Infection Control Coordinators Research Articles

Occupational hazards among dental hygienists: Risk level assessment of scaling work.

This study aimed to classify occupational hazards of ultrasonic scaling by factor and to identify the distribution of occupational risk levels of the study participants according to occupational hazards. In addition, the relationship between the general characteristics of dental hygienists and the occupational risk level of scaling was investigated. This study was conducted on 237 dental hygienists. Exposure frequency and the degree of work loss were investigated on a five-point scale for each of the 15 occupational hazards of scaling. Among occupational hazards, the proportion of high-risk individuals for biological hazards (32.9%) was the highest. Dental clinics (33.6%) were found to have a higher proportion of high-risk individuals than dental hospitals (16.5%) (p < 0.05). The proportion of high-risk individuals was higher in the absence of an infection control coordinator (33.9%) (p < 0.05) and infection control education in the preceding 2 years (28.6%) (p < 0.05). To create a safe dental work environment, appropriate measures according to the risk level and measurement of occupational risk should be discussed.

The Main Tasks of a Dental Infection-Control Coordinator and Awareness about Education

The Main Tasks of a Dental Infection-Control Coordinator and Awareness about Education

Surveillance of the infection prevention and control practices of healthcare workers by an infection control surveillance-working group and a team of infection control coordinators during the COVID-19 pandemic

BackgroundDuring the ongoing coronavirus disease (COVID-19) pandemic, hospitals have strengthened their guidelines on infection prevention and control (IPC), and a rigorous adherence to these guidelines is crucial. An infection control surveillance-working group (ICS-WG) and infection control coordinators (ICCs) team were created to monitor the IPC practices of the healthcare workers (HCWs) in a regional hospital in Korea. This study analyzed the surveillance results and aimed to identify what IPC practices needed improvement. MethodsDuring phase 1 (March to April 2020), the ICS-WG performed random audits, recorded incidences of improper IPC practices, and provided advice to the violators. During phase 2 (April to July), the ICCs inspected the hospital units and proposed practical ideas about IPC. The surveillance and proposals targeted the following practices: patient screening, usage of personal protective equipment (PPE), hand and respiratory hygiene, equipment reprocessing, environmental cleaning, management of medical waste, and social distancing. ResultsIn phase 1, of the 127 violations observed, most (32.3%) corresponded to hand and respiratory hygiene. In phase 2, the highest proportion of violation per category was observed in the management of medical waste (37.8%); among these, a higher proportion of violation (71.4%) was observed in the collection of medical waste. Of the 106 proposals made by the ICCs, the most addressed practice was patient screening (28.3%). No case of nosocomial infection was reported during the study period. ConclusionAdherence to proper hand and respiratory hygiene was inadequate at the early stage of the COVID-19 pandemic. The results indicate that more attention and further training are needed for the management of medical waste, particularly medical waste collection, and that continuous upgrading of the strategies for patient screening is essential. These results will be useful in helping other healthcare facilities to establish their IPC strategies.

Activities of an infection control surveillance-working group for the infection control and prevention of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is unlikely to end soon, and hospitals face a high risk of exposure to COVID-19 and nosocomial infections. Therefore, strengthened infection control and prevention (ICP) strategies are crucial. Here, we share our experience of activities implemented by an infection control surveillance-working group (ICS-WG) and the introduction of a hospital emergency code for patients requiring screening for COVID-19, which were established at a university-affiliated hospital. This hospital applies multi-step processes to identify patients who must visit the outdoor screening clinic for COVID-19 testing, instead of entering the hospital building. However, some of these patients inevitably end up inside the hospital building. To solve this issue, we implemented a process to announce the emergency code (“code apple”) and have the medical personnel escort such patients to the outdoor screening clinic. This process was useful in protecting the hospital from unnecessary exposure to COVID-19. The ICS-WG was assigned to conduct the surveillance of ICP practices, patrol the hospital, and recommend improvements for any practices that did not adhere to the guidelines. The ICS-WG also developed a checklist as a monitoring tool for ICP practices. The checklists were distributed to the infection control coordinators who were assigned to monitor their team’s ICP practices and report to the ICS-WG. Overall, we believe that code apple and the ICS-WG are effective strategies in improving ICP practices of COVID-19 at hospitals.

Regulatory Compliance/Role of the Infection Control Coordinator

"Regulatory Compliance/Role of the Infection Control Coordinator." Journal of the California Dental Association, 48(2), pp. 91–92

Leading an Antibiotic Stewardship Initiative Through a Quality Improvement Collaborative Among 22 Hospitals in a Lower Middle Income Country

BACKGROUND The emergence of colistin resistant Carbapenem Resistant Enterobacteriaceae (CRE's) within a period of 4 months caused a team of professionals to raise the alarm. In a country lacking standardized microbiological testing, no restriction on antibiotics usage and having basic infection prevention programs, there was a need to address antimicrobial stewardship (AMS) nationally. The success of one tertiary hospital in building an AMS program resulted in a national initiative for 22 hospitals. METHODS The AMS program design included a driver diagram for the hospitals covering a catchment area of approximately 80% of the total population. A multidisciplinary team of 5 members from each hospital was responsible for implementing the activities which included; standardization of microbiological testing through hands-on workshops utilizing the American Society for Microbiology and the Clinical and Laboratory Standard Institute (CLSI) guidelines. Developing evidence based national guidelines for infections and empiric treatment and building the capacity of clinical pharmacists, medical doctors, infection control coordinators through shadowing of the AMS core team at the tertiary hospital. A data collection sheet was developed using Microsoft Access to collect data about antibiotics Days of Therapy (DoT) in line with CDC guidelines to evaluate improvements. RESULTS The effect of the AMS program was noted by a statistically significant drop in the restricted antibiotics DoT ranging between 23-74% in the vancomycin, colistin and carbapenems usage (p CONCLUSIONS The achievements of AMS interventions with minimal resources can be used as a model for regional countries in the fight against the spread of resistant bacteria.

Practice infection control co-ordinator

Practice infection control co-ordinator

PATIENT SAFETY Incident reports reflect ongoing blame games

Barbara Wyand Walker is an infection control coordinator at Greenbrier Valley Medical Center in Ronceverte, W.V. The author has disclosed no financial relationships related to this article.

Advancing infection control in dental care settings: Factors associated with dentists' implementation of guidelines from the Centers for Disease Control and Prevention

The authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings-2003. In 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling. Responding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied. Implementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines.

Surgical Site InfectionSurgical Site Infection

Thomas Anthony, MD, MSc; Bryce W. Murray, MD; John T. Sum-Ping, MD; Fima Lenkovsky, MD; Vadim D. Vornik, MD; Betty J. Parker, RN; Jackie E. McFarlin, RN, CIC; Kathleen Hartless, RN, CIC; Sergio Huerta, MDObjective: To determine if an evidenced-based practice bundle would result in a significantly lower rate of surgical site infections (SSIs) when compared with standard practice.Design: Single-institution, randomized controlled trial with blinded assessment of main outcome. The trial opened in April 2007 and was closed in January 2010.Setting: Veterans Administration teaching hospital.Patients: Patients who required elective transabdominal colorectal surgery were eligible. A total of 241 subjects were approached, 211 subjects were randomly allocated to 1 of 2 interventions, and 197 were included in an intention-to-treat analysis.Interventions: Subjects received either a combination of 5 evidenced-based practices (extended arm) or were treated according to our current practice (standard arm). The interventions in the extended arm included (1) omission of mechanical bowel preparation; (2) preoperative and intraoperative warming; (3) supplemental oxygen during and immediately after surgery; (4) intraoperative intravenous fluid restriction; and (5) use of a surgical wound protector.Main Outcome Measure: Overall SSI rate at 30 days assessed by blinded infection control coordinators using standardized definitions.Results: The overall rate of SSI was 45% in the extended arm of the study and 24% in the standard arm (P = .003). Most of the increased number of infections in the extended arm were superficial incisional SSIs (36% extended arm vs 19% standard arm; P = .004). Multivariate analysis suggested that allocation to the extended arm of the trial conferred a 2.49-fold risk (95% confidence interval, 1.36-4.56; P = .003) independent of other factors traditionally associated with SSI.Conclusions: An evidenced-based intervention bundle did not reduce SSIs. The bundling of interventions, even when the constituent interventions have been individually tested, does not have a predictable effect on outcome. Formal testing of bundled approaches should occur prior to implementation.Trial Registration: clinicaltrials.gov Identifier: NCT00953784

Evaluating an Evidence-Based Bundle for Preventing Surgical Site Infection

To determine if an evidence-based practice bundle would result in a significantly lower rate of surgical site infections (SSIs) when compared with standard practice. Single-institution, randomized controlled trial with blinded assessment of main outcome. The trial opened in April 2007 and was closed in January 2010. Veterans Administration teaching hospital. Patients who required elective transabdominal colorectal surgery were eligible. A total of 241 subjects were approached, 211 subjects were randomly allocated to 1 of 2 interventions, and 197 were included in an intention-to-treat analysis. Subjects received either a combination of 5 evidenced-based practices (extended arm) or were treated according to our current practice (standard arm). The interventions in the extended arm included (1) omission of mechanical bowel preparation; (2) preoperative and intraoperative warming; (3) supplemental oxygen during and immediately after surgery; (4) intraoperative intravenous fluid restriction; and (5) use of a surgical wound protector. Overall SSI rate at 30 days assessed by blinded infection control coordinators using standardized definitions. The overall rate of SSI was 45% in the extended arm of the study and 24% in the standard arm (P = .003). Most of the increased number of infections in the extended arm were superficial incisional SSIs (36% extended arm vs 19% standard arm; P = .004). Multivariate analysis suggested that allocation to the extended arm of the trial conferred a 2.49-fold risk (95% confidence interval, 1.36-4.56; P = .003) independent of other factors traditionally associated with SSI. An evidence-based intervention bundle did not reduce SSIs. The bundling of interventions, even when the constituent interventions have been individually tested, does not have a predictable effect on outcome. Formal testing of bundled approaches should occur prior to implementation.

Measurement of Influenza Vaccination Coverage among Healthcare Personnel in US Hospitals

To characterize practices related to measuring influenza vaccination rates among healthcare personnel in US hospitals. Descriptive survey. Nonfederal, short-stay hospitals that provide general medical and surgical services, identified by use of the 2004 American Hospital Association Annual Survey Database. Healthcare personnel from 996 randomly sampled US hospitals stratified by region and bed size. A self-administered questionnaire was distributed in 2006 to infection control coordinators to gather data on policies and practices related to the provision of the influenza vaccine and on the measurement and reporting of influenza vaccination rates. Descriptive statistics and associations were calculated, and logistic regression was conducted. The response rate was 56% (ie, 555 of 996 US hospitals responded to the questionnaire). Weighting accounted for sampling design and nonresponse. Most hospitals provided the influenza vaccine to employees (100%), credentialed medical staff (ie, independent practitioners; 94%), volunteers (86%), and contract staff (83%); provision for students and residents was less frequent (58%). Only 69% of hospitals measured vaccination rates (mean coverage rate, 55%). Most hospitals that measured coverage included employees (98%) in the vaccination rates, whereas contract staff (53%), credentialed medical staff (56%), volunteers (56%), and students and residents (30%) were less commonly included. Among hospitals measuring coverage, 44% included persons for which vaccine was contraindicated, and 51% included persons who refused vaccination. After adjustment for region and size, hospitals with vaccination plans written into policy (odds ratio, 2.0 [95% confidence interval, 1.22-7.67]) or that addressed internally reporting coverage (odds ratio, 4.8 [95% confidence interval, 2.97-7.66]) were more likely to measure coverage than were hospitals without such plans. Hospitals vary in terms of the groups of individuals included in influenza vaccination coverage measurements. Standardized measures may improve comparability of hospital-reported vaccination rates. Measuring coverage in a manner that facilitates identification of occupational groups with low vaccination rates may inform development of targeted interventions.

Ambulatory surgery center infection control coordinator

Ambulatory surgery center infection control coordinator

Adoption of Alcohol-Based Handrub by United States Hospitals: A National Survey

The extent to which the use of alcohol-based handrub for hand hygiene has been adopted by US hospitals is unknown. A survey of infection control coordinators (response rate, 516 [72%] of 719) revealed that most hospitals (436 [84%] of 516) have adopted alcohol-based handrub. Leadership support and staff receptivity play a significant role in its adoption.

Preventing Hospital-Acquired Urinary Tract Infection in the United States: A National Study

Although urinary tract infection (UTI) is the most common hospital-acquired infection in the United States, to our knowledge, no national data exist describing what hospitals in the United States are doing to prevent this patient safety problem. We conducted a national study to examine the current practices used by hospitals to prevent hospital-acquired UTI. We mailed written surveys to infection control coordinators at a national random sample of nonfederal US hospitals with an intensive care unit and >or=50 hospital beds (n=600) and to all Veterans Affairs (VA) hospitals (n=119). The survey asked about practices to prevent hospital-acquired UTI and other device-associated infections. The response rate was 72%. Overall, 56% of hospitals did not have a system for monitoring which patients had urinary catheters placed, and 74% did not monitor catheter duration. Thirty percent of hospitals reported regularly using antimicrobial urinary catheters and portable bladder scanners; 14% used condom catheters, and 9% used catheter reminders. VA hospitals were more likely than non-VA hospitals to use portable bladder scanners (49% vs. 29%; P=.001), condom catheters (46% vs. 12%; P=.001), and suprapubic catheters (22% vs. 9%; P=.001); non-VA hospitals were more likely to use antimicrobial urinary catheters (30% vs. 14%; P=.001). Despite the strong link between urinary catheters and subsequent UTI, we found no strategy that appeared to be widely used to prevent hospital-acquired UTI. The most commonly used practices--bladder ultrasound and antimicrobial catheters--were each used in fewer than one-third of hospitals, and urinary catheter reminders, which have proven benefits, were used in <10% of US hospitals.

Use of Central Venous Catheter-Related Bloodstream Infection Prevention Practices by US Hospitals

To examine the extent to which US acute care hospitals have adopted recommended practices to prevent central venous catheter-related bloodstream infections (CR-BSIs). Between March 16, 2005, and August 1, 2005, a survey of infection control coordinators was conducted at a national random sample of nonfederal hospitals with an intensive care unit and more than 50 hospital beds (n=600) and at all Department of Veterans Affairs (VA) medical centers (n=119). Primary outcomes were regular use of 5 specific practices and a composite approach for preventing CR-BSIs. The overall survey response rate was 72% (n=516). A higher percentage of VA compared to non-VA hospitals reported using maximal sterile barrier precautions (84% vs 71%; P=.01); chlorhexidine gluconate for insertion site antisepsis (91% vs 69%; P<.001); and a composite approach (62% vs 44%; P=.003) combining concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Those hospitals having a higher safety culture score, having a certified infection control professional, and participating in an infection prevention collaborative were more likely to use CR-BSI prevention practices. Most US hospitals are using maximal sterile barrier precautions and chlorhexidine gluconate, 2 of the most strongly recommended practices to prevent CR-BSIs. However, fewer than half of non-VA US hospitals reported concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Wider use of CR-BSI prevention practices by hospitals could be encouraged by fostering a culture of safety, participating in infection prevention collaboratives, and promoting infection control professional certification.

Reading habits of infection control coordinators in the United States: Peer-reviewed or non–peer-reviewed evidence?

Because evidence-based health care is taking on increasing importance, we surveyed a national sample of infection control coordinators on their reading habits to discern which and how often various media are utilized. Infection control coordinators at 797 hospitals in the United States were mailed a survey asking which peer-reviewed journals and other publications they subscribe to, their perception of the quality of the infection control articles provided by each, and the extent to which they use various resources for their work. The survey response rate was 74%. Infection control coordinators spend a mean of 3.6 hours/week reading journals or periodicals. Resources identified as most useful included the Centers for Disease Control and Prevention (CDC) Web site (52%), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) text (11%), and the APIC e-mail list (8%). Proportion of subscribers was highest for the American Journal of Infection Control (84%) and Infection Control Today (72%). The top 3 journals ranked on a scale of 1 to 10 for quality of infection control articles were Infection Control & Hospital Epidemiology (8.0), the American Journal of Infection Control (7.5), and the New England Journal of Medicine (7.4). The American Journal of Infection Control (85%) and Infection Control & Hospital Epidemiology (72%) were the most frequently used peer-reviewed sources of information, whereas Morbidity and Mortality Weekly Report (85%) and Hospital Infection Control (63%) ranked at the top for non-peer-reviewed periodicals. Infection control coordinators devote limited time to reading and critically appraising published evidence and rely heavily on sources that provide rapid access to information or evidence summaries, suggesting a growing need for easy-to-read, reliable sources of information about evidence-based infection prevention and control practices.

Reducing Blood Culture Contamination: What Makes the Difference?

ISSUE: Blood cultures are widely appreciated by physicians to be among the most important diagnostic tool performed in the diagnosis of serious infections. It is equally recognized that falsely positive results due to contamination can result in inappropriate or delayed treatment, increase lenght of stay and increase cost of health care. Early in 2002, Microbiology Laboratory of the VANJHCS notified the Infection Control staff that the blood contamination rate was high. Retrospective review of blood culture contamination rates from the previous 10 years revealed a gradual increase in the rate. In 1990, there were 217 contaminated sets out of 6,241 blood culture sets(3.5%). In 2001 there were 224 contaminated sets of 3,209 blood culture sets (6.8%) tested. The College of American Pathologist and the American Society for Microbiology had set a goal of 3% blood contamination rate. If the institution has a dedicated Phlebotomy Team the rates are lower. VANJHCS is a teaching hospital with no dedicated Phlebotomy Team. Medical residents and ER nurses were drawing specimens. The medical residents rotation is every month. PROJECT: After review of current literature on the subject, the standard operating procedure (SOP) was revised. In the old SOP, 70% to 90% alcohol was used to cleanse the area followed by 2% iodine or iodophor. The skin de-germing agent at the venipuncture site was changed to 2% Chlorhexidine and 70% Alcohol (Chloraprep One-step applicator) in June 2002. The revised SOP and the blood contamination rate data were used to educate the ER nurses and medical residents. Since medical students rotate monthly, this information was made part of the monthly infection control orientation for residents given by the Infection Control Coordinator. Compliance with hand hygiene and keeping the skin flora out by using meticulous aseptic technique in drawing blood cultures are emphasized in those sessions. To facilitate compliance to the new SOP, each patient unit was provided dedicated containers for blood culture bottles, copies of the SOP, Chloraprep applicators and sterile blood transfer devices. RESULTS: Contamination rate of blood cultures decreased after all the measures mentioned were instituted. Table I . Blood Culture Contamination Rate Year Total # Sets # of sets contaminated BCC Rate (%) 2001 3,299 224 6.8% 2002 3,209 198 6.2% 2003 3,281 140 4.3% 2004 3,256 90 3% 2005 3,248 100 3.1% LESSONS LEARNED: Although progress has been made with those measures, continuous vigilance in staff education and dialogue proved to be the key in increasing awareness of providers to this problem. It is extremely important to continue to monitor and give feedback to the staff regarding results of action taken.

Focus on the Myths: An Approach To Improving Healthcare Worker Influenza Immunization Rates

ISSUE: Every year approximately 200,000 Americans are hospitalized and more than 36,000 die from influenza and influenza-related complications, and influenza is the sixth leading cause of death in the United States; despite longstanding recommendations for healthcare worker immunization from the Centers for Disease Prevention and Control, immunization rates for health care workers average only about 36%. For this pediatric care organization which includes inpatient and outpatient rehabilitative and habilitative services, the employee immunization rate was 41% for the 2003-2004 influenza season. PROJECT: In the summer of 2004, the infection control and employee health coordinators conducted a survey to determine employees' knowledge and beliefs regarding influenza vaccine, and to identify barriers to immunization. A 32% response rate was received. Only 78% of respondents who were immunized and 63% of respondents who were not immunized believed that influenza immunization was a patient safety issue. Of the 140 respondents who were not immunized, 46% stated they had a fear of side effects, 33% feared getting influenza from the vaccine and 18% did not believe they were at risk of contracting influenza. Due to the vaccine shortage for the 2004 season, the project was put on hold. With the support of administration, increasing the employee influenza immunization rate to 50% became an organizational goal in 2005. An educational program and publicity campaign were designed to address the issues identified in the 2004 survey, employee incentives were offered, and a system was developed to track education and immunization rates. RESULTS: For the 2005- 2006 influenza season, 74% of employees had documentation of education regarding influenza and influenza immunization, and 57% of total staff received influenza vaccine. Review of discipline specific data indicated that staff in some clinical areas, therapeutic services and support services did not reach the 50% goal. LESSONS LEARNED: The survey process proved beneficial in identifying employee misconceptions and targeting these issues through education. Tracking also identified areas where different strategies may be needed to increase immunization rates. The organizational goal for 2006 includes increasing the total percentage of employees immunized to 60%, with focus on the clinical areas.

Medical Directors See Little Change From F-Tag

Medical Directors See Little Change From F-Tag