This article describes a prolonged outbreak (January 1977 to February 1980) of amikacin-resistant Serratia marcescens (ARSM) urinary infections and the methods used for its control. Significant factors predisposing to ARSM urinary tract infection included an extended hospital stay, being in the urology ward, and undergoing urologie surgery. There had been no prior administration of amikacin or of other aminoglycosides in 20 of 27 patients with ARSM urinary tract infections. Chronically infected patients who required multiple hospitalizations represented a major reservoir for the perpetuation of the outbreak, overshadowing the importance of aminoglycoside use. Traditional control measures and even a major change in the inanimate environment were only partially effective in controlling the outbreak, but treatment of bacteriuric patients in the urology unit with “second and third generation” cephalosporins interrupted patient-to-patient transmission. No new cases of ARSM bacteriuria appeared in the urology unit in the ensuing 12 months [Infect Control 1981; 2(5):367-372.]

The possibility of sepsis or pyrogenic reaction increases in hemodialysis patients as coliform or other gram-negative counts in the dialysis water reach levels ≥ 1000 colonies/ml. After the introduction of Cobe Century II dialysis machines (Cobe, Lakewood, Colorado), routine testing of dialysis water samples revealed gram-negative bacteria in concentrations up to 45,000 colonies/ml. An epidemiologic investigation was performed to determine the source of the bacterial contamination. The amounts of disinfectant solution were increased, but bacterial counts remained unacceptably high. A study of the fluid path within the machines revealed that part of that path was not reached at all by the disinfectant. In addition, the disinfectant was automatically and improperly diluted. Therefore, increased bacterial counts could not be reduced satisfactorily by using the manufacturer's disinfection guidelines.

During a 1979 outbreak of poliomyelitis in Lancaster County, Pennsylvania, we investigated the neccessity for and the response to booster vaccination of hospital personnel. The immune response of hospital employees who received booster injections of Salk vaccine (n=38) was compared with that of residents in the surrounding community who received Sabin trivalent OPV boosters (n=43). Serum neutralizing antibody titers to the three polio serotypes were measured before and after booster immunization. Results indicated that 38% of the subjects in both groups had low initial antibody titers. Salk vaccine was in all circumstances as effective or better than Sabin vaccine in increasing neutralizing IgG antibody titers [Infect Control 1981; 2(5):377-379.]

This study describes the evaluation of 108 patients who had indwelling urethral catheters for acute medical and surgical indications. Patients were evaluated daily, and cultures from bladders and drainage bags were obtained. Appropriateness for continuing catheterization was assessed using preset criteria. Twenty-five patients developed urinary tract infections. Exposure to antibiotics and a shorter duration of catheterization were the only factors that correlated significantly with a delayed onset or decreased prevalence of infection. Factors found to have insignificant effects included age, sex, maintenance of the closed system, underlying host disease status, catheter type, and reason for catheterization. No collection systems with one way valves were used, but significant colony counts in drainage bag urine preceded urinary tract infection in only two patients. Thirty-six percent of the total 562 catheter days were judged unnecessary. A major emphasis must be placed on prompt catheter removal if the prevalence of nosocomial urinary tract infections is to be reduced substantially in a cost-effective manner [Infect Control 1981; 2(5):380-386.]

In recent months several advisory groups have issued recommendations urging hospitals to undertake comprehensive rubella control programs. The primary impetus for these suggestions has been the recognition that, despite a declining rubella incidence in the general population, pregnant women still are being exposed to this infection in hospitals.

In 1979 the Vanderbilt University Hospital initiated a limited rubella control program, encompassing new and current employees working in “traditional” high-risk areas of the hospital: obstetrics (wards and clinics), labor and delivery, nursery, pediatrics (wards and clinics), and the emergency department. Medical and nursing students also were included. All persons were tested serologically and immunization was offered to susceptibles, but was not required (except for students and house officers). The Infection Control Committee and hospital administration readily approved this program.