Pseudomonas aeruginosa is the most common pathogen of Pseudomonas species. One of the most virulent organisms pathogenic to man, P aeruginosa can cause a variety of infections in humans. Despite the introduction of many new antimicrobial agents with enhanced activity against P aeruginosa, the high mortality rate associated with the organism over the past two decades continues.

Tuberculosis (TB) skin-testing practices in long-term care facilities (LTCFs) in North Carolina (NC) were assessed from a 56% (148/263) response to a comprehensive TB screening questionnaire. TB skin tests were administered to employees on initial employment by 98% and annually by 97% of the LTCFs, generally (74%) by the Mantoux method. Employee skin tests were read at the appropriate time interval of 48 to 72 hours by 91%, but less than half used diameter of induration when interpreting reactive tests. The booster test was performed on new employees at eight (6%) of the LTCFs. TB skin tests were routinely performed on newly admitted residents by 56% or conditionally required by 18%, generally (73%) by the Mantoux method. Resident skin tests were read at the appropriate time interval of 48 to 72 hours by 92%, but again only half correctly interpreted reactive tests as significant. Residents received routine annual skin tests at 71% of the LTCFs, generally (80%) by the Mantoux method. Eight (6%) facilities routinely performed the booster test on newly admitted residents. TB infection prevalence in new employees during 1983 was 8.1% (47/578) in seven LTCFs and in newly admitted residents was 6.4% (7/110) in three LTCFs supplying this data. The five-year mean TB skin test conversion rate among employees was 1.1% (101/9545) in 12 LTCFs and among residents was 0.9% (46/5216) in nine LTCFs supplying this data. Lack of compliance to established TB skin-testing guidelines in NC LTCF was prevalent. In recognition of described endemic and epidemic spread of TB in LTCFs, residents and employees of LTCFs should be screened for TB utilizing established skin-testing practices.

We conducted a prospective environmental study for Legionella pneumophila in 15 hospitals in Pennsylvania. Hot water tanks, cold water sites, faucets, and show-erheads were surveyed four times over a one-year period. Sixty percent (9/15) of hospitals surveyed were contaminated with L pneumophila. Although contamination could not be linked to a specific municipal water supplier, most of the contaminated supplies came from rivers. Parameters found to be significantly associated with contamination included elevated hot water temperature, vertical configuration of the hot water tank, older tanks, and elevated calcium and magnesium concentrations of the water (P < 0.05). This study suggests that L pneumophila contamination could be predicted based on design of the distribution system, as well as physicochemical characteristics of the water.

Nosocomial transmission of hepatitis A from patients to staff members is an unusual event. Recently, several cases of occupational transmission of hepatitis A to health care workers have been reported in the literature. Most of these have occurred as a result of transmission from an infected child to a staff member involved in his or her care. We report an additional case of transmission of hepatitis A from an infected adult to a staff member and review the literature regarding nosocomial hepatitis A transmission. The review emphasizes several points that nearly all instances of nosocomial transmission of hepatitis A have in common, including the role of asymptomatic infection, the timing of hospitalization, and the fact that index patients often have an underlying illness that obscures the early diagnosis of hepatitis A. In addition, several other areas of controversy with respect to hepatitis A are discussed.

The purposes of this study were to assess the effect of two quantities (1 mL or 3 mL) of four different handwashing products on reductions in log colony-forming units (CFU) from the hands and to determine the amount of liquid soap used for handwashing by personnel in one hospital. First, 40 subjects were assigned by block randomization to one of four handwashing products (4% chlorhexidine gluconate in a detergent base, two alcohol hand rinses, and a liquid, nonantimicrobial soap) to be used in either 1 mL or 3 mL amounts per wash. Each subject washed his or her hands 15 times per day for five days. After one and five days of handwashing there were significant reductions over baseline in log CFU between handwashing products (P<0.001). Additionally, subjects using 3 mL of antiseptic soap had significantly greater reductions in log CFU than those using 1 mL (P<0.001). Among subjects using control liquid soap there was no such dose response. Second, a survey of 47 members of a hospital nursing staff from nine specialty areas and ten individuals in the general population was conducted to measure amounts of two liquid soaps used for handwashing. Amount of soap ranged from 0.4 to 9 mL per handwash. Personnel working in clinical areas where patients were at high risk for nosocomial infection used significantly more soap than did others (P<0.05). We conclude that quantity of soap used for handwashing is one variable influencing the microbial counts on hands, and that the quantity of soap used by health care personnel varies considerably.

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.

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?