Clinical, bacteriologie, epidemiologic and hospital infection-control observations related to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus are described. The outbreak involved 66 patients at the University of Oregon Health Sciences Center (UOHSC) and its closely affiliated VA hospital, the Portland VA Medical Center (PVAMC). No environmental source of infection was identified; person-to-person transmission was most likely responsible for its spread. Surveillance cultures demonstrated nasal colonization in house staff and nursing personnel at both hospitals. Inter-hospital transfer of infection was, in all likelihood, achieved via nasal carriage by a single physician. Case-control analysis indicated a significantly increased risk (p < 0.05) of acquisition of infection related to age, number of days hospitalized, severity of underlying disease and number of invasive procedures. Prior antibiotic receipt was a significant risk factor when analyzed by univariate analysis (p < 0.01), but, in contrast to previous studies, this was not a significant risk factor (p > 0.05) when related variables were controlled by multivariate analysis. Prevention of spread of infection by routine infection control measures was less effective at PVAMC than at UOHSC. Patients at PVAMC were significantly older and had longer durations of hospitalization (p < 0.05). Antimicrobial therapy of colonized patients and personnel appeared to assist in the control of the outbreak at PVAMC. Antimicrobial therapy with topical bacitracin and oral rifampin, alone or in combination with oral trimethoprim-sulfamethoxazole, was effective in eliminating colonization with methicillin-resistant S. aureus. [Infect Control 1981; 2(6):453-459.]

Blood isolates from 13 patients in one hospital were positive for Klebsiella pneumoniae over a two-week period. Vials of potassium chloride used in intravenous fluid admixture initially were suspected of being contaminated and thus causing the problem. However, a comparison of patients who had blood cultures positive for K. pneumoniae with control patients who had blood cultures negative for this organism during the same period identified no common features that would explain the increase in K. pneumoniae blood isolates. Careful evaluation of laboratory data suggested that six of the 13 culture-positive patients had probable pseudobacteremia, an explanation that would account for the increase in isolates above the endemic level of true K. pneumoniae bacteremia in the hospital. Epidemiologic data suggested that cross-contamination of adjacent and non-adjacent blood culture vials on the radiometric blood culture analyzer was the cause of pseudobacteremia; K. pneumoniae serotyping data supported this hypothesis. A mocktrial using the analyzer demonstrated that cross-contamination of non-adjacent vials by the sampling needles could occur. Changing the sampling needles of the analyzer daily, in accordance with the manufacturer's recommendations, prevented further episodes of pseudobacteremia from the analyzer. [Infect Control 1981; 2(6):460-465.]

The control of Chagas' disease depends on breaking contact between Man and vector organisms living in the house fabric; the primary method utilized is residual insecticide spraying of houses. Ministries of health in afflicted countries have elaborated standard procedures for such combat programs. The first two phases of such a program in Mambai', Goias', Brazil are described. In the third phase of vigilance, community participation is necessary to detect residual organism populations in houses. A house improvement scheme applied to houses with persistent infection, is recommended as being most practical at this time. [Infect Control 2(6):466-470, 1981.]