Sixty-three cases of nosocomial sepsis occurring from April through October 1981, in a 500-bed pediatric hospital, were traced to bacterial contamination of intravenous fluid produced by a single manufacturer. Two species of uncommon blood stream pathogens, Enterobacter cloacae and Enterobacter agglomerans contaminated the fluid. Infections with these organisms might have contributed to the death of four patients; two who were immunosuppressed, one who was asplenic and one premature infant. Epidemiologic and laboratory investigations identified the site of contamination to be within the screw-caps of the bottles containing the intravenous fluid. Contamination occurred during insertion of the intravenous fluid administration set into the bottle. The “epidemic” terminated when the hospital discontinued the use of infusion fluids from that manufacturer. We conclude that intravenous fluids should be examined during outbreaks of nosocomial bacteremia due to unusual pathogens.

Human rotavirus (HRV) epidemics have not been reported in normal full-term newborn nurseries in the US. This report describes an epidemic from April 27 to May 6, 1982 in which 23 infants were infected. Diagnosis was confirmed with Rotazyme (Abbott) in 82% (23/28 ) of the neonates screened. Five were asymptomatic; in the remaining 18 cases, the symptoms were usually mild and self-limited. Transient shedding of the virus was found in 8% (4/52) of personnel screened, and only one of them was symptomatic. Control measures included the following: strict cohorting, closure of transitional nursery, enteric precautions and wiping of horizontal surfaces with 95% ethyl alcohol which has been shown to be an effective virucidal agent for rotavirus in laboratories. Follow-up in 80 of 108 contact neonates born during the epidemic showed only two mildly symptomatic cases after discharge. During an 11-month period of surveillance, 33% of neonates (1,688/5,054) born at Cook County Hospital were screened for excretion of virus in stools; only 3.6% of infants (61/1,688) were positive by Rotazyme and none were symptomatic. This report suggests that strict measures are helpful in control of HRV epidemic gastroenteritis and asymptomatic shedding need not be as high as the previously reported incidence of 40% to 50%.

Health care personnel are exposed to infectious diseases in the community as well as in the health care setting when they care for patients with transmissible conditions. Pregnant nurses, physicians and others face an additional risk—that of exposing their unborn children to some of these infections. Risk factors vary greatly between diseases and it is, therefore, important that each be evaluated and acted upon realistically. We will discuss and compare the risk of infections such as hepatitis, cytomegalovirus, tuberculosis, chickenpox, and others. With this knowledge, administrators and personnel involved will be able to make decisions about which patients should not be cared for by pregnant personnel, and which areas pose too high a risk for the mother and child so that a temporary transfer may be advisable. We address the multiplicity of preventive measures available for the prevention of maternal infections.

In our Intensive Care Nursery, coagulase-negative staphylococcus is the most frequent blood culture isolate. As skin antisepsis is critical in preventing blood culture contamination, we examined the efficacy of the chlorhexidine tincture (CH) used in our nursery for this purpose. Staphylococcus epidermidis colonized the forearms of 88% of infants tested, in a mean density of 104 organisms/cm2. Following a 60-second application of CH (0.5% in 70% ethanol), bacterial growth from forearm skin remained abundant in 15/38 infants (39.4%). Cleansing with 70% isopropyl alcohol, followed by CH as above, left abundant residual growth in only 1/37 infants (2.7%) (P<0.001). All 136 S. epidermidis tested were susceptible to CH (MIC<5(μg/ml) and 14 of 15 exposed to CH 0.02% were rapidly killed (≥98% fall in viable counts within 90 sec). We conclude that two-phase antisepsis using isopropanol followed by CH is a more effective preparation for blood culture in neonates than is CH alone.

This review of the cephalosporin antibiotic family will appear in three parts. The first part will provide general information on the cephalosporins as a class, highlighting the history, chemistry, pharmacokinetics, toxicity, and the segregation of these agents into “generations.” The second segment will discuss the antimicrobial spectra of activity of the first- and second-generation agents, while the last article will focus on the third-generation and investigational cephalosporins under evaluation.

Despite a confusing, and somewhat overwhelming array of cephalosporin antimicrobial agents presently available to the clinician, more are on the way. Since 1962 and the introduction of cephalothin, the first agent in this family, there has been a constant parade of new cephalosporins from various pharmaceutical manufacturers. Drug manufacturers are attempting to develop a more effective drug with attractive pharmacokinetic features and less toxicity by modifying the basic cephalosporin molecule.

Within any hospital setting, an active employee health and infection control program working together can be an effective way of preventing the spread of any disease from patient to employee or from employee to patient. The two programs at Lehigh Valley Hospital Center have worked actively together since the hospital opened ten years ago and have successfully developed many systems for follow-up care of employees, including puncture wounds, blood exposures, and infectious diseases. Ongoing staff educational programs have been given to include personal hygiene, handwashing, and hepatitis. Although each department reports to a different administrator, this has not affected the overall effectiveness and operation of either department.