Monitoring health care workers after smallpox vaccination: findings from the Hospital Smallpox Vaccination-Monitoring System.

BACKGROUND: The Advisory Committee on Immunization Practices and the Healthcare Infection Control Practices Advisory Committee recommended that hospitals establish on-site, daily assessments of health care workers vaccinated with smallpox vaccine. The Hospital Smallpox Vaccination Monitoring System (HSVMS) was 1 component of the smallpox vaccination plan to monitor adverse events on-site in hospitals. This report presents findings from February to August 2003. METHODS: All US institutions participating in the smallpox vaccination program were eligible to enroll in and use HSVMS through the Internet-based Centers for Disease Control Secure Data Network. RESULTS: Of the 730 enrolled vaccinees, 341 (47%) were nurses; 122 (17%) physicians; 75 (10%) laboratory, patient care, radiology, or other technicians; 39 (5%) administrators; 22 (3%) housekeepers; 21 (3%) physical or respiratory therapists; 20 (3%) infection control professionals; 19 (3%) safety or security staff; and 17 (2%) epidemiologists; and 54 (7%) were workers in other job categories. Most (86%) vaccinees had been previously vaccinated. Postvaccination signs and symptoms were frequent: itching (75.2%), pain at the vaccination site (31.6%), swollen or tender lymph nodes (26.4%), fatigue (26.2%), and headache (20.8%). Symptoms were highest during the first week after vaccination; symptoms were more frequently reported among vaccinees without previous vaccination. Adherence to recommended vaccination site care was reported in 2732 of 3091 (88.4%) follow-up visits among workers with patient contact. Of the 4379 days workers planned to work, during 31 (0.7 per 100) days, workers performed restricted activities, and, in 60 (1.4 per 100) days, workers were absent. CONCLUSIONS: Findings from HSVMS indicate that adherence to post-smallpox vaccination site care was high and that the number of days of work affected was low.

Making use of electronic data: the National Healthcare Safety Network eSurveillance Initiative.

Efforts are underway at the Centers for Disease Control and Prevention to foster greater use of electronic data stored in health care application databases for surveillance of health care-associated infections and antimicrobial use and resistance. These efforts, referred to as the National Healthcare Safety Network (NHSN) eSurveillance Initiative, focus on standards-based solutions for conveying health care data and validation processes to confirm that the data received at the Centers for Disease Control and Prevention accurately reflect the data transmitted by health care facilities. Standard vehicles for data transmission, specifically Health Level Seven standards for electronic messages and structured documents, and standard vocabularies for representing microorganisms and other information needed for surveillance, are central features of the eSurveillance Initiative. Progress to date in this initiative is reviewed, and future project plans are outlined. Enhanced interoperability between health care and public health information systems is achievable for surveillance purposes, but major challenges must be overcome to realize the full benefits sought by the eSurveillance Initiative.

Creating public health standard vocabularies: mapping a set of CDC's pathogen codes to SNOMED concepts.

CDC and its public health partners are conducting pilot projects designed to capture data directly from healthcare providers or to exchange existing data electronically.1 The translation of proprietary standards into the accepted national standards is a key part of this effort. This study mapped a set of pathogens within CDC's hospital infection control activities to The Systematized Nomenclature of Medicine (SNOMED) concepts and investigated the differences between the two.

Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection?

OBJECTIVE: To assess the impact of laparoscopy on surgical site infections (SSIs) following cholecystectomy in a large population of patients. SUMMARY BACKGROUND DATA: Previous investigations have demonstrated that laparoscopic cholecystectomy is associated with a shorter postoperative stay and fewer overall complications. Less is known about the impact of laparoscopy on the risk for SSIs. METHODS: Epidemiologic analysis was performed on data collected during a 7-year period (1992-1999) by participating hospitals in the National Nosocomial Infections Surveillance (NNIS) System in the United States. RESULTS: For 54,504 inpatient cholecystectomy procedures reported, use of the laparoscopic technique increased from 59% in 1992 to 79% in 1999. The overall rate of SSI was significantly lower for laparoscopic cholecystectomy than for open cholecystectomy. Overall, infecting organisms were similar for both approaches. Even after controlling for other significant factors, the risk for SSI was lower in patients undergoing the laparoscopic technique than the open technique. CONCLUSIONS: Laparoscopic cholecystectomy is associated with a lower risk for SSI than open cholecystectomy, even after adjusting for other risk factors. For interhospital comparisons, SSI rates following cholecystectomy should be stratified by the type of technique.