Shigellosis is uncommon in the newborn nursery. We describe a case of Shigella sonnei gastroenteritis occurring in a newborn. Three of 32 health care providers caring for the infant acquired shigellosis. The neonate probably acquired the infection from its mother via vertical transmission. All six members of the infant's family had gastroenteritis and two siblings had stool cultures positive for Shigella. Transmission of Shigella in the newborn nursery is potentially great. Emphasis on handwashing and glove use, aggressive case finding, notification of contacts, and a liberal “forced paid sick time” policy may halt the spread.

Aerobic gram-negative bacillus (AGNB) groin skin carriage was prospectively studied in ambulatory geriatric outpatients: 42 from three nursing homes and 44 from private homes. Initially, 12 (28.6%) Proteeae carriers were in the former group and 3 (6.8%) were in the latter (P =0.01). At one year, 6 of 7 surviving nursing home carriers remained Proteeae carriers while none from private homes remained carriers (P =0.007). The annual prevalence of Proteeae carriage was 14 (33.3%) in nursing homes and 4 (9.1%) in private homes (P =0.008); of non-Proteeae AGNB carriage, the annual prevalence was 2 (4.8%) and 4 (11.4%), respectively. Nursing home subjects had similar initial health characteristics; however, by one year, 5 of 12 carriers in contrast to 3 of 30 noncarriers were dead of chronic disease (P =0.03). These nursing homes included persons with chronic diseases that apparently facilitated Proteeae carriage. Urethral catheters, skin ulcers, and recent antibiotics were not factors.

Proteeae carriage was evaluated in groin skin carriers following vigorous antiseptic application. Three Proteus mirabilis carriers were treated with 60% isopropyl alcohol or 4% chlorhexidine, observed to prevent skin contact, and then recultured; at four and eight hours P mirabilis numbers remained undiminished. Ten Proteeae carriers received a series of nine body baths with soap, chlorhexidine, and 0.75% povidone-iodine plus three cefazolin injections over 16 to 34 days; cumulative treatments failed to clear seven carriers. Within three months, all were again carriers. Proteeae carriers also had affinity for groin carriage of various aerobic gram-negative bacilli (AGNB) including cefazolin-resistant strains. In seven subjects, more than one AGNB species were recovered shortly after applying an antiseptic. Proteeae groin skin carriage appears to reflect a major change in the nature of resident bacteria on intact groin skin.

In late January 1985, a measles outbreak occurred at a community hospital in Columbia county, Florida. The outbreak spread throughout the county and to two neighboring counties (Alachua and Marion), resulting in 79 cases with a 29% hospitalization rate. Hospitals represented the site with the highest frequency of transmission. At the Alachua county hospitals, where strict respiratory isolation measures were taken, no secondary cases occurred among hospitalized patients. Two independent risk factors existed for hospitalization: measles exposure in a hospital setting (P <0.05) and nonvaccination (P <0.00l). Of the total measles cases, 24% were under the age of 16 months and 47% of those aged 16 months or older had a history of appropriate vaccination. Columbia county, which experienced 86% of the cases, had a 5% frequency of unvaccinated students compared to 0.6% frequency at Alachua (P <0.00l) where only 10% of the cases occurred. This outbreak demonstrates the role of uncontrolled nosocomial transmission of measles in the propagation of a community outbreak.

Case-control studies (sometimes referred to as case-referent studies) have long been important in epidemiologic research. This technique has been instrumental in allowing researchers to discover the associations between cigarettes and lung cancer, thromboembolism and oral contraceptives, and stilbesterol and vaginal cancer, just to cite a few examples. The case-control method is also a very useful technique for studies in hospital epidemiology. This article will briefly review this technique, its advantages, and some of its potential pitfalls.

In 1972 the Council of Europe, in which most of the Western European countries are represented, adopted a resolution aimed at the improvement of hospital hygiene and the promotion of the prevention of nosocomial infections. The member states were invited to take the required measures, but each country was free to implement the resolution according to its own needs and particularities. In Belgium, the first legal regulations were issued in 1974—every hospital was obliged to set up a committee for hospital hygiene.

Although similar regulations were issued in most other member states. the actual infection control policies adopted can vary. This article highlights some of the particularities for Belgium.

The chlamydia have long been recognized as ubiquitous pathogens capable of producing a wide spectrum of disease both in children and in adults. Common infections caused by this pathogen include pneumonia in infants, trachoma in children, and genital tract disease in adults. While neonatal chlamydial pneumonia is commonly described, chlamydial pneumonia in adults is less commonly recognized and was originally associated only with exposure to psittacine birds. Instances of person-to-person transmission of a chlamydial pneumonia were first identified in San Francisco in 1941. The organism isolated was a chlamydia-like agent with glycogen-staining characteristics unlike those of the well-studied avian chlamydia but much more difficult to maintain in culture. This finding lapsed into obscurity until 1965, when a chlamydial organism again demonstrating a Chlamydia psittaci-like staining pattern was isolated from a Taiwanese child in a trachoma study. This isolate was eventually named TW183. It was not until 1983, however, when a patient with atypical pneumonia was found to be infected with a similar pathogen, dubbed AR39, that the question of prevalence was raised. As the behavior of these isolates was characterized in Grayston's laboratory, it became apparent that they represented a novel human pathogen and the name TWAR (Taiwan acute respiratory agent) was adopted. Subsequent epidemiologic studies of this agent have shown broad exposure over a wide geographic distribution with almost 40% of tested populations showing serologic evidence of exposure.