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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3233"
                     title="Tie Healthcare Jobs to Flu Vaccination, Groups Say (CME/CE)"
                     score="0.015"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/tb/21987?impressionId=1283457924433"
                     
      Healthcare workers should receive annual influenza vaccinations as a condition of employment and professional privileges, according to an updated position paper endorsed by two major infectious disease organizations.&lt;br&gt;
&lt;br&gt;Healthcare personnel have a professional and ethical responsibility to help prevent the spread of infectious pathogens among patients and themselves, a writing group for the Society of Healthcare Epidemiology of America (SHEA) concluded in a position paper published online in &lt;em&gt;Infection Control and Hospital Epidemiology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;SHEA views influenza vaccination of healthcare personnel as a core patient and healthcare personnel safety practice with which noncompliance should not be tolerated,&quot; Thomas R. Talbot, MD, of Vanderbilt University in Nashville, Tenn., and co-authors wrote.&lt;br&gt;
&lt;br&gt;The recommendation has the endorsement of the Infectious Diseases Society of America (IDSA).&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The update affirms and strengthens SHEA&apos;s support for vaccination against influence among healthcare personnel, originally set forth in a 2005 position paper, also endorsed by IDSA (&lt;em&gt;Infect Control Hosp Epidemiol&lt;/em&gt; 2005; 26: 882-890).&lt;/p&gt;
&lt;p&gt;&quot;Healthcare providers are ethically obligated to take measures proven to keep patients from acquiring influenza in healthcare settings,&quot; SHEA president Neil Fishman, MD, of the University of Pennsylvania in Philadelphia, said in a statement.&lt;/p&gt;
&lt;p&gt;&quot;Mandatory vaccination is the cornerstone to a comprehensive program designed to prevent the spread of influenza which also included identification and isolation of infected patients, adherence to hand hygiene and cough etiquette, the appropriate use of protective equipment, and restriction of ill healthcare personnel and visitors in the facility.&lt;/p&gt;
&lt;p&gt;Aside from making vaccination a condition of employment and privileges, the position paper incorporates new evidence that has come to light since publication of the 2005 document that strengthens SHEA&apos;s position on the issue, Talbot and coauthors noted.&lt;/p&gt;
&lt;p&gt;The 2005 document addressed vaccine allocation during shortages at the time, and SHEA&apos;s position on the topic has not changed, the authors wrote in an executive summary.&lt;/p&gt;
&lt;p&gt;SHEA&apos;s support for mandatory vaccination of healthcare personnel reflects &quot;continued frustration surrounding low and unimproved ... vaccination rates.&quot; A 2009 study by the Rand Corp. showed that almost 40% of healthcare workers had no plans to get vaccinated against influenza despite growing concern about the health threat posed by H1N1 virus.&lt;/p&gt;
&lt;p&gt;Studies based on statistical models have shown that a 100% vaccination rate among healthcare personnel in acute-care facilities would reduce the risk of influenza among hospitalized patients by 43%.&lt;/p&gt;
&lt;p&gt;Moreover, vaccination of all personnel in nursing homes would reduce influenza incidence among patients in those facilities by 60%, Talbot and coauthors noted. Other studies have shown that vaccination of healthcare personnel against influenza also reduces patient mortality, they added.&lt;/p&gt;
&lt;p&gt;Multiple healthcare facilities have already adopted mandatory vaccination policies; the first such policy was implemented in 2004 at Virginia Mason Medical Center in Seattle.&lt;/p&gt;
&lt;p&gt;After BJC Healthcare in St. Louis implemented a mandatory vaccination policy in 2008 to 2009, the vaccination rate among their healthcare personnel increased from 71% to 98.4%. Noting that eight employees were terminated for failure to get vaccinated, authors of the SHEA position paper cited the terminations as an indication of institutional commitment to its vaccination policy.&lt;/p&gt;
&lt;p&gt;In 2009, New York became the first state to require influenza vaccination for healthcare personnel.&lt;/p&gt;
&lt;p&gt;Influenza vaccination as a condition of employment should be a component of comprehensive immunization programs in healthcare settings. Other strategies recommended by SHEA include: &lt;ul&gt; &lt;li&gt;Using vaccination rates as a quality measure&lt;/li&gt; &lt;li&gt;Requiring unvaccinated personnel to wear a mask during influenza season&lt;/li&gt; &lt;li&gt;Requiring signed declination statements for personnel that refuse vaccination&lt;/li&gt; &lt;li&gt;Allowing exemptions from vaccination only in cases of medical contraindications&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Talbot disclosed relationships with Joint Commission Resources, GlaxoSmithKline, and Sanofi Pasteur, and spousal relationships with Wyeth, Vaxxinate, and Sanofi Pasteur.&lt;/p&gt;&lt;p&gt;Several coauthors of the writing committee disclosed relationships with mutiple commercial interests.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3230"
                     title="Hospital-Acquired Infections Trend Downward"
                     score="0.015"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/tb/21985?impressionId=1283457924433"
                     
      &lt;p&gt;Although healthcare-associated infections (HAIs) remain a large and at least partly avoidable problem in hospitals, it appears to be less of one than it was a few years ago, according to the Agency for Healthcare Research and Quality.&lt;/p&gt;
&lt;p&gt;After peaking in 2004 and 2005 at 2.30 per 1,000 hospital stays, HAI rates among adults declined to 2.03 per 1,000 stays in 2007, according to the most recent data from the Healthcare Cost and Utilization Project, summarized in an AHRQ statistical brief.&lt;/p&gt;
&lt;p&gt;The 2007 figure was identical to the rate seen in 2000 when the project first began collecting data, according to AHRQ researchers led by Claudia Steiner, MD, MPH.&lt;/p&gt;
&lt;p&gt;HAIs were recorded in just 0.2% of hospital stays in 2007.&lt;/p&gt;
&lt;p&gt;All patient subgroups, stratified by age, geographic region, and type of payer, shared in the decline, the researchers also found.&lt;/p&gt;
&lt;p&gt;The findings were seemingly at odds with &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/19568&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/19568&quot; target=&quot;_blank&quot;&gt;another AHRQ report&lt;/a&gt; issued earlier in the year. The agency&apos;s 2009 National Healthcare Quality Report, released in April, struck a pessimistic note by highlighting increases in the 2007 data for certain types of infections  --  postoperative sepsis and urinary tract infections  --  from 2006.&lt;/p&gt;
&lt;p&gt;But the new report indicates that, overall, 2007 was better than the previous year for HAIs, with the rate per 1,000 hospital stays down from 2.19 in 2006.&lt;/p&gt;
&lt;p&gt;No explanation for the downward trend was offered by Steiner and colleagues, but other investigators who have identified declining hospital infection rates have suggested that improved adherence to treatment guidelines and better management of risk factors for HAIs are responsible.&lt;/p&gt;
&lt;p&gt;The new report identified several hospital characteristics that were significantly (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) associated with increased rates of HAIs: &lt;ul&gt; &lt;li&gt;Hospital size of 500 beds or more&lt;/li&gt; &lt;li&gt;Location in metropolitan area&lt;/li&gt; &lt;li&gt;Teaching hospital&lt;/li&gt; &lt;li&gt;Private for-profit status&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The report also indicated that stays marked by HAIs were distributed almost equally between male and female patients, in contrast with the nearly 2:1 ratio of women to men among hospital patients overall.&lt;/p&gt;
&lt;p&gt;The Healthcare Cost and Utilization Project collects data on all inpatients treated at a rotating nationwide sample of about 1,000 short-term, non-federal hospitals.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3145"
                     title="Hand Cleansers Cut Absenteeism (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/InfectiousDisease/InfectionControl/tb/21868?impressionId=1283457924433"
                     
      Putting alcohol-based hand cleansers in work places slashed the incidence of several common infections and reduced the number of workdays lost, a randomized trial showed.&lt;br&gt;
&lt;br&gt;Access to the disinfectants was associated with odds ratios of 0.35 to 0.45 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) for reported colds, fevers, and coughs in an unblinded trial with 129 participants, according to Nils-Olaf H&amp;#252;bner, MD, of the Institute of Hygiene and Environmental Medicine in Greifswald, Germany, and colleagues.&lt;br&gt;
&lt;br&gt;The researchers also found that putting disinfectants on employees&apos; desks helped reduce absenteeism. The effect was modest overall, but workdays lost because of diarrhea were cut dramatically, they reported in the online open-access journal &lt;em&gt;BMC Infectious Diseases&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Eight workers in the control group said they took days off because of diarrhea, compared with one in the intervention group (OR 0.11, 95% CI 0.01 to 0.93).&lt;/p&gt;
&lt;p&gt;&quot;Our results confirm the findings from other authors, that hand disinfection has preventive effects against acute respiratory and gastrointestinal infections,&quot; H&amp;#252;bner and colleagues wrote.&lt;/p&gt;
&lt;p&gt;Participants were white-collar workers reporting frequent contact with customers or archived paper&lt;strong&gt; &lt;/strong&gt;at a local university and at city and state administrative offices and were recruited by mail or e-mail (response rate 16%). The study period lasted about 13 months from 2005 to 2006.&lt;/p&gt;
&lt;p&gt;Those assigned to the intervention were initially given an ethanol-based antiseptic hand rub. Those who had skin reactions such as dryness or erythema were given a different product containing propanol and mecetronium etilsulfate.&lt;/p&gt;
&lt;p&gt;Both were liquids provided in bottles for desktop use. Participants were told to wet their hands fully with the rubs at least five times a day, especially after visiting the restroom, blowing their noses, before eating, and after touching other people or papers. However, they were also told not to use the rubs at home or otherwise change their hand hygiene away from work.&lt;/p&gt;
&lt;p&gt;No hand-hygiene behaviors were suggested to the control group.&lt;/p&gt;
&lt;p&gt;Both groups completed monthly questionnaires on the incidence of nine respiratory and gastrointestinal symptoms or diagnoses and whether workdays were missed as a result. At the end of the study, participants in the intervention also indicated their compliance with the hand-hygiene protocol.&lt;/p&gt;
&lt;p&gt;No significant benefit for the disinfectants was found for five of the symptoms and conditions: sinusitis, sore throat, bronchitis, pneumonia, and influenza.&lt;/p&gt;
&lt;p&gt;Significant reductions in rates of colds, fevers, and coughing were seen, expressed as odds ratios relative to the control group: &lt;ul&gt; &lt;li&gt;Colds: OR 0.35 (95% CI 0.17 to 0.71)&lt;/li&gt; &lt;li&gt;Fever: OR 0.38 (95% CI 0.14 to 0.99)&lt;/li&gt; &lt;li&gt;Coughing: OR 0.45 (95% CI 0.22 to 0.91)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;When H&amp;#252;bner and colleagues looked at lost workdays, they found that these differed significantly for two of the conditions  --  diarrhea, as noted earlier, and also bronchitis.&lt;/p&gt;
&lt;p&gt;But in the latter case, it went in the opposite direction  --  workdays lost because of bronchitis were more common in the intervention group, with nine of those employees reporting lost workdays compared with two in the control group (OR 5.16, 95% CI 1.07 to 24.88).&lt;/p&gt;
&lt;p&gt;H&amp;#252;bner and colleagues offered no explanation for this paradoxical-seeming result. They noted, though, that effects on relatively uncommon but long-lasting conditions for which individuals may have a predisposition, such as bronchitis and sinusitis, &quot;are hard to interpret&quot; because one such episode can have a large effect on the data.&lt;/p&gt;
&lt;p&gt;Another discordant result was that, although lost workdays because of diarrhea were much less common in the intervention group, the rates of diarrhea overall did not differ significantly between groups (OR 0.48 for the intervention versus control, 95% CI 0.19 to 1.22).&lt;/p&gt;
&lt;p&gt;Limitations to the study included the low response rate to the invitations to participate, the use of both semichronic and acute conditions as endpoints, reliance on participants&apos; self-reports of symptom incidence and duration, and lack of data on work place productivity other than missed workdays.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Bode Chemie, manufacturer of the hand rubs used in the study.&lt;/p&gt;&lt;p&gt;Hu&amp;#776;bner and one co-author reported past grant support from Bode Chemie. Another co-author was an employee of Bode Chemie.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3107"
                     title="Hepatitis E Vaccine Candidate Completely Blocked Disease (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/InfectiousDisease/Hepatitis/tb/21823?impressionId=1283457924433"
                     
      &lt;p&gt;An investigational vaccine against hepatitis E was shown to be completely effective in a large randomized trial in China, researchers reported.&lt;/p&gt;
&lt;p&gt;The trial, involving more than 100,000 patients, found that none of the patients who received the full three doses of the vaccine (HEV 239 or Hecolin) developed hepatitis E over a 12-month follow-up, according to Ning-Shao Xia, MD, of Xiamen University in Xiamen, China, and colleagues.&lt;/p&gt;
&lt;p&gt;In contrast, there were 15 cases of hepatitis E among the participants in the placebo arm (who were given a licensed hepatitis B vaccine)  --  for an efficacy rate of 100%, Xia and colleagues reported online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The vaccine efficacy was equally high when the analysis was expanded to include participants who only got two doses and reached 95.5% among those who got at least one dose, the researchers reported.&lt;/p&gt;
&lt;p&gt;Although the existence of hepatitis E has been known for years, research into the virus has largely been neglected. (See &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ICAAC/16022&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ICAAC/16022&quot; target=&quot;_blank&quot;&gt;ICAAC: Hepatitis E Virus Finally Gets Some Respect&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;But hepatitis E is widespread  --  estimates suggest that a third of the world&apos;s people are infected  --  and can cause serious disease and death, especially in the developing world, according to background provided by the researchers.&lt;/p&gt;
&lt;p&gt;The double-blind, randomized, placebo-controlled trial was done between August, 2007, and June, 2009 in Jiangsu Province in China, where the virus is endemic. In fact, a preliminary analysis of more than 11,000 of the trial participants showed that 47% already had antibodies against hepatitis E, the researchers reported.&lt;/p&gt;
&lt;p&gt;All told, the investigators randomly assigned 56,302 volunteers to get three doses of the vaccine (delivered intramuscularly at baseline, one, and six months) and 56,302 to get the hepatitis B vaccine on the same schedule.&lt;/p&gt;
&lt;p&gt;The main analysis included those who got all three doses -- 86% in each arm -- and were followed for 12 months starting the 31st day after the last dose.&lt;/p&gt;
&lt;p&gt;In that group, there were no cases in the vaccine arm and 15 in the placebo arm.&lt;/p&gt;
&lt;p&gt;As well, five additional volunteers  --  all in the placebo group  --  developed hepatitis E during the period from 14 days after the second dose and before the third dose, the researchers reported, yielding an efficacy rate of 100% among trial participants who got two doses of vaccine.&lt;/p&gt;
&lt;p&gt;In the entire cohort, there were 23 cases of hepatitis E recorded during the follow-up  --  including a case in one volunteer in the vaccine group who had received only one dose, and 22 cases among participants in the placebo group, producing an efficacy rate of 95.5%.&lt;/p&gt;
&lt;p&gt;The high efficacy rate after two doses suggests that the vaccine can be deployed quickly and would be effective in the context of an outbreak or for travelers to an endemic area, the researchers argued.&lt;/p&gt;
&lt;p&gt;The researchers concluded that the vaccine was well tolerated and effective among a general adult population. &quot;Further studies are needed to assess the safety and to support the benefits of the vaccine for pregnant women and for people younger than 15 years or older than 65 years.&quot; they added.&lt;/p&gt;
&lt;p&gt;Adverse events were mostly mild and local, including pain and swelling at the injection site, Xia and colleagues reported.&lt;/p&gt;
&lt;p&gt;The study is &quot;an important event in the prevention and control of hepatitis E.&quot; according to Scott Holmberg, MD, of the CDC.&lt;/p&gt;
&lt;p&gt;In an accompanying comment, Holmberg said that a safe and effective vaccine  --  if it&apos;s affordable  --  &quot;raises the prospect&quot; of routine vaccination to reduce the impact of chronic hepatitis E, as well as epidemic outbreaks.&lt;/p&gt;
&lt;p&gt;Vaccines, he argued, should not substitute for improvements in sanitation. But, given that sanitary conditions in many places have been slow to improve, &quot;this vaccine might be our best new stopgap in the effort to control the scourge of (hepatitis E) in many parts of the world,&quot; he concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from the Chinese National High-tech R&amp;amp;D Programme, the Chinese National Key Technologies R&amp;amp;D Programme, the Chinese National Science Fund for Distinguished Young Scholars, the Fujian Provincial Department of Sciences and Technology, the Xiamen Science and Technology Bureau, and the Fujian Provincial Science Fund for Distinguished Young Scholars.&lt;/p&gt;&lt;p&gt;Two of the authors are employees of Xiamen Innovax Biotech, which is developing the vaccine. The remaining authors, including Xia, said they had no conflicts.&lt;/p&gt;&lt;p&gt;Holmberg said he had no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3063"
                     title="HBV Damage Disappears With Long-Term Therapy (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/Gastroenterology/Hepatitis/tb/21736?impressionId=1283457924433"
                     
      &lt;p&gt;Long-term treatment with entecavir (Baraclude) at least partially reverses cirrhosis and fibrosis in most chronic hepatitis B patients, according to extended follow-up of a clinical trial.&lt;/p&gt;
&lt;p&gt;In nucleoside-naive patients, liver biopsies taken at least six years after starting on three or more years of entecavir treatment revealed histologic improvement in 96% of patients.&lt;/p&gt;
&lt;p&gt;Fibrosis score improved by at least one point in 88% of patients as well, found Ting-Tsung Chang, MD, of National Cheng Kung University Hospital in Tainan, Taiwan, and colleagues.&lt;/p&gt;
&lt;p&gt;All 10 patients with advanced disease at baseline saw improvements in fibrosis and cirrhosis long term, the researchers reported in the September issue of &lt;em&gt;Hepatology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;These results add to evidence challenging the idea that fibrosis is an irreversible and relentlessly progressive process, they noted.&lt;/p&gt;
&lt;p&gt;The researchers analyzed outcomes from 69 patients who provided a long-term biopsy sample after having received entecavir for a total of at least three years as part of one of two identical phase III randomized trials, followed by rollover into an open-label study in which all patients got 1.0 mg entecavir daily.&lt;/p&gt;
&lt;p&gt;The &lt;a href=&quot;http://www.medpagetoday.com/Gastroenterology/Hepatitis/2818&quot; mce_href=&quot;http://www.medpagetoday.com/Gastroenterology/Hepatitis/2818&quot; target=&quot;_blank&quot;&gt;randomized phase&lt;/a&gt; of the trials showed entecavir superior to lamivudine (Epivir) for both patients with chronic e antigen-negative hepatitis B and those with e antigen-positive infections. All patients were nucleoside-naive before the trial.&lt;/p&gt;
&lt;p&gt;Among the 57 patients who met criteria for the long-term efficacy analysis, the median time on entecavir was approximately six years (range three to seven).&lt;/p&gt;
&lt;p&gt;The rate of histologic improvement compared with baseline rose to 96% at the long-term assessment, compared with 73% after just 48 weeks of therapy.&lt;/p&gt;
&lt;p&gt;The same was true for the proportion with at least a one-point improvement in Ishak fibrosis score, rising from 32% at 48 weeks to 88% at the long-term assessment.&lt;/p&gt;
&lt;p&gt;For those with necroinflammation by the Knodell classification at baseline, 75% dropped down to no or minimal necroinflammation long term. Among those with fibrosis at baseline, 72% had no or minimal fibrosis long term.&lt;/p&gt;
&lt;p&gt;Only one of the 57 patients showed an increase in Ishak fibrosis score (1 at baseline versus 2 at long-term biopsy) despite undetectable HBV DNA, normal liver enzymes, and an improvement in necroinflammatory score long term.&lt;/p&gt;
&lt;p&gt;Virologic suppression  --  HBV DNA under 300 copies/mL  --  was maintained for all patients at the time of long-term biopsy, while 86% had normalized alanine transaminase (ALT).&lt;/p&gt;
&lt;p&gt;As expected from the sustained virologic response, there was no evidence of virologic rebound or development of antiviral drug resistance, the researchers noted.&lt;/p&gt;
&lt;p&gt;Although 55% of patients lost e antigen and 33% had seroconversion during long-term treatment, those who didn&apos;t also showed improved liver histology and reversal of fibrosis, which Chang&apos;s group pointed to as evidence that &quot;these outcomes are more closely associated with HBV DNA suppression than with immunologic response to therapy.&quot;&lt;/p&gt;
&lt;p&gt;Moreover, the results confirm the value of long-term treatment for chronic hepatitis B, they concluded.&lt;/p&gt;
&lt;p&gt;&quot;The safety profile, potent suppression of HBV replication, and low potential for antiviral drug resistance in nucleoside-naive patients make long-term treatment of chronic hepatitis B with entecavir monotherapy possible,&quot; they wrote in the paper.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was sponsored by the Bristol-Myers Squibb Pharmaceutical Research Institute.&lt;/p&gt;&lt;p&gt;Chang reported having research funding from Gilead Sciences, Bristol-Myers Squibb, GlaxoSmithKline, Schering-Plough, and Pfizer, as well as receiving speech honoraria from Bristol-Myers Squibb and Schering-Plough.&lt;/p&gt;&lt;p&gt;Several co-authors reported being employees of Bristol-Myers Squibb.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>