Patricia Lynch

Rethinking the Role of Isolation Practices in the Prevention of Nosocomial Infections

To prevent nosocomial infections, hospitals use two types of procedures: routine patient care practices (handwashing, for example), which are used in appropriate circumstances on all patients, and more intensive isolation precautions, which are implemented only when patients are suspected of having particular infections. Aspects of these current practices, however, may limit their effectiveness. We propose the use of body substance isolation, a simpler alternative system that is used for all patients, not just in response to a specific diagnosis, and that emphasizes the increased use of barrier precautions, especially gloving, when contact with potentially infectious bodily secretions is anticipated. Because of its rationale and simplicity, body substance isolation has been enthusiastically accepted at our hospitals, and we encourage others to consider and evaluate this approach.

A national task analysis of infection control practitioners, 1992 Part One: Methodology and demography

A task analysis survey was conducted in 1982 by the Certification Board of Infection Control ( CBIC ) to determine the tasks performed by ICPs and the knowledge and abilities needed to perform these tasks. Data were obtained from 473 (78.8%) respondents to a nationwide mail survey of 600 ICPs . The respondents represent a randomized, stratified sample of ICPs in various types of U.S. acute care hospitals ranging in size from fewer than 50 beds to more than 500 beds. The results of the survey were used, in part, to develop the Infection Control Certification Examination, offered for the first time on November 19, 1983. According to the survey results, the modal or typical ICP is a white woman between the ages of 31 and 50 years using the title of infection control nurse. She has been employed full time for 2 to 10 years in infection control practice in a Joint Commission on Accreditation of Hospitals (JCAH)--accredited community acute care hospital having 301 to 500 beds. She is working at the supervisory level, is on the nursing department payroll, votes as a member of the hospitals infection control committee, and received her last degree or diploma more than 15 years ago.

Blood contacts in the operating room after hospital-specific data analysis and action☆☆☆

BACKGROUND There has been much work recently to quantify risk of blood exposures among operating room personnel. Little has been done to show the outcome of preventive strategies. Three hospitals implemented a variety of changes after detailed feedback on blood contact data. This report follows those hospitals to document changes in blood contact rates. METHODS Each hospital reviewed detailed data on blood exposures and developed a range of strategies to reduce contacts. In a second data collection period, uniformly trained circulating nurses sought information during surgical procedures on blood contacts among staff. Data were collected on all blood contacts and surgeries during which they occurred. These data were then compared with data from the previous study period, before changes in practices. RESULTS All blood contacts combined and in each hospital decreased significantly in the second data collection period. Percutaneous exposures also consistently decreased, but did not reach statistical significance. The distribution of types of contact changed, with percutaneous exposures representing a larger proportion of contacts seen in the second period. Similar anatomic locations, devices, and characteristics of surgeries were associated with blood contacts in both periods. DISCUSSION Specific data provided to operating room personnel motivated the development of specific strategies, although the influence of feedback alone versus specific interventions can not be separated. Analysis and generation of hospital-specific data on blood exposures among operating personnel may have a positive influence in lowering the risk of blood exposures in this population group.

A national task analysis of infection control practitioners, 1982 Part three: The relationship between hospital size and tasks performed

One aspect of the Certification Board of Infection Controls (CBIC) task analysis survey was to determine those tasks done most frequently and considered most important by ICPs. A randomized stratified sample of ICPs was taken from U.S. hospitals of various bed-size categories. There were 473 responses (78.8%) from a targeted sample of 600 ICPs. Statistical analyses were done to find if a relationship existed between hospital size and the tasks performed. The frequency of performance and importance of the majority of infection control tasks studied were found to vary in relation to hospital size. Some tasks were found to be both important and frequently performed by the majority of ICPs in all hospital bed-size categories. These included performing and reporting epidemiologic surveillance, educating personnel, developing infection control policies and procedures, and consulting with hospital personnel. Other tasks were found to be relatively less important and infrequently performed by the majority of ICPs in all hospital bed-size categories. These included performing bedside patient care procedures, recommending specific antimicrobial therapy, and using statistical methods. The greatest differences in the performance of tasks were found in the subsample of the ICPs from hospitals with less than or equal to 100 beds.

AN ALTERNATIVE TO ISOLATING PATIENTS

Summary Traditional isolation practices that focus only on diagnosed cases of infectious diseases provide an incomplete strategy for infection prevention and control. They can cause detrimental psychosocial effects in patients and their families and interfere with the family-like milieu that nursing homes strive to establish. The BSI system is a practical approach that fits well with the nursing home environment. In addition to BSI, we recommend consideration of institutional programs for influenza and pneumococcal vaccines to reduce risk of these infections. There must be an increased awareness that certain clinical symptoms in patients and/or personnel need to be investigated before an outbreak develops. We believe use of the BSI system provides an opportunity for nursing homes to develop strategies that are cost-effective and appropriate to the needs of the residents and that such a system will increase the standard of care for all patients, while maintaing the homelike environment so important to the nursing home setting.

Continuing education series in the American Journal of infection control

This issue of The American Journal of Infection ControZ marks the beginning of a new series of continuing education articles. The series is offered for readers who wish to use journal review and self-study as a means to supplement their continuing education efforts. Hospital infection control and hospital epidemiology are fields undergoing rapid expansion. It is essential for professionals in these fields to maintain current information, but the means by which this objective is achieved is influenced by the economic milieu. With the advent of prospective payment, diagnosis-related groups (DRGs), and continued cost-containment efforts in hospitals and other health care facilities, funds for attending educational conferences may not be available. Recognizing this dilemma, the editorial staff of The American Journal of Znjktion Control offers this educational series 1:o provide an accessible and inexpensive educational alternative. Most of the articles will review topics of interest to ICPs and hospital epidemiologists. The articles will range in content from updates on established practices to new studies or concepts in the epidemiology of infectious diseases. The model being used is not new. It has been used successfully for many years by journals such as Heart and Lung and Postgraduate Medicine. Each article in the series will be peer reviewed in accordance with Journal philosophy for content, accuracy, and style. Psychometric evaluation of the article and test development will be performed by the firm of Health Education International. Learning objectives and multiple-choice questions will accompany each article. A minimum of four American Journal of Znfection Control issues each year will include a continuing education article. The Journal editors hope this series will benefit professionals from the disciplines represented in hospital epidemiology and infection control.