Julie T. Jacobson

Serious pseudomonas infections associated with endoscopic retrograde cholangiopancreatography

After observing a single case of Pseudomonas aeruginosa bacteremia following endoscopic retrograde cholangiopancreatography (ERCP), six other P. aeruginosa infections that were temporally related to ERCP were retrospectively found over one year (August 1985 through July 1986) at LDS Hospital. In all seven patients, infection developed within five days after an ERCP. Five patients had bacteremia and two had cholangitis. All five of the Pseudomonas isolates available for testing were serotype 010. Cultures from the ERCP endoscope and several other endoscopes also yielded P. aeruginosa serotype 10, as did environmental cultures from equipment used to clean endoscopes. Among 167 ERCPs performed during the outbreak period, no other patient acquired P. aeruginosa infection. Each of the patients in the outbreak received the first scheduled ERCP of the day. The mean duration between the cleaning of the ERCP endoscope and its subsequent use was significantly longer in cases than in matched controls, a factor that may have permitted contaminating organisms to achieve high inocula in the inadequately cleaned endoscope. Epidemic control measures included improved disinfection of endoscopes, ongoing surveillance, and appropriate antimicrobial prophylaxis. This experience suggests that exogenous infection with Pseudomonas is associated with ERCP, that protracted and insidious outbreaks may occur, and that the occurrence of even a single case of Pseudomonas infection after ERCP should stimulate an epidemiologic investigation.

Adapting disease-specific isolation guidelines to a hospital information system.

The authors modified the Centers for Disease Controls guideline for disease-specific isolation precautions to a hospital computerized information system. Entering a suspected diagnosis selected from the isolation option on computer terminals generated: a printout listing the isolation instructions, infective material(s), and persons who should avoid exposure; an order for the appropriate supplies; a patient charge based on the supplies required; and an option for stopping, changing, or listing the orders. In order to implement this system, both extensive in-service training for nurses and efforts to change ordering practices of physicians were necessary. Prevalence surveys before and after computerization were used to evaluate the new system. Combined surveys showed that isolation was ordered for only 21% of patients when indicated. Failure to isolate was identified as a significant problem. As a consequence, continuous surveillance and consultation of all infected patients were instituted, resulting in isolation orders for 81% when indicated. The computerized disease-specific system has resulted in better and more accurate use of isolation, probably due to in-service education and surveillance efforts.

Ordering patterns, collection, transport, and screening of sputum cultures in a community hospital: evaluation of methods to improve results.

The clinical usefulness of sputum cultures depends on the quality of specimens submitted to the laboratory. In a community hospital, during two separate surveillance periods, we evaluated ordering practices and circumstances under which sputum specimens were obtained and techniques to improve the quality of the specimens. Physicians themselves rarely participated in obtaining specimens of sputum, and members of the nursing staff directly instructed patients or supervised specimen collection in only one third of cases. The mean elapsed time from collection at the bedside to processing in the laboratory was two hours, with a range from several minutes to 13 hours. One fifth of all the specimens in this study were obtained from patients with no discernible evidence of lower respiratory tract infection. Microscopic screening revealed that one half of the specimens were of poor or uncertain quality. After the first survey, inservice education of nursing personnel in the proper techniques of sputum collection, along with regular use of the screening procedure in the clinical laboratory, failed to effect any long-term change in ordering patterns or collection practices. However, the screening procedure did improve the quality of the sputum cultured, through rejection of unsatisfactory specimens.

Injection-site absccess caused by group A beta-hemolytic streptococcus An unusual complication of tonsillectomy and intramuscular injection

The epidemiologic investigation of any IM injection site infection can be quite complex. In this particular case, one potential source of the organism was established (the patient herself), another source was shown to be less likely (the nurses administering the medications), and a third possible source (the single-dose unit medications) could not be eliminated.

A guide to the certification board of infection control's recertification program

The Certification Board of Infection Control (CBIC) is structured to comply with standards set by the National Commission for Health Certifying Agencies (NCHCA). NCHCA is a special section of the National Organization for Competency Assurance (NOCA). The CBIC is a charter member of NOCA. The written report from NCHCA’s Task Force on Continued Competency’ states that certifying agencies have a. responsibility for recertification. This task force studied the relationship between renewing credentials and continuing education. They stated that although continuing education is firmly linked to continuing competence, it is not by itself a mechanism for assuring continuing competence. Continuing education requirements must be carefully conceived and rigorously analyzed, and continuing education alone may not suficient2y protect the public’s need for continued competence. The task force made certain assumptions to arrive at their recommendations. They assumed that recertification is designed to provide assurance that the skills and knowledge of practitioners are general (even though the certified person may ‘become highly specialized) and that that knowledge is up to date. They

Revisions and commonly asked questions regarding the infection control certification examination

The Certification Board of Infection Control (CBIC) was established by the Association for Practitioners in Infection Control (APIC) in 198 1 to provide its membership with a certification process that would measure knowledge necessary for the practice of infection control.* The first certification examination was given in 1983 to more than 900 infection control practitioners (ICPs). Since that time approximately 250 persons have become certified each year, which means a current total of about 25% of the APIC membership. The CBIC is structured to comply with standards set by the National Commission for Health Certifying Agencies (NCHCA)? This agency, NCHCA, is, as of September 1987, a special section of the National Organization for Competency Assurance (NOCA). The CBIC is a member of NOCA. The NCHCA standards stip-