Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Infection Control Practitioners”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,459 records · Page 81Linked to original sources
PubMed2003

Antibiotic prophylaxis for patients with joint prostheses - still a dilemma for dental practitioners.

OBJECTIVES: To provide a critical review of the current evidence that implicates dental-induced bacteraemia as a risk for joint infections in patients fitted with joint prostheses and appraise the need for antibiotic prophylaxis. DESIGN: Retrospective analysis. SETTING: Mainly hospital-based patients or subjects. OUTCOME MEASURES: The relationship between joint infections and dental treatment is equivocal at the best and there is no evidence that antibiotic prophylaxis provides such patients with any protection. RESULTS: Microbiological evidence linking dental treatment-induced bacteraemia to joint infections is weak and if an oral commensal is implicated, it is more likely to have arisen either from a spontaneous bacteraemia or from a dental infection. As a consequence of the latter, we recommended the institution of good dental health prior to joint replacement. There may be a case for providing prophylaxis to the immuno-compromised patient, but only if the immuno-suppression is associated with a neutropenia. In such circumstances, only emergency treatment should be considered until the neutropenia is resolved. Antibiotic regimens that are recommended by orthopaedic surgeons have not been evaluated in a randomised placebo-controlled study and many of the drugs are not licensed for this purpose. The evidence on cost-risk benefit seems to demonstrate that antibiotic prophylaxis with either amoxicillin or penicillin is not cost effective when compared with no prophylaxis. CONCLUSION: The case for providing antibiotic prophylaxis prior to dental treatment in patients fitted with a joint prosthesis is weak or virtually non-existent. Furthermore, the risk from providing prophylaxis is greater than the risk of a joint infection.

Antibiotic Prophylaxis↗
PubMed2000

Patient care by physician assistants and by physicians in an emergency department.

OBJECTIVE: Decreasing health care dollars have resulted in increased utilization of so-called midlevel practitioners. We compared emergency physicians with emergency department physician assistants (PAs) to determine whether PAs are an appropriate option for providing services rendered by physicians in this setting. METHODS: We undertook an observational retrospective review of a hospital database (July 1995 to June 1996) from an urban urgent-care facility. Collection of data was restricted to times of single-provider coverage. Every patient who visited the clinic was seen by the sole provider (physician or PA) on duty; no one was turned away. If a patient needed emergency care, he (or she) was transferred to the main emergency department at the hospital, as deemed appropriate by either provider after evaluation. Physicians and PAs were compared in regard to length of visit and total charges in 14 diagnostic groups. Adverse outcomes were not evaluated. Age, sex, race, and multiple diagnoses were controlled for by regression analysis. RESULTS: A total of 9,601 patient encounters were analyzed. PAs and physicians had a similar distribution of diagnostic groups. Respiratory infection and musculoskeletal disorders accounted for approximately 36% of visits; lacerations, gastrointestinal disorders, and otitis each accounted for 5% of visits. Overall, visits were 8 minutes longer and total charges $8 less when a patient was treated by a PA. Patients who had headache, otitis, respiratory infection, asthma, gastrointestinal or genitourinary disorder, cellulitis, laceration, or other musculoskeletal disorder had a longer visit when seen by a PA; the difference ranged from 5 to 32 minutes longer. In no diagnostic group was there a statistically significant greater length of visit or total charge because patients were seen by a PA. CONCLUSION: Despite a few large differences in some diagnostic groups, the two types of provider had, overall, small but clinically insignificant differences in length of visit and total charges. The magnitude of difference in length of visit and total charges strongly suggests that PAs, when compared with physicians, are a viable staffing option in an urgent care facility.

Adolescent↗
PubMed2001

An instrument for collecting problem oriented, problem linked data in primary medical care.

AIM: To describe a new form for collecting problem oriented, problem linked data from primary care. METHOD: A novel form is described which has been used to collect these data. These data were validated against secondary data collections. RESULTS: The form has been used to record 10,937 encounters in a variety of primary care settings. The form was acceptable to general practitioners (GPs) and was completed on 87% of eligible patients in a one week data collection. Data captured provide descriptive data about the problems encountered and services provided during the consultation. These elements of the medical record are linked so that it is possible to address questions about patterns of service provision. Uncomplicated lower urinary tract infection is used as an example of how data from the form can be used to examine clinical practice and resource utilisation. CONCLUSION: A method has been demonstrated to collect problem oriented, problem linked data which may be used for clinical costing and to demonstrate compliance with clinical practice guidelines.

Chi-Square Distribution↗
PubMedDate not supplied

Ventriculostomy and intracranial pressure monitoring: in search of a 0% infection rate.

External ventriculostomy intracranial pressure (ICP) monitoring provides bedside practitioners with essential information about cranial dynamics as well as a means to maintain the balance within the cranium. Infection has been cited in the literature as the most common complication associated with ICP monitoring. This article reviews the research literature for the risk factors suggested to increase infection, presents data and practice guidelines from one institution where ICP monitors have been maintained infection free for more than 10 years, and summarizes the experiences of another institution where the 6-month infection rate of 55% associated with external ventriculostomy was reduced to 0% in the subsequent 6-month period. The actions taken by the multidisciplinary team to reduce the risk of infection are detailed. Recommendations for minimizing the risk of infection are made by the authors and are based on research studies and experience.

Catheters, Indwelling↗
PubMed1993

Helping patients handle accusations of infidelity.

You may have experience with women patients who assume their partners are being unfaithful if they try to use condoms because that behavior could indicate they are trying to prevent potential sexually transmitted diseases (STDs). These same women may believe the same will be assumed of them if they begin to use the new female condom. If women present the device to their partners in the context of a birth control product rather than a device to prevent STDs, men might be more willing to accept it, says sexuality expert Beverly Wipple, PhD, RN, an associate professor at Rutgers State University of New Jersey in Newark and the author of Safe Encounters: How a Woman Can Say Yes to Pleasure and No to Unsafe Sex (Pocketbooks, 1990). Wipple has been a leader in female sexuality research since 1979, having conducted the original research on the "G-spot" (Dell Publishers, 1983). Wipple bases her hypothesis on a presentation about the male condom given at the 1992 annual meeting of the International Society for the Scientific Study of Sex, held in San Diego. The presenter showed that if women were using the male condom as their only form of contraception, then the male was more likely to use it. If the woman was taking oral contraceptives or using another form of contraception--and was only relying on the condom or STD protection--then the male was less likely to use the condom. "I think the same thing might apply to the female condom," Wipple suggests. "If she identifies that this is her method of birth control. I think it is much more likely to be accepted than if she says she is using it to prevent the spread of diseases." Wipple says practitioners should tell women to emphasize the birth control angle and downplay the STD angle. "It may not be the only method they are using, but they don't have to tell him that." she says. "This way, it is not putting an accusation [of infidelity] on him." While she acknowledge and dislikes the lack of honesty inherent in this practice, she says the end justifies the means. "Although it is not addressing the issues that should be addressed, we have to recognize there are people in situations where it is just impossible for them to address the issues," Wipple explains. She says this inability to communicate has led to the spread of STDs.

Attitude↗
PubMed2006

The Practical Approach to Lung Health in South Africa (PALSA) intervention: respiratory guideline implementation for nurse trainers.

AIM: This paper describes the design, facilitation and preliminary assessment of a 1-week cascade training programme for nurse trainers in preparation for implementation of the Practical Approach to Lung Health in South Africa (PALSA) intervention, tested within the context of a pragmatic cluster randomized controlled trial in the Free State province. PALSA combines evidence-based syndromic guidelines on the management of respiratory disease in adults with group educational outreach to nurse practitioners. BACKGROUND: Evidence-based strategies to facilitate the implementation of primary care guidelines in low- to middle-income countries are limited. In South Africa, where the burden of respiratory diseases is high and growing, documentation and evaluation of training programmes in chronic conditions for health professionals is limited. METHOD: The PALSA training design aimed for coherence between the content of the guidelines and the facilitation process that underpins adult learning. Content facilitation involved the use of key management principles (key messages) highlighted in nurse-centred guidelines manual and supplemented by illustrated material and reminders. Process facilitation entailed reflective and experiential learning, role-playing and non-judgemental feedback. DISCUSSION AND RESULTS: Preliminary feedback showed an increase in trainers' self-awareness and self-confidence. Process and content facilitators agreed that the integrated training approach was balanced. All participants found that the training was motivational, minimally prescriptive, highly nurse-centred and offered personal growth. CONCLUSION: In addition to tailored guideline recommendations, training programmes should consider individual learning styles and adult learning processes.

Education, Nursing, Continuing↗
PubMed2003

Wound infections in two health institutions in Ile-Ife, Nigeria: results of a cohort study.

The control of wound infections is increasingly complicated, yet treatment is not always guided by microbiological diagnosis. To describe the distribution of wound infections and causative agents, a prospective, 6-month cohort study involving 102 outpatients was conducted at the University Teaching Hospital and the Health Center in Ile-Ife, Nigeria. Location and type of infected wounds were recorded and bacterial isolates were identified by standard microbiological techniques. Almost half (40%) of all infected wounds were attributed to trauma and, in most cases, located on the extremities. Of the 162 bacterial isolates obtained from wound cultures, 39 were monomicrobial and 55 were polymicrobial; no bacterial isolate was obtained in eight cases. Staphylococcus aureus was the predominant micro-organism (25%), followed by Escherichia coli (12%), Pseudomonas aeruginosa (9%), and Staphylococcus epidermidis (9%). The diversity of micro-organisms and the high incidence of polymicrobic flora in this study give credence to the value of identifying one or more bacterial pathogens from wound cultures. The recognition of causative agents of wound infections can assist wound care practitioners in taking appropriate measures. Continuous dialogue between the microbiology department and wound care practitioners is strongly advised in order to improve treatment outcomes and slow the development of antibiotic-resistant bacteria.

Adolescent↗
PubMed2006

Endemically acquired foodborne outbreak of enterotoxin-producing Escherichia coli serotype O169:H41.

PURPOSE: Enterotoxigenic Escherichia coli (ETEC) is traditionally recognized as a common cause of traveler's diarrhea, but is becoming a more frequent cause of foodborne disease outbreaks in the United States. It is important for public health practitioners and clinicians to be aware of ETEC as a domestic cause of gastroenteritis. We investigated a foodborne disease outbreak to understand the epidemiology of ETEC in this setting. METHODS: We conducted a cohort study of 63 employees of Company A. A case was defined as an employee who experienced diarrhea or vomiting or fever and cramps after eating a catered meal at Company A from August 14th-15th. A standardized questionnaire was administered to cases and controls. RESULTS: Of 63 employees, 36 met the case definition (Attack Rate = 57.1%). Diarrhea (94%) and cramps (74%) were common, whereas vomiting was not (3%). Mean duration of illness was 2.7 days. Coleslaw at the August 15th lunch was significantly associated with illness (Odds ratio = 4.4, 95% CI = 1.1-17). Stool specimens were positive for heat-stable enterotoxin-producing E. coli O169:H41. Contamination likely occurred at the point of service. CONCLUSIONS: This outbreak illustrates the changing epidemiology of enterotoxigenic E. coli and the importance for healthcare practitioners to consider ETEC as a potential cause of domestically acquired gastroenteritis.

Adult↗
PubMed1996

A scoring system for predicting group A streptococcal throat infection.

BACKGROUND: Sore throat is very common in general practice and is usually caused by viral infection. Nevertheless, up to 95% of patients may be treated with antibiotics. Previous diagnostic systems have not transferred well from one area to another because of an inability to allow for changing prevalence of streptococcus. AIM: To measure the occurrence rates of symptoms and signs in sore throat patients with and without streptococcal infection, and to develop a Bayesian scoring system which is easily adapted for prevalence to predict if patients have bacterial infection. METHOD: Occurrence rates of symptoms and signs were measured for 206 patients with sore throat symptoms over a 3-year period. Bayesian probability scores (B-scores) for each data item were calculated from the ocurrence rates in the patients with positive throat cultures for group A streptococci and the rates in patients with negative throat cultures. The B-score values were then used to predict the probability of positive culture for each patient. RESULTS: The streptococcal throat B-score system predicted positive culture with a sensitivity of 71% and a specificity of 71%. In comparison, the unaided general practitioners predicted infection with a sensitivity of 61% and a specificity of 65%. If the B-score prediction had been used to decide on treatment, more patients with streptococci present on culture would have been treated with antibiotic (71% instead of 68%) and appreciably fewer patients with negative streptococcal cultures would have been treated (29% instead of 59%). CONCLUSION: Use of the B-score system could result in significant savings in unnecessary antibiotic prescription, and unnecessary throat swab cultures, while achieving better levels of treatment.

Adolescent↗
PubMed2002

Variant Creutzfeldt-Jakob disease--a problem for general dental practitioners?

Over a hundred deaths from variant Creutzfeldt-Jakob disease (vCJD) have now been recorded. The incubation period for vCJD may be up to 40 years and the number of asymptomatic carriers in the population could be as many as 100,000. Confirmed iatrogenic transmission of other human transmissible spongiform encephalopathies raises the possibility of cross-infection from apparently healthy persons who are incubating vCJD. Decontamination techniques routinely used in general dental practice are incapable of inactivating the infective protein responsible for transmitting the disease. So far, no evidence exists to preclude the risk of iatrogenic infection occurring during dental procedures. The author reviews present knowledge of the infective agent, its transmissibility, its origins, current guidelines and the implications for dental practice.

Carrier State↗
PubMed1996

The utilisation of hepatitis A vaccine 1992-1994.

OBJECTIVES: To assess the utilisation of hepatitis A vaccine in Scotland since it was licensed and also any impact this had on the utilisation of immunoglobulin prophylaxis. DESIGN: Collation and analysis of information obtained from the Pharmacy Practice Division and the Scottish National Blood Transfusion Service (SNBTS). SETTING: Scotland. 1992 to 1994 inclusive. SUBJECTS: All supplies/persons for whom hepatitis A vaccine or Human normal immunoglobulin (commercial or via SNBTS) was prescribed or dispensed in Scotland 1992-94. RESULTS: Hepatitis A vaccine started to be utilised very shortly after it became available. Utilisation has increased progressively since April 1992 with nearly 65,000 "courses' being prescribed in 1994. There has been no obvious impact on the use of immunoglobulin which has increased during this period. New formulations of the vaccine, e.g. paediatric and one dose courses have been rapidly assimilated by practitioners into their practice. Both vaccine and immunoglobulin utilisation follow a marked seasonal pattern with a peak every June. CONCLUSION: Statistics from the Pharmacy Practice Division proved useful in monitoring utilisation of this prescribed vaccine. The increasing utilisation of hepatitis A vaccine is a significant financial outlay for the NHS in Scotland. There may be significant non-compliance with the recommendations for restricting its use. The cost effectiveness of this immunisation for travellers has been recently called in question. The changing epidemiology of endemic infection is referred to in respect of possible immunisation programmes and the likely decline in efficacy of immunoglobulin. The need for more research on the incidence of hepatitis A antibody in the Scottish population is highlighted.

Drug Utilization Review↗
PubMed2001

Adverse events associated with methicillin-resistant Staphylococcus aureus in a nursing home.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) generates concern in nursing homes. Restrictive isolation precautions may be applied for indefinite periods. Adverse events driving these concerns include transmission and infection. METHODS: The 721-bed Wisconsin Veterans Home in King performs approximately 645 cultures annually. The site, severity, and number of MRSA infections were determined for 69 months. Pulsed-field gel electrophoresis was performed on all initial isolates, followed by a statistical cluster analysis looking for evidence of transmission. RESULTS: Sixty-seven MRSA infections were identified (1.6 per 100 residents per year); many were polymicrobial, and it was difficult to determine the proportionate role of MRSA in morbidity or mortality. There was an episode of rapidly fatal MRSA septicemia in which empiric antibiotic therapy was ineffective. Twenty-one genetic strains were encountered. Statistical analysis identified 13 clusters of genetically identical strains clustered in time and space (P<.05). CONCLUSIONS: Infections with MRSA were identified at relatively low rates; however, the etiology of many serious nursing home infections is not determined, especially pneumonia. Statistical analysis revealed clustering and evidence of transmission. Nursing home practitioners should consider MRSA when applying empiric treatment to serious infections. We recommend a program including (1) judicious use of antibiotics, including topical agents, to reduce selection of resistant organisms; (2) obtaining and tracking cultures of infectious secretions to diagnose MRSA infections and focus antibiotic therapy; (3) universal standard secretion precautions because any resident could be a carrier; and (4) a detailed assessment and care plan for the carrier that maximizes containment of secretions and independence in activities. However, basic hygiene cannot be maintained in communal areas by some residents without restriction of activities of daily living.

Aged↗
PubMed2004

Infections of the upper extremity in hospitalized diabetic patients: A prospective study.

OBJECTIVES: To study the clinical characteristics of a group of patients with diabetes and established upper extremity infections and to determine the causative factors of hand infections. METHODS: Prospective study of diabetic patients referred in to our service with infections of the upper extremity from January 1992 to December 2001. RESULTS: Twenty-six diabetic patients with an infection of the upper extremity were studied (17 F, 9 M). The admission rate equalled 0.7%. Twenty-one patients (80.8%) presented a Type 2 diabetes and 5 a Type 1 diabetes (19.2%). The diagnosis age of diabetes was 44.6 +/- 13.8 Years (range: 16-62). The average age at the occurrence of the lesion was 52.5 +/- 15.1 Years (range: 21-73). The average duration of diabetes was 8.3 +/- 5.9 Years (range: 0-22). Diabetes was, in all the cases, poorly controlled because of an inadequate hypoglycaemic treatment and/or bad compliance. The patients had a high prevalence of peripheral neuropathy (n=17; 65.4%). The delays in presentation to the doctor and those related to hospitalization were respectively 9.1 +/- 10.0 days (n=23) and 16.8 +/- 12.1 days. The hospitalization length reached 33.6 +/- 22.6 days (range: 7-93). The final results, 6 Months after hospitalization, were as follows: the death rate reached 19.2% (n=5); 23.1% of the patients (n=6) had a minor amputation; for 53.8% of the patients (n=14), the lesions healed without any amputation. One patient left hospital against medical advice. Eleven out of 20 patients (55%), amputated or not, were left with deformities and a subjective dysfunction of the affected limb. CONCLUSION: Infections of the upper extremity in diabetic patients constitute an uncommon but serious complication. They seem to be more frequent in housewives. They result in a high morbIdity. Prevention of these infections should be based on patients' education (compliance with diabetes treatment, hand care, prompt visit to the doctor) and General Practitioners' training for an adequate treatment and/or a rapId patient referral to hospital.

Algeria↗
PubMedDate not supplied

National campaign against hepatitis C in France (1999-2002).

Since 1988, several measures have been applied in France to control HCV infection. HCV seroprevalence in the adult population is estimated at 1.1% (500,000 to 650,000 persons) and the number of chronically infected at 400,000 to 500,000 persons. In 1994, most of them might not be aware of their infection. Blood products administration and injecting-drug use are identified as the main transmission routes. The national hepatitis C plan (1999-2002) was based on scientific data and developed after a consensus conference and several expert consultations. It involves six programs and quantified objectives: prevention of new infections, enforcement of screening access; improvement of care management; implementation of a surveillance system, clinical research and evaluation. Specific financial supports were attributed for the implementation of the plan. The 2001 progress report confirmed a major increase in national and regional actions. In 2000, considering the high proportion of persons still unaware of their infection (at least one third) and the increase of treatment efficacy, the target population of the screening strategy was considerably extended after scientific analysis. A national consciousness-raising campaign directed at general practitioners was launched in June 2000. In 2001, a media campaign directed to the general population was developed, in newspapers and on radio stations. Since the end of 1999, a national toll free phone number provides information to the public. In order to improve access to screening, a new regulation added HCV testing to the missions of anonymous and free HIV testing centres, as well as of family planning centres. The hepatitis C prevention strategy is still included in a national public health program and improved in view of its renewal.

Cost-Benefit Analysis↗
PubMed2006

Increased bacterial burden and infection: the story of NERDS and STONES.

PURPOSE: The purpose of this article is to provide practitioners with an overview of wound infection/inflammation and bacterial balance and to offer a guide to assessment and treatment of chronic wounds. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses who assess and treat wound infections. OBJECTIVES: After reading this article and taking this test, the participant should be able to: 1. Discuss factors associated with infection of the chronic wound, including the concept of bacterial balance and burden. 2. Identify signs of infection in the chronic wound and applicable diagnostic tests. 3. Describe appropriate treatment for the infected chronic wound.

Abbreviations as Topic↗
PubMed1991

Oral care of HIV infected patients: the knowledge and attitudes of Irish dentists.

As the numbers of people with HIV infection and AIDS increase, so will the contribution required from dental practitioners. A postal questionnaire survey was therefore conducted among dental practitioners in Ireland to determine their knowledge and attitudes towards HIV infection and the issues it raises for them. Although a majority of dentists were aware of the facts related to AIDS and the spread and oral manifestations of HIV infection, there were considerable gaps in their knowledge with regard to dental management. Only 41% were prepared to be engaged in continued care of HIV infected patients while contradicting opinions were expressed on the risk of HIV transmission in dentistry and attitudes towards HIV seropositive patients and staff. Further educational efforts on HIV infection and its implications in dentistry should be directed towards dentists in Ireland.

Adult↗
PubMed1992

A prospective study of otitis externa.

A prospective study of otitis externa in the district of South Bedfordshire was undertaken between October 1990 and January 1991. Patients were referred untreated by general practitioners; self-referred patients with external otitis were also included. A detailed history was taken, the severity of the condition assessed, aural toilet performed, bacteriology swabs taken and the patient treated according to department protocol. 48 patients were included in the study; a similar number of age and sex-matched controls without otitis externa were randomly selected from the ENT outpatient clinics for comparison. Regular swimming emerged as a significant factor in the aetiology of otitis externa. The commonest organism cultured was Pseudomonas aeruginosa and this accounted for the most severe cases seen.

Adolescent↗
PubMed1992

Oral care of HIV-infected patients: the knowledge and attitudes of South African dentists.

As the numbers of people with HIV infection and AIDS increase, so will the contribution required from the dental practitioners. A postal questionnaire survey was therefore conducted among dental practitioners in South Africa to determine their knowledge and attitudes towards HIV infection and the issues it raises for them. Although a majority of dentists were aware of the facts related to AIDS, and the spread and oral manifestations of HIV infection, there were considerable gaps in their knowledge with regard to the dental management of infected patients. Only 45 per cent were prepared to be engaged in the continued care of HIV-infected patients while contradicting opinions were expressed on the risk of HIV transmission in dentistry and attitudes towards HIV seropositive patients and staff. Further educational efforts on HIV infection and its implications in dentistry should be directed towards dentists in South Africa.

Adult↗