Linda McDonald

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.

Urinary Catheters: What Type Do Men and Their Nurses Prefer?

OBJECTIVES: Urinary catheters are used frequently, but the relative risks and benefits of different types of devices are not clear. We sought to determine the beliefs of both older male patients and nursing staff about the relative merits and problems of condom and indwelling catheters.

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.

Improving the appropriateness of vancomycin use by sequential interventions

BACKGROUND Vancomycin usage is directly associated with the incidence of vancomycin-resistant enterococci. Optimal methods to reduce inappropriate use have not been delineated. We determined the appropriateness of vancomycin prescribing at our hospital on the basis of national guidelines and assessed the effect of sequential administrative and educational interventions. METHODS In this prospective 3-phase study conducted in a Veterans Affairs Medical Center, we monitored vancomycin prescribing at baseline and in 2 follow-up periods. Administrative interventions included discussions with service chiefs and revising routine perioperative antibiotic prophylaxis orders. Educational interventions included in-services about vancomycin-resistant enterococci and appropriate vancomycin prescribing. In each monitoring period, 50 consecutive new vancomycin orders that could be evaluated were classified for appropriateness and categorized by indication. RESULTS At baseline, 70% of vancomycin use was inappropriate. Surgical services accounted for 84% of orders. Interventions targeted services with high or frequently inappropriate vancomycin use. After administrative interventions, inappropriate vancomycin use dropped to 40% of orders (P =.003). Improvements were noted in targeted services. Educational interventions further decreased inappropriate vancomycin use, but the effect appeared transient. CONCLUSIONS The simple, nonrestrictive administrative interventions used resulted in a statistically significant (30%) reduction in inappropriate vancomycin prescribing. However, educational interventions provided only transient benefit on institutional prescribing patterns.

APIC/CHICA-Canada infection control and epidemiology: Professional and practice standards

Elizabeth Horan-Murphy, BS, MT(ASCP), RN, MSN, CIC (Chair) Bonnie Barnard, MPH, CIC (APIC) Carol Chenoweth, MD (APIC) Candace Friedman, BS, MT(ASCP), MPH, CIC (APIC) Barbara Hazuka, RN, MSN (APIC) Barbara Russell, RN, MPH, ACRN, CIC (APIC) Margie Foster (CHICA-Canada) Carol Goldman (CHICA-Canada) Paula Bullock, MEd, MT(ASCP), CIC (CBIC Liaison) Lisa Docken, RN, BSN, CIC (CBIC Liaison) Linda McDonald, RN, MSPH, CIC (CBIC Liaison) APIC/CHICA-Canada Professional and Practice Standards Task Force

Controlling the spread of vancomycin-resistant enterococci with contact precautions: Time for a randomized trial

Isolations of vancomycin-resistant enterococci (VRE) have increased dramatically over the past decade in. hospitals around the United States.’ In hopes of curbing the nosocomial spread of VRE, the Centers for Disease Control and Prevention Hospital Infection Control Practices Advisory Committee recommended that contact precautions (CP) be implemented in the care of all hospitalized VREpositive patients.‘Requirements for CP in the care of VRE-positive patients contrast with those for body substance isolation (BSI),3 an alternate system of precautions used in patient care (Table 1). Body substance isolation is similar to universal precautions but assumes that all body fluids may contain potential pathogens.3z4 Body sub stance isolation is applied to all patients at all times, using appropriate barriers when contact between health care workers and moist body substances is anticipated. Body substance isolation precautions are not supplemented with other measures for the care of VRE-positive patients.‘,* Since CP for VRE-positive patients generally require more effort and expense than BSI precautions, it would be useful to establish their respective utilities in limiting nosocomial transmission of VRE. Accordingly, the authors retrospectively compared the experience at two similar medical centers that differ in their approach to VRE control. Both centers are part of the Veterans’ Affairs system and are located in the Pacific Northwest. They have similar patient populations, strong academic affiliations, on-site microbiology laboratories, and inpatient and outpatient facilities that include intensive care units and nursing home units. Moreover, both centers