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The role of the infection control link nurse.

Link nurses act as a link between their own clinical area and the infection control team. Their role is to increase awareness of infection control issues in their ward and motivate staff to improve practice. It is essential that they receive training from the infection control team to ensure their competence. They have been shown to be of value to Trusts by improving clinical ward audit scores, helping infection control nurses implement policies and collecting data on hospital-acquired infections. In some hospitals, however, there are operational difficulties for link nurse schemes including high turnover of staff and insufficient time for training and monitoring their effectiveness.

Attitude of Health Personnel↗

Lowbury Lecture 2005: infection control from a global perspective.

All healthcare settings around the world face the problem of healthcare-associated infections (HCAIs). Rates of infection vary between countries and within the same country depending on resources, interest of caregivers and healthcare staff, and patients' socio-economic situation. According to recent publications, 10-70% of HCAIs are preventable. Failure to comply with guidelines on hand hygiene, glove and gown use, and barrier nursing is a problem and unnecessary infection control measures are costly. National legislations and regional, national and international standards and guidelines associated with infection control also have an impact for countries that are not directly involved. They should be based on the assessment of infection risk, and should not increase costs unnecessarily. The International Federation of Infection Control and national infection control societies play an important role in continuing the education of infection control specialists.

Cross Infection↗

An infection control nurse-advisor program.

The nurse epidemiologist and department of nursing in a 100-bed acute-care facility designed, implemented, and evaluated a program with the goal of increasing awareness of prevention and control of infection in nursing practice. The method selected was to have a registered nurse volunteer from each unit to serve as nurse-advisor for a 4-month period. Each nurse-advisor was to serve as a resource for the unit, monitor peer practice, identify weaknesses in nursing practice, educate peers, and identify infection problems. At the end of 2 years, 22 nurses had served as nurse-advisors, with 16 in present employment. All areas of the nursing department had participated in the program. Descriptive analysis of the nurse-advisor program after a 2-year study demonstrated it to be an effective method to increase awareness of prevention and control of infection in nursing practice.

Cross Infection↗

The impact of US-style infection control programs in an Asian country.

The impact of US-style infection control programs is global. There are many Asian countries that have translated US-style infection control programs into their own programs, but reports of those efforts are rarely published in English. This article describes the development of infection control in Taiwan and the development of intensive infection surveillance and control programs in a pioneer acute-care medical center that has 3,000 beds. The article also discusses problems that have arisen in translation of US infection control practices.

Cross Infection↗

HIV/AIDS infection control enforcement: a comparison between Nigeria and the United States.

We examined differences in approaches to HIV-related infection control practices in two university teaching hospitals in the United States and Nigeria. Health care workers (n = 202 in Nigeria and 186 in the USA) responded to a previously validated measure of infection control practices. There were significant differences in the estimated probability of treating a person with HIV disease (higher in USA), and a greater probability of peer ridicule as a way of enforcing group norms on infection control in Nigeria. Peer enforcement of norms was significantly lower in the USA. In both countries, more precautions would be taken if it was known that the patient was HIV infected. Infection control practices were more likely to be followed in the USA compared with Nigeria if they were praised for this activity, if appropriate facilities (sharps containers, gloves, etc.) were nearby, and if they felt that infection control procedures were effective. These data point to the importance of normative social pressures in Nigeria and of knowing the patient is HIV infected in the USA and feeling that infection control procedures are effective ways of avoiding occupational HIV infection. The role of normative pressures and assumptions about HIV infection status as well as cues and availability of facilities for infection control appear to differ between these health care workers in Nigeria and the USA.

Acquired Immunodeficiency Syndrome↗

Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics.

Antimicrobial-drug resistance in hospitals is driven by failures of hospital hygiene, selective pressures created by overuse of antibiotics, and mobile genetic elements that can encode bacterial resistance mechanisms. Attention to hand hygiene is constrained by the time it takes to wash hands and by the adverse effects of repeated handwashing on the skin. Alcohol-based hand rubs can overcome the time problem and actually improve skin condition. Universal glove use could close gaps left by incomplete adherence to hand hygiene. Various interventions have been described to improve antibiotic use. The most effective have been programs restricting use of antibiotics and computer-based order forms for health providers.

Alcohols↗

Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina.

OBJECTIVE: Our aim was to ascertain the effect of an infection control program, using education and performance feedback on intensive care units, for intravascular device (IVD)-associated bloodstream infection (BSI). METHODS: Within 4 level III, adult, intensive care units in Argentina, all admitted, adult patients with a central vascular catheter in place for at least 24 hours were included. This was a prospective before-and-after trial in which rates of IVD-associated BSI determined during a period of active surveillance without education or performance feedback (phase 1) were compared after sequential implementation of an infection control program using education (phase 2) and performance feedback (phase 3). RESULTS: A total of 1219 IVD days were accumulated in phase 1; 586 during phase 2; and 4140 during phase 3. Compliance with central vascular catheter--site care improved significantly from baseline during the study period. Overall rates of IVD-associated BSI were lowered significantly from baseline after sequential implementation of education and performance feedback (11.10 vs 46.63 BSI/1000 IVD days; relative risk=0.25; 95% confidence interval=0.17-0.36; P<.0001). Rates of IVD-associated BSI decreased significantly after implementation of an educational program (phase 1 to phase 2) (relative risk 0.37; confidence interval 0.19-0.73; P=.0026) and further reductions were seen after implementation of a performance feedback program (phase 2 to phase 3), although the reduction did not reach statistical significance (9.9 vs 17.06 BSI/1000 IVD days; relative risk 0.58; confidence interval 0.29-1.18; P=.11). Additional analysis of the data using chi2 for trends demonstrated that sequential implementation of an education and performance feedback program resulted in a significant trend toward reduced rates of IVD-associated BSI (P<.001). CONCLUSION: Implementation of an infection control program, using education and performance feedback, resulted in significant reductions in rates of IVD-associated BSI.

Aged↗

Infection control in the context of hepatitis C disclosure: implications for education of healthcare professionals.

INTRODUCTION: Previous investigation has shown that the health sector is a main source of discrimination against people with hepatitis C. This paper examines the perceptions and experiences of people with hepatitis C of their interactions with healthcare workers, particularly examining the implementation of infection control precautions. We contend that rather than applying infection control precautions universally, health care workers make judgements about individual patients and the likelihood that they are infected with hepatitis C. Thus, infection control practices can be used as a tool to discriminate against people with hepatitis C. Social identity theory is used to illustrate these insights and to propose recommendations for education of health care workers. METHOD: Semi-structured interviews with 19 people who had hepatitis C were conducted. The analysis examines issues of diagnosis, discrimination and disclosure in relation to healthcare workers' use of infection control procedures during clinical interactions. RESULTS: Participants described non-compliance with infection control guidelines by healthcare workers in a range of settings. In some instances, participants expressed disapproval of non-compliance, at other times participants felt vulnerable and discriminated against. Participants felt obliged to disclose their infections, but some decided against future disclosure because of negative reactions from healthcare workers. Infection control procedures were used as a tool to discriminate against some participants. DISCUSSION: Non-compliance with infection control guidelines persists among healthcare workers and can be identified by patients. A minority of workers use infection control as a discriminatory tool against those with hepatitis C. Further intervention is required to ensure infection control guidelines are enacted in the manner intended.

Adult↗

Dental clinical attire and infection-control procedures. Patients' attitudes.

BACKGROUND: The authors surveyed adults in military and civilian dental practices about infection-control procedures and clinical attire to see if patients' attitudes had changed with the alteration of infection-control procedures over the last two decades. METHODS: The authors surveyed 1,500 adults, using a written questionnaire at two military hospital dental practices and at four civilian dental offices, which included two general practices, one periodontal practice and one orthodontic practice. RESULTS: The authors found that the use of name tags and patient safety glasses during treatment were preferred by 52.0 percent and 53.4 percent, respectively, of respondents in military facilities. Respondents had no preference about dentists' clothing, use of protective glasses for examinations or head cover use. A majority of respondents preferred that dentists wear glasses when performing treatment (54.1 percent), and 77.4 percent of respondents preferred that dentists wear masks when providing their care. Respondents preferred the use of plastic barriers, and 63.0 percent said it made them feel confident that proper infection-control procedures were followed. A majority of respondents (52.3 percent) said they would be concerned if barriers were not used. CONCLUSIONS: Military and civilian respondents had similar perceptions of infection-control procedures. Respondents said they preferred that dentists wear name tags in group practices and use masks and protective glasses when performing treatment. The use of plastic barriers made respondents feel confident that proper infection-control procedures were being followed. PRACTICE IMPLICATIONS: This study can be used by dental practices to review their infection-control procedures and how patients perceive them. Dentists may decide to implement some of these procedures, especially those that are not required, and that improve customer satisfaction.

Adolescent↗

Infection control practices in U.S. burn units.

The purpose of this study was to determine infection control procedures most commonly used in burn units in the United States. We used two data collection formats: a brief quantitative survey and a brief qualitative interview. Our response rate was 75% (104/139). We found wide variability in general infection control practices as well as in wound care practices in intensive care units. The majority of units reported having written infection control guidelines specific to the burn unit. Respondents noted challenges that burn injury presents to infection control. A broad range of techniques for preventing device- and procedure-related infection also were provided by respondents. Compliance with hand washing on the part of physicians and ancillary staff remains a major challenge. To improve the quality of infection control and reduce variation in practice, we must continue to monitor the types of practices that are delivered, provide feedback to providers on how they care for their patients, where evidence exists disseminate best practices, and build the evidence base through efficacy trials.

Burn Units↗

Ethical aspects of infection control.

This article describes ethical dilemmas faced routinely by infection control personnel and outlines the basic principles of ethics as applied to the practice of infection control and hospital epidemiology.

Decision Making↗

APIC position paper: hepatitis C exposure in the health care setting. Association for Professionals in Infection Control and Epidemiology, Inc.

The Association for Professionals in Infection Control and Epidemiology, Inc (APIC), is a multidisciplinary, voluntary, international organization of professionals who practice infection control and the application of epidemiology in all health settings. APIC is an international leader in prevention and control of infection transmission.

Hepatitis C↗

[Costs and benefits in hospital infection control].

Economic concerns have taken on increasing importance in infection control since the mid 1970s in the US. The US studies on the economics of infection control have been mainly of the following types: 1) Cost estimates, 2) Effectiveness estimates, 3) Cost-effectiveness analysis, 4) Cost-benefit analysis, 5) Cost-utility analysis, 6) Cost-containment studies, 7) Cost minimization analysis and 8) Meta-analysis. The Japanese Society of Environmental Microbiology was established in 1986. There are, however, few papers on the economics of infection control in Japan. The main problems are shortage in human resources and the health care system. It is high time that a new research system of hospital infections will be established in Japan.

Cost-Benefit Analysis↗

Infection control: public health, clinical effectiveness and education.

In this article the author discusses three main issues in infection control: the development of clinical effectiveness, education and public health. Present day infection control practice is based on principles put forward by Florence Nightingale over 100 years ago. Despite medical advances, hospital-acquired infection remains a major cause of morbidity and mortality. Further research is required to assess how effective present day infection control activities and policies are in reducing the spread of infection. The success of implementing evidence-based practice relies on multidisciplinary, user-friendly educational initiatives. It is imperative that community practitioners are involved in the promotion of infection control. Greater public awareness of infectious agents and the importance of basic hygiene will ensure that infection control cannot remain the exclusive property of hospitals, but must extend to all areas of public health.

Communicable Disease Control↗

Procedure-specific infection control for preventing intraoperative blood exposures.

Contemporary intraoperative infection control must address the risk of infection transmission to both patients and their providers. The patient must be protected from intraoperative wound contamination and exposure to blood-borne pathogens during procedures. Providers must be protected from injuries and mucocutaneous exposure to the patient's blood. Procedure-specific infection control precautions, or similar strategies that address this bidirectional potential for infection transmission, may prove successful in accomplishing improved safety for all.

Blood-Borne Pathogens↗

APIC state-of-the-Art report: the role of infection control during construction in health care facilities.

The Association for Professionals in Infection Control and Epidemiology, Inc (APIC), is a multidisciplinary organization of more than 12,000 health care professionals who practice infection control and epidemiology within a variety of health care settings. This report reviews issues the infection control professional should consider related to construction and renovation projects in health care facilities. Preventing transmission of infectious agents to vulnerable patient populations, health care workers, and visitors remains an important component of infection control programs. Environmental dispersal of microorganisms during construction, resulting in nosocomial infections, has been described previously, and select examples are provided in Table I as a reminder that there is a solid, scientific basis for these concerns. Environmental airborne contaminants and infectious agents are closely related to water and moisture-related conditions and figure prominently in construction activity. Weems et al have established construction activity as an independent variable for infectious risks in such circumstances. Construction-related outbreak literature will not be revisited in detail; however, pertinent citations will identify resources as appropriate.

Cross Infection↗