To evaluate the risk to nurses of childbearing age of acquiring cytomegalovirus (CMV) infection during the care of patients at high risk of the infection, 374 female hospital employees (288 nursing personnel) were interviewed and screened for antibody to CMV. Fifty-six percent of the population surveyed had antibody to CMV as measured by an immunofluorescent assay. Among nursing personnel, analysis of antibody prevalence by job title, work area, and duration of work showed no association between seropositivity and either current or past exposure to “high-risk” patients, such as infants and immunosuppressed individuals. Age, race (non-white), and the number of pregnancies reported by participants were significantly associated with the presence of antibody. Among 73 employees of a children's hospital, the prevalence of CMV antibody was 41%. This survey suggests that hospital nursing is not a major risk factor for acquiring CMV infection. However, this finding needs further evaluation in a prospective study of seroconversion rates among seronegative nurses.

In the neonatal intensive care unit (NICU) of one hospital, 16 infants became colonized or infected with multiply-resistant Escherichia coli (MR-E.coli) over an 8-month period. Isolates were obtained from blood, urine, and sputum of three patients and from rectal surveillance cultures of 13 patients. The one patient with the blood isolate died. A matched case-control study identified continuous feeding (nine of 16 cases vs. one of 16 controls, p ≤ 0.001) and receipt of aminoglycosides (p ≤ 0.03) as risk factors. For case-babies not exposed to continuous feeding, duration of bolus feeding was significantly greater than for their controls (cases, 22 days; controls, 7 days; p ≤ 0.02). All 16 isolates were the same serotype and were resistant to amikacin, tobramycin, kanamycin, and gentamicin. The epidemiologic investigation suggested that MR-E. coli may have spread from person-to-person on the hands of personnel and that MR-E. coli persisted in the NICU for 8 months until effective control measures were instituted.

Data related to risk factors for catheter-acquired bacteriuria were collected prospectively on 112 patients consecutively catheterized for >24 hours at the Hadassah University Hospital. Logistic regression analysis indicated that factors independently associated (p≤0.05) with a higher risk of catheter-acquired bacteriuria were as follows: hospitalization in orthopedics or urology, ethnic origin (Arabs > Jews), insertion of a catheter after the sixth day of hospitalization, catheterization outside the operating theaters, lack of administration of systemic antibiotics, unsatisfactory catheter care, and prolonged duration (≥7 days) of catheterization before infection occurred. The risk associated with catheterization outside the operating theater could be explained by its correlate, that is, catheterization for incontinence/obstruction as opposed to output measurement. Life-table analyses demonstrated that the daily risk for acquiring bacteriuria during the first six days of catheterization was higher among patients ultimately catheterized for ≥7 days than among those ultimately catheterized for < 7 days (P<0.05).

In an acute-care general hospital, 114 telephones, intercoms, dictaphones, and bedpan flusher handles were sampled in patient-care areas for type of bacterial contamination. Nine of these (7%) demonstrated potentially pathogenic bacteria including Klebsiella, Enterobacter, Pseudomonas and Aeromonas. Inanimate, environmental, staff hand-contact objects were only lightly contaminated, did not represent a significant reservoir of gram-negative organisms, and therefore, would be unlikely to be a vehicle of transmission of gram-negative bacteria from the hands of one staff member to another under routine circumstances. Surveillance and disinfection of telephones and related hand-contact items in the hospital appear unnecessary.

In 1978 the Ministry of Health and Social Welfare in Liberia embarked on a major initiative to expand immunization activity countrywide. During its early development, the Expanded Program on Immunization (EPI) experienced the realities of establishing an immunization program in a developing country, including the high costs of maintaining mobile operations and a network of kerosene refrigerators. To improve vaccination coverage with diminishing resources, the Program recently began to place greater emphasis on integrating immunization activities into the existing infrastructure of hospitals, clinics, and health posts. Although the EPI goal and objectives, which in retrospect were highly ambitious, have not yet been achieved, it is possible to immunize effectively the children and women of Liberia. Effective vaccination coverage can be achieved by developing local strategies, coordinating resources, and most importantly, involving the community. International organizations must support such efforts by continuing to supplement essential supplies and by promoting research to develop vaccines that are more heat-stable and immunogenic.

The genera Aeromonas and Plesiomonas are gram-negative, cytochrome oxidase-positive, asporogenous, facultatively anaerobic rods that ferment carbohydrates with the production of acid or acid and gas. They are members of the family Vibrionaceae. Members of these genera are motile by means of polar flagella but in many other ways, resemble organisms belonging to the Enterobacteriaceae. Three species of Aeromonas are currently recognized in the eighth edition of Bergey's Manual, based on the studies of Schubert. A. salmonicida, a pathogen in fish which is non-motile and incapable of growing at 37°C, A. punctata, an aquatic environmental isolate possessing two subspecies and A. hydrophila, an organism associated with a wide range of clinical manifestations including wound cellulitis, septicemia, acute diarrheal disease, urinary tract infections and rarely, endocarditis, neonatal meningitis, otitis, peritonitis and osteomyelitis. In 1976, Popoff and Vern described a new species of Aeromonas A. sobria, which while motile, differed from A. hydrophila by a lack or significant decrease in the presence of several enzymes such as elastase, lipase and B-glucosidase. This organism represented a minority of environmental strains in a survey conducted by Seidler but seemed to predominate in a series of clinical isolates reviewed by Daily and colleagues in which the majority of Aeromonas isolates studied were A. sobria, characteristically cytotoxic, enterotoxigenic and lethal for mice. Unfortunately, since many clinical laboratories have not differentiated A. sobria from A. hydrophila in the past, the true incidence of this organism in human infections is largely unknown. Taxonomic studies performed by Maclnnes and Trust suggested that A. sobria should be included as a biotype of A. hydrophila.