Discontinuation of contact precautions for patients no longer colonized with methicillin-resistant Staphylococcus aureus.

To reduce the number of patients with known methicillin-resistant Staphylococcus aureus (MRSA) colonization who are repeatedly placed in isolation on hospital readmission, we screened patients who had no positive results for MRSA culture in the previous 6 months. Twenty-one (21%) of 98 patients were no longer colonized and were removed from contact precautions.

Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting.

OBJECTIVE: To determine whether hydrogen peroxide vapor (HPV) decontamination can reduce environmental contamination with and nosocomial transmission of Clostridium difficile. DESIGN: A prospective before-after intervention study. SETTING: A hospital affected by an epidemic strain of C. difficile. INTERVENTION: Intensive HPV decontamination of 5 high-incidence wards followed by hospital-wide decontamination of rooms vacated by patients with C. difficile-associated disease (CDAD). The preintervention period was June 2004 through March 2005, and the intervention period was June 2005 through March 2006. RESULTS: Eleven (25.6%) of 43 cultures of samples collected by sponge from surfaces before HPV decontamination yielded C. difficile, compared with 0 of 37 cultures of samples obtained after HPV decontamination (P < .001). On 5 high-incidence wards, the incidence of nosocomial CDAD was significantly lower during the intervention period than during the preintervention period (1.28 vs 2.28 cases per 1,000 patient-days; P = .047). The hospital-wide CDAD incidence was lower during the intervention period than during the preintervention period (0.84 vs 1.36 cases per 1,000 patient-days; P = .26). In an analysis limited to months in which the epidemic strain was present during both the preintervention and the intervention periods, CDAD incidence was significantly lower during the intervention period than during the preintervention period (0.88 vs 1.89 cases per 1,000 patient-days; P = .047). CONCLUSIONS: HPV decontamination was efficacious in eradicating C. difficile from contaminated surfaces. Further studies of the impact of HPV decontamination on nosocomial transmission of C. difficile are warranted.

Calcium hydroxylapatite gel (Radiesse) injection for the correction of postrhinoplasty contour deficiencies and asymmetries.

OBJECTIVES: To describe our technique for the injection of calcium hydroxylapatite gel (Radiesse) to treat postrhinoplasty contour defects and to evaluate the agent's efficacy, duration of action, required dosage, complication rates, and patient satisfaction. Slight defects or asymmetries are not uncommon, even after well-executed rhinoplasty surgery in the most expert of hands. These contour deformities have been treated with filler agents in the past, but with mixed results. Calcium hydroxylapatite gel was recently introduced as a filler agent in facial plastic surgery, but its use has not yet been described in the correction of postrhinoplasty nasal contour defects. DESIGN: A prospective before-and-after trial conducted in a private-practice facial cosmetic surgery office. Eligible patients had postrhinoplasty contour irregularities or asymmetry. Postrhinoplasty irregularities at the nasal dorsum or tip underwent subcutaneous injection with calcium hydroxylapatite. Main outcome measures included number of treatments, posttreatment injection pain score, required dose and complications, natural feel, patient satisfaction, and length of follow-up. Digital photographs were evaluated by blinded observers. RESULTS: Thirteen patients were followed up prospectively for a mean of 2.5 months. The mean injection pain score was 1.9 (scale, 0-5); the mean dose, 0.19 mL. Patient satisfaction was good to excellent in 11 (85%) of 13 cases. Photographic improvement was seen in 15 (88%) of 17 treatment sites. CONCLUSIONS: Calcium hydroxylapatite gel has been shown in this study to improve postrhinoplasty nasal symmetry and smooth the curves and lines that constitute the contour of the nose. The longevity of nasal augmentation by calcium hydroxylapatite remains unsettled; long-term safety is also unknown. Long-term studies of safety and efficacy are indicated.