To define the extent of shedding of respiratory viruses and Mycoplasma pneumoniae among a population of pediatric patients admitted to the hospital during a winter epidemic period and to identify nosocomial infections within this population.

An open, prospective survey of patients admitted to three wards (General Medical, Respiratory Infectious, and Infectious Diseases) of a pediatric hospital during a defined three-month period.

All patients with medical, respiratory, and infectious conditions admitted to three wards of the Adelaide Children's Hospital had nasopharyngeal aspirations performed at the time of admission with the purpose of documenting viral and M pneumoniae shedding. Patients were monitored daily for the development of symptoms of respiratory infection or new symptoms of respiratory disease. Such patients underwent a further nasopharyngeal aspiration for the purpose of diagnosing hospital-acquired infection.

Nasopharyngeal aspirations were obtained from 601 patients. Forty-seven percent of asymptomatic patients were positive for a respiratory virus or M pneumoniae, and 61% of patients with respiratory symptoms were also positive. Gastroenteritis patients shed viruses in 66% of cases. Respiratory symptoms were initially overlooked by admitting physicians but subsequently identified in 110 cases, and 46% of these were found to be positive for a respiratory virus or M pneumoniae. There were 18 possible hospital acquired infections among the 293 initially virus-negative patients. Multiple isolates were obtained from a substantial number of patients, especially those with respiratory symptoms.

A substantial proportion of all patients admitted to a pediatric hospital during winter represent a potential source of infection, and strict infection control measures should be enacted to limit the spread of these infections.

To test the utility of a newly developed multilocus enzyme electrophoresis typing method for Xanthomonas maltophilia.

Isolates were first screened by slide agglutination, which served as the standard to characterize the outbreak strains. All isolates were then subjected to multilocus enzyme elec-trophoresis and the results analyzed based on epidemiological data.

This outbreak occurred in a shock-trauma intensive care unit of a large general community hospital.

Patients admitted to the shock-trauma intensive care unit who had X maltophilia isolated from any site > 24 hours after admission met the case definition. Specimens from patients who fit the case definition were characterized, as were specimens from other patients that were used as controls for nonoutbreak isolates. Environmental samples were also evaluated for X maltophilia.

Most of the 64 isolates received during this outbreak were serotype 10, and when they were subjected to multilocus enzyme electro-phoresis, one electrophoretic type predominated and correlated to most outbreak isolates. Unrelated isolates of serotype 10 from other institutions all exhibited unique electrophoretic types.

Application of multilocus enzyme electrophoresis to X maltophilia outbreaks is a valuable addition to the characterization of suspected outbreak strains.

To determine the incidence of infection in human immunodeficiency virus (HIV)-infected patients during periods of neutropenia and non-neutropenia. To compare the infection rates in patients with HIV disease to those in a group hospitalized with neutropenia and hematologic malignancy.

Prospective observational study conducted between December 1985 and December 1987 at a university teaching hospital. Thirty patients with documented acquired immunodeficiency syndrome (AIDS) and absolute T-helper cells <200 mm/mm3. All patients had a period of non-neutropenia following a neutropenic period (neutrophils <1000 cells/mm3).

The rate of first infection during neutropenic and non-neutropenic periods for opportunistic infection and nonopportunistic infections were compared. There were no differences between infection rates for the two time periods for both types of infections. A subgroup of patient care days in which non-neutropenic days followed neutropenic days also was studied to eliminate selection bias. In this group, a comparison of infection rates also revealed no difference between neutropenic and non-neutropenic periods. An alternate analysis of the time until first infection during periods of neutropenia or non- neutropenia was done using the Kaplan-Meier product limit method. There was a longer infection-free period for the neutropenic group for opportunistic infections, but it was not statistically significant (p<.1). In addition, we compared HIV-infected patients with a group of 37 patients with neutropenia from hematologic malignancy. There was a significantly higher rate of all infections, particularly bacteremias (p<.001), in the group of patients with hematologic malignancies when compared with all subsets of patients with HIV disease.

We conclude that patientswith HIV disease and modest neutropenia do not have an increased risk of bacterial infection. The incidence of all infections is significantly greater in patients with neutropenia secondary to hematologic malignancy, (Infect Control Hosp Epidemiol. 1991;12:429-434.)

To review practices currently used to control transmission of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals, determine the frequency of their use, and discuss the indications for implementing such measures.

A questionnaire survey to determine how commonly selected control practices are used, and a literature review of the efficacy of control practices.

Two hundred fifty-six of 360 hospital-based members fo the Society for Hospital Epidemiology of America, Inc. (SHEA) completed the survey questionnaire.

Many different combinations of surveillance and control measures are used by hospitals with MRSA. Nine percent of hospitals stated that no special measures were used to control MRSA. The efficacy of commonly used control measures has not been established by controlled trials.

Implementing control measures is warranted when MRSA causes a high incidence of serious nosocomial infections, and is desirable when MRSA has been newly introduced into a hospital or into an intensive care unit, or when MRSA accounts for more than 10% of nosocomial staphylococcal isolates. While the value of some practices is well established, measures such as routinely attempting to eradicate carriage of MRSA by colonized patients and personnel require further evaluation.

To investigate the possibility that contaminated commercial activated charcoal may serve as a source for fungal colonization or infection of the lower respiratory tract.

The clinical course of a patient who aspirated commercial activated charcoal was reviewed. Fungal cultures were performed for 2 samples of an activated charcoal in sorbitol product from separate lots produced by a single manufacturer. Details of the manufacturing process were obtained from a representative of the manufacturer.

An intensive care unit in a large community teaching hospital.

A single patient with steroid-treated lung disease who developed a fatal pulmonary illness after aspirating a commercial activated charcoal product.

After aspirating the charcoal product, the patient developed respiratory tract colonization and possible infection with Aspergillus niger, Paecilomyces variotii, and Penicillium species. Similar fungal species were isolated from cultures of samples obtained from two separate lots of the same commercial activated charcoal product. Several opportunities for contamination during the manufacturing process were identified.

Physicians caring for immuno-compromised patients should be aware that commercial activated charcoal products can be a source of fungal respiratory tract colonization that may mimic or cause pneumonia.

To study the effect of various latex and treated glove combinations in reducing the frequency of human immunodeficiency virus (HIV) infection of tissue culture cells after puncture by surgical needles contaminated with infectious human immunodeficiency virus type 1 (HIV 1).

One, two, or three layers of sterile latex glove material, or two latex layers with intermediate cotton or Kevlar (with or without the virucidal compound nonoxynol-9) were used to cover 24-well cell culture dishes containing MT2 cells in cell culture medium. Surgical needles wet with cell culture medium containing HIV- 1 (HTLV IIIA strain) were passed through the glove materials into the culture medium in the wells of the culture dishes. The culture medium in each well was then assayed biweekly for HIV-1 p24 antigen as a test for infection of cells in the well.

The rate of HIV-1 infection of cell cultures after glove puncture was greater than 90% with a single latex surgical glove barrier, 23% to 60% with double or triple layers of latex gloves, less than 8% with an intermediate cotton glove impregnated with 4% nonoxynol-9, 6% with an intermediate Kevlar glove, and 0% with an intermediate Kevlar glove impregnated with non-oxynol-9.

An intermediate glove of Kevlar or of Kevlar or cotton impregnated with virucidal compound nonoxynol-9 between standard latex gloves may improve surgical glove safety, compared with latex gloves alone with respect to needlestick transmission of HIV 1. The experimental model used may permit rapid investigation of other glove systems as barriers to the transfer of infectious agents through gloves by needlestick. (Infect Control Hosp Epidemiol. 1991;12:435-438.)