To determine policies at children's hospitals regarding immunizations, annual tuberculosis (TB) screening, and blood or body fluid exposure follow-up, particularly as they apply to physicians.

A three-page survey was sent to infection control practitioners (ICPs) in April 1994 at hospitals affiliated with the National Association of Children's Hospitals and Related Institutions. One follow-up mailing was sent to nonresponding ICPs.

Responses were received from 62 (67%) of 93 ICPs. Thirty-five (66%) of 53 children's hospitals had an immunity policy that applied to medical students, 42 (79%) of 53 to resident physicians, 32 (52%) of 62 to hospital-based physicians, and 18 (29%) of 62 to private or community physicians (who admit patients to one hospital). Physicians were required to show evidence of an annual TB screen at 36 hospitals (58%). Immunity policies or TB screening were provided for the following physician groups: medical students, 13 (21%); resident physicians, 43 (69%); hospital-based physicians, 50 (81%); and private or community physicians, 23 (37%). Infection control practitioners reported that the following diseases had been identified within the past 5 years at their hospitals: measles, 82%; mumps, 40%; rubella, 31%; TB, 94%; hepatitis B, 94%; pertussis, 90%; varicella, 98%; and influenza, 94%. Physicians in these institutions were reported to have contracted the following diseases from patient exposure: measles, hepatitis B, TB, pertussis, varicella, and influenza.

Children's hospitals vary widely in their policies regarding healthcare-worker immunity, and, in many cases, physicians may not be protected from nosocomial transmission of community infections.

To demonstrate the costs and benefits of vaccinating varicella-susceptible healthcare workers at a university hospital with live, attenuated varicella-zoster virus vaccine.

Retrospective review of employee medical records and data on the cost of special paid absence for susceptible healthcare workers after exposure to varicella or herpes zoster.

A 988-bed tertiary-care university hospital.

In 1994, 224 hospital employees (3.4%) were susceptible to the varicella-zoster virus. There were 40 exposures to varicella and herpes zoster in that year, involving 29 of the susceptible employees. Nine (31%) of the exposed susceptibles became varicella immune by indirect fluorescent antibody testing subsequent to exposure. Seventeen (59%) have had multiple varicella exposures and special paid absences while employed by the hospital. In 1994, wages paid to healthcare workers while furloughed for the communicable period following varicella exposure totaled $38,463.93. An additional $24,748.74 was paid to replacement workers during that same time. Varicella vaccine to immunize all 224 susceptibles in 1994 would have cost $17,920. Absences due to varicella and herpes zoster exposure also result in disruptions to patient care.

Varicella vaccination for varicella-susceptible healthcare workers at a university hospital would result in financial savings and improved patient care. We recommend that other institutions consider the costs and benefits of adopting a varicella immunization program for their susceptible employees.

To assess the effectiveness of a multi-faceted infection control strategy in limiting the nosocomial transmission of respiratory syncytial virus (RSV) infection to patients in a bone marrow transplant (BMT) unit.

Before/after trial.

University-affiliated tertiary cancer center.

Adult BMT recipients hospitalized during two consecutive wintertime community outbreaks of RSV infection.

An infection control strategy against nosocomial RSV infection was implemented in the BMT unit in February 1993. The strategy involved prompt identification, isolation, and cohorting of RSV-infected patients; prompt therapy with aerosolized ribavirin; use of masks and gloves by anyone entering an infected BMT patient's room; screening visitors for respiratory symptoms; restricting visitation by all children under 12 years of age and all family members and other visitors with RSV symptoms; and restricting symptomatic hospital staff from working in the BMT unit.

After implementation of the multifaceted infection-control strategy, there were four cases of nosocomial RSV infection in 3,870 patient days (incidence density, 1.0 case/1,000 patient days) compared with 14 cases of nosocomial RSV infection in 3,152 patient days (incidence density, 4.4 cases/1,000 patient days) during the 1992-1993 RSV season (rate ratio, 4.4; 95% confidence interval [CI95], 1.4-17.9; P<.01). This decrease in incidence occurred despite a comparable prevalence of community-acquired RSV cases between the two seasons (2.2% vs 3.2% in 1992-1993 and 1993-1994, respectively; prevalence ratio, 0.7; CI95, 0.2-2.1; P=0.5)

Institution of a multifaceted infection control strategy significantly reduced the frequency of nosocomial RSV infection in a high-risk group of adult BMT recipients

To evaluate whether hospital strains of antibiotic-resistant bacteria exhibited altered susceptibility to disinfectants.

Antibiotic-susceptible bacteria were obtained from American Type Culture Collection: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Klebsiella pneumoniae, Salmonella choleraesuis, and Pseudomonas aeruginosa. Hospital strains of antibiotic-resistant bacteria were obtained from clinical isolates, including: S aureus, S epidermidis, E coli, Enterococcus species, K pneumoniae, and P aeruginosa. The Association of Official Analytical Chemist's use-dilution method was used to test these 12 strains of 7 bacterial pathogens for their susceptibility to a phenol and a quaternary ammonium compound. For five pathogens, we tested a susceptible and a more resistant strain in 20 comparative trials (5 pathogens, 2 disinfectants, 2 dilutions per disinfectant).

In our 20 comparative trials, the antibiotic-resistant strains exhibited an increased resistance to the disinfectant in only a single instance.

Our data demonstrate that the development of antibiotic resistance does not appear to be correlated to increased resistance to disinfectants.