Enterobacter cloacae outbreak in the NICU related to disinfected thermometers.

In the first week ot December 1997, an increasing incidence of neonates colonized with multi-drug resistant Enterobacter cloacae (MR-E. cloacae) was observed in the neonatal Intensive care unit of our 950-bed university hospital. Initially, re-enforcement of infection control practices including hand disinfection and cohort isolation seemed to be sufficient to control the outbreak. Nevertheless, an increasing number of newly admitted patients was paralleled by another rise in the incidence of colonized neonates. Since E. cloacae was initially found in urine specimens of the patients, surveillance and environmental cultures were aimed at procedures and instruments that might colonize the gastro-intestinal and/or urinary tract. E, cloacae was isolated from a single cap of an electronic digital thermometer. Despite banning of this possible source, newly admitted neonates still became colonized. The unit was closed for further admissions and a second round of extensive screening was started; this time including all available thermometers and continuous rectal temperature probes. Ready-to-use 'disinfected thermometers and probes were found to be colonized with MR-E. cloacae. Observation of disinfection procedures and a laboratory investigation revealed that 'rushed disinfection with alcohol 80% led to a 1 in 10 chance of thermometers still being contaminated. Furthermore, alcoholic hand rub used for convenience disinfection failed to disinfect thermometers in 40% and 20% of the cases when done in a 'rushed' or 'careful' fashion, respectively. Adequate disinfection of the thermometers led to the control of the outbreak, with no new occurrence of MR-E. cloacae in the following months.

Effect of hyperoxia on performance capacity of firemen.

We examined the effect of O2-enriched air upon performance capacity and some physiological and psychological variables. Eight firemen were studied during seven bouts of 2 min treadmill-running while breathing air with 21 or 40% oxygen. The duration of the resting periods between the working bouts was chosed by the subjects themselves, with the instructions to rest as short as possible. Total resting time decreased by 29% and total amount of air used by 6%, under the 40% oxygen condition. There were no differences in 1) minute ventilation during working periods (when the subjects breathed 40% oxygen respiratory rate decreased whereas tidalvolume increased), 2) heart rate reached during working periods, 3) subjective feelings of fatigue as indicated by the subjects at the end of every working period. Advantages of the use of O2-enriched air by firemen are discussed and it is concluded that breathing air with 40% oxygen does not mean an extra physiological or psychological load for the organism. Finally, possible factors that made a subject decide to start again are discussed and the importance of the respiratory rate in this decision is indicated.