Jo-Ann Harris

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.

HIV postexposure prophylaxis for children and adolescents.

HIV postexposure prophylaxis (PEP) is now a well-established part of the management of health care workers after occupational exposures to HIV. Use of PEP for adults exposed to HIV after sexual contact or injection drug use in nonoccupational settings remains controversial with limited data available. There is even less information available concerning HIV PEP for children and adolescents after accidental needlestick injuries or sexual assault. The objective was to describe the current practice of and associated problems with HIV PEP for children and adolescents at an urban academic pediatric emergency department. A retrospective review of all children and adolescents offered HIV PEP between June 1997-June 1998 was conducted. Ten pediatric and adolescent patients were offered HIV PEP, six patients after sexual assault, four patients after needle stick injuries. There were two small children 2 and 3 years of age and eight adolescents. Of these 10 patients, eight were started on HIV PEP. The regimens used for PEP varied; zidovudine, lamivudine, and indinavir were prescribed for in seven patients and zidovudine, lamivudine, and nelfinavir for one other. All 10 patients were HIV negative by serology at baseline testing and all available for follow-up testing (5 of 10) remained HIV negative at 4 to 28 weeks. Only two patients completed the full course of 4 weeks of antiretroviral therapy. Financial concerns, side effects, additional psychiatric and substance abuse issues as well as the degree of parental involvement influenced whether PEP and clinical follow-up was completed. HIV PEP in the nonoccupational setting for children and adolescents presents a medical and management challenge, and requires a coordinated effort at the initial presentation to the health care system and at follow-up. The difficulties encountered in the patients in our series need to be considered before initiating prophylaxis. A provisional management approach to HIV PEP in children and adolescents is proposed.

Pediatric Nosocomial Infections: Children Are Not Little Adults

This issue of Infection Control and Hospital Epidemiology contains articles that highlight pediatric nosocomial infections. Current strategies for surveillance, prevention, and control of nosocomial infections have focused on general hospital services that primarily address the needs of adult patient populations. Although some of these strategies apply to infants and children, it is clear that pediatric patients and pediatric units are unique and require childspecific prevention and control plans. The following areas are critical for development of appropriate intervention strategies and will be the focus of this discussion: (1) surveillance methods appropriate to identify and analyze nosocomial infection rates in pediatric facilities; (2) guideline development based on reservoirs of infection, host-pathogen interactions, and modes of transmission in the pediatric patient population; (3) prevalence of resistant organisms and the use of antimicrobials in pediatric acuteand non—acute-care settings. The concept that pediatric nosocomial infections differ from those in adults has been well established. In the early 1980s, the National Nosocomial Infection Surveillance (NNIS) Systems reported that pediatric services had lower rates of infection than other hospital services; however, Ford-Jones and others in the late 1980s found a substantially higher nosocomial infection rate in children (6-7 infections/100 patients) than adults (4/100 patients) when viral infections and sites such as gastrointestinal and upper respiratory infections were included.2 Although children have fewer wound infections, nosocomial pneumonias (ventilator-associated), and urinary tract infections than adults, they have more viral respiratory and viral gastrointestinal infections, bacteremias, and cutaneous infections.3 Multiple factors contribute to the differences in nosocomial infections of infants and young children and nosocomial infections of adults, including host factors, sources of infection, routes of transmission, and distribution of pathogens.4 Host factors of particular importance that put young children at risk for nosocomial infection are immaturity of the immune system (especially in newborns and premature infants) and congenital anomalies. Premature infants are at high risk, as they have the most immature immune systems and require prolonged hospitalizations and invasive procedures. The rates of nosocomial infections in neonatal intensive-care units (NICUs) have been reported to be as high as 7% to 25%.2,5 Children with congenital anomalies have a high risk of infection, not only from immune deficiencies related to specific syndromes (eg, Wiskott-Aldrich) but also because of loss of protective host factors such as anatomic barriers to infection (eg, cleft palate and meningomyelocele). These children require multiple hospitalizations, increased numbers of devices, multiple surgeries, and prolonged lengths of stay.6 In addition to sources of nosocomial infections common to all patients (invasive monitors, medical devices, other patients, and hospital personnel), the infant and young child are exposed to specific sources of infection including maternal infections; contaminated breast milk and infant formula; visitors to the hospital, including siblings; and contaminated fomites, such as toys shared with other patients on the units.

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.

Infection control in pediatric extended care facilities.

Pediatric extended care facilities provide for the biopsychosocial needs of patients younger than 21 years of age who have sustained self-care deficits. These facilities include long-term and residential care facilities, chronic disease and specialty hospitals, and residential schools. Infection control policies and procedures developed for adult long-term care facilities, primarily nursing homes for elderly people, are not applicable to long-term care facilities that serve pediatric patients. This article reviews the characteristics of pediatric extended care facilities and their residents, and the epidemic and endemic nosocomial infections, infection control programs, and antimicrobial resistance profiles found in pediatric extended care facilities.

NOSOCOMIAL INFECTIONS (NI) IN A NEONATAL INTENSIVE CARE UNIT (NICU) AND CONTROL OF A METHICILLIN RESISTANT (MR) S. AUREUS (SA) OUTBREAK

The evaluation and control of endemic and epidemic NI in a NICU is critical to decrease associated morbidity and mortality and to maintain full functional capacity of such a unit. NI in our NICU were studied from Jan 1981-Dec 1982 after moving into a new hospital. The rate increased from 7.9% (NI/pts at risk) in 1980 to 11% in 1981 and 18% in 1982. Of 561 infants hospitalized over 48 hrs, there were 107 (19%) NI in 66 pts. Major sites of infection were: 21% blood, 7.5% resp, 6% wound, 3% CNS and 1% other. 59% were surface infections. Infection rates were inversely proportional to birth wt, 54% occurring in pts < 1500 gms. Deaths occurred in 7.7% of infected and 9% uninfected pts. 77% of the NI were due to gm + organisms which was unusual, and only 9% were gm -. During the 2 yr period, of the 116 pathogens isolated, 54% were SA. This was accompanied by a high prevalence of SA colonization (32-38%). An outbreak of MRSA began in Jan 1982. Over the next 14 months there were 43 SA infections, 47% were MR. By Nov 1982, 47% of infants surveyed were colonized with SA, 80% of which were MR. What we found was that the additional infection control measures instituted in Feb 1982 (cohorting of infants and personnel and triple dye on the umbilicus) did not alter the outbreak. Two infants were identified as major sources of MRSA. The epidemic terminated abruptly, only following removal of the 2 infants. This control measure rapidly eliminated disease and markedly reduced colonization.

HIV Post-Exposure Prophylaxis (PEP) in Children and Adolescents: Experience at an Urban Teaching Hospital

HIV Post-Exposure Prophylaxis (PEP) in Children and Adolescents: Experience at an Urban Teaching Hospital