Candace Friedman

Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: A Consensus Panel report

The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panels best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Preventions Hospital Infection Control Practices Advisory Committee.

Requirements for Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report

The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panels best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Preventions Hospital Infection Control Practices Advisory Committee.

Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: A Consensus Panel report

In 1997 the Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in out-of-hospital settings. The following report represents the Consensus Panels best assessment of requirements for a healthy and effective out-of-hospital-based infection control and epidemiology program. The recommendations fall into 5 categories: managing critical data and information; developing and recommending policies and procedures; intervening directly to prevent infections; educating and training of health care workers, patients, and nonmedical caregivers; and resources. The Consensus Panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Preventions Healthcare Infection Control Practices Advisory Committee.

Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings : A Consensus Panel Report

In 1997 the Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in out-of-hospital settings. The following report represents the Consensus Panels best assessment of requirements for a healthy and effective out-of-hospital-based infection control and epidemiology program. The recommendations fall into 5 categories: managing critical data and information; developing and recommending policies and procedures; intervening directly to prevent infections; educating and training of health care workers, patients, and nonmedical caregivers; and resources. The Consensus Panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Preventions Healthcare Infection Control Practices Advisory Committee.

APIC/CHICA-Canada infection control and epidemiology: Professional and practice standards

Elizabeth Horan-Murphy, BS, MT(ASCP), RN, MSN, CIC (Chair) Bonnie Barnard, MPH, CIC (APIC) Carol Chenoweth, MD (APIC) Candace Friedman, BS, MT(ASCP), MPH, CIC (APIC) Barbara Hazuka, RN, MSN (APIC) Barbara Russell, RN, MPH, ACRN, CIC (APIC) Margie Foster (CHICA-Canada) Carol Goldman (CHICA-Canada) Paula Bullock, MEd, MT(ASCP), CIC (CBIC Liaison) Lisa Docken, RN, BSN, CIC (CBIC Liaison) Linda McDonald, RN, MSPH, CIC (CBIC Liaison) APIC/CHICA-Canada Professional and Practice Standards Task Force

Ventilator‐Associated Pneumonia in the Home Care Setting

OBJECTIVE To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home. DESIGN Retrospective cohort study. SETTING University-affiliated home care service. PATIENTS Patients receiving mechanical ventilation at home from June 1995 through December 2001. RESULTS Fifty-seven patients underwent ventilation at home for a total of 50,762 ventilator-days (mean +/- SD, 890.6 +/- 644.43 days; range, 76-2,458 days). Seventy-nine episodes of VAP occurred in 27 patients (rate, 1.55 episodes per 1,000 ventilator-days). The first episode of VAP occurred after a mean (+/-SD) of 245 +/- 318.07 ventilator-days. VAP was most common during the first 500 days of ventilation. Rates of VAP were higher among patients who required ventilation for longer daily durations, compared with those who required it for shorter daily durations. There was no association of VAP with age, sex, underlying disease, reason for ventilation, antacid therapy, or steroid use. Microorganisms isolated from 33 episodes of VAP with available culture results included Pseudomonas species (17 isolates), Staphylococcus aureus (11), Serratia species (7), and Stenotrophomonas species (5). Eight patients died during the study; no deaths were attributed to pneumonia. CONCLUSIONS Although the organisms associated with VAP in the home setting are similar to those associated with hospital-acquired VAP, the incidence and mortality is much lower in the home care setting. Interventions to reduce the risk of VAP among patients receiving home care should be focused on patients who require ventilation for longer daily durations or who are new to receiving mechanical ventilation at home.

Hemodialysis-Associated Febrile Episodes: Surveillance before and after Major Alteration in the Water Treatment System

Surveillance for bacteremic or pyrogenic episodes associated with hemodialysis was undertaken before and after the reconstruction of the water treatment system at our University medical center. The new water system included a holding tank with iodination treatment. The water delivered to individual dialysis stations had only occasional positive bacterial cultures (3 of 21 samples before completion of construction, 2 of 16 samples afterwards) and intermittent detection of endotoxin (6 of 21 samples before completion of construction, 9 of 16 samples afterwards) at monthly sampling. Among 51 individual dialysis treatments (25 patients) before reconstruction and 56 treatments (29 patients), after, only 2 and 3 febrile events were identified, respectively. All of these were associated with underlying infectious illness and not with the hemodialysis procedure itself. Overall, we conclude that pyrogenic episodes associated directly with hemodialysis treatment are infrequent, and that the addition of a water storage tank with iodination treatment does not appear to increase the risk of bacteremia or pyrogenic episodes.

Sterile water, and saline solution: Potential reservoirs of nosocomial infection

The serious consequences of contaminated intravenous (IV) therapy solutions have been documented in numerous reports.le3 In one hospital 16% of patients receiving parenteral hyperalimentation developed fungemia.4 In a previous report we documented an outbreak of CaMdidu infections among 21% of patients receiving hyperalimentation therapy.j The potential role of contaminated multidose vials in nosocomial dj sease transmission has received increasing attention.6-g Although incidents of nosocomial infection as a consequence of administering contaminated IV solutions or multidose drugs is well documented, there are few reports documenting contamination of screwcapped large-volume (250 to 1000 ml) bottles of sterile water and saline and other solutions used in patient care. Yet such solutions are associated with the expanding medical technology that has increased the intimate interface between a patient and the devices designed to prolong life and reduce suffering.‘o-12 These devices frequently bypass host defenses such as the intact integument or ciliated epithelium. Respiratory therapy, hemodialysis, peritoneal dialysis, and urinary and cardiac catheterization may involve use of sterile solutions that would represent a significant hazard to patient safety if such solutions are contaminated.

Process surveillance: Auditing infection control policies and procedures

The infection control team in a university hospital designed, implemented, and evaluated a program to audit infection control policies. Process surveillance techniques of observation and monitoring were used during surveys of patient care areas to evaluate infection control practices. Nineteen unit surveys have been completed in a 2-year period. Analysis of the program has demonstrated it to be an effective method to determine compliance with infection control policies.

Setting Up a Patient Care Call Center After Potential HCV Exposure.

Objectives Notify patients of a potential exposure to hepatitis C virus, coordinate testing, and provide follow-up counseling. Methods A team was convened to identify various needs in developing a patient care call center. The areas addressed included the following: location, hours, and duration; telephone accessibility; tracking calls and test results; billing; staffing; notification; and potential issues requiring additional evaluation. Results Disclosure letters were sent to 1275 patients; 57 letters were not deliverable. There were 245 calls to the helpline from October 25 through November 15. Lessons learned centered on hours of availability, staffing, use of an automated phone system and email communication, tracking results, and billing issues. Conclusions A successful patient notification and follow-up effort requires a multidisciplinary team, internal and external communication, collection of data over an extended period, and coordination of patient information.