Material for the Review section, including books, monographs, reprints of articles, and audiovisuals, should be sent to Sego Matsumiya, R.N., Infection Control Nurse, Veierans Administration Medical Center, 500 Foothill Blvd., Salt Lake City, UT 84148.

LITER,ATURE

Catheter=assalciated bacteriuria: Failure to reduce attack; rates using periodic instillations of disinfectant into urinary drainage systtem Thompson RL, Haley CE, Searcy MA, et al: JAMA 251:747- 751, 1984. Reprint requests: Dr. R. P. Wenzel, Division of Virol- ogy and Epidemiology, P.O. Box 473, University of Virginia Medical Center, Charlottesville, VA 22908.

The investigators studied the efficacy of peri- odic instillations of hydrogen peroxide into urinary drainage systems to prevent catheter- associated bacteriuria. The study was a pro- spective, randomized, controlled evaluation of 668 medical and surgical patients undergoing indwelling urethral catheterization.

There was no difference between the hydro- gen peroxide group and the control group in the mean duration of catheterization before the onset of bacteriuria, the attack rate for bac- teriuria, or in the spectrum of etiologic agents recovered. Eleven percent of patients in the hy- drogen peroxide group developed bacteriuria compared with 9% in the control group. Bag contamination with the same organism re- sponsible for bacteriuria preceded infection in only five (7%) of the 68 bacteriuric patients; three of these patients were in the hydrogen peroxide group and two were in the control group.

The investigators concluded that periodic in- stillation of disinfectants into closed sterile drainage systems is not effective in reducing the incidence of catheter-associated bacteri- uria. With closed drainage, they thought that the drainage bag per se was an uncommon primary source for urinary tract infection and suggested that external contamination and periurethral migration of bacteria were more common sources for infection.

This article points out the importance of a well-designed prospective study to evaluate the

clinical impact of new infection control prac- tices. New devices, nursing techniques, or pro- cedures often increase the costs of infection control programs. It is imperative that the ac- tual efficacy of these new approaches be dem- onstrated before they are considered routine standards for care. This article also reviews the basic pathogenesis of catheter-associated uri- nary tract infections. The findings presented by the investigators suggest that the major portal of entry for bacteria into the catheterized uri- nary tract is extraluminal in the periurethral mucous sheath for patients in which closed sterile drainage is maintained.

Legionnaires’ disease. Aspects of nosocomial infection Meyer RD. Am J Med 76:657-663, 1984. Reprint requests: Dr. Richard D. Meyer, Division of Infectious Diseases, Department of Medicine, Schuman 635, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048.

This article reviews the present status of nosocomial Legionnaires’ disease. The author discusses the pathogenesis of Legionella pneu- mophilu with particular emphasis on the role of immunosuppression in hospitalized patients.

The author discusses all that is presently known about the search for sources and modes of transmission of Legionella. He reviews en- demic and epidemic occurrences of legionel- losis in hospitalized patients and comments on some of the apparent paradoxes of nosocomial transmission, such as the limited number of cases despite the almost ubiquitous distribu- tion of L. pneumophila in institutional water. Prevalence of nosocomial as well as commu- nity acquired L. pneumophila infections are discussed. The clinical manifestations, labora- tory diagnosis, therapy, and prevention and

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