OBJECTIVE: The purpose of this study was to identify factors associated with a significant reduction in hospital-wide nosocomial infection rates. METHODS: Methods included a 3-year retrospective and a 10-month prospective follow-up study in a 500-bed hospital with total surveillance, with data collected by two ICPs using Centers for Disease Control and Prevention (CDC) definitions. RESULTS: Infection rates averaged 3.9% over a decade and dropped in 1993 to 2.6% (p < 0.001). This change was unexplained by changes in surveillance methods. Slightly shorter lengths of stay and fewer inpatient surgeries may have had some impact. Additionally, two factors were temporally and statistically associated with the reduction: hospital-wide introduction of the Occupational Health and Safety Administration (OSHA) Blood-borne Pathogen Exposure Control Plan and Body Substance Isolation, and a barrier hand foam. CONCLUSIONS: Introduction of the OSHA Control Plan, with concomitant increase in glove use and widespread use of a barrier hand foam were associated with a significant reduction in nosocomial infection rates. Other demographic variables (shorter hospital stays and less inpatient surgery) probably also played a role. Risk-adjusted rates are necessary to make within-hospital comparisons over time.

Aged↗

PubMed1996

Assessment of urine collection technique for microbial culture.

Two methods of urine collection-clean catch and midstream only-were compared in 200 samples (100 with each technique). There were no significant differences between the two collection methods with regard to number of positive culture results or types and counts of organisms isolated. There is little if any added benefit to special preparation for urine collection for culture.

Adult↗

PubMed1996

Secreted amyloid beta-protein similar to that in the senile plaques of Alzheimer's disease is increased in vivo by the presenilin 1 and 2 and APP mutations linked to familial Alzheimer's disease.

To determine whether the presenilin 1 (PS1), presenilin 2 (PS2) and amyloid beta-protein precursor (APP) mutations linked to familial Alzheimer's disease (FAD) increase the extracellular concentration of amyloid beta-protein (A beta) ending at A beta 42(43) in vivo, we performed a blinded comparison of plasma A beta levels in carriers of these mutations and controls. A beta 1-42(43) was elevated in plasma from subjects with FAD-linked PS1 (P < 0.0001), PS2N1411 (P = 0.009), APPK670N,M671L (P < 0.0001), and APPV7171 (one subject) mutations. A beta ending at A beta 42(43) was also significantly elevated in fibroblast media from subjects with PS1 (P < 0.0001) or PS2 (P = 0.03) mutations. These findings indicate that the FAD-linked mutations may all cause Alzhelmer's disease by increasing the extracellular concentration of A beta 42(43), thereby fostering cerebral deposition of this highly amyloidogenic peptide.

Alzheimer Disease↗

PubMed1995

Compliance with handwashing and barrier precautions.

Compliance with handwashing and barrier precautions remains suboptimal in all health care settings and among all types of staff. Interventions to increase compliance include educational and motivational programmes, providing individual and group feedback on performance, modifying and improving equipment available, changing administrative policy and sanctions, and increasing staff commitment with role modelling. Single, isolated interventions are unlikely to meet with sustained success. A theory-based, multifaceted approach is indicated.

Cooperative Behavior↗

PubMed1995

Conflict of interest in academia.

Conflict of interest in academia has been increasingly recognized over the past decade. Yet, comparatively little is written in respect to this problem. The authors provide an overview of conflict of interest as it applies to nursing research and addresses how it can also affect practice and education. Resources for the development of guidelines to prevent conflicts of interest are presented.

Biomedical Research↗

PubMed1995

Geographically overlapping Alzheimer's disease registries: comparisons and implications.

In the medical and epidemiologic literature, a registry denotes a data base in which registrants share some common characteristic such as disease category. One criticism of registries is that they frequently collect subjects in a haphazard fashion and, hence, are "nonrepresentative of the population purportedly being represented." In this report, we compare two registries: an incident-based Alzheimer's Disease Patient Registry (ADPR) recruiting subjects for epidemiologic studies from a large health maintenance organization; and an Alzheimer's Disease Research Center (ADRC) registry recruiting subjects for phenomenologic, biologic, and pharmacologic studies. While these registries share personnel, overlap geographically, and use similar diagnostic procedures, they differ substantially in their missions and resulting recruitment strategies. We compared these registries with respect to demographic characteristics and cognitive features at subject entry. Subjects enrolled in the incident-based registry are older and report shorter time between symptom onset and recruitment. They are less demented and mirror the general population demographically more closely than do subjects in the other registry. The ADRC registry contains a much greater proportion of subjects with higher educational attainment.

Age Factors↗

PubMed1995

Quality assurance: evaluate thyself.

Explore the source record for details and available documents.

Nursing Services↗

PubMed1994

Selective amylin antagonist suppresses rise in plasma lactate after intravenous glucose in the rat. Evidence for a metabolic role of endogenous amylin.

Data presented here provide the first demonstration that circulating amylin regulates metabolism in vivo, and support an endocrine hormonal role that is distinct from its autocrine action at pancreatic islets. When rats were pre-treated with the potent amylin antagonist AC187 (n = 18), and then administered a 2 mmol glucose load, the rise in plasma lactate was less than in rats administered glucose only (n = 27; P < 0.02). When rats were treated so that plasma glucose and insulin profiles were similar (n = 8), the increase in plasma lactate in the presence of AC187 was only 50.3% as high as the increase when AC187 was absent (P < 0.001). These experimental results fit with the view that some of the lactate appearing in plasma after a glucose load comes from insulin-sensitive tissues. The experiments also support the view that an important fraction of the increase in lactate depends on processes inhibited by a selective amylin antagonist, most likely amylin action in muscle.

Amino Acid Sequence↗

PubMed1994

Opinions, knowledge, and self-reported practices related to infection control among nursing personnel in long-term care settings.

BACKGROUND: Because educational needs of staff in long-term care facilities regarding infection control have, not been well studied, we conducted this study to measure long-term care staff members' knowledge, self-reported practices, and opinions about infection control and handwashing. METHODS: A pilot study was conducted with 24 staff members of one long-term care facility to examine psychometric properties of study instruments. All nursing staff members (n = 105) from two additional long-term care facilities then completed a 14-item knowledge questionnaire, 22-item opinion survey, and 26-item survey of self-reported handwashing practices. RESULTS: Respondents were predominantly female with mean age of 46 years; most had completed high school. Mean length of employment in the study facility was 12.4 years. Registered nurses and licensed practical nurses scored significantly higher on knowledge (p = 0.0002) but significantly lower on self-reported practices (p = 0.01) than did trained nursing assistants. There was no significant correlation between self-reported practices and opinions regarding handwashing (p = 0.55). Neither level of knowledge nor positive opinion about the value of handwashing was associated with self-reported increases in handwashing practices. CONCLUSION: We conclude that education alone is not likely to be associated with changes in handwashing behavior. Instruments developed and tested in this study can be used in further research to correlate self-reported with observed behavior and to evaluate the effects of interventions on knowledge, opinions, and self-reported handwashing behavior.

Aged↗

PubMed1994

Use of image analysis to measure handwashing effectiveness.

BACKGROUND: This study tested a unique quantification technology (image analysis of fluorescent particles) for the measurement of handwashing effectiveness, comparing an automated system with traditional manual handwashing. In this instance, handwashing "effectiveness" was defined as ability of the technique to remove surface soil, as opposed to removal of microorganisms. METHODS: Sixty-five subjects washed their hands by manual handwashing (day 1) and automated handwashing (day 2). Hands were coated with an oil-based fluorescent suspension, photographed under controlled conditions, washed for 10 seconds, and rephotographed. Photographs from before and after handwashing were subjected to image analysis. RESULTS: Manual handwashing removed 73.1% of the particles; the automated method removed 23.2%. Parameters for use of image analysis as a technique to examine removal of gross contamination from the hands are given in the text. CONCLUSIONS: Although this method will not replace traditional culture methods for examining microbial removal, it is useful for measuring removal of particles (gross contamination) from skin or other surfaces. Under the conditions tested, manual handwashing was found to be decidedly superior to use of an automated system for removal of oil-based soil on the hands.

Automation↗

PubMed1994

Intraorganizational influence in the health care setting: a study of strategies preferred by head nurses and infection control practitioners.

BACKGROUND: The purpose of this study was to examine influencing strategy preferences among head nurses (HNs) in the operating room, HNs in critical care and ICPs. METHODS: A 21-item questionnaire on influencing strategy was used to identify 8 dimensions of influence: assertiveness, sanctions, ingratiation, rationality, bargaining, upward appeal, manipulation, and coalitions. The questionnaires were randomly distributed by regional coordinators in nine geographic regions throughout the United States to an operating room HN, a critical care HN, and an ICP at each of 12 hospitals (six with < 250 beds, six with > 250 beds). Two hundred ninety-seven respondents (92%) participated in the study. RESULTS: Although both HNs and ICPs rated rationality (logic, information, and appeal to intelligence) highest as the preferred approach to influence behavior, ICPs rated this dimension significantly higher than both operating room HNs and critical care HNs (p < 0.001). The least preferred strategy among all three groups was sanction (threatening job security). Critical care HNs rated manipulation (threatening to stop working with the other person) significantly higher than did both operating room HNs (p = 0.04) and ICPs (p = 0.01). Age was found to be a factor in the preference for sanctions as an influencing strategy, regardless of specialty: respondents younger than 40 years preferred sanctions less as a means to change behavior than did those older than 40 years (p < 0.01). CONCLUSION: These findings have implications for effective intraorganizational influence in health care settings.

Assertiveness↗

PubMed1994

Barrier protection with examination gloves: double versus single.

In a series of experiments, the barrier integrity of single and double vinyl and latex examination gloves were tested for dye and water leaks after being placed under stress. A total of 886 examination gloves (385 vinyl: single, 199; double, 186; and 501 latex: single, 290; double, 211) were tested with a standardized clinical protocol designed to mimic patient care activities. Leakage rates for single or double gloving were significantly higher for vinyl than for latex gloves. Single vinyl gloves were significantly more likely to leak than were double vinyl gloves (51.3% and 19.7%, p < 0.0001). However, there were essentially no differences in leakage rates for single or double latex gloves (4.1% and 3.8%, p = 1). Significantly higher rates of leakage were identified with the water leak test than with the dye test for vinyl (p < 0.001) but not for latex (p = 0.22) gloves. For vinyl but not latex gloves, there were significant differences in leakage rates by brand. We conclude that double gloving offers little advantage during routine procedures associated with minimal stress to the gloves or when latex gloves are worn.

Gloves, Protective↗

PubMed1994

Assessment of infection control programs in Maryland skilled-nursing long-term care facilities.

BACKGROUND: Nosocomial infections cause substantial morbidity and mortality among residents in long-term care facilities (LTCFs). Although infection control programs now exist in many LTCFs in the United States, little has been published regarding the effectiveness of these programs. The 1976 Centers for Disease Control and Prevention Study on the Efficacy of Nosocomial Infection Control (SENIC) established the effectiveness of infection control programs in acute care facilities. However, a limitation of that study was the exclusion of LTCFs. METHODS: The purpose of this pilot study was to assess infection control programs in LTCFs through the use of an Infection Surveillance and Control Questionnaire adapted from SENIC. The sample consisted of 123 skilled-nursing LTCFs in the State of Maryland. The questionnaire was completed by the person responsible for infection control activities in each LTCF. RESULTS: Results of the study show the following: (1) an upward trend in infection control activity in Maryland LTCFs, with the majority having medium activity, and (2) an estimated overall prevalence rate of infection of 4% on the basis of total resident census. CONCLUSION: The findings indicated that the Infection Surveillance and Control Questionnaire is a reliable instrument to assess infection control programs in LTCFs. A nationwide study is planned to examine the relationship between infection control activity and the risk of nosocomial infection among skilled-nursing LTCFs throughout the United States.

Aged↗