Most routine environmental cultures in the hospital are now considered to be of little use and should not be performed unless there are specific epidemiologic reasons. The decision to perform these cultures should be determined by the microbiologist, infection control practitioner, and hospital epidemiologist. However, certain surveillance cultures are still performed as a method of limiting outbreaks. These include culturing cooling towers or hot water sources for Legionella spp., culture of water and dialysis fluids for hemodialysis as well as endotoxin testing, culture of blood bank products, especially platelets, and surveillance cultures for vancomycin-resistant enterococci, methidllin (or oxacillin)-resistant S. aureus and vancomycin-resistant S. aureus using rectal and oropharyngeal swabs. Physical rehabilitation centers often culture hydrotherapy equipment (whirlpools) quarterly to verify that cleaning methods are adequate; some centers culture more frequentiy.
Routine surveillance of air handlers, food utensils, food equipment surfaces, and respiratory therapy equipment is no longer recommended; neither is monitoring infant formulas prepared in-house nor items purchased as sterile. A better approach is for the infection control team to monitor patients for the development of nosocomial infections that might be related to the use of contaminated commercial products. In the event of an outbreak or an incident related to suspected contamination, a microbiologic study would be indicated. However, most often, such infections are actually caused by in-use contamination, rather than contamination during the manufacturing process. Suspect lots of fluid and catheter trays should be saved, and the U.S. Food and Drug Administration should be notified if contamination of an unopened product is suspected.
Although some institutions still require preem-ployment stool cultures and ova and parasite examinations on food handlers, most now recognize that this is of limited value. It is much more important for food handlers to submit specimens for these tests if they develop diarrhea. Similarly, most hospitals no longer screen personnel routinely for nasal carriage of S. aureus. Although a significant percentage of the general
Type, of Precaution
Specific Etiologlc Agents or Syndromes
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