American journal of infection control
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Am J Infect Control · Dec 2008
Personal protective equipment in health care: can online infection control courses transfer knowledge and improve proper selection and use?
We used observational evaluation to assess the ability of an online learning course to effectively transfer knowledge on personal protective equipment (PPE) selection and removal. During orientations for new hospital staff, 117 participants applied either airborne, droplet, or contact precautions in mock scenarios. Postcourse, all 3 scenarios demonstrated improvement in PPE sequence scores (P = .001); moreover, hand hygiene also was more frequent during both donning and doffing of PPE (P < .001).
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Am J Infect Control · Dec 2008
Infection prevention and control competencies for hospital-based health care personnel.
Infection prevention and control education for hospital-based health care personnel has differed across organizations because of a lack of identified practice competencies. This gap also has resulted in variation of the educational curriculum in the academic setting and a lack of consistent preparation for emergency responses. The purpose of this study was to develop a list of competencies and measurable activities, or terminal objectives, for hospital-based health care personnel applicable for use during routine patient care activities as well as during natural and man-made disasters. ⋯ The final matrix of competencies and terminal objectives developed through this process may be used as a content framework for educational curricula and training materials for hospital-based health care personnel. The process also may be of use in determining the core competencies and terminal objectives regarding infection prevention and control for health care personnel in other settings. Validation of these results is an important next step.
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Central line-associated bacteremia (CLAB) is associated with increased intensive care unit (ICU) length of stay (LOS) of up to 6 days, increased hospital LOS of approximately 21 days, attributable mortality of approximately 35%, and incremental costs of approximately $56,000 per infection. ⋯ Implementation of a self-study module with pre- and posttests, the use of pictorials and other informational tools, and the implementation of a "scrub the hub" bundle were effective in reducing the rate of CLAB in ICUs and in supporting a culture of zero tolerance for infection.
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Am J Infect Control · Dec 2008
Epidemiology of early-onset bloodstream infection and implications for treatment.
HEALTH CARE-ASSOCIATED INFECTIONS: For over 35 years, infections have been divided into hospital acquired or community acquired. In 2002, in a study of bloodstream infections (BSIs), Friedman et al first suggested creating a new classification: health care-associated BSIs. Kollef et al furthered the concept of health care-associated infection in a 2005 population-based study of culture-positive pneumonia cases. Although the site of infection differed, Kollef et al's results supported Friedman et al's original concept. Then in 2006, Kollef et al reported a population-based study focused specifically on BSIs. Of 6697 reported cases, 468 (7%) had hospital-acquired BSIs; 3705 (55.3%) health care-associated BSIs; and 2524 (37.7%) community-acquired BSIs. The clinical features of those with health care-associated BSIs differed from those with community-acquired BSIs. For several organisms, including Staphylococcus aureus, Streptococcus pneumoniae, and gram-negative organisms, the frequencies for health care-associated and hospital-acquired BSIs were similar to each other but significantly different from community-acquired BSIs. After controlling for several clinical features, methicillin-resistant Staphylococcus aureus had the largest odds ratio for predicting in-hospital mortality. Both hospital-acquired and health care-acquired cases were independent risk factors for in-hospital mortality. ⋯ For pneumonia and BSIs, health care-associated infections appear to be distinct entities. However, operational definitions still vary. Compared with hospital-acquired cases, health care-associated cases have different clinical characteristics. The outcomes of health care-associated infections tend to be intermediate of the community-acquired and hospital-acquired groups. Further research is urgently needed on the implications of health care-associated infection for early therapy.
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In July 2005, New York State legislation requiring the mandatory reporting of specific hospital-associated infections (HAIs) was passed by the legislature and signed by the governor. In an effort to measure the impact of this legislation on infection control resources, the New York State Department of Health (NYSDOH) conducted a baseline survey in March 2007. This report presents an overview of the methods and results of this survey. ⋯ This survey was designed to monitor and assess infection prevention and control resources and activities in hospitals as New York State embarks on mandatory public reporting of HAI rates. Monitoring infection control resources and activities will be important as HAI reporting moves forward. The information collected will serve as a baseline, and repeat surveys will be conducted to determine which, if any, of the various indicators correlate with the completeness and accuracy of HAI reporting.