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One thousand hospitals were surveyed on a new measure of healthcare personnel influenza vaccination for the 2012–2013 influenza season. Facilities found it easier to collect data on employees than nonemployees; larger facilities reported more challenges than smaller facilities. Barriers may decrease over time as facilities become accustomed to the measure.Infect. Control Hosp. Epidemiol. 2016;37(2):222–225

Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition. The role of attire in cross-transmission remains poorly established, and until more definitive information exists priority should be placed on evidence-based measures to prevent healthcare-associated infections (HAIs). This article aims to provide general guidance to the medical community regarding HCP attire outside the operating room. In addition to the initial guidance statement, the article has 3 major components: (1) a review and interpretation of the medical literature regarding (a) perceptions of HCP attire (from both HCP and patients) and (b) evidence for contamination of attire and its potential contribution to cross-transmission; (2) a review of hospital policies related to HCP attire, as submitted by members of the Society for Healthcare Epidemiology of America (SHEA) Guidelines Committee; and (3) a survey of SHEA and SHEA Research Network members that assessed both institutional HCP attire policies and perceptions of HCP attire in the cross-transmission of pathogens. Recommendations for HCP attire should attempt to balance professional appearance, comfort, and practicality with the potential role of apparel in the cross-transmission of pathogens. Although the optimal choice of HCP attire for inpatient care remains undefined, we provide recommendations on the use of white coats, neckties, footwear, the bare-below-the-elbows strategy, and laundering. Institutions considering these optional measures should introduce them with a well-organized communication and education effort directed at both HCP and patients. Appropriately designed studies are needed to better define the relationship between HCP attire and HAIs.

In a prevalence study of 209 healthcare workers, 18 (8.6%) and 13 (6.2%) carried methicillin-resistant Staphylococcus aureus in their nares or on their hands, respectively. However, 100 (62%) of 162 workers completing an associated survey believed themselves to be colonized, revealing a knowledge deficit about methicillin-resistant Staphylococcus aureus epidemiology.Infect. Control Hosp. Epidemiol. 2015;37(1):110–112

This study used hierarchical linear modeling to determine the relative contribution of hospital policies and state laws to healthcare worker (HCW) influenza vaccination rates. Hospital mandates with consequences for noncompliance and race were associated with 3%-12% increases in HCW vaccination; state laws were not significantly related to vaccination rates.

Objective.To investigate the impact of finger rings on the transmission of bacteria from the hands of healthcare workers and the impact on the microflora on the hands of healthcare workers in clinical practice.Design.Our study had a nonequivalent control group posttest-only design (pre-experimental). Healthcare workers who wore finger ring(s) on 1 hand and no ring on the other hand (n = 100) and a control group of healthcare workers who did not wear any rings (n = 100) exchanged standardized hand shakes with an investigator wearing sterile gloves. Samples from the gloved hands of the investigators and the bare hands of the healthcare workers were thereafter obtained by the glove juice technique.Setting.Two Norwegian acute care hospitals.Participants.Healthcare workers (n = 200) during ordinary clinical work.Results.A significantly higher bacterial load (odds ratio, 2.63 [95% confidence interval, 1.28-5.43]; P = .009) and a significantly higher number of bacteria transmitted (odds ratio, 2.43 [95% confidence interval, 1.44-4.13]; P = .001) were associated with ringed hands, compared with control hands. However, a multiple analysis of covariance revealed no statistically significant effect of rings alone. The prevalence of nonfermentative gram-negative bacteria (42% vs 26%) and Enterobacteriaceae (26% vs 13%) was also significantly higher among persons who wore rings than among persons who did not wear rings. However, no statistically significant differences in the incidence of transmission of these pathogens were detected after hand contact. The prevalence of Staphylococcus aureus and incidence of transmission of S. aureus were the same in both groups.Conclusions.Wearing finger rings increases the carriage rate of nonfermentative gram-negative bacteria and Enterobacteriaceae on the hands of healthcare workers. However, no statistically significant differences in the incidence of transmission of nonfermentative gram-negative bacteria or Enterobacteriaceae were detected between the healthcare workers who wore rings and those who did not.

SUMMARYGenotyping was used to analysePseudomonas aeruginosaisolates from sink drains and 15 intubated patients as part of a 3-month prospective study of strain transmission in a medical-surgical intensive care unit. Ninety percent of all washbasin drains were persistently contaminated with severalP. aeruginosagenotypes. In 60% (9/15) of the patients,P. aeruginosacolonization or infection was hospital-acquired:P. aeruginosastrains isolated from these patients were present in hospital sinks or in other patients before their admission. Since all patients were immobile, personnel were the probable route of transmission ofP. aeruginosain the hospital. The mechanism of strain transmission from sinks to hands during hand washing was investigated in a children's hospital. WhenP. aeruginosawas present at densities of > 105/c.f.u. per ml in sink drains, hand washing resulted in hand contamination withP. aeruginosavia aerosol generation in the majority of experiments orP. aeruginosawas detected using an air sampler above the washing basin. HighP. aeruginosacfu were present at 4.30 h in the eight sinks (5.4 × 105−7.0 × 1010c.f.u./ml), whereas at 13.00 hP. aeruginosac.f.u. were significantly lower (3.1 × 102−8.0 × 105c.f.u. / ml). These data reveal that the danger of bacterial contamination of hands during hand washing is highest in the morning. The identified transmission routes demand more effective hygienic measures in hospital settings particularly concerning personnel hands and sink drains.

The Occupational Safety and Health Administration (OSHA) revised the Bloodborne Pathogen Standard and, on July 17, 2001, began enforcing the use of appropriate and effective sharps devices with engineered sharps-injury protection. OSHA requires employers to maintain a sharps-injury log that records, among other items, the type and brand of contaminated sharps device involved in each injury. Federal OSHA does not require needlestick injury rates to be calculated by brand or type of device. A sufficient sample size to show a valid comparison of safety devices, based on injury rates, is rarely feasible in a single facility outside of a formal research trial. Thus, calculations of injury rates should not be used by employers for product evaluations to compare the effectiveness of safety devices. This article provides examples of sample-size requirements for statistically valid comparisons, ranging from 100,000 to 4.5 million of each device, depending on study design, and expected reductions in needlestick injury rates.

The emergence of hepatitis C virus compels us to refocus on protecting ourselves, our coworkers, and our families from potential illness, disability, or death. As bloodborne pathogens continue to evolve and mutate, the best option available is to prevent exposure. Surgeons have the opportunity to prevent the majority of exposures by utilizing currently available technology and knowledge. Surgeons should see, use, and evaluate a variety of safety-engineered devices, because their feedback can lead to improvements in technology. Education, communication, and access to safer technology will motivate surgeons to adopt safer behavior patterns. Provided with information and tools, we can change through self-motivation.

Two hundred seventy-five of 325 (85%) healthcare workers (HCWs) completed a questionnaire testing their knowledge of transmission of tuberculosis (TB) and infection control measures for TB. Of the 75 HCWs with no patient contact, 49 (65%) felt that masks should be worn, and 40 (53%) would use gowns. In contrast, 175 (88%) of 200 HCWs having contact with patients thought masks should be worn, and 70 (35%) would use gowns (P=.0001 and .0085, respectively). Only 87% of HCWs with patient contact felt that respiratory precautions should be instituted for TB patients. The results of our sur vey showed that HCWs should be reeducated about TB.

Hospitals are rather strange places to work. The rationale, after all, of purposely concentrating into close quarters the sick, the frail, and the contagious is elusive at times. Further compounding the situation is the introduction of healthcare workers into the mix, usually at the ratio of approximately five or six full-time employees for every hospital bed. In no other circumstance, except perhaps daycare or nursery schools, does a healthy person deliberately walk into an environment where billions of pathogens routinely are coughed and sneezed and excreted into the atmosphere.

SummaryWe have assessed the effectiveness of flexible-film negative-pressure isolators by physical and biological means. We have found that they afford a high degree of containment and therefore also of safety to hospital staff. We offer some recommendations on the operation of these isolators to ensure the optimum degree of protection.

Handwashing practices are often based on tradition and belief. To develop sound rationale for handwashing practices, the physiologic and bacteriologic effects of handwashing must be examined. The purposes of this article are to review the three major microenvironments of the skin with their bacterial flora, to discuss physiologic and bacteriologic characteristics of the skin with particular reference to handwashing, and to describe current handwashing recommendations and practices.

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SUMMARYTuberculin testing of 176 personnel in a Liverpool hospital showed a total incidence of 68 % negative reactors. This remarkably high percentage was similar for each of the various groups of workers tested. We did not find the Tine test to be a satisfactory method of screening for tuberculin sensitivity because 30% were doubtful reactors. In these, further tuberculin testing by the Mantoux reagent was always positive.