Some colleagues are now touting the calculation and confidential reporting of surgeon-specific wound infection rates as the most important mechanism to reduce nosocomial surgical wound infections.' Several studies purport to show either a decline of surgical wound infections after such reporting is introduced or to demonstrate large differences in rates of wound infections among surgeons in a specific hospital. The purpose of this article is to clarify the numerous problems and deficiencies in the development of this concept and to show the essential statistical implausibility of demonstrating its effectiveness.

We examined the persistence of hepatitis B surface antibody following hepatitis B vaccination in a group of health care workers. Of the 187 vaccine recipients screened, 39 were found to be antibody negative. Life table analysis showed the proportion retaining antibody at one, two, three, and four years from the first dose of vaccine was 92%, 84%, 73%, and 55% respectively. The likelihood of retaining antibody was significantly decreased as the age of the vaccine recipient increased. These results indicate that a large proportion of vaccine recipients no longer had detectable antibody four years after receipt of the vaccine. It remains to be shown if such individuals who have lost antibody are susceptible to the development of clinical hepatitis.

Malassezia furfur, a lipophilic yeast, has become recognized as a cause of sepsis in infants receiving parenteral fat emulsions via indwelling deep venous catheters. Colonization of infants' skin may be a prerequisite to colonization of the intravascular catheter and subsequent infection with M furfur. Three hundred ninety-three surveillance cultures were performed on 146 infants during their first 12 weeks of hospitalization in the intensive care unit (ICU) or the neonatal transitional unit (NTU). In addition, 47 full-term newborn infants and 38 healthy infants in the well-baby clinic were cultured. Colonization rates were greatest (48%) during the second month of hospitalization for the infants in the ICU/NTU group. In contrast, 0 of 47 newborn infants and 2 of 38 healthy infants were colonized. Prematurity and a prolonged length of stay were identified as risk factors for colonization.

An infection rate was calculated for all subclavian catheters inserted during a 12-month period. The overall, single lumen, and triple lumen infection rates were 1.7% (42/2,431), 0.4% (8/1,936), and 6.9% (34/495), respectively. After excluding single lumen catheters in patients in a surgical cardiovascular unit who appeared to have a decreased risk of infection, the overall, single lumen, and triple lumen rates were 3.7% (42/1,140), 1.2% (8/645), and 6.9% (34/495), respectively. Within this group, 11.8% (281237) of the catheters used for total parenteral nutrition (TPN) were infected, whereas 1.6% (14/903) of the non-TPN catheters were infected. Of patients receiving total parental nutrition through a triple lumen catheter, 14.5% (25/172) became infected, whereas 4.6% (3/65) of the patients receiving total parental nutrition through a single lumen catheter became infected. Single and triple lumen patient groups appeared comparable based on average age, death rate, immunosuppression, underlying disease, and duration of catheterization, but the risk of infection was approximately three times greater for patients receiving total parental nutrition through a triple lumen catheter.

We surveyed 53 randomly chosen Maryland nursing homes for infection control policies and practices. The majority had written infection control policies, an infection control committee, and a designated practitioner for infection control; in most facilities, however, the infection control practitioner had other major duties, spent little time on infection control, and had no specific training in the field. Thirty-four percent of homes in the survey performed routine environmental cultures, and more than half had insufficient or no isolation policies for infected decubiti and acute diarrhea. In general, the intensity of infection surveillance and the extent of infection control measures increased with the level of care provided, from domiciliary homes to homes providing chronic care. Employee health care fared generally well: 60% of homes offered influenza vaccine to employees and 66% had restriction policies for employees with upper respiratory infections. While the majority of homes offered the influenza vaccine to residents, acceptance of other vaccines recommended for the elderly was less widespread. We conclude that infection control efforts are made in most Maryland nursing homes; however, appropriate guidelines and more effort to educate nursing home personnel in proper infection control practices are badly needed.

The Centers for Disease Control (CDC) have recommended that health care workers use appropriate barriers, referred to as universal precautions, to protect themselves against exposure to the blood and body fluids of all patients. The CDC has suggested that the use of universal precautions eliminates the need for the isolation category blood and body fluid precautions (BBFP). There has been discussion concerning the feasibility of applying these precautions to all patients. Tangential issues involving screening of all hospitalized patients and whether or not informed consent should be required before such testing occurs are also being debated.

The purpose of the current study was to survey those attending a meeting of The Society of Hospital Epidemiologists of America (SHEA) in October 1987 to determine their opinions on these issues and their hospitals' actual practices with regard to universal precautions, human immunodeficiency virus (HIV) screening, and informed consent.

The need for accurate data concerning nosocomial infections has long been appreciated by infection control practitioners. Several major changes in the health delivery environment have highlighted for other care givers and managers the importance of, and indeed necessity of high-quality clinical and financial hospital information. Since 1983, the Medicare prospective payment system (PPS) has used the medical record discharge abstract as the hospital bill. This has created a need for more detailed clinical information in hospital information systems. In several states, all third-party reimbursers are using PPS variants, further strengthening this incentive. The “Agenda for Change” of the Joint Commission on Accreditation of Healthcare Organizations has created further pressure on hospitals to acquire information concerning the quality of care at their own facility, as well as comparative statistics from other facilities. Although trade journals extol the virtues of “good data sets,” and much academic study has been given to individual facets of data processing and handling, the practical aspects of hospital information opportunities and problems have been largely ignored. The purpose of this article is to discuss the nature of hospital data; to detail available sources of national, regional, and local hospital statistics; to delineate potential quality problems common to many types of hospital information; and to discuss difficulties with and solutions to some hospital data application problems.

The genus Capnocytophaga includes three bacterial species: Capnocytophaga ochracea, Capnocytophaga sputigena, and Capnocytophaga gingivalis. Although occasionally found in soil and water, the predominant natural habitat of Capnocytophaga species is the human oropharynx. These organisms are also found throughout the human gastrointestinal tract as well as in the vagina. Initially implicated only in the pathogenesis of periodontal disease, Capnocytophaga has recently been recognized both as an opportunistic pathogen in the immunocompromised host and also as a pathogen associated with a variety of infections in the immunocompetent host. The protean manifestations of infection and the enlarging pathogenic spectrum of Capnocytophaga. disease mandate a high index of diagnostic suspicion on the part of the clinician.