We describe circumstances at the Hospital Rosales, located in San Salvador, El Salvador, and some salient observations from an infection control program begun in 1978. Findings include overuse of antibiotics, especially of penicillin and chloramphenicol; a predominance of gram-negative rod infections, especially Pseudomonas aeruginosa; a relative infrequency of Staphylococcus aureus infections; an apparent doubling of the mean duration of hospitalization for patients with nosocomial infections compared with other patients (22.1 days versus 11.0 days); documentation and partial correction of deficiencies in aseptic and antiseptic practices; an outbreak of Pseudomonas aeruginosa endophthalmitis traced to the hospital's factory for the manufacturing of intravenous fluids; and attitudinal problems such as the care of patients with rabies on open wards. Prevalence surveys conducted during 1981 and 1986 suggest a dramatic increase in the recent incidence of surgical wound infection (44% v 28%, P < 0.001). This latter observation suggests a direct relationship between infection rates and the hardships imposed by poverty and civil war.

A collaborative study was undertaken to assess the degree of variability in disinfectant efficacy test results among laboratories that routinely perform the Association of Official Analytical Chemists (AOAC) Use-Dilution Method. Eighteen laboratories tested identical samples of six EPA-registered, hospital-grade disinfectants (three phenolics and three quaternaries) at the manufacturers' recommended use-dilution using only those modifications of the method approved by the AOAC Use-Dilution Task Force. Each laboratory processed 60 penicylinders for each of the 6 randomly selected disinfectants and 3 test organisms. The current EPA pass criterion for a disinfectant requires a test result of ≤1 positive penicyIinder/60 replicates tested. When compared with the 1 positive/60 replicate criterion, the test results of the 6 disinfectants were: 86 trials (80%) passed and 22 trials (20%) failed against Salmonella choleraesuis ATCC 10708; 71 (66%) passed and 37 (34%) failed against Staphylococcus aureus ATCC 6538; and 41 (38%) passed while 67 (62%) failed against Pseudomonas aeruginosa ATCC 15442. Four laboratories unknowingly tested their own product, and three of the four failed their product against one or more of the test organisms. These results show the inability to reproduce the manufacturers' bactericidal label claims for 6 disinfectants against the 3 AOAC test bacteria. In addition, extreme variability of test results among laboratories testing identical products questions the use of the AOAC Use-Dilution Method for enforcement action.

In a survey of 67,774 patient days in 27 Swedish acute care hospitals, an indwelling urinary tract catheter (IUTC) was in place during 12% of patient days. There were marked differences between services (from 2% in rheumatology to 49% in urology), but also between hospitals for the same type of service (general surgery, internal medicine, gynecology, orthopaedic surgery) concerning proportion IUTC days, average duration of catheterization and the indications for IUTC use. The great local variation in IUTC usage for a particular service was usually not correlated with type of hospital (district, county, or regional/teaching), ie, with the mix of patients studied. We propose that the results mainly reflect a variable local impact of infection control and that a much more restrictive use of IUTCs is possible in many wards. This condition would imply a considerable potential for reducing the incidences of urinary tract infection and bacteremia and thus, mortality among hospitalized patients in Sweden.

The use of protein fingerprinting for the establishment of relatedness among isolates of Acinetobacter calcoaceticus subspecies anitratus, isolated from patients in a surgical intensive care unit was examined. Poly-acrylamide gel electrophoresis was used to analyze the cellular proteins from whole cell lysates of 14 intensive care unit A calcoaceticus subspecies anitratus isolates and 11 control strains. Antimicrobial susceptibilities and plasmid profiles were also determined for all isolates. All intensive care unit A calcoaceticus subspecies anitratus isolates exhibited identical cellular protein fingerprints, no detectable plasmids, and minimum inhibitory concentrations within ±1 log2 dilution of the mode value for each of the antimicrobial agents tested. The other clinical isolates demonstrated a range of antimicrobial susceptibilities, various numbers and sizes of plasmids, and distinctly different protein fingerprints. These data indicate that protein fingerprinting may be useful as an epidemiologic tool in A calcoaceticus subspecies anitratus outbreaks and this method deserves further study.

Aspergillus flavus and Aspergillus fumigatus are important causes of invasive, often fatal, fungal disease in immuno-compromised patients. Sources of aspergilli for hospitalized patients may include window air conditioners, fireproofing materials, dust accumulated above false ceilings and acoustical ceiling tiles, and improperly functioning central ventilation systems. Renovation and construction projects, movement of heavy equipment, and demolition of nearby buildings often occur in or near hospitals. These events may aerosolize dust and soil laden with Aspergillus spores. Immunocompromised patients may acquire invasive aspergillosis in the hospital by inhalation of spores or by direct contact with contaminated intravenous arm boards. We have recently recognized the occurrence of invasive aspergillosis in an area of our hospital that does not contain false ceilings or a central ventilation system. All of the patient rooms in this area contain air conditioners that are attached to ceilings rather than windows, recirculating room air rather than drawing air in from the outside.

Acute gastroenteritis is a public health problem of global proportions. Worldwide there are more than 700 million cases of diarrheal disease resulting in around 5 million deaths. In the United States the incidence of acute gastroenteritis is 11% each year and it is second only to respiratory infection as a contagious disease in the American family. The etiology of this common syndrome is obscure but it is becoming apparent that much of this disease is viral in origin. Recent research has elucidated a growing number of human pathogens: Norwalk-like agents, adenoviruses, caliciviruses, and astroviruses. The best understood of these agents are among the earlier discoveries in gastrointestinal virology—the rotaviruses. The study of these agents has greatly advanced our understanding of viral gastroenteritis.