We controlled the spread of epidemic methicillin-resistant Staphylococcus aureus (MRSA) infection in an 884-bed veterans' facility by cohorting known active MRSA carriers and MRSA-infected patients on one nursing unit. Simultaneously, all previously-institutionalized transfers into the veterans' facility were screened with swab cultures for MRSA at the time of admission. All MRSA patients were maintained on contact (gown and glove) or strict isolation and treated aggressively with topical and enteral antibiotics with the assistance of the infectious disease consultant. The monthly incidence of new MRSA patients dropped from a maximum of 16 per month to three or less per month within six months of instituting these infection control measures. There were no further MRSA bacteremias after the establishment of the MRSA cohort in a single unit. Aggressive cohort management of known MRSA patients and screening of previously-institutionalized patients on admission for MRSA controlled epidemic MRSA in this large institution.

An anonymous national survey of a representative population of healthcare workers who were thought likely to have frequent and intensive exposures to blood and other body fluids (certified nurse-midwives [CNMs]), was conducted to assess the type and frequency of self-reported occupational exposures to blood and body fluids experienced, the extent to which barrier precautions and other infection control measures were used, whether or not reported use of barriers was associated with a lower perceived rate of exposures and factors that influenced the use of infection control procedures.

Of those responding, 74% had soiled their hands with blood at least one time in the preceding six months, 51% had splashed blood or amniotic fluid in their faces and 24% reported one or more needlestick injuries during that same period. Our study also found evidence of an association between the practice of needle recapping and the occurrence of needlestick injury (p = .003). Despite a high level of training and knowledge, only 55% reported routinely practicing universal precautions (UPs).

Several factors that potentially influenced the use of UPS were studied, including healthcare worker perceptions of risk of occupational bloodborne infection, knowledge of routes of transmission of bloodborne pathogens and rationale for not using appropriate barriers. Our data suggest that occupational exposures occur frequently and that healthcare workers' (HCWs') perceptions of risk for occupational infection play an important role in influencing use of UPS. This study emphasizes the importance of developing new strategies for UP training.

In 1980, the Public Health Service established an objective of immunizing 60% of high-risk persons with influenza vaccine annually by the year 1990. As no more than 32% of high-risk persons currently receive influenza vaccine each year, the Health Care Financing Administration (HCFA) has undertaken an influenza vaccination demonstration project for Medicare enrollees. Federally purchased vaccine is being distributed to physicians, health departments, hospitals, nursing homes and health maintenance organizations (HMOs). If the project is cost-effective, Congress has authorized HCFA reimbursement for influenza vaccination. Changing reimbursement policy alone, however, is unlikely to substantially improve influenza vaccine delivery; HCFA reimbursement for pneumococcal immunization since 1981 has not increased the use of pneumococcal vaccine. In contrast, federal purchase and distribution of vaccines to state and local health departments has helped maintain the remarkable success of childhood immunization programs. In addition, in Canada, provincial health departments purchase more than 80% of all influenza vaccine distributed, and from 1980 through 1988, per capita vaccine distribution increased 140%. These experiences suggest the need for an expanded policy goal for the influenza vaccination demonstration project that includes federal purchase and distribution of influenza vaccine. This approach, together with a change in reimbursement policy, offers greater promise for achieving our nation's objective for influenza vaccination.

Recent trends in medical care have resulted in increasing numbers of patients being cared for in the home health setting. The annual growth rate for home care is projected to be between 12% and 20%, at least through 1990. Many patients who would formerly have stayed in the hospital are now being discharged to home care. This trend has been prompted and driven by cost considerations, but other factors, such as new approaches to the care of dying patients, have also played a role. Many patients cared for at home may have communicable diseases, multiple invasive devices or an immunocompromising condition. The patient, family members and the home health professional (HHP) all may be at risk for developing or transmitting infection, although the actual risk has not been determined. Thus, there is a need for prevention and control of home-acquired infections.

The emergence and widespread distribution of the acquired immunodeficiency syndrome (AIDS) have clearly signaled the most important epidemic of the 20th century. In responding to this epidemic in a compassionate and rational voice, the infection control practitioners-physicians, nurses and technologists-have played a crucial role in healthcare delivery. A great deal of information has resulted from numerous scientific studies. Because of the volume and complexity of data currently being generated, the Editorial Board of Infection Control and Hospital Epidemiology has invited Dr. David K. Henderson to initiate a new column on AIDS. He is an internationally recognized expert who has agreed to edit this column for the journal. We welcome your responses, and encourage your submissions to Dr. Henderson in this area.

Although we think of malaria as a disease of the tropics, it is sobering to recall that in the beginning of this century, more than two-thirds of the earth's population lived in areas where malaria was endemic. The United States and Europe were both rife with malaria, and the disease changed the course of world history many times. Indeed, in Western Africa during 1942, the incidence of malaria was as high as 1,071 cases per 1,000 soldiers per year.

The data collection form (also referred to as a questionnaire, case report form or interview guide) is the focal point of any research project. It contains the data used to test the research hypotheses. If errors are made in translating the questions of interest into items on the form, or in coding those items, the answers sought might not be available. Designing an excellent data collection form may be more art than science. However, there are certain principles that, if followed, will generally result in an easy-to-use, efficient and reliable instrument for gathering and coding data.