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PubMed2004

The use of systematic reviews and meta-analyses in infection control and hospital epidemiology.

Systematic review is a type of research that attempts to identify and summarize all of the evidence related to a specific research question. It can be thought of as a "pause" in the process of conducting research in a particular area, in which the following questions are asked: Based on all of the available evidence, what do we know about this specific question so far, and what future studies should be conducted to clarify areas of uncertainty? The systematic review arose as an alternative to the traditional narrative review-which allows authors to pick and choose the studies they discuss and the depth at which they discuss them-a process prone to bias. By adhering to a prospectively defined protocol that specifies how studies should be identified, evaluated, and statistically combined (the statistical process is a component of systematic review and is called "meta-analysis"), systematic reviews reduce the bias inherent to traditional narrative reviews. Systematic reviews are an increasingly common form of published research, and several of the approximately 1000 such studies that are published annually focus on topics important to infection control professionals. Consequently, it is essential that infection control professionals and hospital epidemiologists be able to understand and evaluate the quality of this useful research design. This article discusses the essential elements of a systematic review, provides a framework for evaluating the quality of such an article, and will help the infection control professional and hospital epidemiologist in determining whether the results of such reviews should change clinical practice.

Cross Infection↗
PubMed1991

An alternative strategy for infection control of anesthesia breathing circuits: a laboratory assessment of the Pall HME Filter.

Contaminated breathing systems have been responsible for nosocomial upper respiratory tract and pulmonary infections in patients undergoing general anesthesia. The current infection control guidelines for anesthesia breathing circuits require single-patient use or high-level disinfection of breathing tubes, y-connector, and reservoir bag. An alternative infection control strategy has been suggested that incorporates placement of a microbial filter downstream from the y-connector between the circuit and the patient. This laboratory study assessed the capacity of the Pall HME Filter as a bidirectional barrier to transmission of bacteria between the y-connector of an anesthesia circle breathing system and a test lung. The investigators modified a sterile circle system to allow aerosolization of a suspension of 10(9) Micrococcus luteus over 5 h into the inspiratory limb proximal to the y-connector or downstream from the filter into the test lung. Cultures indicated that the Pall HME Filter placed between the y-connector and the test lung completely prevented transmission of bacteria in both directions. The results of this study suggest that the Pall HME Filter could be used as an effective microbial barrier between the anesthesia circle breathing system and the patient as part of an alternative strategy for infection control.

Anesthesia, Closed-Circuit↗
PubMedDate not supplied

Accidental needlesticks: do anesthesiologists practice proper infection control precautions?

Anesthesiologists as well as patients are at risk for acquiring blood-borne infections such as hepatitis and AIDS. We surveyed 2,530 anesthesiologists, a 10% random sample of the members of the American Society of Anesthesiologists, with a response rate of 57.1%, to determine the incidence of accidental needlestick exposure among anesthesia personnel and whether anesthesiologists are adhering to infection control guidelines to protect themselves and their patients from exposure to infectious diseases. Eighty-eight percent of respondents reported at least 1 accidental needlestick in the past 10 years; 21% received a needlestick from a high-risk patient and 4.5% a needlestick from a known HIV-positive patients. Residents reported significantly more accidental needlesticks from known HIV-positive patients (8.5%). Mucous membrane, open cut, eye, or other significant exposure to HIV-contaminated blood or body fluids was sustained by 8.34% of respondents in the past 10 years. Sixty percent of respondents reported they almost never reuse common syringes now compared with a 40.8% non-reuse rate (P < 0.001) in a similar survey on infection control practices conducted in 1990. Sixty-three percent reported they almost never reuse a vasopressor syringe compared with the 1990 non-reuse rate of 52.5% (P < 0.001). In the current survey, 39% of anesthesiologists reported reusing syringes from one patient to another and 36% reported reusing the same vasopressor syringes for different patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesiology↗
PubMed2004

Evaluation of infection-control practices by orthodontists in Turkey.

The aim of this study was to investigate the cross-infection control procedures used by Turkish orthodontists. A questionnaire was mailed to 268 orthodontists to determine the attitude toward infection-control procedures. Responses were received from 194 orthodontists, and the reply data were analyzed. Of the 194 orthodontists who completed and returned the questionnaire, 77.3% had been vaccinated for hepatitis B, and 24.2% always wear a mask when treating their patients. While 48.5% of the respondent orthodontists always wear gloves, 4.1% never wear gloves.

Attitude of Health Personnel↗
PubMed2005

Spreading the word on infection control.

Jason Rayfield reports from the Seventh Annual Infection Control Nurses Association Conference, where education, surveillance and the threat posed by emerging bacterial strains were high on the discussion agenda.

Congresses as Topic↗
PubMed1998

Improved compliance with recommended infection control practices in the dental office between 1994 and 1995.

OBJECTIVE: To investigate changes in Ontario dentists' infection control practices between 1994 and 1995. METHODS: Data from responses of 4003 dentists to a 1994 survey and responses of 987 dentists to a 1995 survey were compared by using descriptive statistics from all respondents and McNemar's test for paired data from those participating in both surveys. RESULTS: Response rates were 70% (1994) and 62% (1995). There were improvements in reports of routine use of gloves (92% to 94%); masks (73% to 79%); and protective eyewear (83% to 84%); vaccination for hepatitis B virus (HBV) or naturally acquired immunity of dentists (93% to 94%); HBV vaccination of clinical staff (64% to 77%); heat sterilization of handpieces (83% to 95%); and no extra precautions for patients with HIV (13% to 48%). Pairwise comparison of data for 788 dentists participating in both surveys showed statistically significant increases in reports of all practices except use of protective eyewear. The 1995 follow-up data also indicated low compliance with handwashing (74% before treating each patient; 62% after removing gloves); flushing water lines after treating each patient (54%); and using postexposure protocol for needlesticks and cuts (36%). CONCLUSIONS: Dentists' reports of compliance with recommended infection control practices and universal precautions against HBV and HIV infection increased between 1994 and 1995, but most dentists apparently have not adopted universal precautions. More education is needed to promote universal precautions, HBV vaccination for clinical staff, handwashing, and postexposure protocol.

Dental Offices↗
PubMed1993

Use of the total quality process in an infection control program: a surprising customer-needs assessment.

The University of Michigan Hospitals began a quality management and improvement process in 1987 as the framework for all of its quality-related efforts and activities. The Infection Control Services department used total quality techniques to develop its mission statement, identify customers, identify customer requirements, and develop quality improvement objectives to meet the requirements. A service evaluation of customers resulted in specific improvement activities. An unexpected result of this evaluation was the difference noted between the Infection Control Services staff members' perception of customer requirements and these customers' actual needs. ICPs should use the continuous quality improvement tools and techniques to enhance their activities within their institutions, to better meet their customer needs, and to make sure that they are complementing their institution's mission.

Consumer Behavior↗
PubMed1999

Infection control during construction and renovation in the operating room.

This article describes a case study of reconstruction of an operating room suite. Suggestions for completing the renovations while controlling microorganisms are supplied. A comprehensive Infection Control Program is discussed, which includes essential environment controls in the operating room during any construction and renovation. A policy designed by the authors to minimize surgical infections during reconstruction is shared with the readers.

Air Microbiology↗
PubMed1973

Controlling infection in a district general hospital.

The way in which hospital-acquired infection has been brought under control over a three-year period in a district general hospital is described. The main success has been achieved in reducing sepsis caused by Staph. aureus, especially methicillin-resistant strains, and Pseudomonas aeruginosa. These reductions were achieved in spite of inadequate ward isolation and operating theatre facilities, and before there was any marked change in patterns of prescribing antibiotics. Our experiences indicate the significant improvements that can be made in controlling nosocomial sepsis even without structural or other major alterations in a hospital, providing that the problem is fully appreciated and the infection control team are concerned enough to act vigorously in influencing their clinical colleagues.

Communicable Disease Control↗
PubMed1996

[A survey on infection control practices, knowledge and attitudes toward AIDS/HIV among dental practitioners].

A survey was conducted in December 1993 by sending questionnaires to all 566 dentists of the Iwate Dental Association. The questionnaires consisted of 68 items including infection control practices, knowledge, and attitudes towards AIDS/HIV. The response rate was 51.1 percent (N = 289). The average age of dentists in the sample was 43.7 +/- 9.5 (S.D.) (range: 28 to 85). Data was evaluated statistically by Kruskal-Wallis test, Mann-Whitney's U test and Chi-square test, and significant differences were observed. Gloves, masks, and other protective garments were generally worn, but most dentists did not always use them during the full course of treatment limiting usage to surgical treatment, and when treating patients in "high-risk groups". Other infection control procedures, such as instrument sterilization, did not comply with the guidelines of the Ministry of Health and Welfare. Two dentists responded that they had treated AIDS patients and three dentists treated possible AIDS/HIV patients in their dental offices. Despite 71.3% expressing a belief that they have a moral responsibility as a dentist to treat AIDS/HIV patients only 15.6% were willing to treat AIDS/HIV patients. Over 40% of the respondents were not certain as to whether they had treated AIDS/HIV patients or not, and over 60% believed AIDS/HIV patients would come to their dental offices in the near future. Therefore, to practice dentistry on AIDS/HIV patients safely, dentists must provide effective infection control in their dental offices on the assumption that all patients are AIDS/HIV positive, and additional information about AIDS/HIV and adequate training on procedures in the care of AIDS/HIV patients are needed.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Behavioral interventions to improve infection control practices.

No single intervention has been successful in improving and sustaining such infection control practices as universal precautions and handwashing by health care professionals. This paper examines several behavioral theories (Health Belief Model, Theory of Reasoned Action and Theory of Planned Behavior, self-efficacy, and the Transtheoretic Model) and relates them to individual factors, also considering interpersonal and organizational factors. Further, this article includes recommendations of individual and organizational components to be addressed when planning a theoretically based intervention for improving infection control practices. A hypothetic framework to enhance handwashing practice is proposed.

Communicable Disease Control↗
PubMed1988

An overview of infection control in dental practice.

Although it is not possible to cover all of the ramifications of infection control in prosthodontics, currently available information may be summarized as follows: 1. All dental disciplines must be concerned with the dangers involved in the spread of certain infectious diseases. 2. Prosthodontists and their ancillary personnel may be exposed to certain diseases predominantly found in adult patients, such as hepatitis B and tuberculosis. 3. Dentists must ensure that at least six basic infection control procedures are observed when treating patients. 4. Additional control procedures should be observed in the fabrication and handling of impressions and dental prosthesis. 5. Dental offices and commercial laboratories should work closely together to coordinate control of potential cross-infection between the two disciplines. The control of infectious diseases in prosthodontics is not difficult. It requires the expenditure of a little time, a little money, and most important, a great deal of discipline. The rewards are well worth the additional effort and could even be lifesaving.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Quality, equipment hold keys to infection control.

EDs that are the most successful at infection control are the ones that look for new ways to improve on proven strategies and techniques. Follow and observe staff during hand-washing, and make them repeat steps that were omitted or performed improperly. Increase the percentage of isolation rooms in your department to help improve surge capacity. Have all cleaning supplies readily at hand to improve flow.

Efficiency, Organizational↗
PubMed1994

Infection control for health care workers caring for critically injured patients: a national survey.

Prevention of transmission of bloodborne pathogens to health care workers (HCWs) involved in resuscitation of critically injured patients presents special challenges. As a step toward creation of a standard, a telephone survey of the infection control practices in this setting of the 100 busiest EDs in the United States (US) was performed. Departmental staff who were knowledgeable about ED infection prevention protocols were questioned about general policy, barrier protection measures, sharps management, and educational programs directed to HCWs. Surveys were completed for 82 EDs. Of these, 56 (68%) either function as primary trauma care facilities for the local community, or are designated level 1 trauma centers by the American College of Surgeons. Specific infection control protocols for trauma resuscitation had been printed and posted by 18 EDs (22%), with the remaining 64 (78%) using the same universal precautions for care of the severely injured as for other patients. A specific policy relating to invasive procedures had been promulgated by 66 EDs (80%). Barrier protection was used by protocol or by custom for care of all critically injured patients by 43 EDs (52%). Impermeable gowns with sleeves were available in 63 EDs (77%). Eye or face protection included face shields by 74 EDs (90%), face masks by 76 EDs (93%), and goggles by 72 EDs (88%). Only 59 EDs (72%) reported that sharp containers were always within arm's reach of HCWs with material to discard. Specially adapted equipment included self-sheathing intravenous catheters (21, 26%) and needle/syringe combinations (16, 20%). Considerable variation exists in infection control practices in busy US EDs during resuscitation of critically injured patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Illness↗
PubMed2003

Infection control.

Information resources from a variety of governmental agencies and professional organizations are available to facilitate development of site-specific infection control programs. Using a strategic approach to organize and apply the information can result in a comprehensive and effective infection control program.

Cross Infection↗
PubMed2001

Research Priorities Project, year 2000: establishing a direction for infection control and hospital epidemiology.

BACKGROUND: The field called "infection control" has expanded beyond hospitals to include many health care locations, some aspects of personnel health, elements of noninfectious complications, and occasionally the epidemiology of other problems that occur in care facilities. A research agenda that addresses these newer segments and provides a framework for answering fundamental questions is essential for the field and for the work of The Research Foundation for Prevention of Complications Associated with Health Care (formerly APIC Research Foundation). METHODS: We used a multiple-round iterative consensus process (Delphi technique) with 50 experts and a validation round among participants at the 4th Decennial Conference. RESULTS: The expert panel reduced 102 separate items to 21 high-ranked research priorities. The highest-ranked subject areas involved research to improve compliance with excellent practices, to study antibiotic usage and resistance, to measure the financial impact of complications and value of interventions, to perform surveillance of infectious and noninfectious complications across the spectrum of care delivery, and to study effectiveness of interventions to prevent complications at specific sites. There were differences in education and discipline between the expert panel and the 4th Decennial participants and with respect to ranking some of the individual priorities. Among respondents from outside the United States and Canada, occupational health issues were ranked more highly. CONCLUSIONS: The research priorities provide a blueprint for future progress and will require a collaborative, multicenter, multinational approach.

Adult↗