Between April 1982 and March 1983,10 of 26 (38.4%) allogeneic bone marrow transplant recipients housed on a newly opened bone marrow transplant unit developed invasive aspergillosis. By contrast, between September 1977 and March 1982, only 3 of 46 (6%) transplant recipients developed invasive aspergillosis. A case-control study to identify host factors related to Aspergillus infection found that aspergillosis was more common in patients with chronic myelogenous leukemia and aplastic anemia, older patients, patients having cytomegalovirus disease, patients who experienced prolonged granulocytopenia, patients conditioned with ara-C (100-200 mg/day), and patients who received longer duration of antimicrobial therapy. A series of logistic regression analyses revealed that underlying disease was the single best predictor of Aspergillus infection. This study demonstrates that underlying disease is an important risk factor for aspergillosis and that special measures may be warranted when transplanting certain patients.

Infection is an inherent complication in surgery. The high cost, the morbidity and the mortality to which it gives rise require that an effort be made to reduce its incidence. The control of the rates of infection constitutes today a parameter of the quality of the service provided by a hospital. In Brazil the unstructured nature of the vast majority of hospitals makes the recording of hospital infection and any attempt to control it a difficult task.

Isolated studies have appeared in the Brazilian literature such as those of Hultzler et al on data from the São Paulo University Hospital, Zanon et al2 from Ipanema Hospital, Rio de Janeiro, and Ferraz et al from the Federal University of Pernambuco Teaching Hospital. Hultzler et al reported in 1973 that the incidence of acquired infection in the patients admitted to the São Paulo University Hospital was 5.95%. The overall rate of post-operative infection in 4,746 operations performed was 6.59%, while that of wound infection was 3.08%.

In 1979 Zanon et al reported a 7.5% incidence of wound infection in the Division of General Surgery at Ipanema Hospital (Rio de Janeiro).

In 1980 the National Enquiry on Post-Operative Infection was organized under the auspices of the Brazilian College of Surgeons. A questionnaire was sent to 3,225 members of the College throughout the country. Of the 107 questionnaires duly completed and returned (3.31%) only 86 (2.66%) reported controlling infection, and of these, 61 (1.89%) included the outpatient department within the scope of their control of infection. Only 20 of the 107 questionnaires returned gave what were considered answers with regard to surgical wound infection.

We studied rates of peripheral intravenous (IV) catheter tip and insertion site colonization after randomly assigning patients to transparent polyurethane (TP) dressings (N=316) or dry gauze (DG) dressings (N=421). The study was conducted during both summer and fall seasons, in a facility which lacked air conditioning. All patients had a teflon plastic catheter inserted, maintained and cultured by a member of the IV therapy team; no antibiotic or antiseptic ointments were used. Colonization rates were higher in the summer than in the fall for both catheter tips (9.0% vs 3.5%, p=0.005) and sites (21.6% vs 7.0%, p=0.001). During the summer season, the rate of catheter tip colonization with TP dressings was nearly twice that of DG dressings (12.4% vs 6.8%, p=0.04). Logistic regression analysis indicated that catheter tip colonization was associated with the summer season (odds ratio=3.0, 95% CI 1.4-6.2) and TP dressings (odds ratio=1.8, 95% CI 1.1-3.2), and that site colonization was associated with both summer (odds ratio=4.0, 95% CI 2.2-7.1) and receipt of antibiotics (odds ratio=1.9, 95% CI 1.1-3.2). Coagulase-negative staphylococci were isolated from 55.5% of the colonized catheter tips and insertion sites. The data suggest that bacterial colonization of peripheral IV catheters is increased in summer, and that use of TP dressings may increase both tip colonization and cost nearly twofold.

Medical patients receiving IV therapy were randomly assigned to one of two IV tubing change groups. One group had a 48-hour tubing change and the other had no tubing change for the remainder of the cannula placement. A daily IV fluid specimen was processed microbiologically. To complete the study, a minimum of 3 continuous days of therapy and three fluid specimens was required. There were two contaminated specimens, one in each tubing change group. The contamination rate in the 48-hour change group was 0.87% and 0.96% in the no change group. The rate difference of 0.09% has a 95% confidence interval (−0.035 to +0.036) which includes zero. Survival analysis also revealed no significant difference in the cumulative probability of survival, however the mean duration of continuous tubing use of 4.3 days in the no change group and 1.8 days in the 48 hour change group were significantly different (p<0.05). The cumulative probability of surviving contamination free was 0.988 in the 48-hour group and 0.987 in the no-change group. We conclude that it is safe to change IV tubing at intervals up to but not exceeding 4 days.

An outbreak of rubella in a large metropolitan hospital is described. Nineteen cases among employees and three secondary cases in family members occurred. Nosocomial cases occurred among the 3,900 employees of an adult medical-surgical unit where a voluntary program of rubella immunization was in effect. No cases occurred among the 1,400 employees of the women's and pediatric units with mandatory policies, despite interfacility and community exposure. Ten pregnant women were among the 377 contacts of the cases. Five were sero-negative to rubella. Two who developed clinical rubella, one asymptomatic sero-conversion and one other, all elected to terminate their pregnancies. The remaining woman, exposed in her third trimester delivered a normal infant. We conclude a policy requiring new employees to be rubella immune is more effective in preventing nosocomial rubella than a voluntary program and is desirable in view of the potential consequences of an outbreak to pregnant employees.

The era of cost containment is upon us. Bureaucrats and regulators, politicians and insurance administrators have begun to devise schemes for reducing the costs of hospital care and medical services in a country justly proud of the quality of its health care. The term “cost containment” has a neutral ring to it, a tone deliberately chosen by policy makers to soften the impact of its effects. The concept has an aura of virtue, conjuring an image of overflowing expenditures that must be put back into the container. But let us recognize the harsh reality that cost containment is simply another term for rationing, a notion that has somewhat unsavory connotations.

The need to embark on rationing arises when a crisis of available goods or services is imminent. We are told that too much money is being spent today on health care in the US. Since spending too much on anything is considered wasteful, and since wastefulness is at least an inefficient, if not an unethical way to treat resources, the conclusion seems inescapable that there is a moral imperative to cut costs in the health care sector. To be sure, the goals of eliminating waste and reducing excessive costs should be pursued by hospitals and physicians alike. But let us not hide behind these noble goals and accept uncritically the idea that to increase efficiency in delivering health care, it is necessary to embark on rationing schemes.

In 1911, McCoy discovered an unusual illness among ground squirrels in Tulare County, California. The illness resembled plague but was clearly different because a pathogen could not be isolated on the usual culture media. With the addition of egg yolk to the media, McCoy finally isolated an organism and named it Bacterium tularensis. It was soon recognized that B. tularensis could cause disease in humans, and many investigators, especially Edward Francis, did much of the early work defining the bacteriology, pathology, and epidemiology of tularemia. The name of the organism was eventually changed to Francisella tularensis in honor of Francis.

Unlike Pseudomonas aeruginosa and the Enterobacteriaceae which are relatively non-pathogenic in the normal host, F. tularensis can easily cause disease in previously healthy persons. In contrast, F. tularensis has not been implicated in nosocomial infections and person to person spread is rare. The organism is, however, extremely hazardous to workers in the clinical microbiology laboratory. Of all common bacterial and fungal pathogens isolated in the clinical laboratory, F. tularensis is second only to Coccidioides immitis in its potential to infect the laboratory worker. Many experienced investigators claim that it is impossible to work with the pathogen for any length of time without becoming infected. Currently it is highly recommended that persons who routinely work with the organism be immunized.

Intravenous (IV) therapy as a nursing specialty is based on principles of anatomy, physiology, pathophysiology, pharmacology, and infection control. Since IV therapy is an invasive procedure, it is germane that nurses strictly adhere to the fundamental principles that govern this area to assure patient protection. The focus of this article is to assimilate clinical expertise into a process for selecting IV tubing systems that are suitable for the delivery of the prescribed IV therapy.

The first principle that governs the selection of IV tubings is to choose a system that will deliver the prescribed therapy and minimize the risk of infection. The National Intravenous Therapy Association (NITA) Standards of Practice states that 0.22 μm filters shall be utilized for the delivery of IV therapy unless contraindicated. The 0.22 μm filters provide the following four safeguards to patients: 1) they remove particulate matter than could impede circulatory flow through the pulmonary vascular system. 2) They eliminate air from the system and consequently protect patients from the risk of air embolism. The design of the 0.22 μm filter allows air to be automatically vented from the system; therefore, no entry into the sterile IV system is required to remove the air. Because every entry into the IV system may result in inadvertent contamination, the air-eliminating capabilities of the 0.22 μm filter may also be classified as an infection control measure. 3) They will retain virtually every pathogen bacterium or fungus that may have entered the system.