HIV infection per needlestick in health care workers.

risk factors, such as incisions, indwelling IV and urinary catheters, and tracheostomy tubes. Before a patient can come off this type of isolation, certain criteria must be met. The resistant organism must no longer be present at the site, whether or not the infection (eg, the drainage) has cleared. If a wound was infected but has now healed, the skin at the site must still be cultured. In addition, MRSA especially, may have colonized the skin or mucous membranes of the patient. Although one study found that in the presence of a tracheostomy, the site was more often positive than the nares. We require a culture of both anterior nares to be negative for the resistant organism before the patient can be taken off isolation. The other requirement is that infection control personnel must be consulted before the patient comes off isolation, and we check that the culture results are final reports, not pre l iminary or in te r im f indings , before permitting the discontinuance of isolation. Preliminary reports have occasionally been changed later and the extra day is well worth the wait. Although the new category of Isolation for Antibiotic-Resistant Organisms is very demanding on the staff and costly for the institution, we have found that in a large institution such as ours (533 beds), it has prevented premature removal of patients from other types of isolation when their infection, but not necessarily their colonization, cleared. We believe keeping patients on this rather stringent kind of isolation has curtailed the spread, especially of MRSA, because personnel are anxious to avoid new cases, and are thus very strict in enforcing the necessary precautionary measures for themselves and other hospital personnel. REFERENCES 1. Walsh TJ, Vlahov D, Hansen SL, et al: Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylococcus aureus. Infect Control 1987; 8:7-14. 2. Carner J, Simmons BP: Guidelines for Isolation Precautions in Hospitals. Atlanta, Centers for Disease Control, 1983. 3. Bitar CM, Mayhall CG, Lamb VA, et al: Outbreak due to methicillinand rifampin-resistant Staphylococcus aureus: Epidemiology and eradication ofthe resistant strain from the hospital. Infect Control 1987; 8:15-23. 4. Craig C: How should bacteremic MRSA patients and colonized employees be treated? Hosp Infect Control 1987; 14:94-95.