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PubMed2003

Welcome to SARS hell.

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Attitude of Health Personnel↗
PubMed2001

The role of the infection control professional in the intensive care unit.

By design, multiple invasive procedures are performed in the intensive care unit (ICU). Although great care is taken to control morbidity and forestall mortality, this invasive environment places ICU patients and staff at immense risk of nosocomial (hospital-acquired) infection. The role of the infection control professional (ICP) within the ICU involves data collection, dissemination of data with feedback, expertise in the investigation of outbreaks, product evaluation proficiency, and fluid consultation aptitude. This article provides an inside view of how specialty infection control staff and ICU staff can optimize infection control to decrease the incidence of nosocomial infections. A description of what the ICP does not do in the ICU is also given, providing a clear guideline for how these two disciplines can best provide a safe intensive care experience.

Humans↗
PubMed2001

Applying social and behavioral theory as a template in containing and confining VRE.

Infection control professionals play several important roles--surveyors, educators, and ultimately change agents--in the identification and prevention of nosocomial infections in hospitals. The medical and surgical intensive care units (ICUs) in a large inner-city teaching hospital experienced an increased patient colonization rate with vancomycin-resistant enterococcus (VRE). Intervening in this problem required a multifaceted approach to control the spread of VRE and to change behavior by shifting social norms at multiple levels throughout the ICU community. The success of the interventions could be best explained by applying the use of several behavioral science models. The Ecological Model of Behavior Change, the Health Belief Model, and Social Cognitive Theory can be applied and are consistent with the successful interventions. This multifaceted approach to intervening in this problem consists of five levels of influence: (1) intrapersonal or individual factors, (2) interpersonal factors, (3) institutional factors, (4) community factors, and (5) public factors. We implemented educational inservices and developed references, policies, and programs directed at each of the five levels of influence. The Health Belief Model and Social Cognitive Theory were employed for intervention, and behavior change was based on modeling, observational learning, and vicarious reinforcement. Within six months of initial implementation, the number of positive VRE surveillance cultures and positive clinical isolates decreased significantly in both the medical and surgical ICUs. Two years later, there continues to be a marked reduction of VRE.

Behavior↗
PubMed1997

AIDS surveillance: knowledge, attitudes, and practices of health care professionals in Washington State.

Health professionals in Washington State were surveyed in 1993 to assess acquired immunodeficiency syndrome (AIDS) reporting knowledge, attitudes, and practices. Seventy-five percent responded. Two thirds of previous reporters were informed about the 1993 AIDS case definition and reporting requirements, but 32 percent had neglected to report. Forty-eight percent were concerned about confidentiality of reported cases. Half favored human immunodeficiency virus reporting and 21 percent opposed it. In order to promote complete and timely AIDS reporting, current and future reporters need ongoing education on reporting requirements and methods. The importance of AIDS surveillance data for community planning as well as assurance of protection of confidentiality should be emphasized.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Peripheral venous catheters: a review of current practices.

Loss of peripheral intravenous (PIV) catheter patency is a common problem in the clinical setting. A survey of all private and public hospitals in a metropolitan city in Australia was conducted to identify practices related to maintaining patency of PIV catheters. Eighty-three hospitals were surveyed and responses were obtained from all of them. Normal saline was the most commonly used solution for flushing. The frequency for flushing ranged from 4 to 12 hours, and the volume of the irrigant used ranged from 2 to 10 mL in those hospitals where flushing is routine practice. Policy documents were available from only a few hospitals to validate the practice reported. Significant diversity in practices was documented among healthcare organizations.

Anticoagulants↗
PubMed2002

Health professionals' views of contracting for infection control in the NHS internal market.

This paper reports a national study which investigated the involvement of infection control professionals in (and their views about) the formal processes of contracting for health care in the NHS internal market. Health care professionals needed to be involved contracting, if it was to be effective. The study found that many infection control professionals were not, in fact, involved in contracting, while the importance of both contracts and informal professional networks were recognised But respondents did not think that their professional networks entirely compensated for their lack of involvement in contracting. As formal agreements continue to be central to achieving quality of care in the post-internal market NHS, infection control professionals need to be involved in specification and implementation of these arrangements.

Attitude of Health Personnel↗
PubMed1990

Evaluating the efficacy of the infection control liaison nurse in the hospital.

The infection control liaison nurse (ICLN) is a nurse in the ward, appointed to participate in education for infection control, and to liaise between the ward and the infection control nurse (ICN). The efficacy of ICLNs was evaluated when a guideline on urinary catheter care was introduced in a 1000-bed hospital in Hong Kong. The 27 public wards were divided randomly into a test (24 wards) and control group (three wards), and ICLNs were appointed in the test group by the nursing administration. For education, the ICN conducted in-service lectures for both groups, while in the test group, the ICLNs also conducted tutorials for all ward nurses. Before and after the education programme, prevalence surveys were conducted to detect incorrect practices on urinary catheter care. Three practices were evaluated: the securing of catheters, presence of kinking and the use of urinary bags with a drainage spigot. Before education, the percentage of incorrect practices in the test groups was 63%, which was comparable to the 68% of the control group (P = 0.40, chi 2 = 0.71). After education, the percentage of incorrect practices in the test group (36%) was significantly lower than the 48% in the control group (P less than 0.05, chi 2 = 4.25). This indicates that ICLNs can indeed enhance the education programme for infection control.

Evaluation Studies as Topic↗
PubMed1994

Nurses' views of infection control: an interview study.

An interview study was conducted among 173 nurses in two hospitals to explore their views concerning infection risks to themselves and patients and to identify any problems they perceived in safely performing infection control precautions during routine activities. Subjects were interested in the topic of infection control and keen to perform optimally, but perceived difficulties related to lack of expert guidance whether or not they had access to an infection control nurse. In one hospital subjects identified shortages of vital equipment (gloves, appropriate handwashing agents), and this was corroborated on a checklist used independently to document the availability of resources. When the opinions of nurses working in intensive care, surgical and medical units were compared, few differences emerged other than those explained by variation in supplies of equipment, except that intensive care unit nurses were more likely to rate their patients and themselves as particularly at risk of infection, Nurses who had been qualified longer, with more than 3 years experience in their specialty, were more conscious of infection risks.

Cross Infection↗
PubMed1996

An examination of nurses' practices when performing aseptic technique for wound dressings.

The purpose of this study was to establish if nurses' actions when carrying out 'aseptic technique' using the 'gloves technique' are simple and based on up-to-date knowledge and do not incur unnecessary wastage. A sample of convenience was used involving 21 trained nurses. Observation and formal interviews were used to collect quantitative and qualitative data. Results showed that not all nurses in the sample applied a 'simple aseptic technique'. The rationale for the practice of aseptic technique was not always research based, though other aspects of wound management were derived from research findings. The study highlighted other areas of aseptic technique which require investigations.

Asepsis↗
PubMed2004

Infection Control Nurse: a national survey.

AIM: To study presence and activity of Infection Control Nurses (ICN) in Italian National Health System (NHS) hospitals. BACKGROUND: Infection Control Nurses play an essential and evidence-based role for optimal infrastructure and essential activities of infection control and epidemiology programmes in hospitals. METHODS: A survey of all Italian NHS hospitals (N = 529). Hospital health directors were asked to complete a questionnaire with a specific section on ICN presence, activities and roles played. Response rate was 87.5% (463 of 529). RESULTS: More than 50% of hospitals (250 of 463) have an ICN: 25% (116 of 463) have at least one part-time employed ICN and 23.3% (108 of 250) have at least one ICN employed full-time. Infection Control Nurses are more common in hospitals with >250 beds (P < 0.01). Infection Control Nurses working in hospitals with >250 beds are highly active in surveillance activities, personnel education and management of study groups (P < 0.01). CONCLUSIONS: In Italian NHS hospitals ICNs have yet to become pillar figures in hospital infection control.

Attitude of Health Personnel↗
PubMed2005

The training curriculum in hospital infection control.

Standardised training curricula for infection control nurses (ICNs) and recognition of the specialty exist in many European countries, but infection control physician (ICP) is not a specialty recognised by the UEMS. To gather information on curricula for ICPs, members of the ESCMID Study Group on Nosocomial Infections received a questionnaire. There is discussion about which 'professions' should be included in an infection control team. Within the 12 countries included, the average full-time equivalents (FTEs) for ICPs and ICNs per 1000 beds were 1.2 and 3.4, respectively. In addition to ICNs and ICPs, an infection control team should also include a data manager, an epidemiologist, secretarial/administrative support, and possibly, surveillance technicians. Overall, the composition of an ideal infection control team was estimated to be 9.3 FTE per 1000 beds. The background of ICPs can be clinical microbiology or infectious diseases. Among the participants, it was predominantly clinical microbiology. The ideal training curriculum for the ICP should include 6 years of postgraduate training. Of these, at least 2 years should be 'clinical training' (e.g., internal medicine) to acquire experience in the management of high-risk patients. Furthermore, training with regard to infection control and hospital epidemiology should be offered as a 'common trunk' for those being trained in clinical microbiology or infectious diseases. Important issues that remain are: implementation/standardisation of training curricula for doctors, recognition of ICP as a separate specialty or sub-specialty of clinical microbiology and/or infectious diseases, validation of on-the-job training facilities in terms of the number of doctors and nurses who can give training and the category of patients/problems present, and mandatory postgraduate education/continuing medical education specific for infection control for doctors and nurses in the field.

Cross Infection↗
PubMed2005

Report of working group 2: healthcare needs in the organisation and management of infection.

Clinical microbiology should have a physical presence, but not necessarily on-site diagnostic laboratory facilities, in each hospital to ensure a quality laboratory-based infection service and strong professional interaction with clinicians. The adoption of industrial practices and the introduction of new costly molecular techniques raise the possibility that non-microbiological functions of laboratory management could be left to management professionals. This remains highly controversial; the advantages must be contrasted with the potential to disrupt the traditional managerial responsibility of the microbiologist and the links between the laboratory and clinical staff. Managers and healthcare professionals must resolve this issue, perhaps with the support of the ESCMID. Views varied, according to current professional arrangements and size of the laboratory and population served, on whether there should be a common laboratory for microbiology and other pathology disciplines with joint access to new high-technology techniques, or whether microbiology must continue as a separate facility. Clinical microbiology and infection control were viewed as core services that must be present even in smaller hospitals. Larger community hospitals and teaching centres require a full complement of expertise in laboratory and clinical practice. Integration of these disciplines within a department of infection is an emerging concept. A concern was the shortfall in trained expertise because of the ageing nature of current specialists. The importance of recruiting talented new graduates was emphasised. The importance of this topic led to a recommendation that an ESCMID working party be established to investigate the current arrangements of infection services in Europe and to make recommendations for the future organisation.

Communicable Disease Control↗
PubMed2005

Report of working group 3: specialist training and continuing medical education/professional development in the infection disciplines.

The European Union of Medical Specialists (UEMS) core curricula for training in infectious diseases and medical microbiology are adequate with the exception of one deficiency which is the absence of training in epidemiology, public health and infection control. Infectious disease curricula should include training in HIV, tuberculosis, hepatitis and sexually transmitted diseases. There is a need for a core curriculum in infection control. Infection control should have a basis in both medical microbiology and infectious diseases, and should become a specialty dealing with healthcare hygiene in hospitals, in outpatient clinics and also in institutions for the elderly. In the UK, a specialty training in infection is offered and includes internal medicine, clinical infectious diseases and medical microbiology for a total of 9 years. The UEMS should be contacted about the creation of a single specialty of infection, allowing for various degrees of sub-specialisation in infectious diseases or medical microbiology. It is unlikely that a European board examination validating the training of specialists will become a reality soon. Meanwhile, national systems should be created, documenting the content of the training and evaluating the quality of the training institutions. A medical specialist has a constant need for further education. This is generally a national matter, with requirements varying throughout Europe. It should be possible to accumulate continuing medical education/continuing professional development merits on a European level as well as on a national one. With the expansion of the European Union, it is important that the quality and content of specialist training can be verified and training curricula be harmonised. The UEMS should assist in this, in collaboration with scientific societies such as the ESCMID.

Communicable Disease Control↗