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PubMed1995

Infection control in general practice: results of a questionnaire survey.

BACKGROUND: Infection control is an important aspect of quality of care. General practitioners (GPs) have a high throughput of patients, some attending because of a communicable disease, others for investigations or minor operations. This situation provides an opportunity for the spread of infections. This study looked at the development of practice policies on infection control and the need for further information and guidelines. METHODS: A postal questionnaire was sent to 117 practices in a single Family Health Services Authority. The questionnaire contained sections to be completed by a GP and a practice nurse in each surgery. RESULTS: A response rate of 74.5 per cent was obtained. Of the practices replying, 85 per cent did not have a written infection control policy. Sterilization of instruments was carried out in over 90 per cent of surgeries. Autoclaves were used in almost four-fifths of these practices; most did not have any written procedures covering their use. Few practices provided information on procedures for infected patients or staff. A third of practices did not have a needlestick policy, and sharps incidents were not recorded in 42 per cent of surgeries. Three-quarters of practices said that they would welcome guidelines on infection control. Half of the practice nurses thought that more training on infection control was required. CONCLUSIONS: The need for more training and the implications of the information from the study on the development and implementation of guidelines are discussed. Recommendations are made which aim to increase the awareness of this issue by means of guidelines and training focused on practice nurses.

Disinfection↗
PubMed2000

Educating the infection control team - past, present and future. A British prespective.

This review sets out to explore how education and training provisions for members of the Infection Control Team (ICT) have developed alongside their roles and in response to changes in the British National Health Service. It focuses on the Consultant in Communicable Disease Control, the Infection Control Doctor and the Infection Control Nurse in the United Kingdom, but also briefly considers approaches adopted by other countries. Future developments should include maximizing information technology for delivering teaching materials, shared learning and improvements to pre-registration curricula for both doctors and nurses.

Certification↗
PubMed2005

Reducing methicillin-resistant Staphylococcus aureus (MRSA) patient exposure by infection control measures.

INTRODUCTION: To assess the effectiveness of infection control measures (pre-admission screening and patient segregation) on reducing in-patient exposure to methicillin-resistant Staphylococcus aureus (MRSA). PATIENTS AND METHODS: A prospective case-control study in a district general hospital. All admissions to 3 wards over an 83-month period from September 1995 to July 2002 inclusive (a total of approximately 34,000 patients). Outcome measures were a statistical analysis of the difference in numbers of new cases of MRSA colonisation or infection between the 3 wards. RESULTS: There was a statistical significance in incidence of new MRSA cases between the ward with active infection control measures in place and the control wards. CONCLUSIONS: The described infection control measures reduced the exposure of patients to MRSA. This reduces the risk of MRSA infection, which is of importance in orthopaedics, and has further benefits that may also be applied in other surgical specialties.

Case-Control Studies↗
PubMed1981

An evaluation of the efficacy of a hospital infection control program.

To establish the credibility of the hospital infection control program at a major southeastern medical university hospital, the incidence rates of nosocomial infections were analyzed statistically following the implementation of an extensive infection control program. Continuous hospital-wide surveillance included documentation of all detected nosocomial infections by both site and service. Chi-square analysis of the incidence of infection during the years 1977 to 1979 revealed significant decreases in several distinct areas. The overall incidence rate of infection steadily declined from 100.8/1000 admissions in 1977 to 59.9/1000 in 1979. Decreases in the incidence of urinary tract, respiratory tract, and surgical wound infections were primarily involved. Analysis of incidence rates by service revealed that general surgery was responsible for much of the observed decrease. In contrast, none of the intensive care units exhibited a significant decline in morbidity rates over the 3-year period. It is concluded that involvement of infection control personnel at all levels of patient care as a part of a sophisticated hospital infection control program can result in a significant reduction in the incidence of nosocomial infections.

Cross Infection↗
PubMed1990

Controversies in infection control.

Dentistry has made great strides in infection control over the past 10 years. An effective asepsis program is part of "the standard of care" in dental practice as we approach the twenty-first century. Several areas of dental infection control are undergoing change as new information is obtained, thereby providing points for discussion and some controversy. An effective vaccine to protect against hepatitis B viral infection is available but has met with indifference on the part of many. This readily available protection should be obtained by all health care providers. Surface disinfection is another area of controversy. A variety of chemical agents with differing properties are available for use in dentistry. Many of these are effective as disinfectants but have limited cleansing action, and this must be considered in their application. The practice of prosthodontics also presents numerous opportunities for cross-contamination. The sterilization and disinfection of dental impressions, prostheses, appliances, and a variety of plastic and wooden items provide a challenge for future research as newer products and techniques are developed. Infection control has literally been placed in the hands of health professionals. We, our patients, and families will continue to benefit from our positive efforts in this area.

Communicable Disease Control↗
PubMed1992

Advances in hospital infection control programs.

The past decade in infection control has seen remarkable growth of both practitioners and the basic infection control program. Technical advances led to more sophisticated data collection, analysis, and strategies. Health care is being streamlined to be highly effective and efficient. It is easy to become enchanted with new, exciting, and high-tech aspects of disease prevention and control, but we must all remember that the basics of a good program from 10 years ago are still applicable today.

Cross Infection↗
PubMed2006

Steady improvement of infection control services in six community hospitals in Makkah following annual audits during Hajj for four consecutive years.

BACKGROUND: The objective of this study was to evaluate the impact of annual review of the infection control practice in all Ministry of Health hospitals in the holy city of Makkah, Saudi Arabia, during the Hajj period of four lunar Islamic years, 1423 to 1426 corresponding to 2003 to 2006. METHODS: Audit of infection control service was conducted annually over a 10-day period in six community hospitals with bed capacities ranging from 140 to 557 beds. Data were collected on standardized checklists on various infection control service items during surprise visits to the medical, pediatric, surgical, and critical care units, and the kitchens. Percentage scores were calculated for audited items. The results of the audit for hospitals were confidentially sent to them within four weeks after the end of Hajj. RESULTS: Deficiencies observed in the first audit included lack of infection control committees, infection control units, infection control educational activities, and surveillance system and shortage of staff. These deficiencies were resolved in the subsequent audits. The average (range) scores of hospitals in 11 infection control items increased from 43% (20-67%) in the first audit to 78% (61-93%) in the fourth audit. CONCLUSION: Regular hospital infection control audits lead to significant improvement of infection control practice. There is a need to build a rigorous infection control audit into hospitals' ongoing monitoring and reporting to the Ministry of Health and to provide these hospitals with feed back on such audits to continuously strengthen the safety standards for patients, visitors, and employees.

Hand Disinfection↗
PubMed2006

Infection control and the prevention of nosocomial infections in the intensive care unit.

Nosocomial infections continue to be significant causes of morbidity, mortality, and added costs in the health care setting. Half of all life-threatening nosocomial bloodstream infections and pneumonias occur in intensive care units (ICUs), despite ICUs representing only 15 to 20% of all hospital beds. Thus an efficient focus for prevention and control of life-threatening health care-associated infections should be in ICUs. Further, growing antibiotic resistance complicates the therapy of serious infections. Meticulous infection control practice with continued attention to hand hygiene is of paramount importance. Strict adherence to evidence-based catheter insertion and maintenance policies reduces nosocomial bloodstream infections. Evidence-based prevention strategies for ventilator-associated pneumonia, including management of respiratory equipment according to published guidelines and maintaining backrest elevation at 30 to 45 degrees, are effective. For greatest risk reduction, multifaceted programs ensuring maximal adherence with evidence-based infection control guidelines are needed.

Cross Infection↗
PubMed2005

The practice of infection control and applied epidemiology: a historical perspective.

The United States health care system and patient populations have changed substantially over the past several decades. The practice of infection control also has evolved since the landmark Study on the Efficacy of Nosocomial Infection Control project, and infection control professionals (ICPs) must continue to develop the knowledge and skills necessary to practice infection prevention and control. Practice analyses of infection control conducted between 1982 and 2001 were analyzed to determine changes in practice. These data reflect a 145% increase in infection control activities over a 20-year period. However, resources for infection control and prevention have not kept pace with this increased activity. In addition, the current trend toward mandatory reporting of health care-associated infections (HAIs) among several states will add more tasks for ICPs with limited resources, at the risk of spending less time on prevention and control activities. In keeping with its philosophy of quality health care and responsible public reporting, the Association of Professionals in Infection Control and Epidemiology, Inc, continues to explore the issue of mandatory reporting of HAIs.

Cross Infection↗
PubMed2004

Infection control and dental practice: frequently asked questions.

The principles of infection control are constantly evolving to meet the challenges presented by newly emerging diseases. The Centers for Disease Control and Prevention (CDC) Guideline for Infection Control in Dental Health-Care Settings, 2003, is an important update of current infection control practices that will help the dental profession be better prepared to reduce the transmission of infectious disease(s) in the foreseeable future. However, basic questions still abound. This article reviews frequently asked questions and formats their answers according to recommendations from the 2003 CDC document.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

[A survey on nosocomial tuberculosis infection control in hospitals in Osaka City].

PURPOSE: To ascertain nosocomial tuberculosis (TB) infection control practice in hospitals in Osaka City. METHOD: A questionnaire was distributed in the orientation meeting and collected at the occasion of medical inspection in all 196 hospitals in Osaka City in 2003. RESULTS: TB patients were diagnosed in about half of hospitals in the past 3 years. Basic TB infection control measures were taken in the majority of hospitals; such as chest X-ray screening for all inpatients, health check for employees, tuberculin skin test (TST) for newly employed staff, and nomination of a person in charge of TB infection control. Control measures were practiced more often in hospitals where TB patients were diagnosed, such as "fiberoptic bronchoscopy is to be conducted last in the working hours to avoid contamination of TB bacilli in a room," "TST (including two-step method) for all newly employed staff," "Staff wear N95 mask when they deal with TB patients/suspects," and the differences were statistically significant. DISCUSSION: It is necessary in hospitals in Osaka City to strengthen nosocomial TB infection control as TB patients were diagnosed in about half of hospitals in the past 3 years. Low cost infection control measures were undertaken more often among hospitals where TB patients were diagnosed. Introduction of high cost equipment or improvement of facilities should be considered in hospitals of high TB risk. Guidelines formulated based on analysis of the survey should facilitate all hospitals to introduce at least low cost effective tuberculosis infection control measures.

Cross Infection↗
PubMed2006

Cluster of cases of severe acute respiratory syndrome among Toronto healthcare workers after implementation of infection control precautions: a case series.

OBJECTIVE: To review the severe acute respiratory syndrome (SARS) infection control practices, the types of exposure to patients with SARS, and the activities associated with treatment of such patients among healthcare workers (HCWs) who developed SARS in Toronto, Canada, after SARS-specific infection control precautions had been implemented. METHODS: A retrospective review of work logs and patient assignments, detailed review of medical records of patients with SARS, and comprehensive telephone-based interviews of HCWs who met the case definition for SARS after implementation of infection control precautions. RESULTS: Seventeen HCWs from 6 hospitals developed disease that met the case definition for SARS after implementation of infection control precautions. These HCWs had a mean age (+/-SD) of 39+/-2.3 years. Two HCWs were not interviewed because of illness. Of the remaining 15, only 9 (60%) reported that they had received formal infection control training. Thirteen HCWs (87%) were unsure of proper order in which personal protective equipment should be donned and doffed. Six HCWs (40%) reused items (eg, stethoscopes, goggles, and cleaning equipment) elsewhere on the ward after initial use in a room in which a patient with SARS was staying. Use of masks, gowns, gloves, and eyewear was inconsistent among HCWs. Eight (54%) reported that they were aware of a breach in infection control precautions. HCWs reported fatigue due to an increased number and length of shifts; participants worked a median of 10 shifts during the 10 days before onset of symptoms. Seven HCWs were involved in the intubation of a patient with SARS. One HCW died, and the remaining 16 recovered. CONCLUSION: Multiple factors were likely responsible for SARS in these HCWs, including the performance of high-risk patient care procedures, inconsistent use of personal protective equipment, fatigue, and lack of adequate infection control training.

Adult↗
PubMed1990

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↗
PubMed2000

A pilot study on infection control in 10 randomly selected European hospitals: results of a questionnaire survey.

We describe and compare the organization of infection control and some infection control practices in 10 hospitals in seven different European countries. Great differences were observed. By evaluating infection control and hygiene practices in different European centers, areas of prime importance for the development of a European infection control standard may be defined.

Cross Infection↗
PubMed1997

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↗
PubMed1995

Education and infection control audit.

Education and training forms an important part of the role of the infection control team. It is equally important that the infection control nurse and doctor have mechanisms in place to monitor staff utilization of the knowledge gained, in their clinical practice. The infection control audit which I have developed in Southern Derbyshire has been used in various health care settings over the last six years to monitor compliance with local infection control policies. It has proved to be a valuable tool in improving standards of infection control practice, by providing opportunities for education and generally raising the awareness of both staff and managers. Although originally developed for hospital use, it has been modified for general practice premises, ambulance stations and vehicles, and dental practices.

Antisepsis↗
PubMed1990

Infection control practitioners and committees in skilled nursing facilities in Connecticut.

All skilled nursing facilities (SNFs) in Connecticut were surveyed and more than 71% responded to a Centers for Disease Control-funded project, a component of which is reported herein. The study describes the infection control practitioner (ICP), assistance provided ICPs from external sources, and infection control committees. Almost all ICPs received some training in infection control and worked in the field for an average of 3 1/2 years. Both the number of hours devoted to infection control and the percentage of time spent by the ICP on infection control activities increased with the size of the facility. More than one half of the ICPs in SNFs have relationships with hospital ICPs. The majority of SNF infection control committees met quarterly. The chairperson most often was a physician, although ICPs held this office in almost one third of the reporting SNFs. We conclude that ICPs in Connecticut SNFs have increased in number and that they devote more time and effort to infection control than in previous years.

Aged↗