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PubMed2000

Clinical infection control in gene therapy: a multidisciplinary conference.

Gene therapy is being studied for the treatment of a variety of acquired and inherited disorders. Retroviruses, adenoviruses, poxviruses, adeno-associated viruses, herpesviruses, and others are being engineered to transfer genes into humans. Treatment protocols using recombinant viruses are being introduced into clinical settings. Infection control professionals will be involved in reviewing the safety of these agents in their clinics and hospitals. To date, only a limited number of articles have been written on infection control in gene therapy, and no widely available recommendations exist from federal or private organizations to guide infection control professionals. The goals of the conference were to provide a forum where gene therapy experts could share their perspectives and experience with infection control in gene therapy and to provide an opportunity for newcomers to the field to learn about issues specific to infection control in gene therapy. Recommendations for infection control in gene therapy were proposed.

Congresses as Topic↗

PubMed1984

A national task analysis of infection control practitioners, 1982. Part One: methodology and demography.

A task analysis survey was conducted in 1982 by the Certification Board of Infection Control ( CBIC ) to determine the tasks performed by ICPs and the knowledge and abilities needed to perform these tasks. Data were obtained from 473 (78.8%) respondents to a nationwide mail survey of 600 ICPs . The respondents represent a randomized, stratified sample of ICPs in various types of U.S. acute care hospitals ranging in size from fewer than 50 beds to more than 500 beds. The results of the survey were used, in part, to develop the Infection Control Certification Examination, offered for the first time on November 19, 1983. According to the survey results, the modal or typical ICP is a white woman between the ages of 31 and 50 years using the title of infection control nurse. She has been employed full time for 2 to 10 years in infection control practice in a Joint Commission on Accreditation of Hospitals (JCAH)--accredited community acute care hospital having 301 to 500 beds. She is working at the supervisory level, is on the nursing department payroll, votes as a member of the hospital's infection control committee, and received her last degree or diploma more than 15 years ago.

Adult↗

PubMed1993

Infection control aspects for office endoscopy.

While preventing cross-infection has always been important, the current epidemic of human immunodeficiency virus has brought about a greater awareness that infection control standards should be the same regardless of the practice setting. This article discusses infection control practices in office endoscopy including cleaning of endoscopes and the issues surrounding disposable and nondisposable accessories. Staff safety and government agency regulations are also reviewed.

Disinfection↗

PubMed2002

Health professionals' views of contracting for infection control in the NHS internal market.

This paper reports a national study which investigated the involvement of infection control professionals in (and their views about) the formal processes of contracting for health care in the NHS internal market. Health care professionals needed to be involved contracting, if it was to be effective. The study found that many infection control professionals were not, in fact, involved in contracting, while the importance of both contracts and informal professional networks were recognised But respondents did not think that their professional networks entirely compensated for their lack of involvement in contracting. As formal agreements continue to be central to achieving quality of care in the post-internal market NHS, infection control professionals need to be involved in specification and implementation of these arrangements.

Attitude of Health Personnel↗

PubMed2000

Communicable disease and infection control: the surveillance contribution.

In its much-publicized report (2000) the National Audit Office (NAO) has emphasized the important part surveillance plays in determining infection rates and infection control in general. Community nurses may be forgiven for pointing out that this report concentrates on hospitals, however it strongly recommends that surveillance be extended out into the community. This is a sensible move as studies quoted in the NAO report indicate that 50-70% of surgical wound infection occur during the post-discharge period. The boundaries between acute and primary care are becoming ever more blurred; increasing numbers of susceptible patients are being managed in the community and the number of invasive procedures carried out is rising in line with government policy. Action to control infection extends beyond the narrow boundaries of health care to involve the whole population, and although the idea of extending the surveillance of healthcare related infection from hospital to community settings appears to be relatively new, the surveillance of infectious diseases that occur in the community is not. It is, in effect, a key proactive infection control activity which facilitates targeted and effective infection control measures. This article aims to define and explain surveillance as it relates to infection control and communicable disease control in the community by using examples from history, the current Meningitis C vaccination programme and the surveillance of hospital-acquired infection in the USA.

Communicable Disease Control↗

PubMed1996

Cross-infection control: the role of "in-training" dental nurses.

OBJECTIVES: This paper reports the findings of a study on the roles of dental nurses in cross-infection control in general dental practices and who were undergoing training for their initial certificate. The research aimed to find out what factors in their vocation gave them satisfaction, what caused stress and the bearing of these factors on cross-infection control. The study complemented previous research on the same matters carried out face-to-face in dental practices and aimed to test the validity of this previous research. METHODS: The study was made anonymously by means of self-administered questionnaires completed by respondents attending evening classes. RESULTS: Sixty per cent of respondents reported suffering anxiety in their work, the list of causes being headed by lack of experience, language barriers and taking part in general anaesthetic sessions. A third thought their workload was too great and a third quoted lack of time as the reason for not always completing cross-infection control procedures. Half were worried about cross-infection control. Clinical work was the most, and adequate pay the least important of five factors that gave respondents satisfaction in their work. Respondents always welcomed a word of thanks from their dentists and relied on them for information about their tasks. CONCLUSIONS: In order to carry out their work thoroughly, uncertificated dental nurses need sufficient time. They benefit from support and encouragement from their dentist. These are important factors in cross-infection control so that stress is prevented and job satisfaction enhanced. Our two studies validate each other.

Adolescent↗

PubMed2000

Nosocomial respiratory syncytial virus infections: the cost-effectiveness and cost-benefit of infection control.

OBJECTIVE: To determine the cost-effectiveness and cost-benefit of an infection control program to reduce nosocomial respiratory syncytial virus (RSV) transmission in a large pediatric hospital. DESIGN: RSV nosocomial infection (NI) was studied for 8 years, before and after intervention with a targeted infection control program. The cost-effectiveness of the intervention was calculated, and cost-benefit was estimated by a case-control comparison. SETTING: Children's Hospital of Philadelphia, a 304-bed pediatric hospital. PATIENTS: All inpatients with RSV infection, both community- and hospital-acquired. INTERVENTION: Consisted of early recognition of patients with respiratory symptoms, confirmation of RSV infection by laboratory testing, establishing cohorts of patients and nursing staff, gown and glove barrier precautions, and monitoring and education of staff. OUTCOME MEASURES: The incidence density of RSV NI before and after the intervention was calculated as the rate per 1000 patient days-at-risk for infection. Intervention costs included laboratory testing, isolation, and administration of the program. The cost of RSV NI was estimated by comparing hospital charges for 30 cases and matched uninfected controls. RESULTS: A total of 148 patients acquired NI (88 before and 60 after the intervention). The Mantel-Haenszel stratified relative risk for NI in the period before the infection control program, compared with the postintervention period, was.61 (95% confidence interval:.53-.69). By applying the preintervention stratum-specific rates of infection to the days-at-risk in the postintervention period, an estimated 100 NIs would have been expected, which in comparison to the 60 NIs observed, yielded an estimated program effectiveness of 10 RSV NIs prevented per season. The total cost of the program per season was $15 627 or $1,563/NI prevented. In comparison, the mean cost to the hospital was $9,419/case of RSV NI, resulting in a cost-benefit ratio of 1:6. CONCLUSIONS: A targeted infection control intervention was cost-effective in reducing the rate of RSV NI. For every dollar spent on the program, approximately $6 was saved.

Case-Control Studies↗

PubMedDate not supplied

Nosocomial infection control: an overview.

Nosocomial infections are one of the most important public health problems in the world today. Although a great deal of attention is being directed toward the control and prevention of these infections, old problems continue to occur and new problems are constantly arising. The approximately 5% rate of nosocomial infections among patients admitted to acute-care hospitals has a significant impact on patients morbidity and morality and on the financial concerns of the patient, hospital, and community. An effective, efficient, and sensitive surveillance program developed to meet the needs of the individual hospital is absolutely necessary to obtain data on nosocomial infections from which controls and prevention programs can be developed. At the same time, lessons can be learned from the experience of other hospitals. The nosocomial infection control and prevention program must be under the general direction of a representative, interested, effective infection control committee. One area of importance under the committee's responsibility is that of an appropriate isolation program practiced by all persons within the hospital.

Centers for Disease Control and Prevention, U.S.↗

PubMed1986

Infection control in burn patients.

The article primarily deals with infection control practices relating to the burn patient. Burn infections have an endogenous origin rather than an exogenous one. Infection control practices are similar to routine infection surveillance but are also distinctly different.

Anti-Bacterial Agents↗

PubMed1993

Infection control in home care agencies.

BACKGROUND: The purpose of this study was to describe the characteristics of home care agencies, including the nature of care provided and the presence of infection control standards and education. METHODS: Study design was cross-sectional and descriptive; the survey of home health agencies included questions about agency type, nature of care delivered, and infection control policies and educational programs. The sample included all directors of home care agencies in northern California. RESULTS: The response rate was 33.5%. Agency directors reported that 15.3% of their clients required high-technology nursing care; in response to a list of invasive procedures generally considered high in infection risk, more than 90% cared for urinary drainage devices, some categories of wound care, and intravenous management. Of those performing high-risk procedures, more than 75% had policies covering the procedures. Nearly all (87.7% to 100%) had policies on universal precautions, handwashing, handling of needles and sharps, and the cleaning and disinfection of equipment; however, nearly a quarter (24.6%) had no education program regarding the handling of contaminated equipment. CONCLUSIONS: Among agencies responding to this survey, care that is considered high risk for infection is delivered and the agencies for the most part have infection control policies and educational programs. Research is needed to define more clearly infection control efforts in home health care. More work is needed to adapt the knowledge of infection control in hospitals to the home setting.

California↗

PubMed1989

The development of infection control in Italy.

A coordinated national program for the control of Hospital Infection (H.I.) was started in 1981 in Italy as a result of growing interest in many fields of public health. The first three years of the program provided greater awareness of the problem on a national scale. The survey showed that out of 38,000 patients, 6.8% developed a hospital acquired infection. Hospitals as well as research institutions responded with studies, periodical surveys and incidence surveys--some of which were on a national scale. One national incidence survey in intensive care units showed a 30% H.I. incidence rate from 6,000 patients. A five year research fund from the National Research Council provided for the study of H.I. by 18 different research groups. There have been several initiatives regarding presentation and control, such as two national guideline regulations made by the Minister of Health for the establishment of H.I. Control Committees in each hospital. Infection Control Nurses have been identified as key persons for the surveillance program. Two hospital schools have started a one-year, 700-hour course for Infection Control Nurses. The first 50 nurses graduated in June 1988. Health officials have agreed that prevention of hospital infection is feasible, and have mandated for a two year experimental prevention project for the Italian region, coordinated by the National Institute of Health. The project is called PRINOS, and the preliminary results are presented.

Cross Infection↗

PubMed2001

Infection control in South African oral hygiene practice.

OBJECTIVE: The aim was to gain information about the practice of infection control in oral hygiene practice. METHODS: A questionnaire based on OSHA and CDC guidelines was submitted to oral hygienists who attended a refresher course followed by a second posted questionnaire seeking information about hand hygiene practice. The questions were directed to observance of personal protection by oral hygienists and the application of procedures required for infection control in the surgery. RESULTS: 87.5% wore face masks but the proper use of facial protection, overcoats and disposable overcoats was reported by fewer than 50%. A total of 97% wore gloves and 88% changed gloves between patients. Skin reactions to gloves were reported by 26%. Only 7% had not been vaccinated against hepatitis B. The correct procedures for sterilising equipment and instruments were carried out by fewer than 50%, and 57% of participants wanted an improvement of infection control arrangements in their workplace. CONCLUSION: It is concluded that a need exists for proper practice of infection control by oral hygienists which can be remedied by interceptive and preventive education and peer pressure.

Dental Equipment↗

PubMed2001

Systematic review of adherence to infection control guidelines in dentistry.

OBJECTIVES: The purpose of this study was to determine the knowledge and attitudes of dental health care workers (DHCWs) towards infection control procedures, to examine DHCWs' practising behaviour in respect of infection control, and to determine whether a relationship exists between knowledge, attitudes and behaviour. METHODS: Within this systematic review, study quality was assessed in line with selection criteria relating to study design, participants, interventions and outcome measures. Following data extraction, the heterogeneity of study design, targeted participants, sample size and outcome measures precluded a quantitative analysis. Qualitative data synthesis followed. RESULTS: Overall, the quality of the studies reviewed was poor. Only 71 studies meeting the selection criteria were identified. Data indicated that over the period of the review there have been substantial improvements with compliance in some areas of infection control in dentistry, for example glove wearing. However, other aspects, such as the effective management of needlestick injuries, remain problematic. CONCLUSIONS: More rigorously designed studies are required to assess accurately dental team members' adherence to infection control guidelines.

Attitude of Health Personnel↗

PubMed1996

Transmission of hepatitis B virus to multiple patients from a surgeon without evidence of inadequate infection control.

BACKGROUND: Although about 1 percent of surgeons are infected with hepatitis B virus (HBV), transmission from surgeons to patients is thought to be uncommon. In July 1992, a 47-year-old woman became ill with acute hepatitis B after undergoing a thymectomy in which a thoracic-surgery resident who had had acute hepatitis B six months earlier assisted. METHODS: To determine whether the surgeon transmitted HBV to this patient and others, we conducted chart reviews, interviews, and serologic testing of thoracic-surgery patients at the two hospitals where the surgeon worked from July 1991 to July 1992. Hepatitis B surface antigen (HBsAg) subtypes and DNA sequences from the surgeon and from infected patients were determined. RESULTS: Of 144 susceptible patients in whose surgery the infected surgeon participated, 19 had evidence of recent HBV infection (13 percent). One of the hospitals was selected for additional study, and none of the 124 susceptible patients of the other thoracic surgeons at this hospital had evidence of recent HBV infection (relative risk, infinity; 95 percent confidence interval, 4.7 to infinity). No evidence was found for any common source of HBV other than the infected surgeon. The HBsAg subtype and the partial HBV DNA sequences from the surgeon were identical to those in the infected patients. Transmission of the infection was associated with cardiac transplantation (relative risk, 4.9; 95 percent confidence interval, 1.5 to 15.5) but not with other surgical procedures. The surgeon was positive for hepatitis B e antigen and had a high serum HBV DNA concentration (15 ng per milliliter). Our investigations identified no deficiencies in the surgeon's infection-control practices. CONCLUSIONS: In this outbreak there was surgeon-to-patient HBV transmission despite apparent compliance with recommended infection-control practices. We could not identify any specific events that led to transmission.

Adolescent↗

PubMed1997

Reduction in tuberculin skin-test conversions among medical house staff associated with improved tuberculosis infection control practices.

OBJECTIVE: To assess the efficacy of an infection control program as measured by tuberculin skin-test (TST) conversion rates in medical house staff. DESIGN: Observational study. SETTING: University-based hospital in New York City serving a large indigent population. PARTICIPANTS: Medical house staff. INTERVENTIONS: TST conversions were measured every 6 months in medical house staff from June 1992 to June 1994. Compliance with the isolation policy was measured by identifying room locations 24 hours after admission of patients who had Mycobacterium tuberculosis recovered from respiratory specimens. RESULTS: The TST conversion rate decreased from 5.8 to 0, 2.3, and 0 per 100 person years of exposure in successive 6-month periods. The estimated annual TST conversion rate among interns fell from 7 per 100 person years in June 1992 to 0 per 100 person years in June 1993 and 0 per 100 person years in June 1994 (P < .029). The proportion of patients with pulmonary tuberculosis who were isolated in negative-pressure rooms increased from 38% to 75% over the study period (P < .01). CONCLUSION: Development of a multifaceted infection control program can decrease the risk of nosocomial tuberculosis infection in medical house staff.

AIDS-Related Opportunistic Infections↗

PubMed1998

Compliance with infection-control procedures among Illinois orthodontists.

The authors of previous studies have reported an increasing percentage of orthodontists complying with infection-control procedures in their offices, yet compliance was found to be less than ideal. In this study we surveyed Illinois orthodontists to evaluate their compliance with the infection-control guidelines established by the American Dental Association and the Centers for Disease Control and Prevention. This study is an addition to a small number of studies in the field of orthodontics on infection-control procedures. The study population was taken from the World Directory of Orthodontists, which contains 374 listings for the state of Illinois. Responses were received from 140 orthodontists, for a response rate of 37%. Thirty-two percent of the responding orthodontists stated that they always wear masks; 13% said they never do. Almost 97% of the orthodontists said they always wear gloves, and no orthodontist reported never wearing gloves. Nearly 64% of the orthodontists reported always using eyewear, and 34% said they wear gowns, whereas only 5% do not wear eye protection and 35% never wear gowns. With regard to instruments and pliers, most of the orthodontists reported using dry-heat ovens (72% and 80%, respectively), whereas nearly 58% said they use chemical disinfection to some extent on instruments and 39% said they use chemical disinfection on pliers. Only 51% of the orthodontists surveyed in our study reported using a steam autoclave to sterilize handpieces, whereas 27% said they use dry-heat ovens, 11% reported using chemical vapor, and 37% said they use chemical disinfection. In conclusion, compliance with infection control procedures among orthodontists has improved from recent studies but is still less than full compliance.

Adolescent↗

PubMed2004

Basic infection control procedures in dental practice in Khartoum-Sudan.

OBJECTIVES: To survey the infection control procedures used by dental practitioners in Khartoum, Sudan. METHODS: Questionnaires were distributed to150 randomly sampled dentists practising in Khartoum state. Each questionnaire comprised 17 questions about basic infection control procedures. RESULTS: A 100% response rate to the questionnaire showed that 92% of dentists routinely wore gloves when treating patients, 50% face masks, 61% a gown and 14.7% protective eye wear. Furthermore 52% of the practitioners had been immunised against Hepatitis B. The majority of practitioners (72%) used dry heat as their method of instrument sterilisation, 22% used an autoclave, 2% used boiling water and the remainder used chemical sterilisation. Safe disposal of clinical waste was undertaken by only 23% of dentists although 47% of practitioners stored sharp items in closed containers. All respondents used disposable dental needles, but only a few used other disposable items. There was a significant difference in the implementation of cross infection control procedures between salaried and private dental practitioners, especially with regard to handpiece sterilisation, use of disposables, the wearing of face masks and the availability of additional sets of instruments. CONCLUSION: There is a clear need to improve the existing situation particularly with regard to immunisation of dentists against Hepatitis B, the safe disposal of clinical waste and instrument sterilisation in Khartoum.

Cross Infection↗

PubMed1995

Cross-infection control in dental laboratories.

The attitudes to cross-infection control of 800 dental laboratories registered with the Dental Laboratories Association have been surveyed. Considering the topicality of the subject material and the need for careful cross-infection control within and beyond the dental surgery, the response rate of 22% (175) was disappointingly low. As a result of the low response rate, the results should be seen as a guide only. Forty-nine percent of respondents had a cross-infection policy and of those with no policy 64% intended to implement one in the future. Thirty percent of laboratories receive known undisinfected work from the dental surgery. Of those items disinfected on arrival at the laboratory, those most frequently disinfected are dental impressions (77%) and dentures (51%). The most popular chemicals used for disinfection are household bleach, chlorhexidine and glutaraldehyde. Forty-four percent of the respondents generally (90% or more of the time) wear gloves when handling dental work received and opened in the laboratory. Seventy-four percent wear protective eye spectacles when trimming or polishing prostheses. Sixty-one percent used no disinfectant in the pumice and 93% did not disinfect the polishing instruments, eg wheels and mops. Forty-six percent had a policy for immunisation of staff against Hepatitis B.

Attitude of Health Personnel↗