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Griego RD. Rosen T. Orengo IF. Wolf JE.: Dog, cat, and human bites: a review. Journal of the American Academy of Dermatology. 33:1019-29, 1995It is estimated that half of all Americans will be bitten by an animal or another human being during their lifetimes. The vast majority of the estimated 2 million annual mammalian bite wounds are minor, and the victims never seek medical attention. Nonetheless, bite wounds account for approximately 1% of all emergency department visits and more than $30 million in annual health care costs.Infection is the most common bite-associated complication; the relative risk is determined by the species of the inflicting animal, bite location, host factors, and local wound care. Most infections caused by mammalian bites are polymicrobial, with mixed aerobic and anaerobic species.The clinical presentation and appropriate treatment of infected bite wounds vary according to the causative organisms. Human bite wounds have long had a bad reputation for severe infection and frequent complication. However, recent data demonstrate that human bites occurring anywhere other than the hand present no more of a risk for infection than any other type of mammalian bite.The increased incidence of serious infections and complications associated with human bites to the hand warrants their consideration and management in three different categories: occlusional/simple, clenched fist injuries, and occlusional bites to the hand. This article reviews dogs, cat, and human bite wounds, risk factors for complications, evaluation components, bacteriology, antimicrobial susceptibility patterns, and recommended treatments. Epidemiology, clinical presentation, and treatment of infections caused by Pasteurella multocida, Capnocytophaga canimorsus, Eikenella corrodens, and rhabdovirus (rabies only) receive particular emphasis.

Element 5: Every employee must understand that the standards, policies and procedures associated with the compliance program must be adhered to at all times. Employee will be disciplined up to terminations for violations. Employee can be disciplined or terminated for failing to report a problem or suspect activity. All employees are screened prior to being hired for previous actions against them by any law enforcement or government agency regarding any health care prosecution or exclusion from the Medicare or Medicaid program. Adherence to the compliance program's policies and procedures will be a component of every employees annual evaluation and performance review.

If the monitoring results are below the action level, no additional monitoring is required unless there is a change in procedure.However, annual monitoring is recommended as a good safety practice.

The tuberculosis (TB) incidence rate in 2007 was the lowest recorded since national reporting began in 1953. However, the average annual percentage decline in the TB rate has slowed. Multi-drug resistant tuberculosis cases have increased. There is persistent disparity in the incidence of tuberculosis between different ethnic groups and also between foreign-born persons and US-born persons. Reference: Pratt R, Robison V, Navin T. Trends in tuberculosis. MMWR/57(11);281 - 285; Centers for Disease Control and Prevention: March 21, 2008. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm Accessed on May 23, 2008.