Happy new year 2010 all of you God bless you all

Infection prevention and control in the design of healthcare facilities

Author(s):Farrow TS; Black SM

Source:Healthcarepapers [Healthc Pap] 2009; Vol. 9 (3), pp. 32-7; discussion 60-2.

Abstract:The lead paper, “Healthcare-Associated Infections as Patient Safety Indicators,” written by Gardam, Lemieux, Reason, van Dijk and Goel, puts forward the design of healthcare facilities as one of many strategies to improve patient safety with respect to healthcare-associated infections. This commentary explores some of the issues in balancing infection prevention and control priorities with other needs and values brought to the design process. This balance is challenged not only by a lack of supporting evidence but also by the superficial nature in which infection prevention and control are often discussed within a design context. For the physical environment to support any patient safety initiative, the design of the processes must be developed in conjunction with that of the physical environment so that compliance can be natural and convenient. Finally, consideration is given to the value of documenting decision-making related to infection prevention and control in facility design and ongoing assessments of existing facilities.

National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.

Author(s):Pratt RJ; Pellowe CM; Wilson JA; Loveday HP; Harper PJ; Jones SR; McDougall C; Wilcox MH

Source:The Journal Of Hospital Infection [J Hosp Infect] 2007 Feb; Vol. 65 Suppl 1, pp. S1-64.

Abstract:National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001. These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters. The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence). A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines. These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations. Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of healthcare in NHS hospitals in England can be minimised.

‘Clean Care is Safer Care’: the Global Patient Safety Challenge 2005-2006

Author(s):Pittet D; Allegranzi B; Storr J; Donaldson L

Source:International Journal Of Infectious Diseases: IJID: Official Publication Of The International Society For Infectious Diseases [Int J Infect Dis] 2006 Nov; Vol. 10 (6), pp. 419-24. Date of Electronic Publication: 2006 Aug 17.

Abstract:BACKGROUND: Each year the treatment and care of hundreds of millions of patients worldwide is complicated by infections acquired during healthcare. The impact of healthcare-associated infection may imply prolonged stays in hospital, long-term disability, massive additional financial burden, and deaths. ACTION: Patient safety is a global issue that affects both developed and developing countries. In October 2004, the World Health Organization launched the World Alliance for Patient Safety to co-ordinate and accelerate improvements in patient safety internationally. A core element of the Alliance is the identification of a topic to be addressed as a Global Patient Safety Challenge over a two-year cycle. The first topic chosen for 2005-2006 is healthcare-associated infection. PERSPECTIVES: The Challenge aims at implementing several actions to tackle healthcare-associated infections worldwide, regardless of the level of development of healthcare systems and the availability of resources. Implementation strategies include the integration in different healthcare settings of multiple interventions in the areas of blood safety, injection safety, and clinical procedure safety, as well as water, sanitation, and waste management, with the promotion of hand hygiene in healthcare as the cornerstone.

Infection control as a major World Health Organization priority for developing countries

Author(s):Pittet D; Allegranzi B; Storr J; Bagheri Nejad S; Dziekan G; Leotsakos A; Donaldson L Source:The Journal Of Hospital Infection [J Hosp Infect] 2008 Apr; Vol. 68 (4), pp. 285-92. Date of Electronic Publication: 2008 Mar 10.

Abstract:Healthcare-associated infection affects hundreds of millions of people worldwide and is a major global issue for patient safety. It complicates between 5 and 10% of admissions in acute care hospitals in industrialised countries. In developing countries, the risk is two to twenty times higher and the proportion of infected patients frequently exceeds 25%. A growing awareness of this problem prompted the World Health Organization to promote the creation of the World Alliance for Patient Safety. Prevention of healthcare-associated infection is the target of the Alliance First Global Patient Safety Challenge, ‘Clean Care is Safer Care’, launched in October 2005. After 2 years, a formal statement has been signed by 72 ministries of health as a pledge of their support to implement actions to reduce healthcare-associated infection; of these, 30 are developing countries. Additional countries, mostly from the developing world, have planned to sign by the end of 2008 and will represent in total more than three-quarters of the world’s population. Given the emphasis of the proposed strategy on simple and affordable solutions, the impact of the Challenge is expected to be high in developing countries. The combined efforts expected under the Challenge have the potential to save millions of lives, prevent morbidities and long-term disability for hundreds of millions of patients, and lead to major cost savings through the improvement of basic infection control measures in any healthcare setting, regardless of resources available or level of development.

Smoking in the home and children’s health Author(s):Hill SC; Liang L Source:Tobacco Control [Tob Control] 2008 Feb; Vol. 17 (1), pp. 32-7.

Abstract:OBJECTIVES: We estimate for young children the annual excess health service use, healthcare expenditures, and disability bed days for respiratory conditions associated with exposure to smoking in the home in the United States. METHODS: Health service use, healthcare expenditures and disability bed days data come from the 1999 and 2001 Medical Expenditure Panel Survey (MEPS). Reported smoking in the home comes from the linked National Health Interview Survey, from which the MEPS sample is drawn. Multivariate statistical analysis controls for potential confounding factors. The sample is 2759 children aged 0-4. RESULTS: Smoking in the home is associated with an increase in the probability of emergency department visits for respiratory conditions by five percentage points and the probability of inpatient use for these conditions by three percentage points. There is no relation between indoor smoking by adults and either ambulatory visits or prescription drug expenditures. Overall, indoor smoking is associated with $117 in additional healthcare expenditures for respiratory conditions for each exposed child aged 0-4. Indoor smoking is also associated with an eight percentage point increase in the probability of having a bed day because of respiratory illness for children aged 1-4. CONCLUSIONS: Despite the significant progress made in tobacco control, many children are still exposed to secondhand smoke in their home. Reducing exposure to smoking in the home would probably reduce healthcare expenditures for respiratory conditions and improve children’s health.

Prevention of nosocomial infection and standard precautions: knowledge and source of information among healthcare students.

Author(s):Tavolacci MP; Ladner J; Bailly L; Merle V; Pitrou I; Czernichow P

Source:Infection Control And Hospital Epidemiology: The Official Journal Of The Society Of Hospital Epidemiologists Of America [Infect Control Hosp Epidemiol] 2008 Jul; Vol. 29 (7), pp. 642-7.

Abstract:OBJECTIVE: To evaluate the knowledge of healthcare students after four curricula on infection control and to identify sources of information. DESIGN: Cross-sectional study. SETTING: Four healthcare schools at Rouen University (Rouen, France). PARTICIPANTS: Medical students, nursing students, assistant radiologist students, and physiotherapist students taking public health courses. METHODS: To measure students’ knowledge of infection control and their sources of information, 6 multiple-choice questions were asked about 3 specific areas: standard precautions, hand hygiene, and nosocomial infection. Each questionnaire section had 10 possible points, for an overall perfect score of 30. The sources of information for these 3 areas were also recorded: self-learning, practice training in wards, formal training in wards, and teaching during the curriculum. A logistic regression analysis was performed to identify factors associated with acceptable level of knowledge. RESULTS: Three hundred fifty students (107 medical students, 78 nursing students, 71 physiotherapist students, and 94 assistant radiologists tudents) were included in the study. The mean overall score (+/- SD) was 21.5 +/- 2.84. Nursing students had a better mean overall score (23.2 +/- 2.35) than did physiotherapist students (21.9 +/- 2.36), medical students (21.1 +/- 2.35), and assistant radiologist students (20.5 +/- 3.04; P.001). The mean scores ( +/- SD) for the component sections of the questionnaire were 8.5 +/- 1.4 for standard precautions, 7.4 +/- 1.26 for hand hygiene,and 5.7 +/- 1.55 for nosocomial infections (P .001). The main source of information was material taught during the curriculum. CONCLUSION: The overall score for infection control indicated that instruction was effective; however, knowledge levels were different by area (the best scores were results of tests of standard precautions) and curriculum (nursing students achieved the best overall score). Ward training for daily infection control practice (ie, bedside instructions training and course work) could be improved for healthcare students.