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6 January 2009 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit Past highlights are accessible as well.

1. Outbreaks of Viral Hepatitis Linked to Lapses in Infection Control Practices in Health Care Settings

While transmission of Hepatitis B (HBV) and Hepatitis C (HCV) virus in health care settings is considered rare, recent reports of outbreaks indicate a growing problem. Over the past decade, there have been 33 outbreaks in nonhospital health care settings in the United States. These outbreaks have resulted in 450 persons acquiring HBV or HCV infection, and thousands more being placed at risk. Researchers looked at the circumstances surrounding these outbreaks to determine how health care exposure and practices contributed to transmission. In all cases, patient-to-patient transmission resulted from lapses in basic infection control practices among nonhospital health care personnel. According to researchers, health care is increasingly provided in outpatient settings in which infection control training and oversight may be inadequate. Nonetheless, viral hepatitis outbreaks are preventable, and health care should provide no opportunity for transmission. Researchers suggest that a comprehensive preventive approach that includes augmented viral hepatitis surveillance, health care provider education, training in appropriate infection control practices and techniques, improved oversight, and more uniform regulation could help prevent future outbreaks.

2. American College of Physicians Endorses the CDCís Revised Adult Immunization Schedule

The American College of Physicians, along with 16 other medical societies representing various medical practice areas, is endorsing the Centers for Disease Controlís (CDC) adult immunization schedule for 2009. Each year, the CDCís Advisory Committee on Immunization Practices (ACIP) reviews the recommended Adult Immunization Schedule to ensure the schedule reflects current recommendations for the licensed vaccines. The recommendations are intended to guide physicians and other clinicians about the appropriate vaccines for their adult patients. The 2009 schedule contains no new vaccines. However, several indications, footnotes, and clarifications have been made. Several indications were added to the pneumoncoccal polysaccharide vaccine footnote; clarifications were made to the footnotes for human papillomavirus, varicell, and meningococcal vaccines; and schedule information was added to the hepatitis A and hepatitis B vaccine footnotes. The Adult Immunization Schedule can be viewed at

3. Not All Pneumonias Should be Treated Equally: Health Care-associated Pneumonia is Most Serious, Requires Aggressive Treatment

Researchers sought to determine the epidemiology and outcome for patients with community-acquired, health care-associated, or hospital-acquired pneumonia. During two one-week surveillance periods, researchers looked at 362 patients hospitalized with pneumonia. They collected information to identify patients with how their pneumonia was acquired. They then compared information on antibiotics used for treatment, severity of pneumonia, length of hospital stay, and death rates among the three groups. The researchers found that patients with community-acquired pneumonia had the least complicated course, with the shortest hospital stays, and the lowest death rates. Conversely, patients with hospital-acquired pneumonia had the most complicated cases, the longest hospital stays, and the highest in-hospital death rates. Researchers concluded that health care-associated pneumonia is a more serious illness than community-acquired pneumonia with worse patient outcomes. They suggest that doctors carefully identify how patients contracted pneumonia, and administer the appropriate antibiotics for the type of pneumonia the patient has in accordance with established guidelines.

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