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PubMed2004

Hospital-acquired infections in Italy: a region wide prevalence study.

Between October and December 2000, a region-wide prevalence study of hospital-acquired infections (HAI) was conducted in all public hospitals (59 facilities with ca. 16000 beds; 560000 admission yearly) in Piemonte Region, Italy, and in the one hospital of the neighbouring autonomous region of Valle d'Aosta. The study population comprised a total of 9467 patients hospitalized for at least 24 h. The prevalence of HAI was 7.84%, with marked differences in prevalence among the participating hospitals (range: 0-47.8%). The higher relative frequency of urinary tract infections (UTI; 52.7%) was due to the inclusion of urine cultures obtained on the day of the study from asymptomatic UTI in catheterized patients. A significant correlation was found with major risk factors related to medical procedures (urinary catheter, mechanical ventilation, surgical drainage, intravascular catheters). Patients with HAI were found to be older and to have a greater mean length of stay in hospital. Multiple logistic regression analyses showed that lack of independence, indwelling urinary catheter and mechanical ventilation were the risk factors more significantly associated with HAI. The use of antibiotics, in particular prophylactic agents used in surgery (cephalosporins, glycopeptides), provided an incentive for corrective intervention in antibiotic administration and in training of healthcare workers.

Anti-Bacterial Agents↗
PubMed2001

The importance of definitions and methods in surgical wound infection audit.

We investigated the value of a full-time audit nurse personally following up every patient from admission to 30 days postoperatively in order to obtain accurate surgical wound infection rates. Our results show that this type of audit is an effective, although time-consuming, way of collecting accurate data on wound infection rates. It enabled the early identification of problem areas in practice and facilitated the adoption of evidence based practice. As a result of the audit there was a significant reduction in the clean wound infection rate from 13.9% in November 1995 to 7.9% in March 1998 (P= 0.05).

Aftercare↗
PubMedDate not supplied

Vancomycin intermediate-resistant Staphylococcus aureus (VISA).

Methicillin-resistant Staphylococcus aureus (MRSA) has been an infectious disease problem since the early 1980s and until recently was uniformly susceptible to vancomycin, the drug known as the "last resort." Recent reports indicate that Staphylococcus aureus has continued to mutate and has developed intermediate resistance to vancomycin (VISA). This article lists some of the potential clinical manifestations of Staphylococcus aureus as well as a possible explanation of the phenomenon of antibiotic resistance. The reported cases of VISA are reviewed, and intervention strategies for prevention and control are discussed.

DNA, Bacterial↗
PubMedDate not supplied

The management of ballistic trauma: an infection control perspective.

This article discusses the relationship between ballistic trauma, clostridial contamination and potential wound infection and considers the implications for care by nurses and infection control teams. An overview of ballistics is presented followed by an examination of the pathophysiology of wounding and its effects. The philosophy of war surgery is balanced against civilian concepts and the differing management strategies that prevail. It explores the causes of, and relationship between, wound contamination and the seriousness of wound infection. Nurses, inexperienced in dealing and caring for these types of patients, should be aware and understand the beliefs, arguments and controversies that surround ballistic trauma management. By so doing, nurses and infection control teams will be able to provide an enhanced level of holistic nursing care.

Adaptation, Psychological↗
PubMed1991

The use of routine wound swabs and Kardex review for the surveillance of surgical wound infections.

Prospective post-operative wound surveillance was carried out in two phases on 1285 patients. A total of 120 infections were documented. In phase I a review of routine swabs and Kardex was conducted in parallel with continuous surveillance. In this phase continuous surveillance detected 31/35 infections and routine swabs and Kardex methods picked up 28/35 infections. In phase 2 continuous surveillance was not carried out and routine swab and Kardex review detected 78/85 infections. Overall II infections were documented following discharge. Continuous surveillance is sensitive but laborious. The method described here would enable infection control nurses to visit patients in whom infections are more likely to occur, and still provide reliable and accurate rates of infections.

Hong Kong↗
PubMed2002

Post-discharge surveillance: can patients reliably diagnose surgical wound infections?

Post-discharge surgical wound infection surveillance is an important part of many infection control programs. It is frequently undertaken by patient self-assessment, prompted either by a telephone or postal questionnaire. To assess the reliability of this method, 290 patients were followed for six weeks postoperatively. Their wounds were photographed and also covertly assessed for signs of infection by two experienced infection control nurses (ICNs). Patients also responded to a postal questionnaire seeking evidence of infection at both week four and week six post-surgery. Correlation between the patient's assessment of their wound and the ICNs diagnosis was poor (r = 0.37) with a low positive predictive value (28.7%), although negative predictive value was high (98.2%). Assessment of photos for signs of infection by two experienced clinicians also correlated poorly with the ICNs diagnosis of infection (r = 0.54). The patient's recall of prescription of an antibiotic by their general practitioner (GP) for wound infection during the postoperative period correlated best with the ICNs diagnosis (r = 0.76). This latter measure, particularly when confirmed by the GP in those patients reporting an infection, appears to provide the most valid and resource efficient marker of post-discharge surgical wound infection.

Aftercare↗
PubMed1997

A study of nurses' views about the prevention of nosocomial urinary tract infections.

This study sought to discover the contribution of nursing practice to the prevention of hospital-acquired or nosocomial urinary tract infections (NUTIs), the most commonly occurring nosocomial infection. Seventy-five per cent of such infections are associated with urethral catheters. The practices of nurses who are caring for patients on a 24 h basis would appear to be fundamental to achieving any reduction in the incidence of NUTIs. This qualitative study utilized unstructured interviews to explore the views of 12 registered nurses about three key issues: first, what care do nurses give with the aim of preventing catheter-associated NUTIs; secondly, what improvements in practice would further prevent catheter-associated NUTIs; thirdly, what do nurses see as constraints to the prevention of catheter-associated NUTIs? The nurses identified many of the measures that were cited in the literature as effective for preventing NUTIs; however in reality, they stated that their practice differed because of a lack of time to give care and to update themselves. The consequences of under-staffing were that junior and temporary staff (whose competence in preventing NUTIs was questioned) worked unsupervised. Those interviewed identified feelings of powerlessness in effecting preventative measures, and identified not only the role of medical staff in influencing NUTIs but also their inconsistent approach to care. All these forces effectively limited the nurses' ability to prevent NUTIs. The study is concluded with recommendations for changes in practice and further research.

Cross Infection↗
PubMed2005

A national survey of dental hygienists' infection control attitudes and practices.

PURPOSE: The objectives of this study were to: 1) investigate the infection control practices of practicing dental hygienists, 2) document the attitudes and practices of dental hygienists toward patients with infectious diseases, and 3) determine if professional affiliation affected the attitudes and/or practices of the respondents. METHODS: A 49-item survey consisting of eight demographic, nine attitudinal, and 32 practice questions was used for this study. A stratified sampling method was used, in which the United States was divided into four regions. Three states were selected from each region according to geographic location and population. Five percent of registered dental hygienists within each selected state were randomly selected for inclusion in the study. All analyses were conducted using the Statistical Package for Social Scientists (SPSS v.10, Chicago, IL). RESULTS: Of the 2,009 surveys mailed, 104 were undeliverable. A total of 856 completed surveys were returned from practicing dental hygienists for a response rate of 44.9%. Overall, this study found an increased use of barriers and personal protective equipment in comparison to previous studies. A majority of respondents (53.9%) felt that treating patients with HIV or AIDS increased their personal risk for contracting the disease. The majority of respondents also reported always using extra precautions with HIV/AIDS patients (63.5%) and hepatitis patients (60.1%). In addition, most respondents reported they would not use an ultrasonic scaler when treating HIV/AIDS (65.8%) or hepatitis (58.9%) patients, indicating an alteration in clinical practice habits. CONCLUSION: The majority of dental hygienists surveyed reported altering infection control practices and treatment techniques when treating HIV/AIDS or hepatitis patients. While there has been an improvement in compliance with recommended infection control guidelines, practitioners still have misconceptions, and possibly fear, regarding infectious diseases and disease transmission.

Air Pollution, Indoor↗
PubMed2002

Sixteen years' surveillance of surgical sites in an Irish acute-care hospital.

OBJECTIVE: To report a program of continuous surveillance of surgical-site infections (SSIs) using basic surveillance methods. DESIGN: Analysis of routine prospective surveillance data. SETTING: Two hospitals in Ireland (300 and 350 beds) that merged and moved to a new 650-bed hospital in 1987. PATIENTS: 59,335 surgical sites of postoperative patients. INTERVENTIONS: Surgical sites were surveyed by one infection control nurse and SSI rates were produced for selected operations and surgical services. The program was conducted in general accordance with the 1999 HICPAC guidelines, but differed in surveillance strategy. Operations were limited to two to three risk classifications, assigned by the infection control nurse. RESULTS: The overall SSI rate was 4.5%, with 2.4% in clean surgery. Apart from increases in the 3rd, 4th, 13th, and 14th years, rates remained relatively stable during the 16 years. Few significant decreases in SSI rates in surgical services or specific operations were shown, apart from the following: vascular surgery, 8.1% to 5% between the first 8 years and the last 8 years; general surgery services, 9% to 5%, and gynecology, 15.8% to 1.7%, both in the first year compared with in subsequent years; and gastric operations, 21% to 4.3% between the first year and the second year. Organ/space infection was identified in 0.5% of 17,804 operations, including 0.4% meningitis after neurosurgical procedures, 3% graft infections after vascular bypass operations, and 0.2% intra-abdominal infections after abdominal surgery. CONCLUSIONS: With the use of basic principles of surveillance and modest resources, procedure-specific SSI rates were produced, with little significant change during the 16 years. Despite limitations in case-finding, risk stratification, feedback, and surveillance methods, the overall SSI rates were comparable with other published data.

Cross Infection↗
PubMed2004

Promoting quality through surveillance of surgical site infections: five prevention success stories.

BACKGROUND: Public reports of successful quality improvement efforts are useful, but seldom available. We present 5 successful efforts to prevent surgical site infections (SSIs) with the use of prospectively collected surveillance data. METHODS: Before-and-after intervention studies were conducted in 5 acute care public hospitals in the national surveillance network for SSI in The Netherlands from 1992 to 2000. Patients undergoing surgery for total hip prosthesis (3 hospitals), knee prosthesis (2 hospitals), prosthesis of the femur head (1 hospital), or appendectomy (1 hospital) were included. Included were 1066 patients before intervention, and 1269 patients after intervention. Multidisciplinary evaluation of infection control policy led to subsequent changes of infection control measures, mainly involving the discipline of staff and organization of perioperative infection prevention procedures. RESULTS: All 5 hospitals drastically reduced their SSI rates to the national average or below. Absolute declines ranged from 2.1% to 13.9%, but not all reductions were statistically significantly different from 0%. CONCLUSION: Surveillance results provide a basis for improvement of infection prevention.

Bacterial Infections↗
PubMedDate not supplied

A process evaluation of an intervention to improve respiratory infection control practices in family physician offices.

OBJECTIVE: To conduct a process evaluation of a short-term intervention by public nurses for physicians to facilitate the incorporation of new respiratory infection control practices in physicians' offices. DESIGN: Process evaluation. SETTING: Family physician offices in Ottawa, Ontario, Canada. PARTICIPANTS: Five public health nurse-facilitators and 53 primary care practices including 143 family physicians. METHOD: Effectiveness of facilitator training assessed by self-administered questionnaires. Data assessing process of facilitation collected through activity logs and narrative reports. Physicians' satisfaction assessed by post-intervention questionnaire. MAIN FINDINGS: Facilitators reported that training strongly contributed to their knowledge and skills and all were either satisfied or highly satisfied with their facilitation training. All practices received at least two visits by the facilitator and more than half (51%) were visited three or more times. Facilitators identified the provision of the evidence-based Tool Kit and consensus-building with office staff as key factors contributing to the intervention's success. Of the 45% of physicians who completed the questionnaire (65/143), only 5% reported being somewhat dissatisfied with the intervention, 11% reported the visits were not frequent enough, and 9% thought the visits were too close together. The majority (97%) felt the facilitation program should be available to all family physicians and 98% would continue to use the service if available. CONCLUSIONS: It is feasible for public health nurses to be trained in outreach facilitation to improve respiratory infection control practices in physicians' offices and this has been widely appreciated by physicians. This model of public health/primary care collaboration deserves further exploration.

Clinical Competence↗
PubMed1993

Validation of surgical wound classification in the operating room.

OBJECTIVE: To determine the accuracy with which circulating nurses (CNs) classify surgical procedures by risk of contamination in the operating room. DESIGN: Classification of surgical procedures by CNs was compared with the classification of surgical procedures by a physician observer. SETTING: University-affiliated, tertiary care hospital. METHODS: Circulating nurses used the traditional wound classification system of clean, clean-contaminated, contaminated, and dirty-infected to classify surgical wounds in the operating room. A physician remained in the operating room throughout each of 100 surgical procedures and simultaneously classified surgical wounds without the knowledge of the CNs. RESULTS: Classification of surgical wounds by CNs was compared with classification by the physician observer for 50 cases in general surgery and 50 cases in trauma surgery. Compared with the physician observer, the overall accuracy of classification by CNs was 88% (95% confidence interval [CI] of 81.6% to 94.4%; Kappa statistic, 0.83). Classification of surgical wounds was more difficult in trauma surgery (accuracy of 82%) than in general surgery (accuracy of 94%). Accuracy increased for both services when surgical wounds were classified into just two categories (clean or clean-contaminated versus contaminated or dirty-infected). CONCLUSIONS: Surgical wounds can be classified in the operating room with a high degree of accuracy by CNs. Classification was more difficult in trauma than in general surgery, but classification in trauma surgery improved with feedback to and additional education of CNs. The accuracy of classification by CNs was even higher when classifications were divided into just two categories.

Hospital Bed Capacity, 300 to 499↗
PubMed1997

Control of infections caused by drug-resistant organisms in critical care.

The emergence of antibiotic-resistant pathogens has been an ongoing concern of infection-control and infectious disease practitioners. Infections caused by these organisms increase costs and may result in poorer outcomes for patients. Efforts to contain the problem of infections caused by drug-resistant organisms have two objectives: to optimize antibiotic use and to prevent transmission through effective infection-control practices.

Anti-Bacterial Agents↗
PubMed2006

Reduced risk of surgical site infections through surveillance in a network.

OBJECTIVE: To estimate the effect of multicentre surveillance for nosocomial infections on patients' risk of surgical site infection (SSI). DESIGN: Prospective multi-centre cohort study, from January 1996 to December 2000. SETTING: Acute care hospitals in The Netherlands. STUDY PARTICIPANTS: All 50 hospitals performing surveillance for one of seven selected procedures in the Dutch surveillance network for nosocomial infections PREZIES were invited. Thirty-seven hospitals participated (74%) and provided information on 21 920 operations, after which 885 (4%) SSI occurred. INTERVENTIONS: The surveillance comprised the following: Development of surveillance methodology by multidisciplinary team; use of a standardized registration protocol and software; regular training of data collectors; anonymous inter-hospital comparison of infection rates and feedback of results; appointment of one contact person per hospital, responsible for data collection; and dissemination of results to other health care professionals. Regular discussion of both successful and failing prevention strategies that had been instituted based on the surveillance results. OUTCOME MEASURE: Risk of SSI. RESULTS: The risk of infection was reduced for patients who had an operation during the fourth surveillance year (RR = 0.69; 95% confidence interval (CI) = 0.52-0.89) and decreased further for patients operated on during the fifth surveillance year (RR = 0.43; CI = 0.24-0.76) as compared with patients who underwent surgery within one year of the start of surveillance in their hospital. No significant risk reduction was observed for patients operated on during the second and third surveillance years. CONCLUSION: Surveillance, supported by participation in a surveillance network, reduced the risk of SSI in surgical patients registered in the Dutch surveillance network PREZIES. Our results suggest that infection control teams need to be perseverant and that surveillance programmes should be given time before evaluation.

Adult↗
PubMed2004

Clinical nurse specialists and nurse practitioners: complementary roles for infectious disease and infection control.

BACKGROUND: The escalation of infectious diseases worldwide heralds an unprecedented need for nurses with advanced practice graduate preparation. OBJECTIVE: To describe how a graduate program prepares clinical nurse specialists and nurse practitioners in infectious diseases or infection control to provide distinct yet complementary care for patients with contagious disease and potentially antimicrobial-resistant infections. RESULTS: The University of Washington School of Nursing launched a new master of nursing program for infectious disease and infection control to reduce the threat of infectious diseases and multiple-resistant organisms.

Communicable Diseases↗