Hepatitis risk in a small suburban hospital was evaluated by laboratory screening of all hospital employees for hepatitis immunologic markers. Excluding four U.S.-born subjects who had received hepatitis vaccination, the laboratory screening revealed 21% of those tested had some hepatitis B antigen or antibody. Positive markers were found in 46% of foreign-born compared to 10% of native-born (P<0.001). Foreign-born participants accounted for 68% of the employee population. The country of origin appeared to have a statistically significant greater importance as a determinant of hepatitis B status than occupational area in this particular hospital setting.

Reducing the concentration of filamentous fungal spores in the air inhaled by immunosuppressed patients is an important goal. Although it is not clear that air is the exclusive vector of nosocomial filamentous fungal disease, it is quite likely that it is the most important vector. Uncertainties about this assertion are compounded by the great variety of fungal species involved. Aspergillus fumigatus, A. flavus, A. terreus, A. niger, Petriellidium boydii, Fusarium sp., Mucoraceae, Phoma sp., Alternaria, Penicillium, and others have caused invasive disease in immunosuppressed patients. But detailed studies of environmental correlates of nosocomial disease are largely restricted to A. flavus and A. fumigatus. Spores of all of these species may be recovered from unfiltered air. It is probably reasonable to extrapolate from Aspergillus to all of the species involved.

It is thought that the first person to describe the organism subsequently known as Eikenella corrodens was Sverre Henriksen, who in 1948 reported the isolation of three gram-negative anaerobic rods with concentrically spreading colonies and a tendency to pit the agar. This corroding of the agar was seen most reliably with strain AJ, a nonmotile organism isolated from a perineal abscess. Two years later, Per Holm found that a gram-negative anaerobic organism resembling the influenza bacillus was often isolated from specimens of pus, examined for the presence of actinomycetes. Because of its appearance on blood agar, Holm proposed calling this organism the “corroding bacillus.” In 1958, Eiken studied 1,097 anaerobes isolated from 798 patients; of these, 61 corresponded in colony and microscopic morphology with the corroding bacillus.

The “plastics revolution” of the last quarter century disrupted a hospital tradition. Since the 1890s, hospitals processed, packaged, and sterilized most of the medical-surgical items they needed in their own sterile supply departments–a “cottage industry” developed specifically for recycling. Only those consumable items that were too difficult, expensive, or inconvenient to reprocess were purchased from outside manufacturers as presterilized, single-use “disposables.” Since the plastics revolution, however, the “disposables” started to displace the “reusables,” and while claiming to be an economical innovation, have become a significant item in the budget. Some hospitals feel that if disposables save money, reusing the disposable several times will save more. The practice is spreading. The manufacturers, in turn, claim that hospitals do not have adequate quality assurance programs or skills to reprocess their items properly. The debate is further complicated by legal and ethical ramifications, as well as commercial and economic arguments.

There has been a tremendous increase in the number of immunocompromised patients over the past few decades, which has resulted in an increased number of serious fungal infections. These infections frequently require an invasive procedure, such as bone, lung, or lymph node biopsy, in order to obtain tissue for diagnosis. Far too often the tissue obtained by such means is not optimally utilized. For example, the tissue may be placed in formalin without being appropriately cultured, or the incorrect choice of tissue stains may result in the pathogen either being missed or being incorrectly identified. Clearly, this problem should be addressed by both the pathologist and the clinician.

Medicine and infectious disease textbooks have traditionally advised physicians to obtain urine cultures routinely before the initiation of therapy for presumed urinary tract infection. In practice, however, many physicians treat patients empirically, without doing a culture, and a recent cost-effectiveness analysis has supported this approach, at least in selected patients. What, then, are trie pros and cons of diagnostic urine cultures, and in which situations does current evidence favor their use?