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V J Fraser

Publications and source records attributed to V J Fraser.

At least 55 records · Page 3Linked to original sources
PubMed1997

Antiviral chemoprophylaxis after occupational exposure to human immunodeficiency virus: why, when, where, and what.

PURPOSE: To update ophthalmologists on recent developments in the area of antiviral chemoprophylaxis after occupational exposure to human immunodeficiency virus (HIV). Background information is provided by which to make an informed decision about whether to initiate antiviral chemoprophylaxis against HIV infection. METHODS: We discuss why HIV postexposure prophylaxis should be considered; when prophylaxis should be initiated; where prophylaxis medications should be located in the operating or emergency room; and what medications might be used and the factors influencing their selection. Recent provisional recommendations by the United States Centers for Disease Control and Prevention and the International AIDS Society-USA are reviewed along with literature dealing with antiviral chemoprophylaxis against HIV infection. RESULTS: Recommendations are made for specific antiviral chemoprophylaxis after occupational exposure to HIV based on the Centers for Disease Control and Prevention and the International AIDS Society-USA provisional recommendations. Uncertain areas and the minor discrepancies in these two reports are discussed. CONCLUSIONS: Prevention of HIV transmission after accidental occupational exposure is possible. Combination therapy is more effective than monotherapy in treating HIV infections. Zidovudine (AZT or ZDV) is effective in postexposure prophylaxis; the combination of zidovudine and lamivudine (3TC) and indinavir (IDV) has greater antiretroviral activity than zidovudine alone does. The requirements for effective HIV postexposure prophylaxis may be somewhat different than those for optimum HIV treatment in the chronically ill HIV-positive patient. Ophthalmologists should have an in-depth knowledge of current thinking regarding HIV pathophysiology and treatment.

Antiviral Agents↗
PubMed1997

Healthcare workers' attitudes and compliance with universal precautions: gender, occupation, and specialty differences.

We describe variations in healthcare workers' attitudes toward double gloving and reporting needlesticks, and in their readiness to comply with double gloving and hepatitis B vaccine. Differences related to occupation, specialty, and gender have implications for the need to tailor interventions for specific groups of healthcare workers to improve compliance with Universal Precautions.

Adult↗
PubMed1997

Varied approaches to tuberculosis control in a multihospital system.

OBJECTIVES: To document the actual tuberculosis (TB) control policies and procedures in a nonoutbreak setting in a variety of hospitals. To determine if any particular practices are linked to higher rates of employee tuberculin skin-test conversion. DESIGN: Survey of hospital occupational health and infection control practitioners for the year 1994 regarding hospital TB policies. Review of hospital records to verify the number of patients with TB at each hospital and to verify the number of employees with positive tuberculin skin tests. Smoke-stick testing of negative-pressure ventilation rooms. SETTING: A 13-hospital health system in the Midwest. RESULTS: Hospitals ranged in size from 40 to 1,208 beds (median 220) and employed 150 to 6,500 workers (median 875). There were seven rural and six urban centers, including four teaching hospitals. All 13 hospitals had TB control plans, and all performed annual tuberculin skin testing on employees. Annual skin-test positivity rates ranged from 0% to 1.0% (median 0.3%). Negative-pressure ventilation rooms were available in 11 hospitals. The percentage of negative-pressure rooms with effective negative pressure ranged from 44% to 100% (median 95%). Three of the 13 hospitals used high-efficiency particulate air (HEPA) masks as primary personal respiratory protection, and 8 used dust-mist or dust-mist-fume masks. We found no relation between the type of face mask used, number of functional negative-pressure rooms, or hospital TB risk category, and employee skin-test conversion rates. CONCLUSIONS: Considerable variation existed in the TB control policies and procedures between hospitals, but employee TB skin-test conversion rates were low in all settings.

Cross Infection↗
PubMed1997

Tuberculin skin testing of hospitalized patients.

OBJECTIVES: We sought to define the prevalence of tuberculin skin test (TST) positivity in a group of newly hospitalized patients, to identify risk factors for positive tests, and to examine the impact of testing on infection control practices. DESIGN: Unblinded cohort study over 5 days in July 1992. SETTING: A 1,000-bed university-affiliated hospital. PATIENTS: All patients admitted (excluding obstetric patients and newborns) were interviewed. Patients without a history of tuberculosis (TB) or a positive TST were offered a TST with Candida and tetanus controls. RESULTS: Of 346 patients offered the test, 21 (6%) had a prior history of TB or a positive TST, and 36 (10%) declined to participate; 279 of the remaining 289 completed the study. Anergy was demonstrated in 94 (33.7%) of 279 patients. New positive TSTs were identified in 19 (10.3%) of 185 nonanergic patients. Of the 19 TST-positive patients, 6 (32%) had infiltrates on chest radiographs and were evaluated for active TB. One patient was treated empirically for active TB, and five received isoniazid prophylaxis. Risk factors for a new positive TST included age (odds ratio [OR], 1.56 per decade of life; P = .021), African American race (OR, 4.81; P = .008), alcohol abuse (OR, 5.53; P = .005), and peptic ulcer disease (OR, 4.53; P = .017). Risk factors for anergy included admission to a surgical service (OR, 2.1; P = .006), current use of steroids (OR, 2.65; P = .005), and human immunodeficiency virus (HIV) infection (OR, undefined; P = .034). CONCLUSIONS: Despite a high rate of anergy, routine tuberculin skin testing identified a substantial number of patients with TB infection who might otherwise have gone unrecognized.

Adolescent↗
PubMed1997

Mechanical ventilation with or without daily changes of in-line suction catheters.

The purpose of this study was to determine the safety and cost-effectiveness of not routinely changing in-line suction catheters for patients requiring mechanical ventilation. Patients were randomly assigned to receive either no routine in-line suction catheter changes (n = 258) or in-line suction catheter changes every 24 h (n = 263). The main outcome measure was the incidence of ventilator-associated pneumonia. Other outcomes evaluated included hospital mortality, acquired organ system derangements, duration of mechanical ventilation, lengths of intensive care and hospital stay, and the cost for in-line suction catheters. Ventilator-associated pneumonia was seen in 38 patients (14.7%) receiving no routine in-line suction catheter changes and in 39 patients (14.8%) receiving in-line suction catheter changes every 24 h (relative risk, 0.99; 95% CI, 0.66 to 1.50). No statistically significant differences for hospital mortality, lengths of stay, the number of acquired organ system derangements, death in patients with ventilator-associated pneumonia, or mortality directly attributed to ventilator-associated pneumonia were found between the two treatment groups. Patients receiving in-line suction catheter changes every 24 h had 1,224 catheter changes costing a total of $11,016; patients receiving no routine in-line suction catheter changes had a total of 93 catheter changes costing $837. Our findings suggest that the elimination of routine in-line suction catheter changes is safe and can reduce the costs associated with providing mechanical ventilation.

Adult↗
PubMed1997

The impact of nosocomial infections on patient outcomes following cardiac surgery.

STUDY OBJECTIVE: To evaluate the relationship between nosocomial infections and clinical outcomes following cardiac surgery, and to identify risk factors for the development of nosocomial infections in this patient population. DESIGN: Prospective cohort study. SETTING: Barnes-Jewish Hospital, St. Louis, a university-affiliated teaching hospital. PATIENTS: Six hundred five consecutive patients undergoing cardiac surgery. INTERVENTIONS: Prospective patient surveillance and data collection. MAIN OUTCOME MEASURES: Occurrence of nosocomial infections, multiorgan dysfunction, hospital mortality, and risk factors for the acquisition of nosocomial infections. RESULTS: One hundred thirty-one (21.7%) patients acquired at least one nosocomial infection following cardiac surgery. Four independent risk factors for the development of a nosocomial infection were identified: the duration of mechanical ventilation, postoperative empiric antibiotic administration, the duration of urinary tract catheterization, and female gender. Thirty (5.0%) patients died during their hospitalization. The mortality rate of patients acquiring a nosocomial infection (11.5%) was significantly greater than the mortality rate of patients without a nosocomial infection (3.2%) (odds ratio [OR]=4.0; 95% confidence interval [CI]=2.7 to 5.8; p<0.001). Multiorgan dysfunction was found to be the most important independent determinant of hospital mortality (adjusted OR=23.8; 95% CI=13.5 to 42.1; p<0.001) along with the aortic cross-clamp time (adjusted OR=2.3; 95% CI=1.7 to 3.0; p=0.002) and severity of illness as measured by APACHE II (acute physiology and chronic health evaluation) (adjusted OR=1.1; 95% CI=1.1 to 1.2; p=0.019). Ventilator-associated pneumonia, clinical sepsis, female gender, the cardiopulmonary bypass time, and severity of illness were identified as independent risk factors for the development of multiorgan dysfunction. Among hospital survivors, patients acquiring a nosocomial infection had longer hospital lengths of stay compared to patients without a nosocomial infection (20.1+/-13.0 days vs 9.7+/-4.5 days; p<0.001). CONCLUSIONS: Nosocomial infections, which are common following cardiac surgery, are associated with prolonged lengths of hospitalization, the development of multiorgan dysfunction, and increased hospital mortality. These data suggest potential interventions for the prevention of nosocomial infections following cardiac surgery that could substantially improve patient outcomes and decrease medical care costs.

APACHE↗
PubMed1996

Randomized prospective study of the impact of three needleless intravenous systems on needlestick injury rates.

OBJECTIVE: To determine the impact of three needleless intravenous systems on needlestick injury rates. DESIGN: Randomized controlled trial. SETTING: 1,000-bed tertiary-care Midwestern hospital. PARTICIPANTS: Nursing personnel from general medical, general surgical, and intensive-care units. INTERVENTIONS: From June 1992 through March 1994, a metal blunt cannula (MBC), two-way valve (2-way), and plastic blunt cannula (PBC) were introduced into three study areas, and needlestick injury rates were compared to three control areas using traditional needled devices. RESULTS: 24 and 29 needlestick injuries were reported in study and control areas. Intravenous-therapy-related injuries comprised 45.8% and 57.1% of injuries in each area. Thirty-seven percent and 20.7% of study and control area needlestick injuries were considered to pose a high risk of bloodborne infection. The 2-way group had similar rates of total and intravenous-related needlestick injuries compared to control groups. The PBC group had lower rates of total and intravenous-related needlestick injuries per 1,000 patient-days (rate ratios [RR], 0.32 and 0.24; 95% confidence intervals [CI95], 0.12-0.81 and 0.09-0.61; P = .02 and P = .003, respectively) and per 1,000 productive hours worked (RR, 0.11 and 0.08; CI95, 0.01-0.92 and 0.01-0.69; P = .03 and P = .005, respectively) compared to controls. CONCLUSIONS: Needlestick injuries continued in study areas despite the introduction of needleless devices, and risks of bloodborne pathogen transmission were similar to control areas. The PBC device group noted lower rates of needlestick injuries compared to controls, but there were problems with product acceptance, correct product use, and continued traditional device use in study areas. Low needlestick injury rates make interpretations difficult. Further studies of safety devices are needed and should attempt greater control of worker behavior to aid interpretation.

Accidents, Occupational↗
PubMed1996

Follow-up evaluation of respiratory isolation rooms in 10 midwestern hospitals.

As a follow-up to a 1992 study or respiratory isolation, we studied compliance with recommendations for respiratory isolation through smokestick testing (1993) and surveys (1994). Effective negative pressure was demonstrated in 80 of 156 rooms and was associated with the presence of anterooms (P < .001). The proportion of surveyed hospitals periodically testing isolation rooms increased from 0% (1992) to 30% (1993) to 100% (1994; P < .001).

Cross Infection↗
PubMed1996

The epidemiology of chest and leg wound infections following cardiothoracic surgery.

The occurrence of wound infections following cardiothoracic surgery has significant implications. However, the epidemiology of all chest and leg wound infections is infrequently described, and the effects on morbidity, mortality, and cost of care remain undefined. We identified 182 superficial and deep chest and leg infections in 163 patients following 1,554 coronary artery bypass graft (CABG), valve, and CABG/valve procedures over 30 months. The overall infection rate was 11.7%; infections of specific sites involved in the 1,554 procedures occurred at the following rates: 3.1%, superficial chest wounds; 2.3%, deep chest wounds; 4.6%, superficial leg wounds; and 2.2%, deep leg wounds. Chest infection rates were similar for all procedures. Multiple infections occurred in 9.8% of patients and were associated with female sex, diabetes, and prolonged surgery (P < .05). Purulent drainage and fever were more common in chest infections; erythema and pain were more common in leg infections (P < .05). Staphylococcus aureus (32.9%), coagulase-negative staphylococci (27.4%), and Enterobacteriaceae (26.0%) were identified most commonly. Enterobacteriaceae were more commonly isolated from leg wounds (P < .05). Adverse outcomes included reexploration (20.9%), flap surgery (12.3%), and death (4.3%). All adverse outcomes were more commonly associated with deep chest infections (P < .05), but superficial chest and leg infections also had a substantial impact on cardiothoracic surgery-related morbidity. Studies are needed to define site-specific risk factors so that the full potential of prevention and control measures can be realized.

Coronary Artery Bypass↗
PubMed1996

Nosocomial outbreak of gastroenteritis due to Salmonella senftenberg.

We describe a prolonged nosocomial outbreak of Salmonella senftenberg, an uncommon human pathogen. We detected 22 cases of infection due to S. senftenberg that occurred from March 1993 through November 1994 and involved 18 patients and four healthy employees. All infected persons had consumed food prepared by the hospital kitchen. The estimated attack rate for the period of the outbreak was 0.19-0.23 cases per 100,000 meals served. Infection control interventions included observation of food preparation, disinfection of kitchen devices, and education of food handlers. The consumption of lettuce (11 of 15 patients who could recount extended dietary histories vs. 4 of 20 controls; P = .005), cauliflower (5 of 15 vs. 0/20; P = .02), cottage cheese (4 of 15 vs. 0/20; P = .03), and deli turkey (8 of 15 vs. 0/20; P < .001) was associated with S. senftenberg infection. The isolates had identical antibiograms and pulsed-field gel electrophoretic patterns. Cultures of stool samples from food handlers as well as food items, kitchen devices, and kitchen surroundings were negative for S. senftenberg. Interruption of the outbreak occurred coincidentally with the institution of infection control measures. This prolonged outbreak of salmonellosis was probably related to contamination in the kitchen from turkey, with cross-contamination via equipment.

Adult↗
PubMed1995

Mechanical ventilation with or without 7-day circuit changes. A randomized controlled trial.

OBJECTIVE: To determine whether a practice of not routinely changing ventilator circuits in patients who require prolonged mechanical ventilation is associated with an increased incidence of nosocomial pneumonia. DESIGN: Randomized controlled trial. SETTING: Intensive care units in two university-affiliated teaching hospitals. PATIENTS: 300 patients admitted to an intensive care unit who required mechanical ventilation for more than 5 days. INTERVENTION: Patients were randomly assigned to receive either no routine ventilator circuit changes or circuit changes every 7 days. MEASUREMENTS: The primary outcome measure was the incidence of ventilator-associated pneumonia. Other outcome measures included duration of mechanical ventilation, length of hospital stay, and hospital mortality. RESULTS: 147 patients were randomly assigned to receive no routine ventilator circuit changes, and 153 patients were randomly assigned to receive circuit changes every 7 days. The two groups were similar at the time of randomization with regard to demographic characteristics, intensive care unit admission diagnoses, and severity of illness. Ventilator-associated pneumonia was seen in 36 patients (24.5%) receiving no routine changes and in 44 patients (28.8%) receiving changes every 7 days (relative risk, 0.85 [95% CI, 0.55 to 1.17]). No statistically significant differences for hospital mortality, intensive care unit mortality, death during mechanical ventilation, death in patients with ventilator-associated pneumonia, or mortality directly attributed to ventilator-associated pneumonia were found between the two treatment groups (P > or = 0.11). Patients receiving changes every 7 days had 247 circuit changes costing a total of $7410; patients receiving no routine changes had a total of 11 circuit changes costing $330. CONCLUSION: The elimination of routine ventilator circuit changes can reduce medical care costs without increasing the incidence of nosocomial pneumonia in patients who require prolonged mechanical ventilation.

Adult↗
PubMed1995

Risk factors for a positive tuberculin skin test among employees of an urban, midwestern teaching hospital.

OBJECTIVE: To determine the prevalence and incidence of and the relative risks for positive tuberculin skin tests among employees of a large, urban teaching hospital. DESIGN: Retrospective cohort study. SETTING: Barnes Hospital, St. Louis, Missouri. PARTICIPANTS: Hospital personnel employed at any time between January 1989 and July 1991. RESULTS: 684 of 6070 employees screened (11.3% [95% CI, 10.4% to 12.1%]) had positive tuberculin skin tests. Factors associated with a positive result were age (odds ratio, 2.02 per decade [CI, 1.87 to 2.18]; P < 0.0001); black race (odds ratio, 1.58 [Cl, 1.26 to 2.00]; P < 0.0001); Asian race (odds ratio, 16.7 [CI, 9.33 to 29.9]; P < 0.0001); Hispanic ethnicity (odds ratio, 9.45 [CI, 3.58 to 25.0]; P < 0.0001); and percentage of low-income persons within the employee's residential postal zone (odds ratio, 1.14 per 10% [CI, 1.05 to 1.23]; P = 0.001). Twenty-nine of 3106 employees who had at least two tests had skin-test conversions (0.93% [CI, 0.60% to 1.3%]); 15 of these conversions (52%) occurred among employees who had no direct contact with patients. Only the percentage of low-income persons within the employee's residential postal zone (odds ratio 1.39 [CI, 1.09 to 1.78]; P = 0.0075) was independently associated with conversion. CONCLUSIONS: The most important associations with a positive tuberculin skin test were older age, minority group status, and the proportion of low-income persons within the employee's residential postal zone. Skin-test conversion was independently associated only with the percentage of low-income persons in the employee's postal zone. Stratifying employees according to degree of contact with patients or according to departmental group was not useful in determining risk for a positive tuberculin skin test or for skin-test conversion. For certain groups of employees, an exposure to tuberculosis in the community probably poses a greater risk than exposure in the hospital setting.

Adult↗
PubMed1995

Risks of HIV infection in the health care setting.

Health care workers exposed to blood and body fluids have a low but measurable risk of occupational infection with human immunodeficiency virus (HIV). This risk is related to the prevalence of HIV among patients, the frequency of exposure to infected blood, and the method of exposure. The magnitude of risk is thus difficult to assess for any given situation, although the overall risk following percutaneous exposure is approximately 0.3%. Risk can be reduced by paying close attention to infection control procedures and by minimizing risky procedures. Exposure management should include preexposure education and immediate postexposure care and counseling. Chemoprophylaxis is widely used despite doubts as to its effectiveness, and much research is clearly needed to develop more effective prophylaxis. For patients, the risk of nosocomial acquisition of HIV remains extremely low and can be minimized by strict adherence to proper infection control procedures.

Cross Infection↗
PubMed1995

Improvement in user performance following development and routine use of an expert system.

Hospital-acquired (nosocomial) infections represent a significant cause of prolonged inpatient days and additional hospital charges. In many hospitals, infection control nurses manually review positive microbiology culture results to monitor the incidence and prevalence of potential nosocomial infections. We have developed an expert system called GermWatcherTM, which uses the United States Centers for Disease Control and Prevention National Nosocomial Infection Surveillance criteria to classify microbiology results as potential nosocomial infections. In February 1993, we deployed GermWatcher at a large tertiary-care teaching hospital. In July 1993, we implemented a revised version of GermWatcher. With each version, we performed an evaluation of the program by comparing its electronic classification of positive culture results to the paper-based manual classification performed by three infection control nurses and one Infectious Disease specialist (gold standard). In the present study, we focus not on changes in the performance of the expert system, but on changes in performance among the infection control nurses. We found significant improvement in agreement and accuracy in the manual classification of cultures by the infection control nurses in the second evaluation compared to the first evaluation. We attribute this improved manual performance to the development of the expert system's rule base throughout the two evaluation phases and to the use of the expert system in the nurses' daily activities.

Cross Infection↗
PubMed1994

Screening of physicians for tuberculosis.

OBJECTIVE: To determine the prevalence of tuberculous infection among a sample of physicians at Barnes Hospital and to determine the frequency of tuberculin skin testing and the adequacy of follow-up for physicians with positive tuberculin skin tests. DESIGN: Convenience sample. SETTING: 1,000-bed, university-affiliated tertiary care hospital. SUBJECTS: Physicians attending departmental conferences were screened for tuberculosis. Prior history of tuberculosis, antituberculous therapy, BCG vaccination, and previous tuberculin skin test results were obtained with a standardized questionnaire. Tuberculin skin tests were performed on those who were previously skin-test negative. OUTCOME MEASURE: Tuberculosis infection, prophylactic therapy. RESULTS: Eighty-six (24.5%) of 351 physicians in the study were skin test positive by history or currently performed skin test. Of 61 who reported a previously reactive skin test, 40 (66%) had been eligible for isoniazid prophylaxis, but only 15 (37.5%) of 40 had completed at least six months of therapy. Of 290 physicians reporting a previously negative skin test, 25 conversions (8.6%) were identified. Previously undiagnosed, asymptomatic pulmonary tuberculosis was identified in one physician. CONCLUSIONS: Infection with Mycobacterium tuberculosis is common among physicians. Physicians were screened irregularly for tuberculosis, and the use of prophylactic therapy was inconsistent. Aggressive tuberculosis screening programs for healthcare workers should be instituted (Infect Control Hosp Epidemiol 1994;15:95-100).

Adult↗
PubMed1993

Herpes simplex virus from respiratory tract secretions: epidemiology, clinical characteristics, and outcome in immunocompromised and nonimmunocompromised hosts.

PURPOSE: The purpose of this study was to review the course of patients with herpes simplex virus (HSV) recovered from respiratory tract secretions, and to compare the demographics, clinical characteristics, and outcomes of immunocompromised versus nonimmunocompromised patients. PATIENTS AND METHODS: Retrospective review of medical records of 42 consecutive patients who had respiratory tract cultures positive for HSV-1 between May 1988 and August 1990 at a major university-affiliated hospital. RESULTS: Twenty-seven patients (64%) were not immunocompromised. On the average, the nonimmunocompromised patients were 20 years older (mean age: 67 +/- 15, p = 0.001), had a higher incidence of tobacco smoking (p = 0.04), and were more frequently endotracheally intubated prior to HSV isolation (p = 0.002). Nonimmunocompromised patients more frequently had bronchospasm (44% versus 7%, p = 0.01), leukocytosis (16,400 versus 6,900/mm3, p = 0.001), and difficulty weaning from mechanical ventilation (63% versus 13%, p = 0.002). Mortality was also greater in the nonimmunocompromised group (70% versus 33%, p = 0.02). In addition, for survivors, days of mechanical ventilation (8 +/- 7 versus 2 +/- 4, p = 0.03), length of stay in the intensive care unit (10 +/- 8 versus 2 +/- 4 days, p = 0.004), and length of stay in the hospital (37 +/- 23 versus 16 +/- 14 days, p = 0.04) were all significantly longer for the nonimmunocompromised patients. CONCLUSION: These data suggest that HSV isolation from lower respiratory secretions is associated with a more severe presentation and a worse outcome in immunocompetent patients than in immunosuppressed patients.

Adult↗
PubMed1993

Evaluation of rooms with negative pressure ventilation used for respiratory isolation in seven midwestern hospitals.

OBJECTIVE: To determine the number and efficacy of respiratory isolation facilities in St. Louis hospitals and to assess the mechanisms in place for evaluating function of hospital ventilation systems. DESIGN: A prospective multi-hospital surveillance study using direct observation and a standardized questionnaire. SETTING: Seven hospitals (including university-affiliated large teaching, private community, private teaching, and private nonteaching adult hospitals, and one pediatric teaching hospital) in St. Louis, Missouri. MEASUREMENTS: Actual direction of airflow in rooms designated for respiratory isolation was measured using smokesticks. Hospital demographic information, respiratory isolation policies, and frequency of ventilation tests were provided by infection control personnel. RESULTS: One hundred twenty-one (3.4%) of 3,574 hospital rooms were designed to have negative pressure ventilation suitable for respiratory isolation. The percentage of isolation rooms in each institution ranged from 0.4% (92 of 486) to 93% (39 of 42). Only three (43%) of seven hospitals had intensive care respiratory isolation rooms, and none had isolation rooms in the emergency department. No hospital had tested routinely the efficacy of the negative pressure ventilation, and two (28%) of seven had tested airflow for the first time in the past year. We tested 115 (95%) of 121 isolation rooms. With the doors closed, 52 (45%) of 115 designated negative pressure rooms actually had positive airflow to the corridor. The number of negative pressure rooms and the presence or absence of anterooms did not predict correct direction of airflow. There was a significant difference among hospitals in the percentage of designated isolation rooms that had truly negative pressure (P < 0.0001). Hospital age, size, and type correlated with correct direction of airflow (P < 0.0001). CONCLUSION: In the hospitals studied, only a small number of rooms were designated for respiratory isolation, and the performance of these was not tested routinely. High-risk areas including intensive care units and emergency rooms were not equipped to provide respiratory isolation. The direction of airflow in respiratory isolation rooms was not always correct and should be evaluated frequently.

Cross Infection↗