solutions: Health care workers at Barnes-Jewish Hospital (BJH), St. Louis, attended a mandatory educational session that reviewed hand hygiene guidelines and the hospital policy related to hand hygiene and infection control. In addition, posters and flyers were posted. An increase in the use of alcohol hand rubs was found. In a later effort, a multidisciplinary hand hygiene campaign was launched at one of the BJC community hospitals. All physicians were sent hand hygiene materials and supplies, and signs were posted in key areas such as the hospital cafeteria. After a six-month period, the compliance rate increased from 35% to 53%. CONCLUSION: Hospital-related infections will never be completely eradicated, but many can be prevented.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
6/17. iatrogenic disease and the primary care physician.Primary care physicians need to be aware of iatrogenic disease and its causes. Adverse drug reactions, including drug-drug interactions, and certain diagnostic procedures may lead to iatrogenic complications. Hospitalized patients, especially the elderly, face increased risks of such complications. physicians who are aware of common adverse reactions to drugs, drug combinations, and medical procedures may be able to help patients avoid unnecessary distress and morbidity.- - - - - - - - - - ranking = 1.25keywords = physician (Clic here for more details about this article) |
7/17. occupational exposure to influenza--introduction of an index case to a hospital.The epidemiology of influenza in the hospital is frequently confounded by failure to separate community-acquired from nosocomial transmission. An 83-year-old woman was hospitalized one day after returning from asia with complications resulting from acute influenza A (H3N2) infection; she was the first culture-confirmed case in the region during the 1987-1988 influenza season, and her illness antedated other influenza cases in the area by at least four weeks. The patient shed virus at least four days after admission and transmitted influenza to her primary physician; both had received trivalent influenza vaccine four weeks earlier. Surveillance data from the 28 health care providers (HCPs) in contact with the index case (mean age: 34.5 years; median time of contact: four hours, none receiving vaccine) revealed no evidence of transmission as detected by paired type-specific complement-fixation antibodies and throat culture (20 subjects) or acute serologies and culture (7 subjects). No febrile respiratory illnesses were detected among other patients on the same ward, although three were reported among HCPs. Thus, neither secondary spread of influenza from infected patient to hospital HCPs nor nosocomial transmission apparently took place, although transmission did occur to the primary physician.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/17. Nosocomial dermatitis and pruritus caused by pigeon mite infestation.We report an outbreak of pigeon mite infestation involving two patients, two nurses, and one physician on a medical ward in a municipal hospital. The index patient developed a diffuse, pruritic erythematous maculopapular rash on his trunk and extremities. Dermanyssus gallinae, a nonburrowing, blood-sucking avian mite was identified on the patient and his bedding. A second patient who complained of scalp pruritus had mites present on her pillow and bed linen. The intern taking care of both patients, and two nurses who had contact with these patients, had mite infestation. Pigeons roosting on the air conditioners and near the doors connecting the patients' rooms to a sunporch were the source of the mites. The outbreak abated after control measures were instituted that prevented pigeons from roosting on the porch. This outbreak illustrates an unusual cause of nosocomial pruritic dermatitis that may be misdiagnosed as scabies or pediculosis. physicians and health care personnel working in metropolitan areas are alerted to mites as a cause of pruritic dermatitis that may be chronic, recurrent, or unresponsive to ectoparasiticides.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
9/17. Hospital outbreak of hepatitis a: risk factors for spread.A 34-month-old girl with Down's syndrome from the Marshall islands was hospitalized in September, 1981, at Tripler Army Medical Center for evaluation of a heart murmur and definitive repair of an imperforate anus for which she had had a colostomy since birth. She became jaundiced and had serologic evidence of hepatitis a infection. Over the next month eight hospital personnel (four nurses, three nursing assistants and one physician) who had had direct contact with the patient became ill with hepatitis a. Our patient, like the index cases in five previous reports of nosocomial hepatitis a outbreaks, was incontinent of feces. In addition she was hospitalized during the incubation period before clinical illness when virus fecal excretion is likely to be maximal. Patients in the prodromal stage of hepatitis a infection who are hospitalized pose a significant risk to exposed hospital staff. This risk is enhanced if there are additional factors present which promote spread of disease by the fecal-oral route such as infancy, mental retardation, diarrhea and fecal incontinence.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
10/17. Non-A, non-B hepatitis and chronic dialysis--another dilemma.To define the incidence of non-A, non-B (NANB) hepatitis and evaluate possible risk factors, we reviewed records of 163 patients on chronic dialysis during a 3-year period. 23 cases of NANB hepatitis occurred, 13 (27%) in 49 center dialysis, 8 (10%) in 77 home hemodialysis (p less than 0.02) and 2 (5%) in 37 peritoneal dialysis patients (p less than 0.01). Hepatitis patients received significantly more transfusions than controls. Numbers of transfusions and of patients transfused were not significantly different in center patients compared to home and peritoneal. 8 NANB patients received no transfusions. NANB was the most common cause of hepatitis in our unit (68%). Although transfusions were a likely etiologic factor, to explain the increased risk in center dialysis patients, disease in patients not transfused and development of NANB hepatitis without a known parenteral exposure in a physician assigned to the nephrology Service, we feel another etiologic factor was important, the dialysis center.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
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