Institutions and employees in the healthcare industry recently have been flooded with a variety of new preventive devices, with the promise of reducing the risk of needlestick accidents. With the known risk of occupational human immunodeficiency virus (HIV) infection and the greater risk of morbidity and mortality of occupational hepatitis B virus (HBV) infection, it is hard not to get swept away by the tsunami of “safer devices.” The ultimate question of course, is whether these new or improved products actually contribute to the reduction of accidents and diminish the transmission of these diseases. With the demand for safer working conditions in the context of the HIV epidemic and in times of shrinking budgets, the safest and most cost-effective devices must be determined. Although the Occupational Safety and Health Administrations (OSHA) final ruling on occupational exposure to bloodborne pathogens may not directly address the issue of needlestick prevention devices, institutions should be prepared to justify their practices and selection of equipment, given its emphasis on engineering and work practices that states “Engineering and work practice controls shall be used to eliminate or minimize employee exposure.”

Peracetic acid is a component of an equilibrium mixture that includes acetic acid, hydrogen peroxide, and water. Although it was first reported in 1902, not until years later did Greenspan and MacKellar find it to be bactericidal at 0.001%, fungicidal at 0.003%, and sporicidal at 0.30%.’ There are no specific data explaining how peracetic acid actually destroys the cell; it has been speculated that it functions like other peroxides and oxidizing agents. Block suggests that it destroys the chemosmotic function of the lipoprotein cytoplasmic membrane through dislocation or rupture of the cell wall.

Peracetic acid is sporicidal at low temperatures, and it remains effective in the presence of some organic material. Sprossig stated that peracetic acid has advantages for disinfection and sterilization not found in any other agent. Block states that, “It would be desirable to have a chemical with the attributes of hydrogen peroxide-effective germicidal and sterilizing capabilities, no harmful decomposition products, and infinite water solubility-but with greater lipid solubility and freedom from deactivation by catalases and peroxidases. Such a compound exists. It is peracetic acid.” Fraser adds that, “A prime advantage of peracetic acid is that it is a nonfoaming, water-soluble liquid that is fast acting and nonderivatising, as well as environmentally accepted.”

Historically, infection control can, we believe, be divided into three eras, each lasting about a half century. We wonder whether we are now seeing the beginning of a fourth.

The first era, which we call the nascent period, began roughly in the middle of the last century. It arose from the discoveries of Ignaz Semmelweis and Florence Nightingale. The benefits of each of their contributions on hospital mortality were so spectacular that they would qualify for the “lead ball” award. (Del Gurchio quoted Lloyd MacLean as saying, “If you hold a lead ball out of the window and when you let it go it goes up, you do not need a statistician to tell you it was a significant event.” Hence, the “lead ball” award.)

The second era would be the aseptic period. It dates from the acceptance of the findings of Pasteur, Lister, and Koch. Their concepts achieved general acceptance, after a hard fight, at the beginning of the 20th century.

In 1988, the Centers for Disease Control (CDC) published definitions of nosocomial infections However, because of journalistic style and space constraints, these definitions lacked some of the detail provided to National Nosocomial Infections Surveillance (NNIS) System hospitals in the NNIS Manual (unpublished). After the NNIS System hospitals had had considerable experience with the definitions and in response to a request for review by The Surgical Wound Infection Task Force, a group composed of members of The Society for Hospital Epidemiology of America, the Association for Practitioners in Infection Control, the Surgical Infection Society, and the CDC, we slightly modified the definition of surgical wound infection and changed the name to surgical site infection (SSI).

Flavimonas oryzihabitansis an uncommon organism with distinctive microbiological and biochemical features that is infrequently isolated from humans. The presence of foreign material, including indwelling intravascular catheters and artificial grafts, or various surgical procedures appear to predispose patients with underlying disease to bacteremic infection with Flavimonas. A gram-negative bacillus,F oryzihabitans is sensitive to most antibiotics except first- andsecond-generation cephalosporins.F oryzihabitans isolated from blood should be considered pathogenic in patients with indwelling catheters or prosthetic materials.

Previously designatedPseudomonasoryzihabitans and also known as Centers for Disease Control (CDC) Group Ve-2, F oryzihabitans is an unusual gram-negative, nonfermenting, oxidase-negative bacillus that is uncommonly associated with serious illness in humans.’ First described by Dresel and Stickl in 1928 and initially assigned the nameBacterium typhiflavum because of its similarity to the typhoid bacillus, the organism has been isolated from a variety of human sources, including blood, wounds, and abscesses, and (in mixed cultures) from sputum, urine, and cervical cultures.

A pervasive misconception in infection control circles is that simple bland soap handwash reliably prevents hand transmission of transiently acquired bacteria, disregarding the level of hand contamination. Often cited to support this widespread misapprehension is a bigger misconception-the efficacy of bland soap handwash is rooted in the epidemiological research of Ignaz Semmelweis. As emphasized by Walter and Beck, Semmelweis did no such thing. Indeed, it was the observation by Semmelweis of failure of bland soap handwash to prevent healthcare workers from spreading puerperal sepsis that led to his investigations of chlorine hand antisepsis for control of cross-infection. These studies ultimately resulted in his demonstrating that effective hand antisepsis (and not bland soap handwash) could prevent transmission of the agents of postpartum endometritis, sepsis, and death.

Strains of methicillin-resistant Staphylococcus aureus (MRSA) have become increasingly common in the United States and in many other countries since 1975. Although MRSA was recovered primarily in university and federal hospitals in this country during the late 1970s, these organisms are being encountered with increasing frequency in all types of hospitals, especially in the eastern half of the United States. Although there is a paucity of information available on the prevalence of MRSA in long-term care facilities, a few reports suggest that MRSA is also seen frequently in these settings. Because colonized patients are frequently transferred between hospitals and long-term care facilities, a continuing circuit of MRSA transmission occurs in areas where these organisms are prevalent.

MRSA prevalence rates vary widely by locale and by type and size of hospital. In some geographic areas, the prevalence remains low, whereas in other areas, from 10% to 50% of all S aureus isolates recovered from patients in large medical centers are MRSA. Even within a given city, MRSA prevalence rates may vary widely among acute care hospitals.

Little concern was given to the frequency of needlestick injuries in the workplace before the acquired immunodeficiency syndrome (AIDS) epidemic, despite the risk of acquiring more than 20 different infectious diseases from blood or body fluid-contaminated needlestick injuries. Reports of occupational human immunodeficiency virus (HIV) transmission after accidental needlestick injuries' have not only heightened healthcare worker awareness of this occupational hazard, but also galvanized industry to create safety devices designed to reduce this risk.

We recently introduced a “safety” intravenous catheter for use in our emergency department at St. Christopher's Hospital for Children, Philadelphia, Pennsylvania. The catheter we chose is, to our knowledge, the only one readily available on the US market. This catheter is the Protectiv™ IV Catheter Safety System, marketed by Critikon, Inc., Tampa, Florida. The catheter's safety mechanism is an external plastic sheath that, as the user advances the catheter off the introducer needle, slides over the contaminated needle and locks it safely inside. The sheath acts as a needle cap, and the user's hands remain behind the introducer needle during all stages of operation. We prospectively evaluated our registered nurses’ acceptance and proficiency with this “safety” catheter.