Contaminated multiple-dose medication vials (MDV) have been implicated in transmission of bacterial infections. It has been suggested that MDV be discarded after 24 hours or even after a single use. At our hospital, we cultured 1,223 weekly samples from 864 MDV in-use over a three-month period. Medications included xylocaine, insulin, heparin, immunizations, and miscellaneous agents. None of the samples was culture-positive. The duration of use was 9.5d (median), 18d (mean), and 1-402d (range) with 13% of vials in-use for more than 30 days. The mean duration of use was significantly shorter for medicine wards, emergency room, and outpatient clinics than for surgery and obgyn wards (p<0.05). Heparin and insulin MDV were in-use for significantly less time than xylocaine and miscellaneous agents (p<0.05), and insulin MDV were more regularly dated (p=0.001). The percentage of undated MDV declined significantly by month during die study (p=0.003). These results lend support to our current guideline that MDV should be dated upon opening and that, unless visible or suspected contamination occurs, vials are discarded either when empty or at the manufacturer's expiration date.

Nosocomial respiratory tract infections have occasionally been associated with contaminated respiratory therapy devices and techniques. In the past two years, our hospital purchased disposable saline squeeze vials for use during suctioning of intubated patients. These vials have a cap which must be flipped or twisted-off by the user before the contents can be instilled into the patient's respiratory tract. We observed use of this item in our intensive care units (ICU) and studied the potential for contamination. ICU nurses use ungloved hand(s) to flip or twist-off squeeze vial cups resulting in skin contact with the vial opening. Cultures of nurses' hands and squeeze vial contents were obtained in the ICU where 24 nurses opened 92 vials in the manner previously described. Twenty-three percent of vial contents were contaminated and cultures revealed S. epidermidis, S. aureus, Streptococcus viridans and enterococcus. On six occasions, organisms recovered from vial contents were believed to be identical to organisms isolated from the hands of the nurse who opened the vial. When nurses used care in removing the saline vial cap, cultures of vial contents were sterile.

Long-term use of indwelling urinary catheters in nursing home (NH) patients is a potential cause of significant morbidity. We retrospectively studied 10 NH patients with chronic indwelling urinary catheters. Sixty-four percent of all 84 antibiotic courses prescribed were for bacteriuria alone without clinical infection. Seventy percent of 63 antibiotic courses were followed by bacteriuria with organisms resistant to the antibiotic administered. Bacteria isolated from NH patients often displayed greater resistance to specific antibiotics than those isolated from hospitalized patients. Four of the 20 urinary tract infections were associated with bacteremia. Three episodes of bacteremia were with highly-resistant organisms and one was fatal. Use of urinary catheters and inappropriate use of antibiotics in NH patients results in urinary tract colonization and infection with resistant bacteria and is an important cause of morbidity and mortality.

A prevalence survey of infections among 572 acute and long-term care patients in the Albany Veterans Administration Medical Center was conducted in September 1979. Presence of infection was determined by patient examination and chart review. Urine specimens from 94% of patients were cultured. The total number of clinically significant infections was 178; 117 were nosocomial (20.5 per 100 patients). The prevalence rate of nosocomial infections was highest on the Intermediate Service (long-term medical care) followed by the Surgical and Medical Services. Sites with the highest nosocomial infection rates were urinary tract (10.7), skin and subcutaneous tissues (5.1), and surgical wounds (3.0) per 100 patients. Nosocomial infections increased with age and length of hospital stay which partially explained the higher rate on the Intermediate Service. Patients using condom drainage and Foley catheters showed similarly high rates of bacteriuria. Antimicrobial drug use was 17% for acute care patients and 4% for long-term and psychiatry patients. Excepting Providencia stuartii urinary tract infection confined to the Intermediate Service, the bacterial isolates and their antibiotic susceptibilities were similar for the acute and long-term care services.

Acquired immunodeficiency syndrome, or AIDS, is currently a significant public health problem receiving widespread interest as both cause and treatment are sought. Indications are that a transmissible agent is involved. Both clinical and research laboratories are receiving greater numbers of specimens from AIDS patients as both prevalence of the condition increases and research efforts intensify. Until such time as the causative agent is identified, prudent practice warrants that a high level of precaution be observed. The Division of Occupational and Environmental Health Services of the Yale University Health Services presents a set of safety procedures and guidelines for use by personnel of both clinical and research laboratory facilities. These exceed previously suggested containment recommendations.

This review of aminoglycoside pharmacology will appear in two parts. The first segment summarizes general information applicable to all agents, such as aspects of absorption, distribution, and clearance. The subsequent article will focus on specific agents currently in use in clinical practice: gentamicin, tobramycin, netilmicin, amikacin, streptomycin, and kanamycin, highlighting toxicities and pharmacokinetic-based dosing strategies.

Embedded in the history of antimicrobial agents with the discovery of streptomycin in 1944, the aminoglycosides remain a mainstay of contemporary antibiotic therapy. Noteworthy features include rapid bactericidal activity against aerobic gram-negative organisms as well as additive or synergistic activity when coadministered with beta-lactam agents. These positive attributes are offset by limited penetration into various body fluids and tissues, and dose (concentration) related renal and ototoxicity. Despite the proliferation of safer beta-lactam compounds with expanded antimicrobial spectrums, the aminoglycosides are still initial drugs of choice for most life-threatening, aerobic, gram-negative infections. Used in combination with anti-pseudomonal penicillins, the aminoglycosides are the agents of choice for empiric therapy of fever in the neutropenic host or documented tissue infection with Pseudomonas aeruginosa.

A number of resources are available to individuals who are interested in employee health and infection control. These resources can be useful to individuals whose employee health programs are just starting or to those whose programs are well-established.

The most comprehensive document to date is the Employee Health Guidelines published by the Centers for Disease Control. This is perhaps the most comprehensive and thorough document published to date. It is current, reflects the state of the art in employee health, and should provide employee health and infection control practitioners with a wealth of useful information that is practical and clinically relevant.