Before 1970, regularly scheduled culturing of the air and environmental surfaces such as floors, walls, and table tops was widely practiced in US hospitals. By 1970, CDC and the American Hospital Association were advocating that hospitals discontinue routine environmental culturing, since rates of nosocomial infection had not been related to levels of general microbial contamination of air or environmental surfaces, and meaningful standards for permissible levels of microbial contamination of environmental surfaces did not exist. Between 1970 and 1975, 25% of US hospitals reduced the extent of such routine environmental culturing, and this trend has continued.

In the last several years, there has also been a trend toward reducing routine microbiologic sampling for quality control purposes. In 1982, CDC recommended that the disinfection process for respiratory therapy equipment should not be monitored by routine microbiologic sampling. Moreover, the recommendation for microbiolgic sampling of infant formulas prepared in the hospital has been removed from this Guideline, since there is no epidemiologic evidence to show that such quality control testing influences the infection rate in hospitals.

Hepatitis B virus and HTLV-III are quite dissimilar in virology, organ tropism and clinical consequences. However, they are remarkably similar in epidemiology, modes of transmission, affected risk groups, and potentials for nosocomial infection. Presently, the two diseases pose much different problems for hospital epidemiologists. Over the past 10 years, the risks of nosocomial hepatitis B have dropped off sharply. In fact, hepatitis B is now theoretically a totally preventable disease. On the other hand, the epidemic of HTLV-III infection in high-risk groups continues unabated. The fear of acquiring infection has precipitated panic reactions among some groups of health care workers and the lay public.

There is no epidemiologic evidence to suggest that most hospital waste is any more infective than residential waste. Moreover, there is no epidemiologic evidence that hospital waste disposal practices have caused disease in the community. Therefore, identifying wastes for which special precautions are indicated is largely a matter of judgment about the relative risk of disease transmission. Aesthetic and emotional considerations may override the actual risk of disease transmission, particularly for pathology wastes.

Over the past 25 years group B streptococci have become established as one of the main bacterial pathogens of the neonate in Western Europe and the United States. The attack rate of 0.25/1,000 live births found by Mayon White in Great Britain1 appears typical of many European countries. However, in some centers in the United States attack rates can be over 10 times higher.

Two types of neonatal group B streptococcus (GBS) diseases exist, “early” and “late” onset. Early onset disease usually presents within the first few days of life. Often the most serious infections are present at birth or seen within a few hours. Early onset disease presents with pneumonia, respiratory distress and shock. Bacteremia is normally present and meningitis may occur. Mortality is high (50% to 75%). The portal of entry is probably the respiratory tract. Infants normally acquire the infecting organism from their mothers. Heavy maternal and infant colonization, prolonged rupture of membranes, prematurity, and obstetric complications are all risk factors.

Delayed onset disease, as its name suggests, presents after the first week of life, primarily with bacteremia and meningitis. Mortality is much lower than for the early onset form, but still appreciable for a bacterial infection (14% to 18%). Its epidemiology is uncertain.

Despite increased awareness and the availability of potent chemotherapeutic agents, the Group B streptococcus remains the leading cause of life-threatening bacterial infections in the neonatal period. The majority of infections occur in the first few days of life. These so-called “early-onset” infections are often fulminant and are associated with a very high case fatality rate, ranging from more than 20% in recent reports to as high as 80% in older series. “Late-onset” disease occurs, by definition, after the first week of life. It usually presents with meningitis, although a wide spectrum of infections has been reported, including cellulitis, adenitis, septic arthritis, and osteomyelitis. Late-onset disease is usually less serious than early-onset disease, although deaths do occur and major sequelae are not rare. Accordingly, attempts to prevent group B streptococcal infections have concentrated on the more common and frequently lethal early-onset disease. Strategies that have been considered to date include antibiotic- and immuno-prophylaxis. In the preceding article, Easmon advocates an additional approach; topical use of the antiseptic Chlorhexidine gluconate in the vagina during labor.

Although microorganisms are a normal contaminant of walls, floors, and other surfaces, these environmental surfaces rarely are associated with transmission of infections to patients or personnel. Therefore, extraordinary attempts to disinfect or sterilize these environmental surfaces are rarely indicated. However, routine cleaning and removal of soil are recommended. Recommendations for cleaning in the rooms of patients on isolation precautions have been published.

Currently available connectors for IV lines are not well protected against contamination. This also pertains to urinary and peritoneal catheters, as well as any other infusion or drainage system. The male portions of the connectors are particularly vulnerable to accidental contact with the environment, eg, the fingers of caretakers or the patient himself under the conditions of home therapy. Contamination of catheter hubs is well-documented and has recently been implicated as a cause of nosocomial infections with Malassezia furfur in neonates.