Hands and instruments used by healthcare workers may serve as vectors for the nosocomial transmission of microorganisms. The use of cellular telephones by medical personnel and the associated nosocomial transmission of pathogens have not been thoroughly examined. Findings from our study show that cellular telephones are commonly used by hospital personnel, even during patient contact. One-fifth of the cellular telephones examined in this study were found to harbor pathogenic microorganisms, showing that these devices may serve as vectors for transmission to patients.

The aim of the project was to determine whether the rate of contaminant blood cultures could be reduced by using a team of dedicated phlebotomists. Comparisons were made between adult patients requiring blood cultures for suspected bacteremia on medical and surgical units before and after the introduction and withdrawal of a dedicated blood culture team. The results showed that a significant reduction in the contaminant blood culture rate was achieved by the blood culture team (P < 0.001; chi(2) test). Therefore, in our experience, the rate of contaminant blood cultures can be reduced in a teaching hospital by using a team of dedicated phlebotomists. Calculations made with our data and those published by others suggest that cost savings from reducing false-positive blood cultures are greater than the cost of the blood culture team.

Objective: To determine whether telephone follow-up of selected female patients seen in an urban ED would improve domestic violence (DV) case finding. Methods: A prospective, cross-sectional study was conducted on consecutive female patients between the ages of 16 and 65 years treated in an urban trauma center during July and August 1995. Record review identified those patients with conditions suggesting increased risk for D V injury; substance abuse; complaints or diagnoses related to stress, anxiety, depression, or panic attack; or complaints of headache, nonspecific abdominal pain, generalized fatigue, or numbness lasting > I week. Attempts were made to telephone all patients who had high-risk presentations within 3 days of their emergency visits. Patients were contacted by a trained interviewer regarding the circumstances of their visits. Results: There were 142 (9%) high-risk presentations out of 1,500 ED visits by women. Of these high-risk visits, 68 patients denied DV, 19 patients did not speak English, 16 patients gave an incorrect telephone number, 18 patients could not be reached after 3 telephone calls, and 6 patients did not give a telephone number. Of the remaining 15 patients, 5 were diagnosed at the initial visit as having experienced DV, and 10 admitted on the follow-up call that the visit had been related to DV or emotional stress at home. Conclusion: A structured interview, conducted via telephone in follow-up of released ED patients, identified an additional 10 victims out of 142 high-risk presentations and 1,500 total ED presentations. This approach is labor-intensive, with a relatively low yield. Nonetheless, prospective identification of selective high-risk cases by physicians, coupled with subsequent social service telephone contact, may be a complement in department case finding.Key words: domestic violence; injury prevention; domestic assault; emergency department; social services. episode of DV.' While there is controversy about the estimated rates of DV among ED patients,6 there is agreement that obtaining a history of DV from victimized women patients can be difficult. It is estimated that health care providers diagnose DV 4% of the time it is present.' There are many reasons for this failure, including the provider's failure to ask the right questions and the patient's embarrassment or fear to give the right answers.'Experts in the field of family violence emphasize that, to make the diagnosis, there must be a structured interview in a safe and secure environment where the patient can feel comfortable.' Many EDs, especially those in urban areas with a high census and a high prevalence of injured and drug-abusing patients where DV is likely to be greatest," are the antithesis of the atmosphere needed to inspire patient confidence. Even with the best of training and intentions, many providers may not take the necessary unhurried history for potential DV given a crowded ED with a large backlog of patients to be seen. We experienced low rates of suspected DV documentation in our ...