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PubMed2001

Diploma in Hospital Infection Control: a progress report.

The Diploma in Hospital Infection Control (DipHIC) was established by the Hospital Infection Society (HIS), the London School of Hygiene and Tropical Medicine (LSHTM) and the Public Health Laboratory Service (PHLS) in 1997 and has now completed two examinations. We outline progress since the announcement of the diploma and changes to the written examination and reflective portfolio. The reflective process is described and guidance provided to active infection control practitioners wishing to consider application for the diploma by accreditation of prior learning.

Certification↗

PubMed2004

Validation of a multicenter computer-based surveillance system for hospital-acquired bloodstream infections in neonatal intensive care departments.

Automated systems can facilitate surveillance for health care-associated infections. The New York Antimicrobial Resistance Project (NYARP) electronically monitors trends in bloodstream infections from 6 medical centers in New York, NY. To validate NYARP's data, episodes of health care-associated bloodstream infections detected by this system were compared with those obtained by an infection control practitioner performing an unrelated study in 2 participating neonatal intensive care departments. The sensitivity (84%), specificity (99%), and positive (84%) and negative (99%) predictive values of NYARP were excellent when coagulase-negative staphylococcal bloodstream infections were removed.

Bacteremia↗

PubMed1998

Use of amoxicillin-clavulanate and resistance in Escherichia coli over a 4-year period.

OBJECTIVE: To reduce the use of amoxicillin-clavulanate after high-resistance rates in Escherichia coli were detected. DESIGN: Intervention study; the interventions were introduced successively over a 4-year period while closely monitoring the resistance patterns. SETTING: A 260-bed acute-care hospital in Switzerland. INTERVENTIONS: Introduction of therapeutic guidelines for specific departments or indications, which proposed alternative antibiotics to amoxicillin-clavulanate. The perioperative prophylactic use of amoxicillin-clavulanate was eliminated completely. RESULTS: The absolute amount of amoxicillin-clavulanate consumed decreased by 23%, from 24.8 g per 100 patient days in 1992 to 18.5 g per 100 patient days in 1995. The number of courses, a parameter that takes the prophylactic use into account, decreased by 62% from 2.3 per 100 patient days in 1992 to 0.9 per 100 patient days in 1995. The percentage of sensitive strains increased from 54.9% (n=512) in 1992 and 54.0% (n=506) in 1993 to 72.1% (n=546) in 1994 and 83.1% (n=668) in 1995. No major changes were detected for other antimicrobials, such as cotrimoxazole, tetracycline, or cefuroxime, used in this 4-year period. CONCLUSIONS: A decrease in the use of amoxicillin-clavulanate was followed by an increase in susceptibility of E coli to it. It was not possible to prove a causative relationship. Only a temporal association was discovered. The reduction of the use of amoxicillin-clavulanate was achieved through the implementation of treatment guidelines, facilitated through a close collaboration among the clinical pharmacists, the infection control practitioner, the microbiology laboratory, and the physicians in charge of the respective departments.

Amoxicillin-Potassium Clavulanate Combination↗

PubMed1996

The infection control information system of the Hospital Infections Program, Centers for Disease Control and Prevention.

In December 1990 the Investigation and Prevention Branch, Hospital Infections Program, Centers for Disease Control and Prevention (CDC), developed the Hospital Infections Program infection control information system (HIP ICIS) to respond more efficiently to more than 200 public inquiries (telephone or written) that HIP receives daily. The HIP ICIS allows anyone with a Touch-Tone telephone, fax machine, or computer to access CDC information that answers the most commonly asked questions from infection control practitioners and other health care workers. The HIP ICIS has received approximately 56,608 inquiries; of these, 33% were about CDC guidelines on prevention and control of nosocomial infections, 25% about issues related to HIV, 16% about sterilization and disinfection of medical devices, 8% about methicillin-resistant Staphylococcus aureus, 3% about long-term care facilities, and 17% miscellaneous topics (e.g., nosocomial infection rates, infection control courses, and ventilation, construction, and renovation of hospitals). The HIP ICIS is an efficient method of providing infection control guidance to the infection control community. In this article, we a) review the history of the HIP ICIS, b) present data on HIP ICIS usage, c) summarize the current HIP ICIS contents, and d) present step-by-step instructions on how to access the HIP ICIS.

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

PubMed1987

Staphylococcus epidermidis: a significant nosocomial pathogen.

Staphylococcus epidermidis is an organism formerly believed to be nonpathogenic. It is now recognized as a pathogen, causing infections on implanted devices and among immunosuppressed patients. Further, it has been involved in the development of resistance to a number of antibiotics. The epidemiology of this organism, its pathogenesis, and its treatment are important to infection control practitioners.

Anti-Bacterial Agents↗

PubMed2004

[Surgical site infections after cesarean section: results of a five-year prospective surveillance].

AIMS: To determine the incidence of surgical site infections and to identify risk factors for infections. METHOD: A prospective study of surgical site infections (SSI) after cesarean section was carried out from September 1997 to September 1998 (pilot study) and from January 2000 to August 2003, using the methodology of the American National Nosocomial Infection Surveillance System. Follow up of women was performed by midwives until discharge and during the post-natal visit. Suspected surgical site infections were confirmed by surgeons and infection control practitioners. The microbiological file of each patient was edited 30 days after cesarean section. Risk factors were analyzed using a logistic regression model. RESULTS: During the pilot study, infection rate was estimated at 3.2%. At multivariate analysis, factors independently associated with an increased risk of SSI were ASA score > 1, performance of cesarean section in a room not dedicated to this activity, and use of an open urine drainage system. During the following years (2000-2003), infection rates progressively decreased to reach 1.9% in 2003. Infections included superficial wound infections (involving skin and subcutaneous tissue) (47%), deep wound infections (involving deep and soft tissue (fascia and muscle) (20%) and organ/space infections (i.e. endometritis, pelvic abscess) (33%). Infections occurred after patient discharge in 47.5% of cases and diagnosis was based only on clinical findings in 30% of cases. Infected patients were hospitalized longer (median: 6 days) than non infected patients. CONCLUSION: Prospective surveillance of SSI led to better awareness of infectious problems among health care workers, to identification of risk factors and evaluation of health procedures. Surveillance contributed to a decrease in nosocomial infections.

Adult↗

PubMed1991

Novel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens.

Nosocomial pathogens frequently are resistant to antimicrobial agents. Although methicillin-resistant strains of Staphylococcus aureus continue to be a major problem in many hospitals, several new types of resistance determinants have been noted among organisms causing hospital-acquired infections. The mechanisms include extended spectrum beta-lactamases in gram-negative bacilli; resistance to beta-lactams, glycopeptides, and high levels of aminoglycosides among enterococci; quinolone resistance in isolates of methicillin-resistant S. aureus; and the spread of multiple resistance genes simultaneously in gram-negative organisms via Tn21-related genetic elements. These novel mechanisms of resistance complicate the treatment of nosocomial infections by limiting the number of effective antimicrobial agents available to the clinician. It is important for infection control practitioners and microbiologists to work together to detect and control the spread of resistant pathogens in the hospital setting.

4-Quinolones↗

PubMed1992

Chronology of a hospital-wide measles outbreak: lessons learned and shared from an extraordinary week in late March 1989.

In March 1989, Mount Sinai Hospital, a community hospital in Hartford, Connecticut, faced a potential hospital-wide outbreak of measles when eight cases of measles occurred among medical personnel during several days. This article describes the chronology of events, from the initial discovery of the outbreak to the evolution of the hospital-wide containment program designed to protect patients and staff members. Measles IgG immune status was determined for 1249 employees during a 9-day period. Measles vaccine and immune serum globulin were administered to patients and employees. We offer advice from our experience for infection control practitioners who may face outbreak situations in their institutions.

Adult↗

PubMed1994

Controlling ambient biohazards; what you can't see can hurt.

The effective control of ambient biohazards is clearly a team effort. This team includes the EM, the risk manager, the infection control practitioner, purchasing, facilities management, and others. Control measures relate to many different risk factors, such as the environment at the healthcare facility, the healthcare personnel, the procedure, the use of certain devices, or the actual infection host (patient). Usually, only environment-related risk factors are of concern to the EM. For fungal infections, such as Aspergillus, CDC recommends that control of environmental risk factors requires routine maintenance of hospital air-handling systems and the rooms of immunosuppressed patients, as well as extra protection designs when there is new construction. This can be very costly. For Legionella infections, CDC recommends proper design, placement, and maintenance of cooling towers; routine maintenance of water-supply systems; and when contaminated water supplies are identified, appropriate decontamination. CHEM believes that the CDC recommendations are a good way to control these ambient biohazards, but is concerned about some of the costs to meet all the Aspergillus recommendations. Hospitals must weigh costs before proceeding, especially with Category II recommendations that are only "suggested for ... many hospitals." For example, at facilities with no cases of infection, if following the CDC recommendations means that filters need to be changed and ducts cleaned more frequently than usual, the costs may not be worth it. On the other hand, if there have been a series of confirmed cases of nosocomial Aspergillus pneumonia, the cost of HVAC retrofitting or using a portable HEPA filtration systems may be worth it.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollution↗

PubMed2006

[Infection control measures in surgical wards and operating theaters].

A variety of infection control measures are practiced to decrease the risk of transmission of pathogens. Standard precautions are thought to be the most effective against healthcare-associated infections. However, compliance with standard precautions is not sufficiently high in Japanese hospitals. Frequent handwashing is an important measure to reduce the risks of transmitting infectious organisms from one person to another, although it is not easy to maintain high compliance in healthcare settings. This problem has not been fundamentally resolved, although infection control practitioners have addressed this problem for more than 100 years. It is recommended that healthcare workers wear personal protective equipment, such as masks, gowns, gloves, goggles, and face shields, to provide barrier protection. Environmental consideration of operation rooms must be performed in order to decrease surgical site infections. Operating theaters should be cleaned routinely, if possible using a wet vacuum. Clean air should be supplied through high-efficiency particulate air filters and positive pressure maintained. Surgeons should be aware that they are an important potential source of surgical site infection.

Humans↗

PubMed1988

Linking hospital epidemiology and quality assurance: seasoned concepts in a new role.

In this initial presentation, certain concepts central to infection control epidemiology have been discussed and related to the evaluation of noninfectious events in medical care. While most of the examples have focused on parallels in noninfectious hazards of hospital care, a more global evaluation of the functional benefit(s) and cost-effectiveness of medical care intervention using similar epidemiologic principles is possible and of equal value. These issues will be discussed in future presentations. It will be our continuing thesis that the current infection control practitioner and hospital epidemiologist will need to become more involved in the quality assurance and risk management activities of their institutions and that training in all fields of medical care evaluation will need to be founded in epidemiology. Programs in quality assurance and risk management must adopt the use of these standard methods and must generate the databases to allow variations from norms in clinical practice to be evaluated. Those in infection control will need to broaden their expertise to include more sophisticated statistical methods, newer strategies in the observational studies of clinical care, the fundamentals of clinical information systems and data handling, and the appropriate national and regional sources of comparative clinical data. Future articles in the Topics series will provide reviews in these areas and serve as a forum for issues in the changing field of hospital epidemiology. The editors welcome comments on the series or manuscripts for review for possible publication.

Cross Infection↗

PubMed2002

Surveillance as a starting point to reduce surgical-site infection rates in elective orthopaedic surgery.

A surveillance programme was started after a period of high infection rates in an orthopaedic surgical department. The programme was aimed at reducing infection rates in elective hip and knee replacement procedures, and at creating awareness of infection control practices in an acute hospital. Possible causes of the initial high infection rates were analysed and discussed with healthcare workers involved in orthopaedic surgery. No specific cause could be found but substantial logistic improvements were achieved by studying for five years that may have contributed to the reduction of postoperative infections. Surveillance is an important part of any hospital-acquired infection surveillance programme. Its success depends on the ability of the infection control practitioner (ICP) to form a partnership with the surgical staff. Creating a sense of ownership of the surveillance initiative amongst the surgical staff enhances co-operation and ensures that the best use is made of the information generated. It is not possible to eliminate surgical-site infections (SSI) completely, but by a process of sharing information we have been able to influence behaviour to reduce the incidence of SSI.

Arthroplasty, Replacement, Hip↗

PubMed1987

Epidemiologic methods for selective surveillance.

To allow time for problem-solving and staff education aimed at the prevention of future nosocomial infections, it is necessary for infection control practitioners to decrease the quantity of data-gathering activities and increase the quality of data analysis and action based on the data. A system by which certain high-risk patient groups and life-threatening infection sites are monitored by continuous surveillance every month, but other units and sites are selected on a rotating basis for periodic study, has been called "selective surveillance" and used at our 500-bed medical center for eight years. The system is backed by an essential third component: a network of inspections with prevalence studies, prospective studies of medical and surgical procedures, retrospective studies of sites with low endemic rates, and immediate investigations of clusters of infection. Success of this system is based on good daily communication with laboratory and nursing personnel and use of sound epidemiologic methods.

Cross Infection↗

PubMed1995

Infection control in long-term care.

Elderly residents of long-term care facilities are especially vulnerable to certain infectious diseases such as pneumonia, urinary tract infection, and skin or soft tissue infections. As part of quality of care, the detection, control, and prevention of infections in long-term care facilities through an organized infection control program is a requirement of federal, state, and professional regulatory agencies. Implementation of the major components of an infection control program requires a cooperative interdisciplinary effort among the facility administration, medical director, infection control committee, infection control practitioner, staff, and local health department.

Aged↗

PubMed2004

Respiratory protection against Mycobacterium tuberculosis: quantitative fit test outcomes for five type N95 filtering-facepiece respirators.

In preparing to fit test a large workforce, a respirator program manager needs to initially choose respirators that will fit the greatest proportion of employees and achieve the best fits. This article discusses our strategy in selecting respirators from an initial array of seven NIOSH-certified Type N95 filtering-facepiece devices for a respiratory protection program against Mycobacterium tuberculosis (M. tb) aerosol. The seven respirators were screened based on manufacturer-provided fit test data, comfort, and cost. From these 7 devices, 5 were chosen for quantitative fit testing on 40 subjects who were a convenience sample from a cohort of approximately 30,000 workers scheduled to undergo fit testing. Across the five brands, medium/regular-size respirators fit from 8% to 95% of the subjects; providing another size of the same brand improved the pass rates slightly. Gender was not found to significantly affect fit test pass rates for any respirator brand. Among test panel members, an Aearo Corporation respirator (TC 84A-2630) and a 3M Company respirator (TC 84A-0006) provided the highest overall pass rates of 98% and 90%, respectively. We selected these two brands for fit testing in the larger worker cohort. To date, these two respirators have provided overall pass rates of 98% (1793/1830) and 88% (50/57), respectively, which are similar to the test panel results. Among 1850 individuals who have been fit tested, 1843 (99.6%) have been successfully fitted with one or the other brand. In a separate analysis, we used the test panel pass rates to estimate the reduction in M. tb infection risk afforded by the medium/regular-size of five filtering-facepiece respirators. We posed a low-exposure versus a high-exposure scenario for health care workers and assumed that respirators could be assigned without conducting fit testing, as proposed by many hospital infection control practitioners. Among those who would pass versus fail the fit test, we assumed an average respirator penetration (primarily due to faceseal leakage) of .04 and 0.3, respectively. The respirator with the highest overall pass rate (95%) reduced M. tb infection risk by 95%, while the respirator with the lowest pass rate (8%) reduced M. tb infection risk by only 70%. To promote the marketing of respirators that will successfully fit the highest proportion of wearers, and to increase protection for workers who might use respirators without the benefit of being fit tested, we recommend that fit testing be part of the NIOSH certification process for negative-pressure air-purifying respirators with tightly fitting facepieces. At a minimum, we recommend that respirator manufacturers generate and provide pass rate data to assist in selecting candidate respirators. In any event, program managers can initially select candidate respirators by comparing quantitative fit tests for a representative sample of their employee population.

Adult↗

PubMed1999

Preventing central venous catheter-related infection in a surgical intensive-care unit.

The cumulative effect of five measures (introduction of hand disinfection with alcohol, a new type of dressing, a one-bag system for parenteral nutrition, a new intravenous connection device, and surveillance by an infection control practitioner) on central venous catheter colonization and bacteremia was studied. Colonization was significantly reduced (P<.025); the decrease in bacteremia was not statistically significant.

Adolescent↗

PubMed2005

Nursing home practitioner survey of diagnostic criteria for urinary tract infections.

OBJECTIVES: To identify clinical and laboratory criteria used by nursing home practitioners for diagnosis and treatment of urinary tract infections (UTIs) in nursing home residents. To determine practitioner knowledge of the most commonly used consensus criteria (i.e., McGeer criteria) for UTIs. DESIGN: Self-administered survey. SETTING: Three New Haven-area nursing homes. PARTICIPANTS: Physicians (n=25), physician assistants (PAs, n=3), directors/assistant directors of nursing (n=8), charge nurses (n=37), and infection control practitioners (n=3). MEASUREMENTS: Open- and closed-ended questions. RESULTS: Nineteen physicians, three PAs, and 41 nurses completed 63 of 76 (83%) surveys. The five most commonly reported triggers for suspecting UTI in noncatheterized residents were change in mental status (57/63, 90%), fever (48/63, 76%), change in voiding pattern (44/63, 70%), dysuria (41/63, 65%), and change in character of urine (37/63, 59%). Asked to identify their first diagnostic step in the evaluation of UTIs, 48% (30/63) said urinary dipstick analysis, and 40% (25/63) said urinalysis and urine culture. Fourteen of 22 (64%) physicians and PAs versus 40 of 40 (100%) nurses were aware of the McGeer criteria for noncatheterized patients (P<.001); 12 of 22 (55%) physicians and PAs versus 38 of 39 (97%) nurses used them in clinical practice (P<.001). CONCLUSION: Although surveillance and treatment consensus criteria have been developed, there are no universally accepted diagnostic criteria. This survey demonstrated a distinction between surveillance criteria and criteria practitioners used in clinical practice. Prospective data are needed to develop evidence-based clinical and laboratory criteria of UTIs in nursing home residents that can be used to identify prospectively tested treatment and prevention strategies.

Aged↗

PubMed1998

Use of an estimation method to derive an appropriate denominator to calculate central venous catheter-associated bloodstream infection rates.

An outbreak investigation was conducted to determine if an increase in bloodstream infections (BSIs) in patients with central venous catheters (CVC) had occurred. Because other methods of obtaining CVC days were not feasible, we used an estimation method based on a random 5% sample of medical records to determine the proportion of days that a CVC was present for each of three patient units. This calculated ratio was used to estimate the total CVC days for each unit. A cohort study was conducted in which the BSI rates before and during needleless device use were compared. This article describes the methods used to calculate this estimated denominator and discusses the need for such a denominator to be used by infection control practitioners when prospective collection of CVC days is not possible.

Catheterization, Central Venous↗