Healthcare reform is a topic consuming the time and energy of many healthcare professionals, administrators, and politicians. One goal of reform is to improve value—better quality health care for less cost. Unfortunately, much of the current debate proceeds without clear definitions of quality or cost. To have profitable discussion, we must have precise definitions. With these definitions in hand, the technique of decision analysis provides a unique opportunity to evaluate quality and costs of healthcare decisions simultaneously. We believe it is imperative for physicians to become familiar with this important and powerful tool.

We describe variations in healthcare workers' attitudes toward double gloving and reporting needlesticks, and in their readiness to comply with double gloving and hepatitis B vaccine. Differences related to occupation, specialty, and gender have implications for the need to tailor interventions for specific groups of healthcare workers to improve compliance with Universal Precautions.

A series of positive biological indicators in steam autoclaves from different hospital departments within the same building were traced to blocked steam traps on building condensate lines. The steps taken during the investigation and a protocol for management of positive biological indicators are described.

A small group of editors of general medical journals met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the National Library of Medicine, were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually; gradually it has broadened its concerns.

The committee has produced five editions of the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals.” Over the years, issues have arisen that go beyond manuscript preparation. Some of these issues now are covered in the Uniform Requirements; others are addressed in separate statements. Each statement has been published in a scientific journal.

Sera of 500 residents were screened for parvovirus B19 immunoglobulin M (IgM) and immunoglobulin G (IgG) by enzyme-linked immunosorbent assay. Positive IgM and equivocal IgG or IgM results were confirmed by immunofluorescent antibody and Western blot. IgM was detected in 13 sera (2.6%), and IgG was detected in 285 (57%). Records of IgM-positive residents contained no evidence of erythema infectiosum or polyarthropathy.

A prospective survey of all positive blood cultures was performed during a 6-month period at a 390-bed, tertiary-care teaching hospital in St Louis, Missouri. Data were collected from the clinical microbiology laboratory, medical records, and physicians caring for patients with positive blood cultures. Of 5,732 blood cultures, 261 (4.6%) were positive, and approximately half of these (51.3%) were categorized as false positive. Positive cultures were significantly more likely to be true positives if obtained from patients with malignancies or if they became positive within the first 48 hours of incubation.

The purpose of this study was to determine whether any waste was labeled incorrectly as infectious or contained material that could be recycled. Waste generated in preparation for surgery was separated and weighed. Of 530 lbs of operating room waste, 40 lbs were noninfectious, largely plastic and paper. The results of the present study suggest a segment of waste can be removed from the contaminated stream, potentially reducing hospital costs and improving our environment.

The Arlington Hospital Needlestick Injury (NSI) Prevention Program was created to protect healthcare workers from NSI and to assess the effectiveness of our interventions. Interventions included revising NSI policy and procedures. The average NSI rate dropped from 109 to 43 per year after the interventions, over a period of 4 years.

Patients infected or colonized with certain microorganisms must be placed in isolation while hospitalized to prevent nosocomial transmission of these pathogens. Isolation systems enable healthcare workers to identify patients who need to be isolated and to institute the appropriate precautions. This article presents an overview of isolation precautions, emphasizing the latest guidelines from the Centers for Disease Control and Prevention.

The prevalence of, and clinical risk factors associated with, vancomycin-resistant enterococcal colonization were investigated in patients suspected of having Clostridium difficile infection. Stools submitted for C difficile cytotoxin testing were screened for vancomycin-resistant enterococci (VRE). Isolates were speciated and characterized further by antibiotic susceptibility testing, DNA fingerprinting, and DNA:DNA hybridization for detection of specific vancomycin resistance genes. Of the 79 evaluable patients identified during a 3-month period, 16.5% were VRE-positive. The VRE isolates were genetically heterogeneous, although all carried the vanA gene. DNA fingerprinting data suggest that patient-to-patient transmission occurred, implicating colonized patients as potential reser voirs for VRE transmission. A positive C difficile cytotoxin assay and diabetes mellitus were the only identifiable risk factors associated with VRE colonization. Patients at risk for C difficile infection therefore may serve as reser voirs for VRE.

Physicians and hospitals must curtail the excessive use of antimicrobial agents to limit the emergence and spread of multiply resistant organisms. This article describes how to organize an antimicrobial control program and provides options for hospitals working with a range of resources.