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Watson E, Rajkhowa A, Dunt D, Bull A, Worth LJ, Bennett N. Evaluation of an Infection surveillance program in residential aged care facilities in Victoria, Australia. BMC Public Health 2024; 24:254. [PMID: 38254078 PMCID: PMC10801934 DOI: 10.1186/s12889-023-17482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Infection surveillance is a key element of infection prevention and control activities in the aged care sector. In 2017, a standardised infection surveillance program was established for public residential aged care services in Victoria, Australia. This program will soon be expanded to a national level for all Australian residential aged care facilities. It has not been evaluated since its inception. METHODS The current study aimed to evaluate the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Aged Care Infection Indicator Program (ACIIP), to understand its performance and functionality. A mixed methods evaluation was performed using the Updated Guidelines for Evaluating Public Health Surveillance Systems developed by the United States Centers for Disease Control and Prevention as a framework. VICNISS staff who coordinate and manage the ACIIP were invited to participate in interviews. Residential aged care staff who use the program were invited to participate in a survey. Document analysis was also performed. RESULTS Four VICNISS staff participated in the interviews and 38 aged care staff participated in the survey. The ACIIP is stable and able to be adapted quickly to changing definitions for infections. Users found the system relatively easy to use but have difficulties after the long intervals between data entry year on year. VICNISS staff provide expert guidance which benefits users. Users appreciated the benefit of participating and many use the data for improving local practice. CONCLUSIONS The ACIIP is a usessful state-wide infection surveillance program for aged care. Further development of data validation, IT system capacity and models for education and user support will be required to support future scalability.
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Affiliation(s)
- Eliza Watson
- Doherty Institute for Infection and Immunity, Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, 792 Elizabeth St, Melbourne, VIC, 3000, Australia
| | - Arjun Rajkhowa
- Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, The University of Melbourne, Melbourne, VIC, 3000, Australia
| | - David Dunt
- The University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Ann Bull
- Doherty Institute for Infection and Immunity, Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, 792 Elizabeth St, Melbourne, VIC, 3000, Australia
| | - Leon J Worth
- Doherty Institute for Infection and Immunity, Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, 792 Elizabeth St, Melbourne, VIC, 3000, Australia
- Department of Oncology, Department of Infectious Diseases, University of Melbourne Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, 3065, Australia
| | - Noleen Bennett
- Doherty Institute for Infection and Immunity, Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, 792 Elizabeth St, Melbourne, VIC, 3000, Australia.
- Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, The University of Melbourne, Melbourne, VIC, 3000, Australia.
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, 3065, Australia.
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Watson E, Dowson L, Dunt D, Thursky K, Worth LJ, Sluggett JK, Appathurai A, Bennett N. Identifying barriers and enablers to participation in infection surveillance in Australian residential aged care facilities. BMC Public Health 2023; 23:2160. [PMID: 37924023 PMCID: PMC10625226 DOI: 10.1186/s12889-023-16891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Infection surveillance is a vital part of infection prevention and control activities for the aged care sector. In Australia there are two currently available infection and antimicrobial use surveillance programs for residential aged care facilities. These programs are not mandated nor available to all facilities. Development of a new surveillance program will provide standardised surveillance for all facilities in Australia. METHODS This study aimed to assess barriers and enablers to participation in the two existing infection and antimicrobial use surveillance programs, to improve development and implementation of a new program. A mixed-methods study was performed. Aged Care staff involved in infection surveillance were invited to participate in focus groups and complete an online survey comprising 17 items. Interviews were transcribed and analysed using the COM-B framework. RESULTS Twenty-nine staff took part in the focus groups and two hundred took part in the survey. Barriers to participating in aged care infection surveillance programs were the time needed to collect and enter data, competing priority tasks, limited understanding of surveillance from some staff, difficulty engaging clinicians, and staff fatigue after the COVID-19 pandemic. Factors that enabled participation were previous experience with surveillance, and sharing responsibilities, educational materials and using data for benchmarking and to improve practice. CONCLUSION Streamlined and simple data entry methods will reduce the burden of surveillance on staff. Education materials will be vital for the implementation of a new surveillance program. These materials must be tailored to different aged care workers, specific to the aged care context and provide guidance on how to use surveillance results to improve practice.
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Affiliation(s)
- Eliza Watson
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, 3000, Australia
| | - Leslie Dowson
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - David Dunt
- Professor Emeritus, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, 3010, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010 , Australia
- The Royal Melbourne Hospital Guidance Group, Melbourne, VIC, 3000, Australia
| | - Leon J Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010 , Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, SA, 5001, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia
| | - Amanda Appathurai
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Noleen Bennett
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, 3000, Australia.
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, 3010, Australia.
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia.
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Extended spectrum and metalo beta-lactamase producing airborne Pseudomonas aeruginosa and Acinetobacter baumanii in restricted settings of a referral hospital: a neglected condition. Antimicrob Resist Infect Control 2017; 6:106. [PMID: 29075483 PMCID: PMC5654089 DOI: 10.1186/s13756-017-0266-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frequently encountered multidrug-resistant bacterial isolates of P. aeruginosa and A. baumannii are common and prevalent in a hospital environment. The aim of this study was to determine the prevalence and pattern of antibiotic resistance, extended spectrum and metallo beta-lactamase producing P. aeruginosa and A. baumannii isolates from restricted settings of indoor air hospital environment. METHODS A hospital-based cross-sectional study was conducted in Wolaita Sodo University Teaching and referral Hospital, Ethiopia from December 1/2015 to April 30/2015. The Air samples were collected from delivery room, intensive care unit and operation theatre of the hospital by active, Anderson six slate sampler technique during the first week of the months, twice a week during Monday's and Friday's. Standard microbiological procedures were followed to isolate P. aeruginosa and A. baumannii. Susceptibility testing was performed on isolates using the Kirby-Bauer disk diffusion technique. Extended spectrum beta lactamase production was detected by double disc synergy test and Imipenem-resistant isolates were screened for producing Metallo-beta lactamase. RESULTS A total number of 216 indoor air samples were collected from the delivery room, intensive care unit, and operation room. Correspondingly, 43 A. baumannii isolates were identified (13 from delivery room, 21 from intensive care unit and 9 from operation room). Likewise 24 P. aeruginosa isolates were obtained (4 from delivery room, 13 from intensive care unit and 7 from operation room). Extended spectrum beta lactamase and metalo-beta lactamase production were observed in 24 (55.8%) and 13 (30.2%) isolates of A. baumannii respectively, whereas P. aeruginosa showed 15 (62.5%) extended spectrum beta lactamase and 9 (37.5%) metallo-beta lactamase production. CONCLUSIONS Extended spectrum beta lactamase and metallo-beta lactamase producing bacteria in hospital air is a new dimension for specific setting of the study area where antimicrobial resistance is increasing and surgical site infection is prevalent. So, identification of these microorganisms has a great role in reducing the burden of antibiotic resistance and could also provide a significant input for framing hospital infection control policies.
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Solomon FB, Wadilo FW, Arota AA, Abraham YL. Antibiotic resistant airborne bacteria and their multidrug resistance pattern at University teaching referral Hospital in South Ethiopia. Ann Clin Microbiol Antimicrob 2017; 16:29. [PMID: 28403894 PMCID: PMC5389437 DOI: 10.1186/s12941-017-0204-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/05/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospitals provide a reservoir of microorganisms, many of which are multi-resistant to antibiotics. Emergence of multi-drug resistant strains in a hospital environment, particularly in developing countries is an increasing problem to infection treatment. This study aims at assessing antibiotic resistant airborne bacterial isolates. METHODS A cross-sectional study was conducted at Wolaita Sodo university teaching and referral Hospital. Indoor air samples were collected by using passive air sampling method. Sample processing and antimicrobial susceptibility testing were done following standard bacteriological techniques. The data was analyzed using SPSS version 20. RESULTS Medically important bacterial pathogens, Coagulase negative staphylococci (29.6%), Staphylococcus aureus (26.3%), Enterococci species, Enterococcus faecalis and Enterococcus faecium (16.5%), Acinetobacter species (9.5%), Escherichia coli (5.8%) and Pseudomonas aeruginosa (5.3%) were isolated. Antibiotic resistance rate ranging from 7.5 to 87.5% was detected for all isolates. Acinetobacter species showed a high rate of resistance for trimethoprim-sulfamethoxazole, gentamicin (78.2%) and ciprofloxacin (82.6%), 28 (38.9%) of S. aureus isolates were meticillin resistant, and 7.5% Enterococci isolates of were vancomycin resistant. 75.3% of all bacterial pathogen were multi-drug resistant. Among them, 74.6% were gram positive and 84% were gram negative. Multi-drug resistance were observed among 84.6% of P. aeruginosa, of 82.5% Enterococcii, E. coli 78.6%, S. aureus 76.6%, and Coagulase negative staphylococci of 73.6%. CONCLUSIONS Indoor environment of the hospital was contaminated with airborne microbiotas, which are common cause of post-surgical site infection in the study area. Bacterial isolates were highly resistant to commonly used antibiotics with high multi-drug resistance percentage. So air quality of hospital environment, in restricted settings deserves attention, and requires long-term surveillance to protect both patients and healthcare workers.
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Affiliation(s)
- Fithamlak Bisetegen Solomon
- School of Medicine, College of Health Sciences, Wolaita Sodo University, PO Box: 138, Wolaita Sodo, Ethiopia
| | - Fiseha Wada Wadilo
- School of Medicine, College of Health Sciences, Wolaita Sodo University, PO Box: 138, Wolaita Sodo, Ethiopia
| | - Amsalu Amache Arota
- School of Medicine, College of Health Sciences, Wolaita Sodo University, PO Box: 138, Wolaita Sodo, Ethiopia
| | - Yishak Leka Abraham
- School of Medicine, College of Health Sciences, Wolaita Sodo University, PO Box: 138, Wolaita Sodo, Ethiopia
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Worth LJ, Black J, Seymour JF, Thursky KA, Slavin MA. Surveillance for Catheter-Associated Bloodstream Infection in Hematology Units: Quantifying the Characteristics of a Practical Case Definition. Infect Control Hosp Epidemiol 2015; 29:358-60. [DOI: 10.1086/528879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We evaluated 66 patients in a hematology unit, who used a total of 106 central venous catheters (CVCs), to identify CVC-associated bloodstream infections using standard and modified surveillance case definitions. Compared with the National Nosocomial Infection Surveillance system criteria, a modified case definition used by treating physicians demonstrated 100.0% sensitivity and 94.3% specificity. This case definition provides a practical method for effectively excluding CVC-associated bloodstream infection.
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Gadallah MAH, Aboul Fotouh AM, Habil IS, Imam SS, Wassef G. Surveillance of health care-associated infections in a tertiary hospital neonatal intensive care unit in Egypt: 1-year follow-up. Am J Infect Control 2014; 42:1207-11. [PMID: 25238664 DOI: 10.1016/j.ajic.2014.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/20/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reported rates of neonatal health care-associated infections (HAIs) in neonatal intensive care units (NICUs) have risen rapidly in recent years. Little data are available in Egypt, however. The aim of the present study was to determine the incidence of and risk factors for HAIs in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology. METHODS A prospective study was carried out on all neonates admitted in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology in 2012. Centers for Disease Control and Prevention criteria were followed for identifying HAIs. RESULTS A total of 434 neonates were enrolled in the study. The cumulative incidence of HAIs in the NICU was 28%. Bloodstream infections accounted for 85% of HAI episodes; pneumonia, for 10%. The most common organism isolated was Klebsiella spp. The main risk factors identified on multivariable analysis were gestational age <38 weeks (relative risk [RR], 1.63), birth weight <1,500 g (RR, 1.39), mechanical ventilation (RR, 1.74), and surgical procedures (RR, 1.65). The mortality rate attributed to HAIs was 11.75%, and the extra hospital length of stay attributed to HAIs was 8 days. CONCLUSION The high incidence of HAI identified in the study NICU mandates more vigorous infection control interventions.
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Affiliation(s)
| | | | - Ihab Shehad Habil
- Department of Community Medicine, Ain Shams Faculty of Medicine, Cairo, Egypt.
| | - Safaa Shafik Imam
- Department of Pediatrics, Ain Shams Faculty of Medicine, Cairo, Egypt
| | - Ghada Wassef
- Department of Community Medicine, Ain Shams Faculty of Medicine, Cairo, Egypt
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Is it possible to achieve a target of zero central line associated bloodstream infections? Curr Opin Infect Dis 2012; 25:650-7. [DOI: 10.1097/qco.0b013e32835a0d1a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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HealthCare–Associated Infections in the Nursery. INFECTIOUS DISEASES OF THE FETUS AND NEWBORN 2011:1126-1143. [PMCID: PMC7152384 DOI: 10.1016/b978-1-4160-6400-8.00035-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
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Notifiable infectious disease reporting awareness among physicians and registered nurses in primary care and emergency department settings. Am J Infect Control 2010; 38:410-2. [PMID: 20031271 DOI: 10.1016/j.ajic.2009.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 11/21/2022]
Abstract
This study examined knowledge about notifiable infectious disease reporting among physicians and registered nurses (RNs) in primary care and emergency department settings in King County, Washington. In 2005, a total of 165 physicians and 170 RNs completed a questionnaire to assess knowledge, training and feedback regarding notifiable infectious disease reporting. Only 55% of the physicians and 63% of the RNs were aware of reporting procedures within their institution. Awareness was higher when employer-provided training had been provided. Our findings indicate that employer training can improve reporting knowledge.
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Worth LJ, Brett J, Bull AL, McBryde ES, Russo PL, Richards MJ. Impact of revising the National Nosocomial Infection Surveillance System definition for catheter-related bloodstream infection in ICU: reproducibility of the National Healthcare Safety Network case definition in an Australian cohort of infection control professionals. Am J Infect Control 2009; 37:643-8. [PMID: 19589619 DOI: 10.1016/j.ajic.2009.02.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 02/10/2009] [Accepted: 02/12/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective and comparable surveillance for central venous catheter-related bloodstream infections (CLABSIs) in the intensive care unit requires a reproducible case definition that can be readily applied by infection control professionals. METHODS Using a questionnaire containing clinical cases, reproducibility of the National Nosocomial Infection Surveillance System (NNIS) surveillance definition for CLABSI was assessed in an Australian cohort of infection control professionals participating in the Victorian Hospital Acquired Infection Surveillance System (VICNISS). The same questionnaire was then used to evaluate the reproducibility of the National Healthcare Safety Network (NHSN) surveillance definition for CLABSI. Target hospitals were defined as large metropolitan (1A) or other large hospitals (non-1A), according to the Victorian Department of Human Services. Questionnaire responses of Centers for Disease Control and Prevention NHSN surveillance experts were used as gold standard comparator. RESULTS Eighteen of 21 eligible VICNISS centers participated in the survey. Overall concordance with the gold standard was 57.1%, and agreement was highest for 1A hospitals (60.6%). The proportion of congruently classified cases varied according to NNIS criteria: criterion 1 (recognized pathogen), 52.8%; criterion 2a (skin contaminant in 2 or more blood cultures), 83.3%; criterion 2b (skin contaminant in 1 blood culture and appropriate antimicrobial therapy instituted), 58.3%; non-CLABSI cases, 51.4%. When survey questions regarding identification of cases of CLABSI criterion 2b were removed (consistent with the current NHSN definition), overall percentage concordance increased to 62.5% (72.2% for 1A centers). CONCLUSION Further educational interventions are required to improve the discrimination of primary and secondary causes of bloodstream infection in Victorian intensive care units. Although reproducibility of the CLABSI case definition is relatively poor, adoption of the revised NHSN definition for CLABSI is likely to improve the concordance of Victorian data with international centers.
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Affiliation(s)
- Leon J Worth
- Victorian Hospital Acquired Infection Surveillance System (VICNISS) Coordinating Centre, North Melbourne, Victoria, Australia.
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Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008; 29:785-814. [PMID: 18767983 PMCID: PMC3319407 DOI: 10.1086/592416] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Philip W Smith
- Professor of Infectious Diseases, Colleges of Medicine and Public Health, University of Nebraska Medical Center, Omaha, Nebraska 68198-5400, USA.
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Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. SHEA/APIC Guideline: Infection prevention and control in the long-term care facility. Am J Infect Control 2008; 36:504-35. [PMID: 18786461 PMCID: PMC3375028 DOI: 10.1016/j.ajic.2008.06.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 05/07/2008] [Accepted: 05/19/2008] [Indexed: 01/09/2023]
Affiliation(s)
- Philip W Smith
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198-5400, USA.
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Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007; 35:S65-164. [PMID: 18068815 PMCID: PMC7119119 DOI: 10.1016/j.ajic.2007.10.007] [Citation(s) in RCA: 1615] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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KATAYAMA T. Necessity of Pharmacist Promotion to Contribute for Infection Control and Building Patient Safety. YAKUGAKU ZASSHI 2007; 127:1789-95. [DOI: 10.1248/yakushi.127.1789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lee TB, Montgomery OG, Marx J, Olmsted RN, Scheckler WE. Recommended practices for surveillance: Association for Professionals in Infection Control and Epidemiology (APIC), Inc. Am J Infect Control 2007; 35:427-40. [PMID: 17765554 DOI: 10.1016/j.ajic.2007.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 07/19/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Terrie B Lee
- Department of Epidemiology, Charleston Area Medical Center, Charleston, West Virginia 25304, USA.
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Grant PS, Kim AT. Infection control consultation in a 150-bed acute care hospital: making this unobserved and unmeasured critical job function visible. Am J Infect Control 2007; 35:401-6. [PMID: 17660011 DOI: 10.1016/j.ajic.2006.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2006] [Revised: 07/07/2006] [Accepted: 07/10/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND One qualified infection control director, reporting directly to administration, was responsible for the Infection Prevention and Control Program of a 150-bed acute care, non-teaching, for-profit hospital. To observe for potential trending, questions (consultations) and determinations related to infectious processes were documented. OBJECTIVE To explore the possibility of measuring the essential although "hidden" function of the infection control consultation (process), which is a role not formerly linked to infection rates (outcomes). METHODS A 7-year retrospective study was conducted of all infection control consultations requiring more than a 5-minute intervention, as part of routine job responsibilities. The XmR Statistical Process Control charts (XmR Charts) and Pearson's Correlation Coefficient were used to analyze the activity of infection control consultations. RESULTS From January 1, 1998 to December 31, 2004, there were 770 infection control consultations logged for 375.1 hours. Beginning with 2003, the variation in both the number and duration of infection control consultations in the XmR Charts become more standardized and has a smaller moving range between data points. The Pearson's Correlation Coefficient shows statistical significance (P <.05) between the number and duration of consultations. CONCLUSIONS Assessment of infection control consultations at this 150-bed hospital illustrates that this essential component can be measured, and should be formerly tracked to document overall assessment of infection prevention and control interdisciplinary interaction. The consultation process became more efficient over the 7-year study period because, as the number of questions increased, the duration required to achieve closure decreased.
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Affiliation(s)
- Patti S Grant
- Department of Infection Control & Epidemiology, RHD Memorial Medical Center, Dallas, TX, USA.
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Abstract
Central venous catheters are essential in the management of many malignant disorders, but catheter-related bloodstream infections (CR-BSIs) are significant complications in terms of morbidity, mortality, and healthcare expenditure. These outcome measures are useful for monitoring of infection control practice and the effect of preventive strategies. Unlike intensive care unit (ICU) populations, surveillance for CR-BSIs in the hematology population is not standardized, despite the potential value of detecting changes in rate, etiology, and changes in risk for infective complications in association with increasingly intensive chemotherapeutic regimens in this immunocompromised population. Essential components of a successful surveillance strategy include selection of a health outcome of significance, definition of goals of the surveillance system, involvement of key stakeholders in planning and development, application of valid case definitions, allocation of resources and trained personnel, risk stratification, and use of appropriate statistical methods for analysis. These are discussed with reference to patients with hematologic malignancy, together with review of previous surveillance strategies in this population. Only when these issues are addressed can a surveillance strategy reliably assess trends and compare data, leading to improved patient outcomes and a reduction in healthcare expenditure for patients with hematologic malignancy.
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Affiliation(s)
- Leon J Worth
- Centre for Clinical Research Excellence in Infectious Disease, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Bennett NJ, Bull AL, Dunt DR, Spelman DW, Russo PL, Richards MJ. Implementation of a pilot surveillance program for smaller acute care hospitals. Am J Infect Control 2007; 35:196-9. [PMID: 17433944 DOI: 10.1016/j.ajic.2006.04.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Revised: 04/11/2006] [Accepted: 04/11/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND An infection control (IC) surveillance program for smaller (<100 acute beds) hospitals was piloted for 18 weeks in 14 hospitals. The aim of the pilot stage was to test a theoretical program in the context in which it was to be implemented. METHOD An evaluation framework was developed, outlining the program's intended activities for data collection, management, analysis, reporting, and use. This framework was used as a reference to interview each of the 12 IC nurses participating in the pilot stage. RESULTS The preferred case finding methodologies were not uniformly applied. Management, analysis, and reporting of data were delayed because of infrequent and irregular IC hours and laboratory reporting. Reports were not always distributed to key persons. Specific action was only taken in response to the process (and not outcome) module reports. CONCLUSION Discrepancies between the theoretical and actual implementation of a surveillance program for smaller hospitals were highlighted. The program will need to be revised before it is rolled out to all 89 eligible hospitals across Victoria.
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Affiliation(s)
- Noleen J Bennett
- Victorian Nosocomial Infection Surveillance System (VICNISS) Coordinating Centre, Australia.
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Worth LJ, Slavin MA, Black J. Bloodstream infections in a secondary and tertiary care hospital setting. Intern Med J 2007; 37:284-5; author reply 258-6. [PMID: 17388879 DOI: 10.1111/j.1445-5994.2007.01327.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dickson KE, Ashton J, Smith JM. Does setting adolescent-friendly standards improve the quality of care in clinics? Evidence from South Africa. Int J Qual Health Care 2007; 19:80-9. [PMID: 17277012 DOI: 10.1093/intqhc/mzl070] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine whether setting and implementing adolescent-friendly standards improves the quality of adolescent services in clinics. DESIGN The evaluation used a quasi-experimental case-control design. SETTING/PARTICIPANTS Eleven public health clinics involved in the adolescent-friendly program [The National Adolescent Friendly Clinic Initiative (NAFCI)] and 11 control clinics. INTERVENTION This included implementation of a set of 10 adolescent-friendly standards and 41 corresponding criteria. MAIN OUTCOME MEASURES Percentage scores were achieved for each standard and criterion. Clinics were awarded a Gold Star if they achieved an overall clinic score (average standard score) of >or=90%, a Silver Star for a score between 60 and 89% and a Bronze Star for a score between 30 and 59%. RESULTS The NAFCI clinics performed better than the control clinics on most criteria. The combined average overall clinic score of all the NAFCI clinics (79.9%) was significantly higher (P = 0.005) than the overall score for the control group clinics (60.9%). Results showed that the longer NAFCI was implemented at a clinic, the higher the score and the more likely that clinic would be accredited as an 'adolescent friendly' clinic. NAFCI clinics performed significantly better than the control clinics on criteria specific to the provision of adolescent-friendly services including knowledge of adolescent rights and non-judgmental attitudes of staff. CONCLUSION Setting and implementing standards and criteria improves the quality of adolescent services in clinics. The standards and criteria should be set on the basis of the characteristics of adolescent-friendly services and quality of care indicators. Best results are achieved when a facilitator trained in quality improvement methodologies supports clinics.
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Affiliation(s)
- Kim Eva Dickson
- Reproductive Health Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Bertsham, South Africa.
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Szekendi MK, Sullivan C, Bobb A, Feinglass J, Rooney D, Barnard C, Noskin GA. Active surveillance using electronic triggers to detect adverse events in hospitalized patients. Qual Saf Health Care 2006; 15:184-90. [PMID: 16751468 PMCID: PMC2464849 DOI: 10.1136/qshc.2005.014589] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND Adverse events (AEs) occur with alarming frequency in health care and can have a significant impact on both patients and caregivers. There is a pressing need to understand better the frequency, nature, and etiology of AEs, but currently available methodologies to identify AEs have significant limitations. We hypothesized that it would be possible to design a method to conduct real time active surveillance and conducted a pilot study to identify adverse events and medical errors. METHODS Records were selected based on 21 electronically obtained triggers, including abnormal laboratory values and high risk and antidote medications. Triggers were chosen based on their expected potential to signal AEs occurring during hospital admissions. Each AE was rated for preventability and severity and categorized by type of event. Reviews were performed by an interdisciplinary patient safety team. RESULTS Over a 3 month period 327 medical records were reviewed; at least one AE or medical error was identified in 243 (74%). There were 163 preventable AEs (events in which there was a medical error that resulted in patient harm) and 138 medical errors that did not lead to patient harm. Interventions to prevent or ameliorate harm were made following review of the medical records of 47 patients. CONCLUSIONS This methodology of active surveillance allows for the identification and assessment of adverse events among hospitalized patients. It provides a unique opportunity to review events at or near the time of their occurrence and to intervene and prevent harm.
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Affiliation(s)
- M K Szekendi
- Division of Operations and Quality, Patient Safety, Northwestern Memorial Hospital, Chicago, IL 60611, USA.
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Infections Acquired in the Nursery: Epidemiology and Control. INFECTIOUS DISEASES OF THE FETUS AND NEWBORN INFANT 2006:1179-1205. [PMCID: PMC7150280 DOI: 10.1016/b0-72-160537-0/50037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
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Geubbels ELPE, Wille JC, Nagelkerke NJD, Vandenbroucke-Grauls CMJE, Grobbee DE, de Boer AS. Hospital-related determinants for surgical-site infection following hip arthroplasty. Infect Control Hosp Epidemiol 2005; 26:435-41. [PMID: 15954480 DOI: 10.1086/502564] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine hospital-related risk factors for surgical-site infection (SSI) following hip arthroplasty. DESIGN Prospective, multicenter cohort study based on surveillance data and data collected through a structured telephone interview. With the use of multilevel logistic regression, the independent effect of hospital-related characteristics on SSI was assessed. SETTING Thirty-six acute care hospitals in the Dutch surveillance network for nosocomial infections (PREZIES), from 1996 to 2000. PATIENTS Thirteen thousand six hundred eighty patients who underwent total or partial hip arthroplasty. RESULTS A high annual volume of operations was associated with a reduced risk of SSI (risk-adjusted risk ratio [RR] per 50 extra operations, 0.85; 95% confidence interval [CI95], 0.74-0.97). With each extra full-time-equivalent infection control staff member per 250 beds available for prevention of SSI, the risk for SSI was decreased (RR, 0.48; CI95, 0.16-1.44), although the decrease was not statistically significant. Hospital size, teaching status, university affiliation, and number of surgeons and their years of experience showed no important association with the risk of SSI. CONCLUSION Undergoing surgery in a hospital with a low volume of operations increases a patient's risk of SSI.
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Affiliation(s)
- Eveline L P E Geubbels
- Department of Infectious Diseases Epidemiology National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Abstract
OBJECTIVE To define urinary tract infections in critically ill children in the intensive care unit setting for the purpose of surveillance of infection, enrollment of children in sepsis trials, and for trials of therapy and prevention. DESIGN Summary of the literature with review and consensus by experts in the field. RESULTS A variety of definitions, only some of which have been validated for use in children, were identified. The Centers for Disease Control criteria for the definition of nosocomial infection have been used to establish surveillance data for inter-institutional comparison. Validated definitions for the febrile child were identified. Using the known characteristics of symptoms, signs, and laboratory criteria for urinary tract infections, definitions for definite, possible, and probable urinary tract infection were derived. CONCLUSIONS Definitions for definite, probable, and possible urinary tract infection were achieved by consensus that can be used for surveillance and enrolment in sepsis trials. Future research should determine the utility of these definitions in the critically ill child and adapt them accordingly.
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Affiliation(s)
- Joanne M Langley
- Clinical Trials Research Centre, the IWK Health Centre and Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Cordero L, Ayers LW, Miller RR, Seguin JH, Coley BD. Surveillance of ventilator-associated pneumonia in very-low-birth-weight infants. Am J Infect Control 2002; 30:32-9. [PMID: 11852414 DOI: 10.1067/mic.2002.119995] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Surveillance of ventilator-associated pneumonia (VAP) is an essential part of quality patient care. Very-low-birth-weight (VLBW) infants, many with tracheal microbial colonization and bronchopulmonary dysplasia (BPD), comprise a difficult group in whom to make a diagnosis of pneumonia with the Centers for Disease Control and Prevention (CDC) criteria for infants younger than 1 year. OBJECTIVE Our objective was to retrospectively compare VAP surveillance diagnoses made by the hospital infection control practitioner (ICP) with those made by a panel of experts with the same clinical and laboratory evidence and supportive radiologic data. A secondary objective was to compare radiologic diagnosis of pneumonia made by the general hospital radiologists, by the panel of experts, and by a pediatric radiologist from another hospital. STUDY POPULATION Thirty-seven VLBW infants identified as at risk for VAP by the ICP on the basis of a positive bacterial tracheal culture and the application of CDC criteria for the definition of pneumonia were studied. METHODS Clinical and laboratory evidence and routine radiologic reports made by the general radiologist were reviewed independently by a panel of experts composed of 3 experienced neonatologists. Chest x-rays from the day before, day of, and day after the surveillance date were reviewed separately by the 3 neonatologists and also by a pediatric radiologist. RESULTS After inter-reader reliability was found satisfactory (kappa's coefficient, 0.47-0.75; P <.05), the panel of neonatologists determined that the 37 VLBW infants represented 4 distinct clinical categories. Group 1 comprised 12 airway-colonized infants, aged 14 to 30 days, who on the surveillance date, albeit intubated, were asymptomatic, not treated with antibiotics, and survived. Group 2 comprised 11 airway-colonized infants, aged 7 to 42 days, who presented with equivocal clinical, laboratory, or radiologic signs of VAP and survived. Group 3 comprised 7 airway-colonized infants, aged 14 to 21 days, who were acutely ill (3 died) and had clinical and laboratory evidence of nosocomial bloodstream infection (BSI) but no radiologic signs of pneumonia. Group 4 comprised 7 infants, aged 14 to 28 days, who were acutely ill (4 died) and had clinical and laboratory evidence of infection and radiologic changes consistent with VAP. Radiologic Findings: General radiologists, neonatologists, and the pediatric radiologist agreed that none of the asymptomatic airway-colonized infants (Group 1) had VAP. General radiologists reported signs suggestive of pneumonia in 8 of 11 infants (Group 2), a finding not corroborated by the others. Everybody agreed on the absence of radiologic pneumonia in 6 of 7 patients with nosocomial BSI (Group 3) and on the presence of signs consistent with pneumonia in the remaining 7 infants (Group 4). CONCLUSION Surveillance diagnosis of VAP in VLBW infants is difficult because current CDC definitions are not specific for this population. Isolated positive tracheal culture alone does not distinguish between bacterial colonization and respiratory infection. Clinical and laboratory signs of VAP, mostly nonspecific, can be found in other conditions such as bronchopulmonary dysplasia and nosocomial BSI. Routine radiologic reports suggestive of pneumonia in airway-colonized infants without definitive clinical and laboratory evidence of infection could be misleading. To improve accuracy, surveillance diagnosis of VAP in special populations such as VLBW infants should be reformulated; meanwhile, ICPs should seek consultation with experienced clinicians for interpretation of data.
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Affiliation(s)
- Leandro Cordero
- Division of Neonatal-Perinatal Medicine, The Ohio State University College of Medicine, Columbus, Ohio 43210-1228, USA
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Abstract
By design, multiple invasive procedures are performed in the intensive care unit (ICU). Although great care is taken to control morbidity and forestall mortality, this invasive environment places ICU patients and staff at immense risk of nosocomial (hospital-acquired) infection. The role of the infection control professional (ICP) within the ICU involves data collection, dissemination of data with feedback, expertise in the investigation of outbreaks, product evaluation proficiency, and fluid consultation aptitude. This article provides an inside view of how specialty infection control staff and ICU staff can optimize infection control to decrease the incidence of nosocomial infections. A description of what the ICP does not do in the ICU is also given, providing a clear guideline for how these two disciplines can best provide a safe intensive care experience.
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Affiliation(s)
- P S Grant
- Trinity Medical Center, Carrollton, Texas, USA
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Abstract
Although home care has expanded in scope and intensity in the United States in the past decade, infection surveillance, prevention, and control efforts have lagged behind. Valid and reliable definitions and methods for surveillance are needed. Prevention and control efforts are largely based upon acute-care practices, many of which may be unnecessary, impractical, and expensive in a home setting. Infectious disease control principles should form the basis of training home- care providers to assess infection risk and develop prevention strategies.
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Affiliation(s)
- E Rhinehart
- AIG Consultants, Inc., Atlanta, Georgia, USA.
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Rocha BH, Christenson JC, Evans RS, Gardner RM. Clinicians' response to computerized detection of infections. J Am Med Inform Assoc 2001; 8:117-25. [PMID: 11230380 PMCID: PMC134551 DOI: 10.1136/jamia.2001.0080117] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To analyze whether computer-generated reminders about infections could influence clinicians' practice patterns and consequently improve the detection and management of nosocomial infections. DESIGN The conclusions produced by an expert system developed to detect and manage infections were presented to the attending clinicians in a pediatric hospital to determine whether this information could improve detection and management. Clinician interventions were compared before and after the implementation of the system. MEASUREMENTS The responses of the clinicians (staff physicians, physician assistants, and nurse practitioners) to the reminders were determined by review of paper medical charts. Main outcome measures were the number of suggestions to treat and manage infections that were followed before and after the implementation of COMPISS (Computerized Pediatric Infection Surveillance System). The clinicians' opinions about the system were assessed by means of a paper questionnaire distributed following the experiment. RESULTS The results failed to show a statistical difference between the clinicians' treatment strategies before and after implementation of the system (P: > 0.33 for clinicians working in the emergency room and P: > 0.45 for clinicians working in the pediatric intensive care unit). The questionnaire results showed that the respondents appreciated the information presented by the system. CONCLUSION The computer-generated reminders about infections were unable to influence the practice patterns of clinicians. The methodologic problems that may have contributed to this negative result are discussed.
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Affiliation(s)
- B H Rocha
- University of Utah, Salt Lake City, Utah.
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Embry FC, Chinnes LF. Draft definitions for surveillance of infections in home health care. Am J Infect Control 2000; 28:449-53. [PMID: 11114614 DOI: 10.1067/mic.2000.112150] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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McLaws ML, Caelli M. Pilot testing standardized surveillance: Hospital Infection Standardised Surveillance (HISS). On behalf of the HISS Reference Group. Am J Infect Control 2000; 28:401-5. [PMID: 11114609 DOI: 10.1067/mic.2000.111373] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In Australia the time-consuming nature of double handling of surveillance data has meant that surveillance methodology rarely included prospective monitoring of patients at risk for the acquisition of a nosocomial infection. To streamline surveillance activities, infection control professionals favored the collection of case data either from the ward or pathology laboratories. By default, this method introduced a variety of definitions resulting in inconsistencies across health care facilities and artificial fluctuations in the magnitude of infection. In June 1998, the New South Wales Health Department funded its first attempt to develop and implement a standardized approach to collection of nosocomial infection data-Hospital Infection Standardized Surveillance (HISS). Six months later, in December 1998, 10 public acute care hospitals pilot tested the content and methodology of HISS. HISS members tested the application of the National Nosocomial Infection Surveillance system definitions for infection, active and passive surveillance methodology, the handheld computer for data collection, and the Electronic Infection Control Automated Technology (eICAT) version for HISS software and analysis. HISS member hospitals selected from several sentinel monitoring programs such as intravascular device-related bacteremia and nonintravascular device-related bacteremia infections, surgical site infections, respiratory syncytial virus infections, and rotavirus infections. Hospitals continued to perform active surveillance in the first 12 months, collecting demographic variables, risk factors, and outcomes. The completeness of the data sets for the two most frequently monitored programs, surgical site infections and intravascular device-related bacteremia, was high, with 99.6% of the required 36, 372 surgical site infection data fields and 99.4% of the 572,717 intravascular device-related bacteremia data fields completed.
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Affiliation(s)
- M L McLaws
- Hospital Infection Standardized Surveillance program, the New South Wales Hospital Infection Epidemiology and Surveillance Unit, Faculty of Medicine, University of New South Wales, Australia
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Olmsted RN. Turning information into knowledge to prevent health care-associated infections and other adverse events: the electronic ICP as an agent of change. Am J Infect Control 2000; 28:389-91. [PMID: 11114607 DOI: 10.1067/mic.2000.111311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Schweon SJ. Being wired for a year. Infect Control Hosp Epidemiol 1999; 20:299-300. [PMID: 10349940 DOI: 10.1086/503125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baker OG. Outcomes management: trendy phrase or mandate for survival? Am J Infect Control 1999; 27:77-8. [PMID: 10196482 DOI: 10.1016/s0196-6553(99)70084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Outpatient procedures have become more complex, requiring outpatient providers to offer technical procedures in the home, office, and clinic. This shift in health care has brought about the need for staff members to become proficient in a variety of technical procedures that were once done only in the hospital setting. Outpatient i.v. therapy has caused home health care agencies, physicians' offices, and clinics to seek education and training regarding i.v. therapy and to develop basic infection-control guidelines and guidelines related to the insertion and maintenance of i.v. devices. The goals of the outpatient provider are to prevent i.v.-related complications and to provide quality patient care. These can be accomplished by strict adherence to sound infection-control guidelines and routine monitoring of procedure techniques and complications of care. Outpatient providers may wish to seek expertise and guidance from hospital infection-control personnel, infectious diseases specialists, or other infection-control consultants to meet the demands of the complexity of outpatient care.
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Affiliation(s)
- B H Wade
- Center for Prevention and Treatment of Infections, Pensacola, Florida, USA
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