The lack of well-trained, dedicated infection control personnel prevents optimal control of nosocomial infections in Latin American pediatric oncology centers. We collaboratively planned and implemented a multinational training course in San Salvador, El Salvador, to address this need.

The course relied on its organizers' experience in training international healthcare providers, the availability of the International Training Center for Nurses, previous infection control collaboration with the Hospital Nacional de Niños Benjamin Bloom, and resources available at the University of El Salvador. The 4-week course consisted of lecture sessions combined with practical laboratory and hospital experience.

Two courses, one conducted in 2005 and one in 2006, trained 44 professionals from 15 Latin American countries. Evaluations showed that course content and teacher performance met the trainees' needs and that all trainees acquired the necessary knowledge and skills.

The course met the need for the training of Latin American infection control practitioners. Our experience can serve as a model for other organizations interested in strengthening infection control and prevention at international sites.

To compare the ability of 2 types of dressings to contain vaccinia virus after smallpox vaccination.

Prospective, nonrandomized trial.

The smallpox vaccination clinic in a medium-sized military hospital.

Ninety-seven active-duty military members who received smallpox vaccination in accordance with US Department of Defense and Centers for Disease Control and Prevention guidelines.

The first 40 participants enrolled were instructed to cover their vaccination sites with a semipermeable membrane placed over a separate gauze pad, and the subsequent 57 participants were given a semipermeable membrane bonded to an absorbent pad. Swab samples of the external surface of the dressing were collected 7 and 21 days after vaccination. Real-time quantitative polymerase chain reaction was used to detect vaccinia DNA in the samples.

The rate of vaccinia DNA detection was significantly higher for samples obtained from vaccinees who were using the separate gauze and semipermeable membrane, compared with the vacinees who were using the gauze-impregnated semipermeable membrane (22% vs 2.2%; P = .008; odds ratio, 12.3 [95% confidence interval, 1.4-567.4]).

A gauze-impregnated semipermeable membrane more effectively reduced viral passage to the external surface of the dressing than did a semipermeable membrane placed over a separate gauze pad. Routine use of such dressings following smallpox vaccination might reduce the incidence of autoinoculation and secondary transmission.

To compare healthcare workers' skin tolerance for and acceptance of 3 alcohol-based hand rub formulations.

Double-blind, randomized, crossover clinical trial.

Intensive care unit in a university hospital.

Thirty-eight healthcare workers (HCWs).

A total of 3 alcohol-based hand rub formulations (hereafter, formulations A, B, and C) were used in random order for 3-5 consecutive working days during regular nursing shifts. Formulations A and B contained the same emollient, and formulations B and C contained the same alcohol at the same concentration. Use of each test formulation was separated by a “washout” period of at least 2 days. A visual assessment of skin integrity by a blinded observer using a standard 6-item scale was conducted before and after the use of each formulation. Univariate and multivariate analyses were used for the assessment of risk factors for skin alteration, and product acceptability was assessed by use of a customized questionnaire after the use of each formulation.

Thirty-eight HCWs used each of 3 formulations for a median of 3 days (range, 3-5 days). The mean amount of product used daily (±SD) was 54.9 ± 23.5 mL (median, 50.9 mL). Both subjective and objective evaluation of skin conditions after use showed lower HCW tolerance for product C. Male sex (odds ratio [OR], 3.17 [95% confidence interval {CI}, 1.1-8.8]), fair or very fair skin (OR, 3.01 [95% CI, 1.1-7.9]), skin alteration before hand rub use (OR, 3.73 [95% CI, 1.7-8.1]), and use of formulation C (OR, 8.79 [95% CI, 2.7-28.4]) were independently associated with skin alteration.

This protocol permits a fast-track comparison of HCWs' skin tolerance for different alcohol-based hand rub formulations that are used in healthcare settings. The emollient in formulation C may account for its inferior performance.

To study the effectiveness of safety devices intended to prevent percutaneous injuries.

Quasi-experimental trial with before-and-after intervention evaluation.

A 350-bed general hospital that has had an ongoing educational program for the prevention of percutaneous injuries since January 2002.

In October 2005, we implemented a program for the use of engineered devices to prevent percutaneous injury in the emergency department and half of the hospital wards during the following procedures: intravascular catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood sampling, and intramuscular and subcutaneous injections. The nurses in the wards that participated in the intervention received a 3-hour course on occupationally acquired bloodborne infections, and they had a 2-hour “hands-on” training session with the devices. We studied the percutaneous injury rate and the direct cost during the preintervention period (October 2004 through March 2005) and the intervention period (October 2005 through March 2006).

We observed a 93% reduction in the relative risk of percutaneous injuries in areas where safety devices were used (14 vs 1 percutaneous injury). Specifically, rates decreased from 18.3 injuries (95% confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients in the emergency department (P = .002) and from 44.0 injuries (95% CI, 20.1-83.6 injuries) to 5.2 injuries (95% CI, 0.1-28.8 injuries) per 100,000 patient-days in hospital wards (P = .007). In the control wards of the hospital (ie, those where the intervention was not implemented), rates remained stable. The direct cost increase was €0.558 (US$0,753) per patient in the emergency department and €0.636 (US$0,858) per patient-day in the hospital wards.

Proper use of engineered devices to prevent percutaneous injury is a highly effective measure to prevent these injuries among healthcare workers. However, education and training are the keys to achieving the greatest preventative effect.

To assess the surveillance coverage obtained with Centers for Disease Control and Prevention (CDC)-recommended surveillance of healthcare-associated infections (HAIs), which is focused on intensive care units (ICUs) and emphasizes device-related infections (ie, those associated with central venous catheters, ventilators, and/or urinary catheters), compared with the surveillance coverage achieved by comprehensive hospitalwide surveillance. In addition, we assessed whether the infection rates in step-down units more resemble those in wards or ICUs.

Review of prospectively obtained, comprehensive hospitalwide surveillance data from 2004 through 2005 for an acute care tertiary care hospital with approximately 700 beds. Surveillance data was obtained by trained infection control professionals using standard CDC criteria for HAIs.

CDC-recommended ICU surveillance for catheter-related bloodstream infection (BSI) and ventilator-associated pneumonia would have detected only 87 (21.4%) of 407 catheter-related BSIs and only 66 (37.9%) of 174 respiratory tract infections that occurred in the medical and surgical services. Only 31 (34.8%) of 89 infections caused by methicillin-resistant Staphylococcus aureus and 7 (31.8%) of 22 infections caused by vancomycin-resistant Enterococcus occurred in our adult ICUs.

Rates of HAIs were highest in the ICUs, intermediate in step-down units, and lowest in the wards. The rates of infections in the step-down units were more similar to those in the wards than to those in the ICUs. To prevent HAIs, more comprehensive surveillance may be indicated.

To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors.

Nested case-control study in a multicenter cohort (the OutcomeRea database).

Twelve French medical or surgical ICUs.

All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age ( ± 10 years), SAPS (Simplified Acute Physiology Score) II score ( ± 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression.

Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P = .02); the same was true for crude hospital mortality rates (43% vs 30%, P>.01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P = .19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P = .64).

After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.

To determine how inaccurate communication of patient data by clinicians in telephone calls to the prior-approval antimicrobial stewardship program (ASP) staff affects the incidence of inappropriate antimicrobial recommendations made by ASP practitioners.

A retrospective cohort design was used. The accuracy of the patient data communicated was evaluated against patients' medical records to identify predetermined, clinically significant inaccuracies. Inappropriate antimicrobial recommendations were defined having been made if an expert panel unanimously rated the actual recommendations as inappropriate after reviewing vignettes derived from inpatients' medical records.

The setting was an academic medical center with a prior-approval ASP.

All inpatient subjects of ASP prior-approval calls were eligible for inclusion.

Of 200 ASP telephone calls, the panel agreed about whether or not antimicrobial recommendations were inappropriate for 163 calls (82%); these 163 calls were then used as the basis for further analyses. After controlling for confbunders, inaccurate communication was found to be associated with inappropriate antimicrobial recommendations (odds ratio [OR], of 2.2; P = .03). In secondary analyses of specific data types, only inaccuracies in microbiological data were associated with the study outcome (OR, 7.5; P = .002). The most common reason panelists gave for rating a recommendation as inappropriate was that antimicrobial therapy was not indicated.

Inaccurate communication of patient data, particularly microbiological data, during prior-approval calls is associated with an increased risk of inappropriate antimicrobial recommendations from the ASP. Clinicians and ASP practitioners should work to confirm that critical data has been communicated accurately prior to use of that data in prescribing decisions.

To identify independent risk factors associated with isolation of linezolid-resistant, vancomycin-resistant Enterococcus (VRE).

A retrospective, case-case-control study.

A tertiary care, academic medical center.

VRE isolates from clinical cultures were retrospectively analyzed for linezolid resistance during our 18-month study period. Clinical data were obtained from electronic patient records, and the risk factors associated with isolation of linezolid-resistant VRE were determined by comparison of 2 case groups with a control group.

A total of 20% of the VRE isolates analyzed during the study period were linezolid resistant, and resistant isolates were most commonly recovered from the urine (40% of resistant isolates). Risk factors found to be associated with isolation of linezolid-resistant VRE were peripheral vascular disease and/or the receipt of a solid organ transplant, total parenteral nutrition, piperacillin-tazobactam, and/or cefepime. Only 25% of patients from whom linezolid-resistant VRE was isolated had previous linezolid exposure, and in the multivariate model this was not found to be a risk factor associated with the isolation of linezolid-resistant VRE.

The results of this analysis suggest that there is horizontal transmission of linezolid-resistant VRE in our institution and highlight the need for improved infection control measures. Furthermore, the high incidence of linezolid-resistant VRE demands a reassessment of our empirical antibiotic selection for patients infected with VRE.

To investigate relationships between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from hospitals.

We conducted an observational study that used retrospective data from 2002 and linear regression to model relationships. Hospitals were asked to collect data on consecutive S. aureus and P. aeruginosa isolates, consumption rates for antibiotics (ie, anti-infectives for systemic use as defined by Anatomical Therapeutic Chemical class J01), and hospital characteristics, including infection control policies. Rates of methicillin resistance in S. aureus and rates of ceftazidime and ciprofloxacin resistance in P. aeruginosa were expressed as the percentage of isolates that were nonsusceptible (ie, either resistant or intermediately susceptible) and as the incidence of nonsuceptible isolates (ie, the number of nonsuceptible isolates recovered per 1,000 patient-days). The rate of antimicrobial consumption was expressed as the number of defined daily doses per 1,000 patient-days.

Data were obtained from 47 French hospitals, and a total of 12,188 S. aureus isolates and 6,370 P. aeruginosa isolates were tested.

In the multivariate analysis, fewer antimicrobials showed a significant association between the consumption rate and the percentage of isolates that were resistant than an association between the consumption rate and the incidence of resistance. The overall rate of antibiotic consumption, not including the antibiotics used to treat methicillin-resistant S. aureus infection, explained 13% of the variance between hospitals in the incidence of methicillin resistance among S. aureus isolates. The incidence of methicillin resistance in S. aureus isolates increased with the use of ciprofloxacin and levofloxacin and with the percentage of the hospital's beds located in intensive care units (adjusted multivariate coefficient of determination [aR2], 0.30). For P. aeruginosa, the incidence of ceftazidime resistance was greater in hospitals with higher consumption rates for ceftazidime, levofloxacin, and gentamicin (aR2, 0.37). The incidence of ciprofloxacin resistance increased with the use of fluoroquinolones and with the percentage of a hospital's beds located in intensive care (aR2, 0.28).

A statistically significant relationship existed between the rate of fluoroquinolone use and the rate of antimicrobial resistance among S. aureus and P. aeruginosa isolates. The incidence of resistant isolates showed a stronger association with the rate of antimicrobial use than did the percentage of isolates with resistance.