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October 1995, Vol 149, No. 10 >
Article | October 1995

Pediatric Clinical Clerkships Are Associated With an Excess Risk of Acute Infection FREE

Vanthaya N. Gan, MD; Patricia Pastor, MS; Trudy V. Murphy, MD
Arch Pediatr Adolesc Med. 1995;149(10):1152-1155. doi:10.1001/archpedi.1995.02170230106016.
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Objective:  To determine the incidence of acute respiratory and gastrointestinal tract illness and associated absence by third-year medical students during pediatric and nonpediatric (control) clinical clerkships.

Design:  A self-administered questionnaire was completed by students after the first 4 weeks of two pediatric clerkships (inpatient and outpatient) and two nonpediatric clerkships (obstetrics-gynecology and psychiatry). Information was obtained on the symptoms of acute respiratory and gastrointestinal tract illness and related absences.

Analysis:  Results from each student's pediatric clerkship were compared with the results from the same student's control clerkship by means of matched-pair analysis.

Subjects:  Students who made up the junior class at the University of Texas Southwestern Medical School at Dallas, July 1, 1990, to June 30, 1991.

Results:  Of 177 students (77%) who completed questionnaires after one pediatric and one control clerkship, 108 students (61%) had had an acute illness while on pediatric clerkships in contrast to 69 students (39%) on control clerkships (odds ratio, 3.3; 95% confidence interval, 2.0 to 5.4; P<.001). More students were absent for illness during pediatric than control clerkships (23 [13%] vs nine [5%], respectively; odds ratio, 2.7; 95% confidence interval, 1.2 to 6.2; P=.02). The higher risk of illness during pediatric clerkships was not related to the order of the pediatric or control clerkship, the order of inpatient and outpatient pediatrics, or the season of the year.

Conclusion:  Pediatric clinical clerkships in the third year of medical school were associated with excess morbidity from acute infectious illness. Studies are needed to determine whether emphasizing infection control practices decrease this morbidity and any resulting nosocomial spread to patients.(Arch Pediatr Adolesc Med. 1995;149:1152-1155)

REFERENCES

1 +
Goldwater PN, Martin AJ, Ryan B, et al.  A survey of nosocomial respiratory viral infections in a children's hospital: occult respiratory infection in patients admitted during an epidemic season . Infect Control Hosp Epidemiol . 1991;;12: 231-238.
2 +
Ford-Jones EL, Mindorff CM, Gold R, Petric M.  The incidence of viral-associated diarrhea after admission to a pediatric hospital . Am J Epidemiol . 1990;;131:711-718.
3 +
Pachucki CT, Walsh Pappas SA, Fuller GF, Krause SL, Lentino JR, Schaaff DM.  Influenza A among hospital personnel and patients . Arch Intern Med . 1989;; 149:77-80.
4 +
Poland GA, Nichol KL.  Medical students as sources of rubella and measles outbreaks . Arch Intern Med . 1990;;150:44-46.
5 +
Hall CB, Douglas RG Jr, Geiman JM, Messner MK.  Nosocomial respiratory syncytial virus infections . N Engl J Med . 1975;;293:1343-1346.
6 +
Gerth HJ, Gruner C.  Common respiratory and gastrointestinal illness in paediatric student nurses and medical technology students . Epidemiol Infect . 1987;; 98:33-45.
7 +
Ditchburn RK, McQuillin J, Gardner PS, Court SDM.  Respiratory syncytial virus in hospital cross-infection . BMJ . 1971;;3:671-673.
8 +
Doebbeling BN, Li N, Wenzel RP.  An outbreak of hepatitis A among health care workers: risk factors for transmission . Am J Public Health . 1993;;83:1679-1684.
9 +
Gardner PS, Court SDM, Brocklemank JT, Downham MAPS, Weightman D.  Virus cross-infection in paediatric wards . BMJ . 1973;;2:571-575.
10 +
Holzel H, Cubitt DW, McSwiggan DA, Sanderson PJ, Church J.  An outbreak of rotavirus infection among adults in a cardiology ward . J Infect . 1980;;2: 33-37.
11 +
Ryder RW. McGowan JE Jr, Hatch MH, Palmer EL.  Reovirus-like agent as a cause of nosocomial diarrhea in infants . J Pediatr . 1977;;90:698-702.
12 +
Nichol KL, Olson R.  Medical students' exposure and immunity to vaccine-preventable diseases . Arch Intern Med . 1993;;153:1913-1916.
13 +
Murray DL, Weatherly MR, Sperling JL, Farquhar LJ.  Identification and immunization of medical students susceptible to measles and rubella: a nationwide survey . Am J Public Health . 1985;;75:556-557.
14 +
Ohrt CK, McKinney P.  Achieving compliance with influenza immunization of medical house staff and students . JAMA . 1992;;267:1377-1380.
15 +
Englund JA, Sullivan CJ, Jordan MC, Dehner LP, Vercellotti GM, Balfour HH Jr.  Respiratory syncytial virus infection in immunocompromised adults . Ann Intern Med . 1988;;109:203-208.
16 +
Isaacs D, Dickson H, O'Callaghan C, Sheaves R, Winter A, Moxon ER.  Handwashing and cohorting in prevention of hospital acquired infections with respiratory syncytial virus . Arch Dis Child . 1991;;66:227-231.
17 +
Donowitz LG, ed. Hospital Acquired Infection in the Pediatric Patient . Baltimore, Md: Williams & Wilkins Co; 1988;:331-368.
18 +
Poland GA, Nichol KL.  Medical school and immunization policies: missed opportunities for disease prevention . Ann Intern Med . 1990;;113:628-631.
19 +
Murray DL, Lynch MA.  Determination of immune status to measles, rubella, and varicella-zoster virus among medical student: assessment of historical information . Am J Public Health . 1988;;78:836-838.

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References

1 +
Goldwater PN, Martin AJ, Ryan B, et al.  A survey of nosocomial respiratory viral infections in a children's hospital: occult respiratory infection in patients admitted during an epidemic season . Infect Control Hosp Epidemiol . 1991;;12: 231-238.
2 +
Ford-Jones EL, Mindorff CM, Gold R, Petric M.  The incidence of viral-associated diarrhea after admission to a pediatric hospital . Am J Epidemiol . 1990;;131:711-718.
3 +
Pachucki CT, Walsh Pappas SA, Fuller GF, Krause SL, Lentino JR, Schaaff DM.  Influenza A among hospital personnel and patients . Arch Intern Med . 1989;; 149:77-80.
4 +
Poland GA, Nichol KL.  Medical students as sources of rubella and measles outbreaks . Arch Intern Med . 1990;;150:44-46.
5 +
Hall CB, Douglas RG Jr, Geiman JM, Messner MK.  Nosocomial respiratory syncytial virus infections . N Engl J Med . 1975;;293:1343-1346.
6 +
Gerth HJ, Gruner C.  Common respiratory and gastrointestinal illness in paediatric student nurses and medical technology students . Epidemiol Infect . 1987;; 98:33-45.
7 +
Ditchburn RK, McQuillin J, Gardner PS, Court SDM.  Respiratory syncytial virus in hospital cross-infection . BMJ . 1971;;3:671-673.
8 +
Doebbeling BN, Li N, Wenzel RP.  An outbreak of hepatitis A among health care workers: risk factors for transmission . Am J Public Health . 1993;;83:1679-1684.
9 +
Gardner PS, Court SDM, Brocklemank JT, Downham MAPS, Weightman D.  Virus cross-infection in paediatric wards . BMJ . 1973;;2:571-575.
10 +
Holzel H, Cubitt DW, McSwiggan DA, Sanderson PJ, Church J.  An outbreak of rotavirus infection among adults in a cardiology ward . J Infect . 1980;;2: 33-37.
11 +
Ryder RW. McGowan JE Jr, Hatch MH, Palmer EL.  Reovirus-like agent as a cause of nosocomial diarrhea in infants . J Pediatr . 1977;;90:698-702.
12 +
Nichol KL, Olson R.  Medical students' exposure and immunity to vaccine-preventable diseases . Arch Intern Med . 1993;;153:1913-1916.
13 +
Murray DL, Weatherly MR, Sperling JL, Farquhar LJ.  Identification and immunization of medical students susceptible to measles and rubella: a nationwide survey . Am J Public Health . 1985;;75:556-557.
14 +
Ohrt CK, McKinney P.  Achieving compliance with influenza immunization of medical house staff and students . JAMA . 1992;;267:1377-1380.
15 +
Englund JA, Sullivan CJ, Jordan MC, Dehner LP, Vercellotti GM, Balfour HH Jr.  Respiratory syncytial virus infection in immunocompromised adults . Ann Intern Med . 1988;;109:203-208.
16 +
Isaacs D, Dickson H, O'Callaghan C, Sheaves R, Winter A, Moxon ER.  Handwashing and cohorting in prevention of hospital acquired infections with respiratory syncytial virus . Arch Dis Child . 1991;;66:227-231.
17 +
Donowitz LG, ed. Hospital Acquired Infection in the Pediatric Patient . Baltimore, Md: Williams & Wilkins Co; 1988;:331-368.
18 +
Poland GA, Nichol KL.  Medical school and immunization policies: missed opportunities for disease prevention . Ann Intern Med . 1990;;113:628-631.
19 +
Murray DL, Lynch MA.  Determination of immune status to measles, rubella, and varicella-zoster virus among medical student: assessment of historical information . Am J Public Health . 1988;;78:836-838.

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