Antimicrobial devices are often used to prevent nosocomial infection, despite mixed evidence as to their efficacy. Using a national survey, we found that a hospital's use of an antimicrobial device to prevent one type of infection was associated with a higher likelihood that a similar device would be used to prevent a different infection.

Before the days of antisepsis, the infection rate on surgical wards was very high. Mortality from common operations such as limb amputations could run from 40% to 60%, mostly from infection. Hospital gangrene, a type of necrotizing infection, occurred frequently. It would spread rapidly, and the helpless surgeon could do nothing to stop it. The patient would be in agony for many days before death mercifully intervened.

We compared the antibiogram statistics generated by including all clinical isolates to those obtained by tabulating no more than one isolate of a particular organism from a given patient. We found that 48.3% of the isolates presented multiple occurrences in individual patients but found no practical differences in the profiles obtained by the two methods. We also tabulated the occurrence of minimum inhibitory concentration (MIC)-distinct organisms among the sets of multiple isolates of E. coli and of S. aureus and found that only 20.9% of those isolates represented duplicate organisms by MIC profile. This heterogeneity of MIC sensitivity that occurs in multiple isolates from individual patients was not expected but provides an explanation for the lack of difference between the two methods of tabulating antibiotic susceptibility statistics.

The possibility of sepsis or pyrogenic reaction increases in hemodialysis patients as coliform or other gram-negative counts in the dialysis water reach levels ≥ 1000 colonies/ml. After the introduction of Cobe Century II dialysis machines (Cobe, Lakewood, Colorado), routine testing of dialysis water samples revealed gram-negative bacteria in concentrations up to 45,000 colonies/ml. An epidemiologic investigation was performed to determine the source of the bacterial contamination. The amounts of disinfectant solution were increased, but bacterial counts remained unacceptably high. A study of the fluid path within the machines revealed that part of that path was not reached at all by the disinfectant. In addition, the disinfectant was automatically and improperly diluted. Therefore, increased bacterial counts could not be reduced satisfactorily by using the manufacturer's disinfection guidelines.

A human parvovirus was first discovered serendipitously in blood from asymptomatic donors in 1975' and designated B19 because of the location of the original positive serum in a test panel. Subsequently, the newly discovered virus was determined to be the etiologic agent of most cases of transient aplastic crisis in the setting of chronic hemolytic anemia and of the childhood exanthem erythema infectiosum, or fifth disease. While erythema infectiosum with its classic “slapped-cheek” rash is a childhood illness, “fifth disease” in the adult should not be overlooked. At least 40% of adults lack serological evidence of past human parvovirus B19 infection and are at risk. Adults tend to have a more subtle rash, often lacking the “slapped cheeks,” and tend to have a more severe constitutional, flu-like illness with prominent joint symptoms. While the arthralgia and arthritis of adult “fifth disease” are often self-limiting, they may become chronic and lead to an arthropathy that meets American College of Kheumatology criteria for a diagnosis of rheumatoid arthritis. The arthropathy has been reported to persist up to five years, the longest follow-up now available (A. Wolf; MD, personal communication, August 27, 1987).

Patients in two acute care university hospitals were entered into the study using the following method: twenty patients were selected each day from all floors/units in each hospital until the hospital communities had been surveyed only once. A total of 762 hospital patients were identified for the study, and the history of each patient was then abstracted from their charts. The data were analyzed as an historical cohort study design. The two hospital samples were compared to show the effects of the non-random sampling method using one hospital as a comparison group for the other. Expected associations between nosocomial infection and known risk factors were compared and contrasted between the hospitals using cumulative incidence rates and relative risk ratios. The average length of stay of the group of patients in each hospital was extended from a mean of ten days to a mean of 30 days. The only significant difference between the two hospital cohorts was an age effect. The advantages and disadvantages of this method for selecting a long staying cohort at high risk for nosocomial infection in acute care facilities are detailed.

Among 145 Enterococcus faecalis isolates recovered during a 15-month period (April 1997-June 1998) in AHEPA University Hospital, Thessaloniki, Greece, 94 (65%) exhibited high-level resistance to gentamicin or streptomycin and 61 (42%) to both aminoglycosides; 73% of the high-level aminoglycoside-resistant E faecalis isolates belonged to a single clone carrying the gene aac(6')-Ie-aph(2”)-Ia. These findings differ from those of other regions, where high-level aminoglycoside-resistance genes are dispersed into genetically unrelated strains.

For many years the American Occupational Medical Association (AOMA) has had a committee on medical center employee occupational health services. This committee has met periodically to discuss common problems and issues related to occupational health matters in health-care facilities. Two years ago a task force met to develop guidelines for employee health services which would be the official AOMA statement on this matter. The guidelines were published recently in the Journal of Occupational Medicine and have been reprinted here.