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PubMed1990

Infection control in patients undergoing mechanical ventilation: traditional approach versus a new development--selective decontamination of the digestive tract.

Nosocomial infections are major causes of morbidity and mortality in critically ill patients. Traditional infection control practices focus on preventing infection by controlling patient exposure to microorganisms within the patient's environment. We discuss these practices, along with the factors and organisms responsible for nosocomial infection in the patient undergoing mechanical ventilation. Despite traditional infection control measures, nosocomial infection continues to be a major problem. In recent years evidence has accumulated that points to bacterial colonization of the oropharynx and gastrointestinal tract as a major source of infection. A new technique, selective decontamination of the digestive tract, is being studied extensively for its ability to control colonization of the oral cavity and the gastrointestinal tract. In the technique nonabsorbable topical antibiotics are applied to the oropharynx and instilled into the stomach, and a short course of an intravenous cephalosporin is included. The technique appears a worthwhile addition to traditional infection control measures.

Anti-Bacterial Agents↗

PubMed2006

Paediatric emergency department staff perceptions of infection control measures against severe acute respiratory syndrome.

OBJECTIVES: To determine paediatric emergency department (ED) staff perceptions of the effectiveness and practice of infection control measures against a novel virulent pathogen. METHODS: All medical staff of the paediatric ED in a tertiary medical centre completed a written questionnaire near the onset of the severe acute respiratory syndrome (SARS) outbreak. Level of concern regarding SARS, and perceptions of effectiveness and use of infection control measures were assessed on a 5 point scale. Statistical analysis was performed using chi2 test and one way analysis of variance with significance at p<0.05. RESULTS: Response rate was 97% (116/120). All scores were given out of 5 possible points. Using isolation rooms (mean score 4.6), wearing a mask when examining patients (4.5), and handwashing (4.5) were considered most effective. Staff physicians reported handwashing more than nurses and trainees (4.9 v 4.5 and 4.5, respectively; p<0.05) while other measures were reported equally. Respondents considering SARS a high public health threat reported higher compliance with handwashing (4.8 v 4.4), always wearing a mask (3.9 vs 3.2) and gloves (3.6 v 2.9) in the ED (p<0.05), but not eye protection (3.4 v 3.0), gown use (4.9 v 4.7), or wearing a mask when examining patients (5.0 v 4.8). Staff who considered combined infection control measures effective in protecting patients and healthcare workers did not report increased compliance. CONCLUSIONS: Eye protection was perceived as only moderately effective in protecting against the spread of SARS, and reported compliance was relatively poor among ED staff. Concern of SARS as a public health threat rather than perceived effectiveness of infection control measures appears to have a greater impact on compliance.

Adult↗

PubMedDate not supplied

Infection control: principles for practice.

This article discusses the general principles of infection control and outlines the role nurses can play in maintaining a safe environment. This article is the third and final part of our 1998 series on infection control.

Cross Infection↗

PubMed1999

Infection control in outpatient unicomponent penile prosthesis surgery.

The aim of this work is evaluate the efficacy of infection control measures with unicomponent penile implants in two ambulatory surgery units in Cairo and Jeddah. This was a retrospective study of 117 consecutive cases. A patient selection and infection control protocol was followed to implant 12 hydraulic, 53 mechanical and 52 malleable prostheses under local bupivacaine penile ring anesthesia and intravenous propofol. No infection occurred that required prosthesis removal, none required hospitalization or urinary catheterization, one crural and two septal perforations were managed intraoperatively; one case was reoperated upon for mechanical failure, two for oversizing and one for undersizing the girth. We conclude that implantation of unicomponent penile implants under triple antibiotic coverage in an ambulatory surgery setting, with rigid infection control measures appears to be effective in preventing infection.

Adult↗

PubMed2001

Costs and savings associated with infection control measures that reduced transmission of vancomycin-resistant enterococci in an endemic setting.

OBJECTIVE: To determine the costs and savings of a 15-component infection control program that reduced transmission of vancomycin-resistant enterococci (VRE) in an endemic setting. DESIGN: Evaluation of costs and savings, using historical control data. SETTING: Adult oncology unit of a 650-bed hospital. PARTICIPANTS: Patients with leukemia, lymphoma, and solid tumors, excluding bone marrow transplant recipients. METHODS: Costs and savings with estimated ranges were calculated. Excess length of stay (LOS) associated with VRE bloodstream infection (BSI) was determined by matching VRE BSI patients with VRE-negative patients by oncology diagnosis. Differences in LOS between the matched groups were evaluated using a mixed-effect analysis of variance linear-regression model. RESULTS: The cost of enhanced infection control strategies for 1 year was $116,515. VRE BSI was associated with an increased LOS of 13.7 days. The savings associated with fewer VRE BSI ($123,081), fewer patients with VRE colonization ($2,755), and reductions in antimicrobial use ($179,997) totaled $305,833. Estimated ranges of costs and savings for enhanced infection control strategies were $97,939 to $148,883 for costs and $271,531 to $421,461 for savings. CONCLUSION: The net savings due to enhanced infection control strategies for 1 year was $189,318. Estimates suggest that these strategies would be cost-beneficial for hospital units where the number of patients with VRE BSI is at least six to nine patients per year or if the savings from fewer VRE BSI patients in combination with decreased antimicrobial use equalled $100,000 to $150,000 per year.

Adult↗

PubMed1992

Compliance with infection control procedures among California orthodontists.

We conducted a survey of a random sample of California orthodontists and of general dentists to compare their infection control procedures. Questionnaires were returned by 124 orthodontists (56% response rate) and 126 general dentists (61% response rate). Eighteen questions were asked covering practice profile, perception of risk from hepatitis B virus (HBV) and human immunodeficiency virus (HIV), exposure to blood, barrier protection used, and sterilization and disinfection procedures. Gloves always were worn by 80% of the orthodontists sampled, 63% always wore glasses, and 59% changed gloves between patients. Orthodontists sterilized their instruments 66% of the time and pliers 49% of the time. Compared with general dentists, orthodontists' perception of risk, use of barrier protection, and sterilization and disinfection procedures were lower in all areas. Our data suggest that poorer performance may be because orthodontists: (1) perceive their younger population of patients at less risk for HBV and HIV; (2) treat 2.5 times as many patients, which increases the costs of infection control; (3) do not use invasive procedures; and (4) perceive that glove use decreases dexterity. Orthodontists should follow the American Dental Association/Council on Dental Therapeutics infection control guidelines for universal precautions. To meet these guidelines, orthodontists still need improvement in all aspects of their infection control procedures.

Adolescent↗

PubMed1995

Delayed recognition and infection control for tuberculosis patients in the emergency department.

STUDY OBJECTIVE: The recent increase in tuberculosis (TB) cases may have an important effect on emergency department infection-control measures. We describe infection-control interventions for TB patients admitted through the ED and hypothesize that ED suspicion of TB is associated with more rapid isolation and treatment. DESIGN: Retrospective chart review. SETTING: The ED of a 400-bed urban, university-affiliated county hospital. PARTICIPANTS: Fifty-five patients with TB culture-positive and acid-fast bacillus stain-positive respiratory specimens who were evaluated in the ED during 1991 and 1992. RESULTS: We identified cases from the mycobacteriology log. Demographic and historical data and time elapsed before initiation of infection-control measures and TB therapy were recorded. We assessed the relationships of individual clinical findings and the ED presumptive diagnosis of TB (predictor variables) to time elapsed before isolation and therapy (outcome variables) with the log-rank test. The median time (interquartile range) from ED registration to isolation was 8 hours (range, 3 to 13 hours). An ED presumptive diagnosis of TB was made in 71% of cases and was significantly associated with shorter time elapsed before isolation (5 hours [range, 2 to 10 hours] versus 21 hours [range, 11 to 111 hours]; P < .001) and less time elapsed before therapy (12 hours [range, 9 to 22 hours] versus 128 hours [68 to 374 hours]; P < .001). We found TB exposure, radiographic changes typical of TB, absence of HIV risk factors, presence of cough, and sputum production to be associated with more rapid isolation. CONCLUSION: Among patients with active pulmonary TB in the ED, TB is often unsuspected and isolation measures are often not used. ED suspicion of TB is associated with more rapid isolation and treatment.

Adolescent↗

PubMed1998

Evaluation of infection control parameters according to the 1994 Centers for Disease Control and Prevention Tuberculosis guidelines: a 2-year experience.

BACKGROUND: Because of classification as a high-risk institution for potential Mycobacterium tuberculosis exposure and an employee purified protein derivative conversion rate of 2.7%, a large university-affiliated county hospital enhanced administrative and engineering controls, as recommended by its tuberculosis task force in early 1994. METHODS: For 1994 and 1995 the medical records of all patients with culture-confirmed M. tuberculosis were reviewed according to the 1994 Centers for Disease Control and Prevention guidelines for case surveillance and risk assessment (infection control parameters). The chi 2-test was used to compare 1994 and 1995 infection control parameters for statistical significance (p < or = 0.05). RESULTS: In 1994 and 1995 there were 253 patients with tuberculosis, 85% of whom (214/253) had pulmonary-site tuberculosis. The "representative" patient with pulmonary tuberculosis was profiled, along with institution-specific surveillance data on diagnostics, medication regimens, and airborne isolation practices. Between 1994 and 1995 there was a trend toward increased numbers of homeless patients with tuberculosis, from 8.2% to 17% (p = 0.07). Decreases in the numbers of HIV seropositive patients with tuberculosis from 35% in 1994 to 24% in 1995 (p = 0.2) and of jailed patients with tuberculosis from 9.8% to 5% (p = 0.5) were not significant. Drug-resistance patterns increased from 13% to 24%, with borderline significance (p = 0.06). The employee purified protein derivative testing compliance rate increased from 49% in 1994 to 74% in 1995, with the purified protein derivative conversion rate also increasing from 2.7% to 3.5%. CONCLUSION: The infection control parameter data were beneficial in identification of institution-specific risk factors for our population with tuberculosis. Although labor-intensive, the annual tuberculosis reports supported requests for administrative and engineering controls; however, efficacy of the 1994 tuberculosis control plan was difficult to assess from purified protein derivative conversion rates alone, because the testing compliance rate also increased.

Adult↗

PubMed2005

[Infection control in long-term care facilities for the elderly].

BACKGROUND: In Norway, around 20 % of the elderly live in long-term care facilities. The risk of acquiring a nosocomial infection increases by age and the consequences of infections become more severe. This article describes the epidemiology of nosocomial infections and the use of antibiotics in long-term care facilities. Infection control measures are recommended. MATERIAL AND METHODS: We used data from the national prevalence surveys of nosocomial infections and from the national surveillance system for communicable diseases. In addition we reviewed current literature. RESULTS: The prevalence of nosocomial infection is similar in hospitals and long-term care facilities in Norway, between 5 % and 10 %. Legal regulations require all health institutions in Norway to have an infection control programme, but little attention has been given to prevention of nosocomial infections in long-term care facilities. Less than 50 % of them have implemented the mandatory infection control programme. The vaccination coverage for influenza is only about 30 %. The coverage of pneumococcal vaccination is even lower. INTERPRETATION: The following actions are recommended for all long-term care facilities: improved hand hygiene by introducing hand disinfection, implementation of infection control programmes, and improved coverage of pneumococcal and influenza vaccination. Employing more health care personnel, nurses as well as doctors, should be a goal.

Aged↗

PubMed1997

Integrating infection control into the dental curriculum.

The dental profession has possessed traditional standards of cross-infection control but the recent expression of real concerns by both the public and the profession over the transmissibility of infectious diseases in the dental surgery has demanded a formalized and extended approach to teaching cross-infection control in the dental curriculum. Clear curriculum content must be formulated within contemporary Workplace Health and Safety Guidelines and the Strategic Plan of the Dental School or academic health centre. The full integration demands that the area is taught as a discrete entity but recognized as an intrinsic part of each clinical encounter. This paper discusses the structure and integration of cross-infection control into the curriculum at the University of Queensland Dental School.

Curriculum↗

PubMed1996

Infection control.

From an infectious disease point of view, dentistry has never been safer than it is today for both patients and the dental team. This state of affairs has resulted from the establishment and practice of strict infection control in the office using the concept of universal precautions. Infection control consists of a series of procedures directed at reducing the number of microbes shared among people. An approach to the management of infection control involves identification of an office safety coordinator and total involvement of everyone in the office. The procedures of infection control can be grouped into six major areas. 1. Handwashing and gloving provides protection to both patients and the dental team. 2. Protection against aerosols and spatter involves the use of a preprocedure mouthrinse, HVE, rubber dam, saliva ejection, mask, protective eyewear, and protective clothing. 3. Instrument processing provides instruments that are safe for patient use. 4. Surface asepsis eliminates the involvement of environmental surfaces in the spread of disease agents. 5. Management of sharps and other regulated waste reduces the chances for sharps injuries and contact with potentially infectious material. 6. Aseptic techniques include aseptic retrieval of supplies, reducing contamination from dental unit water, aseptic radiographic procedures, proper use of disposables, and preventing contamination of the dental laboratory.

Asepsis↗

PubMed1994

Use of infection control guidelines by workers in healthcare facilities to prevent occupational transmission of HBV and HIV: results from a national survey.

OBJECTIVE: Develop national estimates of compliance with infection control guidelines by workers in healthcare facilities to prevent occupational transmission of hepatitis B virus (HBV) and human immunodeficiency virus. DESIGN: A national survey of 3,094 workers in hospitals. SETTINGS: United States ambulatory care hospitals with emergency rooms. RESULTS: While the sampled hospitals had policies that incorporated the Centers for Disease Control and Prevention's (CDC) infection control guidelines, only 55% of patient care staff, 56% of physicians, and 30% of housekeeping staff reported receiving at least one of the shots recommended in the HBV vaccination series. About one half of patient care staff reported that they recapped used needles at least sometimes after giving injections and after drawing blood. Only 43% of patient care staff "always" wore gloves to draw blood. While most patient care staff "always" changed gloves between patients, only 61% reported that they "always" washed their hands after taking off their gloves. One half of patient care staff reported a percutaneous exposure to a patient's blood, and one quarter reported a percutaneous exposure in the past year. The most common cause of these exposures was recapping used needles. CONCLUSIONS: Efforts to reduce exposures to bloodborne pathogens will involve compliance with the Occupational Safety and Health Administration bloodborne pathogens standard and the CDC's infection control guidelines, continued education and training, and emphasis on engineering controls where applicable.

Acquired Immunodeficiency Syndrome↗

PubMed2002

Respiratory viral infections in hospitalized children: implications for infection control.

BACKGROUND: Identification of children with respiratory viral infections may augment infection-control practices on inpatient units. There are clinical syndromes leading to morbidity among hospitalized children, however, in which a viral etiology of the illness might not be considered. METHODS: Virus infection rates among 243 children aged <1 to 19 years hospitalized between October 1993 and April 1994 with asthma, pneumonia, bronchiolitis, fever, apnea, croup, or respiratory distress were evaluated as part of a University of Maryland Medical Center infection-control protocol. Anonymous data collected included admission diagnoses, age, and virus-identification result. RESULTS: Seventy-one children (29%) had a virus identified, including 19 of 123 (15%) with asthma, 4 of 12 (33%) with pneumonia, 27 of 47 (57%) with bronchiolitis, 13 of 41 (32%) with fever, 4 of 9 (44%) with apnea, 2 of 3 (67%) with croup, and 2 of 8 (25%) with unspecified respiratory distress. CONCLUSION: This study reinforces the concept that clinicians should consider respiratory viruses for a broad range of diagnoses. This heightened awareness may help reduce the number of nosocomial respiratory viral infections.

Adolescent↗

PubMed1995

Survey of knowledge of infectious disease and infection control practices of dental specialists.

A questionnaire was developed to assess the knowledge of clinical specialists regarding infectious disease as well as their infection control practices. The questionnaire was mailed to 202 dental specialists in British Columbia. Seventy per cent returned completed surveys. Their responses indicate that the mechanisms, route and risk of transmission of the viral pathogens of importance in dental practice are not clearly understood. However, infection control practices closely follow the guidelines set forth by the Canadian Dental Association and the licensing bodies, including immunization for hepatitis B (82 per cent), glove use (in 89 per cent of non-surgical and 95 per cent of surgical procedures), and sterilization/disinfection of dental handpieces (94 per cent). Compliance with infection control guidelines was similar to that reported in the United States, where strict enforcement has been instituted. The majority of dental specialists (84-88 per cent) were either treating or willing to provide treatment to patients with infectious disease. Continuing education in the area of infectious disease is needed to improve dentists' understanding of the risk of transmission to dental providers and patients. This will ensure that compliance with infection control recommendations and appropriate patient care practices continue.

Analysis of Variance↗

PubMed2004

Minimum practicable and acceptable infection control recommendations for dental practice in Nigeria.

The advent of HIV/aids has led to a renewed interest in infection control and occupational safety in dentistry. The full implementation of "Universal Precautions" to prevent cross-infection of HIV, hepatitis B, and other blood borne pathogens would have a heavy financial implication on developing countries like Nigeria which are faced with the arduous problem of coping with scarce resources. Dentistry is bound to cost more when effective infection control is practised. This paper therefore proposes recommendations for minimum, practicable and acceptable infection control standards which are not only cost effective but also attainable.

General Practice, Dental↗

PubMed1989

Evaluation of a new method of detection of nosocomial infection in the pediatric intensive care unit: the Infection Control Sentinel Sheet System.

To improve the efficiency of nosocomial infection detection, a highly structured system combining initial reporting by the bedside night nurse of symptoms possibly related to infection with follow-up by the infection control nurse (ICN) was developed: The Infection Control Sentinel Sheet System (ICSSS). Between July 1, 1987 and February 28, 1988, a prospective comparison of results obtained through ICSSS and daily bedside observation/chart review by a full-time trained intensivist was undertaken in the pediatric intensive care unit (PICU). Ratios of nosocomial infections and nosocomially-infected patients were 15.8 and 7.0 respectively among 685 admissions; included are seven infections identified only through the ICSSS so that the "gold standard" became an amalgamation of the two systems. The sensitivity for detection of nosocomially-infected patients by bedside observation/chart review and ICSSS was 100% and 87% respectively. The sensitivity for detection of standard infections (blood, wound and urine) was 88% and 85% respectively. The sensitivity for detection of nosocomial infections at all sites was 94% and 72% respectively. Missed infections were minor (e.g., drain, skin, eye), required physician diagnosis (e.g., pneumonia), were not requested on the sentinel sheet (SS) (e.g., otitis media), related to follow-up of deceased patients or were minor misclassifications or failures to associate with device (e.g., central-line related). Daily PICU surveillance by the ICN required only 20 minutes a day. The ICSSS appears highly promising and has many unmeasured benefits.

Bias↗

PubMed2003

[The importance of the examination of, education on, and infection control of tuberculosis in medical school hospitals in Japan].

Since the incidence of tuberculosis (TB) has markedly decreased over the last half-century, dedicated TB hospitals in Japan have been reducing the beds or have been merging with other hospitals. In accordance with this situation, less than 30% of medical school hospitals (MSHs) have facilities for infectious TB patients. In the meantime, and contrary to the previous trend, elderly TB patients or those who have serious underlying diseases have been increasing. MSHs have therefore not only to take care of these patients, but at the same time they have to reform their TB education system in addition to upgrading TB infection control. To elucidate the current problem regarding TB in MSHs, the survey in the current study was performed for 80 MSHs in Japan in January 2002. Two sets of questionnaires were prepared and delivered to doctors in these hospitals. One set mainly asked about the status of TB examination and education, and was aimed at doctors in the division of respiratory diseases of the department of internal medicine (Rs); and the other mainly asked about the status of TB infection control and was aimed at doctors in the divisions of infectious diseases, or whoever in charge of hospital infection control (Is). Response rates from Rs and Is were 75.0% (60/80) and 65.0% (52/80), respectively. Seventy-three point three percent (44/60) of Rs and 73.1% (38/52) of Is were working in hospitals without TB beds. Because of the current incidence of TB, the number of TB patients they examined in a year was small (35/60 of hospitals examined less than 20 TB patients in a year). Although there were some experienced doctors on TB in each hospital, most MSHs had only a small number of experienced nurses. Nevertheless, 89.3% of doctors in MSHs (a total of 100/112 Rs and Is) believed that they required TB rooms exclusively for TB patients who have some underlying diseases, and for TB education. Regarding the role of MSHs for TB patients care, the majority of doctors (70.5% of Rs and 68.4% of Is) considered MSHs should be able to offer treatment to TB patients with underlying complications. As to the educational aspect, most medical schools (MSs) devoted little time to lectures on TB (the median was 1 to 1.5 hour); on the other hand, some MSs (31.8%: 14/44 of MSHs without TB rooms) included a clinical practices in TB hospitals for TB education, although its term was short. Regarding TB infection control issues, most of the MSHs had active infection control committees in their hospitals and TB was thought to be one of the most important targets for these committees. About 40% (20/51) of these hospitals over the past few years had experienced nosocomial TB infection due in part to the so called "Doctor's delay". As one of the strategies to prevent nosocomial TB infection, special education sessions, not only for staff and residents but also students, were therefore performed in 60.8% (31/51) of MSHs. As to the evaluation of the tuberculin skin test (TST) status of medical students, the two-step TST was performed in 47.1% (24/51) of MSs (as most Japanese underwent their BCG vaccination in their childhood) and 54.9% (28/51) of MSs had a BCG revaccination policy for TST negative students. Although steps toward reforms in TB issues in MSHs were slow, some minor progress had been made as compared with previous surveys performed by us and others. Even though the numbers of TB patients examined in MSHs have been smaller than before, MHSs still have to take care of some TB patients with some complications. A great deal of effort still needs to be expended to establish efficient and effective TB education and infection control systems. Even though many ideas have been put forward to improve the current situation, one of the most successful answers is to set up small number of special rooms, not only for TB patients but also for other airborne infectious diseases, in all MHSs. The other clue is to establish an intimate collaboration between MSHs and TB hospitals with regard to clinical TB education not only for medical students but also for medical staff.

Education, Medical↗

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↗