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PubMed1991

Cost improvements through the establishment of prudent infection control practices in a Brazilian general hospital, 1986-1989.

OBJECTIVES: To review procedures currently practiced in a Brazilian general hospital and to eliminate ineffective and inefficient practices. To measure the resulting cost improvements based on rigid hospital financing control. DESIGN: Implementation of surveillance and control programs and prevalence surveys to detect ineffective and inefficient practices. PARTICIPANTS: The study institution is a 130-bed general care facility affiliated with the Brazilian federal government. There were approximately 4,600 admissions per year during the study period (1986-1989). RESULTS: Instituting infection control measures and eliminating ineffective practices resulted in the following: an overall decrease in wound infection rates from 24.4% in 1987 to 3.45% in 1989; a 71% reduction in the global incidence of infection in the intensive care unit; a 74% reduction in the surgical prophylactic use of antibiotics; and a total savings of approximately $2 million (US dollars). CONCLUSIONS: During the period from 1986 to 1989, the infection control committee was able to decrease the overall wound infection rate from 24.4% in 1987 to 3.45% in 1989. This eliminated special health problems and improved patient care and cost-effectiveness for our hospital.

Anti-Bacterial Agents↗
PubMed1992

An infection control bulletin as an educational tool: is it useful?

For five years a bulletin has been issued to provide information, increase awareness and educate staff on current issues and problems in infection control. To obtain readers' feedback on the value of receiving this one-page bulletin, an evaluation was conducted with the following objectives: to evaluate the content and structure in terms of relevant and current information; to evaluate the format; and to obtain information on frequency and suggested topics. Categories for response were: poor, fair, good and excellent. All respondees (67) rated the topics as good to excellent in the current and applicable category. The detail and clarity were rated as good/excellent by 59 of 67 (88%) and 59 of 67 (88%) of the respondees, respectively. The majority, 61 of 67 (91%), indicated the references were useful. The readability, organization and length were rated as good/excellent by 63 of 67 (94%), 62 of 67 (92.5%) and 65 of 67 (97%), respectively. All but one wished to remain on the mailing list. The results of this evaluation and the list of suggested topics for future bulletins support the conclusion that the infection control bulletin is a useful educational tool.

Audiovisual Aids↗
PubMed1991

Hepatitis & HIV: prevalence of infection and changing attitudes toward infection control procedures in British Columbia.

Dental professionals attending the annual meeting of the College of Dental Surgeons of British Columbia in June 1990 were involved in a survey to assess the prevalence of infection with Hepatitis B, Hepatitis C and Human Immunodeficiency viruses, the acceptance of vaccination for protection against Hepatitis B virus, and the compliance with infection control guidelines. Participation was voluntary and anonymous and required completion of a questionnaire and donation of a blood sample. Four hundred one of 1,995 convention attendees participated. Fourteen were found to have markers of Hepatitis B infection; 13 had antibodies to both Hepatitis B surface antigen and Hepatitis B core antigen, and one was positive for Hepatitis B surface antigen. One individual had markers for both Hepatitis C and Hepatitis B viruses. None tested positive for antibody to Human Immunodeficiency virus. Vaccination against Hepatitis B virus was reported overall by 67 percent of the participants, but dentists and hygienists had a higher rate of vaccination (82 percent and 81 percent, respectively) when compared to dental assistants (41 percent; P less than .001). Acceptance of infection control procedures was high, with 92 percent of participants reporting use of gloves for all patients and 82 percent reporting use of masks and eye protection.

Attitude of Health Personnel↗
PubMed1988

Infection control in correctional facilities: a new challenge.

The potential for communicable disease transmission in a prison setting is high. Infection control programs in correctional facilities must be designed (1) to develop effective systems for identification, prevention, and control of communicable diseases, (2) to collect data in a systematized way, and (3) to ensure follow-up and coordination of health care after release. The role and activities in which the infection control practitioner must engage include surveillance and reporting, administration, education, and consultation with correction personnel, local health agencies, and health care workers. Specific tasks within each of these areas require modification to meet the unique needs of correctional facilities.

Adult↗
PubMedDate not supplied

Infection control in general practice.

Public awareness of cross infection has grown in the wake of hepatitis B and HIV. Sandra Ilott puts forward measures to help nurses keep their knowledge of infection control procedures up to standard.

Ambulatory Care Facilities↗
PubMed1992

Entering first-year residents' experiences and knowledge of infection control of hepatitis B and HIV, at five university-affiliated hospitals.

In 1990, the authors surveyed 149 entering first-year residents at five university-affiliated hospitals concerning the residents' experiences and knowledge of infection control. Sixty residents (40%) had experienced a needlestick injury during medical school, but only 35 of these residents (58%) had reported the mishap. One hundred thirty-nine residents (93%) had received the hepatitis B vaccine. Of those 60 who had experienced a needlestick injury, 57 (95%) had received the vaccine. Of the 149 residents, 111 (74%) reported having received instructions in universal precautions, as advocated by the Centers for Disease Control. There was a trend for residents who had received the vaccine also to have been instructed in universal precautions. Regarding the residents' knowledge of infection control, there was no statistically significant difference between the responses of those who had been instructed in universal precautions and those who had not. The authors conclude that students are at risk for needlestick injuries; however, underreporting is frequent.

Educational Measurement↗
PubMedDate not supplied

[Infection control procedures used in dental offices in Belo Horizonte].

Survey data from 300 randomly selected private dental practitioners working in Belo Horizonte, Minas Gerais, were used to evaluate the infection control procedures routinely practiced here. The function of this report might be to alert the teaching team from Dental Schools and the dentists to the problems that potentially contribute to the transmission of infectious disease as a first step for additional specific recommendations to an effective and safe infection controL program that we intend to discuss later.

Brazil↗
PubMed2006

Infection control measures among senior dental students in Rio de Janeiro State, Brazil.

OBJECTIVE: The aim of this study was to verify the practices and attitudes of senior dental students about infection control procedures. METHODS: A cross-sectional survey was performed during the 1st semester of 2003. Open- and close-ended questions were given to 196 students in 6 universities. RESULTS: Overall, 90.8% of students had been vaccinated for hepatitis B. Only 25.0% have been assessed for anti-HBs. A total of 99.5% students reported always using gloves for all procedures. Eye protection were always used by 84.2% of students, and all the students used face masks for all procedures. Caps or hair covers were used by 92.3% of students and 87.8% reported no objection to treating patients with infectious diseases. Among instructors, the students observed that 60.2% of them did not use gloves for all procedures, 43.4% of those didn't change gloves between patients. CONCLUSIONS: These results address the need for an improved quality assurance, in order for the students and faculty to improve their practices and attitudes on infection control measures.

Accidents, Occupational↗
PubMed2004

Preliminary assessment of an automated surveillance system for infection control.

BACKGROUND AND OBJECTIVE: Rapid identification and investigation of potential outbreaks is key to limiting transmission in the healthcare setting. Manual review of laboratory results remains a cumbersome, time-consuming task for infection control practitioners (ICPs). Computer-automated techniques have shown promise for improving the efficiency and accuracy of surveillance. We examined the use of automated control charts, provided by an automated surveillance system, for detection of potential outbreaks. SETTING: A 656-bed academic medical center. METHODS: We retrospectively reviewed 13 months (November 2001 through November 2002) of laboratory-patient data, comparing an automated surveillance application with standard infection control practices. We evaluated positive predictive value, sensitivity, and time required to investigate the alerts. An ICP created 75 control charts. A standardized case investigation form was developed to evaluate each alert for the likelihood of nosocomial transmission based on temporal and spatial overlap and culture results. RESULTS: The 75 control charts were created in 75 minutes and 18 alerts fired above the 3-sigma level. These were independently reviewed by an ICP and associate hospital epidemiologist. The review process required an average of 20 minutes per alert and the kappa score between the reviewers was 0.82. Eleven of the 18 alerts were determined to be potential outbreaks, yielding a positive predictive value of 0.61. Routine surveillance identified 5 of these 11 alerts during this time period. CONCLUSION: Automated surveillance with user-definable control charts for cluster identification was more sensitive than routine methods and is capable of operating with high specificity and positive predictive value in a time-efficient manner.

Cross Infection↗
PubMed2004

Aerosols and splatter in dentistry: a brief review of the literature and infection control implications.

BACKGROUND: Aerosols and droplets are produced during many dental procedures. With the advent of the droplet-spread disease severe acute respiratory syndrome, or SARS, a review of the infection control procedures for aerosols is warranted. TYPES OF STUDIES REVIEWED: The authors reviewed representative medical and dental literature for studies and reports that documented the spread of disease through an airborne route. They also reviewed the dental literature for representative studies of contamination from various dental procedures and methods of reducing airborne contamination from those procedures. RESULTS: The airborne spread of measles, tuberculosis and SARS is well-documented in the medical literature. The dental literature shows that many dental procedures produce aerosols and droplets that are contaminated with bacteria and blood. These aerosols represent a potential route for disease transmission. The literature also documents that airborne contamination can be minimized easily and inexpensively by layering several infection control steps into the routine precautions used during all dental procedures. CLINICAL IMPLICATIONS: In addition to the routine use of standard barriers such as masks and gloves, the universal use of preprocedural rinses and high-volume evacuation is recommended.

Aerosols↗
PubMed1995

Tuberculosis infection-control practices in United States emergency departments.

STUDY OBJECTIVE: To determine the frequency with which patients with suspected tuberculosis (TB) or TB risk factors present to US emergency departments and to describe current ED TB infection-control facilities and practices. DESIGN: Mailed survey of a sample of EDs in US acute care facilities. PARTICIPANTS: A random sample (n = 446) of subjects who responded to a 1992 survey of all US municipal, Veterans Affairs, and university-affiliated hospitals and a 20% random sample of all private hospitals with more than 100 beds conducted by the Centers for Disease Control and Prevention (CDC). RESULTS: We collected data on patient demographics and general ED characteristics, TB isolation facilities and policies, and employee tuberculin skin-testing policies and results. Of 446 facilities surveyed, 305 surveys (68.4%) were returned. The proportions of facilities reporting that patients suspected of having TB are seen daily, weekly, monthly, and less frequently were, respectively, 12.6%, 17.2%, 23.3%, and 46.9%. The proportion of EDs in which indigent patients are cared for on a daily basis was 89%; the homeless, 57.5%; the HIV-infected, 35.9%; i.v. drug users, 45.4%; and recent immigrants, 30%. Written criteria for isolation of patients with suspected TB at triage or in the ED were in place in 56% and 76% of facilities, respectively. TB isolation rooms fulfilling CDC guidelines were available in triage or waiting areas in 1.7% of facilities and in 19.6% of EDs. Air venting directly outside, high-efficiency particulate air filtration of recirculated air, and UV germicidal lights were used in 21%, 17%, and 8% of general patient care areas of EDs, respectively. At least one ED employee had shown tuberculin skin test conversion in 16.1% of EDs in 1991; this figure was 26.9% in 1992. CONCLUSION: Patients with TB or at risk for TB are often treated in US EDs, and the risk for transmission of TB in this setting appears to be increasing. Prolonged waiting times and lack of infection-control facilities in EDs may contribute to this problem. Consideration should be given to implementation of policies and facilities recommended by the CDC.

Centers for Disease Control and Prevention, U.S.↗
PubMed1992

The role of hospital infection control in the quality system of hospitals.

Like other highly specialized fields, quality systems have their own vocabulary which we must be familiar with; it has been internationally standardized. This standard should be adhered to in order to avoid unnecessary ambiguities and confusion, and to facilitate exchange of information between disciplines. We, in the infection control field, are quality pioneers in hospitals. We have, within our discipline, created quality systems and practised quality surveillance for decades. This must be recognized. Medical quality audits intended for comparisons between hospitals, services and wards require measurable quality criteria and comparable measures for the presence of all relevant patient-related risk factors. To specify quality within our field we need much more detailed information on the effect and cost of infection control practices, as well as the costs of the infections we intend to control. To progress one step further, patients or their representatives, politicians, need to express what monetary value should be put on health, namely freedom from infection and its consequences.

Cross Infection↗
PubMed1998

Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: A consensus panel report. Society for Healthcare Epidemiology of America.

The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.

Accreditation↗
PubMed1998

Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Society for Healthcare Epidemiology of America.

The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.

Accreditation↗
PubMed1992

AIDS education for hospital workers in Manila: effects on knowledge, attitudes, and infection control practices.

OBJECTIVE: To evaluate an AIDS education intervention for health workers in Metro Manila hospitals. METHODS: A randomized controlled education program consisting of lectures, role-plays, posters and pamphlets was delivered to physicians, nurses, laboratory technologists and orderlies in Manila hospitals. Knowledge, attitudes and infection control practices were measured before, immediately after, and 2 months after the intervention. RESULTS: Baseline survey among 641 hospital workers revealed poor knowledge, negative attitudes towards AIDS patients, and inappropriate infection control practices. Immediately after the intervention, there was significant improvement in (1) knowledge scores (8.7-11.2 in the intervention group versus 8.5-9.5 in the control group; range, 0-14), (2) attitude scores (54.4-60.6 versus 54.6-56.8; range, 22-88), and (3) needle-recapping practices (14-43% versus 39-43%) (all P values < 0.001). After 2 months, attitude scores in the experimental group fell to the same level as those of the control group, while improvements in knowledge and needle recapping were largely maintained. Role-playing was considered by the participants to be the most effective component of the intervention. CONCLUSIONS: These results suggest that AIDS training for hospital workers in the Philippines and in similar countries is necessary and can be effective. Ideally, such training should include role-playing and should be ongoing in order to sustain the effect.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Infection control: nursing home liability.

It is apparent that there have been many advances in knowledge and techniques in the area of infection control and prevention. In addition to the common law duty of property owners toward business invitees and applicable governmental regulations, we can expect the courts to look to these developments for guidance in measuring the conduct of nursing homes and their employees in infection cases. It is, therefore, of the utmost importance to the nursing home industry that appropriate attention and resources be devoted to infection control in order to accomplish adequate prevention and control, and in order to avoid civil liability.

Cross Infection↗