American journal of infection control
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Am J Infect Control · Dec 2008
Infection prevention and control competencies for hospital-based health care personnel.
Infection prevention and control education for hospital-based health care personnel has differed across organizations because of a lack of identified practice competencies. This gap also has resulted in variation of the educational curriculum in the academic setting and a lack of consistent preparation for emergency responses. The purpose of this study was to develop a list of competencies and measurable activities, or terminal objectives, for hospital-based health care personnel applicable for use during routine patient care activities as well as during natural and man-made disasters. ⋯ The final matrix of competencies and terminal objectives developed through this process may be used as a content framework for educational curricula and training materials for hospital-based health care personnel. The process also may be of use in determining the core competencies and terminal objectives regarding infection prevention and control for health care personnel in other settings. Validation of these results is an important next step.
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Am J Infect Control · Dec 2008
Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project.
A quality improvement initiative that included rigorous measurement, feasible interventions, and cultural change was shown to nearly eliminate catheter-related bloodstream infections (CR-BSIs) in patients in a surgical intensive care unit (ICU). To build on this research, a statewide collaborative cohort study was conducted using the same evidence-based interventions. ⋯ Results suggest that this program model can be generalized and be implemented on a large scale in the United States or the world to significantly reduce the rate of CR-BSIs and their associated morbidities, mortalities, and costs of care.
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Am J Infect Control · Dec 2008
Randomized Controlled TrialImpact of preoperative anxiolytic on surgical site infection in patients undergoing abdominal hysterectomy.
An increased anxiety may be associated with a higher risk of surgical site infection (SSI), but there is little objective data on the effect of preoperative anxiolytic interventions on SSI. To address this issue, we evaluated the effects of preoperative diazepam on postoperative SSI following abdominal hysterectomy. ⋯ Diazepam-treated patients showed lower postoperative anxiety and lower incidence of SSI up to 30 days after surgery compared with placebo in patients undergoing abdominal hysterectomy.
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Am J Infect Control · Dec 2008
Comparative StudyPreventing central venous catheter-associated bloodstream infections: development of an antiseptic barrier cap for needleless connectors.
Reports of outbreaks associated with the use of needle-free valve connectors suggest 2 common risk factors: (1) poor adherence to disinfection practices before use and (2) a design that allows contamination when not in use. Swabbing a membranous septum with 70% isopropyl alcohol may not eliminate septal surface contamination. Frequent access through and handling of needle-free connectors also puts patients at increased risk of central venous catheter-related bloodstream infections (CR-BSIs). A novel antiseptic barrier cap has been designed to maintain health care worker safety and eliminate the vulnerabilities of existing systems to contamination and CR-BSIs for patients at risk. ⋯ An antiseptic barrier cap was highly effective in sterilizing the septum of a needle-free valve connector and preventing entry of any microorganisms, even with heavy contamination of the septum. This new technology should now be evaluated in a clinical trial with CR-BSI as the primary outcome measure.
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Patient characteristics and system-level factors place children at increased risk for catheter-related bloodstream infection (CR-BSI). National Healthcare Safety Network data from 36 pediatric intensive care units (PICUs) demonstrate a pooled mean of 5.3 CR-BSIs per 1000 catheter-days and a median of 3.5 CR-BSIs per 1000 catheter-days. Almost 60% of CR-BSIs in children are caused by gram-positive bacteria. In the PICU setting, arterial catheterization, increased duration of catheterization, use of extracorporeal life support, and presence of a genetic abnormality are independent risk factors for CR-BSIs. ECONOMICS: In children, cost estimates range from $36,000 to $50,000 per CR-BSI. ⋯ Based on limited data, antimicrobial lock therapy may be appropriate in certain clinical situations, and multifaceted interventions are effective in reducing CR-BSIs in children. In one center, maximum barrier precautions during insertion, antimicrobial-impregnated catheters, annual hospital-wide handwashing campaigns, physical barriers between beds, and use of 2% chlorhexidine skin disinfectant decreased CR-BSIs.