CDC guidelines for the prevention and control of nosocomial infections. Guideline for infection control in hospital personnel.
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Acquired Immunodeficiency Syndrome↗
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Results for “Infection Control”
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APIC and CDC survey of Mycobacterium tuberculosis isolation and control practices in hospitals caring for children. Part 2: Environmental and administrative controls. Association for Professionals in Infection control and Epidemiology, Inc.
BACKGROUND: The 1994 Centers for Disease Control and Prevention draft Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities did not exempt pediatric facilities from instituting controls to prevent nosocomial tuberculosis (TB) transmission. Many researchers contend that TB disease in children does not require such rigid controls. We surveyed acute-care pediatric facilities in the United States to determine adherence to environmental and administrative control recommendations. METHODS: The study included 4 mailings of a survey to infection control professionals at 284 US children's hospitals and adult acute-care hospitals with > 30 pediatric beds. RESULTS: Isolation rooms (IRs) generally conformed to recommended guidelines; 92% of respondents reported IRs with > or = 6 air changes per hour, 90% reported 1-pass air and negative pressure, and 89% reported that IRs were private rooms. A sufficient number of inpatient IRs were reported by 88%, but only 42% had IRs in outpatient areas, and 19% had IRs in off-site clinics. Employee tuberculin skin-test programs were in place at 98% of facilities, but policies pertaining to implementation varied. Employees' use of personal respirators increased at respondent hospitals from 1991 to 1994, but as late as 1994, nearly one third still used surgical masks for high-risk procedures. CONCLUSIONS: Environmental and administrative controls used by respondent hospitals largely conformed to published guidelines. Because definitive studies that quantify the risk of nosocomial M tuberculosis transmission in pediatric settings have yet to be performed, pediatric facilities are required to have the same protections in place as do their adult counterparts.
Adult↗
Recombinant vesicular stomatitis viruses encoding simian immunodeficiency virus receptors target infected cells and control infection.
We have constructed VSV recombinants lacking the viral glycoprotein gene and instead expressing rhesus macaque SIV receptors CD4 and CCR5 with or without the receptor DC-SIGN. The recombinant expressing CD4 and CCR5 specifically infected SIV envelope protein-expressing cells. Incorporation of DC-SIGN into the particles required deletion of the cytoplasmic domain. Inclusion of DC-SIGN in the particles definitely enhanced infection, indicating that the enhancement by coexpression of DC-SIGN with CD4 and CCR5 does not require internalization of the virus into cells. The recombinants also specifically infected, killed, and propagated in CEMx174 cells that were first infected with an SIV expressing EGFP. If cells were superinfected with either of the recombinants after the primary SIV infection, the numbers of SIV-infected cells and titers of infectious SIV in the cultures were significantly reduced. Such antivirals can now be tested in the SIV/non-human primate model for AIDS to determine their therapeutic value in vivo.
Animals↗
Infection control in perspective: infections due to medical equipment and devices.
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Cross Infection↗
Journal of Infection Control Nursing. Handling infection.
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Cross Infection↗
Infection control dogma: top 10 suspects.
As infection control evolved into an art and science through the years, many infection control practices have become infection control dogmas (principles, beliefs, ideas, or opinions). In this "Reality Check" session of the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, we assessed participants' perceptions of prevalent infection control dogmas. The majority of participants agreed with all dogmas having evidence of efficacy, except for the dogma on the frequency of changing mechanical-ventilator tubing. In contrast, the majority of participants disagreed with dogmas not having evidence of efficacy, except for the dogma on perineal care, umbilical cord care, and reminder signs for isolation precaution. As for controversial dogmas, many of the responses were almost evenly distributed between "agree" and "disagree." Infection control professionals were knowledgeable about evidence-based infection control practices. However, many of the respondents still believe in some of the non-evidence-based dogmas.
Attitude of Health Personnel↗
Effect of infection control measures on the frequency of diarrheal episodes in child care: a randomized, controlled trial.
BACKGROUND: Diarrheal infections are common in children who attend child care, and preventing transmission of disease in this setting depends on actions by child care staff. We set out to discover whether transmission of gastrointestinal infections in child care could be reduced by improved infection control procedures. METHODS: We performed a cluster randomized, controlled trial of an infection control intervention conducted in child care centers for 1 city in Australia. The intervention was training of child care staff about transmission of infection and handwashing and focused on both staff and child behavior. Implementation of the intervention was recorded by an observer. Illness was measured by parent report in telephone interviews every 2 weeks. RESULTS: There were 311 child-years of surveillance for diarrheal episodes. The rate of episodes of diarrhea was 1.9 per child-year in intervention centers and 2.7 per child-year in control centers. Multivariable analysis showed that diarrheal episodes were significantly reduced in intervention center children by 50%. However, the impact of the intervention was confined to children over 24 months of age. For those centers in which children's compliance with handwashing was high, diarrheal episodes were reduced by 66%. CONCLUSIONS: This trial supports education about infection control, for staff and children in child care, as a means of reducing transmission of diarrhea. Reduction in episodes of diarrhea in children in child care was limited to children over 24 months of age.
Australian Capital Territory↗
Infection control in the United Kingdom.
Most large acute hospitals have an infection control team, consisting of the infection control officier and nurse, which is responsible for day-to-day control of infection. The infection control officier is usually the medical microbiologist, a physician in charge of the microbiology laboratory, who is responsible to the Health Authority for control of infection. The team responsibilities usually include smaller hospitals, and long-term as well as acute-care facilities in each District. The infection control nurse is the only member of staff involved full-time in infection control. The infection control committee consists of managers of relevant departments, e.g. domestic, pharmacy, as well as infection control nursing and medical representatives, and usually meets 4-6 times a year. Advice or assistance is also available from national organisations, e.g. the Department of Health, the Communicable Diseases Surveillance Centre, reference laboratories and professional organisations such as the Hospital Infection Society, Infection Control Nurses Association and Central Sterilising Club.
Cross Infection↗
Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities.
BACKGROUND: Control of infection within the long-term care facility is a daunting problem. Elderly patients are at high risk for contracting infection because of reduced innate immunity, malnutrition, and the presence of chronic medical conditions. This small study tested the effect of developing and implementing a comprehensive preventive infection control program in the long-term care setting and examined the resultant incidence of infections. METHODS: Eight private, freestanding, long-term care facilities in urban and suburban settings were selected for the study. The 4 test sites had a total of 443 beds; there were 447 beds in 4 matched control sites. Data on infection rates were accrued in both preintervention and intervention years. The control homes maintained their existing infection control policies and procedures. The test homes were provided with an infection control educational program and replaced all currently used germicidal products with single-branded products for a 12-month period. A criteria-based standardized infection control surveillance system was used to monitor and report infections in all facilities. RESULTS: In the preintervention year, the test sites experienced 743 infections (incidence density rate, 6.33) and the control homes experienced 614 infections (incidence density rate, 3.39). In the intervention year, the test homes reported 621 infections, a decrease of 122 infections (incidence density rate, 4.15); in the control homes, the number of infections increased slightly, to 626 (incidence density rate, 3.15). The greatest reduction in infections in the test homes was in upper respiratory infections (P =.06). CONCLUSIONS: This study provides additional evidence that a comprehensive infection control program that includes handwashing and environmental cleaning and disinfecting may help reduce infections among the elderly residing in long-term care settings.
Age Distribution↗
Multidrug-resistant organisms in cystic fibrosis: management and infection-control issues.
Chronic infection and inflammation are the hallmarks of cystic fibrosis lung disease. As cystic fibrosis patients are living longer owing to more intense treatment, multidrug-resistant organisms are being isolated increasingly from patients' respiratory tracts. While the adverse effects of Pseudomonas aeruginosa and Burkholderia cepacia complex are well described, less is known about the clinical significance of other emerging multidrug-resistant organisms, such as methicillin-resistant Staphylococcus aureus and Stenotrophomonas maltophilia. Owing to multiple mechanisms of antimicrobial resistance, these organisms are difficult to treat and often require combination antibiotic therapy. Until more is known about their pathogenicity and effect on clinical outcomes, physicians should be aware of the potential transmissibility of these organisms and implement adequate infection control strategies.
Anti-Infective Agents↗
Nursing assessment program in infection control procedures.
To assess the infection control educational needs of the nursing service while providing a "hands-on" in-service exercise, nurses were invited to test their infection control knowledge as part of a clinical scenario. After a brief review of the "case," participants surveyed for 10 minutes a mock patient's room where a manikin served as the "patient." Through staged breaks in technique, various components of infection control practice were to be identified by the participants. Five basic areas of infection control practice including handwashing and isolation technique, Foley catheter care, intravenous therapy and line maintenance, use of suctioning equipment and fluids, and general sanitation were presented at 12 stations within the room. Immediately after this exercise, members of the infection control staff revealed the errors in the exhibit and demonstrated the correct procedures. The average score among 548 participants was 57% (11.4 out of 20 possible correct answers). Scores were not influenced by the number of years of experience in nursing. However, differences were seen regarding educational degree and nursing units, which served as a basis to recommend specific infection control education.
Antisepsis↗
Infection control in German nursing homes.
Infection control in German nursing homes has become an issue during the past 10 years. The changing demographics and the introduction of the diagnosis-related group reimbursement system, as well as the increasing number of residents who are colonized with methicillin-resistant Staphylococcus aureus, may worsen already-existing infection control problems. The publication of national infection control guidelines for nursing homes that should be implemented and supervised by infection control nurses may increase the standard. However, the lack of responsibility of the caring physicians for the whole population of a nursing home may hinder the process. This article discusses the state of infection control in German nursing homes.
Germany↗
Cross-infection control in dental practice. Part 2: A dental surgery planned with cross-infection control as the design priority.
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Communicable Disease Control↗
Changes in infection control practice to reduce MRSA infection.
An increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) led to a review of infection control practice within the cardiothoracic directorate in a South London teaching hospital. Several changes in aspects of care were implemented including educational initiative, extension of the admission screening policy, a specific isolation nursing team and the development of a care pathway. This led to a considerable reduction in cross-infection rates. It was recognized that high-quality, high nurse-to-patient ratio and education on fundamental aspects of barrier nursing were necessary to maintain the low infection rates.
Critical Care↗
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↗
Activities of infection control practitioners during an outbreak of Salmonella typhimurium. Task Force of Association for Practitioners in Infection Control.
ICPs played an invaluable role, and their activities resulted in minimal nosocomial incidence. The survey reported two cases of nosocomial infection in patients, one in the medical service and one in the pediatric unit, as well as the reported employee cases. Two nosocomial employee cases were reported, a laboratory technologist and medical student. Implementation of these recommendations will make the job of the ICP easier during any outbreak. We believe that our interventions, interactions, and assistance positively affected the course of the epidemic. In the final analysis the activities of surveillance, supervision of isolation, education and consultation, employee health, and public relations served to strengthen the positive image of ICPs.
Allied Health Personnel↗
Perceptions of infection control practices among health professionals.
Infection control practice is a cornerstone of modern health care. However, there is minimal research into health professionals' perception of infection control practices and how those perceptions influence staff compliance with recommended protocols. The objective of this study was to explore health care professionals' perceptions of infection control practices in relation to the management of infectious diseases. A grounded theory approach was used as the research framework. Semi-structured interviews were completed with a sample of 16 nurses and doctors working at hospitals in Western Australia. Four major categories emerged from the data. These were: knowledge, culture, conflict, and risk assessment. The findings indicate the importance of both individual and organisational factors in determining clinicians' levels of compliance with recommended infection control practices. Identification of the factors that influence health professionals' level of compliance can be used to develop strategies to support long-term compliance with infection control practices.
Attitude of Health Personnel↗
Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999.
The National Nosocomial Infections Surveillance (NNIS) system is the oldest and largest monitoring system for health care-acquired infections in the United States. This report describes both the characteristics of NNIS hospitals compared with those of US hospitals with 100 beds or more and their infection control programs. Overall, NNIS hospitals tend to have more hospital beds than the average for-comparable US hospitals. The majority of NNIS hospitals have affiliations with academic medical centers, and most have substantial intensive care units. Even though infection control professionals in NNIS hospitals spend most of their time in inpatient settings, 40% of their time is also spent in a variety of other settings, including home health, outpatient surgery or clinics, extended care facilities, employee health and quality management, and other clinical or administrative activities. As described in this report, the infrastructure of the NNIS system offers a national resource on which to build improved voluntary patient safety monitoring efforts, as outlined in the recent Institute of Medicine report on medical errors.
Cross Infection↗