Transmission of infectious diseases in outpatient health care settings

Article Abstract:

Patterns of nosocomial infections (those acquired in a hospital) among inpatients have been well characterized, and programs for their identification and prevention are required for accreditation of US hospitals. However, nosocomial infections among outpatients are less well understood and are not systematically monitored. This problem is particularly important because an increasing number of procedures are performed on an outpatient basis, and the possibility exists that serious agents such as human immunodeficiency virus could be transmitted in this fashion. To learn more about the transmission of infectious diseases in outpatient settings, a review of the medical literature concerning such outbreaks was carried out. Fifty-three reports of infectious disease transmission in such environments were found between 1961 and 1990; the agents included bacteria, viruses, and parasites. A list of the outbreaks is presented in tabular form. Between 1 and 132 people were affected in each; 29 were the result of transmission from contaminated solutions or equipment, 14 the result of spread from infected health care workers, and 10 were due to the spread of infected droplets from one person to another. The locations of infection were general medical offices, clinics, and emergency departments (23 cases); ophthalmologists' (eye specialists') offices and clinics (11 cases); dental offices (13 cases); and alternative care settings such as chiropractors' or acupuncturists' offices (6 cases). The main causes were inadequate disinfection and sterilization of equipment and instruments; inappropriate use of precautions by infected staff members, or failure to restrict their work; and inadequate hand-washing by medical personnel. Suggestions are presented for the appropriate epidemiological studies that should be conducted to learn more about infectious disease transmission in outpatient settings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Demographic aspects, Hospitals, Nosocomial infections, Cross infection, Hospital outpatient services

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Infectious diseases and injuries in child day care: opportunities for healthier children

Article Abstract:

Children who attend day care have a greater risk of contracting an infectious disease, but are less likely to be injured than children who remain at home. Day care centers are likely sources of infection because they contain many small children in a small area who are susceptible to diseases and may not be completely toilet-trained. Infections such as giardia, shigella, salmonella and hepatitis A can be transmitted by a fecal-oral route, and are best prevented by regular hand-washing. Respiratory diseases are the most common illnesses in day care centers. On the other hand, injury rates in day care centers are often lower than in homes. One study found the injury rate was almost half that in homes. Injuries commonly occur during play, and can be avoided by close supervision, elimination of risky behaviors and the use of safe playground equipment. A study of child abuse in day care centers found that the incidence was lower than the incidence in families.

Health aspects, Diseases, Day care centers, Preschool children

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School-based screening for tuberculous infection: a cost-benefit analysis

Article Abstract:

Screening high-risk school-aged children for tuberculosis may be more cost-effective than universal screening. Children born in foreign countries where tuberculosis is prevalent are considered high risk. Researchers performed a cost-benefit analysis of screening among 18,263 kindergartners and 15,639 high school students in Santa Clara County, California. The universal screening strategy would prevent about 15 cases per 10,000 children screened and the high-risk screening strategy would prevent about 85 cases per 10,000 children screened. The program cost of high-risk screening was $198,143 per year, compared to $471,320 for universal screening. For every dollar spent on the high-risk screening, $1.06 would be saved, compared to 58 cents for universal screening.

Models, Usage, Diagnosis, Tuberculosis, Medical screening, Health screening, Cost benefit analysis

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