Beth H. Stover

Epidemiology of methicillin-resistant Staphylococcus aureus at a children's hospital.

OBJECTIVE To describe the relative contribution of and risk factors for both community-acquired and nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections. DESIGN Retrospective cohort study. SETTING 270-bed, tertiary-care childrens hospital. PARTICIPANTS All MRSA-infected children from whom MRSA was recovered between October 1, 1999, and September 30, 2001. METHODS Demographic, clinical, and risk factor data were abstracted from medical records. Categorical variables were analyzed using the chi-square or Fishers exact test and continuous variables were analyzed using the Mann-Whitney test. RESULTS Of the 62 patients with new MRSA infection, 37 had community-acquired MRSA and 25 had nosocomial MRSA. Most community-acquired MRSA infections were of the skin and soft tissue, the middle ear, and the lower respiratory tract. Nosocomial MRSA infections occurred in the lower respiratory tract, the skin and soft tissue, and the blood. Risk factors for infection, including underlying medical illness, prior hospitalization, and prior surgery, were similar for patients with community-acquired MRSA and nosocomial MRSA. History of central venous catheterization and previous endotracheal intubation was more common in patients with nosocomial MRSA. Only 3 patients with community-acquired MRSA had no identifiable risk factor other than recent antibiotic use. Resistance for clindamycin, erythromycin, and levofloxacin was similar between strains of community-acquired MRSA and nosocomial MRSA. CONCLUSIONS Similarities in patient risk factors and resistance patterns of isolates of both community-acquired and nosocomial MRSA suggest healthcare acquisition of most MRSA. Thus, classifying MRSA as either community acquired or nosocomial underestimates the amount of healthcare-associated MRSA.

Measles-Mumps-Rubella Immunization of Susceptible Hospital Employees during a Community Measles Outbreak: Cost-Effectiveness and Protective Efficacy

OBJECTIVE To determine cost-effectiveness and protective efficacy of a program to identify and immunize susceptible hospital employees during a measles outbreak. DESIGN A cost analysis was made of blind measles-mumps-rubella (MMR) immunization versus directed MMR immunization based on 2,000 employees born after December 31, 1956. A directed MMR immunization program for susceptible employees was instituted. Actual costs of the program were calculated at the conclusion of the program. SETTING A medical center complex with more than 4,000 employees, two acute care community hospitals, and a tertiary care childrens hospital. RESULTS A directed MMR immunization program was projected to be less expensive than blind immunization (

Varicella exposure in a neonatal intensive care unit: Case report and control measures

23,106 versus

APIC and CDC survey of Mycobacterium tuberculosis isolation and control practices in hospitals caring for children Part 1: Patient and family isolation policies and procedures

70,720). MMR vaccine was administered to 169 of 188 susceptible employees. Actual cost of the directed MMR immunization program was

The 1996 CDC and HICPAC isolation guidelines: A pediatric perspective

25,384. CONCLUSIONS The directed MMR immunization program was cost-effective and prevented secondary cases among hospital employees during a community measles outbreak.

Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey

Forty-six infants in a neonatal intensive care unit and 138 health care workers were exposed to a pediatric medical resident during the prodromal period and the early days of unrecognized varicella. An attempt was made to prevent an outbreak of additional cases by the institution of emergency control measures. These measures included rapid identification of varicella antibody status in exposed neonates, varicella antibody testing of health care workers with unknown or uncertain history of varicella, prompt administration of varicella zoster immune globulin to potentially susceptible persons, and cohorting neonates on the basis of exposure and antibody status. Passive maternal antibody was detected in 44 of the neonates. Of 27 health care workers who reported either a negative or an uncertain history of varicella, 26 had detectable antibody. No overt cases of varicella occurred in exposed patients or personnel.

Restriction Endonuclease Fingerprinting of Herpes Simplex Virus DNA: A Novel Epidemiological Tool Applied to a Nosocomial Outbreak

BACKGROUND The 1994 Centers for Disease Control and Prevention draft Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities did not exempt pediatric facilities from instituting controls to prevent nosocomial tuberculosis (TB) transmission. Many researchers contend that TB disease in children does not require such rigid controls. We surveyed acute-care pediatric facilities in the United States to determine adherence to patient and family isolation policies and procedures. METHODS The study included 4 mailings of a survey to infection control professionals at 284 US childrens hospitals and adult acute-care hospitals with > 30 pediatric beds. RESULTS The overall response rate was 69%. Only 41% of respondents reported having a written TB policy specifically designed for pediatric patients. Whereas 98% of respondents isolated pediatric patients with confirmed pulmonary TB, only 69% reported isolation of patients with miliary TB, and 79% reported isolation of patients with positive gastric aspirates. TB isolation policies for adult visitors were in place at 69% of hospitals, and 50% of hospitals evaluated adults for TB as part of the childs TB treatment plan. A median of 3 contact investigations occurred at each of 47% of respondent hospitals in the preceding 5 years. CONCLUSIONS Isolation and infection control policies for children with pulmonary TB largely conformed to published guidelines but varied for children with nonpulmonary TB. Because the greatest risk of nosocomial TB transmission in pediatric facilities comes from adults with TB, a rapid TB screening process for parents and adult contacts accompanying affected children should be instituted at facilities caring for children.

Nosocomial infection rates in US children’s hospitals’ neonatal and pediatric intensive care units

Julia Garner and her Hospital Infection Control Practices Advisory Committee (HICPAC) colleagues are to be congratulated for this timely revision of the Isolation Guideline.’ HICPAC invited ICPs and health care epidemiologists with pediatric expertise to review and comment on a working draft of this guideline. The guideline allows for several differences unique to the pediatric population, particularly in the area of viral respiratory infections and gastroenteritis. Clinical syndromes commonly seen in pediatrics and isolation issues have been included in the 1996 guideline. On page 25 of the guideline, the following statement is made, “HICPAC recognizes that the goal of preventing transmission of infections in hospitals can be accomplished by multiple means, and that hospitals will modify the recommendations according to their needs and circumstances.” In adapting previous isolation guidelines to the pediatric setting, many children’s hospitals have modified isolation policies and signage. These modifications were made as a result of prior experiences at the particular hospital, previous experience of the ICP or epidemiologist, and in response to published reports addressing pediatric infection prevention and control issues. In addition to the Centers for Disease Control and Prevention’s (CDC) isolation guidelines, pediatric ICPs have referred to the American Academy of Pediatrics’ Redbook or other pediatric infectious diseases textbooks for the development and revision of isolation policies.2 Even though this guideline addresses pediatric infection control issues more comprehensively than previous guidelines, pediatric facilities