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PubMedDate not supplied

Patient-care directives and infection control: the potential conflict of interest during epidemics in long-term care facilities.

Patient-care directives in long-term care facilities ensure that the aggressiveness of diagnostic and therapeutic interventions accurately reflects the desires of the patient. The results of our investigation of two outbreaks of fatal respiratory illness in long-term care facilities illustrate how patient-care directives may have delayed response to the outbreaks. Despite a cluster of deaths in each facility, staff delayed collection of laboratory specimens until patients with no directives restricting the medical workup became ill. Directives focus on the needs of the individual patient and family, but when an outbreak occurs, they may conflict with community needs. The challenge for the infection control practitioner is to recognize when community needs outweigh individual desires so that appropriate laboratory investigations can identify the cause of the illness.

Advance Directives↗
PubMed1991

Major trends in nosocomial viral infections.

Viruses have recently become appreciated as nosocomial pathogens. There is insufficient data to characterize trends in rates of viral nosocomial infections, but there have been major trends in methodologies and concepts. New groups of patients, such as infants and the elderly, are becoming appreciated as being at risk for serious nosocomial viral infections, whereas other groups, such as immunodeficient patients are expanding because of the epidemic of human immunodeficiency virus (HIV) infection and expanded use of immunosuppressive treatment. The continued addition of new viruses, such as HIV, human parvovirus B19, and rabies virus, to the list of potential nosocomial pathogens suggest that most human viruses can probably be serious nosocomial pathogens under the right circumstances. Advances in medical treatments and procedures, such as cadaveric dura mater grafts and laser treatment of warts, have provided new avenues for nosocomial transmission of viruses. Improved and wider availability of diagnostics promises to be a major force in improving our understanding and ability to prevent viral nosocomial infections. With these advances, viral diagnostic laboratories should become an important member of the infection control team. In parallel with trends in methodologies and concepts, there have been major advances in our understanding of ways to prevent some nosocomial viral infections. Application of these prevention measures is an important challenge to the infection control practitioner.

Cross Infection↗
PubMed1991

Education programmes for infection control in Canada.

Formal educational programmes for infection control personnel in Canada are limited and most courses have been directed at infection control practitioners (ICPs). Most ICPs report that their preparation comes from in-post training. Although there have been several short, non-credit courses available in the past, the only course available for ICPs at the present time is an intensive 1-week course. Surveys of nurses and ICPs suggest that they prefer flexibly scheduled university credit courses which will not only prepare them for their positions but also enable them to meet entry-to-practice requirements as recommended by the board of the Canadian Nurses Association. The future development of courses for ICPs must endeavour to meet these needs. Moreover, the educational needs of physicians and other health professionals working in this field have not been well identified or addressed and it is clear that educational programmes must also be developed for these health professionals.

Canada↗
PubMed1991

Risk management: an aspect of infection control in an acute care hospital.

The term 'risk management' is one that may cause apprehension in the minds of some infection control practitioners because it conjures up images from the non-health care world. However, when the concept of risk management is analyzed and applied to the field of infection control one discovers a large overlap. The purpose of this article is to highlight some of this common ground. It may show that, rather than fear risk management, one may be better advised to recognize it as an aspect of infection control.

Cross Infection↗
PubMed1992

Computerized identification of patients at high risk for hospital-acquired infection.

Surveillance for hospital-acquired infections is required in U.S. hospitals, and statistical methods have been used to predict the risk of infection. We used the HELP (Health Evaluation through Logical Processing) Hospital Information System at LDS Hospital to develop computerized methods to identify and verify hospital-acquired infections. The criteria for hospital-acquired infection are standardized and based on the guidelines of the Study of the Efficacy of Nosocomial Infection Control and the Centers for Disease Control. The computer algorithms are automatically activated when key items of information, such as microbiology results, are reported. Computer surveillance identified more hospital-acquired infections than did traditional methods and has replaced manual surveillance in our 520-bed hospital. Data on verified hospital-acquired infections are electronically transferred to a microcomputer to facilitate outbreak investigation and the generation of reports on infection rates. Recently, we used the HELP system to employ statistical methods to automatically identify high-risk patients. Patient data from more than 6000 patients were used to develop a high-risk equation. Stepwise logistic regression identified 10 risk factors for nosocomial infection. The HELP system now uses this logistic-regression equation to monitor and determine the risk status for all hospitalized patients each day. The computer notifies infection control practitioners each morning of patients who are newly classified as being at high risk. Of 605 hospital-acquired infections during a 6-month period, 472 (78%) occurred in high-risk patients, and 380 (63%) were predicted before the onset of infection. Computerized regression equations to identify patients at risk of having hospital-acquired infections can help focus prevention efforts.

Cross Infection↗
PubMed1992

A survey of hospital infection control policies and employee measles cases during Los Angeles County's measles epidemic, 1987 to 1989.

BACKGROUND: Between December 1987 and December 1989, 74 adults employed in Los Angeles County acute care hospitals were found to have measles. To investigate measles infection control policies in Los Angeles County and to gain information on employee measles cases, two surveys were performed. METHODS: A survey of all infection control practitioners (N = 102) of acute care hospitals was conducted in July 1989. Reported employee measles cases were surveyed after initial case reports were reviewed. RESULTS: The survey of acute care hospitals revealed that only 17% had mandatory measles infection control policies requiring written proof of past measles vaccination, disease, or seropositivity. Only 4% of hospitals had policies affecting students or volunteers. A second survey of hospital employees with confirmed measles revealed that 46% (34/74) were working in hospitals without measles infection control policies, 43% (32/74) were born before 1957, and 31% (21/67) were working in jobs not traditionally considered to provide a high risk of measles exposure. One third of the sick employees were hospitalized. The standard of either birth date before 1957 or oral history of measles illness or vaccination would have classified 93% (39/42) of the employees with measles as immune. CONCLUSIONS: Effective infection control policies against measles and rubella should be adopted and enforced. Those policies should only allow written documentation as proof of measles immunity and should address all employees, regardless of age or job description.

Adult↗
PubMed1991

Novel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens.

Nosocomial pathogens frequently are resistant to antimicrobial agents. Although methicillin-resistant strains of Staphylococcus aureus continue to be a major problem in many hospitals, several new types of resistance determinants have been noted among organisms causing hospital-acquired infections. The mechanisms include extended spectrum beta-lactamases in gram-negative bacilli; resistance to beta-lactams, glycopeptides, and high levels of aminoglycosides among enterococci; quinolone resistance in isolates of methicillin-resistant S. aureus; and the spread of multiple resistance genes simultaneously in gram-negative organisms via Tn21-related genetic elements. These novel mechanisms of resistance complicate the treatment of nosocomial infections by limiting the number of effective antimicrobial agents available to the clinician. It is important for infection control practitioners and microbiologists to work together to detect and control the spread of resistant pathogens in the hospital setting.

4-Quinolones↗
PubMed1992

Chronology of a hospital-wide measles outbreak: lessons learned and shared from an extraordinary week in late March 1989.

In March 1989, Mount Sinai Hospital, a community hospital in Hartford, Connecticut, faced a potential hospital-wide outbreak of measles when eight cases of measles occurred among medical personnel during several days. This article describes the chronology of events, from the initial discovery of the outbreak to the evolution of the hospital-wide containment program designed to protect patients and staff members. Measles IgG immune status was determined for 1249 employees during a 9-day period. Measles vaccine and immune serum globulin were administered to patients and employees. We offer advice from our experience for infection control practitioners who may face outbreak situations in their institutions.

Adult↗
PubMed1991

Infection control: the premier quality assessment program in United States hospitals.

The three decennial international meetings of the Centers for Disease Control have reaffirmed the national health priority for prevention of nosocomial infections. Moreover, the past 20 years have seen the institutionalization of the infection control practitioner and hospital epidemiologist. The epidemiologic activities of these two groups have included access to medical care, identification of risk factors, and both prevention and control of adverse nosocomial events. As such, they represent experience with issues commonly referred to as quality of care. It is argued that infection control not only is now but has been from its inception the premier quality assessment program in the United States. Moreover, it is the only activity in quality assessment that has been shown to be efficacious.

Cross Infection↗
PubMed1979

Development of a statewide program for surveillance and reporting of hospital-acquired infections.

In 1974, a statewide program was begun to improve surveillance of nosocomial infection in Virginia hospitals. Infection control practitioners were trained at the University of Virginia Hospital, Charlottesville, and were encouraged to submit monthly surveillance reports for analysis. In the first three years of the project, 141 students from 65 hospitals within the state attended a two-week basic course, with eight to 10 students per class. Of the 98 Virginia hospitals that sent students, 75 (73%) submitted monthly reports. The consistency of reporting (number of monthly reports received divided by the number of possible reporting months) was 83%. The sensitivity of reported data was estimated in comparative daily prospective surveys to be 69% for participating hospitals, and the specificity was 99%. The crude infection rate for the first 1.1 million patients at risk was 3.3%.

Cross Infection↗
PubMed1990

[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↗
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↗
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↗
PubMed1991

Northwick Park Infection Consultation Service. Part I. The aims and operation of the service and the general distribution of infection identified by the service between September 1987 and July 1990 [see comment].

The Northwick Park Infection Consultation Service (ICS) is a collaborative service operated by the departments of Medical Microbiology and Infectious Diseases where personnel and skills are combined. Its aim is to improve the availability and effectiveness of consultation for infection-related problems. This paper sets out the framework for establishing an ICS and also details the general distribution of infection identified by the Northwick Park ICS in a study carried out between September 1987 and July 1990. Part II assesses the contribution that the ICS made to the management of infection. One thousand and thirty-eight (1038) patients were seen on the ICS. Seventy-five per cent (776) were judged to be infected and in 691 this was a probable or certain diagnosis. Skin and subcutaneous tissue, respiratory tract, and genito-urinary tract infections accounted for 64% of the total. Eighty-seven per cent of infections required treatment with intravenous antibiotics, 22% were associated with concomitant bacteraemia, and 2.7% of patients died as a direct result of their infection. Sixty-four per cent of consultations were unsolicited and arose from laboratory results or the clinical information on the form accompanying the specimen: over one quarter were initiated before results were available. These infections were no different in either severity or nature from those identified by solicited requests to either department. Fifty-three per cent of consultations had a moderate to high clinical component. The results emphasise the importance of infection in hospitals and highlight the advantages of a collaborative approach from the departments of Medical Microbiology and Infectious Diseases.

Cross Infection↗