Two questions confront data analysts: What's going on in the data? And how certain are the conclusions? One must deal with both questions to make rational decisions. John Tukey has called the two aspects of analysis exploratory and confirmatory. Consider, for example, a study in which patient data are analyzed for patterns that might identify causative agents for a particular disease. First, one should explore the data to reveal meaningful regularity (or perhaps irregularity might be a better way of saying it). For example, is there clustering in the geographic distribution of the patients that might indicate an environmental agent? After tentative pattern identification, confirmation is required to determine whether the patterns could simply be due to chance variation. That is, is the clustering strong enough to merit further detailed investigation or will the pattern disappear when further data are analyzed?

Classical statistical methods approach these questions through the foundation of probabilistic inference. I believe that it is no exaggeration to say that development of such methods during the 20th century are among the most important achievements in the history of science. They have contributed to the scientific method a systematic way of discerning what A.S.C. Ehrenberg calls “lawlike relationships” in empirical data. Their application has been decisive to progress in fields as diverse as nuclear physics, engineering design, genetics, agriculture, and paleontology, as well as medical science.

Five of 18 samples of working dilutions of disinfectants used in the University of Ilorin Teaching Hospital, the University Clinic, and three other urban medical centers were found to be contaminated with bacteria. The results confirmed that disinfectants in storage support the growth of infectious agents, underlining the need to use fresh preparations of disinfectants.

This issue of the journal marks the introduction of a new column “Emporiatrics”: the study of diseases in travelers. The editorial board considers this an important aspect of the expanding role of the physician epidemiologist and the infection control practitioner. We plan to put the common issues into a perspective that will be useful for those who are frequently asked questions about the prevention and control of illness in travelers. We hope this will fill the current void and we invite your response in letters to the editor.

How do you envision your ideal vacation? Relaxing on a sunny beach to watch the sun sparkle on the water? Treading ancient streets of living history? Hiking peacefully over hill and dale? Or are you more adventurous; the kind of person who would consider Indiana Jones an ideal traveling companion? The siren call of travel draws us and our patients to exotic places filled with excitement-and disease. Indeed, many of the epidemics that first gave birth to epidemiology are still in full swing in developing countries. To protect the traveler from illness and to minimize the importation of serious diseases, emporiatrics (from the Greek: emporos [one who goes on shipboard as a passenger] and iatrke [medicine]) has been developed.

Our earliest memories include the games played with friends and parents, sometimes for fun, sometimes for education. Similarly, the roots of decision analysis can be traced to game theory. Game theory is the study of probabilities and outcomes that occur when two or more players interact in a fixed setting. Although not widely applied to health care, an understanding of game theory is fundamental to decision analysis.

We have all attempted game theory at an informal level. In a game of chess, players try not only to see which move is best, but also to predict how an opponent will react to the move. In Monopoly, a player might have to decide if it is profitable to buy Boardwalk if he or she does not own Park Place. In the latter situation, the player must estimate the probability that the random role of the dice will enable him or her to land on Park Place before his or her opponents or that an opponent would not elect to buy the property if given the opportunity.

I have two major concerns about the immunocompromised host field in 1989. The first relates to the tremendous impact that acquired immunodeficiency syndrome (AIDS) has had on nosocomial infections and the management of hospitalized patients. It is a major consideration in screening patients for organ transplants. Concern about AIDS influences all aspects of blood transfusion therapy.

The second concern relates to the increasing demand for expensive technologically-oriented procedures involved in the management of immunocompromised hosts. I believe the demand for these approaches is irresistible and adds to the mounting problems that hospitals face in containing basic costs. Since there is a finite dollar available for medical expenses, 1 see these demands exacerbating the rationing of medical resources.

We investigated whether the presence of hepatitis C virus (HCV) infection can be detected in hemostatic gauze used during oral treatments. We were able to detect both antibody to HCV and HCV RNA in samples from patients serologically proven to have HCV and also in gauze used for these patients that was left at room temperature even for as long as 24 hours. Thus, this method is useful for the screening of HCV infection in situations in which blood sampling is not feasible.

The availability of both plasma-derived and recombinant hepatitis B vaccines has given hospitals and other health care institutions the possibility of significantly reducing a major infectious hazard in the workplace. With the increasing use and acceptance of these vaccines, many employees who have a significant blood or body fluid exposure (percutaneous or mucous membrane) have already completed hepatitis B vaccination. Concerns have arisen over the duration of protection of vaccination, as it has been over five years since the introduction of the plasma-derived vaccine.

Perianal screening can be intrusive. The sensitivities of multianatomical, nonperianal surveillance were 92.3% for methicillin-resistant Staphylococcus aureus (MRSA), 58.7% for vancomycin-resistant enterococci (VRE), and 54.9% for resistant Gram-negative bacilli (R-GNB). Sensitivities improved upon adding environmental surveillance (95.5%, 82.9%, and 67.9%, respectively). Multianatomical, nonperianal screening and room environment surveillance may replace perianal screening and reduce healthy participant bias in nursing homes.

Background:Clostridioides difficile is a major cause of antibiotic-associated colitis and the most common healthcare-associated pathogen in the United States. Interrupting the known transmission mechanisms of C. difficile in hospitals requires appropriate hand hygiene, disinfection of potentially contaminated surfaces, and patient equipment. However, only limited data are available on the effectiveness of germicides against various strains of C. difficile, with and without fetal calf serum, and at multiple exposure times. For this reason, we undertook the following evaluation to determine the effectiveness of germicides. Methods: The effectiveness of the sporicidal activity of the germicides against 5 strains of C. difficile was evaluated using a quantitative carrier test, a standard of ASTM International developed by Sattar et al. In this protocol, metal carriers (1 cm diameter 0.7 mm thick) were inoculated with 10 L spore suspension, containing ~103 or 106 C. difficile spores, and we then exposed them to 50 L germicide for 1, 5, 10, or 20 minutes. The following C. difficile strains were used in these studies: ATCC strains 9689; J9; BI-9; 630; and CF-4. To determine whether C. difficile spore susceptibility was similar to other spores, we also tested Bacillus atrophaeus spores, ATCC strain 19659. Fetal calf serum (FCS) was used to simulate organic matter. Results: In general, high-level disinfectants (eg, OPA, glutaraldehyde), chemical sterilants (eg, peracetic acid), and high concentrations of chlorine (>5,000 ppm) were generally sporicidal (>3 log10 reduction) in 5–10 minutes (and sometimes 1 minute). This level of sporicidal activity was demonstrated for the various strains of C. difficile spores and B. atrophaeus spores (Table 1). There did not appear to be any significant differences in inactivation of C. difficile spores (BI-9 strain) in the presence or absence of FCS (Table 2). Discussion: The sporicidal activity of disinfectants is critical because such formulations are routinely used to eliminate the risk associated with noncritical and semicritical instruments and environmental surfaces. Our data suggest that immersion in most (but not all) high-level disinfectants for 10 minutes is likely to be successful in eradicating C. difficile spores (>4 log10 reduction) from semicritical equipment (eg, endoscopes). Additionally, high concentrations of chlorine and some high-level disinfectants will kill C. difficile spores in 1 or 2 minutes.

Funding: None

Disclosures: Drs. Rutala and Weber are consultants to PDI (Professional Disposable International)