Selection of needlestick prevention devices: A conceptual framework for approaching product evaluation

Needlestick injuries have been associated with blood-borne disease transmission to health care workers. A demand for a safer work environment has contributed to a proliferation of “safety” products. The selection and evaluation of these devices differs from traditional product evaluation in that it considers not only effectiveness in patient care but also health care worker safety and cost-effectiveness in terms of prevention gained. In addition, multiple devices associated with injuries and choices between passive, active, and accessory safety options require that institutions establish priorities for focusing intervention efforts. Selection of products must involve the primary users. Unless new devices are found acceptable for patient care, health care workers are likely to reject them, despite any apparent safety advantages. Five project steps help define a systematic approach for this process: (1) creation of a multidisciplinary team, (2) defining prevention priorities on the basis of collection and analysis of an institution's injury data, (3) development of design and performance criteria for product selection according to needs for patient care and health care worker safety, (4) planning and implementing an evaluation of products in clinical settings, and (5) analyzing product performance and cost-effectiveness to choose the product. Several methodologic issues raise questions for future research in the area of product evaluation, including the selection of study populations, methods of product distribution and data collection, and influence of institutional culture. In addition, there is a need to develop product-specific design and performance criteria by which 'evaluation teams can measure various technologies under consideration. Standardization of the product evaluation process for needlestick prevention technology should lead to the collection of information that can be compared across institutions. Infection control professionals have an important opportunity to assume a leadership role in this process.     

Top Ten List of Long‐Term Care Facility Preparations for the Upcoming Influenza Season

A novel influenza A partly of virus of swine origin (2009 H1N1) emerged this spring, resulting in an influenza pandemic. This pandemic is anticipated to continue into the next influenza season. Given that the 2009 H1N1 and seasonal influenza A appear to be somewhat different in the human populations affected and that two influenza vaccines will be recommended this fall, those who manage long‐term care facilities and treat patients in them will be faced with many uncertainties as they approach the 2009/10 influenza season. Ten specific suggestions are offered to those responsible for the care of patients in long‐term care facilities regarding the upcoming influenza season. These practical suggestions are the clinical opinions of the authors and do not represent official recommendations of the American Geriatrics Society or any agency.     

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.