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PubMedDate not supplied

Survey on AIDS, fear and infection control: attitudes affecting management decisions.

As a result of increased public concern about AIDS and dental treatment, dental professionals need to cope with legislative reactions, increased infection control costs, patient anxiety and vigilance on the part of law enforcement agencies regarding compliance with "universal precautions." Recommendations abound for educating patients about dental office infection control to allay irrational fears and market dental office asepsis, but few studies quantitatively measure these needs or address the behavioral concerns patients have about AIDS infection related to dental care. In this investigation, dental patients were surveyed to determine their beliefs, attitudes and behaviors regarding AIDS and dental office infection control. Several important educational caveats were identified. This paper considers these challenges and provides patient education and practice management recommendations consistent with a preventive focus on allaying dental patients' fears while building more successful dental practices.

Adult↗

PubMed1996

Knowledge of and attitudes about blood-borne viruses and infection control in Brazilian dental practice.

OBJECTIVE: To determine whether there were any recent changes in hepatitis B immunisation of dental staff, infection control or understanding of viral infections in Brazilian dentists. DESIGN: A randomised survey was conducted on 740 dentists attending the National Dental Congress in Sao Paulo, Brazil in 1994. SUBJECTS AND METHODS: The 740 dentists were questioned as to the presence of various viruses in saliva, the perceived risks of dental staff and long-term sequelae, the availability and uptake of vaccines, willingness to treat virus-infected persons, and means of infection control. Nearly 69% of respondents were female dentists, of mean age 30 years. Results were compared with a similar survey from 1990. RESULTS: Most respondents knew that HIV and hepatitis viruses could appear in saliva and almost all knew of infective risks from hepatitis B (HBV), and the availability of the vaccine. Less than half knew of the association of HBV with liver cancer. There was a four-fold increase in those vaccinated against HBV since the low figure of 9% in 1990. Nearly two-thirds of respondents perceived an occupational risk to dental staff from HIV, and a similar proportion were also unwilling to treat virus-infected persons. A similar proportion also used chemical disinfection for some dental instruments. CONCLUSIONS: The results show little improvement over a 4-year period except a much greater proportion of dentists were immunised against HBV. However, still only one third of dentists had been vaccinated, in a country with a high prevalence of infection in the general population.

Adult↗

PubMedDate not supplied

Infection control education for undergraduates.

Healthcare-associated infection (HCAI) is recognised as a major and increasing problem to health (Scottish Executive 2002a). National strategies are being considered to address the problem. This article describes how one Scottish higher education institution collaborated to identify, adapt and implement the Cleanliness Champions programme--a national infection control educational initiative--in established undergraduate nursing and midwifery curricula. The result was that undergraduate nursing and midwifery students were included in the national campaign to tackle HCAI in Scotland.

Attitude of Health Personnel↗

PubMed1997

Public perception of cross-infection control in dentistry.

Since the advent of HIV/AIDS at the beginning of the 1980s, concern has generated considerable impetus for change in cross-infection control procedures in dentistry. This process has been hastened partly by media coverage which, in tending to favour sensation over rational discourse, has played a not inconsiderable role in shaping public understanding and expectations. This study aimed to investigate public perceptions of cross-infection control in dentistry in Australia using a postal follow-up to the 1995 National Dental Telephone Interview Survey. The postal survey response rate was 85.2 per cent. Concerns about the procedures used by their dentist to sterilize instruments were reported by 13.3 per cent of respondents overall, and this was greater among non-health-card-holders, individuals who mainly spoke a language other than English in the home, and those who reported a non-routine dental visiting pattern. Avoidance or delaying of dental visits due to the perceived cross-infection risk was reported by an overall 3.6 per cent of people, and this was higher among females and those who expressed concern about cross-infection control. The profession has a responsibility to ensure that information on the measures which have been taken to reduce the risk of cross-infection in dentistry is disseminated as widely and as clearly as possible so that undue public concern and avoidance of dental care are minimized.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Dentists' attitudes to cross-infection control.

The wearing of gloves by dentists undertaking clinical procedures has been recommended by many authorities as an essential element of dental surgery cross-infection control. This paper reports an investigation into patterns of glove-wearing by practising dentists, and considers the effect of practice location and practising arrangements on this issue and other aspects of cross-infection control. The results show that these factors, including the type of patient treated, may influence the pattern of glove-wearing by dentists in England and Wales. These findings suggest that groups least likely to follow the recommended infection control procedures should be targeted when assessing dental education requirements.

Attitude of Health Personnel↗

PubMed1998

Epidemiology as a tool for hospital infection control.

Epidemiology today studies the occurrence of health and disease and evaluates the global quality of health care, whereas it previously mainly consisted in the investigation of infectious outbreaks. This paper describes basic principles of descriptive and analytical hospital epidemiology, and focuses on the standardized and professional methodology used to manage nosocomial outbreaks. The basis for applied epidemiology for infection control purposes is surveillance. Computer technology permits data retrieval for detailed investigation by filtering the microbiology reports for specific data with nosocomial and epidemiological importance, so that expertise and organization of the microbiology laboratory have become key success factors for surveillance. In Belgium epidemiologists rarely, if ever, practice in hospitals as a separate discipline, although professional hospital epidemiology as part of infection control would be profitable for all. A debate is still to be held on how epidemiology should be organized in Belgian hospitals. It is generally accepted and provided by law that hospital hygiene physicians and nurses should perform epidemiological investigations and surveillance. However, the lack of professional training in epidemiology and insufficient resources constitute two major drawbacks. Microbiological typing techniques have become indispensable tools for epidemiology and should be accessible to every hospital infection control practitioner.

Belgium↗

PubMed1996

Managing HIV. Part 7: Professional issues. 7.1 HIV infection control in medical practice.

Reports of cross-infection with HIV and hepatitis C during routine surgery in Sydney have refocused attention on preventing transmission of HIV and other blood-borne viruses in the health care setting. This review examines the risks of transmission in medical practice, summarises infection control measures and examines issues regarding the HIV-infected health care worker.

Cross Infection↗

PubMed2006

Surveillance of infection control procedures in dialysis units in Japan: a preliminary study.

As there is a high risk of indirect and direct transmission of infectious agents in chronic hemodialysis, infection control procedures should be established in dialysis units. This paper presents the findings of a questionnaire designed to survey the current status of infection control procedures in hemodialysis settings. Two hundred and forty-three hemodialysis units in Japan were surveyed. Nearly 90% of hemodialysis units reported compliance with each procedure recommended by the Center for Disease Control and Prevention in the United States, including use of disposable gloves, handling of non-disposable or non-single-use items, and routine serological testing of blood-borne viruses. However, more than 50% of units reported that they did not comply with recommendations concerning some procedures, such as places for preparing medications and their delivery, clean areas in the units, vaccination for hepatitis B, and additional measures for hepatitis B surface antigen (HBs-Ag) positive patients. Especially, the concept of universal precautions seemed to be misunderstood in units with a high prevalence of anti-hepatitis C antibody-positive (anti-HCV Ab-positive) patients. In conclusion, further intensive education and training will be necessary to establish infection control procedures.

Disposable Equipment↗

PubMed2005

The unexpected impact of a Chlamydia trachomatis infection control program on susceptibility to reinfection.

BACKGROUND: After the introduction of a program to control Chlamydia trachomatis infection in British Columbia, Canada, case rates fell from 216 cases/100,000 population in 1991 to 104 cases/100,000 population in 1997. Since 1998, rates have increased, and case counts now exceed those recorded before the intervention. METHODS: We used Cox proportional-hazards survival analysis and developed a compartmental mathematical model to investigate the cause of resurgence in chlamydia cases. RESULTS: Cox proportional-hazards survival analysis showed that the relative risk of C. trachomatis reinfection has increased 4.6% per year since 1989, with the increased risk greatest among the young and greater among women than men. A compartmental mathematical model of C. trachomatis transmission showed that a control strategy based on shortening the average duration of infection results in an early reduction in prevalence followed by a rebound in prevalence, reproducing the observed trends. CONCLUSIONS: We speculate that a C. trachomatis infection control program based on early case identification and treatment interferes with the effects of immunity on population susceptibility to infection and that, in the absence of strategies to alter sexual networks, a vaccine will be needed to halt the spread of infection at the population level.

Adolescent↗

PubMed2005

Why is an infection control program needed in the hemodialysis setting?

Infections account for the second leading cause of mortality among patients with end-stage renal disease. Many of these infections are due to sepsis, primarily arising from the vascular access site. Septicemia alone accounts for almost 11% of mortality in hemodialysis patients. Hemodialysis patients are also a sentinel population for the emergence of antimicrobial resistance, especially with regards to gram-positive cocci (vancomycin-resistant enterococci (VRE), methicillin resistant S. aureus (MRSA), Staphylococcus aureus with reduced susceptibility to vancomycin (VISA), and vancomycin resistant S. aureus [VRSA]). It is extremely important to follow infection control recommendations designed to prevent these types of adverse events from occurring in the hemodialysis population. The campaign to prevent antimicrobial resistance in dialysis includes four strategies: Prevent infection; diagnose and treat infection; use antimicrobials wisely; and prevent transmission. In addition, efforts to prevent infection should include avoiding use of hemodialysis catheters, whenever possible, and meticulous care of hemodialysis catheters and other vascular access sites. These efforts would improve patient outcomes and quality-of-life issues by reducing hospitalizations and mortality due to infection and vascular access complications.

Bacterial Infections↗

PubMed2003

Clostridium difficile infections related to antibiotic use and infection control facilities in two university hospitals.

We investigated whether a reduction in antibiotic use at the Aker University Hospital (Aker) led to a reduction in Clostridium difficile-associated diarrhoea (CDAD). We compared the incidence of CDAD in Aker and Tromsoe University Hospitals (Tromsoe) and related it to antibiotic use and facilities for infection control between 1993-2001. For this purpose we also performed point prevalence studies. Total antibiotic use was the same in the two hospitals. In spite of a reduction in the use of broad-spectrum antibiotics in Aker the incidence of CDAD increased during 1993-1999. In Tromsoe the use of broad-spectrum antibiotics and clindamycin was two to three times higher than in Aker, but until 1999 the incidence of CDAD remained constant and only half that of Aker. After 1999 the incidence of CDAD was halved in Aker, and increased three-fold in Tromsoe. Point prevalence studies in 2001 revealed an equal prevalence of antibiotic-associated diarrhoea. The facilities for infection control were better in Tromsoe. The percentage of single rooms were 8% in Aker and 14% in Tromsoe, and the percentage of single rooms with a WC was 6% in Aker and 12% in Tromsoe. The bed occupancy was much higher in Aker than in Tromsoe. Lack of facilities for infection control and higher bed occupancy could have contributed to the higher incidence of CDAD in Aker in spite of decreased use of broad-spectrum antibiotics and clindamycin. To limit CDAD in hospitals the focus must be on both rational antibiotic use and infection control.

Anti-Bacterial Agents↗

PubMed1995

Infection control in dental radiology.

Although exposure to blood is rare in oral and maxillofacial radiology, contact with saliva occurs. Thus the spread of infectious diseases is possible through cross-contamination, and specific infection control protocols and unit dosing of items are needed. This article outlines rationale for implementing state-of-the-art infection control procedures; and explains federal standards and guidelines with an impact on infection control and occupational safety in dental radiology procedures.

Cross Infection↗

PubMed1991

Hospital infection control in Thailand.

Nosocomial infection is a relatively new subject in Thailand. A group of interested medical personnel has been identified which has begun to work together. The nationwide prevalence study showed that nosocomial infection is a serious health problem that requires urgent intervention. Attempts have been made to develop proper control programmes. The main obstacles in practice are the lack of both support from administrators and cooperation from medical colleagues. These obstacles can be overcome in future by meetings, distribution of information, and education. Success in epidemic control and expenditure reduction should provide the evidence to convince administrators of the necessity of control of nosocomial infection.

Attitude of Health Personnel↗

PubMed2001

Dental hygienists and infection control: knowledge, attitudes and behaviour in Italy.

This study evaluated knowledge, attitudes and behaviour regarding infection control of dental hygienists in Italy. Among the 185 responders to the self-administered mailed questionnaire, 91.3% agreed with the correct responses to the three questions on knowledge about infection prevention and control procedures chosen as an indicator of 'good' knowledge. However, 21% were uncertain whether, or disagreed that, dental instruments should be rinsed in water after contact with glutaraldehyde and 17.5% agreed that, or were uncertain whether, 10 min contact with glutaraldehyde provided sterilization. Only 36.5% knew all the five oral manifestations of acquired immunodeficiency syndrome (AIDS) (acute periodontal problems, candidiasis, hairy leukoplakia, herpes simplex virus, Kaposi's sarcoma) and this knowledge was significantly higher in dental hygienists with a lower number of years of practice. More than two-thirds used a steam sterilizer or glutaraldehyde for appropriate times and temperatures for disinfection/sterilization of instruments and used appropriate surface disinfection procedures. The correct application of disinfection or sterilization methods for instruments was more likely in the older respondents and in those who attended continuing education courses on infection control. A positive attitude was reported by the majority of dental hygienists who agreed that guidelines should be maintained and applied and was significantly more likely in younger respondents. Only 57.9% routinely follow all recommendations for infection control practices and their use was significantly higher in the older respondents. Educational programmes are needed for improving knowledge about oral manifestations of AIDS in order to support dentists to provide early diagnosis and about the correct use of procedures and universal precautions for preventing infections.

Adult↗

PubMed1995

Success, failures and costs of implementing standards in the USA--lessons for infection control.

In the US, extensive standards for performance and 'guidelines for practice' have been instituted by a number of governmental and non-governmental agencies. New governmental plans for health care depend heavily on practice guidelines, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has been especially enthusiastic about continuous quality improvement. Monitoring the appropriateness of care and altering physician practice appeals to insurance carriers and health care management organizations. Some initial data exist to show that the quality of health care has been enhanced by these regulations. The total cost for health care administration in 1990 in the USA was 24.8% of each hospital's spending for health care. Much of this was associated with spending for new initiatives in practice guidelines, physician profiling, quality assurance, and the like. Few data exist to show that the quality of health care or hospital infection control has been enhanced by these expenditures. Regulations and guidelines also have proliferated in infection control. Guides from the JCAHO have been expanded, and recent mandates from the Occupational Health and Safety Administration (OSHA) for protecting employees from blood-borne and respiratory pathogens promise to be especially costly for health care organizations to implement. Little data exist to show that the quality of infection control has been enhanced by these regulations. Standards are difficult to develop, because the science to back them up often is lacking, interpretation of validating data is imprecise, and inherent biological variation makes exceptions common. Seven lessons are important for those developing standards today. These include focusing on objective measures of the impact of the standard, clearly indicating the degree of scientific validity, making the development process inclusive, allowing for local variation, making sure that funding is provided for mandated standards, considering non-scientific implications of standards, and remaining involved in the process after the guideline is developed. Infection control workers should make sure that standards developed take the lessons above into account before they are promulgated.

Financial Support↗

PubMed2004

Monitoring and educational feedback to improve the compliance of tattooists and body piercers with infection control standards: a randomized controlled trial.

OBJECTIVES: Blood-borne viruses, which present a grim health and economic burden for both developed and developing countries, can be transmitted through tattooing and piercing. Limited data exist concerning intervention strategies for increasing skin penetration operators' compliance with infection control standards. We evaluated the efficacy and acceptability of an educational feedback intervention for tattooists and piercers. METHODS: A randomized controlled trial was conducted in Sydney, NSW, Australia, among 37 tattooing and body-piercing premises in 2002. RESULTS: No effects were found in terms of improved knowledge. There was a significantly greater increase in the experimental group in the perceived risk of being detected and penalized for noncompliance. There was a significantly greater improvement in the demonstration of 2 of 3 infection control procedures and a nonsignificant trend toward greater improvement in inspection scores in the experimental group. The odds of compliance were significantly higher in the experimental group for 2 of the 3 demonstration practices and in 2 of 5 observed infection control practices. CONCLUSION: The findings contribute new information concerning alternative approaches to increasing tattooists and piercers' infection control compliance with regulations/guidelines.

Communicable Disease Control↗

PubMed2004

Infection control for SARS in a tertiary paediatric centre in Hong Kong.

Severe acute respiratory syndrome (SARS) is an emerging infectious disease. After the appearance of an index patient in Hong Kong in February 2003, SARS outbreaks occurred rapidly in hospitals and spread to the community. The aim of this retrospective study is to evaluate the effectiveness of a triage policy and risk-stratified infection control measures in preventing nosocomial SARS infection among paediatric healthcare workers (HCWs) at the Prince of Wales Hospital, a general hospital to which children with SARS are referred in Hong Kong. The acute paediatric wards were stratified into three areas: (1) ultra high-risk area, (2) high-risk area and (3) moderate-risk area according to different risk levels of nosocomial SARS transmission. The implementation of different levels of infection control precautions was guided by this risk stratification strategy. Between 13 March and 23 June, 38 patients with probable and suspected SARS, 90 patients with non-SARS pneumonia, and 510 patients without pneumonia were admitted into our unit. All probable SARS cases were isolated in negative-pressure rooms. Twenty-six HCWs worked in the ultra high-risk area caring for SARS patients and 88 HCWs managed non-SARS patients in other ward areas. None of the HCWs developed clinical features suggestive of SARS. In addition, there was no nosocomial spread of SARS-associated coronavirus to other patients or visitors during this period. In conclusion, stringent infection control precautions, appropriate triage and prompt isolation of potential SARS patients may have contributed to a lack of nosocomial spread and HCW acquisition of SARS in our unit.

Cross Infection↗

PubMed1993

Closing the loop: audit in infection control.

The audit cycle has four parts: setting standards, testing practice and outcome against these standards, correcting practice where it falls short, and re-auditing to confirm that standards are now met. The last two steps complete the audit cycle or 'close the loop'. Infection control can be audited for whether written guidelines exist for each procedure, whether these guidelines are acceptable and whether they are followed in practice. This form of audit is relatively simple provided there are authoritative model guidelines available, produced by organizations such as the Hospital Infection Society. The best outcome measure of infection control is the nosocomial infection rate, but this is the most difficult to audit in practice. If audit results are to be compared between hospitals or between different time periods in the same hospital, infection rates should be adjusted for the underlying risks of infection in the patient population. This type of audit can be done by repeated prevalence surveys.

Cross Infection↗