Julia S. Garner

Guideline for isolation precautions in hospitals

Senala los lineamientos para las precauciones de aislamientos en los hospitales. Describe los razonamientos y responsabilidades para las precauciones del aislamiento, las tecnicas, recomendaciones y modificaciones. Dichas precauciones estan disenadas para prevenir la difusion de microorganismos entre pacientes, personal y visitantes

Recommendations for preventing the spread of vancomycin resistance: Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)

A rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) has been reported from U.S. hospitals in the last 5 years. This increase poses several problems, including a) the lack of available antimicrobials for therapy of infections due to VRE, since most VRE are also resistant to multiple other drugs, e.g., aminoglycosides and ampicillin, previously used for the treatment of infections due to these organisms, and b) the possibility that the vancomycin resistance genes present in VRE may be transferred to other gram-positive microorganisms such as Staphylococcus aureus. An increased risk of VRE infection and colonization has been associated with previous vancomycin and/or multi-antimicrobial therapy, severe underlying disease or immunosuppression, and intra-abdominal surgery. Because enterococci can be found in the normal gastrointestinal or female genital tract, most enterococcal infections have been attributed to endogenous sources within the individual patient. However, recent reports of outbreaks and endemic infections due to enterococci, including VRE, have shown that patient-to-patient transmission of the microorganisms can occur either via direct contact or indirectly via hands of personnel or contaminated patient-care equipment or environmental surfaces.(ABSTRACT TRUNCATED AT 250 WORDS)

Contamination of Intravenous Infusion Fluid: Effects of Changing Administration Sets

Daily change of intravenous (i.v.) infusion administration sets has been recommended by the Center for Disease Control since 1973 to reduce the risk of infusion bacteremia. To evaluate this recommendation, we undertook a prospective, randomized, controlled trial that compared the rates of i.v.-associated bacteremia, in-use i.v. fluid contamination, and phlebitis in 300 patients whose administration sets were changed every 24 h with those in 300 patients whose administration sets were changed every 48 h. No i.v.-associated bacteremia occurred. Twelve of 600 infusions (2%) had positive infusion-fluid cultures: five in one group and seven in the other. Both groups had comparable rates of phlebitis. In this study population with low rates of fluid contamination, no benefit accrued from changing the administration sets every 24 h instead of every 48 h. In hospitals with low rates of fluid contamination, the routine changing of i.v. administration sets every 48 h will result in substantial financial savings.

Nosocomial surgical infections: incidence and cost

The data reported in this article support the findings of Dr. Altemeier; that is, infections among surgical patients remain a serious problem today. Urinary tract infections account for approximately 40 per cent of nosocomial infections among surgical patients. Surgical wound and skin infections account for one third of the nosocomial infections among surgical patients. Rates for wound infections rise with age, with increased length of hospitalization before surgery, and with increased duration of surgery. They are higher for patients who have an infection at a distant site and for those who have the more hazardous surgical procedures as determined by risk categories. Gram-negative organisms are more prevalent than gram-positive organisms. A nosocomial surgical wound infection lengthens the hospitalization by an average of 7.4 days and raises the cost of hospitalization by more than 800 dollars. Further analysis of the data is necessary in order to identify the risk factors likely to be most helpful in determining which patients are at increased risk of acquiring a nosocomial infection. Only when these factors are identified can the most direct and effective contact and preventive measures be implemented.

Options for Isolation Precautions

Excerpt The Centers for Disease Control (CDC) has been involved in the development of isolation precautions for hospitalized patients for more than 20 years. During outbreak investigations conducte...

A new approach to the isolation of hospitalized patients with infectious diseases: Alternative systems

A new guideline developed by the Centers for Disease Control suggests that hospitals adopt one of two alternative isolation systems: the category system or the disease-specific system. The older category system has been modified to reflect current knowledge; for example, the category of protective isolation has been deleted, new categories for contact precautions and tuberculosis precautions have been added, the specific precautions indicated in the other categories have been substantially modified, and many infections have been assigned to new categories. The disease-specific system, a newly developed approach, lists the specific isolation precautions indicated for each infectious disease. Whereas the revised category system offers greater simplicity in practice, the disease-specific system minimizes unnecessary precautions. Both systems allow patient-care personnel more decision-making authority in determining which precautions to apply.

Epidemic infections in surgical patients

From 1967 to 1977, the Centers for Disease Control investigated 22 epidemics of nosocomial infections among surgical patients. Fifteen of the outbreaks involved operative site infections and were caused by various microorganisms: gram-positive bacteria (47%), gram-negative bacteria (13%), atypical mycobacteria (13%), Aspergillus (7%), and multiple microorganisms (20%). Sources for infecting strains were infected personnel or patients (53%), the operating room environment (20%), and four unknown factors (27%). Control measures included treatment of personnel who were carriers and infected patients, adherence to aseptic techniques, improvements in OR airflow and cleaning procedures, and discontinuation of elective surgery during OR construction. The other seven epidemics were associated with perioperative care and caused by gram-negative bacteria. There were six epidemics of primary bacteremia, four of them associated with arterial pressure transducers. Another bacteremia epidemic was caused by the infusion of contaminated commercially prepared normal serum albumin. The remaining primary bacteremia epidemic was caused by using syringes contaminated by ice to obtain blood samples for blood gas determinations. One epidemic of Salmonella gastroenteritis and secondary bacteremia was traced to a contaminated intermittent-suction machine used for postoperative care. Control measures for these epidemics included judicious use and proper decontamination and sterilization of the transducers, recall of the contaminated product, aseptic procedures for caring for arterial cannulae, and proper decontamination of suction equipment. Suggestions for the evaluation and control of potential epidemics are based on the results of these investigations.

Comparison of surveillance and control activities of infection control nurses and infection control laboratories in United States hospitals, 1976–1977

To study the impact of the professional background of infection control personnel, we compared the characteristics and activities of 107 infection control nurses (ICNs) with those of 13 infection control laboratorians (ICLs), all in hospitals with 300 beds or more. Although the two groups performed similarly in many respects. ICNs spent more time teaching, whereas ICLs spent more time and appeared more proficient in investigating outbreaks. Staff nurses at hospitals with ICNs found the infection control person more visible on the wards and more available for discussing infection control matters. ICNs appeared less hesitant to speak up to personnel not following correct handwashing techniques. ICNs and ICLs appear to offer different skills that should be considered when filling different infection control positions.

AIDS: Epidemiological lessons from the health-care setting

The purpose of this presentation is to provide a brief overview of the epidemiology of acquired immunodeficiency syndrome (AIDS) in the United States, comment on portions of the contents of three reports on the AIDS epidemic issued during the past year and a half in the United States, provide an overview of the results of several prospective studies to assess the magnitude of risk to health-care workers of acquiring infection with human immunodeficiency virus (HIV) in the health-care setting, and summarize current Centers for Disease Control (CDC) recommendations for the prevention and control of HIV transmission in the health-care setting.