To review procedures currently practiced in a Brazilian general hospital and to eliminate ineffective and inefficient practices. To measure the resulting cost improvements based on rigid hospital financing control.

Implementation of surveillance and control programs and prevalence surveys to detect ineffective and inefficient practices.

The study institution is a 130-bed general care facility affiliated with the Brazilian federal government. There were approximately 4,600 admissions per year during the study period (1986- 1989).

Instituting infection control measures and eliminating ineffective practices resulted in the following: an overall decrease in wound infection rates from 24.4% in 1987 to 3.45% in 1989; a 71% reduction in the global incidence of infection in the intensive care unit; a 74% reduction in the surgical prophylactic use of antibiotics; and a total savings of approximately $2 million (US dollars).

During the period from 1986 to 1989, the infection control committee was able to decrease the overall wound infection rate from 24.4% in 1987 to 3.45% in 1989. This eliminated special health problems and improved patient care and cost-effectiveness for our hospital.

To investigate the presence and clonal distribution of Legionella species in the water supply of 20 hospitals in Catalonia, Spain.

20 hospitals in Catalonia, an area of 32,000 km2, located in northeast Spain.

Environmental cultures of 186 points of potable water supply and 10 cooling towers were performed for the presence of Legionella species. Following filtration and acid treatment, the samples were seeded in selective MWY (modified Wadowsky Yee)-buffered charcoal yeast extract-a agar. All isolates obtained were characterized microbiologically and genotyped by Sfil pulsed-field gel electrophoresis (PFGE).

73 of 196 water samples, representing 17 of the 20 hospitals included in the study, were positive for Legionella pneumophila (serogroups 1, 2-14, or both). The degree of contamination ranged from 200 to 74,250 colony-forming units/L. Twenty-five chromosomal DNA subtypes were detected by PFGE. A single DNA subtype was identified in 10 hospitals, 2 DNA subtypes were observed in 6 hospitals, and 1 hospital exhibited 3 different DNA subtypes. Each hospital had its own Legionella DNA subtype, which was not shared with any other hospitals.

Legionella was present in the water of most of the hospitals studied; each such hospital had a unique, dominant chromosomal DNA subtype. The verification of several genomic DNA restriction profiles in such a small geographic area demonstrates the great genetic diversity of Legionella in the aquatic environment.

The objective of this study was to quantify the effectiveness of selected surgical masks in arresting vegetative cells and endospores in an experimental model that simulated contagious patients.

Laboratory.

Five commercially available surgical masks were tested for their ability to arrest infectious agents. Surgical masks were placed over the nose and mouth of mannequin head forms (Simulaids adult model Brad CPR torso). The mannequins were retrofitted with a nebulizer attached to an automated breathing simulator calibrated to a tidal volume of 500 mL/breath and a breathing rate of 20 breaths/min, for a minute respiratory volume of 10 L/min. Aerosols of endospores or vegetative cells were generated with a modified microbiological research establishment-type 6-jet collision nebulizer, while air samples were taken with all-glass impinger (AGI-30) samplers downstream of the point source. All experiments were conducted in a horizontal bioaerosol chamber.

Mean arrestance of bioaerosols by the surgical masks ranged from 48% to 68% when the masks were challenged with endospores and from 66% to 76% when they were challenged with vegetative cells. When the arrestance of endospores was evaluated, statistical differences were observed between some pairs, though not all, of the models evaluated. There were no statistically significant differences in arrestance observed between models of surgical masks challenged with vegetative cells.

The arrestance of airborne vegetative cells and endospores by surgical masks worn by simulated contagious patients supports surgical mask use as one of the recommended cough etiquette interventions to limit the transmission of airborne infectious agents.

To describe the implementation of a population-based surveillance system for multidrug-resistant gram-negative bacilli (MDR-GNB).

Population-based active surveillance by the Georgia Emerging Infections Program.

Metropolitan Atlanta, starting November 2010.

Residents with MDR-GNB isolated from urine or a normally sterile site culture.

Surveillance was implemented in 3 phases: (1) surveying laboratory antibiotic susceptibility testing practices, (2) piloting surveillance to estimate the proportion of GNB that were MDR, and (3) maintaining ongoing active surveillance for carbapenem-nonsusceptible Enterobacteriaceae and Acinetobacter baumannii using the 2010 Clinical and Laboratory Standards Institute (CLSI) breakpoints. Pilot surveillance required developing and installing queries for GNB on the 3 types of automated testing instruments (ATIs), such as MicroScan, in Atlanta's clinical laboratories. Ongoing surveillance included establishing a process to extract data from ATIs consistently, review charts, manage data, and provide feedback to laboratories.

Output from laboratory information systems typically used for surveillance would not reliably capture the CLSI breakpoints, but queries developed for the 3 ATIs did. In November 2010, 0.9% of Enterobacteriaceae isolates and 35.7% of A. baumannii isolates from 21 laboratories were carbapenem nonsusceptible. Over a 5-month period, 82 Enterobacteriaceae and 59 A. baumannii were identified as carbapenem nonsusceptible.

Directly querying ATIs, a novel method of active surveillance for MDR-GNB, proved to be a reliable, sustainable, and accurate method that required moderate initial investment and modest maintenance. Ongoing surveillance is critical to assess the burden of and changes in MDR-GNB to inform prevention efforts.

Pediatric infectious diseases (ID) fellows are required to receive training in hospital epidemiology and infection control and prevention. We sought to assess the current state of healthcare epidemiology training for fellows and to determine which topics are considered important by key stakeholders.

US pediatric ID fellowship program directors and hospital epidemiologists.

We conducted an anonymous Web-based survey in February 2012. We assessed the presence and content of curricula, perceived importance of specific topics, and barriers to career development.

Of 97 eligible participants, 76 (78%) completed the survey, representing 54 programs. Respondents were program directors (60%), hospital epidemiologists (25%), or both (15%). A total of 82% of programs with didactic curricula have infection control sessions, most commonly 1–2 hours in total duration. Of 17 identified topics, only 3 were covered by more than 50% of programs: isolation precautions (54%), central line-associated bloodstream infection (CLABSI; 53%), and hand hygiene (51%). Of the 76 respondents, 35% indicated that fellows participate in a dedicated infection control rotation. Six topics were considered very important by more than 75% of respondents: antimicrobial stewardship (94%), isolation precautions (93%), hand hygiene (90%), CLABSI (90%), surveillance for resistant bacteria (81%), and communicable disease exposure management (81%).

Pediatric ID fellowship programs dedicate little time to didactic or experiential learning in healthcare epidemiology. There are a wide array of topics that the majority of programs do not cover, including several subjects that are considered to be very important by program directors and hospital epidemiologists. Creating a standardized pediatric infection control curriculum would likely benefit fellows in training.