Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers.

BACKGROUND: Although pandemic and avian influenza are known to be transmitted via human hands, there are minimal data regarding the effectiveness of routine hand hygiene (HH) protocols against pandemic and avian influenza. METHODS: Twenty vaccinated, antibody-positive health care workers had their hands contaminated with 1 mL of 10(7) tissue culture infectious dose (TCID)(50)/0.1 mL live human influenza A virus (H1N1; A/New Caledonia/20/99) before undertaking 1 of 5 HH protocols (no HH [control], soap and water hand washing [SW], or use of 1 of 3 alcohol-based hand rubs [61.5% ethanol gel, 70% ethanol plus 0.5% chlorhexidine solution, or 70% isopropanol plus 0.5% chlorhexidine solution]). H1N1 concentrations were assessed before and after each intervention by viral culture and real-time reverse-transcriptase polymerase chain reaction (PCR). The natural viability of H1N1 on hands for >60 min without HH was also assessed. RESULTS: There was an immediate reduction in culture-detectable and PCR-detectable H1N1 after brief cutaneous air drying--14 of 20 health care workers had H1N1 detected by means of culture (mean reduction, 10(3-4) TCID(50)/0.1 mL), whereas 6 of 20 had no viable H1N1 recovered; all 20 health care workers had similar changes in PCR test results. Marked antiviral efficacy was noted for all 4 HH protocols, on the basis of culture results (14 of 14 had no culturable H1N1; (P< .002) and PCR results (P< .001; cycle threshold value range, 33.3-39.4), with SW statistically superior (P< .001) to all 3 alcohol-based hand rubs, although the actual difference was only 1-100 virus copies/microL. There was minimal reduction in H1N1 after 60 min without HH. CONCLUSIONS: HH with SW or alcohol-based hand rub is highly effective in reducing influenza A virus on human hands, although SW is the most effective intervention. Appropriate HH may be an important public health initiative to reduce pandemic and avian influenza transmission.

Comparing the pneumonia severity index with CURB-65 in patients admitted with community acquired pneumonia.

Pneumonia severity assessment systems such as the pneumonia severity index (PSI) and CURB-65 were designed to direct appropriate site of care based on 30-d mortality. Increasingly they are being used to guide empirical antibiotic therapy and also possibly to detect patients who will require admission to the intensive care unit (ICU). We retrospectively reviewed the records of all patients admitted to our institution with confirmed community acquired pneumonia (CAP) for the 12 months from January 2002. 408 episodes were studied with an overall 30-d mortality of 15.4% and ICU admission of 10.5%. PSI classes IV/V were significantly better than CURB-65 score > or = 3 for predicting patients who died within 30 d (94% vs 62%; p < 0.001), and those that needed ICU (86% vs 61%; p = 0.01). In addition, for the patients identified as 'low risk' by PSI (classes I/II), there was only 1 death and 1 admission to an ICU compared to 8 deaths and 7 ICU admissions with CURB-65 scores of 0-1. Although easier to use, CURB-65 is neither sensitive nor specific for predicting mortality in CAP patients. Neither rule was sufficiently accurate for predicting need for an ICU, even when patients with 'not for resuscitation' orders were excluded.

Good clinical outcomes but high rates of adverse reactions during linezolid therapy for serious infections: a proposed protocol for monitoring therapy in complex patients.

We assessed the toxicity and clinical outcomes associated with linezolid therapy (mean duration, 29+/-28 days; range, 8 to 185 days) in 44 patients with serious gram-positive infections. Although a clinical cure was achieved in 73% of the cases, 28/44 (64%) had adverse reactions (thrombocytopenia, n=13; anemia, n=7; gastrointestinal, n=12; peripheral neuropathy, n=1; serotonin syndrome, n=1), such that a systematic monitoring protocol was developed.

Impact of an electronic antibiotic advice and approval system on antibiotic prescribing in an Australian teaching hospital.

The impact of a computer-based infectious diseases electronic antibiotic advice and approval system ("IDEA(3)S") was assessed as an alternative to a labour-intensive, phone-based approval system. IDEA(3)S-based approvals replaced 48% of all approvals for the most frequently requested antimicrobial agents (ceftriaxone/cefotaxime, vancomycin) and were associated with stable overall rates of antimicrobial use. Antibiotic prescribing for community-acquired pneumonia was 76% concordant with IDEA(3)S recommendations, and clinical acceptance of IDEA(3)S was excellent. Successful implementation required a coordinated, evidence-based approach between clinicians, pharmacists and hospital administration, together with ongoing staff education and feedback of results. IDEA(3)S is a useful new adjunct to routine clinician consultation to support appropriate antibiotic prescribing for a number of common indications in hospitals.