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PubMed1995

[Hospital management and the role of clinical microbiology laboratory for preventing nosocomial infection].

Nosocomial infection is a serious issue in the hospital management. Countermeasures for this issue have been discussed from various points including clinical and laboratory medicine, nursing as well as hospital administration. This issue is of great importance to those of us medical practitioners, who engage in diagnosis and treatment of infectious diseases. The role of clinical microbiology laboratories for prevention of nosocomial infection includes performing epidemiological survey, giving information and education, and training and instruction to medical staff. In order to instruct and inspect the countermeasures against nosocomial infection, it is necessary to have a dedicated team in the hospital. We have organized an infection control team(ICT) to collect information and offer training and instruction regarding nosocomial infection. The ICT activities include 1) inspecting if the nosocomial infection control manual is followed correctly, 2) reporting the results of epidemiological survey regarding nosocomial infection, 3) offering the information regarding antimicrobial agents and disinfectants, 4) offering the information regarding the isolation of microorganisms in the hospital and their antimicrobial sensitivities, 5) cost calculation for nosocomial infection control.

Cross Infection↗
PubMed2001

The epic project: developing national evidence-based guidelines for preventing healthcare associated infections. Phase I: Guidelines for preventing hospital-acquired infections. Department of Health (England).

In 1998, the Department of Health (England) commissioned the first phase of national evidence-based guidelines for preventing healthcare associated infections. These focused on developing a set of standard principles for preventing infections in hospitals together with guidelines for preventing hospital-acquired infections (HAI) associated with the use of short-term indwelling ureteral catheters in acute care and with central venous catheters in acute care. These guidelines are systematically developed broad statements (principles) of good practice that all practitioners can use and which can be incorporated into local protocols. A nurse-led, multi-professional team composed of infection prevention practitioners, clinical microbiologists/retrovirologist, epidemiologists, and researchers developed the guidelines. A rigorous guideline development process was used to inform the systematic reviews, the clinical and critical appraisal of relevant evidence, and linking that evidence to evolving guidelines. Both general and specialist clinical practitioners were involved in all stages of developing these guidelines, as were representatives from relevant Royal Colleges, learned societies, other professional organisations and key stakeholders. The introduction to these guidelines describes a robust and validated guideline development model that can be used by others to develop future guidelines. This model is described in more detail in the associated technical reports that can be found on the project web site http://www.epic.tvu.ac.uk. Locating and appropriately using good quality evidence to inform guideline development in this field is challenging. Evidence from rigorously conducted experimental studies was frequently limited and consequently a range of other types of evidence were systematically retrieved and carefully appraised. The concluding discussion on implementation highlights potential issues for clinical governance and areas for future research and suggests issues that need to be addressed to allow practitioners to successfully incorporate these guidelines into routine clinical practice.

Acute Disease↗
PubMed1984

Visions for the future.

I have discussed, from my vantage point as a public health specialist, areas for emphasis in control and prevention of nosocomial infections. Surveillance is the key to all control and prevention programs. With the constraints of resources and increasing responsibilities, infection control personnel have to be innovative, inventive, and imaginative in their approach to surveillance. The principles of epidemiology may be overlooked in the rush to perform. Epidemiology is a valuable science; it is being applied to an increasing number of problems inherent to hospitals. The community and the hospital are closely related in regard to nosocomial infections. There is constant two-way traffic of both people and bugs that can be properly addressed through cooperative action. The international arena may not have a great impact on each of you, but collectively, APIC has much to offer to developing countries. We should support with actions those countries that are becoming concerned over nosocomial infections. Regardless of your own priorities, there will be new and significant challenges to all practitioners of infection control, challenges related to new and currently unidentified problems, and unfortunately, fewer resources with which to meet the challenges. I congratulate APIC, its officers, and members on all you have done to focus attention and intellect on the problem of nosocomial infections. A humble beginning has been extremely productive by all possible criteria, especially by imitation, which is "the highest form of praise."

Community-Institutional Relations↗
PubMed2006

A rural public-private partnership model in tuberculosis control in south India.

SETTING: A rural tuberculosis (TB) unit in South India, 2001-2003. OBJECTIVE: To evaluate a rural public-private partnership model (PPPM) within the TB control programme (RNTCP). DESIGN: All of the private practitioners trained in modern medicine (PPs, n = 52) and the private laboratories (PLs, n = 13) in the area were listed. The PPs underwent training about the RNTCP, and PL staff were trained in sputum microscopy. PPPM included referral of TB suspects to the smear microscopy centres (government or PLs) for diagnosis and treatment of patients as per RNTCP guidelines. Patients were back-referred to the PPs. The directly observed treatment providers and centres were chosen by the PPs in consultation with their patients. The case detection rate, cure rate and profile of patients referred by the PPs were compared with those of self-reported patients. RESULTS: Of 489 TB suspects referred by the PPs, 24% were smear-positive compared to 10% of 15 278 self-reported patients (P < 0.001). Of 319 referred to PLs, 7% were smear-positive. The annual average case detection rate increased from 66 to 75 per 100 000 population. The cure rates of patients referred by the PPs were comparable to those of self-reported patients. CONCLUSIONS: This rural PPPM is effective and does not require additional staff or any direct financial incentives.

Adult↗
PubMed2003

An innovative approach to training hospital-based clinicians for bioterrorist attacks.

The recent attacks of September 11, 2001, and the subsequent dissemination event of anthrax in the United States demonstrated the necessity for hospitals to initiate bioterrorism education for clinicians. Events such as the release of sarin gas into the Tokyo subway by the Aum Shinrikyo cult provided some insight into how quickly emergency medical personnel may be overwhelmed by causalities of unconventional weapons. Educational interventions to prepare hospital-based practitioners for such disasters must fit among the demands of patient care, administrative duties, and continuing education within specialties. In addition, the priority placed on the topic, confusion about reputable resources to consult, and concerns of funding for preparedness training mandate the need for an authoritative, comprehensive, and easily accessible approach. A pilot project supported in part by the Agency for Healthcare Research and Quality was developed to facilitate streamlining of preparedness efforts through the implementation of interactive screen savers as an alternative to traditional educational modalities. This report presents the successful application of this model, which was quantified with pretests and posttests given to users of the system.

Bioterrorism↗
PubMed1986

Structure and research activities of pediatric infection control programs in the United States and Canada.

Although this survey was not intended to evaluate all aspects of pediatric infection control programs, we hoped to learn about such programs as reflected by the placement and classification of the practitioner and the infection control program in the hospital administrative hierarchy, by salary, and by research priorities and activities. Perhaps our informal survey may prompt pediatric institutions to evaluate the goals of their infection control programs and to explore possibilities for growth and development of the program as well as the practitioner.

Adolescent↗
PubMed1998

[Ebola virus: what the practitioner needs to know].

The Ebola virus is an RNA virus of Filoviridae family. The earliest documented fatal epidemic of Ebola hemorrhagic occurred in 1976. There are four genetically different subtypes of Ebola virus. The virus remains in the blood for several weeks, can maintain its infectivity for several weeks at 20 degrees C outside the body, and survives for several weeks in corpses. Isolation of Ebola virus requires level 4 laboratory security conditions. Specimens are obtained by culturing mammal cells. Identification is achieved using reference serums. Serologic diagnosis is made using mainly ELISA technique for immunocapture of IgM or EBO Ag. The natural reservoir for Ebola virus is unknown. One possibility is that each isolated strain has a different reservoir. In recorded outbreaks, the index case has often had a history of contact with non-human primates. However since these animals are also highly sensitive to the virus, they cannot be considered as reservoirs but only as intermediate hosts. Transmission requires close contact such as occurs in association with health care, local customs, or funeral rites. In humans, infection causes hemorrhagic fever that progresses to diarrhea within 5 to 10 days. Recovery is observed in only 25% of cases. During outbreaks containment depends on implementation of simple precautions including isolation of suspected cases, appropriate protective clothing, disinfection with hypochlorite solutions, and proper waste disposal.

Africa↗
PubMed1991

Northwick Park Infection Consultation Service. Part I. The aims and operation of the service and the general distribution of infection identified by the service between September 1987 and July 1990 [see comment].

The Northwick Park Infection Consultation Service (ICS) is a collaborative service operated by the departments of Medical Microbiology and Infectious Diseases where personnel and skills are combined. Its aim is to improve the availability and effectiveness of consultation for infection-related problems. This paper sets out the framework for establishing an ICS and also details the general distribution of infection identified by the Northwick Park ICS in a study carried out between September 1987 and July 1990. Part II assesses the contribution that the ICS made to the management of infection. One thousand and thirty-eight (1038) patients were seen on the ICS. Seventy-five per cent (776) were judged to be infected and in 691 this was a probable or certain diagnosis. Skin and subcutaneous tissue, respiratory tract, and genito-urinary tract infections accounted for 64% of the total. Eighty-seven per cent of infections required treatment with intravenous antibiotics, 22% were associated with concomitant bacteraemia, and 2.7% of patients died as a direct result of their infection. Sixty-four per cent of consultations were unsolicited and arose from laboratory results or the clinical information on the form accompanying the specimen: over one quarter were initiated before results were available. These infections were no different in either severity or nature from those identified by solicited requests to either department. Fifty-three per cent of consultations had a moderate to high clinical component. The results emphasise the importance of infection in hospitals and highlight the advantages of a collaborative approach from the departments of Medical Microbiology and Infectious Diseases.

Cross Infection↗
PubMed1991

Northwick Park Infection Consultation Service. Part II. Contribution of the service to patient management: an analysis of results between September 1987 and July 1990.

The establishment of Infectious Disease teams combining microbiological and clinical expertise has recently been recommended by a joint working part of the Royal College of Physicians and the Royal College of Pathologists. The Northwick Park Infection Consultation Service (ICS) has been operating on these lines since 1983; details are given in Part I. Part II assesses the contribution that the ICS has made to the management of infection in a study of 1038 patients undertaken between September 1987 and July 1990. The areas of patient diagnosis, treatment, investigation and isolation were examined to assess the appropriateness of the attending doctor's management of infection and the benefits resulting from recommendations made by the ICS. At the time of consultation the correct diagnosis had already been made or considered in 93% of patients, essential investigations needed to confirm or refute the diagnosis performed in 92%, and side-room isolation correctly instituted in 81% of patients requiring it. However, 41% of 776 infected patients were receiving suboptimal treatment: this was significantly more frequent in unsolicited consultations (P less than 0.05). Advice was given following consultation in 893 of 1038 patients (86%) and related to treatment (66%), investigation (41%), diagnosis (30%) and patient isolation (4%). Of 844 patients where receipt of advice could be accurately assessed, it was taken fully in 708 (84%), partly in III (13%), and went unheeded in 25 (3%). Advice on diagnosis or investigation enabled the correct diagnosis to be reached in 30% of consultations and in a further 47 patients (5%), the diagnosis was proposed by the ICS on initial consultation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Using guidelines, policies and standards: are we in control?

For the hospital microbiologist, the use of guidelines, policies and standards are an integral part of their professional duties. Both patient-related and laboratory activities involve awareness of specific procedures and the use of equipment or products which have been accepted as appropriate for a particular purpose. The means by which policy is formulated, the guidance available and the standards specified, differ widely from country to country. In the UK, there are few legal requirements or statutory regulations in this area. In consequence, there may be some differences in both the nature and the method of implementation of policies from hospital to hospital. There is increasing concern that legislation and standards produced not only by the UK but also by Europe may impose regulations on infection control and laboratory practice and in particular that such mandatory controls may have adverse effects. These are variously perceived as specifying inappropriate standards, inhibiting clinical freedom and stifling innovation. Such concern is embodied in the question 'are we in control?'.

Clinical Protocols↗
PubMed1991

Infection control policies and guidelines--Scandinavian experience.

In the Scandinavian countries few regulations govern hospital infection control. In Sweden a common procedure manual is used nationwide, consisting of guidelines covering a wide range of nursing and medical procedures performed by the nursing staff. It is revised every fifth year. A recent enquiry to over 150 wards in some 100 hospitals demonstrated that the manual is widely accepted and used. In the other Scandinavian countries, guidelines and policies on a variety of infection control topics have been published.

Clinical Protocols↗
PubMed1991

Nursing priorities and the contribution of the International Federation of Infection Control.

Much thought has been given to the role of the nurse in the future. Concern has been expressed that nurses are becoming preoccupied with technology which, despite the undoubted advantages, is diverting attention from simple prevention and control of infection measures. In countries with minimal resources the appointment of a full-time infection control nurse may not be feasible. Therefore, attempts should be made to train all nurses in the basic principles and practice of the prevention and control of nosocomial infection. This training should be designed to suit the needs of the individual country taking into account the culture, common infections and the patient population. The International Federation of Infection Control should be able to assist with this type of education. The nursing priorities for each country will vary and, whereas handwashing will remain a major priority, routine surveillance may be impracticable. The International Federation of Infection Control which was founded in 1987 is planning to take a lead in helping to set up organizations for infection control workers and to improve communications between organizations in different countries.

Cross Infection↗
PubMed1991

Information in infection control.

Effective infection control depends upon a clear understanding of the activities of surveillance, control, communication and management and of the nature and source of information required. Surveillance uses diverse information and computerization of hospital information provides the potential for automated detection of patients at risk of, or affected by, nosocomial infection. Routine visits to all hospital wards by the infection control team is widely advocated but is an inefficient use of a limited resource. 'Targeting' clinical areas with particular problems is more efficient but requires the means to find cases and perform risk assessment through surveillance. While microbiology laboratory reports are effective for case finding, sensitivity and specificity are low. The increasing use of computer held clinical data presents new opportunities for automated surveillance to guide the daily activities of the infection control team. It is essential to stress the importance of infection surveillance to those designing hospital information systems.

Cross Infection↗
PubMed1991

The use of personal computers in hospital infection control.

The storage, retrieval and analysis of hospital infection data is best performed by using computers. Many laboratory mainframe systems have infection control modules and there are some commercial programs for personal computers (PCs). An alternative is to use business and statistical PC software. Because of their large customer base these programs are reliable and easy to use yet extremely sophisticated and flexible, and they can be easily customized for use in infection control. Many combinations of software and hardware are available but the ones described here have been used successfully for several years at the Prince of Wales Hospital in Hong Kong.

Computer Graphics↗
PubMed1991

Microprocessors for auditing the surveillance activity of the Infection Control Nurse.

An important part of the Infection Control Nurse's activity in the UK is the laboratory-based surveillance of patients with infections that are known to be transmissible, i.e. of 'alert' organisms. We have replaced a manual 'T-card' system in which relevant patient information, microbiology and nursing notes are held on all patients yielding 'alert' organisms. The programme is menu driven, requires minimal coding and runs on a microprocessor with a hard disc. The programme enables surveillance patient information to be entered, edited, archived and recorded. Instant retrieval on screen or hard copy includes summarized or full displays of all patients on all wards, sorted by wards, organism, date or risk category. Archived data may be retrieved within minutes and this avoids having to interrogate the whole laboratory database overnight. To illustrate an additional use of the data stored, we analysed the surveillance activities of the Control of Infection Nurse for one year. Of 203 laboratory diagnoses requiring patient surveillance, 30% were viral infections, of which more than two-thirds were caused by hepatitis B virus; of the 142 bacterial isolates, 27% were multiply antibiotic-resistant Enterobacteriaceae, 25% Pseudomonas spp, 12% Salmonella spp., 9% methicillin-resistant Staphylococcus aureus (MRSA), 7% Group A streptococci and 8% meningococci. These isolates resulted in only four outbreaks involving nine patients or staff. This information has proved useful for auditing the nurse's activity and provides evidence for the cost-effectiveness of infection control.

Cross Infection↗
PubMed1991

The HELP system and its application to infection control.

The HELP system is a comprehensive hospital information system that is linked to an allied financial data base. The clinical data base integrates information from areas such as admitting, pharmacy, radiology, surgery, pathology, nursing, respiratory therapy, and the clinical laboratories, including microbiology. This allows for the creation of an electronic medical record that contains all the clinical and financial data for each patient. The HELP system combines both communication and advice features through the use of data- and time-driven algorithms. We have used the HELP system to automate the surveillance and analysis of hospital-acquired infections and to identify patients at high risk for nosocomial infection. The expert system features have also been used to suggest alternatives for patients receiving inappropriate antimicrobial therapy, to improve the timing of antibiotic prophylaxis in surgery, and to curtail unnecessarily prolonged prophylaxis. Automated hospital information systems such as HELP can facilitate the investigation of a broad range of infection control, quality improvement, and cost-containment issues.

Cross Infection↗