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Planning against biological terrorism: lessons from outbreak investigations.

We examined outbreak investigations conducted around the world from 1988 to 1999 by the Centers for Disease Control and Prevention's Epidemic Intelligence Service. In 44 (4.0%) of 1,099 investigations, identified causative agents had bioterrorism potential. In six investigations, intentional use of infectious agents was considered. Healthcare providers reported 270 (24.6%) outbreaks and infection control practitioners reported 129 (11.7%); together they reported 399 (36.3%) of the outbreaks. Health departments reported 335 (30.5%) outbreaks. For six outbreaks in which bioterrorism or intentional contamination was possible, reporting was delayed for up to 26 days. We confirmed that the most critical component for bioterrorism outbreak detection and reporting is the frontline healthcare profession and the local health departments. Bioterrorism preparedness should emphasize education and support of this frontline as well as methods to shorten the time between outbreak and reporting.

Bioterrorism↗

[Monitoring of infections in intensive care units. Strategy of data collection].

The aim of this article defines the principles of the infections surveillance. Its pertinence: its efficiency as a means for prevention of diseases. Its objectives: to spot aggregate cases and the variations of endemic. These specific methods according to the clearing defined priorities on criterions cost effectiveness.

Data Collection↗

Practical tips from clinical nurses: opinions about children visiting.

Children visiting parents in the ICU is still controversial. Here are six different opinions about children visiting from ICU nurses, an infection control practitioner, and even a parent. All view points are important to consider in providing access of children to their critically ill parents. Interestingly, even nurses who do not generally support child visitation have allowed children's visits in special circumstances and found the experience positive.

Child↗

[Importance of infectious diseases and role of the infection specialist in a non-university hospital].

More than 3000 infectious diseases treated in the past 10 years at the Department of Medicine of the Cadolles Hospital in Neuchâtel (Switzerland) have been gathered from a computer data base. The infectious disease specialist is directly involved in the diagnosis and treatment of the most severe or rare affections. However, he influences in a more general fashion the management of anti-infectious treatments by directing the treatment plan and helping to choose the proper antibiotics. He also is responsible for the prevention of nosocomial infections. The role and function of the infectious disease specialist as well as the importance of this specialty in a community hospital are discussed.

Consultants↗

Diarrhea among residents of long-term care facilities.

Diarrhea is a common problem among residents of long-term care facilities. Although the etiology of many cases of diarrhea will be noninfectious, the approach to managing all patients with diarrhea must include assuring the adequacy of hydration and controlling the spread of infection. The latter issue is especially critical in nursing homes where a large proportion of patients can became ill over a several-day period during an outbreak. Although most outbreaks of diarrhea are viral in origin, bacterial outbreaks can lead to hospitalization and even death. Increasing awareness among physicians and infection control practitioners of the correct approaches to investigating and managing cases of diarrhea among nursing home patients is necessary because the magnitude of this problem will grow as the number of individuals being cared for in long-term care facilities increases.

Aged↗

The infection control practices of general dental practitioners.

OBJECTIVES: To investigate the infection control practices of general dentists in Ontario in 1994. DESIGN: Confidential coded questionnaires were mailed to all general dental practitioners in Ontario (n = 5,176), with three follow-up attempts. Data were analyzed using Pearson's chi-squared test and multiple logistic regression. SETTING: Offices of general dental practitioners in Ontario. PARTICIPANTS: General dental practitioners actively involved in treating patients. RESULTS: The response rate adjusted for nondelivery was 70%. A high proportion of respondents reported using gloves (always, 91.8%; sometimes, 7.8%), masks (always, 74.8%; sometimes, 21.1%), or protective eyewear (always, 83.6%; sometimes, 13%); heat sterilization of handpieces (83.9%); and hepatitis B (HBV) vaccination of dentists (92.3%). However, only 61.4% of respondents reported HBV vaccination of all clinical staff, and 87.7% used additional precautions for patients with human immunodeficiency virus (HIV). Significant predictors of the use of recommended infection control procedures (i.e., always using gloves, masks, and eye protection; heat sterilization of handpieces; HBV vaccination for dentist and staff; and no extra precautions for patients with HIV) were age < 40 years (odds ratio [OR], 2.6), lack of concern regarding increased personal risk (OR, 2.0) or costs of infection control procedures (OR, 1.5), and knowledge of the low infectivity of HIV after a needlestick injury (OR, 2.0) and that infection control procedures for HBV are adequate for HIV (OR, 2.7). CONCLUSION: Additional education is required to promote a more realistic perception of risk of HIV transmission in the dental office and the use of all recommended infection control practices, including Universal Precautions.

Adult↗

Infection control programs for long-term care.

1. Many infection control concerns are the same for both hospitals and long-term care facilities (LTCFs), but some are unique to LTCFs. The unique concerns seem to be in the area of "caring." 2. The Association for Practitioners in Infection Control (APIC) offers many educational opportunities for infection control practitioners (ICPs) in LTCFs. 3. The APIC Guideline for Infection Prevention and Control in the Long-Term Care Facility and interpretive assistance for implementing the Guideline in a variety of LTCF settings are available for ICPs.

Aged↗

HIV infection control for podiatric practitioners.

Although significant advances have been made in the treatment of acquired immunodeficiency syndrome (AIDS), neither a curative therapy nor a vaccine is available. Protecting practitioners, medical staff members, and patients from infection with human immunodeficiency virus (HIV) remains a particularly important issue. Fortunately, this virus is not readily transmitted in the health care setting. Adequate protection can be accomplished through the strict implementation of universal infection control policies in the treatment of all patients. Understanding these procedures, providing access to necessary equipment and supplies, and monitoring adherence to universal infection control measures will minimize the risk of exposure.

Acquired Immunodeficiency Syndrome↗

Survey of infection control training program graduates: long-term care facility and small hospital practitioners.

Graduates of a 2-day basic training course in infection control were surveyed. Respondents were generally from Midwestern long-term care facilities and small hospitals. These infection control practitioners had multiple roles in addition to infection control, most notably employee health and quality assurance. Infection control practitioners demonstrated significant job stability. The vast majority of institutions where survey respondents were employed followed recommended infection control practices.

Career Mobility↗

Pro/con clinical debate: isolation precautions for all intensive care unit patients with methicillin-resistant Staphylococcus aureus colonization are essential.

Antibiotic-resistant bacteria are an increasingly common problem in intensive care units (ICUs), and they are capable of impacting on patient outcome, the ICU's budget and bed availability. This issue, coupled with recent outbreaks of illnesses that pose a direct risk to ICU staff (such as SARS [severe acute respiratory syndrome]), has led to renewed emphasis on infection control measures and practitioners in the ICU. Infection control measures frequently cause clinicians to practice in a more time consuming way. As a result it is not surprising that ensuring compliance with these measures is not always easy, particularly when their benefit is not immediately obvious. In this issue of Critical Care, two experts face off over the need to isolate patients infected with methicillin-resistant Staphylococcus aureus.

Cross Infection↗

Primary care management of wounds. Cleaning, suturing, and infection control.

Nurse practitioners working in primary care are often called upon to assess and repair wounds. This article examines the physiology of wounds, and uses this information to improve assessment skills. Depending on the mechanism of injury, certain wounds may require suturing. The organized examination, appropriate cleaning and debriding, and various suturing techniques are discussed. Special wounds and after-care instructions are covered. Recent changes in infection control technique are examined in terms of their impact on wound care.

Bites and Stings↗

The role of the infection control nurse as a clinical nurse specialist or advanced nurse practitioner.

The specialty of infection control is examined regarding the role of the infection control nurse and the educational requirements for practitioners in this field in relation to post titles of clinical nurse specialist and advanced nurse practitioner. Whilst not fulfilling all the role constituents of a clinical nurse specialist, the infection control nurse is seen as more akin to a clinical nurse specialist than an advanced nurse practitioner.

Cost-Benefit Analysis↗

Infection control procedures among New Zealand general practitioners: changes since the emergence of HIV infection.

A random sample of 1000 general practitioners in New Zealand were surveyed to assess their infection control procedures in the surgery, particularly since the emergence of the human immunodeficiency virus (HIV). Forty three per cent of the sample routinely used surgical gloves for minor surgical procedures, 8% used gloves for venepuncture, and 7% for blood glucose testing. Thirty two per cent reported a change in glove use since the emergence of HIV infection. Changes in sterilization procedures were also studied. Thirty eight per cent of the sample reported increased use of disposable equipment, and 38% reported changes in the sterilization solution used. Increased time spent by equipment in the sterilizer was reported by 33% of respondents and increased use of an autoclave by 18%. In general, women were more likely to have adopted infection control procedures than men. Infection control was also more common among those doctors having the greatest number of patients requesting HIV testing.

Acquired Immunodeficiency Syndrome↗