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Australia is a large country divided into six states and two territories, each of which has infection control programmes. This paper looks at the organization of infection control in Australia, as well as describing the national bodies involved and recent state initiatives in infection control.
We think it is important to make up a medical team for the infection control in the hospital since patients admitted often turn to compromised hosts who possessed the high risk to provoke the possible transmission of nosocomial infections. Infection control team(ICT) under the infection control committee(ICC) was established in our Yamagata University Hospital at the 1994 April. Members of the ICT are composed of staffs at various sections: physicians, pharmacists, nurses, clinical laboratory staffs, a neutrionist and administration office staffs, with the aim of preventing the nosocomial infections. Twenty three staffs of ICT who are specialist at each section have practiced the round of wards, leading in hand-washing, checking of the proper use of antibiotics and disinfectants, making and revising of the infection control manual, follow-up of the route of infection, and a countermeasure of prevention for needle pad accidents, etc. Furthermore, ICT has exerted all possible efforts of various investigations for infections when it is necessary. Problems that are faced our ICT are the construction of a network an inter-net among clinical divisions, nursing, pharmacy and clinical laboratory, and a system of the centralized management is actualized thereby.
Although patients in long-term-care facilities are at increased risk of infection, little is known about how to practice infection control in this setting. This article reviews risk factors for infection, the components of an infection control program, and particular infections that are important in long-term-care facilities. In addition, special characteristics of long-term-care facilities that challenge the individuals charged with conducting effective infection control programs will be discussed.
The dental literature contains many recommendations defining standards for infection control. Little information is available, however, documenting the cost of implementing these standards. This article describes the cost incurred by the Indian Health Service Dental Program in the Oklahoma area between 1985 and 1988 for infection control. During this period, comprehensive infection control recommendations were published for oral health programs serving Native Americans and data were collected on supply utilization. While productivity data were collected for that same time period do not support the premise that infection control practices lead to decreased clinical productivity, infection control supply costs did increase over fourfold during this period.
Some articles have suggested that to survive in the 1990s an infection control practitioner (ICP) will have to be "smarter, brighter, or gone"--they assume that new initiatives for hospital peer review (utilization review, risk management, antibiotic use review, and quality assurance) soon will swallow up the ICP and the infection control program. This article questions that assumption. It reviews data supporting the continuing need for hospital infection control programs and presents information suggesting that the need for the ICP will increase rather than decline during the 1990s. Four essential characteristics for infection control programs are listed, and skills that make the ICP a valuable resource for other peer review programs are described. Several ways that the ICP can (and must) bring this information to the attention of other hospital personnel are suggested. Such actions help assure recognition of the continuing important role of the ICP and the hospital infection control program in each U.S. hospital and long-term care institution.
BACKGROUND: Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U. S. hospitals. OBJECTIVE: To determine whether enhanced infection-control strategies reduce transmission of VRE in an endemic setting. DESIGN: Prospective cohort study. SETTING: Adult oncology inpatient unit. PATIENTS: 259 patients evaluated during use of enhanced infection-control strategies and 184 patients evaluated during use of standard infection-control practices. INTERVENTIONS: Patient surveillance cultures were taken, patients were assigned to geographic cohorts, nurses were assigned to patient cohorts, gowns and gloves were worn on room entry, compliance with infection-control procedures was monitored, patients were educated about VRE transmission, patients taking antimicrobial agents were evaluated by an infectious disease specialist, and environmental surveillance was performed. MEASUREMENTS: VRE infection rates, VRE colonization rates, and changes in antimicrobial use. RESULTS: During use of enhanced infection-control strategies, incidence of VRE bloodstream infections decreased significantly (0.45 patients per 1000 patient-days compared with 2.1 patients per 1000 patient-days; relative rate ratio, 0.22 [95% CI, 0.05 to 0.92]; P = 0.04), as did VRE colonization (10.3 patients per 1000 patient-days compared with 20.7 patients per 1000 patient-days; relative rate ratio, 0.5 [CI, 0.33 to 0.75]; P < 0.001). Use of all antimicrobial agents except clindamycin and amikacin was significantly reduced. CONCLUSION: Enhanced infection-control strategies reduced VRE transmission in an oncology unit in which VRE were endemic.
OBJECTIVE: To report the effectiveness of use of comprehensive infection control measures to reduce the incidence of Clostridium difficile (CD) in an acute-care teaching hospital. METHODS: All CD infections were reviewed by the infection control coordinator from 1987 to 1996. The Centers for Disease Control and Prevention's nosocomial infection definition was used. CD-inclusion criteria remained unchanged during the study period. Interventions were started in 1990. INTERVENTIONS: The interventions used were: (1) Isolation policy-revision and enforcement, which included universal precautions policy, (2) educational program-monthly to all health care workers, (3) phenolic disinfectant for environmental cleaning, (4) triclosan (0.03%) soap for handwashing, (5) centralization of sterilization department, (6) cart-washer installation, and (7) aggressive surveillance activity. RESULTS: From 1987 to 1989, before the interventions, a total of 466 CD infections (mean 155 per year) occurred. From 1990 to 1996, after the interventions, 475 infections (mean 67 per year) occurred. Incidence of CD decreased by 60% from 1990 to 1996. CONCLUSION: The sustained decrease of nosocomial CD during the 7-year period demonstrated the effectiveness of aggressive infection control measures that involve multiple disciplines.
BACKGROUND: Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. METHODS: We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data collection period, followed by intervention periods comprising 8 weeks of 'rapid' (<48 hr) and 4 weeks of 'longer-turnaround' (5-10 days) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital-onset COVID-19 infections (HOCIs; detected ≥48 hr from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on the incidence of probable/definite hospital-acquired infections (HAIs), was evaluated. RESULTS: A total of 2170 HOCI cases were recorded from October 2020 to April 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (incidence rate ratio 1.60, 95% CI 0.85-3.01; p=0.14) or rapid (0.85, 0.48-1.50; p=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8 and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2 and 11.6% of cases where the report was returned. In a 'per-protocol' sensitivity analysis, there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources. CONCLUSIONS: While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days. FUNDING: COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) (grant code: MC_PC_19027), and Genome Research Limited, operating as the Wellcome Sanger Institute. CLINICAL TRIAL NUMBER: NCT04405934.
BACKGROUND: The Thoracic Society of Australia and New Zealand (TSANZ) guidelines for infection control in respiratory laboratories are based on a 'Universal Precautions' approach to patient care. This requires that one-way breathing valves, flow sensors, and other items, be cleaned and disinfected between patient use. However, this is impractical in a busy laboratory. The recent introduction of disposable barrier filters may provide a practical solution to this problem, although most consider this approach to be an expensive option. AIM: To compare the cost of implementing the TSANZ infection control guidelines with the cost of using disposable barrier filters. METHODS: Costs were based on the standard tests and equipment currently used in the lung function laboratory at The Alfred Hospital. We have assumed that a barrier filter offers the same degree of protection against cross-infection between patients as the TSANZ infection control guidelines. Time and motion studies were performed on the dismantling, cleaning, disinfecting, reassembling and re-calibrating of equipment. Conservative estimates were made as to the frequency of replacing pneumotachographs and rubber mouthpieces based on previous equipment turnover. Labour costs for a scientist to reprocess the equipment was based on $20.86/hour. The cost of employing a casual cleaner at an hourly rate of $14.07 to assist in reprocessing equipment was also investigated. The new high efficiency HyperFilter disposable barrier filter, costing $2.95 was used in this cost-analysis. RESULTS: The cost of reprocessing equipment required for spirometry alone was $17.58 per test if a scientist reprocesses the equipment, and $15.56 per test if a casual cleaner is employed to assist the scientist in performing these duties. In contrast, using a disposable filter would cost only $2.95 per test. Using a filter was considerably less expensive than following the TSANZ guidelines for all tests and equipment used in this cost-analysis. CONCLUSIONS: The TSANZ infection control guidelines are expensive and impractical to implement. However, disposable barrier filters provide a practical and inexpensive method of infection control.
Being aware and implementing the latest and best scientific evidence in infection control and health care epidemiology is critical to enhancing patient outcomes. In this review, the latest published scientific data in health care epidemiology and patient safety were reviewed for the period May 2003-May 2004. Medline reviews and reviews of infection control and infectious diseases journals were used for this period. The latest guidelines and publications on antimicrobial resistance, nursing or infection control professional staffing, West Nile virus, and Severe Acute Respiratory Syndrome (SARS) are included. Awareness of these and other important infection control publications is essential if the latest measures are to be implemented to prevent and control health care-associated infections.
BACKGROUND: A survey was conducted in 1992 in Los Angeles County, California, to assess changes since an earlier survey in 1989 in the numbers of acute care hospitals that had established policies on measles, mumps, and rubella infection control and the extent to which these policies were implemented. METHODS: A questionnaire inquiring about measles, mumps, and rubella infection control was sent to ICPs of 133 acute care hospitals in Los Angeles County. The results were compared with those of a similar survey conducted in 1989. The increase in the number of hospitals with such policies between 1989 and 1992 was analyzed. RESULTS: In 1989, 29 (28%), 9 (9%), and 65 (64%) of the 102 respondent hospitals had measles, mumps, and rubella infection control policies, respectively. Larger proportions of the 95 respondent hospitals in 1992 had measles (56, 59%), mumps (15, 16%), and rubella (69, 73%) infection control policies. CONCLUSIONS: The number of hospitals with infection control policies for measles, mumps, and rubella increased from 1989 to 1992. Efficiency and scope of such policies varied, however, and could be improved by making the policies mandatory, requiring written documentation of employee immunity, and extending policies to cover all employees. The most dramatic increase was in the number of hospitals with infection control policies for measles; this increase may have been caused by the 1987 to 1989 measles epidemic in Los Angeles County, by increased awareness of the Immunization Practices Advisory Committee recommendations, or by increased sensitivity to the issue of infection control triggered by the 1989 survey.
Infections present a significant hazard in the orthodontic office because they can be transmitted by blood or saliva through direct or indirect contact, droplets, aerosols, or contaminated instruments and equipment. Because the incidence of certain microbial cross-infections in the dental environment has not been well documented, orthodontic personnel may not take the problem of cross-infection as seriously as they should, and they may transmit or contract more infections than they realize. The use of effective infection-control procedures in the orthodontic office and laboratory will prevent cross-contamination that may extend to the orthodontist, office staff, assistants, and patients. The goal of this article is to present infection control in a simple, yet comprehensive, manner, and to encourage all orthodontic practitioners to implement essential infection-control procedures in their practices.
OBJECTIVE: To assess the impact of HIV on procedures to control infection in general practices. DESIGN: A postal questionnaire survey. SETTING: General practices throughout Britain. SUBJECTS: 5359 General practitioners, 3429 (63.9%) of whom returned the questionnaire. MAIN OUTCOME MEASURE: Response to questionnaire on knowledge about HIV and policies for controlling infection. RESULTS: Most doctors (2018) had started to wear gloves when taking blood. Almost half (1510) had not resheathed needles previously but a further 776 had adopted this policy because of HIV. Over half of the doctors did not know or were unsure about the risk of infection from needlestick injuries, and 1759 had no practice policy for controlling infection. CONCLUSIONS: Many doctors are uncertain about measures to control infection in general practice. More information and advice are needed to help doctors develop policies to protect patients and staff.
As public health continues to meet the challenges of old and new health risks, the practice of infection control will be an integral part of its services. The public health infection control program should include effective policies and procedures, in-service programs and implementation, and systems of surveillance specific to each department. Public health personnel must place emphasis on the practice of infection control in the community setting. The ICP who accepts this challenge will be in the forefront of infection control in public health. Infection control is a respected part of the hospital setting and now is the time for the ICP to tailor this program to the public health delivery system.
The risk of transmission of infection within the dental workplace is low, but recent data have indicated that human immunodeficiency virus transmission between dentist and patient can occur, and that while nosocomial transmission of hepatitis B virus is now less likely, a small but significant number of staff may be at risk of hepatitis C virus and varicella zoster virus infection during dental treatment. Despite these continued risks, shortcomings remain in cross-infection control in the dental workplace. Dental clinicians still fail to take adequate steps to minimize nosocomial infection, inconsistently using appropriate methods of sterilization and not providing ancillary staff with suitable protective clothing. Similarly, although vaccinated against hepatitis B virus, a substantial number of clinicians are reluctant to treat hepatitis B virus- or human immunodeficiency virus-infected patients. Cross-infection control procedures continue to be modified. Of importance, it has been confirmed that protective rubber gloves cannot be reused, as micropunctures develop during rewashing. Sharps injuries are common in dental practice, but there are still no effective measures to prevent postinjury human immunodeficiency virus or hepatitis C virus infection. Instrument sterilization is generally safe and effective, but the contamination of dental unit water supplies remains to be overcome, and while impressions can be placed in disinfectants for up to 1 hour without significant dimensional change, it is not known if infectious agents within the impression material are inactivated by this procedure.
Guidelines for developing a dental laboratory infection-control protocol are discussed. A detailed outline of infection-control protocol regarding universal precautions, personal protective equipment, hepatitis B vaccination, environmental and surface cleaning and disinfection, and personnel training is presented.
BACKGROUND: Information regarding compliance with infection control precautions in the dental settings in the Middle East is scant. OBJECTIVE: To examine the knowledge and practices in infection control among dental staff and dental nurses at a university teaching dental center. METHODS: A self-administered, confidential questionnaire concerning various aspects of infection control knowledge and practices was distributed to 48 dental staff and 28 dental nurses working at the Jordan University of Science and Technology Dental Teaching Center. RESULTS: Responses came from 37 (77%) dental teaching staff members and 23 (82%) dental nurses. Of the dental staff participants, 95% received hepatitis B immunization in comparison with 87% of the dental nurses. Dental nurses were more prone to percutaneous dental injuries (P < .05). In both groups, 100% reported routine wearing of gloves. Although the dental staff reported a statistically higher frequency of washing hands before gloving (46%), dental nurses reported a higher frequency of washing hands after removing the gloves (100%). Dental staff reported statistically higher frequency of routine mask use (43%) than dental nurses (30%). CONCLUSION: Compliance with recommended guidelines for control of cross infection varied among the 2 tested groups. A need exists for proper practice of infection control by both dental staff and dental nurses.
An enforced infection control policy in a laboratory will reduce occupational exposure to blood-borne pathogens and other infectious diseases and protect the dental laboratory personnel from exposure to infective disease. An outline of a workable laboratory infection control policy based on "Occupational Exposure to Bloodborne Pathogens" requirements is presented.