The hospital is a unique workplace in terms of the infectious hazards it presents to its employees. Traditionally, infection control programs have focused on various aspects of infection control in patients. However, infections constitute a risk for health care workers, a fact which emphasizes the importance of infection control input into the employee health program. Many health care facilities and most regulatory agencies recognize the importance of infection control in health care workers. However, infection control programs have had varying degrees of influence in occupational health matters. As the discipline of infection control has grown and become more sophisticated, the subdiscipline of employee health has also begun to grow and emerge with a data base of its own. Many infection control conferences, symposia, and meetings now have a session or two related to employee health. Perhaps even more important is the CDC Guideline for Infection Control in Hospital Personnel, written by a CDC panel as part of its guidelines series. It will be responsible for drawing attention to employee health issues as they relate to infection control and should help solidify the discipline. The guideline will also provide opinions and answers to many questions regarding infection control and employee health.

Dr. Phillips introduced his discussion about resistant staphylococci with the statement that nosocomial Staphylococcus aureus infections have steadily declined in England over the past two decades. The peak of infections with multiply antibiotic-resistant S. aureus strains was in the early 1960s. Toward the end of the 1960s, penicillin-resistance decreased and methicillin-resistance increased. Generally, resistant strains were found less frequently in the 1970s. No major outbreaks of cross-infection were seen in the United Kingdom since 1977 although Staphylococcus aureus did emerge from time to time, for example, in the recent epidemic of toxic shock syndrome, previously known to clinicians as staphylococcal scarlatina. In contrast, Staphylococcus epidermidis is in ascendency. In the early 1960s this organism was occasionally seen in stitch abscesses but then it appeared with increasing frequency in urinary tract infections and infections associated with intravascular devices. Dr. Phillips summarized his presentation with the statement that Staphylococcus aureus has lost its will to spread and, probably, to become resistant. Despite extreme provocations by medical procedures, only sporadic episodes of emergence seem to occur. Staphylococcus epidermidis, on the other hand, never had the will to spread but is more able to develop resistance. This organism is an example of the classic opportunist who receives a lot of help (from plastics!). During the discussion, several questions about staphylococcal taxonomy and methods of antimicrobial susceptibility testing were raised. Reference was made to the situation of staphylococcal infections in other countries; for example, the cyclic appearance of methicillin-resistant Staphylococcus aureus in the US.

Nosocomial pseudoepidemics may be detected when clustering of pseudoinfections occur or when artificial clusters of real infection are observed. Nontuberculous mycobacteria were reportedly isolated from specimens obtained from seven patients at one hospital from October 1980 to January 1981. Because the patients' clinical illnesses were not uniformly consistent with mycobacterial disease, we hypothesized that pseudoinfections had occurred and searched for a common source of contamination. The investigation suggested that specimen contamination was associated with one microbiology laboratory technician: 6 of 22 (27%) specimens processed by that person were positive compared with 1 of 103 (1%) specimens processed by the other five technicians. However, a specific mechanism of contamination was not identified. Nosocomial pseudoepidemics associated with false infections should be suspected and investigated when clinical features and laboratory findings do not agree.

Disinfectants come into contact with humans in two principal ways. First, they have involuntary contact with the skin and mucous membranes and are inhaled during the course of normal work. Second, they are applied purposefully directly to the skin and mucous membranes. This applies also to other chemicals in the hospital (eg, detergents), with the long-term danger being much greater for hospital personnel than for the patients.