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PubMed2000

Observing the behavior of senior dental students in relation to infection control practices.

To achieve adequate infection control in the dental practice, dental students should be fully aware and prepared to adopt necessary procedures. But most studies of students' infection control behaviors rely on self-reported data. This study verified, through direct observation, how senior dental students performed basic infection control procedures and assessed how close to reality the reported behavior is to the observed behavior. Eight students were observed in three clinics: pediatric dentistry, minor oral surgery, and primary care promotion. The students were not aware of who was being observed or why. Later all twenty students comprising that clinical subgroup answered a questionnaire. Seventy-two patient-student contacts were observed. Students considered basic infection control procedures as relevant. The reported intention of adoption of these procedures after graduation dropped in relation to their reported relevance. Although the observed behavior in the three clinics was considered satisfactory, when compared to the reported behavior, it was found that the intention was more positive than the behavior itself. Even though the students were conscious about the importance of cross-infection control in the dental practice, the reported intention of future use and mainly the observed behavior should be improved.

Attitude of Health Personnel↗
PubMed2001

Infection control practices among correctional healthcare workers: effect of management attitudes and availabiity of protective equipment and engineering controls.

OBJECTIVES: To determine the relation of the availability of personal protective equipment (PPE) and engineering controls to infection control (IC) practices in a prison healthcare setting, and to explore the effect on IC practices of a perceived organizational commitment to safety. DESIGN: Cross-sectional survey. SETTING: The study population was drawn from the 28 regional Correctional Health Care Workers Facilities in Maryland. PARTICIPANTS: All full-time Maryland correctional healthcare workers (HCWs) were surveyed, and 225 (64%) of the 350 responded. METHOD: A confidential, self-administered questionnaire was mailed to all correctional HCWs employed in the 28 Maryland Correctional Health Care Facilities. The questionnaire was analyzed psychometrically and validated through extensive pilot testing. It included items on three major constructs: IC practices, safety climate (defined as the perception of organizational commitment to safety), and availability of IC equipment and supplies. RESULTS: A strong correlation was found between the availability of PPE and IC practices. Similarly, a strong correlation was found between IC practices and the presence of engineering controls. In addition, an equally strong association was seen between the adoption of IC practices and employee perception of management commitment to safety. Those employees who perceived a high level of management support for safety were more than twice as likely to adhere to recommended IC practices. IC practices were significantly more likely to be followed if PPE was always readily available. Similarly, IC practices were more likely to be followed if engineering controls were provided. CONCLUSION: These findings suggest that ready availability of PPE and the presence of engineering controls are crucial to help ensure their use in this high-risk environment. This is especially important because correctional HCWs are potentially at risk of exposure to bloodborne pathogens such as human immunodeficiency virus and hepatitis B and C viruses. Commitment to safety was found to be highly associated with the adoption of safe work practices. There is an inherent conflict of "custody versus care" in this setting; hence, it is especially important that we understand and appreciate the relation between safety climate and IC practices. Interventions designed to improve safety climate, as well as availability of necessary IC supplies and equipment, will most likely prove effective in improving employee compliance with IC practices in this healthcare setting.

Adult↗
PubMed1996

An analysis of infection control of varicella-zoster virus infections in Addenbrooke's Hospital Cambridge over a 5-year period, 1987-92.

This prospective study analyses infections with varicella-zoster virus (VZV) in Addenbrooke's Hospital, Cambridge during 1987-92 and examines the spread of infection. In total, 93 patients and staff experienced VZV infection. Twenty-one patients had varicella and 49 experienced zoster. None of 101 patients and 1 of 625 staff members in contact with varicella cases acquired infection. By contrast, 2 of 227 patients, and 5 of 1039 staff in contact with zoster cases acquired varicella. One out of 28 (3.6%) VZV antibody-negative patients and staff in contact with varicella acquired infection, compared with 5 out of 29 (17.2%) VZV antibody-negative patients and staff in contact with zoster. Thus, zoster was found to be a more frequent cause of nosocomial infection than varicella. Fourteen members of staff had VZV infection during the study period. One of 99 patients and none of 389 staff members in contact with these cases developed varicella. The cost of dealing with infection control for VZV infections in our hospital is estimated to be Pounds 714 per patient case and a total of Pounds 13,204 per year.

Chickenpox↗
PubMed1996

The infection control information system of the Hospital Infections Program, Centers for Disease Control and Prevention.

In December 1990 the Investigation and Prevention Branch, Hospital Infections Program, Centers for Disease Control and Prevention (CDC), developed the Hospital Infections Program infection control information system (HIP ICIS) to respond more efficiently to more than 200 public inquiries (telephone or written) that HIP receives daily. The HIP ICIS allows anyone with a Touch-Tone telephone, fax machine, or computer to access CDC information that answers the most commonly asked questions from infection control practitioners and other health care workers. The HIP ICIS has received approximately 56,608 inquiries; of these, 33% were about CDC guidelines on prevention and control of nosocomial infections, 25% about issues related to HIV, 16% about sterilization and disinfection of medical devices, 8% about methicillin-resistant Staphylococcus aureus, 3% about long-term care facilities, and 17% miscellaneous topics (e.g., nosocomial infection rates, infection control courses, and ventilation, construction, and renovation of hospitals). The HIP ICIS is an efficient method of providing infection control guidance to the infection control community. In this article, we a) review the history of the HIP ICIS, b) present data on HIP ICIS usage, c) summarize the current HIP ICIS contents, and d) present step-by-step instructions on how to access the HIP ICIS.

Centers for Disease Control and Prevention, U.S.↗
PubMed1993

Lowbury Lecture. Infection control--a challenge in a land of contrasts.

The general level of health care in any country will dictate to a large extent the amount of attention paid to the control of nosocomial infections. In South Africa the apartheid era, although initially supporting a strong economy, did little to foster a good education system among the mass of the population. With the imposition of sanctions and the decline in the economy, the health services which had been curative in nature and centred around the medical schools of the country and their teaching hospitals, began to suffer the effects of rampant inflation and financial cutbacks. Nevertheless, virtually all the medical schools support infection control programmes of one sort or another. In addition, there are a number of Infection Control Societies in the country. With the present political instability and violence in the country, the health services have not escaped. Staff cutbacks are inevitable and wards may have to close; the academic hospitals are under threat. Privatization is strongly favoured by government. The present population of approximately 30 million could double by the year 2020, putting enormous pressure on limited resources. The squatter problem worsens every month. The spectre of human immunodeficiency virus (HIV) infection increases yearly. Any assessment of priorities must therefore be made against this background. Only proven methods of infection control should be encouraged. In the light of the foregoing, three areas of practical activity are examined: the re-processing of heat-labile equipment, the re-use of disposables and the disposal of clinical waste.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross Infection↗
PubMed1997

[Infection control monitoring of physician practices with approval according to section 218 StGB of the public health office. A discussion contribution to the planned infection control law (E-IFSG)].

Public Health authorities in Germany are obliged to check on the hygienic situation in hospitals, homes for the elderly, etc., but are not permitted to perform routine hygiene controls in physician's practices--with the exception of those that are licensed for termination of pregnancy (the latter exception applies to the Federal Land of Hesse). Public Health authorities in Frankfurt/Main have been checking on hygienic conditions in 16 medical practices in Frankfurt since 1990. Initially, severe hygienic defects were found. For example, in only one practice did they find a plan for safeguarding hygienic conditions, or a dispenser for disinfectants. Severe faults in disinfection and sterilisation methods or in handling medicaments, ampoules etc. were seen in many practices. However, in the course of years remarkable improvements have been achieved. These data support the official plan according to which Public Health authorities will be obliged to check on hygienic conditions prevailing also in the consulting rooms of practising specialists.

Adult↗
PubMed2004

Controlling healthcare-associated infections: the role of infection control and antimicrobial use practices.

Healthcare-associated infections are a major cause of morbidity and mortality in pediatric patients in the United States and throughout the world. Overall rates of infection range widely depending on the pediatric population, with the highest rates being in patients in neonatal intensive care units, followed by those in pediatric intensive care units, immunocompromised patients, and those undergoing surgical procedures. Risk factors for healthcare-associated infection include intrinsic and extrinsic factors. The major intrinsic factors are age, birth weight, underlying diseases, and immune status. The major extrinsic factors are presence of invasive devices and procedures. The major risk factors for healthcare-associated infection caused by antimicrobial-resistant pathogens are either the transmission of pathogens from person to person (directly or indirectly, usually via the hands of healthcare workers) or the emergence of resistance after exposure to antimicrobials. Preventing healthcare-associated infections caused by antimicrobial-resistant pathogens requires a comprehensive approach that includes: 1) preventing infections through the use of vaccines and prophylaxis; 2) minimizing the use of invasive devices; 3) understanding and fully implementing (and complying with) current guideline recommendations for the prevention of infections; and 4) using antimicrobials judiciously. Implementing such a comprehensive program will reduce healthcare-associated infections, reduce the prevalence of antimicrobial-resistant pathogens, improve patient outcomes, and reduce health care costs.

Adolescent↗
PubMedDate not supplied

Infection control: old problems and new challenges.

Infection control faces radical changes at the beginning of the third millennium. The first part of this review focuses on problems not yet solved, such as 1) surveillance systems, which should be active and extremely flexible; 2) infection outbreaks in hospitals and strategies to avoid them; 3) hand washing and alternatives such as rapid hand antisepsis; 4) water and food in the hospital as potential reservoirs of nosocomial pathogens; 5) upgrading of infection control programs to turn them into systems to improve the quality of care; 6) fatal Gram-negative bacteremias in hospitals from developing countries, which can be avoided with better standards of care; 7) the elemental role of the microbiology laboratory in the prevention and control of infections; 8) the unprecedented crisis due to the emergence of specific multi-resistant pathogens; 9) the risks for healthcare workers, such as tuberculosis, hepatitis, HIV, SARS, and hemorrhagic fevers; and 10) the need for the consistent application of guidelines. The second part of this review focuses on new challenges for infection control, such as 1) the ever-growing number of immunocompromised patients and basic control measures to avoid opportunistic infections; 2) the concerns about the capacity of the public health systems to deal with terrorist acts; 3) the practice of high-risk procedures in facilities lacking trained personnel, efficient laboratories, and protective items; and 4) gene therapy and its potential infectious complications. Consideration is given to the asymmetric development of infection control globally.

Communicable Disease Control↗
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.↗
PubMed1995

The Certification Board of Infection Control, Inc.

The Certification Board of Infection Control, Inc. (CBIC), was created in 1981 by the Association for Professionals in Infection Control and Epidemiology, Inc, for the sole purpose of developing and administering an examination by which competent infection control professionals could become certified. This independent, voluntary board is multidisciplinary, representing all levels of professionals in the field of infection control, as well as a consumer member. CBIC certification is the only recognized certification for infection control professionals. Since the first examination was administered in 1983, over 3,000 persons have attained infection control certification (CIC) status and are permitted to use the CIC credential.

Educational Measurement↗
PubMed2001

Build your own infection control link nurse: an innovative study day.

Infection control is everyone's business and it is important that all members of staff observe good infection control practice. An effective infection control link nurse system has been shown to support and develop this approach. The strength of ward-based infection control link nurses depends upon their effectiveness as role models and their ability to influence practice on their wards and beyond. In addition, the degree of respect they command from their peers and colleagues and the amount and quality of knowledge they possess is crucial. This paper describes an innovative approach taken in Mid-Essex, which allowed infection control link nurses to assess their capabilities and limitations in communicating with and influencing colleagues. In addition, we show how quantitative measures may be made available by this approach. Such measures may be used to explain to management how particular areas of infection control practice (e.g. the need for infection control link nurses to have more authority and more 'muscle') may be important.

Infection Control↗
PubMed2004

The Lowbury lecture: behaviour in infection control.

The majority of healthcare-associated infections result from cross-transmission related to inappropriate patient-care practices. Improving practices frequently implies modifying healthcare workers' behaviour, a key challenge of today's infection control. To improve healthcare workers' compliance with practices, infection control should learn from the behavioural sciences. Social cognitive models can help to improve our understanding of human behaviour. Cognitive determinants that shape behaviour are acquired through the socialization process and are susceptible to change. Some models have been applied to evaluate predictors of health behaviour but, so far, none have been successfully applied to explain behaviour in the field of infection control. Successful strategies to improve infection control practices result from their multidimensional aspect. Similarly, social models that include several levels of cognitive determinants have more chance of success to explain change in behaviour. Concrete examples applied to infection control issues are presented, including special references to hand hygiene behaviour. The theory of ecological perspective, based on the idea that behaviour is viewed as being affected by and affecting multiple levels of influence, and that it both influences and is influenced by the social environment, seems promising to explain behaviour modification. Studies are needed to assess the key determinants of infection control practices and behaviour promotion among the different populations of healthcare workers, and to implement and evaluate the impact of the different components of multimodal programmes to promote optimal infection control practices.

Behavior↗
PubMed1984

Process surveillance: auditing infection control policies and procedures.

The infection control team in a university hospital designed, implemented, and evaluated a program to audit infection control policies. Process surveillance techniques of observation and monitoring were used during surveys of patient care areas to evaluate infection control practices. Nineteen unit surveys have been completed in a 2-year period. Analysis of the program has demonstrated it to be an effective method to determine compliance with infection control policies.

Communicable Disease Control↗
PubMedDate not supplied

Nosocomial infection control: role of the hospital administrator.

The role of the hospital administrator regarding the implementation and maintenance of programs for the prevention and control of nosocomial infections in U.S. hospitals is discussed. Data obtained in the Study on the Efficacy of Nosocomial Infection Control provide the basis for describing the backgrounds, demographic characteristics, functions, and potential functions of this official as s/he interacts with members of the infection control committee and other hospital staff. The infection control program of a hospital must have the support of the hospital administrator to be effective.

Cross Infection↗
PubMed1999

Results of a comprehensive infection control program for reducing surgical-site infections in coronary artery bypass surgery.

OBJECTIVE: To evaluate the efficacy of a comprehensive infection control program on the reduction of surgical-site infections (SSIs) following coronary artery bypass graft (CABG) surgery. DESIGN: Prospective cohort study. SETTING: 1,000-bed tertiary-care hospital. PATIENTS: Persons undergoing CABG with or without concomitant valve surgery from April 1991 through December 1994. INTERVENTIONS: Prospective surveillance, quarterly reporting of SSI rates, chlorhexidene showers, discontinuation of shaving, administration of antibiotic prophylaxis in the holding area, elimination of ice baths for cooling of cardioplegia solution, limitation of operating room traffic, minimization of flash sterilization, and elimination of postoperative tap-water wound bathing for 96 hours. Logistic regression models were fitted to assess infection rates over time, adjusting for severity of illness, surgeon, patient characteristics, and type of surgery. RESULTS: 2,231 procedures were performed. A reduction in infection rates was noted at all sites. The rate of deep chest infections decreased from 2.6% in 1991 to 1.6% in 1994. Over the same period, the rate of leg infections decreased from 6.8% to 2.7%, and of all SSI from 12.4% to 8.9%. The adjusted odds ratio (OR) for all SSIs for the end of 1994 compared to December 31, 1991, was 0.37 (95% confidence interval [CI95], 0.22-0.63). For deep chest and mediastinal infections, the adjusted OR comparing the same period was 0.69 (CI95, 0.28-1.71). CONCLUSIONS: We observed significant reductions in SSI rates of deep and superficial sites in CABG surgery following implementation of a comprehensive infection control program. These differences remained significant when adjusted for potential confounding covariables.

Adult↗
PubMed1995

Establishing an infection control structure.

In studies from the USA it has been shown that infection control can lower infection rates by 30%. To achieve this an infection control programme has to be given a firm structure. Judging from the opinions presented by an educational workshop within the International Federation of Infection Control (IFIC) and from the literature there is an international consensus on the basic components of hospital infection control. An infection control team, with the task of identifying areas of concern, providing or initiating work on written policies, educating and advising not only medical staff but also hospital administrators, constructors etc., constitutes the backbone of infection control. However, in most countries the infection control team, should it exist, is usually understaffed. This is false economy, a qualified medical input is a proven investment.

Forecasting↗
PubMed1996

Efficacy of hospital infection control in Thailand 1988-1992.

Hospital infection control in Thailand was initiated in 1971, but it was not until 1987 that active infection control activities actually started. To evaluate the efficacy of the infection control programme, two national prevalence studies of hospital acquired infection (HAI) were undertaken. The HAI prevalence rate in 1988 was 11.7%; this was reduced to 7.3% four years later. The reduction of HAI was found in hospitals of all sizes, in all types of infection and almost all services. This reduction happened despite a shortage of infection control personnel. Co-operation of administrators, doctors and nurses is essential for success in HAI control. Such co-operation has been successfully created by the Nosocomial Infection Control Group of Thailand.

Adolescent↗