The present study provides the first systematic evaluation of strategies for increasing handwashing of hospital staff. Nursing staff on two intensive care units (ICUs) were observed over a 3-month period. After baseline observations, two interventions were implemented on the experimental unit: 1) changing to an emollient handwashing agent, and 2) providing feedback to staff about the frequency of handwashing. Feedback focused on the previous day's handwashing following completed patient contacts, interrupted patient contacts, and critical procedures. No increase in handwashing was observed following introduction of the emollient soap. However, when feedback was provided on the experimental ICU, handwashing following completed patient contacts (the major dependent measure) increased to 92%, and was significantly higher than handwashing on the control unit. Follow-up observations suggested that compliance on the experimental unit appeared to return to baseline levels.

A procedure-oriented isolation system, Category 1, 2, 3, and 4, was introduced at a 547-bed, acute and rehabilitative medical center. The system consisted of four categories of isolation which followed a numerical sequence that represented the necessary attire needed to complete the procedure. After 1 year of use, personnel compared the procedure-oriented system with the previously-used system (Strict, Respiratory, Wound and Skin, Enteric, and Limited Barrier). Personnel found the procedure-oriented system easier to understand (84%) and follow (83%). Seventy-six percent felt their isolation techniques had improved with the new system. A reduction in the cross-infection rate with methicillin-resistant Staphylococcus aureus did coincide with the use of the new isolation system, however, no causal relationship was established. The Category 1, 2, 3, and 4 isolation system was well received by personnel and was found to be an effective alternative to the previous, more complicated system used in this setting. Further evaluation of this system in other settings would seem warranted.

Forty subjects participated in a study of four handwashing agents evaluated for their efficacy in removing non-transient bacteria: 70% isopropanol, 0.05% stabilized iodine, 4% chlorhexidine gluconate, and 1% para-chloro-meta-xylenol. Each subject performed a non-medicated handwash to remove transient flora. Afterwards, three consecutive experimental handwashes were performed using a 10-second contact time, and a fourth handwash employed a 1-minute contact time. Quantitative post-handwash cultures were obtained using the sterile bag technique incorporating an effective agent neutralizer. Significant mean log10 reductions were documented for chlorhexidine gluconate, but only after the third (P=.05) and fourth (p=.004) handwash; however, the total log10 reduction was less than 1.0 for any single agent.

Subsequently, three evaporative handwash agents, including 70% isopropanol, 0.5% chlorhexidine in 70% isopropanol, and a 60% isopropanol formulation containing evaporative retardants, were tested in 14 subjects. Contact time was prolonged to the point of evaporation prior to culturing. Four consecutive post-handwash cultures were obtained after performing a baseline pre-handwash culture. When compared with the other two evaporative agents, the 60% isopropanol formulation demonstrated significant mean log10 reductions for each handwash (p ≤ .03), with a total log10 reduction of 2.9 over all four handwashes (p=.0001). The brief contact time incorporated in our handwashing technique reflects clinical usage patterns. The marked bacterial reduction demonstrated by the 60% isopropanol formulation warrants further study.

The recognition of serratia as an opportunistic human pathogen can be dated from 1959, when the microorganism entered the family of Enterobacteriaceae, with features recognizable in the clinical laboratory and related to the Klebsiella/Enterobacter group. Since then, physicians have been challenged to establish the significance of isolation of serratia from a clinical specimen.

Pseudomonas cepacia was first reported in the literature by Burkholder as a phytopathogen responsible for sour skin, a disease of onion bulbs. Similar bacteria were isolated from other sources and given various names including Pseudomonas multivorans, Pseudomonas kingii, and EO-1. The synonymy of these organisms with P. cepacia was eventually established. The first descriptions of human disease due to Pseudomonas cepacia were two reports of infective endocarditis. Subsequently, a series of postoperative urinary tract infections secondary to contaminated disinfectant solution were reported and P. cepacia became identified as a cause of nosocomial infection. P. cepacia has demonstrated a low level of virulence and invasiveness in the general population, but it has been shown to cause severe infection in patients with underlying diseases. Moreover, its nutritional versatility and ability to survive in antiseptic solutions make it a superb agent for causing hospital-acquired infection.

The advent of a non-cost reimbursement system has served as an impetus for the re-examination of the methods by which infectious processes are treated. This system prospectively sets payment rates for illnesses that require hospitalization. Diagnostic-Related Groups (DRGs) are the basis of this new system. DRGs attempt to link reimbursement to the broad category of clinical diagnosis by separating diagnoses into nearly 500 groups; each with a defined reimbursement rate. This rate does not substantially vary with regard to the length of hospital stay, the number of diagnostic tests performed or the cost of therapy employed.