Objective.To increase and sustain hospital-wide compliance with hand hygiene through a long-term ongoing multidimensional improvement program emphasizing behavioral factors.Design.Quasi-experimental short study (August 2000-November 2001) and descriptive time series (April 2003-December 2006).Setting.A 450-bed teaching tertiary-care hospital.Interventions.An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives.Results.A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities;P< .001, compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%–84% of 6,420 opportunities 2 years after hospital-wide dissemination, and remained improved at 59%–81% of 4,990 opportunities during year 6 of the program.Conclusion.This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.

Background: Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in neonatal intensive care unit settings. Historically, authors have questioned the clinical significance of these bacteremia episodes. Recently, clusters of CoNS bacteremia associated with significant morbidity have been reported. The frequency and importance of these clusters of bacteremia and their associated morbidity remains unclear. Objective: We studied a prolonged cluster of 52 cases of persistent CoNS bacteremia in a level III neonatal intensive care unit to clarify risk factors, morbidity and outcomes associated with persistent CoNS bacteremia. Study Design: A retrospective case-control study of infants with CoNS bacteremia >48 h after initiation of appropriate antibiotics and gestational age-matched control infants was performed. We reviewed patient characteristics prior to and during bacteremia, and outcomes at discharge or death. Results: Persistently infected infants were significantly more likely to have greater duration of exposure to parenteral nutrition, hydrocortisone, antibiotics, and mechanical ventilation prior to infection. Persistently infected infants were significantly more likely than controls to experience feeding intolerance and to require inotropic support, increased respiratory support, and blood product transfusion during bacteremia. Infants with persistent CoNS bacteremia took longer to achieve full enteral feeds, had higher rates of chronic lung disease and increased length of stay compared to controls. No significant difference in mortality was noted. Conclusions: Persistent CoNS bacteremia is associated with clinically significant morbidity including feeding intolerance, respiratory failure, blood transfusion and chronic lung disease in this patient population. This impacts hospital course, increases length of stay and impacts medical needs after discharge. During this study, CoNS bacteremia was difficult to clinically eradicate despite in vitro antibiotic susceptibility.

An outbreak of methicillin-resistant Staphylococcus aureus infections at the University of Utah Health Sciences Center occurred over a 7-month period. While the isolates phenotypically appeared to be similar in gross morphology and have similar Vitek antibiotic susceptibility patterns, two additional methods of strain characterization were evaluated to enhance the epidemiological investigation: pulsed-field gel electrophoresis and gas chromatography with the MIDI Sherlock system. Sherlock uses gas chromatography to qualitatively and quantitatively analyze the cellular fatty acid composition of organisms and creates two-dimensional plots based on principal-component analysis to define groups of closely related organisms. All isolates were also evaluated by digesting their chromosomal DNAs with the low-frequency-cutting enzyme SmaI and separating the restriction fragments by contour-clamped homogeneous electric field gel electrophoresis. Sample preparation for this pulsed-field gel electrophoresis included a novel cell lysis procedure involving achromopeptidase, greatly reducing the turnaround time. Isolates tested were recovered from the following: 45 suspected outbreak patients, 6 hospitalized patients believed to be unrelated to the outbreak, 6 patients from outside the hospital, and one health care practitioner implicated in the outbreak. Of 45 phenotypically similar suspect strains, 43 clustered tightly on the Sherlock two-dimensional plot. All outbreak patient isolates were also identical by pulsed-field gel electrophoresis with the exception of the same two outliers identified by Sherlock. In this epidemiologic investigation, we found an excellent correlation between the Sherlock and pulsed-field gel electrophoresis results for strain characterization of methicillin-resistant S. aureus.

DHA is an important component of the brain. Red blood cell (RBC) DHA levels are thought to be related to brain DHA content and to visual acuity in infancy. The DHA content of the RBC of infants is determined by the DHA content of the feeding. To assess the effects of different levels of formula DHA on RBC DHA levels of infants, we conducted a multi-center, double-blind, prospective study. Infants were randomized to one of two infant formulas: Formula Higher DHA with DHA at 0.32% of total fatty acids, similar to worldwide mean levels found in breast milk, and Formula Lower DHA with DHA at 0.15% of total fatty acids, similar to lower levels typically found in breast milk in the USA. Infants were fed study formula from 14 through 120 days of age. Fatty acids in blood lipid fractions were analyzed by capillary gas chromatography at 120 days of age. The table summarizes DHA levels in total-RBC lipids, RBC-phosphatidylcholine (RBC-PC), RBC-phosphatidylethanolamine (RBC-PE), and plasma phospholipids (Plasma-PL) at 120 days (% of total fatty acids, Mean Ϯ SE).Both formulas were well tolerated, and infants in both groups had similar growth. We conclude that infants fed formula containing higher levels of DHA have significantly higher circulating levels of DHA. We speculate that greater incorporation of DHA into brain and retinal tissues may result from higher circulating levels of RBC DHA. EGR-1 NULL MICE EXHIBIT IMPAIRED HEPATIC REGENERATION.Yunjun Liao, Olga N. Shikapwashya, Eyal Shteyer, and David A. Rudnick, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.The liver regenerates itself in response to a wide variety of injuries. The rodent partial hepatectomy model has been a useful tool with which to investigate the signals that regulate this regenerative response. These signals include activation of an immediate-early gene expression program during early liver regeneration which directs growth factor-dependent hepatocellular proliferation and leads to restoration of normal hepatic mass. The early growth response 1 transcription factor (EGR-1), whose expression is known to be regulated in a variety of models of cellular growth and differentiation, has been shown to be induced as part of the immediate early gene expression response during liver regeneration. In the studies reported here the functional significance of EGR-1 expression during liver regeneration was examined by characterizing the hepatic regenerative response to partial hepatectomy in EGR-1 null mice. The results of these studies showed that liver regeneration in EGR-1 null mice is impaired. Although the early signaling events leading up to the first wave of hepatocellular DNA synthesis occurred normally following partial hepatectomy in EGR-1 null mice, subsequent signaling events and cell cycle progression after the first round of DNA synthesis were deranged. This derangement was characterized by increased activation of the p38 mitogen activated protein kinase and inhibition of hepatocellular metaphase-to-anaphase mitotic...