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.

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.

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).

Objective To estimate the incidence and identify risk factors for surgical site infections (SSIs) among infants in the neonatal ICU (NICU). Study Design A prospective cohort study of infants undergoing surgical procedures May 2009–April 2012 in three NICUs was performed. SSI was identified if documented by an attending neonatologist and treated with intravenous (IV) antibiotics. Independent risk factors were identified using logistic regression, adjusting for NICU. Result A total of 902 infants underwent 1,346 procedures and experienced 60 SSIs (incidence: 4.46/100 surgeries). Risk factors for SSIs included younger chronologic age(OR 1.03/day decrease,95% CI 1.01,1.04), lower gestational age(OR 1.09/week decrease, CI 1.02,1.18), male sex(OR 1.18, CI1.04,1.34), and use of central venous catheter(OR 4.40, CI1.89,10.24). Only 43% had surgical site cultures obtained and Staphylococcus aureus was most commonly isolated. Conclusion SSIs complicated 4.46% of procedures performed in the NICU. Although few modifiable risk factors for SSIs were identified, future efforts should focus on evaluating the impact of current prevention strategies on the incidence of neonatal SSI.

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 ≥7 years. Respondents were more likely to appropriately identify use of targeted therapy for methicillin-susceptible Staphylococcus aureus, i.e., use of oxacillin rather than vancomycin, than for E. coli, i.e., use of first generation rather than third generation cephalosporin, (p<0.01). Increased experience significantly predicted appropriate prescribing (p=.02). The proportion of respondents choosing appropriate duration of post-surgical 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.