To investigate a cluster of seven pneumonia cases among persons exposed to a pet-shop worker hospitalized with psittacosis.

Epidemiological study of the outbreak, sero-diagnostic evaluation of exposed persons with pneumonia; and retrospective review of the pneumonia cases.

450-bed teaching community hospital.

Employees of the nursing unit where the patient with psittacosis was hospitalized.

The index case had laboratory and clinical evidence of psittacosis. Four of the seven exposed persons who developed pneumonia had serologic results that met criteria for a diagnosis of psittacosis, and three met criteria for Chlamydia pneumoniae infection, possibly reflecting cross-reactivity between the microimmunofluo-rescence assays for the two diseases. The epidemiological graph suggested a relationship between the index case and the cluster of pneumonias in exposed individuals.

Psittacosis may have been transmitted person to person in a hospital setting.

Recently, blunt 18-gauge (ga) metal cannulae have become nationally commercially available as safety products. The ability of these blunt cannulae to prevent needlestick injury and to enable direct access of all standard latex ports and vial membranes, thus eliminating hypodermic needles entirely from the intravenous (IV) drug administration process, is assessed.

In the laboratory setting, the needlestick injury potential of small-bore blunt cannulae versus hypodermic needles was studied using blinded and randomized methods. Insertion force requirements were studied for cannulae and needles. Metal 18-ga blunt cannulae were inserted into four brands of standard Y-ports and vial stoppers to assess postpuncture integrity and force requirements.

Needlestick injury did not occur using small-bore blunt cannulae (P<.001; n=51). Metal 18-ga cannulae passed into prepierced standard Y-ports as easily as hypodermic needles and without loss of Y-port integrity. Insertion of metal 18-ga cannulae without prior port puncture was possible, but was associated with substantial coring and loss of integrity of the port seal, except for IVAC brand ports (P<.03).

Metal 18-ga cannulae can be inserted through virtually all intact standard rubber vial membranes or standard Y-ports to allow safe IV access. A single prepuncture of any standard latex membrane allows economical blunt metal cannula access equally efficiently as with expensive pre-slit membranes and without loss of membrane integrity.

To assess the impact of a needleless intravenous (IV) connection system on the rate of reported intravenous-connection–related (IVCR) percutaneous injuries, and to assess user satisfaction, frequency of use, and barriers to use.

A pre-post inter vention design, with injury incidence rates being compared 3 years before and 1 year after hospitalwide device implementation; and a cross-sectional descriptive user satisfaction survey.

Two tertiar y-care teaching hospitals, one general and one pediatric, located in a large metropolitan medical center.

All IVCR percutaneous injuries reported to the employee health ser vices at both hospitals during the years from 1989 to 1991 and 1993.

Survey participants were selected randomly from licensed nursing employees at both hospitals.

IV connection system consisting of blunt plastic cannulas and compressed latex injection sites.

After device implementation, the IVCR injury rate was reduced 62.4% (rate ratio [RR], 0.38; 95% confidence inter val [CI95], 0.27-0.53) at the general hospital and 70.2% (RR, 0.30; CI95, 0.17-0.53) at the pediatric hospital. After adjusting for the reduction in injury rate due to factors other than device implementation, the IVCR injury rate was reduced 54.5% (adjusted RR, 0.46; CI95, 0.32-0.65) at the general hospital and 57.2% (adjusted RR, 0.43; CI95, 0.24-0.78) at the pediatric hospital. Approximately 94% of survey respondents (n=478, response rate=51%) were satisfied with the device and recommended continued use. However, needles still were being used for activities that could have been performed with the needleless system because of compatibility, accessibility, and other technical problems related to the device.

The device was effective in reducing the rate of reported IVCR percutaneous injuries and users were satisfied with the device, but barriers to universal use were identified.

To determine whether the greater daily expense of administering total parenteral nutrition (TPN) via plastic bags changed once daily, compared to glass bottles changed thrice daily, could be offset by savings from a reduction in nosocomial infections.

The costs and potential benefits of commercially available TPN bags and TPN in glass containers were compared. Costs were computed from the viewpoint of the hospital, first in a general model and then for two specific examples, Crohn's disease and intensive-care unit (ICU) patients. The extra cost of using bags was $20 per day. The total cost of nosocomial bacteremia was estimated at $6,000. The monetary benefits of using TPN bags were $6,000XT, where XT was the percentage of nosocomial infections averted. We also considered that reduction in intravenous (IV)-line manipulation could reduce bacteremia-related mortality and computed a cost-per-life-saved ratio.

Modeling showed that TPN in bags could yield a net benefit when the absolute reduction in the daily risk of nosocomial bacteremia reached the threshold value of 0.3%. Such a reduction could not be attained in patients with Crohn's disease, and corresponded to a 50% to 60% reduction of infection rates in ICU patients. Varying the risk of mortality attributable to IV-line-related infection from 1% to 13% resulted in a cost effectiveness of using TPN bags ranging from $90,000 to $7,000 per life saved in ICU, assuming a two-thirds reduction in IV-line infections, and from $180,000 to $14,000 if the infection rate was reduced by one third.

The baseline cost-minimization analysis concluded that the extra cost of TPN bags was not justified by the extra savings. The cost-effectiveness analysis, however, found that the cost per life saved fell within the accepted range of public health interventions, provided a large fraction of infections are averted using TPN bags.

To assess factors associated with influenza vaccination of healthcare workers.

Cross-sectional survey.

University-affiliated Veterans' Affairs medical center.

Staff physicians and nurses employed by the medical center.

A mailed, self-administered questionnaire.

The response rate was 38.0%. The mean age of the respondents was 43.6 years, 71.5% were females, and 26.2% were physicians. Nearly all of the practitioners had daily or weekly contact with elderly or high-risk patients. The influenza vaccination rate of the respondents was 61.2%. More than 50% of vaccine recipients indicated that avoiding illness, protecting patients, and being able to receive the vaccine conveniently and free of charge all were very important factors influencing their decisions to receive the vaccine. Avoiding illness was rated the most important factor by 58.8% of vaccine recipients. Among vaccine nonrecipients, concern about side effects was identified as a very important factor by 36.2% and as the most important factor by 30.9%.

Vaccine recipients were significantly more likely than were vaccine nonrecipients to indicate that influenza and its complications are very serious for high-risk patients. They also were more likely to report that the vaccine is very effective, that influenza vaccination is uncommonly associated with side effects, that healthcare workers' risk for contracting influenza is higher than the general public's risk, and that it is very important for healthcare workers to receive the vaccine to decrease risk for transmission to high-risk patients. After stepwise logistic regression, variables independently associated with receipt of vaccine were age, prior receipt of vaccine, being a physician, considering the vaccine to be very effective, believing that systemic side effects are uncommon, and indicating that it is very important for healthcare workers to receive vaccine for the protection of their patients.

Many healthcare workers fail to receive influenza vaccine each year. Strategies to improve immunization levels should address concerns about vaccine safety and efficacy, barriers to vaccination including inconvenience and cost, and the reasons for targeting healthcare workers.

To determine the susceptibilities of vancomycin-resistant and -sensitive enterococci (VRE and VSE) to various concentrations of commonly used, commercial, hospital-grade disinfectants.

A microbial suspension test using inocula of 108 cells per mL in a disinfectant test dilution was used to determine inactivation kinetics of the test strains. In each test, 1-mL aliquots were removed from the cell-disinfectant mixtures at 15 and 30 seconds and then at 1-minute intervals for 5 minutes and neutralized. Appropriate serial dilutions were plated on agar medium for enumeration of survivors.

VRE and VSE challenge inocula (in the absence of any additional protein or serum challenge) were below the limit of detection (5 colony-forming units/mL) after 15 seconds' exposure to the manufacturers' suggested use-dilutions of quaternary ammonium, phenolic, or iodophor germicidal detergents. In subsequent tests, when the disinfectants were diluted far beyond the recommended use-dilutions (extended dilution), no differences were demonstrated between the susceptibilities of VRE and VSE.

VRE and VSE are sensitive to a spectrum of commonly used environmental disinfectants and have parallel inactivation rates when challenged with extended dilutions of these products. Our findings did not demonstrate a relationship between antibiotic and germicide resistance. Routine disinfection and housekeeping protocols presently used in hospitals need not be altered due to concerns about the potential for environmentally mediated transmission of antibiotic-resistant microorganisms.