Persistent hepatitis B infections among patients and frequent new hepatitis B infections among both patients and staff were a major problem in our dialysis unit during its first two and one-half years of operation. During this time the mean quarterly rate of conversion to HBsAg positivity among patients ranged from 0-60% (mean 12%); in staff it ranged from 0-13%. Control efforts, including strict temporal isolation, improved sanitary measures, and use of parallel plate dialyzers without geographic or machine isolation, were begun late in 1976. After a four-month lag, new HBsAg conversions ceased among the 30 patients and staff at risk, despite continued dialysis of eight HBsAg-positive patients (at least four of whom were HBeAg-positive). Over the succeeding three years the conversion rate was zero in both patients and staff. This experience suggests that conservative control measures without geographic separation of patients may be sufficient to control an established outbreak of hemodi-alysis-related hepatitis B. Controlled prospective trials of this hypothesis are warranted.

A limited survey of 90 orthopedic surgery programs throughout the U.S. A. was conducted to determine the use of prophylactic antibiotics in pediatric orthopedic operations. Prophylaxis was used most often in the Harrington rod procedure (80.7%); less often in hip (64.2%) and knee (44.7%) reconstructive surgery; rarely in meniscus repairs (8.0%) and in lengthening of Achilles tendǫns (2.3%). Cephalosporins (85%) were the antibiotics prescribed most frequently. The first dose was administered before surgery in 89.6% of the operations. Prophylaxis was discontinued within five days in 96% of the operations. These data provide a pattern of the use of prophylaxis in pediatric orthopedic surgery.

In a six-month period in 1978 61 patients at a university hospital became colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA). Ninety-three percent of patients with MRSA were on surgical services. Patients with burns acquired MRSA more frequently than did other acutely ill surgical patients (p < .001), and often remained colonized for 30 days or more. The interval between admission and acquisition of S. aureus, number of antibiotics received, duration of antibiotic therapy before becoming colonized, and cost of hospitalization, were significantly greater in patients with MRSA infection than in matched controls with nosocomial methicillin-sensitive S. aureus infections. Acquisition of MRSA was epidemiologically associated with exposure to certain hospital personnel. Fourteen (6%) of 220 personnel exposed to MRSA patients harbored MRSA intranasally. Three of 14 colonized personnel carried MRSA intermittently for three or more months. Appropriate control measures failed to terminate the outbreak.