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Guideline for Prevention of Nosocomial Pneumonia

Published online by Cambridge University Press:  02 January 2015

Ofelia C. Tablan ,
Larry J. Anderson ,
Nancy H. Arden ,
Robert P. Breiman ,
Jay C. Butler ,
Michael M. McNeil  and
The Hospital Infection Control Practices Advisory Committee
Ofelia C. Tablan*
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Larry J. Anderson
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Nancy H. Arden
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Robert P. Breiman
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Jay C. Butler
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Michael M. McNeil
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
The Hospital Infection Control Practices Advisory Committee
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital infections Program, NCID, Centers for Disease Control and Prevention, MailstopA07, Atlanta, GA 30333.
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Extract

This Z-part document updates and replaces the previously published Centers for Disease Control and Prevention Guideline for Prevention of Nosocomial Pneumonia (Infect Control 1982;3:327-33, Respir Care 1983;28:221-32, and Am J Infect Control 1983;11:230-44). The revised guideline is designed to reduce the incidence of nosocomial pneumonia and intended for use by personnel who are responsible for surveillance and control of infections in acute-care hospitals. The guideline may not be applicable in long-term care facilities because of the unique characteristics of these settings.

The revised guideline addresses common problems encountered by infection control practitioners regarding the prevention and control of nosocomial pneumonia in U.S. hospitals. Sections on the prevention of bacterial pneumonia in tnechanically ventilated and/or critically ill patients, care of respiratory-therapy devices, prevention of cross-contamination, and prevention of viral lower respiratory tract infections, such as respiratory syncytial virus (RSV) and influenza infections, have been expanded and updated. New sections on Legionnaires' disease and pneumonia due to Aspergillus spp. have been added. Lower respiratory tract infection due to Mycobacterium tuberculosis is not addressed in this document: it is covered in separate guidelines.

Type
Special Report
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 9 , September 1994 , pp. 588 - 627
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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References

1. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of tuberculosis in health-care facilities, second edition. MMWR. In press.Google Scholar
2. Horan, TC, White, JW, Jarvis, WR, et al. Nosocomial infection surveillance, 1984. MMWR 1986;35:17SS–29SS.Google Scholar
3. Schaberg, DR, Culver, DH, Gaynes, RR Major trends in the microbial etiology of nosocomial infection. Am J Med 1991;91(suppl 3B):72S–75S.CrossRefGoogle ScholarPubMed
4. Bartlett, JG, O'Keefe, P, Tally, FP, et al. Bacteriology of hospital-acquired pneumonia. Arch Intern Med 1986;146:868–871.Google Scholar
5. Fagon, JY, Chastre, J, Domart, Y, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 1989;139:877–884.CrossRefGoogle ScholarPubMed
6. Torres, A, Aznar, R, Gatell, JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523–528.Google Scholar
7. Chastre, J, Fagon, JY, Soler, P, et al. Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation: comparison of the usefulness of bron-choalveolar lavage and the protected specimen brush. Am J Med 1988;85:499–506.CrossRefGoogle Scholar
8. Fagon, J. Chastre, J. Hance, AJ. et al. Detection of nosocomial lung infection in ventilated patients: use of a protected specimen brush and quantitative culture technique in 147 patients. Am Rev Respir Dis 1988;138:110–116.Google Scholar
9. Chastre, J, Via”, F, Brun, P, et al. Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients. Am Rev Respir Dis 1984;130:924–929.Google Scholar
10. Rello, J, Quintana, E, Ausina, V, et al. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest 1991;100:439–444.Google Scholar
11. Jimenez, F ! Torres, A, Rodriguez-Riosin, R. et al. Incidence and etiology of pneumonia acquired during mechanical ventilation. Crit Care Med 1989;17:882–885.CrossRefGoogle ScholarPubMed
12. Pugin, J, Auckenthaler, R, Mili, N, Janssens, JP Lew, PD, Suter, PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic blind bronchoalveolar lavage fluid. Am Rev Respir Dis 1991;143:1121–1129.Google Scholar
13. Torres, A, De La Bellacasa, JP Rodriguez-Riosin, R, De Anta, MT Agusti-Vidal, A. Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the metras catheter. Am Rev Respir Dis 1988;138:117–120.CrossRefGoogle ScholarPubMed
14. Meduri, GU. Reals, DH, Meijub, AG, Baselski, V. Protected bronchoalveolar lavage: a new bronchoscopic technique to retrieve uncontaminated distal airway secretions. Am Rev Respir Dis 1991;143:855–864.CrossRefGoogle ScholarPubMed
15. De Castro, FR, Violan, JS, Capuz, BL Luna, JC. Rodriguez, BG, Alonso, JIM Reliability of bronchoscopic protected catheter brush in the diagnosis of pneumonia in mechanically ventilated patients. Crit Care Med 1991;19:171–175.CrossRefGoogle Scholar
16. Davidson, M, Tempest, B, Palmer, DL. Bacteriologic diagnosis of acute pneumonia. JAMA 1976;235:158–163.CrossRefGoogle ScholarPubMed
17. Fagon, JY. Chastre, J, Hance, AJ Montravers, P Novara, A, Gilbert, C. Nosocomial in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.Google Scholar
18. Higuchi, JH, Coalson, JJ. Johanson, WG Jr. Bacteriologic diagnosis of nosocomial pneumonia in primates: usefulness of the protected specimen brush. Am Rev Respir Dis 1982;125:53–57.Google Scholar
19. Bryan, CS, Reynolds, KL. Bacteremic nosocomial pneumonia: analysis of 172 episodes from a single metropolitan area. Am Rev Respir Dis 1984;129:668–671.CrossRefGoogle ScholarPubMed
20. Espersen, F, Gabrielsen, J. Pneumonia due to Staphylococcus aureus during mechanical ventilation. J Infect Dis 1981; 144:19–23.Google Scholar
21. Inglis, TJJ, Sproat, IJ, Hawkey, PM, Gibson, JS. Staphylococcal pneumonia in ventilated patients: a twelve month review of cases in an intensive care unit. J Hosp Infect 1993;25:207–210.CrossRefGoogle Scholar
22. Reusser, R Zimmerli, W, Scheidegger, D, Marbet, GA, Buser, M. Gyr, K. Role of gastric colonization in nosocomial infections and endotoxemia; a prospective study in neurosurgical patients on mechanical ventilation. J Infect Dis 1989;160:414–421.Google Scholar
23. Johanson, WG Jr, Pierce, AK, Sanford, JR et al. Nosocomial respiratory infections with gram-negative bacilli: the significance of colonization of the respiratory tract. Ann Intern Med 1972;77:701–706.CrossRefGoogle ScholarPubMed
24. Berger, R. Arango, L. Etiologie diagnosis of bacterial nosocomial pneumonia in seriously ill patients. Crit Care Med 1985;13:833–836.CrossRefGoogle Scholar
25. Andrew, CR Coalson, JJ. Smith, JD, et al. Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury. Chest 1981;80:254–258.Google Scholar
26. Salata, RA, Lederman, MM, Shlaes, DM, et al. Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. Am Rev Respir Dis 1987;136:426–432.CrossRefGoogle Scholar
27. Pham, LH, Brun-Buisson, C, Legrand, R et al. Diagnosis of nosocomial pneumonia in mechanically ventilated patients: comparison of a plugged telescoping catheter with the protected specimen brush. Rev Respir Dis 1991;143:1055–1061.CrossRefGoogle ScholarPubMed
28. Meduri, GU. Ventilator-associated pneumonia in patients with respiratory failure. Chest 1990;97:1208–1219.CrossRefGoogle ScholarPubMed
29. Bell, RC, Coalson, JJ, Smith, JO, Johanson, WG Jr. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 1983;99:293–298.Google Scholar
30. ‘robin, MJ, Grenvik, A. Nosocomial lung infection and its diagnosis. Crit Care Med 1984;12:191–200.Google Scholar
31. Villers, D, Deriennic, M, Rafi, R, et al. Reliability of the bronchoscopic protected catheter brush in intubated and ventilated patients. Chest 1985;88:527–530.Google Scholar
32. Guckian, JC, Christensen, WD. Quantitative culture and gram stain of sputum in pneumonia. Am Rev Respir Dis 1978;118:997–1005.Google ScholarPubMed
33. Lowry, FD. Carlisle, PS, Adams, A, Feiner, C. The incidence of nosocomial pneumonia following urgent endotracheal intubation. Infect Control 1987;8:245–248.Google Scholar
34. Craven, DE, Kunches, LM, Kilinsky, V, Lichtenberg, DA. Make, BJ. McCabe, WK. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986;133:792–796.Google Scholar
35. Celis, R, Torres, A, Gatell, JM, et al. Nosocomial pneumonia-a multivariate analysis of risk and prognosis. Chest 1988;93:318–324.Google Scholar
36. Gamer, JS, Jarvis, WR. Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. 1988. Am J Infect Control 1988;16:128–140.Google Scholar
37. Fagon, JY. Chastre, J, Hance, AJ, Domart, Y Trouíllet, JL, Gibert, C. Evaluation of clinical judgment in the identification and treatment of nosocomial pneumonia in ventilated patients. Chest 1993;103:547–553.CrossRefGoogle ScholarPubMed
38. Baughman, RR. Thorpe, JE, Staneck, J, et al. Use of the protected specimen brush in patients with endotracheal or tracheostomy tubes. Chest 1987;91:233–235.CrossRefGoogle ScholarPubMed
39. Meduri, GU, Wunderink, RG, Leeper, KV, Beals, DH. Management of bacterial pneumonia in ventilated patients. The role of protected bronchoalveolar lavage. Chest 1992;101:500–508.CrossRefGoogle Scholar
40. Bryant, LR, Trinkle, JK. Mobin-Uddin, K, Baker, L Griffin, WO. Bacterial colonization profile with tracheal intubation and mechanical ventilation. Arch Surg 1972;104:647–651.CrossRefGoogle ScholarPubMed
41. Torres, A, De La Bellacasa, JP, Xaubet, A, et al. Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheter in mechanically ventilated patients with bacterial pneumonia. Am Rev Respir Dis 1989;140:306–310.CrossRefGoogle ScholarPubMed
42. Lambert, RS, Vereen, LE. George, RB. Comparison of tracheal aspirates and protected brush catheter specimens for identifying pathogenic bacteria in mechanically ventilated patients. Am J Med Sci 1989;297:377–382.Google Scholar
43. Seidenfeld, JJ, Pohl, DF, Bell, RC, et al. Incidence, site and outcome of infections in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 1986; 134:12–16.Google ScholarPubMed
44. Meduri, GU, Chastre, J. The standardization of bronchoscopic techniques for ventilator-associated pneumonia. Chest 1992;102(suppl 1):557S–563S.CrossRefGoogle ScholarPubMed
45. Baselski, V, El-Torky, M, Coalson, SS, Griffin, J. The standardization of criteria for processing and laboratory specimens. Chest 1992;102:571S–579S.Google Scholar
46. Wunderink, RG. Mayhall, G, Gibert, C. Methodology for clinical investigation of ventilator-associated pneumonia: epidemiology and therapeutic intervention. Chest 1992; 102 (suppl 1):580S–588S.CrossRefGoogle ScholarPubMed
47. Martos, JA. Ferrer, M, Torres, A, et al. Specificity of quantitative cultures of protected specimen brush and bronchoalveolar lavage in mechanically ventilated patients. Am Rev Respir Dis 1990;141:A276. Abstract.Google Scholar
48. Marquette, CH, Ramon, P, Courcol, R, et al. Bronchoscopic protected catheter brush for the diagnosis of pulmonary infections. Chest 1988;93:746–755.CrossRefGoogle ScholarPubMed
49. Kahn, FW, Jones, JM. Diagnosing bacterial respiratory infection by bronchoalveolar lavage. J Infect Dis 1987;155:862–869.Google Scholar
50. Thorpe, JE, Baughman, RP, Frame, PT, Wesseler, TA. Staneck, JL. Bronchoalveolar lavage for diagnosing acute bacterial pneumonia. J Infect Dis 1987;155:855–861.CrossRefGoogle ScholarPubMed
51. Johanson, WG Jr, Seidenfeld, JJ, Gomez, P, De los Santos, R. Coalson, JJ. Bacteriologic diagnosis of nosocomial pneumonia following prolonged mechanical ventilation. Am Rev Respir Dis 1988;137:259–264.Google Scholar
52. Guerra, LF, Baughman, PR Use of bronchoalveolar lavage to diagnose bacterial pneumonia in mechanically ventilated patients. Crit Care Med 1990;18:169–173.CrossRefGoogle ScholarPubMed
53. Chastre, J. Fagon, JY, Soler, P et al. Quantification of BAL cells containing intracellular bacteria rapidly identifies ventilated patients with nosocomial pneumonia. Chest 1989;95:190S–192S.Google Scholar
54. Rouby, JJ, Rossignon, MD, Nicolas, MH, et al. A prospective study of protected bronchoalveolar lavage in the diagnosis of nosocomial pneumonia. Anesthesiology 1989;71:679–685.CrossRefGoogle ScholarPubMed
55. Trouillet, JL, Guiget, M, Gibert, C, et al. Fiberoptic bronchoscopy in ventilated patients. Evaluation of cardiopulmonary risk under midazolam sedation. Chest 1990;97:927–933.CrossRefGoogle ScholarPubMed
56. Lindholm, CE, Ollman, B, Snyder, JV, et al. Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients. Chest 1978;74:362–368.CrossRefGoogle ScholarPubMed
57. Rouby, JJ, De Iasalle, EM, Poete, P, et al. Nosocomial bronchopneumonia in the critically ill. Am Rev Respir Dis 1992;146:1059–1066.Google Scholar
58. Piperno, D, Gaussorgues, R Bachmann, P, Jaboulay, M, Robert, D. Diagnostic value of nonbronchoscopic bronchoalveolar lavage during mechanical ventilation. Chest 1988;93:223. Letter.Google Scholar
59. El-ebiary, M, Torres, A, Gonzalez, J, et al. Quantitative cultures of endotracheal aspirates for the diagnosis of ventilator-associated pneumonia. Am Rev Respir Dis 1993;148:1552–1557.CrossRefGoogle ScholarPubMed
60. Marquette, CH, Georges, H, Wallet, E et al. Diagnostic efficiency of endotracheal aspirates with quantitative bacterial cultures in intubated patients with suspected pneumonia. Am Rev Respir Dis 1993;148:138–144.Google Scholar
61. Emori, TG, Gaynes, Rl? An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428–442.Google Scholar
62. Garibaldi, RA, Britt, MR, Coleman, ML, Reading, JC, Pace, NL. Risk factors for postoperative pneumonia. Am J Med 1981;70:677–680.CrossRefGoogle ScholarPubMed
63. Haley, RW. Hooton, TM, Culver, DH, et al. Nosocomial infections in U.S. hospitals, 1975-1976; estimated frequency by selected characteristics of patients. Am J Med 1981;70:947–959.Google Scholar
64. Emori, TG, Banerjee, SN. Culver, DH, et al. Nosocomial infections in elderly patients in the United States. 19861990. Am J Med 1991;91 (suppl 3B):289S–293S.Google Scholar
65. Cross, AS, Roup, B. Role of respiratory assistance device in endemic nosocomial pneumonia. Am J Med 1981;70:681–685.CrossRefGoogle ScholarPubMed
66. Jarvis, WR, Edwards, JR, Culver, DH, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91 (suppl 3B):185S–191S.CrossRefGoogle ScholarPubMed
67. Relio, J, Quintana, E, Ausina, V, et al. Risk factors for Staphylococcus aureus pneumonia in critically ill patients. Am Rev Respir Dis 1990;142:1320–1324.Google Scholar
68. Gaynes, R, Bizek, B, Mowry-Hanley, J. et al. Risk factors for nosocomial pneumonia after coronary artery bypass graft operations. Ann Thorac Surg 1991;51:215–218.CrossRefGoogle ScholarPubMed
69. Joshi, N, Localio, AR, Hamory, BH. A predictive risk index for nosocomial pneumonia in the intensive care unit. Am J Med 1992;93:135–142.Google Scholar
70. Jacobs, S, Chang, RWS. Lee, B. Bartlett, FW. Continuous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients. J Parent Enter Nutr 1990;14:353–356.Google Scholar
71. Ashbaugh, DC, Petty, TL. Sepsis complicating the acute respiratory distress syndrome. Surg Gynecol Obstet 1972;135:865–868.Google Scholar
72. Chevret, S, Hemmer, M, Carlet, J. Langer, M. et al. Incidence and risk factors of pneumonia acquired in intensive care units. Intensive Care Med 1993;19:256–264.Google Scholar
73. Hanson, LC, Wever, DJ, Rutala, WA. Risk factors for nosocomial pneumonia in the elderly. Am J Med 1992;92:161–166.CrossRefGoogle ScholarPubMed
74. Kollef, MH. Ventilator-associated pneumonia . JAMA 1993;270:1965–1970.CrossRefGoogle ScholarPubMed
75. Craven, DE, Kunches, LM. Lichtenberg, DA. et al. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 1988;148:1161–1168.CrossRefGoogle ScholarPubMed
76. Graybill, JR, Marshall, LW. Charache, P, Wallace, CK, Melvin, VE. Nosocomial pneumonia-a continuing major problem. Am Rev Respir Dis 1973;108:1130–1140.Google Scholar
77. Gross, PA, Van Antwerpen, C. Nosocomial infections and hospital deaths. Am J Med 1983;75:658–662.CrossRefGoogle ScholarPubMed
78. Stevens, RM, Teres, D. Skillman, JJ, Feingold, DS. Pneumonia in an intensive care unit. A 30-month, experience. Arch Intern Med 1974;134:106–111.Google Scholar
79. Craig, CP, Connelly, S. Effect of intensive care unit nosocomial pneumonia on duration of stay and mortality Am J Infect Control 1984;4:233–238.Google Scholar
80. Leu, HS, Kaiser, DL. Mori, M, Woolson, RE Wenzel, RP Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidemiol 1989; 129:1258–1267.Google Scholar
81. Haley, KW. Schaberg, DR, Crowley, KH. Von Allmen, SD, McGowan, JE Jr. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med 1981;70:51–58 Google Scholar
82. Freeman, J, Rosner, BA, McGowan, JE. Adverse effects of nosocomial infection. J Infect Dis 1979;140:732–740.Google Scholar
83. Martone, WJ. Jarvis, WR, Culver, DH, Haley, RW. Incidence and nature of endemic and epidemic nosocomial infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston. MA: Little. Brown and Co; 1993;577–596.Google Scholar
84. Huxley, EJ, Viroslav, J. Gray, WR, Pierce, AK. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1973;64:564–568.Google Scholar
85. Olivares, L, Segovia, A, Revuelta, R Tube feeding and lethal aspiration in neurologic patients: a review of 720 autopsy cases. Stroke 1974;5:654–657.CrossRefGoogle ScholarPubMed
86. Spray, SB. Zuidema, GD. Cameron, HL. Aspiration pneumonia: incidence of aspiration with endotracheal tubes. Am J Surg 1976;131:701–703.CrossRefGoogle ScholarPubMed
87. Cameron, JL, Reynolds, J, Zuidema, GD. Aspiration in patients with tracheostomies. Surg Gynecol Obstet 1973;136:68–70.Google Scholar
88. Johanson, WG Jr, Pierce, AK. Sanford, LP Changing pharyngeal bacterial flora of hospitalized patients. N Engl J Med 1969;281:1137–1140.Google Scholar
89. Niederman, MS. Merrill, WW, Ferranti, RD. Nutritional status and bacterial binding in the lower respiratory tract in patients with chronic tracheostomy. Ann Intern Med 1984;100:795–800.Google Scholar
90. Reynolds, HY. Bacterial adherence to respiratory tract mucosa: a dynamic interaction leading to colonization. Seminars Respir Infect 1987;2:8–19.Google Scholar
91. Louria, DB, Kanimski, T. The effects of four antimicrobial drug regimens on sputum superinfection in hospitalized patients. Am Rev Respir Dis 1962;85:649–665.Google ScholarPubMed
92. Rosenthal, S, Tager, IB. Prevalence of gram-negative rods in the normal pharyngeal flora . Ann Intern Med 1975;83:355–357.Google Scholar
93. Mackowiak, PA, Martin, RM, Jones, SK. Pharyngeal colonization by gram-negative bacilli in aspiration-prone persons. Arch Intern Med 1978;138:1224–1227.CrossRefGoogle ScholarPubMed
94. Valenti, WM. Trudell, RG, Bentley, DW. Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged. N Engl J Med 1978;298:1108–1111.CrossRefGoogle ScholarPubMed
95. Woods, DE, Straus, DC, Johanson, WG, Berry, VK, Bass, JA. Role of pili in adherence of Pseudomonas aeruginosa to mammalian buccal epithelial cells. Infect Immun 1980;29:1146–1151.CrossRefGoogle ScholarPubMed
96. Niederman, MS. Bacterial adherence as a mechanism of airway colonization. Eur J Clin Microbiol Infect Dis 1989;8:15–20.Google Scholar
97. Johanson, WG Jr, Higuchi, JH. Chaudhuri, TR. Bacterial adherence to epithelial cells in bacillary colonization of the respiratory tract. Am Rev Respir Dis 1980;121:55–63.Google ScholarPubMed
98. Abraham, SN, Beachey, EH. Simpson, WA, et al. Adherence of Streptococcus pyogenes, Escherichia coli, and Pseudomonas aeruginosa to fibronectin-coated and uncoated epithelial cells. Infect Immun 1983;41:1261–1268.CrossRefGoogle ScholarPubMed
99. Beachey, EH. Bacterial adherence: adhesin-receptor interactions mediating the attachment of bacteria to mucosal surfaces. J Infect Dis 1981;143:325–345.Google Scholar
100. Woods, DE. Straw, DC, Johanson, WG, Bass, JA. Role of fibronectin in the prevention of adherence of Pseudomonas aeruginosa to buccal cells. J Infect Dis 1981;143:784–790.CrossRefGoogle ScholarPubMed
101. Woods, DE. Straus, DC, Johanson, WG, Bass, JA. Role of salivary protease activity in adherence of gram-negative bacilli to mammalian buccal epithelial cells in vitro. J Clin Invest 1981;68:1435–1440.Google Scholar
102. Ramphal, R, Small, PM, Shands, JW Jr, et al. Adherence of Pseudomonas aeruginosa to tracheal cells injured by influenza infection or by endotracheal intubation. Infect Immun 1980;27:614–619.Google Scholar
103. Niederman, MS, Merrill, WW, Polomski, LM. Reynolds, HI: Gee, JBL. Influence of sputum IgA and elastase on tracheal cell bacterial adherence. Am Rev Respir Dis 1986;133:255–260.Google Scholar
104. Niederman, MS, Raferty, TD, Sasaki, CT, et al. Comparison of bacterial adherence to ciliated and squamous epithelial cells obtained from the human respiratory tract. Am Rev Respir Dis 1983;127:85–90.Google Scholar
105. Franklin, AL, Todd, T, Gurman, G, et al. Adherence of Pseudomonas aeruginosa to cilia of human tracheal epithelial cells. Infect Immun 1987;55:1523–1525.Google Scholar
106. Palmer, LB. Merrill, WW, Niederman, MS, et al. Bacterial adherence to respiratory tract cells: relationships between in vivo and in vitro pH and bacterial attachments. Am Rev Respir Dis 1986;133:784–788.Google Scholar
107. Dal Kogare, AR. Toews, GB, Pierce, AK. Increased salivary elastase precedes gram-negative bacillary colonization in postoperative patients. Am Rev Respir Dis 1987;135:671–675.Google Scholar
108. Proctor, RA. Fibronectin: a brief overview of its structure, function, and physiology Rev Infect Dis 1987;9:S317–S321.Google Scholar
109. Niederman, MS, Mantovani, R, Schoch, P, et al. Patterns and routes of tracheobronchial colonization in mechanically ventilated patients: the role of nutritional status in colonization of the lower airway by Pseudomonas species. Chest 1989;95:155–161.CrossRefGoogle Scholar
110. Atherton, ST, White, DJ. Stomach as source of bacteria colonising respiratory tract during artificial ventilation. Lancet 1978;2:968–969.Google Scholar
111. Du Moulin, GC, Paterson, DG, White, JH, Lisbon, A. Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet 1982;2:242–245.CrossRefGoogle Scholar
112. Kappstein, l. Friedrich, T, Hellinger, P. Incidence of pneumonia in mechanically ventilated patients treated with sucralfate or cimetidine as prophylaxis for stress bleeding: bacterial colonization of the stomach. Am J Med 1991;91 (suppl 2A):125S–131s.Google Scholar
113. Daschner, F, Kappstein, l, Reuschenbach, K, Pfisterer, J, Krieg, N, Vogel, W. Stress ulcer prophylaxis and ventilation pneumonia: prevention by antibacterial cytoprotective agents? Infect Control 1988;9:59–65.Google Scholar
114. Torres, A, El-ebiary, M, Gonzalez, J, et al. Gastric and pharyngeal flora in nosocomial pneumonia acquired during mechanical ventilation. Am Rev Respir Dis 1993;148:352–357.CrossRefGoogle ScholarPubMed
115. Martin, LF, Booth, FVM, Karlstadt, KG, et al. Continuous intravenous cimetidine decreases stress-related upper gastrointestinal hemonhage without promoting pneumonia. Crit Care Med 1993;21:19–29.Google Scholar
116. Inglis, TJJ, Sherratt, MJ, Sproat, LJ, Gibson, JS. Hawkey, PM. Gastroduodenai dysfunction and bacterial colonisation of the ventilated lung. Lancet 1993;341:911–913.Google Scholar
117. Pingleton, SK, Hinthron, DR, Liu, C. Enteral nutrition in patients receiving mechanical ventilation: multiple sources of tracheal colonization include the stomach. Am J Med 1986;80:827–832.CrossRefGoogle ScholarPubMed
118. Driks, MR, Craven, DE. Celli, BR, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. N Engl J Med 1987;317:1376–1382.Google Scholar
119. Drasar, BS, Shiner, M. McLeod, GM. Studies of the intestinal flora. I. The bacterial flora of the gastrointestinal tract in healthy and achlorhydric persons. Gastroenterology 1969;56:71–79.Google Scholar
120. Garrod, LR A study of the bactericidal power of hydrochloric acid and of gastric juice. St Barth Hosp Rep 1939;72:145–167.Google Scholar
121. Arnold, I. The bacterial flora within the stomach and small intestine: the effect of experimental alterations of acid-base balance and the age of the subject. Am J Med Sci 1933;186:471–481.Google Scholar
122. Ruddell, WSJ. Axon, ATR, Findlay, JM. Effect of cimetidine on the gastric bacterial flora. Lancet 1980;1:672–674.CrossRefGoogle ScholarPubMed
123. Donowitz, LG, Page, MC. Mileur, BL. Guenthner, SH. Alteration of normal gastric flora in critical patients receiving antacid and cimetidine therapy. Infect Control 1986;7:23–26.CrossRefGoogle ScholarPubMed
124. Priebe, HJ. Skillman, JJ, Bushnell, IS, Long, PC, Silen, W. Antacid versus cimetidine in preventing acute gastrointestinal bleeding. N Engl J Med 1992;302:426–430.Google Scholar
125. Zinner, MJ. Zuidema, GD. Smith, PL, Mignosa, M. The prevention of upper gastrointestinal tract bleeding in patients in an intensive care unit. Surg Gynecol Obstet 1981;153:214–220.Google Scholar
126. Reinarz, JA, Pierce, AK. Mays, BB, Sanford, JR The potential role of inhalation therapy equipment in nosocomial pulmonary infection.] Clin Invest 1965;44:831–839.Google Scholar
127. Schulze, T, Edmondson, EB. Pierce, AK, Sanford, JR Studies on a new humidifying device as a potential source of bacterial aerosol. Am Rev Respir Dis 1967;96:517–519.Google Scholar
128. Pierce, AK, Sanford, JP, Thomas, GD. Leonard, JS. Lang-term evaluation of decontamination of inhalation-therapy equipment and the occurrence of necrotizing pneumonia. N Engl J Med 1970;292:528–531.Google Scholar
129. Edmondson, EB. Reinarz, JA. Pierce, AK, Sanford, Jl? Nebulization equipment: a potentialsource ofinfection ingram-negativepneumonias. Am J Dis Child 1966;111:357–360.Google Scholar
130. Pierce, AK. Sanford, JP Bacterial contamination of aerosols. Arch Intern Med 1973;131:156–159.Google Scholar
131. Brain, JD. Valberg, PA Deposition of aerosol in the respiratory tract. Am Rev Respir Dis 1979;120:1325–1373.Google ScholarPubMed
132. Rhame, FS, Streifel, A, McComb, C, Boyle, M. Bubbling humidifiers produce microaerosols which can carry bacteria. Infect Control 1986;7:403–407.Google Scholar
133. Deitch, EA, Berg, R. Bacterial translocation from the gut: a mechanism of infection. J Burn Care Rehab 1987;8;475–482.Google Scholar
134. Fiddian-Green, RG, Baaker, S. Nosocomial pneumonia in the critically ill: Product of aspiration or translocation? Crit Care Med 1991;19:763–769.Google Scholar
135. Harkness, GA, Bentley, DW, Roghmann, KJ. Risk factors for nosocomial pneumonia in the elderly. Am J Med 1990;89:457–463.CrossRefGoogle ScholarPubMed
136. Windsor, JA, Hill, GL. Risk factors for postoperative pneumonia. Ann Surg 1988;208:209–214.CrossRefGoogle ScholarPubMed
137. Penn, RG, Sanders, WE, Sanders, CC. Colonization of the oropharynx with gram-negative bacilli: a major antecedent to nosocomial pneumonia. Am J Infect Control 1981;9:25–34.Google Scholar
138. Lepper, MH, Kofman, S, Blatt, N, et al. Effect of eight antibiotics used singly and in combination on the tracheal flora following tracheostomy in poliomyelitis. Anthio Chemother 1954;4:829–833.Google Scholar
139. Klick, JM, Du Moulin, GC, Hedley-Whyte, J. Teres, D, Bushnell, IS, Feingold, DS. Prevention of gram-negative bacillary pneumonia using polymyxin aerosol as prophylaxis. J Clin Invest 1975;55:514–519.Google Scholar
140. Feeley, TW, Du Moulin, GC, Hedley-Whyte, J, Bushnell, LS, Gilbert, JR Feingold, DS. Aerosol polymyxin and pneumonia in seriously ill patients. N Engl J Med 1975;293:471–475.Google Scholar
141. Sprunt, K, Redman, W. Evidence suggesting importance of role of interbacterial inhibition in mamtaining balance of normal flora. Ann Intern Med 1968;68:579–590.CrossRefGoogle ScholarPubMed
142. Sprunt, K. Leidy, G, Redman, W. Abnormal colonization of neonates in an ICU: conversion to normal colonization by pharyngeal implantation of alpha hemolytic streptococcus strain 215. Pediatr Res 1980;14:308–313.CrossRefGoogle Scholar
143. Klastersky, J, Huysmans, E, Werts, D, Hensgens, C. Daneau, D. Endotracheally administered gentamicin for the prevention of infections of the respiratory tract in patients with tracheostomy: a double-blind study. Chest 1974;65:650–654.Google Scholar
144. Greenfield, S, Teres, D, Bushnell, LS, Hedley-Whyte, J, Feingold, DS. Prevention of gram-negative bacillary pneumonia using aerosol polymyxin as prophylaxis. J Clin Invest 1973;52:2935–2940.Google Scholar
145. Daschner, F. Stress ulcer prophylaxis and the risk of nosocomial pneumonia in artificially ventilated patients. Eur J Clin Microbiol 1987;6:129–131.Google Scholar
146. Goularte, TA, Lichtenberg, DA. Craven, DE. Gastric colonization in patients receiving antacids and mechanical ventilation: a mechanism for pharyngeal colonization. Am J Infect Control 1986; 14:88. Abstract.Google Scholar
147. Prod'hom, G, Leuenberger, PH. Koerfer, J. et al. Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. Ann Intern Med 1994;120:653–662.Google Scholar
148. Tiyba, M. Risk of acute stress bleeding and nosocomial pneumonia in ventilated intensive care unit patients: sucralfate versus antacids. Am J Med 1987;83(suppl 3B):117–124.Google Scholar
149. Tryba, M, Mantey-Stiers, F. Antibacterial activity of sucralfate in human gastric juice. Am J Med 1987;83(suppl 3B):125–127.Google Scholar
150. Lacroix, J, Infante-Rivard, C, Jenicek, M. Gauthier, M. Prophylaxis of upper gastrointestinal bleeding in intensive care units: a meta-analysis. Crit Care Med 1991;19:942–949.Google Scholar
151. Laggner, AN, Lenz, E, Base, W, Druml, WC, Schneweiss, B, Grimm, G. Prevention of upper gastrointestinal bleeding in long-term ventilated patients. Sucralfate versus ranitidine. Am J Med 1989;86(suppl 6A):81–84.Google Scholar
152. Ryan, P, Dawson, J, Teres, D, Navab, E Continuous infusion of cimetidine versus sucralfate: incidence of pneumonia and bleeding compared. Crit Care Med 1990; 18 (suppl): 253. AbstractGoogle Scholar
153. Pickworfh, KK, Falcone, RE, Hoogeboom, JE, Santanello, SA Occurrence of nosocomial pneumonia in mechanically ventilated trauma patients: a comparison of sucralfate and ranitidine. Crit Care Med 1993;21:1856–1862.Google Scholar
154. Cook, DJ, Laine, LA, Guyatt, GH, Raffin, TA. Nosocomial pneumonia and the role of gastric pH. A meta-analysis. Chest 1991;100:7–13.Google Scholar
155. Stoutenbeek, CP, Van Saene, HKF, Miranda, DR, Zandstra, DE The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med 1984;10:185–192.Google Scholar
156. Unertl, K, Ruckdeschel, G, Selbmann, E, et al. Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med 1987;13:106–113.Google Scholar
157. Kerver, JH, Rommes, JH, Mevissen-Verhage, EAE. et al. Prevention of colonization and infection in critically ill patients: a prospective study. Crit Care Med 1988;16:1087–1093.Google Scholar
158. Ledingham, IM. Alcock, SR, Eastaway, AT, McDonald, JG, Mckay, I, Ramsay, G Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet 1988;785–790.Google Scholar
159. Brun-Buisson, C. Legrand, P, Rauss, A, et al. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli: study of an outbreak in an intensive care unit. Ann Intern Med 1989;110:873–881.Google Scholar
160. Ulrich, C, Harinck-de Weerd, JE. Bakker, NC, Jacz, K, Doornbos, L, de Ridder, VA. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Med 1989;15:424–431.Google Scholar
161. Flaherty, J, Nathan, C, Kabins, SA, Weinstein, RA. Pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit. J Infect Dis 1990;162:1393–1397.Google Scholar
162. Godard, J, Guillaume, C, Reverdy, ME, et al. Intestinal decontamination in a polyvalent ICU. Intensive Care Med 1990;16:307–311.Google Scholar
163. McClelland, R, Murray, AE, Williams, PS, et al. Reducing sepsis in severe combined acute renal and respiratory failure by selective decontamination of the digestive tract. Crit Care Med 1990;18:935–939.CrossRefGoogle ScholarPubMed
164. Rodriguez-Roldan, JM. Altuna-Cuesta, A, Lopez, A, et al. Prevention of nosocomial lung infection in ventilated patients: use of an antimicrobial pharyngeal nonabsorbable paste. Crit Care Med 1990;180:1239–1242.Google Scholar
165 Tetteroo, GWM, Wagenvoort, JHT, Casterlein, A, Tilanus, HW, Ince, C. Buining, HA. Selective decontamination to reduce gram-negative colonisation and infections after “esophageal resection. Lancet 1990;335:704–707.Google Scholar
166. Aerdts, SJA, van Daelen, R, Clasener, HAL, Festen, J, Van Lier, HJJ, Vollaard, EJ. Antibiotic prophylaxis of respiratory tract infection in mechanically ventilated patients: a prospective, blinded, randomized trial of the effect of a novel regimen. Chest 1991;100:783–791.Google Scholar
167. Blair, R Rowlands, BJ, Lowry, K, Webb, H, Armstrong, R Smilie, J. Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit. Surgery 1991;110:303–310.Google Scholar
168. Fox, MA, Peterson, S, Fabri, BM. Van Saene, HKE, Williets, T, Selective decontamination of the digestive tract in cardiac surgical patients. Crit Care Med 1991;19:14S6–1490.Google Scholar
169. Hartenauer, U, Thulig, B, Diemer, W, et al. Effect of selective flora suppression on colonization, infection, and mortality in critically ill patients: a one-year, prospective consecutive study. Crit Care Med 1991;19:463–473.Google Scholar
170. Pugin, J, Auckenthaler, R, Lew, DP, Suter, PM. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia: a randomized. placebo controlled, double-blind clinical trial. JAMA 1991;265:2704–2710.Google Scholar
171. Vandenbroucke-Grauls, CMJE, Vandenbroucke, JP, Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit. Lancet 1991;338:859–862.Google Scholar
172. Cockerill, FR, Muller, SM, Anhalt, JP, et al. Prevention of infection on critically ill patients by selective decontamination of the digestive tract. Ann Intern Med 1992;117:545–553.Google Scholar
173. Gastinne, H, Wolff, M. Destour, F, Faurisson, F, Chevret, S. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 1992;326:594–599.Google Scholar
174. Hammond, JMJ, Potgieter, PD, Saunders, GL, Forder, AA. A double blind study of selective decontamination in Intensive Care. Lancet 1992;340:5–9.Google Scholar
175. Rocha, LA, martin, MJ, Pita, S, et al. Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. Intensive Care Med 1992;398–404.Google Scholar
176. Winter, R. Humphreys, H, Pick, A, MacGowan, R “Wilatts, SM, Speller, DCE. A controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection . J Antimicrob Chemother 1992;30:73–87.Google Scholar
177. Korinek, AM, Laisne, MJ, Nicolas, MH. Raskine, S, Deroin, V, Sanson-Lepors, MJ. Selective decontamination of the digestive tract in neurosurgical intensive care unit patients: a double-blind, randomized, placebo-controlled study. Crit Care Med 1993;21:1466–1473.Google Scholar
178. Selective Decontamination of the Digestive Tract Trialists’ Collaborative Group. Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract. Br Med J 1993;307:525–532.Google Scholar
179. Ferrer, M, Torres, A, Gonzalez, J. et al. Utility of selective decontamination in mechanically ventilated patients. Ann intern Med 1994;120:389–395.Google Scholar
180. Nau, R, Ruchel, R. Mergerian, H, Wegener, U, Winkelmann, T, Prange, HW. Emergence of antibiotic-resistant bacteria during selective decontamination of the digestive tract. J Antimicrob Chemother 1990;25:881–883.Google Scholar
181. Heyland, D, Bradley, C, Mandell, LA. Effect of acidified enteral feedings on gastric colonization in the critically ill patient. Crit Care Med 1992;20:13881394.Google Scholar
182. Bartlett, JC, Gorbach, SL. The triple threat of aspiration pneumonia. Chest 1975;68:560–566.Google Scholar
183 Winterbauer, RH, Duming, RB, Barron, E, McFadden, MC. Aspirated nasogastric feeding solution detected by glucose strips. Ann Intern Med 1981;95:67–68.Google Scholar
184. Nair, P Jani, E, Sanderson, PJ. Transfer of oropharyngeal bacteria into the trachea during endotracheal intubation. J Hosp Infect 1986;8:96–103.Google Scholar
185. Treolar, DM, Stechmiller, J. Pulmonary aspiration oi tube-fed patients with artificial airways. Heart Lung 1984;13:667–671.Google Scholar
186. Metheny, NA, Eisenberg, P, Spies, M Aspiration pneumonia in patients fed through nasoenteral tubes. Heart Lung 1986;15:256–261.Google Scholar
187. Cheadle, WG, Vitale, GC, Mackie, CR, Cuschìere, A Prophylactic postoperative nasogastric decompression. Ann Surg 1985;202:361–366.Google Scholar
188. Ibanez, J, Penafiel, A, Raurich, J. Gastroesophageal reflux and aspiration of gastric contents during nasogastric feeding: the effect of posture. Intensive Care Med 1988;14(suppl 2):296. Abstract.Google Scholar
189. Anderson, KR, Norris, DJ, Godfrey, LB, et al. Bacterial contamination of the tube-feeding formulas. J Parent Enter Nutr 1984;8:673–678.Google Scholar
190. Schroeder, P, Fisher, D, Volz, M. Microbial contamination of enteral feeding solutions in a community hospital. J Rirent Enter Nutr 1983;7:459–461.Google Scholar
191. Thurn, J, Cmssley, K, Gerdts, A, et al. Enteral hyperalimentation as a source of nosocomial infection, J Hosp Infect 1990;15:203–217.Google Scholar
192. Civil, ID, Schwab, CW. The effect of enteral feeding on gastric pH. Am Surg 1987;12:688–690.Google Scholar
193. Lee, B. Chang, RWS, Jacobs, S. Intermittent nasogastric feeding: a simple and effective method to reduce pneumonia among ventilated ICU patients. Clin Intensive Care 1990;1:100–102.Google Scholar
194. Torres, A, Sara-Battles, J, Ros, E. et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med 1992;116:540–542.Google Scholar
195. Wynne, JW, Modell, JH. Respiratory aspiration of stomach contents. Ann Intern Med 1977;87:466–474,Google Scholar
196. Betcher, E, Seltzer, M, Slocum, M, et al. Complications occurring during enteral nutritional support: a prospective study, J Parent Enter Nutr 1983;7:546–552.CrossRefGoogle Scholar
197. Bernard, M, Forlaw, L. Complications and their prevention. In Rombeau, J, Caldwell, M, eds. Clinical Nutrition Vol I: Enteral and Tube Feeding. Philadelphia, PA: W.B. Saunders Co, 1984;534.Google Scholar
198. Dohbie, RP, Hoffmeister, JA. Continuous pump-tube enteric hyperalimentation. Surg Gynecol Obstet 1976;143:273–276.Google Scholar
199. Strong, RM, Condon, SC, Solinger, MR. et al. Equal aspiration rates from postpyloms and intragastric-placed feeding tubes: a randomized, prospective study. J Enter Nutr 1992;16:59.Google Scholar
200. Montecalvo, M, Steger, KA, Farber, HW, et al. Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings. Crit Core Med 1992;20:1377–1387.Google Scholar
201. Sanderson, PJ. Colonisation of the trachea in ventilated patients. What is the bacterial pathway? J Hosp Infect 1983;4:1518.Google Scholar
202. Sottile, FD, Marrie, TJ, Prough, DS, et al. Nosocomial pulmonary infection: possible etiologie significance of bacterial adhesion to endotracheal tubes. Crit Care Med 1986;14:265–270.Google Scholar
203. Inglis, TJJ, Jones, JG, Newman, SP. Gas-liquid interaction with tracheal tube biofilm: a means of bacterial colonisation of the lung. Br J Hosp Med 1989;42:141–142.Google Scholar
204. lnglis, TJJ. Millar, MR. Jones, JG. Robinson, DA. ‘Tracheal tube biofilm as a source of bacterial colonisation of the lung. J Clin Microbiol 1989;27:2014–2018.CrossRefGoogle Scholar
205. McCrae, W, Wallace, P. Aspiration around high volume, low pressure endotracheal cuff. Br Med J 1981;2:1220–1221.Google Scholar
206. Mahul, Ph, Auboyer, C, Jospe, R, et al. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic drainage and stress ulcer prophylaxis. Intensive Care Med 1992;18:20–25.Google Scholar
207. Weinstein, RA. Nathan, C. Gruensfelder, R. Endemic aminoglycoside resistance in gram-negative bacilli: epidemiology and mechanisms. J Infect Dis 1980;141:338–345.Google Scholar
208. Maki, DG. Control of colonization and transmission of pathogenic bacteria in the hospital. Ann Intern Med 1979;89:777–780.Google Scholar
209. Larson, E. Persistent carriage of gram-negative bacteria on hands. Am /infect Control 1981;9:112–119.Google Scholar
210. Adams, BG, Marrie, TJ. Hand carriage of gram-negative rods may not be transient J Hyg 1982;89:33–46.Google Scholar
211. Daschner, FD. The transmission of infections in hospitals by staff carriers. methods of prevention and control. Inject Control 1985;6:97–98.Google Scholar
212. Adams, BG, Marrie, TJ. Hand carnage of aerobic gram-negative rods by health care personnel. J Hyg 1982;89:23–31.Google Scholar
213. Marples, RR, ‘Towers, AG. A laboratory model for the investigation of contact transfer of micro-organisms. J Hyg 1979;82:237–248.Google Scholar
214. Casewell, M. Phillips 1. Hands as a mute of transmission of Klebsiella species. Br Med J 1977;2:1315–1317.Google Scholar
215. Gorman, U, Sanai, L, Notman, AW, Grant, IS, Masterton, RG. Cross infection in an intensive care unit by Klebsiella pneumoniae from ventilator condensate. J Hosp Infect 1993;23:27–34.Google Scholar
216. Cadwallader, HL, Bradley, CR, Ayliffe, GAJ. Bacterial contamination and frequency of changing ventilator circuitry. J Hosp Infect 1990; 15:65–72.Google Scholar
217. Mortimer, EA, Lipsitz, PJ, Wolinsky, E. et al. Transmission of staphylococci between newborns. Am J Dis Child 1962;104:289–295.Google Scholar
218. Lowbury, EJL, Lilly, HA, Bull, JP. Disinfection of hands: removal of transient organisms. Br Med J 1964;2:230–233.Google Scholar
219. Sprunt, K. Redman, W, Leidy, G. Antibacterial effectiveness of routine Imidwashing. Pediatrics 1973;52:264–271.Google Scholar
220. Steere, AC, Mallison, GE Handwashing practices for the prevention of nosocomial infections. Ann Intern Med 1975;83:683–690.Google Scholar
221. Albert, RK, Condie, F. Hand-washing patterns in medical intensive care units. N Engl J Med 1981;304:146–147.Google Scholar
222. Doebbeling, BN, Stanley, GL. Sheetz, CT. et al. Comparative efficacy of alternative Imid-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:88–93.Google Scholar
223. Simmons, B, Bryant, J, Neiman, K, Spencer, L, Arheart, K. The role of Imidwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990;11:589–594.Google Scholar
224. Gamer, JS, Simmons, BP Guideline for isolation precautions in hospitals. Infect Control 1983;4(suppl):245–325.Google Scholar
225. Garner, JS. Simmons, BP Guideline for handwashing and environmental control. Infect Control 1986;7:231–242.Google Scholar
226. LeClair, JM, Freeman, J, Sullivan, BE Crowley, CM. Goldmann., DA. Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions. N Engl J Med 1987;317:329–333.Google Scholar
227. Klein, BS, Perloff, WH, Maki, DG, et al. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320:1714–1721.Google Scholar
228. Doebbeling, BN. Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove. Ann Intern Med 1988;109:394–398.Google Scholar
229 Maki, DG. McCormick, RD. Zilz, MA. et al. An MRSA outbreak in a SICU during universal precautions: new epidemiology for nosocomial MRSA; downside for universal precautions (UPs). Abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy 1990;165. Abstract.Google Scholar
230. Patterson, JE. Vecchio, J. Pantelick, EL. et al. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med 1991;91:479–483.Google Scholar
231. Korniewicz, DM, Laughon, BE, Cyr, WH, Lytle, CD, Larson, E. Leakage of virus through used vinyl and latex examination gloves.] Clin Microbiol 1990;28:787–788.Google Scholar
232. Pandit, SK Mehta, S. Agarwal, SC. Risk of cross-infection from inhalation anesthetic equipment. Br J Anaesth 1967;39:838–844.Google Scholar
233. Cunha, BA, Klimek, JJ, Gracewski, J, McLaughlin, JC, Quintiliani, R. A common source outbreak of Acinetobacter pulmonary infection traced to Wright respirometers. Postgrad Med J 1980;56:169–172.Google Scholar
234. Phillips, J. Pseudomonas aeruginosa respiratory tract infections in patients receiving mechanical ventilation. J Hyg 1967;65:229–235.Google Scholar
235. Wheeler, PW, Iancaster, D. Kaiser, AB. Bronchopulmonary cross-colonization and infection related to mycobacterial contamination of suction valves of bronchoscopes. J Infect Dis 1989;159:954–958.Google Scholar
236. Fraser, VJ. Jones, M, Murray, PK. Medoff, F, Zhang, Y, Wallace, RJ. Contamination of flexible fiberoptic bronchoscopes with Mycobacterium chetonae linked to an automated bronchoscope disinfection machine Am Rev Respir Dis 1992;145:853–855.Google Scholar
237. Grieble, HG, Colton, FR, Thomas, MS. et al. Fine particle humidifiers: source of Pseudomonas aeruginosa infections in a respiratory-disease unit. N Engl J Med 1970;282:531–533.Google Scholar
238. Mertz, JJ. Scharer, L, McClement, JH. A hospital outbreak of Klebsiella pneumonia from inhalation therapy with contaminated aerosols. Am Rev Respir Dis 1967;95:454–460.Google Scholar
239. Ringrose, RE, McKown, B, Felton, EG, Barclay, BO, Muchmore, HG. Rhoades, ER A hospital outbreak of Serratia marcescens associated with ultrasonic nebulizers. Ann Intern Med 1968;69:719–729.Google Scholar
240. Rhoades, ER. Ringrose, R, Mohr, JA. Brooks, L, McKown, BA. Felton, F. Contamination of ultrasonic nebulization equipment with gram negative bacteria. Arch Intern Med 1971;127:228–232.Google Scholar
241. Arnow, PM, Chou, T, Weil, D, Shapiro, EN, Kretzschmar, C. Nosocomial Legionnaires' disease caused by aerosolized tap water from respiratory devices. J Infect Dis 1982;146:460–467.Google Scholar
242. Craven, DE, Lichtenberg, DA. Goularte, TA. Make, BJ. McCabe, WR. Contaminated medication nebulizers in mechanical ventilator circuits. Am J Med 1984;77:834–838.Google Scholar
243. Babington, PCB, Baker, AB, Johnson, HH. Retrograde spread of organisms from ventilator to patient via the expiratory limb. Lancet 1971;1:61–63.Google Scholar
244. Smith, JR, Howland, WS. Endotracheal tube as a source of infection. JAMA 1959;169:343–345.Google Scholar
245. Irwin, RS, Demers, RR, Pratter, MR. An outbreak of Acinetobacter infection associated with the use “f a ventilator spirometer. Respir Care 1980;25:232–237.Google Scholar
246. Gough, J. Kraak, WAG, Amderson, EC, Nichols, WW, Slack, MPE, McGhie, D. Cross-infection by non-encapsulated Haemophilus influenzae . Lancet 1990;336:159–160.Google Scholar
247. Dyer, ED, Peterson, DE. How far do bacteria travel from the exhalation valve of LPPB equipment? Anesth Analg 1972;51:516–519.Google Scholar
248. Hovig, B. Lower respiratory tract infections associated with respiratory therapy and anesthesia equipment. J Hosp Infect 1981;2:301–315.Google Scholar
249. Carson, LA, Favero, MS, Bond, WW, Petersen, NJ. Morphological, biochemical, and growth characteristics of Pseudomonas cepacia from distilled water. Appi Microbiol 1973;25:476–483.Google Scholar
250. Favero, MS, et al. Pseudomonas aeruginosa: growth in distilled water from hospitals. Science 1971;173:836–838.Google Scholar
251. Carson, LA, Petersen, NJ, Favero, MS, Aguero, SM. Growth characteristics of atypical mycobacteria in water and their comparative resistance to disinfectants. Appl Environ Microbiol 1978;36:839–846.Google Scholar
252. Zuravleff, JJ, Yu, VL, Shonnard, JW, Best, M. Legionella pneumophila contamination of a hospital humidifier: demonstration of aerosol transmission and subsequent subclinical infection in exposed guinea pigs. Am Rev Respir Dis 1983;128:657–661.Google Scholar
253. Gorman, GW, Yu, VL, Brown, A. Isolation of Pittsburgh pneumonia agent from nebulizers used in respiratory therapy. Ann Intern Med 1980;93:572–573.Google Scholar
254. Habeeb, AFSA, Hiramoto, R. Reaction of proteins with glutaraldehyde. Arch Biocfam 1968;126;16.Google Scholar
255. Fierer, J, Taylor, PM, Gezon, HM. Pseudomonas aeruginosa epidemic traced to delivery-room resuscitators. N Engl J Med 1967;276:991–996.Google Scholar
256. Berthelot, P, Grattard, F, Mahul, F! et al. Ventilator temperature sensors: an unusual source of Pseudomonas cepacia in nosocomial infection. J Hosp Infect 1993;25:33–43.Google Scholar
257. Weems, JJ. Nosocomial outbreak of Pseudomonas cepacia associated with contamination of reusable electronic ventilator temperature probes. Infect Control Hosp Epidemiol 1993;14:583–586.Google Scholar
258. Mastro, TD, Fields, BS, Breiman, RF, Campbell, J, Plikaytis, BD. Spika, JS. Nosocomial Legionnaires' disease and use of medication nebulizers . J infect Dis 1991;163:667–670.Google Scholar
259. Cefai, C, Richards, J. Gould, FK, McPeake, P. An outbreak of Acinetobacter respiratory tract infection resulting from incomplete disinfection of ventilatory equipment. J Hosp Infect 1990:15:177–182.Google Scholar
260. Spaulding, EH. Chemical sterilization of surgical instruments. Surg Gynecol Obstet 1939;69:738–744.Google Scholar
261. Snow, JC, Mangiaracine, AB, Anderson, ML Sterilization of anesthesia equipment with ethylene oxide. N Engl J Med 1962;266:443–445.Google Scholar
262. Roberts, FJ, Cockcroft, WH, Johnson, HE. A hot water disinsection method for inhalation therapy equipment. Can Med Assoc J 1969;101:30–32.Google Scholar
263. Nelson, EJ, Ryan, KJ. A new use for pasteurization: disinfection of inhalation therapy equipment. Respir Care 1971;16:97–103.Google Scholar
264. Craig, DB, Cowan, SA, Forsyth, W, Parker, SE. Disinfection of anesthesia equipment by a mechanical pasteurization method. Anaesth Soc J 1975;22:219–223.Google Scholar
265. Smith, MD, Box, T, Pockligton, ML, Kelsey, MC. An evaluation of the Hamo LS-76 washing, drying and disinfecting machine for anaesthetic equipment. J Hosp Infect 1992;22:149–157.Google Scholar
266. Favero, MS. Principles of sterilization and disinfection. Anesth Clin N Am 1989; 7:941–949.Google Scholar
267. Favero, MS, Bond, WW. Clinical disinfection of medical and surgical materials. In: Block, S, ed. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, PA: Lea and Febiger, 1991;617–641.Google Scholar
268. Haselhuhn, DH. Brason, FW, Borick, PM. “In-use study” of buffered glutaraldehyde for cold sterilization of anesthesia equipment. Anesth Analg 1967;46:468–474.Google Scholar
269. Moffet, HI,, Williams, T. Bacteria recovered from distilled water and inhalation therapy equipment. Am J Dis Child 1967;114:7–12.Google Scholar
270. Highsmith, AK. Emori, TG, Aguero, SM, Favero, MS, Hughes, JM. Heterotrophic bacteria isolated from hospital water system. International Symposium on Water-Related Health Issues, 1986;181–187.Google Scholar
271. Alary, MA, Joly, JR. Factors contributing to the contamination of hospital water distribution systems by Legionellae. J Infect Dis 1992;165:565–569.Google Scholar
272. Olson, BH, Nagy, LA. Microbiology of potable water. In: Laskin, AI, ed. Advances in Applied Microbiology. Orlando, FL: Academic Press Inc; 1984;73–132.Google Scholar
273. Rutala, WA, Clontz, EP, Weber, DJ, Hoffman, KK. Disinfection practices for endoscopes and other semicritical items. Infect Control Hosp Epidemiol 1991;12:282–288.Google Scholar
274. Gerding, DN, Peterson, LR, Vennes, JA. Cleaning and disinfection of fiberoptic evaluation of glutaraldehyde exposure time and forced-air drying. Gastroenterology 1982;83:613–618.Google Scholar
275. Alfa, MJ, Sitter, DL. In-hospital evaluation of contamination of duodeno scopes: a quantitative assessment of the effect of drying . J Hosp Infect 1991;19:89–98.Google Scholar
276. Ansari, SA, Springhope, VS. Sattar, SA, Tostowaryk, W, Wells, GA. Comparison of cloth, paper, and warm air drying in eliminating viruses and bacteria from washed hands. Am J Infect Control 1991;19:243–249.Google Scholar
277. Martin, MA, Reichelderfer, M. Association for Practitioners in Infection Control. 1991, 1992. and 1993 APIC Guidelines Committee. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 1994;22:19–38.Google Scholar
278. Holdcroft, A, Lumley, J, Gaya, H, et al. Why disinfect ventilators? Lancet 1973;1:240–242 Google Scholar
279. Bishop, C, Roper, WAG, Williams, SR. The use of an absolute filter to sterilize the inspiratory air during intermittent positive pressure respiration. Br J Anaesth 1963;35:32–34.Google Scholar
280. Hellewell, J. The Williams bacterial filter, use in the intensive care unit. Anaesthesia 67;22:497–503.Google Scholar
281. Buckley, PM. Increase in resistance of in-line breathing filters in humidified air. Br J Anaesth 1984;56:637–643.Google Scholar
282. Christopher, KL. Saravolatz, LD, Bush, TL. Cross-infection: a study using a canine model for pneumonia. Am Rev Respir Dis 1983;128:271–275.Google Scholar
283. Goularte, TA, Manning, M. Craven, DE. Bacterial colonization in humidifying cascade reservoirs after 24 and 48 hours of continuous mechanical ventilation. Infect Control 1987;8:200–203.Google Scholar
284. Vesley, D, Anderson, J, Halbert, MM, Wyman, L. Bacterial output from three respiratory therapy humidifying devices. Respir Care 1979;24:228–234.Google Scholar
285. Boyce, JM, White, RL, Spruill, EY, Wall, M. Cost-effective application of the Centers for Disease Control guideline for prevention of nosocomial pneumonia. Am J Infect Control 1985;13:228–232.Google Scholar
286. Craven, DE, Goularte, TA, Make, BA Contaminated condensate in mechanical ventilator circuits-risk factor for nosocomial pneumonia? Am Rev Respir Dis 1984;129:625–628.Google Scholar
287. Lareau, SC, Ryan, KJ, Diener, CF. The relationship between frequency of ventilator circuit changes and infectious hazard. Rev Respir Dis 1978;118:493–496.Google Scholar
288. Craven, DE, Connolly, MG, Lichtenberg, DA. Primeau, PJ, McCabe, WR. Contamination of mechanical ventilators with tubing changes every 24 or 48 hours. N Engl J Med 1982;306:1505–1509.Google Scholar
289. Dreyfuss, D, Djedaini, K, Weber, P, et al. Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours vs no change. Am Rev Respir Dis 1991;143:738–743.Google Scholar
290. Miyao, H, Hirokawa, T, Miyasaka, K, Kawazoe, T. Relative humidity, not absolute humidity, is of great importance when using a humidifier with a heating wire. Crit Care Med 1992;20:674–679.Google Scholar
291. MacIntyre, NR, Anderson, HR, Silver, RM. Pulmonary function in mechanically-ventilated patients using 24- hour use of a hygroscopic condenser humidifier. Chest 1983;84:560–564.Google Scholar
292. Make, BJ, Craven, DE, O'Donnell, C. Clinical and bacteriologic comparison of hygroscopic and cascade humidifiers in ventilated patients. Am Rev Respir Dis 1987;135:A212. Abstract.Google Scholar
293. Suzukawa, M, Usuda, Y, Numata, K, The effects on sputum characteristics of combining anunheated humidifier with a heat-moisture exchanging filter. Respir Care 1989;34:976–984.Google Scholar
294. Hay, R, Millar, WC. Efficacy of a new hygroscopic condenser humidifier. Crit Care Med 1982;10:49–51.Google Scholar
295. Mebius, C. A comparative study of disposable humidifiers. Acta Anaesth Scand 1983;27:403–409.Google Scholar
296. Shelly, MP, Bethune, DW, Latimer, RD. A comparison of five heat and moisture exchangers. Anaesthesia 86;41:527–532.Google Scholar
297. Branson, RD, Hurst, JM. Laboratory evaluation of moisture output of seven airway heat and moisture exchangers. Respir Care 1987;32:741–747.Google Scholar
298. Branson, RD. Campbell, RS, Davis, KJ. Johnson, DJ, Porombka, D. Humidification in the intensive care unit. Prospective study of a new protocol utilizing heated humidification and a hygroscopic condenser humidifier. Chest 1993;104:1800–1805.Google Scholar
299. Roustan, JP, Kienlen, J, Aubas, R Aubas, S, du Cailar, J. Comparison of hydrophobic heat and moisture exchanger with heated humidifier during prolonged mechanical ventilation Intensive Care Med 1992;18:97–100.Google Scholar
300. Misset, B, Escudier, B, Rivara, D, Leclercq, B, Nitenberg, G. Heat and moisture exchanger vs heated humidifier during long-term mechanical ventilation: a prospective randomized study. Chest 1991;100:160–163.Google Scholar
301. Gallagher, J, Strangeways, JE, Allt-Graham, J. Contamination control in long term ventilation: a clinical study using heat and moisture exchanging filter. Anaesthesia87;42:476–481.Google Scholar
302. Martin, C. Perrin, G, Gevaudan, MJ. Saux, P, Gouin, F. Heat and moisture exchangers and vaporizing humidifiers in the intensive care unit. Chest 1990;97:144–149.Google Scholar
303. Kaan, JA, Simoons-Smit, AM, MacLaren, DM. Another source of aerosol causing nosocomial Legionnaire's disease. J Infect 1985;11:145–148.CrossRefGoogle Scholar
304. Sanders, CV, Luby, JP, Johanson, WG. Barnett, JA, Sanford, JP Serratia marcescens infections from inhalation therapy medications: nosocomial outbreak. Ann Intern Med 1970;73:15–21.Google Scholar
305. Decker, MD. Lancaster, AD, Latham, RH. Bunce, CP. Becker, NR. Bums, K. Influence of closed suctioning system on ventilator-associated pneumonias. Abstracts of the Third Annual Meeting of the Society for Hospital Epidemiology of America, 1993:A6. Abstract.Google Scholar
306. Deppe, SA. Kelly, JW. Thoi, LL. et al. Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using Trach Care closed-suction system versus open-suction system: prospective, randomized study. Crit Care Med 1990; 18:1389–1393.Google Scholar
307. Ritz, R. Scott, LR, Coyle, MB, Pierson, DJ. Contamination of a multiple-use suction catheter in a closed-circuit system compared to contamination of a disposable, single-use suction catheter. Respir Care 1986;31:1087–1091.Google Scholar
308. Johnson, KL, Kearney, P 4, Johnson, SB, Niblett, JB, Mcmillan, NL, McClain, RE. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med 1994;22:658–666.Google Scholar
309. Cobley, M. Atkins, M, Jones, Fl. Environmental contamination during tracheal suction. A comparison of disposable conventional catheters with a multiple-use closed system device. Anaesthesia 91;46:957–961.Google Scholar
310. Mayhall, CCG. The Trach Care closed tracheal suction system: a new medical device to permit tracheal suctioning without interruption of ventilatory assistance. Infect Control Hosp Epidemiol 1988;9:125–126.Google Scholar
311. Stone, JW, Das, BC. Investigation of an outbreak of infection with Acinetobacter calcoaceticus'm a special care baby unit. J Hosp Infect 1986;7:42–48.Google Scholar
312. Thompson, AC, Wilder, BJ. Powner, DJ. Bedside resuscitation bags: a source of bacterial contamination. Infect Control 1985;6:231–232.Google Scholar
313. Weber, DJ. Wilson, MB. Rutala, WA, Thomann, CA Manual ventilation bags as a source for bacterial colonization of intubated patients. Am Rev Respir Dis 1990;142:892–894.Google Scholar
‘314. Olds, JW, Kisch, AL, Eberle, BS, Wilson, TN. Pseudomonas aeruginosa respiratory tract infection acquired from a contaminated anesthesia machine. Am Rev Respir Dis 1972;105:628–632.Google Scholar
315. Albrecht, WH. Dryden, GE. Five-year experience with development of an individually clean anesthesia system. Anesth Analg 1974;52:24–28.Google Scholar
316. Du Moulin, GC, Sauberman, AJ. Thr anesthesia machine and circle system are not likely to be sources of bacterial contamination. Anesthesiology 1977;47:353–358.Google Scholar
317. American Association of Nurse Anesthetists. Infection Control Guide. 2nd ed. Chicago, Chicago, IL: American Association of Nurse Anesthetists; 1993;12–28.Google Scholar
318. American Society for Anesthesiologists. Prevention of nosocomial infections in patients. In: Recommendations for Infection Control for the Practice 0/Anesthesiology Park Ridge. IL: American Society of Anesthesiologists; 1991;1–9.Google Scholar
319. Bengtson, JP, Brandberg, A, Brinkhoff, Ei, Sonander, H, Stenqvist, O. Low-flow anesthesia does not increase the risk of microbial contamination through the circle absorber system . Acta Anaesth Scand 1989;33:89–92.Google Scholar
320. Centers for Disease Control and Prevention. Draft guidelines for preventing the transmission of tuberculosis in health-care facilities. Federal Register 1993;58:52810–52854.Google Scholar
321. Parmley, JB, Tahir, AH, Dascomb, HE, Adriani, J. Disposable versus reusable rebreathing circuits: advantages, disadvantages, hazards and bacteriologic studies. Anesth Analg 1972;51:888–894.Google Scholar
322. Shiotani, GM. Nicholes, P Ballinger, CM, et al. Prevention of contamination of the circle system and ventilators with a new disposable filter. Anesth Analg 1971;50:844-X55.Google Scholar
323. Luttropp, HH, Berntman, L. Bacterial filters protect anaesthetic equipment in a low-flow system. Anaesthesia 93;48:520–523.Google Scholar
324. Garibaldi, R 4, Britt, MR, Webster, C. Pace, NL Failure of bacterial filters to reduce the incidence of pneumonia after inhalation anesthesia. Anesthesiology 1981;54:364–368.Google Scholar
325. Feeley, TW, Hamilton, WK. Xavier, B, Movers, J. Sterile anesthesia breathing circuits do not prevent postoperative pulmonary infection. Anesthesiology 1981;54:369–372.Google Scholar
326. Berry, AJ. Nolte, FS. An alternative strategy for infection control of anesthesia breathing circuits: a laboratory assessment of the Pall HME filter. Anesth Analg 1991;72:651–655.Google Scholar
327. Rutala, DR. Rutala, WA, Weber, DJ. Thomann, CA Infection risks associated with spirometry. Infect Control Hosp Epidemiol 1991;12:89–92.Google Scholar
328. Hazaleus, RE, Cole, J. Berdischewsky, M. Tuberculin skin test conversion from exposure to contaminated pulmonary function testing apparatus. Respir Care 1980;26:53–55 Google Scholar
329. Kirk, YL, Kendall, K. Ashworth, HA, Hunter, PR. Laboratory evaluation of a filter for the controlofcross-infection during pulmonary function testing. J Hosp Infect 1992;20:193–198.Google Scholar
330. Leeming, JP, Kendrick, AH. Pryce-Roberts, D, Smith, DR, Smith, EC. Use of filters for the control of cross-infection during pulmonary function testing. J Hosp Infect 1992;20:245–246. Letter.Google Scholar
331. Djokovic, JL, Hedley-White, J. Prediction of outcome of surgery and anrsthesia in patients over 80. JAMA 1979;242:2301–2306.Google Scholar
332. Tisi, GM. Preoperative evaluation of pulmonary function: validity, indications and benefits. Am Rev Respir Dis 1979;119:293–310.Google Scholar
333. Gould, AB. Effect of obesity in respiratory complications following general anesthesia. Anesth Analg 1962;41:448–452.Google Scholar
334. Cain, HD, Stevens, PM. Preoperative pulmonary function and complications after cardiovascular surgery Chest 1979;76:130–135.Google Scholar
335. Wightman, JAK. A prospective study of the incidence of postoperative pulmonary complications. Br J Surg 1968;55:85–91.Google Scholar
336. Culver, CA. Makel, HP, Beecher, HK. Frequency of aspiration of gastric contents by lungs during anesthesia and surgery. Ann Surg 1961;133:289–292.Google Scholar
337. Rigg, IDA. Pulmonary atelectasis after anaesthesia: pathophysiology and management. Anaesth Soc J 1981;28:306–311.Google Scholar
33X. Simonneau, G. Vivien, A. Sartene, R, et al. Diaphragm dysfunction induced by upper abdominal surgery Am Rev Respir Dis 1983;128:899–903.Google Scholar
339. Bartlett, RH, Gazzaniga, AB, Gtraghty, TR. Respiratory maneuvers to prevent postoperative pulmonary complications. JAMA 1973;234:1017–1021.Google Scholar
340. Ali, J. Serette, C. Wood, LDM. et al. Effect of postoperative intermittent positive pressure breathing on lungfunction. Chest 1984;85:192–196.Google Scholar
341. Pontoppidan, H. Mechanical aids to lung expansion in non-intubated surgical patients. Am Rev Respir Dis 1980;122(suppl):109–119.Google Scholar
342. Morran, CG, Finlay, IG, Mithieson, M, McKay, AJ, Wilson, N. McArdle, CS. Randomized controlled trial of physiotherapy for postoperative pulmonary complications. Br J Anaesth 1983;55:1113–1116.Google Scholar
343. Castillo, R, Haas, A. Chest physical therapy: comparative efficacy of preoperative and postoperative in the elderly. Arch Phys Med Rehabil 1985;66:376–379.Google Scholar
344 Cordier, P, Squifflet, JP, Carlier, M. Alexandre, GPJ. Postoperative continuous positive airway pressure helps to prevent pulmonary infection after human renal transplantation. Transplant Proc 1984;16:1337–1339.Google Scholar
345. Vrariu, JK. Effectiveness of breathing exercises in preventing pulmonary complications following open heart surgery. Phys Ther 1977;57:1367–1371.Google Scholar
346. Celli, RR, Rodriguez, KS, Snider, GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery Am Rev Respir Dis 1984;1304:12–15.Google Scholar
347. Schwieger, I, Gamulin, ZB. Forster, A, Meyer, P. Gemperle, MB, Suter, PM. Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy: a controlled randomized study. Chest 1986;89:652–656.Google Scholar
34X. Roukema, JA. Carol, EJ. Prins, JG. The prevention of pulmonary complications after upper abdominal surgery in patients with noncompromised pulmonary status. Arch Surg 1988;123:30–34.Google Scholar
349. Stock, MC, Downs, JB. Gauer, PK, Alster, JM, Imrey, PB. Prevention of postoperative pulmonary complications with CPAR, incentive spirometry, and conservative therapy. Chest 1985;87:151–157.Google Scholar
350. Stein, M, Cassara, El. Preoperative pulmonary evaluation and therapy for surgery patients. JAMA 1970;211:787–790.Google Scholar
351. Avorn, J, Soumerai, SB. Everitt, DE, Ross-Dengan, D, Beers, MH. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med 1992;327:168–173.Google Scholar
352. Rutter, PC, Murphy, D. Dudley, HAF, Morphine: controlled trial of different methods of administration for postoperative pain. Br Med J 1980;280:12–13.Google Scholar
353. Wasylak, TJC. Abbott, FV, English, MJM, Jeans, ME. Reduction of postoperative morbidity following patient-controlled morphine. Can J Anaesth 1990;37:726–731.Google Scholar
354. Egbert, AM. Leland, HP. Short, LM. Burnett, ML. Randomized trial of postoperative patient-controlled analgesia vs. intramuscular narcotics in frail elderly men. Arch Intern Med 1990;150:1897–1903.Google Scholar
355. Lange, MP, Dahn, MS, Jacobs, LA. Patient-controlled analgesia versus intermittent analgesia dosing. Heart Lung 1988;17:495–498.Google Scholar
356. Addison, NV, Brear, FA. Budd, K, Whitaker, M. Epidural analgesia following cholecystectomy. Br J Surg 1974;61:850–852.Google Scholar
357. Rawal, N, Shostrand, U, Christofferson, E. Dahlstrom, B, Arvill, A. Rydman, H. Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function. Anesth Analg 1984;63:583–592.Google Scholar
358. Cushieri, RJ, Morran, CG. Howie, JC, McArtle, CS. Postoperative pain and pulmonary complications: comparison of three analgesic regimens. Br J Surg 1985;72:495–498.Google Scholar
339. Gould, FK. Magee, JG. Ingham, HR. A hospital outbreak of antibiotic-resistant Streptococcus pneumoniae . J Infect 1987;15:77–79.Google Scholar
360. Moore, EP, Williams, EW. Hospital transmission of multiply antibiotic resistant Streptococcus pneumoniae . J Infect 1988;16:199–208.Google Scholar
361. Alvarez, S, Shell, CG, Wooley, TW, et al. Nosocomial infections in long-term care facilities. J Gerontol 1992;43:M9–M12.Google Scholar
362. Advisory Committee on Immunization Practices. Pneumococcal polysaccharide vaccine. MMWR 1989;38:64–76.Google Scholar
363. Shapiro, ED, Clemens, JD. A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk of serious pneumococcal infections. Ann Intern Med 1984;101:325–330.Google Scholar
364. Williams, WW, Hickson, MA, Kane, MA, Kendal, AP Spika, JS, Human, AR Immunization policies and vaccine coverage among adults: the risk for missed opportunities. Ann Intern Med 1988;108:616–625.Google Scholar
365. Linger, M, Cigada, M, Mandelli, M, et al. Early onset pneumonia: a multicenter study in intensive care units. Intensive Care Med 1987;13:342–346.Google Scholar
366. Mandelli, M, Mosconi, P, Langer, M. Cigada, M. Prevention of pneumonia in an intensive care unit: a randomized multicenter clinical trial. Crit Care Med 1989;17:501–505.Google Scholar
367. Petersdorf, RG. Curtin, JA. Hoeprich, PD, Peeler, RN, Bennet, LL. A study of antibiotic prophylaxis in unconscious patients. N Engl J Med 1957;257:1001–1009.Google Scholar
368. Tillotson, JR, Finland, M. Bacterial colonization and clinical superinfection of the respiratory tract complicating antibiotic treatment of pneumonia. J Infect Dis 1969;119:597–624.Google Scholar
369. Sen, P, Kapila, P, Chmel, H. Armstrong, DA. Louria, DB. Superinfection: another look. Am J Med 1982;73:706–718.Google Scholar
370. Nord, CE, Kager, L, Hemdahl, A. Impact of antimicrobial agents on the gastrointestinal micmflora and the risk of infections. Am J Med 1984;80:99–106.Google Scholar
371. Goodpasture, HC, Romig, DA, Voth, DW. A prospective study of tracheobronchial bacterial flora in acute brain-injured patients with and without antibiotic prophylaxis. J Neurosurg 1977;47:228–235.Google Scholar
372. Kelley, RE, Vibulsresth, S, Bell, L, Duncan, RC. Evaluation of kinetic therapy in the prevention of complications of prolonged bed rest secondary to stroke. Stroke 1987;18:638–642.Google Scholar
373. Gentilello, I., Thompson, DA, Tonnesen, AS, et al. Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med 1988;16:783–786.Google Scholar
374. Summer, WR, Curry, P, Haponik, EF, Nelson, S, Elston, R. Continuous mechanical turning of intensive care unit patients shortens length of stay in some diagnostic-elated groups. J Crit Care 1989;4:45–53.Google Scholar
375. Fink, MP Helsmoortel, CM, Stein, KL, Lee, PC, Cohn, SM. The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of blunt trauma: a prospective study. Chest 1990;97:132–137.Google Scholar
376. Nelson, LD, Choi, SC. Kinetic therapy in critically ill trauma patients. Clin Intensive (‘are 1992;37:248–252.Google Scholar
377. deBoisblanc, BP. Castro, M, Everret, B, Grender, J, Walker, CD, Summer, WB. Effect of air-supported, continuous, postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness. Chest 1993;103:1543–1547.Google Scholar
378. Zack, MB, Pontoppidan, H, Kazemi, H. The effect of lateral positions on gas exchange in pulmonary disease: a pmspective evaluation. Am Rev Respir Dis 1974;110:49–54.Google Scholar
379. Wong, JW, Keens, TG, Wannamaker, EM, Crazier, DN, Levison, H, Aspin, N. The effects of gravity on tracheal mucous transport rates in normal subjects and patients with cystic fibrosis. Pediatrics 1977;60:146–152.Google Scholar
380. Blake, JR On the movement of mucous in the lung. J Biochem 1975;8:175–190.Google Scholar
381. Becker, DM, Gonzalez, M, Gentili, A, Eismont, F, Green, BA, Prevention of deep venous thmmbosis in patients with acute spinal card injuries: use of rotating treatment tables. Neurosurgery 1987;20:675–677.Google Scholar
382. Hoge, CW, Breiman, RF, Advances in the epidemiology and control of Legion & infections. Epidemiol Rev 1991;13:329–340.Google Scholar
383. Joseph, CA, Watson, JM, Harrison, TG. Bartlett, CLR Nosocomial Legionnaires disease in England and Wales, 1980-92. Epidemiol Infect 1994;112:329–345.Google Scholar
384. Brennen, C, Vickers, JP Yu, VL, Puntereri, A, Yee, YC. Discovery of occult Legionella pneumonia in a long-stay hospital: results of prospective serologic survey. Br Med J 1987;295:306–307.Google Scholar
385. Marrie, TJ, MacDonald, S, Clarke, K, Haidane, D. Nosocomial Legionnaires' disease: lessons from a four-year prospective study. Am J Infect Control 1991;19:79–85.Google Scholar
386. Muder, RR, Yu, VL, McClure, JK, Kroboth, FJ, Kominos, SD, Lumish, RN Nosocomial Legionnaires' disease uncovered in a prospective pneumonia study: implications for underdiagnoses. JAMA 1983;249:3184–3188.Google Scholar
387. Filermans, CD, Cherry, WB, Orrison, LH. Smith, SJ, Tison, DL, Pope, DH. Ecologie distribution of Legionella pneumophila . Appl Environ Microbiol 1981;41:9–16.Google Scholar
388. Morris, GK, Patton, CM, Feeley, JC, et al. Isolation of the Legionnaires' disease bacterium from environmental samples. Ann Intern Med 1979;90:664–666.Google Scholar
389. Hsu, SC, Martin, R, Wentworth, BB. Isolation of Legionella species from drinking water. Appl Environ Microbiol 1984;48:830–832.Google Scholar
390. Tison, DL, Seidler, RJ. Legionella incidence and density in potable drinking water. Appl Environ Microbiol 1983;45:337–339.Google Scholar
391. Muraca, P, Stout, JE. Yu, VL. Comparative assessment of chlorine, heat. ozone, and UV light for killing Legionella pneumophila within a model plumbing system. Appl Environ Microbiol 1987;53:447–453.Google Scholar
392. Farrell, ID, Barker, JE. Miles, EP, Hutchinson, JCP A field study of the survival of Legionella pneumophila in a hospital hot-water system. Epidemiol Infect 1990;104:381–387.Google Scholar
393. Stout, JE, Yu, VL. Best, MG. Ecology of Legionella pneumophila within water distribution systems . Appl Environ Microbiol 1985;49:221–228.Google Scholar
394. Sanden, GN, Fields, BS, Barbaree, JM, et al. Viability of Legionella pneumophila in chlorine-free water at elevated temperatures. Curr Microbiol 1989;18:61–65.Google Scholar
395. Schulze-Robbecke, R, Rodder, M, Exner, M. Multiplication and killing temperatures of naturally occurring legionellae. Zbl Bakt Hyg B 1987;184:495–500.Google Scholar
396. Hahicht, W, Muller, HE. Occurrence and parameters of frequency of Legionella in warm water systems of hospitals and hotels in Lower Saxony. Zbl Bakt Hyg B 1988;186:79–88.Google Scholar
397. Ciesielski, CA, Blaser, MJ, Wang, WL. Role of stagnation and obstruction of water flow in isolation of Legionella pneumophila from hospital plumbing. Appl Environ Microbiol 1984;48:984–987.Google Scholar
398. Rowbotham, TJ. Preliminary report on the pathogenicity of Legionella pneumophila for freshwater and soil amoebae. J Clin Bithol 1980;33:1179–1183.Google Scholar
399. Fields, BS, Sanden, GN, Barbaree, JM, et al. Intracellular multiplication of Legionella pneumophila in amoebae isolated from hospital hot water tanks. Curr Microbiol 1989;18:131–137.Google Scholar
400. Le Saux, NM. Sekla, L, McLeod, J, et al. Epidemic of nosocomial Legionnaires' disease in renal transplant recipients: a case-control and environmental study. Can Med Assoc J 1989;140:1047–1053.Google Scholar
401. Berendt, RF, Young, HW, Allen, RG, Knutsen, GL. Dose-response of guinea pigs experimentally infected with aerosols of Legionella pneumophila . J Infect Dis 1980;141:186–192.Google Scholar
402. Marston, BJ, Lipman, TLB. Breiman, RF, Surveillance for Legionnaires' disease in the eighties: risk factors for morbidity and mortality related to infection with Legionella . Arch Intern Med 1994. In press.Google Scholar
403. Kirby, BD, Snyder, KM, Meyer, RD, et al. Legionnaires' disease. Report of 65 nosocomially acquired cases and review of the literature. Medicine 1980;59:188–205.Google Scholar
404. Haley, CE. Cohen, ML, Halter, J, Meyer, RD. Nosocomial Legionnaires' disease: a continuing common-source epidemic at Wadsworth Medical Center. Medicine 1979;90:583–586.Google Scholar
405. Bock, BV, Kirby, BD, Edelstein, PH, et al. Legionnaires' disease in renal transplant recipients. Lancet 1978;1:410–413.Google Scholar
406. Brady, MT Nosocomial Legionnaires' disease in a children's hospital. J Pediatr 1989;115:46–50.Google Scholar
407. Horie, H, Kawakami, H, Minoshima, K. et al. Neonatal Legionnaires' disease: histologic fmdings in an autopsied neonate. Acta Pathol Jpn 1992;42:427–431.Google Scholar
408. Helms, CM, Viner, JP, Sturm, RH. et al. Comparative features of pneumococcal, mycoplasma, and Legionnaires' disease pneumonias. Ann Intern Med 1979;90:543–547.Google Scholar
409. Yu, V, Kroboth, FJ, Shonnard, J, Brown, A, McDearman, S, Magnussen, M. Legionnaires' disease: new clinical perspectives from a prospective pneumonia study. Am J Med 1982;73:357–361.Google Scholar
410. Marston, B, Plouffe, J, File, T, et al. Evidence of mixed infection in patients with antibody to Chlamydia pneumoniae . Abstracts of the 32nd Interscience Conference on Antimicrobial Agents end Chemotherapy 1992;808. Abstract.Google Scholar
411. Ussery, XT, Butler, JC, Breiman, R, et al. Outbreak of Legionnaires' disease associated with Mycoplasma infection. Abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy 1992;815. Abstract.Google Scholar
412. Jimenez, ML, Aspa, J, Padilla, B, et al. Fiberoptic bronchoscopic diagnosis of pulmonary disease in 151 HIV-infected patients with pneumonitis. Eur J Clin Microbiol Infect Dis 1991;10:491–497.Google Scholar
413. Centers for Disease Control. Case definitions for public health surveillance. MMWR 1990;39 (RR-13):18.Google Scholar
414. Helms, CM, Renner, ED, Viner, JP, Hierholzer, WJ, Wintermeyer, LA, Johnson, W. Indirect immunofluorescence antibodies to Legionella pneumophila: frequency in a rural community, J Clin Microbiol 1980;12:326–328.Google Scholar
415. Wilkerson, HW, Reingold, AL, Brake, BJ, McGiboney, DL, Gorman, GW, Broome, CV. Reactivity of serum from patients with suspected legionellosis against 29 antigens of Legionellaceae and Legionella-like organisms by indirect immunofluorescence assay. J Infect Dis 1983;147:23–31.Google Scholar
416. Nichol, KL, Parenti, CM, Johnson, JE. High prevalence of positive antibodies to Legionella pneumophila among outpatients. Chest 1991;100:663–666.Google Scholar
417. Storch, G, Hayes, PS, Hill, DL. Baine, W. Prevalence of antibody to Legionella pneumophila in middle-aged and elderly Americans. J Infect Dis 1979;140:784–788.Google Scholar
418. Plouffe, J, Marston, B, Straus, W, Breiman, R, Hackman, B, Moyenuddin, M. Utility of diagnostic studies in Legionnaires' disease: Franklin County. Abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy 1992;817. Abstract.Google Scholar
419. Edelstein, PH. The laboratory diagnosis of Legionnaires' disease. Seminars Respir Infect 1987;2:235–241.Google Scholar
420. Bridge, JA, Edelstein, PH Oropharyngeal colonization with Legionella pneumophila . J Clin Microbiol 1983;18:1108–1112.Google Scholar
421. Fukunaga, H, Akagi, K. Yabuchi, E. Asymptomatic infection of Legionella pneumophila in four cases with pulmonary disease in Japanese. Nippon Saikingaku Zasshi 1990;45:833–840.Google Scholar
422. Dondero, TJ. Rendtorff, RC, Mallison, GF, et al. An outbreak of Legionnaires disease associated with a contaminated airconditioning cooling tower. N Engl J Med 1980;302:365–370.Google Scholar
423. Garbe, PL. Davis, BJ. Weisfield, JS. et al. Nosocomial legionnaires' disease: epidemiologic demonstration of cooling towers as a source. JAMA 1985;254:521–524.Google Scholar
424. O'Mahony, MC, Stanwell-Smith, RE, Tillett, HE. et al. The Stafford outbreak of legionnaires' disease. Epidemiol Infect 1990;104:361–380.Google Scholar
425. Breiman, RF, Fields, BS. Sanden, G. Volmer, I, Meier, A. Spika, J. An outbreak of Legionnaires' disease associated with shower use: possible role of amoebae. JAMA 1990;263:2924–2926.Google Scholar
426. Hanrahan, JP. Morse, DL. Scharf, VB, et al. A community hospital outbreak of legionellosis: transmission by potable hot water . Am J Epidemiol 1987;125:639–649.Google Scholar
427. Breiman, RF, VanLoock, FL. Sion, JP, et al. Association of “sink bathing” and Legionnaires' disease. Abstracts of the 91st Meeting of the American Society for Micmbiology 1991: L18. Abstract.Google Scholar
428. Struelens, MJ, Maes, N. Rost, F, et al Genotypie and phenotypic methods for the investigation of a nosocomial Legionella pneumophila outbreak and efficacy of control measures . J Infect Dis 1992;166:22–30.Google Scholar
429. Johnson, JT, Yu, VL, Best, MG, et al. Nosocomial legionellosis in surgical patients with head and neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet 1985;2:298–300.Google Scholar
430. Marrie, TJ. Haldane, D. MacDonald, S, et al. Control of endemic nosocomial Legionnaires' disease by using sterile potable water for high risk patients. Epidemiol Infect 1991;107:591–605.Google Scholar
431. Blatt, SP Parkinson, MD, Pace, E. et al. Nosocomial legionnaires' disease, aspiration as a primary mode of disease acquisition. Am J Med 1993;95:16–22.Google Scholar
432. Fraser, DW, Tsai, TR. Oremstein, W, et al. Legionnaires' disease: description of an epidemic of pneumonia. N Engl J Med 1977;297:1189–1197.Google Scholar
433. Yu, VI. Routine culturing for Legionella in the hospital environment may be a good idea: a three-hospital prospective study. Am J Med 1987;294:97–99.Google Scholar
434. Allegheny County Health Department. Approaches to Prevention and Control of Legionella Infection in Allegheny County Health Care Facilities. Pittsburgh: Allegheny County Health Department: 1993;1–13.Google Scholar
435. Goetz, A Yu, VI. Screening for nosocomial legionellosis by culture of the water supply and targeting of high-risk patients for specialized laboratory testing. Am J Infect Control 1991;19:63–66.Google Scholar
436. Yu, VL. Nosocomial legionellosis: current epidemiologic issues. In Remington, JS. Swartz, MN. eds. Current Clinical Topics in Infectious Diseases. New York, NY: McGraw-Hill; 1986;239–253.Google Scholar
437. Vickers, RM. Yu, VL, Hanna, SS. Determinants of Legionella pneumophila contamination of water distribution systems: 15-hospital prospective study. Infect Control 1987;8:357–363.Google Scholar
438. Tobin, JO, Swann, RA, Bartlett, CLR. Isolation of Legionella pneumophila from water systems: methods and preliminary results. Br Med J 1981;282:515–517.Google Scholar
439. Dennis, PJ, FItzgeorge, RB, Taylor, JA. et al. Legionella pneumophila in water plumbing systems. Lancet 1982;1:949–951.Google Scholar
440. Marrie, TJ. Haldane, D, Bezanson, G, Peppard, R. Each water outlet is a unique ecologie niche for Legionella pneumophila . Epidemiol Infect 1992;108:261–270.Google Scholar
441. Marrie, TJ, Berzcason, G, Fox, J, Kuehn, R. Haldane, D, Birbridge, S. Dynamics of Legionella pneumophila in the potable water of one floor of a hospital. In: Barbaree, JM. Breiman, RF, Dufow, AP, eds. Legionella: Current Status and Emerging Perspectives. Washington, DC: American Society for Microbiology: 1993;238–240.Google Scholar
442. Plouffe, JF, Para, ME Maher, WE. Hackman, B, Webster, L. Subtypes of Legionella pneumophila serogroup 1 associated with different attack rates. Lancet 1993:2:649–650.Google Scholar
443. Fraser, DW. Sources of legionellosis. In: Thornsberry, C, Balows 4, Feeley, JC, Jakubowski, W. rds. Legionella: Proceedings of the 2nd International Symposium. Washington, DC: American Society for Microbiology; 1984;277–280.Google Scholar
444. Dourmon, E, Bibb, WF, Rajagopalan, P Desplaces, N, McKinney, RM. Monoclonal antibody reactivity as a virulence marker for Legionella pneumophila serogroup 1 strain. J Infect Dis 1992;165:569–573.Google Scholar
445. Brundrett, GW. Guides on avoiding Legionnaires' disease. In- Legionella and Building Services. Oxford. England: Butterworth Heineman; 1992346373.Google Scholar
446. Kugler, JW, Armitage, JO, Helms, CM, et al. Nosocomial Legionnaires' disease. Occurrence in recipients of bone marrow transplants. Am J Med 1983;74:281–288.Google Scholar
447. Department of Health. The Control of fagianella in Health Care Premises: A Code of Practice. London. England: HMSO; 1991.Google Scholar
448. Helms, CM, Massanari, RM, Wenzel, RP, et al. Legionnaires' disease associated with a hospital water system: a five-year progress report on continuous hyperchlorination. JAMA 1988;259:2423–2427.Google Scholar
449. Snyder, MB, Siwicki, M, Wireman, J. et al. Reduction of Legionella pneumophila through heat flushing followed by continuous supplemental chlorination of hospital hot water. J Infect Dis 1990; 162:127–132.Google Scholar
450. Ezzeddine, H, Van Ossel, C, Delmee, M, Wauters, G. Legionella spp. in a hospital hot water system: effect of control measures. J Hosp Infect 1989;13:121–131.Google Scholar
451. Kilbourne, ED. Influenza. New York. NY. Plenum Publishing; 1987 Google Scholar
452. Johnston, JM, Latham, RH. Meier, FA, et al. Nosocomial outbreak of Legionnaires' disease molecular epidemiology and disease control measures . Infect Control 1987;8:53–58.Google Scholar
453. Joly, JR. McKinney, RM. Tobin, JO. Bibb, WE Watkins, ID. Ramsay, I). Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies. J Clin Microbiol 1986;23:768–771.Google Scholar
454. Schoonmaker, D, Helmberger, T, Birkhead, G Comparison of ribotyping and restriction enzyme analysis using pulsed-field gel electrophoresis for distinguishing Legionella pneumophila isolates obtained during a nosocomial outbreak. J Clin Microbiol 1992;30:1491–1498.Google Scholar
455. Barbaree, JM. Selecting a subtyping technique for use in investigations of legionellosis epidemics. In: Barbaree, JM, Breiman, RE Dufow, AP, eds. Legionella: Current Status and Emerging Perspectives. Washington, DC: American Society for Microbiology; 1993.Google Scholar
456. Best, M, Yu, VI. Stout, J. Goetz, A. Muder, RR, Taylor, E Legionellaceae in the hospital water supply: epidemiologic link with disease and evaluation of a method for control of nosocomial legionnaires' disease and Pittsburgh pneumonia. Lancet 1983;2:307–310.Google Scholar
457. Meenhorst, PL. Reingold, AL. Groothuis, DG, et al. Water-related nosocomial pneumonia caused by Legionella pneumophila serogroups 1 and 10. J Infect Dis 1985;152:356–364.Google Scholar
458. Johnston, JM. Latham, RH, Meier, FA, et al. Nosocomial outbreak of Irgionnaires' disease: molecular epidemiology and disease control measures. Infect Control 1987;8:53–58.Google Scholar
459. Matulonis, U, Rosenfetd, CS. Shadduck, RK. Prevention of Legionella infections in a bone marrow transplant unit: multifaceted approach to decontamination of a water system. Infect Control Hosp Epidemiol 1993;14:571–583.Google Scholar
460. Domingue, EL, Tyndall, RL. Mayberry, WR, Pancorbo, OC. Effects of three oxidizing biocidrs of fagianella pneumophila serogroup 1. Appl Environ Microbiol 1988;54:741–747.Google Scholar
461. Landeen, LK. Yahya, MT, Gerba, CP Efficacy of copper and silver ions and reduced levels of free chlorine in inactivation of Legionella pneumophila . Appi Environ Microbiol 1989;55:3045–3050.Google Scholar
462. Liu, Z, Stout, TE, Tedesco, T, et al. Controlled evaluation of copper-silver ionization in eradicating Legionella pneumophila from a hospital water distribution system. J Infect Dis 1994;169:919–922.Google Scholar
463. Edelstein, PH, Whittaker, RE. Kreiling, RL, Howell, CL. Efficacy of ozone in eradication of Legionella pneumophila from hospital fixtures. Appl Environ Microbiol 1982;44:1330–1334.Google Scholar
464. Wisconsin Department of Health and Social Services. Control of Legionella in Cooling Towers: Summary Guidelines Madison. WI: Wisconsin Division of Health; 1987.Google Scholar
465. Best, MG, Goetz, A. Yu, VL. Heat eradication measures for control of nosocomial Legionnaires disease: implementation, education, and cost analysis. Infect Control 1984;12:26–30.Google Scholar
466. Muraca, PW, Yu, VL. Goetz, A. Disinfection of water distribution systems for Legionella: a review of application procedures and methodologies. Infect Control Hosp Epidemiol 1990;11:79–88.Google Scholar
467. Walsh, TJ. Dixon, DM. Nosocomial aspergillosis: environmental microbiology, hospital epidemiology, diagnosis and treatment. Eur J Epidemiol 1985;5:131–142.Google Scholar
468. Bodey, GP, Vartivarian, S. Aspergillosis. Eur J Clin Microbiol Infect Dis 1989;8:413–437.Google Scholar
469. Fraser, DW, Ward, JL, Ajello, L. Plikaytis, BD. Aspergillosis and other systemic mycoses: the growing problem. JAMA 1979;242:1631–1635.Google Scholar
470. Iwen, PC, Reed, EC. Armitage, JO. et al. Nosocomial invasive aspergillosis in lymphoma patients treated with bone marrow or peripheral stem cell transplants. Infect Control Hosp Epidemiol 1993;14:131–139.Google Scholar
471. Cordonnier, C, Bernaudin, JF, Bierling, P, Huet, Y, Vernant, JP. Pulmonary complications occurring after allogeneic bone marrow transplantation: a study of 130 consecutive transplanted patients. Cancer 1986;58:1047–1054.Google Scholar
472. Klimowski, LL. Rotstein, C. Cummings, KM. Incidence of nosocomial aspergillosis in patients with leukemia over a twenty-year period. Infect Control Hosp Epidemiol 1989;10:299–305.Google Scholar
473. Walmsley, S, Devi, S, King, S, Schneider, R. Richardson, S, Ford-Jones, L. Invasive Aspergillus infections in a pediatric hospital: a ten-year review. Pediatr Infect Dis 1993;12:673–682.Google Scholar
474. Sherertz, RJ. Belani, A, Kramer, BS, et al. Impact of air filtration on nosocomial aspergillus infections. Unique risk of bone marrow transplant recipients. Am J Med 1987;83:709–718.Google Scholar
475. Rhame, FS. Lessons from the Roswell Park bone marrow transplant aspergillosis outbreak. Infect Control 1985;6:345–346.Google Scholar
476. Holstein, C, Cummings, KM, Tiddings, J, et al. An outbreak of invasive aspergillosis among bone marrow transplants: a case-control study. Infect Control 1985;6:347–355.Google Scholar
477. Aisner, J. Schimpff, SC. Bennett, JE, et al. Aspergillus infections in cancer patients. Association with fireproofing materials in a new hospital. JAMA 1976;235:411–412.Google Scholar
478. Arnow, PM, Anderson, RI, Mainous, PD. Smith, EJ. Pulmonary aspergillosis during hospital renovation. Am Rev Respir Dis 1978;118:49–53.Google Scholar
479. Streifet, AJ, Laner, JL, Vesley, D. et al. Aspergillus fumigatus and other thermotoierant fungi generated by hospital building demolition. Appi Environ Microbiol 1983;46:375–378.Google Scholar
480. Hopkins, CC. Weber, DJ, Rubin, RH. Invasive aspergillosis infection: possible non-ward common source within the hospital environment. J Hosp Infect 1989;13:19–25.Google Scholar
481. Gurwith, MJ, Stinson, EB. Remington, JS. Aspergillus infection complicating cardiac transplantation: report of five cases. Arch Intern Med 1971;128:541–545.Google Scholar
482. Weiland, D, Ferguson, RM, Peterson, PK, Snover, DC, Simmons, RL, Najarian, JS. Aspergillosis in 25 renal transplant patients. Ann Surg 1983;198:622–629.Google Scholar
483. Hofflin, JM. Potasman, I. Baldwin, JC, Oyster, PE, Stinson, EB, Remington, JS. Infectious complications in heart transplant recipients receiving Ciclosporine and corticosteroids. Ann Intern Med 1987;106:209–216.Google Scholar
484. Schulman, LL, Smith, CR, Drusin, R, Rose, EA. Enson, Y, Reemtsma, K. Respiratory complications of cardiac transplantation. Am J Med Sci 1988;296:1–10.Google Scholar
485. Gustafson, TL, Schaffner, W, Lavely, GB, Stratton, CW, Johnson, HK. Hutcheson, RH. Invasive aspergillosis in renal transplant recipients: conelation with corticosteroid therapy. J Infect Dis 1983;148:230–238.Google Scholar
4%. Ho, M, Dummer, JS. Risk factors and approaches to infections in transplant recipients. In Mandeli, GL. Douglas, RG Jr, Bennett, JE. eds. Principles and Practice of Infectious Diseases. 3rd ed. New York, NY: Churchill Livingstone: 1990;2284–2291.Google Scholar
487. Rhame, FS, Streifel, AJ, Kersey, JHJ. Extrinsic risk factors for pneumonia in the patient at high nsk for infection. Am J Med 1984;76:42–52.Google Scholar
488. Aisner, J, Murillo, J, Schimpff, SC, Steere, AC. Invasive aspergillosis in acute leukemia: correlation with nose cultures and antibiotic use . Ann Intern Med 1979;90:4–9.Google Scholar
489. Ho, M, Dummer, JS, Peterson, PK. Simmons, RL. Infections in solid organ transplant recipients. In: Mandeli, GL. Douglas, RG Jr. Bennett, JE, eds. Principles and Practice of Infectious Diseases. 3rd ed. New York, NY: Churchill Livingstone; 1990;2294–2303.Google Scholar
490. Walsh, TR, Guttendorf, J, Dummer, S, et al. The value of protective isolation procedures in cardiac transplant recipients. Ann Thorac Surg 1989;47:539–545 Google Scholar
491. Denning, DW, Stevens, DA. Antifungal and surgical treatment of invasive aspergillosis: review of 2121 published cases. Rev Infect Dis 1990;12:1147–121.Google Scholar
492. Pannuti, CS. Haller, MA, Wenzel, RP. Nosocomial pneumonia in adult patients undergoing bone manow transplantation: a ‘&year study. J Clin Oncol 1991;9:77–84.Google Scholar
493. Weinberger, M, Elattaar, I, Marshall, D, et al. Patterns of infection in patients with aplastic anaemia and the emergence of aspergillus as a major cause of death. Medicine 1992;71:24–43.Google Scholar
494. Orr, DP, Myerowitz, RL, Jemkins, R, et al. Patho-radiologic correlation of invasive pulmonary aspergillosis in the compromised host. Case report and review of literature. Cancer 1978;41:2028–2039.Google Scholar
495. Young, RC, Bennett, JE. Vogel, CL, Carbone, PP, DeVita, VT. Aspergillosis: the spectrum of the disease in 98 patients. Medicine 1970;49:147–173.Google Scholar
496. Meyer, RD, Young, IS, Armstrong, D. et al. Aspergillosis complicating neoplastic disease. Am J Med 1973;54:6–15.Google Scholar
497. Yu, VL, Muder, RR, Poorsattar, A Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Results of a three-year prospective study. Am J Med 1986;81:249–254.Google Scholar
498. Martino, P, Raccah, R, Gentile, G, Venditti, M. Girmenea, C. Mandelli, F Aspergillus colonization of the nose and pulmonary aspergillosis in neutropenic patients: a retrospective study. Hematologica 1989;74:263–265.Google Scholar
499. Riehet, HM, McNeil, MM, Davis, BJ. et al. Aspergillus fumigatus sternal wound infections in patients undergoing open heart surgery. Am J Epidemiol 1992;135:48–58.Google Scholar
500. Albelda, SM. Talbot, GH, Gerson, SL, Miller, WT, Cassileth, PA Role of fiberoptic bmnchoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia. Am J Med 1984;76:1027–1034.Google Scholar
501. Kahn, FW, Jones, JM, England, DM. The role of bronchoalveolar lavage in the diagnosis of invasive pulmonary aspergillosis. Am J Clin Patholol 1986;86:518–523.Google Scholar
502. Saito, H. Anaissie, EJ. Morice, RC, Dekmezian, R. Bodey, GP. Bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in patients with acute leukemia. Am J Med 1984;76:1027–1034.Google Scholar
503. Cohen, J. Clinical manifestations and management of aspergillosis in the compromised patient. In: Warnock, DW, Richardson, MD, eds. Fungal Infections in the Compromised Patient. London, England: John Wiley&Sons Ltd; 1991;117–152.Google Scholar
504. Pepys, J, Riddell, RW, Citron, KM, Clayton, YM, Short, El. Clinical and immunologic significance of Aspergillus fumigatus in the sputum. Am Rev Respir Dis 1959;80:167–180.Google Scholar
505. Karam, GH, Griffin, JR. Invasive pulmonary aspergillosis in nonimmunocompromised, non-neutropenic hosts. Rev Infect Dis 1986;8:357–363.Google Scholar
506. Kammer, RB, Utz, JP. Aspergillus species endocarditis: the new face of a not so rare disease. Am J Med 1974;56:506–521.Google Scholar
507. Holmberg, K, Berdischewsky, M, Young, LS. Serologic immunodiagnosis of invasive aspergillosis. J Infect Dis 1980;141:656–664.Google Scholar
508. Matthews, R, Burnie, JP, Fox, A Tabaqchali, S. Immunoblot analysis of serological responses in invasive aspergillosis. J Clin Pathol 1985;38:1300–1303.Google Scholar
509. Burnie, JP, Matthews, RC, Clark, I, Milne, LJ. Immunoblot fingerprinting of Aspergillus fumigatus . J Immunol Methods 1989;118:179–186.Google Scholar
510. Talbot, GH. Weiner, MH, Person, SL, Provencher, M, Hurwitz, S. Serodiagnosis of invasive aspergillosis in patients with hematologic malignancy: validation of the Aspergillus fumigatus antigen radioimmunoassay. J Infect Dis 1987;155:12–27.Google Scholar
511. Dupont, B, Huber, M, Kim, SJ, Bennett, JE. Galactomannan antigenemia and antigenuria in aspergillosis: studies in patients and experimentally infected rabbits. J Infect Dis 1987;155:1–11.Google Scholar
512. Gerson, SL. Talbot, GH, Hurwitz, S, Strom, B. Lusk, EJ. Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with leukemia. Ann Intern Med 1984,100:345–351.Google Scholar
513. Wiigard, JR, Beals, SU, Santos, GW, Mertz, WG. Sarai, R. Aspergillus infections in bone marrow transplant recipients. Bone Marrow Transplant 1987;2:175–181.Google Scholar
514. Peters, WP. Use of cytokines during prolonged neutropenia associated with autologous bone marrow transplantation. Rev Infect Da 1991;13:993–996.Google Scholar
515. Lieschke, GJ, Burgess, AW. Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor. N Engl J Med 1992;327:28–35.Google Scholar
516. Karp, JE. Burch, PA, Merz, WG, et al. An approach to intensive antileukemia therapy in patients with previous invasive aspergillosis. Am J Med 1988;85:203–206.Google Scholar
517. Meunier-Carpentier, F, Snoeck, R, Gerain, J, et al. Chemoprophylaxis of fungal infections. Am J Med 1984;76:652–656.Google Scholar
518. Wajszczuk, CP, Dummer, JS, Ho, M, et al. Fungal infections in liver transplant recipients. Transplantation 1985;40:347–353.Google Scholar
519. Rhame, FS, Streifel, A. Stevens, P et al. Endemic Aspergillus airborne spore levels are a major risk factor for aspergillosis in bone marrow transplant patients. Abstracts of the 25th Interscience Conference on Antimicrobial Agents and Chemotherapy 1985. Abstract.Google Scholar
520. Lentino, LR, Rosenkranz, MA, Michaels, JA, et al. Nosocomial aspergillosis: a retrospective review of airborne disease secondary to road construction and contaminated air conditioners. Am J Epidemiol 1982;116:430–437.Google Scholar
521. Sarubbi, FA, Kopf, HB, Brejetta Wilson, M, et al. Increased recovery of Aspergillus flavus fmm respiratory specimens during hospital construction. Am Rev Respir Dis 1982;125:33–38.Google Scholar
522. Krasinski, E, Holzman, RS, Hanna, B, et al. Nosocomial fungal infection during hospital renovation. Infect Control 1985;6:278–282.Google Scholar
523. Weems, JJ, Davis, BJ. Tablan, OC. Kaufman, L, Mattone, WJ. Construction activity: an independent risk factor for invasive aspergillosis and zygomycosis in patients with hematologic malignancy. Infect Control 1987;8:71–75.Google Scholar
524. Cage, AA, Dean, DC. Schimert, G, Minsky, N. Aspergillus infection after cardiac. surgery Arch Surg 1970;101:384–387.Google Scholar
525. Streifel, AJ, Stevens, PI: Rhame, FS. In-hospital source of airborne Penicillium spores. J Clin Microbiol 1987;25:1–4.Google Scholar
526. Keller, NP, Cleveland, TE. Bhatnagar, D. Variable electrophoretic karyotypes of members of Aspergillus flavi . Curr Genet 1992;21:371–375.Google Scholar
527. Denning, DW, Clernons, KV, Hanson, LH, Stevens, DA. Restriction endonuclease analysis of total cellular DNA of Aspergillus fumigatus isolates of geographically and epidemiologically diverse origin. J Infect Dis 1990;162:1151–1158.Google Scholar
528. Rhame, FS. Prevention of nosocomial aspergillosis. J Hosp Infect 1991;18:466–472.Google Scholar
529. Buckner, CD, Clift, RA. Sanders, AJ, et al. Protective environment for marrow transplant recipients. Intern Med 1978;89:893–901.Google Scholar
530. Murray, WA, Streifel, AJ, O'Dea, TJ, Rhame, FS. Ventilation for protection of immune compromised patients. ASHRAE Transactions 1988;94:1185–1191.Google Scholar
531. Streifel, AJ, Vesley, D. Rhame, FS, Murray, B. Control of airborne fungal spores in a university hospital. Environment International 1989;12:441–444.Google Scholar
532. Streifel, AJ, Rhame, FS. Hospital air filamentous fungal spore and particle counts in a specially designed hospital. Proc Indoor Air 1993;4:161–163.Google Scholar
533. Perry, S, Penland, WZ. The portable laminar flow isolator: new unit for patient protection in a germ-free environment. In: Recent Results in Cancer Research. New York, NY: Springer-Verlag; 1970.Google Scholar
534. Barnes, RA, Rogers, TR. Contml of an outbreak of nosocomial aspergillosis by laminar air-flow isolation.] Hosp Infect 1989;14:89–94.Google Scholar
535. Levine, AS, Siegel, SE, Schreiber, AD, et al. Protected environments and prophylactic antibiotics. N Engl Med 1973;288:477–483.Google Scholar
536. ASHRAE. Handbook, Heating Ventilation Air Conditioning Applications. Atlanta, GA: ASHRAE; 1991;7.1–7.12.Google Scholar
537. Rhame, FS. Nosocomial aspergillosis: how much protection for which patients? Infect Control Hosp Epidemiol 1989;10:296–298.Google Scholar
538. Opal, SM. Asp, AA, Cannady, PB, Morse, PL, Burton, IJ, Hammer, PG. Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construed on. J infect Dis 1986;153:634–637.Google Scholar
539. Welliver, RC, McLaughlin, S. Unique epidemiology of nosocomial infections in a children's hospital. Am J Dis Child 1984;138:131–135.Google Scholar
540. Valenti, WM, Hall, CB, Douglas, RG Jr, Menegus, MA, Pincus, PH. Nosocomial viral infections: L Epidemiology and significance. Infect Control 1980;1:33–37.Google Scholar
541. Goldwater, PN, Martin, AJ, Ryan, B. et al. A survey of nosocomial respiratory viral infections in a children's hospital: occult respiratory infection in patients admitted during an epidemic season. Infect Control Hosp Epidemiol 1991;12:231–238.Google Scholar
542. Mintz, L, Ballard, RA, Sniderman, SH, et al. Nosocomial respiratory syncytial virus infections in an intensive care nursery: rapid diagnosis by direct immunofluorescence. Pediatrics 1979;64:149–153.Google Scholar
543. Hall, CB, McBride, JX Walsh, EE, et al. Aerosolized ribavirin treatment in infants with respiratory syncytial virus infection. N Engl J Med 1983;308:1443–1447.Google Scholar
544. Betts, RE Amantadine and rimantadine for the prevention of influenza A. Seminars Respir Infect 1989;4:304–310.Google Scholar
545. Rodriguez, WJ, Parrott, RH. Ribavirin aerosol treatment of serious respiratory syncytial virus infection in infants. Infect Ois Clin N Am 1987;2:425.Google Scholar
546. Krasinski, E. Severe respiratory syncytial virus infection: clinical features, nosocomial acquisition and outcome. Pediatr Infect Dis 1985;4:250–256.Google Scholar
547. Meissner, HC, Murray, SA, Kieman, MA, et al. A simultaneous outbreak of respiratory syncytial virus and parainfluenza virus type 3 in a newborn nursery. J Pediatr 1984;104:680–684.Google Scholar
548. Hall, CB. Powell, KR, MacDonald, NE, et al. Respiratory syncytial virus infection in children with compromised immune function. N Engl J Med 1986;315:77–81.Google Scholar
549. Mathur, U, Bentley, DW, Hall, CB. Concurrent respiratory syncytial virus and influenza A infections in the institutionalized elderly and chronically ill. Ann Intern Med 1980;93:49–52.Google Scholar
550. MacDonald, NE, Hall, CB, Suffin, SC, Alexon, C, Hams, PJ. Manning, JA. Respiratory syncytial viral infection in infants with congenital heart disease. N Engl J Med 1982;307:397–400.Google Scholar
551. Drescher, J, Zink, P, Verhagen, W, et al. Recent influenza virus A infections in forensic cases of sudden unexplained death. Virology 1987;92:63–76.Google Scholar
552. Hertz, MI, Englund, JA, Snover, D, Bitterman, PB, McGlave, PB. Respiratory syncytial virus-induced acute lung injury in adult patients with bone marrow transplants: a clinical approach and review of the literature. Medicine 1989;68:269–281.Google Scholar
553. Baron, RC, Dicker, RC, Busself, KE. Herndon, JL. Assessing trends in mortality in 121 U.S. cities, 19701979, from all causes and from pneumonia and influenza. Public Health Rep 1988;103:120–128.Google Scholar
554. Hall, CB. The nosocomial spread of respiratory syncytial viral infections. Ann Rev Med 1983;34:311–319.Google Scholar
555. Finger, F, Anderson, LJ, Dicker, RC, et al. Epidemic infections caused by respiratory syncytial virus in institutionalized young adults. J Infect Dis 1987;155:1335–1339.Google Scholar
556. Hall, CB. Nosocomial viral infections: perennial weeds on pediatric wards. Am J Med 1981;70:670–676.Google Scholar
557. Hall, CB, Douglas, RG Jr. Nosocomiall influenza infection as a cause of intercurrent fevers in infants. Pediatrics 1975;55:673–677.Google Scholar
558. Glezen, WF! Viral pneumonia as a cause and result of hospitalization. J Infect Dis 1983;147:765–770.Google Scholar
559. Wenzel, RP Deal, EC, Hendley, JO. Hospital-acquired viral respiratory illness on a pediatric ward. Pediatrics 1977;60:367–371.Google Scholar
560. Hall, CB. Hospital-acquired pneumonia in children. Seminars Respir Infect 1987;2:48–56.Google Scholar
561. Glezen, WP, Loda, FA. Clyde, WA Jr, et al. Epidemiologic patterns of acute lower respiratory diseases in pediatric group practice, L Pediatr 1971;78:397–406.Google Scholar
562. Henderson, FW, Collier, AM, Clyde, WA Jr, et al. Respiratory-syncytial-virus infections. reinfections and immunity: a prospective, longitudinal study in young children. N Engl J Med 1979;300:530–534.Google Scholar
563. Hall, WJ, Hall, CB, Speers, DM. Respiratory syncytial virus infection in adults: clinical, virologie, and serial pulmonary function studies. Ann Intern Med 1978;88:203–205.Google Scholar
564. Englund, JA. Anderson, IJ, Rhame, FS. Nosocomial transmission of respiratory syncytial virus in immunocompromised adults. J Clin Microbiol 1991;29:115–119.Google Scholar
565. Falsey, AR, Walsh, EE. Betts, RF, Serologic evidence of respiratory syncytial virus infection in nursing home patients. J Infect Dis 1990;162:568–569.Google Scholar
566. Hall, CB, Kopelman, AE, Douglas, G Jr, Griman, JM. Meagher, MI? Neonatal respiratory syncytial virus infection. N Engl J Med 1979;300:393–396.Google Scholar
567. Hall, CB. Douglas, RG Jr, Geiman, JM, et al. Nosocomial respiratory syncytial virus infections. N Engl J Med 1975;203:1343–1346.Google Scholar
568. Centers for Disease Control. Parainfluenza outbreaks in extended-care facilities. MMWR 1978;27:475–476.Google Scholar
569. De Fabritus, AM. Riggio, RR, David, DS. et al. Parainfluenza type 3 in a transplant unit. JAMA 1979;241:384–385.Google Scholar
570. Mufson, MA, Mocega, HE, Krause, HE. Acquisition of parainfluenza 3 virus infection by hospitalizedchildren. I. Frequencies, rates, and temporal data . J Infect Dis 1973;128:141–147.Google Scholar
571. McNamara, MJ. Phillips, IA, Williams, OR. Viral and Mycoplasma pneumoniae infections in exacerbations of chronic lung disease. Am Rev Respir Dis 1969;100:19–24.Google Scholar
572. Meyers, ID, MacQuarrie, MB, Merigan, TC, Jennison, MH. Nosocomial varicella, part 1. Outbreak in oncology patients at a children's hospital. West J Med 1979;130:196–199.Google Scholar
573. Graman, PS, Hall, CB. Epidemiology and control of nosocomial viral infections. Infect Dis Clin N Am 1989;3:815–841.Google Scholar
574. Atkinson, WL, Markowitz, LE. Adams, NC, Seastrom, GR Transmission of measles in medical settings: United States, 19851989. Am J Med 1991;91(suppl 3B):252S–255S.Google Scholar
575. Brandt, CD, Kim, HW, Arrabio, JO, et al. Epidemiology of respiratory syncytial virus in DC. III. Composite analysis of 11 consecutive yearly epidemics. Am J Epidemiol 1973;98:355–364.Google Scholar
576. Glezen, WP, Denny, FW. Epidemiology of acute lower respiratory disease in children. N Engl J Med 1973;288:498–505.Google Scholar
577. Englund, JA. Sullivan, CJ. Jordan, C, Dehner, LR Vercellotti, GM, Balfour, HH. Respiratory syncytial virus infection in immunocompromised adults. Ann Intern Med 1988;109:203–208.Google Scholar
578. Sorvillo, FJ, Huie, SE Strassburg, MA. Butsumyo, A, Shanderra, WX, Fannin, SL. An outbreak of respiratory syncytial virus pneumonia in a nursing home for the elderly. J Infect 1984;9:252–256.Google Scholar
579. Anderson, LJ, Parker, RA, Strikas, RL. Association between respiratory syncytial virus outbreaks and lower respiratory tract deaths in infants and young children. J Infect Dis 1990;161:640–646.Google Scholar
580. Waner, JL. Whitehurst, NJ, Todd, SJ, et al. Comparison of Directigen RSV with viral isolation and direct immunofluorescence for identification of respiratory syncytial virus. J Clin Microbiol 1990;28:480–483.Google Scholar
581. Ray, CG, Minnich, LL. Efficacy of immunofluorescence far rapid diagnosis of common respiratory viruses. J Clin Microbiol 1987;25:355–357.Google Scholar
582. Popow-Kraupp, T, Kern, G, Binder, C, et al. Detection of RSV in nasopharyngeal secretions by enzyme-linked immunosorbent assay, indirect immunofluorescence and virus isolation. J Med Virol 1986;19:123–134.Google Scholar
583. Kellogg, JA. Culture vs direct antigen assays for detection of microbial pathogens from lower respiratory tract specimens suspected of containing the respiratory syncytial virus. Arch Pathol Lab Med 1991;115:451–458.Google Scholar
584. Hall, CB, Douglas, KG Jr. Modes of transmission of respiratory syncytial virus. J Pediatr 1981;99:100–103.Google Scholar
585. Hall, CB, Douglas, RG Jr, Geiman, JM. Possible transmission by fomites of respiratory syncytial virus. J Infect Dis 1980;141:98–102.Google Scholar
586. Hall, CB, Douglas, RG Jr, Schnabel, EC. Geiman, JM. Infectivity of respiratory syncytial virus by various mutes of inoculation. Infect Immun 1981;33:779–783.Google Scholar
587. Storch, GA, Park, CS. Dohner, DE. RNA fingerprinting of respiratory syncytial virus using ribonuclease protection: application to molecular epidemiology. J Clin Invest 1989;83:1894–1902.Google Scholar
588. Hall, CB, Douglas, RG Jr, Geiman, J. Respiratory syncytial virus infections in infants: quantitation and duration of shedding. J Pediatr 1976;89:11–15.Google Scholar
589. Berglund, M. Respiratory syncytial virus infections in families: a study of family members of children hospitalized for acute respiratory disease. Acta Pediatr Scand 1967;56:395–404.Google Scholar
590. Hall, CB, Douglas, RG Jr. Nosocomial respiratory syncytial viral infections. Should gowns and masks be used? Am J Dis Child 1981;135:512–515.Google Scholar
591. Snydman, DR. Greer, C, Meissner, HC, Mcintosh, E. Prevention of nosocomial transmission of respiratory syncytial virus in a newborn nursery. Infect Control Hosp Epidemiol 1988;9:105–108.Google Scholar
592. Murphy, D, Todd, JK, Chao, RK, et al. The use of gowns and masks to control respiratory illness in pediatric hospital personnel. J Pediatr 1981;99:746–750.Google Scholar
593. Krasinski, E, LaCouture, R, Holzman, RS, Waithe, E, Bank, S, Hanna, B. Screening for respiratory syncytial virus and assignment to a cohort at admission to reduce nosocomial transmission. J Pediatr 1990;116:894–898.Google Scholar
594. Agah, R, Cherry, ID, Garakian, AL et al. Respiratory syncytial virus (RSV) infection rate in personnel caring for children with RSV infections: routine isolation procedure vs routine procedure supplemented by use of masks and goggles. Am J Dis Child 1987;141:695–697.Google Scholar
595. Hall, CR. Geiman, JM, Douglas, RG. Control of nosocomial respiratory syncytial viral infections. Pediatrics 1978;62:728–732.Google Scholar
596. Itano, A, Sorvillo, F, Infection control practices for respiratory syncytial virus (RSV) among acute care hospitals in Los Angeles County. Am J Infect Control 1991;19:107. Abstract.Google Scholar
597. Madge, P, Paton, JY, McColl, JH, Mackie, PLK. Prospective controlled study of four infection control procedures to prevent nosocomial infection with respiratory syncytial virus. Lancet 1992;340:1079–1083.Google Scholar
598. Gala, CL, Hall, CB. Schnabel, MA, et al. The use of eye-nose goggles to control nosocomial respiratory syncytial virus infection. JAMA 1986;256:2706–2708.Google Scholar
599. Louria, DB, Blumenfeld, HL, Ellis, JT. Kilbourne, ED, Rogers, DE. Studies on influenza in the pandemic of 1957-58. II. Pulmonary complications of influenza. J Clin Invest 1959;38:213–265.Google Scholar
600. Lindsay, Ml Jr. Herrman, EC Jr, Monow, GW Jr, et al. Hong Kong influenza: clinical, microbiologic, and pathologic features of 127 cases. JAMA 1970;214:1825–1832.Google Scholar
601. Schwarzmann, SW, Adler, JL, Sullivan, RJ. et al. Bacterial pneumonia during the Hong Kong influenza epidemic of 19681969. Arch Intern Aferf 1971;127:1037–1041.Google Scholar
602. Barker, WH, Mullooly, JP Pneumonia and influenza deaths during epidemics. Arch Intern Med 1982;142:85–89.Google Scholar
603. Mullooly, JP Barker, WH. Impact of type A influenza on children: a retrospective study. Am J Public Health 1982;72:1008–1016.Google Scholar
604. Eickhoff, TC, Sherman, IL, Serfling, RE. Observations on excess mortality associated with epidemic influenza/AMA 1961;176:104–110.Google Scholar
605. Noble, GR. Epidemiological and clinical aspects of influenza. In: Beare, AS, ed. Basic and Applied influenza Research. Boca Raton. FL: CRC Press; 1982;11–49.Google Scholar
606. Monto, AS, Kioumehr, F, The Tecumseh study of respiratory illness, IX. Occurrence of influenza in the community, 19661971. Am J Epidemiol 1975;102:553–563.Google Scholar
607. Blumenfeld, HL, Kilbourne, ED. Louria, DB, et al. Studies on influenza in the pandemic of 1957-1958.I. An epidemiologic, clinical, and serologic investigation of an intrahospital epidemic, with a note on vaccine efficacy. J Clin Invest 1959;38:199–212.Google Scholar
608. Bean, B. Rhame, FS, Hughes, RS, et al. Influenza B: hospital activity during a community epidemic. Drag Microbiol Infect Dis 1983;1:177.183.Google Scholar
609. Hoffman, PC, Dixon, RE. Control of influenza in the hospital. Ann Intern Med 1977;87:725–728.Google Scholar
610. Arden, NH, Patriarca, PA, Fasano, MB, et al. The roles of vaccination and amantadine prophylaxis in controlling an outbreak of influenza A (H3N2) in a nursing home. Arch Intern Med 1988;148:865–868.Google Scholar
611. Arroyo, JC. Posdc, B, Brown, A. et al. Influenza A/Philippines/2/82 outbreak in a nursing home: limitations of influenza vaccination in the elderly. Am J Infect Control 1984;12:329–334.Google Scholar
612. Patriarca, PA, Weber, JA. Parker, RA, et al. Efficacy of influenza vaccine in nursing homes: reduction in illness and complications during influenza A (H3N2) epidemic. JAMA 1985;253:1136–1139.Google Scholar
613. Saah, AJ. Neufeld, R. Rodstein, M, et al. Influenza vaccine and pneumonia mortality in a nursing home population. Arch Intern Med 1986;146:2353–2357.Google Scholar
614. Alford, RH, Kasel, JA. Gerone, PJ. Knight, V. Human influenza resulting from aerosol inhalation. Proc Soc Exp Biol Med 1966;122:800–804.Google Scholar
615. Moser, MR, Bender, TR, Margolis, HS, Noble, GR, Kendal, AP, Ritter, DG. An outbreak of influenza aboard a commercial airliner. Am J Epidemiol 1979; 110: 1–6.Google Scholar
616. Knight, V. Airborne transmission and pulmonary deposition of respiratory viruses. In: Mulder, J. Hers, JFP eds. Influenza. Groningen, Netherkands: Wolters-Noordhoff; 1972;1–9.Google Scholar
617. Loosli, CG, Lemon, HM, Robertson, OH, et al. Experimental air-borne influenza infection I. Influence of humidity on survival of virus in air. Proc Soc Exp Biol Med 1943;53:205–206.Google Scholar
618. Bean, B, Moore, BM, Sterner, B, et al. Survival of influenza viruses on environmental surfaces . J Infect Dis 1982;146:47–52.Google Scholar
619. Glezen, WP, Decker, M, Joseph, SW, Mercready, RG Jr. Acute respiratory disease associated with influenza epidemics in Houston, 1981-1983. J Infect Dis 1987; 155:1119–1126.Google Scholar
620. McQuillin, J. Madeley, CR, Kendal, AP. Monoclonal antibodies for the rapid diagnosis of influenza A and B virus infections by immunofluorescence. Lancet 1985;2:911–914.Google Scholar
621. Berg, RA, Yolken, RH, Rennard, SI. et al. New enzyme immunoassay for measurement of influenza A/Victoria/3/75 virus in nasal washes. Ijincet 1980;1:851–853.Google Scholar
622. Espy, MJ. Smith, TF, Harmon, MW, et al. Rapid detection of influenza virus by shell vial assay with monoclonal antibodies./ Clin Microbiol 1986;24:677–679.Google Scholar
623. Chomel, JJ. Pardon, D, Thouvenot, D, Allard, JP Aynard, M. Comparison between three rapid methods for direct diagnosis of influenza and the conventional isolation procedure. Biologicals 1991;19:287–292.Google Scholar
624. Bucher, DJ. Mikhail, A, Popple, S, et al. Rapid detection of type A influenza viruses with monoclonal antibodies to the M protein (M1) by enzyme-linked immunosorbent assay and time-resolved fluoroimmunoassay. J Clin Microbiol 1991;29:2484–2488.Google Scholar
625. Spada, B, Biehler, E, Chegas, P, Kaye, J. Riepenhoff-Talty, M. Comparison of rapid immunofluorescence assay to cell culture isolation for the detection of influenza A and B viruses in nasopharyngeal secretions from infants and children. J Virol Methods 1991;33:305–310.Google Scholar
626. Barker, WH. Mullooly, JP. Influenza vaccination of elderly persons: reduction in pneumonia and influenza hospitalizations and deaths. JAMA 1980;244:2547–2549.Google Scholar
627. Foster, DA, Tolsma, AN, Newson, AF, et al. Influenza vaccine effectiveness in preventing hospitalizations for pneumonia in the elderly. Am J Epidemiol 1992;136:286–307.Google Scholar
628. Advisory Committee on Immunization Practices. Prevention and control of influenza: part I, vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1993;42(RR-6):1–14.Google Scholar
629. Patriarca, PA, Weber, JA. Parker, RA, et al. Risk factors for outbreaks of influenza in nursing homes: a case control study. Am J Epidemiol 1986;124:114–119.Google Scholar
630. Fox, JP, Elveback, L, Scott, W, Gatewood, L, Ackerman, E. Herd immunity basic concept and relevance to public health immunization practices. Am J Epidemiol 1971;94:171–189.Google Scholar
631. Advisory Committee on Immunization Practices. Prevention and control of influenza: part I. vaccines. MMWR 1994;43: (RR-9).Google Scholar
632. Tominack, RL, Hayden, FG. Rimantadine hydrochloride and amantadine hydrochloride use in influenza A virus infections. Infect Dis Clin N Am 1987;1:459–478.Google Scholar
633. Hall, CB. Dolin, R, Gala, CL. et al. Children with influenza A infection: treatment with rimantadine. Pediatrics 1987;80:275–282.Google Scholar
634. Dolin, R, Reichman, RC. Madore, HP, et al. A controlled trial of amantadine and rimantadine prophylaxis of influenza infection. N Engl J Med 1982;307:580–584.Google Scholar
635. Douglas, RG. Drug therapy: prophylaxis and treatment of influenza. N Engl J Med 1990;322:443–450.Google Scholar
636. Younkin, SW. Betts, RE Roth, FK. et al. Reduction in fever and symptoms in young adults with influenza A/Brazil/78 H1N1 infection after teatmmt. Antimicrob Agents Chemother 1983;23:577–582.Google Scholar
637. Van Voris, LP, Berts, RF, Hayden, FG. Successful treatment of naturally occurring influenza A/USSR/77/H1N1. JAMA 1981;245:1128–1131.Google Scholar
638. Atkinson, WL, Arden, NH, Patriarca, PA. et al. Amantadine prophylaxis during an institutional outbreak of type A(H1N1) influenza. Arch Intern Med 1986;146:1751–1756.Google Scholar
639. O'Donoghue, JM, Ray, CG, Terry, DW Jr, Beaty, HN. Prevention of nosocomial influenza infection with amantadine. Am J Epidemiol 1973;97:276–282.Google Scholar
640. Leeming, JK. Amantadine hydrochloride and the elderly. Lancet 1969;1:313–314.Google Scholar
641. Postma, JU, Tilburg, WV. Visual hallucinations and delirium during treatment with amantadine (Symmetrel). J Am Geriatr Soc 1975;23:212–215.Google Scholar
642. Advisory Committee on Immunization Practices. Prevention and control of influenza: II. Antiviral agents. MMWR. In press.Google Scholar
643. Hayden, FG, Sperber, SJ. Belshe, RB, Clover, RD, Hay, AJ. Pyke, S. Recovery of drug-resistant influenza A virus during therapeutic use of rimantadine. Antimicrob Agents Chemother 1991;35:1741–1747.Google Scholar
644. Mast, EE, Harmon, MW, Gravenstein, S, et al. Emergence and possible transmission of amantadineresistant viruses during nursing home outbeaks of influenza A(H3N2). Am J Epidemiol 1991;13:988–997.Google Scholar
645. Hayden, PG, Blake, RB, Clover, RD, Hey, AJ, Oakes, MG. Soo, W. Emergence and apparent transmission of rimantadine-resistant influenza A virus in families N Engl J Med 1989;321:1696–1702.Google Scholar
646. Hayden, FG, Couch, RB. Clinical and epidemiological importance of influenza A viruses resistant to amantadine and rimantadine. Rev Med Virol 1992;2:89–96.Google Scholar
647. Monto, AS, Arden, NH. Implications of viral resistance to amantadine in control of influenza A. Clin Infect Dis 1992;15:362–367.Google Scholar
648. Fedson, DS. Immunizations for health care workers and patients in hospitals. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infection. Baltimore. MD: Williamsand Wilkins; 1987;116–174.Google Scholar
649. Valenti, WM. Betts, RF, Hall, CB, Hruska, JE Douglas, RG Jr. Nosocomial viral infections: IL Guidelines for prevention and control of respiratory viruses, herpesviruses, and hepatitis viruses. Infect Control 1981;1:165–178.Google Scholar
650. Williams, WW. Guideline for infection control in hospital personnel. Infect Control 1983;4:326–349.Google Scholar
651. Wong, ES, Hooton, TM. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control 1983;11:28–33.Google Scholar
652. Simmons, BP, Hooton, TM, Wong, ES, Allen, JR Guideline for prevention of intravascular infections. Infed Contivi 1982;3:61–72.Google Scholar
653. Simmons, BP, Wong, ES. Guideline for prevention of nosocomial pneumonia. Infect Control 1982;3:327–333.Google Scholar
654. Gamer, JS. Guideline for prevention of surgical wound infections. Infect Control 1986;7:193–200.Google Scholar
655. Britt, MR. Schleupner, CJ, Matsumiya, S. Severity of underlying disease as a predictor of nosocomial infection. JAMA 1978;239:1047–1051.Google Scholar
656. Conly, JM. Hill, S, Ross, J. Lertzman, J. Louie, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relatioinship to infection rates. Am J Infect Control 1989;17:330–339.Google Scholar
657. Seto, WH, Ching, TY, Yuen, KY, Chu, YB, Seto, WU. The enhancement of infection control in-service education by ward opinion leaders. Am J Infect Control 1991;19:86–91.Google Scholar
658. Haiduven, DJ. DeMaiao, TM, Stevens, DA A five-year study of needlestick injuries: significant reduction associated with communication, education, and convenient placement of sharps containers. Infect Control Hosp Epidemiol 1992;13:265–271.Google Scholar
659. Johnson, MW, Mitch, WE, Heller, AH, Spector, R. The impact of an educational program on gentamicin use in a teaching hospital. Am J Med 1982;73:9–14.Google Scholar
660. Soumerai, SB, Salem-Schatz, S, Avorn, J, Casteris, CS. Ross-Degnan, D, Popovsky, MA. A controlled trial of educational outreach to improve blood transfusion practice. JAMA 1993;270:961–966.Google Scholar
661. Eisenberg, JM. An education program to modify laboratory use by house staff. J Med Educ 1977;52:578–581.Google Scholar
662. Haley, KW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
663. Gross, AS. Roup, B. Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med 1981;70:681–685.Google Scholar
664. Hall, JC, Tarala, RA. Hall, JL, Mander, J. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest 1991;99:923–927.Google Scholar
665. Josephson, A, Karanfil, L, Alonso, H. Watson, A, Blight, J. Risk-specific nosocomial infection rates. Am J Med 1991;91(suppl 3B):131S–137S.Google Scholar
666. Freeman, J, McGowan, JE. Mrthodologic issues in hospital epidemiology. I. Rates, case fmding and Interpretation. Rev Infect Dis 1981;3:658–667.Google Scholar
667. Madison, R, Afifi AA Definition and comparability of nosocomial infection rates. Am J Infect Control 1982;10:49–52.Google Scholar
668. American Hospital Association Committee on Infection within Hospitals. Statement on microbiologic sampling. Hospitals 1974;48:125–126.Google Scholar
669. Eickhoff, TC. Microbiologic sampling. Hospitals 1970;44:86–87.Google Scholar
670. Bond, WW, Ott, BJ. Franke, KA, McCracken, JE. Effective use of liquid chemical germicides on medical devices: instrument design problems. In: Block, SS, ed. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, PA: Lea and Febiger; 1991;1097–1106.Google Scholar
671. McDonald, WL. Welch, HJ, Keet, JE. Antisepsis of endotracheal tubes and face masks. Anesthesiology 1955;16:206.Google Scholar
672. Institute for Health Policy Analysis. Proceedings of International Conference on the Reuse of Disposable Medical Devices in the 1980s. Washington, DC: Georgetown University Medical Center: 1984.Google Scholar
673. Bosomworth, PR Hamelberg, W. Effect of sterilization on safety and durability of endotracheal tubes and cuffs. Anesth Analg 1965;44:576–586.Google Scholar
674. Comhaire, A. Lamy, RM. Contamination rate of sterilized ventilators in an ICLL Crit Care Med 1981;9:546–548.Google Scholar
675. Seto, WH, Ching, TY. Yuen, KY. Lam, WK, Evaluating the sterility of disposable wall oxygen humidifiers, during and between use on patients. Infect Control 1990;11:604–605.Google Scholar
676. Stoler, BS. Sterility of a disposable oxygen humidification system. Respir Care 1972;17:572–573.Google Scholar
677. Meehan, TP Sterility in oxygen humidifiers. Respir Tech 1977;14:15–22.Google Scholar
678. Golar, SD. Sutherland, LLA. Ford, GT Multipatient use of prefilled disposable oxygen humidifiers for up to 30 days: patient safety and cost analysis. Respir Care 1993;38:343–347.Google Scholar
679. Henderson, E. Ledgerwood, D, Hope, KM, et al. Prolonged and multipatient use of prefilled disposable oxygen humidifier bottles: safety and cost. Infect Control Hosp Epidemiol 1993;14:463–468.Google Scholar
680. Cabrera, HA. An outbreak of Serratia marcescens, and its control. Arch Intern Med 1969;123:650–655.Google Scholar
681. Longfield, R. Longfield, J, Smith, LP Hyams, K, Strohmer, ME. Multidose medication vial sterility: an in-use study and a review of the literature. Infect Control 1984;5:165–169.Google Scholar
682. Sheth, NK, Post, GT, Winiewski, TR, Uttech, BV. Multi-dose vials versus single-dose vials: a study in sterility and cost-effectiveness. Clin Microbiol 1983;17:377–379.Google Scholar
683. Smith, PW, Massanari, RM. Room humidifiers as the source of Acinetobacter infections. JAMA 1977;237:795–797.Google Scholar
684. Moffet, HL, Allan, D. Survival and dissemination of bacteria in nebulizers and incubators. Am J Dis Child 1967;114:13–20.Google Scholar
685. Berry, AJ. Infection control in anesthesia. Anesth Clin N AM 1989:1:967.Google Scholar
686. Larson, EL, Eke, PI, Laughon, BE. Efficacy of alcohol-based hand rinses under frequent-use conditions. Antimicrob Agents Chemother 1986;30:542–544.Google Scholar
687. Jones, MV, Rowe, GB, Jackson, B, Pritchard, NJ. The use of alcohol paper wipes for routine hand cleansing: results of trials in two hospitals. J Hosp Infect 1986;8:268–274.Google Scholar
688. Ping, FC, Oulton, JL, Smith, JA, Skidmore, AG, Jenkins, LC. Bacterial filters-are they necessary on anesthetic machine?.? Can Anaesth Sac J 1979;26:415–419.Google Scholar
689. Knittle, MA. Eitzman, DV, Baer, H. Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections. J Pediatr 1975;86:433–437.Google Scholar
690. Reybrouck, G. Role of tbe hands in the spread of nosocomial infections. J Hosp Infect 1983;41:103–110.Google Scholar
691. Sutter, VL, Hurst, V. Grossman, M, Calonje, R. Source and significance of Pseudomonas aeruginosa in sputum. JAMA 1966;197:854–856.Google Scholar
692. Bernard, M, Braunstein, N, Stevens, R. et al. Incidence of aspiration pneumonia in enteral hyperalimentation. J Parent Enter Nutr 1982;6:588. Abstract.Google Scholar
693. Harvey, P Bell, P Harris, O. Accidental intrapulmonary clinifeed. Anesth Analg 1981;36:518–522.Google Scholar
694 Hand, R, Kempster, M, Ievy, J. Rogol, R. Spinn F! Inadvertent transbronchial insertion of nanow-bore feeding tubes into the pleural space. JAMA 1984;251:2396–2397.Google Scholar
695. Dorsey, J, Cogordan, J. Nasotracheal intubation and pulmonary parenchymal perforation: an unusual complication of nasoenterai feeding with small-diameter feeding tubes. Chest 1985;87:131–132.Google Scholar
696. Heymsfield, SB, Bethel, RA, Ansley, JD, Nixon, DW, Rudman, D. Enteral hyperalimentation: an alternative to central venous hyperalimentation. Ann Intern Med 1979;90:63–71.Google Scholar
697. Bury, KD. Jambanathan, G. Effects of elemental diets on gastric emptying and gastric secretion in manna>. Am J Surg 1974;127:59–64.Google Scholar
698. Douglas, RG. Influenza in man. In: Kilbourne, ED. ed. The Influenza Viruses and Influenza. New York, NY: New York Academy Press; 1975.Google Scholar
699. Holzapfel, L, Chevret, S. Madinier, G, et al. Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized clinical trial. Crit Care Aferf 1993;21:1132–1138.Google Scholar
700. Cerra, FB. Maddaus, MA. Dunn, DL, et al. Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients. Arch Surg 1992;127:163–169 Google Scholar
701. Nayman, J. Measurement and control of postoperative pain. Ann R Coll Surg Engl 1979;61:419–426.Google Scholar
702. Roberts, NJ, Douglas, RG. Gentamicin use and Pseudomonas and Serratia resistance: effect of a surgical prophylaxis regimen. Antimicrob Agents Chemother 1978; 13:214–220.Google Scholar
703. Genfinello, L, Thompson, DA, Tonnesen, AS, et al. Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med 1988;16:783–786.Google Scholar
704. Ruf, B, Schurmann, D, Horbach, I, et al. Prevalence and diagnosis of Legionella pneumonia: a 3-year prospective study with emphasis on application of urinary antigen detection. J Infect Dis 1990;162:1341–1348.Google Scholar
705. Redd, SC, Cohen, ML. Legionella in water: what should be done? JAMA 1987;257:1221–1222.Google Scholar
706. Woo, AH, Yu, VI, Goetz, A Potential in-hospital modes of transmission of Legion & pneumophila: demonstration experiments for dissemination by showers. humidifiers, and rinsing of ventilation bag apparatus. Am J Med 1986;80:567–573.Google Scholar
707. World Health Organization. Environmental Aspects of the Control of Legionellosis. 14th ed. Copenhagen. Denmark: World Health Organization; 1986;118–120.Google Scholar
708. Bhopal, RS, Barr, G. Maintenance of cooling towers following two outbreaks of Legionnaires' disease in a city. Epidemiol Infect 1990;104:29–38.Google Scholar
709. Pannuti, C, Gingrich, R, Pfaller, MA, Kao, C, Wenzel, RP Nosocomial pneumonia in patients having bone marrow transplant: attributable mortality and risk factors. Cancer 1992;69:2653–2662.Google Scholar
710. Mahoney, DH, Steuber, CP Starling, KA, Barrett, FE Goldberg, J, Fernbach, DJ. An outbreak of aspergillosis in children with acute leukemia. J Pediatr 1979;95:70–72.Google Scholar
711. Rogers, TR. Infections in hematologic malignancy. Infect Control 1986;7S: 124–125.Google Scholar
712. McWhinney, PHM, Kibbler, CC, Hamon, MD. et al. Progress in the diagnosis and management of aspergillosis in bone marrow transplantation: 13 years. J Infect Dis 1993;17:397–404.Google Scholar
713. Staib, E Ecological and epidemiological aspects of aspergini pathogenic for man and animal in Berlin (West) Zbl Bakt Hyg A 1984;257:240–245.Google Scholar
714. Staib, F. Folkens, U. Tompak, B, Abel, T, Thiel, D. A comparative study of antigens of Aspergillus fumigatus isolates from patients and soil of ornamental plants in thr immunodiffusion test. Zbl Bakt Hyg I Abt 0rig 1978;242:93–99.Google Scholar
715. Lie, TS, Hofer, M, Hohnke, C, et al. Aspergillose nach lebertransplantation als hospitalismusinfekion. Dtsck Med Wschr 1987;112:297–301.Google Scholar
716. Bodey, GP Current status of prophylaxis of infection with protected environments. Am of Med 1984;76:678–684.Google Scholar
717. Grossman, ME. Fithian, EC, Behrens, C, Bissinger, J. Fracaro, M, Neu, HC. Primary cutaneous aspergillosis in six leukemic children. J. Am Acnd Dermatol 1985;12:313–318.Google Scholar
718. Walsh, TJ, Van Cutsem, J. Polak, AM, Graybill, JR. Immunomodulation and antifungal treatment of experimental invasive candidosis, histoplasmosis, and aspergillosis. Recent advances and concepts. J. MedVet Mycol 1992;30(suppl 1):225–240.Google Scholar
719. Nichol, KL, Preventing influenza: the physician's role. Seminars Respir Infect 1992;7:71–77.Google Scholar
720. Pachucki, CT, Lentino, JR, Jackson, CG. Attitudes and behavior of health care personnel regarding the use and efficacy of influenza. vaccine. J Infect Dis 1985;151:1170–1171.Google Scholar
721. Fedson, DS, Kessler HA A hospital-based influenza irnmunization program. 1977-78. Am f Public Health 1983;73:442–445.Google Scholar
722. Williams, WW, Hickson, MA, Kane, MA, et al. Immunization policies and vaccine coverage among adults. Ann Intern Med 1988;108:616–625.Google Scholar
723. Arden, N, Patriarca, PA, Kendal, AP Experiences in the use and efficacy of inactivated vaccines in nursing homes. In: Kendal, AP, Patriarca, PA, eds. Options for the Control of Influenza. New York, NY Alan Liss; 1985;155–168.Google Scholar
724. Ksiazek, TG, Olson, JG, Irving, GS. Settle, CS, White, R, Petrusso, R. An influenza outbreak due to A/USSR/77-like (H1N1) virus aboard a US navy ship. Am J Epidemiol 1980:112;487–494.Google Scholar
725. Berlinberg, CD, Weingarten, SR, Bolton, LB, Waterman, SH. Occupational exposure to influenza-introduction of an index case to a hospital. Infect Control Hosp Epidemiol 1989;10:70–73.Google Scholar
726. Askonas, BA. McMichael, AJ, Webster, RG. The immune response to influenza viruses and the problem of protection against infection. In: Beare, AS, ed. Basic and Applied Influenza Research. Boca Raton, FL: CRC Press; 1982;159–182.Google Scholar
727. Schulze-Robbecke, R, Jung, KD, Pullman, H, Hundgeburth, J. Control of Legionella pneumophila in a hospital hot water system. Zbl Hyg 1990;190:84–100.Google Scholar
728. Gmofhis, DG. Veenendaal, HR. Dijkstra, HL. Influence of temperature on the number of Legionella pneumophila in hot water systems. J Appi Bacteriol 1985;59:529–536.Google Scholar
729. Colbourne, JS. Pratt, DJ, Smith, MG. Fisher-Hoch, SP, Harper, D. Water fittings as sources of Legionella pneumophila in a hospital plumbing system. Lancet 1984;1:210–213.Google Scholar
730. Environmental Protection Agency. National interim primary drinking water regulations: control of trihalothanes in drinking water. Final rules. Federal Register 1979;44:68624–68705.Google Scholar
731. Environmental Protection Agency. National interim primary drinking water regulations: trihalothanes. Federal Register 1983;48:8406–8414.Google Scholar
732. Centers for Disease Control and Prevention. Procedures for the Recovery of Legionella from the Environment. Atlanta, GA: Public Health Service; 1992;1–13.Google Scholar
733. Alary, MA, Joly, JR. Comparison of culture methods and an immunofluorescence assay for the detection of Legionella pneumophila in domestic hot water devices. Curr Microbiol 1990;56:19–25.Google Scholar
734. Vickers, RM, Stout, JE. Yu, VL. Failure of a diagnostic monoclonal immunofluorescent reagent to detect Legionella pneumophila in environmental samples. Appi Environ Microbiol 1990;56:2912–2914.Google Scholar
735. Fluornoy, DJ, Belobraydic, KA, Silberg, SL, Lawrence, CH, Guthrie, PJ. False positive Legionella pneumophila direct immunofluorescent monoclonal antibody test caused by Bacillus cereus spores . Diag Microbiol Infect Dis 1988;9:123–125.Google Scholar
736. Bej, AK, Mahbubani, MH, Atlas, RM. Detection ofviable Legionella pneumophila in water by polymerase chain reaction and gene pmbe methods. Appi Environ Microbiol 1991;57:597–600.Google Scholar
737. Barbaree, JM, Gorman, GW, Martin, WT, Fields, BS, Morrill, WE. Protocol for sampling environmental sites for Legionellae. Appl Environ Microbiol 1987;53:1454–1458.Google Scholar