We performed an epidemiological investigation and genome sequencing of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to define the source and scope of an outbreak in a cluster of hospitalized patients. Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission to patients and healthcare workers during a single hemodialysis session, highlighting the importance of infection prevention precautions.

More than 90% of Thai hospitals surveyed reported implementing environmental cleaning and disinfection (ECD) protocols. Hospital epidemiologist presence was associated with the existence of an ECD checklist (P=.01) and of ECD auditing (P=.001), while good and excellent hospital administrative support were associated with better adherence to ECD protocols (P<.001) and ECD checklists (P=.005).

Infect Control Hosp Epidemiol 2017;38:1250–1253

For clean elective surgery, the goal of nosocomial infection control is nothing less than an infection rate of zero. Although infection rates of less than 1% are being posted regularly in selected surgical operations today, infection rates of 2% to 6% persist in many procedures such as coronary artery bypass surgery and vascular surgery. Predictable achievement of a zero infection rate in all of clean surgery will require new directions in both basic and clinical research.

Research into the prevention of infection in clean surgery has, to date, focused upon 1) identifying and controlling the routes of wound contamination, 2) decontamination of a contaminated wound through the prophylactic use of antimicrobials, and 3) modifying the host immune system. The latter is a fascinating area of new research which will not be discussed in detail here.

Routes of contamination are often categorized as endogenous or exogenous. “Endogenous” generally refers to bacterial seeding of the wound from the flora of the patient's own skin, nose, perineum, and GI tract. “Exogenous” contamination has come to mean bacteria originating from the operating room environment or operating room personnel which reach the wound by direct inoculation (eg, improperly sterilized instruments, hands of the surgeon via torn gloves) or by the airborne route. These categories may not be broad enough to satisfy the complexities of the hospital environment, however. The addition of the category “acquired endogenous” may be of help in describing contamination which occurs when patients become colonized with resistant hospital flora and subsequently carry this newly acquired flora into the operating theater.

We describe the incidence rates of home healthcare-associated infections (HHAIs) in a pediatric home healthcare service (PHHCS). The overall incidence density of HHAIs was 11.1 infections per 1,000 patient-days. Average incidence density of ventilator-associated pneumonia (VAP) was 6.8 per 1,000 ventilator-days. Strategies for control of VAP should be prioritized in PHHCSs.

Recurrent skin and soft-tissue infections (SSTIs) due to Staphylococcus aureus are a common problem in children and adults. Many of these SSTIs are caused by a community-associated methicillin-resistant S. aureus (MRSA) strain designated USA300. Dilute bleach baths are commonly used as part of decolonization regimens for recurrent SSTI, particularly in children. However, limited data are available on the microbiological efficacy of dilute bleach on skin, and optimal concentrations are unknown. Recent practice guidelines for MRSA from the Infectious Diseases Society of America recommend a teaspoon of household bleach per gallon of bath water (1.3 μL/mL or a quarter cup per quarter tub of water) for 15 minutes twice weekly. On the basis of in vitro data, Fisher et al suggested that a higher concentration (2.5 μL/mL or a half cup per quarter tub of water) might be more effective (more than a 3-log reduction in MRSA in 5 minutes versus a 2-log reduction for a 1.2-μL/mL concentration). In contrast, more dilute bleach solutions (eg, a quarter cup of 6% sodium hypochlorite per bathtub full of water) for 5 days in combination with intranasal mupirocin were effective for eradication of colonization in a recent randomized trial, but 29% of patients in the mupirocin/bleach bath group developed recurrent colonization within 4 months. Here, we used a pig skin model to examine the effectiveness of various concentrations of dilute bleach solution and an electrochemically activated saline solution containing 0.025% hypochlorous acid (Vashe; PuriCore) for disinfection of MRSA on skin. Vashe is safe for use on skin and is commercially available as a wound care product.

The Enterococcus has become an important nosocomial pathogen despite its low virulence. From 1986 to 1989, the National Nosocomial Infections Surveillance System (NNIS) reported enterococci to be the third most common pathogen associated with bloodstream infections and the second most commonly isolated pathogen overall. This is due in part to the organism's ubiquitous nature and inherent antimicrobial resistance.

Enterococcus faecalis is found in the stool of virtually all adults at concentrations in excess of 106 colony-forming units/g. Enterococcus faecium, the second most common species causing human infection, is found at lesser concentrations in the stool of approximately 25% of healthy adults. Enterococci also can be isolated from the mouth, anterior urethra, groin, and vagina.

We studied methicillin-resistant Staphylococcus aureus (MRSA)-colonized children with multiple intensive care unit (ICU) admissions to assess the persistence of MRSA colonization. Our data found that children with more than 1 year between ICU admissions had a higher prevalence of MRSA colonization than the overall ICU population, which supports empirical contact precautions for children with previous MRSA colonization.

The Project to Monitor Indicators (PMI) will be a collaborative effort between the Society for Healthcare Epidemiology of America (SHEA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The goal of this collaboration is to create an intellectual infrastructure to support the effective use, development, understanding, and continuous improvement of clinical quality indicators through coordinated study by hospital epidemiologists.

The Joint Commission is in the midst of an extensive effort to develop a set of indicators that reflect the performance of various aspects of clinical practice. These indicators will form the foundation of a national comparative measurement system called the Indicator Measurement System (IMSystem). It is the Joint Commission's plan that hospitals will be required to participate in the IMSystem as part of the accreditation process in the near future.

This article describes a case of respiratory syncytial virus pneumonia believed to have been acquired nosocomially in an adult renal transplant recipient. The mode of transmission, diagnosis, and prevention of infection due to this virus in the immunocompromised patient are discussed (Infect Control Hosp Epidemiol 2003;24:548-550.

We assessed various locations and frequency of environmental sampling to maximize information and maintain efficiency when sampling for Acinetobacter baumannii. Although sampling sites in closer proximity to the patient were more likely positive, to fully capture environmental contamination, we found value in sampling all sites and across multiple days.

Infect Control Hosp Epidemiol 2018;39:339–342

Antibiotic use tracking in nursing homes is necessary for stewardship and regulatory requirements but may be burdensome. We used pharmacy data to evaluate whether once-weekly sampling of antibiotic use can estimate total use; we found no significant differences in estimated and measured antibiotic use.

Our case-control study sought to identify risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission among patients with no known healthcare-related risk factors. We found that patients whose most recent hospitalization occurred greater than 1 year before their current hospital admission were more likely to have MRSA colonization. In addition, both the time that elapsed since the most recent hospitalization and the duration of that hospitalization affected risk.

Rising health care costs have prompted hospitals to turn to reprocessing and reuse of disposable devices as a cost-saving measure. The safety, efficacy, and cost benefit of such a practice are largely unknown. Classification schemata are presented as a means of categorizing the reasons for reprocessing and the types of adverse effects that may result from reprocessing and reuse. The very limited literature on reuse of disposable devices is reviewed. Examples of the categories of reprocessing and adverse effects are provided from a review of the experience with reprocessing and reuse at a university medical center. With the rising pressure for containment of health care costs, it is likely that this practice will expand further. The practice of reprocessing and reuse should be subjected to scientific study.