Protecting health care workers from SARS and other respiratory pathogens: a review of the infection control literature

BACKGROUND: Severe Acute Respiratory Syndrome (SARS) was responsible for outbreaks in Canada, China, Hong Kong, Vietnam, and Singapore. SARS focused attention on the adequacy of and compliance with infection control practices in preventing airborne and droplet-spread transmission of infectious agents. METHODS: This paper presents a review of the current scientific knowledge with respect to the efficacy of personal protective equipment in preventing the transmission of respiratory infections. The effectiveness of infection control policies and procedures used in clinical practice is examined. RESULTS: Literature searches were conducted in several databases for articles published in the last 15 years that related to infection control practices, occupational health and safety issues, environmental factors, and other issues of importance in protecting workers against respiratory infections in health care settings. CONCLUSION: Failure to implement appropriate barrier precautions is responsible for most nosocomial transmissions. However, the possibility of a gradation of infectious particles generated by aerosolizing procedures suggests that traditional droplet transmission prevention measures may be inadequate in some settings. Further research is needed in this area.     

Infectious diseases as a Canadian subspecialty, with projections to the year 2000

Infectious diseases is a relatively new subspecialty in Canada. During the past decade, however, important advances have been made. These include the formation of the Canadian Infectious Diseases Society and the development of the first Royal College of Physicians and Surgeons examinations in the subspecialty of infectious diseases. The majority of Canadians training for practice in the field of infectious diseases are now enrolled in programs in Canada. Despite predictions in the United States of an excess of physicians who specialize in infectious diseases, such a situation has not occurred in Canada. More physicians with training in infectious diseases will be required in Canada in the next decade to fill positions in patient care, microbiology (for individuals with both clinical and laboratory training), research, epidemiology and infection control, programs related to human immunodeficiency virus infections, geographic and international medicine, the pharmaceutical industry, and education and administration. In Canada, the extent to which infectious diseases physicians are involved in these areas varies from that in the United States. This review suggests a continued need for physicians with appropriate training in infectious diseases.     

Role of clinical microbiology laboratories in the management and control of infectious diseases and the delivery of health care.

Modern medicine has led to dramatic changes in infectious diseases practice. Vaccination and antibiotic therapy have benefited millions of persons. However, constrained resources now threaten our ability to adequately manage threats of infectious diseases by placing clinical microbiology services and expertise distant from the patient and their infectious diseases physician. Continuing in such a direction threatens quality of laboratory results, timeliness of diagnosis, appropriateness of treatment, effective communication, reduction of health care-associated infections, advances in infectious diseases practice, and training of future practitioners. Microbiology laboratories are the first lines of defense for detection of new antibiotic resistance, outbreaks of foodborne infection, and a possible bioterrorism event. Maintaining high-quality clinical microbiology laboratories on the site of the institution that they serve is the current best approach for managing today's problems of emerging infectious diseases and antimicrobial agent resistance by providing good patient care outcomes that actually save money.     

The state of the science of health care epidemiology, infection control, and patient safety, 2004

Being aware and implementing the latest and best scientific evidence in infection control and health care epidemiology is critical to enhancing patient outcomes. In this review, the latest published scientific data in health care epidemiology and patient safety were reviewed for the period May 2003-May 2004. Medline reviews and reviews of infection control and infectious diseases journals were used for this period. The latest guidelines and publications on antimicrobial resistance, nursing or infection control professional staffing, West Nile virus, and Severe Acute Respiratory Syndrome (SARS) are included. Awareness of these and other important infection control publications is essential if the latest measures are to be implemented to prevent and control health care-associated infections.     

A national task analysis of infection control practitioners, 1982. Part One: methodology and demography

A task analysis survey was conducted in 1982 by the Certification Board of Infection Control ( CBIC ) to determine the tasks performed by ICPs and the knowledge and abilities needed to perform these tasks. Data were obtained from 473 (78.8%) respondents to a nationwide mail survey of 600 ICPs . The respondents represent a randomized, stratified sample of ICPs in various types of U.S. acute care hospitals ranging in size from fewer than 50 beds to more than 500 beds. The results of the survey were used, in part, to develop the Infection Control Certification Examination, offered for the first time on November 19, 1983. According to the survey results, the modal or typical ICP is a white woman between the ages of 31 and 50 years using the title of infection control nurse. She has been employed full time for 2 to 10 years in infection control practice in a Joint Commission on Accreditation of Hospitals (JCAH)--accredited community acute care hospital having 301 to 500 beds. She is working at the supervisory level, is on the nursing department payroll, votes as a member of the hospital's infection control committee, and received her last degree or diploma more than 15 years ago.     

泸州市医疗机构传染病报告管理现状分析

目的了解泸州市2010年医疗机构法定传染病报告管理现状,为进一步提高报告管理水平提供依据。方法采用分层抽样法抽取不同级别的医疗机构48个,参照《2008年全国法定传染病监测报告管理检查督导工作方案》的方法开展调查。结果共抽查挂号(处方)签686张,门诊日志符合率为80.76%,抽查门诊日志登记670份,登记完整率为68.66%,抽查出入院登记、传染病登记各440份,登记完整率分别为34.77%、66.82%,抽查检验登记220份,登记完整率为72.73%,抽查放射科登记429份,登记完整率为76.69%,抽查医务人员109名,传染病报告知识不及格率为68.81%;抽查法定传染病426例,报告率、报告及时率、完整率、准确率、录入一致率分别为98.36%、99.12%、97.80%、96.48%、92.95%。结论泸州市各级医疗机构传染病报告管理水平和报告质量不高,特别是住院部、门诊、检验科、放射科、感染管理科等各种登记缺项较多,登记不完整;医务人员的传染病报告管理相关知识欠缺,对诊断标准的掌握有待提高。     

Infectious disease manpower in the United States--1986. 2. Changes in practice patterns over time and training needs. Manpower and Training Committee, Infectious Diseases Society of America.

Infectious disease-trained internal medicine physicians responding to a questionnaire survey (n = 1802) reported minor differences in time spent in patient care versus laboratory-based research whether they subsequently became practitioners or academicians. Both practitioners and academicians ranked hospital epidemiology first, followed by knowledge of hospital antibiotic policies in order of importance for new trainees to be taught. Internists with greater than 12 months of training in infectious diseases were divided into private practice versus academically based groups, and their distribution of time spent in various professional activities was analyzed by 5-year intervals for each cohort. These studies confirmed an increasing proportion of time spent in infectious disease-related patient care for new practitioners. Over time, patient care activities decreased and administrative activities increased in all groups. These data are important for estimating future manpower needs.     

Infection control knowledge, attitude, and practice among Nepalese health care workers

This study was designed to assess the knowledge, attitudes, and infection control practices among Nepalese health care workers (HCWs). The study comprised a questionnaire survey of 324 staff from acute care hospitals in Kathmandu, Nepal. A total of 158 doctors and 166 nurses participated, 27% of whom had received infection control training. Only 16%, 14%, and 0.3% of the respondents achieved maximum scores for knowledge, attitude, and practice items, respectively. Staff had good knowledge and positive attitude toward most aspects of infection control, although only half had heard of methicillin-resistant Staphylococcus aureus. Logistic regression revealed that profession, age, and having studied abroad significantly predicted markers of infection control knowledge, attitudes, and practice. This is the first survey of infection control practice among Nepalese HCWs and provides useful baseline data by professional group. There is ample opportunity for improvement in current practice, which should be recognized by hospital managers and Nepalese health authorities.     

Impact on knowledge and practice of a multiregional long-term care facility infection control training program.

BACKGROUND: Few affordable training opportunities are specifically designed for the long-term care facility infection control practitioner. There is also little evidence of the success of training in improving infection control practices. The Nebraska Infection Control Network developed a 2-day basic skills training program for Midwestern long-term care facility infection control practitioners that was later disseminated to eastern and western training sites. In this study we examined the effectiveness of the training program in terms of trainee knowledge and practice. METHODS: From 1986 to 1990, a total of 17 courses conducted at the three sites were attended by a total of 266 infection control practitioners. Trainees completed a 40-item multiple choice test before and after training to evaluate their knowledge gain. Implementation of eight key infection control practices and time devoted to infection control duties were measured before training and at 3 and 12 months after training. Implementation of infection control practices was also evaluated in a second study, with infection control practitioners randomly assigned to trained and wait-control conditions. RESULTS: Significant increases after training were found at each site for both knowledge and implementation measures. These increases were maintained at 12 months follow-up. Time devoted to infection control duties increased significantly at the midwest and western sites but not at the eastern site. In the second study, significant differences were found between the trained and the wait-control group in use of infection control practices, providing evidence for a causal relationship between training and increased use of practices. CONCLUSIONS: The training program was effective in producing improvements in knowledge and implementation of recommended infection control practices in long-term care facilities. These improvements were consistent across three diverse geographic areas. There were some specific geographic differences.     

The influence of knowledge, perceptions, and beliefs, on hand hygiene practices in nursing homes

There are few studies that have assessed factors influencing infection control practices among health care workers (HCW) in nursing homes. We conducted a cross-sectional survey of HCWs (N = 392) in 4 nursing homes to assess whether knowledge, beliefs, and perceptions influence reported hand hygiene habits. Positive perceptions and beliefs regarding effectiveness of infection control in nursing homes were associated with reported appropriate glove use and fingernail characteristics, respectively, among HCWs. Further research on hand hygiene interventions, including targeted educational in-services should be conducted in the nursing home setting.     

An analysis of the current status of hospital emergency preparedness for infectious disease outbreaks in Beijing, China

BACKGROUND: In the event of a large-scale infectious disease outbreak, hospitals will play a critical role. The objective of our study is to understand the current status of hospitals preparedness for infectious disease outbreaks in Beijing and to provide basic information for infectious disease prevention and control in hospitals. METHODS: One hundred fifty-two secondary and tertiary care hospitals in Beijing were surveyed by a standardized questionnaire. Data related to hospital demographic information and their emergency plans, laboratory diagnosis capacity, medical treatment procedures for infectious diseases, stockpiles of drugs and personal protective equipment, and staff training were collected. RESULTS: Responses were received from 134 (88.2%) of the 152 hospitals surveyed. Overall, hospitals reported that the number of physicians and nurses in infectious disease accounted for only 1.8% of the total physicians and 2.5% of the total nurses, and surgery beds accounted for 8.5% of all the fixed beds. Approximately 93.3% of the hospitals surveyed reported that they had an emergency plan, and none of those reported that their laboratories were able to isolate and identify all 8 kinds of common pathogens of infectious diseases: 22.4% of the hospitals had medical treatment procedures for all these infectious diseases, 23.1% had stored specific drugs for treatment, 2.2% had all personal protective equipment, and 30.6% reported that their health care staff had been trained in hospital emergency preparedness for infectious diseases. In general, emergency preparedness for infectious diseases in tertiary care hospitals was better than that in secondary care hospitals; the preparedness at general hospitals was better than that at specialized hospitals; and that at teaching hospitals was better than that at nonteaching hospitals. CONCLUSION: Emergency preparedness for infectious disease at hospitals in Beijing was in an early stage of development during this survey. Comprehensive measures should be developed and implemented to enhance their capacity for infectious disease emergency.     

A pseudo-outbreak of Burkholderia cepacia complex in a Kentucky hospital

A cluster of Burkholderia cepacia complex cases from January to October 2020 among outpatients undergoing urologic procedures within a Kentucky hospital's operating rooms was investigated. This investigation included a laboratory look-back, chart reviews, exposure tracing, staff interviews, and direct observation of infection prevention and control practices. A significant protocol breach in a laboratory procedure led to contamination of surgical specimens submitted for culture with nonsterile saline. Pseudo-outbreaks often highlight gaps in infection control processes. Healthcare facilities can make substantial improvements in patient care quality and safety as they respond to identified gaps and improve systems and protocols.     

Clinical nurse specialists and nurse practitioners: complementary roles for infectious disease and infection control

BACKGROUND: The escalation of infectious diseases worldwide heralds an unprecedented need for nurses with advanced practice graduate preparation. OBJECTIVE: To describe how a graduate program prepares clinical nurse specialists and nurse practitioners in infectious diseases or infection control to provide distinct yet complementary care for patients with contagious disease and potentially antimicrobial-resistant infections. RESULTS: The University of Washington School of Nursing launched a new master of nursing program for infectious disease and infection control to reduce the threat of infectious diseases and multiple-resistant organisms.     

Opinions, knowledge, and self-reported practices related to infection control among nursing personnel in long-term care settings

Background: Because educational needs of staff in long-term care facilities regarding infection control have, not been well studied, we conducted this study to measure long-term care staff members' knowledge, self-reported practices, and opinions about infection control and handwashing.Methods: A pilot study was conducted with 24 staff members of one long-term care facility to examine psychometric properties of study instruments. All nursing staff members (n = 105) from two additional long-term care facilities then completed a 14-item knowledge questionnaire, 22-item opinion survey, and 26-item survey of self-reported handwashing practices.Results: Respondents were predominantly female with mean age of 46 years; most had completed high school. Mean length of employment in the study facility was 12.4 years. Registered nurses and licensed practical nurses scored significantly higher on knowledge (p = 0.0002) but significantly lower on self-reported practices (p = 0.01) than did trained nursing assistants. There was no significant correlation between self-reported practices and opinions regarding handwashing (p = 0.55). Neither level of knowledge nor positive opinion about the value of handwashing was associated with self-reported increases in handwashing practices.Conclusion: We conclude that education alone is not likely to be associated with changes in handwashing behavior. Instruments developed and tested in this study can be used in further research to correlate self-reported with observed behavior and to evaluate the effects of interventions on knowledge, opinions, and self-reported handwashing behavior.     

Survey of nursing personnel attitudes toward infections and their control in the elderly

To better understand nursing practice in geriatric care settings as it relates to infections, a survey of nursing attitudes about a variety of infection control issues was undertaken. Nurses were recruited from four settings: a university-affiliated, private nursing home (N = 46), a hospital-based nursing home (N = 33), a private nursing home (N = 20), and a home care agency (N = 26). The nurses appropriately recognized the importance of pneumonia and influenza as major threats to health in these settings and also reported some indifference regarding the notification of physicians about fevers under 38.9 degrees C (102.0 degrees F). Among the groups, similar attitudes about infection control principles were recorded, except that the ratings by the home care agency nurses were different from those of the institution-based nurses in the following areas: isolation as a means to prevent infection spread, proper waste disposal methods, and frequency of catheter change. Assessment of personnel attitudes and practices are important in detecting problems, guiding in-service programing, and revising care practices.     

Knowledge, attitudes and behaviours associated with the provision of hepatitis C care by Canadian family physicians

Summary. The role of primary care physicians in providing care for hepatitis C virus (HCV) infection is increasingly emphasized, but many gaps and challenges remain. This study explores family physicians’ knowledge, attitudes and practices associated with providing care for HCV infection. Seven hundred and forty‐nine members of the College of Family Physicians of Canada (CFPC) completed a self‐administered survey examining knowledge, attitudes and behaviours regarding HCV infection screening and care. Multivariate analyses were performed using the outcome, HCV care provision, and variables based on a conceptual model of practice guideline adherence. Family physicians providing basic–advanced HCV care were more likely to be older, practice in a rural setting, have injection drug users (IDU) in their practice and have higher levels of knowledge about the initial assessment (OR = 1.77; 95% CI = 1.23–2.54) and treatment of HCV (OR = 1.74; 95% CI = 1.24–2.43). They were also less likely to believe that family physicians do not have a role in HCV care (OR = 0.41; 95% CI = 0.30–0.58). Educational programmes should target physicians less likely to provide HCV care, namely family physicians practicing in urban areas and those who do not care for any IDU patients. Training and continuing medical education programmes that aim to shift family physicians’ attitudes about the provision of HCV care by promoting their roles as integral to HCV care could contribute to easing the burden on consultant physicians and lead to improved access to treatment for HCV infection.     

Advanced heart failure: prognosis, uncertainty, and decision making

Heart failure is a serious clinical management challenge for both patients and primary care physicians. The authors studied the perceptions and practices of internal medicine residents and faculty at an academic medical center in the Southeast to guide design of strategies to improve heart failure care. Data were collected via a self-administered survey. Eighty-nine faculty and resident physicians in general internal medicine and geriatrics participated (74% response rate). Items measured perceived skills and barriers, adherence to guidelines, and physician understanding of patient prognosis. Case studies explored practice approaches. Clinical knowledge and related scales were generally good and comparable between physician groups. Palliative care and prognostic skills were self-rated with wide variance. Physicians rated patient noncompliance and low lifestyle change motivation as major barriers. Given the complexities of caring for elderly persons with heart failure and comorbid conditions, there are significant opportunities for improving physician skills in decision making, patient-centered counseling, and palliative care.     

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.     

Hypertension knowledge,attitudes, and practices of nurses and physicians in primary care in Ulaanbaatar Mongolia

Increased blood pressure is a leading risk for death globally, and interventions to enhance hypertension control have become a high priority. An important aspect of clinical interventions is understanding the knowledge, attitudes, and practices (KAP) of differing primary healthcare practitioners. We examined KAP surveys from 803 primary care practitioners in Ulaanbaatar, Mongolia (response rate 80%), using a comprehensive KAP survey developed by the World Hypertension League (WHL). The WHL KAP survey uniquely includes an assessment of key World Health Organization recommended interventions to enhance hypertension control. There were few substantive differences between healthcare professional disciplines. Primary care practitioners mostly had a positive attitude toward hypertension management. However, confidence and practice in performing specific tasks to control hypertension were suboptimal. A low proportion indicated they systematically screened adults for hypertension and many were not aware of the need to or were confident in prescribing more than two antihypertensive medications. It was the practice of a high proportion of doctors to not pharmacologically treat most people with hypertension who were at high cardiovascular risk. There was a reluctance by physicians to task share hypertension diagnosis, drug prescribing and assessing cardiovascular risk to nurses. The minority of health care professions use a hypertension management algorithm, and few have patient registries with performance reporting functions. There were few substantive differences based on the age, gender, and years of clinical practice of the practitioners. The study findings support the need for standardized education and training of primary care practitioners in Ulaanbaatar to enhance hypertension control.