Infection control. Battle of the bugs.
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Advances in hospital infection control programs.
The past decade in infection control has seen remarkable growth of both practitioners and the basic infection control program. Technical advances led to more sophisticated data collection, analysis, and strategies. Health care is being streamlined to be highly effective and efficient. It is easy to become enchanted with new, exciting, and high-tech aspects of disease prevention and control, but we must all remember that the basics of a good program from 10 years ago are still applicable today.
Cross Infection↗
Development of core competencies for infection prevention and control.
The Infection Control Nurses Association (ICNA) has developed a robust framework for infection prevention and control practitioners to demonstrate their competence. This article describes the process of developing these competencies from the first edition (in two parts) to the integrated competencies and assessment framework, which may be useful to other specialist groups considering the development of competencies relevant to their area of interest. It describes how the competencies have been used and how they may be used in the future to accredit ICNA members.
Career Mobility↗
Infection control issues related to pediatric dentistry.
Although the Centers for Disease Control and Prevention CGuidelines for Infection Control in Dental Health-Care Settings--2003 addresses general infection control issues, dental practitioners face many unique situations when treating pediatric patients. Children and adolescents have varying levels of physical, intellectual, emotional, and social development. Dental practitioners are regularly challenged to meet the psychological needs of their young patients while maintaining appropriate infection control practices. This article deals with several of the common clinical issues faced by dental practitioners who treat pediatric dental patients.
Anesthesia, Dental↗
From expert data collectors to interventionists: changing the focus for infection control professionals.
The current economic and political environments challenge health care organizations in the United States to provide affordable, accessible, and comprehensive health services. However, changes in reimbursement to health care providers can affect their ability to offer access to cutting-edge services while reducing costs. Consequently, organizations are restructuring, re-engineering, right-sizing, downsizing, and redesigning, all in an effort to save money while also hoping to maintain a reputation for quality and customer service. Dr Vicky Fraser, in her keynote address at the APIC conference in 2000, reminded us that ICHE programs are cost centers rather than revenue generators, and are often targets for budget cuts. Although Haley's Study on the Efficacy of Nosocomial Infection Control (SENIC), published in 1985, was a landmark event demonstrating the importance of our profession's mission, it is becoming dated. Infection control professionals (ICPs) must continue Haley's work, finding innovative ways to market or demonstrate the value of ICHE programs to health care executives. Closing the 1999 APIC conference with a symposium entitled "Breaking Out of the Box," Jackson and Massanari challenged ICPs to educate themselves about the changing health care environment, to be proactive, and constructively help organizations "re-engineer" more efficiently, rather than feel victimized and helplessly await being re-engineered out of existence. The threat of downsizing prompted ICPs at BJC HealthCare to realize that the time had come to change their own culture and attitudes and to focus on the business of infection control. This change required challenging the traditional roles of solo practitioner, data collector, and keeper of infection control data and knowledge. The goals now include leading intervention teams committed to reducing health care-associated infections, partnering rather than accepting sole responsibility for lowering infection rates, and learning to influence without authority. Staying focused on quality and cost-effectiveness and demonstrating improvements in clinical outcomes became a commitment. This article discusses BJC HealthCare's journey through change so that it may provide useful information and tools for ICPs in any setting looking for the necessary change strategies that might keep them in business.
Cross Infection↗
An assessment of cross-infection control procedures among English-speaking Caribbean general dental practitioners. A regional preliminary study.
A survey was undertaken to assess the level of compliance with recommended infection control procedures among English-speaking Caribbean general dental practitioners. A four page questionnaire was sent to all practitioners in 18 English-speaking Caribbean islands. A response rate of 32 per cent was obtained. A large proportion of dentists followed the recommended barrier techniques particularly the use of gloves and facemasks. The most commonly available methods of sterilisation were steam autoclaves (82 per cent) and cold solutions (94 per cent). Seventy four per cent of respondents had received hepatitis B vaccination. A high percentage of dentists showed willingness to treat HBV (95 per cent) and HIV (84 per cent) carriers and this level of willingness to treat infectious patients has rarely been reported previously. There is an urgent need for further improvements to avoid getting inoculation injuries and splatters in the face or eyes with body fluids. Disposal of sharps and collection of solid waste are to be upgraded. The Caribbean Atlantic Regional Dental Association is planning to carry out similar research before the end of the year 2000.
Cross Infection↗
A comparison of infection control practices of different groups of oral specialists and general dental practitioners.
OBJECTIVE: The purpose of this study was to compare the infection control practices of general dentists and dental specialty groups. METHODS: A survey was mailed to 5997 dentists in 1994; the response rate was 70%. The data were analyzed with multiple logistic regression (reference group: general dentists). RESULTS: When sociodemographic influences were taken into consideration, significant predictors of routine infection control practices included all of the following characteristics (odds ratios are in parentheses): 1. Gloves: being younger than 40 years of age (4.5) and being female (5.9). 2. Using gloves and changing gloves after each patient: being younger than 40 years of age (4.0), being female (3.0), being an oral surgeon (3.6), and being an orthodontist (0.2). 3. Using gloves, masks, and protective eyewear: being younger than 40 years of age (2.5), being female (2.3), and being an orthodontist, oral physician, or oral pathologist (0.2). 4. Hepatitis B vaccination for the practitioner: being younger than 40 years of age (5.1). 5. Hepatitis B vaccination for all clinical staff members: being younger than 40 years of age (1.2), being an oral surgeon (1.7), and being an orthodontist (0.6). 6. Heat sterilization of handpieces: being younger than 40 years of age (1.5), being an oral surgeon (5.4), and being an orthodontist (0.2). 7. Taking no additional precautions for patients with HIV: being younger than 40 years of age (1.7), being a periodontist (2.6), being a pedodontist (2.3), and being an oral physician/oral pathologist (4.3). CONCLUSION: Improved compliance with recommended infection control procedures is required for all groups and is particularly necessary for orthodontists.
Adult↗
AIDS: issues for respiratory care practitioners.
Acquired immunodeficiency syndrome (AIDS) has recently received considerable media attention. Health care workers, including respiratory care practitioners, are concerned about the many medical and psychosocial implications of the disease. This article reviews the epidemiology and clinical features of AIDS. Health care workers do not have a demonstrably higher incidence of AIDS infection than does the general population; risks to the respiratory care practitioner may be minimized by adherence to the suggested guidelines for infection control. Respiratory care practitioners are ethically bound to treat all patients, regardless of the nature of their disease; the guidelines given in this article will help practitioners do this.
Acquired Immunodeficiency Syndrome↗
[A survey on infection control practices, knowledge and attitudes toward AIDS/HIV among dental practitioners].
A survey was conducted in December 1993 by sending questionnaires to all 566 dentists of the Iwate Dental Association. The questionnaires consisted of 68 items including infection control practices, knowledge, and attitudes towards AIDS/HIV. The response rate was 51.1 percent (N = 289). The average age of dentists in the sample was 43.7 +/- 9.5 (S.D.) (range: 28 to 85). Data was evaluated statistically by Kruskal-Wallis test, Mann-Whitney's U test and Chi-square test, and significant differences were observed. Gloves, masks, and other protective garments were generally worn, but most dentists did not always use them during the full course of treatment limiting usage to surgical treatment, and when treating patients in "high-risk groups". Other infection control procedures, such as instrument sterilization, did not comply with the guidelines of the Ministry of Health and Welfare. Two dentists responded that they had treated AIDS patients and three dentists treated possible AIDS/HIV patients in their dental offices. Despite 71.3% expressing a belief that they have a moral responsibility as a dentist to treat AIDS/HIV patients only 15.6% were willing to treat AIDS/HIV patients. Over 40% of the respondents were not certain as to whether they had treated AIDS/HIV patients or not, and over 60% believed AIDS/HIV patients would come to their dental offices in the near future. Therefore, to practice dentistry on AIDS/HIV patients safely, dentists must provide effective infection control in their dental offices on the assumption that all patients are AIDS/HIV positive, and additional information about AIDS/HIV and adequate training on procedures in the care of AIDS/HIV patients are needed.
Acquired Immunodeficiency Syndrome↗
Extracted teeth: decontamination, disposal and use.
With the advent of medical waste and OSHA infection control regulations, many practitioners are unsure about the legal, proper handling of extracted teeth. This article outlines the options available for the disposal of extracted teeth and explains the role each regulatory agency plays in the process.
California↗
Infection control in the dental practice with emphasis on the orthodontic practice.
Infections present a significant hazard in the orthodontic office because they can be transmitted by blood or saliva through direct or indirect contact, droplets, aerosols, or contaminated instruments and equipment. Because the incidence of certain microbial cross-infections in the dental environment has not been well documented, orthodontic personnel may not take the problem of cross-infection as seriously as they should, and they may transmit or contract more infections than they realize. The use of effective infection-control procedures in the orthodontic office and laboratory will prevent cross-contamination that may extend to the orthodontist, office staff, assistants, and patients. The goal of this article is to present infection control in a simple, yet comprehensive, manner, and to encourage all orthodontic practitioners to implement essential infection-control procedures in their practices.
Blood-Borne Pathogens↗
Nosocomial infections in neutropenic cancer patients.
OBJECTIVE: Identification of overall and site-specific rates of nosocomial infection in neutropenic patients with cancer and associated pathogens. DESIGN: Cumulative continuous prospective surveillance over a 42-month period. Criteria and definitions of infection in neutropenic patients (absolute neutrophil counts < 1,000/mm3) were developed, and surveillance was carried out by a certified infection control nurse and a senior oncology research fellow. SETTING: A cancer research center with two designated oncology nursing units. PATIENTS: Neutropenic patients with hematological and solid malignancies undergoing high-dose chemotherapy with and without autologous bone marrow transplantation. All patients admitted to both of the units during the study period were surveyed. Those who developed neutropenia are included in this report. RESULTS: A total of 444 nosocomial infections were identified in 920 neutropenic patients during 9,582 days of neutropenia for an overall rate of 48.3 per 100 neutropenic patients, or 46.3 per 1,000 days at risk. The rate of bloodstream infection per 100 neutropenic patients was 13.5 (gram-positive, 9.2; gram-negative, 4.8; and Candida 1.2). Other site-specific rates were: urinary tract, 5.7; respiratory tract, 5.5; thrush, 6.6; skin, 3.4; and gastrointestinal tract, 3.4. Among 392 pathogens identified, there were 137 (35%) gram-positive cocci, 105 (27%) gram-negative rods, 70 (18%) Candida, 37 (9%) gram-positive rods, 22 (6%) viruses, and 15 (4%) Aspergillus. CONCLUSIONS: The rate of both overall and site-specific nosocomial infections in neutropenic patients is high. Neutropenia is a significant intrinsic risk factor that should be addressed in surveillance programs. Infection control and infectious diseases practitioners may need to modify techniques for surveillance, control, and management of infection in this population.
Adult↗
The evaluation of SafeQuest--a computer-assisted learning program on cross-infection control for the dental team.
OBJECTIVE: Evaluation of a computer-assisted learning (CAL) program (authored by a general dental practitioner-GDP) on cross-infection control (CIC) for the dental team. The aims of the evaluation were to determine how easy the program was to use, to determine if users found the information useful, to ensure that the content was accurate and to see what improvements could be made. METHODS: 96 questionnaires were distributed to dentists, 57 of whom responded (60%). 66% of the respondents were GDPs. RESULTS: Compared with earlier evaluations of hospital-produced CAL programs, SafeQuest was equally well received. 96% of respondents found it easy to use and 93% gave a positive score for their overall impression. 64% felt that the program had extended their knowledge, despite the fact that 74% rated their knowledge on CIC as being good/excellent before using SafeQuest. Suggestions on how the content and presentation of the program could be improved led to changes to the final version. CONCLUSIONS: The SafeQuest program on cross-infection control could be useful as a learning resource in general dental practice. The program, authored and produced by a GDP, compares favourably with those written in dental schools.
Adult↗
Basic infection control procedures in dental practice in Khartoum-Sudan.
OBJECTIVES: To survey the infection control procedures used by dental practitioners in Khartoum, Sudan. METHODS: Questionnaires were distributed to150 randomly sampled dentists practising in Khartoum state. Each questionnaire comprised 17 questions about basic infection control procedures. RESULTS: A 100% response rate to the questionnaire showed that 92% of dentists routinely wore gloves when treating patients, 50% face masks, 61% a gown and 14.7% protective eye wear. Furthermore 52% of the practitioners had been immunised against Hepatitis B. The majority of practitioners (72%) used dry heat as their method of instrument sterilisation, 22% used an autoclave, 2% used boiling water and the remainder used chemical sterilisation. Safe disposal of clinical waste was undertaken by only 23% of dentists although 47% of practitioners stored sharp items in closed containers. All respondents used disposable dental needles, but only a few used other disposable items. There was a significant difference in the implementation of cross infection control procedures between salaried and private dental practitioners, especially with regard to handpiece sterilisation, use of disposables, the wearing of face masks and the availability of additional sets of instruments. CONCLUSION: There is a clear need to improve the existing situation particularly with regard to immunisation of dentists against Hepatitis B, the safe disposal of clinical waste and instrument sterilisation in Khartoum.
Cross Infection↗
Occupational risk and precautions related to HIV infection among dentists in the Lothian region of Scotland.
This retrospective study used a postal questionnaire to measure occupational risks and to assess infection control procedures among 310 dental practitioners. The study comprised general dental practices in the Lothian region of Scotland, Lothian Health Board Community Dental Service and Edinburgh Dental Hospital. Altogether, 217 dental practitioners responded by the due date giving recall of inoculation injuries within the previous 5 years and infection control measures employed. The study revealed that 191 practitioners (88%) had completed a course of hepatitis B vaccination but one-third of them had not been tested for post-vaccination antibody. In 1991, two thirds of dentists (66%: 137 of 207 respondents) wore the same pair of gloves, and 80% of dentists (142 of 177 respondents) wore the same mask, for dealing with more than one patient. The usual practice was to change gloves during sessions (44%: out of 71 dentists) and to change masks for each session or less often (75%: 73 out of 97 dentists). The proportion of dentists who never used gloves fell from 56% in 1981 to 1% in 1991. An autoclave was used for sterilisation by 85% of practitioners in 1991. Reported non-sterile inoculation injuries averaged 1.7 (S.D. = 3.2) injuries per dentist in the previous year with 56% of practitioners having had an injury. The average was 6.8 (S.D. = 15.9) injuries per dentist in the previous 5 years with 76% of practitioners having had an injury. Of recent non-sterile inoculation injuries described by dental practitioners, 30% constituted a moderate or high risk of transmission of infection to the practitioner (43 of 141 described injuries). Combined with HIV seroprevalance rates, probabilities of transmission and numbers of practising dentists, the mean reported number of non-sterile inoculation injuries in the previous 5 years may be used to provide estimates of expected numbers of dental practitioners occupationally infected with HIV in the previous 5 years. U.K. estimates were 0.004 dentists in Lothian region and 0.05 dentists in the Thames region occupationally infected with HIV in the previous five years. Non-sterile inoculation injuries appear to be a common hazard of dental practice. In any year, most dentists are exposed to the risk of blood-borne viral infection. Despite a high reported incidence of such injuries, dental practice within the U.K. appears to carry a low risk of acquiring HIV infection from occupational exposure.
Dentists↗
Respiratory syncytial virus: understanding the threat to communities.
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Antiviral Agents↗
Update on infection control.
Infection control is a dynamic and ever-changing subject and all dental staff should be kept aware of the most up-to-date procedures required to prevent the transmission of infection and should understand why these procedures are necessary. Regular monitoring and updating of all procedures in the light of new scientific evidence is necessary and all new staff must be trained in infection control procedures prior to working in the surgery. A practitioner who is routinely following an appropriate infection control policy, including the use of techniques and products of proven efficacy (perhaps through accreditation), is better placed to refute allegations arising in the course of civil litigation, health and safety at work prosecution, complaints and disciplinary procedures, or investigations by the GDC.
Cross Infection↗