An analysis of health care workers exposed to patients with hantavirus found that no occupational transmission occurred, indicating the deadly virus will not likely spread in health care facilities via person-to-person transmission, the authors found. To determine whether such transmission had occurred among health care workers exposed to patients with confirmed hantavirus pulmonary syndrome, they evaluated health care workers who had cared for patients with hantavirus pulmonary syndrome or who had processed specimens from those patients. Information about exposure to those patients and about recent illnesses was obtained via a standardized questionnaire. Of the 396 workers, 266 (67%) reported they had been exposed to patients with hantavirus pulmonary syndrome or to their body fluids, or they had processed laboratory specimens from those patients.
Although 108 of the health care workers reported fever, myalgias, or respiratory illnesses during the three months before the serum specimens were obtained, no hantavirus antibodies were detected in any worker.
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Sands K, Vineyar G, Platt R, et al. Surgical site infections occurring after hospital discharge. J of Infectious Dis 1996; 173:963-970
Most surgical site infections (SSIs) occur after discharge and are not detectable by conventional surveillance, the authors report. Though they cause substantial morbidity, their epidemiology is not well understood and methods for routine post-discharge surveillance have not been validated.
Postoperative SSIs are among the leading nosocomial causes of morbidity and increased medical expense. An estimated 325,000 SSIs occur each year in the United States and generate additional medical costs in the range of $1-2 billion.
In the study, inpatient and outpatient surveillance were used to follow 5,572 procedures among members of a health maintenance organization with extensive automated records. Records were screened for coded diagnoses, tests, and prescriptions and, if positive, were reviewed by reading full text. Questionnaires regarding the occurrence of an SSI were sent to the same patients and their surgeons. One hundred thirty-two SSIs were documented, of which 84% occurred after hospital discharge and 63% were managed outside the surgical facility. Post-discharge SSIs led to an average of 4.6 additional ambulatory encounters.
"We conclude that the majority of SSIs occur after hospital discharge and that these infections are associated with important morbidity and resource utilization," the authors note. "Identification of SSIs will require that hospitals, managed care organizations, and insurers perform some form of post-discharge surveillance."
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