A one-year prospective study of surgeon-specific nosocomial infection rates was done in two community hospitals. Hospital A (93 beds) and Hospital B (158 beds) have nearly identical surgical staffs. Unified criteria for the diagnosis of infections, methods of data collection, and coding were used. Data were processed with an IBM 370 computer using Statistical Analysis System (SAS). Each surgeon received semiannual reports of 1) overall infection rate by site, 2) number of surgical wound infections by wound class and type of procedure, 3) pathogens for each deep and incisional infection, and 4) quarterly wound infection rates by wound class. Analysis of reports revealed high Class I surgical wound infection rates for both general and orthopedic surgeons. One person in each group had inordinately high infection rates. These data serve as an objective incentive to reduce surgical wound infections, identify individual problems, and suggest surgical privileges be evaluated by performance.

The acquisition of scabies in either the community or the health care setting is not uncommon, although it is infrequently documented. In Missouri, individual cases of scabies infestation are not reportable, but outbreak notification is required. Outside of the nursing home environment, where three to six outbreaks of scabies per year require assistance from the nosocomial disease subprogram of the Kansas City Health Department, only two other outbreaks have been recorded in the community since August 1977. One involved a school with 93 cases and the other a commercial laundry, which is reported here. The latter outbreak illustrates the difficulty encountered when attempting to classify an outbreak as either nosocomially acquired or community-acquired.

Over an eight year period, 1975 to 1982, 1,843 nosocomial bloodstream infections were identified by routine prospective surveillance at the University of Virginia Hospital (106/10,000 admissions). Despite a decline in overall bloodstream infection rates during the study period (P =.085), bloodstream infections due to gram positive organisms increased from 29 (1975-1978) to 43/10,000 (1979-1982), (P<0.001). Notably, rates for coagulase negative staphylococci increased from 5.2 (1975-1978) to 12.4/10,000 (1979-1982), (P<0.001). In 1982, coagulase negative staphylococci accounted for 17% of all bloodstream infections and were the most frequently isolated pathogens. Sixty-four percent of patients with coagulase negative staphylococci were in critical care units versus 41% with other bloodstream infections (P<.05). The recognition of coagulase negative staphylococci as significant bloodstream pathogens markedly alters the clinician's approach to nosocomial septicemia.

Over 20 years ago, Philip Brachman advised us that “… the surveillance of all institutionally associated infections is important in order to minimize the risk of infection to all patients entering the institution and to members of the community.” Seven years later, in 1970, other staff members at the Centers for Disease Control (CDC) offered us more specific surveillance objectives:

A. To determine the frequency and kinds of endemic nosocomial infections, in order to identify deviations from the baseline so that infection control personnel can:

1. Determine where studies are needed.

2. Ascertain where control measures (long-term and emergency) need to be established and how effective new control measures are.

3. Establish policy.

B. To provide the patient and personnel (and in some instances the community) with all possible protection from infections of nosocomial origin.

C. To meet the requirements of the Joint Commission on Accreditation and the medical-legal guidelines of “accepted standards of patient care.”

D. To provide the medical and nursing staff with meaningful data on the level of nosocomial infection in their work areas.

If each single nosocomial infection represented sufficient deviation from the baseline occurrence, then analysis of surveillance data would be quite straightforward. However, that is not the case. A 1976 project report for the National Center for Health Statistics identified various “sentinel health events” whose occurrence should trigger “… scientific search for remediable underlying causes.”

The intensive care unit (ICU) creates the unique situation of subjecting highly susceptible patients to a variety of invasive procedures that are concentrated in a small unit. Effectively providing life-saving care is considered more important than other measures, such as infection control. Nevertheless, it is frustrating to lose a patient due to a sepsis that could have been prevented by simple hygienic arrangements, the application of aseptic techniques, and infection control measures. There is some confusion about the necessity and efficacy of many of these prescriptions, and some of them must certainly be considered rituals: only controlled studies demonstrating the influence of the specific measure on the infection rate will give a decisive answer about usefulness. Most factors determining the occurrence and transmission of infections lie with the patient's resistance and treatment, but technical, diagnostic, and curative measures may also influence the infection rate. Facilities, techniques followed, and prescribed procedures may differ from hospital to hospital. If we want to draw a conclusion from the comparison of infection rates in different ICUs, it is desirable to compare not only the different preventive measures in nursing procedures and techniques, but also the organization and structure of the units. Therefore, our committee decided to study the hygienic situation of ICUs before elaborating a practicable and valuable system for the registration of nosocomial infections. The study was not limited to the small group of interested teaching hospitals with high standards, but rather, was extended to all Austrian (A) ICUs and a significative sample of German (D) and Belgian (B) ICUs.

Cytomegalovirus (CMV) has emerged as an important cause of human illness. Infection with this common virus can result in asymptomatic infection, an acute “mononucleosis-like” illness, or congenital disease. It is capable of persisting in a latent state and reactivating at a later date. It can be transmitted by blood transfusion, organ transplantation, oral or genital contact, intrauterine infection, perinatal infection and perhaps casually by children in day care centers.

Historically, the first reports described “protozoan-like” cells in the organs of a fetus and a stillborn in 1904. In 1932, Farber reported the presence of inclusions in the nucleus and cytoplasm of cells in infants dying of various causes and coined the term cytomegalic inclusion disease. The urine was initially cultured in 1953 by Smith, and the subsequent development of serologic methods of diagnosis made its broad spectrum of disease more fully appreciated.

Hospital personnel, especially women in their child-bearing years, continue to express concern about the risk of acquiring cytomegalovirus (CMV) infection as a result of their occupation. Previous investigations of occupational risk of CMV infection have focused primarily on pediatric nursing personnel. However, assessment of the rate of CMV infection by other hospital personnel who have different clinical responsibilities and levels of patient contact cannot rely solely on the rates obtained for nursing personnel.

Today's infection control practitioners (ICPs) bear a problem other than the one that faced Ignaz Semmelweis: not only do they attempt to get hospital personnel to wash their hands, they are bombarded by the choices of which soap to use. What type of soap is best? Towelette? Powder? Bar? Foam? Waterless? Lotion? Liquid? Should the agent be scented or unscented, medicated or nonmedicated, antimicrobial or antiseptic? Is a residual bacteriostatic effect more desirable than a fast-acting bactericidal effect? Can a ten-second cleansing yield a better handwash than a ten-minute scrub?

Candida (Torulopsis) glabrata is a fungus with a diversity of habitats and an enlarging clinical spectrum. It is found as normal human flora in the gastrointestinal tract, skin, and vagina and also found in nature in soil and in animals. It was initially thought to represent a nonpathogenic saprophyte, however, it has been recovered with increasing frequency from clinical specimens. It is now recognized as a cause of disease in the normal and compromised host.

The importance of vibrio species other than Vibrio cholerae has only recently been appreciated. Vibrio parahaemolyticus has usually been associated with gastrointestinal tract infections although it may be a rare cause of soft tissue infection and septicemia. V alginolyticus is a rare cause of marine wound infections, otitis, and sepsis, and has not been associated with outbreaks of gastroenteritis. In 1976 Hollis et al1 described the characteristics of 38 isolates of a halophilic bacterium isolated from blood cultures (20), cerebrospinal fluid (2), and wound infections (16). Originally called Beneckea vulnifica, this organism was reassigned to the genus Vibrio and named V vulnificus by Farmer. It is a salt-requiring, marine vibrio that can be distinguished from other vibrio species by its ability to ferment lactose. V vulnificus is a particularly virulent organism that typically produces either primary septicemia that occurs after ingestion of raw shellfish, especially in patients with chronic liver disease, or a fulminating wound infection that occurs after exposure to seawater or handling of shellfish.