Challenges in Outbreak Investigations in Intensive Care Units

  • Belinda E. Ostrowky
  • William R. Jarvis


Patients hospitalized in intensive care units (ICUs) are at high risk of developing nosocomial infections. This is a result of severity of the patient’s illness and exposure to life-saving invasive devices and procedures. Each year, multiple hospital ICUs experience increases in nosocomial infections that represent an increase in the incidence over expected rates (i.e., nosocomial outbreaks). This chapter will review selected outbreaks affecting ICU populations (organized by pathogen/agent), approaches for investigating and controlling outbreaks in ICU populations, and special issues associated with outbreaks in ICU populations.


Intensive Care Unit Nosocomial Infection Neonatal Intensive Care Unit Pediatric Intensive Care Unit Bloodstream Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Beck-Sague C, Jarvis W, Martone W. Outbreak investigations. Infect Control Hosp Epidemiol 18:138, 1997.PubMedCrossRefGoogle Scholar
  2. 2.
    Stamm W, Weinstein R, Dixon R. Comparison of endemic and epidemic nosocomial infections. Am J Med 70:393, 1981.PubMedCrossRefGoogle Scholar
  3. 3.
    Edgeworth J, Treacher D, Eykyn. A 25-year study of nosocomial bacteremia in an adult intensive care unit. Crit Care Med 27:1421, 1999.PubMedCrossRefGoogle Scholar
  4. 4.
    Wenzel R, Thompson R, Landry S, Russell B, Miller P, et al. Hospital-acquired infections in intensive care unit patients: An overview with emphasis on epidemics. Infection Control 4:371, 1983.PubMedGoogle Scholar
  5. 5.
    Jarvis W. Nosocomial outbreaks: The Centers for Disease Control’s Hospital Infections Program Experience, 1980-1990. Am J Med 91(suppl 3B):101S, 1991.PubMedCrossRefGoogle Scholar
  6. 6.
    Centers for Disease Control. CDC definitions for nosocomial infections. Am J Infection Control 16:128, 1988.CrossRefGoogle Scholar
  7. 7.
    Tafuro P, Ristuccia P. Recognition and control of outbreaks of nosocomial infections in the intensive care setting. Heart and Lung 13:486, 1984.PubMedGoogle Scholar
  8. 8.
    Martone W, Gaynes R, Horan T, Emori T, Jarvis W, et al. Nosocomial infection rates for interhospital comparison: Limitations and possible solutions. Infect Control Hosp Epidemiol 12:609, 1991.CrossRefGoogle Scholar
  9. 9.
    Bredenberg H, Manangan L, Jarvis W. Selected hospital infections program outbreak investigations, 1994–1998. Infect Control Today August:26, 1999.Google Scholar
  10. 10.
    Wang S, Tokars J, Blanchi ne P, Carson L, Arduino M, et al. Enterobacter cloacae bloodstream infections traced to contaminated human albumin. Clin Infect Dis 30:35, 2000.PubMedCrossRefGoogle Scholar
  11. 11.
    Richards C, Jarvis W. Lessons from recent nosocomial epidemics. Current Opin Infect Dis 12:327, 1999.CrossRefGoogle Scholar
  12. 12.
    Esteban J, Gadea I, Fernandez-Roblas R, Molleja A, Calvo R, et al. Pseudo-outbreak of Aeromonas hydophila isolates related to endoscopy. J Hosp Infect 41:313, 1999.PubMedCrossRefGoogle Scholar
  13. 13.
    Namnyak S, Hussain S, Davalle J, Roker K, Strickland M. Contaminated lithium heparin bottles as a source of pseudobacteraemia due to Pseudomonas flourescens. J Hosp Infect 41:23, 1999.PubMedCrossRefGoogle Scholar
  14. 14.
    Jarvis W, Edwards J, Culver D, Hughes J, Horan T, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 91(suppl 3B):185S, 1991.PubMedCrossRefGoogle Scholar
  15. 15.
    Centers for Disease Control. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1990–May 1999, Issued June 1999. Am J Infect Control 27:520, 1999.CrossRefGoogle Scholar
  16. 16.
    Maloney S, Jarvis W. Epidemic nosocomial pneumonia in the intensive care unit. Clinics Chest Med 16:209, 1995.Google Scholar
  17. 17.
    Widmer A, Wenzel R, Trilla A, Bale M, Jones R, Deobbeling B. Outbreak of Pseudomonas aeruginoas infections in a surgical intensive care unit: Probable transmission via hands of a health care worker. Clin Infect Dis 16:372, 1993.PubMedCrossRefGoogle Scholar
  18. 18.
    Conly J, Klass L, Larson L, Kennedy J, Low D, Harding G. Pseudomonas cepacia colonization and infection in intensive care units. Can Med Assoc J 134:363, 1986.Google Scholar
  19. 19.
    Pegues D, Arathoon E, Samayoa B, Del Valle G, Anderson R, Riddle C, et al. Epidemic gram-negative bacteremia in a neonatal intensive care unit in Guatemala, Am J Infect Control 22:163.Google Scholar
  20. 20.
    Archibald L, Corl A, Shah B, Schulte M, Arduino M, Aguero S, et al. Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap. Infect Control Hosp Epid 18:704, 1997.CrossRefGoogle Scholar
  21. 21.
    McDonald C, Banerjee S, Jarvis W, and the National Nosocomial Surveillance System. Seasonal variation of Acinetobacter infections: 1987–1996. Clin Infect Dis 29:1133, 1999.PubMedCrossRefGoogle Scholar
  22. 22.
    Contant J, Kemeny E, Oxley C, Perry E, Garber G. Investigation of an outbreak of Acinitobacter calcoaceceticus var. anitratus infections in an adult intensive care unit. Am J Infect Control 18: 288, 1990.PubMedCrossRefGoogle Scholar
  23. 23.
    McDonald L, Walker M, Carson L, Arduino M, Aguero S, et al. Outbreak of Acinetobacter spp. bloodstream infections in a nursery associated with contaminated aerosols and air conditioners. Pediatr Infect Dis J 17:716, 1998.PubMedCrossRefGoogle Scholar
  24. 24.
    Beck-Sague C, Jarvis W, Brook J, Culver D, Potts A, et al. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units. Am J Epid 132:723, 1990.Google Scholar
  25. 25.
    Chang H, Christenson J, Pavia A, Bobrin B, Bland L, et al. Ochrobactrum anthropi Meningitis in pediatric pericardial allograft transplant recipients. J Infect Dis 173:656, 1995.CrossRefGoogle Scholar
  26. 26.
    Alnor D, Frimodt-Meller N, Espersen F, Frederiksen W. Infections with the unusual human pathogen Agrobacterium species and Ochrbacterum anthropi. Clin Infect Dis 18:914, 1994.PubMedCrossRefGoogle Scholar
  27. 27.
    Wenger P, Tokars J, Brennan P, Samel C, Bland L, et al. An outbreak of Enterobacter hormachei infection and colonization in an intensive care nursery. Clin Infect Dis 24:1243, 1996.CrossRefGoogle Scholar
  28. 28.
    Archibald L, Ramos M, Arduino M, Aguero S, Deseda C, et al. Enterobacter cloacae and Pseudomonas aeruginosa polymicrobial bloodstream infections traced to extrinsic contamination of a dextrose multidose vial. J Ped 133:640, 1998.CrossRefGoogle Scholar
  29. 29.
    Rudnick J, Beck-Sague C, Anderson R, Schable B, Miller J, Jarvis W. Gram-negative bacteremia in open-heart-surgery patients traced to probable tap-water contamination of pressure. Infect Control Hosp Epid 17:281, 1996.CrossRefGoogle Scholar
  30. 30.
    Richards C, Alonso-Echanove J, Caicedo Y, Jarvis W. Klebsiella pneumoniae bloodstream infections and death in a high risk nursery in Cali, Colombia–1999. Oral presentation 39th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Abstract No 2088.Google Scholar
  31. 31.
    Parvez F, Roeshadi D, Irmawati L, Sidharta Y, Rosenthal S, et al. Investigation of Salmonella Serotype Worthington causing cellulities, sepsis, and death in a neonatal intensive care unit, Indonesia. Oral presentation 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, Abstract No S-M4-04 Atlanta, GA.Google Scholar
  32. 32.
    Toscano C, Pessoa da Silva C, Santos A, Falcao M, Campos E, et al. Nosocomial outbreak of multidrug-resistant Salmonella Infantis bacteremia in neonates. Oral presentation 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, Abstract No S-M4-05 Atlanta, GA, 2000.Google Scholar
  33. 33.
    Lannigan R, Hussain Z, Austin T. Streptococcus pyogenes as a cause of nosocomial infection in a critical care unit. Diag Microb & Infect Dis 3:337, 1985.CrossRefGoogle Scholar
  34. 34.
    Nicolle L, Hume K, Sims H, Rosenal T, Sandham D. An outbreak of group A streptococcal bacteremia in an intensive care unit. Infect Control 7:177, 1986.PubMedGoogle Scholar
  35. 35.
    Ribner B, Landry M, Kidd K, Peninger M, Riddick J. Outbreak of multiply restraint Staphylococcus aureus in a pediatric intensive care unit after consolidation with a surgical intensive care unit. Am J Infect Control 17:244, 1989.PubMedCrossRefGoogle Scholar
  36. 36.
    Guiguet M, Rekacewicz C, Leclercq B, Brun Y, Escudier B, Andremont A. Effectiveness of simple measures to control an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections in an intensive care unit. Infect Control Hosp Epid 11:23, 1990.CrossRefGoogle Scholar
  37. 37.
    Pijol M, Corbella X, Pena C, Pallarés R, Dorca J, et al. Clinical and epidemiological findings in mechanically-ventilated patients with methicillin-resistant Staphylococcus aureus pneumonia. Europ J Clin Microbiol Infect Dis 17:622, 1998.Google Scholar
  38. 38.
    Manhold C, von Rolbicki U, Brase R, Timm J, von Pritzbuer E, et al. Outbreak of Staphylococcus aureus infections during treatment of late onset pneumonia with ciprofloxacin in a prospective, randomized study. Intens Care Med 24:1327, 1998.CrossRefGoogle Scholar
  39. 39.
    Cotterill S, Evans R, Fraise A. An unusual source for an outbreak of methicillin-resistant Staphylococcus aureus on an intensive therapy unit. J Hosp Infect 32:207, 1995.CrossRefGoogle Scholar
  40. 40.
    Jernigan J, Titus M, Groeschel D, Getchell-White S, Farr B. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 143:596, 1996.CrossRefGoogle Scholar
  41. 41.
    Montecalvo M, Shay D, Patel P, Tacsa L, Maloney S, et al. Bloodstream infections with vancomycin-resistant enterococci. Arch Intern Med 156:1458, 1996.PubMedCrossRefGoogle Scholar
  42. 42.
    Shay D, Maloney S, Montecalvo M, Banerjee S, Wormser G, et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. JID 172:993, 1995.PubMedCrossRefGoogle Scholar
  43. 43.
    Slaughter S, Hayden M, Nathan C, Hu T, Rice T, Van Voorhis J, et al. A comparison of the effect of universal use of gloves and gowns with that glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 125:448, 1996.PubMedCrossRefGoogle Scholar
  44. 44.
    Karanfil L, Murphy M, Josephson A, et al. A cluster of vancomycin-resistant enterococci faecium in an intensive care unit. Infect Control Hosp Epid 13:195, 1992.CrossRefGoogle Scholar
  45. 45.
    Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance, recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 41:1, 1995.Google Scholar
  46. 46.
    Burnie J, Odds F, Lee W, Webster C, Williams J. Outbreak of systemic Candida albicans in intensive care unit caused by cross infection. Brit Med J Clin Res Ed 290:746, 1985.CrossRefGoogle Scholar
  47. 47.
    Voss A, Pfaller M, Hollis R, Rhine-Chalberg J, Doebbeling B. Investigation of Candida albicans transmission in a surgical intensive care unit cluster by using genomic DNA typing methods. J Clin Microbiol 33:576, 1995.PubMedGoogle Scholar
  48. 48.
    Pertowski C, Baron R, Lasker B, Werner S, Jarvis W. Nosocomial outbreak of Candida albicans sternal wound infections following cardiac surgery traced to a scrub nurse. J Infect Dis 172:817, 1995.PubMedCrossRefGoogle Scholar
  49. 49.
    Isenberg H, Tucci V, Cintron F, et al. Single source outbreak of Candida tropicalis complicating coronary bypass surgery. J Clin Microbiol 27:2426, 1989.PubMedGoogle Scholar
  50. 50.
    Humphreys H, Johnson E, War nock D, Willatts S, Winter R, Speller D. An outbreak of aspergillosis in a general ITU. J Hosp Infect 18:167, 1991.PubMedCrossRefGoogle Scholar
  51. 51.
    Lovett I, Houang E, Burge S, Turner-Warwick M, Thompson F, Harrison A, et al. An outbreak of Nocardia asteroids infection in a renal transplant unit. Quarterly J Med 50:123, 1981.Google Scholar
  52. 52.
    Centers for Disease Control and Prevention. Guideline for prevention of nosocomial pneumonia. Resp Care 39:1191, 1994.Google Scholar
  53. 53.
    Richet H, McNeil M, Edwards M, Jarvis W. Cluster of Malassezia furfur pulmonary infections in infants in a neonatal intensive care unit. J Clin Microbiol 27:1197, 1989.PubMedGoogle Scholar
  54. 54.
    Chang H, Miller H, Watkins N, Arduino M, Ashford D, et al. An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonization of health care workers’ pet dogs. New Eng J Med 338:706, 1998.PubMedCrossRefGoogle Scholar
  55. 55.
    Archer-Dubon C, Icaza-Chivez M, Orozco-Topete R, Reyes E, Baez-Martinez R, Ponce de Leon S. An epidemic outbreak of Malassezia folliculitis in three adult patients in an intensive care unit: a previously unrecognized nosocomial infection. Int J Derm 38:453, 1999.PubMedCrossRefGoogle Scholar
  56. 56.
    Hanna J, Loewenthal M, Negel P, Wenck D. An outbreak of Hepatitis A in an intensive care unit. Anaesth Intens Care 24:440, 1996.Google Scholar
  57. 57.
    Shanson D. Hepatitis B outbreak in operating-theatre and intensive care staff. Lancet 2:596, 1980.PubMedCrossRefGoogle Scholar
  58. 58.
    Adams G, Stover B, Keenlyside A, Hooton T, Buchman T, Roizman B, et al. Nosocomial herpetic infections in a pediatric intensive care unit. Am J Epid 113:126, 1981.Google Scholar
  59. 59.
    Gurevich I, Cunha B. Non-parenteral transmission of Cytomegalovirus in a neonatal intensive care unit. Lancet 2:222, 1981.PubMedCrossRefGoogle Scholar
  60. 60.
    Davies D, Hughes C, Mac Vicar J, Hawkes P, Mair H. Echovirus-11 infection in a special-care baby unit. Lancet 1:96, 1979.PubMedCrossRefGoogle Scholar
  61. 61.
    Nagington J, Wreghitt T, Gandy G, Roberston N, Berry P. Fatal echovirus 11 infections in outbreak in special-care baby unit. Lancet 2:725, 1978.PubMedCrossRefGoogle Scholar
  62. 62.
    Meibalane R, Sedmak G, Sasidharan P, Garg P, Grausz J. Outbreak of influenza in a neonatal intensive care unit. J Ped 91:974, 1977.CrossRefGoogle Scholar
  63. 63.
    Welliver RC, McLaughlin S. Unique epidemiology of nosocomial infection in a children’s hospital. Am J Dis Children 138:131, 1984.Google Scholar
  64. 64.
    Parvez F, Jarvis W. Nosocomial infections in the nursery. Sem Ped Infect Dis 10:119, 1999.CrossRefGoogle Scholar
  65. 65.
    Langley J, LeBlanc J, Wang E, Law B, MacDonald N, Mitchell I. Nosocomial Respiratory Syncytial Virus infection in Canadian pediatric hospitals: A pediatric investigators’ collaborative network on infections in Canada study. Pediat rics 100:943, 1997.PubMedCrossRefGoogle Scholar
  66. 66.
    Fixier D. Respiratory Syncytial Virus infection in children with congenital heart disease: a review. Pediatric Cardiology 17:163, 1996.CrossRefGoogle Scholar
  67. 67.
    Pohl C, Green M, Wald E, Ledesma-Medina J. Respiratory Syncytial Virus infections in pediatric liver transplant recipients. J Infect Dis 165:166, 1992.PubMedCrossRefGoogle Scholar
  68. 68.
    Wilson C, Stevenson D, Arvin A. A concurrent epidemic of Respiratory Syncytial Virus and Echovirus 7 infections in an intensive care nursery. Ped Infect Dis J 8:24, 1989.CrossRefGoogle Scholar
  69. 69.
    Karanfil L, Conlon M, Lykens K, Masters C, Forman M, et al. Reducing the rate of nosocomially transmitted Respiratory Syncytial Virus. Am J Infect Control 27:91, 1999.PubMedCrossRefGoogle Scholar
  70. 70.
    Guidry G, Black-Payne C, Payne D, Jamison R, George R, Bocchini J. Respiratory Syncytial Virus infection among intubated adults in a university medical intensive care unit. Chest 100:1377, 1991.PubMedCrossRefGoogle Scholar
  71. 71.
    Marton W, Williams W, Mortensen M, et al. Illness with fatalities in premature infants: Association with an intravenous vitamin E preparation, E-Ferol. Pediatrics 78:591, 1986.Google Scholar
  72. 72.
    Centers for Disease Control and Prevention. Guideline for prevention of intravascular device-related infections. Am J Infect Control 17:438, 1996.Google Scholar
  73. 73.
    Weinstein R, Stamm W, Kramer L, Corey L. Pressure monitoring devices: overlooked source of nosocomial infection. J Am Med Assoc 236:936, 1976.CrossRefGoogle Scholar
  74. 74.
    Hekker T, van Overhagen W, Schneider A. Pressure transducers: an overlooked source of sepsis in the intensive care unit. Intensive Care Med 16:511, 1990.PubMedCrossRefGoogle Scholar
  75. 75.
    Goldmann D, Martin W, Worthington J. Growth of bacteria and fungi in total parenteral nutrition solutions. Am J Surg 126:314, 1973.PubMedCrossRefGoogle Scholar
  76. 76.
    D’Angio R, Riechers K, Gilsford R, Constantino J. Effect of the mode of lipid administration on parenteral nutrition-related infections. Ann Pharmacother 26:14, 1992.PubMedGoogle Scholar
  77. 77.
    Reboli A, Koshinski R, Arias K, Marks-Austin K, Stieritz D, Stull T. An outbreak of Burk-holderia cepacia lower respiratory tract infection associated with contaminated Albuterol nebulization solution. Infect Control Hosp Epidemiol 17:741, 1996.PubMedCrossRefGoogle Scholar
  78. 78.
    Labarca J, Trick W, Peterson C, Carson L, Holt S, et al. A multistate nosocomial outbreak of Ralstonia pickettii colonization associated with an intrinsically contaminated respiratory care solution. Clin Infect Dis 29:1281, 1999.PubMedCrossRefGoogle Scholar
  79. 79.
    Agerton T, Valway S, Gore B, Pozsik C, Plikaytis B, Woodley C. Transmission of a highly drug resistant strain (Strain W1) of Mycobacterium tuberculosis: Community outbreak and nosocomial transmission via a contaminated bronchoscope. J Am Med Assoc 278:1073, 1997.CrossRefGoogle Scholar
  80. 80.
    Gubler J, Salinger M, von Graevenitz A. Pseudooutbreak of nontuberulous mycobacteria due to a contaminated bronchoscope cleaning machine. Report of an outbreak and review of the literature. Chest 1245, 1992.Google Scholar
  81. 81.
    Maloney S, Welbel S, Daves B, Adams K, Becker S, et al. Mycobacterium abscess us pseudoinfection traced to an automated endoscope washer: utility of epidemiologic and laboratory investigation. J Infect Dis 169:1166, 1994.PubMedCrossRefGoogle Scholar
  82. 82.
    Centers for Disease Control and Prevention. Bronscopy-related infections and pseudoinfections — New York, 1996 and 1998, 1999, MMWR 48:557, 1999.Google Scholar
  83. 83.
    Marrie T, MacDonald S, Clarke K, Haidane D. Nosocomial Legionnaireses’ diease: lessons from a four year prospective sudy. Am J Infect Control 19:79, 1991.PubMedCrossRefGoogle Scholar
  84. 84.
    Martone W, Jarvis W, Edwards J, Culver D, Haley R. Incidence and nature of endemic and epidemic nosocomial infections. Hospital Infections, Fourth Edition, 461, 1998.Google Scholar
  85. 85.
    Centers for Disease Control and Prevention. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control 11:28, 1983.CrossRefGoogle Scholar
  86. 86.
    Knaus W, Wagner D, Draper E, et al. The APACHE III prognostic system, risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619, 1991.PubMedCrossRefGoogle Scholar
  87. 87.
    Emori G, Culver D, Horan T, Jarvis W, White J, et al. National Nosocomial Infections Surveillance (NNIS) System: Description of surveillance methods. Am J Infect Control 19:19, 1991.PubMedCrossRefGoogle Scholar
  88. 88.
    CDC. Nosocomial infection rates for interhospital comparison: Limitation and possible solutions. Infect Control Hosp Epid 12:609, 1991.CrossRefGoogle Scholar
  89. 89.
    Gaynes R, Culver D, Banerjee S, Edwards J, Henderson T. Meaningful interhospital comparisons of infection rates in intensive care units. Am J Infect Control 21:43, 1993.PubMedCrossRefGoogle Scholar
  90. 90.
    Wenzel R, Osterman C, Donowitz L, Hoyt J, Sande M, et al. Identification of procedure-related nosocomial infections in high-risk patients. Rev Infect Dis 3:701, 1981.PubMedCrossRefGoogle Scholar
  91. 91.
    Gaynes R, Martone W, Culver D, Emori T, Horan T, et al. Comparison of rates of nosocomial infections in neonatal intensive care units in the United States. Am J Med 91(suppl 3B):192S, 1991.PubMedCrossRefGoogle Scholar
  92. 92.
    Kelsey M, Gosling M. A comparison of the morbidity associated with occlusive and non-occlusive dressings applied to peripheral intravenous devices. J Hosp Infect 5:313, 1984.PubMedCrossRefGoogle Scholar
  93. 93.
    Snydman D, Pober B, Murray S, Gorbea H, Majika J, Perry L. Predictive value of surveillance skin cultures in total-parenteral nutrition-related infection. Lancet 2:1385, 1982.PubMedCrossRefGoogle Scholar
  94. 94.
    Fridkin S, Pear S, Williamson T, Galgiani J, Jarvis W. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epid 17:150, 1996.CrossRefGoogle Scholar
  95. 95.
    Archibald L, Manning M, Bell L, Banerjee S, Jarvis W. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 16:1045, 1997.PubMedCrossRefGoogle Scholar
  96. 96.
    Roberts J, Fridkin S, Blumberg H, Anderson B, White N, et al. The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit. Infect Control Hosp Epid 21, 2000.Google Scholar
  97. 97.
    Mayhall C, Archer N, Lamb V, Spadora A, Baggett J, et al. Ventriculostomy-related infections: A prospective epidemiologic study. New Engl J Med 310:553, 1984.PubMedCrossRefGoogle Scholar
  98. 98.
    Trick W, Kioski C, Howard K, Cage G, Tokars J, Yen B, et al. Outbreak of Pseudomonas aeruginosa ventriculitis among patients in a neurosurgical intensive care unit. Infect Control Hosp Epid 21:204,2000.CrossRefGoogle Scholar
  99. 99.
    Bennett S, McNeil M, Bland L, Arduino M, Villarino M, et al. Postoperative infections traced to contamination of an intravenous anesthetic, Propofol. New Engl J Med 333:147, 1995.PubMedCrossRefGoogle Scholar
  100. 100.
    Burwen D, Banerjee S, Gaynes R. Ceftazidime resistance among selected nosocomial Gram-negative bacilli in the United States. J Infect Dis 170:1622, 1994.PubMedCrossRefGoogle Scholar
  101. 101.
    Brachman P. Epidemiology of nosocomial infections, Hospital Infection, 2nd edn. Boston, MA: Little, Brown and Co, 1986.Google Scholar
  102. 102.
    Goldmann D. Bacterial colonization and infection in the neonate. Am J Med 70:417, 1981.CrossRefGoogle Scholar
  103. 103.
    Jarvis W. The epidemiology of colonization. Infect Control Hosp Epid 17:47, 1994.CrossRefGoogle Scholar
  104. 104.
    Centers for Disease Control and Prevention. Guideline for handwashing and hospital environmental control. Am J Infect Control 14:110, 1986.CrossRefGoogle Scholar
  105. 105.
    Centers for Disease Control and Prevention. Guideline for isolation precautions in hospitals. Am J Infect Control 24:24, 1996.CrossRefGoogle Scholar
  106. 106.
    Centers for Disease Control and Prevention. Guideline for infection control in healthcare personnel. Am J Infect Control 26:289, 1998.CrossRefGoogle Scholar
  107. 107.
    Mangram A, Horan T, Pearson M, Silver L, Jarvis W. Guideline for prevention of surgical site infection. Infect Control and Hospital Epid 20:247, 1999.Google Scholar
  108. 108.
    Fridkin S, Welbel S, Weinstein R. Magnitude and prevention of nosocomial infections in the intensive care unit. Infect Dis Clinics North Am 1:479, 1997.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Belinda E. Ostrowky
  • William R. Jarvis

There are no affiliations available

Personalised recommendations