HENRY BENEDA - Academia.edu (original) (raw)

Papers by HENRY BENEDA

Dimensions of Critical Care Nursing, 1999

American Journal of Infection Control, 2007

Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the ... more Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the profile of C difficile infections. Historically, C difficile disease was thought of mainly as a nosocomial disease associated with broad-spectrum antibiotics, and the disease was usually not life threatening. The emergence of an epidemic strain, BI/NAP1/027, which produces a binary toxin in addition to the 2 classic C difficile toxins A and B and is resistant to some fluoroquinolones, was associated with large numbers of cases with high rates of mortality. Recently, C difficile has been reported more frequently in nonhospital-based settings, such as community-acquired cases. The C difficile disease is also being reported in populations once considered of low risk (children and young healthy women). In addition, poor response to metronidazole treatment is increasing. Faced with an increasing incidence of C difficile infections and the changing profile of patients who become infected, this paper will reexamine the current concepts on the epidemiology and treatment of C difficile-associated disease, present new hypotheses for risk factors, examine the role of spores in the transmission of C difficile, and provide recommendations that may enhance infection control practices.

American Journal of Infection Control, 2005

American Journal of Infection Control, 2005

BACKGROUND: Diminishing healthcare dollars led our healthcare system to evaluate the effectivenes... more BACKGROUND: Diminishing healthcare dollars led our healthcare system to evaluate the effectiveness of providing multiple training methods for nine mandatory annual reviews (MAR), including infection control (IC) and bloodborne pathogens (BBP). Training options included lectures (L), self-paced posters with test (PWT), self-paced posters without tests (PWOT), and computer-based (Web). A study was conducted to determine which method led to better retention in each MAR by occupation. plans, and other risk-reduction strategies. Infection control electronic mail and Website information are two tools for rapid and uniform communication to healthcare providers and professionals. PROJECT: In February 2004, the infection control staff developed two linked tools for rapid communication: a prior, internal, health system infection control Web page with policies, procedures, and external resource links, plus a new electronic mail alert system titled ''infection control risk reduction strategies'' (RR-Strategies). RR-Strategies are scheduled timely topics, twice monthly linked to the internal infection control Website with four objectives: 1) alerts for early recognition of community infections, 2) prevention of healthcare-associated infections, 3) links to the Centers for Disease Control and Prevention and external resources, 4) reminders to report health system-associated infections through telephone numbers and electronic links to the infection control staff. RESULTS: RR-Strategies for hand hygiene, exposure control plans, and isolation were linked to the internal Website and increased utilization nearly 20-fold from a baseline of 53 to 999 hits per quarter. The timely RR-Strategies for pertussis and influenza also increased the number of requests for infection control staff assistance. LESSONS LEARNED: Bimonthly electronic infection control ''risk reduction strategies'' enhanced electronic and two-way communication with the medical center staff. Effective electronic RR-Strategies should be timely, crafted for ease of use by providers, and summarized with resource links for additional professional information. Linkage to the health system infection control Website provides uniform communication of policies and procedures. Electronic communication must provide value added information to assist healthcare professionals with limited time to search for infection control information.

American Journal of Infection Control, 2004

positive environmental and staff cultures and was compared to the PFGE done on the patients. In M... more positive environmental and staff cultures and was compared to the PFGE done on the patients. In May 2003, an additional intervention was initiated: changing in-line suction catheters every 24 hours instead of three times/ week. RESULTS: Forty percent (40%) of patient isolates and 27% of EC grew Pseudomonas spp., and 7% of the HC grew Pseudomonas. All patient isolates, HC, and EC were unique. One HC isolate matched one infant and another matched a second infant's isolate. Although we saw intermittent cases after May 2003, our PAI decreased from 29 in 2002 to 13 in 2003 (55%). Our incidence rate of PAI from endotracheal/nasal suction decreased from 2.4 per 1000 patient days in 2002, to 0.7 in 2003. This is less than our pre-outbreak rate of 1.05.

Clinical Infectious Diseases, 2007

Background. Prompted by the changing profile of Clostridium difficile infection and the impact of... more Background. Prompted by the changing profile of Clostridium difficile infection and the impact of formulary policies in hospitals, we performed this study when an increase in the incidence of C. difficile-associated disease was noted at our health care center (Veterans Administration Puget Sound Health Care System, Seattle, Washington). Methods. A retrospective, matched case-control study of patients presenting to the Veterans Administration Puget Sound Health Care System, Seattle, Washington during 2004 was performed. Conditional logistic analysis determined risk factors for case patients, defined as individuals with diarrhea and test results (i.e., culture or toxin assay results) positive for C. difficile, and control subjects, defined as individuals with diarrhea and test results negative for C. difficile. Results. C. difficile-associated disease incidence was 29.2 cases per 10,000 inpatient-days. The increase in the incidence of C. difficile-associated diarrhea that paralleled increased gatifloxacin use was not attributable to use of the antimicrobial but was a reflection of seasonal variation in the rate of C. difficile-associated disease. Multivariate analysis controlling for the time at which the assay was performed, the age of the patient, ward, and source of acquisition (community-acquired vs. nosocomial disease) found 6 significant risk factors for C. difficile-associated diarrhea: receipt of clindamycin (adjusted odds ratio [aOR], 29.9; 95% confidence interval [

Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the ... more Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the profile of C difficile infections. Historically, C difficile disease was thought of mainly as a nosocomial disease associated with broad-spectrum antibiotics, and the disease was usually not life threatening. The emergence of an epidemic strain, BI/NAP1/027, which produces a binary toxin in addition to the 2 classic C difficile toxins A and B and is resistant to some fluoroquinolones, was associated with large numbers of cases with high rates of mortality. Recently, C difficile has been reported more frequently in nonhospital-based settings, such as community-acquired cases. The C difficile disease is also being reported in populations once considered of low risk (children and young healthy women). In addition, poor response to metronidazole treatment is increasing. Faced with an increasing incidence of C difficile infections and the changing profile of patients who become infected, this paper will reexamine the current concepts on the epidemiology and treatment of C difficile-associated disease, present new hypotheses for risk factors, examine the role of spores in the transmission of C difficile, and provide recommendations that may enhance infection control practices. (Am J Infect Control 2007;35:237-53.) Recent events have refocused attention on Clos-tridium difficile infections and caused the medical community to reevaluate its assumptions about the virulence, known risk factors, and possible modes of transmission of this important health care-associated pathogen. Clostridium difficile-associated disease (CDAD) is traditionally thought of as a nosocomial pathogen that may cause limited, small outbreaks. The pathogen-esis of CDAD involves a triad of factors: (1) disruption of normal intestinal flora (usually by broad-spectrum antibiotics), (2) exposure to C difficile (usually during hospitalization), and (3) host factors (comorbidity and advanced age or impaired immune status). The CDAD is not a trivial disease because C difficile may have life-threatening complications, such as ileal perforation , 1 fulminant colitis, 2 toxic megacolon, 3 or brain empyema. 4 Clostridium difficile-associated disease has also been shown to extend hospital stays a mean of 4 to 14 days, 5-7 increase the risk of other nosocomial infections , 8 and increase health care costs. 5-7,9,10 The estimated cost of health care associated with CDAD is $1.1 billion/year in the United States. 7,11 Although most patients with an initial episode of CDAD respond well to either metronidazole or vancomycin, 20% develop recurrent episodes of CDAD that occur episodically over years, despite repeated antibiotic treatments. 9 After more than 20 years of research and experience with C difficile, health care providers became complacent that methods of transmission, risk factors, effective infection control practices, and effective therapies were well understood. However, the incidence of CDAD continues to rise despite continued focus on methods to reduce the number of hospital cases, to eradicate the spores of C difficile from the environment, and to find effective strategies for treating patients with recurrent CDAD. In 2002, hospitals in Quebec, Canada, reported outbreaks of high numbers of cases of serious CDAD infections that were health care associated and had a high mortality rate. These outbreaks challenged practitioners to reevaluate diagnosis, treatment, and infection control strategies in light of the changing profile of CDAD. The purpose of this paper is to summarize and integrate these new findings into our understanding of CDAD and to discuss how these new data should influence infection control practices.

Dimensions of Critical Care Nursing, 1999

American Journal of Infection Control, 2007

Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the ... more Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the profile of C difficile infections. Historically, C difficile disease was thought of mainly as a nosocomial disease associated with broad-spectrum antibiotics, and the disease was usually not life threatening. The emergence of an epidemic strain, BI/NAP1/027, which produces a binary toxin in addition to the 2 classic C difficile toxins A and B and is resistant to some fluoroquinolones, was associated with large numbers of cases with high rates of mortality. Recently, C difficile has been reported more frequently in nonhospital-based settings, such as community-acquired cases. The C difficile disease is also being reported in populations once considered of low risk (children and young healthy women). In addition, poor response to metronidazole treatment is increasing. Faced with an increasing incidence of C difficile infections and the changing profile of patients who become infected, this paper will reexamine the current concepts on the epidemiology and treatment of C difficile-associated disease, present new hypotheses for risk factors, examine the role of spores in the transmission of C difficile, and provide recommendations that may enhance infection control practices.

American Journal of Infection Control, 2005

American Journal of Infection Control, 2005

BACKGROUND: Diminishing healthcare dollars led our healthcare system to evaluate the effectivenes... more BACKGROUND: Diminishing healthcare dollars led our healthcare system to evaluate the effectiveness of providing multiple training methods for nine mandatory annual reviews (MAR), including infection control (IC) and bloodborne pathogens (BBP). Training options included lectures (L), self-paced posters with test (PWT), self-paced posters without tests (PWOT), and computer-based (Web). A study was conducted to determine which method led to better retention in each MAR by occupation. plans, and other risk-reduction strategies. Infection control electronic mail and Website information are two tools for rapid and uniform communication to healthcare providers and professionals. PROJECT: In February 2004, the infection control staff developed two linked tools for rapid communication: a prior, internal, health system infection control Web page with policies, procedures, and external resource links, plus a new electronic mail alert system titled ''infection control risk reduction strategies'' (RR-Strategies). RR-Strategies are scheduled timely topics, twice monthly linked to the internal infection control Website with four objectives: 1) alerts for early recognition of community infections, 2) prevention of healthcare-associated infections, 3) links to the Centers for Disease Control and Prevention and external resources, 4) reminders to report health system-associated infections through telephone numbers and electronic links to the infection control staff. RESULTS: RR-Strategies for hand hygiene, exposure control plans, and isolation were linked to the internal Website and increased utilization nearly 20-fold from a baseline of 53 to 999 hits per quarter. The timely RR-Strategies for pertussis and influenza also increased the number of requests for infection control staff assistance. LESSONS LEARNED: Bimonthly electronic infection control ''risk reduction strategies'' enhanced electronic and two-way communication with the medical center staff. Effective electronic RR-Strategies should be timely, crafted for ease of use by providers, and summarized with resource links for additional professional information. Linkage to the health system infection control Website provides uniform communication of policies and procedures. Electronic communication must provide value added information to assist healthcare professionals with limited time to search for infection control information.

American Journal of Infection Control, 2004

positive environmental and staff cultures and was compared to the PFGE done on the patients. In M... more positive environmental and staff cultures and was compared to the PFGE done on the patients. In May 2003, an additional intervention was initiated: changing in-line suction catheters every 24 hours instead of three times/ week. RESULTS: Forty percent (40%) of patient isolates and 27% of EC grew Pseudomonas spp., and 7% of the HC grew Pseudomonas. All patient isolates, HC, and EC were unique. One HC isolate matched one infant and another matched a second infant's isolate. Although we saw intermittent cases after May 2003, our PAI decreased from 29 in 2002 to 13 in 2003 (55%). Our incidence rate of PAI from endotracheal/nasal suction decreased from 2.4 per 1000 patient days in 2002, to 0.7 in 2003. This is less than our pre-outbreak rate of 1.05.

Clinical Infectious Diseases, 2007

Background. Prompted by the changing profile of Clostridium difficile infection and the impact of... more Background. Prompted by the changing profile of Clostridium difficile infection and the impact of formulary policies in hospitals, we performed this study when an increase in the incidence of C. difficile-associated disease was noted at our health care center (Veterans Administration Puget Sound Health Care System, Seattle, Washington). Methods. A retrospective, matched case-control study of patients presenting to the Veterans Administration Puget Sound Health Care System, Seattle, Washington during 2004 was performed. Conditional logistic analysis determined risk factors for case patients, defined as individuals with diarrhea and test results (i.e., culture or toxin assay results) positive for C. difficile, and control subjects, defined as individuals with diarrhea and test results negative for C. difficile. Results. C. difficile-associated disease incidence was 29.2 cases per 10,000 inpatient-days. The increase in the incidence of C. difficile-associated diarrhea that paralleled increased gatifloxacin use was not attributable to use of the antimicrobial but was a reflection of seasonal variation in the rate of C. difficile-associated disease. Multivariate analysis controlling for the time at which the assay was performed, the age of the patient, ward, and source of acquisition (community-acquired vs. nosocomial disease) found 6 significant risk factors for C. difficile-associated diarrhea: receipt of clindamycin (adjusted odds ratio [aOR], 29.9; 95% confidence interval [

Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the ... more Recent reported outbreaks of Clostridium difficile-associated disease in Canada have changed the profile of C difficile infections. Historically, C difficile disease was thought of mainly as a nosocomial disease associated with broad-spectrum antibiotics, and the disease was usually not life threatening. The emergence of an epidemic strain, BI/NAP1/027, which produces a binary toxin in addition to the 2 classic C difficile toxins A and B and is resistant to some fluoroquinolones, was associated with large numbers of cases with high rates of mortality. Recently, C difficile has been reported more frequently in nonhospital-based settings, such as community-acquired cases. The C difficile disease is also being reported in populations once considered of low risk (children and young healthy women). In addition, poor response to metronidazole treatment is increasing. Faced with an increasing incidence of C difficile infections and the changing profile of patients who become infected, this paper will reexamine the current concepts on the epidemiology and treatment of C difficile-associated disease, present new hypotheses for risk factors, examine the role of spores in the transmission of C difficile, and provide recommendations that may enhance infection control practices. (Am J Infect Control 2007;35:237-53.) Recent events have refocused attention on Clos-tridium difficile infections and caused the medical community to reevaluate its assumptions about the virulence, known risk factors, and possible modes of transmission of this important health care-associated pathogen. Clostridium difficile-associated disease (CDAD) is traditionally thought of as a nosocomial pathogen that may cause limited, small outbreaks. The pathogen-esis of CDAD involves a triad of factors: (1) disruption of normal intestinal flora (usually by broad-spectrum antibiotics), (2) exposure to C difficile (usually during hospitalization), and (3) host factors (comorbidity and advanced age or impaired immune status). The CDAD is not a trivial disease because C difficile may have life-threatening complications, such as ileal perforation , 1 fulminant colitis, 2 toxic megacolon, 3 or brain empyema. 4 Clostridium difficile-associated disease has also been shown to extend hospital stays a mean of 4 to 14 days, 5-7 increase the risk of other nosocomial infections , 8 and increase health care costs. 5-7,9,10 The estimated cost of health care associated with CDAD is $1.1 billion/year in the United States. 7,11 Although most patients with an initial episode of CDAD respond well to either metronidazole or vancomycin, 20% develop recurrent episodes of CDAD that occur episodically over years, despite repeated antibiotic treatments. 9 After more than 20 years of research and experience with C difficile, health care providers became complacent that methods of transmission, risk factors, effective infection control practices, and effective therapies were well understood. However, the incidence of CDAD continues to rise despite continued focus on methods to reduce the number of hospital cases, to eradicate the spores of C difficile from the environment, and to find effective strategies for treating patients with recurrent CDAD. In 2002, hospitals in Quebec, Canada, reported outbreaks of high numbers of cases of serious CDAD infections that were health care associated and had a high mortality rate. These outbreaks challenged practitioners to reevaluate diagnosis, treatment, and infection control strategies in light of the changing profile of CDAD. The purpose of this paper is to summarize and integrate these new findings into our understanding of CDAD and to discuss how these new data should influence infection control practices.