The evidence-based guidelines encompass diagnostic issues, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal (interpandemic) influenza.

Johns Hopkins Hospital researchers and colleagues reported in the journal Critical Care Medicine that bathing critically ill hospital patients with a 4 percent solution of chlorhexidine daily may potentially reduce bloodstream infections by as much as 73 percent. The program compared 2,650 chlorhexidine-bathed patients with 2,670 patients who bathed with soap and water. The study found 32 percent fewer cases of methicillin-resistant Staphylococcus aureus infections and 50 percent fewer cases of vancomycin-resistant Enterococci in the patients who bathed using chlorhexidine in six different hospitals

An update to a 2007 study that examines the effectiveness of strategies to reduce the spread of viral germs that cause respiratory diseases such as the flu  and it concludes that wearing gloves, gowns and masks is effective, as is washing hands more than 10 times a day. Researchers from the Cochrane Acute Respiratory Infections Group in Italy and colleagues reviewed the results of 59 studies and said the highest-quality studies reported that the spread of diseases can be lowered through hygiene in households and among young children. "More resources should be invested into studying which physical interventions are the most effective, flexible and cost-effective means of minimizing the impact of acute respiratory tract infections," the researchers write.

Brendan Wren of the London School of Hygiene and Tropical Medicine and colleagues have found that the recent rise in Clostridium difficile infections is the result of genetic changes that have caused strains to become more virulent, rather than due to dirty hospitals. The PCR-ribotype 027 strain has emerged in the past five years, and the highly virulent strain causes more severe diarrhea and a higher death rate. A comparison of the "hyper-virulent" strains with an older strain has shown that the bacteria have acquired genes enabling them to survive better in the environment, spread more easily and make patients more severely ill. Their findings were reported in the journal Genome Biology.

Research published in the British Medical Journal looked at 59 studies of interventions to prevent respiratory virus transmission, including isolation, quarantine, social distancing, barriers, personal protection and hygiene. Through a meta-analysis of six case-control studies, the researchers found that physical measures are highly effective in preventing the spread of severe acute respiratory syndrome. Among the measures that were deemed most effective were washing hands more than 10 times daily and wearing masks, gloves and gowns. The combination of hand-washing, masks, gloves and gowns was also found to be effective in helping stop the spread of influenza within households.

The study of 446 nurses, published in the Journal of the American Medical Association, found that surgical masks have an estimated effectiveness within 1 percent of N95 respirators and are not associated with an increased rate of infection of influenza or other respiratory viruses.

 A study that found the number of people in the U.S. who could come down with H1N1 ranges from a high of 12.9 million people in California to a low of 186,000 people in Wyoming. The 15 states that could reach capacity include Arizona, California and Nevada, while the 12 that could see most of their beds taken include Colorado, Florida and Utah. The report also found that H1N1 flu pandemic preparedness efforts have suffered from budget cuts and layoffs in states and communities, and almost 50 percent of private-sector workers are without sick leave benefits. The report included suggestions for improvement, such as distributing messages about good hygiene practices and refining plans for rapid distribution and administration of vaccines.

Hong Kong researchers found that noninvasive ventilation masks on simulated hospital patients yielded a jet of exhaled air extending two to three feet from the face and higher pressure during inhalation increased the size of the potential contaminated area, putting health care workers at increased risk for the H1N1 virus and other infectious diseases.

Dr. Michael Millar, a microbiologist from Barts and The London NHS Trust, wrote in BMJ that screening all hospital patients for MRSA in England has produced too many false results. All hospitals in England have had to screen patients admitted for non-emergency surgery since April 2009. "The problem with screening everyone is that in low risk groups you get as many false positives as positives, if not more," Millar said.

A study led by Seema Jain of the CDC revealed the H1N1 influenza strain has particularly hit younger patients. Of the 272 hospitalized patients analyzed in the research, 45 percent were under age 18, according to the findings published in The New England Journal of Medicine. A second study in that journal found H1N1 caused a spike in patients sent to intensive care units in Australia and New Zealand during the Southern Hemisphere’s usual flu season. "They had a 15-fold increase in ICU care," said Michael Osterholm of the University of Minnesota. "We’re still heading into our flu season. Will we see this same big increase in cases over the next several months or will we have a peak in cases in October or November?" The increase for ICU admissions in those nations was especially noted in people with chronic lung disease, obese patients and pregnant women, according to investigators from the Australian and New Zealand Intensive Care Society.

<p>The study of patients in Canada shows that a portion of patients require sophisticated medical techniques and equipment to survive, which can be difficult for some ICUs to provide. &quot;This is the most severely ill that we&rsquo;ve ever seen people,&quot; said Anand Kumar, lead author and an intensive-care attending physician for the Winnipeg Regional Health Authority in Canada. &quot;There&rsquo;s almost two diseases. Patients are either mildly ill, or critically ill and require aggressive ICU care. There isn&rsquo;t that much of a middle ground.&quot;</p>

Laura Temime of the Conservatoire des Arts et Metiers in Paris and colleagues used a mathematical model to determine that "peripatetic" health care workers such as therapists are most likely to spread pathogens if they neglect hand hygiene, while "assigned" workers such as nurses and doctors are less likely to spread pathogens. Researchers used modeling techniques to pinpoint "superspreaders" among three types of health care workers. The three groups were those with frequent contact with a few patients, those with less frequent contact and more patients, and those who typically see patients once a day. They tracked what would happen over a month using the model if a single colonized patient was introduced into an 18-bed ward, relating to several scenarios about hand hygiene rule noncompliance. Findings were published in the Proceedings of the National Academy of Sciences.

Catherine Takacs Witkop and colleagues at the U.S. Air Force Academy in Colorado Springs, Colo., said in the American Journal of Preventive Medicine that, contrary to current public health recommendations, the H1N1 flu virus may linger more than 24 hours after an infected person’s fever has gone away. Witkop looked at a group of cadets at the academy who had been infected with H1N1 in July, with 134 confirmed cases and 33 suspected cases. In 19 percent of cadets who had been symptom-free for more than 24 hours, there were still live viruses in their system. Anne Schuchat of the CDC said, however, that there is a balance between making sure most of the transmission is prevented, and how long and disruptive absences are.

The total number of actual cases of the novel influenza A (H1N1) virus in the United States between April and July may have been 140 times greater than the reported number of laboratory-confirmed cases, according to a new study in the CDC’s journal Emerging Infectious Diseases

An article published in the journal Emerging Infectious Diseases examines the cost of preventing the spread of SARS, swine flu and the Spanish flu within the hospital setting. According to researchers in Singapore, who conducted the study, the severity of the virus and high case-fatality rates were factors that affected cost-effectiveness the most. The study concludes that a calibrated approach based on the severity of the virus and community risks may be the most effective response to future epidemics.

A new study published in Emerging Infectious Diseases finds that outpatients are a “major reservoir” of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), helping drive MRSA incidence at hospitals even as providers attempt to prevent and contain such infections

A new drug-resistant strain of Salmonella typhimurium has emerged in Africa within the last decade and is causing an alarming number of deaths, according to researchers from the Wellcome Trust Sanger Institute and in Kenya and Malawi. Researchers reported in the journal Genome Research that the ST313 strain is causing death in one-fourth of cases among children and vulnerable adults in some African regions, many of whom have been weakened by AIDS, anemia, malaria or malnutrition. Researchers said the strain seems to have been mutating to circulate in humans independently of animals. Study authors concluded that poor countries need increased access to genetic sequencing machines to detect such mutations.

Sandia National Laboratories researcher Jeff Brinker and colleagues found that in the first phase of a staph infection, the switch from harmless bacteria to a virulent bacteria happens in single cells. They also found that by inhibiting a single cell’s signaling mechanism with a small protein that they can stop the switch.  The findings could lead to better treatments for drug resistant bacterial strains, such as the methicillin-resistant Staphylococcus aureus, or MRSA.

Nicole Lurie, assistant secretary for preparedness and response at the Department of Health and Human Services, said in an editorial in The New England Journal of Medicine that despite aggressive pandemic planning since 1997, there is still additional science needed to better inform public health responses. "One challenge will be to continue to invest in science - whether that means basic virology; surveillance; mitigation measures; vaccine development, manufacture, and distribution; operations and logistics; or communication - so that when the next pandemic or other emerging infectious disease appears, we will have the data we need to make informed decisions about how to confront it," Lurie said. "A second challenge will be to strengthen the nation’s public health infrastructure so that we can rapidly turn scientific knowledge into action."

Researchers from Rice University and Baylor College of Medicine in Texas discovered a weakness in the H1N1 influenza virus that could lead to better flu treatments. The team examined residues found in receptor-binding sites and antigenic sites in H1N1’s hemagglutinin protein. They determined that the residues need to mutate in order to avoid the destruction by the immune system’s antibodies, providing a subject to track in virus development. "If studying viral evolution can help predict what will cause a severe problem in humans, you can actually pre-stock vaccines, which will save time," investigator Qinghua Wang said.

A new report released by the California Office of Statewide Health Planning and Development found that the prevalence of MRSA infections is on the rise in California hospitals. The report, based on patient discharge data provided by hospitals statewide from 1999 to 2007, found that MRSA cases increased more than fourfold over the eight-year period, with increases primarily attributed to those aged 18 to 64 years admitted from home with skin infections. In addition, there was a reported 1,663 percent increase in infections among children under the age of 18

Researchers from Christian-Albrechts-University and the University Medical Center Schleswig-Holstein in Germany reported in the journal Antimicrobial Agents and Chemotherapy on their study that identified a new antimicrobial peptide that demonstrates activity against a variety of bacteria, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. The researchers identified the antimicrobial peptide arminin 1a from the ancient metazoan organism Hydra magnipapillata and found that it exhibited wide-spread activity against various bacteria. "Our data suggest that ancient metazoan organisms such as Hydra hold promise for the detection of novel antimicrobial molecules and the treatment of infections caused by the multiresistant bacteria," said the researchers.

2009 H1N1 influenza can cause severe illness and death in pregnant and postpartum women; regardless of the results of rapid antigen testing, prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. The high cause-specific maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality ratio in the United States.

Between May and July 2009, a total of 251 children were hospitalized with 2009 H1N1 influenza. Rates of hospitalization were double those for seasonal influenza in 2008. Of the children who were hospitalized, 47 (19%) were admitted to an intensive care unit, 42 (17%) required mechanical ventilation, and 13 (5%) died. The overall rate of death was 1.1 per 100,000 children, as compared with 0.1 per 100,000 children for seasonal influenza in 2007. (No pediatric deaths associated with seasonal influenza were reported in 2008.) Most deaths were caused by refractory hypoxemia in infants under 1 year of age (death rate, 7.6 per 100,000).

Conclusions Pandemic 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza in previous years.

Methicillin-resistant Staphylococcus aureus is spread by patients who are transferred or move between hospitals. Researchers from the University Medical Center in Groningen, the Netherlands, and colleagues said screening people who are repeatedly admitted to different hospitals could help significantly curb the transmission rate of the drug-resistant bug.

Use of a new genetic profiling tool that was able to distinguish closely related strains of methicillin-resistant Staphylococcus aureus and shed light on how the bacteria spread. Researchers from the University of Cambridge, the Wellcome Trust Sanger Institute and colleagues said having the ability to track how MRSA mutates should help spark novel infection control strategies that can be applied to other emerging superbugs. The researchers used high-throughput DNA sequencing technologies to analyze a common strain of the bacteria known as ST239, and said the technology allowed them to construct a rough genetic evolutionary tree for the strain.

Face masks and hand hygiene may reduce respiratory illnesses in shared living settings and mitigate the impact of the influenza A(H1N1) pandemic.

A policy requiring influenza vaccination improves immunization rates of health care workers, a study published in Clinical Infectious Diseases found. The study, conducted by Hilary Babcock of the Washington University School of Medicine in St. Louis and colleagues, focused on BJC Healthcare, a Midwest multihospital health care system, which implemented a mandatory influenza vaccination policy for its 26,000 employees in 2008. The policy increased the system’s vaccination rate to 98 percent, compared with 71 percent in 2007 and 54 percent in 2006, the study said. These results reveal that such policies lead to extremely high vaccination coverage rates among health care workers, the researchers said.

ICU catheter-related infections can be prevented, a Keystone ICU initiative that kept rates at nearly zero for three years in Michigan hospitals showed. By implementing low-tech measures such as removing unnecessary catheters and handwashing, the hospitals saw no rebound in catheter-related infections, Peter J. Pronovost of Johns Hopkins and colleagues reported online in British Medical Journal. The researchers found that in the first 18 months of their initiative, catheter-related infections dropped from an average of 7.7 per 1,000 catheter days to zero. Three years later, infection rates remained near zero, with an average of 1.1 per 1,000 catheter days. The results show that hospitals are mistaken in thinking these infections are inevitable, Pronovost said.

In 2006, hospital-acquired pneumonia and sepsis took 48,000 lives in the U.S. and cost $8.1 billion. Patients who contracted sepsis following surgery were about 20 percent likely to die; stayed in the hospital an average 11 days longer; and cost $32,900 per patient. Hospital-acquired pneumonia patients, meanwhile, were about 11 percent likely to die; stayed in the hospital an average 14 days longer; and cost $46,400 per patient 

Health care is one of the largest contributors to waste production in the United States. Given increased awareness of the environmental and financial costs associated with waste disposal and its public health impact, many hospitals are adopting environmentally friendly practices that reduce waste production and offer equally effective, yet less expensive alternatives. Reprocessing of medical equipment is one such practice that has gained popularity in recent years and has led to major cost savings across several medical disciplines. In this commentary, we seek to take a closer look at the practice of reprocessing, explore the evidence surrounding its safety, and suggest implications of reprocessing for medical centers.

The overall incidence of both MRSA colonization and MRSA infection increased 17-fold in Canadian hospitals from 1995 to 2007. There has also been a dramatic increase in cases of community-associated MRSA infection due to the CMRSA-10 (USA300) clone. Continued surveillance is needed to monitor the ongoing evolution of MRSA colonization or infection in Canada and globally.

Nearly 40 percent of reported gastrointestinal infections are Clostridium difficile infections, which is rapidly becoming a critical issue in health care, according to preliminary data collected from nursing homes. Researchers at the Pennsylvania Patient Safety Authority and colleagues looked at infection data submitted from state nursing homes and found that from 1993 to 2001, hospital discharges with CDI increased by 74 percent, while cases nearly doubled from 2001 to 2005 with a 102 percent increase in patients discharged with CDI.

Researchers from Johns Hopkins Children’s Center recently reported in the journal Emerging Infectious Diseases that community-acquired methicillin-resistant Staphylococcus aureus is increasingly turning up in children hospitalized in the intensive care unit. Six percent of patients admitted to the pediatric intensive care unit between 2007 and 2008 were colonized with MRSA. Sixty percent of the 72 children who tested positive for MRSA were found the have the community-acquired strain.

The Association for the Advancement of Medical Instrumentation’s Sterility Assurance Levels Working Group, WG 90, presented a poster on acceptable sterilization assurance levels for new products at the U.S. Centers for Disease Control Decennial meeting on March 19.  The poster presentation concluded that new and emerging health care products need to incorporate a variety of SALs in order to be terminally sterilized, labeled as sterile and still function as intended.

Younger age groups and military personnel had higher infection rates with the H1N1 swine flu virus than other groups, according to an analysis of blood samples taken before, during and after an epidemic wave of H1N1 flu in Singapore last year.

Article on a new antibacterial wound dressing developed by researchers from the University of Bath in England. The new dressing contains tiny vesicles that appear to be similar to cells that bacteria would infect. This statement noted that when bacteria attack the vesicles, an antibacterial agent is released that kills them. The dressing has been shown to be effective against a species of Staphylococcus and a member of the Pseudomonas group.

Nonpharmaceutical interventions, including hand washing and mouth covering, might help limit the spread of the pandemic flu; however, more research on such measures is critical, according to a study published in the American Journal of Infection Control. The study presented findings that show that some significant knowledge was acquired concerning NPIs and transmission of pandemic flu in Centers for Disease Control and Prevention-funded studies, but key gaps in the research regarding the acceptability and protective efficacy of such measures remain. Researchers said the gaps fell into two categories: behavioral and social sciences, and biological and technological sciences. Between 2007 and 2009, there were 11 such CDC-funded studies. Among them was a University of Michigan study finding that using alcohol-based hand sanitizers and masks among university students was linked to a 50 percent to 65 percent reduction in the rate of influenza-like illness.

Clostridium difficile, a germ that causes terminal intestinal infections in hospital patients and was thought to spread only by contact with contaminated surfaces, can also travel through the air, according to a study by British researchers published in Clinical Infectious Diseases. Mark H. Wilcox of the University of Leeds and colleagues repeatedly tested 10 patients with symptomatic illness over a 10-hour period, and the air nearby seven of them was positive for C. difficile, generally during visiting hours or when there was activity in patient rooms, such as food delivery or bedding changes. Surfaces around 90 percent of the patients were also contaminated. The scientists stressed, however, that there is no evidence that C. difficile can be contracted through inhalation; the germs just float on the air, landing in places where more people can touch them.

Hospitals across the country are experiencing a decline in infections from central line catheters, according to a report by the CDC. In 2009, the Department of Health and Human Services initiated a program aimed at reducing health care-related infections, with one of the goals being to reduce central line infections by 50 percent by 2013. The study was conducted to track the progress of this program, and it found an 18 percent dip in central line-associated bloodstream infections across 17 states during the first half of 2009, compared with the three previous years

Denise M. Korniewicz of the University of Miami and Maher El-Masri of the University of Windsor in Canada have found that nurses and other health care providers often do not comply with hand hygiene guidelines prior to and after procedures. They noted in the journal Applied Nursing Research that compliance was higher with high-risk procedures and when health care providers were exposed to blood. Korniewicz and El-Masri evaluated hand hygiene practices observed during 612 procedures performed by 67 health care professionals at an oncology hospital.

Among hospitals in the Premier Inc Perspective Database reporting SCIP performance, adherence measured through a global all-or-none composite infection-prevention score was associated with a lower probability of developing a postoperative infection. However, adherence reported on individual SCIP measures, which is the only form in which performance is publicly reported, was not associated with a significantly lower probability of infection.

Methicllin-resistant Staphylococcus aureus infections in children have spiked from two to 21 cases per 1,000 hospital admissions between 1999 and 2008. The findings, based on a review of more than 64,000 children treated for a staph infection in 25 U.S. children’s hospitals, showed that the rate of staph infections has more than doubled in the time period. However, the findings indicated that most of the infections were acquired at schools, locker rooms and gyms, and not health care settings. The study also showed that the use of the antibiotic clindamycin increased threefold, with 63 percent of such infections being treated with the drug in 2008.

Researchers at the University of Bath, working with scientists from the Universities of York and Gothenburg, have identified one of the components of MRSA that is responsible for making it so deadly. Researchers found that the fibronectin binding protein is key to the bacteria’s ability to invade the organs. They will now try and stop the bacteria from invading human cells through the use of antibodies to block FnBP binding.

University of Nottingham researchers found that more than half of those who died from swine flu or were admitted to the hospital because of it during the first wave of the swine flu pandemic in the UK previously were healthy individuals who had no underlying risks.  The study involved clinical data from 55 hospitals in 20 towns and cities.

Scientists at the National Institute of Allergy and Infectious Diseases have identified and isolated a new toxin called LukGH that laboratory studies indicate is a potent killer of human immune cells and could be a key factor in the severity of MRSA infections in otherwise healthy people. The research project was intended to identify all the surface proteins of USA300, the most common community-associated strain of MRSA. The scientists said they are not sure of the full contribution of LukGH to the severity of MRSA infection, but LukGH is the only MRSA toxin currently known to promote the destruction of human neutrophils after the bacteria have been ingested by the immune cells designed to destroy them.

Researchers, led by Duke University’s Bruce Donald, are using a computer algorithm to predict how MRSA will mutate in the future. The team of scientists modeled mutations in a MRSA enzyme known as dihydrofolate reductase, which is targeted by multiple therapies. An algorithm known as K-star helped the investigators find DHFR mutation candidates that would be able to resist new antibiotics. According to the researchers, the knowledge gained from the algorithm could be incorporated into a drug-design strategy by designing antibiotics around those predicted mutations.

J. Hsu from the University of Wisconsin School of Medicine and Public Health at Madison and colleagues reported  that antimicrobial stewardship, glove use, hand hygiene and disposable thermometers should be used routinely to prevent Clostridium difficile infection. However, they reported that environmental disinfection and probiotics should be studied further. To make their recommendations, the investigators searched multiple computerized databases and performed manual searches to retrieve relevant articles.

Cuff pressures for endotracheal tubes may be too high during surgery, according to a new study by British investigators who are calling for routine monitoring of the devices in the operating room.

The study, by anesthesiologists at University College London, found that endotracheal tube (ETT) cuff pressures averaged 41 cm H₂O—16 cm H₂O greater than the recommended maximum level of 25 cm H₂O in the United Kingdom. Pressures that high could increase patients’ risk for sore throat, hoarseness and difficulty swallowing.

The New England Journal of Medicine published findings from researchers at Massachusetts General Hospital that suggested gram-negative bacteria play a significant role in about 30 percent of hospital-acquired infections in the U.S. The findings showed that such bacteria were the predominant players in 47 percent of ventilator-associated pneumonia cases and 45 percent of urinary tract infections. The researchers noted that almost any gram-negative bacteria can cause bloodstream infection if an adequate portal of entry is present.

Lee E. Morrow of Creighton University and colleagues have discovered that cases of ventilator-associated pneumonia in critically ill patients in hospitals were cut in half after patients were given probiotic bacteria. The study involved 138 critically ill patients from a single hospital, who were either given placebo or the probiotic Lactobacillus rhamnosus. Donald Craven of the Lahey Clinic Medical Center in Burlington, Mass., said the results "hold promise for trying to prevent an infection that has serious morbidity, mortality and is a major factor for hospital costs that we’re trying to contain."