Genital herpes testing among persons living with HIV

This cross-sectional survey explored the frequency of genital herpes testing among 110 people living with HIV (PLWH) and reported barriers and facilitators related to testing. Forty-four percent of the respondents had not been tested for genital herpes since receiving an HIV diagnosis, 34% had been tested, and 22% preferred not to say. Respondents' most frequently cited factors affecting a decision to not be tested were: (a) testing not being recommended by a provider, (b) not having herpes symptoms, and (c) not thinking they had herpes. Data from this study indicated that PLWH were not frequently tested for genital herpes; there was a limited understanding of the frequently subclinical nature of infection; and provider recommendations for testing, or lack thereof, affected testing decisions.

Prevalence, risk factors, and molecular epidemiology of methicillin-resistant Staphylococcus aureus among newly arrested men in Baltimore, Maryland

BACKGROUND

Outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) within prison populations seemingly attest to its spread within the corrections industry; however, the extent of MRSA colonization on arrest is unknown.

METHODS

This study determined the prevalence and risk factors of S aureus on arrest. Nasal swabs from 602 newly arrested men were evaluated. Risk factors were assessed through self-report. Molecular characterization of each isolate was completed.

RESULTS

The prevalence of S aureus nasal colonization was 40.4% (243/602). MRSA colonization was found in 15.8% (95/602) of the total population and in 39.1% (95/243) of the total S aureus isolates. Twenty-three skin infections were identified; of these, 11 (47.8%) were S aureus infections, with methicillin-susceptible S aureus (MSSA) in accounting for 3 cases (13.1%) and MRSA accounting for 8 cases (34.8%). In 2 cases (25%) of MRSA wound infection, the nasal colonizing strain was MSSA. By pulsed-field gel electrophoresis, 76 of 95 (80%) nasal isolates were found to be USA300 or related subtypes, with the other 19 (20%) being non-USA300 strains. The Panton-Valentine leukocidin gene was identified in 38 (97.4%) USA300 isolates and in 6 (31.6%) non-USA 300 isolates.

CONCLUSION

MRSA colonization is far greater in this sample than in the general public. USA300 subtypes are highly prevalent. History of previous arrest was not associated with increased MRSA prevalence. MRSA risk factors differed significantly between those with and without a history of previous arrest.

Comparison of the BD GeneOhm methicillin-resistant Staphylococcus aureus (MRSA) PCR assay to culture by use of BBL CHROMagar MRSA for detection of MRSA in nasal surveillance cultures from an at-risk community population

We compared the BD GeneOhm methicillin-resistant Staphylococcus aureus (MRSA) PCR assay to culture with BBL CHROMagar MRSA for nasal surveillance among 602 arrestees from the Baltimore City Jail. The sensitivity and specificity were 88.5% and 91.0%, respectively, and after secondary analysis using enrichment broth, they were 89.0% and 91.7%, respectively. Twenty-three of 42 false-positive PCR lysates contained methicillin-susceptible S. aureus.

Epidemiology, clinical manifestations, and treatment options for skin and soft tissue infection caused by community-acquired methicillin-resistant Staphylococcus aureus

PURPOSE

This article reviews the evolving epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and the appropriate outpatient management of CA-MRSA skin and soft tissue infection. Further, the paper will provide the basis upon which an individualized patient educational plan may be developed.

DATA SOURCES

To complete this review, a search of English language publications was conducted through Medline and CINAHL databases (1966-2006).

CONCLUSIONS

The epidemiology of CA-MRSA is becoming increasingly complex. Research that addresses the impact of this organism in high-risk populations and within families is urgently needed.

IMPLICATIONS FOR PRACTICE

Nurse practitioners must remain informed of the epidemiology of common and emerging drug-resistant organisms in their patient populations.

Handheld computer surveillance: shoe-leather epidemiology in the "palm" of your hand

BACKGROUND

Although urinary tract infections (UTIs) are the most common nosocomial infection, active UTI surveillance is often not feasible for infection control departments.

METHODS

As part of an ongoing urinary catheter evaluation, we investigated the accuracy and cost-effectiveness of using handheld personal digital assistants (PDA) and computer-based UTI surveillance in comparison with traditional surveillance of UTIs among medical intensive care unit (MICU) patients. From September 22, 2000, to October 22, 2000, an infection control practitioner (ICP) actively surveyed all MICU patients who had a urinary catheter to determine criteria for a nosocomial UTI as defined by the Centers for Disease Control and Prevention (CDC). Research assistants visited the unit each day to determine which patients had urinary catheters, and this information was uploaded to a database designed for laboratory-based UTI surveillance. Patients with a urinary catheter were included if admitted to the MICU for >48 hours and excluded if symptoms developed <48 hours after admission.

RESULTS

Both data collection methods identified 8 UTIs within the 1-month period, with 3 UTIs meeting inclusion criteria. Traditional surveillance required 8 hours weekly, whereas the PDA-computer surveillance required 1-and-a-half hours weekly. Traditional surveillance correctly attributed all 3 UTIs to the MICU. The PDA-computer surveillance incorrectly attributed the location of 2 of the UTIs. In both cases, the UTI occurred less than 48 hours after the patient was transferred from the MICU.

CONCLUSION

Our data demonstrate that PDA surveillance detects nosocomial UTIs efficiently and is a novel, timesaving technique that realizes a cost savings in the first year.

Eliminating catheter-related bloodstream infections in the intensive care unit

OBJECTIVE

To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (CR-BSIs).

DESIGN

Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control ICU.

SETTING

The Johns Hopkins Hospital.

PATIENTS

All patients with a central venous catheter in the ICU.

INTERVENTION

To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed.

MEASUREMENT

The primary outcome variable was the rate of CR-BSIs per 1,000 catheter days from January 1, 1998, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion.

MAIN RESULTS

Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study ICU decreased from 11.3/1,000 catheter days in the first quarter of 1998 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and 1,945,922 dollars in additional costs per year in the study ICU.

CONCLUSIONS

Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.

Transitions in psychiatric inpatient clinical social work

As a group, psychiatric inpatient clinical social workers have been dramatically affected by the economic crisis in mental health. As they have attempted to cope with a myriad of changes, they also have become leaders in bringing change about. This article described the transition process as experienced by 27 social workers who were interviewed in a descriptive exploratory study. The study showed that inpatient social workers are struggling to create ways to meet increased workload demands and are questioning the effectiveness of short-term hospital treatment. Respondents reported personal and professional losses as well as challenges. They expressed considerable concern about the future of their profession because of pressure to compromise standards.

The e (P4) outer membrane protein of Haemophilus influenzae: biologic activity of anti-e serum and cloning and sequencing of the structural gene

Outer membrane proteins of nontypeable (NT) Haemophilus influenzae are among the major candidates for inclusion in vaccines against these organisms. This article reports the purification of the e (P4) lipoprotein of H. influenzae and the subsequent production of antiserum directed against this protein. The anti-e polyclonal serum cross-reacted with e protein in multiple clinical NT H. influenzae isolates. Monoclonal antibody analysis of e protein showed at least one surface-exposed epitope to be conserved among NT H. influenzae strains. Anti-e serum also had bactericidal activity against multiple clinical isolates of NT H. influenzae. These results are in contrast to previous reports in the literature that purified P4 protein did not elicit biologically active antibodies. Anti-e antibodies exhibited synergistic bactericidal activity directed against NT H. influenzae when mixed with antibodies directed against another Haemophilus lipoprotein, PCP. This bactericidal synergy was observed against a variety of NT clinical isolates. We also report the cloning of the Haemophilus e lipoprotein, or hel, gene encoding the e protein and its expression and processing in Escherichia coli. The nucleotide sequence of the gene and deduced amino acid sequence of the protein are given. These results demonstrate that e protein is a viable candidate to be a component of a vaccine against NT H. influenzae.

Responses of mental health professionals to lay-offs

In this study, 39 laid-off mental health professionals responded to a questionnaire that focused on the emotional stress of being laid off and the respondents' efforts to cope with the stress. In the early weeks after lay-off, shock, disbelief, anger, and sadness gave way to depression, anxiety, and feelings of being betrayed and discounted. Most respondents coped with these feelings by talking to others who were being laid off or by focusing their energies on seeking a new job. Many respondents felt that mismanagement of the lay-off process was a major factor in their emotional distress. The author makes recommendations for managing lay-offs based on the responses of the laid-off workers and the principles of crisis management. She also speculates about why most of the lay-offs were poorly managed.

Deduced amino acid sequences of class 1 protein (PorA) from three strains of Neisseria meningitidis. Synthetic peptides define the epitopes responsible for serosubtype specificity

The previously determined nucleotide sequence of the porA gene, encoding the class 1 outer membrane protein of meningococcal strain MC50, has been used to clone and sequence the porA gene from two further strains with differing serosubtype specificities. Comparison of the predicted amino acid sequences of the three class 1 proteins revealed considerable structural homology with major variation confined to two discrete regions (VR1 and VR2). The high degree of structural homology between the sequences gave predicted secondary structures that were almost identical, with the variable domains located in hydrophilic regions that are likely to be surface located and hence accessible to antibody binding. The predicted amino acid sequences have been used to define the epitopes recognized by mAbs with serosubtype specificity. A series of overlapping decapeptides spanning each of the class 1 protein sequences have been synthesized on solid-phase supports and probed with mAbs. Antibodies with P1.16 and P1.15 subtype specificity reacted with sequences in the VR2 domain, while antibodies with P1.7 subtype specificity reacted with sequences in the VR1 domain. Further peptides have been constructed to define the minimum epitopes recognized by each antibody. Thus we have been able to define linear peptides on each class 1 protein molecule that are responsible for subtype specificity and that represent targets for a protective immune response.

Cloning of genes encoding a 15,000-dalton peptidoglycan-associated outer membrane lipoprotein and an antigenically related 15,000-dalton protein from Haemophilus influenzae

We have cloned and expressed in Escherichia coli a gene encoding a 15,000-apparent-molecular-weight peptidoglycan-associated outer membrane lipoprotein (PAL) of Haemophilus influenzae. The nucleotide sequence of this gene encodes an open reading frame of 153 codons with a predicted mature protein of 134 amino acids. The amino acid composition and sequence of the predicted mature protein agree with the chemically determined composition and partial amino acid sequence of PAL purified from H. influenzae outer membranes. We have also identified a second gene from H. influenzae that encodes a second 15,000-apparent-molecular-weight protein which is recognized by antiserum against PAL. This protein has been shown to be a lipoprotein. The nucleotide sequence of this gene encodes an open reading frame of 154 codons with a predicted mature protein of 136 amino acids and has limited sequence homology with that of the gene encoding PAL. Southern hybridization analysis indicates that both genes exist as single copies in H. influenzae chromosomal DNA. Both genes encode polypeptides which have amino-terminal sequences similar to those of reported membrane signal peptides and are associated primarily with the outer membrane when expressed in E. coli.