This article was downloaded by: [130.132.123.28] On: 03 January 2015, At: 10:03 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20
Infection Control: A Hospital Program with Demonstrated Results a
David R. Carson & Alan H. Channing a
b
Lankenau Hospital , Philadelphia, USA
b
Ohio State University Hospitals , USA Published online: 13 Jul 2010.
To cite this article: David R. Carson & Alan H. Channing (1976) Infection Control: A Hospital Program with Demonstrated Results, Hospital Topics, 54:2, 1-4, DOI: 10.1080/00185868.1976.9950319 To link to this article: http://dx.doi.org/10.1080/00185868.1976.9950319
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
A Hospital Program with Demonstrated Results
Downloaded by [] at 10:03 03 January 2015
By: DAVID R. CARSON Associate Director Lankenau Hospital, Philadelphia and ALAN H. CHANNING Associate Administrator Ohio State University Hospitals ospital associated infections have been receiving an increasing amount of attention in recent months. There are many reasons why nosocomial, or hospital acquired infections are an important matter for Administration to consider, not the least of which are health care ccsts, the legal climate, and quality patient care. The lack of appropriate infection surveillance and control programming may present several liabilities to an institution and to the public it wishes to serve, such as: 1. Extended length of stay and the resultant added health care costs incurred by patients who acquire a hospital ussociared lnosocomial) infection. 2. Exposure to possible liability suits for negligence. 3. Lack of a control program could be interpreted as insufficient empharison “qua1ity”of care.
I t has been estimated, and is periodically reported by the Center for Disease Control, in Atlanta, GA, that an average of 5% of all patients admitted to short term acute hospitals develop a nosocomial infection.’ Patients acquiring such infections spend an average of three extra days in a hospital setting. The added costs resulting from such infections become a significant portion of this country’s health care expenditure.
David Carson
MARCH/APRIL 1976
With today’s ever changing legal climate, the possible exposure for negligence suits is of growing concern. The application of strict liability to a hospital could result in damage awards to patients who acquire infections during their hospital stay. The Joint Commission on Accreditation of Hospitals has included in its standards the need for the control of infection within a hospital and for a method of evaluating the potential for infection from the environment. The JCAH Manual goes on to say that this responsibility should be vested with a Committee made up of members of the medical staff, administration, and laboratory and nursing service with input from appropriate ancillary services. The Joint Commissions’ Standards outline the duties of such a Committee.2 Institutions giving significant consideration to the support of quality assurance programs will find that a readily indentifiable area of action is that of hospital acquired infections. Although the existing quality control legislation is directed at the individual practitioner and treatment modalities, the institution can, through an infection control and surveillance program, have a significant impact on the quality and cost of care within its walls, as can be seen by the experiences outlined below. In his article, Reporling of Hospital Iiifectioiib: A Methodology, Dr. S. I . Hnatko states that the overall approach to hospital associated infections must:’ 1. Be methodical. 2. Be organizedaroundthe central body - the infection control committee. .Z. Include an infection surveillance program with collection of data andsurwillmce by the infection controlofficer us topatient temperatures, review of patient and unit records, review 4 patients on isolation, etc.
1
The Monitor was a nurse employed for this program due to her epidemiology training and experience in infection control. The major functions of this position included: 1. Plan and implement steps to develop an Infection Surveillance and Conirol Program. 2. Survey patienis and the environment of University Hospiial to identvy exisiing expecied levels for ihis reaching hospiial and esiablish base line daia againsi which to measure future activiiies. 3. Work wiih Infection Control Commitiee, individual physicians, clinical laboraiories, and oihers in developing and updaiing procedures which relate to infeciions.
Downloaded by [] at 10:03 03 January 2015
Alan H. Channing 4. Follow ihe siandard criieria for hospital associated infections. 5. Include a suitable reporiing system.
With a concern for the quality of patient care and for the lack of knowledge about the hospital infection rate, the Administration of The Ohio State University Hospitals encouraged the Infection Control Committee to establish goals for a program to monitor the infection rate at the Hospitals and to develop a systematic effort to prevent nosocomial infections. After research and delibefation, the Committee established the following goals: 1. To avoid serious risk exposure to patienis through (a) nionitoring of envirnntnenial and epidemiological surveys, and (b) ihe development and surveillance of proper isolaiion and saniiaiion procedures. 2. To insure continuous dissemination of informarion ihrough conferences, evaluations, training, inspections, and oiher means of contact wiih patieni care areas andproviders. 3. To follow up the above aciions by initiating preventive iechniques, infection control and isolation manuals, andpersonnel education. 4. To reduce errors and oversights in patient care iechniques which could lead io nosocomial infection and related problems. 5. To avoid additional cost to the patients and third party payers as a result of increased average lengih of stay needed io arresi und treat nosocomial infectiiins. 6. Maintain complete accrediiaiion with the Joint Commission o n Accreditaiion of Hospitals by consisiert fly meeiing all infection control organizational and policy siandards.
In order to achieve the above goals, the Infection Control Committee proposed, and the Hospital Administration approved the initiation of an Infection Surveillance and Control Program. The key to the implementation of this program was the active support and interaction of Administration, The Chairman of the Infection Control Committee, who was a specialist in infectious diseases, the Hospital Bacteriologist and an Infection Control Monitor. 2
A major job responsibility involved the education of nurses, physicians and other personnel as to the goals of the surveillance program and the use of proper isolation and general aseptic techniques. The program established the Infection Control Monitor or Nurse Epidemiologist as a liaison between the Infection Control Committee and the patient. The surveillance program provided feedback 011 improper practices and a mechanism to identify high infection areas so that the Committee would have the necessary data to make decisions and recommendations. The involvement of the medical staff, and their willingness to take action, was crucial to the development and success of the program. Without their active support and commitment, the information the program produced would not have been utilized. Following Hnatko's outline, a monitoring tool (See Diagram #1) was designed to feed information to the Nurse Epidemiologist. The system produced two phases of information. Phase I was case finding, which developed a list of possibly infected patients for further surveillance. This information was gathered from laboratory test results, and from nursing unit personnel and is planned to eventually include data from Pharmacy (i. e. antibiotic usage). A computer listing is generated from these sources as a means of organizing and directing investigations. INFECTION SURVEILLANCE INFORMATION SYSTEM FLOW CHART PHARMACY DATA IPROPOSEDI SOURCE OF
I
L A B TEST RESULTS
CASE LISTING FOR SURVEILLANCE OF POSSIBLY INFECTED PATIENTS
IS INFECTION HOSPITAL
I
COMMUNT Il
COMMUNICABLE 1 ISOLATION RECOMMENOEDI
ACQUIRED NON-COMMUNICABLE [CONTINUE TO MONITOR 1
HOSPITAL ACQUIRED
1
r
DATA GATHERED FOR FURTHER EVALUATION
n
I
PHASE EVALUATION OF INFORMATION
-
SITE OF INFECTiON HOSPITAL LOCATION ATTENDING PHYSICIAN PATHOGEN CAUSING INFECTION IMPAIRED RESISTENCE OF PATIENT PROCEDURES OR SURGERY ANTIBIOTIC THERAPY INFECTION COMMUNlCABLE OTHER THERAPEUTIC FACTORS
4
I
I
RECOMMENDED ACTION BASED ON EVALUATION
Diagram #1 HOSPITAL TOPICS
Downloaded by [] at 10:03 03 January 2015
The actual surveillance of these possibly infected patients establishes if they are clinically infected. If it is felt that infection is present, further study is made to determine if the patient became infected due to his hospitalization or whether the infection came from other sources, i. e. community acquired. Phase I1 of the monitor system is implemented for those patients believed to have hospital acquired infections. This portion of the program includes pieces of data which might be of significance in determining infection patterns or methods of controlling infection communication. The goal of this phase is to provide epidemiologic data relating the patient to as many factors of his care as possible. The evaluation of this data can lead to the probable cause of infection. When this information is known, steps can be taken to prevent future occurrence of infections irom the same source. The tabulation of the surveillance data provides attack rates and patterns for all hospital infected patients and can be broken down to give rates for each Department or geographic area of the hospital. Initialy, the surveillance of infections was limited to certain infection problem areas such as intensive care units. The program was extended in November, 1974 to include the entire Hospital. Data prior to that date is not comparable to national averages due to the predominance of high risk patients. Nonetheless, improvement ifi the monitored areas, baring seasonal fluctuations, can be demonstrated by plotting the infection rate against time (See Diagram #2). With initiation of hospital-wide surveillance, a broader patient mix makes comparison to national averages possible. The most significant aspect of the experience at Ohio State University Hospitals is the noticeable improvement trend in attack rates. This success is directly attributable to the work of the Control Monitor and the Committee to improve techniques and educate personnel to reduce the possible sources of infection. An example of the results of an epidemiologic monitoring system was the discovery, in February of 1974, of a cluster of infections in patients receiving inhalation therapy treatments. This discovery led to the suspicion that inhalation therapy equipment might be a reservoir for infections. A review of the department and its procedures indicated that certain equipment was a source ot contamination. The Nurse Epidemiologist and Bacteriologist were instrumental in lowering the infection rate in the area by identifying an ultrasonic nebulizer attachment to IPPB machines as the major reservoir of infectious agents. The Infection Control Committee subsequently ordered the use of this apparatus discontinued. An educational program for department employees in the proper techniques of cleaning and sterilization of equipment was initiated. Rapid action toaards resolution of this problem was due to information provided and highlighted MARCH/APRIL 1976
OHIO STATE UNIVERSITY HOSPITALS INFECTION RATE
t PRIOR TO THiS OaTF SURVEILLANCE W A S LIMITED TO HIGH RISK A R E A S
Diagram #2 by the Surveillance Information System. The data directed the Control Monitor toward the common element in the treatment of these infected patients. Once the problem was identified, solutions could be implemented. The infection rate of The Ohio State University Hospitals is now close to or below the 5% level. The successful infection control and surveillance program at University Hospitals had three strong foundations that supported it as a viable project. The first was a capable, knowledgeable ‘ and qualified Control Monitor (Nurse Epidemiologist) to undertake the actual work of the program. The second was the support of Administration who implemented the program and assisted in communications across organizational lines. The third foundation was the active interest and support shown by the Chairman of the Infection Control Committee, who provided technical and professional guidance and acted as a liaison with other members of the medical staff, whose interest was crucial in the actual decline of the infection rate. Through a positive and agressive hospital infection control and surveillance program, it is possible to significantly reduce a patient’s exposure to sources of infection. The net result of such a program is improved quality of hospital patient care and reduction in the community health care costs. BIBLIOGRAPHY Infectiiin: Problems Persist While the Costs Mount, “The Modern Hospital,” Vol. 117, No. 4, October, 1971. 2. Accreditation Manual for Hospitals, Joint Contmi.wiiin o n Accreditation if Huspituls, Chicago: JCA H, 1971, I? Environmental I.
Senku.
3. S.I. Hnatko, M.D., “Reportinx iif Hiispita1 1njiectiiin.s - A M e t h i i d ~ i l i i“Canadian ~~~~ Hospital,” December, 1973- p. 24.
See pages 16 and 17 for AAMI Program on Hospital Infection Control - May 5 and 6 1976 at the Ramada Inn, Philadelphia International Airport.
3
HOSPITAL
Scientific Detergents Scientists Prefer for Critical Cleaning
~
.
Simply add to water.. cleans Glassware, Porcelain, Plastic, Rubber, Metal Instruments, and components.
ALCONOX@ For m a n u a l c l e a n i n g
and ultrasonic washers. Powder form, odorless. High sequestering power, mild pH, anionic, helps decontaminate radioactive surfaces. 3 Ib. Box Case o f 1 2 x 3 Ib. Boxes 25 Ib. Carton ALCONOX" 50 Ib. Carton CONVENIENTLY 100 Ib. Drum PACKAGED 300 Ib. Drum 50-Pack Dispenser Box (50 1/2 02. packets) Case of 12 50-Pack Boxes
LIQUI-NOX
@
Downloaded by [] at 10:03 03 January 2015
The perfect liquid detergent. PhosphateFree1 For manual cleaning and ultrasonic washers. Specified for cleaning components and processing equipment. Alconox efficiency i n liquid form. 1 Quart Container Case of 12 x 1 Qts. LIQUI-NOX@J 1 Gallon Container
CONVp:FIE/Ebg
z;faL;of4n
;rul$l*
GORDON M. MARSHALL, Editor and Publkher MARCELLA MARSHALL, Assistant to the Publkher 734 Siesta Key Circle, Sarasota, Florida 33581 (813) 349-7445 MICHAEL DASKALAKIS, Circulation Director P.O. Box 670, Neptune, New Jersey 07753 (201) 531-9200 JOSEPH BOURGHOLTZER, INC., National Advertising Representatives The JBI Building, Box 521, Mahwah, New Jersey 07430 (201) 529-3883 Editorial Advisory Board and Contributors WILLETTA M. OLSSON, R.N., Sarmota, Florida MARIE L. IETT, Chicago, Illinois ERIC W. SPRINGER, L.L.B., LegalAffairs, New York, N. Y. HARRIET R. FELDMAN, R.N., Word Search Editor, Bellmore, N. Y. ARTHUR N. MABBETT, Capt. MSC, Aberdeen Proving Ground, MD., Infection Control C.E. HOUSLEY, Associate Administrator, Columbus, Ohio, Management Metho& HARRY E. MUNN, JR., PH.D., Raleigh, N.C., Communicatons -Leadership TOM PARKER, A.B., M.A., M.P.H., North Wilkesboro, N.C., Supervisory Training and Personnel Services
55 Gallon Drum Includes free 1 02. dispenser pump
ALCOJET@ For mechanical washers.
Powder form. Protects mechanical parts of washing machines, keeps circulating lines and pumps free and clear. Prevents waterspotting. Minimum foaming action,
HOSPITAL TOPICS is published bi-monthly by HOSPITAL TOPICS, INC. 734 Siesta Key Circle, Sarasota, Florida 33581. (813) 349-7445 SUBSCRIPTION RATES: Single subscription one year $20.00; single copy, $4.00. Canadian and foreign subscriptions, one year $25.00; single copy $5.00. Changes of address notices, undeliverable copies, and subscrip tion orders should be sent to: HOSPITAL TOPICS, Subscription Dept., P.O. Box 670, Neptune, N.J. 07753, Subscription Service Dept. (AC 201) 531-9200.
1 I I
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TERG-A-ZY ME Alconox Dowder with Drotease @
enzvme power. Effective in removing fresh or d-ried blood, body soils and other proteinaceous materials. Ideal ' as a pre-soak. Cleans reverse-osmosis installations in cheese and dairy processing. 2 Ib. Box TERG-A-ZYME" Case of 12 x 2 Ib. Boxes CONVENIENTLY 25 Ib. Carton PACKAGED 100 Ib. Drum 300 Ib. Drum
ALCOTABS@
Effervescent tablets for cleaning Pipettes and Test Tubes. Makes syphon-type rinsers into automatic washer/rinsers.
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Available from your local Laboratory Supply Dealer, or write for further information and samples.
ALCONOX, INC. m 2 1 5 Park Avenue South, New York, N.Y. 100031 For More Ad Facts Circle # 2 On Reply Card
4
Controlled circulation postage paid at Pontiac, Ill. 61764. Copyright@ 1976 by Hospital Topics, Inc. All rights reserved. Printed in the U.S.A. ATTENTION, LIBRARIANS: HOSPITAL TOPICS has been microfilmed since 1922 by Universal Microfilms, a Xerox Company, Ann Arbor, Michigan 48106, telephone 313-761-4700. Copies available at $4.75 per volume. HOSPITAL TOPICS is completely indexed in Hospital Literature Index, American Hospital Association, 840 N. Lake Shore Dr., Chicago, Ill. 60611.
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Cumulative Index to Nursing Literature, P.O. Box 871, Glendale, Calif. 91209.
HOSPITAL TOPICS
Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20
Infection Control: A Hospital Program with Demonstrated Results a
David R. Carson & Alan H. Channing a
b
Lankenau Hospital , Philadelphia, USA
b
Ohio State University Hospitals , USA Published online: 13 Jul 2010.
To cite this article: David R. Carson & Alan H. Channing (1976) Infection Control: A Hospital Program with Demonstrated Results, Hospital Topics, 54:2, 1-4, DOI: 10.1080/00185868.1976.9950319 To link to this article: http://dx.doi.org/10.1080/00185868.1976.9950319
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
A Hospital Program with Demonstrated Results
Downloaded by [] at 10:03 03 January 2015
By: DAVID R. CARSON Associate Director Lankenau Hospital, Philadelphia and ALAN H. CHANNING Associate Administrator Ohio State University Hospitals ospital associated infections have been receiving an increasing amount of attention in recent months. There are many reasons why nosocomial, or hospital acquired infections are an important matter for Administration to consider, not the least of which are health care ccsts, the legal climate, and quality patient care. The lack of appropriate infection surveillance and control programming may present several liabilities to an institution and to the public it wishes to serve, such as: 1. Extended length of stay and the resultant added health care costs incurred by patients who acquire a hospital ussociared lnosocomial) infection. 2. Exposure to possible liability suits for negligence. 3. Lack of a control program could be interpreted as insufficient empharison “qua1ity”of care.
I t has been estimated, and is periodically reported by the Center for Disease Control, in Atlanta, GA, that an average of 5% of all patients admitted to short term acute hospitals develop a nosocomial infection.’ Patients acquiring such infections spend an average of three extra days in a hospital setting. The added costs resulting from such infections become a significant portion of this country’s health care expenditure.
David Carson
MARCH/APRIL 1976
With today’s ever changing legal climate, the possible exposure for negligence suits is of growing concern. The application of strict liability to a hospital could result in damage awards to patients who acquire infections during their hospital stay. The Joint Commission on Accreditation of Hospitals has included in its standards the need for the control of infection within a hospital and for a method of evaluating the potential for infection from the environment. The JCAH Manual goes on to say that this responsibility should be vested with a Committee made up of members of the medical staff, administration, and laboratory and nursing service with input from appropriate ancillary services. The Joint Commissions’ Standards outline the duties of such a Committee.2 Institutions giving significant consideration to the support of quality assurance programs will find that a readily indentifiable area of action is that of hospital acquired infections. Although the existing quality control legislation is directed at the individual practitioner and treatment modalities, the institution can, through an infection control and surveillance program, have a significant impact on the quality and cost of care within its walls, as can be seen by the experiences outlined below. In his article, Reporling of Hospital Iiifectioiib: A Methodology, Dr. S. I . Hnatko states that the overall approach to hospital associated infections must:’ 1. Be methodical. 2. Be organizedaroundthe central body - the infection control committee. .Z. Include an infection surveillance program with collection of data andsurwillmce by the infection controlofficer us topatient temperatures, review of patient and unit records, review 4 patients on isolation, etc.
1
The Monitor was a nurse employed for this program due to her epidemiology training and experience in infection control. The major functions of this position included: 1. Plan and implement steps to develop an Infection Surveillance and Conirol Program. 2. Survey patienis and the environment of University Hospiial to identvy exisiing expecied levels for ihis reaching hospiial and esiablish base line daia againsi which to measure future activiiies. 3. Work wiih Infection Control Commitiee, individual physicians, clinical laboraiories, and oihers in developing and updaiing procedures which relate to infeciions.
Downloaded by [] at 10:03 03 January 2015
Alan H. Channing 4. Follow ihe siandard criieria for hospital associated infections. 5. Include a suitable reporiing system.
With a concern for the quality of patient care and for the lack of knowledge about the hospital infection rate, the Administration of The Ohio State University Hospitals encouraged the Infection Control Committee to establish goals for a program to monitor the infection rate at the Hospitals and to develop a systematic effort to prevent nosocomial infections. After research and delibefation, the Committee established the following goals: 1. To avoid serious risk exposure to patienis through (a) nionitoring of envirnntnenial and epidemiological surveys, and (b) ihe development and surveillance of proper isolaiion and saniiaiion procedures. 2. To insure continuous dissemination of informarion ihrough conferences, evaluations, training, inspections, and oiher means of contact wiih patieni care areas andproviders. 3. To follow up the above aciions by initiating preventive iechniques, infection control and isolation manuals, andpersonnel education. 4. To reduce errors and oversights in patient care iechniques which could lead io nosocomial infection and related problems. 5. To avoid additional cost to the patients and third party payers as a result of increased average lengih of stay needed io arresi und treat nosocomial infectiiins. 6. Maintain complete accrediiaiion with the Joint Commission o n Accreditaiion of Hospitals by consisiert fly meeiing all infection control organizational and policy siandards.
In order to achieve the above goals, the Infection Control Committee proposed, and the Hospital Administration approved the initiation of an Infection Surveillance and Control Program. The key to the implementation of this program was the active support and interaction of Administration, The Chairman of the Infection Control Committee, who was a specialist in infectious diseases, the Hospital Bacteriologist and an Infection Control Monitor. 2
A major job responsibility involved the education of nurses, physicians and other personnel as to the goals of the surveillance program and the use of proper isolation and general aseptic techniques. The program established the Infection Control Monitor or Nurse Epidemiologist as a liaison between the Infection Control Committee and the patient. The surveillance program provided feedback 011 improper practices and a mechanism to identify high infection areas so that the Committee would have the necessary data to make decisions and recommendations. The involvement of the medical staff, and their willingness to take action, was crucial to the development and success of the program. Without their active support and commitment, the information the program produced would not have been utilized. Following Hnatko's outline, a monitoring tool (See Diagram #1) was designed to feed information to the Nurse Epidemiologist. The system produced two phases of information. Phase I was case finding, which developed a list of possibly infected patients for further surveillance. This information was gathered from laboratory test results, and from nursing unit personnel and is planned to eventually include data from Pharmacy (i. e. antibiotic usage). A computer listing is generated from these sources as a means of organizing and directing investigations. INFECTION SURVEILLANCE INFORMATION SYSTEM FLOW CHART PHARMACY DATA IPROPOSEDI SOURCE OF
I
L A B TEST RESULTS
CASE LISTING FOR SURVEILLANCE OF POSSIBLY INFECTED PATIENTS
IS INFECTION HOSPITAL
I
COMMUNT Il
COMMUNICABLE 1 ISOLATION RECOMMENOEDI
ACQUIRED NON-COMMUNICABLE [CONTINUE TO MONITOR 1
HOSPITAL ACQUIRED
1
r
DATA GATHERED FOR FURTHER EVALUATION
n
I
PHASE EVALUATION OF INFORMATION
-
SITE OF INFECTiON HOSPITAL LOCATION ATTENDING PHYSICIAN PATHOGEN CAUSING INFECTION IMPAIRED RESISTENCE OF PATIENT PROCEDURES OR SURGERY ANTIBIOTIC THERAPY INFECTION COMMUNlCABLE OTHER THERAPEUTIC FACTORS
4
I
I
RECOMMENDED ACTION BASED ON EVALUATION
Diagram #1 HOSPITAL TOPICS
Downloaded by [] at 10:03 03 January 2015
The actual surveillance of these possibly infected patients establishes if they are clinically infected. If it is felt that infection is present, further study is made to determine if the patient became infected due to his hospitalization or whether the infection came from other sources, i. e. community acquired. Phase I1 of the monitor system is implemented for those patients believed to have hospital acquired infections. This portion of the program includes pieces of data which might be of significance in determining infection patterns or methods of controlling infection communication. The goal of this phase is to provide epidemiologic data relating the patient to as many factors of his care as possible. The evaluation of this data can lead to the probable cause of infection. When this information is known, steps can be taken to prevent future occurrence of infections irom the same source. The tabulation of the surveillance data provides attack rates and patterns for all hospital infected patients and can be broken down to give rates for each Department or geographic area of the hospital. Initialy, the surveillance of infections was limited to certain infection problem areas such as intensive care units. The program was extended in November, 1974 to include the entire Hospital. Data prior to that date is not comparable to national averages due to the predominance of high risk patients. Nonetheless, improvement ifi the monitored areas, baring seasonal fluctuations, can be demonstrated by plotting the infection rate against time (See Diagram #2). With initiation of hospital-wide surveillance, a broader patient mix makes comparison to national averages possible. The most significant aspect of the experience at Ohio State University Hospitals is the noticeable improvement trend in attack rates. This success is directly attributable to the work of the Control Monitor and the Committee to improve techniques and educate personnel to reduce the possible sources of infection. An example of the results of an epidemiologic monitoring system was the discovery, in February of 1974, of a cluster of infections in patients receiving inhalation therapy treatments. This discovery led to the suspicion that inhalation therapy equipment might be a reservoir for infections. A review of the department and its procedures indicated that certain equipment was a source ot contamination. The Nurse Epidemiologist and Bacteriologist were instrumental in lowering the infection rate in the area by identifying an ultrasonic nebulizer attachment to IPPB machines as the major reservoir of infectious agents. The Infection Control Committee subsequently ordered the use of this apparatus discontinued. An educational program for department employees in the proper techniques of cleaning and sterilization of equipment was initiated. Rapid action toaards resolution of this problem was due to information provided and highlighted MARCH/APRIL 1976
OHIO STATE UNIVERSITY HOSPITALS INFECTION RATE
t PRIOR TO THiS OaTF SURVEILLANCE W A S LIMITED TO HIGH RISK A R E A S
Diagram #2 by the Surveillance Information System. The data directed the Control Monitor toward the common element in the treatment of these infected patients. Once the problem was identified, solutions could be implemented. The infection rate of The Ohio State University Hospitals is now close to or below the 5% level. The successful infection control and surveillance program at University Hospitals had three strong foundations that supported it as a viable project. The first was a capable, knowledgeable ‘ and qualified Control Monitor (Nurse Epidemiologist) to undertake the actual work of the program. The second was the support of Administration who implemented the program and assisted in communications across organizational lines. The third foundation was the active interest and support shown by the Chairman of the Infection Control Committee, who provided technical and professional guidance and acted as a liaison with other members of the medical staff, whose interest was crucial in the actual decline of the infection rate. Through a positive and agressive hospital infection control and surveillance program, it is possible to significantly reduce a patient’s exposure to sources of infection. The net result of such a program is improved quality of hospital patient care and reduction in the community health care costs. BIBLIOGRAPHY Infectiiin: Problems Persist While the Costs Mount, “The Modern Hospital,” Vol. 117, No. 4, October, 1971. 2. Accreditation Manual for Hospitals, Joint Contmi.wiiin o n Accreditation if Huspituls, Chicago: JCA H, 1971, I? Environmental I.
Senku.
3. S.I. Hnatko, M.D., “Reportinx iif Hiispita1 1njiectiiin.s - A M e t h i i d ~ i l i i“Canadian ~~~~ Hospital,” December, 1973- p. 24.
See pages 16 and 17 for AAMI Program on Hospital Infection Control - May 5 and 6 1976 at the Ramada Inn, Philadelphia International Airport.
3
HOSPITAL
Scientific Detergents Scientists Prefer for Critical Cleaning
~
.
Simply add to water.. cleans Glassware, Porcelain, Plastic, Rubber, Metal Instruments, and components.
ALCONOX@ For m a n u a l c l e a n i n g
and ultrasonic washers. Powder form, odorless. High sequestering power, mild pH, anionic, helps decontaminate radioactive surfaces. 3 Ib. Box Case o f 1 2 x 3 Ib. Boxes 25 Ib. Carton ALCONOX" 50 Ib. Carton CONVENIENTLY 100 Ib. Drum PACKAGED 300 Ib. Drum 50-Pack Dispenser Box (50 1/2 02. packets) Case of 12 50-Pack Boxes
LIQUI-NOX
@
Downloaded by [] at 10:03 03 January 2015
The perfect liquid detergent. PhosphateFree1 For manual cleaning and ultrasonic washers. Specified for cleaning components and processing equipment. Alconox efficiency i n liquid form. 1 Quart Container Case of 12 x 1 Qts. LIQUI-NOX@J 1 Gallon Container
CONVp:FIE/Ebg
z;faL;of4n
;rul$l*
GORDON M. MARSHALL, Editor and Publkher MARCELLA MARSHALL, Assistant to the Publkher 734 Siesta Key Circle, Sarasota, Florida 33581 (813) 349-7445 MICHAEL DASKALAKIS, Circulation Director P.O. Box 670, Neptune, New Jersey 07753 (201) 531-9200 JOSEPH BOURGHOLTZER, INC., National Advertising Representatives The JBI Building, Box 521, Mahwah, New Jersey 07430 (201) 529-3883 Editorial Advisory Board and Contributors WILLETTA M. OLSSON, R.N., Sarmota, Florida MARIE L. IETT, Chicago, Illinois ERIC W. SPRINGER, L.L.B., LegalAffairs, New York, N. Y. HARRIET R. FELDMAN, R.N., Word Search Editor, Bellmore, N. Y. ARTHUR N. MABBETT, Capt. MSC, Aberdeen Proving Ground, MD., Infection Control C.E. HOUSLEY, Associate Administrator, Columbus, Ohio, Management Metho& HARRY E. MUNN, JR., PH.D., Raleigh, N.C., Communicatons -Leadership TOM PARKER, A.B., M.A., M.P.H., North Wilkesboro, N.C., Supervisory Training and Personnel Services
55 Gallon Drum Includes free 1 02. dispenser pump
ALCOJET@ For mechanical washers.
Powder form. Protects mechanical parts of washing machines, keeps circulating lines and pumps free and clear. Prevents waterspotting. Minimum foaming action,
HOSPITAL TOPICS is published bi-monthly by HOSPITAL TOPICS, INC. 734 Siesta Key Circle, Sarasota, Florida 33581. (813) 349-7445 SUBSCRIPTION RATES: Single subscription one year $20.00; single copy, $4.00. Canadian and foreign subscriptions, one year $25.00; single copy $5.00. Changes of address notices, undeliverable copies, and subscrip tion orders should be sent to: HOSPITAL TOPICS, Subscription Dept., P.O. Box 670, Neptune, N.J. 07753, Subscription Service Dept. (AC 201) 531-9200.
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TERG-A-ZY ME Alconox Dowder with Drotease @
enzvme power. Effective in removing fresh or d-ried blood, body soils and other proteinaceous materials. Ideal ' as a pre-soak. Cleans reverse-osmosis installations in cheese and dairy processing. 2 Ib. Box TERG-A-ZYME" Case of 12 x 2 Ib. Boxes CONVENIENTLY 25 Ib. Carton PACKAGED 100 Ib. Drum 300 Ib. Drum
ALCOTABS@
Effervescent tablets for cleaning Pipettes and Test Tubes. Makes syphon-type rinsers into automatic washer/rinsers.
ALCOTABS" Box of 100 Tablets PACKAGED Carton of 6 Boxes x 100 Tablet,
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Available from your local Laboratory Supply Dealer, or write for further information and samples.
ALCONOX, INC. m 2 1 5 Park Avenue South, New York, N.Y. 100031 For More Ad Facts Circle # 2 On Reply Card
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Controlled circulation postage paid at Pontiac, Ill. 61764. Copyright@ 1976 by Hospital Topics, Inc. All rights reserved. Printed in the U.S.A. ATTENTION, LIBRARIANS: HOSPITAL TOPICS has been microfilmed since 1922 by Universal Microfilms, a Xerox Company, Ann Arbor, Michigan 48106, telephone 313-761-4700. Copies available at $4.75 per volume. HOSPITAL TOPICS is completely indexed in Hospital Literature Index, American Hospital Association, 840 N. Lake Shore Dr., Chicago, Ill. 60611.
Index Medicus, National Library of Medicine, 8600 Rockville Pike, Bethesda, Md. 20014. International Nursing Index (Same as Index Medicus)
Cumulative Index to Nursing Literature, P.O. Box 871, Glendale, Calif. 91209.
HOSPITAL TOPICS
