To measure the proportion of nosocomial diarrhea cases associated with Salmonella and Shigella species.

Prospective 6-month survey.

Tertiary care center in a developing country.

Pediatric and adult patients admitted within the previous 24 hours and all consenting adult or pediatric medical patients with nosocomial diarrhea.

Prevalence of Salmonella and Shigella species isolated from rectal swabs at admission and among subjects with nosocomial diarrhea.

Salmonella species and Shigella species were isolated from 3.0% and 2.5%, respectively, of 667 patients screened on admission. All admission Salmonella isolates were identified in children under 13 years of age; Shigella prevalence was similar for children and adults. Children with Salmonella at admission were significantly older and more likely to have diarrhea, fever, and some indicators of malnutrition than those from whom Salmonella was not isolated. Salmonella and Shigella were isolated from rectal cultures in 36 (10%) and 9 (2.5%) of 360 nosocomial gastroenteritis cases, respectively. Nosocomial cases occurred equally in adults and children. In adults, nosocomial Salmonella acquisition was associated with sharing a room with a diarrhea patient and previous institutionalization. In children, it was associated with recent antimicrobial therapy, crowding at home, and age between 6 months and 6 years. Nine (41%) of 22 nosocomial Salmonella cases in adults occurred in patients with human immunodeficiency virus-type 1 (HIV-1) infection, while none of 79 HIV-1-positive patients had Salmonella isolated at admission.

Salmonella is a frequent cause of nosocomial gastroenteritis in this tertiary care institution in a developing country Risk factors appear to differ for children and adults, and HIV-1-infected subjects may be at increased risk of acquisition. Control measures feasible for the limited resources available to such institutions require evaluation.

To evaluate the effectiveness of a collaborative and participatory approach to professional training to reduce the risk of human immunodeficiency virus (HIV) transmission.

Healthcare settings in Ghana.

Two 5-day workshops were conducted for high-level nurse educators and leaders who could contribute to national policy development A combination of didactics, skill development sessions, field experiences, and development of draft national guidelines and curriculum were used. Outcomes evaluated were pre-to-post training changes in HIV knowledge and attitudes and changes in practice within selected healthcare settings. One-month follow-up visits (times not specified to participants) were used to evaluate outcomes.

At post-test, significantly fewer participants thought HIV was transmitted by saliva, sweat, or tears (chi square, p<.0001), and significantly fewer reported hesitation to care for an HIV-infected patient because of lack of understanding about mode of transmission or because of lack of supplies, such as gloves (chi square, p<.01). In field observations, there was an overall 42% improvement in specific infection control practices.

A collaborative and participatory approach to training can result in significant changes in infection control practices, even in settings with limited resources.

To determine whether an educational program had a beneficial impact on healthcare worker needlestick injuries, particularly those caused by recapping. Secondary goals were to evaluate the efficacy of in-room needle-boxes and to determine whether surveillance data were useful when evaluating new products.

Survey of employee health department reports.

Tertiary care teaching hospital.

Healthcare workers who reported needlestick injuries and other blood and body fluid exposures to the employee health department.

Exposure data from the 10 months prior to institution of the educational program and installation of disposal boxes were compared with data from the following 27 months. Additionally, the type of disposal box was changed for the last 9 months of the survey.

Needlestick injuries caused by recapping fell significantly following the educational program (p=.005). However, injuries caused by previously disposed needles protruding into the mechanical opening of the needle-boxes increased significantly (p=.002). Following a change of needleboxes to a nonmechanical opening design, the latter type of injury declined (p=.052). Total needlestick injuries, most other categories of needlestick injury, and other exposures did not change significantly during the 37 months of the study.

The educational programs appeared to have positive impact on reducing recapping injuries, but many other needlestick categories did not change significantly. Mechanical opening needle disposal boxes appear to present a hazard when compared with fixed opening boxes. Surveillance data appear to be useful in monitoring injuries as well as evaluating products.

To investigate the possibility that contaminated commercial activated charcoal may serve as a source for fungal colonization or infection of the lower respiratory tract.

The clinical course of a patient who aspirated commercial activated charcoal was reviewed. Fungal cultures were performed for 2 samples of an activated charcoal in sorbitol product from separate lots produced by a single manufacturer. Details of the manufacturing process were obtained from a representative of the manufacturer.

An intensive care unit in a large community teaching hospital.

A single patient with steroid-treated lung disease who developed a fatal pulmonary illness after aspirating a commercial activated charcoal product.

After aspirating the charcoal product, the patient developed respiratory tract colonization and possible infection with Aspergillus niger, Paecilomyces variotii, and Penicillium species. Similar fungal species were isolated from cultures of samples obtained from two separate lots of the same commercial activated charcoal product. Several opportunities for contamination during the manufacturing process were identified.

Physicians caring for immuno-compromised patients should be aware that commercial activated charcoal products can be a source of fungal respiratory tract colonization that may mimic or cause pneumonia.