In the past few years, several hospital epidemiology programs in the United States have developed the capacity to monitor drug usage in hospitalized patients. This activity has been stimulated by a Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) mandate to monitor antimicrobial agents and also by the emergence of technology for automated medical record linkage. There is a growing recognition that these methods to link computerized pharmacy records and discharge diagnoses can be used to identify “signals” for side effects and toxicities of all drugs and not only just for antimicrobial agents. In addition, clinical trials designed to detect occurrences of adverse experiences with commonly used antimicrobials have led some hospital epidemiologists to seek collaboration with experts in the methodologies for study of drug usage and drug effects, i.e., pharmacoepidemiologists.

Antimicrobial stewardship programs (ASPs) became an accreditation requirement for Canadian hospitals in 2013. Pediatric programs are in various stages of program development and implementation, with 93% of surveyed Canadian academic pediatric hospitals having established ASPs. The programs varied in their team composition, implementation of stewardship strategies, and measured metrics.

Infect Control Hosp Epidemiol 2018;39:350–354

We describe the trends in the incidence of methicillin-resistant Staphylococcus aureus nosocomial infection in intensive care units in Lyon hospitals from January 1, 2003, through December 31, 2006. The incidence rate decreased from 1.77 cases per 100 ICU patients in 2003 to 1.16 cases per 100 ICU patients in 2006, a reduction of 38.0% (P = .05).

When I went to medical school, I was taught that asepsis had its beginnings with Oliver Wendell Holmes, Lord Joseph Lister, and Ignaz Semmelweis. Holmes introduced the concept that puerperal sepsis was spread from patient to patient by physicians. Lister developed the concept that surgical infection was of bacterial origin. Semmelweis proved that childbed fever was transmitted on the contaminated hands of the attendant. In 1846 he effectively used a chloride as an antiseptic for the first time.

Moreover, Semmelweis, on hearing of the death of Professor Kolletschka following a finger pinprick by a scalpel that had been used in an autopsy, noted that the symptoms and outcome were identical to puerperal sepsis. Thus, he established that “cadaverous particles” had lethal potential.

Tetanus, one of the oldest diseases known to man, continues to exact a tremendous toll worldwide. While the incidence of tetanus has declined dramatically in the United States in this century, more than 50 cases are reported to the Centers for Disease Control and Prevention (CDC) each year. Two thirds of these cases are elderly patients. Some estimate that the actual number of cases may be two to four times greater than the number reported. The overall reported case fatality rate is about 20% to 30%, but is greater than 50% for those older than 60 years.

This article describes the basic framework for developing a tuberculosis (TB) control program. We suggest how to assess the risk of TB in a healthcare delivery setting, how to prioritize control measures based on their effectiveness, and how to meet current regulatory requirements. In addition, we discuss some problematic issues, examples of how other hospitals have confronted these issues, and where to obtain additional information on nosocomial TB.

Institutions and employees in the healthcare industry recently have been flooded with a variety of new preventive devices, with the promise of reducing the risk of needlestick accidents. With the known risk of occupational human immunodeficiency virus (HIV) infection and the greater risk of morbidity and mortality of occupational hepatitis B virus (HBV) infection, it is hard not to get swept away by the tsunami of “safer devices.” The ultimate question of course, is whether these new or improved products actually contribute to the reduction of accidents and diminish the transmission of these diseases. With the demand for safer working conditions in the context of the HIV epidemic and in times of shrinking budgets, the safest and most cost-effective devices must be determined. Although the Occupational Safety and Health Administrations (OSHA) final ruling on occupational exposure to bloodborne pathogens may not directly address the issue of needlestick prevention devices, institutions should be prepared to justify their practices and selection of equipment, given its emphasis on engineering and work practices that states “Engineering and work practice controls shall be used to eliminate or minimize employee exposure.”