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PubMed1997

Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC).

This report summarizes recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of certain immunizing agents in health-care workers (HCWs) in the United States. It was prepared in consultation with the Hospital Infection Control Practices Advisory Committee (HICPAC) and is consistent with current HICPAC guidelines for infection control in health-care personnel. These recommendations can assist hospital administrators, infection control practitioners, employee health physicians, and HCWs in optimizing infection prevention and control programs. Background information for each vaccine-preventable disease and specific recommendations for use of each vaccine are presented. The diseases are grouped into three categories: a) those for which active immunization is strongly recommended because of special risks for HCWs; b) those for which immunoprophylaxis is or may be indicated in certain circumstances; and c) those for which protection of all adults is recommended. This report reflects current ACIP recommendations at the time of publication. ACIP statements on individual vaccines and disease updates in MMWR should be consulted for more details regarding the epidemiology of the diseases, immunization schedules, vaccine doses, and the safety and efficacy of the vaccines.

Adult↗

PubMedDate not supplied

Distance education and technology.

This first in a series of columns regarding distance education identifies existing offerings and introduces conceptual issues. Continuing professional education can be achieved through a variety of means, but university-based distance education degree programs offer particularly valuable attributes. Although a growing number of universities are offering such programs, few pertain specifically to infection control, hospital epidemiology, and health-service quality improvement. This first installment concludes by asking whether the Society for Healthcare Epidemiology of America should be partnering or otherwise collaborating with universities to maintain its leadership position in bringing high-quality educational opportunities to infection control practitioners and healthcare epidemiologists.

Canada↗

PubMed1991

Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital.

To compete more effectively for resources, it is increasingly important for infection control practitioners to estimate the costs of nosocomial infections and the amount of money their infection control programs save the hospital. Studies on costs should estimate both extra length of stay and extra costs attributable to infectious complications. Cost estimates should either adjust charges by a cost to charge ratio, which is relatively easy, or estimate hospital costs directly by detailed cost-accounting, which is comparatively more difficult. If there is insufficient time to measure costs concurrently in every infected patient, comparative studies can be done by comparing infected and uninfected patients matched on characteristics that control for the preexisting differences between them. Diagnosis-related groups and the number of diagnoses appear to be useful matching variables because they are strongly associated with both nosocomial infection and length of stay. The final results should be expressed as either potential or actual savings to the hospital, depending on whether significant reductions in nosocomial infection rates have been achieved.

Cost Savings↗

PubMed1993

Validation of surgical wound surveillance.

OBJECTIVE: To determine the sensitivity and specificity of standard infection control surveillance techniques for the identification of surgical wound infections. DESIGN: Surveillance data collected by three infection control practitioners (ICPs) was compared to surveillance data collected simultaneously by a gold standard observer. SETTING: University-affiliated, tertiary care hospital. METHODS: Using standard infection control surveillance techniques (chart review and discussions with patients' nurses and physicians), ICPs collected surveillance data on patients on the General Surgery and Trauma Surgery Services on days 4 and 7 after surgery and then weekly for 30 days or until patients were discharged from the hospital. Simultaneously, a hospital epidemiologist collected surveillance data and examined each patient's wound daily. RESULTS: Nine hundred twenty-five surgical patients including 537 trauma cases and 388 elective general surgery cases were followed postoperatively. The ICPs identified 67 surgical wound infections, and the hospital epidemiologist identified 80 surgical wound infections for a sensitivity of 83.8% with a 95% confidence interval (CI95) of 75.7% to 91.9%. Specificity was 99.8% with a CI95 of 99% to 100%. The sensitivity was the same for trauma surgery and general surgery, but incisional wound infections were more difficult to identify than deep wound infections. During a second validation period, sensitivity was 92.3% with a CI95 of 62% to 100%. CONCLUSIONS: Standard infection control surveillance techniques have the same sensitivity for detection of surgical wound infections as they do for identification of other nosocomial infections. Accurate data on surgical wound infections can be collected without direct examination of surgical wounds.

Hospital Bed Capacity, 300 to 499↗

PubMed1992

Methicillin-resistant Staphylococcus aureus: a questionnaire survey of 75 long-term care facilities in western New York.

OBJECTIVES: To determine the frequency of recognition of methicillin-resistant Staphylococcus aureus (MRSA) as an infection control problem and its prevalence among long-term care facilities, and to evaluate whether certain long-term care facility characteristics such as bed size, ownership, level of infection control activity, and frequency of resident transfers to acute care hospitals are related to the recognition or prevalence of MRSA in this setting. DESIGN: Questionnaire survey. SETTING: Seventy-five long-term care facilities in the 8 counties of western New York. RESULTS: Seventy-five of 81 (92.6%) long-term care facilities returned a completed questionnaire. Seventy-nine percent were considered to have a "limited" level of infection control activity (part-time infection control practitioner who spent less than 10 hours a week on infection control activities). The larger the long-term care facility, the more time was spent on infection control activities (p = .01). Seventy-two percent of the long-term care facilities screened new admissions for MRSA by reviewing culture reports; 69% of the long-term care facilities had a specific infection control policy for MRSA. Sixteen of the 75 (21%) facilities felt they had an infection control problem with MRSA. By univariate analysis, the only characteristic significantly associated with this recognition was use of nurse practitioners or physician assistants by a facility (p < .05). Eighty-one percent of the 75 long-term care facilities had identified one or more patients with MRSA in the year prior to the survey. By univariate analysis, the only characteristics that were significantly associated with the number of residents with MRSA were the monthly average number of residents transferred to acute care facilities (p = .034) and facility bed size (p = .022); there was also a trend toward increasing intensity of infection control activities (p = .085). However, facility bed size and the average number of resident transfers per month to acute care facilities were strongly associated (p = .0002). By stepwise logistic regression analysis, only bed size was an independent predictor of the number of residents with MRSA. Many long-term care facilities had tried to eradicate MRSA; ciprofloxacin was most commonly used to eradicate MRSA. CONCLUSIONS: The vast majority of the 75 long-term care facilities in the 8 counties of western New York have identified patients with MRSA, although only a minority (21%) of them actually believed that an infection control problem existed. Facility size (a surrogate for the monthly average number of resident transfers to acute care facilities) seems to be an important factor in determining the number of residents with MRSA in long-term care facilities in our geographic region. The major longitudinal studies of MRSA in such facilities have so far been done only in Veterans Affairs facilities. Further studies are needed in freestanding long-term care facilities, the largest group of long-term care facilities in the United States, to determine the epidemiology of MRSA in this setting and to develop practical and valid infection control methods for residents with MRSA.

Health Facility Size↗

PubMed1991

A hospital-based education programme for infection control in Australia.

Fremantle Hospital, a 400-bed teaching hospital has offered an infection control course for registered nurses since 1984. The number of nurses practising infection control in the state of Western Australia has increased from seven in 1984 to over 100. Country areas now have access to appropriate advice. The course is hospital-based and multidisciplinary and is constantly evolving. It lasts for two weeks, is economic and wastage is low due to careful selection of candidates. Basic infection control standards have improved, but teaching of medical and allied health staff and line managers has not yet been addressed. Nurses from overseas are now applying for the course and a regional network of infection control practitioners is a major aim.

Curriculum↗

PubMed2000

Survey of the knowledge and practice of infection control among dental practitioners.

A survey on various aspects of infection control (overall knowledge/problem recognition, formal polices/reducing risk, and willingness to obtain additional education) was conducted among dental professionals and dental students. The survey was administered by a questionnaire at the offices of dental practitioners in Uberlândia and among dentistry students at the Federal University of Uberlândia. The two groups (professional dentists and students) differed significantly (P<0.0001) regarding recognition and reduction of the problem, but they were similarly willing to improve their knowledge of infection control. Dentists scored significantly higher than dental students on questions of recognition and reduction. A high proportion of students reported a lack of concern regarding routine handwashing before and after patient care (28.9% gave wrong answers). Of the dentists, only 8.8% reported a lack of knowledge about this matter. A higher proportion (P<0.0001) of dentists reported glove use and other basic barrier precautions (97.1% versus 51.9% among the students). However, the proportion of dentists who reported that they were aware of HBV vaccination was lower than among the students (81.5% versus 92.0%, p=0.0037). Additional education is required to promote a more realistic perception of the risks for HIV, HBV, and HCV transmission in dental offices and among dental students, and the use of all recommended infection control practices.

Brazil↗

PubMed2004

Multidrug-resistant Pseudomonas aeruginosa cholangitis after endoscopic retrograde cholangiopancreatography: failure of routine endoscope cultures to prevent an outbreak.

BACKGROUND: Nosocomial infections due to medical devices are of increasing concern to infection control practitioners. Attempts to prevent such infections have included surveillance cultures of endoscopes and bronchoscopes. In July 2002, the infectious disease consultation service was asked to see three patients with sepsis due to multidrug-resistant Pseudomonas aeruginosa after endoscopic retrograde cholangiopancreatography (ERCP). OBJECTIVE: To describe an outbreak of multidrug-resistant P. aeruginosa sepsis after ERCP at an institution that performs routine surveillance cultures of endoscopes. DESIGN: A traditional outbreak investigation supplemented by pulsed-field gel electrophoresis (PFGE) was undertaken, including a case-control analysis based on the hypothesis that all infected individuals had their ERCP performed with the same endoscope. SETTING: A tertiary-care academic medical center. RESULTS: The case-control analysis confirmed the hypothesis that undergoing ERCP with the implicated endoscope was associated with a culture positive for Pseudomonas (P = .01). The available strains were identical by PFGE. This outbreak occurred despite a negative surveillance culture of the implicated endoscope 1 month earlier. CONCLUSIONS: Infectious morbidity can occur after endoscopy despite negative surveillance cultures. The practice of routine endoscope cultures does not prevent device-related infectious morbidity.

Aged↗

PubMed1995

Epidemiology, therapy and costs of nosocomial infection.

In the current climate of cost containment and quality control, nosocomial infection is a worrisome adverse event in hospital care. Hospitalised patients require care for increasingly severe illnesses, and are therefore more susceptible to infection, especially by opportunistic micro-organisms. It is thus necessary to accurately assess and adjust for the severity of the underlying illness in studies of risk factors involved in nosocomial infections. The appearance of new diagnostic and therapeutic techniques provides novel opportunities for infection control and represents a constant challenge to hospital systems. The continuous selection of resistant flora, together with the identification of new pathogens, calls for a reconsideration of hospital policies regarding the dispensation of antibiotics. Epidemiological surveillance continues to be the most important aspect of attempts to monitor infection control programmes, and to identify changes in risk factors that may increase the infection rate. Among the major challenges now facing the infection control practitioner is the use of nosocomial infection rates as an indicator of quality of care. Awareness of infection statistics would serve as a stimulus to the prevention and control of infection, but would be useless if not accompanied by adequate systems to guarantee the comparability of data from different studies and centres. Suitably sensitive and specific surveillance systems should be developed, and the use of site-specific and procedure-specific infection rates adjusted for the patient's intrinsic risk should be encouraged.

Anti-Bacterial Agents↗

PubMed1986

Numbers that count: analytic methods for hospital epidemiology, Part 1.

The hospital epidemiologist is responsible for generating information that will be used to evaluate and assure high quality, minimal risk medical care. To accomplish this objective, the epidemiologist uses standard epidemiologic methods. Although used primarily in infection control, these methods are also applicable in the analysis of other types of institutional risks and in the assessment of quality of care. This review provides the reader, who we assume has minimal formal training in epidemiology and statistics, with some basic tools for analyzing data and generating useful information. We consider three major topic areas: basic concepts regarding numbers and data, analysis of nominal data, and analysis of discrete and continuous data. Hypothetical problems that may be encountered in the hospital illustrate the application of epidemiologic methods to studies of risk control, quality assurance, and infection control. The infection control practitioner who is adept in using epidemiologic methods to solve infection control problems should be able to adapt these methods to other programs in her or his institution.

Abortion, Spontaneous↗

PubMed1985

Prevention and control of tuberculosis.

Programs for tuberculosis prevention in health care workers can be complex and often raise questions and controversies among employee health and infection control practitioners alike. Although tuberculosis is declining in incidence in the US, preventive programs for health care workers will continue to be a part of employee health programs. As with other aspects of infection control, the practitioner must develop and modify the program to reflect the state of the art and current thinking in tuberculosis prevention and control.

BCG Vaccine↗

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↗

PubMed2000

Neonatal group B streptococcal disease: how infection control teams can contribute to prevention efforts.

Group B streptococcal (GBS) disease is a leading cause of morbidity and mortality among newborns. Many cases of newborn GBS disease can be prevented by the administration of intrapartum antibiotic prophylaxis. Current consensus guidelines for prevention of perinatal GBS disease have led to substantial declines in the incidence of GBS disease occurring in newborns <7 days of age (early-onset disease). Despite declines in the incidence of early-onset disease, approximately 20% of pregnant women are colonized with GBS at the time of labor and thus have the risk of transmitting the bacteria to their newborns. Consequently, continued and improved implementation of prevention efforts is essential. Infection control teams can contribute uniquely to prevention of perinatal GBS disease by serving as hospital champions of GBS disease prevention. In particular, teams can coordinate with administration and staff to encourage establishment and effective implementation of GBS prevention policies; facilitate improved laboratory processing of prenatal GBS screening specimens; monitor any adverse consequences of increased use of intrapartum antibiotics within the hospital; and investigate GBS cases that occur to determine whether they could have been prevented. By spearheading efforts to improve implementation of perinatal GBS disease prevention at the hospital level, hospital epidemiologists and infection control practitioners can play an important role in reducing the burden of early-onset GBS disease.

Adult↗

PubMed1998

Comparison of genomic methods for differentiating strains of Enterococcus faecium: assessment using clinical epidemiologic data.

Genomic DNA extracted from 45 vancomycin-resistant Enterococcus faecium (VRE) isolates was cleaved with HindIII and HaeIII and subjected to agarose gel electrophoresis. The ability of this method (restriction endonuclease analysis [REA]) to distinguish strains at the subspecies level was compared with results previously determined by pulsed-field gel electrophoresis (PFGE). Chart reviews were performed to provide a clinical correlation of possible epidemiologic relatedness. A likely clinical association was found for 29 patients as part of two outbreaks. REA found 21 of 21 isolates were the same type in the first outbreak, with PFGE calling 19 strains the same type. In the second outbreak with eight patient isolates, HindIII found six were the same type and two were unique types. HaeIII found three strains were the same type, two strains were a separate type, and three more strains were unique types, while PFGE found three were the same type and five were unique types. No single "ideal" method can be used without clinical epidemiologic investigation, but any of these techniques is helpful in providing focus to infection control practitioners assessing possible outbreaks of nosocomial infection.

Anti-Bacterial Agents↗

PubMed1999

Who coordinates infection control programs in Australia?

BACKGROUND: Australian infection control practitioners (ICPs) have not been previously profiled. Knowledge of their practice is limited, making support and evaluation of their programs difficult. To investigate the current role, function, and attributes of this group, we undertook a national survey of members of the Australian Infection Control Association. METHODS: In 1996 a questionnaire was sent to all 1078 nonmedical and nonindustry members of the Australian Infection Control Association. More than half (65%) of the membership responded to the questionnaire, which measured demographics, experience, infection control training and education, staffing levels, perceived deficits, and managerial support. RESULTS: Our results indicate that the typical Australian ICP works in a public acute-care facility with fewer than 251 beds, has 6 years experience in the field, and has completed hospital-based nursing training. Surveillance was the activity that consumed most of the ICPs' time. The majority of ICPs had responsibilities in addition to infection control, and although they considered management to be supportive, additional clerical support was identified as an area for program improvement. CONCLUSIONS: We have provided the first comprehensive profile of Australian ICPs and their practices. Our findings compel professional associations, such as the Australian Infection Control Association, to address the following: standardization in practice and surveillance, provision of appropriate training and ongoing education, and encouragement of research initiatives by infection control staff. These strategies are the key to future evidence-based infection control and will ensure survival of this specialty in Australia.

Adult↗

PubMed1988

Infection control in Maryland nursing homes.

We surveyed 53 randomly chosen Maryland nursing homes for infection control policies and practices. The majority had written infection control policies, an infection control committee, and a designated practitioner for infection control; in most facilities, however, the infection control practitioner had other major duties, spent little time on infection control, and had no specific training in the field. Thirty-four percent of homes in the survey performed routine environmental cultures, and more than half had insufficient or no isolation policies for infected decubiti and acute diarrhea. In general, the intensity of infection surveillance and the extent of infection control measures increased with the level of care provided, from domiciliary homes to homes providing chronic care. Employee health care fared generally well: 60% of homes offered influenza vaccine to employees and 66% had restriction policies for employees with upper respiratory infections. While the majority of homes offered the influenza vaccine to residents, acceptance of other vaccines recommended for the elderly was less widespread. We conclude that infection control efforts are made in most Maryland nursing homes; however, appropriate guidelines and more effort to educate nursing home personnel in proper infection control practices are badly needed.

Aged↗

PubMed2001

What we need to know about bioterrorism preparedness: results from focus groups conducted at APIC 2000.

Infection control practitioners (ICPs) are important partners in enhancing the US public health infrastructure, both as essential recipients of continuing education and as instructors responsible for providing this education. Focus groups were conducted at APIC 2000, the annual meeting for the Association for Professionals in Infection Control and Epidemiology, Inc, to determine the ICPs' priorities for educational opportunities in bioterrorism preparedness and the preferred methods of education delivery. Focus group participants affirmed the need to provide education in sessions of less than 60 minutes, with use of a variety of technologies and methods of presentation such as video, Internet, and paper-based self-learning texts. The participants' comments suggested a lack of awareness by employees in health care institutions about the potential threat of bioterrorism in the United States and a deficiency in knowledge about the potential consequences of an attack. The focus group participants believed this lack of awareness also leads to unwillingness by their administrators to allocate funds for planning and education. Since it appears that ICPs will be looking for direction and expertise from the local health departments in their communities, the first subset of professionals to target for bioterrorism education and preparedness should probably be the public health professionals.

Adult↗

PubMed1997

Skin testing for tuberculosis in university teaching hospitals--is there a problem?

We performed four annual audits of tuberculin tests performed on hospitalized patients at a university teaching hospital complex. Each audit assessed if tests were performed and read correctly. House staff performed skin testing in years 1 to 3. Despite interventions of teaching and then of written instructions on skin testing, performance was poor. When testing was turned over in year 4 to trained infection control practitioners, performance approached 100%. We conclude that university teaching hospitals should assess skin-testing performance.

Documentation↗