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Objective:To assess the value of repeated point-prevalence surveys in measuring the trend in nosocomial infections after adjustment for case mix.Setting:A 3,500-bed teaching facility composed of 4 acute care hospitals.Methods:From May 1992 to June 1996, eight point-prevalence surveys of nosocomial infections were performed in the hospitals using a sampling process. The trend of adjusted nosocomial infection rates was studied for the four surveys that collected data on indwelling catheters. Adjusted rates were calculated using a logistic regression model and a direct standardization method.Results:From 1992 to 1996, a total of 20,238 patients were included in the 8 point-prevalence surveys. The nosocomial infection rate decreased from 8.6% in 1992 to 5% in 1996 (P< .001). The analysis of adjusted nosocomial infection rates included 9,600 patients. Four independent risk factors were identified; length of stay greater than 12 days, hospitalization in an intensive care unit, presence of an indwelling urinary catheter, and history of a surgical procedure. After adjustment for case mix, the nosocomial infection rate still showed a downward trend (from 7.2% in 1993 to 5.1% in 1996;P= .02).Conclusion:Adjusted prevalence rates of nosocomial infections showed a significant downward trend during the period of this study.

Objective:To determine the role of nonmedicated soap as a source ofSerratia marcescensnosocomial infections (NIs) in hospital units with endemicS marcescensNI and to examine the mechanisms of soap colonization.Setting:University-affiliated tertiary-care hospitals.Methods:A prospective case-control study and an environmental investigation were performed to assess the relationship betweenS marcescensNIs in hospital units andS marcescens-contaminated soap. Soap-bottle use and handwashing practices were reviewed. Cultures of healthcare workers’ (HCWs) hands were obtained before and after hand washing with soap.Results:5 of 7 hospital units withS marcescensNIs had soap bottles contaminated withS marcescens, compared to 1 of 14 other units (P=.006). After hand washing with anS marcescens-contaminated soap pump, HCWs' hands were 54 times more likely to be contaminated withS marcescens(PConclusions:Extrinsic contamination of a non-medicated liquid soap byS marcescensresulted in handborne transmission ofS marcescensNIs by HCWs in our setting. This finding led to the application of strict guidelines for nonmedicated soap use and to the reinforcement of alcoholic hand disinfection.

We assessed the ability of a standard disinfection procedure to eliminate hepatitis C virus (HCV) from the air-water channel of hysteroscopes. The residual HCV RNA remaining after the disinfection procedure was measured by polymerase chain reaction. When correctly applied to hysteroscopes, the standard disinfection procedure was sufficient to eliminate the risk of HCV transmission.