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PubMed2003

Guidelines for infection control in dental health-care settings--2003.

This report consolidates previous recommendations and adds new ones for infection control in dental settings. Recommendations are provided regarding 1) educating and protecting dental health-care personnel; 2) preventing transmission of bloodborne pathogens; 3) hand hygiene; 4) personal protective equipment; 5) contact dermatitis and latex hypersensitivity; 6) sterilization and disinfection of patient-care items; 7) environmental infection control; 8) dental unit waterlines, biofilm, and water quality; and 9) special considerations (e.g., dental handpieces and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories). These recommendations were developed in collaboration with and after review by authorities on infection control from CDC and other public agencies, academia, and private and professional organizations.

Dentistry↗

PubMed2003

A framework for infection control surveillance using association rules.

Surveillance of antibiotic resistance and nosocomial infections is one of the most important functions of a hospital infection control program. We employed the association rule method for automatically identifying new, unexpected, and potentially interesting patterns in hospital infection control. We hypothesized that mining for low-support, low-confidence rules would detect unexpected outbreaks caused by a small number of cases. To build a framework, we preprocessed the data and added new templates to eliminate uninteresting patterns. We applied our method to the culture data collected over 3 months from 10 hospitals in the UPMC Health System. We found that the new process and system are efficient and effective in identifying new, unexpected, and potentially interesting patterns in surveillance data. The clinical relevance and utility of this process await the results of prospective studies.

Algorithms↗

PubMed1989

Infection control in Canada.

The information presented here reflects the activities of those organizations and agencies with the most impact on infection control in Canada. There are, however, numerous other organizations both on a national and provincial level that also play important roles in infection control. Although great strides have been made in infection control in Canada, we still have much to do to raise the profile of this important activity.

Canada↗

PubMed1992

State regulations governing infection control issues in long-term care.

OBJECTIVE: To examine states' regulations governing infections and infection control in long-term-care institutions. DESIGN: Collection and examination of relevant documents from all of the states, the District of Columbia, the Joint Commission on Accreditation of Health Care Organizations, and Medicare/Medicaid. MAIN OUTCOME MEASURES: Rules governing (1) admissions of patients with infections, (2) tuberculin testing of residents, (3) employee health, (4) use of immunizations, (5) human immunodeficiency virus (HIV)-infected patients, and (6) infection control were compared. RESULTS: There were wide variations in states' policies in each of these areas and many were inconsistent with current scientific knowledge. CONCLUSION: Uniform federal standards for long-term care would probably provide a better and more economical way to ensure quality of care in these institutions.

Facility Regulation and Control↗

PubMed1997

Anonymous questionnaire survey on the knowledge and practices of hospital staff in infection control.

We carried out an anonymous questionnaire survey to assess the extent to which hospital medical and nursing staff were familiar with the written policies and procedures of infection control and their intended course of action in situations where no formal policies were available. All 25 full-time medical staff below the grade of consultant and 70 of 163 permanent nursing staff caring for inpatients at one day shift were sampled. Nineteen (76%) medical and 56 (80%) nursing staff returned their copies. Nurses were significantly more familiar with all written policies and procedures than medical staff. They were also more likely to seek advice in situations where there were no written guidelines. Many hospital staff were uncertain about the practical details of policies and procedures for infection control. Ways to educate and motivate staff to comply with infection control measures are urgently required; some degree of national standardization of policies and procedures in infection control is desirable.

Cross Infection↗

PubMed2006

[Infection control measures in surgical wards and operating theaters].

A variety of infection control measures are practiced to decrease the risk of transmission of pathogens. Standard precautions are thought to be the most effective against healthcare-associated infections. However, compliance with standard precautions is not sufficiently high in Japanese hospitals. Frequent handwashing is an important measure to reduce the risks of transmitting infectious organisms from one person to another, although it is not easy to maintain high compliance in healthcare settings. This problem has not been fundamentally resolved, although infection control practitioners have addressed this problem for more than 100 years. It is recommended that healthcare workers wear personal protective equipment, such as masks, gowns, gloves, goggles, and face shields, to provide barrier protection. Environmental consideration of operation rooms must be performed in order to decrease surgical site infections. Operating theaters should be cleaned routinely, if possible using a wet vacuum. Clean air should be supplied through high-efficiency particulate air filters and positive pressure maintained. Surgeons should be aware that they are an important potential source of surgical site infection.

Humans↗

PubMed2002

Surveillance of hospital-acquired infections in an intensive care department-the benefit of the full-time presence of an infection control nurse.

In the 42-bed intensive care department of a teaching hospital, the creation of a full-time infection control nurse post was followed by a 42% reduction in device-related hospital-acquired infection rates over a period of three years, and 33% reduction over a period of five years. Permanent surveillance accompanied by revision of procedures and bedside teaching were key factors in the improvement of quality of care. In the specific setting of an intensive care department, this study validates the previous conclusions reached in the SENIC study and emphasizes the essential role played by the infection control nurse in the care of critically ill patients.

Cross Infection↗

PubMed1991

Infection control of in-office dental laboratories.

The importance of observing a sound infection control program in the dental laboratory is clear. Personnel should not be expected to work in an unsafe environment. Many of the reasons for ignoring proper disinfection control procedures are unfounded. Infection control procedures do not adversely affect either laboratory personnel or dental prostheses when carefully executed.

Communicable Disease Control↗

PubMed1997

Infection control and the Internet.

The Internet can be enormously valuable for infection control workers. It provides access to policy documents and discussion groups debating everyday problems, and is a comprehensive source of information on infection-related topics. Here we discuss some of the more useful Internet connections.

Computer Communication Networks↗

PubMed2002

From expert data collectors to interventionists: changing the focus for infection control professionals.

The current economic and political environments challenge health care organizations in the United States to provide affordable, accessible, and comprehensive health services. However, changes in reimbursement to health care providers can affect their ability to offer access to cutting-edge services while reducing costs. Consequently, organizations are restructuring, re-engineering, right-sizing, downsizing, and redesigning, all in an effort to save money while also hoping to maintain a reputation for quality and customer service. Dr Vicky Fraser, in her keynote address at the APIC conference in 2000, reminded us that ICHE programs are cost centers rather than revenue generators, and are often targets for budget cuts. Although Haley's Study on the Efficacy of Nosocomial Infection Control (SENIC), published in 1985, was a landmark event demonstrating the importance of our profession's mission, it is becoming dated. Infection control professionals (ICPs) must continue Haley's work, finding innovative ways to market or demonstrate the value of ICHE programs to health care executives. Closing the 1999 APIC conference with a symposium entitled "Breaking Out of the Box," Jackson and Massanari challenged ICPs to educate themselves about the changing health care environment, to be proactive, and constructively help organizations "re-engineer" more efficiently, rather than feel victimized and helplessly await being re-engineered out of existence. The threat of downsizing prompted ICPs at BJC HealthCare to realize that the time had come to change their own culture and attitudes and to focus on the business of infection control. This change required challenging the traditional roles of solo practitioner, data collector, and keeper of infection control data and knowledge. The goals now include leading intervention teams committed to reducing health care-associated infections, partnering rather than accepting sole responsibility for lowering infection rates, and learning to influence without authority. Staying focused on quality and cost-effectiveness and demonstrating improvements in clinical outcomes became a commitment. This article discusses BJC HealthCare's journey through change so that it may provide useful information and tools for ICPs in any setting looking for the necessary change strategies that might keep them in business.

Cross Infection↗

PubMed1996

Changes in dentists' infection control practices, knowledge, and attitudes about HIV over a 2-year period.

OBJECTIVE: To investigate changes in the infection control practices, attitudes, and knowledge of dentists as they relate to HIV/AIDS: STUDY DESIGN: A comparison of responses to surveys conducted in 1992 (n = 258) and 1994 (n = 262) with the use of univariate/multivariate analyses and McNemar's test for paired data. RESULTS: The response rate were > 70%. There were significant increases in reports of continuing education related to HIV/AIDS, heat sterilization of handpieces, use of masks, and knowledge of risk of HIV infection after a needlestick injury. Significantly fewer respondents reported concerns about staff fears about HIV/AIDS: Reports of willingness to treat patients with HIV increased from 68% to 77%. The best predictors of willingness to treat changed from primarily infection control variables to lack of concern with respect to risk or loss of patients when treating persons with HIV. CONCLUSIONS: Increased use of infection control procedures and knowledge may be partly attributable to the introduction of mandatory continuing education in 1993.

Analysis of Variance↗

PubMed1997

Detecting pediatric nosocomial infections: how do infection control and quality assurance personnel compare?

OBJECTIVE: To compare how well infection control (IC) and quality assurance (QA) personnel in a specialty setting identify the presence, type (nosocomial or community-acquired), and (if nosocomial) site of infection. METHODS: In 1994, we mailed a survey that included 21 pediatric case histories to IC and QA personnel in pediatric settings in the United States (children's hospitals and medical school-affiliated hospitals with pediatric wards of > 30 beds). From the case histories presented, the respondents were asked to determine whether an infection was present and, if so, whether it was nosocomial or community-acquired. If the infection was nosocomial, the respondent was asked to determine the site of the infection (e.g., urinary tract, bloodstream). RESULTS: From the 289 hospitals to which surveys were mailed, 131 respondents (45.3%) completed 212 surveys. Of the 212 returned surveys, 120 (56.6%) were completed by IC personnel and 92 (43.4%) were completed by QA personnel. Among the 183 respondents from acute care pediatric settings, 92.3% of IC personnel (96/104) and 54.4% of QA personnel (43/79) correctly identified at least 75% of the nosocomial infections (n = 14; p < 0.0001). IC and QA personnel were similar in ability to identify community-acquired infection (88/104 vs 70/79, respectively; p = 0.436). IC personnel were significantly more likely than QA personnel to accurately identify the following sites of infection: respiratory tract infection without secondary bloodstream infection, necrotizing enterocolitis, urinary tract infection with and without secondary bloodstream infection, primary bloodstream infection, surgical site infection, gastroenteritis, esophagitis, and clinical sepsis. CONCLUSIONS: Overall, IC personnel were more accurate than QA personnel in determining whether a nosocomial infection was present and in correctly determining most sites of infection. Both IC and QA personnel had difficulty identifying venous infection and respiratory tract infection with secondary bloodstream infection. Both IC and QA personnel could thus benefit from more concise definitions or further training in detection of these sites of nosocomial infections. In addition, QA personnel did not perform overall as well as IC personnel in identifying nosocomial infections and their sites; this finding suggests the need for QA personnel to be provided specific training on detection of nosocomial infections and validation of their ability to do so. Nosocomial infection surveillance should be the responsibility of those trained and proved capable of detecting these infections.

Child↗

PubMed1983

Relationship between demographic variables, nonformal education, and the infection control practitioner's knowledge of surveillance.

Since methods used for surveillance have not been standardized, infection control practitioners choose a method based on peer-teaching, on-the-job training, or nonformal education programs. However, results of a previous study showed that 63% of ICPs were unsatisfied with their method of surveillance but did not know how to proceed with an alternative method. The purpose of this descriptive developmental study was to investigate the relationship between surveillance knowledge and the demographic profiles of ICPs and evaluate how this knowledge was affected by a nonformal education process (seminar). Results showed that the surveillance knowledge of ICPs was significantly (p less than 0.05) related to the hospital type and size in which they worked, their educational preparation, the years spent in infection control, the CDC course they took, and the development of an infection control program. The nonformal education process showed a significant (p less than 0.05) increase in surveillance knowledge. In summary, five demographic variables were found to be related to the surveillance knowledge of ICPs, and this knowledge was significantly increased by a nonformal educational process.

Analysis of Variance↗

PubMed1991

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

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

Cross Infection↗

PubMed2005

Surveillance and infection control in an intensive care unit.

OBJECTIVE: To evaluate the effect of an infection control program on the incidence of hospital-acquired infection (HAI) and associated mortality. DESIGN: Prospective study. SETTING: A 2000-bed, university-affiliated hospital in Italy. PATIENTS: All patients admitted to the general intensive care unit (ICU) for more than 48 hours between January 2000 and December 2001. METHODS: The infection control team (ICT) collected data on the following from all patients: demographics, origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated microorganisms, and antibiotic susceptibility. INTERVENTIONS: Regular ICT surveillance meetings were held with ICU personnel. Criteria for invasive procedures, particularly central venous catheters (CVCs), were modified. ICU care was restricted to a team of specialist physicians and nurses and ICU antimicrobial therapy policies were modified. RESULTS: Five hundred thirty-seven patients were included in the study (279 during 2000 and 258 in 2001). Between 2000 and 2001, CVC exposure (82.8% vs 71.3%; P < .05) and mechanical ventilation duration (11.2 vs 9.6 days) decreased. The HAI rate decreased from 28.7% in 2000 to 21.3% in 2001 (P < .05). The crude mortality rate decreased from 41.2% in 2000 to 32.9% in 2001 (P < .05). The most commonly isolated microorganisms were nonfermentative gram-negative organisms and staphylococci (particularly MRSA). Mortality was associated with infection (relative risk, 2.11; 95% confidence interval, 1.72-2.59; P < .05). CONCLUSION: Routine surveillance for HAI, coupled with new measures to prevent infections and a revised policy for antimicrobial therapy, was associated with a reduction in ICU HAls and mortality.

Adult↗

PubMed1991

Infection control of parenteral nutrition solutions.

Microbial contamination of parenteral nutrition solutions is a preventable cause of in patients receiving nutrition support. The components of the parenteral nutrition solutions have variable microbial growth potential. Crystalline amino acid and dextrose solutions are poor growth media for bacteria but may support fungal growth. Lipid emulsions provide an excellent medium for growth of bacteria and fungal species. Total nutrient admixtures will support microbial growth better than standard parenteral nutrition solutions will but less well than will lipid emulsion alone. Control of infection related to contaminated infusate depends on compounding procedure, quality control, appropriate storage, and procedures to prevent in-use contamination. Guidelines are presented for the preparation and administration of parenteral nutrition infusates that will minimize microbial contamination.

Cross Infection↗

PubMed1999

Infection control--evidence into practice.

This paper arises out of two workshop sessions held at the fourth meeting of the Federation of Infection Societies, Manchester, 1997. The aims of the workshops were, first, to identify the factors which impede the process of translating research findings into infection control practice and second, to suggest how these barriers may be overcome. Key points from the workshops are presented within an idealized framework of creating, implementing and maintaining evidence-based infection control practice. This lends structure to our exploration of the evidence underlying infection control guidance and the reasons why such guidance often does not result in appropriate action by healthcare workers. The strengths and weaknesses of each stage of the process are examined, using examples provided by participants at the workshop.

Attitude of Health Personnel↗

PubMedDate not supplied

Association rules and data mining in hospital infection control and public health surveillance.

OBJECTIVES: The authors consider the problem of identifying new, unexpected, and interesting patterns in hospital infection control and public health surveillance data and present a new data analysis process and system based on association rules to address this problem. DESIGN: The authors first illustrate the need for automated pattern discovery and data mining in hospital infection control and public health surveillance. Next, they define association rules, explain how those rules can be used in surveillance, and present a novel process and system--the Data Mining Surveillance System (DMSS)--that utilize association rules to identify new and interesting patterns in surveillance data. RESULTS: Experimental results were obtained using DMSS to analyze Pseudomonas aeruginosa infection control data collected over one year (1996) at University of Alabama at Birmingham Hospital. Experiments using one-, three-, and six-month time partitions yielded 34, 57, and 28 statistically significant events, respectively. Although not all statistically significant events are clinically significant, a subset of events generated in each analysis indicated potentially significant shifts in the occurrence of infection or antimicrobial resistance patterns of P. aeruginosa. CONCLUSION: The new process and system are efficient and effective in identifying new, unexpected, and interesting patterns in surveillance data. The clinical relevance and utility of this process await the results of prospective studies currently in progress.

Data Interpretation, Statistical↗