This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided. Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of oro-tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care--associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legionella spp., considering routine culturing of water samples from the potable water system of a facility's organ-transplant unit when it is done as part of the facility's comprehensive program to prevent and control health-care--associated Legionnaires disease, and initiating an investigation for the source of Legionella spp. when one definite or one possible case of laboratory-confirmed health-care--associated Legionnaires disease is identified in an inpatient hemopoietic stem-cell transplant (HSCT) recipient or in two or more HSCT recipients who had visited an outpatient HSCT unit during all or part of the 2-10 day period before illness onset. In the section on aspergillosis, the revised recommendations include the use of a room with high-efficiency particulate air filters rather than laminar airflow as the protective environment for allogeneic HSCT recipients and the use of high-efficiency respiratory-protection devices (e.g., N95 respirators) by severely immunocompromised patients when they leave their rooms when dust-generating activities are ongoing in the facility. In the respiratory syncytial virus (RSV) section, the new recommendation is to determine, on a case-by-case basis, whether to administer monoclonal antibody (palivizumab) to certain infants and children aged <24 months who were born prematurely and are at high risk for RSV infection. In the section on influenza, the new recommendations include the addition of oseltamivir (to amantadine and rimantadine) for prophylaxis of all patients without influenza illness and oseltamivir and zanamivir (to amantadine and rimantadine) as treatment for patients who are acutely ill with influenza in a unit where an influenza outbreak is recognized. In addition to the revised recommendations, the guideline contains new sections on pertussis and lower respiratory tract infections caused by adenovirus and human parainfluenza viruses and refers readers to the source of updated information about prevention and control of severe acute respiratory syndrome.

/pdf/guidelines-for-preventing-health-care-associated-pneumonia-3ebalxrxyl.pdf

Guidelines for Preventing Health-Care-- Associated Pneumonia, 2003 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

Summary This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided. Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of orotracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care--associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legionella spp., considering routine culturing of water samples from the potable water system of a facility's organ-transplant unit when it is done as part of the facility's comprehensive program to prevent and control health-care--associated Legionnaires disease, and initiating an investigation for the source of Legionella spp. when one definite or one possible case of laboratory-confirmed health-care--associated Legionnaires disease is identified in an inpatient hemopoietic stem-cell transplant (HSCT) recipient or in two or more HSCT recipients who had visited an outpatient HSCT unit during all or part of the 2--10 day period before illness onset. In the section on aspergillosis, the revised recommendations include the use of a room with high-efficiency particulate air filters rather than laminar airflow as the protective environment for allogeneic HSCT recipients and the use of high-efficiency respiratory-protection devices (e.g., N95 respirators) by severely immunocompromised patients when they leave their rooms when dust-generating activities are ongoing in the facility. In the respiratory syncytial virus (RSV) section, the new recommendation is to determine, on a case-by-case basis, whether to administer monoclonal antibody (palivizumab) to certain infants and children aged <24 months who were born prematurely and are at high risk for RSV infection. In the section on influenza, the new recommendations include the addition of oseltamivir (to amantadine and rimantadine) for prophylaxis of all patients without influenza illness and oseltamivir and zanamivir (to amantadine and rimantadine) as treatment for patients who are acutely ill with influenza in a unit where an influenza outbreak is recognized.

http://rn.org/courses/coursematerial-71.pdf

Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

Blindness and visual impairment are among the 10 most common causes of disability in the United States (1) and are associated with shorter life expectancy and lower quality of life (2,3). Previously, state-specific prevalences of visual impairment and eye disease were estimated from national prevalences. However, in 2005, five states (Iowa, Louisiana, Ohio, Tennessee, and Texas) provided state-specific estimates by using the new CDC Behavioral Risk Factor Surveillance System (BRFSS) vision module. CDC analyzed data from the module to determine the self-reported prevalence of visual impairment, eye disease, eye injury, and lack of eye-care insurance and eye examination among persons aged >50 years in each of these five states and among certain sociodemographic populations overall. This report describes the results of that analysis, which indicated variation in disease prevalence and use of eye care among individual states and also among racial/ ethnic populations and age groups within the five states combined. The variability among state data suggests that statespecific surveillance of visual impairment and eye care and investigation by states to identify influencing factors might lead to creation of vision programs better suited to individual state needs. BRFSS is a state-based, random-digit–dialed telephone survey of the noninstitutionalized, U.S. civilian population aged >18 years. The median Council of American Survey Research Organizations response rate for BRFSS in 2005 was 51.1%, with a range among states of 34.6% to 67.4%. Response rates for the five states using the optional BRFSS vision module in 2005 were as follows: Iowa, 60.2%; Louisiana, 51.4%; Ohio, 49.5%; Tennessee, 59.6%; and Texas, 45.2%. Among the five states, Louisiana provided data only for January–August because of Hurricane Katrina. Respondents were classified as having visual impairment if they answered “a little difficulty,” “moderate difficulty,” “extreme difficulty,” or “unable to do because of eyesight” to the question, “How much difficulty, if any, do you have in recognizing a friend across the street?” or to the question, “How much difficulty, if any, do you have watching television?”* Three selected eye diseases (i.e., cataract, glaucoma, and macular degeneration) and workplace eye injury were identified if respondents answered “yes” to the relevant questions.† Diabetic retinopathy was identified (from the BRFSS diabetes module) if respondents with diabetes answered “yes” to the question, “Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy?” The BRFSS vision module also incorporated questions relating to use of eye care. Respondents were classified as not having eye insurance if they answered “no” to the question, “Do you have any kind of health insurance coverage for eye care?” Respondents were classified as not having had a dilated eye examination in the preceding 12 months if they answered other than “within the past month” or “within the past year (1–12 months ago)” to the question, “When was the last time you had an eye exam in which the pupils were dilated?” They were classified as not having visited an eye-care professional in the preceding 12 months if they answered other than “within

Morbidity and Mortality Weekly Report

This report summarizes recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) concerning influenza vaccination of health-care personnel (HCP) in the United States. These recommendations apply to HCP in acute care hospitals, nursing homes, skilled nursing facilities, physician's offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. The recommendations are targeted at health-care facility administrators, infection-control professionals, and occupational health professionals responsible for influenza vaccination programs and influenza infection-control programs in their institutions. HICPAC and ACIP recommend that all HCP be vaccinated annually against influenza. Facilities that employ HCP are strongly encouraged to provide vaccine to their staff by using evidence-based approaches that maximize vaccination rates.

Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP).

Drinking Water Microbiology

In a pulmonary-disease ward containing a respiratory-disease intensive-care unit, 9 per cent of the patients on the ward and one fifth to one third of those in the intensive-care unit harbored Pseudomonas aeruginosa in their respiratory tracts. Eight patients acquired pseudomonas pulmonary infections in the hospital. The fine-particle aerosol from unheated room humidifiers (Walton "centrifugal atomizer," Model HA) was shown to cause heavy environmental contamination by Ps. aeruginosa. Air sampling by the settling plate method yielded 300 gram-negative bacteria, including pseudomonas, per square foot per minute. Pyocin typing was used to identify the endemic strains of pseudomonas in reservoir water, in room air and in the sputum of patients with chronic respiratory disease. Each of four respirators in the intensive-care unit propagated 6 × 106 organisms per day. Decontamination of humidifiers by various means was unsatisfactory, and their use was discontinued.

Fine-particle humidifiers. Source of Pseudomonas aeruginosa infections in a respiratory-disease unit.

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Fine-particle humidifiers. Source of Pseudomonas aeruginosa infections in a respiratory-disease unit.