Implementing a cost-effective and meaningful ethylene oxide (EtO) environmental monitoring program is more than purchasing an EtO sensitive device and placing it in the department or on an employee. First, the responsible person involved in such a program must have some general knowledge of analytical procedures and methods. Second, the individual should possess an understanding of the various types of equipment that are available and their limitations. Third, and perhaps most importantly, there must be a good thorough understanding of ethylene oxide and the principles of environmental monitoring as it relates to employee exposure. Even if the hospital or department decides to contract with an outside vendor to perform these services, the responsible individual must be involved with the provider from the inception of the program. All too often, departmental managers enter into an ethylene oxide exposure monitoring program with little thought to where, when, or how to monitor. The key to any ethylene oxide exposure monitoring program has to be the measurement of the extent of employee exposure. Once this is established, the monitoring program can be developed.

Of 386 consecutive patients whose wounds were sutured at the emergency ward of the Soroka Medical Center, 228 returned for a follow-up visit during which pus was observed in 40 sutured wounds. Most of the patients were males, 50% lived in the city, and 13% were Beduin. Fifty percent of the wounds were dressed prior to admission. All wounds were rinsed prior to suture, 78% in a cetrimide-chlorhexidine HC1 solution and in 71% an irrigation with a povidone-iodine solution was performed. The physicians who performed the procedure were graded by their medical experience; 43% of the sutures were performed by interns, 32% by junior residents, 19% by senior residents and 6% by a specialist. Silk thread was the most commonly used suture material (79%). Wounds were classified according to size, depth and state of the margins of the wound. It was noted whether an excision was performed and the type of treatment that was prescribed after the procedure. None of the above-mentioned criteria identified a group as high-risk. Experienced physicians sutured the more serious wounds, but their infection rate did not differ significantly from other physicians.

The treatment of suspected septicemia includes empirical antimicrobial regimens and supportive care. The antimicrobial treatment remains empirical until blood cultures reveal the pathogen and antibiotic sensitivities can be determined. Microscopic examination of peripheral blood is a simple method that can be used to hasten the confirmation of septicemia and may allow more specific therapy.

The exotic communicable diseases are highly virulent, transmissible, conditions which occur most often in tropical areas. Since the late 1960s, there have been occasions when these diseases have been exported to the US and Canada. Advance planning will facilitate the care of patients infected with these diseases in health care facilities. Hospitals should develop a contingency plan which addresses the management of patients that present themselves to the emergency department as well as patients diagnosed after admission. The plan should address such topics as the isolation room, protective clothing, disinfection of the environment and equipment as well as the management of waste and handling of corpses. A well thought out plan will prevent subsequent transmission of infection to attending personnel, other patients and the surrounding community.

The responses to a survey of ventilator circuit practices published in Infection Control are shown in the Table. The majority of 249 individuals who responded were located in community hospitals or community teaching hospitals of 100 to 500 beds. Most of the hospitals changed ventilator circuits (tubing humidifying cascades and swivel adapters) every 24 hours or less. Interestingly, 30.1% of the hospitals indicated that “self-study” was used to determine the time interval of ventilator circuit changes. Our 1982 study of contamination in mechanical ventilators at 24 and 48 hours confirmed earlier observations that mechanical ventilators with cascade humidifiers do not generate small particle aerosols.

As with any serious disease whose etiology is not understood, acquired immunodeficiency syndrome (AIDS) is currently causing considerable concern throughout the United States. Stories about individual cases and about research progress in unraveling the etiology and control of AIDS, appear in the news media almost daily.

The overall objectives for implementing an infection control program are to make hospital personnel aware of nosocomial infections and to educate these persons in their role in decreasing the risk of these infections. The infection control practitioner (ICP) implements these objectives by performing surveillance to determine problem areas and by developing policies and procedures that prevent and control nosocomial infections. Appropriate qualities for an ICP include initiative, leadership, communication skills, commitment, and charisma. Expertise in patient care practices, aseptic principles, sterilization practices, education, research, epidemiology, microbiology, infectious diseases, and psychology are acquired skills.

Local, state, and national organizations, as well as universities, are responsible for ICP training. In the US the Centers for Disease Control have established a training program for the beginning ICP and the Association of Practitioners in Infection Control (APIC) has developed a study guide for developing infection control skills. The ultimate responsibility for education is an individual obligation, however. Certification of the ICP would insure a minimum level of knowledge, thereby standardizing and upgrading the practice of infection control.

To assess the frequency of the booster effect as well as the need for and the cost effectiveness of the two-step skin test for tuberculosis screening at our medical center, we conducted a pilot study from June 1980 to March 1983 with hospital and clinic employees. Six (0.4%) of 1,521 employees tested by the two-step skin test demonstrated the booster effect. The mean age of these six employees was 35 years (range, 24 to 44 yr). During the study period, 10 employees converted to a positive skin test. The booster effect would have accounted for approximately 38% (6 of 16) of those converting if the two-step testing were not performed. At our medical center, the additional cost of the two-step skin test was low and justifiable for medical and epidemiologic reasons. We suggest that each hospital review the prevalence of tuberculosis among its patient and employee populations. The need for and cost effectiveness of the two-step skin test for new hospital employees must be re-examined on the basis of these data.