The clinical usefulness of sputum cultures depends on the quality of specimens submitted to the laboratory. In a community hospital, during two separate surveillance periods, we evaluated ordering practices and circumstances under which sputum specimens were obtained and techniques to improve the quality of the specimens. Physicians themselves rarely participated in obtaining specimens of sputum, and members of the nursing staff directly instructed patients or supervised specimen collection in only one third of cases. The mean elapsed time from collection at the bedside to processing in the laboratory was two hours, with a range from several minutes to 13 hours. One fifth of all the specimens in this study were obtained from patients with no discernible evidence of lower respiratory tract infection. Microscopic screening revealed that one half of the specimens were of poor or uncertain quality. After the first survey, inservice education of nursing personnel in the proper techniques of sputum collection, along with regular use of the screening procedure in the clinical laboratory, failed to effect any long-term change in ordering patterns or collection practices. However, the screening procedure did improve the quality of the sputum cultured, through rejection of unsatisfactory specimens [Infect Control 1981; 2(4):307-11.]

Presented is a case report and literature review of the causes of recurrent meningococcal meningitis. After all factors were analyzed, the cause of reinfection in this child was postulated to be ineffective chemoprophylaxis of close contacts following the initial episode. The efficacy of chemoprophylaxis in household members and close contacts in meningococcal disease, although not demonstrated in controlled trials, has been recommended since 1974 by the Meningococcal Disease Surveillance Group. Considering known carriage rates, reports of secondary infections in close contacts, reinfection in the same person, and a high case fatality ratio, chemoprophylaxis in such cases seems justified [Infect Control 1981; 2(4):312-4.]

Electronic thermometers used in many hospitals require insertion into the mouth of a temperature-sensing probe covered by a pre-packaged probe cover. Handling procedures used by hospital personnel can lead to inadvertent manual contact with the probe cover. We attempted to determine the rate of non-sterility of these probe covers under normal hospital conditions and the extent to which pathogens could be detected on these and other components of the thermometer. Probe covers were removed before entry into the patient's mouth and aseptically inoculated into fluid thioglycollate medium. Subcultures were made to appropriate differential media. Over a 13-week period, 180 covers were cultured on two private hospital services. Forty-three percent were found to be non-sterile; control covers from central supply were only 6% non-sterile. Four percent of the probe covers harbored potential pathogens: coagulase positive Staphylococcus aureus, Streptococcus pyogenes, Enterobacter, and Bacteroides. No attempt was made to correlate these findings with infection. These results indicated a potential infection hazard for high-risk patient groups and a need by hospital personnel to consider this as a possible source of contamination [Infect Control 1981; 2(4):315-6.]

A seroepidemiologic investigation was conducted in order to determine the cause of an apparent increase in rates of eosinophilia among 1400 institutionalized children during 1976-1977. The annual serologic survey during this period revealed 283 (20%) individuals with eosinophilia that exceeded 600 cells/cu mm of blood. During a five-month period in 1977, five patients who were hospitalized in adjacent wards developed acute pneumonia with eosinophilia. Because laboratory tests of sputum, bone marrow, and stool failed to identify the, etiologie agent, it was thought that these pneumonia cases might be related to the increased rates of eosinophilia. Analyses of random samples of sera from patients with eosinophilia revealed seroprevalence rates of 12% for Ascaris, 20% for Toxocara cants, 24% for Strongyloides stercoralis, and 32% with increased antibody to Entamoeba histolytica. Further investigation showed a statistically significant positive association between occurrence of eosinophilia and pica behavior, and eosinophilia and contact with dogs. Although the serologic survey showed patients to have had previous exposure to a variety of parasites, we hypothesize that a principal cause of eosinophilia among institutionalized children may be Toxocara infestation, due to their frequent pica behavior and, in this case, contact with resident animals. We recommend that children in similar facilities have limited contact with pet dogs, and only after frequent and vigorous examination of the animals for infectious parasites.