Factors associated with personal protection equipment use and hand hygiene among hemodialysis staff.

BACKGROUND: Because exposure to blood by health care workers is frequent during hemodialysis, gloves are required for all contact with patients and their equipment, followed by hand hygiene. In this study, we investigated factors associated with performing these practices as recommended. METHODS: Staff members from a sample of 45 US hemodialysis facilities were surveyed using an anonymous self-administered questionnaire. Factors independently associated with reporting increased compliance with recommended hand hygiene and glove use practices during patient care were identified with multivariate modeling. RESULTS: Of 605 eligible staff members, 420 (69%) responded: registered nurses, 41%; dialysis technicians, 51%; and licensed practical nurses, 8%. Only 35% reported that dialysis patients were at risk for bloodborne virus infections, and only 36% reported always following recommended hand hygiene and glove use practices. Independent factors associated with more frequent compliance were being a technician (versus a registered nurse) and reporting always doing what was needed to protect themselves from infection. CONCLUSION: Compliance with recommended hand hygiene and glove use practices by hemodialysis staff was low. The rationale for infection control practices specific to the hemodialysis setting was poorly understood by all staff. Infection control training should be tailored to this setting and should address misconceptions.

Risk factors for perinatal transmission of hepatitis C virus (HCV) and the natural history of HCV infection acquired in infancy.

BACKGROUND: The goal of the present study was to assess risk factors for perinatal hepatitis C virus (HCV) transmission and the natural history of infection among HCV-infected infants. METHODS: In a cohort study, 244 infants born to HCV-positive mothers were followed from birth until age > or =12 months. Maternal serum was collected at enrollment and delivery; infant serum was collected at birth and at 8 well-child visits. Testing included detection of antibody to HCV, detection of HCV RNA (qualitative and quantitative), and genotyping. HCV-infected infants were followed annually until age 5 years. RESULTS: Overall, 9 of 190 (4.7% [95% confidence interval (CI), 2.3%-9.1%]) infants born to mothers who were HCV RNA positive at delivery became infected, compared with 0 of 54 infants born to HCV RNA-negative mothers (P=.10). Among HCV RNA-positive mothers, the rate of transmission was 3.8% (95% CI, 1.7%-8.1%) from the 182 who were human immunodeficiency virus (HIV) negative, compared with 25.0% (95% CI, 4.5%-64.4%) from the 8 who were HIV positive (P<.05). Three infected infants resolved their infection (i.e., became HCV RNA negative). In multivariate analysis restricted to HCV RNA-positive mothers, membrane rupture > or =6 h (odds ratio [OR], 9.3 [95% CI, 1.5-179.7]) and internal fetal monitoring (OR, 6.7 [95% CI, 1.1-35.9]) were associated with transmission of HCV to infants. CONCLUSION: If duration of membrane rupture and internal fetal monitoring are confirmed to be associated with transmission, interventions may be possible to decrease the risk of transmission.

Ongoing transmission of hepatitis B virus infection among inmates at a state correctional facility.

OBJECTIVES: We sought to determine hepatitis B virus (HBV) infection prevalence, associated exposures, and incidence among male inmates at a state correctional facility. METHODS: A cross-sectional serological survey was conducted in June 2000, and susceptible inmates were retested in June 2001. RESULTS: At baseline, 230 inmates (20.5%; 95% confidence interval [CI]=18.2%, 22.9%) exhibited evidence of HBV infection, including 11 acute and 11 chronic infections. Inmates with HBV infection were more likely than susceptible inmates to have injected drugs (38.8% vs 18.0%; adjusted prevalence odds ratio [OR]=3.0; 95% CI=1.9, 4.9), to have had more than 25 female sex partners (27.7% vs 17.5%; adjusted prevalence OR=2.0; 95% CI=1.4, 3.0), and to have been incarcerated for more than 14 years (38.4% vs 17.6%; adjusted prevalence OR=1.7; 95% CI=1.1, 2.6). One year later, 18 (3.6%) showed evidence of new HBV infection. Among 19 individuals with infections, molecular analysis identified 2 clusters involving 10 inmates, each with a unique HBV sequence. CONCLUSIONS: We documented ongoing HBV transmission at a state correctional facility. Similar transmission may occur at other US correctional facilities and could be prevented by vaccination of inmates.

Anthrax postexposure prophylaxis in postal workers, Connecticut, 2001.

After inhalational anthrax was diagnosed in a Connecticut woman on November 20, 2001, postexposure prophylaxis was recommended for postal workers at the regional mail facility serving the patient's area. Although environmental testing at the facility yielded negative results, subsequent testing confirmed the presence of Bacillus anthracis. We distributed questionnaires to 100 randomly selected postal workers within 20 days of initial prophylaxis. Ninety-four workers obtained antibiotics, 68 of whom started postexposure prophylaxis, and of these, 21 discontinued. Postal workers who never started or stopped taking prophylaxis cited as reasons disbelief regarding anthrax exposure, problems with adverse events, and initial reports of negative cultures. Postal workers with adverse events reported predominant symptoms of gastrointestinal distress and headache. The influence of these concerns on adherence suggests that communication about risks of acquiring anthrax, education about adverse events, and careful management of adverse events are essential elements in increasing adherence.