Carol O'Boyle Williams

METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) : A BRIEFING FOR ACUTE CARE HOSPITALS AND NURSING FACILITIES

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) has increased in communities and in healthcare facilities in the United States since the mid-1970s. Although MRSA often is thought of as a nosocomial infection problem because it is encountered in facilities of all types and sizes, it also causes many community-acquired infections. Approaches to control of MRSA vary widely, and there is lack of agreement on the most appropriate measures to control MRSA in healthcare facilities. The wide variation in approaches is due, in part, to the lack of data establishing the efficacy of specific control measures. As a result, the approaches that have been advocated have resulted in confusing and often conflicting recommendations and control measures. In some settings, there also have been unreasonable barriers and administrative hurdles that delay or prevent the transfer of patients between acute care and nursing (extended care) facilities.

Compliance with universal precautions and needle handling and disposal practices among emergency department staff at two community hospitals

BACKGROUND To describe rates of needle disposal and barrier use within the emergency departments at two privately owned community hospitals in two suburbs of Minneapolis, a study was conducted. This study consisted of direct observation of a cohort of emergency department personnel providing patient care followed by a self-administered survey of the same personnel. METHODS From June through August 1990, seven specially trained registered nurses observed emergency department personnel for a total of 400 hours. The observers documented the appropriate rates of use of gowns, goggles, masks, and gloves. Observers also noted methods of needle disposal and frequency of needle recapping. After observation, surveys that included items requesting estimates of rates of use for each barrier, as well as estimates of the rates and methods of needle recapping and disposal, were distributed. For each observed and corresponding self-reported behavior, 95% confidence intervals were calculated and compared. RESULTS A total of 1,822 procedures were recorded. Gloves were observed to be used when appropriate 67.2% of the time, followed by goggles (50.7%), masks (16.0%), and gowns (15.3%). Self-reported barrier rates were slightly higher in all cases except for goggle use. About one third (34.4%) of the needles were recapped; 78.1% of these were recapped two-handed. CONCLUSIONS Previous studies have documented low universal precautions compliance rates at urban teaching hospitals. Our data indicate less than optimal levels of compliance also at community hospitals, and show that personnel are less than fully aware of their own noncompliance.

Role of infection control practitioners in human immunodeficiency virus testing

BACKGROUND As a result of the HIV epidemic, the role of the ICP has changed; acute care settings have developed a variety of policies regarding patient and health care worker (HCW) HIV testing and issues related to the HIV-infected HCW. APIC conducted a survey to determine the extent to which ICPs were involved in HCW and patient HIV testing and counseling, the prevalence of routine HIV testing for patients, institutional policies on HIV testing of patients and HCWs, and the management of HIV infected HCWs. METHODS In 1990, a questionnaire was sent to ICPs in a simple random sample of 1300 acute care hospitals (approximately 20%) in the United States. RESULTS Response rate was 52.8%. Of the 686 respondents, 54.8% provided counseling to the HCW after an exposure incident. ICPs were involved not only in HIV testing and counseling for patients and HCWs but also in institutional policy development for HIV-related issues. Most facilities (73.8%) obtained written consent for testing from the patient after an employee exposure. When a direct care giver was known to be HIV positive, 61.5% of the respondents evaluated each case individually. CONCLUSIONS The ICP has a significant role in the development and implementation of institutional policies on HIV testing and counseling and on the management of HIV-infected workers. These findings affirm the need for APIC to provide educational opportunities on the issues related to HIV testing and counseling.