Death due to community-associated Clostridium difficile in a woman receiving prolonged antibiotic therapy for suspected lyme disease.

munity influenza exposure, as measured according to the presence of ill household members. Frontline HCWs were defined as staff who worked in the emergency department , triage unit, or outpatient clinic and screened patients with suspected 2009 H1N1 influenza. In this hospital, all HCWs with suspected or confirmed 2009 H1N1 influenza have been required to report to the hospital's occupational health unit since May 2009, and the infection control policy was for HCWs to wear surgical masks while caring for patients with suspected 2009 H1N1 influenza, whereas the use of N95 masks was restricted to aerosol-generating procedures. A hospital-wide hand hygiene program with monthly monitoring and feedback has been sustained since July 2006 [6]. During the 7.5-month study period, 69 HCWs had confirmed 2009 H1N1 influenza , 51 (74%) of whom met the criteria for HA 2009 H1N1 influenza. Eighteen HCWs with 2009 H1N1 influenza were excluded because of potential community influenza exposure (they had ill household members). All 51 HCWs consented to study enrollment; the median age of the study group was 36 years (range, 24–54 years), and 24 (47%) of 51 HCWs reported unprotected exposure to patients with confirmed 2009 H1N1 influenza (Table 1). Nurses were the most frequently exposed (26 [51%] of 51 exposed HCWs), and most exposures occurred on medical units (30 [59%] of 51 exposed HCWs). According to multivariate analysis, unprotected exposure to patients with 2009 H1N1 influenza (adjusted odds ratio [aOR], 2.41 [95% confidence interval {CI}, 1.19–16.71]) was the sole factor associated with HA 2009 H1N1 influenza infection in the case group, whereas protective factors for the control group included assignment to units with 175% adherence to hand hygiene practices (aOR, 0.45 [95% CI, 0.27–0.89]), use of a surgical mask while caring for a patient with suspected 2009 H1N1 influenza (aOR, 0.79 [95% CI, 0.41–0.99]), and assignment as a frontline HCW who cared for patients with suspected or confirmed 2009 H1N1 influenza (aOR, 0.83 [95% CI, 0.46–0.98]). Notably, exposure to patients who did not meet criteria for influenza-like illness was associated with a high proportion of unprotected HCW exposures (11 [46%] of 24). Notably, 24 (47%) of 51 cases of HA influenza among HCWs in this study group involved unprotected exposures by HCWs—a behavioral risk associated with HA 2009 H1N1 influenza infection. Unprotected exposures were more extensive among the HCWs who provided initial care to patients who did not have classic influenza-like illness, likely …