To review procedures currently practiced in a Brazilian general hospital and to eliminate ineffective and inefficient practices. To measure the resulting cost improvements based on rigid hospital financing control.

Implementation of surveillance and control programs and prevalence surveys to detect ineffective and inefficient practices.

The study institution is a 130-bed general care facility affiliated with the Brazilian federal government. There were approximately 4,600 admissions per year during the study period (1986- 1989).

Instituting infection control measures and eliminating ineffective practices resulted in the following: an overall decrease in wound infection rates from 24.4% in 1987 to 3.45% in 1989; a 71% reduction in the global incidence of infection in the intensive care unit; a 74% reduction in the surgical prophylactic use of antibiotics; and a total savings of approximately $2 million (US dollars).

During the period from 1986 to 1989, the infection control committee was able to decrease the overall wound infection rate from 24.4% in 1987 to 3.45% in 1989. This eliminated special health problems and improved patient care and cost-effectiveness for our hospital.

The study was designed to compare the efficacies of bland soap handwash and isopropyl alcohol hand rinse in preventing transfer of aerobic gram-negative bacilli to urinary catheters via transient hand colonization acquired from direct patient contact. Glove juice recovery of gram-negative bacteria was considered transient colonization; catheter recovery was considered transfer colonization.

The contact source for gram-negative bacteria was a single “high burden” groin skin carrier ( ≥ 104/ml cup scrub fluid). Using a two-period cross-over design, 6 healthcare workers had 2 15-second contacts for each hand followed by either soap handwash or alcohol hand rinse (12 experiments with each treatment). Between 4 to 5 minutes after contact, each hand manipulated a catheter; the catheter was then cultured and the hand was glove juice tested.

Soap handwash failed to prevent gram-negative bacteria transfer to the catheter in 11 of 12 (92%) experiments; alcohol hand rinse in 2 of 12 (17%) (p< .001). Soap handwash failed to prevent transient colonization in 12 of 12 (100%) experiments; alcohol in 5 of 12 (42%) (risk ratio 2.4,95% confidence interval 1.2-4.7). Single gram-negative bacteria species carried at source levels ≥ 5.5 × 103/ml (heavy contamination) established transient colonization in 23 of 30 (77%) exposures following soap handwash; single gram-negative bacteria species carried at levels ≤ 3.5 × 103/ml established colonization in 1 of 22 (5%) similar exposures (p<.001).

Bland soap handwash was generally ineffective in preventing hand transfer of gram-negative bacteria to catheters following brief contact with a heavy-contamination patient source; alcohol hand rinse was generally effective.

To define measles immunity rates among employees at 2 hospitals during a community outbreak in 1990.

Cohort survey using enzyme-linked immunosorbant assay (ELISA) and questionnaire.

Two community hospitals.

Seventy-six percent of 2,060 employees.

Seven percent (115/1566) of participants lacked ELISA-defined measles immunity. Among employees whose ages were known, 14% (64/467) of those born after 1956 and 5% (50/1086) of those born before 1957 lacked serologic evidence of immunity. Fifty-eight percent of the susceptible persons had substantial patient contact. With ELISA results as the reference for immunity, the predictive value of an undocumented positive history of measles disease or vaccination was 95%; the predictive value of a negative history of both was 52%. Measles developed in 7 employees.

A substantial number of hospital employees lacked ELBA-defined measles immunity, including many who had patient contact or who had been born before 1957. Undocumented disease and vaccination histories were not adequate predictors of serologic status. This study supports the recommendations and suggestions of the Immunization Practices Advisory Committee that hospitals should require documented evidence of measles immunity from employees who have patient contact.

To determine the hepatitis B infection risk in a university hospital of obstetrics and gynecology,

The University Hospital of Obstetrics and Gynecology, The University of Sarajevo, Yugoslavia.

Staff members were divided into three groups: 73 doctors, 184 medical technicians working in delivery rooms, and 55 medical technicians working with postnatal care. The patients were 63 women, aged 17 to 39 years (mean = 26.11 years), pregnant for the first time and in the first stage of labor. Participants all had a negative history of hepatitis B and no known contact with the hepatitis B virus.

The incidence of hepatitis B infections among physicians, technicians, and postnatal care technicians was 1.36%, 3.8%, and 3.6%, respectively. The incidence among patients was 4.76%. The daily infection risk varied between 1% and 17% of all deliveries.

The risks of transmission of the hepatitis B virus to hospital workers in this setting is indeed high enough to make a case for hepatitis B vaccination in susceptible staff members. Even if vaccination of staff members is carried out, hygienic measures to prevent the transmission of bloodborne infection between patients and from patients to staff are of the utmost importance.