HH with SW or alcohol-based hand rub is highly effective in reducing influenza A virus on human hands, although SW is the most effective intervention. Appropriate HH may be an important public health initiative to reduce pandemic and avian influenza transmission.

We assessed the toxicity and clinical outcomes associated with linezolid therapy (mean duration, 29 ؎ 28 days; range, 8 to 185 days) in 44 patients with serious gram-positive infections. Although a clinical cure was achieved in 73% of the cases, 28/44 (64%) had adverse reactions (thrombocytopenia, n ‫؍‬ 13; anemia, n ‫؍‬ 7; gastrointestinal, n ‫؍‬ 12; peripheral neuropathy, n ‫؍‬ 1; serotonin syndrome, n ‫؍‬ 1), such that a systematic monitoring protocol was developed.

Pneumonia severity assessment systems such as the pneumonia severity index (PSI) and CURB-65 were designed to direct appropriate site of care based on 30-d mortality. Increasingly they are being used to guide empirical antibiotic therapy and also possibly to detect patients who will require admission to the intensive care unit (ICU). We retrospectively reviewed the records of all patients admitted to our institution with confirmed community acquired pneumonia (CAP) for the 12 months from January 2002. 408 episodes were studied with an overall 30-d mortality of 15.4% and ICU admission of 10.5%. PSI classes IV/V were significantly better than CURB-65 score > or = 3 for predicting patients who died within 30 d (94% vs 62%; p < 0.001), and those that needed ICU (86% vs 61%; p = 0.01). In addition, for the patients identified as 'low risk' by PSI (classes I/II), there was only 1 death and 1 admission to an ICU compared to 8 deaths and 7 ICU admissions with CURB-65 scores of 0-1. Although easier to use, CURB-65 is neither sensitive nor specific for predicting mortality in CAP patients. Neither rule was sufficiently accurate for predicting need for an ICU, even when patients with 'not for resuscitation' orders were excluded.

The impact of a computer‐based infectious diseases electronic antibiotic advice and approval system (“IDEA3S”) was assessed as an alternative to a labour‐intensive, phone‐based approval system. IDEA3S‐based approvals replaced 48% of all approvals for the most frequently requested antimicrobial agents (ceftriaxone/cefotaxime, vancomycin) and were associated with stable overall rates of antimicrobial use. Antibiotic prescribing for community‐acquired pneumonia was 76% concordant with IDEA3S recommendations, and clinical acceptance of IDEA3S was excellent. Successful implementation required a coordinated, evidence‐based approach between clinicians, pharmacists and hospital administration, together with ongoing staff education and feedback of results. IDEA3S is a useful new adjunct to routine clinician consultation to support appropriate antibiotic prescribing for a number of common indications in hospitals.

Aim: To investigate antimicrobial prescribing patterns using a validated point-prevalence approach and to identify intervention targets to optimise antimicrobial use. Method: 3 prospective point-prevalence studies were conducted over 4-day periods in April 2005, September 2005 and April 2006 at a tertiary hospital using a previously published method. Clinical pharmacists used a standardised data collection form on an allocated day to record details of all patients who were prescribed systemic antimicrobials (antivirals, antifungals, antibacterials) and the total number of patients seen. The appropriateness of the IV route was assessed using pre-defined criteria. Results: Over the 3 study periods 1515 drug charts were reviewed. Of these, 508 (34%) patients were prescribed 832 antimicrobial courses. The mean patient age was 67.5 (SD 32.3) years and 55% were males. Treatment accounted for 730 (88%) courses and prophylaxis for 102 (12%). The most frequently prescribed antimicrobials were ceftriaxone (9.7%) and amoxycillin/clavulanate (7.5%). The most commonly prescribed antimicrobial classes were penicillins (26%) and cephalosporins (20%). 342 (41%) courses were restricted antimicrobials and 85% of these had appropriate approval. 478 (58%) courses were given IV with clinical pharmacists identifying that 2.9% of these could have been given orally. Conclusion: Serial point-prevalence studies proved to be an effective tool for examining baseline patterns of antimicrobial use. This efficient and reproducible tool would be appropriate for other hospitals to use as a component of their antimicrobial usage monitoring.