An evaluation of two flash-sterilization-specific biological indicators (BI) and a traditional spore strip indicator was performed to assess sensitivity and reliability as reflected in survive/kill ratios. The Bis tested included: 3M's Attest® #1261, Amsco's Proof Flash™, and Castle® Tec Test. Survival after “come-up” time alone, (0 exposure) and one-, two-, and three-minute exposures at 273°F in a gravity displacement sterilizer was measured by media color change or turbidity after incubation at 55°C. Each cycle was replicated three times on two separate days with six of each BI per run. Positive Bis were subcultured as necessary. Proof Flash presented technical difficulties due to incomplete or impossible crushing of media vials, unexpected media color changes, and evaporation of media. Tec Test was not sufficiently resistant as survivors were not detected at any exposure time. The Attest had 100% survival at zero and one-minute exposures and 94% survival after the two-minute exposure. No survivors were detected after the three-minute exposure. Although each institution should evaluate Bis for their own use independently, the data indicate that Attest #1261 monitored the three-minute flash cycles more satisfactorily than the other Bis tested.

The correlation of fecal gram-negative bacilli (GNB), neutropenia, and bacteremia was studied in 45 bone marrow transplant recipients. Weekly stool cultures were prospectively monitored for GNB resistant to routine prophylactic and empiric antimicrobial agents. Seven cases of GNB bacteremia occurred in 45 patients described as follows. Twenty-three patients had no fecal or blood GNB. Fifteen patients had fecal GNB and no blood GNB; three of these latter patients had ≤50/mm3 circulating white blood cells (WBC) at the time of isolation of fecal GNB but two of the three were concurrently receiving appropriate empiric antibiotics. Two patients had blood GNB but no fecal GNB: one patient had a trimethoprim/sulfamethoxazole (TMP-SMZ)-sensitive isolate that would not be detectable in the feces by our methodology and one patient had feces analyzed only after the bacteremic event. Five patients had fecal GNB and blood GNB: one of these patients did not have a fecal sample analyzed prior to bacteremia but the remaining four patients had the same species/antibiogram of GNB isolated from the feces two to three days prior to the detection of bacteremia. Thus, the fecal GNB could have been used to predict the antibiogram of the subsequent blood GNB. In addition, all four of these latter bacteremic patients had ≤50/mm3 circulating WBC at the time of documented fecal GNB. Thus, bone marrow transplant recipients with fecal GNB coupled with severe neutropenia (≤50/mm3 circulating WBC) were more likely to develop bacteremia (P<0.02) than were those with fecal GNB and ≤50/mm3 circulating WBC.

Reported are the results of a study on the incidence of nosocomial surgical infections in ten wards of the university hospital A. Gemelli, Rome. One thousand, five hundred five patients were studied and the overall incidence of surgical infections was 8.7%. Factors that influenced infection rates included age, immunosuppressive diseases, and immunosuppressive therapy. We assessed the inutility of antibiotic prophylaxis in clean operations and its usefulness in clean operations with insertion of prostheses or other devices. The importance of the duration of preoperative hospitalization and of the length of the operation were also noted. The most frequent etiological agents proved to be Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. The average hospital stay for patients with surgical infection was more than double that of patients with no infection (25.7 days v 11.7 days).

Six cases of acute Staphylococcus aureus mediastinitis after median sternotomy were reported. Five resulted from an asymptomatic disseminator of 5 aureus present in the operating room. Each case was characterized by an acute bacteremic phase, occurring after a mean interval of 8.2 ± 1.7 days after the surgical procedure; within 24 to 36 hours all patients had a temperature above 39°C, toxic appearance, and marked leukocytosis. Pericicatricial inflammation was moderate, instability of the sternum was present in only two patients, and chest roentgenogram was not helpful in making an early diagnosis. No risk factor for mediasinitis in connection with the perioperative or postoperative periods was noted in cases compared with a control group of 103 patients. All strains of S aureus were susceptible in vitro to the antibiotic regimen used in prophylaxis. All patients underwent early surgical reopening of the mediastinum within 47 ± 15 hours after the first sign of acute mediastinitis. Mediastinal debridement and continuous irrigation-suction with dilute povidone-iodine solution were associated with intravenous antistaphylococcal therapy for a period of four to six weeks. All patients survived and no recurrence was observed, a finding we think due to early diagnosis and aggressive medicosurgical therapy.

Hospital personnel, especially women in their child-bearing years, continue to express concern about the risk of acquiring cytomegalovirus (CMV) infection as a result of their occupation. Previous investigations of occupational risk of CMV infection have focused primarily on pediatric nursing personnel. However, assessment of the rate of CMV infection by other hospital personnel who have different clinical responsibilities and levels of patient contact cannot rely solely on the rates obtained for nursing personnel.

Candida (Torulopsis) glabrata is a fungus with a diversity of habitats and an enlarging clinical spectrum. It is found as normal human flora in the gastrointestinal tract, skin, and vagina and also found in nature in soil and in animals. It was initially thought to represent a nonpathogenic saprophyte, however, it has been recovered with increasing frequency from clinical specimens. It is now recognized as a cause of disease in the normal and compromised host.

Sweden is divided into 23 counties, each governed by a county council. Among many other things the county council is by law responsible for health, medical, and dental care for the inhabitants of the county, which means that virtually all hospitals are owned and run by the counties. There are very few private hospitals. The counties also run primary care outpatient centers. There are private practitioners in the larger cities, but only some 5% of physicians work full-time in private practice. However, more than 50% of dentists are in private practice.