VOLUME 21, NUMBER 12 DECEMBER 2000 An Official Journal of The Society for Healthcare Epidemiology of America

PUBLISHED FOR THE SOCIETY BY SLACK INCORPORATED INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY

SPECIAL INSERT New FDA Regulations Affecting Hospitals—see pages 801-804 EDITORIAL Help Wanted MICHAEL D. DECKER, MD, MPH 757 ORIGINAL ARTICLES An Outbreak of Pyodermas Among Neonates Caused by Ultrasound Gel Contaminated With Methicillin-Susceptible Staphylococcus aureus KLAUS WEIST, MD; CONSTANZE WENDT, MD, MPH; LYLE R. PETERSEN, MD, MPH; HANS VERSMOLD, MD; HENNING RUDEN, MD 761 The Nature and Frequency of Blood Contacts Among Home Healthcare Workers ELISE M. BELTRAMI, MD; MARGARET A. MCARTHUR, RN; ALLISON MCGEER, MD; MAXINE ARMSTRONG-EVANS, RN; DEMIE LYONS, RN; MARY E. CHAMBERLAND, MD; DENISE M. CARDO, MD 765 Pyrogenic Reactions Associated With Single Daily Dosing of Intravenous Gentamicin UDO BUCHHOLZ, MD; CHESLEY RICHARDS, MD; REKHA MURTHY, MD; MATTHEW ARDUINO, PHD; DOREEN PON, PHARMD; WAYNE SCHWARTZ, PHARMD; ELSIE FONTANILLA, RN; CLARE PEGUES, RN; NOEMY BOGHOSSIAN, PHARMD; CAROL PETERSON, MD; JACOB KOOL, MD; LAURENE MASCOLA, MD; WILLIAM R. JARVIS, MD 771 Comparison of Three Methods to Recover Vancomycin-Resistant Enterococci (VRE) From Perianal and Environmental Samples Collected During a Hospital Outbreak of VRE BARBARA S. REISNER, PHD; STEPHANIE SHAW, BS; MARY E. HUBER, MT; CARLA E. WOODMANSEE, MT; SILVIA COSTA, MD; PAMELA S. FALK, MPH; C. GLEN MAYHALL, MD 775

TOPICS IN OCCUPATIONAL MEDICINE Experience of Healthcare Workers Taking Postexposure Prophylaxis After Occupational HIV Exposures: Findings of the HIV Postexposure Prophylaxis Registry SUSAN A. WANG, MD, MPH; ADELISA L. PANLILIO, MD, MPH; PEGGY A Doi, BSMT; ALICE D. WHITE, PHD; MICHAEL STEK, JR, MD, MSC; ALFRED SAAH, MD; AND THE UW PEP REGISTRY GROUP 780

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Immunizing Healthcare Workers: A Practical Approach Edited by Gregory A. Poland, MD; William Schaffner, MD; Gina Pugliese, RN, MS 300 pp, Hard Cover, 2000, ISBN 1-55642-450-7, Order # 14507, $109.00 Immunizing Healthcare Workers: A Practical This phenomenal book contains the lattlt I Approach is the first complete resource for dealing mendations from the US Public Health with the immunization of healthcare workers. You Advisory Committees, Healthcare Infection i can find all of the latest information on successfully Practices Advisory Committee (HICPAC), i and safely implementing or updating your immu­ Advisory Committee on Immunization nization program in this landmark book. (ACIP). Inside you will find that for each of the vaccine-pre­ Read how the experts overcame obstaclet|| ventable diseases among workers, there is a discus­ setting up immunization programs in their I Both textbooks are an official sion of disease risks in the healthcare setting, settings. With over 45 contributors to 32 eh publication of vaccine recommendations, special administration Immunizing Healthcare Workers: A Pr; The Society for Healthcare strategies, safety issues, discussion of unresolved Approach is an essential source for the« Epidemiology of America (SHEA). issues, and answers to commonly asked questions. information necessary to implement an efj There are also case studies of sample programs in immunization program. specific settings.

Some Case Study Topics:

Immunizing Providers and Staff in Physicians' Offices • Immunization of Workers with Altered Host Defenses Vaccination of Healthcare Workers in Long-Term Care Facilities • Vaccinating Unimmunized and Partially Immunized Workers for the Elderly • Assessing Immunity and Exposures: Using a Computerized m Immunization of Affiliating Students and Contract Home Surveillance System Healthcare Workers • Managing Information in an Immunization Program Immunization Strategies for Home Healthcare Personnel • The Internet: A Quick Guide to Vaccine & Immunization Infoi

Abo Available ORDER FORM A Practical Handbook for Hospital Epiden lease send me copies of Immunizing Healthcare Workers: A Practical Approach Edited by: Loreen A. Herwaldt, MD and co-edited lf| Drder# 14507) at $109.00 each. Michael D. Decker, MD, MPH 448 pp, Soft Cover, 1998, ISBN 1-55642-302-0, lease send me. . copies of A Practical Handbook for Hospital Epidemiologists Order # 13020, $65.00 Order # 13020) at $65.00 each. A Practical Handbook for Hospital Epidemiok NJ residents add 6% sales tax $_ most complete source for practical advice on hospital e Handling $ 4.50 ogy. It is intended to be a pragmatic guide that will | Total $ beginning and experienced practitioners in establishing a lame: ating a successful hospital epidemiology program, book will supplement the various scientific reference jj iddress: available for this field and will help hospital epidi Sty: State: . Zip: improve their practices. hone: _ Fax: -mail: _ Mail order form to: SLACK Incorporated, Professional Book Dh I Check enclosed (Payable to SLACK Incorporated) 6900 Grove Road, Thorofare, NJ 08086-9

'hargemy: • Lg„ Call: (800) 257-8290 or (856) 848-1000 Fax: (856) 853-5991 [ccount #._ Downloaded from https://www.cambridge.org/core. 02 Oct 2021 at 08:50:04, subject to the Cambridge Core terms of use. E-mail: [email protected] ixp. date: _Signature_ World Wide Web Site: http://www.sla 'rices are subiect to chance. Shiomne chorees mav ODDIV. CODE: 1A448 DIRECTOR of INFECTION CONTROL HOSPITAL EPIDEMIOLOGIST BETH ISRAEL DEACONESS Our Lady of Lourdes Medical Center seeks a Director MEDICAL CENTER-BOSTON of Infection Control/Employee Health to direct the program. The focus is to provide clinical and adminis- Infectious Disease Division seeks full-time Infectious ative leadership in this area to our staff and patients. Disease physician to direct Hospital Epidemiology unit Qualified candidate will be an NJ RN w/ a min of 3-5 and oversee Associate Hospital Epidemiologist and yrs relevant experience and well-developed leadership Nurse Epidemiologist in management of daily issues & statistical skills. We offer competitive pay & excel­ of infection control. Candidate would participate in an lent benefits. Send resume with salary requirements active clinical epidemiology research agenda and to: Our Lady of Lourdes Medical Center, Attn: J. Schi- supervise fellows during research training. Ideal appli­ avo, 1533 Haddon Ave., Camden, NJ 08103. Fax: cant should have advanced training in epidemiology, 856-757-3044. Email: [email protected]. Visit us evidence of research productivity, and recent direct on the web: www.lourdesnet.org or call our jobline experience in hospital infection control. The position 856-757-3202 for info on open positions. EOE. carries an appointment at Harvard Medical School. The BIDMC is an equal opportunity employer. Contact: Adolf Karchmer, MD Beth Israel Deaconess Medical Center Infectious Disease Division 330 Brookline Avenue Boston, MA, 02215 Email: [email protected].

Society for Healthcare Epidemiology of America v^eeus j ournai JSQICOF The Society for Healthcare Epidemiology of America is seeking candidates for the position of Editor for Infection Control and Hospital Epidemiology (ICHE). The Editor of ICHE will chair the editorial advisory board and supervise the editorial office and the editorial staff, including a managing editor and administra­ tive support; will supervise the editorial content and substance of the Journal; will serve as a decision maker in situations involving manuscripts suitable for publication; will serve as the Society's liaison with the pub­ lisher and manage the services to be provided under contractual agreement with the publisher and assure that services are provided in a manner that promotes ICHE's integrity and the Society's professional reputa­ tion; will promote communication among the many individuals involved in the publication; will propose inno­ vation in the Journal in content, emphasis, and form; will represent the Journal at meetings with organiza­ tions and individuals interested in ICHE; will attend Board of Directors, Publication Committee, and Editorial Board meetings as necessary and provide reports on the progress and activities of the Journal. The candidate will begin his or her term at a mutually agreed upon date sometime in the first quarter of 2001 and will serve for a term of 5 years. At the end of the 5-year term, the Editor may be reappointed for an additional 5-year term without a competitive search.

To apply, please forward a letter of application stating your interest and qualifications, including personal publication experience, editorial experience, special training, computer technology, commitment of support from your institution, and membership in SHEA Please include current curriculum vitae. Applications should be sent to John Sellick, DO, SHEA Publications Committee Chair, 19 Mantua Rd, Mt Royal, NJ 08061. For further information regarding the position, please contact Stephanie Dickinson, SHEA Executive Director, at 856423-0087 or [email protected].

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EDITORIAL OFFICES Vanderbilt University School of Medicine INFECTION CONTROL AND A-1131 Medical Center North 8 Nashville, TN 37232-2637 HOSPITAL EPIDEMIOLOGY* (615) 343-1095; (615) 343-1882 (FAX) Email: [email protected] EDITORIAL ADVISORY BOARD EDITOR Jacques F. Acar, MD , France Michael D. Decker, MD, MPH J. Wesley Alexander, MD Cincinnati, Ohio MANAGING EDITOR Paul Arnow, MD Chicago, Illinois Susan Cantrell Graham AJ. Ayliffe, MD Birmingham, United Kingdom STATISTICAL EDITOR Neil L Barg, MD Yakima, Washington Beverly G. Mellen, PhD Manuel Bastanzuri, MD , Cuba SENIOR ASSOCIATE EDITORS Elizabeth Ann Bolyard, RN, MPH, CIC Atlanta, Georgia C. Glen Mayhall, MD John M. Boyce, MD Providence, Rhode Island Gina Pugliese, RN, MS Professor Dr. Ilja Braveny Munich, Germany William Schaffner, MD Christian Brun-Buisson, MD Creteil, France ASSOCIATE EDITORS Charles Bryan, MD Columbia, South Carolina Donald A Goldmann, MD Donald E. Craven, MD Boston, Massachusetts DidierPittet,MD,MS Sue Crow, MSN, RN, CIC Shreveport, Louisiana Andreas Widmer, MD, MS Franz Daschner, MD Freiburg, Germany SECTION EDITORS Leigh G. Donowitz, MD Charlottesville, Virginia Beyond Infection Control: Charles E. Edmiston, Jr., PhD Milwaukee, Wisconsin The New Hospital Epidemiology Theodore C. Eickhoff, MD Denver, Colorado Bruce Farber, MD Manhasset, New York Bryan P Simmons, MD Victoria J. Fraser, MD St. Louis, Missouri Stephen B. Kritchevsky, PhD Peter C. Fuchs, MD, PhD Black Butte, Oregon Memphis, Tennessee Richard A Garibaldi, MD Farmington, Connecticut Wing Hong Seto, MD Robert Gaynes, MD Adanta, Georgia Hong Kong Velvl Greene, PhD, MPH Beer Sheva, Israel Disinfection and Sterilization David W. Gregory, MD Nashville, Tennessee William A Rutala, PhD, MPH David K. Henderson, MD Bethesda, Maryland Chapel Hill, North Carolina Peter N.R. Heseltine, MD Los Angeles, California Emerging Infectious Diseases Karen Hoffmann, RN, CIC, MS Chapel Hill, North Carolina Larry J. Strausbaugh, MD Marguerite McMillan Jackson, RN, PhD San Diego, California Portland, Oregon Janine Jagger, MPH, PhD Charlottesville, Virginia Robert W. Pinner, MD William R Jarvis, MD Atlanta, Georgia Atlanta, Georgia Douglas S. Kernodle, MD Nashville, Tennessee From the Laboratory Robert H. Latham, MD Nashville, Tennessee Marcus Zervos, MD Lewis B. Lefkowitz, MD Nashville, Tennessee Royal Oak, Michigan Hsieh-Shong Leu, MD, MSc Taipei, Taiwan Jack Levy, MD Brussels, Belgium Fred C. Tenover, PhD Victor Lorian, MD Bronx, New York Atlanta, Georgia Dennis G. Maki, MD Madison, Wisconsin Information Management William J. Martone, MD Bethesda, Maryland JohnASellick,DO Allison McGeer, MD , Ontario, Canada Buffalo, New York John E. McGowan, Jr., MD Atlanta, Georgia The International Perspective Jonathan L Meakins, MD, DSc Montreal, Quebec, Canada Mary D. Nettleman, MD, MS Robert R Muder, MD Pittsburgh, Pennsylvania Richmond, Virginia Joseph M. Mylotte, MD, CIC Buffalo, New York Issues in Surgery Lindsay Nicolle, MD Winnepeg, Manitoba, Canada James T. Lee, MD, PhD Juhani Ojajarvi, MD , Finland St. Paul, Minnesota Michael T. Osterholm, PhD, MPH Minneapolis, Minnesota Medical News Jan Evans Patterson, MD San Antonio, Texas Gina Pugliese, RN, MS Sindy M. Paul, MD Trenton, New Jersey Chicago, Illinois Michael A Pfaller, MD Iowa City, Iowa Martin S. Favero, PhD Samuel Ponce de Leon, MD, MSc , Mexico Irvine, California Isaam Raad, MD Houston, Texas Practical Healthcare Epidemiology Manfred L. Rotter, MD, DipBact Vienna, Austria Loreen A Herwaldt, MD Theodore Sacks, MD Jerusalem, Israel Iowa City, Iowa William E. Scheckler, MD Madison, Wisconsin Kent Sepkowitz, MD New York City, New York SHEA News Denis Spelman, MD Prahran Victoria, Australia Andreas Voss,MD, PhD Michael L. Tapper, MD New York, New York Nijmegen, The Netherlands Clyde Thornsberry, PhD Brentwood, Tennessee Statistics for Hospital Epidemiology Professor Leonid P Titov Minsk, Republic of Belarus David Birnbaum, PhD, MPH Timothy R Townsend, MD Millwood, Virginia Sidney, British Columbia, Canada Antoni Trilla, MD, PhD , Spain Topics in Long-Term Care Professor Wang Shu-Qun Beijing, People's Republic of China Philip W Smith, MD J. John Weems, Jr., MD Greenville, South Carolina Omaha, Nebraska Robert A Weinstein, MD Chicago, Illinois Topics in Occupational Medicine Professor Dr. W. Weuffen Greifswald, Germany David Weber, MD, MPH Sergio B. Wey, MD Sao Paulo, Brazil Chapel Hill, North Carolina Rebecca Wurtz, MD Evanston, Illinois SLACK Incorporated 6900 Grove Road Thorofare, New Jersey 08086 (856) 848-1000 Executive Vice President Editorial Assistant Pharmaceutical Group Sales Director Richard N. Roash Christine C. Good Michael LoPresti Vice President, Publishing Operations Circulation Manager Advertising Sales Representative John C. Carter Lester J. Robeson, CCCP Meredith Roash Editorial Director Production Director Advertising Sales Coordinator Jennifer Kilpatrick Christine Malin Lori Souder Production Editor Production Coordinator Classified/Recruitment Sales Manager Shirley P. Strunk, ELS Joanne Patterson Kelly Wark Assistant Editor Vice President, U.S. Advertising Classified/Recruitment Sales Representative Downloaded fromEilee https://www.cambridge.org/coren C. Anderer . 02 Oct 2021 at 08:50:04Wayne, subject McCour to tthe Cambridge Core terms of use. Stacey Goldberg Vol. 21 No. 12 December 2000 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY" O N X E N X S

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CONCISE COMMUNICATIONS Outbreak of Infections in a Greek University Hospital Involving a Single Clone of High-Level Aminoglycoside-Resistant Enterococcus faecalis SPYROS POURNARAS, MD; ATHANASSIOS TSAKRIS, MD, PHD; MARY E. KAUFMANN, MA, MSc; JOHN DOUBOYAS, MD; ANTONIOS ANTONIADIS, MD 786 Choice of Antibiotic and Risk of Colonization With Vancomycin-Resistant Enterococcus Among Patients Admitted for Treatment of Community-Acquired Pneumonia JOHN MANZELLA, MD; RONALD BENENSON, MD; GENE PELLERIN, DO; JAMES KELLOGG, PHD; THEODORE BELL, BS; MICHELLE ROBERTSON, RN, BSN; DORIS POPE, RN, MS 789 FROM THE 4TH DECENNIAL INTERNATIONAL CONFERENCE Reality Check: How Should We Control Antimicrobial Use? Current Practices and Controversies BRUNO COIGNARD, MD, MSc; JANE D. SIEGEL, MD; ROBERTA WEINSTEIN, MD; ANNETTE H. SOHN, MD; RONDA L. SINKOWITZ-COCHRAN, MPH; WILLIAM R. JARVIS, MD 792 READERS' FORUM Antibiotic-Use Screening Evaluations (ABUSE) for Physicians and Patients: Featuring Prizes and Penalties for Physicians LUDWIG A LETTAU, MD, MPH 796 LETTER TO THE EDITOR Point-Prevalettce of Contamination of Healthcare Workers' Stethoscopes With Vancomycin-Resistant Enterococci at Two Teaching Hospitals in Cleveland, Ohio CHRISTOPH G. LANGE, MD; ANNE B. MORRISSEY, MS (ASCP)SM; CURTIS J. DONSKEY, MD 756 MEDICAL NEWS GINA PUGLIESE, RN, MS; MARTIN S. FAVERO, PHD 805 ANNUAL INDEX 808 SHEA NEWS ANDREAS VOSS, MD, PHD 824

To view abstracts of these articles, visit us on the Internet at http://wwn>.slackinc.com/(jeneral/iche

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PUBLISHER: Infection Control and Hospital Epidemiology (TSSN-0899-823X Canadian GST#129780466) is published exclusively by SLACK Incorporated 12 times a year. Address: 6900 Grove Rd., Thorofare, NJ 08086. Telephone: (856) 848-1000. SHEA: 19 Mantua Rd., Mt. Royal, NJ 08061; telephone, 85642SO087; fax, 856423-3420; e-mail address, sheahqetalley.com. COPYRIGHT 2000 The Society for Healthcare Epidemiology of America, Inc., and SLACK Incorporated. All rights reserved. No part of this publication may be reproduced without written per­ mission from the publisher. Printed in the USA SUBSCRIPTIONS: Requests should be addressed to the publisher (except Japan). In Japan, contact Woodbell Incorporated, 4-22-11, Kitakasai, Edogawaku, Tokyo 134, Japan. Subscription rates in the United States and possessions: Individual: One year-$109.O0; Two years-$169.00; Three years^229.00; Institutional: One year-$139.00; Two years^209.00; Three years-$269.00. Fellows: $54.50 per year with proof of training status. Canada: add 7% Goods & Services tax; Overseas: add $49.00 each year for delivery by air service. Single copies of current issues may be obtained for $19.00. INSTRUCTIONS TO AUTHORS: Authors may submit manuscripts prepared in accordance with the 1997 revision of the "Uniform Requirements for Manuscripts Submitted to Biomedical Journals." The Uniform Requirements has been published in several journals, including Infect Control Hosp Epidemiol 1997; 18:457464 and Ann Intern Med 1997; 126:3647. A digital version is available on our web site (http://www.slackinc.com/general/iche/ichehome.htm). Submit to ICHE Editorial Offices, Vanderbilt University School of Medicine, A-1131 Medical Center North, Nashville, TN 37232-2637, USA All sub­ missions must be accompanied by copyright form(s) signed by all authors (see January issue or our web site). REPRINTS: All requests to reprint or use material published herein should be addressed to Karen Lambertson, SLACK Incorporated, 6900 Grove Rd., Thorofare, NJ 08086. For reprint orders and prices, contact Karen Lambertson at (856) 848-1000. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by SLACK Incorporated, provided that tile base fee of $1.00 per copy, plus $.15 per page is paid direcdy to Copyright Clearance Center, 27 Congress St., Salem, MA 01970. This consent does not extend to other kinds of copy­ ing, such as for general distribution, resale, advertising and promotional purposes, or for creating new collective works. CHANGE OF ADDRESS: Notice should be sent to the publisher 6 weeks in advance of effective date. Include old and new addresses with zip codes. The publisher cannot accept responsibility for undelivered copies. Periodicals postage paid at Thorofare, New Jersey 08086-9447 and at additional mailing offices. POSTMASTER: Send address changes to SLACK Incorporated, 6900 Grove Rd., Tho­ rofare, NJ 08086. INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY is listed in Index Medicus, Current Contents-Clinical Practice, Hospital Literature Index, Cumulative Index to Nursing & Allied Health Literature, Nursing Abstracts, Laboratory Performance Information Exchange System, and RNdex Top 100. Downloaded from https://www.cambridge.org/core. 02 Oct 2021 at 08:50:04, subject to the Cambridge Core terms of use.