Understanding the current state of infection preventionists through competency, role, and activity self-assessment

BACKGROUND

The Association for Professionals in Infection Control and Epidemiology (APIC) MegaSurvey, administered in 2015, was completed by approximately 4,079 APIC members. The survey sought to gain a better understanding the current state of 4 components of infection prevention practice: demographic characteristics, compensation, organizational structure, and practice and competency.

METHODS

The data for this analysis come from the APIC MegaSurvey Practice and Competency domain. Descriptive statistics and χ² analyses were conducted to examine differences in infection preventionist (IP) competency, roles, and activity self-assessments.

RESULTS

The majority of IPs self-assessed their competency as Proficient compared with Novice or Expert for each of the 8 IP core competency activities. Forty percent of IPs self-rated their competency as Expert in the Preventing/Controlling the Transmission of Infectious Agents/HAIs component. IPs reported Novice competency in Employee/Occupational Health (29%); Cleaning, Sterilization, Disinfection, and Asepsis (23%); and Education and Research categories (22%). Differences in self-rated competency among IPs by discipline type (public health, nurse, and laboratory) were identified.

CONCLUSIONS

Differences in self-rated competency were identified for each of the 8 IP core competency activities. IPs report using various resource types to gain competency. Future research is needed to identify opportunities to increase competency levels in the weakest-rated competency activities.

[Authorized Qualifications of Staff Conducting Examinations in the Field of Clinical Microbiology]

Because of the increase in healthcare-associated infections, appearance of highly resistant bacteria, and that of emerging/re-emerging infectious diseases, it is necessary for the skills of clinical microbiological technologists and the associated technology to be improved. Technologist in Microbiology (4,717 certified) and Specialist in Microbiology (58 certified) are authorized qualifications in the field of examination for clinical microbiology, with a history of 60 years, and Clinical Microbiological Technologist (670 certified) and Infection Control Microbiological Technologist (ICMT) (528 certified) are necessary qualifications to become a member of an infection control team. As problems to be resolved, clarifying the relationships among the authorized qualifications, reconsidering the fairness of evaluating written examinations, and further consideration of the administration method for an increasing number of examinees need to be tackled.

Promoting hand hygiene in clinical practice

Nurses are well known and respected for championing practices that contribute to high standards of patient care, save lives, and help to influence other disciplines to do the same. Hand hygiene is one such practice. This article discusses the role nurses play in championing hand hygiene and explores how senior managers can support them in this.

Improving adherence to hand hygiene practice

Hand hygiene compliance rates continue to vary between healthcare settings and individual professionals. This article looks at how a multimodal approach to infection prevention and control, using expertise from other disciplines, can increase compliance with hand hygiene practices.

The Certification Board of Infection Control and Epidemiology white paper: the value of certification for infection control professionals

In its Vision 2012: A Strategic Plan, the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) states that APIC will be recognized as the leader in infection prevention and control. However, if the APIC Strategic Plan is to be advanced by its members, infection control professionals must choose a leadership role by becoming certified, validating their competency and setting a standard of excellence. Certification by the Certification Board of Infection Control and Epidemiology, Inc. (CBIC) validates an infection control professional's competence to the public, the profession, employers, and regulators. The White Paper presented here by the CBIC provides a rationale for certification and recertification in infection prevention and control practice.

A process evaluation of an intervention to improve respiratory infection control practices in family physician offices

OBJECTIVE

To conduct a process evaluation of a short-term intervention by public nurses for physicians to facilitate the incorporation of new respiratory infection control practices in physicians' offices.

DESIGN

Process evaluation.

SETTING

Family physician offices in Ottawa, Ontario, Canada.

PARTICIPANTS

Five public health nurse-facilitators and 53 primary care practices including 143 family physicians.

METHOD

Effectiveness of facilitator training assessed by self-administered questionnaires. Data assessing process of facilitation collected through activity logs and narrative reports. Physicians' satisfaction assessed by post-intervention questionnaire.

MAIN FINDINGS

Facilitators reported that training strongly contributed to their knowledge and skills and all were either satisfied or highly satisfied with their facilitation training. All practices received at least two visits by the facilitator and more than half (51%) were visited three or more times. Facilitators identified the provision of the evidence-based Tool Kit and consensus-building with office staff as key factors contributing to the intervention's success. Of the 45% of physicians who completed the questionnaire (65/143), only 5% reported being somewhat dissatisfied with the intervention, 11% reported the visits were not frequent enough, and 9% thought the visits were too close together. The majority (97%) felt the facilitation program should be available to all family physicians and 98% would continue to use the service if available.

CONCLUSIONS

It is feasible for public health nurses to be trained in outreach facilitation to improve respiratory infection control practices in physicians' offices and this has been widely appreciated by physicians. This model of public health/primary care collaboration deserves further exploration.

Audit in infection control

Audit is a key function of infection control teams. Infection control audit programmes should include audits of infection control policies in wards and departments, and microbiological safety audits of the healthcare environment. This paper reviews the literature on healthcare audit with particular emphasis on published audits in infection control. Evidence of the efficacy of audit and feedback in improving infection control outcomes is presented, together with the nature of interventions necessary to bring about change.

Protocol-driven ventilator weaning reduces use of mechanical ventilation, rate of early reintubation, and ventilator-associated pneumonia

BACKGROUND

Mechanical ventilation is the defining event of intensive care unit management. To reduce use, a literature-based protocol was introduced to facilitate weaning. The effect of protocol-driven ventilator weaning on ventilator use, ventilator-associated pneumonia (VAP), and intensive care unit (ICU) length of stay (LOS) is described in a survey of 2 years' activity in a multidisciplinary surgical ICU.

METHODS

Data were gathered from April to September 2000 and from April to September 2002 before and after introduction of nurse/therapist-driven weaning. VAP was identified by chest radiography, clinical presentation, Gram's stains, and cultures from tracheal aspirates or bronchoalveolar lavage. Infection control practitioners diagnosed VAP. Failed extubation was defined as reintubation within 72 hours.

RESULTS

Overall, there was a 2:1 ratio of male patients to female patients. The total number of patients and days of mechanical ventilation increased, but the use ratio (ventilator days/ICU days) fell from 0.47 to 0.33. Patients failing extubation fell from 43 (in 2000) to 25 (in 2002). From these patients, 17 cases of VAP occurred in 2000 and 5 in 2002. Mean age (40 years), Injury Severity Score (24), and ICU LOS (5.7-7.4 days; p = not significant) were unchanged in injured patients. ICU discharge was frequently delayed because of the need for subsequent respiratory care.

CONCLUSION

Protocol-driven weaning reduces use of mechanical ventilation and VAP. Injured and general surgical patients show reduction in complications, but shorter ICU LOS depends on resources elsewhere in the health care system.

Practice analysis for infection control and epidemiology in the new millennium

BACKGROUND

The Certification Board of Infection Control and Epidemiology appointed an advisory committee to conduct a practice analysis (PA) of infection control professionals (ICPs) to identify current practices of ICPs. Results of the PA would assist in the development of a revised certification examination.

METHODS

Five thousand seven hundred fifty-three questionnaires were distributed to ICPs in the United States and in Canada, as well as to a subsample of ICPs in other countries. Decision rules and criteria were applied to each identified task in the PA.

RESULTS

A total of 1306 responses were available for analysis, for a 24% return rate. The majority of the respondents were certified in infection control, had a background as a registered nurse, and worked in a community hospital with 200 or fewer beds. Six major categories, with 135 tasks, were identified in the PA. The following 2 new categories were included: education and research and infection control aspects of employee health.

CONCLUSIONS

The PA reflects current changes in the practice of infection prevention/control and applied epidemiology in the United States and Canada. The test specifications accepted for adoption by the Certification Board of Infection Control and Epidemiology will be used to build all examination forms for a certification program for ICPs.

[The introduction of ICD, ICN in Japan, and future expectations]

Infection Control Doctor(ICD) and Infection Control Nurse(ICN) are known as specialist in infection control. In Western countries Infection Control Teams have already been organized under Hospital Infection Control Committees, and ICDs and ICNs have been deployed in them and actively participate in them. The organizations and personnel that should cope with hospital infections in this manner cannot be said to be sufficient in Japan, and there is an urgent need to train specialists for infection control. Accordingly, in 1999 an ICD accreditation system was inaugurated, principally by the Japanese Association for Infectious Diseases and the Japanese Society of Environmental Infections, and in 2000 the Japanese Nursing Association inaugurated an ICN accreditation system in the form of accredited nurses. This paper describes the introduction of ICD and ICN in Japan, future expectations, and associated problems.

Post-discharge surveillance: can patients reliably diagnose surgical wound infections?

Post-discharge surgical wound infection surveillance is an important part of many infection control programs. It is frequently undertaken by patient self-assessment, prompted either by a telephone or postal questionnaire. To assess the reliability of this method, 290 patients were followed for six weeks postoperatively. Their wounds were photographed and also covertly assessed for signs of infection by two experienced infection control nurses (ICNs). Patients also responded to a postal questionnaire seeking evidence of infection at both week four and week six post-surgery. Correlation between the patient's assessment of their wound and the ICNs diagnosis was poor (r = 0.37) with a low positive predictive value (28.7%), although negative predictive value was high (98.2%). Assessment of photos for signs of infection by two experienced clinicians also correlated poorly with the ICNs diagnosis of infection (r = 0.54). The patient's recall of prescription of an antibiotic by their general practitioner (GP) for wound infection during the postoperative period correlated best with the ICNs diagnosis (r = 0.76). This latter measure, particularly when confirmed by the GP in those patients reporting an infection, appears to provide the most valid and resource efficient marker of post-discharge surgical wound infection.

The business of health care epidemiology: creating a vision for service excellence

To achieve service excellence in infection control in an era of fiscal constraint requires infection control specialists to demonstrate the value of their department in business terms to their health care administrators. Models for achieving service excellence in infection control based on cost-effective interventions found effective in our organization are described, including development and maintenance of effective teams, guidelines for structuring and implementing interventions, and establishment of business standards for excellence in health care.

Nursing homes infection control audit

OBJECTIVES

To carry out a telephone audit looking at the number of nursing homes adhering to the recommendations that nursing homes should-. have a trained infection control link nurse have appropriate reference material respond appropriately to enteric outbreaks record residents with previously identified MRSA and C. diff. be aware of clients with possible infections offer influenza vaccination to all residents.

DESIGN

An initial telephone survey of all 23 nursing homes within Forth Valley Health Board area in February 2000 was followed by offering a training programme and repeating the survey in December 2000 to find out if improvements had been made.

RESULTS

In February 2000 there were 17(74%) nursing homes with link nurses. In December 2000 this was 19(83%). The numbers who had attended a PHICN induction course were low (11% vs 16%). The lack of availability of reference material in a number of homes gave cause for concern. About one third of nursing homes had residents with diarrhoea and vomiting in the last three months and had called the GP. In February none and in December one of the respondents said that Public Health had been informed. The number of homes which took specimens was 33% in February vs 88% in December and with carriers of MRSA was 75% vs 83%. Those flagging notes increased from 73% to 100%. The number with residents with C.diff was extremely small (1vs2) and all notes were reported to be flagged.

CONCLUSION

Staff retention and training were highlighted as areas to be addressed. Improvements in availability of reference material in nursing homes, standardisation of "flagging" or marking of notes and increased notification of possible outbreaks to the Communicable Disease Team are required.

Credentialing, diversity, and professional recognition-foundations for an Australian infection control career path

BACKGROUND

There are no regulatory, legislative, or professional criteria stipulating minimum qualifications or experience that a health care worker must meet to be capable of coordinating an Australian infection control (IC) program. Measurement of IC competence is important to protect the public and for the ongoing credibility and growth of the profession.

METHOD

Our study group was all 1078 nonmedical and nonindustry members of the Australian Infection Control Association in 1996. The survey examined perceived level of proficiency, level of education, and experience in health care and infection control. Almost three quarters (65%) of the members responded, and almost all (85%) of these respondents fulfilled the inclusion criterion of coordinating an IC program.

RESULTS

Experience in IC ranged from less than 2 years (33.6%) to more than 20 years (10.0%). The majority (65.0%) of infection control professionals (ICPs) had between 8 years and 12 years IC experience. The respective proportions of respondents' self-ranked levels of proficiency on a 5-point scale were novice (3.6%), advanced beginner (21.2%), competent (33.8%), proficient (34.7%), and expert (6.8%). Almost half (47%) of the novices agreed that a registered nursing (RN) qualification was required, whereas a majority (41%) of advanced beginners considered both an RN and a basic IC course (BASIC) were required. Competent ICPs agreed less often than the other levels about their requirements. However, 27% of competents identified a BASIC and an undergraduate degree (UG) as the minimum requirements for a competent ICP. Proficient ICPs agreed that they required an RN, UG, BASIC, and a postbasic course in IC. Nearly all experts (80.0%) agreed that they required an RN, UG, BASIC, postbasic course, and a course in hospital epidemiology (EP). Two thirds of experts expected a master's degree as a requirement.

CONCLUSION

The Australian IC profession is in an exciting period of development; however, the variation in ICP perception of the most appropriate qualifications and experience threatens the credibility and viability of the profession. This variation indicates the need for a clear-cut pathway that includes a system of credentialing, recognition of expertise, adoption of divergent roles, and improved networking. This pathway will lead to an increasingly credible and viable IC profession in Australia. Developing IC communities globally can benefit from the Australian experience.

Job analysis 1996: Infection control professional. Certification Board in Infection Control and Epidemiology, Inc, 1996 Job Analysis Committee

The Certification Board in Infection Control and Epidemiology, Inc, directed its Test and Administrative Subcommittees to compose a Job Analysis Committee in 1995. This 16-member Job Analysis Committee, in collaboration with Applied Measurement Professionals, Inc, conducted a job analysis survey of infection control professionals in the United States and Canada during 1996. The reassessment of the previous Certification Board in Infection Control and Epidemiology, Inc, task analysis, formation of a job-analysis survey tool, the actual job-analysis process, and its results are described in this article. The previous and newly revised test specification outlines are compared. The Revised Certification Examination for Infection Control offered beginning in 1997 will reflect the efforts of this endeavor.

Measuring and improving the performance of health care providers: accreditation in the 21st century

Outcomes data will become part of the Joint Commission on Accreditation of Healthcare Organizations' accreditation process. Accredited organizations will select a measurement system that they will use to submit data to the Commission. Data trends will be reviewed to determine response by the accreditor. The Joint Commission will work with organizations to assist with improvement opportunities. Accreditation decisions will continue to be based on standards. The Joint Commission's system, the IMSystem, is one of several systems available for use in accreditation activities.

Detecting pediatric nosocomial infections: how do infection control and quality assurance personnel compare?

OBJECTIVE

To compare how well infection control (IC) and quality assurance (QA) personnel in a specialty setting identify the presence, type (nosocomial or community-acquired), and (if nosocomial) site of infection.

METHODS

In 1994, we mailed a survey that included 21 pediatric case histories to IC and QA personnel in pediatric settings in the United States (children's hospitals and medical school-affiliated hospitals with pediatric wards of > 30 beds). From the case histories presented, the respondents were asked to determine whether an infection was present and, if so, whether it was nosocomial or community-acquired. If the infection was nosocomial, the respondent was asked to determine the site of the infection (e.g., urinary tract, bloodstream).

RESULTS

From the 289 hospitals to which surveys were mailed, 131 respondents (45.3%) completed 212 surveys. Of the 212 returned surveys, 120 (56.6%) were completed by IC personnel and 92 (43.4%) were completed by QA personnel. Among the 183 respondents from acute care pediatric settings, 92.3% of IC personnel (96/104) and 54.4% of QA personnel (43/79) correctly identified at least 75% of the nosocomial infections (n = 14; p < 0.0001). IC and QA personnel were similar in ability to identify community-acquired infection (88/104 vs 70/79, respectively; p = 0.436). IC personnel were significantly more likely than QA personnel to accurately identify the following sites of infection: respiratory tract infection without secondary bloodstream infection, necrotizing enterocolitis, urinary tract infection with and without secondary bloodstream infection, primary bloodstream infection, surgical site infection, gastroenteritis, esophagitis, and clinical sepsis.

CONCLUSIONS

Overall, IC personnel were more accurate than QA personnel in determining whether a nosocomial infection was present and in correctly determining most sites of infection. Both IC and QA personnel had difficulty identifying venous infection and respiratory tract infection with secondary bloodstream infection. Both IC and QA personnel could thus benefit from more concise definitions or further training in detection of these sites of nosocomial infections. In addition, QA personnel did not perform overall as well as IC personnel in identifying nosocomial infections and their sites; this finding suggests the need for QA personnel to be provided specific training on detection of nosocomial infections and validation of their ability to do so. Nosocomial infection surveillance should be the responsibility of those trained and proved capable of detecting these infections.

Skin testing for tuberculosis in university teaching hospitals--is there a problem?

We performed four annual audits of tuberculin tests performed on hospitalized patients at a university teaching hospital complex. Each audit assessed if tests were performed and read correctly. House staff performed skin testing in years 1 to 3. Despite interventions of teaching and then of written instructions on skin testing, performance was poor. When testing was turned over in year 4 to trained infection control practitioners, performance approached 100%. We conclude that university teaching hospitals should assess skin-testing performance.

Ethical aspects of infection control

This article describes ethical dilemmas faced routinely by infection control personnel and outlines the basic principles of ethics as applied to the practice of infection control and hospital epidemiology.

The Certification Board of Infection Control, Inc

The Certification Board of Infection Control, Inc. (CBIC), was created in 1981 by the Association for Professionals in Infection Control and Epidemiology, Inc, for the sole purpose of developing and administering an examination by which competent infection control professionals could become certified. This independent, voluntary board is multidisciplinary, representing all levels of professionals in the field of infection control, as well as a consumer member. CBIC certification is the only recognized certification for infection control professionals. Since the first examination was administered in 1983, over 3,000 persons have attained infection control certification (CIC) status and are permitted to use the CIC credential.

A clinical infection control audit programme: evaluation of an audit tool used by infection control nurses to monitor standards and assess effective staff training

In today's competitive market infection control teams are under increasing pressure from purchasing authorities to provide hard data on quality issues. The initial aim of this study was to determine whether a modified form of the audit system used to monitor infection control standards in Derbyshire could be used effectively across three district health authorities. Infection control nurses in each of the study districts have different approaches to training with only Stafford using a link nurse system. Our additional aim therefore was to examine the relationship between the knowledge base of nursing staff and their ward audit score, and to determine whether wards with link nurses achieved significantly higher scores. To establish this a questionnaire was devised and completed by three different grades of staff on each ward at the time of the audit. These results were fed back to the wards and to managers by the infection control nurse, and an action plan given with a review date where applicable. Results of the study indicated that the audit tool could be used effectively in any district but would need modifying for psychiatric departments. The value of education in improving standards of infection control was clearly demonstrated. An important finding in Stafford was that wards with link nurses obtained significantly higher scores. The value of using such a clinically based audit will be discussed.

Validation of surgical wound classification in the operating room

OBJECTIVE

To determine the accuracy with which circulating nurses (CNs) classify surgical procedures by risk of contamination in the operating room.

DESIGN

Classification of surgical procedures by CNs was compared with the classification of surgical procedures by a physician observer.

SETTING

University-affiliated, tertiary care hospital.

METHODS

Circulating nurses used the traditional wound classification system of clean, clean-contaminated, contaminated, and dirty-infected to classify surgical wounds in the operating room. A physician remained in the operating room throughout each of 100 surgical procedures and simultaneously classified surgical wounds without the knowledge of the CNs.

RESULTS

Classification of surgical wounds by CNs was compared with classification by the physician observer for 50 cases in general surgery and 50 cases in trauma surgery. Compared with the physician observer, the overall accuracy of classification by CNs was 88% (95% confidence interval [CI] of 81.6% to 94.4%; Kappa statistic, 0.83). Classification of surgical wounds was more difficult in trauma surgery (accuracy of 82%) than in general surgery (accuracy of 94%). Accuracy increased for both services when surgical wounds were classified into just two categories (clean or clean-contaminated versus contaminated or dirty-infected).

CONCLUSIONS

Surgical wounds can be classified in the operating room with a high degree of accuracy by CNs. Classification was more difficult in trauma than in general surgery, but classification in trauma surgery improved with feedback to and additional education of CNs. The accuracy of classification by CNs was even higher when classifications were divided into just two categories.

Study of the definition of nosocomial infections (SDNI). Research Committee of the Association for Practitioners in Infection Control

If nosocomial infections are to be used as clinical indicators of quality, their definitions must be accurate. To assess validity and reliability of definitions of nosocomial infection, a study was conducted in two groups of U.S. hospitals. Group A consisted of a stratified, random sample of 715 hospitals and excluded those that are part of the National Nosocomial Infections Surveillance System. The 112 NNIS hospitals were surveyed separately in group B. Both groups used the same instrument, consisting of 36 case studies simulating patients' charts. Content and construct validity were formally tested and demonstrated. Six case studies were presented for each of the four major NI sites and for community-acquired or no infection. The pooled hospital response was 48% (396/827). The pooled number of individual responders whose data were used in the analysis was 469. Their overall mean score was 84%, and the score for correctly identifying any NI was 83%. Both groups were best at identifying urinary nosocomial infections (Group A = 92%, Group B = 93%) and poorest for no infection (Group A = 62%, Group B = 75%). Group A responders had significantly higher scores if they were certified, had a baccalaureate or higher degree, had taken a formal infection control course, had worked in infection control for greater than or equal to 2 years, or had worked full time in infection control in a greater than or equal to 200-bed hospital that was affiliated with a medical school (all p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The nonexistent problem

Effective assessment of problems is essential for the infection control practitioner to function optimally. Today's infection control practitioner not only learns problem solving on the job but is trained in both individual and participatory problem solving techniques. Correct response to a potential problem requires careful investigation and identification of causal relationships. Most literature, however, is directed at solving problems that exist. The phenomenon of nonexistent problems exists when the presented problem is not real but exists only in the perception of the presenter. In some cases, the nonexistent problem may partially represent a real problem, but the relationship may not be readily apparent. Time spent by infection control practitioners responding to nonexistent problems is significant. Without the ability to distinguish between nonexistent and existent problems, needless and ineffective actions may be taken. It is essential that the infection control practitioner understand both the dynamics resulting from the presentation of nonexistent problems and their characteristics.

Infection control policies and guidelines--Scandinavian experience

In the Scandinavian countries few regulations govern hospital infection control. In Sweden a common procedure manual is used nationwide, consisting of guidelines covering a wide range of nursing and medical procedures performed by the nursing staff. It is revised every fifth year. A recent enquiry to over 150 wards in some 100 hospitals demonstrated that the manual is widely accepted and used. In the other Scandinavian countries, guidelines and policies on a variety of infection control topics have been published.

Microprocessors for auditing the surveillance activity of the Infection Control Nurse

An important part of the Infection Control Nurse's activity in the UK is the laboratory-based surveillance of patients with infections that are known to be transmissible, i.e. of 'alert' organisms. We have replaced a manual 'T-card' system in which relevant patient information, microbiology and nursing notes are held on all patients yielding 'alert' organisms. The programme is menu driven, requires minimal coding and runs on a microprocessor with a hard disc. The programme enables surveillance patient information to be entered, edited, archived and recorded. Instant retrieval on screen or hard copy includes summarized or full displays of all patients on all wards, sorted by wards, organism, date or risk category. Archived data may be retrieved within minutes and this avoids having to interrogate the whole laboratory database overnight. To illustrate an additional use of the data stored, we analysed the surveillance activities of the Control of Infection Nurse for one year. Of 203 laboratory diagnoses requiring patient surveillance, 30% were viral infections, of which more than two-thirds were caused by hepatitis B virus; of the 142 bacterial isolates, 27% were multiply antibiotic-resistant Enterobacteriaceae, 25% Pseudomonas spp, 12% Salmonella spp., 9% methicillin-resistant Staphylococcus aureus (MRSA), 7% Group A streptococci and 8% meningococci. These isolates resulted in only four outbreaks involving nine patients or staff. This information has proved useful for auditing the nurse's activity and provides evidence for the cost-effectiveness of infection control.

Using guidelines, policies and standards: are we in control?

For the hospital microbiologist, the use of guidelines, policies and standards are an integral part of their professional duties. Both patient-related and laboratory activities involve awareness of specific procedures and the use of equipment or products which have been accepted as appropriate for a particular purpose. The means by which policy is formulated, the guidance available and the standards specified, differ widely from country to country. In the UK, there are few legal requirements or statutory regulations in this area. In consequence, there may be some differences in both the nature and the method of implementation of policies from hospital to hospital. There is increasing concern that legislation and standards produced not only by the UK but also by Europe may impose regulations on infection control and laboratory practice and in particular that such mandatory controls may have adverse effects. These are variously perceived as specifying inappropriate standards, inhibiting clinical freedom and stifling innovation. Such concern is embodied in the question 'are we in control?'.

Nursing priorities and the contribution of the International Federation of Infection Control

Much thought has been given to the role of the nurse in the future. Concern has been expressed that nurses are becoming preoccupied with technology which, despite the undoubted advantages, is diverting attention from simple prevention and control of infection measures. In countries with minimal resources the appointment of a full-time infection control nurse may not be feasible. Therefore, attempts should be made to train all nurses in the basic principles and practice of the prevention and control of nosocomial infection. This training should be designed to suit the needs of the individual country taking into account the culture, common infections and the patient population. The International Federation of Infection Control should be able to assist with this type of education. The nursing priorities for each country will vary and, whereas handwashing will remain a major priority, routine surveillance may be impracticable. The International Federation of Infection Control which was founded in 1987 is planning to take a lead in helping to set up organizations for infection control workers and to improve communications between organizations in different countries.