Guideline for infection control in healthcare personnel, 1998. Hospital Infection Control Practices Advisory Committee.
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Biomedical subjects
Publications and source records attributed to E A Bolyard.
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Recent nosocomial outbreaks of tuberculosis have increased concern about the occupational acquisition of tuberculosis by health care workers. The Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, and the Occupational Safety and Health Administration, Department of Labor, have issued recommendations and regulations in an effort to decrease health care workers' risk for exposure to patients with infectious tuberculosis. Within the CDC, the National Center for Infectious Diseases, the National Center for Prevention Services, and the National Institute for Occupational Safety and Health collaborated to produce the 1994 Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities. As stated in the Draft Guidelines, the major components of health care worker protection from Mycobacterium tuberculosis infection include administration or source controls, engineering controls, and respiratory protective devices. We review the evolution of the seemingly conflicting recommendations for respiratory protective devices made by these Centers of the CDC and explain how the recommendations in the current CDC Guidelines were reached.
Bloodborne pathogens are transmitted from person to person by sexual contact and by injection of drugs and, in health-care settings, by needlesticks and, in the case of HBV, by mucous membrane exposure. Conventional disinfection and sterilization and housekeeping strategies are sufficient for the environmental control of bloodborne viruses. Environmentally mediated infection transmission of bloodborne viruses is unlikely and only HBV, because of the extraordinarily high viral concentration in blood, is thought to have a real potential for such transmission. No epidemiologic or laboratory data support the hypothesis that surgeons or other health care workers are at increased risk of infection by bloodborne pathogens. Although theoretically possible, airborne transmission does not appear likely. Studies that claim to show the potential for airborne transmission of bloodborne pathogens ignore the basic principles of aerobiology and the requirements for proving environmental transmission.
Between 1989 and 1992, reports of outbreaks and transmissions of tuberculosis in institutional settings prompted the Centers for Disease Control and Prevention to review the guidelines for TB infection control it had published in 1990. The CDC published an updated version of the guidelines in October 1994. This article gives dentists an overview of the guidelines' recommendations that are applicable to most outpatient dental settings.
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We prospectively evaluated infections with several gastrointestinal pathogens in patients undergoing bone-marrow transplantation, in an attempt to correlate infection with morbidity and mortality. Thirty-one of 78 patients (40 per cent) were infected with one or more of the following enteric pathogens during the study: adenovirus (12 infections), rotavirus (nine), coxsackievirus (four), or Clostridium difficile (12). Several patients were infected with more than one pathogen. Infection correlated with the occurrence of diarrhea and abdominal cramps. The mortality rate among the infected patients was 55 per cent--significantly higher than the rate (13 per cent) among the noninfected patients (P less than 0.001). This study indicates that enteric pathogens that often cause mild diarrhea in normal populations can cause serious infections in marrow-transplant recipients. Measures aimed at preventing or treating such infections might reduce the morbidity and mortality associated with marrow transplantation.
In a three-week period 7 of 14 transplant recipients were infected with coxsackie A1 virus. Diarrhoea and mortality were significantly associated with infection (7 of 7 infected compared with 0 of 7 non-infected, and 6 of 7 infected compared with 1 of 7 non-infected, respectively). Early in the outbreak, the diarrhoea was presumed to be due to acute graft-versus-host disease (AGVHD). However, the distribution of AGVHD among infected and non-infected patients was nearly equal, and at necropsy 3 of 6 infected patients who had had diarrhoea showed no evidence of gastrointestinal involvement with AGVHD. Infection with viral enteric pathogens may be an important factor in the clinical course of transplant recipients.
A cluster of Serratia marcescens infections complicating cardiopulmonary bypass operations was traced to contaminated quaternary ammonium disinfectant. Failure of hospital personnel to clean the disinfectant spray bottles before refilling them had enabled the organisms to survive and contaminate the environment, including the extracorporeal circulator. The organisms grew in two of four formulations of quaternary ammonium disinfectant. Serratia sensitivity to ampicillin and tetracycline was an epidemiological marker of a common-source outbreak.
A consortium's infection control nurse and physician epidemiologists boost the member hospitals' infection control efforts through onsite rounds, establishment of group standards, reports on each hospitals' performance, ongoing education, medicolegal assistance, monitoring of use of isolation evaluation of infection control products, and other activities.