Three years of erlotinib in routine practice for non-small cell lung cancer in South East Scotland

We present a review of 111 patients who were treated over an initial 3-year period with erlotinib. The median treatment time was 68 days and 59% of patients had stopped treatment within the first 3 months. However, 20 patients were on erlotinib for more than 12 months. Performance status and smoking history were the significant prognostic factors. The overall 3-year survival in patients who had never smoked was 26%.

Infection prevention and control competencies for hospital-based health care personnel

Background

Infection prevention and control education for hospital-based health care personnel has differed across organizations because of a lack of identified practice competencies. This gap also has resulted in variation of the educational curriculum in the academic setting and a lack of consistent preparation for emergency responses. The purpose of this study was to develop a list of competencies and measurable activities, or terminal objectives, for hospital-based health care personnel applicable for use during routine patient care activities as well as during natural and man-made disasters.

Methods

Competencies and terminal objectives related to infection prevention and control were developed using an evidence-based approach comprising the following steps: (a) review of the literature, (b) review of existing competencies and published curricula/training objectives, (c) synthesis of new competencies and terminal objectives, (d) expert panel review and competency refinement using the Delphi survey process, and (e) delineation of competencies by occupation. The 8 disciplines addressed were nurses (RNs and LPNs), nursing assistants, physicians, respiratory therapists, physical and occupational therapists, environmental services, laboratory professionals, and ancillary staff.

Results

An initial list of competency statements and terminal objectives were compiled and then vetted by a Delphi panel of experts in infection prevention and control until > 80% agreement was achieved on all competency statements and terminal objectives.

Conclusion

The final matrix of competencies and terminal objectives developed through this process may be used as a content framework for educational curricula and training materials for hospital-based health care personnel. The process also may be of use in determining the core competencies and terminal objectives regarding infection prevention and control for health care personnel in other settings. Validation of these results is an important next step.

Occupational transmission of Acinetobacter baumannii from a United States serviceman wounded in Iraq to a health care worker

BACKGROUND

Acinetobacter baumannii is increasingly recognized as being a significant pathogen associated with nosocomial outbreaks in both civilian and military treatment facilities. Current analyses of these outbreaks frequently describe patient-to-patient transmission. To date, occupational transmission of A. baumannii from a patient to a health care worker (HCW) has not been reported. We initiated an investigation of an HCW with a complicated case of A. baumannii pneumonia to determine whether a link existed between her illness and A. baumannii-infected patients in a military treatment facility who had been entrusted to her care.

METHODS

Pulsed-field gel electrophoresis and polymerase chain reaction/electrospray ionization mass spectrometry, a form of multilocus sequencing typing, were done to determine clonality. To further characterize the isolates, we performed a genetic analysis of resistance determinants.

RESULTS AND CONCLUSIONS

A "look-back" analysis revealed that the multidrug resistant A. baumannii recovered from the HCW and from a patient in her care were indistinguishable by pulsed-field gel electrophoresis. In addition, polymerase chain reaction/electrospray ionization mass spectrometry indicated that the isolates were similar to strains of A. baumannii derived from European clone type II (Walter Reed Army Medical Center strain type 11). The exposure of the HCW to the index patient lasted for only 30 min and involved endotracheal suctioning without use of an HCW mask. An examination of 90 A. baumannii isolates collected during this investigation showed that 2 major and multiple minor clone types were present and that the isolates from the HCW and from the index patient were the most prevalent clone type. Occupational transmission likely occurred in the hospital; HCWs caring for patients infected with A. baumannii should be aware of this potential mode of infection spread.

Disaster preparedness lessons learned and future directions for education: results from focus groups conducted at the 2006 APIC Conference

Background

Infection control professionals (ICP) who have experienced disaster response have not been assessed in terms of the lessons they have learned, gaps they perceive in disaster preparedness, and their perceived priorities for future emergency response training.

Methods

Focus groups were conducted at the APIC 2006 Conference to evaluate ICPs' perceived needs related to disaster planning topics, products they feel are needed for education and reference materials, and lessons learned from past disasters.

Results

ICPs' role in disaster preparedness and response is essential, even in noninfectious disease emergencies. Infection control issues in shelters, such as overcrowding, foodborne illness, lack of restroom facilities, inadequate environmental cleaning procedures and products, difficulty assessing disease outbreaks in shelters, inability to isolate potentially contagious patients, and too few hand hygiene supplies can contribute to secondary disease transmission. Other important topics on which ICPs need to be trained include surge capacity, employee health and safety, incident command system, educating responders and the public on disaster preparedness, addressing changing standards/recommendations, and partnering with public health. ICPs need quick reference materials, such as checklists, templates, tool kits, and algorithms to better equip them for disaster response.

Conclusion

Infection control must continue to partner with public health and other responding agencies to address gaps in disaster planning.

Hospital infectious disease emergency preparedness: a survey of infection control professionals

BACKGROUND

Hospital preparedness for infectious disease emergencies is imperative for local, regional, and national response planning.

METHODS

A secondary data analysis was conducted of a survey administered to Infection Control Professionals (ICPs) in May, 2005.

RESULTS

Most hospitals have ICP representation on their disaster committee, around-the-clock infection control support, a plan to prioritize health care workers to receive vaccine or antivirals, and non-health care facility surge beds. Almost 20% lack a surge capacity plan. Some lack negative pressure rooms for current patient loads or any surge capacity. Less than half have a plan for rapid set-up of negative pressure, and Midwest hospitals are less likely than other areas to have such plans. Smaller hospitals have less negative pressure surge capacity than do larger hospitals. About half have enough health care workers to respond to a surge that involves < or =50 patients; few can handle > or =100 patients. Many do not have sufficient ventilators or can handle < or =10 additional ventilated patients. Most do not have enough National Institute for Occupational Safety and Health-approved respirators, and less than half have sufficient surgical masks to handle a significant surge.

CONCLUSIONS

United States hospitals lack negative pressure, health care worker, and medical equipment/supplies surge capacity. Hospitals must continue to address gaps in infectious disease emergency planning.

Reported hospital needlestick injuries in relation to knowledge/skill, design, and management problems

OBJECTIVES

To investigate reported needlestick injuries in hospital workers from an adult learner theory perspective: identifying safe needle device knowledge and practice, and flaws in needle designs and management practices surrounding such problems.

DESIGN

Exploratory descriptive study of reported needlestick injuries from hollow needled devices in a hospital. Injured healthcare workers were counseled via hospital protocol, then a survey was filled out containing no identifiers of individual or institution.

SETTING

Seventeen Metropolitan Washington, DC, area hospitals.

PARTICIPANTS

All workers reporting needlestick injuries during February 1-28, 1990.

RESULTS

Seventy-two injuries were reported; there were no multiple injuries to any individual. Thirty-three (45.8%) were to registered nurses (RNs)-more than any other group of workers. Recapping accounted for a higher percentage than any other activity (10 sticks, 14.1%). Of workers incurring recapping injuries, 3 identified a knowledge of a one-handed spearing technique and did not practice it; 4 neither knew nor practiced it. Eighteen (25.0%) were to "down-stream" housekeepers and aides who did not use such devices in their practice. Disposable needle/syringes caused 49.3% of injuries; hypodermic needles on intravenous lines caused 16.9%. Of the needlesticks, 60.6% were after use and before disposal, 4.2% occurred as the worker was putting an item into a needlebox, and 9.9% occurred from needles protruding from inappropriate bags. Many injuries occurred in the first 2 hours of work after being off the previous day, on Sunday, and on Monday.

CONCLUSIONS

Of nurses and medical technologists reporting knowledge of a spearing recapping technique, 97.3% suffered injury via other methods. This strongly suggests that knowledge leads to different action. Safer needled devices and needle-free systems would make a safer workplace. Further study is indicated to identify if and why the first two hours after returning to work on Sunday or Monday are risky for needlestick injuries. Management practices must ensure compliance to safe practice both by employees and related medical staff.