Voluntary screening for the presence of human immunodeficiency virus (HIV) is recommended by the healthcare profession. The optimal settings to accomplish screening have not been established. We evaluated an admission HIV screening program in a large private hospital to assess advantages and disadvantages in this setting. In a three-month study period, 4,535 of 8,868 patients (51%) admitted to the hospital agreed to HIV testing. Serum specimens from 500 patients who refused testing were blindly, anonymously tested. The seroprevalence of the patients agreeing to (0.26%) and refusing (0.60%) testing was not statistically different (p = .12). There were 12 HIV cases discovered; ten (83%) of these were known to be in a high-risk group at the time of admission. Eighty-five percent of patients interviewed were in favor of this screening program. Difficulties associated with confidentiality or consent were not evident. Calculated charges of testing for each HIV case discovery was $14,550. There was no evidence that this screening program provided for a more effective infection control policy to prevent nosocomial HIV transmission. A hospital admission HIV screening program can be implemented can meet with favorable patient opinion and can detect previously unknown HIV-positive patients. Hospitals are an efficient and practical setting for HIV testing. The benefit of this program appears to be greater for the patient than hospital or healthcare worker. Cost-benefit analyses will identify optimal candidates to be screened in different hospital populations.

We developed an educational program that reported the rate of needle recapping to healthcare workers, in conjunction with emphasis on appropriate disposal procedures. Over 12 months, the rate of recapping needles used for venipuncture and for percutaneous medication injections fell from 61% to 16% (p<.0001). Over the same period, the recapping of needles used primarily for intravenous (IV) administration fell from 44% to 33% (p = .03). Re-evaluation of the rate of recapping eight months later showed a continuation of these lowered rates. Needlestick injuries were too few in number during the study period to detect any change accompanying the decreased recapping rate. We conclude that programs that report back to employees their rate of recapping can significantly reduce this activity in the disposal of needles used for venipuncture and for percutaneous medication injections. While such reporting may reduce the rate of recapping of needles used for IV administration, the effect is not nearly so marked. Modifications in design remain the most promising approach to preventing needlestick injuries from recapping needles used for IV administration.

In the period 1975 to 1981, methicillin-resistant Staphylococcus aureus (MRSA) emerged as an important nosocomial pathogen in tertiary care centers in the United States. To determine if the prevalence of this organism has continued to increase, a questionnaire was sent to hospital epidemiologists in 360 acute care hospitals. A total of 256 (71%) of the 360 individuals responded. Overall, 97% (246/256) of responding hospitals reported having patients with MRSA in the period 1987 through 1989. Respondents in 217 hospitals provided estimates of the number of cases seen in 1987, 1988 and 1989. The percentage of respondents reporting one or more patients with MRSA increased from 88% in 1987 to 96.3% in 1989 (p = .0008). The percent of respondents reporting large numbers (≥50) of cases per year increased from 18% in 1987 to 32% in 1989 (p = .0006). Increasing frequency of large outbreaks was observed in community, community-teaching, federal, municipal and university hospitals.

A cluster of four group A (β-hemolytic Streptococcus postoperative wound infections was investigated at a community hospital. The serotypes of the Streptococcus isolated from all four cases, an asymptomatic anesthesiologist and one of his household members were M nontypable T28. During the outbreak period, December 1988, the infection rate among the 40 patients of the anesthesiologist was 7.5%. Among other patients not having contact with this healthcare worker, it was 0.09% (p = .0002 Fisher's exact test). This is only the second reported Group A β-hemolytic Streptococcus hospital outbreak in which the pathogen was traced to a member of a healthcare worker's household. Early outbreak detection and intervention limited the extent of the outbreak.

Consensus statements bearing on issues related to healthcare workers (HCWs) who are, or may be, infected by the human immunodeficiency virus (HIV) have been developed by the Centers for Disease Control (CDC), the American Medical Association (AMA), the American Academy of Pediatrics, the American Hospital Association (AHA), the American Academy of Orthopedic Surgeons, the American College of Obstetricians and Gynecologists8 and the British working groups. In general, these organizations conclude that few, if any, special procedures are required to accommodate an HIV-infected HCW. All except one oppose routine screening of HCWs for HIV infection; all except one oppose broad practice proscriptions for HIV-infected HCWs. Only one of these consensus statements focuses on the HIV-infected HCW. None address important related questions that confront hospitals and other healthcare institutions. These issues are difficult to resolve because: 1) there are insufficient data to establish a scientific basis for their solution; 2) the questions involve medicolegal, ethical or public relations issues that are beyond the usual scope of scientific consensus body recommendations; and/or 3) the situations occur infrequently. Nevertheless, in actual hospital practice, decisions about these questions, at least occasionally, must be made.