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PubMed1981

Nosocomial pseudoepidemics and pseudoinfections: an increasing problem.

The infection control practitioner often relies on microbiologic data in order to conduct nosocomial infection surveillance and control activities. On the basis of a review of the medical literature, false positive culture and stained smear results representing pseudoinfection are being reported with greater frequency. Documented cases and clusters of pseudoinfectons are reviewed, and the epidemiologic characteristics and methods for detection and prevention of this increasingly recognized problem are discussed.

Cross Infection↗

PubMed1987

Nosocomial infection surveillance in the United States: historical perspective.

During the past 30 years, many important strides have been made in the prevention of nosocomial infections in the United States. Infection control programs have been established in hospitals throughout the country. Techniques for surveillance of nosocomial infections have been developed and utilized extensively. Results of the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) and the experience with surveillance of surgical wound infections have documented the fact that surveillance is an integral component of an effective nosocomial infection control program. In recent years, a number of approaches to nosocomial infection surveillance have been proposed as alternatives to comprehensive or hospital-wide surveillance. In 1986, four surveillance components were introduced in the National Nosocomial Infections Surveillance (NNIS) system to provide participating institutions the option to tailor their surveillance program to their local needs and priorities while continuing to provide information to the national database on nosocomial infections. Infection control practitioners currently face a challenge to develop more meaningful nosocomial infection rates to permit identification of new infection control priorities for their institution and to assess progress toward specific prevention objectives.

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

PubMed1999

Prospective evaluation of a hospital epidemiologist's activities at a European tertiary-care medical center.

OBJECTIVE: Assessment of the distribution of tasks and consultations provided by the hospital epidemiologist (HE) at University Hospital of Zurich (UHZ). DESIGN: Prospective collection of data on hospital epidemiology consultations over a 3-year period (1995-1997). Time spent per consultation and activities of infection control practitioners were not recorded. SETTING: A 1,040-bed tertiary-care university hospital in Zurich, Switzerland. RESULTS: Between January 1, 1995, and December 31, 1997, the HE received 1,660 requests for consultation. Advice or action was sought in the following areas: epidemiology (27.5% of requests); quality assurance, including antibiotic utilization and technology assessment (24.8%); infection control and practice guidelines (22.5%); disinfection and sterilization (11.6%); clinical infectious diseases (13.4%). During 1997, 35% of epidemiology consults were related to methicillin-resistant Staphylococcus aureus and 5.8% to tuberculosis. Public or private hospitals not affiliated with UHZ requested 40% of all consults. CONCLUSIONS: This study shows that HEs are involved in many different activities. Only 27.5% of hospital epidemiology consultations were directly related to issues of epidemiology. Practical knowledge of the methodologies for continuous quality improvement and assessment of various new technologies is important for HEs. The results of this study may be useful in discussions between HEs and administrators about allocation of resources or issues of reimbursement.

Epidemiology↗

PubMed2002

[Outline of the hospital infection control in USA and UK].

To establish Infection Control Network System is very important issue to reduce nosocomial infections in the hospital. CDC in United States of America and PHLS in United Kingdom are the core organization in infection control and, since the early 1970s, they have established the infection control system that span the efficient surveillance system, spectrum of hospital practice and clinical activity and provide a means of evaluating the outcome of infection by clinical audit. In many hospitals, the infection control program is well underpinned by a dedicated and knowledgeable infection control team(ICT), in which the infection control doctor(ICD) and infection control practitioner(ICP) involved.

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

PubMed1980

Legal aspects of nosocomial infection.

There are numerous nosocomial infections in hospitals; because they are an unexpected and undesired result of treatment, patients are inclined to bring lawsuits in an endeavor to recover damages. Although some patients do recover damages for nosocomial infections, on the whole it is difficult to do so. However, developing proper standards within a health care facility and updating them through well-educated and informed infection control practitioners such as the nurse epidemiologist are effective methods of preventing lawsuits. Strong infection control committees with the assistance of the medical staff and the hospital staff can reduce the threat of lawsuits stemming from nosocomial infections.

Aged↗

PubMed2004

Assessing the status of infection control programs in small rural hospitals in the western United States.

BACKGROUND: Organized infection control (IC) interventions have been successful in reducing the acquisition of hospital-associated infections. Rural community hospitals, although contributing significantly to the US health care system, have rarely been assessed regarding the nature and quality of their IC programs. METHODS: A sample of 77 small rural hospitals in Idaho, Nevada, Utah, and eastern Washington completed a written survey in 2000 regarding IC staffing, infrastructure support, surveillance of nosocomial infections, and IC policies and practices. RESULTS: Almost all hospitals (65 of 67, 97%) had one infection control practitioner (ICP), and 29 of 61 hospitals (47.5%) reported a designated physician with IC oversight. Most ICPs (62 of 64, 96.9%) were also employed for other activities outside of IC. The median number of ICP hours per week for IC activities was 10 (1-40), equating to a median of 1.56 (0.30-21.9) full-time ICPs per 250 hospital beds. Most hospitals performed total house surveillance for nosocomial infections (66 of 73, 90.4%) utilizing Centers for Disease Control and Prevention (CDC) definitions (69 of 74, 93.2%). Most also monitored employee bloodborne exposures (69 of 73, 94.5%). All hospitals had a written bloodborne pathogen exposure plan and isolation policies. CDC guidelines were typically followed when developing IC policies. Access to medical literature and online resources appeared to be limited for many ICPs. CONCLUSIONS: Most rural hospitals surveyed have expended reasonable resources to develop IC programs that are patterned after those seen in larger hospitals and conform to recommendations of consensus expert panels. Given these hospitals' small patient census, short length of stay, and low infection rates, further studies are needed to evaluate necessary components of effective IC programs in these settings that efficiently utilize limited resources without compromising patient care.

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

PubMedDate not supplied

Patient-care directives and infection control: the potential conflict of interest during epidemics in long-term care facilities.

Patient-care directives in long-term care facilities ensure that the aggressiveness of diagnostic and therapeutic interventions accurately reflects the desires of the patient. The results of our investigation of two outbreaks of fatal respiratory illness in long-term care facilities illustrate how patient-care directives may have delayed response to the outbreaks. Despite a cluster of deaths in each facility, staff delayed collection of laboratory specimens until patients with no directives restricting the medical workup became ill. Directives focus on the needs of the individual patient and family, but when an outbreak occurs, they may conflict with community needs. The challenge for the infection control practitioner is to recognize when community needs outweigh individual desires so that appropriate laboratory investigations can identify the cause of the illness.

Advance Directives↗

PubMed1991

Major trends in nosocomial viral infections.

Viruses have recently become appreciated as nosocomial pathogens. There is insufficient data to characterize trends in rates of viral nosocomial infections, but there have been major trends in methodologies and concepts. New groups of patients, such as infants and the elderly, are becoming appreciated as being at risk for serious nosocomial viral infections, whereas other groups, such as immunodeficient patients are expanding because of the epidemic of human immunodeficiency virus (HIV) infection and expanded use of immunosuppressive treatment. The continued addition of new viruses, such as HIV, human parvovirus B19, and rabies virus, to the list of potential nosocomial pathogens suggest that most human viruses can probably be serious nosocomial pathogens under the right circumstances. Advances in medical treatments and procedures, such as cadaveric dura mater grafts and laser treatment of warts, have provided new avenues for nosocomial transmission of viruses. Improved and wider availability of diagnostics promises to be a major force in improving our understanding and ability to prevent viral nosocomial infections. With these advances, viral diagnostic laboratories should become an important member of the infection control team. In parallel with trends in methodologies and concepts, there have been major advances in our understanding of ways to prevent some nosocomial viral infections. Application of these prevention measures is an important challenge to the infection control practitioner.

Cross Infection↗

PubMed2005

Vancomycin-resistant staphylococci and enterococci: epidemiology and control.

PURPOSE OF REVIEW: This review updates information on the development and spread of vancomycin resistance in staphylococci and enterococci. RECENT FINDINGS: New information on the genetic characterization of vancomycin-resistant Staphylococcus aureus isolates from the US indicates that each of the four was the result of an independent genetic event. New data suggest that vancomycin-intermediate S. aureus isolates, particularly those showing heteroresistance, are clinically significant. Finally, vancomycin-resistant enterococci continue to be reported from around the world. Novel infection control measures, however, may aid in reducing the spread of these organisms in healthcare settings. SUMMARY: The exchange of genetic information, particularly the vanA gene, between and among staphylococci and enterococci will continue to challenge physicians, microbiologists, and infection control practitioners in efforts to identify, treat, and prevent infections with these pathogens.

Enterococcus↗

PubMed1996

[Infection control systems in the United States: its history and problems].

The purpose of this study is to review recent literature regarding the role of the infection control nurse in the United States. Recent relevant literature, published between 1982 and 1995, was selected by using a computerized literature search, cumulative index to nursing and allied health literature (CINAHL). Four major points in the development of infection control practitioners (ICPs) were identified from the literature review: (1) Since the late 1960s the number of ICPs had increased continuously, through the Center for Disease control training programs, and through training programs developed by members of the Association for Professionals in Infection Control and Epidemiology (APIC) at the national, regional and local chapter levels. (2) The ICPs became certified upon receiving satisfactory results on the infection of 2 years of work in the field of infection control, and then are authorized to use the title "CIC". The certification was valid for five years and is renewed after the ICP passed a re-examination. (3) Six duties of the ICP were identified: management, prevention, surveillance, identification, education, and research. (4) The cost of health care was constantly restructuring the health care delivery system in the United States. The ICPs also were influenced by these changes. New challenges facing ICPs today were, a) the integration of resources to be shared by infection control and quality assurance, b) the change of role from specialist to generalist, c) the expansion of their roles in the area of epidemiology.

Certification↗

PubMed1982

Cost and benefit--a critical issue for hospital infection control. Fifth Annual National Foundation for Infectious Diseases Lecture.

New patterns of health care financing have made it essential for infection control practitioners to become familiar with information on cost of nosocomial infection and cost effectiveness ("benefit") of the procedures and devices used to control hospital infection. Even the lowest estimates of cost show the considerable economic impact of nosocomial infection. Studies to date separate control procedures and practices into categories of proven efficacy, likely efficacy, lack of efficacy, and those for which cost of implementation is likely to outweight any benefit that might result. Many procedures and practices have not yet been studied. To survive in a hospital world of limited finances, ICPs will have to make sure that they employ only procedures for which benefit outweighs cost of implementation.

Cost-Benefit Analysis↗

PubMedDate not supplied

Learning styles and teaching/learning strategy preferences: implications for educating nurses in critical care, the operating room, and infection control.

OBJECTIVE: To assess the learning styles and educational strategy preferences among critical care nurses, operating room nurses, and infection control practitioners. DESIGN: Descriptive multicenter survey using a self-report questionnaire. SETTING: 108 hospitals from nine geographic regions of the United States. PARTICIPANTS: A random sample of 303 (93%) nurses in the three specialties responded to the survey questionnaires. RESULTS: The majority of participants (64%) had an abstract learning style and preferred the self-directed, discovery approach to learning. CONCLUSIONS: Nurses may be more abstract in their learning styles than previously reported. Experiential learning theory is an effective means of identifying nurses' learning styles and teaching/learning preferences, which can then be used to plan basic and continuing educational programs.

Adult↗

PubMed1991

Education programmes for infection control in Canada.

Formal educational programmes for infection control personnel in Canada are limited and most courses have been directed at infection control practitioners (ICPs). Most ICPs report that their preparation comes from in-post training. Although there have been several short, non-credit courses available in the past, the only course available for ICPs at the present time is an intensive 1-week course. Surveys of nurses and ICPs suggest that they prefer flexibly scheduled university credit courses which will not only prepare them for their positions but also enable them to meet entry-to-practice requirements as recommended by the board of the Canadian Nurses Association. The future development of courses for ICPs must endeavour to meet these needs. Moreover, the educational needs of physicians and other health professionals working in this field have not been well identified or addressed and it is clear that educational programmes must also be developed for these health professionals.

Canada↗

PubMed1984

Antibiotic monitoring as a surveillance tool for nosocomial infections.

A programme for surveillance of nosocomial infections utilizing antibiotic review was developed and carried out at Saint Barnabas Medical Center, Livingston, New Jersey, USA. Over a 6-month period 1083 charts were reviewed on the surgical units by an infection control practitioner utilizing two methods of surveillance for nosocomial infections. The first method utilized positive laboratory cultures, admission data and head nurse interviews. The second method used a prevalence study of all surgical patients on antibiotic therapy and all positive culture reports. A comparison of both methods revealed that all nosocomial infections were realized using antibiotic review. It was also noted that 16.2 per cent of nosocomial infections were missed by not using antibiotic review as a surveillance tool. We also noted that the overall percentage of patients with nosocomial infections not cultured was 10.5 per cent. Our conclusions were that antibiotic review is a useful instrument that can successfully be incorporated into any currently existing infection control surveillance programme.

Anti-Bacterial Agents↗

PubMed2005

Prevention of hospital infection.

The prevention of nosocomial infections is an important aspect of patient care, particularly in high-risk areas such as intensive care units (ICUs). Local hospital leadership needs to develop easily defined infection-control policies that are evidence-based. These infection-control policies also require the presence of a dedicated group of infection-control practitioners to provide education, collect surveillance data, and oversee the implementation of the local infection-control plan.

Cross Infection↗

PubMed1996

Characterization and control of intraamniotic infection in an urban teaching hospital.

OBJECTIVES: Our purpose was to determine (1) whether risk factors for intraamniotic infection were similar in women delivered of preterm infants versus term infants and (2) whether infection control techniques could decrease the incidence of intrapartum fever on a labor and delivery unit. STUDY DESIGN: A total of 5409 consecutive patients (group 1) admitted to the Medical College of Virginia's labor and delivery unit were followed up prospectively to determine the development of intraamniotic infection. Demographic and intrapartum data were collected by use of a standard data form by infection control practitioners. An additional 2549 consecutive patients (group 2) were followed up after institution of infection-control measures. RESULTS: Intraamniotic infection occurred in 416 of 5399 (7.7%) women (group 1) admitted to the labor and delivery suite. Odds ratios for term and preterm patients having intraamniotic infection with rupture of membranes > or = 12 hours compared with < 12 hours were 5.81 (95% confidence interval 512 to 6.59 and 2.49 (95% confidence interval 1.77 to 3.50), respectively. Odds ratios for term and preterm patients with internal monitors having intraamniotic infection compared with patients in whom internal monitors were not used were 2.01 (95% confidence interval 1.7 to 2.4) and 1.42 (95% confidence interval 0.99 to 2.04), respectively. Odds ratios for term and preterm patients having intraamniotic infection with more than four vaginal examinations compared with four or fewer vaginal examinations was 3.07 (95% confidence interval 2.53-3.73) and 1.59 (95% confidence interval 1.11-2.27), respectively. Intrapartum fever occurred in 475 (8.8%) women in group 1 and in 252 (9.8%) women in group 2 (not significant). CONCLUSIONS: Risk factors (duration of ruptured membranes, use of internal monitoring, number of vaginal examinations) were similar in both term and preterm women with intraamniotic infection. Infection control measures failed to decrease the incidence of intrapartum fever in our patient population.

Adult↗

PubMed1995

Infection control in a country with annual inflation of 3,600%.

The economic crisis that has been seen worldwide affects developing countries such as Brazil even more severely. Worsening budget shortfalls for the healthcare system progressively threaten patients care. Infection control programs also are affected, and basic preventive policies are not implemented. Infection control practitioners face lack of equipment and poor microbiological support. In contrast, the motivation of the infection control people can be maintained through training courses, conferences, and meetings. Administrative support may be the most important single factor determining success in decreasing the infection control rate and should be (but is not always) provided, given that several infection control measures are cost effective.

Brazil↗

PubMed2004

Protocol-driven ventilator weaning reduces use of mechanical ventilation, rate of early reintubation, and ventilator-associated pneumonia.

BACKGROUND: Mechanical ventilation is the defining event of intensive care unit management. To reduce use, a literature-based protocol was introduced to facilitate weaning. The effect of protocol-driven ventilator weaning on ventilator use, ventilator-associated pneumonia (VAP), and intensive care unit (ICU) length of stay (LOS) is described in a survey of 2 years' activity in a multidisciplinary surgical ICU. METHODS: Data were gathered from April to September 2000 and from April to September 2002 before and after introduction of nurse/therapist-driven weaning. VAP was identified by chest radiography, clinical presentation, Gram's stains, and cultures from tracheal aspirates or bronchoalveolar lavage. Infection control practitioners diagnosed VAP. Failed extubation was defined as reintubation within 72 hours. RESULTS: Overall, there was a 2:1 ratio of male patients to female patients. The total number of patients and days of mechanical ventilation increased, but the use ratio (ventilator days/ICU days) fell from 0.47 to 0.33. Patients failing extubation fell from 43 (in 2000) to 25 (in 2002). From these patients, 17 cases of VAP occurred in 2000 and 5 in 2002. Mean age (40 years), Injury Severity Score (24), and ICU LOS (5.7-7.4 days; p = not significant) were unchanged in injured patients. ICU discharge was frequently delayed because of the need for subsequent respiratory care. CONCLUSION: Protocol-driven weaning reduces use of mechanical ventilation and VAP. Injured and general surgical patients show reduction in complications, but shorter ICU LOS depends on resources elsewhere in the health care system.

Adult↗