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PubMed1988

Infection control in Maryland nursing homes.

We surveyed 53 randomly chosen Maryland nursing homes for infection control policies and practices. The majority had written infection control policies, an infection control committee, and a designated practitioner for infection control; in most facilities, however, the infection control practitioner had other major duties, spent little time on infection control, and had no specific training in the field. Thirty-four percent of homes in the survey performed routine environmental cultures, and more than half had insufficient or no isolation policies for infected decubiti and acute diarrhea. In general, the intensity of infection surveillance and the extent of infection control measures increased with the level of care provided, from domiciliary homes to homes providing chronic care. Employee health care fared generally well: 60% of homes offered influenza vaccine to employees and 66% had restriction policies for employees with upper respiratory infections. While the majority of homes offered the influenza vaccine to residents, acceptance of other vaccines recommended for the elderly was less widespread. We conclude that infection control efforts are made in most Maryland nursing homes; however, appropriate guidelines and more effort to educate nursing home personnel in proper infection control practices are badly needed.

Aged↗

PubMed1979

Consortium upgrades 12 hospitals' infection control programs.

A consortium's infection control nurse and physician epidemiologists boost the member hospitals' infection control efforts through onsite rounds, establishment of group standards, reports on each hospitals' performance, ongoing education, medicolegal assistance, monitoring of use of isolation evaluation of infection control products, and other activities.

Consultants↗

PubMed1992

Nosocomial infection control activities in Thailand 1989.

The study on the infection control activities was done in 89 general regional and community hospitals. Seventy-seven hospitals responded to the questionnaire (87%). All hospitals had set up infection control committees. Infection control nurses had been appointed in 84 per cent; 45 and 39 per cent were part-time and full-time ICNs respectively. Reports of surveillance were sent to the committees in 74 of the hospitals. Doctors took part in infection control in 75 per cent of the hospitals. Isolation units were available in 86 per cent and incinerators were installed in 13 per cent of the hospitals. These results indicate that the allocation of manpower and resources are not sufficient for effective nosocomial infection control.

Cross Infection↗

PubMedDate not supplied

A statewide characterization of hospital infection control practices and practitioners.

Selected features of infection control programs among the 163 general hospitals in Tennessee were surveyed in 1976 and 1979. Each hospital but one had a designated infection control practitioner. Three-fourths of the hospitals had fewer than 200 beds and most were in rural areas. The practitioners in these small hospitals worked in an isolated professional milieu: few (4%) had attended a basic training course or were members of a national (11%) or local (16%) infection control association. They also had significantly less access to standard infection control resource publications than did practitioners in large hospitals. Use of aqueous quaternary ammonium compounds for disinfection was reported by 37% of all hospitals in 1979; 68% of hospitals routinely performed bacteriologic cultures of personnel or the environment. In contrast, only 3% of hospitals did not have a policy specifying the use of sterile closed-system drainage of indwelling bladder catheters. Although these practices varied somewhat by hospital size, the differences were not statistically significant. Modest improvement in each parameter was noted since 1976. Pathology was the most common medical specialty (34%) among chairman of infection control committees; internal medicine and pediatrics accounted for only 13%. The practice of routine microbiologic monitoring was significantly more common among hospitals with chairmen who were pathologists. The implications of these findings for national priorities in hospital infection control are discussed.

Bacteria↗

PubMed2004

Infection control programs in Italian hospitals.

OBJECTIVE: To quantify the frequency and features of infection control programs implemented in Italian public hospitals. METHODS: In 2000, a questionnaire was mailed targeting all teaching and research hospitals and those with more than 300 beds, and a random sample of 50% of the district hospitals with fewer than 300 beds. RESULTS: The overall response rate was 80%. Fifty percent of the 428 respondent hospitals claimed to have an infection control committee, 43% an infection control physician (average, 1 infection control physician per 2,963 beds), and 33% an infection control nurse (average, 1 infection control nurse per 572 beds). Having an infection control committee, nurse, and physician occurred significantly more frequently in Northern and Central Italy, where the Regional Authority had implemented a regional infection control policy, and in larger hospitals. Thirty-nine percent of the hospitals claimed to have ongoing surveillance in place, mostly based on laboratory results. Eighty percent of the hospitals had defined at least one written protocol related to infection control policies, mostly for housekeeping, cleaning, disinfecting and sterilizing patient equipment, or standard precautions; on the contrary, policies aimed at preventing specific infections were less frequent. CONCLUSION: This national representative survey showed that the infrastructure for infection control is suboptimal when compared with the guidelines and surveys published in other countries.

Cross Infection↗

PubMed2006

The 2003 SARS outbreak: global challenges and innovative infection control measures.

In early 2003, the global infection control community faced a great challenge, sudden acute respiratory syndrome (SARS). The rapid spread of SARS, its capacity to infect health care workers, and its many unknown features in the early days of the outbreak meant that health care workers were unsure of the most effective methods of infection control to prevent disease transmission. These conditions made designing appropriate, effective and standard infection control responses difficult. Innovation was necessary. This article provides a brief overview of global challenges in infection control and SARS. The author reports field observations and describes five selected examples of highly innovative, SARS-related infection control practices observed in three affected countries during the height of the 2003 outbreak. These examples relate to risk assessment, patient segregation, strategies to limit access to clinical areas, health care worker protection, and efforts to promote public confidence. Many of these strategies could be considered for use in the post-2003 SARS era, especially in preparation for an influenza or Avian influenza pandemic.

Disease Outbreaks↗

PubMed2006

Impact of an aggressive infection control strategy on endemic Staphylococcus aureus infection in liver transplant recipients.

BACKGROUND: Methicillin-resistant Staphylococcus aureus has emerged as a leading pathogen in transplant recipients and has become endemic in many institutions where transplantation is performed. The role of active surveillance programs based on the detection of colonization in the prevention of S. aureus infection in liver transplant recipients has not been defined. METHODS: A total of 47 consecutive patients who underwent liver transplantation during 1996-1999 were compared with 97 patients who received a liver transplant during 2000-2004 after implementation of an intensive intervention program that included use of surveillance cultures to detect nasal and rectal colonization, use of cohorting and contact isolation precautions, and decolonization with intranasal mupirocin therapy. RESULTS: The rate of new acquisition of S. aureus colonization of nares after transplantation decreased from 45.6% (21 of 46 patients) during the preintervention period to 9.9% (9 of 91 patients) during the postintervention period (P<.001). An increased length of hospital stay (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P<.002) was associated with new carriage acquisition, and transplantation during the postintervention period (odds ratio, 0.21; 95% confidence interval, 0.08-0.51; P<.001) was independently protective against new carriage. The rate of infection due to S. aureus decreased from 40.4% (19 of 47 patients) during the preintervention period to 4.1% (4 of 97 patients) during the postintervention period (P<.001), and the rate of bacteremia decreased from 25.5% (12 of 47 patients) to 4.1% (4 of 97 patients), respectively (P<.001). Overall, S. aureus infections occurred more frequently among patients with new carriage than among patients who were carriers at the time of transplantation (P<.001) or patients who were noncarriers (P<.001). CONCLUSIONS: Use of active surveillance cultures to detect colonization and implementation of targeted infection control interventions proved to be effective in curtailing new acquisition of S. aureus colonization and in decreasing the rate of S. aureus infection that was endemic in our population of liver transplant recipients.

Cohort Studies↗

PubMed2005

[Desirable role of the clinical laboratory in hospital infection control].

Prevention of hospital-acquired infection is the most important strategy to control infection in terms of the well being of patients and the medical economy. Infection control in hospitals is carried out by the action against hospital-based infection, for which clinical laboratory functions, such as surveillance and outbreak investigation, should be primary responsible. Therefore, it is essential for clinicians to have clinical laboratory rapidly detect pathogenic organisms and provide new and update information on appropriate antibiotics and clinical isolates. It is also desirable for clinical laboratory to collaborate with infection control team (ICT) and link nurse, and provide them with useful information on on-going infection.

Anti-Bacterial Agents↗

PubMed1991

Health care personnel's perception of infection control.

Although the administration believes the 20-year-old infection program at the authors' institution has been effective in reducing nosocomial infection risk, the perceptions of nurses and physicians were unknown. Two hundred and twenty-seven nurses and 50 physicians were surveyed to determine their concept of infection control. Of all surveyed, 97% considered handwashing the most critical aspect of infection control and felt that additional teaching would increase this practice. Although physicians (40%) and nurses (30%) surmised the major infection control problem was lack of handwashing, 95% of physicians and 90% of nurses believed they personally washed their hands correctly and appropriately. One-half of all surveyed were not able to define 'asepsis' correctly. Sixty percent of nurses and 70% of physicians were not familiar with a monthly nosocomial report. On-site inspections and more educational programs were the primary recommendations of nurses and physicians. Of all participants, 99% could name the infection control nurse, whereas only 11% could name the infection control committee chairman. Although most infection control nurses feel they create a negative impression when they make rounds, the attitudes of nurses (81%) and physicians (68%) were positive. It is concluded that the perception of infection control differs among nurses and physicians. An effective infection control program must address the specific needs of all groups.

Attitude of Health Personnel↗

PubMed1988

The role of the infection control doctor.

The ideal infection control doctor would be a combination of an infectious disease specialist, microbiologist, epidemiologist, social worker, psychologist, teacher, researcher, antibiotic therapy specialist, policeman, priest, supervisor for housekeeping, architect, partner for the infection control nurse, and who should combine the qualities of Mary Poppins, Sherlock Holmes, Francis von Assisi and Margaret Thatcher. A new role is that of a specialist in environmental pollution by detergents, disinfectants and certain disposables.

Cross Infection↗

PubMed1994

Same problems, different system? A UK perspective of infection control in an American hospital.

1. Infection control practitioners are at the forefront of enforcement of infection control procedures in the US. 2. HIV infection is cited as the single most prominent cause of increases in cases of TB in most US health departments. 3. Attention to record keeping is an area in which infection control practitioners in the UK would be well advised to emulate their US colleagues.

HIV Infections↗

PubMed2004

Making hospitals safer: the need for a global strategy for infection control in health care settings.

Healthcare Associated Infections (HAI) have a substantial impact on morbidity, mortality and health costs. At least 5 to 10% of patients admitted to acute care hospitals acquire an infection. Factors that promote HAI include underlying diseases and decreased patient immunity; invasive diagnostic and therapeutic techniques, the widespread antimicrobial resistance, lack of infection control measures and environmental hygiene. HAI are preventable and infection control programmes are cost-effective. Health care workers education, HAI surveillance, appropriate legislation and basic infection control measures are the essential elements of an infection control programme. A recent consultation on the 'Prevention and Control of HAI' identified the need for an international strategy that would establish standards, procedures and methods for HAI surveillance, prevention and control and promote their implementation at national level.

Cross Infection↗

PubMed1986

Infection with human immunodeficiency virus in the hospital. Epidemiology, infection control, and biosafety considerations.

Infection with the human immunodeficiency virus (HIV) (formerly HTLV-III/LAV) is transmitted by sexual contact, by blood and blood products, and perinatally. There is no evidence for casual transmission. The risk to health care workers is low but appropriate infection control precautions should be taken. Specimens should be transported to the laboratory in plastic bags labeled with an easily recognized biohazard warning. Placing patients in private rooms is unnecessary unless a patient has an additional illness that requires such an arrangement. Disinfection, sterilization, housekeeping, and waste management must be done according to recommended guidelines. Asymptomatic hospital personnel with HIV antibody can safely engage in direct patient care. Routine HIV serologic screening of personnel or patients is not recommended. Counseling and HIV antibody testing should be offered to pregnant high-risk women. Laboratories that process specimens potentially containing HIV virus should adhere to maximum containment procedures. An intensive and continuing educational program on the epidemiology of HIV infection and appropriate infection control practice is recommended.

Acquired Immunodeficiency Syndrome↗

PubMed2000

The fifth evolutionary era in infection control: interventional epidemiology.

A historical review of infection control over the last 4 decades indicates that the field has evolved from being one whose investigative work laid the foundation for understanding the chain of infection to an influential profession whose research on effective prevention methods have revoluntionized clinical practice throughout the world. Underlying our successes is the fact that growth in the profession has brought with it an enormous expansion in responsibilities, which in turn has impacted, in some cases severely, the personnel and time resources of infection control departments. At the same time, the economic pressures brought on by the upheavals in the business of health care have trickled down wherein it now influences the makeup and effectiveness of infection control programs. To continue with our mission of reducing morbidity and mortality, and perhaps to avoid a diminishing of our own professional influence, it will become essential that new approaches to the management of infection control programs be implemented. The approach must start by incorporating a basic mandate for change in the infection control professional.

Cross Infection↗

PubMedDate not supplied

Three major issues in infection control.

In considering the three major issues in infection control the author decided upon education and empowerment, community practices, and research availability and application as they span a range of infection control practices and healthcare settings. Education and empowerment of staff is needed to ensure safe practice. This requires collaboration between education providers and infection control personnel and should be available to all disciplines of staff. Infection control needs to be seamless across the primary and secondary care interface and must include infection prevention advice to the population in general. Evidence relating to infection control is either lacking or not achievable. When it is available, it is not always implemented because of lack of resources.

Humans↗

PubMed1996

Infection control practices in the home: a survey of households of HIV-infected persons with hemophilia.

OBJECTIVE: To assess infection control practices and risk for human immunodeficiency virus (HIV) transmission in households where home infusion for hemophilia is used. DESIGN: Cross-sectional prospective survey from 1992 through 1994. SETTING: Hemophilia treatment centers. PARTICIPANTS: Human immunodeficiency virus (HIV)-infected persons with hemophilia who receive home infusions of clotting factor concentrate and their household members. MAIN OUTCOME MEASURES: Frequency of specific infection control practices in the home and the risk of HIV transmission to household members. RESULTS: We surveyed 235 persons from 75 families (79 HIV-infected persons with hemophilia and 156 household members) about infection control practices in the home. Forty-eight percent of household members surveyed helped with the infusion process. Of 74 members who assisted with infusion, 13 (18%) had sustained a needlestick injury, 11 of whom were injured during the past year. One hundred fifty household members tested for antibody to HIV were antibody negative. These household members had a total of 903 person-years of contact after HIV was diagnosed in the index case. Household members' adherence to recommended infection control measures was highest for washing hands after cleaning up infusion equipment and waste, and for using sharps disposal containers. Adherence was lowest for wearing gloves when helping with infusions and proper disposal of bloody waste from the infusion. CONCLUSIONS: No HIV transmission was found among persons living with HIV-infected persons with hemophilia, although there was a high rate of needlestick injuries during home infusion. Because persons who assisted with infusions often did not wear gloves and many households did not dispose of bloody waste properly, hemophilia treatment center personnel should emphasize these areas when training for home infusion. Adherence to appropriate infection control practices should help to keep the risk of HIV transmission in households extremely low.

Adolescent↗

PubMed2004

Infection control guidelines, the new generation.

Attention to infection control and concerns over transmission of disease is not a new phenomenon relative to the human immunodeficiency virus epidemic. There is evidence dating back to the early part of the 19th century of theories and practices designed to minimize infection risks associated with health care delivery. These strategies were not necessarily based in research, or what is referred to as evidence-based, but more on observation. Nonetheless, the practices were successful and evolved over time into principles of infection control. Over the past decade, guidelines for infection control have become evidence-based, where possible. In the absence of evidence, assumptions based on past experience and knowledge have driven recommendations. The newly released Centers for Disease Control and Prevention Guideline for Infection Control in Dental Health-Care Settings, 2003, reflect a format different from the 1993 guidelines, and the recommendations are ranked according to categories of existing scientific data, theoretical rationale, and the opinions of experts.

Blood-Borne Pathogens↗

PubMed2003

Infection control during gastrointestinal endoscopy.

Infection-control issues during gastrointestinal endoscopy, which are becoming increasingly important, can generally be divided into three major areas: (1) infectious complications resulting from a patient's own microbial flora (autologous), (2) infections transmitted from patient to patient by way of the endoscope (exogenous), and (3) infections transmitted between the patient and the health-care provider. The mean frequency of postprocedure bacteremia ranges from 0.5% for flexible sigmoidoscopy to 2.2% for colonoscopy, 4.2% for esophagogastroduodenoscopy, 8.9% for variceal ligation, 11% for endoscopic retrograde cholangiopancreatography, 15.4% for variceal sclerotherapy, and 22.8% for esophageal dilation. Although postprocedure bacteremia is not uncommon, it seldom results in infectious complications. Exogenous infections transmitted during endoscopy, which are extremely rare, generally result from failure to follow accepted guidelines for the cleaning and disinfection of gastrointestinal endoscopes, underscoring the importance of meticulous attention to endoscope reprocessing. Finally, although the risk of patient-staff transmission of infection is also rare, standard infection-control recommendations are important in protecting both patients and health-care providers.

Antibiotic Prophylaxis↗