Subject(s)
Carrier State/microbiology , Community-Acquired Infections/epidemiology , Methicillin Resistance , Staphylococcal Infections/epidemiology , Staphylococcus aureus/drug effects , Adult , Child , Child, Preschool , Community-Acquired Infections/microbiology , Community-Acquired Infections/transmission , Humans , Staphylococcal Infections/microbiology , Staphylococcal Infections/transmissionSubject(s)
Enterococcus/drug effects , Gram-Positive Bacterial Infections/drug therapy , Vancomycin Resistance , Communicable Diseases, Emerging/drug therapy , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/microbiology , Communicable Diseases, Emerging/prevention & control , Cross Infection/drug therapy , Cross Infection/epidemiology , Cross Infection/microbiology , Cross Infection/prevention & control , Disease Outbreaks , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/prevention & control , Guidelines as Topic , Humans , Infection Control/methods , United States/epidemiologyABSTRACT
BACKGROUND: Few data are available on nosocomial infections (NIs) in US children's hospitals' neonatal or pediatric intensive care units. The Pediatric Prevention Network (PPN) was established to improve characterization of NIs in pediatric patients and to develop and test interventions to decrease NI. METHODS: Fifty participating children's hospitals were surveyed in 1998 to determine NI surveillance methods used and neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) 1997 NI rates. Data were collected on standardized forms and entered and analyzed by using SPSS for Windows. RESULTS: Forty-three (86%) children's hospitals returned a completed questionnaire. All reported conducting NICU and PICU NI surveillance (range, 2-12; median, 12 months). Nineteen children's hospitals provided NICU NI rate data in one or more formats suitable for comparison. Denominators used for NICU NI rate calculations varied: 17 reported overall NI by patient-days; 19 reported bloodstream infection (BSI) by central venous catheter (CVC)-days, and 8 reported BSI by patient-days. Sixteen (16) children's hospitals reported NICU BSI data stratified by CVC-days and birth-weight cohort, and ventilator-associated pneumonia (VAP) by birth weight cohort was reported by 12. Twenty-four children's hospitals reported PICU NI rate data in one or more formats suitable for comparison. Denominators used for PICU NI rate calculations also varied: 20 reported overall NI rates by patient-days; 23 reported BSI rates by CVC-days, and 10 reported BSI rates by patient-days; 24 reported VAP by ventilator-days; and 15 reported urinary tract infections (UTIs) by urinary catheter-days. Median overall NI rates per 1000 patient days were 8.9 in NICUs and 13.9 in PICUs. Median NICU NI device-associated rates by birth weight (>2500 g, 1501-2500 g, 1001-1500 g, and =1000 g) were BSI 4.4, 4.7, 8.9, and 12.6, and VAP 0.9, 1.1, 4.9, and 3.5, respectively. Median PICU NI rates per 1000 device days were 6.5 for BSI; 3.7 for VAP; and 5.4 for UTI. CONCLUSIONS: The number of months that NICU or PICU NI surveillance was conducted varied among hospitals. Reported NICU and PICU NI rates varied by hospital; some reported overall NI rates, and others focused on one or more particular sites of infection (eg, BSI or pneumonia). Many did not provide NICU device-associated rates stratified by birth-weight group. Denominators used to calculate device-associated infection rates also varied, with hospitals reporting either patient-days or device-days. These findings suggest the need to determine reasons for variations and to identify optimal NI surveillance methods at children's hospitals so that valid interhospital NI rate comparisons can be made.
Subject(s)
Cross Infection/epidemiology , Hospitals, Pediatric/statistics & numerical data , Intensive Care Units, Pediatric/statistics & numerical data , Birth Weight , Catheterization , Child , Cross Infection/prevention & control , Humans , Infant, Newborn , Intensive Care Units, Neonatal/statistics & numerical data , Population Surveillance/methods , Respiration, Artificial , United States/epidemiologyABSTRACT
The evaluate elders' risk factors for fire injury, we performed in-home assessments on our Geriatric Clinic clients. Nearly two-thirds of the subjects had physical impairments that could compromise escaping a fire. Fire safety equipment often was suboptimal. Nearly three-fourths of our subjects were not worried about fire injury, yet all had at least one fire injury risk factor. Fire safety knowledge was poor. Apathy was common, with fewer than one-third of our subjects complying with our recommendations.
Subject(s)
Fires/prevention & control , Geriatric Nursing/methods , House Calls , Safety Management/methods , Aged , Aged, 80 and over , Burns/epidemiology , Burns/etiology , Burns/prevention & control , Female , Humans , Incidence , Male , Prospective Studies , United States/epidemiologyABSTRACT
Physicians and clinical employees at a children's hospital were surveyed to compare their tuberculosis (TB) screening and immunization statuses. Failure to offer screening and immunization services to non-employee physicians was associated with lower rates of reported immunity to several vaccine-preventable diseases and with markedly lower rates of TB screening.
Subject(s)
Guideline Adherence/statistics & numerical data , Mass Screening/statistics & numerical data , Tuberculosis/prevention & control , Vaccination/statistics & numerical data , Health Personnel/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Kentucky , Tuberculosis/immunology , Tuberculosis/transmissionABSTRACT
Varicella-zoster virus is a herpes virus that produces a primary infection, chickenpox, manifested by a vesicular eruption and is considered one of the common childhood infectious diseases. After the initial infection the virus becomes latent, then when activated it is manifested as herpes zoster, commonly known as shingles. This highly communicable human disease is associated with serious morbidity and significant mortality, particularly among the immunocompromised. When introduced in the hospital, significant disruptions occur and serious sequelae may results. Recently, a live virus varicella vaccine was approved by the Food and Drug Administration in the United States. Studies have shown the vaccine to be safe and effective. Widespread use of this vaccine may be beneficial in reducing the opportunities for varicella-zoster virus introductions in health care settings.
Subject(s)
Chickenpox/prevention & control , Herpes Zoster/prevention & control , Adult , Chickenpox Vaccine/therapeutic use , Child , Cross Infection/prevention & control , Female , Herpesvirus 3, Human , Humans , Personnel, Hospital , PregnancyABSTRACT
OBJECTIVE: To determine if pediatric emergency physicians (PEP) are following Centers for Disease Control and Prevention (CDC) recommendations that all health care workers receive routine vaccines and annual tuberculosis screens. DESIGN: A two-page mail survey with one follow-up mailing. PARTICIPANTS: All active members of the American Academy of Pediatrics (AAP), Section on Emergency Medicine. Additional inclusion criteria were completion of training and employment in an emergency setting. RESULTS: Of 407 surveys, 286 (60%) were returned; 209 met inclusion criteria. Proof of immunization was not required of 43% of PEP; 42% were not required to have an annual tuberculosis (TB) screen. PEP reported immunity to the following: polio (95%), measles (94%), hepatitis B (91%), rubella (90%), mumps (90%), varicella (90%), and diphtheria-tetanus (86%). However, only 72% received a TB screen, and 60% received an influenza vaccine within the past year. Proof of vaccination for employment was required by 57/85 hospitals, 47/79 universities, and 6/32 self-employed/group practices (chi 2, P < 0.001). Proof of an annual TB screen was required by 64/87 hospitals, 44/82 universities, and 8/32 self-employed/group practices (chi 2, P < 0.001). PEP were more likely to have had a recent annual TB screen if required by their employer (104/117) than if left to their own initiative (42/87) (chi 2, P < 0.001). CONCLUSIONS: Although PEP are well protected against most vaccine-preventable diseases, many are not receiving annual TB screens nor influenza vaccines. The CDC guidelines are not being routinely followed by PEP.
Subject(s)
Emergency Medicine/statistics & numerical data , Guideline Adherence , Immunization/statistics & numerical data , Infection Control/standards , Pediatrics/statistics & numerical data , Physicians/statistics & numerical data , Adult , Child , Data Collection , Emergency Medicine/standards , Emergency Service, Hospital , Humans , Immunization/legislation & jurisprudence , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pediatrics/standards , Physicians/standards , Tuberculin Test/statistics & numerical data , Tuberculosis, Pulmonary/prevention & control , Tuberculosis, Pulmonary/transmission , United States/epidemiologyABSTRACT
OBJECTIVE: To determine policies at children's hospitals regarding immunizations, annual tuberculosis (TB) screening, and blood or body fluid exposure follow-up, particularly as they apply to physicians. DESIGN AND PARTICIPANTS: A three-page survey was sent to infection control practitioners (ICPs) in April 1994 at hospitals affiliated with the National Association of Children's Hospitals and Related Institutions. One follow-up mailing was sent to nonresponding ICPs. RESULTS: Responses were received from 62 (67%) of 93 ICPs. Thirty-five (66%) of 53 children's hospitals had an immunity policy that applied to medical students, 42 (79%) of 53 to resident physicians, 32 (52%) of 62 to hospital-based physicians, and 18 (29%) of 62 to private or community physicians (who admit patients to one hospital). Physicians were required to show evidence of an annual TB screen at 36 hospitals (58%). Immunity policies or TB screening were provided for the following physician groups: medical students, 13 (21%); resident physicians, 43 (69%); hospital-based physicians, 50 (81%); and private or community physicians, 23 (37%). Infection control practitioners reported that the following diseases had been identified within the past 5 years at their hospitals: measles, 82%; mumps, 40%; rubella, 31%; TB, 94%; hepatitis B, 94%; pertussis, 90%; varicella, 98%; and influenza, 94%. Physicians in these institutions were reported to have contracted the following diseases from patient exposure: measles, hepatitis B, TB, pertussis, varicella, and influenza. CONCLUSION: Children's hospitals vary widely in their policies regarding healthcare-worker immunity, and, in many cases, physicians may not be protected from nosocomial transmission of community infections.
Subject(s)
Hospitals, Pediatric , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Medical Staff, Hospital , Humans , Immunization/statistics & numerical data , Organizational Policy , Tuberculin Test/statistics & numerical data , Tuberculosis/prevention & control , Tuberculosis/transmission , United States , Virus Diseases/prevention & control , Virus Diseases/transmissionSubject(s)
Agammaglobulinemia/drug therapy , Diseases in Twins , Hepatitis C Antibodies/analysis , Hepatitis C/immunology , Immunoglobulins, Intravenous/adverse effects , Agammaglobulinemia/complications , Agammaglobulinemia/genetics , Base Sequence , Child , DNA, Viral/analysis , Hepacivirus/genetics , Hepacivirus/immunology , Hepatitis C/diagnosis , Humans , Immunoglobulins, Intravenous/therapeutic use , Liver Function Tests , Male , Molecular Sequence Data , Polymerase Chain Reaction , RNA, Viral/analysis , Remission, SpontaneousABSTRACT
Group A beta-hemolytic streptococcal sepsis may cause life-threatening disease. We describe a child with severe invasive streptococcal syndrome in whom severe respiratory failure and pulmonary pneumatoceles required extracorporeal life support. Physicians should be aware of the full spectrum of pathologic changes and life-threatening complications caused by group A beta-streptococcus.
Subject(s)
Streptococcal Infections/complications , Barotrauma/etiology , Cysts/etiology , Extracorporeal Circulation , Female , Humans , Infant , Lung Diseases/etiology , Respiratory Insufficiency/etiology , Shock, Septic/etiology , Streptococcal Infections/therapy , Streptococcus pyogenes , SyndromeABSTRACT
Cytomegalovirus (CMV) is the most common congenital viral infection, but little is known about the protective immune mechanisms. The guinea pig (gp) model of congenital CMV was used to evaluate the effects of passive antibody given to pregnant dams on pup survival. Dams received three doses of high-titer gpCMV or control antibody on days -3, -1, and +7, or +1, +3, and +7, in relation to gpCMV challenge. gpCMV was inoculated in the late second to early third trimester at three different doses. Compared with controls, gpCMV antibody begun before gpCMV challenge significantly increased pup survival from 14% to 52%, 21% to 84%, and 51% to 77%, respectively, for the three challenge doses. gpCMV antibody started after viral challenge increased pup survival after only the lowest challenge dose (51% to 81%). Antibody did not protect against CMV infection of the pups. CMV antibody appeared to improve survival in congenital CMV infection but did not affect vertical transmission.
Subject(s)
Antibodies, Viral/administration & dosage , Cytomegalovirus Infections/transmission , Cytomegalovirus Infections/veterinary , Immunization, Passive , Infectious Disease Transmission, Vertical , Animals , Animals, Newborn/virology , Antibodies, Viral/blood , Cytomegalovirus Infections/congenital , Cytomegalovirus Infections/prevention & control , Female , Guinea Pigs , Male , Pregnancy , Survival Analysis , Treatment OutcomeABSTRACT
Exposure to u.v. radiation increases the local level of prostaglandins which may play a role in u.v. radiation-induced herpes simplex virus (HSV) recurrences. We used the guinea-pig model of u.v. radiation-induced recurrent genital HSV-2 disease for examining the effects of indomethacin, a prostaglandin inhibitor, on u.v.-induced recurrences. In the first experiment, performed 100 days after HSV-2 inoculation, treatment with indomethacin for 5 days begun 24 h before u.v.-irradiation decreased the proportion of animals developing HSV disease recurrences from 11/13 (84.6%) to 2/13 (15.4%) (P < 0.001). In the second experiment, performed 135 days after HSV-2 inoculation, treatment with indomethacin for 5 days begun 24 h before u.v.-irradiation decreased the number of animals developing recurrences from 12/21 (57.1%) to 5/21 (23.8%) (P < 0.05). Five days of indomethacin treatment begun 4 h after u.v.-irradiation, however, did not reduce the percentage of animals developing disease recurrences but did decrease the mean number of days with recurrent lesions in animals that developed recurrences. Our data suggest that indomethacin may modify u.v. radiation-induced recurrent lesions by decreasing viral reactivation when given before u.v. radiation exposure or by reducing prostaglandin-induced immunosuppression when given before or after exposure. Future studies are needed for evaluating indomethacin prophylaxis for recurrent HSV disease when prolonged u.v. radiation exposure is anticipated.