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PubMed1997

The use of extracted teeth for in vitro bonding studies: a review of infection control considerations.

OBJECTIVE: Infection control concerns regarding the handling of teeth for research purposes have prompted investigators to evaluate the effects of disinfection/sterilization on extracted teeth. The objectives of this literature review were to assess the reported findings of the effect of disinfection or sterilization on teeth used for in vitro bonding studies and make recommendations on their use. METHODS: A search of the literature was performed to obtain background information on infection control guidelines and current findings regarding disinfection or sterilization of extracted teeth. Published articles addressing the effects of different disinfection and sterilizing procedures on the tooth, such as structural changes of dentin and dentin permeability or effect on bond strengths, were examined and compared for agreement or disagreement of findings. The review was organized by the type of disinfection or sterilization method utilized by the investigators. These methods were evaluated in an attempt to address whether disinfection/sterilization of extracted teeth can be recommended or if the procedure simply produces another variable. RESULTS: Formalin, chemical heat sterilization (Chemiclave), autoclave, ethylene oxide and gamma radiation methods of disinfection/sterilization have been investigated for their effects on extracted teeth. When the effect of formalin storage on dentin bond strengths was examined, investigator results were extremely varied. Autoclave and chemical sterilization were found to produce comparable dentin bond results when compared to controls. Gamma radiation did not produce structural changes in the dentin but it currently has not been investigated for its effect on dentin bond strength. And while ethylene oxide produced similar dentin bond strength results when compared to controls, its use as a sterilant was determined to be ineffective. SIGNIFICANCE: Investigators have found formalin storage to be effective for infection control purposes. It cannot, however, be recommended as a storage medium for dentin bonding studies due to the variability in dentin bond strengths resulting from its use. Ethylene oxide is also not recommended due to its inability to effectively sterilize teeth. Chemical heat and autoclave sterilization methods are recommended for preventing cross-contamination during in vitro dentin bonding research. This recommendation is based on current research findings which examined the effect of these sterilization methods on dentin and dentin bond strengths.

Dental Bonding↗
PubMed2003

Factors influencing hospital infection control policies in Italian hospitals.

A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January-May 2000 a questionnaire about infection control was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active programme was defined as a hospital infection control committee (HICC) meeting at least four times in 1999, the presence of a doctor with infection control responsibilities, a nurse employed in infection control and at least one surveillance activity and one infection control guideline issued or updated in the past two years. There was a response rate of 87.5% (463/529). Almost fifteen percent (69/463) of hospitals had an active programme for Infection Control and 76.2% (353/463) had a HICC. Seventy-one percent (330/463) of the hospitals had a hospital infection control physician and 53% (250/463) had infection control nurses. Fifty-two percent (242/463) reported at least one surveillance activity and 70.8% (328/463) had issued or updated at least one guidance document in the last two years. The presence of regional policies [odds ratio (OR) 8.7], operative groups (OR 4.2), at least one full-time nurse (OR 4.6) and a hospital annual plan which specified infection control (OR 2.1) were statistically associated with an active programme in the multivariate analysis.

Cross Infection↗
PubMedDate not supplied

Serratia marcescens-a marker for an infection control program.

An infection control program was instituted at The Victoria General Hospital, an 800-bed acute care hospital, in July 1977. Serratia marcescens had infected or colonized (I/c) 225 to 232 patients yearly for each of the three previous years. Since this organism is usually acquired nosocomially, we decided to use Serratia I/C as a marker for our infection control program. During the years 1977 to 1980, we identified and eliminated several reservoirs of Serratia (contaminated urine measuring containers, urometers, diabetic urine testing equipment and in-use contamination of 2% Hibitane). Readmission of previously I/C patients proved to be an increasingly important reservoir. During 1980, only 120 patients were I/C, and gentamicin-resistant isolates of S.marcescens had dropped from 44% in 1977 to 4.4% in 1980. Use of Serratia as a marker enabled us to monitor the efficacy of our infection control program and allowed us to prove to our health care workers the usefulness of many of the measures we introduced.

Adolescent↗
PubMed2000

Hospital infection control in an era of HIV infection and multi-drug resistant tuberculosis.

Tuberculosis infection control in hospitals has received renewed interest after decades of low prominence following the occurrence of multiply drug-resistant strains in populations of patients with immune systems affected by HIV. This paper examines the history of tuberculosis infection control in hospitals and how recent outbreaks have influenced contemporary measures. The principal infection control measure must always be early recognition and isolation of patients in HIV-care situations who may be dispersing Mycobacterium tuberculosis, in both ward and outpatient areas. If there is either a high degree of suspicion or proven TB, patients should be housed in negative pressure isolation rooms whilst undergoing treatment and investigation. Procedures which may generate infectious aerosols should be carried out in similarly ventilated rooms. The quality assurance in such infection control is through the administrative systems put in place, staff training and the engineering controls of isolation room ventilation.

AIDS-Related Opportunistic Infections↗
PubMed2003

Safety of patients isolated for infection control.

CONTEXT: Hospital infection control policies that use patient isolation prevent nosocomial transmission of infectious diseases, but may inadvertently lead to patient neglect and errors. OBJECTIVE: To examine the quality of medical care received by patients isolated for infection control. DESIGN, SETTING, AND PATIENTS: We identified consecutive adults who were isolated for methicillin-resistant Staphylococcus aureus colonization or infection at 2 large North American teaching hospitals: a general cohort (patients admitted with all diagnoses between January 1, 1999, and January 1, 2000; n = 78); and a disease-specific cohort (patients admitted with a diagnosis of congestive heart failure between January 1, 1999, and July 1, 2002; n = 72). Two matched controls were selected for each isolated patient (n = 156 general cohort controls and n = 144 disease-specific cohort controls). MAIN OUTCOME MEASURES: Quality-of-care measures encompassing processes, outcomes, and satisfaction. Adjustments for study cohort and patient demographic, hospital, and clinical characteristics were conducted using multivariable regression. RESULTS: Isolated and control patients generally had similar baseline characteristics; however, isolated patients were twice as likely as control patients to experience adverse events during their hospitalization (31 vs 15 adverse events per 1000 days; P<.001). This difference in adverse events reflected preventable events (20 vs 3 adverse events per 1000 days; P<.001) as opposed to nonpreventable events (11 vs 12 adverse events per 1000 days; P =.98). Isolated patients were also more likely to formally complain to the hospital about their care than control patients (8% vs 1%; P<.001), to have their vital signs not recorded as ordered (51% vs 31%; P<.001), and more likely to have days with no physician progress note (26% vs 13%; P<.001). No differences in hospital mortality were observed for the 2 groups (17% vs 10%; P =.16). CONCLUSION: Compared with controls, patients isolated for infection control precautions experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care.

Canada↗
PubMed2001

Post-operative endophthalmitis: the application of hazard analysis critical control points (HACCP) to an infection control problem.

Hazard analysis critical control points (HACCP) is a quality assurance system widely used in the food industry to ensure safety. We adopted the HACCP approach when conventional infection control measures had failed to solve an ongoing problem with an increased incidence of postoperative endophthalmitis, and our ophthalmology unit was threatened with permanent cessation of intraocular surgery. Although time-consuming, the result was an entirely new set of protocols for the care of patients undergoing intraocular surgery, the development of an integrated care pathway, and a comprehensive and robust audit programme, which enabled intraocular surgery to continue in a new spirit of confidence. HACCP methodology has so far been little used in healthcare, but it might be usefully applied to a variety of apparently intractable infection control problems.

Cataract Extraction↗
PubMed2005

Infection control practices reduce nosocomial infections and mortality in preterm infants in Bangladesh.

OBJECTIVE: The skin is a potential source for invasive infections in neonates from developing countries such as Bangladesh, where the level of environmental contamination is exceedingly high. A randomized controlled trial was conducted from 1998 to 2003 in the Special Care Nursery of a tertiary hospital in Bangladesh to test the effectiveness of topical emollient therapy in enhancing the skin barrier of preterm neonates less than 33 weeks of gestational age. In the initial months of the study, the infection and mortality rates were noted to be unacceptably high. Therefore, an infection control program was introduced early in the trial to reduce the rate of nosocomial infections. STUDY DESIGN: After a comprehensive review of neonatal care practices and equipment to identify sources of nosocomial infections, a simple but comprehensive infection control program was introduced that emphasized education of staff and caregivers about measures to decrease risk of contamination, particularly hand-washing, proper disposal of infectious waste, and strict asepsis during procedures, as well as prudent use of antibiotics. RESULTS: Infection control efforts resulted in declines in episodes of suspected sepsis (47%), cases of culture-proven (61%) sepsis, patients with a clinical diagnosis of sepsis (79%), and deaths with clinical (82%) or culture-proven sepsis (50%). CONCLUSION: The infection control program was shown to be a simple, low-cost, low-technology intervention to reduce substantially the incidence of septicemia and mortality in the nursery.

Bangladesh↗
PubMedDate not supplied

[Infection control in orthodontics: infective agents and modality of transmission. 1].

Adequate attention to prevention of cross-contamination in dental operatory is largely ignored by orthodontists. This occurs for two principal reasons. The first one is that orthodontic patients, usually children, are erroneously considered a low-risk population. The second one is that orthodontic procedures are usually considered nontissue invasive and not able to produce contamination of staff, patients or instruments. Nevertheless, since 1972, we know that we can find HBsAg in saliva too and moreover we cannot exclude to see blood in the mouth of our patients during orthodontic procedures. Furthermore the high volume of patients that orthodontists see every day and the possibility to treat orthodontically adult patients, take the risk of cross-contamination in orthodontic at the same level of other dental practices. The aim of the Authors is to sensitize orthodontists to the risk of cross-contamination giving the latest data of prevalence of hepatitis, tuberculosis and AIDS in adolescent population.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Using the hierarchy of control technologies to improve healthcare facility infection control: lessons from severe acute respiratory syndrome.

Health care facilities need to review their infection control plans to prepare for the possible resurgence of severe acute respiratory syndrome, other emerging pathogens, familiar infectious agents such as tuberculosis and influenza, and bioterrorist threats. This article describes the classic "hierarchy of control technologies" that was successfully used by occupational and environmental medicine professionals to protect workers from illness and death during the resurgence of tuberculosis in the 1990s. Also discussed are related guidelines from building and equipment professional organizations and novel infection control techniques used successfully by various hospitals in Asia, Canada, and the United States during the 2003 severe acute respiratory syndrome epidemic. Taken together, they suggest a framework upon which a comprehensive infection control plan can be crafted to prevent the spread of deadly infectious agents to health care workers (clinicians and paraprofessionals), uninfected patients and visitors.

Disaster Planning↗
PubMed2005

Models for the organisation of hospital infection control and prevention programmes.

Hospital infection control is an essential part of infectious disease management and must be firmly structured and professionally organised. Prevention, limitation and eradication of nosocomial infections requires specific expertise not fully provided by clinical microbiologists and/or infectious disease consultants. Therefore, dedicated infection control physicians and nurses are essential. The basic components for successful hospital infection control include: (1) personnel and supporting resources proportional to size, complexity and estimated risk of the population served; (2) trained hospital infection control practitioners; and (3) the necessary structure to implement changes in medical, nursing and logistical organisation. The identification of areas of concern, provision of written policies and education still constitute the backbone of infection control. The infection control team must propose priorities and necessary resources, objectives, development methods, implementation and follow-up. The strategic approach must be discussed and approved by the infection control committee, comprising the hospital administrator(s), medical and nursing directors, a microbiologist, a hospital pharmacist and a delegation of clinicians. Follow-up of the projects is regularly presented to the committee by the infection control team. To what extent may evolution in the organisation of hospital infection control contribute to the optimisation of allocated resources and fulfillment of these objectives? From the Belgian experience, we conclude that structural changes represent an essential incentive. The impact of changes is greater when they are directed by the national authorities, providing resources and imposing new standards. Recommendations for staffing must consider not only the number of beds but also the objectives, complexity and characteristics of the patient population.

Belgium↗
PubMed1993

Rules of infection control.

The subject of infection control in dentistry has aroused much controversy and debate during the past decade as a result of the global spread of the human immunodeficiency virus infection. Consequently a number of regulatory bodies have promulgated guidelines for infection control in dentistry and the current consensus is that the 'universal infection control' policy--which considers every patient as infectious--should be the norm in every dental practice. The reasons for this are the asymptomatic carriage of pathogens due to the sub-clinical nature, the prodromal period and the carrier state associated with a number of diseases. The universal infection control rules should encompass six elements: routine patient evaluation, personal protection with barrier techniques, instrument sterilisation including sterilisation control, surface and equipment disinfection, asepsis in the laboratory and appropriate disposal of contaminated waste including sharps. Finally, practitioners should attempt to keep abreast of the rules and regulations related to the subject of infection control in dentistry which are continuously evolving due to the steadily increasing data pool on infectious diseases and their modes of prevention.

Cross Infection↗
PubMed1993

Hospitalwide monitoring of infection control.

Responsibility for infection control lies with all hospital departments in proportion to patient contact share. The primary focus in the development of a Continuous Quality Improvement (CQI) team concept was determined by the concern over increased surgical wound infections at Audie L. Murphy Memorial Veterans Hospital, San Antonio, Texas, during the previous year. Concerns over increased morbidity and mortality and extended lengths of stay created a major impetus to implement phase II of the hospitalwide monitoring of infection control at the facility. The implementation of this hospitalwide monitor illustrates the diversity of ways in which employees are empowered, encouraged, and expected to become involved in daily implementation of CQI.

Cross Infection↗
PubMed2004

[Requirements for infection control during surgery].

Infections of the surgical site following surgery may compromise the outcome of surgery and may under certain circumstances even endanger the life of the patient. Therefore, hospital epidemiology plays an important role in various surgical fields of medicine by developing guidelines and recommendations for the prevention of surgical site infections. In addition, surveillance of patients regarding the development of surgical site infections should be another important component of infection control activities in all hospitals. In order to develop appropriate guidelines and to perform surveillance in surgery, it is important to utilize uniform definitions of surgical site infections and to know the pathogenesis and risk factors of surgical site infections. Knowledge in this field has increased dramatically over the course of the last several decades and has resulted in the creation of guidelines for prevention, their implementation, and revision. The current review will summarize the state-of-the-art of the requirements for infection control. The recommendations will be grouped according to their respective timing during the course of a surgical procedure, which includes a pre- as well as a postoperative phase in addition to the intraoperative phase. Despite the significant progress that has been achieved in this field, some issues remain unresolved. Among these, the practical implementations of nasal decolonization regarding S. aureus prior to surgery and improvement of glucose control during surgery in patients with diabetes are mentioned as examples for unfinished work, which awaits further research.

Communicable Disease Control↗
PubMed2005

Audit in infection control.

Audit is a key function of infection control teams. Infection control audit programmes should include audits of infection control policies in wards and departments, and microbiological safety audits of the healthcare environment. This paper reviews the literature on healthcare audit with particular emphasis on published audits in infection control. Evidence of the efficacy of audit and feedback in improving infection control outcomes is presented, together with the nature of interventions necessary to bring about change.

Humans↗
PubMed2005

Infection control policies and hospital-associated infections among surgical patients: variability and associations in a multicenter pediatric setting.

BACKGROUND: Hospital-associated infections are an important cause of patient morbidity and death. Little is known about the variability of infection rates and infection control practices among pediatric hospitals. METHODS: This cross-sectional study was performed with the Pediatric Health Information System database, which includes demographic and diagnostic data for 35 freestanding, noncompeting, children's hospitals, and with data from a survey of the hospitals, which yielded additional information on infection control policies and practices. Patients undergoing elective surgical procedures were included in this study. RESULTS: Of the 35 eligible hospitals, 31 (89%) chose to participate in the survey component of this study. A total of 48278 patients met the inclusion criteria for the study; 2.3% of these patients had respiratory infections and 0.8% had gastrointestinal infections. The frequency of patients diagnosed with respiratory or gastrointestinal infections varied considerably among the hospitals and ranged from <1% to 6%. Certain infection control processes also varied among the hospitals during the study period. For instance, of the 31 hospitals, 12 monitored hand hygiene, 19 had administrative support of hand hygiene, and 16 had alcohol hand gel present for the entire study period. The presence of alcohol hand gel for the entire study was strongly and independently associated with lower odds of gastrointestinal infections (adjusted odds ratio: 0.64; 95% confidence interval: 0.49-0.85). CONCLUSIONS: Hospitals should support the use of alcohol hand gel, with the aim of decreasing hospital-associated infection rates.

Alcohols↗
PubMed2005

The training curriculum in hospital infection control.

Standardised training curricula for infection control nurses (ICNs) and recognition of the specialty exist in many European countries, but infection control physician (ICP) is not a specialty recognised by the UEMS. To gather information on curricula for ICPs, members of the ESCMID Study Group on Nosocomial Infections received a questionnaire. There is discussion about which 'professions' should be included in an infection control team. Within the 12 countries included, the average full-time equivalents (FTEs) for ICPs and ICNs per 1000 beds were 1.2 and 3.4, respectively. In addition to ICNs and ICPs, an infection control team should also include a data manager, an epidemiologist, secretarial/administrative support, and possibly, surveillance technicians. Overall, the composition of an ideal infection control team was estimated to be 9.3 FTE per 1000 beds. The background of ICPs can be clinical microbiology or infectious diseases. Among the participants, it was predominantly clinical microbiology. The ideal training curriculum for the ICP should include 6 years of postgraduate training. Of these, at least 2 years should be 'clinical training' (e.g., internal medicine) to acquire experience in the management of high-risk patients. Furthermore, training with regard to infection control and hospital epidemiology should be offered as a 'common trunk' for those being trained in clinical microbiology or infectious diseases. Important issues that remain are: implementation/standardisation of training curricula for doctors, recognition of ICP as a separate specialty or sub-specialty of clinical microbiology and/or infectious diseases, validation of on-the-job training facilities in terms of the number of doctors and nurses who can give training and the category of patients/problems present, and mandatory postgraduate education/continuing medical education specific for infection control for doctors and nurses in the field.

Cross Infection↗