Influenza is a frequent cause of epidemic and endemic respiratory illness in long-term-care facilities (LTCFs), resulting in considerable morbidity and mortality. Detection of influenza outbreaks in this setting can be difficult, because the clinical presentation in older adults is atypical and other pathogens also cause influenza-like illness (ILI) during the influenza season. Use of the standard case definition for influenza has not been effective in detecting episodes in residents of LTCFs. Alternative case-definitions that reflect the atypical presentation of influenza in this population have been recommended but not validated. The use of rapid tests for the detection of influenza in conjunction with more sensitive case definitions of ILI may lead to the earlier detection of influenza outbreaks in LTCFs, earlier initiation of infection control measures, and reduction in transmission.

The definition of outbreak, eg, the number of episodes of ILI or episodes of confirmed influenza A that would result in the initiation of antiviral chemoprophylaxis, remains controversial in this setting. The use of newer antivirals could limit the side effects seen in older adults in LTCFs. However, annual vaccination of residents and staff remains the most effective way to prevent the introduction of influenza A or influenza B into LTCFs. In addition, vaccination of LTCF residents reduces rates of illness and pneumonia due to influenza, as well as cardiopulmonary exacerbation, hospitalization, and death.

This prospective study was conducted to evaluate the risk of nosocomial pneumonia when changing heat and moisture exchangers every 48 hours in 1996 instead of every 24 hours in 1995 for patients needing continuous mechanical ventilation. Medical and surgical patients in the two periods did not differ in terms of demographic characteristics and markers of acute or underlying illnesses. The incidence density of nosocomial pneumonia was not different in the two groups. Extended heat and moisture exchanger use reduces circuit manipulation and cost.

The Centers for Disease Control and Prevention (CDC) recommends periodic tuberculin skin testing of healthcare workers with potential exposure to Mycobacterium tuberculosis. However, many healthcare facilities have neither a system to identify workers due for their skin test nor a means of analyzing aggregate data. To illustrate some of the complexities involved in tuberculin skin test (TST) tracking and analysis, and how these might be addressed, this report describes a software package called staffTRAK-TB, developed by the CDC to facilitate surveillance of tuberculosis infection in healthcare workers. staffTRAK-TB records data for each healthcare worker, including demographic information, occupation, work location, multiple TST results, and results of evaluations to determine if clinically active tuberculosis is present. Programmed reports include lists of workers due and overdue for skin tests, and skin test conversion rates by occupation or worksite. Standardization of types of occupations and locations allows data from multiple facilities to be aggregated and compared. Data transfer to the CDC can be performed via floppy diskettes. staffTRAK-TB illustrates important issues in software structure, standardization of occupation and work-location information, relevant data items, and reports and analyses that would be useful in practice. Developing software that adequately addresses the epidemiological issues is complex, and the lessons learned may serve as a model for hospital epidemiologists, infection control personnel, occupational health personnel, and computer programmers considering software development in this area or trying to optimize their facility's TST surveillance.

Prospective studies were conducted for nosocomial Pseudomonas aeruginosa infections from February 1, 1994, to October 30,1995. Of 97 P aeruginosa isolates from 97 patients, 35 were resistant to ceftazidime. Logistic regression revealed previous cephalosporin or piperacillin use as independent risk factors for nosocomial ceftazidime-resistant P aeruginosa infection. Pulsed-field gel electrophoresis revealed that four nosocomial ceftazidime-resistant P aeruginosa infections were caused by cross-infection, probably through medical personnel.

Before the days of antisepsis, the infection rate on surgical wards was very high. Mortality from common operations such as limb amputations could run from 40% to 60%, mostly from infection. Hospital gangrene, a type of necrotizing infection, occurred frequently. It would spread rapidly, and the helpless surgeon could do nothing to stop it. The patient would be in agony for many days before death mercifully intervened.

This retrospective case-control study was performed to determine risk factors for bacteremia due to persistent coagulase-negative staphylococci in our neonatal intensive-care unit. Enteral nutrition and the presence of a nasogastric tube were identified as possible risk factors for coagulase-negative staphylococcal bacteremia involving one of the persistent strains.