We conducted a retrospective review of nosocomial outbreak investigations conducted by the Hospital Infections Program, Centers for Disease Control and Prevention, from January 1991 through March 1994. Selected outbreaks have demonstrated the utility of molecular methods such as plasmid analysis, plasmid restriction endonuclease analysis, ribotyping, restriction fragment polymorphism, pulsed-field gel electrophoresis, and polymerase chain reaction in confirming the clonality of the outbreak and in confirming the source of the outbreak implicated in the epidemiologic investigation. These data show that molecular typing of isolates is particularly useful when combined with epidemiologic investigations of nosocomial outbreaks.

There have been many changes in infection control in the 10 years since the last publication of isolation guidelines for hospitals by the Centers for Disease Control and Prevention (CDC). Hospitals since have used the 1988 CDC Update on Universal Precautions as a minimum because it is required by the Occupational Safety and Health Administration. Even before these changes, Lynch and Jackson described the concept of body substance isolation, which is intended primarily to decrease cross-transmission between patients. Many hospitals' universal precautions policies also incorporate the concept of body substance isolation to prevent the transmission of non-bloodborne as well as bloodborne pathogens. The 1988 CDC update states that the use of universal precautions does not eliminate the need for other category- or disease-specific isolation, or an institution's own system of isolation precautions.

West Haven Veterans Affairs Medical Center in Connecticut and the University Health System and Audie L. Murphy Memorial Veterans Hospital in San Antonio, Texas, have adopted a universal precautions/body substance isolation (UP/BSI) policy as a standard for all patients in an attempt to lessen the confusion. All three hospitals are large, university-affiliated, tertiary care teaching institutions. Blood and all body fluids or tissue from all patients are considered potentially infectious and barrier precautions are used accordingly. Body substance isolation has been shown to decrease the transmission of some non-blood-borne pathogens.

Few issues in hospital infection control have evoked as much debate as the controversies regarding the risk and prevention of transmission of blood-borne pathogens to healthcare workers and patients during invasive procedures. To promote direct discussions among researchers and other interested participants from multiple disciplines affected by these issues, the American College of Surgeons and the Centers for Disease Control and Prevention cosponsored a Conference on Prevention of Transmission of Bloodborne Pathogens in Surgery and Obstetrics, February 13-15, 1994, in Atlanta, Georgia. The conference was attended by approximately 200 participants from nine countries, including surgeons from a variety of specialties, obstetricians, operating and delivery room personnel, anesthesiologists, hospital epidemiologists and infection control personnel, occupational health specialists, and public health professionals.

Titles of plenary sessions included Risk of Occupational Transmission of Bloodborne Pathogens, Microbiologic Aspects (dealing with aerosols and disinfection and sterilization issues), Prevention of Injuries by Needles and Other Sharp Instruments, Hand Protection, Body and Facial Protection, Evaluation of New products on the Market, Postexposure Management, Are Universal Precautions Realistic, and Bloodborne Pathogen Transmission to Patients. Feedback from the attendees indicated that the conference achieved its goals and that future conferences on these issues would be welcome.