The authors are from the Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Perl is also from the Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland. Address correspondence to Trish M. Perl, MD, MSc, 425 Osler, 600 North Wolfe Street, The Johns Hopkins Hospital, Baltimore, MD 21287. tperl@jhmi.edu The Next Battleground for Patient Safety: Influenza Immunization of Healthcare Workers

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/87363E046D81C1F225F02BFFE609228D/S0899823X00199027a.pdf/div-class-title-the-next-battleground-for-patient-safety-influenza-immunization-of-healthcare-workers-div.pdf

The next battleground for patient safety: influenza immunization of healthcare workers.

Preparing for the next influenza pandemic

Background The use of artificial nails (ANs) as part of nail-care cosmetics is very popular. Several side effects and complications, such as contact dermatitis and bacterial and fungal infections, have been reported in patients using ANs.



Objective  The purpose of this study was to identify the fungal pathogens in nail abnormalities appearing in patients with ANs.



Methods  We evaluated 68 patients suffering from nail changes and paronychia, which appear after removal of ANs. Mycological samples were obtained from two sites: distal parts of the involved nail and the proximal nail fold. KOH examination and fungal culture were used for detection and identification of fungal infection.



Results  Mycological results from the distal part of the nail showed positive KOH test in 57 cases (83.8%), and culture was positive in 67 patients (98.5%). Mycological results obtained from the proximal nail fold showed positive KOH test in 36 patients (52.9%); in 36 of the cases, culture was positive. Candida spp. were the most common pathogen. Both KOH and culture results were significantly better while sampling from the distal part of the nail compared with sampling from the proximal nail fold (P = 0.0001).



Conclusion  Onychomycosis was found to be very common in nail changes due to ANs, leading to an increased risk of transmitting microbial infections. Therefore, health care personnel and workers in the food industry should avoid using ANs.

Onycomycosis due to artificial nails

The recent outbreak of avian influenza in Asia is a timely reminder of the ever present possibility of a human influenza pandemic in the near future.1 Work continues to develop vaccines effective against emergent influenza strains, but another component of effective prevention and infection control programs is the ability to administer vaccine in a timely and efficient manner. Even in the absence of a pandemic, influenza-associated respiratory and circulatory illness results in more than 200,000 hospitalizations and 36,000 deaths each year in the United States, according to recent estimates.2,3 These numbers suggest that the routine administration of influenza vaccine to targeted populations remains a major challenge. The efficacy of influenza and pneumococcal vaccines in preventing illness is well established,4,5 and during the past decade substantial progress has been made in increasing influenza and pneumococcal vaccination coverage in targeted populations. Estimates of influenza vaccination levels among individuals 65 years and older based on the National Health Interview Survey (NHIS) showed an increase from 33% in 1989 to 66% in the 2001–2002 season.4,6 NHIS estimates for pneumococcal vaccine coverage in this population also increased (from 15% in 1989 to 54% in 2001).6,7 However, influenza vaccination rates in all other targeted adult populations remained well below 50% in the 2001–2002 season, including healthcare workers (38%) and adults 18 to 49 years old with high-risk conditions (23%).4 Influenza vaccination rates among children at increased risk for influenza complications have also been low.4 This year, the Advisory Committee on Immunization Practices (ACIP) extended use of influenza vaccine by recommending vaccination for healthy children 6 to 23 months old and close contacts of children 0 to 23 months old.4 These figures suggest that despite some progress, targeted populations, including many workers and patients of healthcare institutions, still remain vulnerable. In this issue of Infection Control and Hospital Epidemiology, several articles address the challenges we face in further increasing vaccination levels among targeted populations.8-12 The study by Coyle and Currie is a welcome addition to the literature about interventions to increase pneumococcal vaccination rates among hospitalized patients.8 This study compared a standing orders protocol with computerized physician reminders and with routine practice in a prospective trial. The study found a clear superiority of standing orders over physician reminders, a finding consistent with previous studies13 and supportive of the ACIP recommendation for healthcare institutions to implement standing orders programs to increase pneumococcal and influenza vaccine coverage of high-risk individuals.4,5 Two studies examine employee influenza vaccination policies at healthcare institutions.9,10 In a large survey of healthcare institutions in North Carolina, Goldstein et al. found that only 38% reported having formal written policies regarding employee influenza vaccination.9 The lowest rates were found in assisted living facilities and dialysis centers. The authors also noted that barriers to increasing levels of influenza vaccination may differ depending on the type of institution, further emphasizing the need to adapt vaccination interventions to the specific needs of an individual institution. The article by Bryant et al. describes a survey of influenza vaccination policies among several pediatric hospitals.10 The median employee vaccination rate reported by infection control practitioners was 43% in this voluntary survey. A point-prevalence survey of employ-

/pdf/influenza-and-pneumococcal-vaccination-how-far-we-have-come-2fb7mbr6ee.pdf

Henry M. Wu

Papers

Influenza and pneumococcal vaccination: how far we have come and how to go farther.