A prospective three-month study of the hospital costs associated with nosocomial infections was done in a 390-bed, 30-bassinet community-teaching hospital early in 1978. All hospital charges for diagnostic and therapeutic services required by nosocomial infections, and added length of stay due to the infections, were recorded. During the study period 123 infections occurred in 104 patients (a 2.7% incidence, considering the 4,485 patients discharged during this time). The average length of stay was prolonged 3.0 days for all nosocomial infections; this accounted for about half of the $636 average hospital charges for each nosocomial infection. The 65 nosocomial urinary tract infections prolonged the length of stay an average of 0.6 days and the total hospital charges were $146 for each infection, leading us to believe that the proportion of nosocomial infections at any given site may greatly alter the “average” cost of nosocomial infections. Our data from a community hospital show a shorter prolongation of length of stay and lower hospital costs when compared with the few other studies in the literature.

One measure used in the management of staphylococcal disease outbreaks in newborn nurseries is to obtain nasal cultures from nursery personnel and then treat nasal carriers with topical antibiotic ointments. Because recent infection control guidelines often omit reference to this measure, we surveyed current practices in larger hospitals in the U.S.A. Seventy-one percent of respondents indicated that they would obtain nasal cultures from personnel during a staphylococcal disease outbreak, and 40% indicated that they would prescribe topical antibiotic ointments for personnel with positive nasal cultures before the results of bacteriophage typing became known. Because little has been written about the efficacy of topical intranasal antibiotics within the past decade, we compared bacitracin ointment with a vancomycin ointment for treatment of the staphylococcal nasal carrier state. Both ointments reduced nasal carriage in the majority of instances. However, similar reduction was also observed in an untreated control group. The need for different approaches to the problem of nasal carriers is discussed.

Protracted hospital-based epidemics of urinary tract infection and bacteremia due to multiply resistant gram-negative bacilli have become an increasingly common and serious problem. Failure to control such outbreaks stems partly from inability to eradicate a key reservoir, the catheterized bladder. Since eradication of bacteriuria in noncatheterized patients can be achieved with single doses of antimicrobials and correlates with urinary rather than with serum antibiotic concentrations, drugs to which an organism appears resistant by discdiffusion testing, if excreted in the urine in high concentrations, might also prove useful in eliminating catheter-associated bacteriuria. Alternatively, urinary antiseptics, for which antimicrobial sensitivity testing is not usually done, might be effective. To test this hypothesis we determined the minimum inhibitory concentrations (MICs) of 45 multiply resistant Proteus, Serratia, Klebsiella, and Pseudomonas strains isolated in 13 recent epidemics of nosocomial urinary tract infections against 10 selected antimicrobials and urinary antiseptics, and compared these MICs with expected urinary concentrations of each drug. For each genus tested, MICs for at least two antimicrobials or urinary antiseptics were well below easily achievable urinary drug concentrations. Zone size criteria often predicted which drugs had MICs below achievable urinary levels. Little difference was found between MICs determined in Mueller-Hinton broth and in urine. During an epidemic, simultaneous treatment of all patients with bacteriuria by administration of a urinary antiseptic or an antibiotic that achieves high concentrations in urine, in conjunction with brief catheter removal, might prove useful in controlling any further infection.

This article reviews the most likely mechanisms of transmission of the commonly encountered respiratory viruses (influenza, respiratory syncytial virus, parainfluenza, rhinovirus), herpesviruses, and hepatitis viruses, and presents the guidelines used currently for prevention and control that are in use at Strong Memorial Hospital.