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.

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.