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PubMed1991

Educational programmes for infection control in Austria.

Educational aims and strategies (simply arousing awareness, sensitivity and understanding; and/or training in practical skills and knowledge; or the ability to teach infection control, and to convince those taught) depend on the target group. Infection control is part of the curriculum for students of medicine and other health care professions, and is included in course examinations. Postgraduate doctors may seek training on courses which are organized by the Hygiene Institute of the University of Vienna in co-operation with the Austrian Society of Hygiene, Microbiology and Preventive Medicine. Registered nurses may enroll in the Austrian Nurses' Association training scheme (6 weeks of theory with professional work for 2 years), leading to approval as Hygieneschwester/-pfleger. Postgraduate in-hospital education for all health-care professions occurs in many Austrian hospitals, with resources from Vienna and Linz. Hospital managements, health authorities and politicians are influenced via their own educational activities and via publications.

Austria↗
PubMed1991

Motivation to comply with infection control procedures.

This paper addresses the critical issue of motivating hospital staff to comply with standard infection control procedures. Previous psychological assessment of infection control knowledge, attitudes and behaviour has indicated that the reasons for non-compliance are very basic and reflect inter alia a low perception of the importance of the measures and a lack of motivation. It is argued that, although staff have a theoretical awareness of the value of complying with such procedures, in practice these seem to have a low priority. Compliance levels, therefore, are variable and generally of a low order. If recent advances in the fields of social psychology, behavioural psychology and clinical psychology could be imported to hospital medicine, they could have a dramatic impact in infection control. The Elaboration Likelihood Model, an effective theoretical approach to message-based persuasion, and the energizing effects of intrinsic and extrinsic motivational processes are defined. Finally, the implications of these concepts for persuasive intra-hospital communication in infection control are highlighted. They can provide a framework for developing effective infection prevention programmes.

Health Knowledge, Attitudes, Practice↗
PubMed1993

How to cost and fund an infection control programme.

Infection control (IC) services in the United Kingdom are provided as part of the microbiology services and therefore they have not, to date, been costed separately. This paper addresses the cost of providing the service, the savings that accrue from the IC policies in a hospital and, finally, the cost of infective episodes and outbreaks. The point of the exercise is to enable readers to cost their own services and separate the IC and microbiology budgets while maintaining the provision of service under one department.

Budgets↗
PubMed1993

Introduction of laboratory based ward liaison surveillance of hospital infection into six district general hospitals.

A previous study demonstrated that laboratory based ward liaison surveillance (LBWLS) of hospital infection was an effective and efficient method. The method involved the follow-up of positive microbiology reports by the review of patient records and liaison with ward nursing staff to consider whether any patients had infection. Here we report the introduction of LBWLS into six district general hospitals to determine whether it is feasible to use this method on an everyday basis. The time required for data collection was assessed and the method was compared with a reference method in one hospital to check its ability to detect infections. To assess reproducibility two infection control nurses (ICNs) performed LBWLS independently, but concurrently, for 5 weeks. The method could be used in all hospitals studied; however, the time for data collection ranged from 3.0 to 6.8 h/100 beds per week. In comparison with the reference method, LBWLS detected 15/41 (37%) of community acquired infections and 30/43 (70%) of hospital acquired infections. In the reproducibility assessment 72 patients were identified by both ICNs. There was agreement about the infected/non-infected status of 65 of these patients. The mean pair agreement and Kappa statistic were 0.88 and 0.72. Laboratory based ward liaison was readily used in all hospitals and was reproducible.

Adolescent↗
PubMed1993

A clinical infection control audit programme: evaluation of an audit tool used by infection control nurses to monitor standards and assess effective staff training.

In today's competitive market infection control teams are under increasing pressure from purchasing authorities to provide hard data on quality issues. The initial aim of this study was to determine whether a modified form of the audit system used to monitor infection control standards in Derbyshire could be used effectively across three district health authorities. Infection control nurses in each of the study districts have different approaches to training with only Stafford using a link nurse system. Our additional aim therefore was to examine the relationship between the knowledge base of nursing staff and their ward audit score, and to determine whether wards with link nurses achieved significantly higher scores. To establish this a questionnaire was devised and completed by three different grades of staff on each ward at the time of the audit. These results were fed back to the wards and to managers by the infection control nurse, and an action plan given with a review date where applicable. Results of the study indicated that the audit tool could be used effectively in any district but would need modifying for psychiatric departments. The value of education in improving standards of infection control was clearly demonstrated. An important finding in Stafford was that wards with link nurses obtained significantly higher scores. The value of using such a clinically based audit will be discussed.

England↗
PubMed1993

Closing the loop: audit in infection control.

The audit cycle has four parts: setting standards, testing practice and outcome against these standards, correcting practice where it falls short, and re-auditing to confirm that standards are now met. The last two steps complete the audit cycle or 'close the loop'. Infection control can be audited for whether written guidelines exist for each procedure, whether these guidelines are acceptable and whether they are followed in practice. This form of audit is relatively simple provided there are authoritative model guidelines available, produced by organizations such as the Hospital Infection Society. The best outcome measure of infection control is the nosocomial infection rate, but this is the most difficult to audit in practice. If audit results are to be compared between hospitals or between different time periods in the same hospital, infection rates should be adjusted for the underlying risks of infection in the patient population. This type of audit can be done by repeated prevalence surveys.

Cross Infection↗
PubMed1995

Infection control programmes--are they cost-effective?

Infection control (IC) programmes are cost-effective in the long-term but much depends on the available resources and the support from management. The funding of IC programmes at present is linked to the Microbiology Department and a separate budget needs to be established. The best use of resources is to apply a risk assessment to each situation which presents and to adapt protocols accordingly. For example, the treatment of a carrier or an infected patient with methicillin-resistant Staphylococcus aureus cost 374 pounds and 2454 pounds, respectively in 1993, the major portion of the cost being due to an increased length of stay which was two days and 10 days, respectively. It is more cost-effective to treat carriers. The other cost-effective investment is in education and reinforcement of simple messages. Formal lectures seem to be the least effective way of producing long-term effect; frequent ward visits or contacts are most effective. Also, there is better compliance when there is a perceived risk to the staff themselves. The availability of the IC team to advise helps reduce waste and therefore cost. This is particularly true of antibiotic usage where it was noted that without guidance, the antibiotic usage increased by 2000 pounds per month when compared to a similar period in the previous year. The available provisions for IC programmes in the UK are utilized exceptionally well when compared with other countries.

Anti-Bacterial Agents↗
PubMed1995

Progress with establishing and implementing standards for infection control in the UK.

The process of agreeing standards for infection control in England and Wales is described. To ensure ownership of these standards an extensive consultation exercise was undertaken. Further development has been left to Infection Control Teams (ICTs) and the relevant health care workers. Management and Consultants in Communicable Disease Control were also sent the standards to further encourage support for their implementation. The results of a questionnaire of ICT resources and activities is alluded to and these data will be a valuable point of reference to monitor changes in the status quo of a rapidly changing health service.

Communicable Disease Control↗
PubMed1995

Establishing an infection control structure.

In studies from the USA it has been shown that infection control can lower infection rates by 30%. To achieve this an infection control programme has to be given a firm structure. Judging from the opinions presented by an educational workshop within the International Federation of Infection Control (IFIC) and from the literature there is an international consensus on the basic components of hospital infection control. An infection control team, with the task of identifying areas of concern, providing or initiating work on written policies, educating and advising not only medical staff but also hospital administrators, constructors etc., constitutes the backbone of infection control. However, in most countries the infection control team, should it exist, is usually understaffed. This is false economy, a qualified medical input is a proven investment.

Forecasting↗
PubMed1995

The impact of surveys on hospital infection.

The major impact of surveys of hospital infection has been the improvement in the quality of infection control programmes. The earlier surveys became an incentive to others to find out their infection rates and risk factors for infection. Surveys are now more sophisticated in design and the surveillance methods more refined, but they have had little impact on the rates of infection. Without doubt, the greatest improvements have been made by carrying out targeted surveillance with interpretive feedback to clinical staff. This has led to the use of guidelines for good practice and measures of outcome. This strategy has been shown to decrease infection rates, decrease the need for antibiotics therapy, alleviate morbidity and save on hospital costs.

Cross Infection↗
PubMed1995

Evaluation of the objectivity of an infection control audit tool.

A national study involving 22 districts was carried out during 1993 to evaluate an infection control audit tool. The tool was found to be objective and can be used by infection control teams to monitor practices and assess the impact of training programmes. It can also be used to provide purchasers with a measurable standard in relation to infection control quality issues. In total, 440 wards were audited. A few districts had problems in meeting some of the standards, particularly on sharps and waste. A subgroup of the West Midlands Infection Control Nurses Association was able to adapt the audit tool for specialized areas including general practice, nursing homes and dentistry.

Evaluation Studies as Topic↗
PubMed1984

In-hospital needlesticks and other significant blood exposures to blood from patients with acquired immunodeficiency syndrome and lymphadenopathy syndrome.

There have been no documented cases of acquired immunodeficiency syndrome (AIDS) in personnel after a prospectively recognized in-hospital blood exposure. To assess the frequency of such exposure the membership of the Association for Practitioners in Infection Control was surveyed in early June 1983. Thirty-three percent of the membership responded, accounting for 42% of U.S. hospitals with more than 250 beds. Respondents reported needlestick or other significant blood exposures to blood from patients with AIDS occurring in 157 instances and to blood from patients with lymphadenopathy syndrome in 43 instances. Nineteen and twenty of the exposures, respectively, occurred before July 1982. There are two bases for believing that AIDS will not pose a substantial risk to hospital workers: the lack of demonstrated in-hospital AIDS transmission to date and the recognition that other viruses besides the hepatitis B virus--viruses that seem to have less potential for in-hospital transmission--are equally plausible models of AIDS transmission.

Acquired Immunodeficiency Syndrome↗
PubMed1989

APIC and the 1985 position paper: "Listen to the music".

The Association for Practitioners in Infection Control (APIC), in existence now for 16 years, is still considered to be a relatively young professional organization. During that time its many accomplishments include membership growth to more than 7500 persons, establishment of a national office, annual revenues of more than $700,000, publications of a bimonthly scientific journal, publication of the standard reference work for infection control practice, establishment of the process leading to a certifying examination in infection control, an annual educational conference attended by more than 1000 persons, and increasing recognition by other professional groups, state and federal agencies, and the scientific community as a leading voice that represents professionals involved in infection control practice in the United States. These accomplishments have been due in large part to the dedication and hard work of its members, especially the hundreds of persons who have filled local and national positions of leadership. However, APIC now finds itself at a crossroads; changes in the current health care climate and publication of the results of a national study on the efficacy of infection control practice have contributed to a reassessment of infection control programs and the role and scope of persons involved in the field. The purpose of this editorial is to review the background of our two position papers, to comment on an expanded role of hospital epidemiology, and to examine the response of APIC to our membership in terms of commitments identified in the two papers.

Cross Infection↗