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infection control

Management: Precautions to prevent spread of infection include: 1) universal precautions 2) standard precautions a) airborne precautions b) droplet precautions c) contact precautions 3) hand hygiene is the single most important measure for preventing healthcare-associated infections 4) stethoscopes may also transmit pathogens - disinfection of stethoscopes may be prudent [9] 5) tuberculosis isolation 6) strict isolation Hospital environment: 1) higher risk for acquiring MRSA in patients admitted to a hospital room where prior occupant was MRSA-positive (3.9% vs 2.9%) [2] 2) higher risk of VRE in patients admitted to an ICU room where prior occupant was MRSA-positive (4.5% vs 2.8%) [2] 3) > 90% of in-hospital acquisitions of MRSA & VRE occur in patients admitted to a hospital room where prior occupant was neither MRSA or VRE positive [2] 4) MRSA decolonizing all ICU patients is superior to targeted decolonization or to screening & isolation [6] 5) universal use of gowns & gloves in ICU may not reduce risk of infection with antibiotic-resistant organisms [7] 6) use of non sterile glove after hand washing may reduce infection in pre-mature infants [11] 7) nasal mupirocin for preventinb MRSA infections in ICU patients received daily baths with chlorhexidine [14] Staffing: - Nurse staffing levels, and especially job-related burnout, seem to be contributing factors in hospital infection rates [3] Inpatient attire: - bare-below-the-elbows attire for inpatient settings - if white coats are mandatory, more than one should be available, & hooks should be provided so that coats can be removed before patient contact - all clothing that comes in contact with patients or patient environment should be washed after daily use; a hot water cycle, followed by a dryer cycle or ironing that can kill bacteria [8] Waste disposal - drug-resistant Escherichia coli are abundant in hospital waste water [10] - the E coli survive waste water treatment Emergence of antibiotic-resistant organisms - see antimicrobial stewardship

Related

antimicrobial stewardship hand hygiene nosocomial infection; nursing home acquired infection standard precautions universal precautions

Useful

infection (infectious disease)

Specific

airborne pathogen infection control in correctional facilities infectivity of HIV

General

clinical procedure

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
  2. Huang SS et al, Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006, 166:1945 PMID: 17030826
  3. Cimiotti JP et al Nurse staffing, burnout, and health care - associated infection American Journal of Infection Control 40(6):486-490, August 2012 PMID: 22854376 http://www.ajicjournal.org/article/S0196-6553(12)00709-2/fulltext
  4. Burke JP. Infection control - a problem for patient safety. N Engl J Med. 2003 Feb 13;348(7):651-6. PMID: 12584377
  5. Siegel JD, Rhinehart E, Jackson M et al 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007 Dec;35(10 Suppl 2):S65-164. PMID: 18068815
  6. Huang SS et al Targeted versus Universal Decolonization to Prevent ICU Infection. N Engl J Med 2013 Jun 13; 368:2255 PMID: 23718152 http://www.nejm.org/doi/full/10.1056/NEJMoa1207290 - Edmond MB and Wenzel RP Screening Inpatients for MRSA - Case Closed N Engl J Med. May 29, 2013 PMID: 23718155 http://www.nejm.org/doi/full/10.1056/NEJMoa1207290
  7. Harris AD et al Universal Glove and Gown Use and Acquisition of Antibiotic- Resistant Bacteria in the ICU. A Randomized Trial. JAMA. Published online October 04, 2013 PMID: 24097234 http://jama.jamanetwork.com/article.aspx?articleid=1746112 - Malani PN Preventing Infections in the ICU. One Size Does Not Fit All. PMID: 24097192 http://jama.jamanetwork.com/article.aspx?articleid=1746111
  8. Bearman G et al Healthcare Personnel Attire in Non-Operating-Room Settings. Infection Control and Hospital Epidemiology 35(2) 2014 PMID: 24442071 http://www.jstor.org/stable/10.1086/675066
  9. Longtin Y et al. Contamination of stethoscopes and physicians' hands after a physical examination. Mayo Clin Proc 2014 Mar; 89:291. PMID: 24582188 - Maki D. Stethoscopes and health care-associated infection. Mayo Clin Proc 2014 Mar; 89:277 PMID: 24582185
  10. Brechet C et al. Wastewater treatment plants release large amounts of extended-spectrum beta-lactamase-producing Escherichia coli into the environment. Clin Infect Dis 2014 Jun 15; 58:1658. PMID: 24795329 http://cid.oxfordjournals.org/content/58/12/1658 - Griffiths JK and Barza M. What happens in hospitals should stay in hospitals. Clin Infect Dis 2014 Jun 15; 58:1666 PMID: 24795327 http://cid.oxfordjournals.org/content/58/12/1666
  11. Kaufman DA et al Nonsterile Glove Use in Addition to Hand Hygiene to Prevent Late-Onset Infection in Preterm InfantsRandomized Clinical Trial. JAMA Pediatr. Published online August 11, 2014 PMID: 25111196 http://archpedi.jamanetwork.com/article.aspx?articleid=1894732 - Coffin SE Fighting Infections in the Neonatal Intensive Care Unit. Gloves On or Off? JAMA Pediatr. Published online August 11, 2014 PMID: 25111036 http://archpedi.jamanetwork.com/article.aspx?articleid=1894730
  12. Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev. 2011 Jan;24(1):141-73. Review. PMID: 21233510 Free PMC Article
  13. Banach DB, Johnston BL, Al-Zubeidi D et al Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals. Infection Control & Hospital Epidemiology. Published Dec 2017 https://www.cambridge.org/core/services/aop-cambridge-core/content/view/8C035426B3C86E075BBB0AFFAE42F0AC/S0899823X17002124a.pdf/outbreak_response_and_incident_management_shea_guidance_and_resources_for_healthcare_epidemiologists_in_united_states_acutecare_hospitals.pdf
  14. Huang SS, Septimus EJ, Kleinman K et al Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs. A Randomized Clinical Trial. JAMA. 2023;330(14):1337-1347 PMID: 37815567 https://jamanetwork.com/journals/jama/fullarticle/2810510
  15. Centers for Disease Control & Prevention (CDC) Executive Summary: Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services (2019) https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/exec-summary.html
  16. Centers for Disease Control and Prevention (CDC) Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. http://www.cdc.gov/hai/settings/outpatient/outpatient-care-guidelines.html