The Journal of hospital infection
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Selective decontamination of the digestive tract (SDD), a strategy designed to prevent or minimize the impact of infection by potentially pathogenic micro-organisms in critically ill patients requiring long-term mechanical ventilation, comprises four component protocols, aiming to control the three types of infection occurring in such cases: (i) a parenteral antibiotic, cefotaxime, administered for a few days to prevent primary endogenous infections typically occurring 'early'; (ii) the topical antimicrobials polymyxin E, tobramycin and amphotericin B employed throughout the stay in the intensive care unit to prevent secondary endogenous infections tending to develop 'late'; (iii) a high standard of hygiene to prevent exogenous infections that may occur throughout the stay in the intensive care unit; (iv) surveillance samples of throat and rectum to distinguish between these three types of infection, to monitor the compliance and the efficacy of the treatment, and to detect the emergence of resistance at an early stage. A recent, rigorous, meta-analysis examining 33 randomized SDD trials involving 5727 patients demonstrated a significant reduction in overall mortality (20%) and in the incidence of respiratory tract infections (65%); conclusive evidence that SDD saves the lives of critically ill patients and confirmation that SDD is now an evidence based medicine manoeuvre. This same meta-analysis found no instance of the emergence of resistance or of associated superinfections and/or outbreaks in any of the 33 studies during a period extending upwards of 10 years. By the criterion of cost-per-survivor, four recent randomized trials showed that patient survival is improved more cheaply by employing SDD than by the traditional approaches.
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Tuberculosis infection control in hospitals has received renewed interest after decades of low prominence following the occurrence of multiply drug-resistant strains in populations of patients with immune systems affected by HIV. This paper examines the history of tuberculosis infection control in hospitals and how recent outbreaks have influenced contemporary measures. ⋯ Procedures which may generate infectious aerosols should be carried out in similarly ventilated rooms. The quality assurance in such infection control is through the administrative systems put in place, staff training and the engineering controls of isolation room ventilation.
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Long term care facilities (LTCFs) include a variety of different types of healthcare settings, each with their own unique infectious disease problems. This report focuses on the epidemiological considerations, risk factors and types of infections that occur in elderly patients institutionalized in nursing home settings. In the US, the number of patients in nursing homes continues to grow as the population ages. ⋯ The potential for epidemic infections with antibiotic-resistant organisms is real. In the nursing home setting, attention must be given to develop and support strong infection control programmes that can monitor the occurrence of institutionally-acquired infections and initiate control strategies to prevent the spread of epidemic infections. Education in infection control issues and attention to employee health is essential to enable staff to care appropriately for today's nursing home population and to prepare them for the even more complicated patients who will be cared for in this type of setting in future.
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This paper arises out of two workshop sessions held at the fourth meeting of the Federation of Infection Societies, Manchester, 1997. The aims of the workshops were, first, to identify the factors which impede the process of translating research findings into infection control practice and second, to suggest how these barriers may be overcome. ⋯ This lends structure to our exploration of the evidence underlying infection control guidance and the reasons why such guidance often does not result in appropriate action by healthcare workers. The strengths and weaknesses of each stage of the process are examined, using examples provided by participants at the workshop.