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PubMedDate not supplied

Infection control knowledge, practice, and attitudes of Mississippi dental hygienists.

PURPOSE: The purpose of this study was to assess Mississippi dental hygienists' knowledge and use of infection control techniques, attitudes pertaining to universal precautions and the risk of clinician/patient cross-infection, and attitudes toward treatment of patients with infectious diseases. METHODS: A 41-item questionnaire was mailed to all 508 licensed dental hygienists in Mississippi. Inactive, retired, and out-of-state hygienists (n = 59) were deleted from this study. The data were tested for significant associations using Chi-square. RESULTS: After adjusting for the 59 unusable returns, the response rate for analysis was 58% (n = 297). Dental hygienists reported using infection control techniques including sterilization or disposal of common items such as prophylaxis angles, suction tips, and air/water syringe tips. Although 98% of the respondents believed that barrier techniques were effective, some believed patients infected with HIV/AIDS (43%), hepatitis B (31%), or tuberculosis (40%) are best treated in public clinics rather than in private settings and that these clients pose a threat to dental hygiene practitioners. Further, a majority of the respondents believed that all oral healthcare workers and patients should be tested for HIV/AIDS. CONCLUSIONS: The incongruity between perceived knowledge, reported practice, and attitudes suggests the need for continuing education courses designed to allow dental hygienists to explore the affective domain regarding the care of patients with infectious diseases. In addition, courses on working with patients with HIV/AIDS should be offered in smaller cities for greater accessibility.

Adult↗
PubMed2001

Role of clinical microbiology laboratories in the management and control of infectious diseases and the delivery of health care.

Modern medicine has led to dramatic changes in infectious diseases practice. Vaccination and antibiotic therapy have benefited millions of persons. However, constrained resources now threaten our ability to adequately manage threats of infectious diseases by placing clinical microbiology services and expertise distant from the patient and their infectious diseases physician. Continuing in such a direction threatens quality of laboratory results, timeliness of diagnosis, appropriateness of treatment, effective communication, reduction of health care-associated infections, advances in infectious diseases practice, and training of future practitioners. Microbiology laboratories are the first lines of defense for detection of new antibiotic resistance, outbreaks of foodborne infection, and a possible bioterrorism event. Maintaining high-quality clinical microbiology laboratories on the site of the institution that they serve is the current best approach for managing today's problems of emerging infectious diseases and antimicrobial agent resistance by providing good patient care outcomes that actually save money.

Communicable Disease Control↗
PubMed2004

Developing national outcome standards for the management of gonorrhoea and genital chlamydia in genitourinary medicine clinics.

BACKGROUND: Measuring clinical performance within a framework of clinical governance is increasingly important for monitoring improvements in patient care. Standards for quality indicators must, however, be achievable and evidence based. We describe an approach to the development of national standards for measuring outcomes of care for gonorrhoea and genital chlamydia in genitourinary medicine clinics. METHODS: Two standards for each infection, one reflecting quality of case management and one reflecting partner management were chosen by consensus. A systematic review of published and unpublished UK studies about gonorrhoea and chlamydia management was carried out and weighted averages calculated for each parameter, stratified by location. Genitourinary medicine practitioners around the country were also asked for their opinion about desirable values for each standard and the results compared. Variability in performance between centres was examined using Shewhart's control charts. RESULTS: We identified 17 reports about gonorrhoea outcomes and 14 about chlamydia. There was marked heterogeneity in results according to geographical location and different standards were set for clinics in and out of London. Opinions from practitioners suggested much higher standards than the values obtained from the systematic review. There was evidence for special cause variation related to management of gonorrhoea and chlamydia in London clinics. CONCLUSIONS: Standards set using expert opinion are unrealistic when compared to evidence of what is achievable. Evidence based methods should therefore be used to derive outcome standards for case management gonorrhoea and chlamydia. The control chart method identified clinics where investigation to find reasons for special cause variation in performance should be undertaken to change practice.

Ambulatory Care↗
PubMed2006

An armamentarium of wart treatments.

Patients and clinicians experience the frustration of cutaneous viral warts caused by infection with the human papilloma virus (HPV).Warts appear in various forms on different sites of the body and include common warts (verruca vulgaris), plane or flat warts, myrmecia, plantar warts, coalesced mosaic warts, filiform warts, periungual warts, anogenital warts (venereal or condyloma acuminata), oral warts and respiratory papillomas. Cervical infection with HPV is now known to cause cervical cancer if untreated. A review of the medical literature reveals a huge armamentarium of wart monotherapies and combination therapies. Official evidence-based guidelines exist for the treatment of warts, but very few of the reported treatments have been tested by rigorous blinded, randomized controlled trials.Therefore, official recommendations do not often include treatments with reportedly high success rates, but they should not be ignored when considering treatment options. It is the purpose of this review to provide a comprehensive overview of the wart treatment literature to expand awareness of the options available to practitioners faced with patients presenting with problematic warts.

Condylomata Acuminata↗
PubMed2001

Public-private partnership in tuberculosis control: experience in Hyderabad, India.

SETTING: Hyderabad, India. OBJECTIVE: To determine whether private practitioners and the government can collaborate with a nongovernmental intermediary to implement DOTS effectively. DESIGN: A non-profit hospital provided DOTS services to a population of 100000 for 3 years, then expanded coverage to 500000 in October 1998. A hospital physician visited all private practitioners, encouraged them to refer patients, and gave feedback on each patient referred. After diagnosis, patients received directly observed treatment free of charge at the trust hospital or at 30 conveniently located small hospitals operated by local private practitioners. No financial incentives were used to encourage physicians to refer patients or to provide treatment observation. Diagnosis, treatment, and case and outcome definitions were performed as per DOTS policies; medicines and laboratory reagents were provided by the government. RESULTS: All 244 allopathic and 114 non-allopathic physicians practising in the area agreed to participate; 59% referred at least one patient. Of 2244 persons referred, 969 (43%) had tuberculosis. Physicians had obtained chest radiographs on 80% of patients before referral for sputum microscopy. The detection rate increased from 50 to 200/100000 over the first 2-3 years of the project, and has increased gradually since expansion; 90% of new smear-positive patients and 77% of re-treatment patients were successfully treated. Compared with those treated at a neighbouring government DOTS centre, patients in this project paid less for diagnosis ($5 vs. $20) and treatment ($1 vs. $11), largely due to lower transport costs. CONCLUSIONS: Collaborative efforts between private practitioners and the government can achieve moderate-high rates of case detection and high rates of treatment success. Public-private services appeared to be more convenient to patients, who paid less for care and were less likely to miss work in order to participate in DOTS. Clearly defined roles and expectations and frequent communication are essential to success. An institution such as a non-profit hospital can serve as an effective intermediary between the government DOTS programme and private practitioners.

Adolescent↗
PubMed1986

The Inter-Regional, Epidemiological Study of Childhood Cancer (IRESCC): case-control study in children with germ cell tumours.

In 1980-1983 members of IRESCC interviewed parents of 555 children with newly diagnosed cancer on topics of possible aetiological significance. Identical questions were asked of the parents of 1100 control children chosen from hospital admissions and general practitioner lists. Medical information was confirmed whenever possible by cross-checking with NHS records. Data for the 41 children with germ cell tumours and their 82 controls are reported here. The cases had more major congenital malformations than controls, including one neural tube defect. More case than control mothers and fathers reported occupational exposure to chemicals. Nine close relatives of cases had multiple primary tumours, which were often benign or of low-grade malignancy, compared with 1 hospital control and 3 general practitioner control relatives. Cases and controls differed with respect to birth weight and paternal age. No case-control differences were shown for: birth rank, maternal age, chronic illnesses and smoking, mothers' reproductive histories and oral contraceptive usage. In index pregnancies there were no case-control differences for maternal illness, infections, alcohol intake and X-ray and ultrasound exposure. There was no difference between cases and controls for the frequency of twinning the families.

Adolescent↗
PubMed1997

Infection control in the orthodontic office in Canada.

Because of the difficulty of identifying infected persons, current recommendations for infection control are to treat all patients as if they are infected with blood-borne pathogens such as human immunodeficiency virus (HIV) and the hepatitis viruses. Dentists' compliance with these recommendations has been investigated previously, however, there are few data related to orthodontists. The objective of this study was to measure the proportion of orthodontists who report the use of recommended infection control procedures and to compare the infection control practices of orthodontists and general dentists. A mailed survey with three follow-up attempts was administered to all orthodontists and general dentists in Ontario (N = 5441) in 1994. There were significant differences in the routine use of gloves (orthodontists 85%, general dentists 92%); masks (orthodontists 38%, general dentists 75%); protective eyewear (orthodontists 60%, general dentists 84%); changing gloves after each patient (orthodontists 84%, general dentists 96%); and heat sterilization of handpieces (orthodontists 57%, general dentists 84%). Hepatitis B virus (HBV) vaccination of all clinical staff was reported by 46% of orthodontists, compared with 61% of general dentists (p < 0.001). Reports of HBV vaccination of orthodontists (94%) and general dentists (92%) were not significantly different. The use of additional precautions for patients with HIV was reported by 80% of orthodontists and 78% of general dentists. More education is required to promote the use of universal precautions by both general practitioners and orthodontists. Increased use of barrier methods, HBV vaccination of clinical staff, and heat sterilization of handpieces is required to reduce the potential for cross infection in the orthodontic practice. This is particularly important with the increasing number of microorganisms that are resistant to antibiotics.

Acquired Immunodeficiency Syndrome↗
PubMed1992

A review of toxic shock syndrome: the need for education still exists.

Toxic shock syndrome is a multisystem disease that is believed to be caused by a toxin produced by Staphylococcus aureus. The syndrome can occur in persons of any gender, age or race and should be considered as a possible diagnosis in any patient displaying symptoms compatible with the illness. Most reported cases of toxic shock syndrome have occurred in young menstruating women and have been associated with the use of tampons. Toxic shock syndrome cases reported to the Centers for Disease Control have decreased substantially since May of 1980. The decreases in diagnosis and reporting may be attributed to diminished public and professional attention to the syndrome. In addition, it is likely that cases of the syndrome that do not meet the strict Centers for Disease Control case definition are not being diagnosed. Until more is understood about toxic shock syndrome, particularly its relationship to menstruation and tampon use, patient education remains a primary key to prevention. Women should be aware of the symptoms of toxic shock syndrome and, if symptoms occur, seek medical attention immediately.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Evidenced-based practice: priorities and implementation strategies.

Evidenced-based practice (EBP) should be a driving force behind establishing optimal clinical practices. Recently, clinicians and hospitals have started efforts to introduce key EBP. These efforts hold the potential to improve patient outcomes and reduce costs. However, many practices need updating with EBP. Which ones should be chosen? While practices often vary in terms of importance for each hospital, some changes in practice are likely to have a better return on the investment (ROI). Two key areas affecting most hospitals are practices associated with high costs and increased mortality. In critical care areas, these two key areas often involve addressing outlier management and severe sepsis. In addition, the recognition of the need for the change is only one step in ensuring EBP. To ensure EBP is implemented, clinical leaders who will ensure that the new practice standards are being utilized are necessary. Fortunately, many hospitals have strong leaders. The advanced practice nurse (APN) is one such leader. The APN is often in a unique position to help recognize, prioritize, and implement EBP into the hospitals culture. This article illustrates steps in making EBP a reality by highlighting the management of outliers and severe sepsis and the implementation strategies for these conditions.

Bias↗
PubMed2002

[Universal vaccination against group C meningococci and pneumococci; advice from the Health Council of the Netherlands].

A committee of the Health Council of the Netherlands recently advised the Minister of Health on nationwide vaccination against group-C meningococci and pneumococci. They recommended the introduction of both vaccines into the national vaccination programme. The meningococcal C vaccine should be introduced as soon as possible, and the pneumococcal vaccine should be introduced as soon as a combined vaccine against diphtheria, tetanus, pertussis and polio and H. influenzae type B is available. In the meantime, due to various clusters of meningococcal disease caused by Neisseria meningitidis C in the Netherlands, parents have started to have their children vaccinated by buying vaccines and asking their general practitioners to perform the vaccination. This unfavourable situation must be controlled by the government through clear publicity to parents and healthcare workers.

Health Policy↗
PubMed1995

[Inquiry of veterinarians in Niedersachsen concerning the occurrence of parasitic diseases and their control in small animals].

A questionnaire was sent to all veterinarians in Lower Saxony (approximately 3500). The regular occurrence of parasitic infections in small animals, problems with particular parasites, the routine application of diagnostic and therapeutic measures, and the significance of Echinococcus multilocularis were asked for. Due to the disappointing low number of filled-in questionnaires sent back by the practitioners (n = 68) a statistical analysis of the data was not applicable. Nevertheless, certain trends could be recognized. Cestodes and ascarids are stated as regularly occurring parasites of dogs (92.1% and 94.1%) and cats (94.1% and 95.6%) by most veterinarians. Cestodes are most frequently regarded as parasites causing problems in dogs (16.2%) and cats (17.5%). Pyrantel and praziquantel are the anthelmintics preferred by the majority of the practitioners for the treatment of parasitic infections in dogs (86.7% and 63.2%) and cats (47.1% and 75.0%). Coproscopical methods are performed by most veterinarians (92.6%) and they are generally regarded as adequate diagnostic tools (86.8%). To date, Echinococcus multilocularis is not noticed as a major problem in Lower Saxony by the practitioners, although sporadically veterinarians are asked for advice.

Animals↗
PubMed1997

Intravenous cannulation: potential complications.

The procedure of establishing peripheral venous access carries the risk of potential complications to both the patient and the practitioner. Complications include infection, phlebitis and thrombophlebitis, emboli, pain, haematoma or haemorrhage, extravasation, arterial cannulation and needlestick injuries. Careful adherence to guidelines and procedures can minimise these risks.

Catheterization, Peripheral↗
PubMed1998

Disposable contact lens use as a risk factor for microbial keratitis.

AIMS: A case-control study was performed to evaluate soft contact lens (SCL) wear modality as a risk factor for microbial keratitis. METHODS: Contact lens wearers presenting as new patients to Moorfields Eye Hospital accident and emergency department during a 12 month period completed a self administered questionnaire detailing demographic data and contact lens use habits. Cases were patients with a clinical diagnosis of SCL related microbial keratitis. Controls were SCL users attending with disorders unrelated to contact lens wear. Odds ratios (estimates of relative risks) and 95% confidence limits (CL) were calculated through multivariable logistic regression analysis. RESULTS: There were 89 cases and 566 controls. A substantially increased risk with 1-4 weekly disposable SCL compared with non-disposable SCL was identified among both daily wear (DW) (odds ratio = 3.51, 95% CL 1.60-7.66, p = 0.002) and extended wear (odds ratio 4.76, 95% CL 1.52-14.87, p = 0.007) users after adjustment for demographic, lens use and hygiene variables. Other significant factors among DW users were "occasional" overnight use, use of chlorine based (as opposed to other chemical) systems in combination with poor storage case hygiene, and irregular disinfection. CONCLUSION: Properties of some disposable SCL may be partly responsible for these excess risks. It is also possible, however, that this finding is largely a reflection of widespread complacency among patients and practitioners with respect to disposable SCL fitting and use.

Adolescent↗
PubMed2005

Environmental surface asepsis.

Environmental surface disinfection is easily accomplished with precleaning and disinfection techniques, and prepared surfaces or difficult-to-clean items can be covered with impermeable barriers. When carried out effectively, both practitioners and patients are protected from exposure to microorganisms that transmit disease and cause illness.

Asepsis↗
PubMed2005

Physician knowledge and perspectives regarding influenza and influenza vaccination.

BACKGROUND: Recent studies have demonstrated that healthy children younger than 24 months of age are at risk for influenza-associated hospitalization and influenza related complications. In light of this, the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention changed their recommendation for influenza vaccination for the 2004-05 season to include universal vaccination for all healthy children 6-23 months of age. METHODS: A self-administered survey was distributed to a random sampling of family practitioners and pediatricians in Chicago, IL. Questions were asked regarding demographics, current use of influenza vaccines, and knowledge regarding influenza vaccines and influenza infection in children. Answers were scored as correct based on published literature and AAP/ACIP recommendations. RESULTS: During the 2002-2003 influenza season, recommendation for influenza vaccination and perceived use for both healthy children and children with a high-risk medical condition were both low. The majority of physicians were not aware of the severity of influenza infection in young children, could not correctly identify all contraindications to receiving vaccination, did not know which children require two vaccinations, and were not aware of the complications of influenza in children. CONCLUSIONS: To achieve the goal of universal influenza vaccination coverage for the 2004-05 season for healthy children 6-23 months of age, physicians will need a greater understanding of the severity of influenza illness in this age group coupled with an increased knowledge of indications for vaccine administration.

Adolescent↗
PubMed1997

A case-control study of measles vaccination and inflammatory bowel disease. The East Dorset Gastroenterology Group.

BACKGROUND: The cause of inflammatory bowel disease (IBD) remains to be established. Evidence has linked measles infection in early childhood with the subsequent risk of developing IBD, particularly Crohn's disease. A cohort study raised the possibility that immunisation with live attenuated measles vaccine, which induces active immunity to measles infection, might also predispose to the later development of IBD, provoking concerns about the safety of the vaccine. METHOD: We report a case-control study of 140 patients with IBD (including 83 with Crohn's disease) born in or after 1968, and 280 controls matched for age, sex and general practitioner (GP) area, designed to assess the influence of measles vaccination on later development of IBD. Documentary evidence of childhood vaccination history was sought from GP and community health records. FINDINGS: Crude measles vaccination rates were 56.4% in patients with IBD and 57.1% among controls. Matched odds ratios for measles vaccination were 1.08 (95% CI 0.62-1.88) in patients with Crohn's disease, 0.84 (0.44-1.58) in patients with ulcerative colitis, and 0.97 (0.64-1.47) in all patients with IBD. INTERPRETATION: These findings provide no support for the hypothesis that measles vaccination in childhood predisposes to the later development of either IBD overall or Crohn's disease in particular.

Adult↗
PubMed2001

Classical and variant Creutzfeldt-Jakob diseases and their potential impact on the practice of clinical dentistry in Australia.

Following recent published evidence regarding the experimental transmission of prion diseases via blood transfusion, dental practitioners have expressed their concern about the potential impact of these transmissible spongiform encephalopathies on dental care provision. This review provides updated information on Creutzfeldt-Jakob disease and related disorders and highlights their potential significance for the practice of clinical dentistry. The current guidelines in Australia relating to infection control and clinical dental procedures are discussed together with recommended guidelines and considerations from the United Kingdom and the World Health Organization (WHO).

Animals↗