We describe an outbreak of Candida albicans systemic infection involving five premature infants in a neonatal intensive care unit. Molecular and epidemiologic characterization of all C. albicans isolates was performed by DNA fingerprinting with the 27A probe. This genotypic analysis demonstrated that the isolates were identical, providing evidence for the circulation of a unique C. albicans strain.

Nosocomially acquired completely resistant Acinetobacter baumannii strains are a major clinical concern. We identified completely resistant A. baumannii in 6 (4.9%) of 122 A. baumannii isolates in a retrospective chart review at two teaching hospitals. All of these patients had received broad-spectrum antibiotics and had severe underlying comorbid illnesses, long hospitalizations, or recent surgical procedures; 3 had been in the intensive care unit. Five (83%) of the 6 patients were older than 70 years. Only one death occurred. Strict infection control measures may limit further spread.

Vancomycin and rifampicin replaced cephazolin as antibiotic prophylaxis for coronary artery bypass surgery at our institution. Following this intervention, there was a significant decrease (P < .001) in the surgical-site infection rate from 10.5 (95% confidence interval, 8.2 to 13.3) to 4.9 (95% confidence interval, 3.2 to 7.1) infections per 100 procedures. An estimated $576,655 (Australian) was saved between two 12-month periods.

Bacteria-controlled nursing units (BCNUs) are laminar air-flow patient isolation units. The rate of cross-colonization with resistant organisms in 66 critically ill pediatric burn patients with massive open wounds and ventilators housed in BCNUs during 5 years was examined and found to be extremely low (3.2 cases per 1,000 patient-days)

Single-drug prophylaxis is recommended after tuberculin skin test conversion, but not when there is active disease on chest radiograph because resistance develops frequently. Isoniazid-resistant tuberculosis developed in a physician receiving prophylaxis despite “faint left upper lobe soft tissue density” on chest radiograph. Ignoring active disease on chest x-ray renders this strategy counterproductive and cost ineffective. '(Infect Control Hosp Epidemiol 2002;23:622-625).

We documented a case of occupational human immunodeficiency virus (HIV) despite postexposure prophylaxis (PEP) with a combination drug regimen after percutaneous injury with a needle from a sharps disposal container in the hospital room of an HIV-infected patient. This failure of PEP with a combination drug regimen may have been related to antiretroviral drug resistance, other factors, or both. This case highlights the importance of preventing injury to prevent occupational transmission of HIV.

The routine sampling of environmental surfaces within a healthcare facility is generally not recommended by the Centers for Disease Control and Prevention (CDC), the Association for the Advancement of Medical Instrumentation (AAMI), and several other healthcare organizations. There are a few circumstances, however, for which some organizations do recommend this practice. For instance, the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC) recommend environmental sampling as clinically required during an outbreak investigation. The CDC and AAMI also recommend routine sampling of the rinse water used during hemodialyzer (but not endoscope) reprocessing. The rationale for this recommendation is based in part on reports of pyrogenic responses, patient infections, and bacteremia due to waterborne, gram-negative bacteria during hemodialysis. To determine whether the basis for this rationale might similarly apply to the rinse water used during endoscope reprocessing, the Food and Drug Administration's medical device reporting database, the endoscope reprocessing literature, and other sources were reviewed. The results of this review indicate that nosocomial outbreaks linked to endoscopes contaminated with gram-negative bacteria have been frequently reported. As a result, for several reasons, including to minimize the risk of patient infection due to gram-negative bacteria following endoscopy, this article recommends routine microbiologic sampling of the rinse water used during endoscope reprocessing.

We initiated surveillance for surgical-site infections (SSIs) in a Japanese hospital using Centers for Disease Control and Prevention definitions and the approach of the National Nosocomial Infections Surveillance (NNIS) System. Patients were observed following clean and clean-contaminated abdominal operations. SSI rates were higher than those of the NNIS System, but there was a trend toward decreased SSI rates in the latter half of the study period.