Guidelines for the indications for use, requirements for consent, and mechanisms for reporting of serologic tests for human immunodeficiency virus (HIV) infection are not standardized. In trying to establish such guidelines for our hospital, we surveyed all Veterans Administration Medical Centers regarding their current approach to testing both patients and employees. Infection control practitioners from 67 hospitals representing 37 states responded. Patients are likely to be tested for diverse reasons, unlikely to be counseled about the test or be required to consent to it, and test results are given no special precautions. Although 66% of the respondents do not use any extra precautions concerning patient confidentiality, 80% utilize more stringent criteria for testing and result-reporting with employees than patients. Thus, while the majority of hospitals maintain that current modes of confidentiality are acceptable for patients, practice suggests that these modes are considered inadequate for employees.

Human immunodeficiency virus (HIV), the etiological agent of the acquired immunodeficiency syndrome (AIDS), was treated with either Betadine® (povidone-iodine) Solution or Betadine Surgical Scrub®. HIV inactivation was analyzed using the viral reverse transcriptase assay or by observing the cytopathic effect produced in HIV-infected, H-9, T-cell cultures. The minimum effective Betadine dose was 0.25% for complete inactivation of HIV that was treated for various time intervals (immediate vortex to ten minutes). The titer of HIV stocks used in these experiments (105 TCID50 per mL) was greater than amounts generally detected in clinical specimens. Our results provide a rationale for the use of povidone-iodine as a topical antiseptic against HIV in the clinic or laboratory.

Since 1981, the Centers for Disease Control (CDC) has been publishing Guidelines for the Prevention and Control of Nosocomial Infections as a useful reference tool in infection control. The extent to which practices recommended by CDC to reduce hospital-acquired infections have been successfully diffused and adopted were evaluated in a stratified random sample of 445 US hospitals that were sent a questionnaire in 1985. The data suggest that over 84% of infection control practitioner respondents (78% response rate) are aware of each guideline, although small hospitals (<50 beds) are least likely to be aware of the guidelines or to have reviewed them thoroughly. Adoption of the recommendations remains far from universal, ranging from 23% to 75% for 16 specific recommendations investigated. Smaller hospitals were significantly less likely than large hospitals to have adopted each suggested policy. Recommendations that carried Category I rankings were more likely to be adopted, as were those procedures that had cost-savings implications.

A simple and inexpensive method to assess the contamination of environmental surfaces and the associated potential risk of exposure of autopsy room personnel to potentially hazardous materials is described. Blood was selected as a marker of contamination and HEMASTIX® reagent strips were used to determine its presence on selected surfaces. The surfaces selected for examination typically do not come into direct contact with cadavers or tissues during a routine postmortem examination and thus are not included in routine cleanup. We documented the presence of blood on a variety of environmental surfaces in the autopsy suite and suggest that the contamination resulted from a breakdown in good work practices, most probably the indiscriminate handling or touching of materials and equipment with contaminated gloves. The risk of exposure to blood by the indirect route was deemed significant. The results of this study underscore the importance of establishing and consistently following good work practices and cleanup procedures to minimize the risk of exposure to blood before, during, and after postmortem examinations.

The acquisition of scabies in either the community or the health care setting is not uncommon, although it is infrequently documented. In Missouri, individual cases of scabies infestation are not reportable, but outbreak notification is required. Outside of the nursing home environment, where three to six outbreaks of scabies per year require assistance from the nosocomial disease subprogram of the Kansas City Health Department, only two other outbreaks have been recorded in the community since August 1977. One involved a school with 93 cases and the other a commercial laundry, which is reported here. The latter outbreak illustrates the difficulty encountered when attempting to classify an outbreak as either nosocomially acquired or community-acquired.

The importance of vibrio species other than Vibrio cholerae has only recently been appreciated. Vibrio parahaemolyticus has usually been associated with gastrointestinal tract infections although it may be a rare cause of soft tissue infection and septicemia. V alginolyticus is a rare cause of marine wound infections, otitis, and sepsis, and has not been associated with outbreaks of gastroenteritis. In 1976 Hollis et al1 described the characteristics of 38 isolates of a halophilic bacterium isolated from blood cultures (20), cerebrospinal fluid (2), and wound infections (16). Originally called Beneckea vulnifica, this organism was reassigned to the genus Vibrio and named V vulnificus by Farmer. It is a salt-requiring, marine vibrio that can be distinguished from other vibrio species by its ability to ferment lactose. V vulnificus is a particularly virulent organism that typically produces either primary septicemia that occurs after ingestion of raw shellfish, especially in patients with chronic liver disease, or a fulminating wound infection that occurs after exposure to seawater or handling of shellfish.