In late January and early February 1983, an outbreak of skin infections (7 of 145 infants) caused by a penicillin/erythromycin resistant strain of Staphylococcus aureus (SA), phage type 3A/3C, occurred in our newborn nursery. A week following the first cluster of infections, another nursery outbreak due to SA with the same antibiogram occurred in a nearby community hospital (11 of 114 infants). Subsequently, a second cluster of infections with the same SA was identified at our nursery. The epidemic strain was carried in the anterior nares of a single nurse who worked at both hospital nurseries on alternate weeks. Investigation revealed that the nurse had an upper respiratory tract infection during each of these outbreaks—simulating “a cloud baby.” No further infections have occurred since this nurse was treated and her SA nasal carrier state eliminated.

Rising health care costs have prompted hospitals to turn to reprocessing and reuse of disposable devices as a cost-saving measure. The safety, efficacy, and cost benefit of such a practice are largely unknown. Classification schemata are presented as a means of categorizing the reasons for reprocessing and the types of adverse effects that may result from reprocessing and reuse. The very limited literature on reuse of disposable devices is reviewed. Examples of the categories of reprocessing and adverse effects are provided from a review of the experience with reprocessing and reuse at a university medical center. With the rising pressure for containment of health care costs, it is likely that this practice will expand further. The practice of reprocessing and reuse should be subjected to scientific study.

A national effort to reduce nosocomial infections includes a program developed at the National Institutes of Health to encourage handwashing in hospitals and day care centers. The program promotes a symbolic teddy bear (T. Bear) with slogans to remind hospital personnel and patients to practice handwashing. One of the items used is a stuffed toy T. Bear to be dispensed to the hospitalized child. Considering the manner in which children handle stuffed toys, we suspected the T. Bear might serve as a “fomite” for transmission of nosocomial microbes. A prospective study of 39 sterilized T. Bears revealed that all became colonized with bacteria, fungi, or both within 1 week of hospitalization. Hospital acquired organisms cultured from the T. Bear included Staphylococcus epidermidis, Staphylococcus aureus, alpha streptococci, Corynebacterium acnes, Micrococcus sp, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Bacillus sp, and species of Candida, Cryptococcus, Trichosporon, Aspergillus and others. Concomitant cultures of the patients revealed similar isolates. Although the T. Bear handwashing campaign should not be discredited, the promotional toy may pose an unnecessary expense and hazard and should not be used in hospitals or day care centers.

Effects of ultra high speed (UHS) floor burnishing upon air quality in health care facilities were evaluated. A 2,000-rpm burnisher can disseminate high-velocity (190 km/hr) dust and microbial particles. A UHS burnisher used with either inadequate or no air restraint produced significant increases (P<0.05) in the levels of airborne dust particles and microorganisms. A UHS burnisher equipped with an air restraint assembly specifically designed for use in health care facilities produced no significant increase (P>0.05) in the levels of airborne dust particles or microorganisms when compared to ambient air levels. The types and distribution of airborne microorganisms isolated from microbial air samples were not unusual nor were they directly influenced by the floor burnishing processes. Furthermore, the UHS floor burnishing process produced a significant reduction (P<0.05 ) in microbial floor contaminants (96%). When the use of UHS floor burnishing is contemplated for productivity improvement and esthetic enhancement, the possible adverse effects on air quality should also be considered.

Nosocomial infection rates, as determined by either incidence or prevalence methods, are considered important data in infection control programs. Many factors besides infection control measures affect infection rates— eg, illness acuity of the patient population. However, there is evidence that when these factors remain constant, a lowering of the infection rate can be the result of infection control efforts. We wish to illustrate how a dramatic drop in infection rate may mislead infection control personnel into a false sense of accomplishment, when in reality it is an effect of changing medical practices.

The “plastics revolution” of the last quarter century disrupted a hospital tradition. Since the 1890s, hospitals processed, packaged, and sterilized most of the medical-surgical items they needed in their own sterile supply departments–a “cottage industry” developed specifically for recycling. Only those consumable items that were too difficult, expensive, or inconvenient to reprocess were purchased from outside manufacturers as presterilized, single-use “disposables.” Since the plastics revolution, however, the “disposables” started to displace the “reusables,” and while claiming to be an economical innovation, have become a significant item in the budget. Some hospitals feel that if disposables save money, reusing the disposable several times will save more. The practice is spreading. The manufacturers, in turn, claim that hospitals do not have adequate quality assurance programs or skills to reprocess their items properly. The debate is further complicated by legal and ethical ramifications, as well as commercial and economic arguments.

Metronidazole was introduced to the market in 1959 as the only effective therapy for Trichomonas vaginalis. A nitroimidazole derivative, its success in the therapy of parasitic infections, including Entamoeba histolytica and Giardia lamblia, has been well documented. Metronidazole's activity against anaerobic bacteria was first described in 1962 by Shinn, and by Davies and associates in 1964. In both reports, metronidazole effectively treated patients with Vincent's angina (necrotizing ulcerative gingivitis). Metronidazole's excellent activity against anaerobes has been substantiated by numerous articles. It has the best bactericidal activity of all drugs active against anaerobic bacteria.