|
1
|
Nalliah RP, Chheda R, Belgal PG, Kaur J, Mhay S, Haas S, Rowan SA. Variation in response to the coronavirus disease 2019 (COVID-19) at US dental school clinics. J Dent Educ 2024; 88:425-433. [PMID: 38229474 DOI: 10.1002/jdd.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Although the threat of coronavirus disease 2019 (COVID-19) was the same at different US dental schools, the response wasn't. There is no study that documents the variation in mitigation strategies, COVID-19 transmission, and clinical educational changes at US Dental schools during the ongoing pandemic that began in 2020 in the US. METHODS The current study was approved as exempt research (project number HUM00199261). Our survey of Associate Dean's of Clinical Operations was individually emailed in July 2021. There were no reminders and descriptive statistics were calculated using Microsoft Excel. RESULTS We received 46 completed surveys from the 68 sent out. Note that 65.2% of respondents reported requiring N95 masks for aerosol-generating procedures. Note that 38.9% of respondents said they required student partnering as chairside dental assistants for aerosol-generating procedures. Note that 37.7% of respondents began using alternate cubicles. A total of 6.52% of schools reported a transmission of the severe acute respiratory syndrome coronavirus 2 virus from patient to provider. There were no reported transmissions from provider to patient or from patient to patient. CONCLUSION In our study, we found a lot of similarities between the approach taken by Dental School Clinics across the US to mitigate the risks of COVID-19, however, we also observed many differences.
Collapse
Affiliation(s)
- Romesh P Nalliah
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Riddhi Chheda
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | | | - Jasmine Kaur
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Sahil Mhay
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Steven Haas
- School of Dentistry, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Susan A Rowan
- University of Illinois College of Dentistry, Chicago, Illinois, USA
| |
Collapse
|
|
2
|
Rennert-May E, Conly J, Leal J, Smith S, Manns B. Economic evaluations and their use in infection prevention and control: a narrative review. Antimicrob Resist Infect Control 2018; 7:31. [PMID: 29492261 PMCID: PMC5828323 DOI: 10.1186/s13756-018-0327-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this review is to provide a comprehensive overview of the different types of economic evaluations that can be utilized by Infection Prevention and Control practitioners with a particular focus on the use of the quality adjusted life year, and its associated challenges. We also highlight existing economic evaluations published within Infection Prevention and Control, research gaps and future directions. Design Narrative Review. Conclusions To date the majority of economic evaluations within Infection Prevention and Control are considered partial economic evaluations. Acknowledging the challenges, which include variable utilities within infection prevention and control, a lack of randomized controlled trials, and difficulty in modelling infectious diseases in general, future economic evaluation studies should strive to be consistent with published guidelines for economic evaluations. This includes the use of quality adjusted life years. Further research is required to estimate utility scores of relevance within Infection Prevention and Control.
Collapse
Affiliation(s)
- Elissa Rennert-May
- 1Departments of Medicine and Community Health Sciences, University of Calgary, and Alberta Health Services, AGW5 Ground Floor SSB, 1403 29 St NW, Calgary, AB T2N 2T9 Canada
| | - John Conly
- 2Departments of Medicine, Immunology, Microbiology and Infectious Diseases, Pathology and Laboratory Medicine, O'Brien Institute for Public Health and Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB Canada
| | - Jenine Leal
- Department of Community Health Sciences, University of Calgary and Infection Prevention and Control, Alberta Health Services, Foothills Medical Centre, Calgary, AB Canada
| | - Stephanie Smith
- 4Department of Medicine, University of Alberta and University of Alberta Hospital and Alberta Health Services, Edmonton, AB Canada
| | - Braden Manns
- 5Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, University of Calgary and Alberta Health Services, Calgary, AB Canada
| |
Collapse
|
|
3
|
Yoon YK, Lee SE, Seo BS, Kim HJ, Kim JH, Yang KS, Kim MJ, Sohn JW. Current status of personnel and infrastructure resources for infection prevention and control programs in the Republic of Korea: A national survey. Am J Infect Control 2016; 44:e189-e193. [PMID: 27810068 PMCID: PMC7132641 DOI: 10.1016/j.ajic.2016.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is significant variability in personnel and infrastructural resources for infection prevention and control (IPC) among health care institutions. The aim of this study is to evaluate the current status of individual hospital-based IPC programs in the Republic of Korea (ROK). METHODS A multicenter cross-sectional survey of 100 hospitals participating in the national surveillance programs for multidrug-resistant organisms (MDROs) in the ROK was conducted in September 2015. The survey consisted of 140 standardized Web-based questionnaires. RESULTS The survey response rate was 41.0%. The responding hospitals are largely organized with multibed rooms, with an insufficient numbers of single rooms. Employment status of infection specialists and hand hygiene resources were better in larger hospitals. The responding hospitals had 1 full-time infection control nurse per 400.3 ± 154.1 beds, with wide variations in training and experience. Facilities have great diversity in their approach to preventing MDROs. There appeared to be no difference in supplies consumption and protocols for IPC among the hospitals, stratified according to size. CONCLUSIONS A greater availability of specialist personnel, single rooms, and a comprehensive IPC program, with the support of a policy-oriented management, is necessary to achieve effective IPC.
Collapse
Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea; Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea
| | - Sung Eun Lee
- Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea
| | - Beom Sam Seo
- Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea
| | - Hyeon Jeong Kim
- Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Sook Yang
- Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea; Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea; Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea.
| |
Collapse
|
|
4
|
Russo PL, Chen G, Cheng AC, Richards M, Graves N, Ratcliffe J, Hall L. Novel application of a discrete choice experiment to identify preferences for a national healthcare-associated infection surveillance programme: a cross-sectional study. BMJ Open 2016; 6:e011397. [PMID: 27147392 PMCID: PMC4861107 DOI: 10.1136/bmjopen-2016-011397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To identify key stakeholder preferences and priorities when considering a national healthcare-associated infection (HAI) surveillance programme through the use of a discrete choice experiment (DCE). SETTING Australia does not have a national HAI surveillance programme. An online web-based DCE was developed and made available to participants in Australia. PARTICIPANTS A sample of 184 purposively selected healthcare workers based on their senior leadership role in infection prevention in Australia. PRIMARY AND SECONDARY OUTCOMES A DCE requiring respondents to select 1 HAI surveillance programme over another based on 5 different characteristics (or attributes) in repeated hypothetical scenarios. Data were analysed using a mixed logit model to evaluate preferences and identify the relative importance of each attribute. RESULTS A total of 122 participants completed the survey (response rate 66%) over a 5-week period. Excluding 22 who mismatched a duplicate choice scenario, analysis was conducted on 100 responses. The key findings included: 72% of stakeholders exhibited a preference for a surveillance programme with continuous mandatory core components (mean coefficient 0.640 (p<0.01)), 65% for a standard surveillance protocol where patient-level data are collected on infected and non-infected patients (mean coefficient 0.641 (p<0.01)), and 92% for hospital-level data that are publicly reported on a website and not associated with financial penalties (mean coefficient 1.663 (p<0.01)). CONCLUSIONS The use of the DCE has provided a unique insight to key stakeholder priorities when considering a national HAI surveillance programme. The application of a DCE offers a meaningful method to explore and quantify preferences in this setting.
Collapse
Affiliation(s)
- Philip L Russo
- Institute of Health and Biomedical Innovation, School of Public Health and Welfare, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Gang Chen
- Flinders Health Economics Group, School of Medicine, Flinders University, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Allen C Cheng
- Infectious Diseases Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Infection Prevention and Healthcare Epidemiology Unit, Monash University, Alfred Health, Prahran, Victoria, Australia
| | - Michael Richards
- Faculty of Medicine, Dentistry and Health, University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, School of Public Health and Welfare, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Lisa Hall
- Institute of Health and Biomedical Innovation, School of Public Health and Welfare, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| |
Collapse
|
|
5
|
Necessary Infrastructure of Infection Prevention and Healthcare Epidemiology Programs: A Review. Infect Control Hosp Epidemiol 2016; 37:371-80. [PMID: 26832072 DOI: 10.1017/ice.2015.333] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The scope of a healthcare institution's infection prevention and control/healthcare epidemiology program (IPC/HE) should be driven by the size and complexity of the patient population served, that population's risk for healthcare-associated infection (HAI), and local, state, and national regulatory and accreditation requirements. Essential activities of all IPC/HE programs include but are not limited to the following: ∙ Surveillance.∙ Performance improvement to reduce HAI ∙ Acute event response, including outbreak investigation ∙ Education and training of both healthcare personnel and patients ∙ Reporting of HAI to the Centers for Disease Control and Prevention's National Healthcare Safety Network as well as entities required by law.
Collapse
|
|
6
|
Mathioudakis N, Pronovost PJ, Cosgrove SE, Hager D, Golden SH. Modeling Inpatient Glucose Management Programs on Hospital Infection Control Programs: An Infrastructural Model of Excellence. Jt Comm J Qual Patient Saf 2015; 41:325-36. [PMID: 26108126 DOI: 10.1016/s1553-7250(15)41043-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nestoras Mathioudakis
- Inpatient Diabetes Management Service, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore, USA
| | | | | | | | | |
Collapse
|
|
7
|
Borer A, Gilad J, Hyam E, Schlaeffer F, Schlaeffer P, Eskira S, Aloni P, Wagshal A, Katz A. Prevention of Infections Associated With Permanent Cardiac Antiarrhythmic Devices by Implementation of a Comprehensive Infection Control Program. Infect Control Hosp Epidemiol 2015; 25:492-7. [PMID: 15242198 DOI: 10.1086/502428] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To implement a comprehensive infection control (IC) program for prevention of cardiac device-associated infections (CDIs).Design:Prospective before-after trial with 2 years of follow-up.Setting:A tertiary-care, university-affiliated medical center.Patients:A consecutive sample of all adults undergoing cardiac device implantation between 1997 and 2002.Intervention:An IC program was implemented during late 2001 and included staff education, preoperative modification of patient risk factors, intraoperative control of strict aseptic technique, surgical scrubbing and attire, control of environmental risk factors, optimization of antibiotic prophylaxis, postoperative wound care, and active surveillance. The clinical endpoint was CDI rates.Results:Between 1997 and 2000, there were 7 CDIs among 725 procedures (mean annual CDI incidence, 1%). During the first 9 months of 2001, there were 7 CDIs among 167 procedures (4.2%; P = .007): CDIs increased from 7 among 576 to 3 among 124 following pacemaker implantation (P = .39) and from 0 among 149 to 4 among 43 following cardioverter-defibrillator implantation (P = .002). Of the 14 CDIs, 5 involved superficial wounds, 7 involved deep wounds, and 2 involved endocarditis. Following intervention, there were no cases of CDI among 316 procedures during 24 months of follow-up (4.2% reduction; P = .0005).Conclusions:We observed a high CDI rate associated with substantial morbidity. IC measures had an impact on CDI. Although the relative weight of each measure in the prevention of CDI remains unknown, our results suggest that implementation of a comprehensive IC program is feasible and efficacious in this setting.
Collapse
Affiliation(s)
- Abraham Borer
- Infectious Disease Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
|
8
|
Stone PW, Pogorzelska-Maziarz M, Herzig CT, Weiner LM, Furuya EY, Dick A, Larson E. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. Am J Infect Control 2014; 42:94-9. [PMID: 24485365 DOI: 10.1016/j.ajic.2013.10.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND This report provides a national cross-sectional snapshot of infection prevention and control programs and clinician compliance with the implementation of processes to prevent health care-associated infections (HAIs) in intensive care units (ICUs). METHODS All hospitals, except Veterans Affairs hospitals, enrolled in the National Healthcare Safety Network (NHSN) were eligible to participate. Participation involved completing a survey assessing the presence of evidence-based prevention policies and clinician adherence and joining our NHSN research group. Descriptive statistics were computed. Facility characteristics and HAI rates by ICU type were compared between respondents and nonrespondents. RESULTS Of the 3,374 eligible hospitals, 975 provided data (29% response rate) on 1,653 ICUs, and there were complete data on the presence of policies in 1,534 ICUs. The average number of infection preventionists (IPs) per 100 beds was 1.2. Certification of IP staff varied across institutions, and the average hours per week devoted to data management and secretarial support were generally low. There was variation in the presence of policies and clinician adherence to these policies. There were no differences in HAI rates between respondents and nonrespondents. CONCLUSIONS Guidelines for IP staffing in acute care hospitals need to be updated. In future work, we will analyze the associations between HAI rates and infection prevention and control program characteristics, as well as the inplementation of and clinician adherence to evidence-based policies.
Collapse
|
|
9
|
Conway LJ, Raveis VH, Pogorzelska-Maziarz M, Uchida M, Stone PW, Larson EL. Tensions inherent in the evolving role of the infection preventionist. Am J Infect Control 2013; 41:959-64. [PMID: 23880116 DOI: 10.1016/j.ajic.2013.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/22/2013] [Accepted: 04/05/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of infection preventionists (IPs) is expanding in response to demands for quality and transparency in health care. Practice analyses and survey research have demonstrated that IPs spend a majority of their time on surveillance and are increasingly responsible for prevention activities and management; however, deeper qualitative aspects of the IP role have rarely been explored. METHODS We conducted a qualitative content analysis of in-depth interviews with 19 IPs at hospitals throughout the United States to describe the current IP role, specifically the ways that IPs effect improvements and the facilitators and barriers they face. RESULTS The narratives document that the IP role is evolving in response to recent changes in the health care landscape and reveal that this progression is associated with friction and uncertainty. Tensions inherent in the evolving role of the IP emerged from the interviews as 4 broad themes: (1) expanding responsibilities outstrip resources, (2) shifting role boundaries create uncertainty, (3) evolving mechanisms of influence involve trade-offs, and (4) the stress of constant change is compounded by chronic recurring challenges. CONCLUSION Advances in implementation science, data standardization, and training in leadership skills are needed to support IPs in their evolving role.
Collapse
|
|
10
|
Murphy RJ. Preventing multidrug-resistant gram-negative organisms in surgical patients. AORN J 2013; 96:315-29. [PMID: 22935259 DOI: 10.1016/j.aorn.2012.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/30/2012] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
Abstract
Multidrug-resistant gram-positive infections have consumed the attention of health care organizations as well as the media, but recently multidrug-resistant gram-negative organisms (MDR-GNOs) have become more and more prevalent. Limited treatment options are available for MDR-GNO infections; thus, prevention is key. Patients who are at high risk for developing infections must be identified, and specialized prevention interventions must be developed for their care. Surgical patients are one subset of patients at high risk for developing MDR-GNOs. Advanced practice nurses must support nurses and other health care personnel in preventing MDR-GNO infections. Education should include active surveillance, contact precautions, cohorting patients and staff members, unit closures, reinforced hand hygiene practices, and environmental cleaning tailored to the care of surgical patients in regard to their preoperative, intraoperative, and postoperative care.
Collapse
|
|
11
|
Abstract
Disinfection and sterilization in hospitals, is of increasing concern. Nosocomial infections can be defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. They affect 1 in 10 patients admitted to hospital. Nosocomial infections are associated with a great deal of morbidity, mortality, and increased financial burden
Collapse
Affiliation(s)
- Angela Revelas
- Department of Pathological, General Hospital of St.Nicolaos, Crete-Greece
| |
Collapse
|
|
12
|
Borkow G, Monk A. Fighting nosocomial infections with biocidal non-intrusive hard and soft surfaces. World J Clin Infect Dis 2012; 2:77-90. [DOI: 10.5495/wjcid.v2.i4.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Approximately 7 million people worldwide acquire a healthcare associated infection each year. Despite aggressive monitoring, hand washing campaigns and other infection control measures, nosocomial infections (NI) rates, especially those caused by antibiotic resistant pathogens, are unacceptably high worldwide. Additional ways to fight these infections need to be developed. A potential overlooked and neglected source of nosocomial pathogens are those found in non-intrusive soft and hard surfaces located in clinical settings. Soft surfaces, such as patient pyjamas and beddings, can be an excellent substrate for bacterial and fungal growth under appropriate temperature and humidity conditions as those present between patients and the bed. Bed making in hospitals releases large quantities of microorganisms into the air, which contaminate the immediate and non-immediate surroundings. Microbes can survive on hard surfaces, such as metal trays, bed rails and door knobs, for very prolonged periods of time. Thus soft and hard surfaces that are in direct or indirect contact with the patients can serve as a source of nosocomial pathogens. Recently it has been demonstrated that copper surfaces and copper oxide containing textiles have potent intrinsic biocidal properties. This manuscript reviews the recent laboratory and clinical studies, which demonstrate that biocidal surfaces made of copper or containing copper can reduce the microbiological burden and the NI rates.
Collapse
|
|
13
|
Hübner NO, Fleßa S, Jakisch R, Assadian O, Kramer A. Review of indicators for cross-sectoral optimization of nosocomial infection prophylaxis - a perspective from structurally- and process-oriented hygiene. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2012; 7:Doc15. [PMID: 22558049 PMCID: PMC3334955 DOI: 10.3205/dgkh000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the care of patients, the prevention of nosocomial infections is crucial. For it to be successful, cross-sectoral, interface-oriented hygiene quality management is necessary. The goal is to apply the HACCP (Hazard Assessment and Critical Control Points) concept to hospital hygiene, in order to create a multi-dimensional hygiene control system based on hygiene indicators that will overcome the limitations of a procedurally non-integrated and non-cross-sectoral view of hygiene. Three critical risk dimensions can be identified for the implementation of three-dimensional quality control of hygiene in clinical routine: the constitution of the person concerned, the surrounding physical structures and technical equipment, and the medical procedures. In these dimensions, the establishment of indicators and threshold values enables a comprehensive assessment of hygiene quality. Thus, the cross-sectoral evaluation of the quality of structure, processes and results is decisive for the success of integrated infection prophylaxis. This study lays the foundation for hygiene indicator requirements and develops initial concepts for evaluating quality management in hygiene.
Collapse
|
|
14
|
Sydnor ERM, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev 2011; 24:141-73. [PMID: 21233510 PMCID: PMC3021207 DOI: 10.1128/cmr.00027-10] [Citation(s) in RCA: 343] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to grow as rates of antimicrobial resistance rise and HAIs lead to increasing risks to patients and expanding health care costs. In this review, we summarize the history of the development of hospital epidemiology and infection control, common HAIs and the pathogens causing them, and the structure and role of a hospital epidemiology and infection control program.
Collapse
Affiliation(s)
- Emily R. M. Sydnor
- Department of Medicine, Division of Infectious Diseases, Department of Hospital Epidemiology and Infection Control, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trish M. Perl
- Department of Medicine, Division of Infectious Diseases, Department of Hospital Epidemiology and Infection Control, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
|
15
|
The impact of health care restructuring on nosocomially acquired blood stream infections. Can J Infect Dis 2010; 11:34-7. [PMID: 18159263 DOI: 10.1155/2000/869091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/1999] [Accepted: 07/28/1999] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the impact of the health care restructuring, which occurred in Alberta in 1995, on the occurrence of nosocomial blood stream infection and risk factors for these infections at the University of Alberta Hospital. PATIENTS AND METHODS Changes in patient population, hospital bed numbers, admissions and hospital days for 1993 and 1994 (1993/94) were compared with those for 1996 and 1997(1996/97). Central venous catheter (CVC) use in intensive care units (ICU), days of total parenteral nutrition (TPN) and hemodialysis were compared for the two time periods. Prospectively collected data obtained by monitoring blood culture results on nosocomial blood stream infections in 1993/94 were compared with those obtained in 1996/97. RESULTS Hospital bed number fell by 10% between 1993/94 and 1996/97. Annual admissions fell by 19% and patient days by 17%. Some services markedly increased patient days (neurosurgery 49%, nephrology 30%, orthopedic surgery 24%), and others markedly reduced patient days (obstetrics and gynecology 99%, ophthalmology 100%, adult medicine 41%, general paediatrics 38%). ICU use of CVCs increased by 41%, TPN days increased by 25% and hemodialysis runs increased by 9%. Annual nosocomial blood stream infections increased by 31% and the annual rate per 10,000 patient days increased by 60%. TPN-related blood stream infection rates and ICU CVC infection rates did not change from 1993/94 to 1996/97. CONCLUSIONS Hospital restructuring has been associated with a 31% increase in nosocomial blood stream infection number and a 60% increase in rate. The increase has been associated with a change in patient populations and increases in risk factors for blood stream infection.
Collapse
|
|
16
|
Rangel-Frausto MS, Higuera-Ramirez F, Martinez-Soto J, Rosenthal VD. Should we use closed or open infusion containers for prevention of bloodstream infections? Ann Clin Microbiol Antimicrob 2010; 9:6. [PMID: 20122280 PMCID: PMC2829484 DOI: 10.1186/1476-0711-9-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 02/02/2010] [Indexed: 11/23/2022] Open
Abstract
Background Hospitalized patients in critical care settings are at risk for bloodstream infections (BSI). Most BSIs originate from a central line (CL), and they increase length of stay, cost, and mortality. Open infusion containers may increase the risk of contamination and administration-related (CLAB) because they allow the entry of air into the system, thereby also providing an opportunity for microbial entry. Closed infusion containers were designed to overcome this flaw. However, open infusion containers are still widely used throughout the world. The objective of the study was to determine the effect of switching from open (glass, burettes, and semi-rigid) infusion containers to closed, fully collapsible, plastic infusion containers (Viaflex®) on the rate and time to onset of central line-associated bloodstream infections CLABs. Methods An open label, prospective cohort, active healthcare-associated infection surveillance, sequential study was conducted in four ICUs in Mexico. Centers for Disease Control National Nosocomial Infections Surveillance Systems definitions were used to define device-associated infections. Results A total of 1,096 adult patients who had a central line in place for >24 hours were enrolled. The CLAB rate was significantly higher during the open versus the closed container period (16.1 versus 3.2 CLAB/1000 central line days; RR = 0.20, 95% CI = 0.11-0.36, P < 0.0001). The probability of developing CLAB remained relatively constant in the closed container period (1.4% Days 2-4 to 0.5% Days 8-10), but increased in the open container period (4.9% Days 2-4 to 5.4% Days 8-10). The chance of acquiring a CLAB was significantly decreased (81%) in the closed container period (Cox proportional hazard ratio 0.19, P < 0.0001). Mortality was statistically significantly lower during the closed versus the open container period (23.4% versus 16.1%; RR = 0.69, 95% CI = 0.54-0.88, P < 0.01). Conclusions Closed infusion containers significantly reduced CLAB rate, the probability of acquiring CLAB, and mortality.
Collapse
|
|
17
|
Guerra CM, Ramos MP, Penna VZ, Goto JM, Santi LQ, de Andrade Stempliuk V, Sallas J, Medeiros EAS. Perceptions and attitudes of the professional staff concerning infection surveillance and control programs in Brazilian hospitals. Am J Infect Control 2010; 38:59-62. [PMID: 19748704 DOI: 10.1016/j.ajic.2009.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 03/04/2009] [Accepted: 05/12/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several countries have conducted studies to assess the status of their infection control programs (ICP) with the objective of improving quality of infection control practices. METHODS To assess the perceptions and attitudes of the health care workers (HCW) concerning ICP in Brazilian hospitals, we conducted a cross-sectional survey using a self-administered online questionnaire during a Web-based course (WBC) on infection control (IC) and antimicrobial resistance (AR). RESULTS Of 6256 Brazilian HCW registered for the WBC, 1998 were members of infection control committees (ICC) and answered the survey. Eight hundred six (40.4%) respondents said that an ICP was established for more than 10 years in their institutions. Most professionals reported that their hospitals perform microbiologic surveillance targeted at epidemiologically important multidrug-resistant organisms, but the majority underestimated the prevalence of AR. CONCLUSION Our survey highlights important information about the perceptions and attitudes of ICC members that may be used to tailor key interventions for implementing effective ICP. It suggests, additionally, that, to achieve countrywide standardized IC mechanisms in a developing country, authorities should consider the social, cultural, and economical disparities between regions and identify specific regional needs to make available the resources required to minimize such disparities.
Collapse
|
|
18
|
Claridge JA, Golob JF, Fadlalla AMA, D'Amico BM, Peerless JR, Yowler CJ, Malangoni MA. Who is monitoring your infections: shouldn't you be? Surg Infect (Larchmt) 2009; 10:59-64. [PMID: 19250007 DOI: 10.1089/sur.2008.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the era of pay for performance and outcome comparisons among institutions, it is imperative to have reliable and accurate surveillance methodology for monitoring infectious complications. The current monitoring standard often involves a combination of prospective and retrospective analysis by trained infection control (IC) teams. We have developed a medical informatics application, the Surgical Intensive Care-Infection Registry (SIC-IR), to assist with infection surveillance. The objectives of this study were to: (1) Evaluate for differences in data gathered between the current IC practices and SIC-IR; and (2) determine which method has the best sensitivity and specificity for identifying ventilator-associated pneumonia (VAP). METHODS A prospective analysis was conducted in two surgical and trauma intensive care units (STICU) at a level I trauma center (Unit 1: 8 months, Unit 2: 4 months). Data were collected simultaneously by the SIC-IR system at the point of patient care and by IC utilizing multiple administrative and clinical modalities. Data collected by both systems included patient days, ventilator days, central line days, number of VAPs, and number of catheter-related blood steam infections (CR-BSIs). Both VAPs and CR-BSIs were classified using the definitions of the U.S. Centers for Disease Control and Prevention. The VAPs were analyzed individually, and true infections were defined by a physician panel blinded to methodology of surveillance. Using these true infections as a reference standard, sensitivity and specificity for both SIC-IR and IC were determined. RESULTS A total of 769 patients were evaluated by both surveillance systems. There were statistical differences between the median number of patient days/month and ventilator-days/month when IC was compared with SIC-IR. There was no difference in the rates of CR-BSI/1,000 central line days per month. However, VAP rates were significantly different for the two surveillance methodologies (SIC-IR: 14.8/1,000 ventilator days, IC: 8.4/1,000 ventilator days; p = 0.008). The physician panel identified 40 patients (5%) who had 43 VAPs. The SIC-IR identified 39 and IC documented 22 of the 40 patients with VAP. The SIC-IR had a sensitivity and specificity of 97% and 100%, respectively, for identifying VAP and for IC, a sensitivity of 56% and a specificity of 99%. CONCLUSIONS Utilizing SIC-IR at the point of patient care by a multidisciplinary STICU team offers more accurate infection surveillance with high sensitivity and specificity. This monitoring can be accomplished without additional resources and engages the physicians treating the patient.
Collapse
Affiliation(s)
- Jeffrey A Claridge
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44109-1998, USA.
| | | | | | | | | | | | | |
Collapse
|
|
19
|
Freixas N, Sallés M, García L. Cambios en el control de la infección nosocomial: nuevos retos y competencias de la enfermera de control de infección. Enferm Infecc Microbiol Clin 2009; 27:285-9. [DOI: 10.1016/j.eimc.2008.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 01/31/2008] [Indexed: 11/30/2022]
|
|
20
|
Khan MS, Siddiqui SZ, Haider S, Zafar A, Zafar F, Khan RN, Afshan K, Jabeen A, Khan MS, Hasan R. Infection control education: impact on ventilator-associated pneumonia rates in a public sector intensive care unit in Pakistan. Trans R Soc Trop Med Hyg 2009; 103:807-11. [PMID: 19342068 DOI: 10.1016/j.trstmh.2009.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 03/05/2009] [Accepted: 03/05/2009] [Indexed: 11/17/2022] Open
Abstract
We describe efforts towards introducing infection control (IC) practices and establishment of antimicrobial resistance (AMR) surveillance in a public sector hospital in Pakistan. The study was conducted in an eight-bed intensive care unit. IC principles, introduced through interactive sessions, were used as an intervention and their impact was observed by conducting surveillance for ventilator-associated pneumonia (VAP) before and after the intervention. Respiratory isolates of VAP patients in the period after intervention were screened for AMR, and empiric antibiotic at the time of admission was compared with the antimicrobial sensitivity pattern reported. VAP rates were high in general and declined in the period after intervention, although the difference was not significant. Of 37 VAP patients in the period after intervention, 68% had more than one clinically significant organism isolated from the respiratory specimen. Acinetobacter spp. were isolated from 76% of patients and Pseudomonas aeruginosa from 43%. All Acinetobacter spp. and 72% P. aeruginosa were multidrug resistant. The mean stay of the nosocomially infected patients was significantly higher than for the uninfected group (6.5 vs. 2.1 days, P<0.001). Our study suggests IC education needs to be supplemented by a hospital system that facilitates IC practices and development of surveillance programmes.
Collapse
Affiliation(s)
- M S Khan
- Department of Microbiology and Pathology, Aga Khan University, Karachi 74800, Pakistan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
21
|
Stone PW, Kunches L, Hirschhorn L. Cost of hospital-associated infections in Massachusetts. Am J Infect Control 2009; 37:210-4. [PMID: 19111366 DOI: 10.1016/j.ajic.2008.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 07/29/2008] [Indexed: 11/19/2022]
Abstract
The Massachusetts Department of Public Health appointed an Expert Panel to assess the problem of health care-associated infections (HAI) in the state and make recommendations regarding mandatory reporting. At the Expert Panel's request, a cost-of-illness study was conducted using available data sources. In Massachusetts, the excess hospital costs attributed to HAIs were estimated at approximately $233 to $275 million in 2006.
Collapse
|
|
22
|
Factors affecting performance of hospital infection control in Japan. Am J Infect Control 2009; 37:136-42. [PMID: 19249641 DOI: 10.1016/j.ajic.2008.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 03/04/2008] [Accepted: 03/05/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND In Japan, hospital infection control (IC) programs are frequently underresourced, and their improvement is considered a pressing issue. METHODS In 2005, we conducted a questionnaire survey of 638 teaching hospitals (most with 300 or more beds) and 882 nonteaching hospitals (most with fewer than 300 beds) in Japan. We analyzed associations among resources, infrastructures, activities, and performance related to IC. RESULTS A total of 423 teaching hospitals (66.3%) and 377 nonteaching hospitals (50.2%) responded to the survey. The teaching hospitals had more IC infrastructure, such as full-time infection control practitioners (ICPs), link nurses, and infection control teams (ICTs), compared with the nonteaching hospitals. Infection surveillance was more likely to be implemented in hospitals with more ICP full-time equivalents (FTEs). IC performance scores were significantly higher in the teaching hospitals than in the nonteaching hospitals. In multivariate analyses, greater IC infrastructure, such as ICP FTEs, full-time IC nurses, and regular ICT rounds were significantly associated with IC performance. Hospital accreditation and hospital size also were significantly associated with higher IC performance scores. CONCLUSION Given the strong associations found among IC infrastructure and performance, a new framework for evaluating IC infrastructure and for providing financial support may be effective in enhancing IC programs.
Collapse
|
|
23
|
Stricof RL, Schabses KA, Tserenpuntsag B. Infection control resources in New York State hospitals, 2007. Am J Infect Control 2008; 36:702-5. [PMID: 18834740 DOI: 10.1016/j.ajic.2008.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 01/10/2008] [Accepted: 01/11/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND In July 2005, New York State legislation requiring the mandatory reporting of specific hospital-associated infections (HAIs) was passed by the legislature and signed by the governor. In an effort to measure the impact of this legislation on infection control resources, the New York State Department of Health (NYSDOH) conducted a baseline survey in March 2007. This report presents an overview of the methods and results of this survey. METHODS An electronic survey of infection control resources and responsibilities was conducted by the NYSDOH on their secure data network. The survey contained questions regarding the number and percent time for infection prevention and control professional (ICP) and hospital epidemiologist (HE) staff members, ICP/HE educational background and certification, infection control program support services, activities and responsibilities of infection prevention and control program staff, and estimates of time dedicated to various activities, including surveillance. RESULTS Practitioners in 222 of 224 acute care hospitals (99%) responded. The average number of ICPs per facility depended on the average daily census of acute care beds and ranged from a mean of 0.64 full-time equivalent (FTE) ICP in facilities with an average daily census of < or = 100 beds to 6.5 FTE ICPs in facilities with an average daily census of > or = 900 beds. Averaging the ICP resources over the health care settings for which they were responsible revealed that the "average full-time ICP" was responsible for 151 acute care facility beds, 1.3 intensive care units (ICUs) (average, 16 ICU beds), 21 long-term care facility beds, 0.6 dialysis centers, 0.5 ambulatory surgery centers, 4.8 ambulatory/outpatient clinics, and 1.1 private practice offices. The ICPs reported that 45% of their time is dedicated to surveillance. Other activities for which ICPs reported at least partial responsibility include staff education, quality assurance, occupational health, emergency preparedness, construction, central supply/processing, and risk management. CONCLUSIONS This survey was designed to monitor and assess infection prevention and control resources and activities in hospitals as New York State embarks on mandatory public reporting of HAI rates. Monitoring infection control resources and activities will be important as HAI reporting moves forward. The information collected will serve as a baseline, and repeat surveys will be conducted to determine which, if any, of the various indicators correlate with the completeness and accuracy of HAI reporting.
Collapse
Affiliation(s)
- Rachel L Stricof
- New York State Department of Health, HAI Reporting Program, Empire State Plaza Corning Tower, Albany, NY 12237, USA.
| | | | | |
Collapse
|
|
24
|
Stone PW, Pogorzelska M, Kunches L, Hirschhorn LR. Hospital staffing and health care-associated infections: a systematic review of the literature. Clin Infect Dis 2008; 47:937-44. [PMID: 18767987 PMCID: PMC2747253 DOI: 10.1086/591696] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the past 10 years, many researchers have examined relationships between hospital staffing and patients' risk of health care-associated infection (HAI). To gain understanding of this evidence base, a systematic review was conducted, and 42 articles were audited. The most common infection studied was bloodstream infection (n=18; 43%). The majority of researchers examined nurse staffing (n=38; 90%); of these, only 7 (18%) did not find a statistically significant association between nurse staffing variable(s) and HAI rates. Use of nonpermanent staff was associated with increased rates of HAI in 4 studies (P<.05). Three studies addressed infection control professional staffing with mixed results. Physician staffing was not found to be associated with patients' HAI risk (n=2). The methods employed and operational definitions used for both staffing and HAI varied; despite this variability, trends were apparent. Research characterizing effective staffing for infection control departments is needed.
Collapse
Affiliation(s)
- Patricia W Stone
- Columbia University School of Nursing, New York, New York 10032, USA.
| | | | | | | |
Collapse
|
|
25
|
Infection control in acute care facilities: Evidence-based patient safety. Can J Infect Dis 2007; 12:131-2. [PMID: 18159327 DOI: 10.1155/2001/826915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Infection control in acute care facilities has a noble history. These programs were born of the nosocomial penicillin-resistantStaphylococcus aureusoutbreaks in the post-World War II era. Over the past four decades, an impressive body of evidence has emerged that documents the effectiveness of infection control programs and systematically evaluates specific program components. Fumigation, tacky floor mats, shoe covers and 'reverse' isolation have disappeared. They are replaced by focused surveillance programs, prophylactic antimicrobial therapy, outbreak investigation and control, routine barrier practices and molecular typing of organisms for epidemiological analysis.
Collapse
|
|
26
|
Siegel JD, Rhinehart E, Jackson M, Chiarello L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007; 35:S165-93. [PMID: 18068814 DOI: 10.1016/j.ajic.2007.10.006] [Citation(s) in RCA: 696] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jane D Siegel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | |
Collapse
|
|
27
|
Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007; 35:S65-164. [PMID: 18068815 PMCID: PMC7119119 DOI: 10.1016/j.ajic.2007.10.007] [Citation(s) in RCA: 1675] [Impact Index Per Article: 93.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
|
28
|
Borkow G, Gabbay J. Biocidal textiles can help fight nosocomial infections. Med Hypotheses 2007; 70:990-4. [PMID: 17959322 DOI: 10.1016/j.mehy.2007.08.025] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Accepted: 08/14/2007] [Indexed: 12/12/2022]
Abstract
The rates of nosocomial infections, especially by those caused by antibiotic resistant bacteria, are increasing alarmingly over the globe. Although more rigorous infection control measures are being implemented, it is clear that the current modalities to reduce nosocomial infections are not sufficient. Textiles are an excellent substrate for bacterial growth under appropriate moisture and temperature conditions. Patients shed bacteria and contaminate their pyjamas and sheets. The temperature and humidity between the patients and the bed are appropriate conditions allowing for effective bacterial proliferation. Several studies have found that personnel in contact with contaminated textiles were the source of transmission of the micro-organisms to susceptible patients. Furthermore, it has been reported that bed making in hospitals releases large quantities of micro-organisms into the air, which contaminate the immediate and non-immediate surroundings. Contaminated textiles in hospitals can thus be an important source of microbes contributing to endogenous, indirect-contact, and aerosol transmission of nosocomial related pathogens. We hypothesize that the use of antimicrobial textiles, especially in those textiles that are in close contact with the patients, may significantly reduce bioburden in clinical settings and consequently reduce the risk of nosocomial infections. These textiles should possess broad spectrum biocidal properties. They should be safe for use and highly effective against antibiotic resistant micro-organisms, including those that are commonly involved in hospital-acquired infections, and they should not permit the development of resistant micro-organisms to the active compound.
Collapse
Affiliation(s)
- Gadi Borkow
- Cupron Inc., P.O. Box 10973, Greensboro, NC 27404, USA.
| | | |
Collapse
|
|
29
|
Haas JP. Measurement of infection control department performance: state of the science. Am J Infect Control 2006; 34:543-9. [PMID: 17097447 DOI: 10.1016/j.ajic.2005.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 12/03/2005] [Accepted: 12/05/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Study of the Efficacy of Nosocomial Infection Control (SENIC) conducted in 1975-1976 is the gold standard for judging the resource needs of infection control departments; however, the scope of responsibilities of infection control and the patient populations served have changed dramatically over the last 30 years. OBJECTIVES The objective of this paper is to explore the state of the science for performance measurement of infection control departments. METHODS A search of English language literature was conducted using the PubMed, Medline, and CINAHL databases. The terms "infection control" and "department" along with the words "performance," "measurement," "staffing," "effectiveness," and "requirements" were used to search for relevant articles. Reference lists of selected articles were also searched for other papers of interest. RESULTS Twelve articles were deemed relevant to infection control department performance since the SENIC study. These fell into four main categories: time management studies, expert opinion, outcome studies, and reports about international infection control departments. CONCLUSION The SENIC study remains the most thorough assessment of the relationship between infection control department activities and patient outcomes. However, the scope of infection control practice has broadened, and the health care delivery system has changed dramatically since that study was performed. Few new studies have assessed infection control department performance and its relationship to patient outcomes, compliance with accepted standards of patient care, or cost of care. A current assessment of infection control department resources, functions and scope of responsibility linked to patient outcomes and cost is needed to give health care institutions a relevant benchmark for infection control resource needs and the return to be expected from that investment.
Collapse
Affiliation(s)
- Janet P Haas
- Columbia University School of Nursing, New York, NY 10032, USA.
| |
Collapse
|
|
30
|
Singh A, Goering RV, Simjee S, Foley SL, Zervos MJ. Application of molecular techniques to the study of hospital infection. Clin Microbiol Rev 2006; 19:512-30. [PMID: 16847083 PMCID: PMC1539107 DOI: 10.1128/cmr.00025-05] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Nosocomial infections are an important source of morbidity and mortality in hospital settings, afflicting an estimated 2 million patients in United States each year. This number represents up to 5% of hospitalized patients and results in an estimated 88,000 deaths and 4.5 billion dollars in excess health care costs. Increasingly, hospital-acquired infections with multidrug-resistant pathogens represent a major problem in patients. Understanding pathogen relatedness is essential for determining the epidemiology of nosocomial infections and aiding in the design of rational pathogen control methods. The role of pathogen typing is to determine whether epidemiologically related isolates are also genetically related. To determine molecular relatedness of isolates for epidemiologic investigation, new technologies based on DNA, or molecular analysis, are methods of choice. These DNA-based molecular methodologies include pulsed-field gel electrophoresis (PFGE), PCR-based typing methods, and multilocus sequence analysis. Establishing clonality of pathogens can aid in the identification of the source (environmental or personnel) of organisms, distinguish infectious from noninfectious strains, and distinguish relapse from reinfection. The integration of molecular typing with conventional hospital epidemiologic surveillance has been proven to be cost-effective due to the associated reduction in the number of nosocomial infections. Cost-effectiveness is maximized through the collaboration of the laboratory, through epidemiologic typing, and the infection control department during epidemiologic investigations.
Collapse
Affiliation(s)
- Aparajita Singh
- Department of Medicine, Section of Infectious Diseases, Henry Ford Hospital, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | | | | | | | | |
Collapse
|
|
31
|
Pearman JW. 2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci – from disaster to ongoing control. J Hosp Infect 2006; 63:14-26. [PMID: 16563562 DOI: 10.1016/j.jhin.2005.10.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 10/25/2005] [Indexed: 12/16/2022]
Abstract
The first hospital outbreak of a vancomycin-resistant enterococcus (VRE) in Western Australia (WA) started in the Royal Perth Hospital in July 2001 and initially involved the Intensive Care Unit (ICU) and the Nephrology and Dialysis Units. The outbreak was caused by vancomycin-resistant Enterococcus faecium (VREF) of the vanB genotype. Pulsed-field gel electrophoresis and plasmid analysis of the isolates demonstrated a single-strain outbreak. Despite the isolation of carriers and implementation of all the additional precautions recommended to control VRE, VREF spread rapidly. Two months after the index patient was detected, the epidemic strain had spread to 22 wards and units and one outpatient unit (Satellite Dialysis). Four patients were infected and 64 were colonized. A Hospital VRE Executive Group, which included the Chief Executive and Directors of Clinical Services and Nursing, was formed to eradicate the outbreak and to prevent the epidemic strain from becoming endemic in the hospital. The WA Department of Health agreed to provide substantial extra funding to enable the hospital to use expensive enhanced infection control practices, as follows. Control was handicapped by the slowness of conventional laboratory methods, which took four to five days to identify VRE and allowed environmental contamination and nosocomial transmission to occur before carriers were detected and isolated. A laboratory procedure to make rapid provisional identification of VRE within 30-48h was developed by performing multiplex polymerase chain reaction (PCR) for vanA and vanB genes directly on 24-h selective enrichment broth cultures. On average, four rectal swabs, each collected on separate days, were needed to detect >90% of carriers. In total, 1977 ward contacts were screened after discharge from hospital and 54 (2.73%) were found to be carrying VREF. The electronic labelling and active follow-up of ward contacts resulted in a significant number of carriers being detected who otherwise posed a risk of initiating further outbreaks in hospital if they were re-admitted. The outbreak was terminated after five months and the cost of the enhanced infection control practices was 2,700 000 Australian dollars (1,000,000 pounds sterlings). Ongoing control has been facilitated by targeted active surveillance cultures: on admission to high-risk units (ICU, Burns, Nephrology, Haematology, Bone Marrow Transplant Unit), on transfer out of the ICU to other hospital units, by monthly screening of patients regularly attending Dialysis Units, and by opportunistic laboratory screening of inpatient faecal specimens submitted for Clostridium difficile culture and toxin. Vigilance needs to be maintained as the epidemic strain of VREF remains in the Perth community. Ward contacts of the first outbreak have caused small outbreaks in two hospitals, and seven to 19 sporadic new carriers have been detected annually since the first outbreak. The key elements of the VRE control programme are as follows: To date, this programme has prevented VRE from becoming established in any WA hospital.
Collapse
Affiliation(s)
- J W Pearman
- Gram-positive Bacteria Typing and Research Unit, Royal Perth Hospital Department of Microbiology and Infectious Diseases, Curtin University Molecular Genetics Research Unit and Western Australian Department of Health.
| |
Collapse
|
|
32
|
Rosenthal VD, Guzman S, Crnich C. Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals. Am J Infect Control 2006; 34:58-63. [PMID: 16490607 DOI: 10.1016/j.ajic.2005.11.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hospitalized, critically ill patients have a significant risk of developing nosocomial infection. Most episodes of nosocomial pneumonia occur in patients undergoing mechanical ventilation (MV). OBJECTIVE To ascertain the effect of an infection control program on rates of ventilator-associated pneumonia (VAP) in intensive care units (ICUs) in Argentina. METHODS All adult patients who received MV for at least 24 hours in 4, level III adult ICUs in 2 Argentinean hospitals were included in the study. A before-after study in which rates of VAP were determined during a period of active surveillance without an infection control program (phase 1) were compared with rates of VAP after implementation of an infection control program that included educational and surveillance feedback components (phase 2). RESULTS One thousand six hundred thirty-eight MV-days were accumulated in phase 1, and 1520 MV-days were accumulated during phase 2. Rates of VAP were significantly lower in phase 2 than in phase 1 (51.28 vs 35.50 episodes of VAP per 1000 MV-days, respectively, RR = 0.69, 95% CI: 0.49-0.98, P <or= .003). CONCLUSION Implementation of a multicomponent infection control program in Argentinean ICUs was associated with significant reductions in rates of VAP.
Collapse
|
|
33
|
Macías AE, Ponce-de-León S. Infection Control: Old Problems and New Challenges. Arch Med Res 2005; 36:637-45. [PMID: 16216645 DOI: 10.1016/j.arcmed.2005.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 05/27/2005] [Indexed: 11/20/2022]
Abstract
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.
Collapse
Affiliation(s)
- Alejandro E Macías
- Department of Infectious Diseases, University of Guanajuato School of Medicine at Leon, Leon, Guanajuato, Mexico
| | | |
Collapse
|
|
34
|
Rosenthal VD, Guzman S, Migone O, Safdar N. The attributable cost and length of hospital stay because of nosocomial pneumonia in intensive care units in 3 hospitals in Argentina: a prospective, matched analysis. Am J Infect Control 2005; 33:157-61. [PMID: 15798670 DOI: 10.1016/j.ajic.2004.08.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No information is available on the financial impact of nosocomial pneumonia in Argentina. To calculate the cost of nosocomial pneumonia in intensive care units, a 5-year, matched cohort study was undertaken at 3 hospitals in Argentina. SETTING Six adult intensive care units (ICU). METHODS Three hundred seven patients with nosocomial pneumonia (exposed) and 307 patients without nosocomial pneumonia (unexposed) were matched for hospital, ICU type, year admitted to study, length of stay more than 7 days, sex, age, antibiotic use, and average severity of illness score (ASIS). The patient's length of stay (LOS) in the ICU was obtained prospectively in daily rounds, the cost of a day was provided by the hospital's finance department, and the cost of antibiotics prescribed for nosocomial pneumonia was provided by the hospital's pharmacy department. RESULTS The mean extra LOS for 307 cases (compared with controls) was 8.95 days, the mean extra antibiotic defined daily doses (DDD) was 15, the mean extra antibiotic cost was $996, the mean extra total cost was $2255, and the extra mortality was 30.3%. CONCLUSIONS Nosocomial pneumonia results in significant patient morbidity and consumes considerable resources. In the present study, patients with nosocomial pneumonia had significant prolongation of hospitalization, cost, and a high extra mortality. The present study illustrates the potential cost savings of introducing interventions to reduce nosocomial pneumonia. To our knowledge, this is the first study evaluating this issue in Argentina.
Collapse
Affiliation(s)
- Victor D Rosenthal
- Department of Infectious Diseases and Hospital of Epidemiology, Bernal Medical Center, Buenos Aires, Argentina.
| | | | | | | |
Collapse
|
|
35
|
Stevenson KB, Murphy CL, Samore MH, Hannah EL, Moore JW, Barbera J, Houck P, Gerberding JL. Assessing the status of infection control programs in small rural hospitals in the western United States. Am J Infect Control 2004; 32:255-61. [PMID: 15292888 DOI: 10.1016/j.ajic.2003.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
Collapse
|
|
36
|
Memish ZA, Arabi Y, Cunningham G, Kritchevsky S, Braun B, Richards C, Weber S, Pereira CR. Comparison of US and non-US central venous catheter infection rates: evaluation of processes and indicators in infection control study. Am J Infect Control 2003; 31:237-42. [PMID: 12806362 DOI: 10.1067/mic.2003.5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to identify the presence or absence of international variation in central venous catheter-associated bloodstream infection (BSI) rates and to examine associated infection control practices that might underlie the differences. DESIGN The Evaluation of Processes and Indicators in Infection Control (EPIC) study was conducted as a prospective surveillance study. SETTINGS The study took place in intensive care units (ICUs) from 14 countries, which were from the Asian Pacific (3), Europe (7), Middle East (2), and South America (2), in addition to 41 US hospitals. METHODS We compared the National Nosocomial Infections Surveillance catheter-associated BSI rate between the non-US and US units. We also compared the following organization factors between the 2 groups: hospital factors (ownership, average daily census of patients); ICU type (medical vs surgical); number of beds; and infection control-related factors (number of staff, number of hours spent on study ICU surveillance, years of experience, number of inservice sessions on line infection, number of blood cultures drawn/1000 patients). RESULTS We found no significant difference in catheter-associated BSI rates between non-US and US hospitals (5.02 +/- 0.75 vs 3.82 +/- 0.42/1000 days, respectively; P =.27). Non-US hospitals were more likely to be government-owned (10/14 vs 7/41;P <.001) and to have larger daily patient census (795 +/- 84 vs 276 +/- 47 patients; P <.001). There was no difference in ICU type or number of beds. Infection control committees were present in all US and non-US hospitals. No significant differences were found in the number of staff involved in surveillance in the study ICU, years of experience, hours spent on surveillance, or the provision of inservices on line care. The use of barriers during line insertion also did not differ. CONCLUSIONS Catheter-associated BSIs in patients in the ICU were not significantly different between non-US and US hospitals. All hospitals had infection control committees, and there were no significant differences in time spent and numbers of persons involved in ICU surveillance activities. These findings suggest that many aspects of the standards of care do not differ between the 2 groups.
Collapse
Affiliation(s)
- Ziad A Memish
- King Abdulaziz Medical City, King Fahad National Guard Hospital, PO Box 22490, Riyadh 11426, Saudi Arabia
| | | | | | | | | | | | | | | |
Collapse
|
|
37
|
Bhansali A, Chattopadhyay A, Dash RJ. Mortality in diabetes: a retrospective analysis from a tertiary care hospital in North India. Diabetes Res Clin Pract 2003; 60:119-24. [PMID: 12706320 DOI: 10.1016/s0168-8227(03)00013-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cause(s) of death in patients with diabetes mellitus (DM) admitted to a tertiary care hospital in North India was analysed from classified information in patients' death records and case file. Of the 306652 total admissions from 1991 to 1999, 21584 patients died (7.04%), 592 of whom (355 men and 237 women) had DM (2.7%). Information from 92 patients with diabetes could not be retrieved and six patients with hyperglycemia of short duration (two with gestational DM, three with post-transplant diabetes and one with stress hyperglycemia) were excluded. Of the 494 patients, 456 (92.3%) had T2DM and 38 (7.7%) had T1DM. Four hundred and forty patients had diabetes related mortality: infections (230, 46.5%), cardiovascular events (86, 17.4%), chronic renal failure (CRF) (48, 9.7%), stroke (30, 6%), diabetic ketoacidosis (DKA) (15, 3%), hyperosmolar coma (11, 2.2%), and hypoglycemia (5, 1%), while others (54 patients) had diabetes unrelated deaths. Cause of death could not be ascertained in six patients (1.2%). Death was attributed to a single cause in 301 (60.9%), to two causes in 175 (35.4%) and to three or more causes in 12 (2.4%) patients. Analysis of the cause of death in DM versus hospital in-patients in general, showed infection (P<0.02), coronary artery disease (CAD) (P<0.001), and CRF (P<0.001) to be more frequent in diabetes.
Collapse
Affiliation(s)
- Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | | | | |
Collapse
|
|
38
|
Affiliation(s)
- John P Burke
- Department of Clinical Epidemiology and Infectious Diseases, LDS Hospital, Salt Lake City, Utah, USA
| |
Collapse
|
|
39
|
O'Boyle C, Jackson M, Henly SJ. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control 2002; 30:321-33. [PMID: 12360140 DOI: 10.1067/mic.2002.127930] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The guideline for staffing infection control programs of 1 infection control professional (ICP) for every 250 occupied acute care beds has been used in many health care facilities in the United States since 1985. Since that time, the health care system, patient populations, and expectations about the work of infection prevention and control programs have changed substantially. METHODS The Delphi method was used; data were obtained from a group of ICPs through a series of 10 surveys. Through this iterative process, participant responses were progressively synthesized and areas of agreement and disagreement identified. These surveys were conducted by electronic and paper mail to identify the personal ICP characteristics and structural variables associated with performance of activities required for contemporary infection prevention and control programs in a variety of health care settings. RESULTS Delphi panel members (n = 32) from 20 states and who represented acute care, long-term care, and community care settings reported tasks in addition to those identified in earlier task analyses as well as expanded responsibilities. Competing responsibilities and lack of adequate resources were the most frequently cited reasons for nonperformance of essential infection control tasks. A ratio of 0.8 to 1.0 ICP for every 100 occupied acute care beds was suggested as adequate staffing by the Delphi panel. CONCLUSIONS Infection control responsibilities have expanded beyond the traditional acute care setting. Recommendations for staffing must not only consider the number of occupied beds (average daily census) but also include the scope of the program, the complexity of the health care facility or system, the characteristics of the patient population, and the unique or urgent needs of the facility and community.
Collapse
Affiliation(s)
- Carol O'Boyle
- School of Nursing, University of Minnesota, Minneapolis 55455, USA
| | | | | |
Collapse
|
|
40
|
Smith PW, Helget V, Sonksen D. Survey of infection control training program graduates: long-term care facility and small hospital practitioners. Am J Infect Control 2002; 30:311-3. [PMID: 12163867 DOI: 10.1067/mic.2002.122437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Graduates of a 2-day basic training course in infection control were surveyed. Respondents were generally from Midwestern long-term care facilities and small hospitals. These infection control practitioners had multiple roles in addition to infection control, most notably employee health and quality assurance. Infection control practitioners demonstrated significant job stability. The vast majority of institutions where survey respondents were employed followed recommended infection control practices.
Collapse
Affiliation(s)
- Philip W Smith
- Nebraska Infection Control Network and University of Nebraska Medical Center, Omaha 68198-5400, USA
| | | | | |
Collapse
|
|
41
|
Wright J, Stover BH, Wilkerson S, Bratcher D. Expanding the infection control team: development of the infection control liaison position for the neonatal intensive care unit. Am J Infect Control 2002; 30:174-8. [PMID: 11988713 DOI: 10.1067/mic.2002.119927] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neonatal survival has risen progressively during the past 30 years. As the limits of viability continue to decline, the challenges of providing care to infants at the lowest extremes of gestational age and birth weight continually increase. Nosocomial infections in this very fragile population can be devastating. The complexity of care of these premature infants requires specialized knowledge of the neonate, infectious disease processes, and methods to reduce infection risks in the neonatal intensive care unit. The role of infection control liaison has been established in our institution as an adjunct to meeting this challenge by providing a line of communication between staff, neonatologists, and the infection control team. This article describes the role of the infection control liaison and its overall impact on the infection control program in an 87-bed level II, III, and IV neonatal intensive care unit from 1995 to 1999.
Collapse
Affiliation(s)
- Judy Wright
- Neonatal Intensive Care Unit, Kosair Children's Hospital, Louisville , Kentucky, USA
| | | | | | | |
Collapse
|
|
42
|
Murphy DM. From expert data collectors to interventionists: changing the focus for infection control professionals. Am J Infect Control 2002; 30:120-32. [PMID: 11944003 DOI: 10.1067/mic.2002.120526] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The current economic and political environments challenge health care organizations in the United States to provide affordable, accessible, and comprehensive health services. However, changes in reimbursement to health care providers can affect their ability to offer access to cutting-edge services while reducing costs. Consequently, organizations are restructuring, re-engineering, right-sizing, downsizing, and redesigning, all in an effort to save money while also hoping to maintain a reputation for quality and customer service. Dr Vicky Fraser, in her keynote address at the APIC conference in 2000, reminded us that ICHE programs are cost centers rather than revenue generators, and are often targets for budget cuts. Although Haley's Study on the Efficacy of Nosocomial Infection Control (SENIC), published in 1985, was a landmark event demonstrating the importance of our profession's mission, it is becoming dated. Infection control professionals (ICPs) must continue Haley's work, finding innovative ways to market or demonstrate the value of ICHE programs to health care executives. Closing the 1999 APIC conference with a symposium entitled "Breaking Out of the Box," Jackson and Massanari challenged ICPs to educate themselves about the changing health care environment, to be proactive, and constructively help organizations "re-engineer" more efficiently, rather than feel victimized and helplessly await being re-engineered out of existence. The threat of downsizing prompted ICPs at BJC HealthCare to realize that the time had come to change their own culture and attitudes and to focus on the business of infection control. This change required challenging the traditional roles of solo practitioner, data collector, and keeper of infection control data and knowledge. The goals now include leading intervention teams committed to reducing health care-associated infections, partnering rather than accepting sole responsibility for lowering infection rates, and learning to influence without authority. Staying focused on quality and cost-effectiveness and demonstrating improvements in clinical outcomes became a commitment. This article discusses BJC HealthCare's journey through change so that it may provide useful information and tools for ICPs in any setting looking for the necessary change strategies that might keep them in business.
Collapse
Affiliation(s)
- Denise M Murphy
- Infection Control & Healthcare Epidemiology Consortium, BJC HealthCare, St Louis, MO 63110, USA
| |
Collapse
|
|
43
|
Murphy CL, McLaws ML. Variation in administrators' and clinicians' attitudes toward critical elements of an infection control program and the role of the infection control practitioner in New South Wales, Australia. Am J Infect Control 2001; 29:262-70. [PMID: 11486270 DOI: 10.1067/mic.2001.117037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Debate remains over the core activities of infection control (IC) programs. Differences in stakeholder opinions must be considered if consensus panel guidelines and recommendations are to be broadly applied. This article describes a survey of administrators and clinicians employed in hospitals in New South Wales, Australia. Respondents self-reported their levels of agreement with affirmative statements regarding the role of the infection control practitioner (ICP) and the essential requirements and infrastructure of IC programs. METHOD The study population included administrators and clinicians in each public, private, and freestanding day hospital in New South Wales. Respondents reported the intensity of their agreement with 16 affirmative statements relating to IC program infrastructure and resources and the ICP's role and responsibilities. RESULTS The overall response rate was 62.1% (587/945). Clinicians (349/587) and administrators (238/587) accounted for 59.5% and 40.5% of the response rate, respectively. Overall, administrators and clinicians reported greatest levels of agreement for those elements not requiring additional resources. CONCLUSION The extent of divergence between administrators and clinicians is not so great that it can not be resolved. Our findings demonstrate the degree of administrator support that clinicians can expect for each element. We advocate better communication between clinicians and administrators in conjunction with objective strategic planning. Our findings provide a guide for ICPs to either establish or negotiate the core components of their IC program.
Collapse
Affiliation(s)
- C L Murphy
- Sexual Health and Clinical Services, New South Wales Health Department, North Sydney, Australia
| | | |
Collapse
|
|
44
|
Girouard S, Levine G, Goodrich K, Jones S, Keyserling H, Rathore M, Rubens C, Williams E, Jarvis W. Infection control programs at children's hospitals: a description of structures and processes. Am J Infect Control 2001; 29:145-51. [PMID: 11391275 DOI: 10.1067/mic.2001.115406] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Infection control (IC) structures and processes determine the effectiveness of surveillance efforts to prevent infections in health care settings. METHODS A survey was sent to 56 children's hospitals collaborating in the Pediatric Prevention Network (PPN). RESULTS Completed surveys were returned from 48 hospitals. Responsibility for the IC program resided with the medical director (21%); vice president for patient care (18%); quality improvement director (17%); other senior hospital administrator (15%); or other hospital personnel (18%). Forty-two hospitals had an IC committee; 32 had antimicrobial restriction/control policies; and 21 had an antimicrobial restriction/control task force or committee. Components of antimicrobial restriction programs included infectious disease specialist approval, restricted formularies, selective susceptibility test reporting, and staff education programs. Many methods were used to detect infections, including microbiology laboratory reports (100%); record reviews (98%); informal reports from providers (90%); and readmission reviews (77%). CONCLUSIONS Children's hospitals vary widely in how they design and implement their IC functions. These variations influence adverse event detection and nosocomial infection rate calculations. If medical errors, including nosocomial infections, are to be detected and hospital rates compared, standardized methods to collect, analyze, and report data are needed. The PPN has initiated activities to standardize surveillance and IC practices in participating hospitals.
Collapse
Affiliation(s)
- S Girouard
- National Association of Children's Hospitals and Related Institutions, Alexandria, VA 22314, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
|
45
|
Abstract
Subtyping methicillin- resistant Staphylococcus aureus (MRSA) isolates and tracking nosocomial infections have evolved from phenotypic to genotypic approaches; most laboratories now depend on pulsed-field gel electrophoresis (PFGE). We discuss the limitations of current image-based genotyping methods, including PFGE, and the advantages (including ease of entering data into a database) of using DNA sequence analysis to control MRSA infections in health-care facilities.
Collapse
Affiliation(s)
- B Shopsin
- Public Health Research Institute and Department of Microbiology, New York University School of Medicine, New York, New York, USA
| | | |
Collapse
|
|
46
|
Murphy CL, McLaws ML. Australian Infection Control Association members' use of skills and resources that promote evidence-based infection control. Am J Infect Control 2000. [DOI: 10.1067/mic.2000.102379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
|
47
|
Murphy CL, McLaws ML. Methodologies used in surveillance of surgical wound infections and bacteremia in Australian hospitals. Am J Infect Control 1999; 27:474-81. [PMID: 10586150 DOI: 10.1016/s0196-6553(99)70024-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of nosocomial infection in Australian hospitals is estimated to be between 5.5% and 6.3%. Since 1989, infection control professionals (ICPs) in hospitals accredited by the Australian Council on Health Care Standards (ACHS) have been encouraged to collect nosocomial infection data according to ACHS methodology. METHOD In 1996, we surveyed members of the Australian Infection Control Association to examine the time spent on surveillance, the practice of surveillance of all hospital infections (hospital-wide surveillance), case-finding methods, case definitions, and reporting routinely used by ICPs in acute care hospitals. We also examined the ICPs' education and experience in infection control (IC). RESULTS The survey was completed and returned by 65% (644 of 993) of Australian Infection Control Association members. Of the ICPs who completed the survey, 47.8% (308 of 644; 95% CI, 43.9%-51.7%) met the criteria for inclusion, because they coordinated an IC program in an acute care or surgical hospital and performed surveillance for either surgical wound infection, intravascular device-related bacteremia, or non-device-related bacteremia. Of the ICPs who reported their facility's accreditation status, 93.5% participated in ACHS system. Most (97.6%) ICPs had completed hospital-based general registered nurse training. Only 1.9% (6 of 308) of ICPs reported completion of continuing education relating to hospital epidemiology. The number of years of IC experience ranged from zero to 35 years, with a median of 4 years. ICPs spent a substantial proportion of their total weekly IC time on surveillance irrespective of ACHS accreditation; 19.5 hours in ACHS hospitals and 15.6 hours in non-ACHS hospitals (P =.33). More than three quarters (76.0%) of ICPs performed hospital-wide surveillance. The case-finding methods, definitions of infections, and reporting formats varied greatly. The definition most commonly applied by ICPs (6.8%; 95% CI, 4.1%-10.4%) to define surgical wound infection was infection within 30 days after the operative procedure, plus purulent drainage, plus isolation of organisms from a culture from the incision site, plus diagnosis by a medical officer. A 5-item definition of a patient being asymptomatic, plus afebrile on admission, plus infection occurring at least 48 hours after admission, plus the patient having a fever of >38 degrees C, plus a recognized culture from one or more bottles was used by 15.7% (95% CI, 11.3%-21.0%) of ICPs to define a case of bacteremia. CONCLUSION Surveillance is the core business of Australian ICPs and consumes a substantial proportion of their time. The importance of surveillance, the epidemiologic limitations of the current ACHS system, and the nonstandard methods we report indicate that improved methodology is required for case finding and reporting of nosocomial infections. Australian ICPs should complete training in the principles of surveillance and epidemiology. With this training, ICPs can work collaboratively with other health care professionals to develop epidemiologically sound, local, nosocomial surveillance systems and lobby for a voluntary, national, standardized, risk-adjusted system of targeted nosocomial surveillance.
Collapse
Affiliation(s)
- C L Murphy
- AIDS/Infectious Disease Unit, New South Wales Health Department, North Sydney, Australia
| | | |
Collapse
|
|
48
|
Gastmeier P, Daschner F, Rüden H. Guidelines for infection prevention and control in Germany: evidence- or expert-based? J Hosp Infect 1999; 43 Suppl:S301-5. [PMID: 10658797 DOI: 10.1016/s0195-6701(99)90104-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nosocomial infections (NI) are a major problem, and numerous measures are being recommended for preventing NIs in Germany. However, the evidence for the efficacy of many currently recommended measures is incomplete or has been established for certain sub-groups of patients or specific conditions only. In view of this situation, it is necessary to improve the established measures for preventing NIs. Since many procedures and components of infection control involve additional expenditure, their deployment can only be justified if their efficiency has been demonstrated or is highly likely on the basis of rational considerations.
Collapse
Affiliation(s)
- P Gastmeier
- Institute for Hygiene, Free University Berlin
| | | | | |
Collapse
|
|
49
|
Cardo DM, Soule BM. Hospital infection prevention and control: A global perspective. Am J Infect Control 1999; 27:233-5. [PMID: 10358224 DOI: 10.1053/ic.1999.v27.a98298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
|
50
|
de Oliveira TC, Branchini ML. Infection control in a Brazilian regional multihospital system. Am J Infect Control 1999; 27:262-9. [PMID: 10358230 DOI: 10.1053/ic.1999.v27.a98520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study describes the organization of infection control committees in a Brazilian multihospital system, identifying their major problems. Our goal is to discuss the main deficiencies in infection control and to target some interventions that can improve the efficiency of these actions in Brazilian hospitals. DESIGN AND SETTING We used a descriptive epidemiologic design. We interviewed the chairs and the nurses of the infection control committees and visited the main areas to observe infection control in a multihospital system with 3146 beds. For analysis of the results, we performed a standardization process, establishing a score for each hospital by using infection control organization as a surrogate marker for quality outcome. The mean hospital scores for infection control, existence of policies, and infrastructure at each hospital were compared by using different stratification and multivariate analysis. RESULTS Statistically significant differences were found among surveyed hospitals by using stratification by size, funding status, and presence of teaching activities. CONCLUSIONS Diverse patterns of infection control organization were found among surveyed hospitals. Small hospitals represented the major problem in providing effective infection control. Chiefly for these hospitals, the epidemiologic indicators and the surveillance and control system proposed by the Brazilian Ministry of Health and based on the Centers for Disease Control and Prevention model showed poor suitability.
Collapse
Affiliation(s)
- T C de Oliveira
- Medical Sciences College, State University of Campinas, São Paulo, Brazil
| | | |
Collapse
|