To assess the scope of infection control programs in extended care facilities, 1-day surveys were conducted in 12 North Carolina facilities over an 8-month period using a standardized questionnaire. All 12 facilities had a designated infection control practitioner (ICP), although none had attended an infection control education course. Eleven had an Infection Control Committee of which 8 (73%) met regularly. The Director of Nurses generally (58%) was the ICP and spent about 2 hr/wk on infection control. Ten (83%) facilities conducted infection surveillance among residents but did not accurately compute nosocomial infection rates. Eleven (92%) facilities had employee health programs that included preemployment and annual tuberculosis screening. None had a comprehensive resident health program. Infection control aspects of patient care practices often varied from facility to facility. Nosocomial infection surveillance among 336 residents in 9 facilities using modified CDC criteria revealed an overall prevalence rate of 5.4%. Additional infections were suspected but not included because of limitations of laboratory data and chart documentation.

The role of the pulmonary function (PF) laboratory and PF testing equipment in the transmission of infections has not been established. Although microorganisms have been cultured from parts of in-use pulmonary function testing equipment, a relationship between equipment contamination and transmission of infection or colonization has not been documented. Nosocomial outbreaks of respiratory infections, eg, influenza, tuberculosis, and legionellosis have been described, but transmission of the microorganisms has not been shown to be more likely in the PF laboratory or with PF testing equipment than in other areas in the hospital or with other hospital equipment. Unlike nebulizers, which have been implicated in epidemic and endemic nosocomial gram-negative bacterial infections, PF machines do not generate aerosols. PF testing equipment is thus built without provision for easy machine disassembly and disinfection, except for parts that routinely come in contact with mucous membranes or secretions (eg, mouthpieces, valves, and some tubings).

A retrospective study of 204 patients culture positive for methicillin-resistant Staphylococcus aureus compared infected and colonized patients. Seventy-eight patients were colonized and never developed infection (C), 24 were colonized and subsequently infected (C➧I), and 102 patients had 1 or more nosocomial infections with MRSA at time of first culture (I). The most prevalent sites of infection were wound (26.5%) and bloodstream (20.7%), whereas the respiratory tract and surgical wounds were both frequent sites of colonization. Stepwise discriminant analysis found the most important factors in differentiating likelihood of colonization vs. infection were recent prior hospitalization, history of wound debridement, and number of invasive procedures. Ten percent of (C) died and 25.5% of (I) died. MRSA contributed to death in 57.6% of the (I) deaths (p<.05). These results underscore the importance of differentiating (C) vs. (I) in hospitals where MRSA is endemic so that early specific treatment may be initiated. Risk factors for infection should be discriminated from those for acquisition of the organism.

Biological monitors (BI) are considered to be the best monitor of the sterilization process yet false positives may result in recalls and quality assurance difficulties. To assess the frequency, type and reasons for questionable results, we undertook a 4-year in-use study of two commonly used BI types—spore strips (Spordi®) and a self-contained crushable ampule (Attest®)—for both steam and ethylene oxide (EO). After laboratory verification of time/kill ratios for a portion of each involved lot, 2 BI of each type were placed in test pack within a randomly selected load run at standard time and temperature. All resulting positive BI were subcultured. Steam cycle positives were uncommon (32/1,1710 positive Spordi, 1.9%; 20/1,710 positive Attest, 1.2%) and could be related to chamber temperature or steam quality. All of the 4 BI per load were positive in only three loads; physical monitors indicated gross malfunction. Five positive Spordi were due to either contaminants or a malfunctioning incubator. EO-related positives were more common (53/1,109 positive Spordi, 4.8%; 25/1,109 positive Attest, 2.3%). One-half of the Spordi tests became positive after 48 hours of incubation. Organisms other than B. subtilis were recovered from 49.1% of the positive tests (26/53). The Attest was remarkable for its lack of contamination; 1/25 was positive for Pseudomonas stutzeri only. More positives were observed during the winter months when relative humidity was below 20%. This finding was more commonly observed with the EO Attest. In summary, we found no significant difference in the performance of either BI. Subculturing of positives and maintenance of proper humidity during storage should be emphasized.

The adequacy of a currently recommended protocol for disinfecting CPR manikins was investigated. Known quantities of Herpes simplex type 1 virus were applied to various sites on both adult and infant manikin heads, exposed to disinfectant under simulated classroom conditions, and then assayed for infectious virus. Results indicate that the disinfecting protocol and disinfectant are adequate for inactivating herpesvirus on CPR manikins, but that care must be exercised to ensure thorough cleaning.

In a recent communication, the manufacturer of a glutaraldehyde-based disinfectant described several important discoveries that became apparent during a recent review of claims of their product. Such updating of materials is an ongoing quality assurance mechanism for many reputable manufacturers.

Manufacturer A maintains that the old Association of Official Analytical Chemists (AOAC) tuberculocidal testing procedure is prone to significant errors. Therefore, they developed a new, more reliable test (in their opinion), which has also been filed with the Environmental Protection Agency (EPA), and on which their new recommendations are based. Other manufacturers may use the old or new AOAC test methods to satisfy requirements of the EPA.

Not long after the introduction of penicillin G for anti-staphylococcal therapy, penicillin G resistant strains of staphylococci were isolated and were found to produce penicillinase enzymes. In 1959 methicillin, a penicillinase resistant penicillin (PRP), was introduced in England for therapy of these strains. Within 2 years the first strains of methicillin-resistant Staphylococcus aureus (MRSA) were reported in that country. Subsequently, reports of MRSA infections throughout Europe appeared. Reports from Switzerland and Denmark indicated that 30% to 50% of all nosocomial S. aureus isolates and 40% of all S. aureus bacteremia isolates, respectively, were due to MRSA. Although sporadic reports of MRSA infections appeared in the US after 1960 the first documented outbreak of MRSA infections occurred at Boston City Hospital in 1968. Even today there is not a complete understanding of MRSA and its role in infectious diseases, however, a vast amount of information has accumulated and certain aspects of this information will be discussed.