Material for the Review section, in&ding books, monographs, articles, and audiovisuals, should bs sent to Sa$o Matsumiya, R.N., lnfactiin Control Nurse, Veterans Administration Madicaf Center, 500 Foothill B&d., Salt Lake City, UT 84143. Individual reprints of articles reviewed must be obtained from the designated author.

K. E. Fkrlsen, F? A. , 0. E. Schraufna@, J. Jackson: Am Dks trP:97-100, t983. Reprint requests: Kenrad E.

Nelson, M.D., ~&IO& Medical Center, 835 South Wolcott St., Chicago, IL 6V612.

Investigators at the University of Illinois Medical Center initiated a study of the efficacy of iodophors as chemical disinfectant for fiber- optic bronehoscopes after two incidents indi- cated that decontamination procedures were ineffective for Mycobacterium tuberculosis. One episode involved the transmission of M . tuber- cuIo.sis from one patient to another by a bron- choscope that had been disinfected with a commonly used iodophor solution. The second episode involved the isolation of M . tuberculosis on a surveillance culture from a bronchoscope after it had been cleaned and disinfected with an iodophor solution.

The investigators studied the tuberculocidal effect of various iodophor preparations and ac- tivated glutaraldehyde after exposure times of from 10 to 30 m inutes. In several of their exper- iments the iodophors failed to kill M . tubercu- losis. In addition, prospective surveillance cul- tures were performed on bronchoscopes that were in routine clinical use. These broncho- scopes were cleaned and disinfected with a povidone-iodine solution (1 part 70% ethyl al- cohol and 1 part sterile distilled water). During the surveillance period M . tuberculosis was re- covered after decontamination of a broncho- scope that had been used on a patient with ac- tive disease. Follow-up of patients who were subsequently exposed to this bronchoscope re- vealed no evidence of disease transmission. However, another unrelated episode was iden-

tified in which was converted instrument that bad been with active disease. The been cleaned with povidor~ exposures.

Many physicians routinely use povidone-iodine diluted in 70% and water to decontaminate scopes. However, iod0+3r co developed as skin a~i~~~~~

bronchoscopes becai;tse they do M . t&ercwfosisis. ICPs need to rei&f&ce the 43X recommendations for disinfection and sterili- zation of these instruments. At a m inimum, bronchoscopes should be s&e&z& with acti- vated glutaraldehyde or ethylene oxide after ex- posure to M . tuberculosis.

This brief report describes the various tests used in the d&gnus& of ~~~~~ B vim1 i&c- tion (HEW). It discusses the i hepatitis B n~~~t~ ,a# sponse to H&V in&a&on. The ance of serologic markers in i~~~~~~ d&rig the acute and convalescent ~#WNZJ is well de- picted in a simple Ggme. T&ore is an easy-to- follow fluw chart of the three ,m~3st useful serologic markers of hq3a@k3 E. % .k Cka% in- cludes a clinical interpretation of te& results as

Reviews: Literature

well as the infectivity and immunity status of the patient. The clinical significance of each of these serologic markers is also described in the text.

This article explains in nontechnical lan- guage what the various test results mean in an infection with HBV. ICPs will find it an excel- lent review as well as a useful reference for in- service education programs and questions re- garding hepatitis B serology.

lsolrtion guidellnms for obstetric patients and newborn infants Ft. A. Weinstein, K. M. Bayer, and E. S. Linn: Am J Obstet Gynecol 148:352-359, 1983. Reprint requests: Robert A. Weinstein, M.D., Department of Medicine, Michael Reese Hospital and Medical Center, 29th St. and Ellis Ave., Chicago, IL 60616.

The authors note that none of the published guidelines of isolation procedures currently available address the specifics of isolation for obstetric and newborn patients in an inte- grated, accessible format. To help fill this void in their own hospital, they developed a set of isolation policies for obstetric and neonatal patients and guidelines for maternal-infant contact and breast feeding. In this article they

Baoks

American Journal of

INFECTION CONTROL

outline their recommendations in a concise table that includes precautions for more than 30 infectious conditions that pose problems during the perinatal period. These guidelines take into account our improved understanding of the epidemiology of infections from hepatitis B, chlamydia, group B streptococcus, and her- pesvirus. They include precautions that should be taken for common conditions such as diar- rhea1 diseases, endometritis, and staphylococ- cal disease as well as some of the more unusual maternal-neonatal infections such as listeri- osis, toxoplasmosis, and tuberculosis. The guidelines include recommendations for time and duration of isolation for both maternal and newborn infections. They also address the is- sues of mother-infant contact (for purposes of bonding) and the advisability of breast feeding.

These guidelines are a welcome addition to Isolation Techniques for Use in Hospitals that do not include this very important group of hospitalized patients. The chart presented in this article is diagramed for quick and easy ref- erence; it should be available on all obstetrics/ gynecology units. Every ICP whose hospital includes an obstetric unit should be aware of this article.

Microbes, man and animals A. H. Linton. Bristol, England, 1982, John Wiley & Sons, Ltd.; 342 pages: hard cover $47.95.

This book is an outgrowth of a course on pathogenicity and epidemiology taught by the author at the University of Bristol. His relaxed, narrative style flows through most of the book; eight chapters, written by fellow staff mem- bers, are more confined presentations. The author acknowledges the contributions of his colleagues and the data excerpted from the sci- entific literature with a delightful quotation from Montaigne: “I have gathered a bouquet of

246

flowers from other men’s gardens: naught but the string is my own.”

The book is divided into three parts. Part I is devoted to interactions between the host and microorganisms in health and disease. The section dealing with the health of the host in- cludes a review of the natural mechanical bar- riers to infection, the function of normal flora, and how alterations of normal flora influence susceptibility to infectious diseases. The chap- ter on host responses to microbial invasion is an excellent review that includes tables on cel- lular involvement in the immune responses and mechanisms of immunologically mediated dis-