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A total closure of an affected medical department is one of the most expensive infection control measures during investigation of a nosocomial outbreak. However, until now there has been no systematic analysis of typical characteristics of outbreaks, for which closure was considered necessary. This article presents data on features of such nosocomial epidemics published during the past 40 years in the medical literature. A search of the Outbreak Database (1561 nosocomial outbreaks in file) revealed a total of 194 outbreaks that ended up with some kind of closure of the unit (median closure time: 14 days). Closure rates (CRs) were calculated and stratified for medical departments, for causative pathogens, for outbreak sources, and for the assumed mode of transmission. Data were then compared to the overall average CR of 12.4% in the entire database. Wards in geriatric patient care were closed significantly more frequently (CR: 30.3%; P<0.001) whereas paediatric wards showed a significantly lower CR (6.1%; P=0.03). Pathogen species with the highest CR were norovirus (44.1%; P<0.001) and influenza/parainfluenza virus (38.5%; P<0.001). If patients were the source of the outbreak, the CR was significantly increased (16.7%; P=0.03). Infections of the central nervous system were most often associated with closure of the ward (24.2%; P=001). A systematic evaluation of nosocomial outbreaks can be a valuable tool for education of staff in the absence of an outbreak, but may be even more helpful for potentially cost-intensive decisions in the acute outbreak setting on the ward.

A systematic search was performed to identify outbreaks of methicillin-resistant Staphylococcus aureus infection and colonization caused by healthcare workers (HCWs). Of 191 outbreaks identified, 11 had strong epidemiological evidence that HCWs were the source. In 3 of these outbreaks, asymptomatic carriers were the cause. The frequent practice of screening asymptomatic HCWs should be reconsidered.

Outbreak reports in the literature are a valuable resource and should be used for educational purposes as well as for preparing outbreak investigations.

ObjectivesTo evaluate the multinational medical-student-delivered tobacco prevention programme for secondary schools for its effectiveness to reduce the smoking prevalence among adolescents aged 11–15 years in Germany at half year follow-up.SettingWe used a prospective quasi-experimental study design with measurements at baseline (t1) and 6 months postintervention (t2) to investigate an intervention in 8 German secondary schools. The participants were split into intervention and control classes in the same schools and grades.ParticipantsA total of 1474 eligible participants of both genders at the age of 11–15 years were involved within the survey for baseline assessment of which 1200 completed the questionnaire at 6-month follow-up (=longitudinal sample). The schools participated voluntarily. The inclusion criteria were age (10–15 years), grade (6–8) and school type (regular secondary schools).InterventionTwo 60 min school-based modules delivered by medical students.Primary and secondary outcome measuresThe primary end point was the difference from t1 to t2 of the smoking prevalence in the control group versus the difference from t1 to t2 in the intervention group (difference of differences approach). The percentage of former smokers and new smokers in the two groups were studied as secondary outcome measures.ResultsIn the control group, the percentage of students who claimed to be smokers doubled from 4.2% (t1) to 8.1% (t2), whereas it remained almost the same in the intervention group (7.1% (t1) to 7.4% (t2); p=0.01). The likelihood of quitting smoking was almost six times higher in the intervention group (total of 67 smokers at t1; 27 (4.6%) and 7 (1.1%) in the control group; OR 5.63; 95% CI 2.01 to 15.79; p<0.01). However, no primary preventive effect was found.ConclusionsWe report a significant secondary preventive (smoking cessation) effect at 6-month follow-up. Long-term evaluation is planned.

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A clear primary preventive effect of the program was demonstrated, although it apparently did not induce persons who were already smokers to quit.

IntroductionA survey conducted by the German Federal Centre for Health Education in 2012 showed that 35.2% of all young adults (18–25 years) and 12.0% of all adolescents (12–17 years) in Germany are regular cigarette smokers. Most smoked their first cigarette in early adolescence. We recently reported a significantly positive short-term effect of a physician-delivered school-based smoking prevention programme on the smoking behaviour of schoolchildren in Germany. However, physician-based programmes are usually very expensive. Therefore, we will evaluate and optimise Education against Tobacco (EAT), a widespread, low-cost programme delivered by about 400 medical students from 16 universities in Germany.Methods and analysisA prospective quasi-experimental study design with two measurements at baseline (t1) and 6 months post-intervention (t2) to investigate an intervention in 10–15-year-olds in grades 6–8 at German secondary schools. The intervention programme consists of two 60-min school-based medical-student-delivered modules with (module 1) and without the involvement of patients with tobacco-related diseases and control groups (no intervention). The study questionnaire measuring smoking status (water pipe and cigarette smoking), smoking-related cognitions, and gender, social and cultural aspects was designed and pre-tested in advance. The primary end point is the prevalence of smokers and non-smokers in the two study arms at 6 months after the intervention. The percentage of former smokers and new smokers in the two groups and the measures of smoking behaviour will be studied as secondary outcome measures.Ethics and disseminationIn accordance with Good Epidemiologic Practice (GEP) guidelines, the study protocol was submitted for approval by the responsible ethics committee, which decided that the study does not need ethical approval (Goethe University, Frankfurt-Main, Germany). Findings will be disseminated in peer-reviewed journals, at conferences, within our scientific advisory board and through medical students within the EAT project.