To assess the potential for nosocomial measles transmission by measuring seropositivity among healthcare workers in Utah.

Blood specimens were collected for measurement of measles IgG antibody by enzyme immunoassay (EIA). Individuals with undetectable or equivocal antibody levels were considered at risk for infection. Employees were grouped according to the decade of their birth, and analyses of serological findings were done by the Mantel-Haenszel chi-square test for trend.

The study was performed in a healthcare organization comprised of six urban and 10 rural hospitals.

Employees (n = 5825) were tested regardless of age, history of disease, or immunization.

There were 599 employees (10.3%) who were nonimmune. A trend showing age-related differences in immunity was not noted among employees born prior to 1957 (4.7% nonimmune). However, for employees born after that time, there was a significant age-associated increase in the percentage of susceptible individuals (P= 0.00001). The rate of susceptibility was 8.1% for individuals born between 1957 and 1959, 16.3% for individuals born during the 1960s, and 33.7% for those born in the 1970s.

We concluded that employees born after 1960 represent a material risk for transmission of measles in the hospital setting. Despite the low percentage of susceptibility among those born before 1957, the 144 susceptible individuals in this group also are at risk for measles transmission. Thus, during periods of increased measles prevalence, we would recommend screening all healthcare workers regardless of age and vaccinating those who are susceptible.

To evaluate measles seroprev-among cohorts of new employees and to evaluate vaccine responses of susceptible adult healthcare workers.

New employees were screened for measles susceptibility as part of employee evaluations. Anti-IgG measles antibody tests were completed on 2,473 workers. Demographic, measles history, and measles vaccination information was collected using a short questionnaire. Susceptible workers were vaccinated and screened for vaccine responses following vaccination.

Ninety-three workers (4%) were seronegative, and 56 (2%) were equivocal. Individuals in the youngest cohort (born after 1956) were significantly more likely to be susceptible than those in the middle cohort (born 1951 to 1956) and those in the oldest cohort (born before 1951) (P<0.01). The middle cohort included eight (5%) of the 149 seronegative or equivocal workers. Among the members of the youngest cohort, those from the United States were more likely to be susceptible (P<0.01) than those from outside the United States.

Of the 106 vaccinated susceptible workers whose follow-up serologies were determined, 90 (85%) developed positive IgG serologies, six had equivocal results, and 10 were seronegative. Eleven of the 16 non- or hyporesponders were revaccinated and re-evaluated; nine developed low positive IgG antimeasles levels, one exhibited an equivocal response, and one failed to respond.

A small but important proportion of healthcare workers are susceptible to measles. Whenever feasible, measles immunity programs for healthcare workers should include workers born before 1957. Of workers born after 1956, those from outside the United States are more likely to be immune than workers from inside the United States. Using the currently available vaccine, revaccination of initial non- or hyporesponders appears to be effective.

To determine cost-effectiveness and protective efficacy of a program to identify and immunize susceptible hospital employees during a measles outbreak.

A cost analysis was made of blind measles-mumps-rubella (MMR) immunization versus directed MMR immunization based on 2,000 employees born after December 31, 1956. A directed MMR immunization program for susceptible employees was instituted. Actual costs of the program were calculated at the conclusion of the program.

A medical center complex with more than 4,000 employees, two acute care community hospitals, and a tertiary care children's hospital.

A directed MMR immunization program was projected to he less expensive than blind immunization ($23,106 versus $70,720). MMR vaccine was administered to 169 of 188 susceptible employees. Actual cost of the directed MMR immunization program was $25,384.

The directed MMR immunization program was cost-effective and prevented secondary cases among hospital employees during a community measles outbreak.

Outbreaks of salmonella gastroenteritis in nursing homes are common. Person-to-person transmission to nursing home personnel occurs occasionally, but infection of laundry staff as a result of handling soiled linen rarely has been reported.

To examine the nosocomial transmission of infection to laundry staff during an outbreak of salmonellosis in a nursing home.

A 250-bed nursing home in a rural Tennessee county.

Residents and staff of the nursing home were interviewed and cultures of stool samples examined for enteric pathogens.

Stool cultures from 32 residents and 8 employees were positive for Salmonella hadar. Infection among the residents was food-borne, but infection among employees likely represented secondary transmission, as none of the employees ate food prepared in the kitchen and their onset of symptoms occurred seven to 10 days after that of ill residents. Three laundry personnel who had no contact with residents were infected. Most of the ill residents (81%) were incontinent, which led to an increase in both the degree of fecal soiling and the amount of soiled linen received by the laundry during the outbreak. Laundry personnel regularly ate in the laundry room, did not wear protective clothing, and did not wear gloves consistently while handling soiled laundry,

This investigation implicates linen soiled with feces as the source of nosocomial S hadar infection in laundry workers and underscores the importance of using appropriate precautions when handling linen.

To characterize the epidemiology of percutaneous injuries of healthcare workers (HCWs) in Ile-Ife, Nigeria.

A cross-sectional survey of a randorn sample of HCWs regarding details of needle-stick and sharp instrument injuries within the previous year

University hospital and clinics in Ile-Ife, Nigeria.

Hospital personnel with potential occupational exposure to patients' blood.

Needlestick accidents during the previous year were reported by 27% of 474 HCWs, including 100% of dentists, 81% of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff. The rate of needlestick injuries was 0.6 per person-year overall: 2.3 for dentists, 2.3 for surgeons, 0.4 for nonsurgical physicians, and 0.6 for nursing staff. Circumstances associated with needlestick injuries included unexpected patient movement in 29%, handling or disposal of used needles in 23%, needle recapping in 18%, accidental stick by a colleague in and needle disassembly in 10%. Sharp instrument injuries were reported by 15% of and most commonly involved broken glass patient specimen containers (39%). Almost all were aware of the potential risk of HIV transmission through percutaneous injuries, and 91% considered themselves very concerned about their occupational risk of HIV acquisition.

The high frequency of percutaneous exposure to blood among HCWs in this Nigerian hospital potentially could be reduced by simple interventions at modest cost.

To survey the attitudes of internal medicine residents regarding the influenza vaccine and their reasons for accepting or refusing the vaccine during a hospitalwide immunization campaign.

Internal medicine residents responded to a written survey.

A university-owned, 891-bed, tertiary referral hospital and a 278-bed Veterans Administration hospital in Iowa.

Immediately following the immunization campaign, 51% of residents had received the vaccine. Of those residents who were not vaccinated, 42% never had time to go to the vaccine clinic, but only 8% worried about side effects of the vaccine. Residents whose clinics were staffed by infectious disease subspecialists were significantly more likely to be vaccinated (odds ratio = 2.55; CI95 = 1.01 to 6.42) than residents working with general internists or other subspecialists.

Knowledge, vaccine availability, and social pressure all increase the likelihood that residents will be vaccinated. Faculty, particularly those interested in infectious diseases, may influence residents to accept the vaccine.