Cost-effective application of the Centers for Disease Control Guideline for Isolation Precautions in Hospitals

Isolation, as practiced in many hospitals today, is associated with ineffective, costly rituals. The isolation process can be monitored and critically examined to determine illogical practices. When these practices and their associated costs are known, specific strategies can be implemented to reduce the costs associated with isolation.     

Cost-effective application of the Centers for Disease Control Guideline for Prevention of Nosocomial Pneumonia

Some parts of the Guideline are clearly cost-effective. Abandoning routine cultures of respiratory therapy equipment is cost-effective and should be adopted by any hospitals that have not done so already. Other practices such as the use of preoperative and postoperative instructions regarding deep breathing and incentive spirometry, and the policy of never reusing respiratory therapy equipment items that are intended for single use probably warrant further cost-benefit analysis. Finally, there is increasing evidence that changing ventilator tubing every 24 hours is not cost-effective. Changing tubing every 48 hours appears to be safe and can save hospitals substantial sums of money.     

Cost-effective application of the Centers for Disease Control Guideline for Infection Control in Hospital Personnel

I have tried to summarize the spirit of the Centers for Disease Control Guideline for Infection Control in Hospital Personnel. By eliminating certain unnecessary practices and preventing one infectious disease, we could have saved the hospital in these examples more than $18,000 in just 1 year. We must continue to evaluate and eliminate unnecessary practices while maintaining a safe environment for our employees.     

Cost-effective application of the centers for disease control guideline for prevention of intravascular infections

Implementation of the recommendations in the CDC Guideline for Prevention of Intravascular Infections pertaining to MDVs and 48-hour administration set changes are cost-effective. Application of antibiotic ointment to cut-down sites is also cost-effective. Although not stated in the guideline, reserving antibiotic ointment only for IV lines inserted in one site more than 3 days would appear to be cost-effective. Finally, the cost-effectiveness of using IV in-line filters cannot be determined on the basis of current existing data. More information is needed pertaining to the effect of filtration on infection rates and the cost of filtration versus the cost of a case of phlebitis.     

Recommendations for reducing risks of infection associated with suction collection procedures.

It is recognized that risks are incurred when health care workers contact various body fluids. The handling of suction collection equipment poses a risk because it is one way workers may come in contact with these fluids. Minimizing the risks associated with suction procedures can be accomplished if appropriate policies and procedures can be developed in health care facilities.     

Cost-effective application of the centers for disease control guideline for prevention of catheter-associated urinary tract infections

To decrease UTIc in a cost-efficient manner, efforts should be concentrated in areas that have been shown to be beneficial. These include the following measures: have an established infection control program; catheterize patients only when necessary, by using aseptic technique, sterile equipment, and trained personnel; maintain a closed sterile drainage system; do not disconnect the catheter and drainage tubing unless absolutely necessary; remove the catheter as soon as possible; and follow and reinforce good handwashing technique. Changing indwelling catheters at arbitrary fixed intervals and regular bacteriologic monitoring of catheterized patients are not cost-effective practices and should not be performed. Other measures should be avoided until further data are available. New products that appear to be questionable or gimmicky probably are and should also be avoided.     

Customizing infection control educational programs within the health care facility. Meeting a challenge vs. just satisfying a requirement

Infection control practitioners working within health care facilities are charged with the providing of in-service education programs for all new employees and volunteers as well as for all hospital departments, at least annually. To be effective, each program should be customized to meet the needs of the group for which it is given. Such a charge may be viewed as simply a "requirement that must be satisfied," or it may be approached as a challenge to be met with a measure of ingenuity and inventiveness. Academic preparation in the principles and skills germane to teaching are traditionally lacking in the training of health care professionals, and the ICP is thus left accountable for a job function for which she/he may have little proficiency. Customized education programs may be achieved with thoughtful planning and through the use of a few innovative ideas and resource materials available to most practitioners.     

Postoperative wound infections detected during hsopitalization and after discharge in a community hospital

Postoperative wound infections were evaluated in 1271 patients who had 1389 surgical procedures. There were 49 postoperative wound infections identified, of which 26 (53%) were discovered after discharge. Wound infections varied from 2.5% for clean wounds up to 13.3% for dirty wounds. Among the specialties, the infection rate ranged from no infection for otolaryngologists and urologists to 8.6% for general surgeons. With routine hospital surveillance, the overall infection rate was 1.8% or 2.2%, including readmissions for infection, but less than the actual rate of 3.8%. Persons who had three procedures had an infection rate of 27.3%; for two procedures, 8.1%; and for one procedure, 3.2%. Most postoperative wound infections detected after discharge were based on clinical grounds and not positive cultures. Rehospitalization was required for seven patients because of infection. This study demonstrates that postoperative wound infection surveillance must be continued after discharge.     

Echocardiographic diagnosis of pericardial disease.

Echocardiograms were performed in 11 patients with constrictive pericarditis or effusive-constrictive pericarditis confirmed by cardiac catheterization and pericardiectomy. Three echocardiographic patterns of pericardial disease were noted and were related to three types of pericardial pathology. Parallel moving echoes separated by a clear space were reflected from chronically fibrosed and thickened pericardium without associated pericardial exudate. Effusive-constrictive pericarditis or subacute wet pericarditis was characterized on the echocardiogram by a posterior echo-free space representing the liquid pericardial effusion and multiple ultrasonic lines from the thickened visceral pericardium. Subacute dry pericarditis was associated with numerous ultrasonic signals filling the space between the visceral pericardium and the relatively flat parietal pericardium. These ultrasonic signals were reflected from coagulated pericardial exudate which was adherent both to the parietal pericardium and the visceral pericardium. Parallel moving echoes or dense bands of echoes were reflected from either or both thickened visceral and parietal pericardium.