September 14, 2001

Needs Assessment for Guidelines to Prevent Nosocomial Pneumonia: Canada
A questionnaire was sent to all CHICA-Canada, APPI, and CHEC members asking respondents to rate the usefulness of particular topics related to background information and recommendations and indicate preference for document formatting for a new guideline. Of 1202 questionnaires mailed out, 469 responses were received, a response rate of 39%. Background on the following topics was rated very useful: risk factors (85%), diagnosis (73%), etiologic agents (67%), epidemiology (55%) and pathogenesis (54%). Respondents rated recommendations on patient surveillance (81.4%) more useful than on environmental surveillance (69%). Recommendations for prevention relating to equipment (89%) and interrupting transmission of organisms (84%) ranked highest in importance. Recommendations for long term care were rated very useful by 73%. Preference was indicated for a concise document with details in appendices (57%) and separate background and recommendation sections (52%). Responses indicate that the majority believe there is need for good coverage of the topics relating to prevention of nosocomial pneumonia. These results and associated comments will be useful in developing a new guideline focused on the needs of Canadian Infection Control Professionals.
Source: Division of Nosocomial and Occupational Infections, Bureau of Infectious Diseases, Centre for Infectious Disease Prevention and Control, Health Canada, August 2001

Injection Drug Use: British Columbia
Many injection drug users (IDUs) seek care at emergency departments and some require hospital admission because of late presentation in the course of their illness. The Vancouver Injection Drug User Study (VIDUS), a prospective cohort study involving IDUs that began in 1996, determined the predictors of frequent emergency department visits and hospital admissions among community-based IDUs and estimated the incremental hospital utilization costs incurred by IDUs with early HIV infection relative to costs incurred by HIV-negative IDUs. The analyses were restricted to 598 participants who gave informed consent for the study. The data were obtained from participants' responses to the baseline VIDUS questionnaire and, from medical records at St. Paul's Hospital, Vancouver, for all visits or hospital stays between May 1, 1996, and Aug. 31, 1999. A total of 440 (73.6%) of the 598 IDUs made 2763 visits to the emergency department at St. Paul's Hospital during the study period. Of these 440,265 (60.2%) made three or more visits. The following factors were associated with frequent use: HIV-positive status, seroconverted during study period, more than four injections daily, cocaine use more frequent than use of other drugs and unstable housing. During the study period 210 of the participants were admitted to hospital 495 times; 118 (56.2%) of them were admitted frequently (two or more admissions). The two most common reasons for admission were pneumonia (132 admissions among 79 patients) and soft-tissue infections (cellulitis and skin abscess) (90 admissions among 59 patients). The following factors were independently associated with frequent hospital admissions: HIV-positive status; seroconverted during study period; and female sex. The incremental hospital utilization costs incurred by HIV-positive IDUs relative to the costs incurred by HIV-negative IDUs were $1752 per year. Hospital utilization was significantly higher among community-based IDUs with early HIV disease than among those who were HIV negative. Much of the hospital use was related to complications of injection drug use and may be reduced with the establishment of programs that integrate harm reduction strategies with primary care and addiction treatment.
Source: Canadian Medical Association Journal, Vol 165, No4, August 21, 2001

Vaccination Against Meningococcal C Disease : British Columbia
Risk factors for the deadly meningococcal disease typically rise in the fall due to an increase of indoor group gatherings and social activities, and students living in dorms are at higher risk of contracting the disease than other students. The Fraser Valley Health Region's Medical Officer of Health stressed that the only way they can stop this outbreak is through immunization of the affected group. Those in the high-risk group who qualify for free immunization are young adults aged 18-29 who live, work or study in Abbotsford, young adults aged 18-29 who live in Mission, Abbotsford high school students and teens born before December 31, 1987 and youth born between January 1, 1971 and December 31, 1987, regardless of where they live, who have repeated saliva sharing (since December 2000) with young adults aged 18-29 who live, work or study in Abbotsford. The group most at risk remains older high school students and young adults. The eight people who came down with meningococcal C disease in this outbreak were between the ages of 17 and 27, seven of whom lived in Abbotsford and one of whom lived in Mission but worked in Abbotsford. The fact that just over 90% of the grade 9 to 12 students in Abbotsford are immunized will help to stop the disease from spreading into the younger age groups.
Source: BC Centre for Disease Control Press Release, September 5, 2001

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.

[Infectious Diseases News Brief]