A questionnaire study was carried out of all orthopedic surgical procedures in the operating rooms of a teaching hospital over an 8-week period to describe the frequency and circumstances of accidental blood contact. Blood exposure occurred in 11% of the procedures. Contamination of intact skin was the most common incident (79%); percutaneous injury occurred in 13%. The majority of the incidents were believed to be preventable.

The American Society of Anesthesiology (ASA) scoring was performed for the National Nosocomial Infection Sur veillance (NNIS) System surgical-site–infection (SSI) risk indexing in 250 prosthetic-joint surgeries. There were ASA scoring discrepancies in 59% of 116 ASA-3 surgeries and 2 out of 10 ASA-3 SSI. The original ASA scoring led to an uncorrected SSI rate of 5.8 per 100 surgeries in the NNIS risk group 0; with corrected ASA scores, the rate was 4.5 per 100 surgeries.

We performed four annual audits of tuberculin tests performed on hospitalized patients at a university teaching hospital complex. Each audit assessed if tests were performed and read correctly. House staff performed skin testing in years 1 to 3. Despite inter ventions of teaching and then of written instructions on skin testing, performance was poor. When testing was turned over in year 4 to trained infection control practitioners, performance approached 100%. We conclude that university teaching hospitals should assess skin-testing performance

In a study of the impact of notifiable communicable disease admissions on infection control work load, we found notifiable disease cases to be responsible for less than 10% of admissions but 27% of infection control ward visits and to require extensive community liaison. Measures of work load based on nosocomial infections alone will underestimate infection control activity considerably.

Breathing circuit filters (BCFs) are used in respiratory and critical-care settings for humidification of air and to limit transmission of respiratory pathogens. Three types of BCFs (Pall BB 25A, BB 100, and HME 15-22) were evaluated (in triplicate) for removal of Mycobacterium species. Filters were challenged with aerosolized Mycobacterium bovis (a surrogate for Mycobacterium tuberculosis), at minimum total concentrations of 104 colony-forming units. No M bovis was recovered in the effluent, providing removal efficiencies of >99.99% to >99.999% for the filters tested.

In 1993, several departments at Millard Fillmore Health System joined efforts to initiate a new approach to infection control. The main emphasis of this program is to move infection control to a real-time mode to manage patient outcomes daily. The principal objective was to decrease the number of nosocomial infections by 10%, with a particular emphasis on surgical-site infections. Besides real-time surveillance, we are critically evaluating several aspects of the management of nosocomial infections.

High-level computer support has been the framework upon which this program was built. We have micro-computers that are linked directly to microbiology, pharmacy, billing, and admissions, downloading data several times daily. An expert software system merges all of the data, and from this we can target patients for real-time interventions. The computer system allows all inpatients to be screened for either infection control or antibiotic management inter ventions on a daily basis, with minimal time being spent on data collection and maximal efforts devoted to inter ventions at the bedside.

Additionally, the infection management program will assist in maintaining the extraordinarily low expenditures on antimicrobial agents. During 1993, the Millard Fillmore Health System spent $924,884 on antibiotics, an amount approximately 50% that of comparably sized hospitals.

Physicians and hospitals must curtail the excessive use of antimicrobial agents to limit the emergence and spread of multiply resistant organisms. This article describes how to organize an antimicrobial control program and provides options for hospitals working with a range of resources.

Healthcare professionals often are presented with data that appear to indicate an upward or downward trend over time. For example, admissions of acquired immunodeficiency syndrome (AIDS) patients appear to be increasing, cesarean section rates appear to be decreasing, or nosocomial pneumonia rates appear to be increasing. Critical decisions sometimes are based on such trends, which often are presented without a statistical analysis. Those responsible for decision making may be left wondering whether these apparent trends represent only chance variation. Graphs showing trends over time generally present one of three kinds of outcome data: counts (eg, three AIDS admissions), proportions (eg, 10 cesarean sections per 100 total deliveries), or person-time data (eg, 13 cases of nosocomial pneumonia per 10,000 patient days). Using familiar examples and a minimum of technical language, we illustrate the analysis of time trends.

Antimicrobial resistance results in increased morbidity, mortality, and costs of health care. Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs. Appropriate antimicrobial stewardship that includes optimal selection, dose, and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms. A comprehensively applied infection control program will interdict the dissemination of resistant strains