The development of a new method for achieving respiratory isolation in hospitals, clinics, and residential facilities, in response to the increasing risk of transmission of tuberculosis and the limitations of the currently available isolation systems.

Ultraviolet (UV) light and ultra-low-penetration air filtration were combined with a ventilation unit and adapted for use in modular isolation rooms or for conversion of existing rooms.

The ventilation-filtration unit efficiently cleared bacterial aerosols and particles >0.2 μm from the air, maintained required negative pressures and airflows, and provided directional airflow within rooms.

From April 2-23, 1992, the housekeeping staff of the University of Granada Hospital was on strike. Measures were implemented to minimize the effects of the strike on patients' health and especially to diminish the risk of hospital infection.

To assess the risk of nosocomial infection during the housekeeping personnel strike.

An 800-bed, tertiary care hospital.

A case-cohort approach was used. One hundred forty-eight infected patients (with 184 hospital infections) were detected prospectively from March 1, 1992, to May 31, 1992. A sample of 459 of the base population (patients admitted during the same period) was selected. Information on relevant risk factors for hospital infection was abstracted from patients' clinical charts after hospital discharge. Crude odds ratios and adjusted (by proportional hazards model) relative risks (RRs) for the strike period were estimated.

Risk of nosocomial infection did not increase during the strike period (multiple-risk factor adjusted RR= 0.99, 0.96 to 1.01/day of strike). Similar results were observed for major sites of infection (especially surgical wound) and major areas of the hospital (including gynecology, surgery, and intensive care).

We concluded that there was no increase in the risk of nosocomial infection during the housekeeping strike.

The current study was designed to assess the sporicidal activity of chemical sterilants using the Association of Official Analytical Chemists (AOAC) sporicidal test. Chemical sterilants are used most commonly in the healthcare setting to disinfect medical instruments such as endoscopes. This study was undertaken to evaluate the efficacy of several newer formulations of glutaraldehydes and hydrogen peroxide as chemical sterilants.

Using the AOAC test the following agents were tested: two 2% alkaline glutaraldehydes (2% Alk-Glut), 2% acid glutaraldehyde (2% Acid Glut), 2% glutaraldehyde-7.05% phenol-1.20% sodium phenate, 10% glutaraldehyde-0.5% phenylphenol-0.1% tertiary amylphenol, and 6% hydrogen peroxide (H202). Growth in > 1 of 60 seeded penicylinders is considered by the AOAC to indicate failure of sporicidal activity,

Test results of the six disinfectants against Bacillus subtilis using the manufacturers' specified use-dilution and exposure time were: 0/60 with 2% Alk-Glut (product 1) at 10 hours, 0/60 with 2% Alk-Glut (product 2) at 8 hours, 0/60 with 2% Acid Glut at 10 hours, 2/60 with 2% glutaraldehyde-7.05% phenol-1 .20% sodium phenate at 6.75 hours, 0/60 with a 1:5 dilution (2.0% Glut) of 10% glutaraldehyde-0.5% phenylphenol-0. 1% amylphenol at 6 hours, 59/60 with a 1:20 dilution (0.5% Glut) of 10% glutaraldehyde-0.5% phenylphenol-0.1% tertiary amylphenol at 12 hours and 0/60 with 6% H202 at 6 hours. Test results against Clostridium sporogenes were: 2/60 with 2% Alk-Glut (product 1) at 10 hours, 1/60 with 2% Alk-Glut (product 2) at 8 hours, 1/60 with 2% Acid Glut at 10 hours, 2/60 with undiluted 2% glutaraldehyde-7.05% phenol-1.20% sodium phenate at 6.75 hours, 6/60 with a 1:5 dilution (2% Glut) of 10% glutaraldehyde-0.5% phenylphenol-0.1% amylpenol at 6 hours, 60/60 with a 1:20 dilution (0.5% Glut) of 10% glutaraldehyde-0.5% phenylphenol-0.1% amylpenol at 12 hours, and 0/60 with 6% H202 at 6 hours. Dilutions of 2% glutaraldehyde-7.05% phenol-1.20% sodium phenate yielded the following results against C sporogenes: 59/60 with a 1:8 dilution (0.25% Glut) at 6.75 hours, 60/60 with a 1:16 dilution (0.125% Glut) at 6.75 hours, 11/90 with a 1:8 (0.25% Glut) dilution at 12 hours, and 60/60 with a 1:16 dilution (0.125% Glut) at 12 hours.

Both 2% acid and alkaline glutaraldehydes are effective chemical sterilants. Diluting glutaraldehyde-based sterilants below 2% glutaraldehyde resulted in failure to kill spores of B subtilis and C sporogenes.

To determine the cause of meningitis associated with Cryptococcus neoformans in two patients with recent ventricular-peritoneal (VP) shunt placement.

A retrospective review of materials, records, and concurrent cases of VP shunt procedures. Isolates of C neoformans from each patient were submitted for analysis by colony morphology, biochemical testing, and karyotyping by pulsed-field electrophoresis.

Two 400-bed community hospitals.

Two immunocompetent patients presented with symptoms of progressive hydrocephalus in August 1991. Each received a VP shunt on the same day by the same surgeon using materials from a common vendor and hospital.

Both patients presented within six to eight weeks with symptoms of fever, headache, rash, and cultures of cerebrospinal fluid (CSF) that yielded C neoformans. Each patient recovered after therapy with amphotericin B and flucytosine followed by several months of fluconazole, although one required replacement of the VP shunt for cure. Review of each patient's history and CSF characteristics at the time of shunt placement suggested re-activation of a pre-existing infection. Isolates of C neoformans from each patient were submitted for analysis by colony morphology, biochemical testing, and karyotyping by pulsed-field electrophoresis. Each isolate was found to be unique by chromosomal karyotyping.

Our data and previous reports suggest that cryptococcal VP shunt infections appear to be a complication of shunts placed in previously infected persons rather than noso-transmission of cryptococcus during placement.