Horizontal infection prevention measures and a risk-managed approach to vancomycin-resistant enterococci: An evaluation.

BACKGROUND: The use of infection control measures in the management of vancomycin-resistant enterococci (VRE) is hotly debated. A risk-managed approach to VRE control after the introduction of 2 horizontal infection prevention measures-an environmental cleaning (EC) and an antimicrobial stewardship (AMS) program-was assessed. METHODS: Routine screening for VRE was discontinued 6 and 4 months after introduction of the EC and AMS programs, respectively. Only 4 units (intensive care, burns-trauma, solid organ transplant, and bone marrow transplant units) where patients were deemed to be at increased risk for VRE infection continued screening and contact precautions. Cost avoidance and value-added benefits were monitored by the hospital finance department. VRE monitoring on these high-risk units and facility-wide comprehensive bacteremia surveillance continued as per established protocols. Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection (CDI) remained unchanged. RESULTS: VRE bacteremia rates did not increase with the change to the VRE risk-managed approach. The number of patients requiring VRE isolation in all areas of the hospital decreased from an average of 32 to 6 beds per day. Statistically significant reductions in CDI and MRSA rates were observed possibly related to the aggressive decluttering, equipment cleaning, and AMS program elements. CONCLUSION: A risk-managed approach to VRE can be implemented without adverse consequences and potentially with significant benefits to a facility.

Bedpan washer disinfectors: an in-use evaluation of cleaning and disinfection.

BACKGROUND: As part of a comprehensive approach to decreasing Clostridium difficile in our health authority, an evaluation of the in-use performance of 2 brands of bedpan decontaminators (BPDs) in 2 acute care facilities was performed. METHODS: A continuous quality improvement approach consisting of 5 BPD audits and 4 intervention phases was used over a 16-month evaluation period. Visible fecal soil on processed items was used as the progress indicator, and infection preventionists performed audits. RESULTS: A total of 1,982 observations was recorded. Percent failures rates ranged from 7.6% to 33% dependent on the intervention phase. Polypropylene materials had fewer failures compared with stainless steel. The addition of rinse agent significantly improved results particularly in polypropylene items (1% failure rate). A number of human factors issues and equipment design features compromised the BPD's ability to function adequately. CONCLUSION: Users should thoroughly evaluate the in-use efficacy of BPDs and use a step-wise approach to identify and correct both human and equipment deficiencies. Forced function and compliance features for correct loading of machines, detergent and rinse agent dispensing, and ability to operate the machine only when detergent is present should be integral to the BPD design.

Health care workers' perceptions of respiratory and gastrointestinal algorithms for patient management in emergency care settings.

BACKGROUND: Patients with respiratory or gastrointestinal illness in emergency care settings are often not yet diagnosed but are at risk of transmitting disease. Infection control algorithms delineating a standard approach to patient management decrease risk of secondary exposure, but few articles document health care workers' (HCWs) perceptions as to their effectiveness and ease of implementation. METHODS: A cross-sectional survey approach was used to explore HCWs perceptions in 2 emergency departments of the current algorithms for management of potentially infectious respiratory and gastrointestinal illnesses. RESULTS: Surveys from 96 HCWs revealed that algorithms were perceived as invaluable in protecting staff, patients, and colleagues. Differences in self-reported compliance, clarity, and ease of implementation of the respiratory algorithm were noted between facilities, likely reflecting variation in the physical plant. Physicians scored significantly lower for compliance with the respiratory algorithm. CONCLUSION: Algorithms were perceived to offer a clear and consistent approach to patient management and protect HCWs in spite of environmental and resource limitations.

The infection control audit: the standardized audit as a tool for change.

BACKGROUND: Health care workers' compliance with infection control practices and principles is vital in preventing the spread of disease. One tool to assess infection control practice in clinical areas is the infection control audit; however, many institutions do not approach this in a systematic fashion. METHODS: Key features of the infection control audit were identified by the infection control team and developed into a standardized format for review of clinical areas. The audit incorporates a review of the physical layout, protocols and policies, knowledge of basic infection control principles, and workplace practice review. RESULTS: Over the last 13 years, the infection control unit has completed 17 audits involving 1525 employees. Four-hundred-one staff members have filled out questionnaires that assessed their understanding of standard precautions. A total of 257 recommendations have been made, and 95% of these have been implemented. The majority of recommendations address separation of clean and dirty supplies, hand hygiene compliance, hand hygiene signage, proper use of barriers, and environmental cleaning. CONCLUSION: The infection control audit is an opportunity to implement changes and to introduce remedial measures in collaboration with various departments and services. A standardized approach to the audit allows benchmarking of practices across the institution and enhances standards of care.