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PubMed1990

The role of medical records in infection control.

The concept of "infection" has been well known to the medical world ever since an interest began to be taken in medicine. Infection has taken many hundreds of thousands of lives, and even today it is a very serious threat for human beings. Hospital, or nosocomial infections (NCI) are a major health problem in every medical institution in the world. In the light of the seriousness of the problem, this paper is to demonstrate how medical records can play an important role in effective alerting and infection control programmes before an outbreak turns into an epidemic.

Cross Infection↗
PubMed2004

Infection control issues related to pediatric dentistry.

Although the Centers for Disease Control and Prevention CGuidelines for Infection Control in Dental Health-Care Settings--2003 addresses general infection control issues, dental practitioners face many unique situations when treating pediatric patients. Children and adolescents have varying levels of physical, intellectual, emotional, and social development. Dental practitioners are regularly challenged to meet the psychological needs of their young patients while maintaining appropriate infection control practices. This article deals with several of the common clinical issues faced by dental practitioners who treat pediatric dental patients.

Anesthesia, Dental↗
PubMed1999

Infection control in a Brazilian regional multihospital system.

OBJECTIVE: This study describes the organization of infection control committees in a Brazilian multihospital system, identifying their major problems. Our goal is to discuss the main deficiencies in infection control and to target some interventions that can improve the efficiency of these actions in Brazilian hospitals. DESIGN AND SETTING: We used a descriptive epidemiologic design. We interviewed the chairs and the nurses of the infection control committees and visited the main areas to observe infection control in a multihospital system with 3146 beds. For analysis of the results, we performed a standardization process, establishing a score for each hospital by using infection control organization as a surrogate marker for quality outcome. The mean hospital scores for infection control, existence of policies, and infrastructure at each hospital were compared by using different stratification and multivariate analysis. RESULTS: Statistically significant differences were found among surveyed hospitals by using stratification by size, funding status, and presence of teaching activities. CONCLUSIONS: Diverse patterns of infection control organization were found among surveyed hospitals. Small hospitals represented the major problem in providing effective infection control. Chiefly for these hospitals, the epidemiologic indicators and the surveillance and control system proposed by the Brazilian Ministry of Health and based on the Centers for Disease Control and Prevention model showed poor suitability.

Brazil↗
PubMedDate not supplied

Nurses' documentation of infection control precautions: 2.

A small action research study was undertaken, using a quasi-experimental approach, to establish to what extent infection control advice was documented and to assess the effectiveness of the provision of an example care plan for control of infection. The study population comprised two groups of patients colonized or infected with ALERT organisms and involved 28 wards in six hospitals. Baseline data confirmed that infection control precautions were documented for less than 25% of patients overall. Provision of an 'example' care plan, together with guidance in its use, was followed by an increase in documentation for all items audited, while identification of the infection in the care plan showed a statistically significant increase (P < 0.05). However, in spite of this apparent improvement the documentation of appropriate care for control of infection remained inadequate. It is concluded that, while various strategies to effect change are at the infection control nurse's disposal, the need to integrate infection control with practice must be addressed at every level to include managers, educators and practitioners.

Education, Nursing, Continuing↗
PubMed1996

Attitudes, practices, and infection risks of hemophilia treatment center nurses who teach infection control for the home.

OBJECTIVE: To examine the practices toward infection control training and to assess the attitudes about, and risks for, exposures to blood among hemophilia treatment center (HTC) nurses who teach home infusion therapy (HIT). DESIGN AND POPULATION: Written and telephone interview surveys of the 153 nurses who teach HIT at federally funded HTCs. MAIN OUTCOME MEASURES: Hemophilia treatment center nurses' teaching practices and infection control messages taught, and frequency of exposures to blood. RESULTS: The response rate to the written nurses' survey was 60% and to the telephone interview 88%. Nurses taught patients a median of three HIT sessions totaling 4 hours of instruction. Reevaluation of patients' HIT practices took place every 6 months by 22% and every 12 months by 59% of nurses. Nurses frequently reported teaching proper use of a sharps disposal container (99%) and gloves (93%), but less often reported teaching patients to wash hands after infusions (26%) and to report needlestick injuries to HTCs (11%). The respondents identified several barriers to effective infection control as it is practiced in the home by patients. Although at least 30% of HTC nurses recalled having had percutaneous exposure to blood, they considered their risk for hepatitis B infection low but greater than for infection with the human immunodeficiency virus (HIV). CONCLUSIONS: While some important infection control messages are stressed during HIT teaching, others may be underemphasized. Failure to instruct patients about all infection control precautions may be related to nurse educators' perception of low to moderate personal risk for hepatitis B and HIV infection. Patients receiving HIT, and those who assist them, need to be fully aware of, and to have reinforced periodically, universal infection control strategies in the home.

Health Knowledge, Attitudes, Practice↗
PubMed2000

Survey on attitudes toward HIV-infected individuals and infection control practices among dentists in Mexico City.

BACKGROUND: The teaching of infection control is gradually being introduced at dental schools in Mexico. However, most practicing dentists have limited access to current infection control standards. Deficiencies of knowledge with regard to blood-borne pathogens such as HIV and hepatitis B virus may influence attitudes toward infected individuals and reduce compliance with infection control recommendations. OBJECTIVE: The purpose of this study was to assess (1) attitudes toward HIV-infected patients and hepatitis B virus-infected patients and (2) infection control knowledge and practices among dental practitioners in Mexico City. METHOD: A total of 196 dentists were interviewed by means of a questionnaire with Likert-type scales and open-ended questions (response rate, 86.1%). RESULTS: Most respondents had no previous social or professional contact with HIV-positive individuals. Nine percent indicated that they had knowingly treated HIV-positive patients. Perceived professional and moral obligations to treat HIV-positive patients were high. Thirty-five percent of the respondents perceived the risk of HIV infection as "considerable" to "very strong." The risk of hepatitis B infection was considered significantly higher than the risk of HIV infection (P <.01); however, 78% of the respondents had not been immunized against hepatitis B. Reported use of personal protective equipment was high. Most respondents used dry heat sterilization. The principal disinfectants used were quaternary ammonium compounds, bleach, and glutaraldehyde. Fifty-four percent of the respondents acknowledged that clinical precautions reduced occupational risks. CONCLUSIONS: This survey revealed contradictory attitudes toward HIV-positive individuals and limited understanding of infection control recommendations. Educational and regulatory efforts are needed to promote better adherence to current infection control standards.

Adult↗
PubMed2004

Infection Control Nurse: a national survey.

AIM: To study presence and activity of Infection Control Nurses (ICN) in Italian National Health System (NHS) hospitals. BACKGROUND: Infection Control Nurses play an essential and evidence-based role for optimal infrastructure and essential activities of infection control and epidemiology programmes in hospitals. METHODS: A survey of all Italian NHS hospitals (N = 529). Hospital health directors were asked to complete a questionnaire with a specific section on ICN presence, activities and roles played. Response rate was 87.5% (463 of 529). RESULTS: More than 50% of hospitals (250 of 463) have an ICN: 25% (116 of 463) have at least one part-time employed ICN and 23.3% (108 of 250) have at least one ICN employed full-time. Infection Control Nurses are more common in hospitals with >250 beds (P < 0.01). Infection Control Nurses working in hospitals with >250 beds are highly active in surveillance activities, personnel education and management of study groups (P < 0.01). CONCLUSIONS: In Italian NHS hospitals ICNs have yet to become pillar figures in hospital infection control.

Attitude of Health Personnel↗
PubMed1997

Clostridium difficile-associated diarrhea: epidemiology, risk factors, and infection control.

OBJECTIVES: To evaluate the effectiveness of specific infection control measures on the incidence of Clostridium difficile-associated diarrhea (CDAD) and to identify risk factors for its development. SETTING: 370-bed, tertiary-care teaching hospital with approximately 12,000 to 15,000 admissions per year. METHODS: Several infection control measures were implemented in 1991 and 1992, and the attack rates of CDAD were calculated quarterly. Antibiotic use for 1988 through 1993 was analyzed. A case-control study was conducted from January 1992 to December 1992 to identify risk factors for acquisition of CDAD. RESULTS: From 1989 to 1992, the attack rate of CDAD increased from 0.49% to 2.25%. An increase in antibiotic use preceded the rise in the incidence of CDAD in 1991. Despite implementation of various infection control measures, the attack rate decreased to 1.32% in 1993, but did not return to baseline. Ninety-two cases and 78 controls (patients with diarrhea but with negative toxin assay) were studied. By univariate analysis, history of prior respiratory tract infections (odds ratio [OR], 3.6; 95% confidence interval [CI95], 1.2-10.4), the number of antibiotics, and the duration of exposure to second-generation cephalosporins (OR, 3.55; CI95, 1.47-9.41) and to ciprofloxacin (OR, 7.27; CI95, 1.13-166.0) were related significantly to the development of CDAD. By stepwise logistic regression analysis, only exposure to antibiotics and prior respiratory tract infections (P = .0001 and .0203, respectively) were found to be significant. CONCLUSION: Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline.

Analysis of Variance↗
PubMed2005

Partnering globally and acting locally for infection control in Nepal.

AIMS: To describe the process and outputs of an international collaborative oral health promotion project to develop a national infection control policy and training programme for oral health care workers in the low income country of Nepal between April, 2003 and May, 2004. METHOD: The project process was implemented in phases: 1) extensive review of national and international infection control documents; 2) development of draft infection control policies and protocols; 3) development of instruments to assess knowledge, attitude and behaviour and infection control practices; 4) baseline survey to assess these factors; 5) development of training programmes and training of oral health care providers; 6) revision of infection control policies and protocols, survey questions, assessment instruments, and training programme. OUTPUTS: Project outputs include a national infection control policy and protocols, infection control assessment instruments, infection control training materials and programmes, and oral health care providers trained in infection control. SUMMARY: The results of the project to develop a national infection control policy and training programme for oral health care workers in dental clinics, dental education institutions and the Nepal Primary Health Care System, required the collaboration of policy makers, health professionals, health managers, oral health care providers and educators from the government sector, private sector, Non-Government Organisations (NGOs) and International Non-Government Organisations (INGOs).

Dental Staff↗
PubMed2006

Sustained reductions in neonatal nosocomial infection rates following a comprehensive infection control intervention.

OBJECTIVE: Nosocomial infections (NI) are a frequent and important cause of morbidity and mortality in newborn infants who receive intensive care. We sought to determine if comprehensive infection control (CIC) measures decrease rates in a large neonatal intensive care nursery. METHODS: Single center interventional study. The CIC intervention consisted of increasing nursing and physician education and awareness of infection rates, establishing common improvement goals, training in hand and environment care, and implementing a specialty nursing team for central venous and arterial catheter care. Demographic and microbiology information for all infants admitted to the NICU from January 1, 1999 to December 31, 2000 established baseline data. The intervention period was during January and February 2001. The postintervention period was March 1, 2001 to February 29, 2004. The main outcome measure was the rate of blood, cerebrospinal and/or urinary tract bacterial infections per 1000 hospital days. RESULTS: Baseline infection rate was 8.5 per 1000 hospital days. The NI rate fell 26% (P=0.002) from baseline in the first year and 29% (P<0.001) in the second and third years after the CIC intervention. The reduction in total NI was due mostly to a 46% fall in coagulase-negative Staphylococcus infection rate (P<0.001); however, rates of all other organisms also fell by 21% (P=0.05). CONCLUSIONS: CIC measures can reduce bacterial and fungal NI rates. This effect has been sustained for 3 years following the intervention.

Alabama↗
PubMed1986

Infection control in the Netherlands.

A survey was made by the Dutch association of infection control practitioners (VHIG) concerning the organization of infection control in Dutch hospitals and the activities of its members. The results are reported and compared with recent American studies. A comparison is made between a group of infection control technicians (ICTs) who were not nurses and a group of nurses (ICNs), working in infection control. Although the ICT has significantly more daily contacts with the hospital microbiologist and is more often secretary to the infection control committee and the ICN visits the outpatient department significantly more often, the other activities in their practice are essentially the same. From this study we conclude that either an ICT or an ICN can adequately function as an infection control practitioner in the Netherlands.

Adult↗
PubMed2006

Reading habits of infection control coordinators in the United States: peer-reviewed or non-peer-reviewed evidence?

BACKGROUND: Because evidence-based health care is taking on increasing importance, we surveyed a national sample of infection control coordinators on their reading habits to discern which and how often various media are utilized. METHODS: Infection control coordinators at 797 hospitals in the United States were mailed a survey asking which peer-reviewed journals and other publications they subscribe to, their perception of the quality of the infection control articles provided by each, and the extent to which they use various resources for their work. RESULTS: The survey response rate was 74%. Infection control coordinators spend a mean of 3.6 hours/week reading journals or periodicals. Resources identified as most useful included the Centers for Disease Control and Prevention (CDC) Web site (52%), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) text (11%), and the APIC e-mail list (8%). Proportion of subscribers was highest for the American Journal of Infection Control (84%) and Infection Control Today (72%). The top 3 journals ranked on a scale of 1 to 10 for quality of infection control articles were Infection Control & Hospital Epidemiology (8.0), the American Journal of Infection Control (7.5), and the New England Journal of Medicine (7.4). The American Journal of Infection Control (85%) and Infection Control & Hospital Epidemiology (72%) were the most frequently used peer-reviewed sources of information, whereas Morbidity and Mortality Weekly Report (85%) and Hospital Infection Control (63%) ranked at the top for non-peer-reviewed periodicals. CONCLUSION: Infection control coordinators devote limited time to reading and critically appraising published evidence and rely heavily on sources that provide rapid access to information or evidence summaries, suggesting a growing need for easy-to-read, reliable sources of information about evidence-based infection prevention and control practices.

Attitude of Health Personnel↗
PubMed1988

Hospital infection control in Sweden.

In Sweden the 23 counties are respnsible for the medical care of their inhabitants. They own and run virtually all hospitals. This system facilitates a county-based hospital infection control system. The infection control team is based in the county hospital department of clinical bacteriology. It is headed by an MD clinical bacteriologist or, in some counties, by an infectious disease specialist. In the majority of cases this is a part-time job besides other duties in the department, but some ten hospital epidemiologists work full-time with infection control. Totally there are only some 50 full-time infection control nurse positions in Sweden. This means that on the average every infection control nurse is in charge of some 2,400 hospital beds, of which some 800 are somatic acute-care ones. These beds are situated in several hospitals, often at considerable distance from each other. The county-wise organization of hospitals facilitates infection control work. Medical and nursing procedures can be coordinated between the different hospitals within the county, and teaching is facilitated. However, the scarcity of infection control nurses makes it impossible to perform ongoing complete surveillance. Only surveillance based on laboratory reports can be performed routinely. In Swedish geriatric care there has been a strong movement not to accept incontinence as a reason for inserting and maintaining indwelling urinary catheters. This has greatly reduced urinary tract infections, and the rates of other infections as well. It has also reduced the costs in this type of medical care.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross Infection↗
PubMed1999

Waterbirths: regional audit of infection control practices.

Waterbirths are increasingly being offered as an option, although concerns about associated infection risks have been expressed. We undertook an audit of current practice in our region to help formulate an infection control policy. Questionnaires were sent to the Infection Control Nurses at 16 centres, with a request for completion in conjunction with the Infection Control Doctor. Fourteen (88%) centres responded, 11 of which carried out waterbirthing. Eight had permanent on-site pools, of which five were permanently plumbed in and provided with separate water inlets and outlets. All eight centres had infection control policies for waterbirthing. Six policies included care of the pool using detergent and disinfectant (chlorine-releasing compounds) and two using detergent alone. In none of the centres were the mothers tested for blood-borne viruses. Six centres collected data on infection in mother or child, and two carried out regular microbiological testing of pools. Infection control policies for waterbirths should include instructions for pool maintenance and decontamination, for prevention of legionella, for universal precautions and for use of personal protective equipment. Post-natal surveillance of mothers and babies is required in order to ascertain infection rates.

Baths↗
PubMed1989

[A survey on elements of an effective hospital infection control program for Korea].

The main purpose of this survey was to identify for elements of an effective hospital infection control program for Korea. Nurses and doctors who had participated in an education program for infection control or were responsible for hospital infection control were selected as data informers. The data were collected from 51 subjects by employing a Delphi technique in a series of three rounds from September 1, 1987, to March 31, 1988. In each round the responses to questionnaires were analyzed and the results were communicated back to the individuals. Finally 32 elements of effective hospital infection control program were reduced to 10 elements. 10 elements are as follows; 1) Hospital administrator's knowledge of importance and necessity for HIC (hospital infection control) 2) Supporting HIC administratively 3) Constituting infection control committee and role of ICC 4) Developing an educational program and providing a work manual for the hospital infection control staff 5) Educating and informing medical staff about hospital infection 6) Surveillance for hospital infection 7) Developing patient care technique 8) Controlling the hospital environment 9) Executing regular health examinations of all medical staff 10) Recruiting the medical staff sufficiently Three rankings of response rate about 32 elements are as follows: 1) Hiring a full time staff member for the HIC (66%) 2) Establishing a hospital policy and standards for the HIC (66%) 3) Activating the infection control committee and taking administrative action to support the ICC (63%) In addition the rankings of importance score by Likert 5 scale are as follows: 1) Washing hands scrupulously (4.88) 2) Nurses participation as key members of the ICC (4.75) 3) Reviewing and evaluating all ongoing aseptic techniques (4.69) In conclusion, first of all, administrative support must be given to hiring a full time staff member and to organization of infection control committee for the HIC in Korea.

Cross Infection↗
PubMed2000

Infection control in long-term care facilities.

Infections are common in long-term care facilities. The most frequent endemic infections are urinary infection, respiratory infection, and skin and soft tissue infections. Outbreaks also occur frequently, and some facilities have a high prevalence of colonization of residents with antimicrobial-resistant organisms. Our understanding of infections and the development of infection-control programs for long-term care facilities have progressed greatly over the past 15 years. Whereas the occurrence of infections has been described and specific guidelines for infection-control programs in long-term care facilities have been developed, there is still limited evaluation of the effectiveness of programs or specific interventions to support prioritization of infection-control resources. In addition, the spectrum of patients and care delivered in long-term care facilities continues to evolve. Increasingly, chronic care patients, including those requiring chronic respirator therapy, dialysis, or percutaneous feeding tubes, are cared for in these facilities. Our understanding of prevention of infection in these patients remains limited. Important questions include what interventions may prevent endemic infections, what are the most effective means to identify outbreaks early, and what interventions may minimize the prevalence of antimicrobial-resistant organisms. Programs to optimize antimicrobial use need to be developed. Thus, although progress in understanding and practice has been made, important questions remain.

Aged↗
PubMed2001

Infection control in the ICU.

Nosocomial infections (NIs) now concern 5 to 15% of hospitalized patients and can lead to complications in 25 to 33% of those patients admitted to ICUs. The most common causes are pneumonia related to mechanical ventilation, intra-abdominal infections following trauma or surgery, and bacteremia derived from intravascular devices. This overview is targeted at ICU physicians to convince them that the principles of infection control in the ICU are based on simple concepts and that the application of preventive strategies should not be viewed as an administrative or constraining control of their activity but, rather, as basic measures that are easy to implement at the bedside. A detailed knowledge of the epidemiology, based on adequate surveillance methodologies, is necessary to understand the pathophysiology and the rationale of preventive strategies that have been demonstrated to be effective. The principles of general preventive measures such as the implementation of standard and isolation precautions, and the control of antibiotic use are reviewed. Specific practical measures, targeted at the practical prevention and control of ventilator-associated pneumonia, sinusitis, and bloodstream, urinary tract, and surgical site infections are detailed. Recent data strongly confirm that these strategies may only be effective over prolonged periods if they can be integrated into the behavior of all staff members who are involved in patient care. Accordingly, infection control measures are to be viewed as a priority and have to be integrated fully into the continuous process of improvement of the quality of care.

Bacteremia↗