Precautions used for dialysis patients who have acquired immunodeficiency syndrome or non-A, non-B hepatitis are based on infection control strategies developed for the control of hepatitis B in dialysis centers. Specificially, these recommendations include identifying infected patients; isolating (except for non-A, non-B hepatitis patients) patients, and separating staff, and equipment; applying blood precautions and aseptic techniques; and using good environmental control procedures. AIDS patients can be safely dialyzed by either hemodialysis or peritoneal dialysis in hospital-based or free-standing centers, or at home without risk of AIDS transmission to other patients or to staff members, if precautions that have been developed for the control of hepatitis B infection in dialysis units are employed. Further, the type of dialysis treatment, or modality, should be based on the needs of the patient and not on a fear of risk of disease transmission.

Health care personnel with frequent blood contact are at high risk for being exposed to and developing hepatitis B infection. Exposure to unidentified infectious patients may lead to personnel inadvertently foregoing appropriate, passive immunoprophylaxis. For these reasons, our hospital elected to conduct an aggressive program to administer hepatitis B vaccine to all employees at high risk for exposure to hepatitis B virus, thus protecting such employees from inadvertent occupational exposure. Administrators agreed to offer the vaccine as a free employee health benefit. “High-risk” employees attended mandatory inservice presentations covering hepatitis B disease, vaccine safety and efficacy, and related concerns. High-risk individuals were required to either receive vaccine or sign “informed refusal” forms. The vaccine clinic was organized to accommodate employee work schedules. Of high-risk employees eligible for vaccination, 90% completed a three-dose vaccine course. Extensive inservice education, financial and administrative support, and careful advance planning are all crucial in achieving high compliance with vaccination programs. A description of key steps in designing a successful vaccination program is outlined.

Primary infections caused by Klebsiella species are uncommon, but the organism is an important nosocomial pathogen. We report the predisposing factors, clinical features and outcome of 44 hospitalized patients in whom Klebsiella oxytoca was isolated. Twenty-one (48%) isolates were community-acquired and 23 (52%) were considered nosocomial in origin. Most of the patients were elderly males with serious underlying diseases. There were significant differences between those patients who acquired Klebsiella oxytoca in the hospital and in the community. Nosocomially acquired organisms were associated with a higher mortality (52% vs. 24%) (p<0.05), a higher incidence of infection vs. colonization (83% vs. 57%) (p<0.05), and a higher percentage of cases of pneumonia (43% vs. 19%) (p<0.05). The clinical features, the hospital service and the patients' underlying diseases were similar when patients who died and those who survived were compared. Patients who died were exposed to antibiotics more often prior to the positive culture with K. oxytoca (p<0.05). K. oxytoca is a significant pathogen in hospitalized elderly patients. It is likely to cause infections, especially pneumonia, and carry a high mortality. The organism can become endemic within the hospital setting with continued carriage and nosocomial spread.

Results with a VZV skin test as a marker of past infection were compared with histories of chicken pox and specific antibody detected by ELISA in 100 individuals—25 of whom were pediatric patients with malignant diseases. A negative or uncertain history was not reliable, neither were the skin test results among the oncology patients. However, among the normal individuals, the skin test when compared with the ELISA had a sensitivity of 85%, a specificity of 100%, and a positive predictive value of 100%.

By now, most of us have seen IBM's version of Charlie Chaplin's tramp in their omnipresent advertising campaign: each commercial begins with the little tramp struggling valiantly to keep up with the complexity of modern business, only to find himself up to his neck in hats or, more recently, roller skates; of course the IBM personal computer soon arrives to save him by replacing cacophony and chaos with computational harmony and the soothing sounds of smooth skating. It is no accident that the little tramp was chosen to represent the harried everyman—Charlie Chaplin made the connection himself in his film Modern Times. There, as in the IBM campaign, he struggled valiantly but vainly to master the madness of modern mechanical times. IBM's message is clear: computers do not increase the madness, but cure it; the micro is the machine to tame the machine age.

Prospective reimbursement is changing hospital laboratories from profit centers to cost centers. As a result, hospital administrators will try to reduce expenses for operating laboratories. Clinical microbiology could suffer more seriously than other sections because these laboratories are least able to use automation to increase productivity. Both the volume of specimens submitted and the complexity of processing specimens continue to increase in most clinical microbiology laboratories and the only immediate solution, although unlikely, will be increases in personnel. Freezes on replacement hiring and elimination of vacated positions are already occurring in some laboratories. Increased work can be controlled by reducing the numbers of clinically unnecessary specimens that are submitted and the numbers of specimens that are of a type or of such quality that they would not be likely to produce clinically useful information. Secondly, the amount of work expended on certain types of specimens may be reduced both to eliminate unnecessary labor and produce reports that are actually more useful clinically. Eventually changes in the way in which hospitals and physicians are reimbursed may create a greater incentive for physicians to minimize laboratory use. In the meantime, the burden of living within available resources will fall on the clinical microbiologist.

Antibiotics exert a number of effects on bacteria other than simply killing them or inhibiting their growth. Increasing evidence that exposure of bacteria to antibiotics induces profound alterations in the interaction between bacteria and host defense has been noted. The effect of antibiotics on polymorphonuclear leukocytes and the immune specific response of mononuclear cells is reviewed. An understanding of such effects would allow a more rational application of antibiotics, as well as provide direction in the development of new antibiotics that have both specific antibacterial action and positive effects on host defense mechanisms.

In recent years, increased emphasis has been placed on immunization of adults. The reintroduction of the pneumococcal vaccine in 1976 seems to have begun a new era in adult medicine that targets certain vaccines toward adults. Prior to this, most of our efforts at immunization in the US were directed toward young children. Although the pneumococcal vaccine has been underutilized, publications from the CDC and the American College of Physicians suggest that this particular public health strategy will be with us for some time to come.