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\"As the Zika virus continues to spread throughout North America, people need answers. What are the origins of this virus? How does it spread? Should we be concerned? How can we stop the spread of infected mosquitos? With the increasing prevalence of Zika, concrete answers are needed now more than ever - The Zika Prevention Handbook serves as the best reference for readers to stay informed about side-effects and symptoms, and to minimize your chance of contracting the virus. The Zika virus is a mosquito-borne infection that is estimated to have originated in Africa in the mid 1940's. In the last several years, the Zika virus has infected thousands of people around the world and has spread to over 60 countries. As of August 2016, Zika-infected mosquitoes have found a new home, the United States. The Zika virus has been reported in all 50 U.S. states, in addition to hundreds of reported cases throughout Mexico and Canada. With the assistance of infectious disease expert, Laura D. Kramer, PhD, author Alexander Webb has compiled the leading research from the U.S. Centers for Disease Control and Prevention (CDC). Whether you're an expectant mother worried about microcephaly (a side effect of Zika that causes babies to be born with abnormally small heads), planning a vacation to a tropical area, or living in an area where these contagious mosquitoes reside, this book is guaranteed to answer all your questions and ease your fears. Readers will learn about Zika's origins, transmission of the infection, leading prevention techniques, medical testing, symptoms and diagnosis, and much more.\" --Publisher's description.

The hospital environment is a reservoir for the transmission of microorganisms. The effect of improved cleaning on patient-centred outcomes remains unclear. We aimed to evaluate the effectiveness of an environmental cleaning bundle to reduce health care-associated infections in hospitals. The REACH study was a pragmatic, multicentre, randomised trial done in 11 acute care hospitals in Australia. Eligible hospitals had an intensive care unit, were classified by the National Health Performance Authority as a major hospital (public hospitals) or having more than 200 inpatient beds (private hospitals), and had a health-care-associated infection surveillance programme. The stepped-wedge design meant intervention periods varied from 20 weeks to 50 weeks. We introduced the REACH cleaning bundle, a multimodal intervention, focusing on optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning. The primary outcomes were incidences of health-care-associated Staphylococcus aureus bacteraemia, Clostridium difficile infection, and vancomycin-resistant enterococci infection. The secondary outcome was the thoroughness of cleaning of frequent touch points, assessed by a fluorescent marking gel. This study is registered with the Australian and New Zealand Clinical Trial Registry, number ACTRN12615000325505. Between May 9, 2016, and July 30, 2017, we implemented the cleaning bundle in 11 hospitals. In the pre-intervention phase, there were 230 cases of vancomycin-resistant enterococci infection, 362 of S aureus bacteraemia, and 968 C difficile infections, for 3 534 439 occupied bed-days. During intervention, there were 50 cases of vancomycin-resistant enterococci infection, 109 of S aureus bacteraemia, and 278 C difficile infections, for 1 267 134 occupied bed-days. After the intervention, vancomycin-resistant enterococci infections reduced from 0·35 to 0·22 per 10 000 occupied bed-days (relative risk 0·63, 95% CI 0·41–0·97, p=0·0340). The incidences of S aureus bacteraemia (0·97 to 0·80 per 10 000 occupied bed-days; 0·82, 0·60–1·12, p=0·2180) and C difficile infections (2·34 to 2·52 per 10 000 occupied bed-days; 1·07, 0·88–1·30, p=0·4655) did not change significantly. The intervention increased the percentage of frequent touch points cleaned in bathrooms from 55% to 76% (odds ratio 2·07, 1·83–2·34, p<0·0001) and bedrooms from 64% to 86% (1·87, 1·68–2·09, p<0·0001). The REACH cleaning bundle was successful at improving cleaning thoroughness and showed great promise in reducing vancomycin-resistant enterococci infections. Our work will inform hospital cleaning policy and practice, highlighting the value of investment in both routine and discharge cleaning practice. National Health and Medical Research Council (Australia).

In this cluster-randomized trial, the use of expanded barrier precautions did not decrease the incidence of vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units; however, adherence to the precautions was suboptimal. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) are major causes of health care–associated infection. 1 Infections caused by these bacteria are usually preceded by colonization of mucous membranes, skin, wounds, or the gastrointestinal tract. Colonization occurs by means of indirect patient-to-patient transmission of MRSA and VRE through the hands of health care providers and through contaminated fomites and environmental surfaces 2 , 3 or, less commonly, by direct transmission from colonized health care providers. 4 Standard interventions to prevent the transmission of MRSA and VRE in health care facilities include hand hygiene, the use of barrier precautions (gloves and gowns) in the care . . .

Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.

In this cluster-randomized study at ICUs in six hospitals, chlorhexidine-impregnated washcloths were associated with significantly lower rates of bloodstream infections and acquisition of multidrug-resistant organisms than were nonantimicrobial washcloths. Multidrug-resistant organisms (MDROs), including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE), have become endemic in many acute care and long-term care facilities. 1 – 5 Infections with these organisms are often difficult to treat, owing to a dwindling armamentarium of active antimicrobial agents. The Centers for Disease Control and Prevention (CDC) has promulgated a variety of strategies, including hand hygiene and the use of isolation precautions, to limit the spread of these organisms among patients, but these strategies require consistent adherence to practices by large numbers of health care personnel during frequent patient encounters and can be difficult to sustain. 6 In . . .

In an open-label, randomized study involving men who have sex with men, doxycycline use after high-risk sexual exposure reduced the incidence of sexually transmitted infections (chlamydia, gonorrhea, and syphilis).

Staphylococcus aureus is an important cause of surgical-site infections. In this randomized trial, eradication of colonization by rapid screening at admission and subsequent decolonization (with intranasal mupirocin and chlorhexidine skin washes) were associated with a decrease in postoperative surgical-site infections. In this randomized trial, eradication of colonization with S. aureus by rapid screening at admission and subsequent decolonization (with intranasal mupirocin and chlorhexidine skin washes) were associated with a decrease in postoperative surgical-site infections. Nasal carriers of high numbers of Staphylococcus aureus organisms have a risk of health care–associated infection with this microorganism that is three to six times the risk among noncarriers and low-level carriers. 1 – 3 More than 80% of health care–associated S. aureus infections are endogenous. 4 – 6 Intranasal application of mupirocin has been shown to be effective for the decolonization of this microbe and the prevention of invasive S. aureus infections in patients receiving long-term dialysis treatment. 7 – 10 However, in other nonsurgical patients, mupirocin had no effect on the rate of health care–associated S. aureus infections. 11 Mupirocin nasal ointment was reported to . . .

Prevention of nosocomial infection, especially with MRSA, is a high priority. In this trial involving 74 ICUs at 43 hospitals, universal decolonization with the use of chlorhexidine and mupirocin was associated with a decrease in all-cause bloodstream infections. Health care–associated infection is a leading cause of preventable illness and death and often results from colonizing bacteria that overcome body defenses. 1 – 5 Among the pathogens causing health care–associated infection, methicillin-resistant Staphylococcus aureus (MRSA) has been given priority as a target of reduction efforts because of its virulence and disease spectrum, multidrug-resistant profile, and increasing prevalence in health care settings, particularly among patients in the intensive care unit (ICU). Hospitals commonly screen patients in the ICU for nasal carriage of MRSA and use contact precautions with carriers. 2 – 6 Nine states mandate such screening. 7 Decolonization has been used to reduce transmission . . .

In a phase 3 trial, adults (≥60 years of age) received one 120-μg dose of RSVpreF vaccine (17,215) or placebo (17,069). Vaccine efficacy against RSV-associated lower respiratory tract illness was 67 to 86%.