AJIC: American Journal of Infection Control

APIC’s 2012 Annual Conference is just around the corner

2012-05-01

For more than 39 years, health care professionals throughout the world have turned to APIC as they strive to create a safer world through the prevention of infection. In less than one month, health care professionals will come together in San Antonio, TX, June 4-6, for the APIC 2012 Annual Conference to broaden their multidisciplinary knowledge base and engage in educational programs, networking opportunities, and viable conference activities essential to protect patients from health care-associated infections.

The Road to 2020—Guest Editorial

Michelle R. Farber, Katrina S. Crist — 2012-05-01

As the Association for Professionals in Infection Control and Epidemiology (APIC) looks ahead, we are mapping our journey via a compelling vision. The association is pursuing ambitious strategic goals, and we encourage all infection prevention stakeholders to join with us. We have come a long way in recent years, but our ultimate destination remains on the horizon. Only through collaborative efforts will we meet with success. For that reason, the APIC invites you to travel with us on the road to 2020.

APIC Strategic Plan 2020

The APIC Board of Directors — 2012-05-01

The health care system has reached a critical juncture among patient safety, infection prevention, and quality of care. Significant changes in where care is and will be delivered are central issues. These changes represent an unprecedented opportunity for infection preventionists (IPs) to accelerate progress toward the elimination of health care-associated infections (HAIs). APIC leaders believe this is the right time to commit to an uncompromising vision and organize the association's mission and goals around a plan to advance toward health care without infection. We propose to advance our mission to create a safer world through prevention of infection and embrace this bold direction through patient safety, implementation science, competencies and certification, advocacy, and data standardization.

The value of certification and the CIC credential

Katrina S. Crist, Barbara S. Russell, Michelle R. Farber — 2012-05-01

The rapidly changing landscape of infection prevention and control, especially the onslaught of public reporting, has created a growing demand for credentialing within the profession. The process increases professional credibility. It confirms to an employer, to colleagues, to patients, and to the public that an individual possesses “current” skills and knowledge in a specific field or profession to meet the challenges of a dynamic and demanding environment.

Competency in infection prevention: A conceptual approach to guide current and future practice

2012-05-01

Professional competency has traditionally been divided into 2 essential components: knowledge and skill. More recent definitions have recommended additional components such as communication, values, reasoning, and teamwork. A standard, widely accepted, comprehensive definition remains an elusive goal. For infection preventionists (IPs), the requisite elements of competence are most often embedded in the IP position description, which may or may not reference national standards or guidelines. For this reason, there is widespread variation among these elements and the criteria they include. As the demand for IP expertise continues to rapidly expand, the Association for Professionals in Infection Control and Epidemiology, Inc, made a strategic commitment to develop a conceptual model of IP competency that could be applicable in all practice settings. The model was designed to be used in combination with organizational training and evaluation tools already in place. Ideally, the Association for Professionals in Infection Control and Epidemiology, Inc, model will complement similar competency efforts undertaken in non-US countries and/or international organizations. This conceptual model not only describes successful IP practice as it is today but is also meant to be forward thinking by emphasizing those areas that will be especially critical in the next 3 to 5 years. The paper also references a skill assessment resource developed by Community and Hospital Infection Control Association (CHICA)-Canada and a competency model developed by the Infection Prevention Society (IPS), which offer additional support of infection prevention as a global patient safety mission.

Performance improvement and implementation science: Infection prevention competencies for current and future role development

Marilyn Hanchett — 2012-05-01

The Association for Professionals in Infection Control and Epidemiology, Inc, developed its first model of infection preventionist (IP) competency in 2011. The model is based on the principles of patient safety, professional and practice standards, and core competencies identified through research conducted by the Certification Board of Infection Control and Epidemiology, Inc. In addition, the model highlights 4 domains that are predicted to be key areas for future competency development. Performance improvement (PI) and implementation represent 1 of the 4 forward-focused domains. Concurrently, the inclusion of implementation science (IS) in the competency model is consistent with the research goals established by the Association for Professionals in Infection Control and Epidemiology, Inc, in its 2020 strategic plan. This article explains the importance of PI and IS and describes their relevance to the current and future IP role development. Significant challenges such as role delineation and compression are discussed. The need for the IP to acquire new competencies at integrating, as well as differentiating, PI and IS are explored in terms of emerging issues and trends.

The APIC research agenda: Results from a national survey

2012-05-01

Background: Research is an integral component of the Association for Professionals in Infection Control and Epidemiology (APIC) Strategic Plan 2020. As the role of the infection preventionist (IP) has evolved toward consumers and implementers of research, it becomes increasingly necessary to assess which topics require further evidence and how best APIC can assist IPs. In 2010, APIC determined that the research priorities first described in 2000 needed to be re-evaluated.Methods: A 33-question Web-based survey was developed and distributed via e-mail to APIC members in March 2011. The survey contained sections inquiring about respondents' demographics, familiarity with implementation science, and infection prevention research priorities. Priorities identified by a Delphi study 10 years ago were re-ranked, and open-ended items were used to identify new research priorities and understand how APIC could best serve its members in relation to research.Results: Seven hundred one members responded. Behavioral management science, surveillance standards, and infection prevention resource optimization were the highest ranked priorities and relatively unchanged from 2000. Proposed additional research topics focused on achieving standardization in infection prevention practices and program resource allocation. The majority of respondents described APIC's role in the field of research as a disseminator of low-cost, highly accessible education to its members.Conclusion: This report should be used as a roadmap for APIC leadership as it provides suggestions on how APIC may best direct the association's research program. The major research priorities described and ranked in 2000 continue to challenge IPs. APIC can best serve its members by disseminating research findings in a cost-effective and easily accessed manner. Recurrent assessments of research priorities can help guide researchers and policy makers and help determine which topics will best support successful infection prevention processes and outcomes.

Perceived impact of the Medicare policy to adjust payment for health care-associated infections

2012-05-01

Background: In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts.Methods: A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010.Results: Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0-5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3-0.8; P = .005).Conclusion: Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear.

Effectiveness of an audible reminder on hand hygiene adherence

Morkos Fakhry, George B. Hanna, Oliver Anderson, Alison Holmes, Dinesh Nathwani — 2011-09-16

Background: Multimodal interventions aim to improve health care workers’ adherence to hand hygiene guidelines. Visitors are not primarily targeted, but may spread epidemic infections. Effective interventions that improve the adherence of visitors to hand hygiene guidelines are needed to prevent the transmission of epidemic infections to or from health care environments.Methods: An electronic motion sensor–triggered audible hand hygiene reminder was installed at hospital ward entrances. An 8-month preinterventional and postinterventional study was carried out to measure the adherence of hospital visitors and staff to hand hygiene guidelines.Results: Overall hand hygiene adherence increased from 7.6% to 49.9% (P < .001). The adherence of visitors and nonclinical staff increased immediately from 10.6% to 63.7% and from 5.3% to 34.8%, respectively (P < .001). Adherence of doctors, nurses, and physiotherapists increased gradually from 4.5% to 38.3%, from 5.4% to 43.4%, and from 8.7% to 49.5%, respectively (P < .001). Improved adherence was sustained among visitors and clinical staff (P < .001), but not among nonclinical staff (P = .341).Conclusions: The electronic motion sensor–triggered audible reminder immediately and significantly improved and sustained greater adherence of hospital visitors and clinical staff to hand hygiene guidelines. This is an effective addition to multimodal hand hygiene interventions and may help control epidemic infections.

A multifaceted pilot program to promote hand hygiene at a suburban fire department

Christine McGuire-Wolfe, Donna Haiduven, C. Duncan Hitchcock — 2011-09-12

Background: Firefighters (FFs) and Emergency Medical Services (EMS) personnel provide care in uncontrolled settings, where the risk of hand contamination is great and opportunities for handwashing are few. Knowledge, attitudes, and beliefs about hand hygiene in this group have not been well reported.Methods: Written surveys were administered to FFs and EMS personnel to assess their practices, attitudes, and beliefs before and after installation of alcohol hand gel dispensers, hanging of reminder posters, and completion of PowerPoint training.Results: A majority of the participants (n = 131; 58.5%) indicated they had not received any training on hand hygiene from the fire department before the intervention. Responses to Likert scale questions about attitudes, practices, and beliefs regarding handwashing did not reveal any statistically significant differences between preintervention and postintervention surveys; however, responses to direct questions about the impact of the intervention were more promising.Conclusions: Implementation and evaluation of an intervention to target groups of EMS personnel and FFs can guide future efforts to improve hand hygiene practices in this distinctive group.

Testing of the World Health Organization recommended formulations in their application as hygienic hand rubs and proposals for increased efficacy

2011-12-02

Background: In Central Europe, alcohol-based hand rubs have been the preferred choice for hand hygiene, whereas, in other countries, other preparations have been used that are based on other active agents. Recently, a move towards alcohol-based hand rubs has begun, but they may be costly and unaffordable to some. Therefore, the World Health Organization (WHO) has recommended 2 hand rub formulations (WHO I and WHO II) for local production in health care settings where commercial products are not available or are too expensive.Objectives: WHO I, based on ethanol 80% (vol/vol), and WHO II, based on isopropanol 75% (vol/vol), were investigated for their bactericidal efficacy in their application as hygienic hand rubs.Methods: The investigation took place at the Institute for Hygiene and Applied Immunology, Medical University Vienna, Austria, as a prospective, randomized, in vivo laboratory study, comparative in crossover design. Both formulations were tested according to the European Standard EN 1500 in 2 applications (1 × 3 mL/30 seconds or 2 × 3 mL/2 × 30 seconds). Additionally, modifications with increased alcohol concentrations (weight instead of volume percent) were tested in the short application. Bactericidal efficacies were compared with those of the respective reference procedure “R,” ie, rubbing 2 × 3 mL 60% vol/vol isopropanol for 2 × 30 seconds onto hands artificially contaminated with Escherichia coli K12.Results: The short application of either WHO formulation resulted in bacterial reductions significantly inferior to the respective ones of R. However, prolonging the contact time to 60 seconds or increasing the alcohol content produced reductions similar to those of R.Conclusion: Both WHO-recommended formulations meet the efficacy requirements of EN 1500 within 60 seconds but not within 30 seconds. Increasing the respective alcohol concentrations from 80% vol/vol to 80% wt/wt and 75% vol/vol to 75% wt/wt renders the formulations sufficiently active to conform to the norm also within 30 sections.

An alternative methodology for interpretation and reporting of hand hygiene compliance data

Giulio DiDiodato — 2011-09-26

Background: Since 2009, all hospitals in Ontario have been mandated to publicly report health care provider compliance with hand hygiene opportunities (http://www.health.gov.on.ca/patient_safety/index.html). Hand hygiene compliance (HHC) is reported for 2 of the 4 moments during the health care provider-patient encounter. This study analyzes the HHC data by using an alternative methodology for interpretation and reporting.Methods: Annualized HHC data were available for fiscal years 2009 and 2010 for each of the 5 hospital corporations (6 sites) in the North Simcoe Muskoka Local Health Integration Network. The weighted average for HHC was used to estimate the overall observed rate for HHC for each hospital and reporting period. Using Bayes' probability theorem, this estimate was used to predict the probability that any patient would experience HHC for at least 75% of hand hygiene moments. This probability was categorized as excellent (≥75%), above average (50%-74%), below average (25%-49%), or poor (<25%). The results were reported using a balanced scorecard display.Results: The overall observed rates for HHC ranged from 50% to 87% (mean, 75% ± 11%, P = .079). Using the alternative methodology for reporting, 6 of the 12 reporting periods would be categorized as excellent, 1 as above average, 2 as below average, and 3 as poor.Conclusion: Population-level HHC data can be converted to patient-level risk information. Reporting this information to the public may increase the value and understandability of this patient safety indicator.

Predicting hand hygiene among Iranian health care workers using the theory of planned behavior

Mary-Louise McLaws, Najmeh Maharlouei, Farideh Yousefi, Mehrdad Askarian — 2011-08-01

Background: This study was conducted to identify significant predictors of handwashing associated with hospital elective (clean) and hospital inherent (dirty) contacts.Methods: This cross-sectional survey of 1,700 health care workers was based on the theory of planned behavior. Data were aggregated into components according to the theory and tested for predictors of hospital elective and hospital inherent handwashing using multiple logistic regression analysis. The α value was set at 0.05, and odds ratios (ORs) for significant predictors were adjusted by interquartile range. All wards studied were in private and government hospitals associated with the University of Medical Sciences, Shiraz, Iran between April and September 2008.Results: Of the 1,200 healthcare workers surveyed 1,077 (90%), of whom 83% were nurses, returned a completed survey. Hospital elective handwashing practice was positively influenced by community elective practice (adjusted OR [aOR], 2.1; P < .000), hospital inherent practice (aOR, 1.6; P < .000), perception that handwashing required little effort (aOR, 1.1; P = .039), and subjective norms (nursing peers) (aOR, 1.1; P = .025) and negatively influenced by poor attitudes regarding handwashing (aOR, 0.91; P = .01). Hospital inherent handwashing practice was positively influenced by hospital elective practice (aOR 2.5; P < .000), community inherent practice (aOR, 1.5; P = .001), subjective norms (infection control practitioners) (aOR, 1.4; P = .001, and attitudes (aOR, 1.1; P = .001) and negatively influenced by poor subjective norms (nurses) (aOR, 0.74; P < .000).Conclusion: Community-based handwashing practices exerted a strong influence on handwashing compliance in the hospital. Given this interdependence between community and hospital handwashing, a campaign to improve awareness of the benefit of community handwashing may improve clinicians' compliance.

Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby

2011-08-24

Background: Reports regarding hand hygiene compliance (HHC) among hospital visitors are limited. Although there is an implicit assumption that the availability of alcohol-based hand sanitizer (AHS) promotes visitor HHC, the degree of AHS use by visitors remains unclear. To assess AHS use, we observed visitor HHC and how it is affected by visual cues in a private university hospital.Methods: Using an observational controlled study, we tested 3 interventions: a desk sign mandating all visitors to use AHS, a free-standing AHS dispenser directly in front of a security desk, and a combination of a freestanding AHS dispenser and a sign.Results: HHC was 0.52% at baseline and did not improve significantly when the desk sign was provided as a cue 0.67% (P = .753). However, HHC did improve significantly with use of the freestanding AHS dispenser (9.33%) and the sign and dispenser combination (11.67%) (P < .001 for all comparisons of dispenser alone and sign and dispenser with baseline and sign alone). The degree of improvement with the sign and dispenser combination over the dispenser was not statistically significant.Conclusions: Hospital visitors represent an important factor in infection prevention. A coordinated effort is needed to increase visitor HHC, including an evaluation of the AHS placement, education of visitors on the importance of HHC, and evaluation of corresponding changes in hand hygiene behavior.

Suppression of regrowth of normal skin flora under chlorhexidine gluconate dressings applied to chlorhexidine gluconate-prepped skin

Muhammad H. Bashir, Linda K.M. Olson, Shelley-Ann Walters — 2011-07-08

Background: Catheter colonization and bloodstream infection during the first week after insertion of a central venous catheter have been shown to result from the patient’s own skin flora.Methods: The backs of 32 healthy subjects were prepped with a 2% chlorhexidine gluconate (CHG)/70% isopropyl alcohol antiseptic. Three dressings, 2 of which contained CHG, were placed on the prepped skin in a randomized design. Samples of aerobic bacteria were collected using the cup scrub method. Skin under the dressings was sampled by quadrant on days 1, 4, and 7. Relative suppression of regrowth was compared using an adjusted paired t test.Results: Mean log counts were 3.2 log10 colony-forming units (CFU)/cm2 before antisepsis and 0.4 after antisepsis. Mean log counts obtained on days 1, 4, and 7 were 0.4, 0.3, and 0.5 log10 CFU/cm2 for the CHG gel; 0.4, 0.4, and 0.9 log10 CFU/cm2 for the CHG disk; and 0.9, 1.2, and 1.5 log10 CFU/cm2 for the Control, respectively.Conclusion: Skin flora was not completely eradicated during antisepsis, and bacterial regrowth occurred postantisepsis. The use of CHG dressings helped sustain a reduced bacterial count on the skin. The continuously releasing CHG gel maintained suppression to a greater extent than the CHG disk at 7 days (P = .01).

A Clostridium difficile infection “intervention”: Change in toxin assay results in fewer C difficile infection cases without changes in patient outcomes

2011-07-28

Background: Clostridium difficile infection (CDI) is most commonly diagnosed using toxin enzyme immunoassays (EIAs). A sudden decrease in CDI incidence was noted after a change in the EIA used at Barnes-Jewish Hospital in St Louis. The objective of this study was to determine whether the decreased CDI incidence related to the change in EIA resulted in adverse patient outcomes.Methods: Electronic hospital databases were used to collect data on demographics, outcomes, and treatment of inpatients who had a C difficile toxin assay performed between January 4, 2009, and April 3, 2009 (period A, preassay change) and between May 21, 2009, and August 17, 2009 (period B, postassay change).Results: Assays were positive in 240 of 1,221 patients (19.7%) during period A and in 106 of 1160 patients (9.1%) during period B (P < .01). There was no difference in mortality or discharge to hospice between the 2 periods (10.3% vs 10.1%; P = .90). Patients tested in period B were less likely to receive metronidazole or oral vancomycin (P < .01).Conclusions: The new EIA resulted in fewer positive tests and reduced anti-CDI therapy. There was no difference in mortality between the 2 periods, suggesting that the decreased incidence was due to increased assay specificity, not decreased sensitivity.

Disposal of sharps medical waste in the United States: Impact of recommendations and regulations, 1987-2007

Jane Perry, Janine Jagger, Ginger Parker, Elayne Kornblatt Phillips, Ahmed Gomaa — 2011-08-08

Background: To gauge the impact of regulatory-driven improvements in sharps disposal practices in the United States over the last 2 decades, we analyzed percutaneous injury (PI) data from a national surveillance network from 2 periods, 1993-1994 and 2006-2007, to see whether changes in disposal-related injury patterns could be detected.Methods: Data were derived from the EPINet Sharps Injury Surveillance Research Group, established in 1993 and coordinated by the International Healthcare Worker Safety Center at the University of Virginia. For the period 1993-1994, 69 hospitals contributed data; the combined average daily census for the 2 years was 24,495, and the total number of PIs reported was 7,854. For the period 2006-2007, 33 hospitals contributed data; the combined average daily census was 6,800, and the total number of PIs reported was 1901.Results: In 1992-1993, 36.8% of PIs reported were related to disposal of sharp devices. In 2006-2007, this proportion was 19.3%, a 53% decline.Conclusions: This comparison provides evidence that implementation of point-of-use, puncture-resistant sharps disposal containers, combined with large-scale use of safety-engineered sharp devices, has resulted in a marked decline in sharps disposal–related injury rates in the United States. The protocol for removing and replacing full sharps disposal containers remains a critical part of disposal safety.

Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection

2011-08-26

Background: The catheter-associated urinary tract infection (CAUTI) measure recommended by the National Healthcare Safety Network (NHSN) accounts for the risk of infection in patients with an indwelling urinary catheter, but might not adequately reflect all efforts aimed to enhance patient safety by reducing urinary catheter use.Methods: We used computer-based Monte Carlo simulation to compare the NHSN-recommended CAUTI rate (CAUTIs per 1,000 catheter-days) with the proposed “population CAUTI rate” (CAUTIs per 10,000 patient-days). We simulated 100 interventions with a wide range of effects on catheter utilization and CAUTI risk in patients with catheters, and then compared the 2 measures before and after intervention across the simulated interventions.Results: Out of our 100 simulated interventions, 93 yielded reductions in CAUTI; however, in 25 (27%) of these 93 simulations, the NHSN CAUTI rate increased after the intervention. In addition, among the 68 simulations in which both the NHSN and the population CAUTI rates decreased, the percent decreases in the population CAUTI rate were consistently greater than those in the NHSN rate.Conclusion: The population CAUTI rate—CAUTIs per 10,000 patient-days—should be calculated along with the NHSN rate, particularly in settings where interventions lead to substantial reductions in catheter placement. We suspect that this population CAUTI rate may eventually emerge as a primary outcome for hospital-based quality improvement interventions for reducing urinary catheter utilization, especially those focusing on avoiding urinary catheter placement.

Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in a diabetic outpatient population: A prospective cohort study

2011-08-24

Background: Diabetes mellitus is a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection. We attempted to determine the prevalence and risk factors for MRSA colonization in a population of outpatients with diabetes.Methods: This prospective cohort study enrolled patients with diabetes. Anterior nares cultures were obtained from patients with diabetes admitted to outpatient endocrinology and metabolism clinics, and risk factors for MRSA colonization were analyzed.Results: Out of the 304 patients evaluated, 127 (41.9%) were colonized with S aureus and 30 (9.9%) were colonized with MRSA. Overall, 23.6% of all S aureus isolates were MRSA. In multivariate analysis, factors independently associated with an increased risk of MRSA colonization included the presence of connective tissue disease (odds ratio, 7.075; 95% confidence interval, 2.157-23.209; P = .001) and insulin therapy (odds ratio, 3.910; 95% confidence interval, 1.652-9.251; P = .002).Conclusions: The prevalence of MRSA colonization in our sample of diabetic outpatients was 9.9%. Independent risk factors for MRSA colonization were the presence of connective tissue disease and insulin use. A better understanding of the epidemiology and risk factors for nasal MRSA colonization in the persons with diabetes may have significant implications for the treatment and prevention of MRSA infections.

Effect of single- versus double-gloving on virus transfer to health care workers’ skin and clothing during removal of personal protective equipment

Lisa M. Casanova, William A. Rutala, David J. Weber, Mark D. Sobsey — 2011-08-11

Background: The removal of personal protective equipment (PPE) after patient care may result in transfer of virus to hands and clothing of health care workers (HCWs). The risk of transfer can be modeled using harmless viruses to obtain quantitative data. To determine whether double-gloving reduces virus transfer to HCWs’ hands and clothing during removal of contaminated PPE, we conducted a human challenge study using bacteriophages to compare the frequency and quantity of virus transfer to hands and clothes during PPE removal with single-gloving and double-gloving technique.Methods: Each experiment had a double-gloving phase and a single-gloving phase. Participants donned PPE (ie, contact isolation gown, N95 respirator, eye protection, latex gloves). The gown, respirator, eye protection, and dominant glove were contaminated with bacteriophage. Participants then removed the PPE, and their hands, face, and scrubs were sampled for virus.Results: Transfer of virus to hands during PPE removal was significantly more frequent with single-gloving than with double-gloving. Transfer to scrubs was similar during single-gloving and double-gloving. The amount of virus transfer to hands ranged from 0.15 to 2.5 log10 most probable number. Significantly more virus was transferred to participants’ hands after single-gloving than after double-gloving.Conclusions: Our comparison of double-gloving and single-gloving using a simulation system with MS2 and a most-probable number method suggests that double gloving can reduce the risk of viral contamination of HCWs’ hands during PPE removal. If incorporated into practice when full PPE is worn, this practice may reduce the risk of viral contamination of HCWs’ hands during PPE removal. The use of double gloves should be explored in larger controlled studies.

Impact of multiple consecutive donnings on filtering facepiece respirator fit

2011-08-24

Background: A concern with reuse of National Institute for Occupational Safety and Health–certified N95 filtering facepiece respirators (FFRs) is that multiple donnings could stress FFR components, impairing fit. This study investigated the impact of multiple donnings on the facepiece fit of 6 N95 FFR models using a group of 10 experienced test subjects per model.Methods: The TSI PORTACOUNT Plus and N95 Companion accessory were used for all tests. After qualifying by passing a standard Occupational Safety and Health Administration fit test, subjects performed up to 20 consecutive tests on an individual FFR sample using a modified protocol. Regression analyses were performed for the percentage of donnings resulting in fit factors (FFs) ≥100 for all 6 FFR models combined.Results: Regression analyses showed statistical significance for donning groups 1-10, 1-15, and 1-20. The mean percentage of donnings with an FF ≥100 was 81%-93% for donning group 1-5, but dropped to 53%-75% for donning group 16-20.Conclusions: Our results show that multiple donnings had a model-dependent impact on fit for the 6 N95 models evaluated. The data suggest that 5 consecutive donnings can be performed before FFs consistently drop below 100.

Occurrence of and risk factors for methicillin-resistant Staphylococcus aureus at a teaching hospital in Philadelphia

2011-08-24

Manual medical record mining and data analysis were performed at a tertiary care university teaching hospital to establish the rate of occurrence of and risk factors for infection with methicillin-resistant Staphylococcus aureus (MRSA). Patients with surgical site infections had the highest rate of MRSA infection, representing 59% of the MRSA infections recorded. The mortality rate in patients with relapsed MRSA was 45% (13 of 30), compared with no deaths in 149 new MRSA cases. The majority of deaths in patients with relapsed MRSA occurred in the intensive care unit.

Guide to the elimination of orthopedic surgery surgical site infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide

Linda R. Greene — 2011-08-26

This article is an executive summary of the APIC Guide to the Elimination of Orthopedic Surgical Site Infections. Infection preventionists, care providers, and perioperative personnel are encouraged to obtain the original, full length APIC Elimination Guide for more thorough coverage on strategies to prevent surgical site infections in orthopedic surgery.

Correlation between glove use practices and compliance with hand hygiene in a multicenter study with elderly patients

Matthieu Eveillard, Marie-Laure Joly-Guillou, P. Brunel — 2011-08-24

In a study conducted in 11 health care settings for elderly patients, we demonstrated a significant negative correlation between the proportion of glove use outside any risk of exposure to body fluids and compliance with hand hygiene (P < .02). This result underscores a major limitation of strategies for controlling the spread of multidrug-resistant bacteria that recommend systematic glove use for each contact with carriers or their environment.

Removal of contaminating bacteria from computers by disinfection and hand sanitation

Maanasa Joga, Enzo A. Palombo — 2012-02-17

Computer terminals are well-recognized potential vehicles for the transmission of pathogenic bacteria. Contamination of keyboards and mice with bacteria, including staphylococci, enterococci, and coliforms, has been documented in health care and non-health care settings. The recent article by Messina et al provides support for our previous findings that shared computers, such as those used found in classrooms and computer laboratories on university campuses, are readily contaminated by many common bacteria, including pathogens. As in previous reports, the authors suggested that cleaning and hand hygiene are useful to reduce the risk of cross-contamination and recommended “thorough handwashing before and after keyboard contact.”

Effect of surgical site infections with waterless and traditional hand scrubbing protocols on bacterial growth

Chia-Feng Chen, Chih-Lu Han, Chiou-Ping Kan, Shyi-Gen Chen, Ping Wei Hung — 2012-02-10

Background: Alcohol-based antiseptic scrub formulation has long been used for hand cleansing in the operating room. Recently, a waterless surgical scrub formulation containing 1% chlorhexidine gluconate was developed to provide a comparable antiseptic effect. The present study explored the scrub time required when using waterless hand scrub and traditional hand scrub formulations for operating room staff and compared bacterial growth on the hands after surgical hand scrubbing in the 2 groups.Methods: Operating room staff members (n = 100) were recruited randomly from medical centers in Taiwan. Two days in July 2010 were chosen for testing in advance, and the participants were assigned equally to use either a waterless scrub or traditional scrub formulation on 2 separate days. Scrub times were recorded and microorganisms on hands after scrubbing were sampled on 2 separate days. Two days after sampling, the colonies grown on bacterial culture plates were counted and expressed as colony-forming units (CFU) per plate.Results: At 48 hours after sampling, microorganisms were found on 7 of the 50 plates in the waterless scrub group (1-9 CFU) and on 7 of the 50 plates in the traditional scrub group (1-5 CFU). The difference between the groups was no statistically significant (95% CI, 0.85-1.71). Nine surgical patients were found to have contact with the 14 participants with microorganisms found after scrubbing in the operating room. Among these 9 patients, 1 patient with diabetes who underwent amputation developed local reddish swelling suggestive of surgical site infection necessitating a 7-day course of cefalexin. The incidence of surgical site infection was not signifcantly different in the 2 groups.Conclusions: Our findings suggest that waterless hand scrub is as effective as traditional hand scrub in cleansing the hands of microorganisms and more efficient in terms of scrub time.

2012-05-01

Editorial Board

2012-05-01

APIC Masthead

2012-05-01

Information for Readers

2012-05-01

AJIC: American Journal of Infection Control

APIC’s 2012 Annual Conference is just around the corner

The Road to 2020—Guest Editorial

APIC Strategic Plan 2020

The value of certification and the CIC credential

Competency in infection prevention: A conceptual approach to guide current and future practice

Performance improvement and implementation science: Infection prevention competencies for current and future role development

The APIC research agenda: Results from a national survey

Perceived impact of the Medicare policy to adjust payment for health care-associated infections

Effectiveness of an audible reminder on hand hygiene adherence

A multifaceted pilot program to promote hand hygiene at a suburban fire department

Testing of the World Health Organization recommended formulations in their application as hygienic hand rubs and proposals for increased efficacy

An alternative methodology for interpretation and reporting of hand hygiene compliance data

Predicting hand hygiene among Iranian health care workers using the theory of planned behavior

Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby

Suppression of regrowth of normal skin flora under chlorhexidine gluconate dressings applied to chlorhexidine gluconate-prepped skin

A Clostridium difficile infection “intervention”: Change in toxin assay results in fewer C difficile infection cases without changes in patient outcomes

Disposal of sharps medical waste in the United States: Impact of recommendations and regulations, 1987-2007

Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection

Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in a diabetic outpatient population: A prospective cohort study

Effect of single- versus double-gloving on virus transfer to health care workers’ skin and clothing during removal of personal protective equipment

Impact of multiple consecutive donnings on filtering facepiece respirator fit

Occurrence of and risk factors for methicillin-resistant Staphylococcus aureus at a teaching hospital in Philadelphia

Guide to the elimination of orthopedic surgery surgical site infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide

Correlation between glove use practices and compliance with hand hygiene in a multicenter study with elderly patients

Removal of contaminating bacteria from computers by disinfection and hand sanitation

Effect of surgical site infections with waterless and traditional hand scrubbing protocols on bacterial growth

Table of Contents

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