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PubMed1993

Use of the total quality process in an infection control program: a surprising customer-needs assessment.

The University of Michigan Hospitals began a quality management and improvement process in 1987 as the framework for all of its quality-related efforts and activities. The Infection Control Services department used total quality techniques to develop its mission statement, identify customers, identify customer requirements, and develop quality improvement objectives to meet the requirements. A service evaluation of customers resulted in specific improvement activities. An unexpected result of this evaluation was the difference noted between the Infection Control Services staff members' perception of customer requirements and these customers' actual needs. ICPs should use the continuous quality improvement tools and techniques to enhance their activities within their institutions, to better meet their customer needs, and to make sure that they are complementing their institution's mission.

Consumer Behavior↗
PubMed1994

Epidemiologic perspectives on Enterobacter for the infection control professional.

Enterobacter species have emerged as important nosocomial pathogens. Common reservoirs for these organisms include wounds and the gastrointestinal, urinary, and respiratory tracts. Enterobacter bacteremia typically occurs in patients with long-standing underlying illnesses who received antimicrobial agents before their bacteremia. The wide use of broad-spectrum antibiotics has contributed to the increased prominence of Enterobacter infections. Enterobacter species have a propensity to emerge resistant to the antibiotic therapy administered. Plasmid analysis, restriction endonuclease analysis of total cellular DNA, pulsed-field electrophoresis, and ribotyping can be valuable in investigating the spread of antibiotic-resistant strains.

Anti-Bacterial Agents↗
PubMed1994

Standardizing glutaraldehyde use in a regional group of ten major medical centers.

The ICPs of 10 Southern California medical centers were able to coordinate efforts to standardize the use of glutaraldehyde for high-level disinfection. In implementing "APIC Guidelines for Selection and Use of Disinfectants," variations in practice similar to those recognized nationally were identified. Through coordinated efforts, the regional ICP group researched and developed a position paper to facilitate standardization of high-level disinfection practice.

Disinfection↗
PubMed1995

Training needs of infection control professionals in long-term care facilities in Virginia.

BACKGROUND: Infection control professionals from area long-term care facilities contacted us and asked for help in securing infection control training. To determine whether there was sufficient statewide need to warrant University activity, we conducted a needs assessment. METHOD: An eight-page questionnaire was mailed to 220 infection control professionals in nursing homes statewide. The instrument focused on training needs and also on training accessibility issues. Ninety-nine completed questionnaires were returned for a 41% response rate. RESULTS: The infection control professionals who responded came from a representative group of long-term care facilities throughout the state. Ninety-three percent indicated that they were "very interested" or "interested" in a series of sessions addressing a wide variety of long-term care infection control topics. Ninety-nine percent of the respondents indicated that it was "extremely important" or "important" for any such training to focus specifically on long-term care facilities. CONCLUSIONS: Considerable need for infection control training was expressed by infection control professionals in Virginia long-term care facilities. Such training must be relevant to long-term care facilities and should meet accessibility requirements.

Attitude of Health Personnel↗
PubMed2004

Development of a resource model for infection prevention and control programs in acute, long term, and home care settings: conference proceedings of the Infection Prevention and Control Alliance.

There is mounting concern about the impact of health care restructuring on the provision of infection prevention services across the health care continuum. In response to this, Health Canada hosted two meetings of Canadian infection control experts to develop a model upon which the resources required to support an effective, integrated infection prevention and control program across the health care continuum could be based. The final models project the IPCP needs as three full time equivalent infection control professionals/500 beds in acute care hospitals and one full time equivalent infection control professional/150-250 beds in long term care facilities. Non human resource requirements are also described for acute, long term, community, and home care settings.

Adult↗
PubMed2005

The practice of infection control and applied epidemiology: a historical perspective.

The United States health care system and patient populations have changed substantially over the past several decades. The practice of infection control also has evolved since the landmark Study on the Efficacy of Nosocomial Infection Control project, and infection control professionals (ICPs) must continue to develop the knowledge and skills necessary to practice infection prevention and control. Practice analyses of infection control conducted between 1982 and 2001 were analyzed to determine changes in practice. These data reflect a 145% increase in infection control activities over a 20-year period. However, resources for infection control and prevention have not kept pace with this increased activity. In addition, the current trend toward mandatory reporting of health care-associated infections (HAIs) among several states will add more tasks for ICPs with limited resources, at the risk of spending less time on prevention and control activities. In keeping with its philosophy of quality health care and responsible public reporting, the Association of Professionals in Infection Control and Epidemiology, Inc, continues to explore the issue of mandatory reporting of HAIs.

Cross Infection↗
PubMed2006

Toward a socioethical approach to behavior change.

Infection control professionals have traditionally relied on didacticism to promote behavior change among health care workers, but this approach yields disappointing results in a postmodern era of social fragmentation and intellectual ambiguity. We define a socioethical approach to behavior change and propose its implementation in 4 movements: from individualism to community, from rationality to rhetoric, from productivity to praxis, and from monologue to dialogue.

Behavior Therapy↗
PubMed2006

Measurement of infection control department performance: state of the science.

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.

Cross Infection↗
PubMed2006

National survey of the status of infection surveillance and control programs in acute care hospitals with more than 300 beds in the Republic of Korea.

BACKGROUND: This study was conducted to assess the status of infection surveillance and control programs (ISCPs) and to analyze the trends associated with ISCP implementation since the first program was established in Korea in 1991. METHODS: A questionnaire modified from the Study on the Efficacy of Nosocomial Infection Control was mailed 4 times nationwide to acute care hospitals (n = 164) with more than 300 beds between June and October 2003. Eighty-five hospitals participated (52%). RESULTS: The mean number of beds (649) in the responding hospitals was significantly greater than in nonresponding hospitals. Of the participating hospitals, 92% had educational functions, 40% to 90% used hand hygiene resources, and 100% had infection control committees; 86% had infection control doctors, 98% had infection control nurses (ICNs), 89% employed only 1 ICN, and 59% employed an ICN only part-time; 68% performed surveillance, undertaking 2.7 epidemic investigations per year and 8.4 teaching programs per year; 88% undertook needlestick prevention programs; 58% performed regular air culture; and 64% discarded ineffective ISCPs. Annual trends analysis of ISCPs indicated that accreditation and legislation impact strongly on Korean ISCPs. CONCLUSION: The figures for ISCPs in this study indicate that improvements have been made since the 1990s. Legislation and accreditation have strongly influenced ISCPs. Much consideration should be given to the weaknesses in Korean ISCPs: surveillance, insufficient hand hygiene resources, and shortage of ICNs.

Accreditation↗
PubMed2006

Reading habits of infection control coordinators in the United States: peer-reviewed or non-peer-reviewed evidence?

BACKGROUND: Because evidence-based health care is taking on increasing importance, we surveyed a national sample of infection control coordinators on their reading habits to discern which and how often various media are utilized. METHODS: Infection control coordinators at 797 hospitals in the United States were mailed a survey asking which peer-reviewed journals and other publications they subscribe to, their perception of the quality of the infection control articles provided by each, and the extent to which they use various resources for their work. RESULTS: The survey response rate was 74%. Infection control coordinators spend a mean of 3.6 hours/week reading journals or periodicals. Resources identified as most useful included the Centers for Disease Control and Prevention (CDC) Web site (52%), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) text (11%), and the APIC e-mail list (8%). Proportion of subscribers was highest for the American Journal of Infection Control (84%) and Infection Control Today (72%). The top 3 journals ranked on a scale of 1 to 10 for quality of infection control articles were Infection Control & Hospital Epidemiology (8.0), the American Journal of Infection Control (7.5), and the New England Journal of Medicine (7.4). The American Journal of Infection Control (85%) and Infection Control & Hospital Epidemiology (72%) were the most frequently used peer-reviewed sources of information, whereas Morbidity and Mortality Weekly Report (85%) and Hospital Infection Control (63%) ranked at the top for non-peer-reviewed periodicals. CONCLUSION: Infection control coordinators devote limited time to reading and critically appraising published evidence and rely heavily on sources that provide rapid access to information or evidence summaries, suggesting a growing need for easy-to-read, reliable sources of information about evidence-based infection prevention and control practices.

Attitude of Health Personnel↗
PubMed2004

Development of a surveillance system for nosocomial infections: the component for neonatal intensive care units in Germany.

Neonates are at high risk of nosocomial infections and surveillance has been shown to be valuable for the reduction of nosocomial infections. The National Nosocomial Infections Surveillance (NNIS) system established in the US has a special surveillance component for neonatal intensive care units (NICUs) with some fairly specific methods. However, there are no specific definitions of nosocomial infections in this patient group. When creating a surveillance component for NICUs in Germany we therefore decided not to adopt merely all Centers for Disease Control and Prevention definitions and NNIS methods, but also to develop our own surveillance methods for this patient group. For this process four steps became necessary: (1)development of modified definitions for nosocomial infections and their evaluation; (2)testing the NNIS method in three NICUs with infection control nurses; (3)a pilot project for a surveillance component within the national surveillance system in Germany; and (4)establishment of a surveillance component within our national surveillance system. The system is now established in 33 hospital departments and 66 NICUs participate in the surveillance system. We have an overview of 3357 neonates in three birthweight groups. This article explains the reasons for the various steps, and the advantages and disadvantages of modification of the original NNIS methods and definitions.

Clinical Protocols↗
PubMed2004

Reducing ventilator-associated pneumonia rates through a staff education programme.

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilation and results in increases in mortality, prolonged hospitalization and costs. Preventive measures for VAP are well-documented and evidence-based, yet remain poorly implemented in most intensive care units. We undertook an observational pre and post-intervention study to assess whether an educational programme focusing on preventive practices for VAP could reduce the incidence. Six hundred and seventy-seven adult patients, mechanically ventilated for >48 h were included in the study population. An evidence-based guideline for preventive practices at the bedside was developed and disseminated to the intensive care unit staff. VAP incidence rates before and after implementation of the educational programme were compared. VAP infection rates reduced by 51%, from a mean of 13.2+/-1.2 in the pre-intervention period to 6.5+/-1.5/1000 device days in the post-intervention period (mean difference 6.7; 95% CI: 2.9-10.4, P =0.02). A multidisciplinary educational programme geared towards intensive care unit staff can successfully reduce the incidence rates of VAP. Further studies will be needed to assess the impact on broader outcome measures such as costs or mortality.

Adult↗
PubMed2004

Winning ways.

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England↗