Ophthalmology operating room standards and infection control concerns.

Postoperative infection is a rare complication of intraocular surgery. Although the incidence is low, the morbidity is high in terms of long-term sequelae. Because some ophthalmologists have requested separate operating rooms to reduce the risk of exogenous sources of infection, ophthalmology training program directors were surveyed to determine national standards of practice. Among the 100 centers responding, most were university affiliated (73%), had more than 500-bed hospitals (67%), and had fewer than 50 practicing ophthalmologists (92%). A single operating room was used in 50 centers and only 33 did not permit nonophthalmology cases in the ophthalmology operating rooms. Centers with a greater ophthalmology volume did not differ from low-volume centers in the scheduling of ophthalmology and nonopthalmology clean or infected cases. Program directors from larger centers, however, were more frequently of the opinion that a separate ophthalmology operating room was needed: 86.2% vs. 63.5% (p = 0.04).

An outbreak of gentamicin-resistant Klebsiella pneumoniae: analysis of control measures.

In April 1978, a strain of gentamicin-resistant Klebsiella pneumoniae (GRK) was introduced into the neonatal intensive care unit of Henry Ford Hospital. An additional ten cases of GRK occurred over the subsequent 16 months and intestinal colonization occurred in up to 91% of admissions per month. All GRK were susceptible to amikacin and were capsular serotype 19. Though hand contamination of hospital personnel with GRK was documented, increased handwashing practices did not reduce colonization rates of neonates with the epidemic strain. Intestinal carriage persisted for up to ten months and could not be eradicated by administering oral colistin sulfate. Discontinuation of gentamicin and utilization of amikacin were associated with a significant reduction in colonization with GRK (p less than 0.05). However, the only control measure that prevented both new cases and colonization with the epidemic strain was the utilization of a strict cohort system.

The risk of hepatitis B among select employee groups in an urban hospital.

Hospital employees are at various degrees of risk for development of hepatitis B infections. A retrospective review of surveillance records in five clinical areas at high risk for hepatitis B exposure was carried out to determine its prevalence and incidence in each area. The area surveyed with the highest risk was the emergency department. It was followed, in descending order, by the operating room, the medical and surgical intensive care units, and the dentistry-oral surgery clinic. The surveyed area at the lowest risk was the hemodialysis unit. Strict infection-control guidelines probably minimize the employees' risk to hepatitis in the hemodialysis unit. In the emergency department, however, employees may be increasingly exposed to hepatitis B by dealing with life-threatening problems in an uncontrolled setting.

Community-acquired methicillin-resistant Staphylococcus aureus infections: a new source for nosocomial outbreaks.

Over a 19-month period, 165 patients with 183 infections caused by community-acquired, methicillin-resistant Staphylococcus aureus were seen at Henry Ford Hospital in Detroit, Michigan. The proportion of community-acquired staphylococcal infections resistant to methicillin rose from 3 % in March 1980 to 38% in September 1981. Drug abuse, serious underlying illness, previous antimicrobial therapy, and previous hospitalization were all associated with the development of this infection. Concurrent with the community epidemic was a nosocomial epidemic of methicillin-resistant S. aureus infection, which accounted for 30.6% of all nosocomial staphylococcal infections in January 1981. Control measures that included isolation, discharge precautions for carriers, and eradication of employee carriage were effective in preventing nosocomial transmission. The prevalence of methicillin-resistant S. aureus carriage among employees was 0.7%. Methicillin-resistant S. aureus may originate in the community as well as in the hospital, and presents a threat to patients in both settings.

Methicillin-resistant Staphylococcus aureus. Epidemiologic observations during a community-acquired outbreak.

Infection with strains of methicillin-resistant Staphylococcus aureus occurred in 40 patients at time of admission to a large urban hospital from March to December 1980. Community-acquired methicillin-resistant S. aureus infections occurred in 24 drug abusers and 16 nonabusers. Patients with infections had a longer mean hospitalization and previously had received antimicrobial therapy more frequently than control subjects. Drug abusers with infections had been treated with cephalosporins more often than control subjects (P less than 0.05). Phage typing of 32 isolates showed that 21 were linked by a common phage type (29/52/80/95). Transmission of methicillin-resistant S. aureus from community-acquired cases occurred in the hospital. By January 1981, methicillin-resistant S. aureus accounted for 30.6% of nosocomial S. aureus infections at Henry Ford Hospital. Methicillin-resistant S. aureus infection may arise in the community as well as in the hospital and has the potential to disseminate in both settings.

Prevalence of antibody to the Legionnaires' disease bacterium in hospital employees.

A sereopidemiologic survey was done to ascertain the level of immunity in a population of hospital employees after contact with patients with Legionnaires' disease. Two matched groups were compared: hospital staff in positions of contact with patients diagnosed with the disease (N1 = 215), and hospital staff not in a position of contact with patients diagnosed with Legionnaires' disease (N2 = 269). Antibody titer was measured by the hemagglutination technique. Subjects from N1 and N2 were surveyed for age, sex, race, smoking, patient care unit, air conditioning unit, occupation, symptoms, and patient contact. No significant correlation was found between titer distribution and any one of the first seven factors. The prevalence of antibody (greater than or equal to 128) was 9.3% and 3.7% (P less than 0.02) for the N1 and N2 groups. Also, 40% of employees with titers of 128 or above had had an unexplained febrile respiratory illness in the preceding year. This study suggests the possibility of person-to-person transmission in Legionnaires' disease.