To better assess the risk of exposure to bloodborne pathogens following puncture injuries due to needles removed from intravenous(IV) lines.

Tertiary care community medical center.

A convenience sample of hospitalized patients requiring IV piggy-back medications.

Examination of 501 IV ports of peripheral lines, heparin-locks, and central venous lines for visible blood and testing the residual fluid in the needles removed from these ports for the presence of occult blood by using guaiac-impregnated paper.

The proximal ports of central venous lines and heparin-locks were statistically more likely to contain visible blood than proximal and distal ports of peripheral lines (17% and 20% versus 1% and 3% respectively, P<0.05). Similarly, needles removed from proximal ports of central venous lines and heparin-locks were statistically more likely to contain occult blood than those from peripheral lines ( 11% and 14% versus 2%, respectively, P<0.05). Only two needles removed from IV lines without visible blood contained occult blood: one from the proximal port of a central line and another from a heparin-lock. None of the needles from peripheral lines without visible blood contained occult blood.

Estimation of the risk of transmission of hepatitis B and C and human immunodeficiency virus (HIV) following injury by needles from various IV lines revealed that injury due to needles removed from peripheral IV lines and distal ports of central lines without visible blood was associated with “near zero” risk of transmission of these bloodborne infections at our medical center.

Routine serological testing of source patients involving injury due to needles removed from peripheral IV lines and distal ports of central lines without visible blood is not necessary at our medical center. Conversely, due to the relatively high rate of occult blood in the needles removed from proximal ports of central venous lines and heparin-locks, puncture injuries due to these needles are considered significant and managed accordingly.

To test the hypothesis that multiple needlestick injuries in hospital employees may he due to intrinsic deficits in hand dexterity.

A case-control study comparing employees with multiple reported needlestick injuries to those with none. Hand dexterity was tested using the Purdue Pegboard Test, a standardized validated test of hand dexterity.

A 300-bed, acute care teaching hospital.

Fifteen hospital employees who sustained four or more injuries were compared to 19 controls.

No differences were detected in hand dexterity between the case and control groups.

While employees with multiple needlestick injuries accounted for 85% of reported injuries, underlying factors responsible for injuries in this high-risk subgroup do not include measurable deficits in hand dexterity.

The purpose of this study was to determine current regulations and policies in the United States concerning maximal water temperatures in acute care hospitals.

A standardized questionnaire administered by telephone to health department officials from 50 states and the District of Columbia.

See also page 636

State Health Departments in the 50 states and the District of Columbia.

All states responded to the survey. Respondents from 39 states (77%) reported regulating maximum allowable hospital water temperature at a mean of 116°F (median, 120°F; mode 110°F; range, 110°F to 129°F). Twelve states (23%) have no regulations for maximum water temperature. Of the 39 states regulating maximum water temperature, 30 (77%) routinely monitor hospital compliance. Nine states (23%) conduct inspections only in response to a complaint or incident.

There is great variation among the states with respect to the existence, enforcement, and specific regulations controlling hospital water temperature. Risk-benefit and cost-effectiveness analyses would help to assess the risk of scald injuries at water temperatures that will inhibit microbial contamination (Infect Con-trol HOsp Epidemiol1993;14:642-645).

To describe the spectrum of clinical infection caused bymethicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers.

Case series.

Two Veterans Affairs hospitals in which methicillin-resistant S aureus (MRSA) is endemic.

Five employees presenting to employee health or infectious disease clinic.

All employees had had direct exposure to patients colonized with MRSA. Employee infections included cellulitis, impetigo, folliculitis, paronychia, and conjunctivitis. MRSA was isolated from all clinically infected sites and from the anterior nares of two employees. Three employees received a variety of ineffective oral antimicrobials before MRSA was recognized as the causative agent. All infections responded to appropriate therapy.

Employees of hospitals with endemic MRSA may acquire MRSA infection. Presentation in our employees was that of relatively uncomplicated soft tissue infection, but several employees received inappropriate therapy before bacteriologic diagnosis. We recommend that culture and susceptibility testing be obtained prior to institution of therapy when hospital employees present with soft tissue infection.

To determine the effect of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a nursing home on the subsequent MRSA caseload in a closely affiliated hospital.

Observational and descriptive; routine and special MRSA surveillance data for nursing home and hospital were reviewed for a four-year period (1988 to 1991) as were records regarding patient transfers from nursing home to hospital.

The 120-bed nursing home care unit (NHCU) and the geographically separate 434-bed acute care facility (hospital) of the Portland Veterans' Affairs Medical Center (PVAMC).

Veterans hospitalized in the acute care division of NHCU.

Following the introduction of MRSA into the NHCU in December 1987, it quickly disseminated. Two to 32 newly colonized or infected patients were recognized in each quarter of the study period. Facilitywide prevalence surveys on two occasions disclosed MRSA colonization rates of 34% and 10%. During the study period, 15 to 54 (mean: 37.6) patients were transferred each quarter from the NHCU to the hospital of the PVAMC. The number of MRSA cases transferred ranged from 0 to 16 per quarter (mean: 5.4). During the same period, the total number of MRSA cases in the hospital increased, rising from 7 cases in 1987 to 16 in 1988, 48 in 1989, 34 in 1990, and 35 in 1991. The percentage of hospital MRSA cases accounted for by NHCU transfers was 0% in 1988, 38% in 1989, 12% in 1990, and 11% in 1991.

Despite the steady flow of patients between the NHCU and the hospital, the MRSA outbreak in the NHCU was associated with only a modest increase in the MRSA caseload at the affiliated hospital.