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.

Surveillance methods vary in different hospitals, but are mainly based on laboratory reports, as in Sweden. These reports are supplemented by ward visits by the infection control nurse and by the usual epidemiologic methods in the investigation of outbreaks.

An increasing interest in surveillance of hospital infection occurred in the 1950s when outbreaks of staphylococcal infection were causing problems throughout the world. The appointment of an MD as infection control officer in every hospital was suggested in 1955 by Colebrook in the Birmingham Accident Hospital, but no full-time officer has so far been appointed in the United Kingdom (UK). The task was taken on by medical microbiologists, who are usually physicians and, currently in England and Wales, make up 82% of infection control officers.”

In the early days, the recording of the incidence of infection was usually confined to surgical wounds, as in the US. The problem of collecting a large amount of data by the microbiologist was recognized by Moore who appointed the first infection control nurse.” He also described the importance of laboratory reports in the early detection of outbreaks.

Surveillance was a major topic for discussion at the international Conference on Nosocomial Infections in 1970, and Moore suggested that incidence rates were of little value for determining changes in a hospital or for comparisons between hospitals. The number of infections in individual hospitals was too small for statistical comparison, particularly if rates were low and infections influenced bv many factors were not corrected for in the overall rates.

The Centers for Disease Control (CDC) have recommended that health care workers use appropriate barriers, referred to as universal precautions, to protect themselves against exposure to the blood and body fluids of all patients. The CDC has suggested that the use of universal precautions eliminates the need for the isolation category blood and body fluid precautions (BBFP). There has been discussion concerning the feasibility of applying these precautions to all patients. Tangential issues involving screening of all hospitalized patients and whether or not informed consent should be required before such testing occurs are also being debated.

The purpose of the current study was to survey those attending a meeting of The Society of Hospital Epidemiologists of America (SHEA) in October 1987 to determine their opinions on these issues and their hospitals' actual practices with regard to universal precautions, human immunodeficiency virus (HIV) screening, and informed consent.

Needle recapping has been shown to be one of the leading causes of needlestick injuries. Frequency of recapping has not been reported. This study was designed to determine the frequency of needle recapping by nursing personnel and the effect of bedside needle disposal units on the frequency of recapping and needlesticks. Seventy-four nurses carrying out 312 activities involving use of needles were observed. The subjects were not aware of the nature of the study. The recapping frequency was 93.9%. The study was repeated after educational programs and following installation of a hospital-wide bedside needle disposal system. Fifty-three nurses performing 151 activities with needles were observed. Frequency of recapping was 94%. There was no significant difference in the rate of recapping or needlestick injuries after installation of the new needle disposal system. Educational programs regarding recapping, a very common practice, may be ineffective. Alternate methods for preventing nee-dlesticks may be necessary.

The need for accurate data concerning nosocomial infections has long been appreciated by infection control practitioners. Several major changes in the health delivery environment have highlighted for other care givers and managers the importance of, and indeed necessity of high-quality clinical and financial hospital information. Since 1983, the Medicare prospective payment system (PPS) has used the medical record discharge abstract as the hospital bill. This has created a need for more detailed clinical information in hospital information systems. In several states, all third-party reimbursers are using PPS variants, further strengthening this incentive. The “Agenda for Change” of the Joint Commission on Accreditation of Healthcare Organizations has created further pressure on hospitals to acquire information concerning the quality of care at their own facility, as well as comparative statistics from other facilities. Although trade journals extol the virtues of “good data sets,” and much academic study has been given to individual facets of data processing and handling, the practical aspects of hospital information opportunities and problems have been largely ignored. The purpose of this article is to discuss the nature of hospital data; to detail available sources of national, regional, and local hospital statistics; to delineate potential quality problems common to many types of hospital information; and to discuss difficulties with and solutions to some hospital data application problems.

Surveillance methods vary in different hospitals, but are mainly based on laboratory reports, as in Sweden. These reports are supplemented by ward visits by the infection control nurse and by the usual epidemiologic methods in the investigation of outbreaks.

An increasing interest in surveillance of hospital infection occurred in the 1950s when outbreaks of staphylococcal infection were causing problems throughout the world. The appointment of an MD as infection control officer in every hospital was suggested in 1955 by Colebrook in the Birmingham Accident Hospital, but no full-time officer has so far been appointed in the United Kingdom (UK). The task was taken on by medical microbiologists, who are usually physicians and, currently in England and Wales, make up 82% of infection control officers.”

In the early days, the recording of the incidence of infection was usually confined to surgical wounds, as in the US. The problem of collecting a large amount of data by the microbiologist was recognized by Moore who appointed the first infection control nurse.” He also described the importance of laboratory reports in the early detection of outbreaks.

Surveillance was a major topic for discussion at the international Conference on Nosocomial Infections in 1970, and Moore suggested that incidence rates were of little value for determining changes in a hospital or for comparisons between hospitals. The number of infections in individual hospitals was too small for statistical comparison, particularly if rates were low and infections influenced bv many factors were not corrected for in the overall rates.