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Volume 7, Number 2—April 2001

Volume 7, Number 2—April 2001   PDF Version [PDF - 2.62 MB - 205 pages]

THEME ISSUE
4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections

Introduction

  • About the Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections PDF Version [PDF - 101 KB - 1 page]
    S. L. Solomon
  • Infection Control and Changing Health-Care Delivery Systems PDF Version [PDF - 78 KB - 4 pages]
    W. R. Jarvis
       View Abstract

    In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly. The home-care industry and managed care have become major providers of health care. The role of specialists in health-care epidemiology has changed accordingly.

  • The Impact of Hospital-Acquired Bloodstream Infections PDF Version [PDF - 77 KB - 4 pages]
    R. P. Wenzel and M. B. Edmond
       View Abstract

    Nosocomial bloodstream infections are a leading cause of death in the United States. If we assume a nosocomial infection rate of 5%, of which 10% are bloodstream infections, and an attributable mortality rate of 15%, bloodstream infections would represent the eighth leading cause of death in the United States. Because most risk factors for dying after bacteremia or fungemia may not be changeable, prevention efforts must focus on new infection-control technology and techniques.

  • The Changing Epidemiology of Staphylococcus aureus? PDF Version [PDF - 66 KB - 5 pages]
    H. F. Chambers
       View Abstract

    Strains of methicillin-resistant Staphylococcus aureus (MRSA), which had been largely confined to hospitals and long-term care facilities, are emerging in the community. The changing epidemiology of MRSA bears striking similarity to the emergence of penicillinase-mediated resistance in S. aureus decades ago. Even though the origin (hospital or the community) of the emerging MRSA strains is not known, the prevalence of these strains in the community seems likely to increase substantially.

  • Emergence of Vancomycin-Resistant Enterococci PDF Version [PDF - 62 KB - 5 pages]
    L. B. Rice
       View Abstract

    Vancomycin and ampicillin resistance in clinical Enterococcus faecium strains has developed in the past decade. Failure to adhere to strict infection control to prevent the spread of these pathogens has been well established. New data implicate the use of specific classes of antimicrobial agents in the spread of vancomycin-resistant enterococci (VRE). Extended-spectrum cephalosporins and drugs with potent activity against anaerobic bacteria may promote infection and colonization with VRE and may exert different effects on the initial establishment and persistence of high-density colonization. Control of VRE will require better understanding of the mechanisms by which different classes of drugs promote gastrointestinal colonization.

  • Controlling Antimicrobial Resistance in Hospitals: Infection Control and Use of Antibiotics PDF Version [PDF - 82 KB - 5 pages]
    R. A. Weinstein
       View Abstract

    Antimicrobial-drug resistance in hospitals is driven by failures of hospital hygiene, selective pressures created by overuse of antibiotics, and mobile genetic elements that can encode bacterial resistance mechanisms. Attention to hand hygiene is constrained by the time it takes to wash hands and by the adverse effects of repeated handwashing on the skin. Alcohol-based hand rubs can overcome the time problem and actually improve skin condition. Universal gloving could close gaps left by incomplete adherence to hand hygiene. Various interventions have been described to improve antibiotic use. The most effective have been programs restricting use of antibiotics and computer-based order forms for health providers.

Prevention is Primary

  • Impact of Hospital Care on Incidence of Bloodstream Infection: The Evaluation of Processes and Indicators in Infection Control Study PDF Version [PDF - 42 KB - 4 pages]
    S. B. Kritchevsky et al.
       View Abstract

    The Evaluation of Processes and Indicators in Infection Control (EPIC) study assesses the relationship between hospital care and rates of central venous catheter-associated primary bacteremia in 54 intensive-care units (ICUs) in the United States and 14 other countries. Using ICU rather than the patient as the primary unit of statistical analysis permits evaluation of factors that vary at the ICU level. The design of EPIC can serve as a template for studies investigating the relationship between process and event rates across health-care institutions.

  • New Technologies to Prevent Intravascular Catheter-Related Bloodstream Infections PDF Version [PDF - 46 KB - 3 pages]
    L. A. Mermel
       View Abstract

    Most intravascular catheter-related infections are associated with central venous catheters. Technologic advances shown to reduce the risk for these infections include a catheter hub containing an iodinated alcohol solution, short-term chlorhexidine-silver sulfadiazine-impregnated catheters, minocycline-rifampin-impregnated catheters, and chlorhexidine-impregnated spong dressings. Nontechnologic strategies for reducing risk include maximal barrier precautions during catheter insertion, specialized nursing teams, continuing quality improvement programs, and tunneling of short-term internal jugular catheters.

  • Ventilator-Associated Pneumonia or Not? Contemporary Diagnosis PDF Version [PDF - 50 KB - 5 pages]
    C. G. Mayhall
       View Abstract

    Ventilator-associated pneumonia (VAP) is pneumonia in patients who have been on mechanical ventilation for >48 hours. VAP is most accurately diagnosed by quantitative culture and microscopic examination of lower respiratory tract secretions, which are best obtained by bronchoscopically directed techniques such as the protected specimen brush and bronchoalveolar lavage. These techniques have acceptable repeatability, and interpretation of results is unaffected by antibiotics administered concurrently for infection at extrapulmonary sites as long as antimicrobial therapy has not been changed for <72 hours before bronchoscopy.

  • Preventing Infections in Non-Hospital Settings: Long-Term Care PDF Version [PDF - 46 KB - 3 pages]
    L. E. Nicolle
       View Abstract

    Infection concerns in long-term care facilities include endemic infections, outbreaks, and colonization and infection with antimicrobial-drug resistant microorganisms. Infection control programs are now used in most long-term care facilities, but their impact on infections has not been rigorously evaluated. Preventive strategies need to address the changing complexity of care in these facilities, e.g., the increased use of invasive devices. The anticipated increase in the elderly population in the next several decades makes prevention of infection in long-term care facilities a priority.

  • Infection Control in Home Care PDF Version [PDF - 44 KB - 4 pages]
    E. Rhinehart
       View Abstract

    Although home care has expanded in scope and intensity in the United States in the past decade, infection surveillance, prevention, and control efforts have lagged behind. Valid and reliable definitions and methods for surveillance are needed. Prevention and control efforts are largely based upon acute-care practices, many of which may be unnecessary, impractical, and expensive in a home setting. Infectious disease control principles should form the basis of training home-care providers to assess infection risk and develop prevention strategies.

  • Automated Methods for Surveillance of Surgical Site Infections PDF Version [PDF - 58 KB - 5 pages]
    R. Platt et al.
       View Abstract

    Automated data, especially from pharmacy and administrative claims, are available for much of the U.S. population and might substantially improve both inpatient and postdischarge surveillance for surgical site infections complicating selected procedures, while reducing the resources required. Potential improvements include better sensitivity, less susceptibility to interobserver variation, more uniform availability of data, more precise estimates of infection rates, and better adjustment for patients' coexisting illness.

  • New Surgical Techniques and Surgical Site Infections PDF Version [PDF - 80 KB - 3 pages]
    S. M. Gordon
       View Abstract

    Technologic advances in surgery include a trend toward less invasive procedures, driven by potential benefits to patients and by health care economics. These less invasive procedures provide infection control personnel opportunities for direct involvement in outcomes measurement.

  • Preventing Surgical Site Infections: A Surgeon's Perspective
    R. L. Nichols
       View Abstract

    Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. National studies have defined the patients at highest risk for infection in general and in many specific operative procedures. Advances in risk assessment comparison may involve use of the standardized infection ratio, procedure-specific risk factor collection, and logistic regression models. Adherence to recommendations in the 1999 Centers for Disease Control and Prevention guidelines should reduce the incidence of infection in surgical patients.

  • Hygiene of the Skin: When Is Clean Too Clean? PDF Version [PDF - 62 KB - 6 pages]
    E. Larson
       View Abstract

    Skin hygiene, particularly of the hands, is a primary mechanism for reducing contact and fecal-oral transmission of infectious agents. Widespread use of antimicrobial products has prompted concern about emergence of resistance to antiseptics and damage to the skin barrier associated with frequent washing. This article reviews evidence for the relationship between skin hygiene and infection, the effects of washing on skin integrity, and recommendations for skin care practices.

  • Antiseptic Technology: Access, Affordability, and Acceptance PDF Version [PDF - 55 KB - 3 pages]
    J. M. Boyce
       View Abstract

    Factors other than antimicrobial activity of soaps and antiseptic agents used for hand hygiene by health personnel play a role in compliance with recommendations. Hand hygiene products differ considerably in acceptance by hospital personnel. If switching from a nonmedicated soap to an antiseptic agent or increased use of an existing antiseptic agent for hand hygiene prevented a few more infections per year, additional expenditures for antiseptic agents would be offset by cost savings.

  • Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach PDF Version [PDF - 67 KB - 7 pages]
    D. Pittet
       View Abstract

    Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol-based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene.

  • "Cloud" Health-Care Workers PDF Version [PDF - 56 KB - 4 pages]
    R. J. Sherertz et al.
       View Abstract

    Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the existence of cloud health-care workers.

  • Preventing Nosocomial Mycobacterium tuberculosis Transmission in International Settings PDF Version [PDF - 56 KB - 4 pages]
    S. W. Hong
       View Abstract

    Tuberculosis (TB) is a worldwide disease, and nosocomial transmission is known to occur. Authoritative preventive guidelines such as the one developed by the Centers for Disease Control have been published, but the expenses for implementing them can be prohibitive. Each country needs to develop its own protocol to prevent nosocomial transmission of TB. This article describes the key elements of a protocol undertaken for all public hospitals in Hong Kong, where TB is endemic.

  • Epidemiology and Prevention of Pediatric Viral Respiratory Infections in Health-Care Institutions PDF Version [PDF - 55 KB - 5 pages]
    D. A. Goldmann
       View Abstract

    Nosocomial viral respiratory infections cause considerable illness and death on pediatric wards. Common causes of these infections include respiratory syncytial virus and influenza. While primarily a community pathogen, rhinovirus also occasionally results in hospitalization and serious sequelae. This article reviews effective infection control interventions for these three pathogens, as well as ongoing controversies.

  • HIV Postexposure Prophylaxis in the 21st Century PDF Version [PDF - 53 KB - 5 pages]
    D. K. Henderson
       View Abstract

    The administration of postexposure prophylaxis has become the standard of care for occupational exposures to HIV. We have learned a great deal about the safety and potential efficacy of these agents, as well as the optimal management of health-care workers occupationally exposed to HIV. This article describes the current state of knowledge in this field, identifies substantive questions to be answered, and summarizes basic principles of postexposure management.

  • Tuberculosis Control in the 21st Century PDF Version [PDF - 50 KB - 5 pages]
    K. A. Sepkowitz
       View Abstract

    In response to tuberculosis (TB) outbreaks in the United States in the late 1980s and early 1990s, U.S. hospitals spent tremendous resources to ensure a safer workplace. A remarkable decrease in nosocomial transmission resulted, along with a decrease in TB cases nationally. Federal standards have been promulgated to ensure a safer work environment for all U.S. workers potentially exposed to TB. However, these measures may prove costly and burdensome and thus may compromise the ability to deliver care.

  • Hospital Infection Control in Hematopoietic Stem Cell Transplant Recipients PDF Version [PDF - 57 KB - 5 pages]
    C. A. Dykewicz
       View Abstract

    Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant Recipients contains a section on hospital infection control including evidence-based recommendations regarding ventilation, construction, equipment, plants, play areas and toys, health-care workers, visitors, patient skin and oral care, catheter-related infections, drug-resistant organisms, and specific nosocomial infections. These guidelines are intended to reduce the number and severity of hospital infections in hematopoietic stem cell transplant recipients.

  • Emerging Health Care-Associated Infections in the Geriatric Population PDF Version [PDF - 51 KB - 4 pages]
    L. J. Strausbaugh
       View Abstract

    The increasing number of persons >65 years of age form a special population at risk for nosocomial and other health care-associated infections. The vulnerability of this age group is related to impaired host defenses such as diminished cell-mediated immunity. Lifestyle considerations, e.g., travel and living arrangements, and residence in nursing homes, can further complicate the clinical picture. The magnitude and diversity of health care-associated infections in the aging population are generating new arenas for prevention and control efforts.

State of the Art

  • Emerging Waterborne Infections in Health-Care Settings PDF Version [PDF - 55 KB - 5 pages]
    A. M. Emmerson
       View Abstract

    Water is used in vast quantities in health-care premises. Many aquatic microorganisms can survive and flourish in water with minimal nutrients and can be transferred to vulnerable hospital patients in direct (e.g., inhalation, ingestion, surface absorption) and indirect ways (e.g., by instruments and utensils). Many outbreaks of infection or pseudoinfection occur through lack of prevention measures and ignorance of the source and transmission of opportunistic pathogens.

  • Biofilms and Device-Associated Infections PDF Version [PDF - 116 KB - 5 pages]
    R. M. Donlan
       View Abstract

    Microorganisms commonly attach to living and nonliving surfaces, including those of indwelling medical devices, and form biofilms made up of extracellular polymers. In this state, microorganisms are highly resistant to antimicrobial treatment and are tenaciously bound to the surface. To better understand and control biofilms on indwelling medical devices, researchers should develop reliable sampling and measurement techniques, investigate the role of biofilms in antimicrobial drug resistance, and establish the link between biofilm contamination and patient infection.

  • Applying Economic Principles to Health Care PDF Version [PDF - 48 KB - 4 pages]
    R. D. Scott et al.
       View Abstract

    Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering health care in a hospital. Health-care markets lack the characteristics needed to determine a "market" price that reflects the economic value of resources used. However, resource allocation in a hospital can be analyzed by using production theory to determine efficient resource use. The information provided by hospital epidemiologists is critical to understanding health-care production processes used by a hospital and developing economic incentives to promote antibiotic effectiveness and infection control.

  • Economic Impact of Antimicrobial Resistance PDF Version [PDF - 66 KB - 7 pages]
    J. E. McGowan
       View Abstract

    One reason antimicrobial-drug resistance is of concern is its economic impact, which affects physicians, patients, health-care administrators, pharmaceutical producers, and the public. Measurement of cost and economic impact of programs to minimize antimicrobial-drug resistance is imprecise and incomplete. Studies to describe and evaluate the problem will have to employ new methods and be of large scale to produce information that is broadly applicable.

  • Cost-Effective Infection Control Success Story: A Case Presentation PDF Version [PDF - 38 KB - 2 pages]
    F. Slater
       View Abstract

    In a surgical intensive care unit, the 1996-1997 incidence of central catheter-associated bloodstream infections exceeded that of hospitals participating in the National Nosocomial Infections Surveillance System. Interventions were implemented, and a cost-benefit analysis was done that led to hiring a vascular catheter care nurse. Subsequent outcome data demonstrated a substantial reduction in central catheter-associated bloodstream infections.

  • Feeding Back Surveillance Data To Prevent Hospital-Acquired Infections PDF Version [PDF - 47 KB - 4 pages]
    R. Gaynes et al.
       View Abstract

    We describe the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance (NNIS) system. Elements of the system critical for successful reduction of nosocomial infection rates include voluntary participation and confidentiality; standard definitions and protocols; identification of populations at high risk; site-specific, risk-adjusted infection rates comparable across institutions; adequate numbers of trained infection control professionals; dissemination of data to health-care providers; and a link between monitored rates and prevention efforts.

  • Promoting Quality Through Measurement of Performance and Response: Prevention Success Stories PDF Version [PDF - 43 KB - 3 pages]
    C. Richards et al.
       View Abstract

    Successful efforts to prevent health-care acquired infections occur daily in U.S. hospitals. However, few of these "prevention success stories" are presented in the medical literature or discussed at professional meetings. Key components of successful prevention efforts include multidisciplinary teams, appropriate educational interventions, and data dissemination to clinical staff.

  • Clinical Microbiology in Developing Countries PDF Version [PDF - 49 KB - 4 pages]
    L. K. Archibald and L. B. Reller
       View Abstract

    We review the problem of limited microbiology resources in developing countries. We then demonstrate the feasibility of a cohort-based approach to integrate microbiology, epidemiology, and clinical medicine to survey emerging infections in these countries.

  • New Technology for Detecting Multidrug-Resistant Pathogens in the Clinical Microbiology Laboratory PDF Version [PDF - 79 KB - 6 pages]
    L. R. Peterson and G. A. Noskin
       View Abstract

    Northwestern Memorial Hospital instituted in-house molecular typing to rapidly assess microbial clonality and integrated this typing into an infection control program. We compared data on nosocomial infections collected during 24 months before and 60 months after implementing the new program. During the intervention period, infections per 1,000 patient-days fell 13% (p=0.002) and the percentage of hospitalized patients with nosocomial infections decreased 23% (p=0.000006). In our hospital, the percentage of patients with nosocomial infections is 43% below the U.S. rate. Our typing laboratory costs approximately $400,000 per year, a savings of $5.00 for each dollar spent

  • Molecular Approaches to Diagnosing and Managing Infectious Diseases: Practicality and Costs PDF Version [PDF - 98 KB - 7 pages]
    M. A. Pfaller
       View Abstract

    As molecular techniques for identifying and detecting microorganisms in the clinical microbiology laboratory have become routine, questions about the cost of these techniques and their contribution to patient care need to be addressed. Molecular diagnosis is most appropriate for infectious agents that are difficult to detect, identify, or test for susceptibility in a timely fashion with conventional methods.

  • Building Communication Networks: International Network for the Study and Prevention of Emerging Antimicrobial Resistance (INSPEAR)
    H. M. Richet et al.
       View Abstract

    The global nature of antimicrobial resistance and the failure to control the emergence of resistant organisms demand the implementation of a global surveillance program involving both developed and developing countries. Because of the urgent need for infection control interventions and for rapid distribution of information about emerging organisms, we initiated the International Networks for the Study and Prevention of Emerging Antimicrobial Resistance (INSPEAR). Its main objectives are to serve as an early warning system for emerging antimicrobial-drug resistant pathogens, to facilitate rapid distribution of information about emerging multidrug-resistant pathogens to hospitals and public health authorities worldwide, and to serve as a model for the development and implementation of infection control interventions.

  • Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus PDF Version [PDF - 129 KB - 4 pages]
    B. Shopsin and B. N. Kreiswirth
       View Abstract

    Subtyping methicillin-resistant Staphylococcus aureus (MRSA) isolates and tracking nosocomial infections have evolved from phenotypic to genotypic approaches; most laboratories now depend on pulsed-field gel electrophoresis (PFGE). We discuss the limitations of current image-based genotyping methods, including PFGE, and the advantages (including ease of entering data into a database) of using DNA sequence analysis to control MRSA infections in health-care facilities.

  • Increasing Resistance to Vancomycin and Other Glycopeptides in Staphylococcus aureus PDF Version [PDF - 82 KB - 6 pages]
    F. C. Tenover et al.
       View Abstract

    Strains of Staphylococcus aureus with reduced susceptibility to glycopeptides have been reported from Japan, the United States, Europe, and the Far East. Although isolates with homogeneous resistance to vancomycin (MICs = 8 µg/mL) continue to be rare, there are increasing reports of strains showing heteroresistance, often with vancomycin MICs in the 1-4 µg/mL range. Most isolates with reduced susceptibility to vancomycin appear to have developed from preexisting methicillin-resistant S. aureus infections. Many of the isolates with reduced susceptibility to glycopeptides have been associated with therapeutic failures with vancomycin. Although nosocomial spread of the vancomycin-intermediate S. aureus (VISA) strains has not been observed in U.S. hospitals, spread of VISA strains has apparently occurred in Japan. Broth microdilution tests held a full 24 hours are optimal for detecting resistance in the laboratory; however, methods for detecting heteroresistant strains are still in flux. Disk-diffusion tests, including the Stokes method, do not detect VISA strains. The Centers for Disease Control and Prevention and other groups have issued recommendations regarding appropriate infection control procedures for patients infected with these strains.

  • Controversies about Extended-Spectrum and AmpC Beta-Lactamases PDF Version [PDF - 54 KB - 4 pages]
    K. S. Thomson
       View Abstract

    Many clinical laboratories have problems detecting extended-spectrum beta-lactamases (ESBLs) and plasmid-mediated AmpC beta-lactamases. Confusion exists about the importance of these resistance mechanisms, optimal test methods, and appropriate reporting conventions. Failure to detect these enzymes has contributed to their uncontrolled spread and sometimes to therapeutic failures. Although National Committee for Clinical Laboratory Standards recommendations exist for detecting ESBL-producing isolates of Escherichia coli and Klebsiella spp., no recommendations exist for detecting ESBLs in other organisms or for detecting plasmid-mediated AmpC beta-lactamases in any organisms. Clinical laboratories need to have adequate funding, equipment, and expertise to provide a rapid and clinically relevant antibiotic testing service in centers where these resistance mechanisms are encountered.

  • Emerging Mechanisms of Fluoroquinolone Resistance PDF Version [PDF - 55 KB - 5 pages]
    D. C. Hooper
       View Abstract

    Broad use of fluoroquinolones has been followed by emergence of resistance, which has been due mainly to chromosomal mutations in genes encoding the subunits of the drugs' target enzymes, DNA gyrase and topoisomerase IV, and in genes that affect the expression of diffusion channels in the outer membrane and multidrug-resistance efflux systems. Resistance emerged first in species in which single mutations were sufficient to cause clinically important levels of resistance (e.g., Staphylococcus aureus and Pseudomonas aeruginosa). Subsequently, however, resistance has emerged in bacteria such as Campylobacter jejuni, Escherichia coli, and Neisseria gonorrhoeae, in which multiple mutations are required to generate clinically important resistance. In these circumstances, the additional epidemiologic factors of drug use in animals and human-to-human spread appear to have contributed. Resistance in Streptococcus pneumoniae, which is currently low, will require close monitoring as fluoroquinolones are used more extensively for treating respiratory tract infections.

  • Engineering out the Risk of Infection with Urinary Catheters PDF Version [PDF - 164 KB - 6 pages]
    D. G. Maki and P. A. Tambyah
       View Abstract

    Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection. Each year, more than 1 million patients in U.S. acute-care hospitals and extended-care facilities acquire such an infection; the risk with short-term catheterization is 5% per day. CAUTI is the second most common cause of nosocomial bloodstream infection, and studies suggest that patients with CAUTI have an increased institutional death rate, unrelated to the development of urosepsis. Novel urinary catheters impregnated with nitrofurazone or minocycline and rifampin or coated with a silver alloy-hydrogel exhibit antiinfective surface activity that significantly reduces the risk of CAUTI for short-term catheterizations not exceeding 2-3 weeks.

  • New Disinfection and Sterilization Methods PDF Version [PDF - 62 KB - 6 pages]
    W. A. Rutala and D. J. Weber
       View Abstract

    New disinfection methods include a persistent antimicrobial-drug coating that can be applied to inanimate and animate objects (Surfacine), a high-level disinfectant with reduced exposure time (ortho-phthalaldehyde), and an antimicrobial drug that can be applied to animate and inanimate objects (superoxidized water). New sterilization methods include a chemical sterilization process for endoscopes that integrates cleaning (Endoclens), a rapid (4- hour) readout biological indicator for ethylene oxide sterilization (Attest), and a hydrogen peroxide plasma sterilizer that has a shorter cycle time and improved efficacy (Sterrad 50).

  • Engineering Infection Control through Facility Design PDF Version [PDF - 54 KB - 4 pages]
    G. A. Noskin and L. R. Peterson
       View Abstract

    Many medical centers have modified their facility design to provide a safer environment for patients. From an infection control perspective, the primary objective of hospital design is to place the patient at no risk for infection while hospitalized. We describe historical landmarks about hospital design, modern facility design, and specific designs to prevent acquisition and spread of infections such as tuberculosis and aspergillosis.

  • Can Managed Health Care Help Manage Health-Care-Associated Infections? PDF Version [PDF - 63 KB - 5 pages]
    R. Platt and B. Caldwell
       View Abstract

    Managed-care organizations have a unique opportunity, still largely unrealized, to collaborate with health-care providers and epidemiologists to prevent health care-associated infections. Several attributes make these organizations logical collaborators for infection control programs: they have responsibility for defined populations of enrollees and for their overall health, including preventive care; they possess unique data resources about their members and their care; and they are able to make systemwide changes in care. Health-care associated infections merit the attention and effort of managed-care organizations because these infections are common, incur substantial illness and costs, and can be effectively prevented by using methods that are unevenly applied in different health-care settings. Both national and local discussions will be required to enable the most effective and efficient collaborations between managed care organizations and health-care epidemiologists. It will be important to articulate clear goals and standards that can be readily understood and widely adopted.

  • Health-Care Quality Promotion through Infection Prevention: Beyond 2000 PDF Version [PDF - 46 KB - 4 pages]
    J. Gerberding
       View Abstract

    Health-care value purchasing, complex health-care systems, and information technology are the three most important change drivers influencing the interrelated themes of the 4th decennial conference: accountability, quality promotion through infection prevention across the health-care delivery system, and medical informatics. Among the change drivers influencing themes of future conferences may be a societal mandate for health promotion and health-care access for all.

Volume 7, Number 2—April 2001 - Continued

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