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PubMed1999

Infection control programs in skilled nursing long-term care facilities: an assessment, 1995.

BACKGROUND: In 1989 the Health Care Financing Administration mandated that long-term care facilities (LTCFs) maintain infection control programs; however, few data are available to guide the design of these programs. The purpose of this study was to assess the current status of infection control programs in LTCFs by using methodology adapted from Phase I of the Centers for Disease Control and Prevention Study on the Efficacy of Nosocomial Infection Control. METHODS: A descriptive study of infection control programs in skilled nursing LTCFs was undertaken in a representative sample of 136 New England skilled nursing LTCFs that have >/=25 beds, with use of a self-report Infection Surveillance and Control Questionnaire. RESULTS: Nearly all (98%) the LTCFs reported having personnel responsible for infection control, with a median of 8 hours per week spent on infection control activities. Ninety percent of these persons were registered nurses; 52% had formal training in infection control. Twenty-five percent of the respondents reported that their infection control program was either "inactive" or nonexistent in 1988, and 60% rated their programs as either "moderately active" (43%) or "very active" (17%) during that year. By 1994, most LTCFs (67%) rated themselves as "very active," and only 3% as inactive or nonexistent. The mean scores on the questionnaire's surveillance and control indices were 23 (out of a possible 30) and 47 (out of a possible 60), respectively, which indicates medium infection surveillance and control activity. On the basis of the data provided by 72% of the respondents (n = 98), a crude estimate of 13.97 infections per 1000 resident-days was calculated, which is a higher rate than previously reported for LTCFs. CONCLUSIONS: Findings from the study indicate that it is feasible to use methodology adapted from Phase I of the Centers for Disease Control and Prevention Study on the Efficacy of Nosocomial Infection Control to assess infection control programs in LTCFs; however, further research into the efficacy of nosocomial infection control in skilled nursing LTCFs is needed.

Chi-Square Distribution↗
PubMed1991

State-of-the-art infection control in dentistry.

This paper defines infection control in dentistry as it exists in 1991 and makes some predictions about the future of this area. A total of 21 items form the basis of a comprehensive infection control program.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Designing an infection control program.

Designing and implementing an infection control program for home care poses many challenges. Some of these challenges stem from a long-standing lack of research and on-site expertise in the home care setting. Recent changes in health care and the proliferation of external regulations regarding home care practice further complicate the development of an effective and efficient infection control program.

Home Care Services↗
PubMed1984

Infection control and the nursing process--making the best use of resources.

The approach to infection control is often 'bugs and drugs' (which organisms are controlled by which drugs), or 'rules, routines and rituals'. But the only fully effective way is the 'hands and human beings' approach, since it is their activities which make other approaches effective or ineffective. The nursing process is an aid to providing the nursing care needed by a person (or people) in their particular health situation. Through systematic assessment of relevant factors and the person's needs for nursing care, planning, implementation and then evaluation of care, available resources are used to the best advantage. Involvement of the patient throughout the process makes care activities more likely to be successful and reduces the stress which might lower resistance to infection. All nurses should include an infection control perspective in their practice. Patient factors such as resistance to infection, daily living activities and self-care abilities (physical and non-physical), cultural, religious or alternative health care practices, communication, dependence/independence tendencies, and environmental factors may all be relevant to infection control. Infection control requires planned good use of the resources of all those concerned-nurses, patients, other staff, visitors. Nurses can use the nursing process to help to achieve this.

Cross Infection↗
PubMed2002

Safety of technology: infection control standards in endoscopy.

Transmission of infection related to gastrointestinal endoscopy continues to be a subject of much discussion. The principles of infection control during endoscopy are reviewed. Guidelines set forth by a number of gastrointestinal endoscopy associations have emphasized the need for meticulous cleaning of endoscopes immediately after use, followed by appropriate disinfection, rinsing and drying. Most, if not all, episodes of transmission of infection during endoscopy are associated with lapses in cleaning and disinfection protocols. The need for universal compliance with infection control standards, and for the development of strategies to achieve such compliance, is highlighted.

Bacterial Infections↗
PubMed1998

Infection control and prevention of Clostridium difficile infection.

Clostridium difficile has become a major problem as a nosocomial pathogen that is associated with the use of antibiotics. In the prevention and control of C. difficile disease it is important that programmes are directed at primary and secondary prevention. The three main elements of prevention are: (i) restricted use of antibiotics; (ii) strict enteric precautions when looking after patients with diarrhoea; and (iii) meticulous cleaning of clinical areas. Although poor handwashing is known to play a key role in the spread of infection, there is evidence that compliance with handwashing protocols is low in many hospitals. Infection control teams need to continue to develop creative education programmes to improve compliance with simple infection control procedures. Consideration needs to be given to ensure that patients have access to handwashing and are well informed about infection prevention. Further work needs to be carried out to establish the efficacy of disinfectants in the environment and the identification of a user-friendly, effective sporicide. The importance of both thorough cleaning with detergents to reduce the number of spores in the environment, and clean equipment for each patient should continue to be emphasized.

Clostridioides difficile↗
PubMed1992

[Infection control in Norwegian somatic hospitals 1990].

The authors present results from a survey of infection control in Norwegian somatic hospitals, carried out during summer/autumn 1990. In 15 of 74 hospitals (20%) one of the hospital doctors was appointed as responsible for infection control. 35 hospitals (48%) had an infection control nurse. Only nine hospitals (12%) reported routine prospective surveillance of hospital infections. The survey revealed a clear under-utilization of commonly accepted methods to survey and prevent hospital infections. Many of the respondents stated the need for national guidelines for infection control. The health authorities should take the initiative to remedy this situation. A new law concerning secondary health care will be passed in the near future, requiring hospitals to establish effective quality assurance systems. Infection control is a very concrete example of quality assurance, and should be given priority when setting up quality assurance systems for hospitals.

Cross Infection↗
PubMed2000

Competency standards in the context of infection control.

BACKGROUND: To ensure quality patient care and enhance career development, competency levels of infection control professionals (ICPs) need to be identified and strengthened so that high standards of practice are established and maintained. OBJECTIVE: The purpose of this study was to apply a modified version of Benner's (1984) "Novice to Expert" model of skill acquisition to levels of competency and to seek to measure practices of the specialist practitioner in the context of infection control. METHOD: A self-administered questionnaire was developed and mailed to 464 members of the Infection Control Association, New South Wales (NSW) Inc, Australia. RESULTS: Seventeen percent of respondents reported full-time infection control responsibilities, 78% part time, and 5% unknown. The sample comprised 4 groups of ICPs. The largest groups were registered nurses, representing 37% of total respondents and "Other health care professionals" representing 35%. Forty-nine percent of the sample had completed a basic or advanced infection control certificate course, 21% had completed a bachelor of nursing or health science degree, and 21% had completed other studies not related to the specialty. Key findings of this study indicated that the clinical nurse consultant group rated their individual levels of skills and knowledge as proficient (competent). Although a small percentage from this group had completed higher level education, years of service within the specialty contributed to an increase in competent performance. This was also applicable to the other groups studied. CONCLUSION: The findings highlighted the need for a framework to be developed on which to build a model to measure and reflect progression of infection control competence at the beginner, advanced beginner, competent, and expert levels. Continuing education as a means of achieving competence needs to be further developed, maintained, and nurtured so that the ICP can acquire appropriate specialty knowledge and skills.

Education, Nursing, Continuing↗
PubMed2005

Characteristics of infection control programs in U.S. Air Force dental clinics: a survey.

BACKGROUND: National organizations and regulatory agencies have issued a number of guidelines on proper infection control procedures in dentistry. The objective of the authors' research was to gather information about current infection control practices in U.S. Air Force (USAF) Dental Corps clinics for the purpose of updating previously issued guidelines and developing infection control training programs. METHODS: The authors mailed a 60-item self-administered survey to the commanders of all USAF dental clinics located in the United States and overseas (n=82). The survey used primarily fixed-response questions to gather information about aspects of the clinics' infection control programs. The authors obtained descriptive statistics of the returned data by means of a statistical software package. RESULTS: The results indicated a high degree of compliance with existing USAF dental infection control guidelines. All clinics had personnel assigned to manage their programs, had a written exposure control plan and took measures to improve dental unit water quality. Facilities used a number of approaches to achieve and monitor compliance and exhibited a considerable amount of variation in infection control procedures when specific guidelines did not exist. CONCLUSIONS: In general, USAF dental clinics reported high levels of compliance with current infection control policies and procedures. Recurrent training, continual oversight, a highly motivated staff and teamwork are essential for reaching and maintaining these levels. Clinical Implications. Although compliance with recommended infection control guidelines is challenging, the results of this survey indicate that compliance is achievable, even in large group practices.

Dental Clinics↗
PubMed1997

Aspects of HIV infection: current infection control policies for HIV.

A coherent infection control policy within healthcare facilities designed for patients with human immunodeficiency virus (HIV) infection requires the application of a risk management strategy. The central feature is the adoption of universal precautions whereby it is assumed that all patients could potentially be infected by HIV. The major tenets of this are the adoption of good clinical hygiene and the adoption of agreed infection control policies with a consistent approach throughout the institution. This involves a teaching and training programme, and clearly defined policies to protect individuals from HIV infection itself and infection with other pathogens, in particular tuberculosis. Special attention is required for bronchoscopy and lung function, as well as a coherent and proactive policy regarding chemoprophylaxis for HIV infection following accidental injury such as needlestick.

Case-Control Studies↗
PubMed2002

Staffing requirements for infection control programs in US health care facilities: Delphi project.

BACKGROUND: The guideline for staffing infection control programs of 1 infection control professional (ICP) for every 250 occupied acute care beds has been used in many health care facilities in the United States since 1985. Since that time, the health care system, patient populations, and expectations about the work of infection prevention and control programs have changed substantially. METHODS: The Delphi method was used; data were obtained from a group of ICPs through a series of 10 surveys. Through this iterative process, participant responses were progressively synthesized and areas of agreement and disagreement identified. These surveys were conducted by electronic and paper mail to identify the personal ICP characteristics and structural variables associated with performance of activities required for contemporary infection prevention and control programs in a variety of health care settings. RESULTS: Delphi panel members (n = 32) from 20 states and who represented acute care, long-term care, and community care settings reported tasks in addition to those identified in earlier task analyses as well as expanded responsibilities. Competing responsibilities and lack of adequate resources were the most frequently cited reasons for nonperformance of essential infection control tasks. A ratio of 0.8 to 1.0 ICP for every 100 occupied acute care beds was suggested as adequate staffing by the Delphi panel. CONCLUSIONS: Infection control responsibilities have expanded beyond the traditional acute care setting. Recommendations for staffing must not only consider the number of occupied beds (average daily census) but also include the scope of the program, the complexity of the health care facility or system, the characteristics of the patient population, and the unique or urgent needs of the facility and community.

Bed Occupancy↗
PubMed2001

[Importance of a network construction with each division and clinical laboratory in the hospital--from a ground of the infection control nurse].

To reduce the frequency and extent hospital infection, the infection prevention team is required to work properly. Infection control nurses play various roles in the infection prevention team, including surveillance of the occurrence of infection and checking the actual conditions of infection prevention activities, as well as the communication and coordination with other sections. Thus, they take part in almost all the activities of the infection prevention team, except the diagnosis and the medical treatment of infectious diseases; that is to say, they make reports, communicate, consult and cooperate with the staff members of other sections. As for surveillance, the results of microbiological tests by a laboratory are most important. By feedback regarding the results of surveillance measures against infection, infection prevention activities become more effective. The staff members of the microbiological laboratory and the infection control nurses can obtain information about the outbreak of infection at an early stage, which is critical in infection prevention activities. Therefore, good cooperation between nurses and the laboratory staff facilitates prompt and appropriate actions to prevent further spread of infection. The test section, especially the microbiological laboratory, is the most important section with which the infection control nurses should work in close cooperation.

Cross Infection↗
PubMed1991

Dental public health and infection control in industrialized and developing countries.

Infection control has long been a concern for dentistry but attention has been placed on it internationally by all health disciplines, prompted by the AIDS/HIV pandemic. Guidelines to eliminate cross-transmission of infectious pathogens in the dental health care setting have been established by the FDI and many national and private dental organizations. However, getting providers to comply with guidelines is a difficult task. Education, peer and social pressure, regulation and litigation are some of the factors which influence compliance. Chief dental officers can either act as a liaison among the various organized dental groups in their country or they may be the primary spokesperson for dental health. In either case, they need to champion the cause for infection control standards. They need to be flexible in establishing guidelines to fit individual circumstances, base recommendations on available resources, and be sensitive to the powerful social, political, and psychological forces behind the public and professional response to the AIDS pandemic.

Developing Countries↗
PubMed2005

Instructions for infection control in outpatient care of patients with cystic fibrosis.

RATIONALE AND GOALS: Infections of the respiratory tract with multiresistant bacteria and other pathogens lead to a poor prognosis in patients with cystic fibrosis. The patient-to-patient transmission of infectious agents during the clinic visit and the transmission via the hands of healthcare workers has gained increased attention in the cystic fibrosis community. For this reason practical and possibly evidence-based instructions for infection control measures are needed that are feasible in every day outpatient management of patients with cystic fibrosis. - METHODS: For generating these instructions, a committee consisting of medical doctors and nursing staff providing care to cystic fibrosis patients, infectious diseases specialists and members of the department of infection control analyzed the patients' route through our cystic fibrosis unit during a routine clinic visit. First, the expert committee defined instructions concerning important infection control measures for each step. Next, each instruction was compared with the published literature and categorized as to its grade of evidence (I, II, 0). Instructions with grades of evidence I and II and instructions without demonstrated evidence (0) but theoretically reasonable and practically feasible, were accepted and outlined in a flow diagram. All other instructions were rejected. - RESULTS: The expert committee defined 45 instructions for infection control measures during an outpatient visit of a cystic fibrosis patient. 43 instructions within the categories "principles", "measures before entering the clinic", "measures in the examination room" and "measures when leaving the clinic" matched the criteria mentioned above and were accepted. 2 instructions were rejected. - CONCLUSIONS: Here we report evidence-based instructions for infection control in the setting of outpatient care for cystic fibrosis patients which are feasible in every day care. Since some instructions could only be assigned low evidence grade levels, i. e. II or 0, a further clarification of these issues by scientific investigations is warranted. Unresolved issues are primarily the recommendation for or against wearing a face mask for patients with certain pathogens and the issues of colonization with Stenotrophomonas maltophilia and Alcaligines xylosidans, but also with Aspergillus spp.. Continuous education of patients and healthcare workers as well as the validation of these practical instructions by a close monitoring and documentation of pathogens are of great importance.

Adolescent↗
PubMed1999

Certification in infection control and epidemiology-a celebration of 15 years!

Certification in infection control has been available since 1983. In this, the 15th anniversary of the Certified in Infection Control examination, it seems appropriate to examine how the program was developed, how it has evolved, and future opportunities for Certification in Infection Control and Epidemiology. This article was written to provide a brief history and an update on the current status of the Certified in Infection Control program.

Certification↗
PubMed1989

Infection control in North American dental schools.

A questionnaire concerning infection control issues was sent to all North American dental schools in 1987. The results were compared with a similar survey conducted by the same authors in 1982. The purposes of the survey were to identify changes that have occurred in dental school infection control policies in the past six to seven years, and to study strengths and weaknesses of current policies. The results of the survey indicate a much greater emphasis on instrument sterilization and the use of barriers during dental treatment than in 1982. Compliance with the policy is not always satisfactory, however. It also shows some inconsistency and confusion in areas dealing with hepatitis B and HIV carrier patients and dental school personnel. Several respondents included written infection control protocols with the questionnaire. Information gained from the survey and the enclosures were used to develop guidelines to help schools improve and update their infection control policies.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Quality assurance and the role of infection control: a retrospective study of hospital-acquired infection in a District General Hospital based on three sites, 1978-1988.

A retrospective study of hospital-acquired infection surveillance data from 1978 to 1988 showed a reduction in the incidence rate from 7.6 to 3.9% respectively, while simultaneously there was a 25% increase in throughput of patients. The reduction in the incidence of hospital-acquired infection is considered to be multifactorial. Since the rates of infection appear to be significantly altered by staff awareness and infection control programmes, they could be used as an outcome measure to reflect the quality of care in hospitals.

Cross Infection↗