To evaluate the feasibility and effectiveness of an influenza control bundle to minimize healthcare-associated seasonal influenza transmission among healthcare workers (HCWs) in an intensive care unit (ICU) equipped with central air conditioning.

A quasi-experimental study was conducted in a 500-bed tertiary care center in Thailand from July 1, 2005, through June 30, 2009. The medical ICU (MICU) implemented an influenza control bundle including healthcare worker (HCW) education, influenza screening of adult community-acquired pneumonia patients, antiviral treatment of patients and ill HCWs who tested positive for influenza, promotion of influenza vaccination among HCWs, and reinforcement of standard infection control policies. The surgical ICU (SICU) and coronary care unit (CCU) received no intervention.

The numbers of influenza infections among HCWs during the pre- and postintervention periods were 18 cases in 5,294 HCW-days and 0 cases in 5,336 HCW-days in the MICU (3.4 vs 0 cases per 1,000 HCW-days; P < .001), 19 cases in 4,318 HCW-days and 20 cases in 4,348 HCW-days in the SICU (4.4 vs 4.6 cases per 1,000 HCW-days; P = .80), and 18 cases in 5,000 HCW-days and 18 cases in 5,143 HCW-days in the CCU (3.6 vs 3.5 cases per 1,000 HCW-days; P = .92), respectively. Outbreak-related influenza occurred in 7 MICU HCWs, 6 SICU HCWs, and 4 CCU HCWs before intervention and 0 MICU HCWs, 9 SICU HCWs, and 8 CCU HCWs after intervention. Before and after intervention, 25 (71%) and 35 (100%) of 35 MICU HCWs were vaccinated, respectively (P < .001); HCW vaccination coverage did not change significantly in the SICU (21 [70%] of 30 vs 24 [80%] of 30; P = .89) and CCU (19 [68%] of 28 vs 21 [75%] of 28; P = .83). The estimated costs of US $6,471 per unit for postintervention outbreak investigations exceeded the intervention costs of US $4,969.

A sustained influenza intervention bundle was associated with clinical and economic benefits to a Thai hospital.

Certain emerging infections, such as severe acute respiratory syndrome and avian influenza, represent a great risk to healthcare workers (HCWs). There are few data about the epidemiology of H1N1 influenza among HCWs.

We conducted a prospective surveillance study for all HCWs at King Abdulaziz Medical City (Riyadh, Saudi Arabia) who were confirmed positive for H1N1 influenza by polymerase chain reaction (PCR) from June 1 through November 30, 2009.

During 6 months of surveillance, 526 HCWs were confirmed positive for H1N1 influenza. The distribution of these cases showed 2 clear outbreaks: an initial outbreak (peak at early August) and a shorter second wave (peak at end of October). Among all PCR-confirmed cases, the attack rate was significantly higher in clinical HCWs than in nonclinical HCWs (6.0% vs 4.3%; P < .001 ) and in HCWs in emergency departments than in HCWs in other hospital locations (17.4% vs 5.0%, P < .001). The percentage of HCWs who received regular influenza vaccination was greater for clinical HCWs than for nonclinical HCWs (46.2% vs 24.6%; P < .001). The majority of HCWs with confirmed H1N1 influenza were young (mean age ± standard deviation, 34.5 ± 9.5 years), not Saudi (58.4%), female (55.1%), and nurses (36.1%). Approximately 4% of women who were less than 50 years old were pregnant. Reported exposures included contact with a case (41.0%), contact with a sick household member (23.8%), and recent travel history (13.3%). Respiratory symptoms (98.0%), including cough (90.1%), were the most frequently reported symptoms, followed by muscle aches (66.2%), fever (62.5%), headache (57.9%), diarrhea (16.5%), and vomiting (9.8%). None of these HCWs died, and all recovered fully without hospital admission.

The results confirm the vulnerability of HCWs, whether clinical or nonclinical, to emerging H1N1 influenza.

Before the emergence of the pandemic (H1N1) 2009 virus, estimates of the stockpiles of facial protective equipment (FPE) and the impact that information had on personnel during a pandemic varied.

To describe the impact of H1N1 on FPE use and hospital employee absenteeism.

One tertiary care hospital and 2 community hospitals in the Vancouver Coastal Health (VCH) region, Vancouver, Canada.

All persons with influenza-like illness admitted to the 3 VCH facilities during the period from June 28 through December 19, 2009.

Data on patients and on FPE use were recorded prospectively. Data on salaried employee absenteeism were recorded during the period from August 1 through December 19, 2009.

During the study period, 865 patients with influenza-like illness were admitted to the 3 VCH facilities. Of these patients, 149 (17.2%) had laboratory-confirmed H1N1 influenza infection. The mean duration of hospital stay for these patients was 8.9 days, and the mean duration of intensive care unit stay was 9.2 days. A total of 134,281 masks and 173,145 N95 respirators (hereafter referred to as respirators) were used during the 24-week epidemic, double the weekly use of both items, compared with the previous influenza season. A ratio of 3 masks to 4 respirators was observed. Use of disposable eyewear doubled. Absenteeism mirrored the community epidemiologic curve, with a 260% increase in sick calls at the epidemic peak, compared with the nadir.

Overall, FPE use more than doubled, compared with the previous influenza season, with respirator use exceeding literature estimates. A significant proportion of FPE resources were used while managing suspected cases. Planners should prepare for at least a doubling in mask and respirator use, and a 3.6-fold increase in staff sick calls.

To assess healthcare workers' attitudes and concerns regarding seasonal and pandemic influenza vaccines in order to improve vaccination campaign communications.

Cross-sectional survey.

All 6 health authorities in British Columbia, Canada.

An anonymous, self-administered online survey was conducted from August 30 through September 30, 2009. Question topics included demographic characteristics, factors influencing acceptance of seasonal influenza vaccine, factors influencing intentions to accept pandemic H1N1 influenza vaccine, and knowledge and concerns regarding the effect of the influenza pandemic.

All 96,217 British Columbia healthcare workers were eligible to participate.

A volunteer sample of 4,046 healthcare workers returned the survey; 3,563 (88%) were women, 58% were under 50 years old (mean age ± standard deviation, 45.3 ± 10.9 years), 3,152 of 4,023 (79%) had 5 or more years of experience in their profession, 1,853 of 4,023 (46%) were nurses, and 2,833 (70%) had been vaccinated against seasonal influenza the previous year. Two thousand eight hundred (69%) respondents reported intending to receive the pandemic H1N1 vaccine. The most important predictor of this intention was having received the seasonal vaccine the previous year (odds ratio [OR], 6.25 [95% confidence interval {CI}, 5.39-7.26]). Worry about making loved ones ill was the only attitude associated with intention to receive the pandemic H1N1 vaccine (adjusted OR, 1.38 [95% CI, 1.27-1.50]). Concerns with vaccine safety (adjusted OR, 0.31 [95% CI, 0.25-0.39]) and belief “that H1N1 is not severe enough” (adjusted OR, 0.29 [95% CI, 0.26-0.32]) were independently associated with the intention to reject the pandemic H1N1 vaccine.

Vaccination campaigns for pandemic H1N1 vaccine should use messages that emphasize the risk of illness among younger people and the opportunity to protect loved ones by getting the vaccine and should address concerns about the safety and effectiveness of the vaccine.

To determine the effectiveness of a UV-C-emitting device to eliminate clinically important nosocomial pathogens in a contaminated hospital room.

This study was carried out in a standard but empty hospital room (phase 1) and in a room previously occupied by a patient with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) infection (phase 2) in an acute care tertiary hospital in North Carolina from January 21 through September 21, 2009. During phase 1, 8 × 8 cm Formica sheets contaminated with approximately 104-105 organisms of MRSA, VRE, multidrug-resistant (MDR) Acinetobacter baumannii, or Clostridium difficile spores were placed in a hospital room, both in direct line of sight of the UV-C device and behind objects. After timed exposure, the presence of the microbes was assessed. During phase 2, specific sites in rooms that had housed patients with MRSA or VRE infection were sampled before and after UV-C irradiation. After timed exposure, the presence of MRSA and VRE and total colony counts were assessed.

In our test room, the effectiveness of UV-C radiation in reducing the counts of vegetative bacteria on surfaces was more than 99.9% within 15 minutes, and the reduction in C. difficile spores was 99.8% within 50 minutes. In rooms occupied by patients with MRSA, UV-C irradiation of approximately 15 minutes duration resulted in a decrease in total CFUs per plate (mean, 384 CFUs vs 19 CFUs; P < .001), in the number of samples positive for MRSA (81 [20.3%] of 400 plates vs 2 [0.5%] of 400 plates; P < .001 ), and in MRSA counts per MRSA-positive plate (mean, 37 CFUs vs 2 CFUs; P < .001).

This UV-C device was effective in eliminating vegetative bacteria on contaminated surfaces both in the line of sight and behind objects within approximately 15 minutes and in eliminating C. difficile spores within 50 minutes.

To compare incidence rates of Clostridium difficile infection (CDI) during a 6-year period among 5 geographically diverse academic medical centers across the United States by use of recommended standardized surveillance definitions of CDI that incorporate recent information on healthcare facility (HCF) exposure.

Data on C. difficile toxin assay results and dates of hospital admission and discharge were collected from electronic databases. Chart review was performed for patients with a positive C. difficile toxin assay result who were identified within 48 hours after hospital admission to determine whether they had any HCF exposure during the 90 days prior to their hospital admission. CDI cases, defined as any inpatient with a stool toxin assay positive for C. difficile, were categorized into 5 surveillance definitions based on recent HCF exposure. Annual CDI rates were calculated and evaluated by use of the χ2 test for trend and the χ2 summary test.

During the study period, there were significant increases in the overall incidence rates of HCF-onset, HCF-associated CDI (from 7.0 to 8.5 cases per 10,000 patient-days; P < .001); community-onset, HCF-associated CDI attributed to a study hospital (from 1.1 to 1.3 cases per 10,000 patient-days; P = .003); and community-onset, HCF-associated CDI not attributed to a study hospital (from 0.8 to 1.5 cases per 1,000 admissions overall; P < .001). For each surveillance definition of CDI, there were significant differences in the total incidence rate between HCFs.

The increasing incidence rates of CDI over time and across healthcare institutions and the correlation of CDI incidence in different surveillance categories suggest that CDI may be a regional problem and not isolated to a single HCF within a community.

Enterococcal bloodstream infections (BSIs) cause morbidity and mortality in children. This study aims to describe the epidemiological characteristics of enterococcal BSI, to determine the risk factors for vancomycin-resistant Enterococcus (VRE) BSI, and to compare outcomes of VRE BSI and vancomycin-susceptible Enterococcus (VSE) BSI in this population.

A retrospective cohort study at a 418-bed tertiary care children's hospital in Philadelphia, Pennsylvania, examined the epidemiological characteristics of children hospitalized with enterococcal BSI during the period from 2001 through 2006. A nested case-control study compared patients with VRE BSI with control patients with VSE BSI. Analysis included regression modeling to identify independent risk factors for VRE BSI.

We identified 339 patients with enterococcal BSI during the study period, including 39 patients with VRE infection. Fifty-three patients (16%) died before hospital discharge. Risk factors for VRE included long-term receipt of mechanical ventilation (adjusted odds ratio [OR], 5.40 [95% confidence interval {CI}, 1.28-6.48]), receipt of immunosuppressive medications during the preceding 30 days (adjusted OR, 2.88 [95% CI, 1.40-20.78]), use of vancomycin during the 2 weeks before onset of bacteremia (adjusted OR per day of vancomycin use, 1.25 [95% CI, 1.14-1.38]), and older age (adjusted OR, 1.08 [95% CI, 1.03-1.14]). VRE BSI was not associated with an increased length of stay after onset of bacteremia (0.77 days [95% CI, 0.55-1.07 days]). Mortality was higher for VRE BSI, but the difference was not statistically significant (adjusted OR, 1.94 [95% CI, 0.78-4.8]).

Most enterococcal BSI in children was caused by VSE. Risk factors for VRE BSI included receipt of vancomycin, long-term receipt of mechanical ventilation, immunosuppression, and older age. Differences in length of stay and mortality were not detected.

To determine whether an earlier determination of staphylococcal species and their antibiotic susceptibility decreases unnecessary antistaphylococcal treatment and/or facilitates earlier appropriate treatment.

We used the Xpert MRSA/SA BC system (Cepheid) for immediate determination of species and their drug susceptibility in patients whose blood cultures revealed gram-positive cocci in clusters. We compared the treatment of patients whose physicians received early notification of these results (group 1) with the treatment of patients in a historical cohort with delayed reporting after traditional microbiological studies (group 2). Outcomes were analyzed according to whether blood culture was positive for Staphylococcus species other than S. aureus, methicillin-susceptible S. aureus (MSSA), or methicillin-resistant S. aureus (MRSA) and whether the drugs used were appropriate for methicillin-susceptible or methicillin-resistant staphylococci (hereafter referred to as “MSS drug” or “MRS drug” therapy, respectively).

There were 44 (76%) of 58 patients with bacteremia due to Staphylococcus species other than S. aureus in group 1 and 58 (55%) of 106 patients with bacteremia due to Staphylococcus species other than S. aureus in group 2 who received no antistaphylococcal antibiotics (P <.01). Five (6%) of 89 patients in group 1 and 31 (25%) of 123 patients in group 2 received 0-168 hours (0-7 days) of MRS drug therapy (P < .01). Among patients with MSSA bacteremia, the mean time to initiation of appropriate therapy was 5.2 hours in group 1 and 49.8 hours in group 2 (P < = .007). Excluding patients who received MRS drug therapy for unrelated conditions, the mean duration of treatment was 19.7 hours in group 1 and 80.7 hours in group 2 (P = .003). Six (50%) of the 12 patients in group 1 and 39 (81%) of the 48 patients in group 2 received MRS drug therapy for MSSA bacteremia (P = .025). Time to initiation of therapy for MRSA bacteremia did not differ between groups.

The use of an assay with rapid results reduced the use of antistaphylococcal therapy among patients who did not have S. aureus bacteremia; it also decreased the use of MRS drug therapy and led to earlier appropriate therapy among patients with MSSA bacteremia.

We sought to identify risk factors for central line-associated bloodstream infection (CLABSI) to describe children who might benefit from adjunctive interventions.

Case-control study of children admitted to the medical-surgical intensive care unit (ICU) or cardiac ICU from January 1, 2004, through December 31, 2007.

Children's Hospital Boston is a freestanding, 396-bed quaternary care pediatric hospital with a 29-bed medical-surgical ICU and a 24-bed cardiac ICU.

Case patients were patients with CLABSI who were identified by means of prospective surveillance. Control subjects were patients with a central venous catheter who were matched by ICU admission date.

Multivariate conditional logistic regression models were used to identify independent risk factors for CLABSI and to derive and to validate a prediction rule.

Two hundred three case patients were matched with 406 control subjects. Independent predictors of CLABSI included duration of ICU central access (odds ratio [OR] for 15 or more days, 18.41 [95% confidence interval {CI} 4.10-82.56]; P < .001), central venous catheter placement in the ICU (OR for 2 or more ICU-placed catheters, 8.63 [95% CI, 2.63-28.38]; P = .001), nonoperative cardiovascular disease (OR, 7.44 [95% CI, 2.13-25.98]; P = .012), presence of gastrostomy tube (OR, 3.48 [95% CI, 1.55-7.79]; P = .003), receipt of parenteral nutrition (OR, 3.12 [95% CI, 1.55-6.32]; P= .002), and receipt of blood transfusion (OR, 2.55 [95% CI, 1.21-5.36]; P = .014). By use of risk factors known before central venous catheter placement, our model predicted CLABSI with a positive predictive value of 54% and a negative predictive value of 79%.

Duration of central access, receipt of parenteral nutrition, and receipt of blood transfusion were confirmed as risk factors for CLABSI among children in the ICU. Newly identified risk factors include presence of gastrostomy tube, nonoperative cardiovascular disease, and ICU placement of central venous catheter. Children with these risk factors may be candidates for adjunctive interventions for CLABSI prevention.

To characterize the clinical outcomes of patients with bloodstream infection caused by carbapenem-resistant Acinetobacter baumannii during a 2-state monoclonal outbreak.

Multicenter observational study.

Four tertiary care hospitals and 1 long-term acute care hospital.

A retrospective medical chart review was conducted for all consecutive patients during the period January 1, 2005, through April 30, 2006, for whom 1 or more blood cultures yielded carbapenem-resistant A. baumannii.

We identified 86 patients from the 16-month study period. Their mortality rate was 41%; of the 35 patients who died, one-third (13) had positive blood culture results for carbapenem-resistant A. baumannii at the time of death. Risk factors associated with mortality were intensive care unit stay, malignancy, and presence of fever and/or hypotension at the time blood sample for culture was obtained. Only 5 patients received adequate empirical antibiotic treatment, but the choice of treatment did not affect mortality.

Fifty-seven patients (66.2%) had a single positive blood culture result for carbapenem-resistant A. baumannii; the only factor associated with a single positive blood culture result was the presence of decubitus ulcers. Interestingly, during the study period, a transition from single to multiple positive blood culture results was observed. Four patients, 3 of whom were in a burn intensive care unit, were bacteremic for more than 30 days (range, 36–86 days).

To our knowledge, this is the first time a study has described 2 patterns of bloodstream infection with A. baumannii: single versus multiple positive blood culture results, as well as a subset of patients with prolonged bacteremia.