Infection prevention and control in the long-term-care facility. SHEA Long-Term-Care Committee and APIC Guidelines Committee.

More than 1.5 million residents reside in US nursing homes. In recent years, the acuity of illness of nursing home residents has increased. Long-term-care facility residents have a risk of developing nosocomial infection that is similar to acute-care hospital patients. A great deal of information has been published concerning infections in the long-term-care facility, and infection control programs are nearly universal. This position paper reviews the literature on infections and infection control program in the long-term-care facility, covering such topics as tuberculosis, bloodborne pathogens, epidemics, isolation systems, immunization, and antibiotic-resistant bacteria. Recommendations are developed for long-term-care infection control programs based on interpretation of currently available evidence. The recommendations cover the structure and function of the infection control program, including surveillance, isolation, outbreak control, resident care, and employee health. Infection control resources also are presented.

Infection prevention and control in the long-term-care facility. SHEA Long-Term-Care Committee and APIC Guidelines Committee.

More than 1.5 million residents reside in US nursing homes. In recent years, the acuity of illness of nursing home residents has increased. Long-term-care facility residents have a risk of developing nosocomial infection that is similar to acute-care hospital patients. A great deal of information has been published concerning infections in the long-term-care facility, and infection control programs are nearly universal. This position paper reviews the literature on infections and infection control programs in the long-term-care facility, covering such topics as tuberculosis, bloodborne pathogens, epidemics, isolation systems, immunization, and antibiotic-resistant bacteria. Recommendations are developed for long-term-care infection control programs based on interpretation of currently available evidence. The recommendations cover the structure and function of the infection control program, including surveillance, isolation, outbreak control, resident care, and employee health. Infection control resources also are presented.

The adenylate kinases from a mesophilic and three thermophilic methanogenic members of the Archaea.

Adenylate kinase has been isolated from four related methanogenic members of the Archaea. For each, the optimum temperature for enzyme activity was similar to the temperature for optimal microbial growth and was approximately 30 degrees C for Methanococcus voltae, 70 degrees C for Methanococcus thermolithotrophicus, 80 degrees C for Methanococcus igneus, and 80 to 90 degrees C for Methanococcus jannaschii. The enzymes were sensitive to the adenylate kinase inhibitor P1, P5-di(adenosine-5')pentaphosphate, a property that was exploited to purify the enzymes by CIBACRON Blue affinity chromatography. The enzymes had an estimated molecular mass (approximately 23 to 25 kDa) in the range common for adenylate kinases. Each of the enzymes had a region of amino acid sequence close to its N terminus that was similar to the canonical P-loop sequence reported for all adenylate kinases. However, the methanogen sequences lacked a lysine residue that has previously been found to be invariant in adenylate kinases, including an enzyme isolated from the archaeon Sulfolobus acidocaldarius. If verified as a nucleotide-binding domain, the methanogen sequence would represent a novel nucleotide-binding motif. There was no correlation between amino acid abundance and the optimal temperature for enzyme activity.

Impact on knowledge and practice of a multiregional long-term care facility infection control training program.

BACKGROUND: Few affordable training opportunities are specifically designed for the long-term care facility infection control practitioner. There is also little evidence of the success of training in improving infection control practices. The Nebraska Infection Control Network developed a 2-day basic skills training program for Midwestern long-term care facility infection control practitioners that was later disseminated to eastern and western training sites. In this study we examined the effectiveness of the training program in terms of trainee knowledge and practice. METHODS: From 1986 to 1990, a total of 17 courses conducted at the three sites were attended by a total of 266 infection control practitioners. Trainees completed a 40-item multiple choice test before and after training to evaluate their knowledge gain. Implementation of eight key infection control practices and time devoted to infection control duties were measured before training and at 3 and 12 months after training. Implementation of infection control practices was also evaluated in a second study, with infection control practitioners randomly assigned to trained and wait-control conditions. RESULTS: Significant increases after training were found at each site for both knowledge and implementation measures. These increases were maintained at 12 months follow-up. Time devoted to infection control duties increased significantly at the midwest and western sites but not at the eastern site. In the second study, significant differences were found between the trained and the wait-control group in use of infection control practices, providing evidence for a causal relationship between training and increased use of practices. CONCLUSIONS: The training program was effective in producing improvements in knowledge and implementation of recommended infection control practices in long-term care facilities. These improvements were consistent across three diverse geographic areas. There were some specific geographic differences.

Design and dissemination of a multiregional long-term care infection control training program.

Long-term care facilities have only recently begun to receive attention in the area of infection control. A training program was developed in Nebraska to help supply practitioners with knowledge and techniques designed specifically for the long-term care environment. This program's success led to its implementation in other regions. The regional extensions of the program were designed to operate with independent faculty but standardized course materials.

Mode of sodium ion action on methanogenesis and ATPase of the moderate halophilic methanogenis bacterium Methanohalophilus halophilus.

Cells of Methanohalophilus halophilus swelled when exposed to hypotonic solutions of NaCl at pH 7.0. The swelling of the cells ceased in the presence of Mg2+. Methane formation by non-growing cells was strongly dependent on the NaCl concentration. Among other monovalent and divalent cations only Li+ and Mg2+ could partly substitute for a specific function of sodium ions. The artificial Na+/H+ antiporter, monensin, exerted a strong inhibitory effect on methane formation from methylamine. The membrane-bound Mg(2+)-stimulated ATPase of these cells was enhanced at low (40 mM) NaCl concentration while higher concentrations of this solute were inhibitory. The results obtained show that sodium ions are a prerequisite for optimal methane formation and ATPase activity in these cells. However, both of these processes required different sodium ion concentrations.

A microbiologic survey of long term care urinary catheters.

Culture and sensitivity data were collected on over 500 isolates from indwelling urinary catheters in 23 Nebraska long-term care facilities. Four percent of all nursing home patients had indwelling urinary catheters. The prevalence of bacteriuria in catheterized patients was 79%., and the most frequent isolates were E. coli, Proteus mirabilis, and Enterococcus species. Thirteen percent of catheterized patients were receiving systemic antibiotics, and 85% had at least one urinary bacterial isolate resistant to the antibiotic being administered. Antibiotic resistance correlated positively with a number of factors in the long-term care institutions, including size and skill level.

Mild beta-thalassemia in black subjects.

In two American black families with beta-thalassemia, globin chain synthesis was investigated in vitro. The resultant alpha/beta and alpha/non-alpha labelling ratios were expressed in terms of both specific activity and total counts. In one family, two brothers with clinical presentations compatible with thalassemia intermedia had apparently each inherited two different beta-thalassemia alleles. Thus, they are compound heterozygotes. Their alpha/beta (or alpha/non-alpha) ratios were in the same range as those found in Caucasian subjects with severe Cooley's anemia. In addition, alpha/beta ratios in heterozygotes in this study were the same as those found in Caucasian heterozygotes. A difference in degree of chain imbalance measured by our present method cannot explain the relative lack of severe clinical manifestations of beta-thalassemia in blacks. Further family studies are indicated to discover other genetic or environmental factors modifying the effects of beta-thalassemia.