A prospective study was undertaken to examine the clinical presentation of peritonitis in patients maintained on intermittent peritoneal dialysis and to determine the value of qualitative and quantitative dialysate cultures, gram stain, neutrophil counts, and a semiquantitative leukocyte test strip for case detection. Seven cases of peritonitis developed among 30 patients who underwent 553 dialyses. In most cases, neutrophil counts, cultures, and leukocyte test strip determinations were done within 48 hours prior to the clinical onset of peritonitis and in all instances failed to provide clues for incipient infection. Peritonitis was associated with a dialysate neutrophil count of >500/mm3 and leukocyte test strips were highly sensitive and specific for the detection of this quantity of neutrophils. A total of 16 dialysate cultures was positive in asymptomatic patients who did not have peritonitis. None of these patients subsequently developed peritonitis with the same organism. Dialysate gram stains, cultures, neutrophil counts or leukocyte test strips did not provide an early diagnosis of peritonitis and their use in the absence of symptoms is therefore not recommended.

From September 14, 1981 to February 28, 1982, an epidemic of bullous impetigo caused by a penicillin/tetracycline resistant strain of Staphylococcus aureus, phage type 3A/3C, occurred in a newborn nursery in Louisville, Kentucky. Twenty of 1,181 (1.7%) infants at risk developed disease during the six-month epidemic period. Clinically all case-infants had bullous impetigo skin lesions. One infant developed staphylococcal septicemia. No infant died. An epidemiologic investigation identified a nurse as having significantly greater contact with case-infants than control-infants (p=0.0013). She was also found to be a nasal carrier of the epidemic strain. Infection control measures appeared to decrease infant-to-infant transmission via the hands of non-colonized nurses, but did not affect transmission from the nurse carrying the epidemic strain to infants. No cases of bullous impetigo have occurred since this nurse was temporarily removed from the nursery for treatment.

How often infection rates should be calculated and how large a change is required for “significance” are pertinent questions in nosocomial infection surveillance programs. A method is presented which establishes outbreak threshold infection frequencies. Comparison is direct and immediate: computation of rates or use of electronic data processing is not required. We have validated this method, using computer systems, by comparing the distributions of mean weekly incidence and prevalence statistics for each ward by nosocomial infection site in an acute care general hospital against both our theoretical outbreak threshold limits and the distribution of proven infection outbreaks. Sensitive and specific distinction between random variation or sporadic cross-infection and true persisting outbreaks requiring intervention is obtained. This approach provides a simple and timely alternative to intuitive after-the-fact interpretation of infection patterns which is applicable to infection surveillance and cost-effective infection control in hospitals of all sizes.

Sterile irrigation solutions, used in open systems in a conventional orthopedic operating theatre, were examined for bacterial contamination. At the end of 13 of 21 operations (duration ≥ one hour) the solution tested displayed the growth of Staphylococcus epidermidis and/or diphtheroid rods and/or other species. It is concluded that irrigation by solutions, kept in open bowls during an operation, is a potential source of contamination.

Belonging to the tribe Klebsielleae found in the family Enterobacteriaceae, the genus Klebsiella is the second most populous enteric genus found in the gastrointestinal tract of man. The genus Klebsiella is named after the late nineteenth century German microbiologist, Edwin Klebs, but the Klebsiella bacillus was for many years referred to as the Friedlander bacillus after being described by Carl Friedlander. The genus consists of four species, recognized by the Centers for Disease Control (CDC), and Bergey's Manual of Determinative Bacteriology, namely, K. pneumoniae (the type species), K. ozaenae, K. rhinoscleromatis, and K. oxytoca. K. pneumoniae is one of a few gram-negative rods that can cause a primary pneumonia.

Implementing a cost-effective and meaningful ethylene oxide (EtO) environmental monitoring program is more than purchasing an EtO sensitive device and placing it in the department or on an employee. First, the responsible person involved in such a program must have some general knowledge of analytical procedures and methods. Second, the individual should possess an understanding of the various types of equipment that are available and their limitations. Third, and perhaps most importantly, there must be a good thorough understanding of ethylene oxide and the principles of environmental monitoring as it relates to employee exposure. Even if the hospital or department decides to contract with an outside vendor to perform these services, the responsible individual must be involved with the provider from the inception of the program. All too often, departmental managers enter into an ethylene oxide exposure monitoring program with little thought to where, when, or how to monitor. The key to any ethylene oxide exposure monitoring program has to be the measurement of the extent of employee exposure. Once this is established, the monitoring program can be developed.

The responses to a survey of ventilator circuit practices published in Infection Control are shown in the Table. The majority of 249 individuals who responded were located in community hospitals or community teaching hospitals of 100 to 500 beds. Most of the hospitals changed ventilator circuits (tubing humidifying cascades and swivel adapters) every 24 hours or less. Interestingly, 30.1% of the hospitals indicated that “self-study” was used to determine the time interval of ventilator circuit changes. Our 1982 study of contamination in mechanical ventilators at 24 and 48 hours confirmed earlier observations that mechanical ventilators with cascade humidifiers do not generate small particle aerosols.