Adapting disease-specific isolation guidelines to a hospital information system.

The authors modified the Centers for Disease Control's guideline for disease-specific isolation precautions to a hospital computerized information system. Entering a suspected diagnosis selected from the isolation option on computer terminals generated: a printout listing the isolation instructions, infective material(s), and persons who should avoid exposure; an order for the appropriate supplies; a patient charge based on the supplies required; and an option for stopping, changing, or listing the orders. In order to implement this system, both extensive in-service training for nurses and efforts to change ordering practices of physicians were necessary. Prevalence surveys before and after computerization were used to evaluate the new system. Combined surveys showed that isolation was ordered for only 21% of patients when indicated. Failure to isolate was identified as a significant problem. As a consequence, continuous surveillance and consultation of all infected patients were instituted, resulting in isolation orders for 81% when indicated. The computerized disease-specific system has resulted in better and more accurate use of isolation, probably due to in-service education and surveillance efforts.

Computer surveillance of hospital-acquired infections and antibiotic use.

Surveillance of hospital-acquired infections and antibiotic use is required of US hospitals. The time and cost needed to actively perform this surveillance can be extensive. We developed a computerized infectious disease monitor that automatically generates four types of surveillance "alerts" for patients with hospital-acquired infections, not receiving antibiotics to which their pathogens are susceptible, who could be receiving less expensive antibiotics, or who are receiving prophylactic antibiotics too long. Surveillance personnel using computer screening for two months found more hospital-acquired infections when compared with our traditional surveillance methods, while requiring only 35% of the time. In addition, alerts from the computer identified 37 patients not receiving appropriate antibiotics, 31 patients who could have been receiving less expensive antibiotics, and 142 patients, during one month, receiving prolonged cephalosporin prophylaxis. Computer screening can help focus the activities and improve the efficiency of hospital surveillance personnel.

Injuries of hospital employees from needles and sharp objects.

During a 30-month period in our 570-bed private community hospital, employees reported 218 injuries from needles and other sharp objects. Five of these injuries were from needles used on patients known to be hepatitis B surface antigens (HBsAg) positive. Four were from blades or scalpels used on HBsAg positive patients. Another needle injury resulted in serious Staphylococcus aureus infection. Thirty-three percent of the injuries were from improperly disposed objects, generally in trash baskets in patient rooms. Housekeeping employees were the "innocent victims" of more than one-half of the injuries from such improperly disposed objects. A survey of reporting practices revealed housekeepers reported all their injuries. Underreporting was identified as a problem with laboratory personnel and nurses who tended to make their own judgment concerning the extent of the injury. An effective innovation resulting from our survey was the use of plastic irrigation bottles as an inexpensive and readily available container for disposal of sharps.

Evaluation of daily meatal care with poly-antibiotic ointment in prevention of urinary catheter-associated bacteriuria.

Meatal care with a poly-antibiotic ointment twice daily was evaluated in a prospective, randomized, controlled study of patients with temporary indwelling urethral catheters. Bacteriuria was acquired in 14 of 214 patients treated (6.5 per cent), compared to 16 of 214 patients not given treatment (7.5 per cent). The rate of bacteriuria was slightly lower in the treated than in the untreated group by each of 4 different statistical methods. In a subset of female patients at high risk a significant reduction in the rate of bacteriuria in treated patients was found by 1 method of analysis. These results contrast to previous studies in our hospital in which meatal care, using either nonantiseptic soap and water or an iodophor solution and ointment, was found to predispose to bacteriuria in high risk female patients. The benefit, if any, of meatal care with poly-antibiotic ointment appears to be small.