Biomedical subjects
Publications and source records attributed to W M Valenti.
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Health care workers may be exposed to a variety of infectious agents in the workplace. The pregnant health care worker presents additional concerns because of the potential risk of infection to the developing fetus. Health care workers often misunderstand the basic elements of infection transmission. The result of this misinformation is that personnel are most often concerned about the agents that are least transmissible. To develop an infection control program that is rational and workable, the infection control practitioner must have a thorough understanding of the mechanisms of disease transmission. With this foundation, an infection control program for the pregnant health care worker will rarely involve transfer to alternative assignments or work restriction based on pregnancy alone. The approach outlined in this article stresses a more generic approach to infection control by isolating the disease and not the employee.
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In this evaluation of the prevalence and quality of systemic antibiotic use in nursing homes, 42 skilled nursing facilities (SNFs) and their 11 attached intermediate care facilities (ICFs) were surveyed. A random sample of 2238 patients (51%) from the total of 4378 beds was selected and of these, 7.7% of the total (8.6% of the SNF and 4.5% of the ICF) patients were on systemic antibiotics on the day of the survey. The most common suspected sites of infection were urinary tract (58.4%), lower respiratory tract (19.1%), and skin or subcutaneous tissue (4.6%). Criteria for appropriateness of initiating systemic antibiotics, for adequacy of initial diagnostic workup, and for appropriate specific antibiotics were developed by the authors, with input from a group of medical directors of nursing homes, based on Centers for Disease Control and Federal Drug Administration guidelines. Evidence to start an antibiotic was judged adequate in 62.4% of cases. Workups were considered inadequate in a high proportion of cases. For example, urinalysis was ordered in only 23.8% and urine culture in 57.4% of suspected urinary tract infections; chest x-ray was ordered in 24.2% and sputum culture in 3.0% of suspected lower respiratory infections. Recommendations are made as to minimum adequate workup for suspected infections and appropriate evidence to justify start of a systemic antibiotic, recognizing the limitations in diagnostic modalities in the nursing home setting and the special problems of their resident populations.
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Programs for tuberculosis prevention in health care workers can be complex and often raise questions and controversies among employee health and infection control practitioners alike. Although tuberculosis is declining in incidence in the US, preventive programs for health care workers will continue to be a part of employee health programs. As with other aspects of infection control, the practitioner must develop and modify the program to reflect the state of the art and current thinking in tuberculosis prevention and control.
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A prospective analysis of patients hospitalized with pneumococcal infection at two Rochester (NY) hospitals was performed during an 18-month period to assess the feasibility of a pneumococcal vaccination program directed at inpatients. Of the 113 patients hospitalized with pneumococcal infection, only nine patients (8%) had previously received pneumococcal vaccine and 76 patients (67%) had been hospitalized at least once in the previous three years. Of the 104 patients who had a source of regular medical care, 100% had made at least one outpatient visit in the previous three years. The association between the acquisition of a serious pneumococcal infection and hospitalization within the previous three years suggests that a vaccination strategy directed at hospitalized high-risk patients would be potentially effective. Also, vaccination of high-risk ambulatory patients remains a viable strategy to prevent serious pneumococcal infection.