{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T14:58:37Z","timestamp":1781017117096,"version":"3.54.1"},"reference-count":9,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":6820,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp.\n Epidemiol."],"published-print":{"date-parts":[[1996,5]]},"abstract":"Abstract<\/jats:title>\n \n Objective:<\/jats:bold>\n To\n determine the cause(s) of an outbreak of\n gram-negative bacteremia (GNB) in\n open-heart\u2013surgery (OHS) patients at hospital\n A.\n <\/jats:p>\n \n Design:<\/jats:bold>\n Case-control and cohort studies and an\n environmental survey.\n <\/jats:p>\n \n Results:<\/jats:bold>\n Nine\n patients developed GNB with\n Enterobacter cloacae<\/jats:italic>\n (6),\n Pseudomonas\n aeruginosa<\/jats:italic>\n (5),\n Klebsiella pneumoniae<\/jats:italic>\n (3),\n Serratia\n marcescens<\/jats:italic>\n (2), or\n Klebsiella oxytoca<\/jats:italic>\n (1)\n following OHS; five of nine patients had\n polymicrobial bacteremia. When the GNB patients\n were compared with randomly selected OHS patients,\n having had the first procedure of the day (8 of 9\n versus 12 of 27,\n P<\/jats:italic>\n =.02), longer\n cardiopulmonary bypass (median, 122 versus 83\n minutes,\n P<\/jats:italic>\n =.01) or\n cross-clamp times (median, 75 versus 42 minutes,\n P<\/jats:italic>\n =.008), intraoperative\n dopamine infusion (9 of 9 versus 15 of 27,\n P<\/jats:italic>\n =.01), or exposure to\n scrub nurse 6 (6 of 9 versus 4 of 27,\n P<\/jats:italic>\n =.001) were identified\n as risk factors. When stratified by length of the\n procedure, only being the first procedure of the\n day and exposure to scrub nurse 6 remained\n significant. First procedures used\n pressure-monitoring equipment that was assembled\n before surgery and left open and uncovered\n overnight in the operating room, whereas other\n procedures used pressure-monitoring equipment\n assembled immediately before the procedure. At\n night, operating rooms were cleaned by maintenance\n personnel who used a disinfectant-water solution\n sprayed through a hose connected to an automatic\n diluting system. Observation of the use of this\n hose documented that this solution could have\n contacted and entered uncovered\n pressure-monitoring equipment left in the\n operating room. Water samples from the hose\n revealed no disinfectant, but grew\n P\n aeruginosa<\/jats:italic>\n . The outbreak was\n terminated by setting up pressure-monitoring\n equipment immediately before the procedure and\n discontinuing use of the hose-disinfectant\n system.\n <\/jats:p>\n \n Conclusions:<\/jats:bold>\n This\n outbreak most likely resulted from contamination\n of uncovered preassembled pressure-monitoring\n equipment by water from a malfunctioning spray\n disinfectant device. Pressure-monitoring equipment\n should be assembled immediately before use and\n protected from possible environmental\n contamination.\n <\/jats:p>","DOI":"10.1086\/647296","type":"journal-article","created":{"date-parts":[[2009,9,9]],"date-time":"2009-09-09T16:29:13Z","timestamp":1252513753000},"page":"281-285","source":"Crossref","is-referenced-by-count":13,"title":["Gram-Negative Bacteremia in\n Open-Heart\u2013Surgery Patients Traced to Probable\n Tap-Water Contamination of Pressure-Monitoring\n Equipment"],"prefix":"10.1017","volume":"17","author":[{"given":"Judith R.","family":"Rudnick","sequence":"first","affiliation":[{"name":"Hospital Infections\n Program"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Consuelo M.","family":"Beck-Sague","sequence":"additional","affiliation":[{"name":"Hospital Infections\n Program"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger L.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Hospital Infections\n Program"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Schable","sequence":"additional","affiliation":[{"name":"Hospital Infections\n Program"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Michael","family":"Miller","sequence":"additional","affiliation":[{"name":"Hospital Infections\n Program"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Jarvis","sequence":"additional","affiliation":[{"name":"Hospital Infections\n Program"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700003957_auto_ref-n640ac20905a33ced","doi-asserted-by":"publisher","DOI":"10.1378\/chest.69.3.338"},{"key":"S0195941700003957_auto_ref-n66d53037c3f6db85","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/7.6.1513"},{"key":"S0195941700003957_auto_ref-na1f4877bad77a6f9","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-198510000-00009"},{"key":"S0195941700003957_auto_ref-nfeae364052ad497c","first-page":"371","volume-title":"Handbook of Hospital-Acquired\n Infections","author":"Maki","year":"1981"},{"key":"S0195941700003957_auto_ref-n4d38b21eb7e3f6f7","doi-asserted-by":"publisher","DOI":"10.1086\/645961"},{"key":"S0195941700003957_auto_ref-nf17a507d319de7a","doi-asserted-by":"publisher","DOI":"10.1016\/0196-6553(83)90079-2"},{"key":"S0195941700003957_auto_ref-n4b6c45efe98cd85f","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-198706000-00007"},{"key":"S0195941700003957_auto_ref-n962177715eb660c3","first-page":"184","volume-title":"Nonparametric Statistics for the\n Behavioral Sciences","author":"Siegel","year":"1956"},{"key":"S0195941700003957_auto_ref-n57c9dad641f619f5","volume-title":"Identification of unusual pathogenic\n gram-negative aerobic and facultative anaerobic\n bacteria","author":"Clark","year":"1984"}],"container-title":["Infection Control and Hospital\n Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0195941700003957","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T14:08:28Z","timestamp":1781014108000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0195941700003957\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,5]]},"references-count":9,"journal-issue":{"issue":"5","published-print":{"date-parts":[[1996,5]]}},"alternative-id":["S0195941700003957"],"URL":"https:\/\/doi.org\/10.1086\/647296","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[1996,5]]}}}