![[Return to article]](../../../images/backbutton.gif){kind=small}
1. Author Larson E
Title Compliance with isolation technique.
Source Am J Infect Control 1983 Dec;11(6): p221-5
ISSN 0196-6553
AbstractWe found that compliance with isolation precautions was less than optimal. It appeared that personnel were unaware of instances in which they had become contaminated. Increasing such awareness is indicated as an incentive to improve compliance. In addition, there were two areas in which education seemed to be indicated: for housekeeping staff to assure that they understood the need to contain infectious organisms within the isolation room as well as protecting themselves and for all personnel to identify the need for handwashing after removing gloves. Others have found that a careful monitoring program by an ICP can significantly reduce the overuse, but not underuse, of isolation. Such monitoring leads to considerable cost savings. We recommend that compliance with isolation technique be monitored on a periodic basis in other acute care institutions.
2. Author Albert RK; Condie F
Title Hand-washing patterns in medical intensive-care units.
Source N Engl J Med 1981 Jun 11;304(24): p1465-6
ISSN 0028-4793
3. Author Mayer JA; Dubbert PM; Miller M; Burkett PA; Chapman SW
Title Increasing handwashing in an intensive care unit.
Source Infect Control 1986 May;7(5): p259-62
ISSN 0195-9417
AbstractThe present study provides the first systematic evaluation of strategies for increasing handwashing of hospital staff. Nursing staff on two intensive care units (ICUs) were observed over a 3-month period. After baseline observations, two interventions were implemented on the experimental unit: changing to an emollient handwashing agent, and providing feedback to staff about the frequency of handwashing. Feedback focused on the previous day's handwashing following completed patient contacts, interrupted patient contacts, and critical procedures. No increase in handwashing was observed following introduction of the emollient soap. However, when feedback was provided on the experimental ICU, handwashing following completed patient contacts (the major dependent measure) increased to 92%, and was significantly higher than handwashing on the control unit. Follow-up observations suggested that compliance on the experimental unit appeared to return to baseline levels.
4. Author Stamm WE; Weinstein RA; Dixon RE
Title Comparison of endemic and epidemic nosocomial infections.
Source Am J Med 1981 Feb;70(2): p393-7
ISSN 0002-9343
AbstractEpidemics account for a small proportion of preventable infections acquired in hospitals, but they have been important in defining sources, modes of spread, and methods for prevention and control of nosocomial infections. To characterize hospital-based epidemics, 265 consecutive outbreaks investigated by the Center for Disease Control between 1956 and 1979 were reviewed. Pseudoepidemics were found in 11 percent of the investigations, most often resulting from errors in processing microbiologic specimens or from surveillance artifacts. In 223 actual epidemics, the pathogens most commonly involved were Staphylococcus aureus (19 percent), tribe Klebsielleae (14 percent), Salmonella (13 percent), hepatitis B virus (8 percent), enteropathogenic Escherichia coli (5 percent), Pseudomonas (4 percent) and group A streptococci (4 percent). Sites of epidemic infection were closely linked to the responsible pathogens. Gastroenteritis (21 percent), skin infection (18 percent), bacteremia (12 percent), meningitis (11 percent) and hepatitis (10 percent), infrequent causes of endemic nosocomial infections, were frequently involved in epidemics. Over the 25-year period reviewed, staphylococcal epidemics and outbreaks of gastroenteritis due to Salmonella and Esch. coli declined in frequency and those due to gram-negative bacilli and hepatitis B virus increased. Since 1970, clusters of primary bacteremia were the most frequently investigated type of epidemic. Many epidemic strains of staphylococci obtained since 1975 or Enterobacteriaceae obtained since 1970 exhibited unusual drug resistance. Specific site-pathogen combinations were closely associated with characteristic reservoirs and modes of spread.
5. Author Preston GA; Larson EL; Stamm WE
Title The effect of private isolation rooms on patient care practices, Colonization and infection in an intensive care unit.
Source Am J Med 1981 Mar;70(3): p641-5
ISSN 0002-9343
AbstractConversion of an intensive care unit (ICU) from an open unit to isolation rooms permitted study of patient care practices, colonization and infection in both settings. Air sampling and observation of patient care practices included 99 of 410 open unit patients (168 patient-hours during nine months) and 68 of 1,022 isolation room patients matched on the basis of risk factors for infection and staff contact (113 patient-hours during 12 months). Number and type of interactions between staff and patients, and frequency of handwashing and its relationship to patient-staff interactions were recorded. All ICU patients were monitored daily for signs of and selected risk factors for infection, and material for culture for six surveillance organisms was obtained every four days. Numbers of persons interacting with a patient hour were 6.1 +/- 3.5 in the open units and 4.9 +/- 2.8 in the isolation rooms (0.05 less than P less than 0.10). Frequency of handwashing did not increase significantly in the unit providing convenient sinks, occurring in an observed to expected ratio of only 24 percent. Over-all rates of infection in the open unit and isolation rooms were 15.0 and 13.4, respectively. Half of the infections occurring in patients with complete cultures obtained on admission were caused by organisms colonizing the patient upon admission to the ICU. The isolation rooms did not appear to reduce nosocomial acquisition (P = 0.168, Mantel-Haenszel) of the six surveillance organisms. We conclude that many patient-staff interactions in an ICU are not followed by handwashing, and that the new unit design had no apparent effect upon the frequency of handwashing or over-all incidence of colonization and infection in the ICU.
6. Author Doebbeling BN; Pfaller MA; Houston AK; Wenzel RP
Institution University of Iowa College of Medicine, Iowa City.
Title Removal of nosocomial pathogens from the contaminated glove. Implications for glove reuse and handwashing.
Source Ann Intern Med 1988 Sep 1;109(5): p394-8
ISSN 0003-4819
AbstractSTUDY OBJECTIVE: To evaluate the effectiveness of three different types of handcleansing agents in decontaminating gloved hands that were inoculated with a series of four nosocomial pathogens. DESIGN: A controlled, experimental trial. SETTING: Tertiary care referral center. PATIENTS OR OTHER PARTICIPANTS: Five healthy volunteers participated in all portions of the study. INTERVENTIONS: A standard concentration of one of four representative nosocomial pathogens was placed on the gloved hand, spread, and allowed to dry. One of three different handcleansing agents--a nonmedicated soap, a 60% isopropyl alcohol preparation, or 4% chlorhexidine gluconate--was used to cleanse the gloves, which were cultured using a broth-bag technique. The gloves were then removed and the hands were cultured in a similar manner. MEASUREMENTS AND MAIN RESULTS: The handwashing agents reduced the median log10 counts of organisms to 2.1 to 3.9 after an inoculation of 10(7) colony forming units. The proportion of positive glove cultures for Staphylococcus aureus, 8% to 100%; Serratia marcescens, 16% to 100%; and Candida albicans, 4% to 60% varied greatly after use of the different handcleansers (P less than 0.001), and varied considerably for Pseudomonas aeruginosa, 20% to 48% (P = 0.085). After the gloves were removed, the differences among the observed proportions of hands contaminated with the test organisms varied from 5% to 50%, depending on the handcleansing agent used (P less than 0.001). CONCLUSIONS: In the era of universal precautions these data suggest that it may not be prudent to wash and reuse gloves between patients. Further, handwashing is strongly encouraged after removal of gloves.
7. Author van de Mortel T; Heyman L
Title Performance feedback increases the incidence of handwashing by staff following patient contact in intensive care.
Source Aust Crit Care 1995 Jun;8(2): p8-13
ISSN 1036-7314
AbstractNosocomial infections affect up to 30% of ICU patients. Although infection rates decline with increasing handwashing frequency, handwashing rates in ICU's are poor. This study investigated the hypotheses that the subjects' profession would not influence, and performance feedback would not increase, the incidence of handwashing post-patient contact. The study involved an initial period of covert observation to record the baseline level of handwashing, followed by a period of overt observation with regular feedback on handwashing performance by means of letters to staff and histograms of the data displayed in the ICU. Handwashing incidence was reassessed 6 months after performance feedback had ceased. Handwashing differed significantly between professions (P = 0.0001). Initially, the incidence of handwashing was highest amongst wardsmen (90%) and lowest amongst Visiting Medical Officers (VMOs) (20%). Sixty-nine percent (69%) of Registered Nurses (RNs), 57% of physiotherapists, 41% of Resident Medical Officers (RMOs) and 35% of radiographers washed their hands after touching patients. With the exception of the wardsmen, there was a trend towards an increased frequency in handwashing in all groups after performance feedback, but the differences were only statistically significant in the VMO and physiotherapist groups (P < 0.001). The improvements were maintained for 6 months after the feedback phase ended in 4 of the 6 groups.
8. Author Daschner FD
Title The transmission of infections in hospitals by staff carriers, methods of prevention and control [editorial]
Source Infect Control 1985 Mar;6(3): p97-9
ISSN 0195-9417
9. Author Olson B; Weinstein RA; Nathan C; Chamberlin W; Kabins SA
Title Occult aminoglycoside resistance in Pseudomonas aeruginosa: epidemiology and implications for therapy and control.
Source J Infect Dis 1985 Oct;152(4): p769-74
ISSN 0022-1899
AbstractThe epidemiology of aminoglycoside-resistant Pseudomonas aeruginosa was evaluated in an intensive care unit (ICU) with serial surveillance cultures of throat and rectum. Bacterial population analysis performed by replica plating of primary isolation plates onto gentamicin-containing agar revealed the presence of resistant subpopulations in the initial isolates from 41 (71%) of 58 consecutive assessable patients; these isolates were stably resistant and proportionately less susceptible to other aminoglycosides. An increase in resistant subpopulations occurred during the ICU stay in 34% of 38 colonized patients cultured serially as opposed to none of 23 followed after ICU discharge (P = .0008). Isolates of P. aeruginosa from patients who received aminoglycosides in the ICU were more likely to show an increase in resistance than were isolates from other patients (55% vs. 11%; P = .005); decreasing resistance after ICU discharge followed discontinuation of antibiotic administration. ICU mortality was higher in patients with increasingly resistant subpopulations (69% vs. 16%; P = .0004). The difficulty in treating infections with P. aeruginosa and in controlling drug resistance likely relates to the common carriage of clinically undetected resistant subpopulations that emerge during therapy.
10. Author Goldmann DA
Institution Hospital Epidemiology Department, Children's Hospital, Boston, Massachusetts 02115.
Title The role of barrier precautions in infection control.
Source J Hosp Infect 1991 Jun;18 Suppl A:515-23
ISSN 0195-6701
AbstractBarrier precautions are a fundamental component of any infection control strategy and a critical aspect of all isolation systems. Because many infections are transmitted from patient-to-patient via the hands of personnel, gloves and gowns are widely recommended to provide an extra measure of protection against cross-infection. It is not clear whether gloves are superior to handwashing (if performed obsessionally) in this respect, and there is little evidence that gowns confer additional benefit. These concerns notwithstanding, barrier precautions can substantially reduce the risk of some infections, such as respiratory syncytial virus disease. On the other hand, the modes of transmission of many infections are complex (e.g. with rotavirus) or controversial (e.g. with rhinovirus), and, even though hands are involved in transmission, barrier precautions alone may not suffice to prevent spread. Moreover, neither gloves nor gowns can prevent nosocomial infections caused by endogenous microbial flora; perhaps this explains the limited efficacy of barrier precautions in reducing the endemic rate of infection due to bacteria such as Pseudomonas aeruginosa in intensive care units. Barrier precautions may also fail if colonized patients are not identified promptly. One potential solution to this problem is 'body substance isolation' (BSI), in which all patients are considered to be potential carriers of nosocomial pathogens whether or not they have been cultured or have developed a clinical infection. In BSI barrier techniques are used when any potentially contaminated patient material is handled. BSI also provides barrier protection from bloodborne pathogens for personnel.(ABSTRACT TRUNCATED AT 250 WORDS).
11. Author Patterson JE; Vecchio J; Pantelick EL; Farrel P; Mazon D; Zervos MJ; Hierholzer WJ Jr
Institution Yale University School of Medicine, New Haven, Connecticut 06510.
Title Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit.
Source Am J Med 1991 Nov;91(5): p479-83
ISSN 0002-9343
AbstractPURPOSE: Acinetobacter calcoaceticus var. anitratus is an important nosocomial pathogen that has been associated with environmental reservoirs. An increased isolation rate of A. anitratus in our intensive care units (ICUs), from 0.03% (two of 7,800) to 0.5% (seven of 1,300) (p less than 0.00003), prompted an investigation. PATIENTS, METHODS, AND RESULTS: Ten patients were admitted to the surgical ICU and nine to the medical ICU during the outbreak period (late December 1987 to January 1988). Controls were all patients on the units who were not infected or colonized with the transmitted strain of A. anitratus. Three patients had A. anitratus pneumonia. A throat culture prevalence survey demonstrated three patients colonized with A. anitratus. Cases were placed in a cohort and symptomatic cases treated. An epidemiologic investigation was conducted to identify reservoirs and modes of transmission. Latex gloves were being used for universal precautions without routine changing of gloves between patients. Environmental sources culture-positive for A. antitratus included a small volume medication nebulizer and gloves in use for patient care. Plasmid typing showed that plasmid profiles of isolates from two symptomatic patients, two colonized patients, the nebulizer, and the gloves were identical. Other A. anitratus ICU isolates had distinct plasmid profiles. All patients with the transmitted strain had been in the surgical ICU. The need for changing gloves between patients and contaminated body sites was reinforced. CONCLUSION: Gloves, used incorrectly for universal precautions, may potentially transmit A. anitratus.
12. Author Conly JM; Hill S; Ross J; Lertzman J; Louie TJ
Institution Infection Control Unit, University of Manitoba, Winnipeg, Canada.
Title Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates.
Source Am J Infect Control 1989 Dec;17(6): p330-9
ISSN 0196-6553
AbstractHandwashing is the single most important procedure in the prevention of nosocomial infections and yet it remains the most violated of all infection control procedures. With a sequential intervention study in an intensive care unit we have demonstrated that poor handwashing practices are associated with a high nosocomial infection rate, whereas good handwashing practices are associated with a low nosocomial infection rate. An educational and enforcement program designed to improve handwashing procedures can significantly reduce endemic nosocomial infection rates.
13. Author Tablan OC; Anderson LJ; Arden NH; Breiman RF; Butler JC; McNeil MM
Title Guideline for prevention of nosocomial pneumonia. The Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention [published erratum appears in Infect Control Hosp Epidemiol 1998 May; 19(5):304]
Source Infect Control Hosp Epidemiol 1994 Sep;15(9): p587-627
ISSN 0899-823X14. Author Larson E
Institution Johns Hopkins University, School of Nursing.
Title Guideline for use of topical antimicrobial agents [published erratum appears in Am J Infect Control 1991 Feb; 19(1):59]
Source Am J Infect Control 1988 Dec;16(6): p253-66
ISSN 0196-6553
AbstractThis Guideline is based on published data available at the time of writing. The ideal means for comparing performance of various antimicrobial agents is through the conduct of carefully designed, large-scale clinical trials. Recommendations contained in this Guideline are subject to modification as additional data become available. It particularly should be noted that the implementation of universal precautions or body substance isolation has resulted in marked increase in the use of gloves for direct patient contact. Whether there is an additional cost-benefit rationale for handwashing with an antimicrobial agent remains to be studied.
15. Author Kelleghan SI; Salemi C; Padilla S; McCord M; Mermilliod G; Canola T; Becker L
Institution Department of Infection Control, Kaiser Permanente Medical Center, Fontana, CA 92335.
Title An effective continuous quality improvement approach to the prevention of ventilator-associated pneumonia.
Source Am J Infect Control 1993 Dec;21(6): p322-30
ISSN 0196-6553
AbstractIn 1989, our medical center used continuous quality improvement concepts in the creation of a Nosocomial Pneumonia Prevention Team whose aim was to significantly reduce nosocomial ventilator-associated pneumonia. The team included representatives from nursing, respiratory therapy, pulmonary medicine, internal medicine, anesthesiology, education and training, and infection control. Because the majority of mechanically ventilated patients were located in the intensive care unit, this unit became the focus of the prevention efforts. Team meetings were held regularly, with all representatives brainstorming barriers, possible interventions, methods of outcome measurement, and frequency of evaluation. Policies and procedures were reviewed, surveillance was increased, handwashing practices were surveyed, periodic feedback to staff was begun, and an educational program was developed and presented. During 1990, we observed a 57% reduction in ventilator-associated pneumonia from the baseline years, 1987 and 1988. Statistical comparison of proportions by z test indicated a p value less than 0.05. Fifteen cases of nosocomial ventilator-associated pneumonia were prevented and a cost saving of $105,000 was realized. Performance of traditional surveillance for outliers, coupled with literature-based thresholds, can lead to tolerance of inordinately high endemic rates. Infection control programs can significantly reduce endemic rates of nosocomial ventilator-associated pneumonia through continuous quality improvement methods and multidisciplinary interventions, with standard infection control procedures used for improvement.
16. Author Leclair JM; Freeman J; Sullivan BF; Crowley CM; Goldmann DA
Title Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions.
Source N Engl J Med 1987 Aug 6;317(6): p329-34
ISSN 0028-4793
AbstractTo determine whether increased compliance with a policy of glove and gown isolation precautions could reduce the high rate of nosocomial respiratory syncytial virus (RSV) infection on an infant and toddler ward, we conducted a longitudinal intervention trial during three RSV seasons, from 1982 to 1985, with an intervention to increase compliance introduced midway through the second season. The risk of acquiring RSV infection in the hospital was adjusted for the intensity of nosocomial exposure to the virus by assigning each study week to one of five strata, defined by the proportion of hospital days on which virus was shed by children on the ward. Overall, 37 patients acquired nosocomial RSV infections during 7547 days at risk. The adjusted relative risk, comparing the infection rate in the period before the intervention (when compliance with isolation precautions was noted in only 38.5 percent of the observed patient contacts) with the infection rate in the postintervention period (when compliance more than doubled) was 2.9 (95 percent confidence interval, 1.5 to 5.7). Rates of nosocomial RSV infection increased linearly with increasing levels of exposure to patients shedding virus, but the rise in the infection rate with increasing exposure was less than one fourth as great (P less than 0.001) in the period after the intervention as it was before. We conclude that glove and gown precautions can substantially reduce the nosocomial transmission of RSV, particularly with increasing exposure to patients shedding the virus.
17. Author Klein BS; Perloff WH; Maki DG
Institution Department of Medicine, University of Wisconsin Medical School, Madison.
Title Reduction of nosocomial infection during pediatric intensive care by protective isolation [see comments]
Source N Engl J Med 1989 Jun 29;320(26): p1714-21
ISSN 0028-4793
AbstractTo determine whether simple protective isolation reduces the incidence of nosocomial bacterial and fungal infection during pediatric intensive care, we randomly assigned 70 children who were not immuno-suppressed and who required mechanical ventilatory support and three or more days of intensive care to receive standard care (n = 38) or protective isolation (n = 32) with use of disposable, non-waven, polypropylene gowns and nonsterile latex gloves. Risk factors predisposing patients to infection were comparable in the two groups. Nosocomial colonization occurred later among isolated patients (median, vs. 7 days; P less than 0.01) and was associated with subsequent infection in 12 patients, as compared with 12 patients given standard care (P = 0.01). Among patients who were isolated, the interval before the first infection was significantly longer than (median, 20 vs. 8 days; P = 0.04), the daily infection rate was 2.2 times lower than (95 percent confidence interval, 1.2 to 4.0; P = 0.007), and there were fewer days with fewer (13 percent vs. 21 percent; P = 0.001). The benefit of isolation was most notable after seven days of intensive care. Isolation was well tolerated by patients and their families. Regular monitoring showed that the children in each group were touched and handled comparably often by hospital personnel and family members. We conclude that the use of disposable, high-barrier gowns and gloves for the care of selected, high-risk children who require prolonged intensive care significantly reduces the incidence of nosocomial infection, is well tolerated, and does not compromise the delivery of care.
18. Author Goldmann D; Larson E
Title Hand-washing and nosocomial infections [editorial; comment]
Source N Engl J Med 1992 Jul 9;327(2): p120-2
ISSN 0028-479319. Author Tablan OC; Anderson LJ; Arden NH; Breiman RF; Butler JC; McNeil MM
Institution Guideline for prevention of nosocomial pneumonia. The Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention [published errata appear in Am J Infect Control 1994 Oct; 22(5):324 and 1994 Dec; 22(6):351]
Title Am J Infect Control 1994 Aug;22(4): p247-92
Vernacular Title 0196-6553
Source Comparative Study; Human
ISSN N; M
Abstract English
Copyright © 2009 Electronic Handbook of Legal Medicine