The gastric and tracheal flora of 142 consecutive patients receiving stress ulcer prophylaxis were investigated, identifying identical isolates by typing. Furthermore, the growth pattern of normal respiratory bacteria and organisms causing ventilation pneumonia at different pH values and the in vitro effect of sucralfate and bismuth subsalicylate on these bacteria in simulated gastric fluid were studied. The results obtained were as follows: (1) with rising gastric pH bacterial counts in gastric aspirates, especially gram-negatives, increased significantly; (2) in 45 (31.7%) of the patients identical organisms were first isolated in gastric samples and one to two days later in tracheal secretions; (3) ventilation pneumonia was significantly more frequent in patients with high gastric pH; (4) pathogens causing ventilation pneumonia grew well in simulated gastric fluid at higher pH values, unlike normal respiratory organisms; and (5) sucralfate and bismuth subsalicylate showed antibacterial activity against frequent causative organisms of ventilation pneumonia.

We compared the cost of antibody screening and the projected cost for hepatitis B vaccination of antibody-negative individuals at hospitals with “high prevalence” and “low prevalence” rates for hepatitis B virus antibodies among their employees. The use of hepatitis B core antibody for screening and subsequent hepatitis B vaccination of antibody-negative personnel was most cost-effective for hospitals considered to have high prevalence for hepatitis B virus antibodies among its staff, although use of hepatitis B surface antibody in this setting only increased costs by 1.4%. In a hospital with low prevalence for hepatitis B virus antibodies among its staff, use of hepatitis B surface antibody and subsequent vaccination of antibody-negative individuals was the most cost-effective approach, while use of hepatitis B core antibody for the above purposes would have increased costs by 3.4%. The use of both hepatitis B surface antibody and core antibody in either setting followed by immunization was least economical, as costs were increased by 13% and 13.5% respectively.

We concluded that hepatitis B core antibody should be used for screening in hospitals with high prevalence for hepatitis B virus antibodies among employees while hepatitis B surface antibody be used for screening in hospitals with low prevalence for hepatitis B virus antibodies among employees. A prediction of high and low prevalence for hepatitis B virus antibodies in hospital personnel may be made by knowledge of the distribution in ethnicity of staff.

The incidence of hacteriuria, significant urinary tract infection, and cost associated with the use of two urinary catheter drainage systems were evaluated in a population of hospitalized adult males. A commercially available device comprised of a Foley catheter attached with a heat-shrunk plastic seal to the tubing of a closed drainage hag (preconnected system) was compared with a standard system that had the Foley catheter attached to the closed drainage hag after it had been inserted. Using a randomized prospective design, the performance of the preconnected system in 97 patients was compared with that of the standard system in 105 patients. Catheters were left in place a mean of 6.4 and 7.6 days in the respective groups. Bacteriuria occurred after catheter insertion in 11.3% of patients receiving the preconnected system and 13.3% of patients receiving the standard system (not statistically significant). When bacteriuria developed, it occurred within seven days of catheter insertion in 50% of instances, irrespective of drainage system employed, suggesting that manipulations related to catheter insertion were important in initiating bacteriuria. Significant urinary tract infections occurred in only 2% of all patients studied. The higher cost for purchasing the preconnected system was not warranted for the population of patients studied.

Conjunctivitis accounted for 5% of nosocomial infections occurring in a university-affiliated pediatric hospital between January 1984 and April 1986. Pseudomonas aeruginosa was recovered from the conjunctiva of 30 patients. The primary diseases of these patients were chronic and debilitating. Eighty percent of patients were under 18 months of age although only 30% of admissions are represented in this age group. Seventy percent of cases occurred in pediatric intensive care unit/neonatal intensive care unit patients. Seventy percent of patients who had antecedent nasopharyngeal/ endotracheal cultures obtained were colonized with P aeruginosa. All patients except one had one or more of the following interventions prior to the onset of conjunctivitis: tracheostomy, endotracheal tube, oxygen by hood, or suctioning. Two children (7.4%) have residual corneal scars. Improvements in eye care including protection of the eye during suctioning, other respiratory care, and nasogastric tube procedures are warranted.

Beyond a potential role in infection surveillance, computers offer epidemiologists several important and unique potentials. Epidemiologists deal with complex interrelationships when interpreting or contributing information in the biomedical literature. Annals of Internal Medicine recently published a series dealing with the general problem of information management. The commentary that follows examines one area in which computers can be applied to our advantage-electronic exchange of information-and presents a practical example of using database searches.

In 1971, Yabuuchi and Ohyama named and described Achromobacter xylosoxidans as a distinctive gram-negative, nonfermentative bacillus. During the past 15 years, A xylosoxidans has been infrequently reported in the literature as a nosocomial pathogen. The organism has usually been associated with aquatic surroundings and frequently colonizes aqueous fluids in the hospital environment, awaiting the opportunity to infect compromised patients. Several outbreaks have been reported to be caused by Achromobacter, and all have contaminated fluids as the epidemiologic “common denominator.” Achromobacter is an emerging pathogen that has been recognized and appreciated with increasing frequency during the past few years. It is a microorganism ideally suited to the hospital environment in that it is resistant to many disinfectants and most antibiotics. Achromobacter mimics Pseudomonas aeruginosa microbiologically and clinically, but may be differentiated from the latter on the basis of flagella arrangement and antibiotic suscep-tibilities.

Financial resources for health care have been restricted. Constraints demand that physicians and administrators get the most for their money, yet the myriad of diagnostic tests and antibiotics available today can easily boggle the minds of those who must choose among them. This situation is particularly true of infection control where active research continually produces new products. Each hospital must choose among disinfectants, detergents, antibiotics, protective clothing, immunizations, dressing supplies, respiratory therapies, and many other products. At every point, questions arise. Is a new product worth the extra money? Alternatively, is a less expensive product really more cost-effective? How many additional infections must be prevented before a product “pays” for itself?