Infection Prevention And Control Guidelines Research Articles

Patient involvement in the implementation of infection prevention and control guidelines and associated interventions: a scoping review

ObjectiveTo explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions.DesignScoping review.MethodsA methodological framework was followed to identify recent publications on patient involvement in...

Current practice of infection control in Dutch primary care: Results of an online survey

Good infection prevention is an important aspect of quality of medical care. The aim was to evaluate infection prevention and control (IPC) performance among Dutch general practitioners (GPs). Based on the current national IPC guidelines for GPs, a self-administered anonymous online questionnaire was developed and sent to GPs in the Nijmegen region of the Netherlands. Thirty-two questions were constructed to survey characteristics of GPs' offices and assess current performance of IPC measures. One hundred questionnaires were included in our analysis. The preferred method of hand hygiene was soap and water (56%) versus alcohol-based handrub (44%). The cleaning of nondisposable, noncritical, semicritical, and critical instruments was consistent with national guideline recommendations or superior to them in 100%, 49%, and 97% of cases, respectively. An average of 57% of GPs reported environmental cleaning frequencies that were compliant with the national guidelines or superior to them. Personal protective equipment was available in 62% of GPs' practices but used in only 25% of home visits to patients. Not all national IPC guidelines seem to be followed to the fullest extent. The current situation indicates there is room for potential improvement regarding implementation of IPC measures in GPs' offices. Area-specific guidelines and continuous medical education regarding IPC may help improve the situation.

A qualitative exploration of infection prevention and control guidance for Australian paramedics

IntroductionThe paramedic work setting in Australia presents challenges for applying recommended infection prevention and control (IPC) practices. Our study had two aims: to describe the guidance provided across a range of documents used by Australian ambulance services; and to explore the views of health experts regarding the adequacy of guidance on IPC practices for Australian paramedics.MethodsContent analysis was used to evaluate the degree of alignment between IPC operating procedures from four state ambulance services and the IPC guidelines issued by the National Health and Medical Research Council (NHMRC) in 2010. Semi-structured interviews were conducted to explore perspectives of 14 experts about IPC practices among paramedics and IPC guidance provided to them. ResultsWhile the ambulance operating procedures aligned well with the NHMRC IPC guidelines, we identified differences in the nature of advice provided that could lead to differing practices by paramedics across Australia. Experts identified several domains of IPC practices by paramedics that would benefit from closer scrutiny and/or more specific guidance, including hand and environmental hygiene, governance and surveillance, environmental challenges, vehicle design, cultural barriers and communication with state health regulators. ConclusionOur study has further highlighted unique challenges faced by paramedics in adhering to recommended IPC practices while providing healthcare in the mobile primary emergency environment. Two recommendations arise from our research. First, there is a need to adapt the current national risk-based framework for IPC in Australia to paramedicine. Second, that targeted research into staff compliance is required to identify the key barriers and enablers to the uptake of IPC practices in paramedicine.

Reported incidences and factors associated with percutaneous injuries and splash exposures among healthcare workers in Kahama District, Tanzania

Background: Percutaneous injuries and mucocutaneous blood and other body fluids exposure are among the common hospital hazards affecting health care workers (HCWs) worldwide. These exposures pose risks of contracting infections such as Hepatitis B and C and Human Immunodeficiency viruses. This study aimed to determine the incidence and human factors associated with percutaneous injuries and splash exposures among healthcare workers in Kahama District, Tanzania. Methods : This descriptive cross sectional study was conducted in Kahama District of north-western Tanzania and involved randomly selected healthcare workers. Structured self-administered questionnaire was used to collect data between July and October 2015. Results: A total of 277 HCWs participated in the study. Among them 146 (53%) were nurses, 138 (14%) auxiliary staff 36 (13%), 32 (12%) laboratory personnel and 25 (9%) were doctors. The mean age was 37.4 years. Seventy-one percent of the participants had more than 10 years’ of working experience. About 59% of participants reported incidences of percutaneous injuries and mucocutaneous blood and other fluids exposures. About 90% of participants agreed to experience the incidences several times. While 60% disagreed with availability of personal protective gears, non-reporting of the cases was noted by 26% of participants. Majority (81%) disagreed with existence of infection prevention and control (IPC) guidelines and protocols. The main human factors associated with the percutaneous injuries and splash exposures included HCWs experience at work (71%), long working hours (29%), type of workplace (48%) and inadequate use of IPC guidelines and protocols (48%). Conclusion: More than half of participants reported incidents of percutaneous injuries and mucocutaneous blood and other body fluids in Kahama District of Tanzania. Adherence to universal precautions, training and reduction of long working hours are necessary in order to reduce infections from percutaneous injuries and exposures.

Australia's response to Ebola Virus disease in West Africa, 2014-15.

In March 2016, the World Health Organization declared the 2014-15 Ebola virus disease (EVD) outbreak officially over. With around 29 000 cases and 11 000 deaths in 27 months, this EVD outbreak was more than 60 times larger than any before, and unique in its cross-border spread and involvement of urban centres. Local and international responses were slow and initially inadequate, but establishment of the United Nations Mission for Ebola Emergency Response, 9 months after the outbreak began, allowed a coordinated effort that slowed and eventually controlled the spread of disease. Internationally, there were fears that EVD would spread widely beyond Africa, despite reassurances from public health authorities. However, after nurses in the US became infected, public fear and concern for the safety of healthcare workers led to political intervention and varied, sometimes excessive, border controls, quarantine arrangements and hospital preparations. Altogether, fewer than 30 EVD cases were managed in countries outside Africa, all but three of which were acquired in West Africa. In Australia, the Australian Health Protection Principal Committee led the internal response, including enhanced screening of incoming passengers at international airports and development of public health and laboratory testing protocols by expert subcommittees. States and territories nominated designated hospitals to care for EVD patients. Development of EVD infection prevention and control (IPC) guidelines was initially poorly coordinated within and between jurisdictions, often with significant discrepancies, causing confusion and fear among healthcare workers. The Infection Prevention and Control Expert Advisory Group was established to develop national IPC guidelines. There were no confirmed cases in Australia, but investigation of several people with suspected EVD provided valuable experience in use of protocols and high-level containment facilities. The Australian Government was initially reluctant to send aid workers to West Africa, but later contracted a private company to staff and manage a treatment centre in Sierra Leone, which treated 91 patients with EVD during 4 months of operation. Among the lessons learnt for Australia was the need to increase awareness of routine IPC practices in hospitals, where significant deficiencies were exposed, and to maintain a high enough level of preparedness to protect healthcare workers and the public from the next, inevitable, infectious disease emergency.

Knowledge, awareness, and attitude regarding infection prevention and control among medical students: a call for educational intervention.

BackgroundMedical students can be exposed to serious health care-associated infections, if they are not following infection prevention and control (IPC) measures. There is limited information regarding the knowledge, awareness, and practices of medical students regarding IPC and the educational approaches used to teach them these practices.AimTo evaluate the knowledge, awareness, and attitude of medical students toward IPC guidelines, and the learning approaches to help improve their knowledge.MethodsA cross-sectional, interview-based survey included 73 medical students from Weill Cornell Medical College, Qatar. Students completed a questionnaire concerning awareness, knowledge, and attitude regarding IPC practices. Students’ knowledge was assessed by their correct answers to the survey questions.FindingsA total of 48.44% of the respondents were aware of standard isolation precautions, 61.90% were satisfied with their training in IPC, 66.13% were exposed to hand hygiene training, while 85.48% had sufficient knowledge about hand hygiene and practiced it on a routine basis, but only 33.87% knew the duration of the hand hygiene procedure.ConclusionKnowledge, attitude, and awareness of IPC measures among Weill Cornell Medical Students in Qatar were found to be inadequate. Multifaceted training programs may have to target newly graduated medical practitioners or the training has to be included in the graduate medical curriculum to enable them to adopt and adhere to IPC guidelines.

Device Cleaning and Infection Control in Aerosol Therapy.

Aerosol delivery equipment used to administer inhaled medications includes the nebulizer, positive expiratory pressure devices added to the nebulizer, and valved holding chambers (spacers). These devices are semi-critical medical devices, and as such, infection prevention and control (IPC) guidelines recommend that they be cleaned, disinfected, rinsed with sterile water, and air-dried. There is confusion surrounding the care of aerosol devices because of inconsistencies in the various published IPC guidelines, lack of a standard of practice among institutions and respiratory therapists (RTs), and manufacturer's instructions for use of these devices are not always compatible with guidelines or practice. Challenges lie in awareness of IPC guidelines and establishing a standard for the care of aerosol delivery devices among all stakeholders/manufacturers, governments, vendors, and users. The latest IPC guideline from the Cystic Fibrosis Foundation, reviewed and endorsed by the Society for Healthcare Epidemiology of America and the Association for Professionals in Infection Control, has a recommendation for disposable nebulizers and a recommendation for reusable nebulizers. Reusable nebulizers should be cleaned, disinfected, rinsed with sterile water (if using a cold disinfectant), and air-dried between uses. The mouthpiece/mask of disposable nebulizers should be wiped with an alcohol pad, the residual volume should be rinsed out with sterile water after use, and the nebulizer should be replaced every 24 h. The RT plays a significant and responsible role in providing and teaching aerosol therapy to patients. The RT and all stakeholders need to work together to provide a standard of care for the safe use of aerosol delivery devices.

Health Care Worker Exposures to Pertussis: Missed Opportunities for Prevention

Pediatric health care workers (HCWs) are at particular risk for pertussis exposure, infection, and subsequent disease transmission to susceptible patients. This cross-sectional study describes the epidemiology of occupational exposures to pertussis and identifies factors that may inform interventions to promote effective implementation of infection prevention and control (IPC) guidelines. We abstracted data from occupational health (OH) and IPC records for pertussis cases that resulted in an exposure investigation in a large quaternary pediatric care network, January 1, 2002 to July 18, 2011. We calculated the frequency of occupational exposures and measured associated characteristics. To assess the frequency of potential missed exposures, we reviewed electronic health record (EHR) data identifying laboratory-confirmed pertussis cases not documented in OH or IPC records. A total of 1193 confirmed HCW pertussis exposures were associated with 219 index cases during the study period. Of these, 38.8% were infants <6 months old and 7 were HCWs. Most (77.5%) of exposures occurred in the emergency department or an ambulatory site; 27.0% of exposures occurred after documented initiation of IPC precautions. We identified 450 laboratory-confirmed pertussis cases through EHR review, of which 49.8% (N = 224) had no OH or IPC investigation. The majority of uninvestigated cases (77.2%) were from ambulatory sites. Occupational exposures to pertussis occur frequently in pediatric health care settings despite appropriate IPC guidelines. Interventions are needed to ensure consistent implementation of IPC practices and timely identification and reporting of pertussis index cases to prevent HCW exposures and potential transmission to patients.

Infection Prevention and Control Guidance for Ronald McDonald Houses: A Needs Assessment

We surveyed Ronald McDonald Houses (RMHs) to assess infection prevention and control (IPC) practices. A diverse patient population is served by RMH. Most sites have locally written IPC guidelines, and consultation resources vary, increasing the potential for inconsistent IPC practices. RMH would benefit from a standardized IPC guideline.

Lowbury Lecture 2007: infection prevention and control strategies for tuberculosis in developing countries – lessons learnt from Africa

The World Health Organization ranks South Africa among the top ten of high-burden countries for tuberculosis (TB). The Western Cape Province has the highest prevalence of TB in the country. Studies performed in healthcare facilities both at Tygerberg Hospital and from Kwa-Zulu Natal province indicate a significant risk for nosocomial transmission of tuberculosis. An audit of provision for infection prevention and control (IPC) programmes revealed that although there were adequate supplies of protective clothing, the greatest need was for training and understanding of IPC principles among healthcare workers. In establishing national IPC guidelines for TB in South Africa, it has become evident that most of these were derived from existing guidelines in developed countries. Though the principles were sound, the practices were not realistic for developing economies and generally not implemented in healthcare facilities. Factors that influence a robust TB management programme are poverty, concurrent human immunodeficiency virus infection, overcrowding, ignorance of the disease and a varied level of health service delivery. It is recommended that a foundation of sound knowledge should be established upon which best practices should be built within the framework of good IPC principles.