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PubMed1997

Healthcare textile services: infection control.

The purpose of this technical document is to acquaint managers with the basic infection control practices that are generally considered to be appropriate for a textile care services operation in a health care facility. An infection control program that provides the information needed by employees to conduct operational activities in a safe manner is essential to avoid the contamination of personnel. This document discusses the responsibilities of various staff members in the department, basic infection control practices, the physical control of organisms, appropriate housekeeping as well as engineering and maintenance and employee health issues relevant to the textile care department.

Cross Infection↗

PubMed2000

Keeping the lid on infection: infection control practices of a regional Queensland hospital 1930-50.

Nurses have played an important role in infection control practices throughout the past century. However, the desire for minimisation of cross infection has not always been the basis for many of the activities undertaken by nurses within the general ward. This paper is a historical analysis of those practices that formed the basis of infection control within the medical and surgical wards of the Rockhampton Hospital between 1930 and 1950. In particular, those activities dealing with the disposal of body fluids, ward cleaning, aseptic techniques and associated sterilisation of instruments and articles, the nurses' personal cleanliness and isolation nursing have been addressed. This study has identified economic factors, professional image and local traditions as being influential in the origins and persistence of many activities which may be loosely grouped as infection control measures.

Cross Infection↗

PubMed2006

How many infection control staff do we need in hospitals?

During a one-day workshop experienced infection control practitioners (ICPs) and medical microbiologists debated how much time was needed for the delivery of infection control activities in a model hospital. They agreed a standard of one full-time equivalent (FTE) ICP per 178 hospital beds and one FTE medical microbiologist per 806 hospital beds. This is 40% and 24% more than the usual standard, respectively. Now that official numbers of hospital beds have become an inadequate parameter for work delivered by hospitals, a new standard is proposed, with the number of admissions as the denominator. This is one FTE ICP per 5000 admissions and one medical microbiologist or epidemiologist per 25000 admissions.

Humans↗

PubMed1992

Nurses' perceptions of infection control issues in two small district general hospitals.

The need for quality assurance is given considerable emphasis in the Strategy for Nursing (1). Quality assurance is arguably inseparable from effective infection control, the practice of which is dependent on an adequate knowledge of microbiology. Yet research suggests that infection control in hospitals could be significantly improved (2) and that much of the problem is due to inadequate knowledge of microbiology on the part of both tutors and nurses (3). This paper presents the results of a study aimed at eliciting both the value placed on, and the general awareness of, infection control by tutors and nurses in two small general hospitals in two health districts. Technical knowledge was not tested (except indirectly). The overall findings suggest that nurses rely almost exclusively on the knowledge gained through training to inform their infection control practice. This, together with the research quoted above, suggests that if infection control in hospitals is to be improved, nurse education must place a much greater emphasis on microbiology than is currently the case.

Cross Infection↗

PubMed1997

Community-acquired notifiable infectious diseases in a pediatric hospital: effect on infection control work load.

In a study of the impact of notifiable communicable disease admissions on infection control work load, we found notifiable disease cases to be responsible for less than 10% of admissions but 27% of infection control ward visits and to require extensive community liaison. Measures of work load based on nosocomial infections alone will underestimate infection control activity considerably.

Child↗

PubMed2003

Comparison of US and non-US central venous catheter infection rates: evaluation of processes and indicators in infection control study.

OBJECTIVE: We sought to identify the presence or absence of international variation in central venous catheter-associated bloodstream infection (BSI) rates and to examine associated infection control practices that might underlie the differences. DESIGN: The Evaluation of Processes and Indicators in Infection Control (EPIC) study was conducted as a prospective surveillance study. SETTINGS: The study took place in intensive care units (ICUs) from 14 countries, which were from the Asian Pacific (3), Europe (7), Middle East (2), and South America (2), in addition to 41 US hospitals. METHODS: We compared the National Nosocomial Infections Surveillance catheter-associated BSI rate between the non-US and US units. We also compared the following organization factors between the 2 groups: hospital factors (ownership, average daily census of patients); ICU type (medical vs surgical); number of beds; and infection control-related factors (number of staff, number of hours spent on study ICU surveillance, years of experience, number of inservice sessions on line infection, number of blood cultures drawn/1000 patients). RESULTS: We found no significant difference in catheter-associated BSI rates between non-US and US hospitals (5.02 +/- 0.75 vs 3.82 +/- 0.42/1000 days, respectively; P =.27). Non-US hospitals were more likely to be government-owned (10/14 vs 7/41;P <.001) and to have larger daily patient census (795 +/- 84 vs 276 +/- 47 patients; P <.001). There was no difference in ICU type or number of beds. Infection control committees were present in all US and non-US hospitals. No significant differences were found in the number of staff involved in surveillance in the study ICU, years of experience, hours spent on surveillance, or the provision of inservices on line care. The use of barriers during line insertion also did not differ. CONCLUSIONS: Catheter-associated BSIs in patients in the ICU were not significantly different between non-US and US hospitals. All hospitals had infection control committees, and there were no significant differences in time spent and numbers of persons involved in ICU surveillance activities. These findings suggest that many aspects of the standards of care do not differ between the 2 groups.

Asia↗

PubMed1992

Selective decontamination of the digestive tract as an infection-control measure in intensive care unit patients.

Infection is responsible for a large percentage of morbidity and mortality in intensive care unit (ICU) patients. Conventional infection-control measures are directed at decreasing infection by exogenous sources and have had variable success in significantly reducing nosocomial infection rates. Selective gastrointestinal decontamination with topical nonabsorbable antibiotics attempts to reduce infection by eliminating intestinal mucosal colonization by pathogenic microorganisms. These antibiotics are selectively bactericidal against gram-negative organisms and yeasts, thereby leaving the normal flora (mainly anaerobes) unharmed. In the majority of clinical trials, selective decontamination effectively reduced colonization and infection among ICU patients, with the most significant reductions observed in gram-negative respiratory infections. Resistance to the antimicrobials was not documented in the majority of trials; however, follow-up periods were minimal and may not have been adequate to detect selection of resistant strains. Reductions in infection do not alter mortality; however, patients without significant underlying disease appear to be the subgroup that will most likely benefit.

Anti-Infective Agents↗

PubMed1995

The 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 with over 10,000 members. Its purpose is to influence, support, and improve the quality of healthcare through the practice and management of infection control and the application of epidemiology in all health settings. The organization, which is based in Washington, DC, is led by an elected board of members who volunteer their time and expertise.

Epidemiology↗

PubMed1980

The infection control nurse in US hospitals, 1976-1977. Characteristics of the position and its occupant.

Within the past decade, the infection control nurse (ICN) has become an important element in organized infection surveillance and control programs. Before 1970, only a few hospitals (6%) had an ICN, but, by 1977, over 80% had hired at least one ICN, the majority of those hospitals having done so since 1973. To determine the characteristics of the position and its occupant, the authors analyzed data from interviews with a representative sample of ICNs from 347 hospitals nationwide, conducted in 1976-1977 as part of Phase II of the Study on the Efficacy of Nosocomial Infection Control (SENIC Project), the Hospital Interview Survey. Results varied most widely by hospital size. The ICN in the smaller hospitals (less than or equal to 300 beds) typically worked only part time in infection control, spending the rest of her or his time as a nursing supervisor. The ICN in the larger hospitals (greater than 300 beds) generally worked full time but actually worked less time in relation to the number of beds; she or he also had completed a higher level of nursing education and had attended more infection control courses. The ICN was typically a woman in the young or middle age group who had worked in her current hospital six years altogether--two of them in infection control--and was receiving a supervisor's salary. Most ICNs were under the Nursing Service Department but generally looked to the physician in the infection control program for advice or supervision.

Adult↗

PubMed2005

[Cooperation of the clinical laboratory and infection control department in prevention of hospital infections].

Recently, environments that surround hospitals are changing every moment, and hospital infections are no exceptions. As medical technology advances and population of the elderly grow larger steadily, so does the number of immune-compromised hosts. Many patients come to hospitals infected, and in such situations prevention of hospital infections has great amount of importance. Cooperation of microbiological laboratory and ICT is indispensable, accumulation and analysis of the data of resistant bacteria isolated from various medical materials are the biggest task of microbiological lab. Furthermore, nutrition support based on the values of clinical examinations is set as the ultimate goal and NST's cooperation plays a big part in supporting the control of hospital infections.

Cross Infection↗

PubMed2006

Infection control program disparities between acute and long-term care facilities in Maryland.

BACKGROUND: In January 2003, the Maryland State Department of Health and Mental Hygiene (DHMH) surveyed, for the first time, all acute care hospitals (ACHs), long-term care facilities (LTCFs), and specialty hospital (acute rehabilitation and behavioral health) facilities in the state to determine the current state of infection control resources and practices in Maryland. Federal health care facilities in Maryland were not surveyed. METHODS: A self-administered questionnaire was sent to all 40 ACHs, 247 LTCFs, and 20 specialty hospitals in the state. The senior infection control professional (ICP) in the facility completed the questionnaire. RESULTS: The response rates were 85% for ACHs, 39% for LTCFs, and 95% for specialty hospitals. Data were analyzed separately for each type of facility. The ICPs in acute care reported 1.2 full-time equivalent positions (FTEs) for each 200 acute care beds, whereas ICPs in LTCFs reported 0.3 FTEs per 200 LTCF beds. Ninety percent of acute care ICPs reported taking some type of basic infection control course, whereas only 3% of long-term care ICPs reported taking a basic infection control course. CONCLUSION: In this survey of ICPs in Maryland, striking differences were noted between ACHs and LTCFs in the ratio of ICP FTEs to beds and in basic infection control educational preparation for ICPs. These findings suggest that Maryland LTCFs could benefit from basic infection control training and from regulatory actions addressing staff-to-resident ratios.

Hospitals↗

PubMed2005

Plan-do-study-act cycles as an instrument for improvement of compliance with infection control measures in care of patients after cardiothoracic surgery.

The aim of this study was to determine whether compliance with infection control measures for the care of patients during and after cardiothoracic surgery could be improved by using 'plan-do-study-act' (PDSA) improvement cycles in a 715-bed university hospital. The endpoints of these cycles were indices of correct procedure based on infection control standards. The intervention consisted of instruction and training of nursing and medical staff on the use of PDSA cycles, feedback of the baseline measurements, and the use of posters in the proximity of the operating room (OR). At follow-up, overall compliance only improved in the room used by the perfusionists and the OR. After the follow-up period, monitoring revealed a drop in compliance in the OR, but improved compliance during vascular catheter care of patients with prolonged stay in the intensive care unit (ICU), and during wound care of patients on the nursing ward. The last series of monitoring showed that compliance with general infection control measures in the OR had improved again, and that compliance had remained satisfactory on the ward and in the ICU, with the exception of patients recently transferred to the ICU from the OR. The results show that by using PDSA cycles, compliance with infection control measures can improve significantly. However, repeated monitoring is necessary to ensure continued compliance.

Cardiac Surgical Procedures↗

PubMed2005

Nosocomial infection control in regional and provincial hospitals.

OBJECTIVES: To study the organization and practices in nosocomial infection (NI) control in regional and provincial hospitals. MATERIAL AND METHOD: Data were collected by questionnaires answered by chairpersons of infection control committees (ICC) infection control nurses (ICNs) and link nurses in regional and provincial hospitals. RESULTS: From April to June 2002, sets of questionnaires were sent to all chair persons of regional and provincial hospitals, 120 infection control nurses and 57 link nurses. Of 92 hospitals, 78.3% of chairpersons and all ICNs and link nurses responded. The ICC were chaired by the directors or deputy directors in 26.4% and by doctors in various specialties in the remaining. Among ICNs, 14.2% had never attended a course in infection control and 62.5% had less than 6 years experience. Lack of support from administrators, budget, co-operation from medical personnel and ICN position were the main problems in the IC program. CONCLUSION: Nosocomial infection control in regional and provincial hospitals in Thailand needs more support from administrators and more co-operation from medical personnel.

Adult↗

PubMed1993

An expert system for culture-based infection control surveillance.

Hospital-acquired infections represent a significant cause of prolonged inpatient days and additional hospital charges. We describe an expert system, called GERMWATCHER, which applies the Centers for Disease Control's National Nosocomial Infection Surveillance culture-based criteria for detecting nosocomial infections. GERMWATCHER has been deployed at Barnes Hospital, a large tertiary-care teaching hospital, since February 1993. We describe the Barnes Hospital infection control environment, the expert system design, and a predeployment performance evaluation. We then compare our system to other efforts in computer-based infection control.

Cells, Cultured↗

PubMed2005

Infection control for dental radiographic procedures.

The employment of proper infection control procedures in the dental office is necessary to prevent the spread of infectious agents. The potential for cross contamination between dental personnel and the patient is considerable when exposing intraoral radiographs. The dental office darkroom or daylight loader can also be a potential contamination source if good infection control measures are not followed. By utilizing PPE, plastic barriers and disinfectants, DHCPs can minimize the likelihood of problems with contamination.

Dental Disinfectants↗

PubMed1998

Use of DNA fingerprinting to assess tuberculosis infection control.

BACKGROUND: DNA fingerprinting establishes the genetic relatedness of Mycobacterium tuberculosis isolates and has become a powerful tool in tuberculosis epidemiology. OBJECTIVE: To use DNA fingerprinting to assess the efficacy of current tuberculosis infection-control practices. DESIGN: Retrospective molecular and descriptive epidemiologic study. SETTING: A 700-bed urban public hospital that follows the Centers for Disease Control and Prevention (CDC) guidelines for tuberculosis infection control. PATIENTS: 183 patients who had positive cultures for M. tuberculosis from 1 April 1995 to 31 March 1996. RESULTS: 173 of 183 M. tuberculosis isolates from the study period underwent DNA fingerprinting. Fingerprinting revealed that five isolates represented false-positive cultures and that 91 (54%) of the remaining 168 isolates were in 15 DNA fingerprinting clusters, which ranged in size from 2 to 29 isolates. Risk factors for clustering were birth in the United States, African-American ethnicity, homelessness, substance abuse, and male sex. Retrospective epidemiologic analysis of inpatient and outpatient visits by the 91 patients who had clustered isolates revealed only one possible instance of patient-to-patient transmission. CONCLUSIONS: The DNA fingerprinting of all M. tuberculosis isolates from a 1-year period revealed one possible instance of nosocomial transmission and five false-positive M. tuberculosis cultures. However, these results did not lead to changes in infection-control practices or in clinical care. The study findings do not support the use of DNA fingerprinting for nosocomial tuberculosis surveillance, but they suggest that compliance with the CDC tuberculosis infection-control guidelines may control patient-to-patient transmission in high-risk urban hospitals.

Chicago↗

PubMed2004

Improved infection control in the prevention of variant Creutzfeldt-Jakob disease in Australia: costs and benefits.

OBJECTIVE: To evaluate the costs and benefits of infection control strategies to prevent the transmission of variant Creutzfeldt-Jakob disease (vCJD) in ophthalmic surgery in Australia. METHODS: The reduction in the risk of iatrogenic transmission of vCJD from feasible infection control strategies was calculated using decision analytic models. A static model calculated the direct secondary transmission for surgical eye procedures, and a simple dynamic model estimated the change in the risk of a subsequent sustained epidemic over the longer term. The expected number of vCJD infections, their cost of care and years of life lost and the estimated cost of strategies included the direct costs of infection control measures were calculated taking a health system perspective. RESULTS: The dynamic model (Markov process) predicted that from a hypothetical pool of as many as 100 primary vCJD cases there would be less than five iatrogenic infections in the next 30 years. If there are fewer than five primary cases the model predicted no secondary cases of vCJD. The costs of providing care for a vCJD case is estimated to be about $50,000, subject to considerable uncertainty. The minimum cost for using a partial infection control strategy to prevent an iatrogenic infection is likely to be in the order of several millions of dollars. CONCLUSIONS: Substantial public health investment would need to be made in order to reduce a low risk of iatrogenic transmission of vCJD. Given the likely number of cases of iatrogenic infection, and the order of magnitude of the costs of caring for cases of vCJD, it may be difficult to justify the high cost of risk reduction strategies.

Australia↗

PubMed2006

Impact of an infection control program in an intensive care unit in France.

OBJECTIVE: To evaluate the impact of an infection control program in an intensive care unit (ICU). DESIGN: Prospective before-after study. Two 6-month study periods were compared; between these periods, an infection control program based on isolation was implemented. SETTING: Polyvalent ICU of Montpellier Teaching Hospital.Patients. Any patient who was hospitalized in the ICU for >48 hours and was discharged during 1 of the 2 periods. MAIN OUTCOME MEASURES: The main patient-related variables were sex, age at admission, type of patient (surgical, medical, or trauma), Simplified Acute Physiology Score II, length of ICU stay, need for intubation, duration of exposure to invasive devices, onset of nosocomial infection and pathogens responsible, and death. We compared the 2 study periods with respect to the incidence of 4 nosocomial infections (pneumonia, urinary tract infection, bacteremia, and catheter-associated infection), the frequency of infection with the main multidrug-resistant pathogens, and patient survival. RESULTS: Patients in periods 1 and 2 were similar with regard to sex, age, physiology score, and exposure to invasive devices. The rates of infection with multidrug-resistant pathogens were significantly lower during period 2 than during period 1 (infection rate: 28.1% of patients in period 1 and 9.6% of patients in period 2 [P = .01]; pneumonia rate: 32.6% of patients in period 1 and 4.2% of patients in period 2 [P = .008]). The mortality rate among patients with nosocomial pneumonia was 38.2% in period 1 and 4.3% in period 2 (P = .009). CONCLUSIONS: After implementation of an infection control program, the rate of infection with multidrug-resistant pathogens decreased, as did the mortality rate among patients with nosocomial pneumonia.

Adolescent↗