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PubMed1995

An overview of nosocomial infection control in Brazil.

Brazil is the largest country in Latin America, with a population of 146 million people. The socioeconomic development and the distribution of population and health services varies widely within the country. There are approximately 1.2 million hospital admissions per month, 80% of them paid by a government healthcare program that follows the diagnosis-related groups (DRGs) model. The Ministry of Health has been trying to establish a nationwide nosocomial infection control program since 1983. Most Brazilian hospitals now have some kind of infection control activity, but only a few of them have complete programs. Infrastructural deficiencies, the scarcity of well-trained healthcare workers, and the widespread occurrence of multiresistant Staphylococcus aureus and gram-negative bacteria are some of the challenges faced by Brazilian hospitals in the control of nosocomial infection.

Bacterial Infections↗
PubMed2006

Exogenous sources of pseudomonas aeruginosa in intensive care unit patients: implementation of infection control measures and follow-up with molecular typing.

BACKGROUND: In 1998, a study in the intensive care unit (ICU) of our institution suggested possible transmission of Pseudomonas aeruginosa from faucet to patient and from patient to patient. Infection-control measures were implemented to reduce the degree of P. aeruginosa colonization in faucets, to reduce the use of faucet water in certain patient care procedures, and to reduce the rate of transmission from patient to patient. OBJECTIVE: To evaluate the effect of the control measures instituted in 1999 to prevent P. aeruginosa infection and colonization in ICU patients. DESIGN: Prospective, molecular, epidemiological investigation. SETTING: A 870-bed, university-affiliated, tertiary care teaching hospital. METHODS: The investigation was performed in a manner identical to the 1998 investigation. ICU patients with a clinical specimen positive for P. aeruginosa were identified prospectively. Swab specimens from the inner part of the ICU faucets were obtained for the culture on 9 occasions between September 1997 and December 2000. All patients and environmental isolates were typed by pulsed-field gel electrophoresis (PFGE). RESULTS: Compared with the 1998 study, in 2000 we found that the annual incidence of ICU patients colonized or infected with P. aeruginosa had decreased by half (26.6 patients per 1,000 admissions in 2000 vs 59.0 patients per 1,000 admissions in 1998), although the populations of patients were comparable. This decrease was the result of the decreased incidence of cases in which an isolate had a PFGE pattern identical to that of an isolate from a faucet (7.0 cases per 1,000 admissions in 2000, vs 23.6 per 1,000 admissions in 1998) or from another patient (6.5 cases per 1,000 admissions in 2000 vs 16.5 cases per 1,000 admissions in 1998), whereas the incidence of cases in which the isolate had a unique PFGE pattern remained nearly unchanged (13.1 cases per 1,000 admissions in 2000 vs 15.6 cases per 1,000 admissions in 1998). CONCLUSIONS: These results suggest that infection control measures were effective in decreasing the rate of P. aeruginosa colonization and infection in ICU patients, confirming that P. aeruginosa strains were of exogenous origin in a substantial proportion of patients during the preintervention period.

Electrophoresis, Gel, Pulsed-Field↗
PubMed2002

Using surveillance data to direct infection control efforts to reduce surgical-site infections following clean abdominal operations in Japan.

We initiated surveillance for surgical-site infections (SSIs) in a Japanese hospital using Centers for Disease Control and Prevention definitions and the approach of the National Nosocomial Infections Surveillance (NNIS) System. Patients were observed following clean and clean-contaminated abdominal operations. SSI rates were higher than those of the NNIS System, but there was a trend toward decreased SSI rates in the latter half of the study period.

Abdomen↗
PubMed1997

Status of tuberculosis infection control programs at Texas hospitals, 1989 through 1991.

BACKGROUND: Paralleling the resurgence of tuberculosis (TB) in the United States, the reported number of persons with TB in Texas increased by 33% during 1985 through 1992, the third largest rise among all the states. This increase prompted us to survey hospitals in Texas to determine their degree of compliance with recommendations in the Centers for Disease Control and Prevention TB guidelines. METHODS: In April 1992, we mailed a voluntary questionnaire about TB infection control practices, health care worker tuberculin skin testing procedures, and Mycobacterium tuberculosis laboratory methods to a convenience sample of hospitals in Texas. RESULTS: Of 180 hospitals surveyed, 151 (83%) returned completed questionnaires. Of these, 90 (60%) were nonteaching community hospitals; 28 (19%) were teaching community hospitals; 13 (9%) were university-affiliated hospitals; and 20 (13%) were other hospitals. The number of hospitals to which patients with TB were admitted increased from 98 (65%) in 1989 to 122 (81%) in 1991. Respondent hospitals had a mean of 183 acute care beds (median 100, range 5 to 999), 6 acid-fast bacillus isolation rooms (median 2, range 0 to 57) and 7.5 admissions/year of patients with TB (median 2, range 0 to 202). Of hospitals responding to specific questions, 20% (27/137) admitted patients with multidrug-resistant TB, 18% (25/140) reported not having any acid-fast bacillus isolation rooms, and 28% (35/125) had no rooms meeting all of the Centers for Disease Control and Prevention criteria for acid-fast bacillus isolation (negative air pressure, > or = 6 air changes per hour, and air directly vented to the outside). The tuberculin skin test conversions among health care workers rose from 246 (0.6%) in 1989 to 547 (0.9%) in 1991. CONCLUSION: Although the number of Texas hospitals admitting patients with TB increased during 1989 through 1991, many facilities still did not have infection control practices consistent with the 1992 Centers for Disease Control and Prevention TB guidelines.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Infection control: the environment and service organisation.

Healthcare-associated infection is one of the major challenges to providing high quality health care. Policy makers in the United Kingdom are emphasising initiatives to increase compliance with hand hygiene protocols because most cross-infection occurs via hands. The contribution of the environment to risks of infection has received less attention, despite media reports of dirty hospitals. However, the environmental contribution may be greater than previously considered. Changes in the way health care is delivered, especially the movement of patients and staff between different hospitals and wards, may also contribute to the difficulty of controlling infection.

Cross Infection↗
PubMed2004

[Role and responsibilities of infection control practitioners and hospital epidemiologists in the context of cost effectiveness].

In the past it was a guiding principle of hospital epidemiologists and infection control practitioners to compare the particular standards prevailing in their hospitals with the regulations, directives, and guidelines laid down by law and then to aim for some change. However, if we are to ever really achieve a reduction in nosocomial infections, it will be necessary to sensitize all hospital personnel to the problems associated with such infections and to convince them of the unavoidability of having to introduce specific new measures. Accordingly, surveillance of nosocomial infections and multiresistant pathogens, analysis of possible infection-associated problems, and initiating appropriate intervention procedures are indispensable goals for hospital hygiene if a decrease in nosocomial infections is to be realized. It would be possible to thus reduce expenditures representing more than the present costs for the hygiene staff. On the strength of their thorough specialist knowledge of the spread of nosocomial infections, it is also part of the responsibilities of infection control practitioners and hospital epidemiologists to question and to do away with senseless preventive measures and thereby contribute to reducing hospital expenditures.

Cost Control↗
PubMed1996

Analysis of infection control surveillance data in a long-term-care facility: use of threshold testing.

OBJECTIVE: To describe long-term trends in nosocomial infection rates and the threshold testing method for evaluating nosocomial surveillance data in a long-term-care facility (LTCF). DESIGN: Descriptive epidemiology of prospectively collected infection control surveillance data and application of threshold testing for detecting possible outbreaks. Threshold testing uses the binomial distribution to calculate probabilities of infection frequency at selected endemic levels (mean number of infections per month) and compares these probabilities to observed infection frequency. SETTING: One hundred twenty-bed LTCF located within a public, university-affiliated hospital. PATIENTS AND METHODS: The study period was 1987 through 1994. Yearly endemic levels of specific types of infection were calculated and threshold levels were determined using a previously published method. In this study, a probability of P = .01 was chosen to determine the threshold at a specific endemic level; if the observed number of infections in a month reached or exceeded the threshold level, the likelihood that this occurred by chance alone was 1% or less. INTERVENTIONS: None. RESULTS: The overall mean nosocomial infection rate ranged from three to five episodes per 1,000 resident care days per year; mean yearly rates from 1990 onward were higher and more stable than those from 1987 to 1989. The most common infections identified were lower respiratory tract, skin and soft tissue, urinary tract, and conjunctivitis. For each of these infections, threshold levels were calculated periodically, using only the monthly frequency of infection. Despite variations in the yearly mean endemic level of various infections, threshold levels were stable except for skin and soft-tissue infection. CONCLUSIONS: Threshold testing for analysis of infection control surveillance data in the LTCF setting is straightforward and does not require knowledge of statistics, special computer software, or calculation of rates; given the stable population in the typical LTCF, threshold testing can be based on variations in the monthly count of infections and provides an objective evaluation of surveillance data and a method to identify when outbreaks may be occurring.

Analysis of Variance↗
PubMedDate not supplied

Infection control: a career option for the critical care nurse.

Infection control is a nursing career option that offers variety, autonomy, expert status, and lifelong learning. The critical care nurse's experience with invasive procedures, knowledge of physiology, and readiness to handle the unexpected are an excellent background for this role.

Career Choice↗
PubMed2005

Managing infection in the critical care unit: how can infection control make the ICU safe?

The goal of this article is to use ventilator-associated pneumonia (VAP) as a prototype for nosocomial infections to explore the issues of patient safety and infection control. To do this, we review disease-specific aspects of VAP, develop a brief working definition of patient safety, and then determine how the concepts of infection control fit into the broader context of patient safety.

Anti-Bacterial Agents↗
PubMed1999

Minimum standards in laboratories for infection control.

Laboratory services should be available to support every infection control programme, whether in a hospital or community setting. The services will depend upon available resources and the expectation of the clinicians using the services. Equally, resources reflect the level of staff expertise, equipment and finances supporting laboratory practice. All information given to the clinical staff should be sensible, accurate, comprehensible and in keeping with the clinical needs of the healthcare setting. Internal and external quality controls should be rigorous. Not all laboratories are expected to provide an all-encompassing service and therefore primary, secondary and tertiary or referral laboratories should be established where necessary. It is essential to have clear protocols on laboratory usage, mutually agreed between the laboratory and clinical staff to be cost effective.

Guidelines as Topic↗
PubMed1992

Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks.

During a 3-week period, nine babies in the neonatal unit of a large teaching hospital in Durban were infected or colonized with Klebsiella pneumoniae resistant to a range of antimicrobial agents including amikacin and cefotaxime. Resistance to cefotaxime was reduced by clavulanic acid in vitro suggesting production of extended-spectrum beta-lactamase activity. All the isolates had the same antibiotic resistance profile, belonged to the same serotype (K17), were non-typable with bacteriophages, and had identical plasmid profiles indicating that they belonged to the same strain. During a 1-day microbiological survey of the ward, the outbreak strain was isolated from the nose and hands of a doctor based in the nursery and from the hands of a nurse and the mother of an infected baby. The strain was also isolated from nine of 67 environmental samples. Investigation revealed that infection control practices which had been instituted following a previous outbreak in the nursery with multi-resistant methicillin-resistant Staphylococcus aureus (MRSA) were not being adhered to. The re-introduction and strict enforcement of these procedures under the supervision of an Infection Control Nurse resulted in the abrupt end of the outbreak.

Amikacin↗
PubMed1991

Acute pulpal-alveolar cellulitis syndrome. V. Apical closure of immature teeth by infection control: the importance of an endodontic seal with therapeutic factors. Part 2.

During orthodontic treatment to promote eruption of maxillary and mandibular second bicuspids, a young male patient had a severe endodontic cellulitis of a mandibular bicuspid. Apexogenesis and resolution of the periapical lesion was achieved by infection control with nonspecific intracanal medication without calcium hydroxide, as stated by Das. A mild periodontal cellulitis occurred shortly thereafter and rapidly resolved. A second endodontic cellulitis, after apexogenesis without an endodontic seal, occurred shortly after completion of orthodontic treatment. This also quickly resolved, and the canal was effectively sealed. This case indicates the importance of an effective endodontic seal shortly after apexogenesis is induced by infection control. This report and others on the subject indicate that apexogenesis of nonvital permanent immature teeth by infection control is a predictable endodontic treatment procedure.

Acute Disease↗
PubMed1992

Compliance with infection control procedures in a dental hospital clinic.

Dental hospital staff and students were observed during clinical work for their compliance with infection control procedures, as recommended by the British Dental Association. A total of 183 contacts between health care worker and patient were scrutinised during December 1990. Nearly all health care workers (96%) wore gloves to carry out dental treatment, but in some cases gloves were neither changed nor hands washed between patients. Only one half wore protective eyewear and about one third (38%) wore no mask. Some dental surgery assistants used heavy duty gloves and some even scrubbed dirty dental instruments without wearing any gloves. Strict audit is clearly needed in every clinical setting in order to ensure compliance with infection control.

Attitude of Health Personnel↗
PubMedDate not supplied

Impact of hospital care on incidence of bloodstream infection: the evaluation of processes and indicators in infection control study.

The Evaluation of Processes and Indicators in Infection Control (EPIC) study assesses the relationship between hospital care and rates of central venous catheter-associated primary bacteremia in 54 intensive-care units (ICUs) in the United States and 14 other countries. Using ICU rather than the patient as the primary unit of statistical analysis permits evaluation of factors that vary at the ICU level. The design of EPIC can serve as a template for studies investigating the relationship between process and event rates across health-care institutions.

Bacteremia↗
PubMed2005

[Extended-spectrum beta-lactamases: their role in clinical microbiology laboratory, treatment and infection control].

The major mechanism responsible for resistance to beta-lactam antibiotics is the production of beta-lactamases. These enzymes, which have the ability to inactivate extended-spectrum beta-lactam antibiotics, like cefotaxime and ceftazidime are called as extended-spectrum beta-lactamases (ESBL). The most important pathogen which produces beta-lactamases among Gram positive bacteria is Staphylococcus aureus and the members of the Enterobacteriaceae family are the leading beta-lactamase producing organisms among Gram negative bacteria. Although the beta-lactamase inhibitors like clavulanic acid, sulbactam and tazobactam could block ESBL effects, ESBL's have still been considered as a threat since they are coded by plasmids and can easily be transmitted between species. Recently, more than 150 ESBLs have been identified. Numerous methods have been proposed for the detection of ESBLs in clinical isolates. Imipenem seems to be the most effective agent for the therapy and control of the spread of infections caused by ESBL-producing bacteria. In this review article, the roles of ESBL in clinical microbiology laboratory, treatment and infection control, have been discussed.

Anti-Bacterial Agents↗
PubMed1994

Opinions, knowledge, and self-reported practices related to infection control among nursing personnel in long-term care settings.

BACKGROUND: Because educational needs of staff in long-term care facilities regarding infection control have, not been well studied, we conducted this study to measure long-term care staff members' knowledge, self-reported practices, and opinions about infection control and handwashing. METHODS: A pilot study was conducted with 24 staff members of one long-term care facility to examine psychometric properties of study instruments. All nursing staff members (n = 105) from two additional long-term care facilities then completed a 14-item knowledge questionnaire, 22-item opinion survey, and 26-item survey of self-reported handwashing practices. RESULTS: Respondents were predominantly female with mean age of 46 years; most had completed high school. Mean length of employment in the study facility was 12.4 years. Registered nurses and licensed practical nurses scored significantly higher on knowledge (p = 0.0002) but significantly lower on self-reported practices (p = 0.01) than did trained nursing assistants. There was no significant correlation between self-reported practices and opinions regarding handwashing (p = 0.55). Neither level of knowledge nor positive opinion about the value of handwashing was associated with self-reported increases in handwashing practices. CONCLUSION: We conclude that education alone is not likely to be associated with changes in handwashing behavior. Instruments developed and tested in this study can be used in further research to correlate self-reported with observed behavior and to evaluate the effects of interventions on knowledge, opinions, and self-reported handwashing behavior.

Aged↗