Neglect of skin wounds and the risk of becoming a Staphylococcus aureus nasal carrier: a cohort study.

BACKGROUND: Nasal carriers of Staphylococcus aureus have an increased risk of acquiring skin and soft tissue infections, which could manifest as outbreaks, especially in crowded settings. Current prevention programs are ineffective, antibiotic resistance is rising and risk factors for becoming a carrier are incompletely understood. We aimed to examine whether a behavior, the neglect of skin wounds, is a risk factor for becoming a Staphylococcus aureus carrier during training. METHODS: We conducted a field-based cohort study among male infantry trainees in three seasons in Israel during 2011-12. Participants underwent anterior nares cultures and answered structured questionnaires on potential risk factors on two occasions: before and 3 weeks after start of training (N = 542). Attitudes and practices toward neglect of skin wounds were defined as perseverance in training at all costs, despite having a wound. Samples were processed within 18 hours for identification of Staphylococcus aureus. Univariable and multivariable logistic regression analyses were performed to assess risk factors for becoming a carrier. RESULTS: Carriage prevalence increased by 43.3% during training, from 33.2% to 47.6% (p < 0.01). One-fourth (25.4%) of those with a negative culture before training became carriers. None of the socio-demographic characteristics was a risk factor for becoming a carrier while the risk was lower in the winter (Odds ratio [OR] = 0.42; 95% confidence interval [CI]: 0.23-0.78, p < 0.01) and spring (OR = 0.46; 0.26-0.81, p < 0.01) seasons compared to the summer season. Neglect of skin wounds in practice and attitude was a risk factor for becoming a carrier (OR = 2.40; 1.13-5.12, p = 0.02), as well as neglect in practice or attitude (OR = 1.86; 1.04-3.34, p = 0.04) compared to no neglect when controlled for season. The preventable fraction in the population attributed to neglect of skin wounds was 33%. CONCLUSIONS: Neglect of skin wounds is an independent, common and strong risk factor for becoming a Staphylococcus aureus carrier during training. This preventable behavior should not be ignored and should be addressed in public health programs during training and in other settings. Further research on behavioral determinants of Staphylococcus aureus carriage and infection is warranted.

Airway control in case of a mass toxicological event: superiority of second-generation supraglottic airway devices.

INTRODUCTION: Early respiratory support and airway (AW) control with endotracheal intubation (ETI) are crucial in mass toxicology events and must be performed while wearing chemical personal protective equipment (C-PPE). AIM: The aim of this study is to evaluate the efficiency of AW control by using second-generation supraglottic AW devices (SADs) as compared with ETI and first-generation SAD while wearing C-PPE. METHODS: This is a randomized crossover trial involving 117 medical practitioners. Four AW management devices were examined: endotracheal tube, the first-generation SAD, laryngeal mask AW unique and 2 second-generation SAD, the laryngeal tube suction disposable, and supreme laryngeal mask AW (SLMA). Primary end point measured were success or failure, number of attempts, and time needed to achieve successful device insertion. Secondary end point was a subjective appraisal of the AW devices by study population. RESULTS: More attempts were required to achieve AW control with endotracheal tube, with and without C-PPE (P<.001). Time to achieve AW control with ETI was, on average, 88% longer than required with other devices and improved with practice. The mean times to achieve an AW were longer when operators were equipped with C-PPE as compared with standard clothing. Subjectively, difficulty levels were significantly higher for ETI than for all other devices (P<.0001). CONCLUSIONS: When compared with ETI, the use of SADs significantly shortened the time for AW control while wearing C-PPE. Second-generation SAD were superior to laryngeal mask AW unique. These finding suggest that SADs may be used in a mass toxicology event as a bridge, until definite AW control is achieved.

Secular trends of chickenpox among military population in Israel in relation to introduction of varicella zoster vaccine 1979-2010.

Chickenpox is a contagious disease caused by the varicella zoster virus. There is scarce data on long-term trends of chickenpox and its relation to vaccinations practices. We aimed to evaluate trends of chickenpox in a military population during the period 1979-2010 and to assess temporal associations in relation with the introduction of varicella zoster vaccine to the civilian population in Israel in 2000. The archives of the Epidemiology Section of the Israel Defense Forces, where chickenpox is a notifiable disease, were reviewed for all cases of chickenpox from January 1, 1979-December 31, 2010. Annual and monthly incidence rates were calculated and analyzed in relation to vaccine introduction. Between 1979-2000, incidence rates fluctuated around 10 cases per 10,000 soldiers without a clear trend. Since 2000 there has been a dramatic 10-fold decline in incidence, especially notable since 2008, from eight per 10,000 soldiers in 2000 to the lowest rate ever recorded, in 2009, of 0.57 cases per 10,000 soldiers. A seasonal sinusoidal pattern was clearly demonstrated, with rising incidence from November to May followed by a gradual decline to October. The results of this long-term study suggest that the rates of chickenpox in the military population have significantly declined since the introduction of the vaccine to the civilian population in Israel and almost disappeared completely since 2008 as the vaccine was included in the state-funded routine childhood immunization schedule. These findings underscore the need for a strong surveillance system and will aid in determing vaccination policies.