What's in a name? The evolution of universal precautions to standard precautions. A guide to the latest recommendations in isolation practices.

New guidelines are intended to provide infection protection to patients and hospital staff. Many approaches to infection prevention in hospitals have been considered in the past. Guidelines for infection control must be thorough, reasonable to apply, and protective of patients, visitors, and staff.

CDC definitions for nosocomial infections, 1988.

The Centers for Disease Control (CDC) has developed a new set of definitions for surveillance of nosocomial infections. The new definitions combine specific clinical findings with results of laboratory and other tests that include recent advances in diagnostic technology; they are formulated as algorithms. For certain infections in which the clinical or laboratory manifestations are different in neonates and infants than in older persons, specific criteria are included. The definitions include criteria for common nosocomial infections as well as infections that occur infrequently but have serious consequences. The definitions were introduced into hospitals participating in the CDC National Nosocomial Infections Surveillance System (NNIS) in 1987 and were modified based on comments from infection control personnel in NNIS hospitals and others involved in surveillance, prevention, and control of nosocomial infections. The definitions were implemented for surveillance of nosocomial infections in NNIS hospitals in January 1988 and are the current CDC definitions for nosocomial infections. Other hospitals may wish to adopt or modify them for use in their nosocomial infections surveillance programs.

The role and efficacy of the infection control nurse in U.S. hospitals.

Although infection control nurses have played a major role in hospital infection control programs for more than a decade, there was little published scientific evidence with which to evaluate whether having an infection control nurse, or any other component of an infection control program, would actually reduce a hospital's nosocomial infection rate. To develop such evaluative evidence, the Centers for Disease Control (CDC) carried out several nationwide studies in random samples of U.S. hospitals. Data from the studies show that having an infection control nurse for every 250 occupied hospital beds is an important component in reducing nosocomial urinary tract infections, bacteremia, and postoperative pneumonia.

A new approach to the isolation of hospitalized patients with infectious diseases: alternative systems.

A new guideline developed by the Centers for Disease Control suggests that hospitals adopt one of two alternative isolation systems: the category system or the disease-specific system. The older category system has been modified to reflect current knowledge; for example, the category of protective isolation has been deleted, new categories for contact precautions and tuberculosis precautions have been added, the specific precautions indicated in the other categories have been substantially modified, and many infections have been assigned to new categories. The disease-specific system, a newly developed approach, lists the specific isolation precautions indicated for each infectious disease. Whereas the revised category system offers greater simplicity in practice, the disease-specific system minimizes unnecessary precautions. Both systems allow patient-care personnel more decision-making authority in determining which precautions to apply.

How frequent are outbreaks of nosocomial infection in community hospitals?

A statistical algorithm was used to identify potentially important clusters among nosocomial infections reported each month by 7 community hospitals. Epidemiologic review and on-site investigations distinguished outbreaks of clinical disease from factitious clusters. In 1 year, 8 outbreaks were confirmed. They involved 82 patients--approximately 2% of patients with nosocomial infections and 0.09% of all discharges. One true outbreak occurred for every 12,000 discharges--at least 1 outbreak per year for the average community hospital. Five (63%) outbreaks were recognized independently by the hospitals' infection control personnel. Four (50%) resolved spontaneously; the hospitals' own control measures were necessary in 2; and 2 resolved only after an outside investigation. Organized surveillance appears necessary to detect some outbreaks, and control measures are needed to stop many. Since, however, outbreaks account for such a small proportion of nosocomial infections, infection control programs should be sufficiently staffed and managed so that most of the effort is directed toward the surveillance and control of endemic infection problems, but with adequate resources remaining to respond to outbreaks when they occur.

Operating room practices for the control of infection in U. S. hospitals, October 1976 to July 1977.

We estimated the frequency of selected infection control practices in the operating room from a nationwide survey of hospitals. Our survey confirmed that, in many hospitals, practices which have not received scientific or budgetary scrutiny have become part of the perioperative routine. Almost half of the hospitals reported using nonrecommended tacky, or disinfectant, mats at the entrance to operating rooms, and more than three-fourths were performing nonrecommended environmental cultures in the operating room at a cost ranging from $2,000 to $20,000 per year. When routine nose and throat cultures were taken of operating room personnel, we found an obvious pecking order, rather than a scientific rationale for culturing. In almost all instances, we found wide variations in practice among hospitals. This nonuniformity may be due to such factors as lack of a convincing scientific basis for evaluating the relative efficacy of alternative practices, the strong influence of industry marketing, the individual preferences of surgeons and operating room supervisors and the lack of completeness and agreement of statements from various scientific and professional organizations.