To evaluate the relationship between Staphylococcus aureus nasal and tracheal colonization and infection in medical intensive care unit (MICU) patients. The primary outcome was the incidence of S. aureus infection in colonized versus non-colonized patients.

Prospective, observational cohort study. Patients admitted to the MICU during the study period were screened for S. aureus nasal and tracheal colonization by culture and a PCR assay twice weekly. Demographic, clinical, and microbiologic data were collected in the MICU and for 30 days after discharge. PFGE and antibiotic susceptibility testing were performed on all S. aureus nasal, tracheal, and clinical isolates.

Twenty-three percent of patients (47 of 208) were nasally colonized with S. aureus. Twenty-four percent of these patients developed S. aureus infections versus 2% of noncolonized patients (P < .01). Nine of 11 patients with both nasal colonization and infection were infected by their colonizing strain. Two of 47 nasally colonized patients developed an infection with a different strain of S. aureus. Fifty-three percent of intubated patients with nasal colonization (10 of 19) had tracheal colonization with S. aureus as opposed to 4.9% of intubated, non-colonized patients (3 of 61) (P < .01). Parenteral antibiotics were ineffective at clearing nasal colonization. PCR detected S. aureus colonization (nasal and tracheal) within 6.5 hours with a sensitivity of 83% and a specificity of 99%.

The incidence of S. aureusinfection was significantly elevated in nasally colonized MICU patients. Techniques to rapidly detect colonization in this population may make targeted topical prevention strategies feasible. (Infect Control Hosp Epidemiol 2005;26:622-628)

To determine the prevalence of influenza vaccination in patients who present to the emergency department (ED) who meet current guidelines for its use. To evaluate the feasibility of an ED-based program to provide influenza vaccine to at-risk patients.

A survey of ED patients and their family physicians, using a convenience sample.

Consecutive patients presenting to the emergency department of Prince George Regional Hospital, Prince George, BC, a regional hospital in Northern British Columbia, during designated shifts between Nov. 6, 1997, and Dec. 10, 1997.

Age, gender, family physician (FP), eligibility for influenza vaccine, vaccination status, willingness to receive vaccine in the ED, and FP methods for ensuring use of influenza vaccine.

935 patients were interviewed; 816 met study eligibility criteria. Of 214 patients eligible for influenza vaccine, 113 (52.8%) had not been vaccinated. Fifty-three (46.9%) agreed to vaccination, and 49 were vaccinated in the ED. A survey of the patients’ FPs revealed that 85% used callback lists, but that only 49% of vaccine-eligible patients identified in the study were on a callback list. Positive associations were found between the presence of an FP and the likelihood of having been vaccinated (odds ratio [OR] = 8.8), being on a callback list and having been vaccinated (OR = 4.1), and age >64 and being on a callback list (OR = 2.1).

Up to 50% of patients eligible for influenza vaccine are not adequately immunized. Administering influenza vaccine in the ED is acceptable to patients and should reduce influenza rates in at-risk populations. There is a role for administering influenza vaccine in the ED.