Clarice O. Hargiss

A decentralized approach to maintenance of intravenous therapy

A prospective experiment was conducted in a university-affiliated hospital to evaluate the effectiveness of a core of specially trained staff nurses in the maintenance of IV therapy. Five staff nurses for each of two experimental units were trained for 1 month by an IV nurse educator and were expected to perform venipuncture and monitor peripheral IV care on their units. On three control units, IV therapy continued to be a shared function of all medical house staff and nurses. During this study, 876 IV infusions on 707 patients were studied. There was a decrease in the phlebitis rate on experimental units from baseline to study periods of from 33.5% to 20.9% (relative risk, controlled for duration of the use of an IV device, 0.53, p = 0.05), whereas the rate on control units increased slightly (23.8% to 26.7%, p = greater than 0.5). Regardless of duration of use, steel needles were associated with lower phlebitis rates than were plastic catheters. The mean duration that each infusion device was in place was significantly shorter on experimental units than on control units (2.4 vs. 3.3 days, p = less than 0.001). However, bacterial colonization of IV devices occurred more often on experimental units than on control units both at baseline (12.7% vs. 7.1%; p = 0.25) and during the study phase (19.4% vs. 5.9%; p = less than 0.01). This increased colonization occurred with IV infusions started by both physicians and nurses. There were no septic complications of IV therapy in the patients studied. Patient comfort, measured by number of sticks for each venipuncture and patient interview, was significantly improved (p = less than 0.001) on experimental units during the study phase. Costs to start such a decentralized IV program on 10 clinical units was calculated to be about +10,000. This study provides information useful to those making administrative decisions regarding the value of IV teams or other methods for IV therapy maintenance. We concluded that a decentralized program can be successful with commitment of time and money resources and with a system of monitoring to ensure compliance with written IV guidelines.

Prevalence survey for hepatitis B in high-risk university hospital employees

A 1974 prevalence survey of laboratory and dialysis employees identified 8.7% (4 of 46) with evidence of past hepatitis B infection. Since then increasing numbers of asymptomatic carriers have been admitted to University Hospital. Reports of exposures by employees have also increased. With the availability of a hepatitis B vaccine and the changes in patient population, a second prevalence survey was conducted to target employees at greatest risk for hepatitis B virus. Sixty-two percent (422 of 687) of high-risk employees who completed both blood work and questionnaires were study participants; 10.66% (45 of 422) had positive markers for hepatitis B virus. Laboratory personnel had the highest prevalence rate, 15% (25 of 164), whereas obstetric personnel had the lowest, 0% (0 of 52). Prevalence increased with age (chi 2 for linear trend, p = 0.000005), years of blood handling (p = 0.00003), work in a laboratory setting (p = 0.02), increasing numbers of puncture wounds from needles of patients with hepatitis B virus infection (p = 0.02), previous history of jaundice (p = 0.0003), and history of hepatitis (p = 0.000002).

Stopcock Contamination in an ICU

Because Propionibacterium acnes and Staphylococcus epidermidis are the predominant organisms found on human skin, it seemed probable that st phylococci, at least, would be found in the open stopcocks (1). Other organisms normally present on the skin are Staphylococcus aureus, nonhemolytic streptococci, enterococci (Streptococcus faecalis), and Candida. Gram-negative coliforms and mimeae may be found. Some of the normal flora of the

Postoperative wound infection surveillance by use of bacterial contamination categories

A prospective 2-year surveillance of 7129 wounds was conducted on all surgical services of the University Hospital in Seattle to determine the postoperative infection rates by surgical wound category. Rates on all services for clean (0.8%), clean-contaminated (3.4%), contaminated (3.6%), and dirty (9.9%) wounds were recorded and compared to rates reported in the surgical literature. The overall wound infection rate was 1.7%. When the incidence of infection for a specific service in a category was observed to be in excess of a previously reported upper rate, patient charts were critically reviewed to determine if host, pathogen, or technical factors could be implicated in the excessive infection rates. Extending postoperative wound surveillance to include critical chart analysis in these categories provides hospital staff members responsible for infection control the opportunity to organize corrective measures against excessive rates in a broader category of wounds.

Guidelines for Prevention Of Hospital Acquired Infections

Hospital acquired, or nosocomial, infections affect nearly two million patients each year in the United States. Aside from the more than

Instability of Antibiotic Resistance in a Strain of Staphylococcus epidermidis Isolated from an Outbreak of Prosthetic Valve Endocarditis

1 billion dollars a year this figure reflects, nearly 3 percent of these patients die as a direct result of hospital acquired infection(l). The factors that interact to produce infection are complex, and there are no simple solutions to prevention or cure. It has been estimated, however, that, with certain precautions, nearly half of the nosocomial infections could be prevented(2). There are certain factors that predispose individual patients to infection over which we, as clinicians, have little or no control. These include the patients age, the degree to which the patient is compromised by disease processes, the type and number of invasive procedures administered, the therapy received, and the length of hospitalization(3). Even healthy patients, however, are targets for nosocomial infection from exposure to hospital pathogens or from therapeutic or diagnostic invasive procedures. In general, most infection control measures are directed at: * Minimizing numbers and kinds of organisms transmitted to potential sites of infection in susceptible hosts. * Avoiding transmission of any organisms by sterilization or disinfection of supplies and equipment. * Boosting host defenses whenever possible. The major sites affected by nosocomial infections are the urinary tract, surgical wounds, the res-