A performance improvement task force of Rhode Island infection control professionals was created to develop an epidemiologic model of statewide consistent infection control practices that could reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA).

This model encompasses screening protocols, isolation techniques, methods of cohorting positive patients, decolonization issues, postexposure follow-up, microbiology procedures, and standardized surveillance methodologies. These “best practice guidelines” include three categories of recommendations that define priority levels based on the availability of scientific data.

From 1995 through 2000, several Rhode Island hospitals experienced a fivefold increase in nosocomial acquisition of MRSA.

Rhode Island infection control professionals are a highly interactive group in the unique position of sharing patients and ultimately experiencing similar trends and problems.

The task force collaborated on developing the best hospital infection control practices to prevent and control the spread of MRSA in Rhode Island.

The task force met with local infectious disease physicians and representatives from the Rhode Island Department of Health, the Hospital Association of Rhode Island, and Rhode Island Quality Improvement Partners. Discussions identified numerous and diverse MRSA control practices, issues of consensus, and approaches to resolving controversial methods of reducing the spread of MRSA The guidelines regarding the best hospital practices for controlling MRSA were finalized 8 months later.

These guidelines were distributed to all chief executive officers of Rhode Island hospitals by the Rhode Island Department of Health in December 2001. They were issued separate and apart from any regulations, with the intent that hospitals will adopt them as best hospital practices in an attempt to control MRSA.

To investigate an outbreak of Staphylococcus aureus surgical-site infections.

Case–control study.

Pediatric cardiothoracic surgery service of a tertiary-care university medical center.

Molecular typing was used to identify healthcare workers who carried the epidemic strain.

Three children acquired surgical-site infections caused by a single strain of S. aureus. Fourteen (25%) of the staff members in the operating room and 17 (11%) on nursing units carried the epidemic strain (P = 01). A case–control study identified 4 healthcare workers who were associated statistically with the outbreak, 2 of whom (a cardiothoracic surgeon and a perfusionist) carried the epidemic strain in their nares. The surgeon also carried the epidemic strain on his hands. Each staff member who carried the epidemic strain was treated with mupirocin; those carrying the strain on their hands were required to wash their hands with chlorhexidine. The surgeon was not allowed to perform surgery until 2 of his hand cultures did not grow S. aureus.

Only three children were infected with the epidemic strain, but it was disseminated widely among staff who cared for children who underwent cardiothoracic surgery. No additional cases were identified after staff members who carried the epidemic strain were decolonized. Both classic epidemiologic methods and molecular typing techniques were necessary to identify the source and extent of this outbreak.

To evaluate the effectiveness of influenza vaccines against influenza-like illness (ILI) among nursing home residents.

Prospective, nonrandomized, cohort study.

Nine nursing homes during the 1998-1999 influenza season and 11 nursing homes during the 1999-2000 influenza season in Niigata Prefecture, Japan.

Six hundred ninety-nine residents and 440 healthcare workers (HCWs) during the first season, and 930 residents and 517 HCWs during the second season, with vaccination rates ranging from 0% to 97.7%.

Overall, ILI decreased from 24.3% during the 1998-1999 season to 8.8% during the 1999-2000 season. Multivariate analysis adjusted for several factors, including gender, age, underlying diseases, and resident and HCW vaccination rates, failed to demonstrate clear individual protection of residents (relative risk [RR], 1.42; P = .2 for the first season; RR, 0.95; P = .9 for the second season). However, vaccination rates of 60% or greater for residents and HCWs reduced the risk of ILI, and also could prevent outbreaks during the 2 seasons. Highly impaired activities of daily living and chronic respiratory diseases were significantly associated with increased ILI.

A high vaccination rate for both residents and HCWs may reduce the risk of ILI and institutional outbreaks in nursing homes

To study the humoral immune responses, safety, and tolerability of intradermal recombinant hepatitis B vaccination in healthcare workers (HCWs) nonresponsive to previous repeated intramuscular vaccination.

An open, prospective, before–after trial.

A tertiary referral hospital and surrounding district health service in Queensland, Australia.

Hospital and community HCWs nonresponsive to previous intramuscular hepatitis B vaccination.

Intradermal recombinant hepatitis B vaccine was administered every second week for a maximum of 4 doses. Hepatitis B surface antibody (anti-HBs) responses were assessed 2 weeks after each dose.

Protective anti-HBs levels developed in 17 (94%) of 18 study subjects. Three doses resulted in seroconversion of all responding subjects and the highest geometric mean antibody concentration. The vaccine was well tolerated.

More than 90% of previously nonresponsive HCWs responded to intradermal recombinant hepatitis B vaccine with protective anti-HBs levels.

To reduce the number of nosocomial infections (NIs) in surgical patients by a quality management approach.

Prospective, controlled study in 8 medium-sized hospitals during a 26-month period.

Four study hospitals and 4 control hospitals.

In two 10-month intervention periods, 4 external physicians introduced quality circles and ongoing surveillance in the 4 study hospitals. There were three 8-week observation periods in all 8 hospitals with the same physicians before, during, and after the intervention periods.

During the first observation period, almost identical overall incidence densities were found for the study hospitals and the control hospitals. During the course of the study, the overall incidence density decreased significantly in the study hospitals (risk ratio [RR], 0.74; 95% confidence interval [CI95], 0.59 to 0.94) and nonsignificantly in the control hospitals (RR, 0.90; CI95 0.70 to 1.16). With the use of a Cox regression model to evaluate the impact of the intervention periods while taking into account the distribution of risk factors for NI in both groups, a significant risk reduction (RR, 0.75; CI95, 0.58 to 0.97) was observed after the first intervention period when comparing study and control hospitals. At the end of the study (ie, after the second intervention period), the difference between the study hospitals and the control hospitals was not significant (RR, 0.78; CI95, 0.60 to 1.01). This was due to no further improvement at the end of the study in the study hospitals and a decrease in the control hospitals.

This study demonstrates that NI rates can be significantly reduced by appropriate intervention methods in hospitals that are interested in quality management activities. However, continuous intense efforts are necessary to maintain these improvements.