Degree of Adherence to Contact Precautions by Healthcare Workers in the Medical Laboratory

Objective:To determine adherence to contact precautions, and trends in knowledge, attitudes, and adherence by healthcare workers in a selected medical laboratory. Methods:The study design was quantitative, cross-sectional, and observational. Medical technologists and laboratory aides of one laboratory operating by the GYS 170 Standard were studied for twenty-four days. Firstly, compliance and supply availability were discretely observed and recorded on standardized tally charts. Secondly, thirty questionnaires were randomly distributed to determine knowledge of, attitudes to, and self-perceived compliance with contact precautions; twenty-four were returned. Data was analyzed in Microsoft Excel 2007 via percentages for observational results and averages for questionnaire results. Actual and perceived adherences were compared. Pearson’s χ2 test was used to determine association between variables. Results:Of 2,564 events, compliance (72.4%) was greater than non-compliance (27.4%). Medical technologists were more non-compliant (74.1%) than laboratory aides (37.7%). Staff were more likely to practice hand hygiene upon leaving (84.1%) than entering (39.9%). Laboratory coats were most used (86.2%) and gloves the least (69.9%). Also, gloving was associated with hand hygiene and with laboratory coat usage. The questionnaires revealed low knowledge, positive attitudes and low perceived compliance among workers. Finally, perceived adherence was larger than actual adherence. A p-value of less than 0.05 was determined to be statistically significant. Conclusion:Although supplies and guidelines exist and are positively received by workers, implementation is a challenge. Low knowledge and actual compliance, especially among medical technologists, is risky. Therefore, stricter initiatives and educational training are necessary.

Brote de queratoconjuntivitis epidémica en un Servicio de Oftalmología / A nosocomial outbreak of epidemic keratoconjunctivitis

We describe a nosocomial outbreak of keratoconjunctivitis at the Ophthalmology Clinic in Hospital Carlos Van Buren, that affected 150 patients, during August and September of 2006. This outbreak was concomitant with a community outbreak produced by the same agent in the city of Valparaiso that affected 681 other patients. Although adenovirus was not isolated in the nosocomial cases, positive cultures were obtained from community cases, so the diagnosis was based on clinical and epidemiological criteria. The infection rate within the Clinic patients was 5.2 percent considering the population that attended the Clinic in this period. The evaluation of patient care practices showed that common risk factors among affected cases were measurement of ocular tension with a tonometer in the Ophthalmology Clinic (without disinfection of the tonometer between patients), contamination of work surfaces (equipment, furniture), and poor compliance of hand hygiene. Control measures adopted were cleaning, disinfection of tonometer, equipment and work surfaces, and reinforcement of hand hygiene measures. With these measures, it was possible to control the nosocomial outbreak, despite the continued outpatient care of community-acquired cases.

Se describe un brote nosocomial de queratoconjun-tivitis epidémica en la Policlínica de Oftalmología del Hospital Carlos Van Burén, que afectó a 150 pacientes, durante los meses de agosto y septiembre de 2006. Este brote se presentó en el contexto de un brote en la ciudad de Valparaíso que afectó a otros 681 pacientes. Aun cuando no se logró aislar adenovirus (ADV) en los casos nosocomiales, se aisló ADV en pacientes del brote comunitario, por lo que el diagnóstico de los casos nosocomiales se basó en criterios clínicos y epidemiológicos. La tasa de ataque del brote nosocomial fue de 5,2 por ciento considerando la población consultante del período. La evaluación de prácticas de atención directa mostró que los factores de riesgo de los casos serían la medición de la tensión ocular mediante tonómetro en la Policlínica de Oftalmología (sin desinfección del tonómetro entre paciente y paciente), contaminación de superficies de trabajo (equipos, mobiliario) y bajo cumplimiento de la higienización de manos. Las medidas de control fueron limpieza, desinfección del tonómetro, equipos y superficies de trabajo, junto a reforzamiento de lavado de manos. Con estas medidas se logró controlar el brote intrahospitalario a pesar de mantenerse las consultas provenientes del brote en la comunidad.

The Effect of Contact Precautions and Active Surveillance Culture on the Methicillin-Resistant Staphylococcus aureus Reduction in an Intensive Care Unit / 병원감염관리

BACKGROUND: This study investigated the effectiveness of reinforced contact precautions and active surveillance cultures (ASCs) in reducing the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections (HAIs). METHODS: A before- and after-experimental study was performed at the intensive care unit (ICU) in a university-affiliated hospital. Reinforced contact precautions were applied to all patients, and ASCs for MRSA were performed for newly admitted patients at the time of admission and once a week thereafter. The HAIs were investigated in accordance with the National Nosocomial Infections Surveillance (NNIS) definitions and compared before and after the interventions. The data were analyzed using descriptive statistics. RESULTS: The number of HAIs caused by MRSA decreased from 2.2 to 0.5 per 100 patients discharged (P=0.02) and from 3.6 to 1.0 per 1,000 patient-days (P=0.032). The number of overall HAIs decreased from 7.6 to 4.0 per 100 patients discharged (P=0.011) and from 12.7 to 7.3 per 1,000 patient-days (P=0.034). The invasive device-associated infections caused by MRSA and other pathogens decreased, but the decrease was not statistically significant. CONCLUSION: Reinforced contact precautions and ASCs were effective in decreasing both MRSA infections and overall HAIs in the ICU. Further, it was assumed that the incidence of device-associated infections would have decreased if the intervention period was extended.