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BackgroundBased on the current status of the COVID-19 global pandemic, there is an urgent need to systematically evaluate the effectiveness of wearing masks to protect public health from COVID-19 infection.MethodsWe conducted a systematic review and meta-analysis to evaluate the effectiveness of using face masks to prevent the spread of SARS-CoV-2. Relevant articles were retrieved from PubMed, Web of Science, ScienceDirect, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI), VIP (Chinese) database. There were no language restrictions. This study was registered with PROSPERO under the number CRD42020211862.ResultsA total of 6 case-control studies were included. In general, wearing a mask was associated with a significantly reduced risk of COVID-19 infection (OR = 0.38, 95% CI = 0.21-0.69, I2 = 54.1%). Heterogeneity modifiers were investigated by subgroup analysis. For healthcare workers group, masks were shown to have a reduce risk of infection by nearly 70%. Studies in China showed a higher protective effect than other countries. Adjusted estimates and subgroup analyses showed similar findings.ConclusionsThe results of this systematic review and meta-analysis support the conclusion that wearing a mask could reduce the risk of COVID-19 infection.

Background A practice change of replacing peripheral intravenous (PIV) catheters when clinically indicated was implemented concurrent with a new PIV chlorhexidine securement dressing and existing IV care bundle to prevent the risk of infection. Purpose The purpose of this study was to examine the impact of replacing PIV catheters when clinically indicated on infection rates, nurse satisfaction, and costs in 3 high-risk, vulnerable hospital populations (Critical Care, Step Down, and Oncology units). Methods A retrospective review of 473 medical records, 737 peripheral IV sites, and 2 nursing surveys were completed after the practice change. Data were gathered related to PIV 1) catheter dwell times, 2) phlebitis rates, 3) catheter-related bloodstream infection rates, 4) skin tears related to the new PIV dressing, 5) costs, and 6) a nurse satisfaction survey. Results The average PIV dwell time was 7 days with a 3% phlebitis rate. Findings showed no catheter-related bloodstream infections and 2 (0.27%) skin tears. Cost savings of $17,100.00 in PIV supplies occurred one year after the practice change. Nurse satisfaction with the new dressing was 94.2%, with a 17-month sustainment of satisfaction. Conclusions The impact of the practice change and new dressing had positive quality outcomes on infection rate, nurse satisfaction, and costs in 3 vulnerable hospital populations.

Background Surveillance of health care–associated infections (HAIs) plays a key role in the hospital infection control program and reduction of HAIs. In India, most of the surveillance of HAIs is reported from private sector hospitals that do not depict the situation of government sector hospitals. Other studies do not confirm with the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) surveillance criterion, or deal with ventilator-associated pneumonia (VAP) instead of ventilator-associated event (VAE). The aim of this study was to identify the incidences of 3 device-associated HAIs (DA-HAIs) (VAE, central line–associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) by active surveillance using CDC's NHSN surveillance criteria and to identify the pathogens associated with these DA-HAIs. Methods This was a prospective surveillance study (January 2015-December 2016) conducted in an intensive care unit (ICU) of a large, tertiary care, government hospital situated in Delhi, India. Targeted surveillance was done as per the CDC's NHSN 2016 surveillance criteria. Results There were 343 patients admitted to the ICU that were included in the study. The surveillance data was reported over 3,755 patient days. A DA-HAIs attack rate of 20.1 per 100 admissions and incidence of 18.3 per 1,000 patient days was observed. The duration of use for each device for patients with DA-HAIs was significantly longer than for patients without DA-HAIs. The device utilization ratios of central line, ventilator, and urinary catheters were 0.57, 0.85, and 0.72, respectively. The crude excess length of stay for patients with DA-HAI was 13 days, and crude excess mortality rate was 11.8%. VAE, CLABSI, and CAUTI rates were 11.8, 7.4, and 9.7 per 1,000 device days, respectively. Among 69 DA-HAIs reported, pathogens could be identified for 49 DA-HAI cases. Klebsiella spp was the most common organism isolated, accounting 28.5% for all DA-HAI cases, followed by Enterococcus spp (24.4%). The most common organisms causing VAE, CAUTI, and CLABSI were Acinetobacter (6/15, 40%), Enterococcus spp (11/31, 35.4%), and Candida spp (5/19, 26.3%), respectively. Most of the gram-negative organisms were carbapenem resistant; however, none of the isolates were colistin resistant. Conclusions To reduce the risk of infection in hospitalized patients, DA-HAI surveillance is of primary importance because it effectively describes and addresses the importance and characteristics of the threatening situation created by DA-HAIs. The present surveillance shows high rates of ICU-onset DA-HAIs and high resistance patterns of organisms causing HAIs, representing a major risk to patient safety.

Background Few studies of occupational exposure (OE) to infectious risk among emergency medical personnel (EMP) or their use of personal protective equipment (PPE) have been conducted in the Republic of Korea. Objective To determine the status of OE to infectious risks and use of PPE. Methods A convenience sample of 907 questionnaires (response rate, 88.5%) was collected from September 1, 2014, to January 31, 2015, in 5 metropolitan Korean cities. Results Respiratory diseases were significantly prevalent (44.5%) and influenza (29.5%) was the most frequently reported illness. An exposure report was only made in 19.5% of cases. The primary reason for OE report noncompletion was the complexity of the reporting process (23.9%). A total of 365 participants reported OE to body fluids and blood (40.2%) with needlestick injury being the most frequent OE type (17.6%). More than 5 years of job experience (47.8%) (P

Background Infections among hemodialysis patients continues to be major causes of morbidity and mortality despite advances in the science of infection prevention. Many infections are potentially preventable, yet research suggests that evidence-based interventions are not uniformly practiced in dialysis settings. The purpose of the project was to reduce the risk of infection among hemodialysis patients in an outpatient dialysis clinic in upstate New York through the development of an enhanced patient safety culture. Methods A survey was used to assess the safety culture of a large outpatient dialysis program. A Comprehensive Unit-based Safety Program was instituted to enhance infection prevention practices. Evidence-based checklists and audit tools were used to track staff adherence to protocols. Results Scores on the survey were strongly correlated with bloodstream infection rates. Adherence to infection control standards improved when the End Stage Renal Disease Safety Program was implemented, with audits improving from 27%-82% of procedures performed correctly. Bloodstream infection rates decreased from 2.33-1.07 events per 100 patient months, and the standardized infection ratios decreased from 1.960-0.985 in the 12-months after implementation. Conclusions The Comprehensive Unit-based Safety Program model and implementation of the safety program may be effective in improving the culture of safety and adherence to evidence-based practices in hemodialysis. Enhanced patient safety culture is correlated with improved patient outcomes.

Background The intensive care unit (ICU) is considered the epicenter of infections, and patients in the ICU are at higher risk of infection because of their vulnerability, age, and lengthy hospitalization. Methods The ethnographic design has been used to describe, examine, and evaluate the policies and procedures that are implemented to prevent and control hospital-acquired infections (HAIs) in the medical ICU in King Abdullah University Hospital. In-depth semi-structured interviews with 23 participants supported by nonparticipant observation and document analysis were carried out to collect triangulated data. The themes and subthemes were developed through a software package and hand-coding procedure. Results Health care workers were aware but not fully engaged to prevent and control HAIs; nevertheless, they presented themselves as knowledgeable. Staff recognized the importance of involving family members and visitors. However, they had serious concern toward open visitation. The nurse to patient ratio was another challenge of infection prevention and control practices. The findings demonstrated that performing continuous prospective surveillance by highly qualified and trained staff can reduce the risk of endemic HAIs. Conclusions The study highlighted the importance of changing behaviors and practices of health care providers and visitors to improve adherence to infection prevention and control policies and practices.

Background In the postacute and long-term care setting, the practice of changing the indwelling urinary catheter large sterile drainage bag to a small-size leg drainage bag is intended to maintain a person's mobility, dignity, and comfort. There is scant evidence that assesses the impact of intermittent use of a leg bag on frequency of urinary tract infection since this breaks the closed urinary drainage system. Methods We reviewed research published between 1993 and 2014 for the answers to 20 practice questions developed by experts and long-term care clinicians on the risks and benefits, cleaning, connection, and storage of reusable leg bags. Results Seventeen of the 26 publications and studies provided varying advice on the risk of breaking the closed system and on practices for changing, disinfecting, and storing leg bags between uses. Thirteen of 20 practice questions were answered by ≥1 publications, few of which were evidence based. Conclusions We identified the existence of low-level evidence that leg bags pose no evident, disproportionate risk of infection compared with maintaining a closed system. The lack of uniformity in evidence in the literature suggests aseptic technique should guide practice. Available evidence suggests that aseptic technique should guide practice.

BACKGROUND Gaining access to educational resources supports knowledge development for all individuals across the continuum of care. A dedicated multimedia education center (MEC) serves inpatients, outpatients, and the surrounding community at an acute inpatient rehabilitation facility by lending paper-based resources such as books. Resultantly, inpatients and their caregivers can take the paper-based resources back to inpatient rooms for review. Leadership from the MEC sought guidance from the infection prevention team on best practices for lending paper-based resources to all inpatients as the resources could serve as potential sources for infection transmission when handled by inpatients on isolation precautions or when handled by the caregivers of such patients. METHODS The infection prevention team and medical librarian conducted a literature search to determine the risk of organism transmission on paper and the feasibility of lending paper-based resources to inpatients on isolation precautions. The medical librarian also consulted several health science libraries for comparison and guidance of library circulation policies with patients. RESULTS It was determined all inpatients and their caregivers could continue to bring paper-based resources back to inpatient rooms. Additional interventions to reduce infection transmission risk included education of the MEC's staff on low level disinfection, the creation of a bookmark with infection prevention messaging, the application of polyester film covers to hardcover books, and the application of polypropylene covers to softcover books. The MEC also provided plastic carriers, which displayed messaging promoting hand hygiene, for each paper-based resource to serve as a barrier in areas of potential surface contact contamination. CONCLUSIONS This collaboration between the infection prevention team and the MEC's team supports the continued lending of paper-based resources to all inpatients and their caregivers within the facility. Being able to continue to lend books improves patient satisfaction with a normalcy that reinforces condition information, health literacy, and holistic well-being.

Background This study aimed to examine the knowledge, attitudes, and practices towards the use of facemasks among hospital-based health care workers (HCWs) in Hanoi, Vietnam. Methods A qualitative study incorporating 20 focus groups was conducted between August 2010 and May 2011. HCWs from 7 hospitals in Vietnam were invited to participate. Results Issues associated with the availability of facemasks (medical and cloth masks) and respirators was the strongest theme to emerge from the discussion. Participants reported that it is not unusual for some types of facemasks to be unavailable during nonemergency periods. It was highlighted that the use of facemasks and respirators is not continuous, but rather is limited to selected situations, locations, and patients. Reuse of facemasks and respirators is also common in some settings. Finally, some participants reported believing that the reuse of facemasks, particularly cloth masks, is safe, whereas others believed that the reuse of masks put staff at risk of infection. Conclusions In low and middle-income countries, access to appropriate levels of personal protective equipment may be restricted owing to competing demands for funding in hospital settings. It is important that issues around reuse and extended use of medical masks/respirators and decontamination of cloth masks are addressed in policy documents to minimize the risk of infection., Highlights • Knowledge, attitudes, and practices around the use of facemasks and respirators were examined. • Views were mixed regarding the protection afforded by various types of facemasks. • The availability of products was the main issue highlighted by participants. • Facemask use is limited to selected situations, locations, and types of patients. • Extended use and reuse of facemasks is a common practice in low-resource settings.

Background The risk of infection, including surgical site infection (SSI), after spine surgery has increased due to aging and more immunocompromised hosts. An infection control team (ICT) is responsible for management of health care-associated infections at our institution. Methods The study subjects were 40 patients (18 men and 22 women with an average age of 54 years) referred to the ICT after spine surgery since 2010. Pathogenic bacteria and treatment in these cases were reviewed. Results Collaboration with the ICT involved guidance on use of antibiotics for infection in 30 patients (16 SSI and 14 non-SSI) and a search for the infection focus for fever of unknown origin in 10 patients (7 patients were found to have urinary tract infections and 2 patients were found to have pneumonia). The detection rate of causative bacteria in ICT consultation was 88% (35 out of 40 patients). SSI patients with instrumentation involved had a significantly higher rate of methicillin-resistant Staphylococcus aureus infection compared with those without instrumentation (42% vs 13%; P Discussion All cases of SSI with instrumentation involved were cured by ICT support without removal of instrumentation. Early assistance from the ICT was important for prevention of worsening of methicillin-resistant S aureus infection. Conclusions Collaboration with the ICT was helpful for detection of pathogenic bacteria and allowed appropriate use of antibiotics at an early stage.

Background Home health emergency management plans are essential and must address infection prevention issues. Few home health planning documents exist, and many of those that have been developed do not address infection prevention issues, combine them with non–infection prevention issues, or are disease/event-specific. An all-encompassing home health infection prevention emergency management planning guide is needed. Methods A literature review and Internet search were conducted in the summer of 2010, and data from relevant sources were extracted. A spreadsheet was created delineating home health emergency management plan components related to infection prevention. Results Of the sources screened, 41 were deemed relevant. Ten domains were identified: (1) having a plan; (2) assessing agency readiness; (3) having infection prevention policies and procedures; (4) having occupational health policies and procedures; (5) conducting surveillance and triage; (6) reporting incidents, having a communication plan, and managing information; (7) addressing surge capacity issues; (8) having anti-infective therapy and/or vaccines; (9) providing infection prevention education; and (10) managing water and waste management issues. Conclusion Home health disaster planners or managers should use this article as an assessment tool for evaluating their agency’s emergency management plan and for developing policies and procedures that will decrease the risk of infection transmission during a mass casualty event.

Background Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as important health care-associated pathogens. Colonization precedes infection but the risk of developing infection amongst those colonized with CRE is not clear. Methods We searched multiple databases for studies reporting rates of CRE-colonized patients subsequently developing infection. Results Ten studies fulfilled our inclusion criteria, including 1,806 patients used in our analysis. All studies were observational and conducted among adult inpatients. The cumulative rate of infection was 16.5% in our study. The most common site of infection was the lung, identified in half of patients, followed in decreasing frequency by urinary tract; primary bloodstream; and skin and soft tissue, including surgical sites. Colonization or infection by CRE prolonged stay and was associated with a 10% overall mortality in our analysis. Conclusion Our study results suggest an overall 16.5% risk of infection with CRE amongst patients colonized with CRE. Given the high mortality rate observed with CRE infection and the difficulty in treating these infections, research to investigate and develop strategies to eliminate the colonization state are needed.

This review demonstrates that funeral service professionals (FSPs) have a risk of exposure to bacterial and viral pathogens as well as to prion-mediated diseases. It reveals a lack of published studies focusing on the implementation and effectiveness of infection control policies for this occupational group as well as the difficulty involved in determining actual infection rates related to workplace exposure events. Possible reasons for this lack of data include the categorization of these workers by the Bureau of Labor Statistics Standard Occupational Classification System as service providers rather than health care professionals.

Proper hand hygiene has long been recognized as a primary tool in reducing transmission of health care-acquired infections. Compliance with recommended practices and an increase in the frequency of hand hygiene can have a negative impact on skin condition. Poor skin condition can result in reduced compliance with hand hygiene guidelines. In addition to reduced compliance with proper hand hygiene, deterioration in skin condition leads to reduced barrier function of the skin, changes in skin microflora, and increased shedding of skin squames. Thus, poor skin condition can increase the risk of infection, increase costs to the facility, and reduce the quality of life for the health care worker. To address the problem of skin irritation and its link to low compliance to hand hygiene practices, the Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene for Health Care Settings recommends that hand hygiene agents should be well accepted, well tolerated, and formulated to minimize irritancy. Sophisticated formulation technologies and the proper selection of ingredients can provide products that encourage hand hygiene compliance through pleasing aesthetic properties and by overcoming the damaging effects of hand hygiene practices.

Background Traditional infection control policies have focused on engineering controls, specific protocols, and personal protective equipment (PPE). In light of the variable success in protecting health care workers (HCWs) from Severe Acute Respiratory Syndrome (SARS) in 2003, organizational and individual factors related to self-protective behavior in health care settings may also play an important role. Methods A critical review of the literature was conducted, directed at understanding what organizational and individual factors are important in protecting HCWs from infectious diseases at work. Results Organizational factors, such as a positive safety climate, have been associated with increased HCW adherence to universal precautions. There is some evidence that appropriate training of HCWs could be effective in changing HCW behavior if appropriate follow-up is applied. Very little research into these factors has been conducted with regard to preventing exposures to respiratory tract pathogens, but there was evidence from the SARS outbreaks that training programs and the availability of adequate PPE were associated with a decrease risk of infection. Conclusion Variations in organizational and individual factors can explain much of the variations in self-protective behavior in health care settings. It is likely that these factors were also important determinants during the SARS outbreaks, but they have not been extensively studied.

Background Removing unnecessary central lines is a critical step in reducing risk of infection and was 1 focus of a national quality improvement collaborative. We examined if participating adult intensive care units (ICUs) reduced central line days during the project period compared with the period before implementation of the "On the CUSP: Stop BSI" program. Methods We used a linear regression model on a total of 9,225 ICU-quarters of data to examine the effect of the intervention on total central line days of ICU participants in the national project (2008-2012), adjusting for ICU type, hospital characteristics, project cohort, season, and accounting for repeated measures on the same unit and clustering within states using random intercepts. Results The regression results showed no significant change in preintervention quarters. However, significant decreases in total line days started during quarter 4 after intervention and differences were sustained through quarter 6. There were 4% fewer central line catheter days reported at the project's conclusion compared with the baseline. Conclusions To keep central lines from doing patients harm, clinicians must assess the need for lines and remove them as soon as clinically advisable to halt the possibility of infection via the line. Effective communication and empowering providers to identify unnecessarily extended use of central lines could accelerate the realization, someday, of eliminating central line associated bloodstream infections in ICUs.

Although health care-associated methicillin resistant staphylococcus aureus and clostridium difficile strains are primarily a risk to hospital patients, people are increasingly concerned about their potential to circulate in the community and the home. They are thus looking for support in order to understand the extent of the risk, and guidance on how to deal with situations where preventing infection from these species becomes their responsibility. A further concern are the community-acquired MRSA and C. difficile strains, and other antibiotic resistant strains circulating in the community such as the Extended-spectrum beta-lactamase (ESBL) Escherichia coli. In response to concerns about such organisms in the community, the International Scientific Forum on Home Hygiene has produced a report evaluating MRSA, C. difficile, and ESBL-producing E. coli from a community viewpoint. The report summarizes what is known about their prevalence in the community, their mode of transmission in the home, and the extent to which they represent a risk. It also includes "advice sheets" giving practical guidance on what to do when there is a risk of infection transmission in the home.

The overall risk of infection from medical devices is very low, but high infection transmission rates have been related to inadequate reprocessing of arthroscopic shavers and flexible duodenoscopes. Monitoring of manual and automated cleaning is needed to ensure that inadequately cleaned medical devices are recleaned prior to disinfection or sterilization.

This study examined risk factors for extended-spectrum β-lactamase (ESBL) infection in patients at the University of Minnesota Medical Center, Fairview.Laboratory-confirmed cases of ESBL infection between January 2005 and June 2008 were evaluated in a case-control study. Risk factors were assessed based on source of infection, either health facility-acquired (HFA) or community-acquired (CA). Cases were identified through hospital infection control department ESBL surveillance records. Controls were selected from the patient population present within the same facility as the cases.Our evaluation revealed that 60.6% of the health facility-acquired ESBL infections were due to Escherichia coli. Risk factors included previous antibiotic use (odds ratio [OR], 23.7; P.0001), recurrent urinary tract infection (OR, 7.0; P.022), venous or arterial catheter use (OR, 12.5; P.0001), and long-term care facility residence (OR, 7.7; P = .043). For each day of antibiotic use, the risk of infection increased by 2%. Similarly, 76.5% of the community-acquired ESBL infections were due to E coli. Risk factors included previous antibiotic use (OR, 5.1; P = .0005) and recurrent urinary tract infection (OR, 9.1; P = .0098). For each day of antibiotic use, the risk of infection increased by 1%.Developing policies and methods to promote good antibiotic stewardship and reduce the incidence of urinary tract infections will decrease the risk of ESBL infection.

Infections with Pseudomonas aeruginosa and other waterborne pathogens (WBPs) are major contributors to serious morbidity and mortality in hospitals. We sought to determine whether point-of-use (POU) water filtration might result in decreased risk of infection in the subacute care unit (SACU) of a 208-bed medical center. Our findings indicate that POU water filtration can significantly and cost-effectively reduce colonization of and infection with WBPs, including ventilator-associated pneumonia, in an SACU.

Background The major concern after occupational exposures is the possible transmission of blood-borne pathogens, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study was undertaken to evaluate the risk of infection after exposure to blood or body fluids of an unknown or an HBV-, HCV-, and HIV-negative source and to determine the epidemiologic characteristics of these incidents in health care workers. Methods The survey was conducted over a 6-year period at a university hospital in Turkey, using a questionnaire to elicit demographic and epidemiologic information. Serologic tests for HBV, HCV, and HIV were performed and repeated after 3 months. Results Of the 449 incidents, complete follow-up was achieved in 320 (71.3%), and no seroconvertion was observed for HBV, HCV and HIV. Most of the incidents occurred in medical (34.7%) and surgical (25.4%) work areas. The most frequent type of exposure was percutaneous injury (94%), most commonly caused by handling of garbage bags (58.4%), needle recapping (16.5%), and invasive interventions (13.4%). Conclusion Infection risk seems to be extremely low for HCV and HIV, because of low endemicity, and for HBV in groups immunized against HBV.

Background Universal Precautions (UPs) and more recently Standard Precautions have been widely promoted in high-income countries to protect health care workers (HCWs) from occupational exposure to blood and the consequent risk of infection with bloodborne pathogens. In low-income countries, the situation is very different: UPs are often practiced partially, if at all, thereby exposing the HCWs to unnecessary risk of infection. The aim of this study is to describe rural north Indian HCWs knowledge and understanding of UPs and identify predictors of compliance to target intervention programs appropriately. Methods A cross-sectional survey was undertaken, involving 266 HCWs (response rate, 87%) from 7 rural north Indian health care settings. Information was gathered regarding compliance with UPs and a range of other relevant variables that potentially influence compliance (eg, demographic information, perception of risk, knowledge of bloodborne pathogen transmission, perception of safety climate, and barriers to safe practice). Results Knowledge and understanding of UPs were partial, and UPs compliance was suboptimal, eg, only 32% wore eye protection when indicated, and 40% recapped needles at least sometimes. After controlling for confounding, compliance with UPs was associated with being in the job for a longer period, knowledge of bloodborne pathogen transmission, perceiving fewer barriers to safe practice and a strong commitment to workplace safety climate. Conclusion Interventions to improve UPs compliance among HCWs in rural north India need to address not only their knowledge and understanding but also the safety climate created by the organizations that employ them.

measures were established simultaneously. As a result, we were unable to determine the specific impact of the education towards the reduction. We did however recognize that patients better understood their MRSA status and risk of infection. Additionally, this effort was a patient satisfier as evidenced by positive patient and family comments. Finally, we believe that this process will enhance our efforts towards The Joint Commission's national patient safety goal of patient education on surgical site infection reduction. Lesson Learned: All patients meeting the criteria were not educated. Outpatient surgery patients were discharged before the IP could see them. Some patients were medicated for pain while

Background: To measure rates of incisional surgical site infection (ISSI) after cesarean section (CS) and to assess risks for infection. Methods: Prospective surveillance for ISSI at a 540-bed hospital in Saudi Arabia by using Centers for Disease Control and Prevention definitions for infection and the National Nosocomial Infections Surveillance (NNIS) system risk index. Results: Seven hundred thirty-five CSs were studied from September 1998 to July 1999; 72% were emergency procedures, despite a 95% rate of antenatal care. The overall ISSI rate was 2.8% (95% confidence interval [CI], 1.7%-4.3%). The rate for NNIS risk category 0 was 2.4% (95% CI, 1.3%-4.2%; n=536) and for category 1 was 4.1% (95% CI, 1.8%-8.6%; n=170). In the multivariate analysis, the only independent risks for ISSI were duration of surgery (OR = 1.01; 95% CI, 1.00-1.03; P =.02) and no antibiotic prophylaxis (OR = 3.09; 95% CI, 1.10-9.11; P =.04). Antibiotic prophylaxis was inconsistently administered among both emergency and elective CS. Infection control procedures were inadequate in the obstetric suite operating room. Conclusions: Despite deficient infection control practices in the setting described, ISSI rates after CS were judged "acceptable" compared with NNIS benchmark rates. This was attributed to prescribing antibiotic prophylaxis for patients at low risk as well as high risk of infection. (AJIC Am J Infect Control 2001;29:85-8)

Objectives: To evaluate the ambulatory surgical site infection rate and risk factors associated with surgical site infection. Methods: We conducted a case-control analysis of all ambulatory surgeries between January 1, 1993, and December 31, 1997. The frequency of surgical site infection per 100 surgeries was calculated. The odds ratio (OR) was estimated by using logistic regression analysis. Setting: A 140-bed tertiary-care teaching hospital for adult patients with cancer. Results: The study followed 1350 outpatient surgeries. Thirty-eight patients had a surgical site infection (rate per 100 surgeries: 2.8). The risk factors statistically associated with surgical site infection were postoperative antibiotics (OR = 7.5; 95% CI, 2.5-23.0), and surgical time >35 minutes (OR = 2.4; 95% CI, 1.1-5.5). Conclusions: The surgical site infection rate for same-day surgery at our hospital is within the limits reported in the literature and below the rates reported previously for inpatient surgeries at our hospital. Full review of medical records and microbiology reports at day 30 allowed us to identify infections that otherwise would have been missed. Postoperative antibiotics may increase the risk of infection. (AJIC Am J Infect Control 2001;29:99-103)

The Association for Professionals in Infection Control and Epidemiology, Inc, is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation. This learner-paced study package is designated for 1.1 contact hours. APIC's California nursing provider number is CEP 7146. This continuing medical laboratory education activity is recognized by the American Society of Clinical Pathologists as meeting the criteria for 1 CMLE credit hour. ASCP CMLE credit hours are acceptable to meet the continuing education requirements for the ASCP Board of Registry Continuing Competence Recognition Program. (See the instructions and examination at the end of the article.)Infectious diseases represent a major cause of morbidity and mortality in immunocompromised patients. Infectious complications are often predictable and may be preventable. This article is an overview of practical considerations in the care of immunocompromised patients. Recognizing the compromised host, identifying and correcting risk factors in advance, and reducing sources of infection all play a role in prevention. Topics were chosen to include the areas of care that differ from the immune competent patient, such as diet, pet therapy, handwashing, immunizations, augmentation of host resistance, prevention of pneumonia, and antibiotic prophylaxis. National practice guidelines are cited when possible; evidence-based literature review and experience are applied to situations lacking consensus statements. Treatment decisions are made in areas for which information is often incomplete. A systematic approach to care of the immunocompromised host, tailored to the individual patient's needs, should reduce the risk of infection.

BACKGROUND/OBJECTIVES: During a bioterrorism attack in which infectious agents are used, nurses will provide direct care to ill and/or infected patients. Nurses have expressed concerns regarding possible transmission of microorganisms to their families and loved ones. There are few studies on nurses in disaster situations and the psychological stressors put on them related to the risk of infection to nurses and subsequent transmission to their families of others. The aim of this study is to identify beliefs, concerns, and feelings of nurses who work in hospitals designated as receiving sites for victims of a bioterrorism attack. METHODS: A qualitative descriptive approach with focus groups was used. A total of 33 nurses from hospitals designated as bioterrorism-receiving sites participated in focus groups in 2003. Data from audiotapes were analyzed; categories and themes were identified. RESULTS: Fear of abandonment was an overarching theme. Nurses believed they would be functioning in chaotic clinical settings, without a clear chain of command, and with some colleagues refusing to work. Limited access to protective equipment, risk of being infected with a deadly disease, unmanageable numbers of patients, and a potential risk of being assaulted for their personal protective equipment resulted in the sense that they would not be functioning in safe clinical environments. Loss of freedom to leave the hospital and fears that hospitals would not provide treatment and care to them or their families should they become ill as a result of providing care to infected patients also resulted in a sense of abandonment. CONCLUSIONS: Although the nurses in this study were in hospitals with comprehensive bioterrorism plans and resource materials, they feared they would not have readily accessible resources (human and material) to cope with the surge of patients during a bioterrorism event. Bioterrorism readiness plans should include a systematic assessment of the needs, concerns, and fears of the nursing personnel expected to provide care to infected patients. Using the assessment results, specific interventions could be incorporated into the plan to improve a sense of safety and control and facilitate nurses coping in the clinical environment.

ISSUE: Each year, over 8000 medical devices enter the U.S. market. A small number of these devices fall within the high-risk (class III) category, requiring careful FDA review. The explosive growth of the biomedical device industry has lead to several problematic issues for infection control practitioners, including implementation of appropriate surveillance strategies and development of effective interventional practices reducing the risk of infection. PROJECT: This project was developed as an educational exhibit, discussing the microbial etiology, pathogenesis, and risk factors associated with infection in biomedical devices. The exhibit would serve as a focus for discussion of device-related infections in both surgical and critical-care patients. In addition to identifying the scientific basis for infection, the exhibit was developed as a vehicle for reviewing specific evidence-based strategies for reducing device-associated infectious complications. RESULTS: The exhibit was presented at hospital-staff venues involving nursing and medical/surgical clinical practitioners. An effort was made to incorporate specific patient-care episodes within selected case discussions. Following review of this exhibit, the healthcare professionals were able to: 1) identify major microbial pathogens associated with biomedical device-associated infections in high-risk patients, 2) discuss the microbial pathogenesis and risk factors associated with device-associated infections and 3) identify strategies for prevention and management of biomedical device-associated infections. LESSONS LEARNED: The rapid increase in the development and implementation of new invasive biomedical technologies requires that infection control practitioners become familiar with these innovative devices, the risk factors predisposing infection, and appropriate interventional strategies to reduce the risk of infection in surgical/critical care patient populations.

Introduction: The Infection Control Unit at our 950-bed (two-site) teaching facility is a member of the National Nosocomial Infection Surveillance (NNIS) system. Targeted surveillance, using NNIS criteria by five infection control practitioners has been performed in surgery and in the medical, surgical, pediatric, and neonatal intensive care units (ICUs). OBJECTIVES: Our comprehensive surveillance program is to monitor high-risk, high-volume surgical procedures; to monitor compliance with surgical prophylactic antibiotic guidelines; to monitor high-risk, compromised patients in the ICU setting; to reduce the incidence of hospital-associated infections by feedback of data to healthcare providers; to compare results from year to year; and to initiate quality improvement (QI) strategies. RESULTS: Surgical site infection (SSI) rates during the past 4 years of vascular, neurosurgery, and orthopedic surgery has ranged from 0% to 3%. A cluster of SSIs during 4 months of cardiothoracic (CT) surveillance contributed to a 9.4% SSI rate in 2000. Following QI strategies, subsequent annual CT SSI rates ranged from 0.16% to 4%. Excellent compliance with selection and timing of prophylactic antibiotic agents was identified during surgical surveillance. Post-op antibiotic dosing has been targeted for QI initiatives. Inappropriate use of vancomycin as a prophylactic agent by CT surgery decreased from 25% in 1995 to 5% in 1996, with subsequent rates not exceeding 2%. Ventilator-associated pneumonia rates (VAPR) during the last four surveillance periods in the surgical ICU ranged from 21 to 29 per 1000 ventilator days. Initiatives were implemented to reduce these rates. NICU surveillance has documented that neonates in the birthweight category (BWC) 1–1000 gm are at higher risk of infection. From January through June 2003, 17 of 19 NICU infections occurred in the BWC 1–1000 gm. CONCLUSION: The effectiveness of our surveillance and prevention program is demonstrated by an overall decrease in hospital-associated infections and the ability to identify areas for improvement. This surveillance program with ongoing data feedback and quality improvement initiatives has contributed to our patient safety initiatives.

Health care workers have expressed concern regarding the risk of infection from patients with AIDS. Much less attention is given to the possibility of exposure to patients infected with the hepatitis B virus. This article reviews the data on the probability of exposure to HIV or hepatitis B and subsequent seroconversion, as well as the mortality and morbidity rates associated with both viruses. A decision-analytic analysis of the occupational risk for HIV and hepatitis B is also presented. This model indicates that quality-adjusted loss in life expectancy is greater after percutaneous exposure to a patient who is seropositive for the hepatitis B e antigen than after exposure to a patient with symptomatic HIV infection.

Background: Body substance precautions was the name given to the body substance isolation-based infection control system that was introduced in January 1990 at a Canadian university hospital with 650 acute care beds and 570 long-term care beds. When the body substance precautions system was begun, traditional category-specific isolation was discontinued. Methods: After 2 years, we reviewed the incidence of several types of nosocomial infections and the frequency of isolation of hospital strains of bacteria before and after the introduction of body substance precautions to find out whether this system was as effective as the previous system of infection control. Results: Most nosocomial infections did not increase. There was another likely cause for the only one that did. For many years, we had isolated patients infected or colonized by hospital bacteria, limiting their spread throughout the institution. Body substance precautions proved equally effective in doing this. Conclusion: Our results to date therefore indicate that the body substance precautions system was as successful as category-specific isolation used with other standard infection control techniques in maintaining low rates of nosocomial infections and in controlling the dissemination of hospital strains of bacteria in our institution. Body substance precautions provided a satisfactory alternative to universal precautions and traditional isolation categories for the protection of health care workers against the risk of infection by blood-borne viruses.

Home care accreditation standards from the Joint Commission on the Accreditation of Healthcare Organizations require a system for recording, reporting, and evaluating infections related to the services provided. We developed a surveillance system for home care related infections to meet these requirements. Our goal was to reduce the risk of infection and improve the quality of care. Definitions for home care-related infections were adapted from the Centers for Disease Control's 1988 definitions for nosocomial infections. The home health care staff assisted by reporting clients with possible infections. Surveillance was completed by the infection control coordinator. On the basis of our findings in the population, we concentrated our efforts on reducing the risk of catheter-related genitourinary infection in our home care patients.

Surveillance for hospital-acquired infections is required in U.S. hospitals, and statistical methods have been used to predict the risk of infection. We used the HELP ( H ealth E valuation through L ogical P rocessing) Hospital Information System at LDS Hospital to develop computerized methods to identify and verify hospital-acquired infections. The criteria for hospital-acquired infections are standardized and based on the guidelines of the Study of the Efficacy of Nosocomial Infection Control and the Centers for Disease Control. The computer algorithms are automatically activated when key items of information, such as microbiology results, are reported. Computer surveillance identified more hospital-acquired infections than did traditional methods and has replaced manual surveillance in our 520-bed hospital. Data on verified hospital-acquired infections are electronically transferred to a microcomputer to facilitate outbreak investigation and the generation of reports on infection rates. Recently, we used the HELP system to employ statistical methods to automatically identify high-risk patients. Patient data from more than 6000 patients were used to develop a high-risk equation. Stepwise logistic regression identified 10 risk factors for nosocomial infection. The HELP system now uses this logistic-regression equation to monitor and determine the risk status for all hospitalized patients each day. The computer notifies infection control practitioners each morning of patients who are newly classified as being at high risk. Of 605 hospital-acquired infections during a 6-month period, 472 (78%) occurred in high-risk patients, and 380 (63%) were predicted before the onset of infection. Computerized regression equations to identify patients at risk of having hospital-acquired infections can help focus prevention efforts.

ISSUE: Our institution has had a standard practice in place since 1996 to ensure that during a time of renovation, construction and demolition, hospital occupants are protected from mold and other potentially harmful environmental organisms. The Standard Practice, written in conjunction with the Center for Disease Control and Prevention Guidelines for Environmental Infection Control in Health-Care Facilities has been continually improved and refined over time. In our institution, each construction or repair activity is categorized as a Class I or a Class II risk based entirely on whether or not the activities significantly increase the risk of infection. The use of only two classes leans heavily towards protection and was based on the high number of immune compromised patients who traverse our hallways on any given day.

ISSUE: In Surgical Trauma ICU (SICU), the rate of central line related bloodstream infections (CRBSI), as defined by CDC, was at or above the National Nosocomial Infection Surveillance System(NNIS) mean for several sucessive quarters. There is strong evidence that use of full sterile barriers and chlorhexidine skip prep during insertion of central lines reduces the risk of infection. In an effort to facilitate best practices, a “Barrier Kit” was designed with all necessary supplies and was to be provided to each physician by nursing personnel assisting. These are available in all clinical units. A Central Venous Catheter Insertion form was created to monitor several aspects of central line insertion including use of maximum sterile barriers and chlorhexidine skin prep. These were designed to allow physicians to use them as the procedure note as well. If the physician chose to document the procedure elsewhere, the nurse could complete monitoring information. To facilitate ussage, Materials Management attached a form to each central line kit before delivery to patient care units. Medical Staff and nursing were educated. Compliance with completion of the form was poor and documentation of appropriate barriers and skin prep was less than 100% on completed forms. PROJECT: In April, 2005, the new medical director of SICU accepted the challenge of reducing this infection rate. First, she created a policy on the insertion procedure and presented it for approvel by appropriate medical staff committees. Included in the procedure, nursing personnel assisting the physician were to remind the physician inserting the line if policy was not being followed and complete the form if the physician chose not to. In SICU, if a physician didn't comply, she was to be notified and would discuss policy with that physician. Medical Directors of all units were encouraged to adopt a similar procedure. In SICU a cart was stocked with frequently used central line kits and all needed supplies. She supported a trial of a timed release chlorhexidine gluconate dressing in SICU, and when complete, use of the product on all central lines in the facility. RESULTS: In the four preceeding quarters, the average CRBSI rate in surgical ICU had been 6.8%. In the two quarters following her intervention, there were no CRBSI in the unit. LESSONS LEARNED: Physician involvement and willingness to provide feedback to other physicians is vital in process improvements that require a change in physician practice.

We studied data from 500 health care workers to answer the question: Are health care workers at risk for infection during an outbreak of nosocomial Legionnaires' disease? These workers were employed at a hospital where eight cases of nosocomial Legionella pneumophila serogroup 1 pneumonia occurred over a 4-week period. The source was potable water. Acute-phase blood samples were collected on the day the water supply was decontaminated, convalescent samples were collected 4 to 6 weeks later from 373 subjects, and a single serum sample was obtained from an additional 127 subjects. Antibody titers to L. pneumophila were determined by an indirect immunofluorescent antibody (IFA) technique and by a microagglutination assay with the epidemic strain as the test antigen. Subjects who had an IFA titer of greater than or equal to 1:256 were retested with an anti-human IgM conjugate. None of the 373 health care workers had a fourfold rise in antibody titer. The geometric mean antibody titer of 73.8 for the 500 health care workers was significantly higher than that of 68.1 for 976 blood donors (p less than 0.01). Only 2.4% had recent infection as evidenced by a microagglutination test, despite the fact that 84% were susceptible. We conclude that in the setting of a short-term outbreak of Legionnaires' disease caused by contaminated potable water the risk of infection among health care workers is low: 2.4% or less.

The prevalence of tuberculous infection (i.e., reactions greater than or equal to 10 mm to 5 tuberculin units of purified protein derivative; Mantoux skin test) was determined among employees of 10 hospitals located throughout the United States. The risk of infection was strongly associated with age and race/ethnicity; nonwhites and older individuals were at higher risk. The prevalence of infection among hospitals varied threefold, from 7.0% to 21.4%. After adjusting for differences in the characteristics of employee groups (e.g., age, race/ethnicity, and sex), twofold differences among hospitals were still observed. The occurrence of "boosting" on retest was also studied. Among the different hospitals, the rate varied from 0% to nearly 10%. Race/ethnicity and age were the characteristics most closely associated with boosting. From our data and other data in the literature, we conclude that all hospitals should use two-step testing at least on a pilot basis. Our calculations suggest that two-step testing for employees over 35 years of age could be cost effective if the booster rate is greater than 1% of the employees retested.

Bacterial endophthalmitis is a rare but devastating disease. The risk of infection after intraocular surgery has declined from about 10% at the turn of the century to about 1% in the 1950s and about 0.35% at present.’ Most reports, however, stress that infection incidence rates are not easily established and not easily interpretable,‘*’ and actual rates may be higher. Intraocular prosthetic lens implantation has become an increasingly popular procedure in the therapy of patients with cataracts. This national trend is reflected by the 100% per year increase of this procedure at our institution in each of the past 3 years. Before May 1984, we had documented two hospital-acquired eye infections after cataract removal and lens implantation in 707 patients (0.3%). The Department of Ophthalmology called our attention to two cases of postimplant endophthalmitis in June 1984. Intensive hospital and postdischarge surveillance identified a total of six cases of bacterial endophthalmitis in 456 patients (1.3%) during the next 5 months. This report summarizes our epidemiologic investigations and steps taken to control this outbreak.

A 4-month prospective medical records review was done to investigate the occurrence of central venous catheter-related infections. Nineteen percent of the patients developed a catheter-related infection, either local infection at the insertion site (8.9%) or septicemia (10.0%). There were 7.5 catheter-related infections per 1000 catheter-use days. The infection rate was five times greater in patients with Hickman catheters than in those with Broviac catheters (p = 0.01). Analysis by the life table approach produced a linear curve of catheter-related infection over time, suggesting a constant dialy risk of catheter-related infection.

A survey of discharged patients revealed that 62% of respondents were aware of the risk of nosocomial infection before they received the survey. Of the respondents 12.4% said they had suffered from a nosocomial infection; 70% were concerned about their risk of acquiring a nosocomial infection in the future; 83% believed nosocomial infections were preventable; 69% said the risk of acquiring a nosocomial infection was never explained to them during hospitalization; and 62% were dissatisfied with the information that hospitals and the medical community provided concerning the risk of nosocomial infections. Fifty-seven percent were willing to pay an extra $7.14 mean per diem charge to enhance the hospital's infection control program if this payment would lower their risk of infection. This survey suggests that the subset of responding patients want to know more about the risk of nosocomial infections, and they are willing to pay for more resources to be channeled into effective infection control programs.