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PubMed1995

Towards European Union standards in hospital infection control.

Some providers of health care within the European Union (EU)--whether public or private--seem to give little priority to the establishment of quality control and common standards for infection control. Though uniform practice of infection control in hospitals was recommended by The Council of Europe no formal declaration about conformity or quality assessment of this important area seems to have been actively promoted within the EU. This is the setting against which local, and even international infection control protocols are promoted and discussed mainly by dedicated individuals and within informal groups, which may be endorsed by professional societies. So far no definite attempt to formulate European coordination has been recognized apart from initiatives taken by the World Health Organization (WHO) regional office for Europe. We may have a long way to go towards EU standards for infection control even though the benefits of European cooperation in the field of infection control have been recognized, and there are still serious doubts within the medical profession as to the feasibility of harmonization of these activities. EU standards in hospital infection control should be based on the best documented evidence and set at an appropriate level allowing wide participation. The medical profession must be involved and the inclusion of indicators of outcome must be considered.

Accreditation↗
PubMed2004

Looking inside the 2003 CDC dental infection control guidelines.

On Dec. 19, 2003, the Centers for Disease Control and Prevention published updated infection control guidelines for dentistry. The guidelines provide comprehensive information on all aspects of dental infection control. The recommendations are designed to prevent or reduce the potential for disease transmission from patient to dental health care personnel, from dental health care personnel to patient, and from patient to patient. Most recommendations will be familiar and are already practiced routinely. This article highlights major updates and additions in the CDC guidelines and provides additional information to assist readers in applying the latest guidelines. Almost a year ago, the CDC and Prevention published updated dental infection control guidelines in a supplement to the Morbidity and Mortality Weekly Report. The Guidelines for Infection Control in Dental Health Care Settings--2003 represent a collaborative effort between leading experts in infection control from other federal agencies, public health, and hospital epidemiology and infection control. Unlike regulatory agencies such as the Occupational Safety and Health Administration, the U.S. Food and Drug Administration, or the U.S. Environmental Protection Agency, the CDC cannot mandate certain practices; it can only recommend. However, the CDC is recognized as the nation's disease prevention agency and develops a broad range of guidelines intended to improve health care and to inform clinicians and the public. As a result, many dental licensing boards adopt CDC's recommendations, or variations of them, as the infection control standard for dental practice in their states. In contrast to the 1986 and 1993 CDC dental infection control recommendations, the 2003 CDC publication includes more background information and the scientific rationale for the recommendations. Also, readers will notice that each recommendation has a rank assigned to it categorizing the recommendation on the basis of existing scientific data, theoretical rationale, and applicability (Table 1). Most recommendations will be familiar and already are practiced routinely. As with previous CDC recommendations, the guidelines are designed to prevent or reduce the potential for disease transmission from patient to dental health care personnel; from dental health care personnel to patient, and from patient to patient. The following is an overview highlighting major updates and additions in the 2003 CDC guidelines. It is not intended to be a comprehensive review. Readers can access the complete document (Figure 1) by visiting www.cdc.gov/oralhealth/ infectioncontrol.

Centers for Disease Control and Prevention, U.S.↗
PubMed1987

The role and efficacy of the infection control nurse in U.S. hospitals.

Although infection control nurses have played a major role in hospital infection control programs for more than a decade, there was little published scientific evidence with which to evaluate whether having an infection control nurse, or any other component of an infection control program, would actually reduce a hospital's nosocomial infection rate. To develop such evaluative evidence, the Centers for Disease Control (CDC) carried out several nationwide studies in random samples of U.S. hospitals. Data from the studies show that having an infection control nurse for every 250 occupied hospital beds is an important component in reducing nosocomial urinary tract infections, bacteremia, and postoperative pneumonia.

Cross Infection↗
PubMed1991

Factors that affect patient attitudes toward infection control measures.

This study examined how differences in infection control procedures and patients' perceived knowledge of infection control, and how AIDS and hepatitis might affect attitudes toward the use of such measures. Patients receiving treatment at two sites where the methods of infection control and the frequency of their use differed (dental school and private dental practices) were surveyed concerning their approval/acceptance of infection control measures and self-report of knowledge concerning infectious disease and possible transmission of infectious disease during dental treatment. Data were collected from 379 patients, 272 from the dental school and 107 from five private practices. A high percentage (95 percent) of both dental school and private patients felt they were adequately protected, while fewer than 2 percent expressed anxiety about infection control procedures being used in either setting. Factors such as gender, age, and years of formal education did not significantly affect attitudes toward infection control measures, but age and education were correlated with perceived knowledge of infectious diseases. Patients' reported knowledge of infectious disease had a significant effect on their decision to leave a practice if the dentist was HIV positive. A significantly higher percentage of dental school patients felt that barrier infection control techniques should be used routinely. Patients treated where such techniques were not routinely used nevertheless expressed satisfaction with that level of protection, implying that patients tend to accept the level of infection control being practiced where they receive treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1982

A program for infection surveillance utilizing an infection control liaison nurse.

Today's infection control programs require a practical, efficient, and effective surveillance system. The Epidemiology Section of a 650-bed, university-affiliated hospital has implemented a two-phase approach. Phase I is surveillance by service. Each service receives a minimum of 2 months' concentrated surveillance, with critical care units monitored each month. The entire hospital is covered within a year. Monthly statistics are issued for each surveyed service and the individual patient units within that service. Phase II involves the infection control liaison nurse (ICLN). An ICLN, established in each patient unit, monitors infection control practices and acts as a liaison between the unit and the epidemiology section. Selected candidates are trained by the epidemiology section. The ICLN aids in more immediate identification of problems and better monitoring of aseptic practices. This approach is effective and manageable. Better understanding of unit problems result in more relevant educational programs with time to conduct additional activities. Statistics have more meaning and support for infection control is improved.

Connecticut↗
PubMed2000

Effect of infection control measures on the frequency of upper respiratory infection in child care: a randomized, controlled trial.

BACKGROUND: Acute upper respiratory infections are common in children who attend child care, and preventing transmission of disease in this setting depends on actions by child care staff. We set out to discover whether transmission of respiratory infections in child care could be reduced by improved infection control procedures. METHODS: We performed a cluster, randomized, controlled trial of an infection control intervention conducted in child care centers in 1 city in Australia. The intervention was training of child care staff about transmission of infection, handwashing, and aseptic nosewiping technique. Implementation of the intervention was recorded by an observer. Illness was measured by parent report in telephone interviews every 2 weeks. RESULTS: There were 311 child-years of surveillance for respiratory symptoms. By multivariable analysis, there was no significant reduction in colds in intervention center children across the full age range. However, a significant reduction in respiratory illness was present in children 24 months of age and younger. When compliance with infection control practices was high, colds in these children were reduced by 17%. CONCLUSIONS: This trial supports the role of direct transmission of colds in young children in child care. The ability of infection control techniques to reduce episodes of colds in children in child care was limited to children 24 months of age and under.

Australian Capital Territory↗
PubMed1982

Hospital infection control for varicella zoster virus infection.

More than 500 hospital employees and 209 patients were exposed to varicella zoster virus (VZV) as a consequence of 22 uncontrolled hospital introductions that occurred over a period of 34 months. Five introductions of varicella were by hospital employees who acquired the infection outside the hospital. Successful infection control of VZV requires an accurate definition of the susceptible population and the limitation of transmission. Individuals with prior VZV infection are epidemiologically not at risk for developing clinical illness. Serologic screening of hospital employees with uncertain prior VZV history is effective in identifying those at risk of developing the infection. A prior history of intimate exposure to VZV does not imply immunity in the absence of clinical illness.

Chickenpox↗
PubMed1990

AIDS and infection control in forensic investigation.

Infection control in the workplace is becoming an increasingly important issue, not only for health care workers, but also for any workers who could potentially be exposed to infectious material. We discuss the nature, modes of transmission, and infectivity of important infectious agents likely to be encountered in the course of forensic investigations. We provide principles and guidelines for appropriate procedures and practices to be followed in a program of infection control.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Survey of acute hospital infection control resources and services in the Republic of Ireland.

Following the development of national guidelines on the control of antimicrobial resistance in 2001, a survey was carried out in 2003 of all 68 acute hospitals in the Republic of Ireland on resources available and current practice to control and prevent nosocomial infection. Completed questionnaires were received from 66 hospitals (97%). The median number of acute inpatient beds per hospital was 156; this was 522 in regional/tertiary referral centres. Only 31 (47%) hospitals had on-site consultant microbiologist sessions, and there was an infection control nurse in 56 (85%) hospitals. Eighteen (29%) hospitals had an occupational health physician, and 48 (73%) hospitals had an infection control committee. There was a median of one isolation room for every 16 acute beds, and a median of five rooms with en-suite bathroom facilities per hospital in those hospitals that provided data. All hospitals had documented infection control policies, and these were available in electronic format in 25 (38%) hospitals. Fifty-five (83%) hospitals undertook surveillance of nosocomial infection, and alcohol-based hand hygiene facilities were available, either at a handwashing sink or at the entrance to a ward, in 57 (86%) hospitals. In the Republic of Ireland, there remains a significant shortage of microbiologists/infection control doctors, occupational health physicians and infection control nurses. Isolation facilities are also inadequate. Although there is much agreement internationally on the importance of nosocomial infection and the priorities for surveillance, there are no agreed basic minimum standards for the resources and facilities necessary to control and prevent nosocomial infection.

Cross Infection↗
PubMed1986

Infection control of herpes simplex virus infections in obstetrics and gynecology.

The rising incidence of herpes simplex virus (HSV) infections and concern about nosocomial transmission require the establishment of effective, reasonable infection control measures. Guidelines are based on the knowledge that herpes is usually transmitted by direct contact but may also be spread by droplets. Obstetric inpatients with evidence of HSV infection, including lesions or a positive culture, should be given a private room and bathroom. Gown and glove precautions should be taken by hospital personnel in contact with contaminated areas or articles. Perineal pads and bed linens should be handled as infected discharges and double bagged. The mother can handle and feed her infant under supervision. Infants with suspected herpes infections should be kept in a special care, observation or isolation nursery unit. Hospital personnel with herpetic lesions on exposed body surfaces should not work with newborns, if possible. They may work with obstetric patients if the lesions are covered and strict hand washing is employed. To avoid herpetic whitlow, gloves should be worn on both hands when handling suspicious lesions. An employee with active herpetic whitlow must wear a glove on the involved hand while working in patient care areas. Anecdotal reports suggest that acyclovir is of value in suppressing whitlow.

Cross Infection↗
PubMed2001

Infection control in developing countries.

Infection control activities in developing countries have increased substantially during the last decade, particularly in certain regions of the world. Pressure to improve hospital care cost-effectiveness, the emergence of highly resistant microorganisms, the perception of healthcare worker occupational hazards, and public claims for improved health assistance quality have been important factors responsible for this development. A major challenge for infection control personnel in developing countries is to sustain this development.

Cost of Illness↗
PubMed1998

Nursing home infection control: a status report.

Infection control in the long-term-care facility has expanded substantially since "Topics in Long-Term Care" debuted in this journal in 1989. This section has been on hiatus, but now, after a 4-year lag, resumes its exploration of these topics. In the first article, endemic and epidemic infections in long-term care are discussed and compared to nosocomial infections in the hospital. The basic elements of an infection control program in this setting, as well as the recent advances in the field, are reviewed.

Cross Infection↗
PubMed2005

Preventing infections in nursing homes: a survey of infection control practices in southeast Michigan.

BACKGROUND: Studies on adherence to infection control policies in nursing homes (NHs) are limited. This pilot study explores the use of various infection control practices and the role of infection control practitioners in southeast Michigan NHs. METHODS: A 43-item self-administered questionnaire and explanatory cover letter were mailed to 105 licensed NHs in southeast Michigan. A second mailing was sent to the nonresponders 4 weeks later. RESULTS: Significant variability existed in adoption of various infection control measures with respect to time spent in infection control activities (50% of facilities having a full-time infection control practitioner), definitions used in monitoring infections, and immunization rates (influenza: range, 0%-100%; mean, 73.2%; pneumococcal: range, 0%-100%; mean, 38.5%). CONCLUSION: Although strides have been made in infection control research in NHs, significant variations exist in implementation of infection control methods and guidelines. Future research should focus on identifying barriers to infection control in NHs.

Cross Infection↗
PubMed2003

Infection control in British nursing homes.

Infection control in British nursing homes is different from that in U.S. nursing homes in seveal ways. Most British nursing homes, for example, do not have a designated on-site infection control nurse, and several agencies are responsible for regulatory oversight. This article discusses the state of infection control in British nursing homes.

Health Care Surveys↗
PubMed1984

Training of personnel for infection control.

The overall objectives for implementing an infection control program are to make hospital personnel aware of nosocomial infections and to educate these persons in their role in decreasing the risk of these infections. The infection control practitioner (ICP) implements these objectives by performing surveillance to determine problem areas and by developing policies and procedures that prevent and control nosocomial infections. Appropriate qualities for an ICP include initiative, leadership, communication skills, commitment, and charisma. Expertise in patient care practices, aseptic principles, sterilization practices, education, research, epidemiology, microbiology, infectious diseases, and psychology are acquired skills. Local, state, and national organizations, as well as universities, are responsible for ICP training, In the US the Centers for Disease Control have established a training program for the beginning ICP and the Association of Practitioners in Infection Control (APIC) has developed a study guide for developing infection control skills. The ultimate responsibility for education is an individual obligation, however. Certification of the ICP would insure a minimum level of knowledge, thereby standardizing and upgrading the practice of infection control.

Asepsis↗
PubMed1991

New laboratory techniques for hospital infection control.

The clinical microbiologist has important responsibilities in hospital infection control. Duties include participating in hospital-wide infection control activities (especially the infection control committee), recovering and identifying accurately the organisms responsible for nosocomial infection, characterizing antimicrobial susceptibility of many of these nosocomial pathogens, reporting in timely fashion laboratory data relevant to infection control, carrying out the few routine microbiologic studies of the hospital environment that are useful, supporting investigations of specific hospital infection problems as they arise, and providing special typing studies when necessary to establish similarity or difference of organisms. In the past decade, improvements in laboratory instrumentation and/or procedures have provided dramatic help to infection control efforts in several of these areas. Among these are new techniques for more rapid detection and differentiation of organisms and improved systems of reporting for both patient data and trend analysis. Perhaps the most dramatic advances have come in special procedures for examining (typing) hospital organisms for similarity or difference; here, molecular and other techniques have permitted more definitive examination of a wider range of organisms than previously was possible. With health care resources in the United States now at a premium, the current and future challenge for laboratories is to make their participation in infection control more efficient as well as effective. Establishing adequate quality control of methods and obtaining clinical data to allow correct interpretation will be crucial for efficient use of the new typing procedures. Deciding when these techniques are needed and whether they should be performed on site also will be an important part of this process.

Clinical Laboratory Information Systems↗