number of patients on a doctor’s list (P ¼ 0.067), although this was not significant. Awareness rate for all patients was independent of age and sex of the patient, as well as doctor grade. HAI has had much publicity recently, and there is a drive to reduce incidence. A recent Depart- ment of Health publication highlighted specific areas whereby catheter care could be improved to reduce urinary infections. It focused on cath- eter type, improving insertion technique, and con- tinuing care such as the use of a closed circuit system. It also mentioned the need for care in deciding when to catheterize and the fact that catheters require daily assessment as regards re- quirement, but did not provide specific indications for their use or suggest methods by which regular assessment could be achieved. 6 The incidence of catheter-related complications increases with the length of time that the catheter is in place, so it is essential that they are removed as promptly as possible after the original indication has resolved. This study shows that doctors’ awareness of their patients’ catheterization status is hugely variable, but appears to be correlated with an increasing number of patients under their care. This was significant when considering the group at risk (patients with a catheter). Clearly, with an increased total workload, and less time with each patient, the doctor’s awareness for the intricacies of their care may suffer. In a typical busy district general hospital the average junior doctors have been shown to be unaware of the catheter status in more than 25% of their patients. Increasing awareness of their presence leads to prompt removal and hence de- creased complications. 7 It is therefore recommen- ded that a prominent recording of catheterization status should be instituted on patients’ charts, so that a routine daily assessment of their need can be made. References 1. Haley RW, Hooton TM, Culver DH, et al. Nosocomial infec- tions in U.S. hospitals, 1975e1976; estimated frequency by selected characteristics of patients. Am J Med 1981;70: 947e959. 2. Haley RW, Culver D, White JW, Morgan WM, Emori TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159e167. 3. Kreiger JN, Kaiser DL, Wenzel RP. Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis 1983;148:57e62. 4. Gokula RRM, Hickner JA, Smith MA. Inappropriate use of uri- nary catheters in elderly patients at a Midwestern community teaching hospital. Am J Infect Control 2004;32:196e199. 5. Saint S, Wiese J, John K, et al. Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109:476e480. 6. Department of Health and Hospital Infection Society. Guide- lines for preventing infections associated with the insertion and maintenance of short-term indwelling urethral catheters in acute care. J Hosp Infect 2001;47(Suppl. 1):s39es46. 7. Saint S, Kaufman SR, Thompson M, Rogers MA, Chenoweth CE. A reminder reduces urinary catheterisation in hospitalised pa- tients. Jt Comm J Qual Patient Saf 2005;31:455e462. E.R. Tayton* R.J. Johnson P. Agarwal Department of Surgery, Weston General Hospital, Weston-Super-Mare, UK E-mail address: edwardtayton@hotmail.com Available online 12 March 2007 * Corresponding author. Address: Flat 4, 29 Berkeley Square, Clifton, Bristol BS8 1HP, UK. Tel.: þ44 7946 604510; fax: þ44 1291 641747. ª 2007 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2007.01.005 Acceptance of influenza vaccination by nursing personnel in Mexico Madam, Influenza is responsible for yearly epidemics and significant excess morbidity and mortality in the community. 1 Healthcare workers (HCWs) may be at increased risk for acquiring and transmitting influenza. Vaccination of HCWs has been recom- mended as a means of reducing influenza spread to high-risk patients. 2 In addition, the present threat of an influenza pandemic increases the risk of exposure to severe disease among HCWs, and HCWs are among those who should receive pri- ority for immunization when vaccines against pan- demic influenza viruses are available. Despite these recommendations, reported influenza vacci- nation rates among HCWs tend to be low in many countries. 3e5 In Mexico, there is little information regarding influenza vaccination rates among HCWs. For several years influenza vaccination has been offered to HCWs at our hospital. Vaccination is offered at the Preventive Medicine Office; when supply is limited, personnel working in high-risk areas, such as intensive care units, are prioritized to receive vaccine, and only after personnel work- ing in these areas have been immunized is vaccine Letters to the Editor 381