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PubMedDate not supplied

Are tympanic thermometers a source of cross-infection?

AIM: To find out if tympanic thermometers are a source of cross-infection in critical care and whether cleaning is effective. METHOD: An observational study. RESULTS; In most of the inspections the surfaces of the tympanic thermometers looked clean, but three inspections revealed spots of dried fluid and one revealed a dirty base. None of the swabs taken before or after cleaning was positive, but seven of the inspections identified that the lens of the tympanic thermometer was dirty, poSsibly with cerumen (earwax). CONCLUSION: The findings from this study do not support the assumption that tympanic thermometers are a source of cross-infection in critical care, but a potential risk of cross-infection by this route cannot be excluded.

Cerumen↗
PubMed1972

Continued surveillance of Serratia marcescens infections by bacteriocin typing: investigation of two outbreaks of cross-infection in an intensive care unit.

During an 8.5-month period, 198 additional isolates of Serratia marcescens were typed by bacteriocin sensitivity; 154 isolates were typable and were categorized according to our current system of 54 provisional bacteriocin sensitivity patterns. Two outbreaks of nosocomial infection due to S. marcescens occurred in our intensive care unit, involving two and five patients, respectively. The latter outbreak was caused by a strain of S. marcescens which was not sensitive to any of the 10 bacteriocins normally used. Therefore we developed a supplementary procedure based on bacteriocin production rather than bacteriocin sensitivity. Bacteriocin production was induced with mitomycin C, and the crude lysates were applied to 15 provisional bacteriocin indicator strains. The reverse typing procedure was necessary to determine the spread and ultimate subsidence of this particular outbreak of cross-infection.

Bacteriocins↗
PubMed1996

Cross-infection control: the role of "in-training" dental nurses.

OBJECTIVES: This paper reports the findings of a study on the roles of dental nurses in cross-infection control in general dental practices and who were undergoing training for their initial certificate. The research aimed to find out what factors in their vocation gave them satisfaction, what caused stress and the bearing of these factors on cross-infection control. The study complemented previous research on the same matters carried out face-to-face in dental practices and aimed to test the validity of this previous research. METHODS: The study was made anonymously by means of self-administered questionnaires completed by respondents attending evening classes. RESULTS: Sixty per cent of respondents reported suffering anxiety in their work, the list of causes being headed by lack of experience, language barriers and taking part in general anaesthetic sessions. A third thought their workload was too great and a third quoted lack of time as the reason for not always completing cross-infection control procedures. Half were worried about cross-infection control. Clinical work was the most, and adequate pay the least important of five factors that gave respondents satisfaction in their work. Respondents always welcomed a word of thanks from their dentists and relied on them for information about their tasks. CONCLUSIONS: In order to carry out their work thoroughly, uncertificated dental nurses need sufficient time. They benefit from support and encouragement from their dentist. These are important factors in cross-infection control so that stress is prevented and job satisfaction enhanced. Our two studies validate each other.

Adolescent↗
PubMedDate not supplied

Is there a risk of cross-infection from laundered reusable bedpads?

The risk of cross-infection from reusable incontinence bedpads was assessed by determining their microbial content after one night's use by incontinent adults and after laundering using the standard foul wash procedure specified by the NHS Executive (NHS E, 1995) (which includes heat disinfection at 71 degrees C for 3 minutes). Measurements were made on a total of 145 bedpads from five different product designs. It was found that effective laundering destroyed all known pathogenic organisms, although some commensal flora were isolated in small numbers (mean 12.2 colony forming units/ml). It is concluded that laundering reusable incontinence pads using the foul wash procedure leaves pads safe for multiple patient reuse with no demonstrable risk of cross-infection.

Adult↗
PubMed2000

[Standards, Options and Recommendations (SOR) for the surveillance and the prevention of cross infections in oncology. Fédération Nationale des Centres de Lutte Contre le Cancer].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the prevention and the surveillance of cross infection in oncology. METHODS: Data were identified by searching Medline and the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 106 independent reviewers, and to the medical committees of the 20 French Cancer Centres. RESULTS: 1) Criteria of infection status and nosocomiality defined by the Centers for Infectious Diseases (CDC) and Prevention and the Superior Council of Public Hygiene (CSHPF) are not adapted and have to be redefined in oncology. 2) The epidemiology of nosocomial infections in oncology is not well known but their incidence seems to be higher. Numerous risk factors of cross infections coexist in cancer patients, among which the duration and depth of neutropenia. 3) Surveillance and prevention of cross infection are compulsory and were taken into account in the accreditation of hospitals. Obligation is expressed in terms of means and results. 4) The objectives of the cross infection surveillance are to detect major problems and critic situations, to guide probabilistic antibiotic therapy and to assess the effectiveness of the infections control. The surveillance means consist in prevalence and incidence survey, punctually and continuously conducted. 5) The three specific behaviors to be adopted to prevent cross infections are to control: all the patients, infected patients carrying multiresistant bacteria, immunodepressed patients. 6) Standards of care have to be applied to a/l patients with cancer. 7) It is necessary to add particular septic cares for the patients infected with micro-organisms indicated on reference lists or carrying multiresistant bacteria. 8) The only objective of the protective isolation of immunodepressed cancer patients is to reduce the cross infection. There is no standard behavior for the indications and the modalities of protective isolation. The prevention behaviors to be taken are defined by expert agreements.

Algorithms↗
PubMed2000

Effects of "isolating hemodialysis" on prevention of methicillin-resistant Staphylococcus aureus cross-infection in a hemodialysis unit.

AIM: To evaluate the effects of a contact isolation program against methicillin-resistant Staphylococcus aureus (MRSA) cross-infection among patients in a hemodialysis unit. CLINICAL SETTING AND METHODS: In all patients maintaining hemodialysis therapy were tested for MRSA infection and who had MRSA infection, not only inpatients but also outpatients were separated into a designated area (isolating hemodialysis). Clinically isolated MRSA strains were clonotyped with coagulase typing, staphylococcal enterotoxin typing and restriction enzyme analysis of plasmid DNA. RESULTS: The frequency of patients with MRSA infection was 4.5% before starting this protocol and was reduced to 2.9% two and a half years later. At this time, MRSA was isolated from the 8 patients. These 8 clinical strains were differentiated into 6 clonotypes and 3 strains showed the same patterns. Two of 3 were isolated from inpatients and the other was from a patient with community onset MRSA colitis. In this case, most MRSA infections were independent under prophylaxis control and cross-infection was observed only once between hospitalized patients who stayed in a same ward. CONCLUSION: This "isolating hemodialysis" should be useful to prevent cross-infection among patients in end-stage renal disease in a dialysis unit.

Adult↗
PubMed1995

Cross-infection control in general dental practice: dentists' behaviour compared with their knowledge and opinions.

This study aimed to establish how dentists' knowledge, opinion and behaviour about cross-infection control were related and how they were affected by their ages, gender and the sizes of the practices in which they worked. In 1990/91 all general dental practitioners in the North Western Health Region of England were asked to complete a questionnaire about cross-infection control; 917 (75%) did so. Responses from all single-handed and one dentist selected randomly from each group practice were analysed (n = 546). The score to measure behaviour was based on guidelines on cross-infection control issued by the British Dental Association and this was correlated with scores for knowledge and opinion. The more knowledgeable not only tended to hold favourable opinions about the guidelines but also to practise them. Younger dentists were more knowledgeable about cross-infection control measures than older and more likely to wear gloves. Irrespective of age, all female dentists were more likely to wear gloves than their male colleagues. Single-handed dentists were less willing to treat carriers of HIV and HBV. Although 65% thought that recommended control procedures are feasible, 43% considered them prohibitively expensive.

Adult↗
PubMed1995

Prophylaxis with enteral antibiotics in ventilated patients: selective decontamination or selective cross-infection?

Selective decontamination of the digestive tract (SDD) has been evaluated as a method to prevent colonization and infection in ventilated patients in 40 trials. On the basis of an assumption that cross-infection would be reduced as a consequence of SDD and that this would distort the results of SDD studies that used concurrent controls, 14 studies used historic controls. To test this assumption, three observations from the two types of studies were compared. (i) The differences between observed and expected event rates for each study were used to perform a meta-analysis. This revealed that the summary odds ratios for bacteremia and respiratory infection were marked by significant heterogeneity (P > 0.95) and inconsistencies between those derived from studies with concurrent versus studies with historic controls. (ii) Where the data were available, the rates of acquisition of colonization in control groups were higher in studies with concurrent controls than in studies with historic controls. (iii) At least four studies with concurrent controls have shown a pattern of pathogenic isolates consistent with cross-infection between groups. These results are contrary to the initial assumption and suggest the possibility that SDD represents a major cross-infection hazard.

Anti-Bacterial Agents↗
PubMed1995

Prevention of cross infection during outpatient spirometry.

Lung function apparatus may be a source of cross infection in patients with cystic fibrosis and may be prevented using a 'bag in bottle' system. As this system has never been validated in children the flow volume loops performed using a Vitalograph Compact in the usual way were compared with results obtained blowing into the bag and bottle system, in random order, in 20 children with asthma (age 8-15 years). Three reproducible flow volume loops were recorded for each apparatus. There was no order effect. Mean (SE) results for forced expiratory volume in one second, forced vital capacity (FVC), peak expiratory flow rate, and maximum expiratory flow at between 75% and 25% of FVC showed respectively that the bag in bottle results were significantly greater than those obtained blowing directly into the spirometer by 90 (17) ml, 12.7 (5.1) l/min, 130 (60) ml/min. Although statistically significant, these differences are within the previously described coefficients of variation for children with cystic fibrosis and are of doubtful clinical relevance. It is concluded that the bag in bottle system does not introduce any important systematic error. It potentially offers absolute protection from cross infection.

Adolescent↗
PubMed2004

[Investigation of cross-infection of Pseudomonas aeruginosa in an intensive care unit].

OBJECTIVE: To investigate the factors responsible for Pseudomonas aeruginosa nosocomial cross-infection in the intensive care unit (ICU) and provide effective measure for the prevention and management. METHODS: The homology of 7 Pseudomonas aeruginosa strains isolated from the patients in the ICU and the environment was examined by biological, serological, drug-resistance and plasmid analysis. RESULTS: The results of serological and plasmid analyses had good consistency, which demonstrated that the 7 Pseudomonas aeruginosa strains originated from solution in the oxygen humidifier, with uniform serological and plasmid type, and belonged to the same clone with cross-infection by contact between the patients or nursing staff and the objects in the ICU. CONCLUSION: Serological and plasmid analyses are more practical for identifying the sources of Pseudomonas aeruginosa cross-infection, which can be prevented by strict disinfection of the instrument and supervision of the nursing staff in the ICU.

Cross Infection↗
PubMedDate not supplied

[Epidemiology of S. aureus cross-infections in dermatological wards].

Over a three-year period, 196 of 3115 patients admitted in a dermatological department became infected with S. aureus (6,2 %). 205 strains of S. aureus were isolated. Serologic typing, phage-typing and antibiotic sensitivity tests revealed 3 epidemic and 2 endemic strains. The 3 epidemic strains infected 24 patients: 12 from july to november 1972 were infected with a serotype 66438 S. aureus resistant to fusidic acid. 6 patients (male) were infected with a serotype III in february and march 1972; 8 patients were contaminated with a serotype 18 S. aureus from december 1973 to february 1974, after staying in a surgical department. Of the 2 endemic strains 1, phage-pattern 53/79, is non-typable by serologic-typing; this strain has been observed only in the dermatological department and 20 patients were infected with, from january to october 1974. The second endemic strain, phage-pattern 81/+ serotype I, cross-infected 16 patients during this three-year survey; 12 of them were admitted repeatedly. During this three-year survey, it could be proved that, at least, 1 out of 3 patients is infected with an epidemic or an endemic strain. We can suggest that the factors enhancing cross-infection in dermatological department are: the sex of patients (80 % were male); presence of a tween splitting enzyme by S. aureus promotes growth of Staphylococci on the skin; patients transfered from a department to another or repeatedly admitted are more often infected. But, as they are source of some outbreaks, they need special measures (asepsis and hygiene); corticoïds or immunodepressors enhance cross-infection; antibiotics must not be only limited but varied too.

Cross Infection↗
PubMed1985

Outbreak of systemic Candida albicans in intensive care unit caused by cross infection.

The first documented outbreak of systemic candidosis shown to be due to cross infection with a particular strain of Candida albicans is reported. Over nine months in an intensive care unit 13 patients developed definite and one probable systemic candidosis. Twenty five further patients had superficial candidal infections. The strain that caused the outbreak (serotype A, morphotype A1, biotype 0/(1)5 5/7) was responsible for all the cases of systemic candidosis acquired in the intensive care unit, 11 (44%) of the superficial candidal infections in the unit, and 17% of candidal infections outside the unit but in the same hospital. The strain was also isolated from oral swabs taken from four nurses working in the unit and the hands of one of these nurses. Two out of 17 nurses were shown to have acquired the strain on their hands when examined immediately after nursing systemically infected patients. No environmental source could be identified. The strain also showed enhanced survival in handwashing experiments and was relatively resistant to Hibiscrub. Management of patients with systemic candidosis might include measures to prevent cross infection and handwashing with disinfectants that are active against candida.

Adult↗
PubMed2006

Cross-infection in cystic fibrosis: the knowledge and behaviour of adult patients.

INTRODUCTION: The knowledge and behaviour of adult patients with cystic fibrosis (CF) regarding cross-infection are ill understood. METHODS: A questionnaire was designed to investigate this at the West Midlands Adult CF Centre. RESULTS: 94 patients completed the questionnaire. 54%, 36% and 46% had "no idea" of the lifetime risk of contracting Burkholderia cepacia complex, epidemic strains of Pseudomonas aeruginosa, and MRSA, respectively. 25-33% did not know the consequences of infection with these bacteria. 35% mixed with other people with CF, 6.5% during physiotherapy or nebulizer use. Most respondents did not think quality of life was significantly linked with segregation from other patients with CF. CONCLUSIONS: Adults with CF, at least in the West Midlands, have poor knowledge of the risk and consequences of cross-infection. A significant proportion ignored advice not to mix with other patients, although segregation was not thought to impact upon quality of life. This suggests that more education about the risks of cross-infection would be beneficial.

Adult↗
PubMed1993

Final year dental students' views on cross-infection precautions.

This study was undertaken to determine the influence that undergraduate training currently has on the formation of clinical management strategies for minimizing cross-infection, among final year dental students. A 10-page questionnaire was sent to final year dental students attending 15 of the UK's 16 dental schools. A response rate of 60.5% was obtained. A large proportion of the students said they would be prepared to treat a known HBV carrier (90.4%) or HIV carrier (84.3%); a much higher proportion than has previously been found among qualified dental personnel. However, only 55.6% of the students agreed with current recommendations that they ought to adopt a universal cross-infection policy. Nevertheless, most students agreed with recommendations that they ought to wear gloves (96.6%), eye protection (84.3%) and a surgical mask (62.6%). Disparity between some responses suggested that some final year dental students might not have a fully thought out cross-infection strategy.

Attitude of Health Personnel↗
PubMed1991

Simplified cross-infection control: a study of cost, time and patient flow in Antigua.

This study was designed to assess the factors, such as cost of imported dental materials, time spent on cross-infection control procedures and the limited number of dental instruments, that determine the suitability of cross-infection control methods in a government dental clinic in a developing country. During the 6-month study period, 510 adult patients received extraction treatment, the mean treatment time for each patient being 8-9 min. In each session, it was found that every 1-1 1/2 hours, instruments had to be autoclaved again for the treatment of further patients, but patient-flow was maintained. Between patients, a hand washing time of 20-25 s with chlorhexidine was recorded. Every 1 1/2-2 hours a new pair of gloves had to be used. Work surfaces were disinfected with either 1 per cent chlorine or 2 per cent glutaraldehyde. Extraction of 22 teeth per session was completed within the available working time of 3-3 1/2 hours at a cost for materials of US 50 cents per patient. These cross-infection control procedures were deemed suitable for use in the Government Dental Clinic.

Adult↗
PubMed1995

Ascaris infections in humans from North America: molecular evidence for cross-infection.

Cases of human Ascaris infection occur sporadically in areas such as N. America and Western Europe, where this parasite is thought to be non-endemic. Clinical case histories suggest that many of these cases may be cross-infections from pigs. I describe patterns of variation in the ribosomal DNA of Ascaris from 9 such cases. For comparative purposes, I also describe patterns of variation in parasites obtained from pigs and humans from worldwide locations. A Hae III restriction site distinguishes two classes of rDNA repeats; repeats bearing this restriction site were found in > 96% of parasites from pig populations worldwide and in all 9 worms from humans in N. America. In contrast, repeats bearing this restriction site were detected in < 2% of parasites from humans in endemic areas. The molecular data clearly incriminate pigs as the source of infection in the N. American cases. I discuss evolutionary and public health implications of incomplete host fidelity in Ascaris.

Adult↗