Postoperative infection rates were determined for gynecologic outpatient surgical procedures performed in a traditional operating room environment and a separate, recently opened, surgicenter within the same hospital. Infections were self-reported by attending surgeons responding to computer-generated line listings of their recent surgical procedures. Responses were obtained on 97.9% (612/625) of women having surgery in the operating room and 99.5% (629/632) of women with surgicenter procedures. The overall infection rate for reported women was 0.9% (11/1,241). The difference between operating room and surgicenter rates was not statistically significant. Postoperative infections occurred in 2.5% (3/118) of diagnostic laparoscopies with tubal lavage and 1.4% (3/214) of voluntary abortions by dilatation and evacuation and curettage (D&E&C). The five other infections were scattered among the remaining 25 procedure categories. Ten of the 11 infections were limited to the “clean-contaminated” wounds. No serious or life-threatening infections were encountered. The computer-assisted surveillance system worked well and was easily incorporated into the existing infection surveillance system. The degree of ascertainment of postoperative wound infections is unknown due to reliance on physician self-reporting. However, no patients requiring readmission for infection went unreported by the attending surgeons.

Handwashing practices may be adversely influenced by the detrimental effects of handwashing on skin. A protocol was developed to assess the physiologic and microbiologic effects of frequent handwashing. Fifty-two female volunteers washed their hands 24 times per day for 5 days. Five agents were tested: water alone, non-medicated bar soap, a chlorhexidine-containing antiseptic, and two agents containing povidone-iodine (one currently available on the market and one being tested for possible marketing). Some damage to the outer membrane of skin, the stratum corneum, occurred in all groups. There were significant changes in the amount of evaporation water loss (p=.001) and in self assessments of skin condition (p=.005) from pre-to-post test for the entire group. Skin damage was also assessed by visualizing desquamating stratum corneum cells, which are shed in large aggregates when detergents injure skin. Significantly less such shedding occurred in subjects using water alone, bar soap, and the Chlorhexidine formulation (p=.02). Greater antimicrobial activity of an agent was not correlated with increased skin trauma. We have quantitated, using objective physiologic parameter, the skin damage that occurs during even a short period of frequent handwashing. We recommend that further studies using the methods described be conducted to quantitate skin damage over longer periods of time, more closely resembling handwashing practices of health care personnel.

The Centers for Disease Control Advisory Committee on Immunization Practices has based recommendations for hepatitis B vaccine for hospital employees on studies done in large urban hospitals. Data on the prevalence of hepatitis B in employees of small hospitals have been lacking. We measured hepatitis B surface and core antibody in 422 employees of six small, rural hospitals who were exposed to blood. The overall prevalence among those “high-risk” employees was 5.5%. The highest prevalence was found in General Nursing, Intensive Care Nursing, Recovery Room, IV Therapy, Laboratory, and Respiratory Therapy, although differences were seen between hospitals. Results of such testing for individual hospitals may have a major impact on the cost-effectiveness of vaccination programs for their employees.

Thirty-two clinical specimens submitted to the laboratory during a 12-month period from July 1980 to June 1981 were reported to be culture-positive for Mycobacterium gordonae, an organism generally considered to be a slow-growing saprophyte with natural habitats which include soil and water. Only seven similar isolates had been recovered in the preceding 4½ year period. The discordance between clinical findings and the mycobacterial cultures suggested extrinsic contamination of the specimens. Contamination in the laboratory was believed unlikely because: 1) clinical samples obtained in an aseptic manner were never contaminated; 2) various surveillance cultures of reagents and deionized water used in the laboratory were negative; and 3) substitution of deionized water with sterile water did not control the outbreak. Extensive hospital-wide cultures of water sources implicated the use of ice and ice water from contaminated ice machines as the source of this pseudoepidemic. Cleaning of the ice machines resulted in a sharp decrease in the number of M. gordonae isolates. Pseudoinfection by M. gordonae from improperly maintained ice machines has not been reported before.

Following an outbreak of varicella, 18% of a group of 174 young female Filipino nurses ranging in age from 20 to 25 years and working at the American University of Beirut Medical Center (AUMC) were found susceptible to the varicella-zoster virus; as compared to 3% of a matched group of 133 of their Lebanese colleagues. The level of antibody was determined by the Enzyme Linked Immunosorbent Assay (ELISA). Those susceptible were assigned duties in low-risk areas to varicella-zoster in the hospital.

Since the introduction of hepatitis B immune globulin (HBIg) and more recently, the hepatitis B vaccine, programs for hepatitis B prevention have become a major part of most employee health/infection control programs. In fact, hepatitis B prevention activities have probably been responsible for increased collaboration between the two programs. Hepatitis B prevention is a very fluid process and is constantly changing as we develop a greater understanding of the creative uses of both HBIg and the vaccine. On e important trend that has emerged from the introduction and widespread use of HBIg and vaccine has been a greater emphasis on pre-exposure prevention of hepatitis B infection. In the past, programs for hepatitis B prevention consisted of periodic hepatitis B screening in dialysis units and some laboratories. Unfortunately, screening only monitors introduction of infection and does very little to prevent hepatitis B virus (HBV) infection.

There has been a tremendous increase in the number of immunocompromised patients over the past few decades, which has resulted in an increased number of serious fungal infections. These infections frequently require an invasive procedure, such as bone, lung, or lymph node biopsy, in order to obtain tissue for diagnosis. Far too often the tissue obtained by such means is not optimally utilized. For example, the tissue may be placed in formalin without being appropriately cultured, or the incorrect choice of tissue stains may result in the pathogen either being missed or being incorrectly identified. Clearly, this problem should be addressed by both the pathologist and the clinician.