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Activities of infection control practitioners during an outbreak of Salmonella typhimurium. Task Force of Association for Practitioners in Infection Control.

ICPs played an invaluable role, and their activities resulted in minimal nosocomial incidence. The survey reported two cases of nosocomial infection in patients, one in the medical service and one in the pediatric unit, as well as the reported employee cases. Two nosocomial employee cases were reported, a laboratory technologist and medical student. Implementation of these recommendations will make the job of the ICP easier during any outbreak. We believe that our interventions, interactions, and assistance positively affected the course of the epidemic. In the final analysis the activities of surveillance, supervision of isolation, education and consultation, employee health, and public relations served to strengthen the positive image of ICPs.

Allied Health Personnel

Results of CHICA-Canada survey of long term care infection control practitioners.

Recognizing the unique and varied needs of infection control practitioners (ICPs) in long term care (LTC) facilities across Canada, CHICA-Canada established a task group to explore this area of practice and to determine the needs that could be met by CHICA-Canada. In March 1992 surveys were sent to CHICA-Canada members practicing in LTC facilities. Surveys were also sent to LTC associations in each province for distribution to their member agencies. A copy of the survey was published in The Canadian Journal of Infection Control in Summer 1992. As of August 31, 1992, 271 surveys have been returned from both members and nonmembers. The findings of the survey depict the special needs, unique practice settings and varied roles of ICPs in LTC facilities.

Canada

Physician and infection control practitioner HIV/AIDS reporting characteristics.

We surveyed a random sample of South Carolina physicians and infection control practitioners about the reporting of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) cases. Of physicians surveyed, 79% indicated that HIV infection as well as AIDS should be reported by name. The following characteristics were associated with those physicians who do not report AIDS cases: not feeling responsible for reporting, not reporting a case perceived to have been reported in another state, believing that information required for reporting is not on the chart, and residing in an urban setting. Targeted education can address these underreporting factors.

Acquired Immunodeficiency Syndrome

National survey of infection control practitioners' educational needs.

The purpose of this study was to conduct a nationwide survey to determine the number of master's-prepared infection control practitioners (ICPs) and those eligible for admission to graduate programs. Continuing education needs also were assessed to determine whether they might best be met through formal education or in a continuing education format. ICPs at 3765 health care facilities listed by the American Hospital Association as having more than 100 beds were invited to participate, and 2197 usable responses were received. Respondents' perceived educational needs were categorized into the eight sections outlined by the Educational Committee of the Association for Practitioners in Infection Control (APIC). Whenever possible, demographic characteristics of subjects were compared with the findings of the 1976-1977 Study on the Efficacy of Nosocomial Infection Control; apparent shifts have occurred in age, basic educational preparation, and numbers of practitioners with advanced degrees. The major perceived educational needs of the respondents were in the areas of Management and Communication, followed by Infectious Diseases and Epidemiology and Statistics. Nationwide generalization of the results may be hampered by the skewed regional distribution of responses. ICPs, however, expressed a multiplicity of perceived educational needs in each of APIC's eight sections, which may indicate that many ICPs believe that their performance and effectiveness are hampered by knowledge deficits.

Adult

Infection control practitioners and committees in skilled nursing facilities in Connecticut.

All skilled nursing facilities (SNFs) in Connecticut were surveyed and more than 71% responded to a Centers for Disease Control-funded project, a component of which is reported herein. The study describes the infection control practitioner (ICP), assistance provided ICPs from external sources, and infection control committees. Almost all ICPs received some training in infection control and worked in the field for an average of 3 1/2 years. Both the number of hours devoted to infection control and the percentage of time spent by the ICP on infection control activities increased with the size of the facility. More than one half of the ICPs in SNFs have relationships with hospital ICPs. The majority of SNF infection control committees met quarterly. The chairperson most often was a physician, although ICPs held this office in almost one third of the reporting SNFs. We conclude that ICPs in Connecticut SNFs have increased in number and that they devote more time and effort to infection control than in previous years.

Aged

Power and motivation: important concepts for infection control practitioners.

Organizations are composed of people vying with one another for power. Failure to acquire it may result in a limited ability to have an impact on organizational politics, and ultimately can lessen the success of motivating personnel. Therefore, using the power sources described to acquire power and developing strategies to motivate others are essential in attaining the goals of an infection control program. In summary, infection control practitioners have tended to focus on the technical aspects of their roles and may have neglected the development of influencing and motivational strategies that well could have an impact on improving compliance to infection control. Knowledge of key concepts, such as power and motivation, should be as important as any component of an infection control practitioner's training.

Behavior

The infection control practitioner: an action plan for the 1990s.

Some articles have suggested that to survive in the 1990s an infection control practitioner (ICP) will have to be "smarter, brighter, or gone"--they assume that new initiatives for hospital peer review (utilization review, risk management, antibiotic use review, and quality assurance) soon will swallow up the ICP and the infection control program. This article questions that assumption. It reviews data supporting the continuing need for hospital infection control programs and presents information suggesting that the need for the ICP will increase rather than decline during the 1990s. Four essential characteristics for infection control programs are listed, and skills that make the ICP a valuable resource for other peer review programs are described. Several ways that the ICP can (and must) bring this information to the attention of other hospital personnel are suggested. Such actions help assure recognition of the continuing important role of the ICP and the hospital infection control program in each U.S. hospital and long-term care institution.

Communicable Disease Control

Recognition of endemic and epidemic prosthetic device infections: the role of surveillance, the hospital infection control practitioner, and the hospital epidemiologist.

Surveillance as a means of identifying endemic and epidemic problems is an established and useful public health practice, which increasingly has been applied to the hospital population. The current practice of hospital infection control surveillance tends to concentrate on acute, in-hospital events. It will miss most longer-term prosthetic device infections, since they will often appear at a distance both in time and place. Currently, case report information is not reliably returned to the hospital or physician responsible for the implantation of the device. Since ongoing analysis of the epidemiologic patterns involved in these cases would seem useful, it is proposed that existing infection control units create, define, and maintain a system of net-working communication to return case data to the hospital of origin. This hospital could then combine these data with its own population data, in the hopes of generating useful epidemiologic information for the future.

Cross Infection

Surgical wound infections occurring in day surgery patients.

The occurrence of surgical wound infection in outpatient day surgery has not been extensively studied despite the increasing popularity of this mode of treatment. The present study was conducted to determine the frequency of surgical wound infections in a day surgery population. We randomly selected during a 6-month period 635 (25%) of 2540 patients undergoing a day surgery procedure in which a skin incision was made. The patients were telephoned 1 month after their procedure by an infection control practitioner. Infection was diagnosed if the patient reported that (1) their physician had made a diagnosis of a wound infection or (2) pus was or had been issuing from the wound. Of the 515 patients contacted, 72% had undergone a clean and 28% a clean-contaminated procedure. Patient risk factors for infection were almost completely absent in our day surgery patients. Twenty-six wound infections were diagnosed, 19 of which were identified by physicians' diagnosis and 7 by patient description, for a rate of 5.05%. Two patients required hospitalization for their infections, and 14 were treated with antibiotics. The clean wound infection rates were 4.62%, less than half the infection rate seen in our patients undergoing inpatient surgery at 1 month follow-up by the same surveillance technique. We conclude that day surgery infection rates are much lower than inpatient surgery infection rates at our facility, probably because of a relative absence of risk factors in the day surgery patients.

Ambulatory Surgical Procedures