Data on the resources and staff compensation of hospital epidemiology and infection control (HEIC) departments are limited and do not reflect current roles and responsibilities, including the public reporting of healthcare-associated infections. This study aimed to obtain information to assist HEIC professionals in negotiating resources.

A 28-question electronic survey was sent via e-mail to all Society for Healthcare Epidemiology of America (SHEA) members in October 2006 with the use of enterprise feedback management solution software. The survey responses were analyzed using Microsoft Excel.

Responses were received from 526 (42%) of 1,255 SHEA members. Of the respondents, 84% were doctors of medicine (MDs) or doctors of osteopathy (DOs), 6% were registered nurses, and 21% had a master of public health or master of science degree. Sixty-two percent were male (median age range, 50-59 years). Their practice locations varied across the United States and internationally. Two-thirds of respondents practiced in a hospital setting, and 63% were the primary or associate hospital epidemiologist. Although 91% provided HEIC services, only 65% were specifically compensated. In cases of antimicrobial management, patient safety, employee health, and emergency preparedness, 75%-80% of respondents provided expertise but were compensated in less than 25% of cases. Of the US-based MD and DO respondents, the median range of earnings was $151,000-$200,000, regardless of their region (respondents selected salary ranges instead of specifying their exact salaries). Staffing levels varied: the median number of physician full-time equivalents (FTEs) was 1.0 (range, 1-5); only about 25% of respondents had 3 or more infection control practitioner FTEs.

Most professionals working in HEIC have had additional training and provide a wide, growing range of services. In general, only traditional HEIC work is compensated and at levels much less than the time dedicated to those services. Most HEIC departments are understaffed. These data are essential to advocate for needed funding and resources as the roles of HEIC departments expand.

To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country.

A before-and-after study from December 2006 through June 2008, with a 6-month baseline evaluation period and a follow-up period of 8 months from the beginning of the intervention.

University Hospital, Bamako, Mali.

TWO hundred twenty-four healthcare workers.

The intervention consisted of introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Hand hygiene infrastructure, compliance, healthcare workers' knowledge and perceptions, and handrub consumption were evaluated at baseline and at follow-up.

Severe deficiencies in the infrastructure for hand hygiene were identified before the intervention. Local handrub production and quality control proved to be feasible, affordable, and satisfactory. At follow-up, handrubbing was the quasi-exclusive hand hygiene technique (93.3%). Compliance increased from 8.0% at baseline to 21.8% at follow-up (P < .001). Improvement was observed across all professional categories and medical specialities and was independently associated with the intervention (odds ratio, 2.50; 95% confidence interval, 1.8-3.5). Knowledge enhanced significantly (P < .05), and perception surveys showed a high appreciation of each strategy component by staff.

Multimodal hand hygiene promotion is feasible and effective in a low-income country. Access to handrub was critical for its success. These findings motivated the government of Mali to expand the intervention nationwide. This experience represents a significant advancement for patient safety in developing countries.

To understand the behavioral determinants of hand hygiene in our hospital.

Qualitative study based on 17 focus groups.

Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto.

We recruited 153 healthcare workers (HCWs) representing all major patient care job categories.

Focus group discussions were transcribed verbatim. Thematic analysis was independently conducted by 3 investigators.

Participants reported that the realities of their workload (eg, urgent care and interruptions) make complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and participants expressed that their judgement is adequate to determine when to perform hand hygiene. Discussions revealed gaps in knowledge among participants; most participants expressed interest in more information and education. Participants reported self-protection as the primary reason for the performance of hand hygiene, and many admitted to prolonged glove use because it gave them a sense of protection. Limited access to hand hygiene products was a source of frustration, as was confusion related to hospital equipment as potential vehicles for transmission of infection. Participants said that they noticed other HCWs' adherence and reported that others HCWs' hygiene practices influenced their own attitudes and practices. In particular, HCWs perceive physicians as role models; physicians, however, do not see themselves as such.

Our results confirm previous findings that hand hygiene is practiced for personal protection, that limited access to supplies is a barrier, and that role models and a sense of team effort encourage hand hygiene. Educating HCWs on how to manage workload with guideline adherence and addressing contaminated hospital equipment may improve compliance.

To describe the procedures used during an influenza immunization program and the use of a randomized survey to quantify the vaccination rate among healthcare workers with and without patient contact.

Influenza immunization vaccination program and a randomized survey.

Johns Hopkins University and Health System.

The 2008/2009 Johns Hopkins Influenza Immunization Program was administered to 40,000 employees, including 10,763 healthcare workers. A 10% randomized sample (1,084) of individuals were interviewed to evaluate the vaccination rate among healthcare workers with direct patient contact.

Between September 23, 2008, and April 30, 2009, a total of 16,079 vaccinations were administered. Ninety-four percent (94.5%) of persons who were vaccinated received the vaccine in the first 7 weeks of the campaign. The randomized survey demonstrated an overall vaccination rate of 71.3% (95% confidence interval, 68.6%-74.0%) and a vaccination rate for employees with direct patient contact of 82.8% (95% confidence interval, 80.1%-85.5%). The main reason (25.3%) for declining the program vaccine was because the employee had received documented vaccination elsewhere.

The methods used to increase participation in the recent immunization program were successful, and a randomized survey to assess participation was found to be an efficient means of evaluating the workforce's level of potential immunity to the influenza virus.

While the Republic of Georgia has a high prevalence of hepatitis B virus (HBV) infection (3.4% of blood donors tested positive for HBV surface antigen [HBsAg]), relatively few healthcare workers (HCWs) are thought to be immunized.

To measure rates of HBV vaccination coverage and identify predictors of vaccine acceptance among HCWs.

Cross-sectional survey.

A study was conducted among full-time physicians and nurses at 2 large hospitals. Self-administered questionnaires included questions about demographic characteristics, HBV vaccine status, willingness to recommend vaccination to other HCWs, and barriers to vaccination. Laboratory tests were conducted for identification of HBsAg and antibody to hepatitis B core antigen.

A total of 297 (91%) of 325 randomly selected HCWs provided information for the study (124 physicians and 173 nurses). The rate of HBV vaccination coverage was 12%, and 54% of respondents indicated that they would recommend vaccination to other HCWs. Perception of vaccine safety was identified as the most important predictor for acceptance (prevalence ratio [PR] 3.3 [95% confidence ratio {CI}, 1.2-8.9]) and for willingness to recommend HBV vaccination to other HCWs (PR, 5.5 [95% CI, 3.1-9.4]). Vaccinated HCWs were more likely to recommend vaccination to other healthcare personnel (PR, 1.7 [95% CI, 1.5-2.1]), as were those younger than 40 years of age (PR, 6.0 [95% CI, 2.8-12.6]). Multivariate analyses identified 2 additional factors associated with vaccine acceptance and willingness to recommend vaccination: the hospital at which the HCW was employed and the perception of risk of infection for HCWs.

Georgia plans a major HBV vaccination campaign for HCWs in 2009. The campaign's success will depend on addressing vaccine safety concerns identified in this study and educating HCWs about risk factors for infection and benefits of immunization.

To determine the rate of bacterial and viral contamination of endocavitary ultrasound probes after endorectal or endovaginal examination with the use of probe covers and to evaluate the antimicrobial efficacy of a disinfection procedure consisting of cleaning with a disinfectant-impregnated towel followed by disinfection with ultraviolet C (UVC) light.

Endovaginal or endorectal ultrasound examinations were performed for 440 patients in 3 institutions. All probes were covered by a condom or sheath during the examination. For bacterial analysis, 1 swab was applied lengthwise across one-half the surface of the probe just after removal of the probe cover. The second swab was similarly applied over the probe immediately after the end of a 2-step process consisting of cleaning with a towel impregnated with a disinfectant spray and a 5-minute UVC disinfection cycle. Swabs were applied onto plates and incubated for 48 hours. The number of colony-forming units was counted, and organisms were identified. A similar protocol was used for viral detection of Epstein-Barr virus, human cytomegalovirus, and human papillomavirus, except that an additional swab was applied along the entire external surface of the probe cover before its removal. Viruses were detected by means of a polymerase chain reaction-based protocol.

After removal of probe covers, contamination by pathogenic bacteria was found for 15 (3.4% [95% confidence interval, 2.0%-5.6%]) of 440 probes, and viral genome was detected on 5 (1.5% [95% confidence interval, 0.5%-3.5%]) of 336 probes. After cleaning with a towel impregnated with a disinfectant spray and disinfecting with UVC light, neither bacterial pathogenic flora nor viral genome was recovered from the probe.

Endocavitary ultrasound probes may carry pathogens after removal of covers under routine conditions. A disinfection procedure consisting of cleaning with a disinfectant-impregnated towel followed by disinfection with UVC may provide a useful method for disinfecting endocavitary ultrasound probes.

To determine blood culture contamination rates after skin antisepsis with Chlorhexidine, compared with povidone-iodine.

Retrospective, quasi-experimental study.

Emergency department of a tertiary care children's hospital.

Children aged 2-36 months with peripheral blood culture results from February 2004 to June 2008. Control patients were children younger than 2 months with peripheral blood culture results.

Blood culture contamination rates were compared using segmented regression analysis of time-series data among 3 patient groups: (1) patients aged 2-36 months during the 26-month preintervention period, in which 10% povidone-iodine was used for skin antisepsis before blood culture; (2) patients aged 2-36 months during the 26-month postintervention period, in which 3% Chlorhexidine gluconate was used; and (3) patients younger than 2 months not exposed to the Chlorhexidine intervention (ie, the control group).

Results from 11,595 eligible blood cultures were reviewed (4,942 from the preintervention group, 4,274 from the postintervention group, and 2,379 from the control group). For children aged 2-36 months, the blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000 cultures (P < .05) after implementation of Chlorhexidine. This decrease of 7.62 contaminated cultures per 1,000 cultures (95% confidence interval, —0.781 to —15.16) represented a 30% relative decrease from the preintervention period and was sustained over the entire postintervention period. No change in contamination rate was observed in the control group (P = .337).

Skin antisepsis with Chlorhexidine significantly reduces the blood culture contamination rate among young children, as compared with povidone-iodine.

The rising incidence and mortality of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in children has become a great concern. This study aimed to determine the clinical and economic impact of MRSA colonization or infection on infants and to measure excess mortality, length of stay, and hospital charges attributable to MRSA.

This is a retrospective cohort study.

The study included infants admitted to a level III-IV neonatal intensive care unit from September 1, 2004, through March 31, 2008.

A time-dependent proportional hazard model was used to analyze the association between MRSA colonization or infection and mortality. The relationships between MRSA colonization or infection and length of stay and between MRSA colonization or infection and hospital charges were assessed using a matched cohort study design.

Of 2,280 infants, 191 (8.4%) had MRSA colonization or infection. Of 132 MRSA isolates with antibiotic susceptibility results, 106 were resistant to clindamycin and/or trimethoprim-sulfamethoxazole, thus representing a noncommunity phenotype. The mortality rate was 17.8% for patients with MRSA colonization or infection and 11.5% for control subjects. Neither MRSA colonization (hazard ratio [HR], 0.9 [95% confidence interval {CI}, 0.5-1.5]; P > .05) nor infection (HR, 1.2 [95% CI, 0.7-1.9]; P > .05) was associated with increased mortality risk. Infection caused by MRSA strains that were resistant to clindamycin and/or trimethoprim-sulfamethoxazole increased the mortality risk by 40% (HR, 1.4 [95% CI, 0.9-2.2]; P > .05), compared with the mortality risk of control subjects, but the increase was not statistically significant. MRSA infection independently increased length of stay by 40 days (95% CI, 34.2—45.6; P < .001) and was associated with an extra charge of $164,301 (95% CI, $158,712-$169,889; P < .001).

MRSA colonization or infection in infants is associated with significant morbidity and financial burden but is not independently associated with increased mortality.

To document the introduction of the methicillin-resistant Staphylococcus aureus (MRSA) USA300 clone into a children's hospital. Current molecular epidemiology of infections due to the USA300 strain of MRSA in the pediatric healthcare setting remains obscure.

Retrospective study of patients with hospital-acquired S. aureus infection during the period from August 1, 2001, through July 31, 2007, at Texas Children's Hospital in Houston.

Patients with hospital-acquired S. aureus infection from whom an isolate was available for molecular analysis were included. Clinical information was obtained from patient medical records and the electronic hospital information system. S. aureus isolates underwent antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and polymerase chain reaction testing for staphylococcal cassette chromosome (SCC) mec, agr, the diamine N-acetyltransferase gene, and the Panton-Valentine leukocidin genes (pvl).

Of 242 patients with hospital-acquired S. aureus infection, 147 (61%) had methicillin-susceptible S. aureus infection. Of the 95 MRSA isolates causing hospital-acquired infection, 69 (73%) were USA300 isolates, and that rate did not increase over time. Skin and soft tissue infection (P < .001), onset of infection less than 10 days after admission (P = .007), and lack of comorbidities (P < .001) were associated with hospital-acquired MRSA infection caused by the USA300 strain, compared with other isolates (hereafter referred to as non-USA300 isolates). Nine of 10 patients with a S. aureus infection at the time of death were infected with a non-USA300 strain. USA300 carried SCCmec IV, agr I, the diamine N-acetyl transferase gene, and pvl. USA300 isolates were more susceptible to clindamycin, gentamicin, and trimethoprim-sulfamethoxazole than were other non-USA300 isolates (P < .01).

In our patient population, the annual numbers of observed cases of hospital-acquired S. aureus infection have remained constant. USA300 was the most common clone and, compared with other non-USA300 MRSA isolates, was associated with skin and soft tissue infection, early onset of infection after admission, and greater susceptibility to antimicrobial agents.