To examine factors associated with nosocomial acquisition of Pseudomonas cepacia in adult patients with cystic fibrosis.

A retrospective case-control study of 5 patients with nosocomial acquisition of P cepacia versus 20 matched controls who failed to develop P cepacia infection. Selective handwashing, air sampling, and respiratory equipment sampling also were performed.

A university hospital providing tertiary care to 95 adult cystic fibrosis patients.

All patients are adults with known cystic fibrosis. Case definition required multiple negative sputum cultures for P cepacia prior to and during admission, with a positive sputum culture prior to discharge. Controls had negative sputum cultures for P cepacia prior to and throughout hospitalization. Controls were matched for age, gender, disease severity, and frequency of hospitalizations.

Factors associated with increased risk of nosocomial acquisition of P cepacia included receiving humidifier or nebulized treatments (60% versus 5%, p = .016, odds ratio= 28.5, 95% confidence interval= 1.93 to 420.58). Factors without significance included ward, room, teaching versus nonteaching status, use of steroids, sharing a hospital room with another cystic fibrosis patient, antibiotic use, presence of portocath in situ, or socializing with another individual with cystic fibrosis known to be P cepacia -positive. Air sampling studies failed to demonstrate aerosolization of P cepacia by coughing cystic fibrosis patients over a 1-hour sampling time. Handwashing studies failed to demonstrate P cepacia on hands of cystic fibrosis patients, nurses, or physiotherapists (before or after physiotherapy). Reservoirs from nebulizers consistently grew P cepacia following therapy.

Respiratory equipment may be an important source of nosocomial acquisition of P cepacia in adult cystic fibrosis patients.

To determine the accuracy with which circulating nurses (CNs) classify surgical procedures by risk of contamination in the operating room.

Classification of surgical procedures by CNs was compared with the classification of surgical procedures by a physician observer.

University-affiliated, tertiary care hospital.

Circulating nurses used the traditional wound classification system of clean, clean-contaminated, contaminated, and dirty-infected to classify surgical wounds in the operating room. A physician remained in the operating room throughout each of 100 surgical procedures and simultaneously classified surgical wounds without the knowledge of the CNs.

Classification of surgical wounds by CNs was compared with classification by the physician observer for 50 cases in general surgery and 50 cases in trauma surgery. Compared with the physician observer, the overall accuracy of classification by CNs was 88% (95% confidence interval [CI] of 81.6% to 94.4%; Kappa statistic, 0.83). Classification of surgical wounds was more difficult in trauma surgery (accuracy of 82%) than in general surgery (accuracy of 94%). Accuracy increased for both services when surgical wounds were classified into just two categories (clean or clean-contaminated versus contaminated or dirty-infected).

Surgical wounds can be classified in the operating room with a high degree of accuracy by CNs. Classification was more difficult in trauma than in general surgery, but classification in trauma surgery improved with feedback to and additional education of CNs. The accuracy of classification by CNs was even higher when classifications were divided into just two categories.