current methodological

concepts
articles
Searching the health care literature
efficiently: From clinical decision-
making to continuing education
Kaveh G. Shojania, MDa
Russell N. Olmsted, MPH, CICb
San Francisco, California, and Ann Arbor, Michigan

Searching the health care literature is an activity in which infection control professionals must routinely engage to seek evi-
dence-based answers to specific practice questions and to stay abreast of developments in the field. Without the appropriate
tools, the tremendous volume of clinical literature makes both of these daunting tasks. In this article, we illustrate techniques
for searching MEDLINE efficiently, both as a means of answering particular clinical questions and for generating periodic
updates on topics of general interest. With use of a specific example relevant to infection control, we demonstrate the identi-
fication of appropriate Medical Subject Headings terms that capture a given question or topic and the development of effec-
tive searches with use of these terms. We also touch on the advantages of targeting systematic reviews and meta-analyses in
searching for evidence and staying abreast of the literature in general. (Am J Infect Control 2002;30:187-95.)

Infection control professionals (ICPs) confront • Critically appraise identified studies

numerous practice-related questions on a daily
basis. Such questions range from the optimal inser-
tion and maintenance of vascular access devices1-3
to the transmission of waterborne and airborne dis-
eases in health care facilities.4-6 Consequently, ICPs
require the skills to locate and appraise studies of
practices that improve the safety and quality of
patient care. One recent source7 formulated such
“evidence-based practice” in terms of the following
steps:
• Identify areas of uncertainty
• Translate uncertainty into focused questions
• Search the literature for studies that address
these questions
From the Department of Medicine, University of California San
Francisco,a and Infection Control Services, St. Joseph Mercy Hospital,
Ann Arbor, Michigan.b
This review was supported in part by the Research Foundation for
Prevention of Complications Associated with Health Care, an affiliate of the
Association for Professionals in Infection Control and Epidemiology, Inc.
Reprint requests: Kaveh G. Shojania, MD, Department of Medicine, Box
0120 UCSF, San Francisco, CA 94143-0120.
Copyright © 2002 by the Association for Professionals in Infection
Control and Epidemiology, Inc.
0196-6553/2002/$35.00 + 0 17/52/120801
doi:10.1067/mic.2002.120801
• Change practices when warranted by the balance
of evidence
Searching the health care literature is thus an activi-
ty in which all ICPs should routinely engage to seek
evidence-based answers to specific practice ques-
tions and to stay abreast of developments in the
field.
Unfortunately, the explosion of clinical research in
recent years has transformed both of these tasks
into daunting activities. The MEDLINE database
alone contains more than 11 million citations from
1966 to present.8 A number of valuable resources
provide frequently updated summaries of the cur-
rent state of evidence on a wide range of important
clinical topics9-11 or highlight recent well-designed
studies relevant to clinical practice (eg, the American
College of Physicians’ ACP Journal Club). For those
working in specialized areas such as infection con-
trol, however, there remains the need to search and
appraise the literature on one’s own.
In this article, we illustrate techniques for searching
MEDLINE efficiently, both as a means of answering
particular clinical questions and for generating peri-
odic updates on topics of general interest. With use
of a specific example relevant to ICPs, we demon-

187
188 Vol. 30 No. 3 Shojania and Olmsted

Fig 1. The main search page for the National Library of Medicine’s PubMed, which is free and available via
the Internet at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi. As described in the text, the key task of finding
the optimal search terms for a given clinical topic can be accomplished by clicking on “MeSH Browser” (high-
lighted in Figure) in the left-hand column. Other useful functions available from this page include “Clinical
Queries,” which allows users to find articles relating to diagnosis, therapy, prognosis, and etiology with use of
powerful built-in search templates and the “Cubby” function.The “Cubby” feature provides a storage mecha-
nism for search strings created by the user, although searches combining more than 1 string cannot be stored
(nor can any string longer than 64 characters). Although not shown in the Figure, this Web page also includes
links to ClinicalTrials.gov, which provides current information about ongoing clinical research studies (search-
able by disease or granting agency) and clinical alerts.These alerts expedite the release of findings from Na-
tional Institutes of Health-funded clinical trials when such release could significantly affect patient care.

strate the identification of appropriate Medical
Subject Headings (MeSH) terms that capture a given
question or topic and the development of effective
searches with use of these terms. We also touch on
the advantages of targeting systematic reviews and
meta-analyses in searching for evidence and staying
abreast of the literature in general.
AN EXAMPLE SCENARIO
The director of cardiac surgery at your facility has
reviewed a recent publication on the use of
mupirocin for preventing surgical site infections.12
After discussing the article with her colleagues, she
asks Infection Control and Epidemiology Services for
an opinion on the use of this prophylaxis strategy. In
addition to addressing its efficacy, she asks that you
assess the cost-effectiveness of this strategy and the
risk of promoting the emergence of resistant micro-
organisms. To respond to this request, you decide to
conduct a literature search.
THE BASICS OF MEDLINE AND
PUBMED
MEDLINE is an on-line bibliographic database main-
tained by the US National Library of Medicine.8 It
indexes more than 4000 biomedical journals and con-
tains more than 11 million articles published from
1966 to the present. Many other useful bibliographic
databases exist. For instance, the Cumulative Index to
Nursing and Allied Health Literature (CINAHL) pro-
vides access to abstracts from journal articles, text-
books, conference proceedings, and other resources.
 Shojania and Olmsted
CINAHL covers 1200 professional journals in nursing,
17 allied health disciplines, and health sciences librar-
ianship from 1982 forward. Most universities and sev-
eral proprietary services13-15 provide access to these
and other databases.
Searching any bibliographic database can occur via
multiple interfaces. As with general Internet search
engines, these interfaces seek the same target con-
tent but differ in their appearance and internal logic.
Many search interfaces are proprietary, but the
National Library of Medicine has provided public
access to MEDLINE through PubMed since 1997.8
Because MEDLINE is such an extensive health care
database and is also freely accessible, we used
PubMed (Fig 1) to demonstrate the search techniques
discussed in this article. Similar techniques will work
for other bibliographic databases, such as CINAHL.
Finding the MeSH terms that capture your
question
The quick approach. Each MEDLINE record is
indexed using a system of MeSH terms. Searches
that incorporate MeSH terms consistently yield more
articles than searches by title or text words.16,17
PubMed automatically translates free text into MeSH
terms, so it is reasonable to begin any search simply by
typing in some key words. For instance, typing
“mupirocin cardiac surgery” into the search window,
shown in Fig 1, and clicking the “Go” function retrieves
4 articles, at least 2 of which appear directly relevant to
your search.18,19 Importantly, though, these 4 citations
do not include the recent article12 that prompted this
search. Thus, although this free text query provides a
promising start, a more comprehensive search is clear-
ly required.
This “quick search” may provide some useful leads on
MeSH terms for constructing a more comprehensive
search. When a free text query is typed into the search
window, PubMed translates some of the words into
MeSH terms. By clicking on the “Details” function
(located below the search window in Fig 1), the specif-
ic translation for the query can be viewed. In this case,
mupirocin and thoracic surgery were both MeSH
terms. One can supplement this initial approach to
identifying relevant MeSH terms by choosing a promis-
ing reference and then displaying the article in
“Citation” format, instead of “Summary,” which is the
default format in the window to the right of the
“Display” icon (see Fig 1). In this format, the specific
MeSH terms used to index this article are listed below the
abstract. Displaying the third reference19 retrieved by our
initial search in “Citation” format revealed several useful
May 2002 189
general MeSH terms (eg, “Infection Control” and “Cost-
Benefit Analysis”) along with more specific ones such as
“Surgical Wound Infection,” “Staphylococcal Infections,”
and “Nasal Mucosa/microbiology.”
The few minutes spent thus far have already produced
enough information to construct a potentially effective
search string. Typing the second search string demon-
strated in Table 1 into the PubMed search window and
clicking the “Go” function produced 35 hits, including
all 4 of the references from the quick search, as well as
the more recent reference12 reviewed by the cardiac
surgeon.
The more comprehensive approach. When one
wants to simply find a recent article shedding some
light on a topic, a “quick search” will often suffice. In
this case, however, you have been asked to provide an
opinion that takes into consideration all of the available
evidence, so a more reliable and comprehensive
approach is warranted. The “MeSH Browser” function
in PubMed (located in the left-hand column of the main
search screen in Fig 1) provides this more reliable
means of constructing comprehensive search strings.
One MeSH term that we would like to add to our search
is one that captures the concept of nosocomial infec-
tion. Typing “nosocomial” into the “MeSH Browser”
search window and clicking the “Go” function retrieves
a menu of possible matches, with “Nosocomial
Infection” at the top of the list. Clicking the “Browse”
function reveals that “Cross Infection” is the correct
MeSH term for nosocomial infection. Since we already
know from our “quick search” that “Infection Control”
is also a MeSH term, we can try to use the third search
from Table 1 as our more comprehensive search.
Typing this string into the main search window and
clicking the “Go” function retrieves 143 citations, many
of which appear relevant to your questions.
You notice that the third reference20 addresses the
topic of emergent resistance. To make sure that you
find more articles on the topic of antibiotic resis-
tance due to increased mupirocin use, you return
to the “MeSH Browser” and type in “antibiotic resis-
tance.” Clicking the “Go” function produces the
message “antibiotic resistance is not a MeSH term,
but it is associated with the MeSH term Drug
Resistance, Microbial,” accompanied by the screen
shown in Fig 2.
MeSH terms are organized as a kind of taxonomic tree.
The screen shown in Fig 2 indicates that “Drug
Resistance, Microbial” appears on 2 branches of this
190 Vol. 30 No. 3 Shojania and Olmsted

Fig 2. Example use of the “MeSH Browser.” Typing “antibiotic resistance” in the MeSH browser search win-
dow (after clicking on the icon shown in left-hand column of Fig 1) produces the message “antibiotic resis-
tance is not a MeSH term, but it is associated with the MeSH term Drug Resistance, Microbial.” The 2 portions
of the “MeSH tree” where “Drug Resistance, Microbial” appears are then displayed. As explained in the text,
searches incorporating “Drug Resistance, Microbial [mh]” will retrieve any article indexed by this term or any
of the terms that appear underneath either of its occurrences in the MeSH tree.

tree. Searches incorporating “Drug Resistance,
Microbial” will retrieve any article indexed by this term
or any of the terms that appear underneath either of its
occurrences in the MeSH tree. If you are worried that
the term you have found may not capture all the con-
cepts relevant to your search, you can click on the term
immediately above (eg, “Drug Resistance” in the lower
half of Fig 2) to see whether this includes other head-
ings of potential interest. In this case, headings such as
“Insecticide Resistance,” “Insulin Resistance,” and
“Drug Resistance, Neoplasm,” are not relevant to your
search. Equipped now with the MeSH term for antibi-
otic resistance and the “Cost-Benefit Analysis” term
that you came across in the “quick search,” you would
like to narrow your previous search to focus on articles
that address these 2 topics, which we discuss in the
next section.
Step 2: Narrowing the results of your search
Combining different search strings. The “History”
function, located underneath the main search window
in Fig 1, allows one to view the search strings that have
been tried so far. Suppose you click on the “History”
function and see that the string that returned 143 cita-
tions is listed as search No. 3. You could then type in
the last string shown in Table 1, which produces 84
hits, most of which look quite relevant.
Focusing on specific publication or study
types. Even though the aforementioned maneuvers
may seem like a lot of work, surprisingly little expe-
rience is required to reach the point of being able to
construct such search strings within minutes. Thus,
the task with which you will quickly find yourself
 Shojania and Olmsted
Table 1. Building an example PubMed search string with MeSH terms
Search Search
PubMed string*
No. 1 mupirocin cardiac surgery
No. 2 (Surgical Wound Infection OR
Thoracic Surgery [mh]) OR (Nasal
Mucosa/microbiology [mh] OR
Mupirocin [mh])
No. 3 (Cross Infection [mh] OR Infection
Control [mh] OR Surgical Wound
Infection OR Thoracic Surgery [mh])
AND (Nasal Mucosa/microbiology[mh]
OR Mupirocin [mh])
No. 4 No. 3 AND (Drug Resistance [mh]
OR Cost-Benefit Analysis [mh])
*Terms in square brackets represent abbreviations for the search fields targeted by the preceding terms. mh, MeSH term; ti, title word; au, author; tw, text word.
These and other abbreviations can be obtained from the listing of any record displayed in MEDLINE format (one of the options on the “Display” pull-down
menu in Fig 1) or by clicking on “Help/FAQ” function (left-hand column in Fig 1). Boolean operators such as AND, OR, and BUTNOT must be written in capi-
tal letters.
†The listed yield of each search string reflects the number of citations obtained July 25, 2001.
confronted is having to “prune” searches so that they
retrieve manageable numbers of articles. One imme-
diate option consists of clicking on the “Limits” func-
tion (located below and to the left of the search
widow in Fig 1) and restricting the language of pub-
lication to English. The “Limits” function provides a
number of other options for narrowing searches.
Some of these options are reasonable to pursue (eg,
restricting publication type to reviews or clinical tri-
als), but one should generally resist the temptation to
choose limits related to age or even subjects (eg,
human or animal). Straightforward as these selections
may appear, many articles that do not specify an age
range or state that the subjects are human, for exam-
ple, will not be displayed. Restricting the final search
shown in Table 1 to English slightly reduces the num-
ber of hits to 71; adding the further limit of publication
type (review) dramatically reduces this number to 10.
If you retrieve only review articles, you clearly run the
risk of missing important primary information. A more
sophisticated way of limiting the results of searches is
to target certain study types. The “Limits” function for
publication type includes clinical trials, meta-analyses,
and even practice guidelines. Unfortunately, the list of
options does not include study types of particular rele-
vance to infection control, such as case reports, cohort
studies, and other epidemiologic analyses. Table 2 pre-
sents 2 search strings that target these study types and
May 2002 191
Retrieved
citations† Comments
4 The free text query produces a small number of hits in this case (other
free text searches will produces many more hits, depending on the
topic), but these references are quite relevant to the search, so they
offer a quick start.You can use the Related Articles function to augment
this approach and/or find a few MeSH terms with the “Details”
function, as described in the text and shown later in the table.
35 Clicking on the “Details” function reveals the MeSH terms PubMed used
to translate your free text query. Combining these terms as shown pro
duces 35 hits, most of which appear quite promising.
The “MeSH Browser” allows one to develop a more complete search
143 string, in this case by introducing the concept of nosocomial infection
and later in the table by determining the correct term for antibiotic
resistance.
84 The “History” function allows one to combine 2 or more search strings.
illustrates how to combine them with a given topic
search. A third very important search string targets
systematic reviews, but this is discussed separately
later in the article.
TAKING ADVANTAGE OF
SYSTEMATIC REVIEWS
Having identified a number of very promising arti-
cles,12,18-28 the question now becomes what to do
with them. A number of useful resources exist for
familiarizing oneself with the techniques of article
appraisal. For instance, the “Users Guide to the
Medical Literature” series published in the Journal of
the American Medical Association29 provides extremely
accessible, case-based illustrations of the techniques
appropriate for assessing different types of articles.30-
36 However, applying these critical appraisal tech-
niques to each of these articles would take consider-
able time. Occasionally, one has to invest the time
required to not only conduct a comprehensive litera-
ture search but also to appraise the identified studies
in a formal manner. Increasingly, though, systematic
reviews expedite the work of both these activities.
In the last few years, there has been an explosion of
systematic reviews of the literature.37,38 These arti-
cles identify and synthesize the evidence pertaining
to a wide variety of topics in every field of medicine,
192 Vol. 30 No. 3
Table 2. Narrowing searches on the basis of study type
Search string
epidemiologic studies [mh] OR clinical trials [mh] OR comparative
study [mh]
case report [mh] OR (case* [ti] AND report [ti])
Example use of the search strings shown here for study types. Click on the “History” function (below the search window in Fig 1) to find the search number
for the search string that retrieved 143 citations in Table 1. Suppose it is listed as search No. 3 (as it is in Table 1). In that case, you could type the following into
the search window:
No. 3 AND (epidemiologic studies [mh] OR clinical trials [mh] OR comparative study [mh])
This combination reduces the number of citations retrieved to 30.
with infection control well represented among the
roughly 1000 such articles now published annual-
ly.1,2,39-43 In contrast to traditional narrative reviews,
systematic reviews of the literature address a well-
defined clinical question, use an explicit strategy to
locate relevant evidence, evaluate the retrieved stud-
ies with prospectively defined methodologic criteria,
and formally synthesize the results.37,38,44,45 (Meta-
analyses are systematic reviews that use quantitative
methods to pool study results.) In other words, the
authors of such reviews have already performed pre-
cisely the work you would need to do to answer the
question at hand in a comprehensive and evidence-
based fashion. They have conducted an extensive
search for relevant studies, taken the time to appraise
the study methods, summarized the results in a readily
comprehensible manner, and possibly even combined
the results from multiple studies to generate a pooled
estimate of the benefit of the practices related to, for
example, eradication of staphylococci nasal carriage in
selected patient populations.
Despite their importance, MEDLINE does not specifical-
ly index systematic reviews as a publication type.
Review represents a publication type, but the vast
majority of such articles are traditional narrative
reviews.37,45 Meta-analysis is also a publication type,
but not all systematic reviews are meta-analyses and
not all meta-analyses are indexed by this term.46 A
recently described PubMed search retrieved systematic
reviews with high sensitivity (approximately 95%),
without overwhelming users with numerous “false-pos-
itives.”46 (This search can be obtained directly from the
on-line version of the article at http://www.acponline.
org/journals/ecp/pastiss.htm.) Combining this search
string with the third search in Table 1 retrieved 1 poten-
tially relevant article.26 The abstract for this review sug-
gests that a comprehensive search for relevant literature
was carried out and that this search included articles
Shojania and Olmsted
Comments
Retrieves various types of observational studies (eg, retrospective
and prospective cohorts, case-control studies), various types of
clinical trials, and other comparison studies
Case report is a MeSH term, but, as explained in the text, some
articles will not be indexed (either at all or with this term), hence
the inclusion of the title words
published up to and including 1997. Thus, you might
consider pulling this article along with the key refer-
ences from your search published after 1997.
RETURNING TO THE CLINICAL
QUESTION
The comprehensive search just outlined identified a
number of articles that address the target practice
questions.18-24,27,28,47 Review of these articles suggests
that mupirocin is effective in reducing surgical site
infection after cardiothoracic surgery12,18,19 and other
procedures.48 Resistance can develop, although this
risk appears to diminish with controlled use among
surgical patients,20,21,24,27,28 and facilities implement-
ing these strategies have reported them to be cost-
effective.12,19,23
PERIODIC MEDLINE SEARCHES TO
STAY UP-TO-DATE
In addition to providing answers to questions as they
arise in practice, MEDLINE searches offer an effective
means of staying abreast of the literature in general.
Rather than relying solely on traditional activities such
as browsing tables of contents from journals of interest
to look for important new articles, ICPs may find it
helpful to conduct periodic literature searches around
target areas of interest. Maintaining a text file of search
strings such as those shown in Table 3 facilitates this
process and allows one to track literature of interest by
running these searches several times a year.
Any one of the search strings shown in Table 3 can be
combined with one of the methodologic search
strings in Table 2 and then limited by date of publi-
cation. For instance, at the time of this writing, search
No. 3 retrieved 567 articles. However, the search, No.
3 AND (epidemiologic studies [mh] OR clinical trials
 Shojania and Olmsted May 2002 193

Table 3. Some “prefabricated” PubMed search strings relevant to infection control

Search* Search string† Comments

No. 1 (Cross Infection [mh] OR Nosocomial [ti] OR Disease Outbreaks [mh]
OR Disease Reservoirs [mh] OR Disease Transmission [mh] OR
Environmental Microbiology [mh] OR Infection Control [mh] OR
Disease Notification [mh] OR Handwashing [mh] OR Universal
Precautions [mh] OR Contact Tracing [mh])
No. 2 (No. 1 AND Catheterization, Central Venous [mh]) OR
(Catheter Related [ti] AND Infection* [ti])
No. 3 No. 1 AND (Pneumonia [mh] OR pneumonia [ti])
No. 4 (Pneumonia [mh] OR pneumonia [ti] OR Cross Infection
[mh]) AND (Respiration, Artificial [mh] OR Ventilators,
Mechanical [mh] OR Ventilator [ti])
Retrieves most articles of interest to infection
control personnel
Retrieves most articles involving infectious com
plications of central venous catheters.The asterisk
after infection truncates the search term, so that
title words infection and infections are both
retrieved
Retrieves most articles related to nosocomial
pneumonia
Focuses specifically on ventilator-associated
pneumonia

*As explained previously, the number for the search strings can be obtained by clicking the “History” function, located just below the main search window in
Fig. 1.
†Readers will note that these search terms contain title words and MeSH terms. Although MeSH terms represent the preferred search field, supplementing
these terms with title and text words may retrieve important references for 2 reasons. First, the MeSH system is not perfect and may miss indexing relevant
papers with the MeSH terms that have been identified. Second, some MEDLINE records are not indexed with MeSH terms at all.This occurs with all new arti-
cles (with the turn-around time varying with the prominence of the journal), but some references are never indexed (eg, if the MEDLINE record supplied by
the journal publisher does not permit ready indexing by the National Library of Medicine).Thus, including key title words may identify some important articles
not captured by a search string that contains only MeSH terms.

[mh] OR comparative study [mh]), yielded only 212
citations (mh stands for MeSH term). By using the
“Limits” function to select articles published in 2000
and 2001, the number of articles is further reduced to
28, at least 4 of which1,49-52 one might reasonably
peruse to stay abreast of developments in this area.
For the entire field of infection control, the number
of citations retrieved will obviously be quite large,
even with tight restrictions on the date of publica-
tion. In this case, then, it may be more useful to
search periodically for systematic reviews rather
than original research. Combining the first search
string in Table 3 (covering the whole field of infection
control) with the search string for systematic
reviews46 yielded 383 articles at this writing.
Limiting this search to articles published in 2001
reduced this number to only 9 hits, at least 5 of
which are of potential interest to ICPs.39,53-56
IMPORTANT ONLINE RESOURCES
IN ADDITION TO MEDLINE
Most of the articles retrieved in PubMed include an
abstract, and an increasing number of journals pro-
vide links to full text articles. Many journals provide
free online access to print subscribers (eg, the New
England Journal of Medicine, Journal of the American
Medical Association, and AJIC). Along with full text
access for subscribers to AJIC, the publisher’s Web
site includes links to related articles and information
about drugs that are included in the article.
Some journals now provide free online access to all
users of PubMed. In addition to providing such free pub-
lic access, the British Medical Journal has also published
a number of articles that assist readers in evidence
appraisal.57-65 Evidence Based Nursing is also freely avail-
able on-line (http://ebn.bmjjournals.com/) and has pub-
lished a number of articles on literature appraisal7,66,67
that ICPs may find useful in conjunction with the search
techniques discussed here. Other valuable and publicly
available on-line resources include Morbidity and
Mortality Weekly Report (MMWR) (available at
http://www.cdc.gov/mmwr) and Emerging Infectious
Diseases (available at http://www.cdc.gov/ncidod/eid/).
In addition, the Agency for Healthcare Research and
Quality has commissioned a number of evidence-based
reviews, including a recent review of patient safety prac-
tices that covers a number of infection control prac-
tices.68 These evidence reports are free and available on-
line at http://www.ahrq.gov/clinic/epcix.htm.
CONCLUSION
The enormous and ever-increasing volume of impor-
tant clinical research requires that ICPs develop effi-
cient strategies for searching the health care literature.
194 Vol. 30 No. 3
As we have discussed, PubMed provides a powerful
and freely available MEDLINE interface that allows
users to find evidence-based answers to specific clin-
ical questions in a timely manner. Built-in features of
PubMed allow for a reasonable success rate with
“quick searches,” but a few extra minutes spent
developing more comprehensive searches are usual-
ly well spent. When these searches reveal multiple
relevant studies, one should consider searching for
systematic reviews that address the question of
interest. Finding such articles may substantially
reduce the amount of work one has to do in search-
ing for and appraising the evidence. The appearance
of a systematic review on a given topic often reflects
a certain critical mass of clinical investigations. Thus,
periodically searching for systematic reviews of key
topics provides an efficient means of staying abreast
of important developments in infection control and
related clinical areas.
References
1. Marin MG, Lee JC, Skurnick JH. Prevention of nosocomial bloodstream infec-
tions: effectiveness of antimicrobial-impregnated and heparin-bonded central
venous catheters. Crit Care Med 2000;28(9):3332-8.
2. Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern
Med 2000;132(5):391-402.
3. Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD. Efficacy of antiseptic-impreg-
nated central venous catheters in preventing catheter-related bloodstream
infection: a meta-analysis. JAMA 1999;281(3):261-7.
4. Rudnick JR, Beck-Sague CM,Anderson RL, Schable B, Miller JM, Jarvis WR. Gram-
negative bacteremia in open-heart-surgery patients traced to probable tap-
water contamination of pressure-monitoring equipment. Infect Control Hosp
Epidemiol 1996;17(5):281-5.
5. Kool JL, Bergmire-Sweat D, Butler JC, Brown EW, Peabody DJ, Massi DS, et al.
Hospital characteristics associated with colonization of water systems by
Legionella and risk of nosocomial legionnaires’ disease: a cohort study of 15 hos-
pitals. Infect Control Hosp Epidemiol 1999;20(12):798-805.
6. Eickhoff TC. Airborne nosocomial infection: a contemporary perspective. Infect
Control Hosp Epidemiol 1994;15(10):663-72.
7. Cullum N. Users’ guides to the nursing literature: an introduction. Evid Based
Nurs 2000;3(3):71-8.
8. Lindberg DAB. Internet access to the National Library of Medicine. Eff Clin Pract
2000;3(5):256-60.
9. Clinical Evidence: British Medical Journal (BMJ) Publishing Group; 2001. Available
at: http://www.evidence.org.
10. Best evidence. Philadelphia: American College of Physicians; 2001. Available at:
http://www.acponline.org/catalog/electronic/best_evidence.htm.
11. Rose BD, editor. UpToDate. Wellesley (MA): UpToDate, Inc; 2001. Available at:
http://www.uptodate.com.
12. Cimochowski GE, Harostock MD, Brown R, Bernardi M, Alonzo N, Coyle K.
Intranasal mupirocin reduces sternal wound infection after open heart surgery
in diabetics and nondiabetics. Ann Thorac Surg 2001;71(5):1572-8; discussion
78-9.
13. International Digital Electronic Access Library (IDEAL); Harcourt, Inc. Available
at: http://www.academicpress.com/www/ideal/aboutid.htm.Accessed August 14,
2001.
14. EBSCO Information Services; EBSCO Publishing. Available at:
http://www.epnet.com/database.html. Accessed August 14, 2001.
15. OVID Homepage; OVID Technologies. Available at: http://www.ovid.com.
Accessed August 14, 2001.
Shojania and Olmsted
16. Wilczynski NL,Walker CJ, McKibbon KA, Haynes RB. Reasons for the loss of sen-
sitivity and specificity of methodologic MeSH terms and textwords in MEDLINE.
Proc Annu Symp Comput Appl Med Care 1995:436-40.
17. Allison JJ, Kiefe CI, Weissman NW, Carter J, Centor RM.The art and science of
searching MEDLINE to answer clinical questions. Finding the right number of
articles. Int J Technol Assess Health Care 1999;15(2):281-96.
18. Kluytmans JA, Mouton JW,VandenBergh MF, Manders MJ, Maat AP,Wagenvoort
JH, et al. Reduction of surgical-site infections in cardiothoracic surgery by elimi-
nation of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol
1996;17(12):780-5.
19. VandenBergh MF, Kluytmans JA, van Hout BA, Maat AP, Seerden RJ, McDonnel
J, et al. Cost-effectiveness of perioperative mupirocin nasal ointment in cardio-
thoracic surgery. Infect Control Hosp Epidemiol 1996;17(12):786-92.
20. Watanabe H, Masaki H, Asoh N, Watanabe K, Oishi K, Furumoto A, et al.
Emergence and spread of low-level mupirocin resistance in methicillin-resistant
Staphylococcus aureus isolated from a community hospital in Japan. J Hosp Infect
2001;47(4):294-300.
21. Vasquez JE, Walker ES, Franzus BW, Overbay BK, Reagan DR, Sarubbi FA. The
epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus
aureus at a Veterans’ Affairs hospital. Infect Control Hosp Epidemiol
2000;21(7):459-64.
22. Soto NE, Vaghjimal A, Stahl-Avicolli A, Protic JR, Lutwick LI, Chapnick EK.
Bacitracin versus mupirocin for Staphylococcus aureus nasal colonization. Infect
Control Hosp Epidemiol 1999;20(5):351-3.
23. Davey P. Eradication of nasal carriage of Staphylococcus aureus—is it cost-effec-
tive? J Hosp Infect 1998;40(suppl B):S31-7.
24. Santos KR,Teixeira LM, Bravo Neto GP, Fonseca LS, Gontijo Filho PP. Mupirocin-
and methicillin-resistant Staphylococcus aureus spreading in an intermediate-care
unit in a Brazilian hospital. Infect Control Hosp Epidemiol 1998;19(9):622-3.
25. Casewell MW. The nose: an underestimated source of Staphylococcus aureus
causing wound infection. J Hosp Infect 1998;40(suppl B):S3-11.
26. Perl TM, Golub JE. New approaches to reduce Staphylococcus aureus nosocomi-
al infection rates: treating S. aureus nasal carriage. Ann Pharmacother
1998;32(1):S7-16.
27. Netto dos Santos KR, de Souza Fonseca L, Gontijo Filho PP. Emergence of high-
level mupirocin resistance in methicillin-resistant Staphylococcus aureus isolated
from Brazilian university hospitals. Infect Control Hosp Epidemiol
1996;17(12):813-6.
28. Miller MA, Dascal A, Portnoy J, Mendelson J. Development of mupirocin resis-
tance among methicillin-resistant Staphylococcus aureus after widespread use of
nasal mupirocin ointment. Infect Control Hosp Epidemiol 1996; 17(12):811-3.
29. Oxman AD, Sackett DL, Guyatt GH. Users’ guides to the medical literature. I.
How to get started. The Evidence-Based Medicine Working Group. JAMA
1993;270(17):2093-5.
30. Jaeschke R, Guyatt GH, Sackett DL. Users’ guides to the medical literature. III.
How to use an article about a diagnostic test. B. What are the results and will
they help me in caring for my patients? The Evidence-Based Medicine Working
Group. JAMA 1994;271(9):703-7.
31. Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature. II. How
to use an article about therapy or prevention. B.What were the results and will
they help me in caring for my patients? Evidence-Based Medicine Working
Group. JAMA 1994;271(1):59-63.
32. Levine M, Walter S, Lee H, Haines T, Holbrook A, Moyer V. Users’ guides to the
medical literature. IV. How to use an article about harm. Evidence-Based
Medicine Working Group. JAMA 1994;271(20):1615-9.
33. Oxman AD, Cook DJ, Guyatt GH. Users’ guides to the medical literature. VI.
How to use an overview. Evidence-Based Medicine Working Group. JAMA
1994;272(17):1367-71.
34. Hayward RS,Wilson MC,Tunis SR, Bass EB, Guyatt G. Users’ guides to the med-
ical literature.VIII. How to use clinical practice guidelines. A. Are the recommen-
dations valid? The Evidence-Based Medicine Working Group. JAMA
1995;274(7):570-4.
35. Bucher HC, Guyatt GH, Cook DJ, Holbrook A, McAlister FA. Users’ guides to
the medical literature: XIX. Applying clinical trial results. A. How to use an arti-
 Shojania and Olmsted
cle measuring the effect of an intervention on surrogate end points. Evidence-
Based Medicine Working Group. JAMA 1999;282(8):771-8.
36. Guyatt GH, Haynes RB, Jaeschke RZ, Cook DJ, Green L, Naylor CD, et al. Users’
guides to the medical literature: XXV. evidence-based medicine: principles for
applying the users’ guides to patient care. JAMA 2000; 284(10):1290-6.
37. Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence
for clinical decisions. Ann Intern Med 1997; 126(5):376-80.
38. Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing
the gap between research and practice: an overview of systematic reviews of
interventions to promote the implementation of research findings. The
Cochrane Effective Practice and Organization of Care Review Group. BMJ
1998;317(7156):465-8.
39. Naikoba S, Hayward A. The effectiveness of interventions aimed at increasing
handwashing in healthcare workers—a systematic review. J Hosp Infect
2001;47(3):173-80.
40. Cook D.Ventilator associated pneumonia: perspectives on the burden of illness.
Intensive Care Med 2000;26(suppl 1):S31-7.
41. Liberati A, D’Amico R, Pifferi S,Telaro E. Antibiotic prophylaxis in intensive care
units: meta-analyses versus clinical practice. Intensive Care Med 2000;26(suppl
1):S38-44.
42. Saint S. Clinical and economic consequences of nosocomial catheter-related
bacteriuria. Am J Infect Control 2000;28(1):68-75.
43. Carmeli Y, Samore MH, Huskins C. The association between antecedent van-
comycin treatment and hospital-acquired vancomycin-resistant enterococci: a
meta-analysis. Arch Intern Med 1999;159(20):2461-8.
44. Oxman AD. Checklists for review articles. BMJ 1994;309(6955):648-51.
45. McAlister FA, Clark HD, van Walraven C, Straus SE, Lawson FM, Moher D, et al.
The medical review article revisited: has the science improved? Ann Intern Med
1999;131(12):947-51.
46. Shojania KG, Bero L.Taking advantage of the explosion of systematic reviews: an
efficient MEDLINE search strategy. Eff Clin Pract 2001;4:157-62.
47. Roth VR, Murphy C, Perl TM, DeMaria A, Sohn AH, Sinkowitz-Cochran RL, et al.
Should we routinely use mupirocin to prevent staphylococcal infections? Infect
Control Hosp Epidemiol 2000;21(11):745-9.
48. Gernaat-van der Sluis AJ, Hoogenboom-Verdegaal AM, Edixhoven PJ, Spies-van
Rooijen NH. Prophylactic mupirocin could reduce orthopedic wound infections.
1,044 patients treated with mupirocin compared with 1,260 historical controls.
Acta Orthop Scand 1998;69(4):412-4.
49. Mahieu LM, De Dooy JJ, Lenaerts AE, Ieven MM, De Muynck AO. Catheter
manipulations and the risk of catheter-associated bloodstream infection in
neonatal intensive care unit patients. J Hosp Infect 2001;48(1):20-6.
50. Hanna HA, Raad I. Blood products: a significant risk factor for long-term
catheter-related bloodstream infections in cancer patients. Infect Control Hosp
Epidemiol 2001;22(3):165-6.
51. Roghmann MC, Siddiqui A, Plaisance K, Standiford H. MRSA colonization and the
May 2002 195
risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. J Hosp
Infect 2001;47(2):98-103.
52. Larwood KA, Anstey CM, Dunn SV. Managing central venous catheters: a
prospective randomised trial of two methods. Aust Crit Care 2000;13(2):44-
50.
53. Knoll A, Helmig M, Peters O, Jilg W. Hepatitis C virus transmission in a pediatric
oncology ward: analysis of an outbreak and review of the literature. Lab Invest
2001;81(3):251-62.
54. Allington DR, Rivey MP. Quinupristin/dalfopristin: a therapeutic review. Clin Ther
2001;23(1):24-44.
55. Rischitelli G, Harris J, McCauley L, Gershon R, Guidotti T. The risk of acquiring
hepatitis B or C among public safety workers: a systematic review. Am J Prev
Med 2001;20(4):299-306.
56. Dennis DT, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, et al.
Tularemia as a biological weapon: medical and public health management. JAMA
2001;285(21):2763-73.
57. Greenhalgh T. Assessing the methodological quality of published papers. BMJ
1997;315(7103):305-8.
58. Greenhalgh T. How to read a paper. Papers that report diagnostic or screening
tests. BMJ 1997;315(7107):540-3.
59. Greenhalgh T. How to read a paper. Papers that tell you what things cost (eco-
nomic analyses). BMJ 1997;315(7108):596-9.
60. Guyatt GH, Juniper EF, Walter SD, Griffith LE, Goldstein RS. Interpreting treat-
ment effects in randomised trials. BMJ 1998;316(7132):690-3.
61. Wald NJ, Hackshaw AK, Frost CD.When can a risk factor be used as a worth-
while screening test? BMJ 1999;319(7224):1562-5.
62. Torgerson DJ, Roberts C. Understanding controlled trials. Randomisation meth-
ods: concealment. BMJ 1999;319(7206):375-6.
63. Thompson SG, Barber JA. How should cost data in pragmatic randomised tri-
als be analysed? BMJ 2000;320(7243):1197-200.
64. McKee M, Britton A, Black N, McPherson K, Sanderson C, Bain C. Methods in
health services research. Interpreting the evidence: choosing between ran-
domised and non-randomised studies. BMJ 1999;319(7205):312-5.
65. Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Clinical guidelines: developing
guidelines. BMJ 1999;318(7183):593-6.
66. Cullum N. Evaluation of studies of treatment or prevention interventions. Evid
Based Nurs 2000;3(4):100-8.
67. Cullum N. Evaluation of studies of treatment or prevention interventions. Part
2: applying the results of studies to your patients. Evid Based Nurs
2001;4(1):7-8.
68. Shojania KG, Duncan BW, McDonald KM,Wachter RM, editors. Making health-
care safer: a critical analysis of patient safety practices. Evidence report/technol-
ogy assessment No. 43 from the Agency for Healthcare Research and Quality:
AHRQ Publication No. 01-E058; 2001. Available at: http://www.ahrq.gov/clin-
ic/ptsafety/.