The composition and antibiotic sensitivity pattern of bacteria recovered from the hands of nurses and physicians in two service units of a major teaching hospital were compared with those found in a control population. Significant differences in the composition of bacteria were found in dermatology and oncology unit personnel. Staphylococcus aureus was recovered from 31% of dermatology nurses and 37% of dermatology physicians compared with 20% of oncology nurses, 15% of oncology physicians, and 17% of controls. Oncology personnel had a significantly higher carriage of gramnegative bacteria, yeasts, and multiple antibiotic-resistant, aerobic coryneforms (group JK bacteria). Both dermatology and oncology nursing personnel were colonized by organisms resistant to multiple antibiotics. Methicillin resistance was found in 26% and 66% of the staphylococci recovered from dermatology and oncology nurses respectively. Flora from physicians on the two units had sensitivity patterns similar to controls.

Two models of hot water washer disinfectors (Decomat 128 and Hospital A, Euroclean Canada Inc; Ontario, Canada) were evaluated by two methods for their efficacy in disinfecting anesthesia equipment. In the first method, three different microbial suspensions were each sealed into 30 capillary tubes. In the second method, corrugated anesthesia tubes were rinsed with suspensions of each of two bacterial strains. The tubes then underwent a standard cycle in the hot water washer disinfectors and were subsequently tested for growth of microorganisms. All experiments were repeated three times, and the temperature was registered in all cases. In the capillary test, growth was rarely detected (13/540 tubes) and the inactivation factor for both apparatus was > 5 log,,. In the rinse test, no growth was detected. The mean temperature for 15 disinfection cycles was 84.2 ± 0.8°C for Decomat 128 and 88.9 ± 0.5% for Hospital A. However, for Decomat 128 we observed a variation of 3°C from one disinfection cycle to another and a progressive reduction of 2.2°C over a series of five consecutive complete cycles. Both methods gave reproducible results. Under our experimental conditions, both hot water washer disinfectors proved to be efficacious for the disinfection of reusable anesthesia equipment.

We reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized.

Nine hundred seventy-two cultures taken from the external nares and the vaginal vestibules of 54 women for the isolation of Staphylococcus aureus were studied. The swabs were plated directly to a trypticase soy agar plate containing 5% sheep blood and were then placed into a selective staphylococcal broth. Both culture methods were compared for the ability to recover S aureus.

Twenty percent (26/131) and 66% (38/58) of the S aureus-positive cultures taken from the nares and vagina respectively were cultured from the selective broth only. We believe that a selective staphylococcal broth should be used in addition to routine culture techniques to isolate S aureus from infection control surveillance cultures.

Infusion therapy for the administration of blood products, fluids, and parenteral nutrition are essential parts of medical practice. The risks associated with such therapy are well documented but frequently unappreciated. Intravascular infusions are the single most common cause of nosocomial bacteremia.’ Many studies have focused on the epidemiology, microbiology, and pathophysiology of these infections.

In recent years, several companies have introduced a multi-lumen intravenous catheter that is placed through the subclavian or internal jugular vein. Unlike a multi-lumen pulmonary artery catheter, the multi-lumen intravenous catheter is designed solely for intravenous access. The first of these catheters was introduced in 1983, and it was soon followed by several others. These catheters have been designed to allow multiple infusions to be given simultaneously. In addition, one of the ports can be used for venous access. The advantages of these catheters are obvious. The clinician is given three ports for use instead of one. The catheter may be used to simplify infusion therapy. In some instances, cut-downs and other invasive procedures (Hickmans, Broviacs, Mediports) may be avoided. It is not surprising that the use of these catheters has grown. In many institutions, multi-lumen catheters account for a majority of all centrally placed catheters, and in some intensive care units, they are used almost exclusively. The enormous growth of the use of the multi-lumen catheter has occurred despite minimal data regarding risk, cost, and the proper procedures needed for its care.

Gram-positive bacterial infections remain a serious challenge for infectious disease practitioners. Many gram-positive organisms are developing new methods of antibiotic resistance, thus rendering our standard antimicrobial agents ineffective. Penicillin G resistance, methicillin-resistant Staphylococcus aureus and recently, a laboratory strain of vancomycin-resistant S aureus have become catalysts in the search for effective alternatives in the treatment of gram-positive bacterial infections. This review will briefly describe an investigational agent (investigational in the US, although used widely overseas) that has been very successful in treating gram-positive bacterial infections. The antibiotic, named teicoplanin. (Merrell-Dow Pharmaceuticals) may be approved for release in the United States in the future.

Originally known as teichomycin A, teicoplanin is a glycopeptide antibiotic, chemically similar to the vancomycin-ristocetin antibiotic group. Teicoplanin was discovered following the fermentation process of Actinoplanes teichomyceticus The antibiotic has a linear heptapeptide structure and weighs approximately 2000 daltons.