Infection Control Officer Research Articles

Devastating Water Intrusion in a New Children's Hospital: How Much Remediation Is Enough?

ISSUE: A microburst storm occurred over a new 208-bed children's hospital, resulting in extensive water damage to 265,000 square feet of space. Challenges to remediation efforts included evaluation of water damage, rapid removal of water-damaged materials, assessment for microbial growth, infection control procedures during remediation, and documentation of adequate decontamination through air and surface microbial sampling. PROJECT: Time was of the essence. A multidisciplinary team was formed. A contractor expert in water remediation was hired. Water extraction began immediately. Building materials not completely dried out within 48 hours were removed to a minimum of 2 feet above saturation. Samples for fungal spores were collected before remediation to determine baseline levels. Remediation used proper critical barriers with fire-rates plastic sheeting, air filtration equipment with high-efficiency particulate air (HEPA) filters, wet removal methods, and HEPA vacuuming. RESULTS: Drywall and base molding for approximately 70,000 square feet was removed and replaced. All impacted fireproofing, insulation, and ceiling tiles were removed. Cabinetry was pulled out and inspected. Eighty windows were replaced and resealed. Sampling for fungal spore counts after remediation assisted in documenting proper decontamination. No adverse patient outcomes occurred. LESSONS LEARNED: Water intrusion requires rapid action. Having a remediation plan and knowing local vendors can prevent delays in remediation efforts. Immediate removal of affected cove bases hastens the drying process. Routine inspections of window seals prevent windows from being a source of water intrusion. Using greenboard for rebuilding is advantageous due to its resistance to water penetration. Infection control and safety officers must have front-line involvement and continuously monitor the remediation efforts.

Career alternative: clinical trials.

1. Peter M Colaninno, MS CLS(NCA)[⇑][1] 1. is Laboratory Manager, Infectious Diseases, Icon Laboratories Inc, Farmingdale NY, and Adjunct Professor, Allied Health Professions, at St John's University, Jamaica NY, City University of NY, Queensborough Campus, State University of NY, Farmingdale Campus, and Hofstra University, Hempstead NY 1. Address for correspondence: Peter M Colaninno MS CLS(NCA), Laboratory Manager, Infectious Diseases, Icon Laboratories Inc, 260 Smith Street, Farmingdale NY 11735. As an adjunct professor instructing clinical laboratory science (CLS) students, I'm frequently asked about employment opportunities in the field. Historically, the proclivity of graduating students is to find employment in a hospital setting, but with hospitals under severe fiscal constraint, especially in the New York City area, they are no longer the hiring centers for clinical laboratory scientists (CLSs) that they were in the past.1,2 Because of this, graduates are forced to find career alternatives in order to utilize their degree. There are a number of employment opportunities available to CLSs.3,4 These include: Technical: Private laboratories; physician's office laboratories; college research laboratories; health maintenance organization and union health offices; government laboratories; state and city health departments; blood banks; veterinary offices. Non-technical: Inspector; infection control officer; quality assurance officer; safety officer; laboratory management; planning and development; information technology; risk management officer; consultant. Education: Teaching; administration; mentoring. Commercial: Marketing; sales; public relations; technical writing and illustrations.5 However, a career alternative that has come to the forefront in recent years is employment in a clinical trials laboratory. What are clinical trials? Clinical trials laboratories work closely with pharmaceutical companies to assist them in the FDA approval process of new compounds and are dedicated to testing samples procured from patients who are enrolled in phase 2, phase 3, and phase 4 trials, testing the efficacy of compounds being introduced by the pharmaceutical companies. After working in a hospital setting for more than 17 years as a microbiologist, I made the transition five years ago… ABBREVIATIONS: CAP = College of American Pathologists; FDA = Food and Drug Administration. [1]: #corresp-1

Burkholderia cepacia complex infection in patients with cystic fibrosis.

The word 'complex' has several meanings and synonyms such as composite, obsession, heterogeneous, mixed and network, can all be used in its place. Our obsession with bacteria from the Burkholderia cepacia complex started in the early 1990s. In less than 10 years, we have seen the status of this bacterium move from: (i) a lesser known pseudomonad opportunist pathogen, (ii) to devastating infections transmitted between patients with cystic fibrosis (CF), (iii) through divisions into several new species, and (iv) now on towards one of the largest gram-negative genome sequencing projects. For microbiologists, hospital infection control officers, caregivers, and most of all the CF community, the changes in our understanding of the taxonomy, epidemiology and pathogenesis of the bacterium 'B. cepacia' are complex.

Perceptions of administrators, infection control officers, and infection control professionals of acute care infection control programs

Perceptions of administrators, infection control officers, and infection control professionals of acute care infection control programs

Hepatitis B vaccination of personnel employed in Victorian hospitals: are those at risk adequately protected?

To examine the policies and practices in hospitals within the state of Victoria, Australia, with respect to vaccination of staff against hepatitis B infection. A written self-administered questionnaire to be completed by the infection control officer (or designated officer for hepatitis B vaccination) within each hospital. Public (teaching and nonteaching) and private hospitals, including metropolitan and rural institutions in Victoria. A random sample of 30% of Victorian hospitals were asked to participate in the survey. Of 78 eligible institutions, 69 (88%) completed and returned questionnaires. There was no consistent hepatitis B prevention policy in place across Victoria. Of the 69 responding hospitals, 63 (91%) offered hepatitis B vaccination to staff, and 58 (84%) of these also paid all costs of vaccination. Of the 63 hospitals offering vaccination to staff, 39 offered vaccination to all staff, 23 offered vaccination based on job title, and one offered vaccination based on anticipated exposure. In many institutions, postexposure protocols were recalled more readily than preexposure vaccination guidelines. Numerous respondents indicated a need for clear guidelines on policy and clarification on practical matters of management, such as acceptable immune levels, management of nonresponders to the primary series, and the need for, and timing of, booster doses of vaccine. Eleven (18%) of the 63 hospitals offering hepatitis B vaccination to staff undertook routine prevaccination screening, a practice not generally regarded as cost-effective in Australia. Fifty-five of these hospitals (91%) also undertook postvaccination screening. It is evident from this study that a considerable number of potentially susceptible healthcare personnel in Victorian hospitals remain unprotected against hepatitis B infection. A more reliable and consistent approach to preexposure hepatitis B vaccination is recommended.

Application of PCR for the characterization of Enterococci

Accurate and rapid species identification of enterococci is becoming increasingly important to clinical micro-biology laboratories since low level vancomycin-resistant species with a diverse epidemiology have been involved in human infections. Van B phenotype, low-level vancomycin-resistant E. faecalis and E. faecium should be differentiated from E. casseliflavus and E. gallinarum group as the latter organisms are not of the same epidemiologic importance as van B-type VRE. The PCR assays described in this review address these issues in relation to enterococci. They are relatively rapid, not labor intensive, may be performed by anyone with expertise in PCR methodology, and do not require the purchase of expensive equipment. Newly detected VRE isolates should be reported to the hospital infection control officers quickly for prompt implementation of proper isolation and barrier precaution.

From eradication to resistance: five continuing concerns about pediculosis.

A school nurse, serving in the capacity of infection control officer, is responsible for managing head lice infestations. The nurse's concerns on the student and parent levels include dispelling misconceptions about lice, screening, motivating correct treatment, and providing follow-up. The nurse's responsibility to the community as a whole also involves putting into practice policies that prevent the spread of infestations without promoting pediculicide resistance.

Level 4: Virus Hunters of the CDC

The Centers for Disease Control and Prevention (CDC) celebrates its 50th anniversary this year. What started as a malaria control agency has blossomed into an institution renowned for its excellence in the field of epidemiology. The first class of Epidemic Intelligence Service (EIS) officers graduated in 1951. These "disease detectives," so wonderfully depicted in the January 1991 issue of the National Geographic magazine by Peter Jaret, have blazed a trail of success and glory worldwide. "The CDC says" has become a common refrain for sweaty-palmed hospital infection control officers prior to the inevitable visit by the Joint Commission on Accreditation of Healthcare Organizations when they wish to provide legitimacy to their infection control ventures. EIS officers have been involved in global programs for the eradication of infectious diseases ranging from poliomyelitis to dracunculiasis. They have investigated and defined the scope of such new diseases as legionnaire disease, toxic shock syndrome,

Value of Molecular Epidemiologic Analysis in a Nosocomial Methicillin-Resistant Staphylococcus aureus Outbreak

To evaluate two molecular epidemiologic methods used in the analysis of a nosocomial methicillin-resistant Staphylococcus aureus (MRSA) outbreak. Restriction endonuclease analysis of plasmid DNA (REAP) was used in the analysis of 45 MRSA isolates. After termination of the outbreak, isolates were retrospectively analyzed in a blind fashion using the newly described technique of arbitrarily primed polymerase chain reaction (AP-PCR). Molecular analyses were compared with epidemiologic and antimicrobial susceptibility data. Tertiary care university hospital. Twenty-eight patients and 12 employees infected or colonized with MRSA during a 6-week period. A clonal relationship demonstrated among isolates from burn unit patients and staff was clearly distinguishable from MRSA isolates arising from other hospital wards. The combination of REAP and AP-PCR provided complementary information in several instances. Aggressive measures to isolate infected patients and eradicate colonization from patients and staff terminated the outbreak. Although traditional epidemiologic methods retain their central role in modern hospital infection control, molecular epidemiologic analysis can significantly enhance the ability of infection control officers to analyze and terminate hospital epidemics. The combination of AP-PCR and REAP may prove to be a particularly informative means of tracking the nosocomial spread of microbial strains and their mobile genetic elements.

Israeli dentists: a survey of infection control office practices and care of medically compromised patients.

A survey was conducted by interviewing a randomly selected sample of practicing dentists in Israel in 1991. The aim of this study was to evaluate methods of infection control in current use and to learn about the access to care for medically compromised patients. One hundred seventeen dentists were interviewed. This group represented a majority of graduates from Israeli schools (66). With respect to infection control, only 28% of the population surveyed routinely uses gloves, but 43% use steam autoclave, and 70% use dry-heat sterilization. A very high percentage (87%) took a verbal medical history, while a small minority (27%) had their patients fill out a written questionnaire. Only occasionally was the name of the patient's physician requested or recorded, implying a flaw in interprofessional communications. Only 26% of the dentists said they would treat patients with hepatitis and/or AIDS. Only about half the dentists accepted patients on chemotherapy or radiotherapy or those who were taking anticoagulant drugs. Physical access for dental patients in wheelchair or stretcher was markedly limited, with referral to regional hospitals the routine for these patients.

Transmission of human immunodeficiency virus in a dental practice.

To determine if patients of a dentist with the acquired immunodeficiency syndrome (AIDS) became infected with human immunodeficiency virus (HIV) during their dental care and, if so, to identify possible mechanisms of transmission. Retrospective epidemiologic follow-up of the dentist, his office practice, and his former patients. The practice of a dentist with AIDS in Florida. A dentist with AIDS, his health care providers and employees, and former patients of the dentist, including eight HIV-infected patients. Identification of risks for HIV transmission (if present), degree of genetic relatedness of the viruses, and identification of infection control and other office practices. Five of the eight HIV-infected patients had no confirmed exposures to HIV other than the dental practice and were infected with HIV strains that were closely related to those of the dentist. Each of the five had invasive dental procedures, done by the dentist after he was diagnosed with AIDS. Four of these five patients shared visit days (P greater than 0.2). Breaches in infection control and other dental office practices to explain these transmissions could not be identified. Although the specific incident that resulted in HIV transmission to these patients remains uncertain, the epidemiologic evidence supports direct dentist-to-patient transmission rather than a patient-to-patient route.

Nosocomial Fungal Infections: Old Problems and New Challenges

The frequency of nosocomial mycoses has substantially increased in recent years, primarily because of the use of intensive therapeutic regimens in patients with cancer and organ transplantation. Furthermore, newer fungi previously considered as contaminants or harmless colonizers have now emerged as significant human pathogens, particularly in the immunocompromised host. Only through the collaboration between clinicians, pathologists, microbiologists, and infection control officers can these fungal infections be recognized and treated early. It is hoped that the proper implementation of infection control policies, the advent of newer antifungals and biological response modifiers, and the advances in immunosuppressive regimens for organ transplant recipients will result in a significant improvement in the prevention and treatment of these life-threatening opportunistic mycoses.

Current challenges and future opportunities.

This article is the first in a new series entitled “Topics in Long-Term Care.” The author, a full-time academic physician, is based at a chronic disease hospital with a 577-bed nursing home where he is head of infectious diseases and, with the support of a full-time infection control officer (RN), manages the infection control programs as the hospital epidemiologist and chair of the infection control committee. Although most interest centers on the nursing home setting, the title reflects the need to consider all long-term care facilities (LTCFs) with special populations and risk factors for acquiring infection, e.g., rehabilitation units, day care centers and day hospitals for the elderly and institutions for developmental disabled persons of all ages.

Occupational biohazards affecting clinical engineers & BMETs. Part V: Skin and urogenital diseases.

BMETs and clinical engineers must be aware of the biological hazards they face in the hospital so they can take precautions to avoid work-related illnesses. A need for educational material on the subject prompted this series of papers examining various biohazards. This paper, the last in the series, reviews a variety of common diseases of the skin and urogenital systems. Common pathogens, their routes of transmission, isolation precautions, and infection control techniques are discussed. The precautions cited are not intended to constitute a full infection control program. Persons interested in further information are advised to contact the infection control officer at their facility, or the Centers for Disease Control.

Occupational biohazards affecting clinical engineers & BMETs. Part IV: Respiratory and gastrointestinal systems.

A previously published survey indicated that clinical engineers and BMETs may not be aware of the scope of biological hazards they may encounter in their work (Baker, 1989). In this third article of a four-part series, various pathogens affecting the respiratory and gastrointestinal systems are discussed. Infection hazards and methods of transmission are examined, and recommendations are provided to help ensure the safety of CEs, BMETs, and patients. The recommendations presented include suggested disinfection procedures for contaminated equipment. Persons interested in further information are advised to contact the infection control officer at their facility, or the Centers for Disease Control.

Occupational biohazards affecting clinical engineers & BMETs. Part III: Blood and other body fluids.

Results of a previously reported survey of BMETs and CEs indicated a need for further education of these professionals concerning work-related biohazards. In this third article of a five-part series, the dangers of disease transmission by blood and other body fluids are discussed. Susceptibility factors are cited to indicate those persons at greatest risk of infection, and recommendations are provided to assist BMETs and CEs in effectively protecting both themselves and other clinical and nonclinical personnel from infection. The recommendations presented include suggested disinfection procedures for contaminated equipment. Persons interested in further information are advised to contact the infection control officer at their facility, or the Centers for Disease Control.

Predictors of surgical wound infection in Australia: a national study.

In July 1984, the first national Australian Nosocomial Prevalence Survey collected data on 12,742 surgical patients from 265 hospitals. This sample represented 59% of public and private hospitals with 50 or more acute-care beds in Australia. The infection control officers at each hospital provided data on patients in a random sample of beds. The over-all surgical wound infection rate was 4.6%. The surgical wound infection rate was twice (5.4%) as high in public than in private (2.8%) hospitals. The infection rates were greater in larger hospitals in both the public and private sector. However, after adjusting for the other predictor factors that are noted below the infection rate did not show any particular pattern for the size of hospital. Clean surgery had a higher (4.8%) infection rate than did clean-contaminated surgery (2.9%). The infection rate for contaminated surgery was 15.0%. Men were found to have nearly twice (6.5%) the infection rate of women (3.4%). Infection rates were lowest in the 15-to-34 years' age-group and highest in those of over 55 years of age. These trends remained even after adjusting for the other risk factors for infection. The cost of surgical wound infections for all hospitals during the year of 1984 was estimated at approximately $60 million. We suggest that a concerted effort should be made to attempt to reduce the infection rate for clean surgery to 1% or less.

Hospital infection surveillance in the United Kingdom.

Surveillance methods vary in different hospitals, but are mainly based on laboratory reports, as in Sweden. These reports are supplemented by ward visits by the infection control nurse and by the usual epidemiologic methods in the investigation of outbreaks.An increasing interest in surveillance of hospital infection occurred in the 1950s when outbreaks of staphylococcal infection were causing problems throughout the world. The appointment of an MD as infection control officer in every hospital was suggested in 1955 by Colebrook in the Birmingham Accident Hospital, but no full-time officer has so far been appointed in the United Kingdom (UK). The task was taken on by medical microbiologists, who are usually physicians and, currently in England and Wales, make up 82% of infection control officers.”In the early days, the recording of the incidence of infection was usually confined to surgical wounds, as in the US. The problem of collecting a large amount of data by the microbiologist was recognized by Moore who appointed the first infection control nurse.” He also described the importance of laboratory reports in the early detection of outbreaks.Surveillance was a major topic for discussion at the international Conference on Nosocomial Infections in 1970, and Moore suggested that incidence rates were of little value for determining changes in a hospital or for comparisons between hospitals. The number of infections in individual hospitals was too small for statistical comparison, particularly if rates were low and infections influenced bv many factors were not corrected for in the overall rates.

Cross-infection and its prevention

The problem of cross-infection in a burns unit was recognized by Cruickshank (1935) when he described the acquisition of Streptococcus pyogenes in patients after admission to hospital. He also showed that the organism was frequently present in the air. Investigations into the spread of Str. pyogenes and later Staphylococcus aureus continued throughout and following the Second World War. In 1950 Colebrook, working in Birmingham, described the principles for preventing the spread of infection. He considered that a specialized centre with trained staff was necessary and proposed the following: (1) All dressing techniques should be done in clean air; (2) A strict aseptic technique, e.g., including masks, caps, gowns and overshoes, should be used; (3) Patients should be nursed whenever possible in properly designed cubicles; (4) Chemotherapy should be applied when changing dressings, depending on bacteriological findings, and dayto-day liaison should take place with the bacteriologist acting as ' Infection Control Officer'; (5) An operating theatre and anaesthetist should always be available so that skin grafts can be applied at the optimal time. These principles still apply today, but modifications of the techniques might be considered in relation to increased knowledge of the spread of organisms, particularly of Gram-negat ive bacilli. Cross-infection in a burns unit mainly occurs with Staph. aureus, Pseudomonas aeruginosa and other Gram-negat ive bacilli, such as Acinetobacter calcoaceticus var. anitratum. Aminoglycoside-resistant Ps. aeruginosa is a particular problem, limiting the choice of therapy in clinical infections. Staphylococcus aureus tend to spread widely in a unit, but are not usually a major clinical problem. Streptococcus pyogenes also cause occasional outbreaks and graft failure in individual patients, but can usually be controlled by therapy or prophylaxis with penicillin. These organisms spread by the airborne route or by direct or indirect

Enzyme immunoassays for the detection of microbial antigens in body fluids: an overview

Abstract