Between January and September 1986, 61 patients underwent corneal transplantation at a university hospital, and three (4.9%) of the patients developed endophthalmitis. Cultures of the donor cornea were positive for Streptococcus pneumoniae. The transplant program was stopped and an investigation begun. Review of corneal transplants in 1985 showed that S pneumoniae was recovered from only 1 (1.5%) of 66 donor corneas compared with 6 (9.8%) of 61 in 1986 (P = 0.045; Fisher's exact test). Investigation showed that major changes had occurred in the corneal transplant program in 1986 as a result of a new state law. Coroner's cases had become the source of most corneas; younger donors were available, and corneas, instead of whole eyes, were collected in the coroner's office, often by part-time technicians. All of the infected corneas had been harvested by part-time technicians, instead of the regular eye bank technician, and came from younger donors (mean age 11.8 years v 27.2; P ≤ 0.02). Based on these observations, collection techniques were modified to reduce contamination of corneas during harvesting. This included the use of surgical drapes and gloves, collecting the cornea without interruption, saline irrigation of the eye, and inversion of the eye chamber to ensure complete contact of the cornea with the antibiotic-containing media. The program was restarted, and there were no corneal infections with S pneumoniae during a one-year follow-up period. The study indicates that techniques sufficient to prevent infection when whole eyes were taken and the cornea harvested by experienced technicians were not effective for direct harvesting of corneas in a coroner's office by less experienced technicians. The use of younger donors may also increase the risk of S pneumoniae contaminating the cornea and require additional measures for control.

Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly frequent in both acute care facilities (ACFs) and skilled nursing facilities (SNFs). Admissions to SNFs from ACFs with endemic MRSA are one likely source of infection in SNFs. The occurrence of MRSA in SNFs and the relative roles of ACFs and SNFs in MRSA transmission have not been well characterized. We conducted an epidemiologic investigation in an SNF reporting a high incidence of MRSA cases and found that the prevalence of MRSA exceeded that reported in acute care settings. Fifteen (9.1%) of the 164 residents were colonized or infected with MRSA. Risk factors for MRSA identified through a prevalence case-control study were nasogastric intubation (odds ratio = 5.5; 95% confidence interval = 1.2, 26.4), antibiotic therapy (OR= 3.9; CI = 1.2, 13.0), and hospitalization in an acute care facility within the previous six months (OR = 2.9; CI = 0.9, 9.7). During a three-month period, 6 of 100 new admissions were MRSA-positive; all positive patients were from ACFs. Five new cases also emerged from previously MRSA-negative residents. SNF residents are often discharged to ACFs. Transmission of MRSA within the SNF and the transfer of patients to ACFs increases the reservoir of potentially infective patients and the potential for MRSA infections in ACFs. Modest control measures, including targeted surveillance culturing and cohorting of colonized residents, may minimize MRSA transmission in the SNF and decrease the reservoir of MRSA in the community.

Staphylococcal infection of a vascular prosthesis is a relatively uncommon complication of peripheral vascular surgery; however, these infections and their sequelae can be catastrophic. The majority of prosthetic graft infections are caused by mucin-producing strains of Staphylococcus epidermidis, which express varying degrees of adherence to the synthetic substrates. Studies have demonstrated that the components and construction characteristics of the graft, implantation site, administration of antimicrobial agents, and endogenous microbial flora are all identifiable risk factors in vascular graft infections. Mucin production, a known virulence factor, has recently been shown to occur in endogenous coagulase-negative staphylococci (CNS) at the time of hospital admission. While mucin production plays an important role in the persistence of graft infections, there is no evidence that suggests a relationship between mucin and antimicrobial resistance.

Identifying characteristics of (CNS) graft infections may include a draining wound sinus, poor graft incorporation, a perigraft exudate or a pseu-doaneurysm at the anastomotic site. The occult nature of these infections, in which the patient is often asymptomatic, makes diagnosis and treatment difficult. The graft or graft exudate may be negative when routine culture methods are employed. The recognition of CNS graft infections requires a high index of suspicion and the treatment of these infections requires understanding of the pathogenic process, individualized surgical management, and the judicious use of antimicrobial agents.

The epidemic of human immunodeficiency virus (HIV) infection has provided a major impetus to strengthen infection control practices in health care and laboratory settings. The widespread nature of blood contamination in the hospital environment, however, is often underappreciated. In this study, we evaluated the frequency and origin of blood contamination of medical records.

A case of primary and recurrent herpes simplex virus (HSV) infection resulting from a bite wound' occurring in a pediatric nurse is presented. HSV infection as an occupational hazard among hospital, personnel is briefly reviewed.

Herpes simplex virus occurring as herpes whitlow is a well-known hazard among dentists and dental technicians. There is one report in the literature of a large series of nurses in a neurosurgical unit contracting herpetic whitlow. There is one case in the literature of a physician contracting primary herpes simplex infection from mouth-to-mouth resuscitation of a patient with herpes simplex pneumonia. Three days after performing mouth-to-mouth resuscitation, the physician developed painful papulovesicular lesions over the beard area, which subsequently ulcerated and crusted. One year after the resuscitation, the physician experienced cervical lymphadenop-and a recurrence of herpetic lesions in the same areas as the original infection. We report a case of primary and recurrent herpes simplex type 1 infection with disabling causalgia in a licensed practical nurse resulting from a bite wound received from a child hospitalized with pneumonia.

The Canadian health care system serves a population of approximately 25 million people spread out over a very large geographic area (9,960,000 km2). Canada is a federal state consisting of ten provinces and two territories. It was formally created in 1867 when the British North America Act (BNA Act) was passed by the British Parliament, uniting several of the British North American colonies.

The BNA Act grants the provincial governments primary jurisdiction over most health services. The federal government has jurisdiction over quarantine, the establishment and maintenance of marine hospitals, and the quality of food and drugs, and until recently provided health care services to the territories. The federal government also helps to finance provincial health care services and, therefore, the provincial governments have been persuaded to establish hospital and medical care insurance programs. The shared-cost federal programs require each province to meet certain conditions in order to obtain federal funding. This division of powers has resulted in ten distinct, although related, health systems.

Introduction in order to study the association between disease status (eg, nosocomial infection) and some exposure variable (eg, number of days on urinary catheter), it is often necessary to take into account other variables that may influence either the disease status or the exposure variable. For example, Freeman et al described a retrospective (in their terminology “case-referent”) study of a neonatal population. In this study, cases of nosocomial infection are selected in addition to corresponding control individuals who did not experience a nosocomial infection. All patients were selected from a neonatal intensive care unit, and the goal was to study the role of umbilical artery catheterization and its association with nosocomial infection. As noted by Freeman et al, this is a complex question because the risk of nosocomial infection might reasonably depend not only on the duration of catheterization, but also on the birth weight of the infant.