The Occupational Safety and Health Act of 1970 requires that every worker be provided with a safe and healthful workplace and authorizes the Occupational Safety and Health Administration (OSHA) to conduct workplace inspections. OSHA conducts workplace inspections in hospitals and checks for compliance with the Bloodborne Pathogens Standard, the Enforcement Policy and Procedures for Occupational Exposure to Tuberculosis, and the Hazardous Chemicals Standards, among others. The hospital epidemiologist bears considerable responsibility for developing and implementing plans to protect employees from occupational exposures to infectious hazards such as bloodborne pathogens and tuberculosis. To prepare for an inspection, the hospital epidemiologist must understand the basis on which OSHA operates and must proceed in a thoughtful, coordinated manner.

A rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (WE) has been reported from U.S. hospitals in the last 5 years. This increase poses several problems, including: a) the lack of available antimicrobials for therapy of infections due to VRE, since most VRE are also resistant to multiple other drugs, e.g., aminoglycosides and ampicillin, previously used for the treatment of infections due to these organisms, and b) the possibility that the vancomycin resistance genes present in VRE may be transferred to other gram-positive microorganisms such as Staphylococcus aureus.

An increased risk of VRE infection and colonization has been associated with previous vancomycin and/or multi-antimicrobial therapy, severe underlying disease or immuno-suppression, and intra-abdominal surgery. Because enterococci can be found in the normal gastrointestinal or female genital tract, most enterococcal infections have been attributed to endogenous sources within the individual patient. However, recent reports of outbreaks and endemic infections due to enterococci, including VRE, have shown that patient-to-patient transmission of the microorganisms can occur either via direct contact or indirectly via hands of personnel or contaminated patientcare equipment or environmental surfaces.

Prevention and control of the spread of vancomycin resistance will require coordinated, concerted effort from various departments of the hospital, and can only be achieved if each of the following elements is addressed: 1) prudent vancomycin use by clinicians, 2) education of hospital staff regarding the problem of vancomycin resistance, 3) early detection and prompt reporting of van-comycin resistance in enterococci and other gram-positive microorganisms by the hospital microbiology laboratory, and 4) immediate implementation of appropriate infection-control measures to prevent person-to-person transmission of VRE.

We are pleased to bring to our readership the contents of a symposium on nosocomial colonization held on January 14-16, 1994, in Clearwater, Florida, under the aegis of the University of South Florida College of Medicine and the National Foundation for Infectious Diseases.

The symposium was developed with the following goals: (1) to provide an up-to-date over view of the factors important in microbial colonization of human nonsterile surfaces or tissues, especially skin, nose, oropharynx, and gastrointestinal tract; (2) to provide an understanding of the impact of colonization upon the development of nosocomial infections; and (3) to provide an appreciation of how to control or manage colonization to prevent nosocomial infections.

Despite advances in computers and software for data analysis, hospital epidemiologists still must use manual methods for data collection. To automate infection control surveillance fully, healthcare institutions need computerized medical records; however, very few institutions currently have such a system. Healthcare institutions appreciate the need for automation, but frequently do not see a clear path to the desired outcome. In this article, we outline the important issues that hospital epidemiologists must understand if they wish to help their institutions to computerize their medical records.

Antibiotic lock therapy, an alternative treatment for Hickman catheter sepsis, was evaluated in six recipients of prolonged outpatient intravenous therapy. Twenty-two episodes of catheter sepsis were identified, involving coagulase-negative staphylococci (11), gram-negative bacilli (3), gram-positive bacilli (1), yeast (4), and mixed bacteria or fungi (3). In a select group of patients, treatment was successful 92% of the time.

While the Democrats and the Republicans debate the Health Care Reform Bill and how we are going to pay for universal coverage, a revolution in healthcare delivery already is taking place right under our eyes. Even if the federal government doesn't pass legislation on healthcare this term, the healthcare delivery system will have been changed so dramatically that it will be unrecognizable from what we knew just a couple of years ago. Consolidation of hospitals, cost reduction, and the quality of care are themes that will be evident in medical delivery for the next few years. Among these three, cost reduction is and will be the engine of change.

Bacteria have developed a wide variety of molecular mechanisms that permit firm adherence to a biologic surface. This review summarizes basic principles involved in this process, as exemplified by adherence of the group A streptococcus to oral epithelium, staphylococci to indwelling prostheses, and Escherichia coli to uroepithelium and enterocytes.

The Joint Commission on Accreditation of Healthcare Organizations was founded in 1951 as a private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations. In 1987, the JCAHO launched its Agenda for Change to create a more modem and sophisticated accreditation process to place primary emphasis on actual performance. Coincident with this new emphasis, a number of task forces were established, including two for infection control standards.

Although patients in long-term-care facilities are at increased risk of infection, little is known about how to practice infection control in this setting. This article reviews risk factors for infection, the components of an infection control program, and particular infections that are important in long-term care facilities. In addition, special characteristics of long-term-care facilities that challenge the individuals charged with conducting effective infection control programs will be discussed.