Translating infection control guidelines into practice: implementation process within a health care institution.

Health-care-associated infections (HAIs) remain a major patient safety problem even as policy and programmatic efforts designed to reduce HAIs have increased. Although information on implementing effective infection control (IC) efforts has steadily grown, knowledge gaps remain regarding the organizational elements that improve bedside practice and accommodate variations in clinical care settings. We conducted in-depth, semistructured interviews in 11 hospitals across the United States with a range of hospital personnel involved in IC (n = 116). We examined the collective nature of IC and the organizational elements that can enable disparate groups to work together to prevent HAIs. Our content analysis of participants' narratives yielded a rich description of the organizational process of implementing adherence to IC. Findings document the dynamic, fluid, interactional, and reactive nature of this process. Three themes emerged: implementing adherence efforts institution-wide, promoting an institutional culture to sustain adherence, and contending with opposition to the IC mandate.

Aqueous extracts of Rhizopus oryzae induced nitric oxide production in rat hepatocyte cell line RLN-10.

Aqueous extracts of Rhizopus oryzae (Aq-ROU) have a broad range of physiological activity. Here we identified a new physiological effect of Aq-ROU in rat hepatocyte cell line RLN-10. Aq-ROU induced the accumulation of nitrite, a stable metabolite nitric oxide (NO), in cell culture medium and induced potent diaminofluorescein-FM diacetate staining in the cells. Real-time reverse transcriptase (RT)-PCR analysis showed marked inducible NO synthase gene expression. Additionally, markedly enhanced expression of p22(phox) and temporally increased expression of NADPH oxidase1 indicated that superoxide was produced. Nuclear translocation of nuclear factor-kappa (NF-κ) B p65 increased remarkably following Aq-ROU and following lipopolysaccharide treatment, a potent activator of NF-κB. Ammonium pyrrolidine-1-carbodithioate, an inhibitor of NF-κB, inhibited NO production following Aq-ROU treatment. Our data indicate that Aq-ROU induces NO production and potentially the production of superoxide, which may contribute to the broad range of physiological effects observed for Aq-ROU ingested by animals.

California hospitals response to state and federal policies related to health care-associated infections.

In October 2008, the Centers for Medicare and Medicaid Services (CMS) denied payment for ten selected health care-associated infections (HAI). In January 2009, California enacted mandatory reporting of infection prevention processes and HAI rates. This longitudinal mixed-methods study examined the impact of federal and state policy changes on California hospitals. Data on structures, processes, and outcomes of care were collected pre- and post-policy changes. In-depth interviews with hospital personnel were performed after policy implementation. More than 200 hospitals participated with 25 personnel interviewed. We found significant increases in adoption of and adherence to evidence-based practices and decreased HAI rates (p < .05). Infection preventionists (IP) spent more time on surveillance and in their offices and less time on education and in other locations (p < .05). Qualitative data confirmed mandatory reporting had intended and unintended consequences and highlighted the importance of technology and organizational climate in preventing infections and the changing IPs' role. This is especially relevant because the California Department of Public Health has since mandated hospitals to report data on 29 different for surgical site infections and a lawsuit has been filed to delay the implementation of these requirements.

Exploring infection prevention: policy implications from a qualitative study.

Health care-associated infections (HAIs) are common and costly patient safety problems that are largely preventable. As a result, numerous policy changes have recently taken place including mandatory reporting and lack of reimbursement for HAIs. A qualitative approach was used to obtain dense description and gain insights about the current practice of infection prevention in California. Twenty-three in-depth, semistructured interviews were conducted at six acute care hospitals. Content analysis revealed 4 major interconnected themes: (a) impacts of mandatory reporting; (b) impacts of technology on HAI surveillance; (c) infection preventionists' role expansion; and (d) impacts of organizational climate. Personnel reported that interdisciplinary collaboration was a major facilitator for implementing effective infection prevention, and organizational climate promoting a shared accountability is urgently needed. Mandatory reporting requirements are having both intended and unintended consequences on HAI prevention. More research is needed to measure the long-term effects of these important changes in policy.

Nitric oxide production and its contribution to hepatocyte proliferation in normal juvenile rats.

Nitric oxide (NO) has been reported as a key mediator in enhancing hepatocyte proliferation during liver regeneration. Juvenile hepatocytes have a strong ability to proliferate while still in their undifferentiated state but the mechanism of NO production and its contribution to hepatocyte proliferation are not yet fully understood. The present study was designed to investigate NO production in the normal liver and its contribution to hepatocyte proliferation in juvenile rats. Endogenous NO production was evaluated quantitatively using a spin trap followed by electron paramagnetic resonance spectroscopy with the Fe-N, N-diethyldithiocarbamate complex as an NO-trapping reagent in the rat liver. NO production in the liver significantly peaked at 3 weeks after birth, but NO synthase (NOS) 3 expression did not change between 2 to 5 weeks after birth, while NOS 1 and NOS 2 mRNA were not detected. Hepatocyte proliferation, measured by the incorporation of 5-bromo-2'-deoxyuridine into the DNA, was found to decline significantly when endogenous NO production was inhibited by the administration of the NOS inhibitor N(G)-nitro- (L)-arginine methyl ester. These findings indicate that endogenous NO production peaked at 3 weeks after birth and hepatocyte proliferation declined significantly when NO production was inhibited. Thus, this study provides a novel insight into the contribution of NO to hepatic growth and liver maturation in juveniles.

Infection prevention in long-term care: a systematic review of randomized and nonrandomized trials.

The purpose of this systematic review was to critically review and synthesize current evidence and the methodological quality of nonpharmacological infection-prevention interventions in long-term care (LTC) facilities for older adults. Two reviewers searched three electronic databases for studies published over the last decade assessing randomized and nonrandomized trials designed to reduce infections in older adults in which primary outcomes were infection rates and reductions of risk factors related to infections. To establish clarity and standardized reporting of findings, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used. Data extracted included study design, sample size, type and duration of interventions, outcome measures reported, and findings. Two reviewers independently assessed study quality using a validated quality assessment tool. Twenty-four articles met inclusion criteria; the majority were randomized control trials (67%) in which the primary purpose was to reduce pneumonia (66%). Thirteen (54%) studies reported statistically significant results in favor of interventions on at least one of their outcome measures. The methodological clarity of available evidence was limited, placing them at potential risk of bias. Gaps and inconsistencies surrounding interventions in LTC are evident. Future interventional studies need to enhance methodological rigor using clearly defined outcome measures and standardized reporting of findings.