Guide to the elimination of orthopedic surgery surgical site infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide

This article is an executive summary of the APIC Guide to the Elimination of Orthopedic Surgical Site Infections. Infection preventionists, care providers, and perioperative personnel are encouraged to obtain the original, full length APIC Elimination Guide for more thorough coverage on strategies to prevent surgical site infections in orthopedic surgery.     

Preventing methicillin-resistant Staphylococcus aureus transmission in hospitals: an Executive Summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide

This article is an executive summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide for methicillin-resistant Staphylococcus aureus, including the 2009 California Supplement. Infection preventionists are encouraged to obtain the original, full-length Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guides for more thorough coverage of Staphylococcus aureus prevention.     

Preventing Clostridium difficile infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology's elimination guide

This article is an executive summary of the Association for Professionals in Infection Control and Epidemiology's Clostridium difficile infection elimination guide. Infection preventionists are encouraged to obtain the original, full-length elimination guide for more thorough coverage of C difficile infection prevention.     

Preventing mediastinitis surgical site infections: executive summary of the Association for Professionals in Infection Control and Epidemiology's elimination guide

This article is an executive summary of the Association for Professionals in Infection Control and Epidemiology's elimination guide for mediastinitis surgical site infections. Infection preventionists are encouraged to obtain the original, full-length elimination guide for more thorough coverage of mediastinitis surgical site infection prevention.     

The Certification Board of Infection Control and Epidemiology white paper: the value of certification for infection control professionals

In its Vision 2012: A Strategic Plan, the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) states that APIC will be recognized as the leader in infection prevention and control. However, if the APIC Strategic Plan is to be advanced by its members, infection control professionals must choose a leadership role by becoming certified, validating their competency and setting a standard of excellence. Certification by the Certification Board of Infection Control and Epidemiology, Inc. (CBIC) validates an infection control professional's competence to the public, the profession, employers, and regulators. The White Paper presented here by the CBIC provides a rationale for certification and recertification in infection prevention and control practice.     

Afterload mismatch and preload reserve: A conceptual framework for the analysis of ventricular function

A two-dimensional framework can be used for considering the characteristics of left ventricular ejection in terms of the appropriateness of the matching between afterload and the level of inotropic state, as modulated by the preload reserve. An afterload mismatch (reduced velocity and extent of shortening) can be induced acutely in the normal heart under controlled conditions if the preload is not allowed to compensate for an increased afterload, or if the limit of preload (Frank-Starling) reserve has been reached. In the intact circulation the normal heart is sensitive to some degree to acute changes in afterload, perhaps due to impaired venous return; but under basal resting conditions the ejection phase measures (such as the ejection fraction and the mean velocity of circumferential fiber shortening or V_CF, corrected for heart size) encompass a relatively narrow range. This finding, and the lack of change in ejection phase measures after the normal heart has adapted to a chronic pressure or volume overload, provides justification for the use of ejection phase indices for detecting depressed inotropic state under basal conditions. When there is mild depression of myocardial inotropic state, with or without accompanying mechanical overload, enhanced preload may allow full compensation, but acute pressure loading may allow early detection of a less than normal preload reserve. When the inotropic state is substantially reduced, however, a mismatch between afterload and contractility (a reduction in mean V_CF) will become evident even in the basal state (venous return being presumed to be adequate under these conditions). The concept of afterload mismatch with limited preload reserve provides an explanation for the value of ejection phase indices compared to isovolumic phase measures in assessing the basal level of inotropic state: the former may be more reliable because they are sensitive to afterload. The effects and implications of therapeutic afterload reduction as modulated by the preload also are understood within this framework.     

Seroprevalence of 2009 H1N1 Virus Infection and Self‐Reported Infection Control Practices Among Healthcare Professionals Following the First Outbreak in Bangkok,Thailand

A serologic study with simultaneous self‐administered questionnaire regarding infection control (IC) practices and other risks of influenza A (H1N1) pdm09 (2009 H1N1) infection was performed approximately 1 month after the first outbreak among frontline healthcare professionals (HCPs). Of 256 HCPs, 33 (13%) were infected. Self‐reported adherence to IC practices in >90% of exposure events was 82·1%, 73·8%, and 53·5% for use of hand hygiene, masks, and gloves, respectively. Visiting crowded public places during the outbreak was associated with acquiring infection (OR 3·1, P = 0·019). Amongst nurses, exposure to HCPs with influenza‐like illness during the outbreak without wearing a mask was the only identified risk factor for infection (OR = 2·3, P = 0·039).     

Preventing the transmission of multidrug-resistant Acinetobacter baumannii: an executive summary of the Association for Professionals in infection control and epidemiology's elimination guide

This article is an executive summary of the Association for Professionals in Infection Control and Epidemiology's guide to the elimination of multidrug-resistant Acinetobacter baumannii transmission in health care settings. Infection preventionists are encouraged to obtain the original, full-length elimination guide for more thorough coverage.     

An Examination of the Association Between Therapeutic Anticoagulation Control and Glycemic Control for Patients with Diabetes on Oral Anticoagulation Therapy

Background: Observations by pharmacists monitoring anticoagulated patients suggested that patients with diabetes often require more frequent international normalized ratio (INR) monitoring than patients without diabetes. The purpose of this investigation was to examine the association between glycemic control and therapeutic anticoagulation control.Methods: Patients with diabetes who were receiving warfarin therapy monitored by the Kaiser Permanente of Colorado Clinical Pharmacy Anticoagulation Service were eligible for inclusion. Patients were included if they had a diagnosis of diabetes mellitus type 1 or 2, aged ≥18 years, and had initiated anticoagulant therapy ≥120 days before their most recent hemoglobin A1C measurement. The primary outcome was the correlation between hemoglobin A1C value and percent of time in the patient-specific INR range. Multivariate analysis was undertaken to regress percent of time in INR range on an A1C value ≥8.0 while adjusting for other possible explanatory variables.Results: A total of 911 patients with diabetes were included in the study. Subjects with an A1C value ≥8.0 had similar characteristics as those subjects with an A1C value < 8.0. Correlation analysis revealed no relationship between percent of time spent in INR range and A1C value (Spearman Correlation Coefficient = 0.012, p = 0.805). Multivariate analysis revealed no relationship between percent of time spent in INR range and A1C value ≥8.0 (Odds Ratio = 1.00; 95% Confidence Interval = 0.99, 1.01) when adjusting for possible explanatory variables.Conclusions: For patients with diabetes on warfarin anticoagulation therapy, there is no association between glycemic control and therapeutic anticoagulation control. However, anticoagulation therapy providers should manage these patients with the same diligence and care as patients without diabetes.