ICHE本期文章一览（只显示摘要）2012.10

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第一篇：

The Epidemiology of Methicillin-Resistant Staphylococcus aureus on a Burn Trauma Unit

Fri, 05 Oct 2012 21:15:19 -0400

Abstract: Objective. We assessed the frequency and relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine whether healthcare workers, the environment, or admitted patients could be a reservoir for MRSA on a burn trauma unit (BTU). We also assessed risk factors for MRSA colonization among BTU patients. Design. Prospective cohort study and surveillance for MRSA carriage. Setting. BTU of a Midwestern academic medical center. Patients and Participants. Patients admitted to a BTU from February 2009 through January 2010 and healthcare workers on this unit during the same time period. Methods. Samples for MRSA culture were collected on admission from the nares and wounds of all BTU patients. We also had collected culture samples from the throat, axilla, antecubital fossa, groin, and perianal area of 12 patients per month. Samples collected from healthcare workers’ nares and from environmental sites were cultured quarterly. MRSA isolates were typed by pulsed-field gel electrophoresis. Results. Of 144 patients, 24 (17%) carried MRSA in their nares on admission. Male sex (odds ratio [OR], 5.51; 95% confidence interval [95% CI], 1.25–24.30), admission for necrotizing fasciitis (OR, 7.66; 95% CI, 1.64–35.81), and MRSA colonization of a site other than the nares (OR, 23.40; 95% CI, 6.93–79.01) were independent predictors of MRSA nasal carriage. Cultures of samples collected from 4 healthcare workers and 4 environmental cultures had positive results. Two patients were colonized with strains that were indistinguishable from strains collected from a healthcare worker or the environment. Conclusions. Patients were a major reservoir for MRSA. Infection control efforts should focus on preventing transmission of MRSA from patients who are MRSA carriers to other patients on the unit.

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Needlestick Injuries among Employees at a Nationwide Retail Pharmacy Chain, 2000–2011

Abstract:
We reviewed a nationwide retail pharmacy chain’s centralized needlestick injury reports. From 2000 to 2011, 33 needlestick injuries were reported by 31 different pharmacy locations and were likely preventable. The annual incidence of needlestick injuries ranged from 0 to 3.62 per 100,000 vaccinations and ranged from 0 to 5.65 per 1,000 immunizing pharmacists

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第三篇：
Contribution of a Winged Phlebotomy Device Design to Blood Splatter


Abstract:
Background. Despite a proliferation of phlebotomy devices with engineered sharps injury protection (ESIP), the impact of various winged device designs on blood splatter occurring during venipuncture procedures has not been explored. Objectives. To evaluate the potential for blood splatter of 6 designs of winged phlebotomy devices. Design. A laboratory-based device evaluation without human subjects, using a simulated patient venous system. Methods. We evaluated 18 winged phlebotomy devices of 6 device designs by Terumo, BD Vacutainer (2 designs), Greiner, Smith Medical, and Kendall (designated A-F, respectively). Scientific filters were positioned around the devices and weighed before and after venipuncture was performed. Visible blood on filters, exam gloves, and devices and measurable blood splatter were the primary units of analysis. Results. The percentages of devices and gloves with visible blood on them and filters with measurable blood splatter ranged from 0% to 20%. There was a statistically significant association between device design and visible blood on devices ( ) and between device design and filters with measurable blood splatter ( ), but not between device design and visible blood on gloves. A wide range of associations were demonstrated between device design and visible blood on gloves or devices and incidence of blood splatter. Conclusions. The results of this evaluation suggest that winged phlebotomy devices with ESIP may produce blood splatter during venipuncture. Reinforcing the importance of eye protection and developing a methodology to assess ocular exposure to blood splatter are major implications for healthcare personnel who use these devices. Future studies should focus on evaluating different designs of intravascular devices (intravenous catheters, other phlebotomy devices) for blood splatter.

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第四篇：Burden of Clostridium difficile Infection in Long-Term Care Facilities in Monroe County, New York

Fri, 05 Oct 2012 21:15:14 -0400

Abstract:
Background. Long-term care facility (LTCF) residents are at increased risk of Clostridium difficile infection (CDI). However, little is known about the incidence, recurrence, and severity of CDI in LTCFs or the extent to which acute care exposure contributes to CDI in LTCFs. We describe the epidemiology of CDI in a cohort of LTCF residents in Monroe County, New York, where recent estimates suggest a CDI incidence in hospitals of 9.2 cases per 10,000 patient-days. Design. Population-based surveillance study. Setting. Monroe County, New York. Patients. LTCF residents with onset of CDI while in the LTCF or less than 4 calendar-days after hospital admission from the LTCF from January 1 through December 31, 2010. Methods. We conducted surveillance for CDI in residents of 33 LTCFs. A CDI case was defined as a stool specimen positive for C. difficile obtained from a patient without a C. difficile–positive specimen in the previous 8 weeks; recurrence was defined as a stool specimen positive for C. difficile obtained between 2 and 8 weeks after the last C. difficile–positive stool specimen. Results. There were 425 LTCF-onset cases and 184 recurrences, which yielded an incidence of 2.3 cases per 10,000 resident-days (interquartile range [IQR], 1.2–3.3) and a recurrence rate of 1.0 case per 10,000 resident-days (IQR, 0.3–1.4). The cases occurred in 394 LTCF residents, and 52% of these residents developed CDI within 4 weeks after hospital discharge. Hospitalization for CDI occurred in 70 cases (16%). Of those cases that involved hospitalization for CDI, 70% were severe CDI, and 23% ended in death within 30 days after hospital admission. Conclusion. CDI incidence in Monroe County LTCFs is one-fourth the incidence among hospitalized patients. Approximately 50% of LTCF-onset cases occurred more than 4 weeks after hospital discharge, which emphasizes that prevention of CDI transmission should go beyond acute care settings.

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第五章和第六章：
Assessing Sensitivity and Specificity in New Diagnostic Tests: The Importance and Challenges of Study Populations
Assessing Sensitivity and Specificity in New Diagnostic Tests: The Importance and Challenges of Study Populations
Paula Strassle, BS; Aaron S. Hess, BS; Kerri A. Thom, MD, MS; Anthony D. Harris, MD, MPH
Infection Control and Hospital Epidemiology
Vol. 33, No. 11 (November 2012), pp. 1177-1178
(article consists of 2 pages)
Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America
DOI: 10.1086/668036
Stable URL: http://www.jstor.org/stable/10.1086/668036