Multicenter Study of Hand Carriage of Potential Pathogens by Neonatal ICU Healthcare Personnel.

A multicenter surveillance study was performed to determine the rates of hand carriage of potential pathogens among healthcare personnel in four neonatal intensive care units. Staphylococcus aureus, enterococci, and gram-negative bacilli were recovered from 8%, 3%, and 2% of 1000 hand culture samples, respectively.

Predictors of flu vaccination among urban Hispanic children and adults.

BACKGROUND: Flu vaccination is effective for preventing infection, but coverage levels in the USA remain low-especially among racial/ethnic minorities. This study examines factors associated with flu vaccination in a predominantly Hispanic community in Manhattan, New York. METHODS: Households were recruited during the 2006-2007 and 2007-2008 flu seasons. Primary household respondents were interviewed to determine knowledge of flu transmission/treatment and vaccination status and demographic information for all household members. RESULTS: Vaccination coverage was 47.3% among children <5, 39.3% among 5-17-year-olds, 15.3% among 18-49-year-olds, 31.0% among 50-64-year-olds and 37.1% among adults ≥65 in year 1; and 53.1% among children <5, 43.6% among 5-17-year-olds, 19.5% among 18-49-year-olds, 34.1% among 50-64-year-olds and 34.3% among adults ≥65 in year 2. For children, younger age, having a chronic respiratory condition (eg, asthma), and greater primary respondent knowledge of flu were positively associated with vaccination. Among adults, female gender, older age, higher education, greater primary respondent knowledge of flu, having been born in the USA and having a chronic respiratory condition were positively associated with vaccination. The most common reasons cited for not being vaccinated were the beliefs that flu vaccination was unnecessary or ineffective. CONCLUSIONS: Possible methods for increasing vaccination levels in urban Hispanic communities include improving health literacy, making low-cost vaccination available and encouraging providers to use other office visits as opportunities to mention vaccination to patients. REGISTRATION NUMBER: This study is registered at http://ClinicalTrials.gov (NCT00448981).

Clinical vignettes provide an understanding of antibiotic prescribing practices in neonatal intensive care units.

OBJECTIVE: To use clinical vignettes to understand antimicrobial prescribing practices in neonatal intensive care units (NICUs). DESIGN: Vignette-based survey. SETTING: Four tertiary care NICUs. PARTICIPANTS: Antibiotic prescribers in NICUs. METHODS: Clinicians from 4 tertiary care NICUs completed an anonymous survey containing 12 vignettes that described empiric, targeted, or prophylactic antibiotic use. Responses were compared with Centers for Disease Control and Prevention guidelines for appropriate use. RESULTS: Overall, 161 (59% of 271 eligible respondents) completed the survey, 37% of whom had worked in NICUs for 7 or more years. Respondents were more likely to appropriately identify use of targeted therapy for methicillin-susceptible Staphylococcus aureus, that is, use of oxacillin rather than vancomycin, than for Escherichia coli, that is, use of first-generation rather than third-generation cephalosporin, (P < .01). Increased experience significantly predicted appropriate prescribing (P = .02). The proportion of respondents choosing appropriate duration of postsurgical prophylaxis (P < .01) and treatment for necrotizing enterocolitis differed by study site (P = .03). CONCLUSIONS: The survey provides insight into antibiotic prescribing practices and informs the development of future antibiotic stewardship interventions for NICUs.

Barriers to mask wearing for influenza-like illnesses among urban Hispanic households.

OBJECTIVES: To identify barriers to mask wearing and to examine the factors associated with the willingness to wear masks among households. DESIGN AND SAMPLE: We used data sources from a study assessing the impact of 3 nonpharmaceutical interventions on the rates of influenza: exit interviews; home visits with a subset of the mask group; and a focus group. MEASURES: Risk perception score, univariate analysis, and logistic regression were conducted to identify the characteristics and predictors of mask use. Thematic barriers to mask wearing were identified from qualitative data obtained at home visits and focus group. RESULTS: Respondents from the mask group, when compared with the nonmask group, demonstrated higher risk perception scores concerning influenza (maximum score: 60, means: 37.6 and 30.2, p<.001) and increased perception of effectiveness of mask wearing (maximum score: 10, means: 7.8 and 7.3, p=.043). There was no significant association between demographic, attitudinal, or knowledge variables and adherence to wearing masks. Thematic barriers were identified such as social acceptability of mask use, comfort and fit, and perception of the risk/need for masks. CONCLUSIONS: Face masks may not be an effective intervention for seasonal or pandemic influenza unless the risk perception of influenza is high. Dissemination of culturally appropriate mask use information by health authorities and providers must be emphasized when educating the public.

Impact of non-pharmaceutical interventions on URIs and influenza in crowded, urban households.

OBJECTIVES: We compared the impact of three household interventions-education, education with alcohol-based hand sanitizer, and education with hand sanitizer and face masks-on incidence and secondary transmission of upper respiratory infections (URIs) and influenza, knowledge of transmission of URIs, and vaccination rates. METHODS: A total of 509 primarily Hispanic households participated. Participants reported symptoms twice weekly, and nasal swabs were collected from those with an influenza-like illness (ILI). Households were followed for up to 19 months and home visits were made at least every two months. RESULTS: We recorded 5034 URIs, of which 669 cases reported ILIs and 78 were laboratory-confirmed cases of influenza. Demographic factors significantly associated with infection rates included age, gender, birth location, education, and employment. The Hand Sanitizer group was significantly more likely to report that no household member had symptoms (p < 0.01), but there were no significant differences in rates of infection by intervention group in multivariate analyses. Knowledge improved significantly more in the Hand Sanitizer group (p < 0.0001). The proportion of households that reported > or = 50% of members receiving influenza vaccine increased during the study (p < 0.001). Despite the fact that compliance with mask wearing was poor, mask wearing as well as increased crowding, lower education levels of caretakers, and index cases 0-5 years of age (compared with adults) were associated with significantly lower secondary transmission rates (all p < 0.02). CONCLUSIONS: In this population, there was no detectable additional benefit of hand sanitizer or face masks over targeted education on overall rates of URIs, but mask wearing was associated with reduced secondary transmission and should be encouraged during outbreak situations. During the study period, community concern about methicillin-resistant Staphylococcus aureus was occurring, perhaps contributing to the use of hand sanitizer in the Education control group, and diluting the intervention's measurable impact.

Retention and protocol adherence of Hispanic volunteers in a longitudinal trial.

OBJECTIVES: To compare Hispanic research volunteers with high and low levels of study retention and adherence. METHODS: Correlational analysis of demographics, recruitment strategies, knowledge, and attitudes of 470 households in a clinical trial. RESULTS: Within 12 months, 53 (11.3%) households dropped out; those less certain about some factual information were more likely to drop out (P < 0.05). Participants born outside the United States were more likely to adhere to protocols (P = 0.03). Flyers were effective for recruiting only 3% of participants. CONCLUSIONS: In newly immigrated populations, written recruitment materials may be ineffective; knowledge and attitudes may be important for study retention and adherence.

Preferences among immigrant Hispanic women for written educational materials regarding upper respiratory infections.

The need for culturally appropriate health education materials for Hispanic populations has been widely recognized, and Spanish-language materials are available through a number of private and governmental organizations. We convened two focus groups to elucidate preferences regarding how health-related messages are obtained and to identify which educational materials available in Spanish were preferred by 26 recently immigrated Hispanic homemakers who had received 15 different bimonthly written documents as part of a community-based clinical trial to prevent household transmission of colds and influenza. Participants gave three primary reasons for volunteering to participate in the study: to provide better care for their children (96.2%, 25/26), to get information (96.2%, 25/26), and to get free products (47.1%, 8/17). Their primary sources of health-related information were relatives and friends (42.9%, 6/14), clinicians (35.7%, 5/14), mass media (14.3%, 2/14) or the emergency room (7.1%, 1/14); none mentioned the internet. Materials using either a question and answer or true/false format were clearly preferred, even when other options were more colorful or had lower reading levels. Printed educational materials may be ineffective unless they include a more systematic assessment of the user's perceived needs for the information as well as consideration of format. In this population, a question and answer or true/false format and materials that could be shared with their children were greatly preferred.