A prospective four-year study on the infection rate of clean operative wounds is presented. From January 1982 to June 1985, a nurse epidemiologist and a medical team assessed 4,468 operative procedures, from the day of surgery to the patients' discharge from the hospital. The infection rate was 3.2%. A higher incidence of wound infection was detected in patients requiring emergency operations (5.1%), in drained wounds (5.4%), and in patients with conditions thought to predispose to infection, such as advanced cancer, hepatic cirrhosis, diabetes, nephrotic syndrome, previous splenectomy, and treatment with immunosuppressive drugs (7.8%). Age over 65 did not influence infection rates. There were up to tenfold differences in infection indices between surgeons performing the same clean procedures. The continued monitoring of clean wound infection rates allowed the early detection and control of infection outbreaks. Providing periodic information on infection rates to the different surgical services was associated with decreasing infection rates over time.

Five clusters of pseudobacteremias over a seven-month period were traced to a BACTEC® radiometric device. Four episodes were due to enterococcus and one involved Staphylococcus aureus. Each cluster began with multiple positive blood cultures from a patient with clinical evidence of bacteremia. On subsequent days each bottle in sequence yielded growth of the identical organism, as shown by phage typing and antibiograms. Cultures from patients believed to be infected with the organisms tested positive earlier (mean = 1.4 days) than those patients believed to be pseudobacteremic (mean = 4.8 days). Investigation pointed toward the BACTEC device as the most likely source. Resin beads were found in the needle on several occasions and were shown to be transferred from bottle to bottle. We postulated that contaminated resin beads or liquid from a positive bottle remained in the needle above the portion that was heat-sterilized, contaminating the next bottle when it was sampled.

A significant unremitting increase in the incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections in a 500-bed acute care community teaching hospital prompted reevaluation of the efficacy of the infection control measures used. A well-accepted, low-iodine, antimicrobial soap was used to replace a liquid natural handsoap in two areas with the highest incidence of MRSA—the intensive care unit, and a medical division.

Over a two-year period, an analysis was made of the effect of soap replacement on nosocomial infections and pathogens. Soap changeover occurred at the midpoint of the two-year period. From year to year, the nosocomial MRSA rate decreased 80% (t test, P=0.005). Other pathogens that demonstrated a dramatic decrease included methicillin-sensitive Staphylococcus aureus (MSSA), infections where no pathogens were isolated, and various gram-negative infections. Categories of nosocomial infections that decreased included surgical wound infections, primary bacteremias, and respiratory tract infections. The overall nosocomial infection rate of the two combined areas decreased 21.5%, representing a year-to-year savings of $109,500. As a result, the decision was made to install the low-iodine hand-soap permanently at all sinks within the hospital.

We investigated the effect of the following on the sterile integrity of surgical packs: four wrapping materials (two-ply reusable, nonbarrier wovens, both new and previously used; disposable, barrier nonwovens; and polypropylene peel pouches), dustcovers, two storage locations, and storage times ranging from 2 to 50 weeks. Two hundred sixty-three packs containing stainless steel coupons were prepared, wrapped, sterilized, and stored. Half of the packs were dustcovered prior to storage. At monthly intervals for a year, packs of each type were opened in a laminar flow hood, and the coupons inoculated into trypticase soy broth. The coupon contamination probabilities were 0.019 for reusable, woven packs; 0.017 for disposable, nonwoven packs; and 0.016 for peel pouches. These differences were not significant. The probability of finding a contaminated coupon in any pack after 50 weeks was 0.018. No trend toward increased probability of contamination over time was observed for any of the pack types studied.

Herpes simplex viral infection is a common cause of infection involving the eye and skin adjacent to the eye. Acute keratoconjunctivitis is a frequently observed herpetic manifestation often accompanied or exacerbated by stress factors, including fever (especially when associated with respiratory or intestinal infection), stress, trauma, environmental exposure, drugs, and menstruation. Each year approximately 300,000 to 500,000 cases of corneal herpes are reported. Complications such as decreased or lost vision may be associated with attacks of ophthalmic herpes infections. Therefore, effective treatment is imperative.1 Experts estimate that nearly 25% of patients with a primary ocular infection will have a recurrence of the infection, and approximately 50% of these patients will have a recurrence within two years. Herpes viral infections are a significant cause of blindness and a primary indication for corneal transplants.