During a recent investigation in our surgical intensive care unit, we found that several bottles of the antiseptic handwashing soap, OR Scrub®, were contaminated with Serratia marcescens. OR Scrub® contains 1% triclosan, lanolin, and detergents. The antimicrobial efficacy of OR Scrub® was examined in vitro using serial two-fold dilutions of soap inoculated with various concentrations of different nosocomial pathogens. The minimal bactericidal concentration (MBC) of OR Scrub® against Pseudomonas aeruginosa and several strains of S. marcescens was ≤1:2 By comparison, a non-antiseptic soap from the same manufacturer (Wash®) and 4% chlorhexidine (Hibiclens®) had MBCs for all strains tested of at least 1:64. Time-kill curves confirmed the findings of the initial experiments.

This is the first report of extrinsic contamination of antiseptic soap containing triclosan. No infections could be attributed to the contaminated soap, but sporadic outbreaks of Serratia have occurred in the intensive care unit with no identifiable source. Although there have been few studies on the impact of antiseptic soap in reducing nosocomial infection, we question whether a soap with the limitations of OR Scrub® should be used in intensive care units or operating rooms.

Male patients with spinal cord injury are frequently colonized with P. aeruginosa and K. pneumoniae on the perineum. Regular bathing with bar soap has not influenced this colonization. We have attempted to remove these bacteria using antiseptic agents. The number of P. aeruginosa, K. pneumoniae and total aerobic bacteria on the perineum and the penile shaft was determined before and after cleaning with bar soap, chlorhexidine, povidone-iodine and pHresh. Povidone-iodine and chlorhexidine had no advantage over bar soap or pHresh in the removal of P. aeruginosa or K. pneumoniae from the perineum of patients with spinal cord injury.

Oral mercury-in-glass thermometers are contaminated with each use and must be decontaminated prior to reuse. It has been shown that the application of a thermometer sheath prevents contamination of the rectal thermometer. The purpose of the present study is to evaluate sheathed thermometers for contamination after oral use on dentulous patients. One hundred sterile sheathed thermometers were distributed into four groups and subjected to in vitro and in vivo conditions.

After clinical use 80% of the sheathed thermometers became contaminated, while not one of those exposed to microorganisms in vitro was contaminated. The cause for contamination was shown to be perforation of the sheath by the dentition. Thus the thermometer sheath is ineffective in preventing contamination of the mercury-in-glass thermometer when used for obtaining oral temperatures from dentulous patients. Sheathed mercury-in-glass thermometers should be decontaminated after each oral use.

Any medical intervention is expected to prevent sickness and complications of a disease rather than to induce them. This is true for therapy as well as prophylaxis. Special formulas have been developed to calculate the risks and benefits of vaccinations simply but with sufficient accuracy. The risk ratio (Q) tells how many times the risk of contracting certain complications or even death from a disease is greater in unvaccinated than in vaccinated individuals. The risk difference (D) directly expresses the number of complications or deaths that may be prevented by a certain vaccination. It is even possible to evaluate the epidemiologic trend of a disease and to calculate or estimate the point of time when the risks of disease and vaccination are just balanced, ie, when a vaccination has lost its beneficial effect. Vaccinations against measles, poliomyelitis and tick borne encephalitis in Austria are highly beneficial. BCG vaccination is still beneficial on a low level in Austria as far as protection against tuberculosis is concerned. This effect will persist for the rest of this century. The benefit of pertussis vaccination depends on the local epidemiologic situation. It has expired for non-risk groups in Austria since 1976 but continues to persist in the US.

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.