1. ABSTRACT INTRODUCTION, CONTINUED RESULTS, CONTINUED REFERENCES RESULTS INTRODUCTION This was a secondary analysis of the Rapid Empiric Treatment with Oseltamivir Study (RETOS) is a Centers for Disease Control and Prevention (CDC) randomized clinical trial to evaluate the effectiveness of early antiviral (Oseltamivir/Tamiflu) use in patients with lower respiratory tract Infections due to influenza. Study population: All adult patients (>18y) admitted to any hospital in Jefferson County with Community Acquired Pneumonia (CAP) were included in the analysis. Hospitals in Jefferson County include; University of Louisville Hospital, Robley Rex VA medical center, Norton Brownsboro, Norton Suburban, Norton Audubon, Norton Downtown, Jewish hospital, and Baptist East hospital. Microbiological culture results for those patients were collected, analyzed and classified into three groups according to the etiology. These included; 1) airborne precautions when Mycobacterium tuberculosis was identified; 2) droplet precautions for all respiratory viruses including; Influenza, Respiratory Syncytial Virus (RSV), Parainfluenza Virus, Adenovirus, and Human Metapneumovirus, and 3) contact precautions for MRSA. MATERIAL AND METHODS A total of 801 hospitalized adult patients with CAP were included in the study. 1 patient required airborne isolation (0.1%). 262 patients required droplet isolation, (33%). The Need of Various Forms of Isolation in Hospitalized Adult Patients with Community Acquired Pneumonia (CAP) in Jefferson County. Rehab Abdelfattah MD MPH, Francisco Fernandez MD, Johnson Britto MD, Katherine Rivera MD, Daniel Curran MD, Joannis Baez MD, Kendra Thompson BSc, Timothy Wiemken PhD MPH, Raul Nakamatsu MD, Arnold Forest DO, Ruth Carrico PhD. Introduction: Community-acquired pneumonia (CAP) is a common and potentially serious illness. It is associated with substantial morbidity and mortality, especially in elderly patients and those with multiple comorbidities. Pneumonia and Influenza combined is the eighth most common cause of death in the US. Due to this, demand has increased for preventing and controlling transmission of pneumonia in health care settings. Proper protection of health care workers is a key to achieving this objective. This study evaluates the need for different types of isolation for CAP patients in Jefferson County. Methods: A secondary data analysis of organisms isolated from CAP patients enrolled in Rapid Empiric Therapy with Oseltamivir Study (RETOS) database was performed. Organisms were grouped according to types of isolation required; airborne isolation for particles 5 microns or smaller in size (Tuberculosis), droplet isolation for particles greater than 5 microns in size (Influenza, Respiratory Syncytial Virus (RSV), Parainfluenza Virus, Adenovirus, Human Metapneumovirus), and contact isolation {Methicillin Resistant Staph Aureus (MRSA)}. Results: A total of 801 hospitalized adult patients with Community Acquired Pneumonia (CAP) were included in the study. Results showed that; 262 patients required droplet isolation, (33%), 30 patients required contact isolation (4%), and 1 patient required airborne isolation (0.1%). Conclusion: Our results showed that one in every three (about 35%) adult patients hospitalized with Community Acquired Pneumonia (CAP) in Jefferson County required some form of isolation precaution. This reflects the great need for developing and implementing an effective respiratory protection program in various health care settings to prevent and control transmission of these pathogens. Influenza, as well as other respiratory pathogens that may present as community-acquired pneumonia (CAP) may be transmissible person-to- person. Three elements are required for transmission of infectious agents within a healthcare setting: infectious agent, a susceptible host, and a mode of transmission. The mode of transmission differs according to the type of organism; however, some infectious agents might be transmitted by more than one route. (1) Airborne transmission occurs by dissemination of either airborne droplet nuclei or small particles (<5 microns) containing infectious agents in an inhalational range and could remain infective over a long time (e.g. Mycobacterium tuberculosis). Microorganisms transmitted in this way may be dispersed over long distances by air currents and may be inhaled by susceptible individuals who have not had face-to-face contact with or been in the same room with the infectious individual. Airborne isolation precautions include personal respiratory protection (N95 respirator) or powered air- purifying respirator (PAPR) and use of an airborne infection isolation room (AIIR). (1) Respiratory droplets (>5 microns) are generated when an infected person coughs, sneezes, or talks or during procedures such as suctioning and endotracheal intubation. (2) Some infectious agents transmitted by the droplet route could be transmitted also by direct or indirect contact (e.g., influenza, respiratory Syncytial virus, parainfluenza virus, adenovirus, and human metapneumovirus). Respiratory droplets carry infectious pathogens and travel directly from the respiratory tract of the infectious individual to the mucus membranes of the susceptible subject over short a short distance (3 feet), which necessitates facial barrier protection. Droplet precautions include the use of barrier protection (e.g., a surgical mask with or without face shield) worn when working within 3 feet of the patient. Contact transmission is the most common mode of transmission; it is divided into two types: direct contact and indirect contact. Contact precautions are used with specified patients known or suspected to be infected or colonized with epidemiologically important micro-organisms (e.g., MRSA) that can be transmitted by direct contact with the patients or indirect contact with environmental surfaces or patient-care items in the patients’ environment. Isolation policies should be based upon the latest recommendations from the Centers for Disease Control and Prevention. However, we do not know how frequently different types of isolation precautions need to be applied. The objective of this study was to evaluate the need for different types of isolation precautions in hospitalized, adult adult patients with CAP in Jefferson County. RESULTS 45 years female patient with history of COPD, essential hypertension, HIV and recurrent hospital admissions due to pneumonia. Patient was 10% less than ideal body weight and had recent exposure to active tuberculosis. During her hospital stay, sputum culture came back positive for Mycobacterium tuberculosis, and her chest x-ray showed multiple opacities and apical cavitations. 30 patients required contact isolation (4%). Our results showed that one in every three (about 35%) adult patients hospitalized with CAP in Jefferson County had a pathogen identified that indicated the need for some form of isolation precaution. This reflects the importance of developing and implementing an effective respiratory protection program for hospitals that recognize CAP as a transmission risk to healthcare personnel CONCLUSIONS Unrecognized transmissible diseases represent a risk to healthcare personnel. Exploration of activities that include a systems approach to prevention can be important elements in healthcare personnel safety programs. These activities may include processes that recognize risk early in the patient encounter and preemptive use of respiratory protection and environmental controls. Implementing an effective respiratory protection program requires many steps include but not limited to; developing aerosol transmissible diseases exposure control plan, evaluating infectious hazards and who is exposed, exposure control procedures including respiratory protection (using respirators), staff training and record keeping. ( 3) Although we classified our patients into three groups based on the type of isolation needed, we do not have any documented data regarding what percentage of those patients had the appropriate method of isolation precaution in place. The hospital environment contains hazards such as bacteria, viruses, and fungi that might be inhaled by workers, cause illness and transmit diseases among patients. Due to this, hospitals need respiratory protection programs to control respiratory hazards. In order to protect employees from aerosol transmissible diseases, health care facilities must always implement a combination of engineering, administrative, and work practice controls. Due to H1N1 influenza outbreak in spring 2009 there has been considerable interest in the use of surgical masks (facemasks) and respirators as infection control measures. Respirators and facemasks are both called “masks” in many health care settings; however, they are very different in their design and in their purpose. 1- Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf 2- Healthcare Infection Control Practices Advisory Committee (HICPAC),, and National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID). 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Atlanta, GA: Centers for Disease Control and Prevention, 2009. **Date Accessed** <http://www.cdc.gov/hicpac/2007ip/2007ip_part1.html Type of respiratory virus Number of CAP patients infected with that virus Adenovirus 1 Corona Virus 14 Influenza Virus 117 Metapneumovirus 33 Parainfluenza Virus 12 Respiratory Syncytial Virus 28 Rhinovirus 67 Other Virus 1