To trace the routes of transmission and sources of Staphylococcus aureus found in the surgical wound during cardiothoracic surgery and to investigate the possibility of reducing wound contamination, with regard to total counts of bacteria and S aureus, by wearing special scrub suits.

A total of 65 elective operations for coronary artery bypass graft with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Bacteriological samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves and from the patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Bacteriological samples also were taken from the subcutaneous walls of the surgical wound just before closing the wound. Total counts of bacteria on sternal skin and wound walls (colony-forming units [CFUs//cm2) were calculated, as well as total counts of bacteria in the air (CFUs/m3). Strains of S aureus recovered from the different sampling sites were compared by pulsed-field gel electrophoresis (PFGE).

Special scrub suits significantly reduced total counts of bacteria in air compared to conventional scrub suits (P=.002). The number of air samples in which S aureus was found was significantly reduced by special scrub suits compared with conventional scrub suits (P=.016; relative risk, 4.4; 95% confidence interval [CI95], 1.3-14.9]). By use of PFGE, it was possible to identify two cases of possible airborne transmission of S aureus when wearing conventional scrub suits, whereas no case was found when wearing special scrub suits. When exposed to airborne S aureus, the concomitant sternal carriage of S aureus was a risk factor for having S aureus in the wound.

Use of tightly woven special scrub suits reduces the dispersal of total counts of bacteria and of S aureus from staff in the operating room, thus possibly reducing the risk of airborne contamination of surgical wounds. The importance of careful preoperative disinfection of the patient's skin should be stressed.

We have developed and analyzed a large surgical prophylaxis database and now report the factors significantly associated with early infection, readmission due to infection, and death within 28 days of surgery. This study is intended to be a stepping-stone for further studies using our clinical database.

A computerized database of 9,016 surgical patients from a 400-bed community hospital was examined. Multivariate logistic regression and tree-based modeling were used to identify factors associated with the outcomes. Factors considered included surgical procedure, prophylactic antibiotic, age, gender, serum creatinine, and albumin.

12.6% had an early infection, 2.5% were read-mitted due to infection, and 2.5% died within 28 days. Most combination prophylactic antibiotics were associated with an increased probability of an early infection. Decreased albumin and increased age were associated with an increased probability of an early infection. Tracheostomy and amputations were associated with an increased probability of an early infection, whereas gallbladder and orthopedic procedures involving the arm were associated with a decreased probability. Factors associated with readmission due to infection included dialysis shunt, vascular repair, and an early infection. Factors associated with increased probability of death within 28 days included age, albumin, serum creatinine, and an early infection. Gallbladder procedures and obstetric-gynecologic procedures were associated with a decreased probability of death within 28 days.

Older patients and those with a decreased albumin were most likely to have an early infection. To the extent that an early infection was a significant risk factor for readmission due to infection, the impact of age and albumin on the probability of readmission due to infection is demonstrated by their effects on early infections. Interestingly, albumin and age were significantly associated with death within 28 days, in addition to early infection, showing the predictive association between these factors and early death.

To estimate the extent of, and evaluate risk factors for, elevated carboxyhemoglobin levels among patients undergoing general anesthesia and to identify the source of carbon monoxide.

Matched case-control study to measure carboxyhemoglobin levels.

Large academic medical center.

45 surgical patients who underwent general anesthesia.

Case-patients were more likely than controls to undergo surgery on Monday or Tuesday (10/15 vs 7/30; matched odds ratio [mOR], 7.7; 95% confidence interval [CI95], 1.8-34; P=.01), in one particular room (7/15 vs 4/30; mOR, 8.5; CI95, 1.5-48; P=.03) or in a room that was idle for ≥24 hours (11/15 vs 1/30; mOR, 95.5; CI95, 8.0-1,138; P≤.001). In a multivariate model, only rooms, and hence the anesthesia equipment, that were idle for ≥24 hours were independently associated with elevated intraoperative carboxyhemoglobin levels (OR, 22.4; CI95, 1.5-338; P=.025). Moreover, peak carboxyhemoglobin levels were correlated with the length of time that the room was idle (r=0.7; CI95, 0.3-0.9). Carbon monoxide was detected in the anesthesia machine outflow during one case-procedure. No contamination of anesthesia gas supplies or CO2 absorbents was found.

Carbon monoxide may accumulate in anesthesia circuits left idle for ≥24 hours as a result of a chemical interaction between CO2-absorbent granules and anesthetic gases. Patients administered anesthesia through such circuits may be at increased risk for elevated carboxyhemoglobin levels during surgery or the early postoperative period.

To identify risk factors and describe the microbiology of catheter exit-site and hub colonization in neonates.

During a period of 2 years, we prospectively investigated 14 risk factors for catheter exit-site and hub colonization in 862 central venous catheters in a cohort of 441 neonates. Cultures of the catheter exit-site and hub were obtained using semiquantitative techniques at time of catheter removal.

A neonatal intensive care unit at a university hospital.

Catheter exit-site colonization was found in 7.2% and hub colonization in 5.3%. Coagulase-negative staphylococci were predominant at both sites. Pathogenic flora were found more frequently at the catheter hub (36% vs 14%; P<.05). Through logistic regression, factors associated with exit-site colonization were identified as umbilical insertion (odds ratio [OR], 8.1; 95% confidence interval [CI95], 2.35-27.6; P<.001), subclavian insertion (OR, 54.6; CI95, 12.2-244; P<.001), and colonization of the catheter hub (OR, 8.9; CI95,3.5-22.8; P<.001). Catheter-hub colonization was associated with total parenteral nutrition ([TPN] OR for each day of TPN, 1.056; CI95,1.029-1.083; P<.001) and catheter exit-site colonization (OR, 6.11; CI95, 2.603-14.34; P<.001). No association was found between colonization at these sites and duration of catheterzation and venue of insertion, physician's experience, postnatal age and patient's weight, ventilation, steroids or antibiotics, and catheter repositioning.

These data support that colonization of the catheter exit-site is associated with the site of insertion and colonization of the catheter hub with the use of TPN. There is a very strong association between colonization at both catheter sites.

To determine adherence to Hazard Analysis and Critical Control Points (HACCP) methods and to evaluate knowledge, attitudes, and practices of food-services staff with regard to food hygiene in hospitals.

A survey.

Hospital medical directors and food-services staff of 36 hospitals in Calabria, Italy.

A questionnaire about hospital characteristics, food-services organization, and measures and procedures for the control and prevention of foodborne diseases was sent to medical directors; a questionnaire about demographic and practice characteristics, knowledge, attitudes, and behaviors about control and prevention of foodborne diseases was sent to food-services staff. Multiple logistic regression analysis was performed.

Only 54% of the 27 responding hospitals were using the HACCP system and, of those using HACCP, 79% adopted a food-hygiene–practice manual; more than one half already had developed written procedures for food storage, personal hygiene, cleaning and disinfection; one half or less performed microbiological assessment of foods and surfaces. Of the 290 food-services staff who responded, 78.8% were aware of the five leading food-borne pathogens; this knowledge was significantly higher among those with a higher educational level and those who worked in hospitals that had implemented the HACCP system. Younger staff and those who had attended continuing educational courses about food hygiene and hospital foodborne diseases had a significantly higher knowledge of safe temperatures for food storage. A positive attitude toward foodborne-diseases prevention was reported by the great majority, and it was significantly higher in older respondents and in those working in hospitals with a lower number of beds. Only 54.9% of those involved in touching or serving unwrapped raw or cooked foods routinely used gloves during this activity; this practice was significantly greater among younger respondents and in those working in hospitals using HACCP.

Full implementation of the HACCP system and infection control policies in hospital food services is needed.

To characterize the epidemiology of invasive pulmonary aspergillosis (IPA).

A retrospective case series.

An 850-bed, academic, tertiary-care medical center.

Adult inpatients, between January 1, 1990, and December 31, 1998, with either a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis.

We reviewed medical records and categorized case-patients as definitive or probable and acquisition of IPA as nosocomial, indeterminate, or community using standard definitions. To determine the rate of aspergillus respiratory colonization, we identified all inpatients who had a respiratory culture positive for Aspergillus species without a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis. Three study intervals were defined: interval 1,1990 to 1992; interval 2,1993 to 1995; and interval 3,1996 to 1998. Carpeting in rooms for patients following heart-lung and liver transplant was removed and ceiling tiles were replaced during interval 1; a major earthquake occurred during interval 2.

72 case-patients and 433 patients with respiratory colonization were identified. Acquisition was nosocomial for 18 (25.0%), indeterminate for 9 (12.5%), and community-acquired for 45 (62.5%) case-patients. Seventeen (23.6%) of the 72 case-patients had prior transplants, including 15 solid organ and 2 bone marrow. The IPA rate per 100 solid organ transplants (SOTs) decreased from 2.45 during interval 1 to 0.93 during interval 2 and to 0.52 during interval 3 (chi-square for trend, 5.44; P<.05). The hospitalwide IPA rate remained stable at 0.03 per 1,000 patient days.

The SOT IPA rate decreased after intervals 1 and 2, although the hospitalwide IPA rate remained stable during the study period. Post-earthquake hospital demolition and construction occurring after interval 2 was not associated with an increase in the rate of IPA at our institution.