Infection Control Resources Research Articles

Survey of acute hospital infection control resources and services in the Republic of Ireland

SummaryFollowing the development of national guidelines on the control of antimicrobial resistance in 2001, a survey was carried out in 2003 of all 68 acute hospitals in the Republic of Ireland on resources available and current practice to control and prevent nosocomial infection. Completed questionnaires were received from 66 hospitals (97%). The median number of acute inpatient beds per hospital was 156; this was 522 in regional/tertiary referral centres. Only 31 (47%) hospitals had on-site consultant microbiologist sessions, and there was an infection control nurse in 56 (85%) hospitals. Eighteen (29%) hospitals had an occupational health physician, and 48 (73%) hospitals had an infection control committee. There was a median of one isolation room for every 16 acute beds, and a median of five rooms with en-suite bathroom facilities per hospital in those hospitals that provided data. All hospitals had documented infection control policies, and these were available in electronic format in 25 (38%) hospitals. Fifty-five (83%) hospitals undertook surveillance of nosocomial infection, and alcohol-based hand hygiene facilities were available, either at a handwashing sink or at the entrance to a ward, in 57 (86%) hospitals. In the Republic of Ireland, there remains a significant shortage of microbiologists/infection control doctors, occupational health physicians and infection control nurses. Isolation facilities are also inadequate. Although there is much agreement internationally on the importance of nosocomial infection and the priorities for surveillance, there are no agreed basic minimum standards for the resources and facilities necessary to control and prevent nosocomial infection.

Extending Your Reach: Developing an Infection Control Resource Program

ISSUE: In 2003, the Infection Control practitioners(ICPs) at two facilities in an integrated health care system identified a need for increased involvement of front-line staff in the infection control(IC) programs. To address this need, the ICPs developed an Infection Control Resource(ICR) program. The initial goal of the ICR program was to develop staff expertise in IC, thus empowering them to function as resources, especially in areas and on shifts not readily accessible to IC. The ICR program participants attended educational programs on IC topics, identified IC issues in their work areas, and developed projects to improve IC practices and patient outcomes. PROJECT: The first and most important step in developing the ICR program was to gain the support of hospital and nursing administration and the IC Committee. A model for the ICR program was presented to key stakeholders. This model included the commitment of material and staff resources, as well as the intended benefits and outcomes. Once approved, the ICR program was marketed to staff at informational meetings. Involvement in the ICR program could be used for promotion in the staff nurse clinical ladder series, which was one incentive to participate. The ICR program included staff from a variety of clinical areas, including outpatient locations. RESULTS: The ICR program was considered successful by all stakeholders and has continued from the pilot period to present. The initial goals of the ICR program were met as staff became IC resources for their areas. Additional unexpected benefits included identification of barriers to successful implementation of IC practices and enhanced collaboration with leadership to overcome these barriers. In addition, several ICR participants have expressed interest in IC as a future career. Outstanding achievements were: improved hand hygiene compliance, development of unit specific policies, novel approaches to educational presentations, surveillance of IC practices, and evaluation of safety devices. LESSONS LEARNED: The ICR program has many benefits for the IC program as well as for the facility. The benefits include a dedicated IC resource and a heightened awareness of IC issues at the front-line staff level. It does, however, require a significant investment of time by the ICPs. Staff required more education, direction, and support in project development and management than anticipated. Staffing demands sometimes hindered the ICR member's participation in educational programs and completion of unit-based projects. Leadership support as well as the strong commitment of the ICPs and staff to the program are essential for success.

Enhanced Isolation Practices To Improve Patient Safety: Preventing Nosocomial Transmission in a Hospital

ISSUE: Healthcare associated infections (HAI) are transmitted by predictable routes. Reservoirs and susceptible hosts contribute significantly. Transmission occurs via the indirect spread of pathogens from these identified reservoirs to susceptible hosts. In 2006, the Joint Commission National Patient Safety Goals propose reducing HAI. PROJECT: Isolation precautions (IP) at the Johns Hopkins Hospital (JHH, 1026 bed capacity) are designed to prevent transmission of microorganisms. In an effort to provide quicker and more efficient use of our infection control resources, we developed a new computer program with TheraDoc^® that generated a log that provides real-time data on patients with 11 epidemiologically significant microorganisms/drug resistance patterns. These logs were transmitted to the units listing patients that required isolation. Patients having more than one organism requiring isolation were triaged "hierarchally" to facilitate appropriate isolation. RESULTS: The isolation rate throughout JHH was compared on January 11, 2005 and 2006. A search of the old database revealed 148 patients (14.4%) were isolated for drug-resistant microorganisms (MRSA or methicillin-resistant S. aureus, VRE or vancomycin-resistant Enterococcus, and extended spectrum beta-lactamases or ESBLs). Using the new expanded database, a query of all 11 microorganisms/tests reported (MRSA-also differentiating respiratory source or non-respiratory source), VRE, ESBL, multiply-drug resistant Acinetobacter or MDRAC, multiply-drug resistant Gram-negative rods or MDRGNR, Varicella zoster, Influenza, respiratory syncytial virus or RSV, Clostridium difficile, and acid-fast bacilli), 199 patients (19.4%) were isolated within 1 day of admission. The new system provided isolation precaution requirements an average of 72 hours sooner. LESSONS LEARNED: Automated computer systems that provide fundamental functions and distribute information house-wide automatically reduce the time an infection control epidemiologist spends doing surveillance. Tools such as this new isolation system allows the ICE to truly prevent and control the spread of infection within their facility.

Hospital- and community-acquired infections: a point prevalence and risk factors survey in a tertiary care center in Saudi Arabia

Point prevalence studies are useful in revealing the prevalence of hospital-acquired infections (HAIs) and community-acquired infections (CAIs). Such information allows prioritization of infection control resources and aids in overall hospital expenditure cut-backs. A one-day point prevalence survey was conducted on May 19, 2003 at the King Fahad National Guard Hospital in Riyadh. Since the survey included HAIs and CAIs all patients were included. Data were collected on the underlying diagnosis, infection if present and whether it was hospital-acquired or community-acquired. We identified the presence of a line-associated blood stream infection (BSI), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (UTI) or a surgical site infection (SSI) based on the United States National Nosocomial Infection Surveillance (NNIS) definitions. Five hundred and sixty-two inpatients were included in the survey. There were 38 patients with 45 (8.0%) HAIs and 76 (13.5%) patients with a CAI. Of the HAIs, 31.1% had a line-related BSI, while 28.9% and 24.4% had a VAP and catheter-related UTI, respectively. Most of the HAIs took place in the intensive care units (ICU) (21 (46.7%)), followed by the medical and surgical wards with six (13.3%) cases in each ward. For all HAIs there was a 12.7-fold increased risk with a hospital stay exceeding eight days (OR: 12.7, CI 3.2-50.6). Most of the 76 CAIs were admitted to the medical ward with community-acquired pneumonia (34.9%) as the most common diagnosis. Among the 89 pathogens isolated, Pseudomonas aeruginosa was the most common (21.3%) followed by Enterococcus spp (16.9%). The overall rate of HAIs in our hospital was 8%, with significant risk factors including a hospital stay exceeding eight days. A device-related infection was more likely in a patient with a venous or bladder catheter in place for more than eight days, or a patient mechanically ventilated for more than eight days. Catheter-related UTIs were identified as an important source of infection, requiring ongoing surveillance.

Infection control program disparities between acute and long-term care facilities in Maryland

In January 2003, the Maryland State Department of Health and Mental Hygiene (DHMH) surveyed, for the first time, all acute care hospitals (ACHs), long-term care facilities (LTCFs), and specialty hospital (acute rehabilitation and behavioral health) facilities in the state to determine the current state of infection control resources and practices in Maryland. Federal health care facilities in Maryland were not surveyed. A self-administered questionnaire was sent to all 40 ACHs, 247 LTCFs, and 20 specialty hospitals in the state. The senior infection control professional (ICP) in the facility completed the questionnaire. The response rates were 85% for ACHs, 39% for LTCFs, and 95% for specialty hospitals. Data were analyzed separately for each type of facility. The ICPs in acute care reported 1.2 full-time equivalent positions (FTEs) for each 200 acute care beds, whereas ICPs in LTCFs reported 0.3 FTEs per 200 LTCF beds. Ninety percent of acute care ICPs reported taking some type of basic infection control course, whereas only 3% of long-term care ICPs reported taking a basic infection control course. In this survey of ICPs in Maryland, striking differences were noted between ACHs and LTCFs in the ratio of ICP FTEs to beds and in basic infection control educational preparation for ICPs. These findings suggest that Maryland LTCFs could benefit from basic infection control training and from regulatory actions addressing staff-to-resident ratios.

The practice of infection control and applied epidemiology: A historical perspective

The United States health care system and patient populations have changed substantially over the past several decades. The practice of infection control also has evolved since the landmark Study on the Efficacy of Nosocomial Infection Control project, and infection control professionals (ICPs) must continue to develop the knowledge and skills necessary to practice infection prevention and control. Practice analyses of infection control conducted between 1982 and 2001 were analyzed to determine changes in practice. These data reflect a 145% increase in infection control activities over a 20-year period. However, resources for infection control and prevention have not kept pace with this increased activity. In addition, the current trend toward mandatory reporting of health care-associated infections (HAIs) among several states will add more tasks for ICPs with limited resources, at the risk of spending less time on prevention and control activities. In keeping with its philosophy of quality health care and responsible public reporting, the Association of Professionals in Infection Control and Epidemiology, Inc, continues to explore the issue of mandatory reporting of HAIs.

The economic impact of infection control: Making the business case for increased infection control resources

The economic impact of infection control: Making the business case for increased infection control resources

Infection control professionals: roles and responsibilities in New York State acute care hospitals, 1999 and 2004

OBJECTIVES: In 1999 and 2004, the New York State (NYS) Department of Health conducted a survey of acute care hospital (ACH) infection control program resources and responsibilities. METHODS: Surveys were mailed (hard copy in 1999, and electronic version in 2004) to the infection control department of all ACHs. The surveys were designed to assess infection control (IC) staffing, IC support services, interaction in other hospital programs, and routine surveillance activities. RESULTS: The response rate was 202/255 (79%) in 1999, and 167/234 (71%) in 2004. In 1999 and 2004, the average infection control professional (ICP) covered the following facilities and services:19992004Acute Care Hospitals0.80.8ACH Beds195150.5ICUsn/a1.3ICU Bedsn/a14.4LTC Facilities0.30.2LTC Beds4524Dialysis Centers0.40.6Ambulatory Surgery Centers0.60.5Ambulatory Clinics2.43.9Private Practice Settings3.01.1n/a=not available. In 2004, IC programs were most frequently integrated into the quality assurance program (32%), followed by nursing (29%), administration (14%), infectious disease (5%), internal medicine (4%), laboratory (1%), or other/unknown (14%). In 2004, only 57% had some secretarial support and for those with secretarial support, the average was 0.7 full-time employees (FTEs); 96% had a personal computer, 99% had Internet access, 86% had a fax, 53% had access to partial or complete electronic medical records, 93% computerized laboratory records, and 86% computerized radiology records. ICPs had some responsibility for employee/occupational health (68%), central supply (52%), staff education (73%), risk management (45%), emergency/BT preparedness (70%) and quality assurance (55%). Routine surveillance activities included bloodstream infections (57% total house, 40% targeted), surgical site infections (51% total house, 44% targeted), pneumonias (36% total house, 57% targeted) and urinary tract infections (28% total house, 41% targeted). CONCLUSIONS: Infection control resources cannot be accurately described or allocated solely on the basis of acute care beds. This survey revealed that the average ICP has responsibilities covering a broad array of facilities, services, and roles.

Quantitative analysis of the burden of monitoring construction upon an infection control (IC) program

BACKGROUND: Monitoring construction projects is an integral part of hospital IC programs. Regulatory agencies mandate that IC policies adhere to environment of care standards. This university medical center is an 800-bed hospital with 45 affiliated clinics. Recently, the IC program has devoted considerable resources to monitoring construction activities in the hospital and clinics. OBJECTIVE: To quantify IC time and labor costs expended in monitoring construction activities in our medical center. METHODS: Infection control practitioners (ICPs) recorded the number of 1) construction projects and 2) hours devoted to monitoring those sites during 2003-2004. To calculate IC construction labor costs for 2004, we multiplied the number of IC hours devoted to construction activities by an average ICP hourly wage of $30.63. We also recorded the number of times that projects were altered due to IC input and the number that deviated from IC recommendations on follow-up visits. RESULTS: During 2004, which was a typical year for construction, there were a total of 22 new construction projects and 45 incidental renovations (e.g., water leaks and mold remediation) at the medical center. The estimated cost of these construction projects was $76,971,266. ICPs attended a total of 56 planning meetings and made a total of 144 site visits. In total, ICPs devoted an estimated 427 hours related to monitoring construction renovations in 2004 (estimated cost = $13,079.01). Due to IC input, 54 construction plans were altered. Of the 67 construction projects, a total of 67 deviated from original IC recommendations. CONCLUSION: Monitoring construction is fundamental to the duties of IC and to the goal of maintaining a safe environment for patients, staff, and visitors. Monitoring construction involves planning, meetings, infection prevention strategies, and rounding in involved areas. Twenty-five percent (25%) of ICPs' time is spent on construction during any standard period of time. In addition, incidental events place additional time demands upon the ICP. Responsibilities related to construction required significant IC resources at this medical center in 2004. BACKGROUND: Monitoring construction projects is an integral part of hospital IC programs. Regulatory agencies mandate that IC policies adhere to environment of care standards. This university medical center is an 800-bed hospital with 45 affiliated clinics. Recently, the IC program has devoted considerable resources to monitoring construction activities in the hospital and clinics. OBJECTIVE: To quantify IC time and labor costs expended in monitoring construction activities in our medical center. METHODS: Infection control practitioners (ICPs) recorded the number of 1) construction projects and 2) hours devoted to monitoring those sites during 2003-2004. To calculate IC construction labor costs for 2004, we multiplied the number of IC hours devoted to construction activities by an average ICP hourly wage of $30.63. We also recorded the number of times that projects were altered due to IC input and the number that deviated from IC recommendations on follow-up visits. RESULTS: During 2004, which was a typical year for construction, there were a total of 22 new construction projects and 45 incidental renovations (e.g., water leaks and mold remediation) at the medical center. The estimated cost of these construction projects was $76,971,266. ICPs attended a total of 56 planning meetings and made a total of 144 site visits. In total, ICPs devoted an estimated 427 hours related to monitoring construction renovations in 2004 (estimated cost = $13,079.01). Due to IC input, 54 construction plans were altered. Of the 67 construction projects, a total of 67 deviated from original IC recommendations. CONCLUSION: Monitoring construction is fundamental to the duties of IC and to the goal of maintaining a safe environment for patients, staff, and visitors. Monitoring construction involves planning, meetings, infection prevention strategies, and rounding in involved areas. Twenty-five percent (25%) of ICPs' time is spent on construction during any standard period of time. In addition, incidental events place additional time demands upon the ICP. Responsibilities related to construction required significant IC resources at this medical center in 2004.

Monitoring hand hygiene compliance in a university-affiliated medical center

BACKGROUND: HICPAC hand hygiene (HH) guidelines recommend periodic monitoring of HH compliance. Thus, we carried out a 3-month observational assessment of HH practice in our 719-bed hospital using “light-duty” nursing personnel. OBJECTIVES: To determine the reliability of using alternative available hospital resources to obtain baseline HH compliance data for use in the development of an effective HH program. METHODS: Two light-duty nursing staff members were deployed during the day and evening shifts over a 3-month period (576 hours) to observe compliance with HH policy throughout the adult and pediatric units and departments. Observers were trained and supervised by infection control (IC) staff to ensure inter-observer reliability. Staff members were observed to determine if hands were washed with soap and water or if alcohol-based hand gels was used before and after A) patient contact, after removal of gloves, and when caring for patients on contact precautions. RESULTS: From June through August 2004, 3890 opportunities for HH were observed. Overall compliance with use of soap and water or alcohol-based hand gel was 31% (1216/3890). HH before patient contact was 9% (170/1802) and after patient contact was 50% (1046/2088). Alcohol-based hand gel was used before or after patient contact 69% of the time compared to soap and water. Staff members were more likely to perform HH after contact with contact precautions patients and were more likely to use HH if they worked in pediatrics or intensive care units. HH occurred more often during the day (7 am–3 pm) (p CONCLUSIONS: Light-duty nursing personnel can be an important adjunct to IC departments when monitoring infection control practice. An additional 48 hours/week for 12 weeks (equivalent IC practitioner salary value of $16,883) were devoted to monitoring HH compliance and data entry by light-duty nursing staff. This effectively relieved the IC department staff from the data collection burden and allowed IC staff time to focus on interventions. The additional resources were IC budget-neutral and allowed us to obtain a level of detail that would otherwise not have been possible given our current IC staffing. The experience provided the opportunity to develop additional IC resources as well as provide immediate feedback for staff regarding HH practice. In addition, the data collected will serve as the basis for current and future interventions to improve HH compliance at our institution.

Clinical Issues and Research in Respiratory Failure from Severe Acute Respiratory Syndrome

The National Heart, Lung, and Blood Institute, along with the Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases, convened a panel to develop recommendations for treatment, prevention, and research for respiratory failure from severe acute respiratory syndrome (SARS) and other newly emerging infections. The clinical and pathological features of acute lung injury (ALI) from SARS appear indistinguishable from ALI from other causes. The mainstay of treatments for ALI remains supportive. Patients with ALI from SARS who require mechanical ventilation should receive a lung protective, low tidal volume strategy. Adjuvant treatments recommended include prevention of venous thromboembolism, stress ulcer prophylaxis, and semirecumbent positioning during ventilation. Based on previous experience in Canada, infection control resources and protocols were recommended. Leadership structure, communication, training, and morale are an essential aspect of SARS management. A multicenter, placebo-controlled trial of corticosteroids for late SARS is justified because of widespread clinical use and uncertainties about relative risks and benefits. Studies of combined pathophysiologic endpoints were recommended, with mortality as a secondary endpoint. The group recommended preparation for studies, including protocols, ethical considerations, Web-based registries, and data entry systems.

Detection of Methicillin-Resistant Staphylococcus aureus Directly from Nasal Swab Specimens by a Real-Time PCR Assay

Screening for colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a key aspect of infection control to limit the nosocomial spread of this organism. Current methods for the detection of MRSA in clinical microbiology laboratories, including molecularly based techniques, require a culture step and the isolation of pure colonies that result in a minimum of 20 to 24 h until a result is known. We describe a qualitative in vitro diagnostic test for the rapid detection of MRSA directly from nasal swab specimens (IDI-MRSA; Infectio Diagnostic, Inc., Sainte-Foy, Quebec, Canada), based upon a real-time PCR and direct detection of MRSA via amplicon hybridization with a fluorogenic target-specific molecular beacon probe. Samples from 288 patients were analyzed for the presence of MRSA with the IDI-MRSA assay, compared to detection by either direct plating or enrichment broth selective culture methods. The diagnostic values for this MRSA screening method were 91.7% sensitivity, 93.5% specificity, 82.5% positive predictive value, and 97.1% negative predictive value when compared to culture-based methods. The time from the start of processing of specimen to result was approximately 1.5 h. In our hands, the IDI-MRSA assay is a sensitive and specific test for detection of nasal colonization with MRSA and providing for same-day results, allowing more efficient and effective use of infection control resources to control MRSA in health care facilities.

Infection control practices for SARS in Lao People's Democratic Republic, Taiwan, and Thailand: Experience from mobile SARS containment teams, 2003

BackgroundDespite available recommendations on infection control for severe acute respiratory syndrome (SARS), information is limited on actual practices in Asian hospitals during the epidemic. We describe practices observed by mobile SARS containment teams (mobile teams) during outbreak investigations.MethodsWe retrospectively summarized infection control practices observed in hospitals visited by mobile teams in the Lao People's Democratic Republic (PDR), Taiwan, and Thailand, during March and April 2003.ResultsMobile teams investigated 22 reports of SARS in 20 hospitals (1, 5, and 14 hospitals in Lao PDR, Taiwan, and Thailand, respectively). Facilities ranged from urban hospitals with negative-pressure isolation rooms and high-efficiency particulate air filtration to rural hospitals with patient rooms open to outside air circulation and intermittent running water. At the time of mobile team visits, 5 (25%) hospitals implemented infection control practices consistent with World Health Organization recommendations on visitor policies, private negative-pressure rooms, and personal protective equipment.ConclusionsEarly in the SARS epidemic, mobile teams found wide variations in infection control practices and resources among Asian hospitals evaluating patients for SARS, indicating the importance of ongoing assessment during SARS preparedness. Mobile teams are one mechanism to assess practices and promote implementation of recommended infection control measures.

Infection Control Resources and Practices in Maryland, 2003

ISSUE: In January 2003, the Maryland State Department of Health and Mental Hygiene (DHMH) surveyed, for the first time, all acute-care facilities (ACFs) and long-term-care facilities (LTCFs) in the state to determine the current state of infection control resources and practices in Maryland. PROJECT: A self-administered questionnaire was sent to all 48 ACFs and 248 LTCFs. The questions asked about 1) infection control resources, such as staffing, infection control educational preparation, and administrative support and 2) infection control practices, such as outbreak management, isolation capability, and emergency preparedness. The senior infection control professional (ICP) in the facility completed the questionnaire. RESULTS: The response rates were 85% for ACFs and 44% for LTCFs. Data were analyzed separately for each type of facility. The ICPs in acute care reported 1.2 full-time equivalent positions (FTEs) for each 200 ACF beds, while ICPs in LTCFs reported 0.36 FTEs per 200 LTCF beds. The greatest disparity was noted between ACFs and LTCFs in infection control educational preparation of ICPs. Ninety percent of acute-care ICPs reported taking some type of basic infection control course, while only 3% of long-term-care ICPs reported taking a basic infection control course. LESSONS LEARNED: In this survey of ICPs in Maryland, striking differences were noted between ACFs and LTCFs in the ratio of ICP FTEs to beds and in basic infection control educational preparation for ICPs. DHMH will further assess the impact of these findings on infection control effectiveness and quality of patient care in Maryland.

Infection Control Resources and Practices in Maryland, 2003

Infection Control Resources and Practices in Maryland, 2003

The state of infection surveillance and control in Canadian acute care hospitals

Background: Nosocomial infections and antibiotic-resistant pathogens cause significant morbidity, mortality, and economic costs. The infection surveillance and control resources and activities in Canadian acute care hospitals had not been assessed in 20 years. Methods: In 2000, surveys were mailed to infection control programs in all Canadian hospitals with more than 80 acute care beds. The survey was modeled after the US Study on the Efficacy of Nosocomial Infection Control instrument, with new items dealing with resistant pathogens and computerization. Surveillance and control indices were calculated. Results: One hundred seventy-two of 238 (72.3%) hospitals responded. In 42.1% of hospitals, there was fewer than 1 infection control practitioner per 250 beds. Just 60% of infection control programs had physicians or doctoral professionals with infection control training who provided services. The median surveillance index was 65.6/100, and the median control index was 60.5/100. Surgical site infection rates were reported to individual surgeons in only 36.8% of hospitals. Conclusions: There were deficits in the identified components of effective infection control programs. Greater investment in resources is needed to meet recommended standards and thereby reduce morbidity, mortality, and expense associated with nosocomial infections and antibiotic-resistant pathogens. (Am J Infect Control 2003;31:266-73.)

Improving quality in health care: our perspective

Our Association's commitment to and pursuit of total quality management can be demonstrated through the AICA strategic plan and publications that support this concept. In the context of surveillance of health care associated infection, which is common to all infection control programmes, the need for measurable performance indicators within the constraints of limited infection control resources drove AICA to review surveillance methodology. In order to promote a nationally consistent approach, a multi-disciplinary National Advisory Board (NAB) was established.

Variation in administrators' and clinicians' attitudes toward critical elements of an infection control program and the role of the infection control practitioner in New South Wales, Australia

Background: Debate remains over the core activities of infection control (IC) programs. Differences in stakeholder opinions must be considered if consensus panel guidelines and recommendations are to be broadly applied. This article describes a survey of administrators and clinicians employed in hospitals in New South Wales, Australia. Respondents self-reported their levels of agreement with affirmative statements regarding the role of the infection control practitioner (ICP) and the essential requirements and infrastructure of IC programs. Method: The study population included administrators and clinicians in each public, private, and freestanding day hospital in New South Wales. Respondents reported the intensity of their agreement with 16 affirmative statements relating to IC program infrastructure and resources and the ICP's role and responsibilities. Results: The overall response rate was 62.1% (587/945). Clinicians (349/587) and administrators (238/587) accounted for 59.5% and 40.5% of the response rate, respectively. Overall, administrators and clinicians reported greatest levels of agreement for those elements not requiring additional resources. Conclusion: The extent of divergence between administrators and clinicians is not so great that it can not be resolved. Our findings demonstrate the degree of administrator support that clinicians can expect for each element. We advocate better communication between clinicians and administrators in conjunction with objective strategic planning. Our findings provide a guide for ICPs to either establish or negotiate the core components of their IC program. (Am J Infect Control 2001;29:262-70)

Role of the clinical microbiology laboratory in infection control — a Danish perspective

Clinical microbiology laboratories in Denmark are located in hospitals and staffed by clinical microbiologists who are clinically trained medical doctors. Each county has its own clinical microbiology unit, serving a population of 0.3–0.6 million. The responsibilities of clinical microbiology unit cover many different aspects of infection control. They include detection of outbreaks of hospital-acquired infections, screening for multi-resistant organisms, advice to clinicians about disinfection, sterilization and isolation procedures, and the rational use of antibiotics. Clinical microbiologists work closely with infection control nurses. Together they form the infection control team, which is the executive part of the local infection control committee. The infection control team is also the main body responsible for the development of guidelines, which are approved by the regional infection control committee. The local microbiology laboratories work in close contact with the National Department of Hospital Hygiene and other reference laboratories at the State Serum Institute. The present structure of infection control was established 25 years ago. The main aim at that time was to decentralize infection control and establish facilities as close to clinicians and patients as practically possible. This has solved most basic problems related to infection control, and compliance by clinicians has been fairly good. However, the present organization will not meet future requirements for standardization and documentation of quality. Currently a national standard for infection control is being prepared. It consists of a main standard defining requirements for the management system and 12 subsidiary standards defining requirements for specific areas of infection control. Adoption of the standard will undoubtedly require additional resources for infection control at a local level, and some organizational changes may also be needed. Infection control should be maintained as an integrated part of clinical microbiology.

The relationship of a clonal outbreak of Enterococcus faecium vanA to methicillin-resistant Staphylococcus aureus incidence in an Australian hospital

Australian isolates of vancomycin-resistant enterococci (VRE) have been widely scattered geographically, predominantly polyclonal and of the VanB phenotype. Forty-nine VRE were isolated from 47 patients in our hospital from October 1996 to December 1999. Forty-four of these VRE were Enterococcus faecium with a vanA glycopeptide resistance genotype. Four isolates were pathogenic. Thirty-five VRE were from an outbreak in the Renal and Infectious Diseases Units over a four-month period. Pulsed-field gel electrophoresis (PFGE) demonstrated that 41 of the 49 VRE were indistinguishable or closely related. Enhanced environmental cleaning, strict contact isolation of colonized patients and reducing inpatient admissions terminated the epidemic. Cohorting of methicillin-resistant Staphylococcus aureus (MRSA)-positive patients was restricted because VRE patients occupied the isolation facilities. This resulted in a statistically significant increase in MRSA infections across the hospital. VRE epidemics have the ability to influence the epidemiology of other nosocomial pathogens when infection control resources are exhausted.