Infection Control Advice Research Articles

Good citizens, perfect patients, and family reputation: Stigma and prolonged isolation in people with drug-resistant tuberculosis in Vietnam.

Stigma and isolation are common in people with tuberculosis (TB). Social isolation contributes to reduced health outcomes and TB treatment adherence. Stigma and the drivers of isolation in people with Drug-Resistant (DR)-TB may include modifiable advice and practices of family and Health Care Workers (HCW). This study aimed to understand the drivers of isolation and stigma from the perspective of people with DR-TB in Vietnam. A greater understanding of stigma and isolation is important to identify and balance patients' needs and disease transmission risk. In-depth interviews were conducted with 12 people with DR-TB and seven HCWs who care for people with DR-TB in two provinces in Vietnam. Interviews were audio-recorded, transcribed verbatim and translated to English. Data collection and analysis were conducted simultaneously. The data were then analysed using a thematic framework approach. Stigma and extended isolation were common experiences among people with DR-TB. To mitigate stigma, people with DR-TB used the local term 'lao lực' to describe their condition to others which is believed to be a less infectious and less stigmatising type of TB. This study identified that although HCW informed people with DR-TB of when they were no longer infectious and isolation was no longer required, their infection control advice was not always consistent. Despite knowing they were no longer infectious, most people with DR-TB continued to self-isolate to minimise the perceived repercussions of societal stigma, to protect their 'thể diện' (honour, prestige, reputation), and eliminate all risk of transmitting DR-TB to their family. This study identified three interconnected drivers of self-isolation in Vietnam, including fear of infecting others, fear of stigmatization, and to protect family reputation. TB control programmes need to better understand the social aspects of DR-TB to enable them to better support patients. Educating HCW to provide evidence-based infection control advice is vital.

Recorded infection control messages delay inter-professional communication but are not associated with COVID-19 prevalence or mortality: insights from a national switchboard analysis

Appropriate dissemination of information to the general public is a key component of the pandemic response. In 2018, recorded infection control advice messages were affixed to 30% of England's automated hospital switchboards during the seasonal influenza and norovirus outbreaks. As the majority of messages were mandatory for all callers, healthcare professionals using the hospital switchboard - including during time-critical emergencies - had their enquiries significantly delayed by these measures. Importantly, published analyses did not demonstrate an association between these messages and patient outcomes. As of May 2020, 85% of NHS trusts made use of infection control messages; on average, these delayed healthcare professionals by 59.4 seconds per call, but had no clear association with patient outcomes from COVID-19. An ongoing national switchboard quality improvement project seeks to establish a gold standard whereby healthcare professionals with urgent enquiries can press 'X' to skip past infection control messages and have their calls triaged immediately.

Lasting lessons learnt in the radiology department from the battle with COVID-19

Lasting lessons learnt in the radiology department from the battle with COVID-19

P207 Outbreak of hep a affecting msm: the london response

Introduction:Outbreaks of hepatitis A virus (HAV) have previously been described in men who have sex with men (MSM). BASHH only recommends HAV vaccination for MSM during outbreaks. A UK cluster of HAV cases was identified and, by 27/2/2017, London had 45 probable and confirmed cases in MSM. London sexual health commissioning is in flux with new arrangements imminent.Methods:For individual notified cases, Health Protection Teams (HPT) routinely assess source, offer infection control advice to the case and organise vaccination of household and sexual contacts. A London outbreak control team (OCT) comprised epidemiologists, commissioners and providers of immunisation and sexual health services, health promotion partners and communications. The OCT scoped possible additional interventions to control the outbreak.Results:The OCT recommended: Awareness raising re risk behaviour:Distribute a nationally commissioned leaflet with safer sex advice to cases and to genitourinary medicine (GUM) clinics, plus relevant content on digital platforms.Liaison with providers, commissioners: Inform GPs. Survey current practice in GUM for HAV immunisation. Vaccinate MSM opportunistically in GUM clinics (if had a new or casual partner in last 3 months).Link with existing health promotion networks: Working with gay venues, to get understanding and cooperation.Set up vaccination clinics near the popular venuesDiscussion:It is challenging to set up an immunisation programme in a large city with complex commissioning relationships at short notice. Consideration should be given to vaccination between outbreaks to reduce the proportion susceptible, or ‘outbreak ready’ plans included in sexual health commissioning arrangements.

Knowledge, attitudes, experience and behaviour of frontline health care workers during the early phase of 2009 influenza A(H1N1) pandemic, Birmingham, UK.

During the early ('containment') phase of the influenza A(H1N1) pandemic, when the severity of the pandemic was unclear, health care workers (HCWs) across the UK were deployed to swab and prescribe antiviral drugs to suspected cases. This study describes the knowledge, attitudes, experience and behaviour of frontline HCWs in Birmingham, West Midlands, during this period. During June 2009, a 25-item semi-structured questionnaire was used to survey HCWs who undertook defined clinical duties as part of the public health response during the early phase of the pandemic. Participants were clinical staff based in a primary care out-of-hours service provider. The response rate was 50% (n = 20). All respondents provided direct clinical care that necessitated prolonged close contact with potentially infectious cases. Knowledge and use of personal protective equipment and infection control procedures was consistently high. However, the main source of infection control advice was local guidance. Uptake of, and attitude towards, vaccination as a preventive measure and antiviral prophylaxis was poor. HCWs were prepared to provide an essential health care response during the pandemic even when the severity of disease was unclear. However, more needs to be done to change health care workers' negative attitudes towards taking antivirals and receiving influenza vaccination.

A review of the winter influenza strategy for hospitals within a major district health board in New Zealand following the 2012 Influenza season

Abstract Winter influenza planning is an integral part of a health services preparation for the annual increase in respiratory virus infections and associated hospital admissions in New Zealand. A moderate to severe influenza A (H3N2) outbreak occurred in the winter of 2012 resulting in an unprecedented number of attendances of patients with influenza-like illness at the Canterbury District Health Board (CDHB) hospital’s emergency assessment areas. A review of the hospital winter influenza strategy following this outbreak, included the use of dedicated influenza wards, extensive diagnostic testing of patients, infection control advice, staff influenza vaccination and the use of Oseltamivir for treatment of patients and prophylaxis of their contacts. The review found that 534 patients were seen and laboratory confirmed to have influenza, 347 patients were admitted and 40 nosocomial influenza infections recorded over an 11 weeks period. The strategy contributed to the management of the hospital admission of patients with influenza, a relatively low number of nosocomial influenza infections in the dedicated admission wards and low in-hospital mortality. The use of diagnostic testing for influenza with planned escalation of services supported the clinical decision to treat patients with confirmed influenza and prophylaxis contacts with Oseltamivir probably facilitated appropriate discharge of patients.

Integration of Primary Health Care and Public Health During a Public Health Emergency

We have provided a detailed evaluation of how collaboration between an Ontario public health unit and its primary care providers facilitated an optimal response to the 2009 H1N1 influenza pandemic. Family health teams (integrated, interdisciplinary teams that provide a range of care options) provided flu assessment centers, with public health as a partner providing infection control advice, funding, coordination, antiviral medication, clinical care guidelines, supplemental nurse staffing, and arrangement of communication strategies with the public. The family health team structure offers a new capacity for timely, coordinated, and comprehensive response to public health emergencies, in partnership with public health, and provides a promising new direction for healthcare organization.

Evaluation of Infection Control Advice for Patients at Risk of Chemotherapy-Induced Neutropenia in 2 Pediatric Oncology Centers: Cape Town, South Africa, and Newcastle-Upon-Tyne, UK

Childhood cancers are treated with myelotoxic chemotherapy. Resultant neutropenia can lead to life-threatening infections. There is no consistent guidance on infection control precautions for neutropenic patients who are not yet febrile or infected. Although it is not possible to eradicate infection risk, it is conceivable that the risk could be reduced by effective infection prevention. This study compared infection control measures advised to pediatric and adolescent oncology patients receiving chemotherapy in 2 centers (Cape Town, South Africa, and Newcastle, UK). Prospective, observational, cross-sectional surveys of staff and patients/parents were undertaken using standardized, study-specific questionnaires. Seventy-eight staff and 56 patients/parents participated. Precautions advised in Newcastle were significantly different to Cape Town (all P < .05), except both agreed inpatient isolation was unnecessary. Over 40% of patients/parents felt isolation was important (P < .01). In Cape Town, staff and patients had similar views. In Newcastle, patients/parents had stricter opinions on particular precautions than staff, for example, attending school, playing outside and avoiding busy places (P < .01). Patient/parent responses were similar between centers. Over 90% of staff felt advising patients/parents about hand washing was important. Currently infection prevention advice is inconsistent. Further research is needed to elucidate effective guidance for infection prevention in pediatric neutropenic patients.

News

Bad dental hygiene could possibly increase the risk of swine flu as the National Dental Survey reveals the UK's failure to heed infection control advice.

The future for infection prevention and control in English primary care trusts

Although less well developed than in the hospital sector, the infection prevention and control function is important to primary and community care. In each reorganisation in the NHS, any specialist workforce needs to align with that part of the system that holds the relevant responsibilities and duties. This paper describes how infection control nursing has shifted its focus over the past decade. It questions whether the primary care trust (PCT) will remain an appropriate employing organisation in the future, as those provider functions currently within PCTs move away. The challenge will then be to ensure that infection prevention and control remains prominent within the decision making of PCTs and practice-based commissioners, with expert infection control advice and support also remaining available to independent primary care practitioners. A market for infection prevention and control advice and support services would be possible, provided suitable employment conditions could be ensured.

Help or hindrance? Is current infection control advice applicable in low- and middle-income countries? A review of the literature

High-income countries with established infection control programs have demonstrated effective control of infection transmission in health care settings. The guidelines and advice underlying these effective control programs have been produced by high-income countries for their own social, economic, and health environments. These have also been adopted by low- and middle-income (LMI) countries, but these countries appear to have a limited ability to apply these principles using the same methods. A systematic search for literature published in English was conducted exploring the relationship between the available infection prevention and control advice and the capacity of LMI countries to apply this guidance in their health care settings. Articles relevant to this exploration were identified and subsequently informed further search terms and identified other significant documents. Infection control guidelines designed for high-income countries are being utilized by LMI countries, with varying degrees of success mainly because of physical, environmental, and socioeconomic factors. There is a lack of published studies exploring the implementation of comprehensive infection control advice and programs, including the minimal advice, which is designed specifically for resource-limited settings. What is evident from the literature is that there is a need for the development of infection control and prevention guidelines based on evidence but adapted to the specific needs of health care workers in LMI countries. This must be done in collaboration with those same LMI countries' health care workers. Equally, because of finance and health priorities, health care facilities should choose those interventions most relevant to the needs of their population and workers to prevent infection transmission. Opportunities for further research into application of available infection control advice in LMI countries are identified. Through such research, more appropriate advice may be devised to assist with the development of infection control programs in these settings.

Infection control policies and procedures for meticillin-resistant Staphylococcus aureus in care homes for older people in Northern Ireland: a questionnaire study

ackground: Limited information is available regarding the role of infection control in the prevention of infection in nursing and residential care homes. Objectives: To determine what infection control policies and procedures are in place in care homes for older people in Northern Ireland. Methods: Anonymous postal questionnaire survey of all 410 nursing and residential homes in Northern Ireland that provide care to residents over the age of 65. Results: A total of 318 (78%) questionnaires were returned. Visits from infection control nurses from health boards or community trusts were infrequent, with only 23% of homes receiving such a visit. Nearly all homes (99.7%) had a policy on infection control, with 72.4% and 84.3% of homes having a policy on the admission and care of residents with meticillin-resistant Staphylococcus aureus (MRSA) respectively. Of those respondents that had a policy on admission of persons with MRSA, only a small percentage (9.2%) would not admit residents with MRSA. Only 11% of respondents believed that MRSA was a problem in their particular home, but at least 30% agreed that there was a problem with MRSA in care homes. A desire was expressed for more information and support, with 75% of respondents agreeing that more information should be provided to homes on MRSA. Conclusions: There is a clear need for additional infection control advice to be available to care homes and for the development of uniform policies and an infection control audit tool. The audit tool could then be used to ensure that the appropriate policies and standards are in place within care homes and that these standards are met on an ongoing basis.

German guidelines for reprocessing endoscopes and endoscopic accessories: guideline compliance in Frankfurt/Main, Germany

Guidelines for reprocessing flexible endoscopes have been published in many countries. The present survey investigated compliance with German guidelines in all hospitals and private practices in Frankfurt/Main, Germany. In 2003, all endoscopic units in Frankfurt/Main [15 hospitals and 23 private practices (10 large practices performing >1,000 endoscopies/year and 13 small practices performing <1,000 endoscopies/year)] were visited by members of the Public Health Service and assessed using a checklist based on the recommendations of the German guidelines. In 2004, a re-evaluation took place, either by analysing the written reports of the institutions or by visiting them again. Meanwhile, one hospital had closed and three small practices had ceased performing endoscopy, so the re-evaluation encompassed 14 hospitals and 20 private practices. In 2003, hospital compliance with the guidelines was satisfactory but many problems were identified in private practices. Between 2003 and 2004, great improvements were made. By the end of 2004, 90% of private practices had adequate storage facilities for reprocessed endoscopes, and were performing reprocessing of bottles and tubes for air-/water-channel flushing correctly (2003: adequate storage 52%; correct reprocessing 74%). Sterilization of endoscopic accessories was satisfactory, and routine testing of endoscopes after reprocessing was performed in all private practices at the end of 2004 (2003: sterilization of accessories 57%; microbiological control tests 56%). In 2003, although hospital compliance with the guidelines was satisfactory, mandatory improvements were required in private practices, notably in smaller units. Infection control advice and the control of public health regulations resulted in the correction of most processing faults between 2003 and 2004.

MRSA eradication in a health care worker with cystic fibrosis; re-emergence or re-infection?

Methicillin-resistant Staphylocosis aureus (MRSA) is an emerging infection in patients with cystic fibrosis (CF). MRSA may be a management dilemma for healthcare workers (HCWs) with CF. Eradication of MRSA with long-term rifampicin and fusidic acid can be achieved in patients with CF. We describe a case of recurrent MRSA infection in a HCW with CF. Molecular typing of the MRSA isolates supported re-infection rather than re-emergence of an earlier MRSA infection. Infection control advice for HCWs with CF who acquire MRSA remains controversial.

The public health response to a case of Lassa fever in London in 2000.

Evaluation of the Department of Health 1996 guidance, the Memorandum on the Management and Control of Viral Haemorrhagic Fevers. Description of the public health management in 2000 of the fifth UK patient confirmed to have Lassa fever. Delayed risk categorisation of the patient occurred for a variety of reasons. DH Guidance was followed once infection control advice was sought. Active surveillance of 125 contacts was extremely resource intense, involving over 3000 communications. Self-monitoring by healthcare workers should be considered in future. Advice on use of ribavirin prophylaxis is not included in the Memorandum, nor advice or templates for information sheets for contacts. Information sheets are now available from the Health Protection Agency in the event of future cases. International aspects not adequately addressed include the need for reliable risk assessment to be carried out before patients are medically evacuated from the country of origin, and the steps required to repatriate UK nationals. Effective and efficient communication is required between national and international organisations involved in such incidents. If guidelines are unclear or impracticable they will not be followed. It is important that lessons are learned and documented and that national guidance be regularly reviewed.

Nurses' documentation of infection control precautions: 2.

A small action research study was undertaken, using a quasi-experimental approach, to establish to what extent infection control advice was documented and to assess the effectiveness of the provision of an example care plan for control of infection. The study population comprised two groups of patients colonized or infected with ALERT organisms and involved 28 wards in six hospitals. Baseline data confirmed that infection control precautions were documented for less than 25% of patients overall. Provision of an 'example' care plan, together with guidance in its use, was followed by an increase in documentation for all items audited, while identification of the infection in the care plan showed a statistically significant increase (P < 0.05). However, in spite of this apparent improvement the documentation of appropriate care for control of infection remained inadequate. It is concluded that, while various strategies to effect change are at the infection control nurse's disposal, the need to integrate infection control with practice must be addressed at every level to include managers, educators and practitioners.