Titus L. Daniels

Due to the nature of their underlying illness and treatment regimens, cancer patients are at increased risk of infection. Though the advent and widespread use of anti-infective agents has allowed for the application of ever-greater immune-suppressing therapies with successful treatment of infectious complications, prevention of infection remains the primary goal. The evolutionary changes of microorganisms, whereby resistance to anti-infective therapy is increasingly common, have facilitated a paradigm shift in the field of healthcare epidemiology. No longer is the focus on “control” of infection once established in a healthcare environment. Rather, the emphasis is on prevention of infection before it occurs. The most basic tenet of infection prevention, and the cornerstone of all well-designed infection prevention and control programs, is hand hygiene. The hands of healthcare workers provide a common potential source for transmission of infectious agents, and effective decontamination of the hands reduces the risk of transmission of infectious material to other patients. Once infection is suspected or established; however, implementation of effective control strategies is important to limit the spread of infection within a healthcare environment. This chapter outlines the basic tenets of infection prevention, principles of isolation precautions and control measures, and elements for a successful infection control and prevention program.

(See the major article by Hornbeck et al, on pages 1549–57.)

To the Editor—We thank Dr Snyder for the thoughtful response to our recent editorial. Dr Snyder raises several issues about our statements addressing the importance of hand hygiene for the prevention of influenza-like illness. Although Dr Snyder raises some important points, we respectfully disagree with the notion that hand hygiene is not an important strategy in the prevention of influenza-like illness.

The 2009 novel influenza A(H1N1) (hereafter “nH1N1”) pandemic has sparked renewed interest in, and controversy regarding, the use of respiratory protection to reduce influenza transmission. Use of masks to prevent influenza generally applies to 2 populations: health care workers (HCWs) providing care for patients with proven or suspected influenza to both protect the HCW and prevent nosocomial transmission to high-risk patients; and persons in certain community settings, such as in households of individuals at high risk for influenza complications.

A retrospective, propensity-matched cohort study was conducted to determine the mortality rate in patients with healthcare-associated infection (HAI) due to multidrug-resistant (MDR) Acinetobacter baumannii. The 28-day mortality rate for patients with MDR A. baumannii HAI was not significantly different than that for patients with non-MDR A. baumannii HAI. The median length of hospital stay before diagnosis of HAI was 4.5 days longer for patients with MDR A. baumannii infection than for patients with non-MDR A. baumannii infection (P <.001).

Severe sepsis in lung transplant recipients is a challenging problem and carries a high mortality. Recombinant human activated protein C (drotrecogin alfa [activated]) has been approved for use in patients with severe sepsis. Its use has been shown to be safe and impart a survival advantage. However, the safety of drotrecogin alfa activated has not been evaluated in lung transplant recipients. We report for the first time on the use of drotrecogin alfa activated in six lung transplant recipients. Clinical trials are warranted to further evaluate the use of drotrecogin alfa activated in transplant recipients.