We found reductions in peripherally inserted central catheter (PICC) complication rates over 2 years of observation (20.4 vs 13.8/1,000 line-days; relative risk, 0.5-0.9). This difference represents a cost saving due to reduced line reinsertions and reduced use of thrombolytic agents. The presence of a dedicated PICC insertion nursing team and education of ward nurses in PICC maintenance is a plausible explanation for the observed differences.

Gowns and drapes are used widely in healthcare facilities. Gowns have been used to minimize the risk of disease acquisition by healthcare providers, to reduce the risk of patient-to-patient transmission, and during invasive procedures to aid in maintaining a sterile field. Drapes have been used during invasive procedures to maintain the sterility of environmental surfaces, equipment, and patients. This article reviews the use of gowns and drapes in healthcare facilities, including the characteristics, costs, benefits, and barrier effectiveness of single-use and reusable products.

Currently, gowns protect healthcare personnel performing invasive procedures from contact with bloodborne pathogens. Although gowns have been recommended to prevent patient-to-patient transmission in certain settings (eg, neonatal intensive care unit) and for certain patients (eg, those infected with vancomycin-resistant enterococci), scientific studies have produced mixed results of their efficacy. While appropriate use of drapes during invasive procedures is recommended widely as an aid in minimizing contamination of the operative field, the efficacy of this practice in reducing surgical-site infections has not been assessed by scientific studies.

Based on an evaluation of the functional requirements, environmental impact, and economics of gowns and drapes, clear superiority of either reusable or single-use gowns and drapes cannot be demonstrated. The selection of particular gowns and drapes by individual healthcare facilities requires an assessment of the facility's requirements, available products, and costs and should be based on the desired characteristics of an ideal gown or drape as defined in this paper.

Influenza and pneumococcal vaccination rates among Hawaii long-term-care facilities (LTCFs) statewide during the 1996/97 through the 1998/99 influenza seasons revealed that resident influenza vaccination rates remained over 89%, but pneumococcal vaccination was underutilized. LTCF staff influenza vaccination rates over the same time period were low.

We surveyed pediatric hemodialysis centers (PHDCs) concerning their hepatitis B virus (HBV) prevention strategies. One hundred thirty-one patients were being dialyzed in these PHDCs in December 1996. Although all centers immunized HBV-susceptible hemodialysis patients and had infection control policies to curtail the spread of HBV infection, most centers were not in compliance with all of the Centers for Disease Control and Prevention recommendations for isolating hepatitis B surface antigen-positive patients.

We evaluated the differences in antimicrobial susceptibility among hospitals in three different integrated healthcare systems. Each system provided antibiogram-susceptibility reports from representative hospitals. Reports were analyzed for statistically significant differences between hospitals in a given system for nine important organisms. We found numerous significant interhospital differences in antimicrobial-susceptibility patterns within health systems. For this reason, the practice of combining antibiotic-susceptibility data into a systemwide antibiogram should be discouraged.

An outbreak of a multiresistant Acinetobacter baumannii in February through September 1996 affected 103 patients in a regional hospital in Singapore. We describe the effectiveness of closure of the outbreak area and the importance of good teamwork in the management of the outbreak.

In a developmental center, 257 potential bloodborne pathogen exposures (119 bites, 91 scratches, 30 sharps injuries, 17 mucosal breaks) occurred during 8 years (13,187 employee-years and 6,980 resident-years). Of the residents, 9% were hepatitis B virus (HBV) surface antigen carriers. Serological follow-up of exposed, susceptible employees and residents identified no transmission of HBV, hepatitis C virus (HCV), or human immunodeficiency (HIV) virus. This outcome has been due primarily to hepatitis B immunization and low prevalences of HCV or HIV infections among the subjects. Proper follow-up of all potential exposures is crucial to identify transmission promptly, allay anxiety, and prevent unwarranted workmen's compensation claims. Measures are suggested to reduce exposure further.