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PubMed2002

Community infection control: what is the evidence?

Evidence-based practice is the conscientious use of current best evidence in decision-making about care or the delivery of health services (National Institute for Public Health, 1996). Evidence-based health care is one aspect of the quality improvement activities of clinical governance as a main component of the programme of quality in the NHS (Hek, 2000). Practitioners working in clinical areas are therefore being required to deliver care that has been shown to be effective. (Playle, 2000).

Bandages↗
PubMed2005

[Risk of infection in institutions for elderly people].

The infectious risk in long-term care facilities and nursing homes is significant. Patients living in those facilities are very old, with a poor health status, and a high degree of dependency. The risk for epidemic outbreaks, in particular with viruses, is very high. A simple system for surveillance and action, in relation with hospital infection control units, is mandatory. An educational program is needed to define the prevention program based on the use of hand disinfection and other standard precautions, anti-viral and pneumococcal vaccination. The program must be simple, pragmatic, allowing to maintain social links and quality of life, which are essential for these patients. A strong cooperation between these long-term care facilities and nursing homes, general practitioners, healthcare team, and relatives is necessary.

Age Factors↗
PubMed1984

Lack of effect of influenza and pneumococcal vaccines on anticoagulation by warfarin.

The effects on anticoagulation of a purified trivalent sub-unit influenza vaccine and a 14-valent pneumococcal vaccine were investigated in a single-blind controlled study involving 69 well-stabilised warfarin recipients. There were no clinically or statistically significant alterations of anticoagulant control in vaccine recipients as compared with controls at 2, 7 and 21 days after vaccination. On the basis of these data, concern about warfarin-vaccine interaction should not deter practitioners from immunising warfarin recipients against influenza or infection with Streptococcus pneumoniae.

Aged↗
PubMed1996

Natural history of human immunodeficiency virus disease in perinatally infected children: an analysis from the Pediatric Spectrum of Disease Project.

OBJECTIVE: To describe the progression of human immunodeficiency virus (HIV) disease through clinical stages from birth to death among a large number of perinatally infected children. METHODS: The Pediatric Spectrum of Disease (PSD) project, coordinated by the Centers for Disease Control and Prevention (CDC), has conducted active surveillance for HIV disease since 1988 in seven geographic regions. PSD data are collected from medical and social service records every 6 months through practitioners at each participating hospital clinic. We analyzed data from perinatally HIV-infected children born between 1982 and 1993. The natural history of HIV disease was divided into five progressive stages using the clinical categories in the CDC 1994 pediatric HIV classification system: stage N, no signs or symptoms; stage A, mild signs or symptoms; stage B, moderate signs or symptoms; stage C, severe signs or symptoms; and stage D, death. A five-stage Markov model was fitted to the PSD data. To compare the estimates from the PSD project with the published estimates, we also fitted an alternative Markov model using acquired immunodeficiency syndrome (AIDS; 1987 case definition) in place of stage C and also calculated standard Kaplan-Meier estimates. RESULTS: A total of 2148 perinatally HIV-infected children were included in the analysis. The estimated mean times spent in each stage were: N, 10 months; A, 4 months; B, 65 months; and C, 34 months. We estimated that a child born with HIV infection has a 50% (95% confidence interval [CI], 40%-60%) chance of severe signs or symptoms developing by 5 years of age and a 75% (95% CI, 68%-82%) chance of surviving to 5 years of age. For a child in stage B, there is a 60% (95% CI, 49%-71%) chance of severe signs or symptoms developing within the next 5 years and a 65% (95% CI, 56%-73%) chance of surviving 5 more years. The estimated mean time from birth to stage C was 6.6 (95% CI, 5.7-7.5) years, and the estimated mean survival time from birth was 9.4 (95% CI, 8.1-10.7) years. From the alternative Markov model, the estimated mean time from birth to AIDS was 4.8 (95% CI, 4.5-5.2) years. CONCLUSION: Markov modeling using the revised pediatric classification system allowed us to describe the natural history of HIV disease in children before diagnosis of AIDS. On average, children progress to moderate symptoms in the second year of life and then remain moderately symptomatic for more than half of their expected lives, underscoring their need for clinical care before the onset of AIDS. The results from the Markov model are useful in family counseling, health care planning, and clinical trial designs.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Diarrheal diseases in Brazil: clinical features of rotavirus-associated gastroenteritis in children.

This study was undertaken to detect the presence of rotavirus in the stools of children with gastroenteritis, using the enzyme-linked-immunosorbent assay (ELISA), and to compare the signs and symptoms of rotavirus-positive and -negative children. Over a period of fifteen months, 367 children ranging in age from less than 1 month to 5 years or more with diarrhea and 86 children, in the same age group, without diarrhea and respiratory infections, used as controls, were evaluated. Human rotavirus was detected in 15.8% of children with diarrhea attending out-patient clinics and in 28.9% of patients seen by general practitioners. In the control groups, the percentages of identification of rotavirus were 1.4% and 5.5% respectively. Frequency of other enteropathogens was determined. The hydration state of diarrheal cases, different clinical symptoms and the type of medical attendance distinguished the rotavirus positive from the rotavirus negative patients.

Brazil↗
PubMed1992

Glove wearing in Northern Ireland and an assessment of the loss of tactile perception.

The increased awareness of the need for cross-infection control in dentistry has led to recommendations that operating gloves be worn routinely by dental surgeons. A survey conducted amongst general dental practitioners in Northern Ireland showed a drop in glove wearing from 100% in the newly qualified to 47% in those who had qualified between 15 to 35 years ago. A frequently stated reason for the non wearing of gloves in this group is the diminution of tactile sense. To test this, a blind tutor was engaged to read a random standard length Braille passage whilst wearing selected gloves and the reading time recorded and compared with ungloved reading. The wearing of gloves increased reading time and, by implication, the loss of tactile perception, by between 14% and 37%, depending on the glove used. The thickness and stiffness of the gloves were also determined and the results suggest a relationship between these quantities and the loss of tactile perception.

General Practice, Dental↗
PubMed1989

A survey of dentists' drug prescribing practices.

The drug prescribing practices of dentists should be of interest to the dental profession, drug manufacturers, the medical profession and dental educators. This article presents an update on an earlier similar survey reported by the authors as well as information on current infection control procedures, the treatment of hepatitis and AIDS patients, and generic drug substitution. The classes of drugs that are important to the practitioner and the level of prescribing activity have not changed appreciably since the earlier study. There has been, however, a significant change in nonopioid analgesic drug preference with ibuprofen overtaking aspirin and acetaminophen by a wide margin. That age affects the character of practice was confirmed: far fewer older practitioners report prescribing drugs than do their younger counterparts. A very gratifying finding was the high level of compliance with ADA recommendations regarding infectious diseases although fears over treating AIDS patients remain high.

Adult↗
PubMed2001

Provision of extractions by main diagnoses.

AIMS/OBJECTIVES: The aim of this study was to investigate the association of extractions by the diagnoses of caries, pulpal/periapical infection and periodontal disease, controlling for visit type, insurance and age. DESIGN: Cross-sectional analysis of the 1993-94 wave of a longitudinal study. SETTING: Private general dental practice. PARTICIPANTS: A random sample of Australian registered dentists, (response rate = 74%). METHODS: Practitioners completed service logs over one to two typical clinical days. MAIN OUTCOME MEASURE: Percentage of patients receiving extractions. RESULTS: Overall, 7.05% of patients received extractions, with the highest percentages occurring for persons with caries (7.90%), periodontal disease (17.45%) and pulpal/periapical infection (17.54%). Odds of extraction were higher at emergency visits for insured and uninsured patients compared to non-emergency visits by insured patients, while odds of extraction (Logistic regression: OR = Odds ratio; 95% CI) were higher for 18-44 year-olds with caries (OR = 1.44; 1.09-1.89), for 18-44 (OR = 1.84; 1.34-2.54) and 45+ year-olds (OR = 1.83; 1.27-2.63) with pulpal/periapical infection, and for 45+ year-olds (OR = 6.82; 4.68-9.95) with periodontal disease. CONCLUSIONS: There were different age-specific causes of extraction, controlling for visit type and insurance. Effect sizes were highest for pulpal/periapical infection and periodontal disease, but caries remained a major cause of tooth loss due to the higher prevalence of this condition.

Adolescent↗
PubMed1982

A study of measles virus and canine distemper virus antibodies, and of childhood infections in multiple sclerosis patients and controls.

We investigated the levels of neutralizing antibodies to measles virus and canine distemper virus (CDV) in 72 multiple sclerosis patients (MS) and matched controls and also examined the frequency and age of onset of a number of childhood illnesses, including measles. The frequency of each childhood illness was not significantly different between cases and controls, but cases did report a later age at measles infection. Our data suggest that the risk of MS is increased by a factor of 1.9 if measles infection occurs between 5 and 9 years of age. A validity survey, based on a questionnaire to general practitioners, suggested substantial inaccuracy in the patients' reports of when they had measles, but the direction and degree of inaccuracy did not appear to be different between cases and controls. We also found higher titres of neutralizing antibodies in cases than controls to both measles virus and CDV, although the CDV difference was not statistically significant. In the light of a significant correlation between measles and CDV titres in both cases and controls, we used paired logistic regression to determine if the case-control difference in titres for each virus could be explained by a confounding effect on one by the other. The numbers were too small, however, to enable us to separate out any independent association of either virus with MS.

Age Factors↗
PubMed1998

Rubber dam.

In a busy dental practice the many advantages of the routine use of dental dam for day-to-day procedures are often not appreciated. Many general dental practitioners (GDPs) are unaware of the simple and rapid techniques for placement that exist and the important role that rubber dam plays in infection control.

Air Microbiology↗
PubMedDate not supplied

[First documented case of enterocolitis in Yugoslavia caused by enterohemorrhagic Escherichia coli O157].

A 'new' group of pathogenic agents, enterohemorrhagic Escherichia coli (EHEC) (particularly the strains of O157 serogroup), emerged in the last 20 years, causing an increased number of sporadic and epidemic diarrhoeal diseases with hemorrhagic enterocolitis as a most common clinical manifestation of the infection. As a consequence of the absorption and cytotoxic effect of the main virulence factor of these bacteria--verotoxin (shiga-toxin), in about 10% of the affected persons extraintestinal complications, most frequently hemolytic-uremic syndrome (HUS), occurred 7-14 days after an episode of diarrhoeal disease. The first case of hemorrhagic enterocolitis with the documented EHEC O157 infection in Yugoslavia is presented in this paper. Considering the existing expansion trend of these carriers, practitioners should be aware of them in case of the occurrence of diarrhoeal disease, (particularly hemorrhagic enterocolitis), and keep these patients under control during the reconvalescence period because of potential development of extraintestinal complications, such as HUS.

Aged↗
PubMed1992

Oral antibiotics: practical prescribing rules for practitioners.

Oral antibiotics are frequently prescribed for older patients for the treatment of such common bacterial infections as upper respiratory and urinary tract infections. Six practical prescribing rules can help control the cost of therapy. 1) Oral antimicrobials used to prevent hospitalization are always cost-effective. 2) Oral antimicrobials are always less expensive than parenteral antimicrobials. 3) Generic antimicrobials are not always less expensive than proprietary antimicrobials. 4) The best drug for the infection is usually the most cost-effective in the long run, regardless of cost. 5) The use of antimicrobials for marginal indications is almost always cost-ineffective. 6) The simplest regimens are often the most cost-effective.

Administration, Oral↗
PubMed2001

Performance of number-between g-type statistical control charts for monitoring adverse events.

Alternate Shewhart-type statistical control charts, called "g" and "h" charts, have been developed for monitoring the number of cases between hospital-acquired infections and other adverse events, such as heart surgery complications, catheter-related infections, surgical site infections, contaminated needle sticks, medication errors, and other care-induced concerns. This article investigates the statistical properties of these new charts and illustrates several design considerations that significantly can improve their operating characteristics and sensitivity, including the use of within-limit rules, a new in-control rule, redefined Bernoulli trials, and probability-based limits. These new charts are based on inverse sampling from geometric and negative binomial distributions, are simple for practitioners to use, and in some cases exhibit significantly greater detection power over conventional binomial-based approaches, particularly for infrequent events and low "defect" rates.

Cross Infection↗
PubMed2006

The effect of giving influenza vaccination to general practitioners: a controlled trial [NCT00221676].

BACKGROUND: No efficacy studies of influenza vaccination given to GPs have yet been published. Therefore, our purpose was to assess the effect of an inactivated influenza vaccine given to GPs on the rate of clinical respiratory tract infections (RTIs) and proven influenza cases (influenza positive nose and throat swabs and a 4-fold titre rise), while adjusting for important covariates. METHODS: In a controlled trial during two consecutive winter periods (2002-2003 and 2003-2004) we compared (77 and 100) vaccinated with (45 and 40) unvaccinated GPs working in Flanders, Belgium. Influenza antibodies were measured immediately prior to and 3-5 weeks after vaccination, as well as after the influenza epidemic. During the influenza epidemic, GPs had to record their contact with influenza cases and their own RTI symptoms every day. If they became ill, the GPs had to take nose and throat swabs during the first 4 days. We performed a multivariate regression analysis for covariates using Generalized Estimating Equations. RESULTS: One half of the GPs (vaccinated or not) developed an RTI during the 2 influenza epidemics. During the two influenza periods, 8.6% of the vaccinated and 14.7% of the unvaccinated GPs had positive swabs for influenza (RR: 0.59; 95%CI: 0.28 - 1.24). Multivariate analysis revealed that influenza vaccination prevented RTIs and swab-positive influenza only among young GPs (ORadj: 0.35; 95%CI: 0.13 - 0.96 and 0.1; 0.01 - 0.75 respectively for 30-year-old GPs). Independent of vaccination, a low basic antibody titre against influenza (ORadj 0.57; 95%CI: 0.37 - 0.89) and the presence of influenza cases in the family (ORadj 9.24; 95%CI: 2.91 - 29) were highly predictive of an episode of swab-positive influenza. CONCLUSION: Influenza vaccination was shown to protect against proven influenza among young GPs. GPs, vaccinated or not, who are very vulnerable to influenza are those who have a low basic immunity against influenza and, in particular, those who have family members who develop influenza.

Belgium↗
PubMed1989

HIV infection and Scottish general practice: workload and current practice.

To estimate the effect of human immunodeficiency virus (HIV) infection on general practice, a postal survey was undertaken of one in three of all principals in Scotland. Of the 834 general practitioners who responded (78% response rate), 31% were working in practices with patients known to be infected with HIV. The estimated prevalence of known HIV infection in general practice was 19 per 100,000 population, and the estimated annual consultation rate for HIV related problems (including consultations by the 'worried well') was seven per 1000 population. Both statistics showed considerable variation between health boards, with peaks in Lothian and Tayside. Few practices had drawn up policies relevant to HIV infection, and the use of procedures for controlling infection was variable. Policies about HIV and for infection control tended to be more common in areas where the prevalence of HIV infection was higher. Most respondents were offering both opportunistic health education and counselling about HIV infection, especially to patients at high risk. Although general practitioners are responding positively to the increasing demands of HIV infection, there is an urgent need for policies, both national and local, to guide specific aspects of practice.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Autoclave performance and practitioner knowledge of autoclave use: a survey of selected UK practices.

OBJECTIVE: It is essential that the dental surgery autoclave be tested regularly to ensure that it is operating at a temperature and pressure that will kill all microorganisms. The aims of this study were to investigate the knowledge of general dental practitioners on aspects of autoclave use, to examine their autoclaving routines, and to test the effectiveness of the sterilization cycle of their practice's autoclave. METHOD AND MATERIALS: A 35-question questionnaire was distributed to 840 dental practitioners in the United Kingdom. They were also sent three spore test ampules with details of their function and instructions on their use. The practitioners were asked to use the spore test ampules in their own practice's autoclave and to return these for testing. RESULTS: Four hundred one questionnaires and associated spore test ampules were returned for analysis, a 47.7% response rate. Eight practice autoclaves (2.0%) failed to sterilize the spores. These practices were offered a retest following counseling. A total of 77.8% of respondents had received formal training in infection control. Of the 71.3% of respondents who stated that they check the performance of their autoclave routinely, 31.5% use a chemical strip every cycle, 17.5% use it once per day, and 30.4% use it once per week. However, only five respondents (1.2%) use a spore test; two of these respondents use it every cycle, one once per day, and two once per week. CONCLUSION: Further education of practitioners may be necessary to enhance their awareness of the need for routine checking of autoclave effectiveness.

Dental Equipment↗
PubMed2006

Topical and systemic medications for wounds.

There are a plethora of topical and systemic medications available to the veterinary practitioner today that aid the wound healing process. Some of these help to maintain a moist environment. Others increase growth factors, provide local energy sources, control infection, provide for debridement, increase wound blood flow and temperature, or reduce wound edema. Modern wound care requires that the proper products(s)be used, depending on the condition of the wound and the phase of wound healing. This article discusses various wound care products and provides guidelines on their use.

Administration, Topical↗
PubMed1996

Tinea capitis in south-east London--a new pattern of infection with public health implications.

Recent observations on tinea capitis cases in London suggest that there has been a change in the pattern of infection with a recent and significant rise in the incidence of infections due to anthropophilic fungi. The purpose of this study was to investigate the prevalence and identity of tinea capitis in schools in south-east London and factors which might affect the spread of infection. This was achieved by carrying out a survey of all children, with parental consent for scalp examination, in 14 nursery, infant or junior schools in Lambeth. In addition, the accuracy of clinical diagnosis was compared with mycological findings. There were 1057 children from 4 to 14 years of age in the study. The infection rate in different schools ranged from 0 to 12% with a mean of 2.5%. A further 4.9% of children were scalp carriers of dermatophytes (range in classes 0-47%). A striking feature was that all infections were caused by anthropophilic fungi, mainly Trichophyton tonsurans or Microsporum rivalieri, and there was a correlation between the presence of two or more carriers within a class and the infection in the other children. There was a poor correlation between ability of trained observers to predict infection on clinical grounds and mycological results. This investigation shows variable but significant levels of scalp ringworm in schools and that the dominant organisms are anthropophilic. It provides support for the observation that there has been a shift in the pattern of tinea capitis in London and, possibly, other U.K. centres, with a trend towards more infections transmissible among children, with T, tonsurans being the commonest organism. The implications for control, which involve screening in schools, where appropriate, and guidance to general practitioners on treatment, are discussed.

Carrier State↗