These surveys continue to serve as a glimpse of public health laboratory activities at a point just prior to a Consensus Conference. Generally, the surveys offer some benefit to Consensus Conference deliberations by providing data for emerging issues or identifying problems not previously thought to be an issue.

Response to the surveys continues to fall short of replies from all 54 states and territories. Each has its own reason for not responding, but it would be nice if someday the response was 100%. Figure 1 shows that responses were received from 42 states, one territory and one city. The fact that states with significant involvement in the human immunodeficiency virus (HIV) epidemic did not respond greatly reduces the overall value of this survey, but the limited data must suffice.

Clostridium difficile is a major cause of gastrointestinal infections. In 1978, Bartlett and colleagues identified C difficile and its toxin as the cause of the antibiotic-associated pseudomembranous colitis (PMC). Within a few years, there was the development of a diagnostic assay, a description of a clinical and pathological spectrum of the disease, a definition of risk factors and characterization of the two toxins that account for the pathological event. Additional information regarding the microbiology, pathogenesis, clinical manifestations, diagnosis and treatment has rapidly developed. These features are beyond the scope of this report, and the reader is referred to several recent reviews.

Glutaraldehyde was first synthesized by Harries and Tank in 1908, and first marketed as a chemosterilizer in 1963. Since that time, glutaraldehyde has been used extensively as a disinfectant and chemical sterilizing solution. Even though it is generally agreed that moist heat is the preferred method of sterilization for medical, dental and hospital instruments, glutaraldehyde is a relatively safe, simple-to-use and effective chemical solution that can sterilize heat-sensitive materials.

Glutaraldehyde (1,5-pentanedial) has two free aldehyde groups that combine irreversibly with bacterial cell membranes and enzyme systems. These properties give glutaraldehyde its biocidal effect. Contact time with glutaraldehyde is critical if sterilization, rather than disinfection, is to be achieved. Sterilization time ranges from minutes to ten hours, depending upon bacterial type and conditions of the test results. Sterilization with glutaraldehyde solutions usually requires prolonged contact times. Manufacturer instructions must be strictly followed.