In a 750-bed community-teaching hospital with 3,200 employees, throat cultures were routinely done in hospital personnel complaining of a sore throat. During a 3-month period, 323 employees had throat cultures; only 20 (6.2%) of these throat cultures grew group A streptococcus. The prevalence of positive throat cultures was similarly low in employees (6.2%) and adult patients (7.3%). There was no evidence that employees either had higher prevalence of group A streptococcal pharyngitis or that they spread the infection to patients. It is concluded that routine throat cultures are not warranted in employees complaining of a sore throat, and that throat cultures should be done only selectively in hospital personnel with a high probability of group A streptococcal pharyngitis.

The effect of daily treatment with 0.5% Chlorhexidine in 70% ethanol and in 70% isopropanol, respectively, on navel colonization and on rates of infection in newborns has been studied in 438 infants in two maternity wards during a 3-month period. In spite of isopropanol being reported as a more efficient skin disinfectant than ethanol in several experimental models, no significant differences were seen in the frequency of navel colonization or in infection rates between the two treatment groups. The colonization rate with S. aureus was lower in this than in an earlier investigation on navel disinfection with Chlorhexidine in ethanol performed in the same wards. This may reflect a progressive effectiveness of the treatment due to fewer S. aureus sources in the nursery. For practical reasons we continue to recommend daily navel disinfection with 0.5% Chlorhexidine in 70% ethanol on healthy newborns in hospital nurseries.

Endometritis is an infectious complication in 9% to 65% of patients delivered by cesarean section. The risk of developing endometritis is greater in the high-risk emergent patient as compared to routine repeat abdominal deliveries. This study describes the incidence of endometritis following cesarean section delivery in different patient groups at the University of Virginia Hospital during a 1-year period and reviews the literature on the efficacy and risks of prophylactic antibiotics in this setting. Of patients not receiving antibiotic prophylaxis, 11 (<1%) of 1,461 normal spontaneous vaginal delivery patients, 7 (16.7%) of 42 repeat and 39 (29.8%) of 131 emergent cesarean section patients developed endometritis. This contrasts to none of the 24 emergent patients who received antibiotic prophylaxis. The literature review shows multiple prospective well-designed and executed studies that demonstrate reliable decreases in the incidence of endometritis with short course antibiotic prophylaxis. Our conclusion is that short course antibiotic prophylaxis is a safe, reproducible, cost-effective and indicated method of reducing the incidence of this costly and serious postoperative infection.

Due to sporadic infections attributed to contaminated multiple-dose medication vials (MDV), some authorities have suggested discarding all MDV within 24 hours. We inoculated 11 commonly used medications with suspensions of 10 bacterial species previously associated with contaminated parenteral solutions and determined microbial persistence at both room and refrigerator temperature. At 22°C, atropine, curare, folic acid, NPH insulin and triamcinolone did not allow microbial persistence beyond 4 hours. Lidocaine and heparin were sterile by 24 hours. Regular insulin, immune serum globulin, and myochrysine allowed persistence for up to 7 days. At 4°C, bacterial persistence was significantly prolonged for all medications including those MDV requiring refrigeration. No organisms proliferated; however, F. meningosepticum and P. maltophilia were particularly persistent at both temperatures. The risk of persistent MDV contamination appears to be dependent upon specific pharmaceutical, microbe and storage temperature interactions. Recommendations for the refrigeration of MDV medications may require reevaluation on a product-by-product basis.

Acquired immunodeficiency syndrome (AIDS) has created new and difficult challenges for infection control services. Limited information on the pathogenesis and means of transmission coupled with the reported high mortality rates of this disease, have heightened public fears about the potential risks resulting from exposure to AIDS. Hospitalization of these patients, with the attendant responsibilities for their care by hospital personnel, has served to focus and amplify these public concerns in a relatively small and inter-related community. The result, in some hospitals, has been an increase in incidents which interfere with the proper care of AIDS patients. While a great deal has been written about the appropriate precautions recommended for the care of these patients, little attention has been focused on the practical problems encountered within the institution of these policies and within the education of the concerned and relatively uninformed hospital community. The success of such a program is essential to assure the proper care of these patients. The purpose of the present report is to summarize the experience at our institution and to outline the approach adopted by the Infection Control Unit to deal with these problems.

Chancroid, or soft chancre (ulcus molle), was first differentiated from syphilis by Bassereau in 1852. The causative organism, Haemophilus ducreyi, was first described by Ducrey in 1889, although he was unable to grow the organism in vitro. The first successful culture has been attributed to Petersen (1895). Haemophilus ducreyi has been clinically associated only with genital ulcer disease and direct inoculation infections. There is no difficulty accepting Haemophilus ducreyi as a legitimate clinical and taxonomic species because it is the sole human Haemophilus species with a requirement only for X factor as determined by the porphyrin test. The emergence of Haemophilus ducreyi strains resistant to multiple antibiotics has restricted efforts to curb the spread of this increasingly prevalent sexually transmitted disease.