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PubMed1993

A survey of hospital postpartum and postabortion rubella vaccination policies in Los Angeles County, 1992.

OBJECTIVE: To determine the proportion of Los Angeles County (LAC) hospitals offering obstetrical services that have postpartum and postabortion rubella vaccination policies. DESIGN: A survey was sent to the infection control practitioners (ICPs) of all operational acute care hospitals (N = 133) in LAC in 1992. A remainder and second survey was mailed to ICPs who did not respond to the first mailing. RESULTS: Of 75 hospitals with obstetrical departments, 56 (75%) responded. Thirty-four (61%) of the 56 respondent hospitals had post-partum rubella vaccination policies. Of the 34 hospitals with policies, 30 (88%) accepted only a written record of rubella seropositivity as proof of immunity, 30 (88%) screened women with unknown immunity status before hospital discharge, and 32 (94%) vaccinated susceptible women before hospital discharge. Of the 32 hospitals that performed induced abortions, only two (6%) provided screening and vaccination services for these women. CONCLUSION: Only 61% of hospitals in LAC offering obstetrical services had postpartum rubella vaccination policies while only minimal screening and vaccination occurred in association with abortion services. Widespread implementation of postabortion screening and vaccination, and more stringent compliance with Advisory Committee on Immunization Practices recommendations for postpartum screening and vaccination in hospitals offering obstetrical services would reduce the number of rubella-susceptible women who have been missed by other prevention strategies.

Female↗

PubMed1986

Infection control and the pregnant health care worker.

Health care workers may be exposed to a variety of infectious agents in the workplace. The pregnant health care worker presents additional concerns because of the potential risk of infection to the developing fetus. Health care workers often misunderstand the basic elements of infection transmission. The result of this misinformation is that personnel are most often concerned about the agents that are least transmissible. To develop an infection control program that is rational and workable, the infection control practitioner must have a thorough understanding of the mechanisms of disease transmission. With this foundation, an infection control program for the pregnant health care worker will rarely involve transfer to alternative assignments or work restriction based on pregnancy alone. The approach outlined in this article stresses a more generic approach to infection control by isolating the disease and not the employee.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Nosocomial infections in 15 rural Wisconsin hospitals--results and conclusions from 6 months of comprehensive surveillance.

Fifteen rural Wisconsin acute care community hospitals with an average approved bed size of 55 and an average daily census of 28 patients participated in a nosocomial infection control project. Each hospital Infection Control Practitioner (ICP) was trained and conducted prospective nosocomial infection surveillance on all patients admitted to the hospital for 6 consecutive months between May 1, 1984 and April 30, 1985. Two hundred twenty nosocomial infections were reported among 13,420 discharged patients for an incidence rate of 1.64 infections per 100 discharged patients. One hundred sixty-four patients had one nosocomial infection. Twenty-three patients had two or more. Infection rates were highest among gynecology--4.9% and general surgery patients--4.0%, and lowest among newborns--0.3% and pediatric patients--0%. 39.7% of the infections were of the urinary tract, 27.9% of surgical wounds, 16% pneumonia, and 1.4% primary bacteremia. The other infections were in seven additional sites. Risk factors associated with acquisition of infections included old age, urinary catheterization, and/or a surgical procedure. The overall nosocomial surgical wound infection incidence for inpatient procedures was 1.9%, with incidences of 0.4% for hernia repair, 1.3% for cholecystectomy, 3.3% for appendectomy, 4.0% for total abdominal hysterectomy, and 3.9% for cesarean sections. The incidence of nosocomial infections was 2.7 infections per 100 discharged patients age 65 years or over and 0.9 infections per 100 discharged patients less than 65 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Nosocomial viral infections: IV. Guidelines for cohort isolation, the communicable disease survey, collection, and transport of specimens for virus isolation, and considerations for the future.

Virus transmission within the hospital is related to transmissibility of the virus and susceptibility of the population at risk. General guidelines for the use of cohort isolation, for the control of virus transmission in the hospital, and for the use of the communicable disease survey for pediatric patients and visitors to the hospital are out-lined. We also present a brief review of how to collect and transport specimens for virus isolation to assist the infection control practitioner and the clinician and conclude with recommendations for further investigations in the areas of virology and infection control.

Child↗

PubMed1988

Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA).

Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs). However, reimbursement under the DRG system is not acceptable for all patients in all hospitals because it is neither an accurate predictor of costs nor of clinical outcome. This deficiency poses significant problems for hospitals because DRGs are used nationwide as the prospective payment system for inpatients covered by Medicare. Several case-mix adjusters have been proposed to modify DRGs to improve their accuracy in predicting costs and outcome. We reviewed five of the most widely available indices: Acute Physiologic and Chronic Health Evaluation (APACHE II), Coded Disease Staging, Computerized Severity Index (CSI), Medical Illness Severity Group System (MEDISGROUPS), and Patient Management Categories (PMC). Recommendations for the use of a single case-mix adjuster cannot be made at this time because all indices have not been compared in sufficiently diverse settings and because some are better predictors of costs while others are better predictors of clinical outcome. Hospital epidemiologists and other infection control practitioners should be informed about these indices and their potential applications as they expand their role beyond infection control problems to issues concerning cost containment, quality assurance, and reimbursement.

Cost Control↗

PubMed1995

Vascular infections: exceeding the threshold.

During fiscal year 1988, our hospital infection control practitioner identified a 400% increase in the incidence of vascular surgery nosocomial infections. The six graft and six amputation infections were validated as nosocomial against hospital definitions adopted from the Centers for Disease Control. Our Infection Control Committee mandated an audit of the infected vascular surgery patients using a case/control design to identify and examine associated variables that may need attention. The significant finding was microbial resistance to prophylactic antibiotics used during surgery (p > 0.0001, Fisher's exact). The use of vancomycin as a prophylactic antimicrobial agent for all major vascular cases was recommended to the surgeons.

Anti-Bacterial Agents↗

PubMed1988

Surgical gowns and drapes as aseptic barriers.

The use of surgical gowns and drapes has become the standard of practice in the arena of surgical aseptic technique. Because of myriad of materials, both woven and nonwoven, are currently available, users are faced with the difficult task of choosing a bacteriologic barrier material that is effective, safe, and economical. Although recommendations are available for general selection and use of barrier materials, no specific guidelines exist to assist the user in evaluating the important features of barriers. In addition, standards are lacking for safety characteristics such as flammability and fiber content. The infection control practitioner needs to be aware of the issues surrounding surgical barrier materials to be able to put the infection control merits of these materials in their proper perspective.

Antisepsis↗

PubMed1988

Validating the certification process for infection control practice.

Approximately 5 years ago a task analysis was conducted by the Certification Board of Infection Control (CBIC) to describe infection control practice. This task analysis served as the basis for development of the certification examination. This article describes the process used to update and revalidate the original task analysis to ensure the continued validity and job relatedness of the certification process. Using a modified Delphi technique, several panels of representative expert infection control practitioners (ICPs), a total of 29 persons, participated in an iterative process to define the practice dimensions of infection control and to link these practice dimensions to the certification examination. In general, there was a high level of congruence between respondents on the original task analysis and the expert panels, although a few differences in practice were identified among ICPs in extended care facilities and a few new tasks were identified. In addition, a revised content outline for the examination was created by placing clusters of knowledge statements together around common themes.

Certification↗

PubMed2005

Cost of a ventilator-associated pneumonia in a shock trauma intensive care unit.

BACKGROUND: Nosocomial pneumonia and especially ventilator-associated pneumonia (VAP) are costly complications for the hospitalized patient. Nosocomial pneumonia has been estimated to cost $5,000 per episode, but the specific cost for a VAP has not been well estimated. As part of a successful performance improvement program in decreasing VAP from 10 VAPs/100 ICU admissions to 2.5 VAPs/100 ICU admissions, we examined the costs associated with VAP. METHODS: From January 1, 2002, through September 30, 2003, Shock Trauma Intensive Care Unit patients and charts were reviewed concurrently by an infection control practitioner for development of VAP as defined by National Nosocomial Infection Surveillance (NNIS) guidelines. Costs were obtained from the hospital's cost accounting software Transition Systems version 3.1.01 (TSI). All patients requiring greater than one day of mechanical ventilation were evaluated. Seventy patients with VAP and 70 patients without VAP were matched according to age and Injury Severity Score. Differences were compared using Kruskal-Wallis and two sample T-tests. Significance was considered for p < 0.05. RESULTS: The ICU cost difference was significant (p < 0.05) between the case-controlled patients with VAP ($82,195) and those without VAP ($25,037). There was also a significant increase in ICU length of stay (21.6 versus 6.4 days) and the number of ventilator days (17.7 versus 5.8; both, p < 0.05). Mortality was not different in the case-controlled population. A substantial portion of the increased cost of a VAP was from the increase in ICU length of stay ($1,861/day). Pharmacy, respiratory and "other" also accounted for the increases when cost distribution was analyzed. This translates into a cost avoidance of approximately $428,685 per 100 admissions to the ICU. CONCLUSIONS: Ventilator-associated pneumonia not only leads to a significant increase in ventilator days and ICU length of stay, but adds substantially to hospital costs. In our ICU, an episode of VAP costs $57,000 per occurrence.

Adult↗

PubMed1985

Survey of purchasers of The APIC Curriculum for Infection Control Practice: findings and recommendations.

A survey of purchasers of The APIC Curriculum for Infection Control Practice was conducted in early 1985 by the APIC Curriculum Committee to determine characteristics of purchasers, usability of the text, reasons for purchase, and availability of references cited. Data were obtained from 342 (54.3%) respondents to a nationwide mail survey sent to a 20% sample (630) of all who were purchasers prior to January 1985. The average purchaser was an Infection Control Practitioner (ICP) who was a nurse employed by an acute care community hospital and had 6.9 years experience in infection control practice; 41% of purchasers worked in hospitals with greater than 300 beds. APIC members represented 93% of the respondents, and their disciplines were similar to those of the membership. Primary reasons for purchasing the Curriculum were to use it as the major reference for infection control information and to study for the Infection Control Certification Examination. Almost half of the respondents had taken and passed the examination. The overall satisfaction with format and style suggests that it was well-received and usable. Purchase of the Curriculum was strongly associated with hospital size. ICPs practicing in hospitals with less than 100 beds were less likely to have purchased the book than those in larger hospitals. Availability of references was also associated with hospital size. Future editions of the Curriculum need to reflect consideration of the relationship between hospital size and availability of references in their approach to completeness of information.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2004

An unwanted visitor. Aggressive infection control strategies are needed to shorten the hospital visit of the easily spread norovirus.

Norovirus is the name for a group of Norwalk-like viruses that cause acute gastroenteritis of rapid onset. A recent outbreak at a tertiary care facility in Alberta provided an opportunityfor staff and management to review their outbreak protocol and improve their infection prevention and control procedures. The outbreak caused illness in 32 of 73 exposed patients as well as 42 staff members. None of the infected patients or staff developed complications. The source of norovirus contamination was probably associated with a symptomatic food services staff member serving food cafeteria style in a satellite patient dining room. Food service procedures and serving techniques were reviewed; although no breaks in technique were identified, correct food handling procedures were reviewed with staff. Subsequent patient and staff cases were probably related to the cross contamination of environmental surfaces and patient care equipment. The director of nursing and the infection control practitioner led the investigation and management of the outbreak. An Outbreak Management Committee was also formed to reinforce routine infection prevention practices and implement infection control strategies. Communication strategies for staff, patients and visitors were quickly devised and implemented. Gaps in the outbreak protocol were identified and resolved promptly Four permanent changes were made: the use of alcohol hand rinse in designated locations; the development of a comprehensive e-mail to facilitate site-wide communication; the development of teamwork checklists and accountabilities; and the establishment of criteria for use in outbreak situations to proactively determine essential and non-essential therapies and treatments.

Alberta↗

PubMed1989

Containing costs of antimicrobials in the hospital: a critical evaluation.

Because reimbursement of hospitals from patient sources for the cost of antimicrobial agents varies considerably according to the nature of the patient population, the actual savings potential of cost-containment efforts is proportional to the extent that costs are not reimbursed. Meaningful cost estimations include calculations for drug preparation, administration, necessary laboratory tests, toxicity, and acquisition. Savings in surgical antimicrobial prophylaxis may be estimated according to the type and volume of operations, history of usage excesses, and anticipated degree of cooperation of surgeons. In therapy, savings generally derive from restricting use of costly drugs. Studies that demonstrate similar outcomes of patient care in restricted and unrestricted settings are presently lacking. Such studies are essential for programs that promote change from parenteral to oral antimicrobials, because they may shorten the length of hospitalization. The outcome of antimicrobial cost-containment efforts in patient care should be monitored as a surveillance activity to be conducted by infection control practitioners involved with quality assessment.

Anti-Bacterial Agents↗

PubMed1984

Epidemic keratoconjunctivitis: report of an outbreak in an ophthalmology practice and recommendations for prevention.

In Fall 1981, an outbreak of acute infectious conjunctivitis with keratitis (EKC) occurred in patients who had visited a private ophthalmology clinic just prior to onset of illness. Among an estimated 2,200 patient visits to the office from August 10 to October 15, 1981 for problems unrelated to infectious conjunctivitis, 39 (1.8%) persons subsequently developed EKC. The median incubation period was 6.5 days (range, 1 to 14 days). A case-control study was done to identify risk factors associated with contracting EKC; patients with EKC were more likely than control patients to have been examined by one or the other of two of the four ophthalmologists at the clinic and to have undergone procedures such as tonometry or foreign body removal. Adenovirus was isolated from conjunctival swabs from four of five persons with conjunctivitis; three were type 8 and one was type 7. Recognition of the problem and improved handwashing practices were associated with terminating the outbreak. This outbreak illustrates the potential for transmission of adenovirus infection during the provision of eye care. Infection control practitioners should be familiar with measures for the prevention of such infections among ophthalmology patients.

Adenoviridae Infections↗

PubMed1982

Customizing infection control educational programs within the health care facility. Meeting a challenge vs. just satisfying a requirement.

Infection control practitioners working within health care facilities are charged with the providing of in-service education programs for all new employees and volunteers as well as for all hospital departments, at least annually. To be effective, each program should be customized to meet the needs of the group for which it is given. Such a charge may be viewed as simply a "requirement that must be satisfied," or it may be approached as a challenge to be met with a measure of ingenuity and inventiveness. Academic preparation in the principles and skills germane to teaching are traditionally lacking in the training of health care professionals, and the ICP is thus left accountable for a job function for which she/he may have little proficiency. Customized education programs may be achieved with thoughtful planning and through the use of a few innovative ideas and resource materials available to most practitioners.

Communicable Disease Control↗

PubMed1989

Infections in open heart surgery.

More than 250,000 open heart surgical procedures are performed annually in the United States. The majority of these procedures are coronary artery bypass grafts (CABG) and valve replacements. In this forum our authors discuss the kinds of infections that occur in patients following open heart surgery, as well as the documented risk factors and microbiology of these infections. We also asked each author to outline the criteria used to diagnose post open heart surgery infections, and to address associated consequences and complications. Finally, we were interested in each author's definition of the infection control practitioner's role in the prevention of this particular subset of nosocomial infections.

Cardiac Surgical Procedures↗

PubMed1984

Literature search reveals focus of cost savings.

In the midst of this economic crisis, a role of the Infection Control Practitioner (ICP) is to creatively seek a means of defining cost effective practices. One approach is reflected through this 10-year retrospective analysis of all published infection control literature between 1974 and 1984 (up to February 1984).

Communicable Disease Control↗

PubMed1981

Nosocomial infections--a 1980 view: progress, priorities and prognosis.

Following a brief historic perspective, this review highlights the progress that has been made in the field of nosocomial infections in the past decade. Scientific progress has been made in a few efficacy studies, the determinative role of the host, concepts of immunoincompetence, emerging pathogens, such as Legionnella pneumophila, the epidemiology of antimicrobial drug resistance and concepts of chemoprophylaxis. Major advances have been made in preventing a few specific nosocomial infections such as hepatitis B. The evolving roles of infection control practitioners and hospital epidemiologists represent important progress in meeting manpower needs. Major failures of the past decade include the continuing absence of an acceptable scientific basis for infection control, the lack of standards for hospital infection control and the consequent inability to carry out effective education. Major challenges in the 1980s will be to determine what is effective and what is not in infection control activities, and to focus control activities and recommendations more sharply.

Cross Infection↗

PubMed1991

Risk management: an aspect of infection control in an acute care hospital.

The term 'risk management' is one that may cause apprehension in the minds of some infection control practitioners because it conjures up images from the non-health care world. However, when the concept of risk management is analyzed and applied to the field of infection control one discovers a large overlap. The purpose of this article is to highlight some of this common ground. It may show that, rather than fear risk management, one may be better advised to recognize it as an aspect of infection control.

Cross Infection↗