Severe acute respiratory syndrome (SARS) is characterized by a risk of nosocomial transmission; however, the risk of airborne transmission of SARS is unknown. During the Toronto outbreaks of SARS, we investigated environmental contamination in SARS units, by employing novel air sampling and conventional surface swabbing. Two polymerase chain reaction (PCR)-positive air samples were obtained from a room occupied by a patient with SARS, indicating the presence of the virus in the air of the room. In addition, several PCR-positive swab samples were recovered from frequently touched surfaces in rooms occupied by patients with SARS (a bed table and a television remote control) and in a nurses' station used by staff (a medication refrigerator door). These data provide the first experimental confirmation of viral aerosol generation by a patient with SARS, indicating the possibility of airborne droplet transmission, which emphasizes the need for adequate respiratory protection, as well as for strict surface hygiene practices.

BackgroundIn the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission.MethodsA retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission.Results45 laboratory-confirmed intubated SARS patients were identified. Of the 697 HCWs involved in their care, 624 (90%) participated in the study. SARS-CoV was transmitted to 26 HCWs from 7 patients; 21 HCWs were infected by 3 patients. In multivariate GEE logistic regression models, presence in the room during fiberoptic intubation (OR = 2.79, p = .004) or ECG (OR = 3.52, p = .002), unprotected eye contact with secretions (OR = 7.34, p = .001), patient APACHE II score ≥20 (OR = 17.05, p = .009) and patient Pa02/Fi02 ratio ≤59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients.ConclusionClose contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients.

Acquisition of multiresistant A. baumannii was likely multifactorial, related to environmental contamination and contact with transiently colonized healthcare providers. Control measures addressing these potential sources of multiresistant A. baumannii were successful in terminating the outbreak. Ongoing surveillance and continued attention to hand hygiene and adequate environmental cleaning are essential to prevent recurrent outbreaks due to antibiotic-resistant bacteria in burn units.

Oseltamivir is safe and appears to be effective when used as treatment or prophylaxis to control outbreaks of influenza in older nursing home residents.

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The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.

METHODOLOGY 3.0 DEFINITIONS 3.1 General definitions 3.2 Operational definition of CA-MRSA 3.3 Definition limitations 4.0 EPIDEMIOLOGY 4.1 The rise of CA-MRSA 4.2 CA-MRSA in Canada 4.3 Origin of CA-MRSA and its ability to disseminate 4.4 Populations at risk 4.5 Transmission 5.0 MICROBIOLOGY 5.1 S aureus and MRSA 5.2 Virulence factors 5.3 Nomenclature of strains 5.4 Resistance to non-beta-lactam antibiotics 5.4.1 Clindamycin 5.4.2 Erythromycin 5.4.3 Quinolones 5.5 Differences between CA-MRSA and HA-MRSA 6.0 MANAGEMENT 6.1 Diagnostic evaluation 6.1.1 When to suspect CA-MRSA 6.1.2 When to obtain cultures 6.2 Treatment 6.2.1 Minor SSTIs (folliculitis, furuncles and small abscesses without cellulitis) 6.2.2 Empirical therapy of non-lifethreatening infections other than minor skin infections, potentially due to CA-MRSA 6.2.3 Empirical therapy of lifethreatening infections potentially due to CA-MRSA 6.2.4 Confirmed non-life-threatening CA-MRSA infections other than minor skin infections 6.2.5 Confirmed CA-MRSA lifethreatening infections 6.2.6 Adjunctive therapy 7.0 SCREENING AND DECOLONIZATION 7.1 Screening for CA-MRSA 7.2 Decolonization 7.3 Guidelines for the use of decolonization regimens 8.0 POPULATION SURVEILLANCE 8.1 Population surveillance program for CA-MRSA 8.2 Laboratory support 9.0 PREVENTION 9.1 Prevention of transmission of CA-MRSA 9.1.1 Role of the individual 9.1.2 Role of health care practitioners 9.1.3 Role of health authorities 9.

Overall adherence with appropriate PPE use in health care settings involving febrile respiratory illness patients was modest, particularly on pediatric units. Interventions to improve PPE use should be targeted toward the use of recommended precautions (eg, eye protection), HCWs working in pediatric units, the correct sequence of PPE removal, and performing hand hygiene.