To study the natural course of nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA) among residents in a nursing home.

A cohort study with eight surveys of nasal cultures over 15 months.

A community nursing home in Chicago, Illinois.

Between 117 and 129 residents of the nursing home in each survey.

MRSA carriers were present throughout the study period. On the average, 24.4% (range: 17.1% to 34.2%) of the residents carried S aureus, and 35.3% (range: 20% to 62.5%) of the isolates were methicillin resistant at each survey. The carrier state was persistent or transient and was affected little by a roommate's carrier status. Approximately 70% to 80% of residents who were bedridden or who had decubitus ulcers or foreign bodies carried MRSA at least once during the study period. Residents' prior hospitalization was not associated with MRSA carriage.

This study demonstrated that MRSA was perpetuated in the nursing home by persistently or intermittently colonizing debilitated residents who required more intensive nursing care and that the prior hospitalization of the residents was not an important cause of its perpetuation. (Infect Control Hosp Epidemiol. 1991;12:416-421.)

To assess the effects of an automated sink on handwashing practices and attitudes of staff.

Quasi-experimental crossover design.

Two high-risk patient care areas, one postanesthesia recovery room (Site 1), and one neonatal intensive care unit (Site 2) in two tertiary care hospitals.

All patient care staff on study units; approximately 55 individuals.

An automated sink was installed to replace one handwashing sink for about five weeks; the sink was then crossed-over for an equivalent time period to the other location. Handwashing practices of all unit staff were observed in three two-hour observation periods/week. Questionnaires were distributed to staff two weeks after sink installation and at the study's end.

One thousand, six hundred ten handwashes were observed. Handwashing practices differed significantly by site. For both sites, hands were washed significantly better but significantly less often with the automated sink (all p<.001). Staff expressed negative attitudes, however, about certain features of the sink, and these negative attitudes increased over the study period.

Automated devices must be flexible enough to allow adjustments based on staff acceptance. Application of new technology to improve hand hygiene requires a multifaceted approach to behavior change. (Infect Control Hosp Epidemiol. 1991;12:422-428.)

To determine the incidence of infection in human immunodeficiency virus (HIV)-infected patients during periods of neutropenia and non-neutropenia. To compare the infection rates in patients with HIV disease to those in a group hospitalized with neutropenia and hematologic malignancy.

Prospective observational study conducted between December 1985 and December 1987 at a university teaching hospital. Thirty patients with documented acquired immunodeficiency syndrome (AIDS) and absolute T-helper cells <200 mm/mm3. All patients had a period of non-neutropenia following a neutropenic period (neutrophils <1000 cells/mm3).

The rate of first infection during neutropenic and non-neutropenic periods for opportunistic infection and nonopportunistic infections were compared. There were no differences between infection rates for the two time periods for both types of infections. A subgroup of patient care days in which non-neutropenic days followed neutropenic days also was studied to eliminate selection bias. In this group, a comparison of infection rates also revealed no difference between neutropenic and non-neutropenic periods. An alternate analysis of the time until first infection during periods of neutropenia or non- neutropenia was done using the Kaplan-Meier product limit method. There was a longer infection-free period for the neutropenic group for opportunistic infections, but it was not statistically significant (p<.1). In addition, we compared HIV-infected patients with a group of 37 patients with neutropenia from hematologic malignancy. There was a significantly higher rate of all infections, particularly bacteremias (p<.001), in the group of patients with hematologic malignancies when compared with all subsets of patients with HIV disease.

We conclude that patientswith HIV disease and modest neutropenia do not have an increased risk of bacterial infection. The incidence of all infections is significantly greater in patients with neutropenia secondary to hematologic malignancy, (Infect Control Hosp Epidemiol. 1991;12:429-434.)

To study the effect of various latex and treated glove combinations in reducing the frequency of human immunodeficiency virus (HIV) infection of tissue culture cells after puncture by surgical needles contaminated with infectious human immunodeficiency virus type 1 (HIV 1).

One, two, or three layers of sterile latex glove material, or two latex layers with intermediate cotton or Kevlar (with or without the virucidal compound nonoxynol-9) were used to cover 24-well cell culture dishes containing MT2 cells in cell culture medium. Surgical needles wet with cell culture medium containing HIV- 1 (HTLV IIIA strain) were passed through the glove materials into the culture medium in the wells of the culture dishes. The culture medium in each well was then assayed biweekly for HIV-1 p24 antigen as a test for infection of cells in the well.

The rate of HIV-1 infection of cell cultures after glove puncture was greater than 90% with a single latex surgical glove barrier, 23% to 60% with double or triple layers of latex gloves, less than 8% with an intermediate cotton glove impregnated with 4% nonoxynol-9, 6% with an intermediate Kevlar glove, and 0% with an intermediate Kevlar glove impregnated with non-oxynol-9.

An intermediate glove of Kevlar or of Kevlar or cotton impregnated with virucidal compound nonoxynol-9 between standard latex gloves may improve surgical glove safety, compared with latex gloves alone with respect to needlestick transmission of HIV 1. The experimental model used may permit rapid investigation of other glove systems as barriers to the transfer of infectious agents through gloves by needlestick. (Infect Control Hosp Epidemiol. 1991;12:435-438.)