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To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.
Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.
Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.
A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months; P = .003).
These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.
Considerable morbidity, mortality, and costs are associated with household emergency situations involving natural hazards and fires. Many households are poorly prepared for such emergency situations, and little is known about the psychosocial aspects of household emergency preparedness.
The aim of this study is to promote a better understanding of homeowners' experiences and perceptions regarding household emergency situations and related preparedness practices.
A brief survey was administered and three focus group sessions were conducted with homeowners (n = 16) from two metro Atlanta homeowners'associations.The survey inquired about basic demographic information, personal experience with a natural hazard or fire, and awareness of preparedness recommendations. The focus group discussions centered on household emergency preparedness perceptions and practices.
Participants defined household emergency preparedness as being able to survive with basic supplies (e.g., water, flashlights) for 48 hours or longer. While most participants had sufficient knowledge of how to prepare for household emergency situations, many did not feel fully prepared or had not completed some common preparedness measures. Concern about protecting family members and personal experience with emergency situations were identified as strong motivations for preparing the household for future emergencies.
The focus group findings indicate that most participants have prepared for household emergency situations by discussing the dangers with family members, stockpiling resources, and taking a CPR or first-aid class. However, to the extent that behavior is influenced, there is a gap between maintaining preparedness levels and internalizing preparedness recommendations. Prevention efforts in Georgia should focus on closing that gap.
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