Infection Control Barriers Research Articles

Resourcing hospital infection prevention and control units in Australia: A discussion paper

Abstract Background Infection control professionals (ICPs) are critical in maintaining high standards of quality patient care. Until recently, little was known about the scope of practice, structures, resources and priorities for ICPs and infection control units more generally. Over the past three years we have undertaken a program of work to explore these issues. The purpose of this discussion paper is to synthesise these results and outline implications for the Australian infection control community. Methods We undertook a survey of individual ICPs in Australian and New Zealand and a survey of hospital infection control units within Australia. To understand how our research program could be used to inform and be of value, we also convened a stakeholder workshop to discuss how data from our studies could be translated into meaningfully constructed findings. A synthesis of the findings from the two surveys and the workshop was undertaken and this formed the basis of this discussion paper. Results We were able for the first time, to comprehensively report on infection control staffing levels, priorities and barriers within Australia. We identified considerable variability in the scope, experience and expertise of ICPs and the potential value that credentialing has with respect to effective infection control programs. We were however, unable to develop recommendations with respect to staffing. Conclusion The findings of our work may be used in designing and justifying business cases for infection prevention and control resources. There is also a need to undertake a similar study in settings other than hospitals.

Evaluation of effect of different disposable infection control barriers on light intensity of light-curing unit and microhardness of composite - An in vitro study.

Aims:This study evaluated effect of infection control barriers on light intensity (LI) of light-curing unit (LCU) and microhardness of composite.Materials and Methods:Four different disposable barriers (n = 30) were tested against the control. LI for each barrier was measured with Lux meter. One hundred and fifty Teflon molds were equally divided into five groups of thirty each. Composite was filled in bulk in these molds and cured without and with barrier. Microhardness was evaluated on top and bottom surface of composite specimen with microhardness testing machine and hardness ratio (HR) was derived.Statistical Analysis Used:One-way analysis of variance, Tukey's honestly significant difference test, and paired t-test using SPSS version 18 software.Results:All barriers had significantly reduced the baseline LI of LCU (P < 0.0001), but only Cure Elastic Steri-Shield and latex cut glove pieces (LCGP) significantly reduced the microhardness of the composite (P < 0.05). However, HR determined inadequate curing only with LCGP.Conclusions:Although entire tested barrier significantly reduced the LI; none, except LCGP markedly affected the degree of cure of the composite.

Infection Control Behaviors and Barriers in Medical Institutions

Background/Objectives: This study was to investigate a dental hygienistersity, Samcheok, 25949, Korea and effects on barriers. Methods/Statistical Analysis: A survey was conducted among 311 persons who were employed in dental and medical institutions in Busan, Korea from March 16 to April 15, 2012. Statistical analysis was performed using SPSS 18.0 employed in dental and medical Inago, IL, USA). Findings: In terms of personal safety and protective equipment behaviors, employees in dental hospitals showed higher fulfillment on all items than employees in dental clinics. The importance of dental infection control was recognized by most respondents, though with the exception of infectious waste control, the fulfillment rates of infection control behaviors were not that high. Therefore, to increase the fulfillment rate by behavior, the institutional preparation for the standard of infection control must be urgently made at the national level. Improvements/Applications: Thus, realistic infection control training to enhance the dental hygienists, though with the exception of infectious waste.

Tuberculosis infection control measures in health care facilities offering tb services in Ikeja local government area, Lagos, South West, Nigeria.

BackgroundTuberculosis infection among health care workers is capable of worsening the existing health human resource problems of low - and middle-income countries. Tuberculosis infection control is often weakly implemented in these parts of the world therefore, understanding the reasons for poor implementation of tuberculosis infection control guidelines are important. This study was aimed at assessing tuberculosis infection control practices and barriers to its implementation in Ikeja, Nigeria.MethodsA cross-sectional study in 20 tuberculosis care facilities (16 public and 4 private) in Ikeja, Lagos was conducted. The study included a facility survey to assess the availability of tuberculosis infection control guidelines, the adequacy of facilities to prevent transmission of tuberculosis and observations of practices to assess the implementation of tuberculosis infection control guidelines. Four focus group discussions were carried out to highlight HCWs’ perceptions on tuberculosis infection control guidelines and barriers to its implementation.ResultsThe observational study showed that none of the clinics had a tuberculosis infection control plan. No clinic was consistently screening patients for cough. Twelve facilities (60 %) consistently provided masks to patients who were coughing. Ventilation in the waiting areas was assessed to be adequate in 60 % of the clinics while four clinics (20 %) possessed N-95 respirators. Findings from the focus group discussions showed weak managerial support, poor funding, under-staffing, lack of space and not wanting to be seen as stigmatizing against tuberculosis patients as barriers that hindered the implementation of TB infection control measures.ConclusionTuberculosis infection control measures were not adequately implemented in health facilities in Ikeja, Nigeria. A multi-pronged approach is required to address the identified barriers to the implementation of tuberculosis infection control guidelines.

Efficiency of the Verigene® Blood Culture System on Time to Infection Control Barrier Precautions in Bacteremic Patients with Multidrug-Resistant Organisms

Efficiency of the Verigene® Blood Culture System on Time to Infection Control Barrier Precautions in Bacteremic Patients with Multidrug-Resistant Organisms

Antibiotic resistance and extended spectrum beta-lactamases: Types, epidemiology and treatment

Antibiotic resistance is a problem of deep scientific concern both in hospital and community settings. Rapid detection in clinical laboratories is essential for the judicious recognition of antimicrobial resistant organisms. Production of extended-spectrum β-lactamases (ESBLs) is a significant resistance-mechanism that impedes the antimicrobial treatment of infections caused by Enterobacteriaceae and is a serious threat to the currently available antibiotic armory. ESBLs are classified into several groups according to their amino acid sequence homology. Proper infection control practices and barriers are essential to prevent spread and outbreaks of ESBL producing bacteria. As bacteria have developed different strategies to counter the effects of antibiotics, the identification of the resistance mechanism may help in the discovery and design of new antimicrobial agents. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Hence, more expeditious diagnostic testing of ESBL-producing bacteria and the feasible modification of guidelines for community-onset bacteremia associated with different infections are prescribed.

Effect of cross infection control barriers used on the light-curing device tips on the cure depth of a resin composite

Background:Among the advice on prevent cross-infection was included usage of mechanical barriers on tips of photoactivation units. However, questions about the use of protective barriers placed on the light-curing unit's tips and the possibility of interference with the ability of guaranteeing an effective polymerization of composite resins need to be clarified.Aims:The aim of this study was to evaluate the effect of cross infection control barriers used on the light-curing device tips on the cure depth of composite resin.Materials and Methods:Power density measurements from the light-cure unit were recorded with a radiometer on ten separate occasions with different types and placement modes of each barrier (low-density polyethylene and polyvinyl chloride (PVC) film – smooth and folds) and no-barrier (control). Cure depth of TPH™ Spectrum™ resin, A2-A4, was evaluated by the scraping test.Statistical Analysis:The data were analyzed using Student's t-test or ANOVA one-way with Tukey's test (α =0.05).Results:Same type of barrier and different shades (A2, A4) of composite exhibited significant difference in the cure depth among all groups (P < 0.05). Both low-density polyethylene and PVC film folded barriers produced a significant reduction in the light intensity (P < 0.05).Conclusions:Regarding the resin shade, there was a significant reduction in the cure depth of A4 composite resin (dark shade) but this reduction is not enough to cause any adverse effect on the material's clinical performance. Therefore, disposable barriers can be recommended for use over the end of the light guide.

Effect of a multi-layer infection control barrier on the micro-hardness of a composite resin

ObjectiveThe aim of this study was to evaluate the effect of multiple layers of an infection control barrier on the micro-hardness of a composite resin. Material and MethodsOne, two, four, and eight layers of an infection control barrier were used to cover the light guides of a high-power light emitting diode (LED) light curing unit (LCU) and a low-power halogen LCU. The composite specimens were photopolymerized with the LCUs and the barriers, and the micro-hardness of the upper and lower surfaces was measured (n=10). The hardness ratio was calculated by dividing the bottom surface hardness of the experimental groups by the irradiated surface hardness of the control groups. The data was analyzed by two-way ANOVA and Tukey's HSD test. ResultsThe micro-hardness of the composite specimens photopolymerized with the LED LCU decreased significantly in the four- and eight-layer groups of the upper surface and in the two-, four-, and eight-layer groups of the lower surface. The hardness ratio of the composite specimens was <80% in the eight-layer group. The micro-hardness of the composite specimens photopolymerized with the halogen LCU decreased significantly in the eight-layer group of the upper surface and in the two-, four-, and eight-layer groups of the lower surface. However, the hardness ratios of all the composite specimens photopolymerized with barriers were <80%. ConclusionsThe two-layer infection control barrier could be used on high-power LCUs without decreasing the surface hardness of the composite resin. However, when using an infection control barrier on the low-power LCUs, attention should be paid so as not to sacrifice the polymerization efficiency.

Characteristics, Services, and Infection Control Practices of New York City Assisted Living Facilities, 2010

To describe New York City (NYC) assisted living facility (ALF) characteristics, services offered, and infection control practices and to identify infection control barriers and unmet needs. Cross-sectional. ALFs licensed or applying to be licensed in NYC. Seventy ALFs; 70 of 77 eligible facilities participated (91% participation rate). Telephone interview questions assessed ALF characteristics, services offered, and infection control practices, including glucometry practices. ALFs provided a broad range of services, such as vaccination (90%), assistance with taking medication (75%), bathing and showering (33%), and blood glucose monitoring (90%). Ninety percent of the facilities had nurses on site (directly employed or through a contract agency). Five facilities reported that residents sometimes shared glucometers, and one reported that fingerstick devices were sometimes shared. The majority of facilities wanted educational materials for staff (83%) and residents (77%) on topics including influenza, respiratory illness, norovirus, standard precautions, and general infection control. ALFs had a range of sick leave policies and infection control training requirements. Eighty-nine percent of the facilities reported having designated staff responsible for infection control, although 50% had nonclinical job titles. NYC ALFs were varied in terms of nursing services offered, characteristics, and residents' needs; therefore, public health agencies may need to be flexible in their assistance. Public health agencies should consider strengthening relationships with ALFs to identify unmet needs and gaps in services.

English

Pseudomonas aeruginosa&nbsp;is the most common pathogen causing nosocomial infections. The objective of this study was to investigate the extended-spectrum-beta-lactamase (ESBLs) producing and multidrug resistance of hospital isolates of&nbsp;P. aeruginosa&nbsp;and to determine the presence of several resistance genes. A total of 86 isolates of&nbsp;P. aeruginosa&nbsp;were collected from teaching hospital in Kashan, Iran. Susceptibility to eight antimicrobial agents was performed by disk diffusion method. ESBL-phenotypic detection was carried out by double-disk synergy test; and the presence of the genes encoding ofbla(TEM),&nbsp;bla(SHV),&nbsp;bla(CTX-M),&nbsp;bla(OXA) and&nbsp;bla(GES)-like genes was studied by polymerase chain reaction. The prevalence of ESBLs was 8.1%. The presence of genes encoding ESBLs was confirmed in seven isolates, comprising seven&nbsp;bla(GES-2), onebla(SHV-1), one&nbsp;bla(SHV-5) and one&nbsp;bla(CTX-M-1) genes.&nbsp;P. aeruginosa&nbsp;demonstrated the highest resistance rate to piperacillin (38.4%), 67.5% of isolates were sensitive to imipenem whereas 32.5% were MDR (resistant to three or more classes of antibiotics). A multidrug-resistant (MDR) phenotype occurred frequently in&nbsp;P. aeruginosa.&nbsp;bla(GES-2), which compromises the efficacy of imipenem detected in all of seven ESBL-producing&nbsp;P. aeruginosa&nbsp;strains.&nbsp;Proper infection control practices and barriers are essential to prevent spreading and outbreaks of ESBL-producing and MDR&nbsp;P. aeruginosa&nbsp;in our teaching hospital. &nbsp; Key words:&nbsp;Pseudomonas aeruginosa, extended-spectrum-beta-lactamase, multidrug-resistant.

Guided Reflection 2nd Edition

This is the 2nd edition of Guided Reflection: A Narrative Approach to Advancing Professional Practice and when one sees the list of three other books on this subject by the editor one wonders how much meat there is left on the bone of reflection. This edition has expanded the themes to include art and performance and the latter is significant as unfortunately the narrative seems to play to the crowds far too much. Reflection or reflective practice as it is usually known can be a useful tool for some to help improve their care through insight into their actions, but books such as this have developed it beyond all recognition and usefulness to a point where it is of debatable benefit. The book itself is not well structured and uninspiring to read with long sections of text and far too much self referencing. There are neither counter-arguments to the techniques described nor description of their suitability in specific situations. I cannot recommend this book as useful and would suggest those looking for a reference book on reflective practice would be better off with something more practical. This edition of the Journal of Renal Nursing focuses on infection control, an area of increasing concern over the past few years. Hospital acquired infections (HAI) are a significant burden to the patient and society as a whole. As many as 10% of people will contract an HAI during their hospital stay, which often leads to an increased risk of complications and higher mortality rates. In addition, evidence from the National Audit Office suggest they cost the NHS in the region of £1 billion. In our specialist renal field, the risk of infection is particularly high due to the necessity for various forms of vascular access. Dialysis catheters are associated with the highest rates of infection and poor outcomes, and should be avoided for longterm treatment where possible. However, while the renal community recommends all patients have dialysis via some sort of native fistula or graft, there is a group of patients for whom this is just not possible or acceptable. It is this group of patients who we need to be particularly careful with to avoid any infections. Books such as these provide the clinical knowledge and evidence we should use in our daily practice. The real benefit of this book is its detail. There are chapters on all major infections and antibiotic treatments. Some chapters are likely to be used more often than others such as that on the recognition and treatment of intravascular catheter (IVC)-related infections. It describes in detail the different types of IVC infections such as exit or tunnel site, phlebitis or catheter colonization and suggests the most appropriate treatment. Recommendations are based on the latest evidence and there are useful statistics on the epidemiology of IVC related HAIs. Other useful chapters describe the potential infection problems associated with transplantation, the use of universal infection control precautions and barrier nursing, and an interesting chapter on hand washing. At first glance hand washing may not appear to be the most interesting subject, but there is much more to it than most would imagine, with a multitude of different organisms that require specific eradication techniques. This excellent book provides everything the renal nurse needs to prevent, diagnose and treat infections, and should be available on all renal wards, dialysis units and outpatient areas. Oxford Handbook of Infectious Diseases and Microbiology

Oxford Handbook of Infectious Diseases and Microbiology

Journal of Renal NursingVol. 3, No. 5 Book ReviewsOxford Handbook of Infectious Diseases and MicrobiologyChris JonesChris JonesSearch for more papers by this authorChris JonesPublished Online:29 Sep 2013https://doi.org/10.12968/jorn.2011.3.5.255AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 1 September 2011Volume 3Issue 5ISSN (print): 2041-1448ISSN (online): 2052-2894 Metrics History Published online 29 September 2013 Published in print 1 September 2011 Information© MA Healthcare LimitedPDF download

The effect of disposable infection control barriers and physical damage on the power output of light curing units and light curing tips

This study investigated the effects that disposable infection control barriers and physical damage through use had on the power output from dental light curing units (LCUs) and light curing tips (LCTs). Five disposable infection control barriers were tested on a number of LCUs and LCTs. Testing involved the repeated measurement of power output of LCUs and LCTs on a radiometer. Two of the barriers tested caused statistically significant reductions in the mean light output intensity when compared to the no barrier control groups. One barrier type reduced the power output by 30 to 40%. It was also noted that physical damage to the LCTs affected power output by between 20 and 30%, which was then further reduced by the disposable barrier. This study showed that three of the five disposable infection control barriers had little effect on the overall efficiency of the power output of the LCUs. It also showed that physical damage to LCUs and LCTs can affect power output significantly. Infection control measures should be carefully considered before use to avoid undue effects on power output delivered from the LCUs/LCTs to ensure that the degree of polymerisation within the resin-based composite and curing efficiency are not affected unduly.

Summary of: The effect of disposable infection control barriers and physical damage on the power output of light curing units and light curing tips

Summary of: The effect of disposable infection control barriers and physical damage on the power output of light curing units and light curing tips

Effect of infection control barrier thickness on light curing units

Objectives: This study investigated the effect of infection control barrier thickness on power density, wavelength, and light diffusion of light curing units. Materials and Methods: Infection control barrier (Cleanwrap) in one-fold, two-fold, four-fold, and eightfold, and a halogen light curing unit (Optilux 360) and a light emitting diode (LED) light curing unit (Elipar FreeLight 2) were used in this study. Power density of light curing units with infection control barriers covering the fiberoptic bundle was measured with a hand held dental radiometer (Cure Rite). Wavelength of light curing units fixed on a custom made optical breadboard was measured with a portable spectroradiometer (CS-1000). Light diffusion of light curing units was photographed with DSLR (Nikon D70s) as above. Results: Power density decreased significantly as the layer thickness of the infection control barrier increased, except the one-fold and two-fold in halogen light curing unit. Especially, when the barrier was four-fold and more in the halogen light curing unit, the decrease of power density was more prominent. The wavelength of light curing units was not affected by the barriers and almost no change was detected in the peak wavelength. Light diffusion of LED light curing unit was not affected by barriers, however, halogen light curing unit showed decrease in light diffusion angle when the barrier was four-fold and statistically different decrease when the barrier was eight-fold ( p < 0.05). Conclusions: It could be assumed that the infection control barriers should be used as two-fold rather than one-fold to prevent tearing of the barriers and subsequent cross contamination between the patients. [J Kor

Infection control in cystic fibrosis: barriers to implementation and ideas for improvement

This review will focus on recent research documenting baseline adherence to infection control recommendations and barriers to their implementation as experienced by multidisciplinary cystic fibrosis (CF) care providers. In addition, controversies regarding optimal infection control will be discussed. Finally, suggestions to improve infection control in CF will be proposed. Compliance with recent guidelines was assessed for clinical microbiology laboratories and for infection control policies at CF care centers in the United States. Unlike earlier reports, the vast majority of laboratories used selective media for Burkholderia cepacia complex and identified all species of nonlactose fermenting Gram-negative bacilli. Fewer used selective media for Staphylococcus aureus or used agar-based susceptibility testing assays for Pseudomonas aeruginosa. Only 103 (65%) of 158 CF care centers provided written infection control policies for review and these were more likely to address inpatient than outpatient settings. Surveys of healthcare professionals showed that access to a copy of the CF infection control guidelines reduced barriers to adherence to selected infection control practices. These data suggest that access to national infection control guidelines and written local policies are critically important to improving infection control for CF.

Prevalence and Risk Factors for Bloodborne Exposure and Infection in Correctional Healthcare Workers

To determine the prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers (CHCWs).Design. Cross-sectional risk assessment study with a confidential questionnaire and serological testing performed during 1999-2000. Correctional systems in 3 states. Among 310 participating CHCWs, the rate of percutaneous injury (PI) was 32 PIs per 100 person-years overall and 42 PIs per 100 person-years for CHCWs with clinical job duties. Underreporting was common, with only 25 (49%) of 51 PIs formally reported to the administration. Independent risk factors for experiencing PI included being age 45 or older (adjusted odds ratio [aOR], 2.41 [95% confidence interval (CI), 1.31-4.46]) and having job duties that involved needle contact (aOR, 3.70 [95% CI, 1.28-10.63]) or blood contact (aOR, 5.05 [95% CI, 1.45-17.54]). Overall, 222 CHCWs (72%) reported having received a primary hepatitis B vaccination series; of these, 150 (68%) tested positive for anti-hepatitis B surface antigen, with negative results significantly associated with receipt of last dose more than 5 years previously. Serologic markers of hepatitis B virus infection were identified in 31 individuals (10%), and the prevalence of hepatitis C virus infection was 2% (n=7). The high hepatitis B vaccination rate limited the ability to identify risk factors for infection, but hepatitis C virus infection correlated with community risk factors only. Although the wide coverage with hepatitis B vaccination and the decreasing rate of hepatitis C virus infection in the general population are encouraging, the high rate of exposure in CHCWs and the lack of exposure documentation are concerns. Continued efforts to develop interventions to reduce exposures and encourage reporting should be implemented and evaluated in correctional healthcare settings. These interventions should address infection control barriers unique to the correctional setting.

Phase 2 contract for FW

This study evaluated the rubber dam as an infection control barrier during standard restorative procedures. Microbial collection tuas performed during preparation and placement of amalgam and composite resin restorations with and without the rubber dam, and during handpiece and air-water syringe spraying with and without the rubber dam. The results showed a significant reduction in microorganisms with the use of the rubber dam—70% to 88% and 95% to 99%, respectively; and 90% to 98% when all data were combined. These results indicate that using the rubber dam is a method of reducing microbial contamination at the primary source. Used with gloves, mask, and protective eyewear, the rubber dam provides an excellent barrier to the potential spread of infectious disease in the dental office.

The nature and frequency of blood contacts among home healthcare workers.

To estimate the frequency of, and assess risk factors for, percutaneous, mucous membrane, and cutaneous blood contacts sustained by healthcare workers (HCWs) during the delivery of infusion therapy and the performance of procedures involving sharp instruments in the home setting. Prospective surveillance of percutaneous, mucous membrane, and cutaneous blood contacts. Eleven home healthcare agencies in the United States and Canada from August 1996 through June 1997. HCWs who provided home infusion therapy or performed procedures using hollow-bore needles and other sharp instruments in the home setting. Each participating worker recorded information about the procedures performed and blood contacts experienced during each of his or her home visits for a 2- to 4-week period using standard questionnaires. HCWs also completed questionnaires regarding job duties, reporting of previous occupational blood contacts, and their use of protective barriers in the home setting. Participating HCWs provided information about 33,606 home visits. A total of 19,164 procedures were performed during 14,744 procedure visits. Fifty-three blood contacts occurred during these visits, for a blood-contact rate of 2.8 blood contacts per 1,000 procedures and 0.6 percutaneous injuries per 1,000 procedures with needles or lancets. Gloves were worn for 52%, masks for 5%, gowns for 3%, and protective glasses or goggles for 2% of all procedure visits. HCWs used barriers for 53% of visits during which at least 1 procedure was performed and for 27% of other visits. HCWs involved in home health care are at risk for blood contact. Infection control barrier use was low in our study. The majority of skin contacts could have been prevented by glove use.

Environmental Barriers in Dental Office Infection Control

The emphasis of this article is to explain the utility of incorporating disposable, single-use environmental-surface infection control barriers into dental office infection control programs. Use of barriers in dental operatories and x-ray rooms can increase infection control effectiveness, reduce operatory turn-around time between patients, and actually reduce office time and expenses associated with infection control. This article is not intended to be a cookbook on how to do it, but rather a guide to the understanding of why dentists should consider using disposable barriers in place of chemical disinfectants wherever possible. Understanding the barrier concept will enable readers to problem-solve their own facility's needs and to select appropriate materials on their own.