Antimicrobial treatment for Intensive Care Unit (ICU) infections including the role of the infectious disease specialist.

Between 5 and 10% of patients admitted to acute care hospitals acquire one or more infections, and the risks have steadily increased during recent decades. Three types of infection account for more than 60% of all nosocomial infections: pneumonia, urinary tract infection and primary bloodstream infection, all of them associated with the use of medical devices. Nearly 70% of infections are due to micro-organisms resistant to one or more antibiotics (multidrug resistant or MDR). A higher incidence of inappropriate antibiotic therapy is expected when infections are caused by antibiotic-resistant micro-organisms and initial inappropriate empirical therapies, and the further need to modify them substantially increases the mortality risk. Despite new antibacterial agents such as linezolid, and also tigecycline and daptomycin, now being available for the treatment of infections due to MDR micro-organisms, the best strategy for improving the cure rate and minimising the development of resistance, probably remains the infectious disease specialist consultation.

National survey of the status of infection surveillance and control programs in acute care hospitals with more than 300 beds in the Republic of Korea.

BACKGROUND: This study was conducted to assess the status of infection surveillance and control programs (ISCPs) and to analyze the trends associated with ISCP implementation since the first program was established in Korea in 1991. METHODS: A questionnaire modified from the Study on the Efficacy of Nosocomial Infection Control was mailed 4 times nationwide to acute care hospitals (n = 164) with more than 300 beds between June and October 2003. Eighty-five hospitals participated (52%). RESULTS: The mean number of beds (649) in the responding hospitals was significantly greater than in nonresponding hospitals. Of the participating hospitals, 92% had educational functions, 40% to 90% used hand hygiene resources, and 100% had infection control committees; 86% had infection control doctors, 98% had infection control nurses (ICNs), 89% employed only 1 ICN, and 59% employed an ICN only part-time; 68% performed surveillance, undertaking 2.7 epidemic investigations per year and 8.4 teaching programs per year; 88% undertook needlestick prevention programs; 58% performed regular air culture; and 64% discarded ineffective ISCPs. Annual trends analysis of ISCPs indicated that accreditation and legislation impact strongly on Korean ISCPs. CONCLUSION: The figures for ISCPs in this study indicate that improvements have been made since the 1990s. Legislation and accreditation have strongly influenced ISCPs. Much consideration should be given to the weaknesses in Korean ISCPs: surveillance, insufficient hand hygiene resources, and shortage of ICNs.

Informing the future: 2. Developing the role of community IPCNs.

This paper is the second in a two-part series summarising the main findings and conclusions of a review of the roles and responsibilities of infection prevention and control nurses commissioned by the Department of Health. It describes the core work of IPCNs, discusses the strengths and constraints of the current role and makes suggestions for future development.

From expert data collectors to interventionists: changing the focus for infection control professionals.

The current economic and political environments challenge health care organizations in the United States to provide affordable, accessible, and comprehensive health services. However, changes in reimbursement to health care providers can affect their ability to offer access to cutting-edge services while reducing costs. Consequently, organizations are restructuring, re-engineering, right-sizing, downsizing, and redesigning, all in an effort to save money while also hoping to maintain a reputation for quality and customer service. Dr Vicky Fraser, in her keynote address at the APIC conference in 2000, reminded us that ICHE programs are cost centers rather than revenue generators, and are often targets for budget cuts. Although Haley's Study on the Efficacy of Nosocomial Infection Control (SENIC), published in 1985, was a landmark event demonstrating the importance of our profession's mission, it is becoming dated. Infection control professionals (ICPs) must continue Haley's work, finding innovative ways to market or demonstrate the value of ICHE programs to health care executives. Closing the 1999 APIC conference with a symposium entitled "Breaking Out of the Box," Jackson and Massanari challenged ICPs to educate themselves about the changing health care environment, to be proactive, and constructively help organizations "re-engineer" more efficiently, rather than feel victimized and helplessly await being re-engineered out of existence. The threat of downsizing prompted ICPs at BJC HealthCare to realize that the time had come to change their own culture and attitudes and to focus on the business of infection control. This change required challenging the traditional roles of solo practitioner, data collector, and keeper of infection control data and knowledge. The goals now include leading intervention teams committed to reducing health care-associated infections, partnering rather than accepting sole responsibility for lowering infection rates, and learning to influence without authority. Staying focused on quality and cost-effectiveness and demonstrating improvements in clinical outcomes became a commitment. This article discusses BJC HealthCare's journey through change so that it may provide useful information and tools for ICPs in any setting looking for the necessary change strategies that might keep them in business.

Expanding the role of the infection control professional in the cost-effective use of antibiotics.

There is a growing demand that health care expenses be contained and that excessive and inappropriate use of antibiotics be eliminated. At the University of California, San Diego Medical Center, strategies aimed at controlling drug usage and subsequently reducing costs have been implemented and found to be effective. Mechanisms designed to achieve such goals without diminishing quality of care involve expanding the role of the infection control professional (ICP) while implementing antibiotic control stratagems such as antimicrobial utilization teams, antibiotic order sheets, audits of use, automatic stop orders, computer-assisted management, drug use reviews, educational efforts, formulary practice, restricted drug policies, and target drug monitoring. The infection control professional, as well as other members of the antimicrobial utilization team, contributes to the promotion of the appropriate use of antibiotics in part by identifying individual cases in which antibiotics might be used inappropriately, such as for the treatment of colonization rather than infection or when appropriate microbiologic testing has not been carried out.

Investigacoes sobre a prevalencia de infeccoes pelos retrovirus HTLVI em comunidades Okinawas que imigram para o Brasil ha mais de meio seculo: nota preliminar / Investigation on the prevalence of HTLVI retroviral infections in Okinawa communities that imigrated to Brazil more then half century ago: preliminary report

Foi feito um levantamento historico das pesquisas sobre HTLV no Brasil desde 1974 por pesquisadores americanos, japoneses e brasileiros. A maior comunidade de imigrantes japoneses, de origem Okinawa, fora do Japao, e vivendo em Sao Paulo, foi submetida a inquerito soroepidemiologico para os retrovirus HTLV I e II. Cento e uma amostras de sangueforam testadas para anticorpos anti-HTLV, atraves dos testes de aglutinacao de particulas de latex (Particle Aglutination test-Serodia-Fujirebio), Elisa(Embrabio HTLVI e II)e Wester Blot (Problot-Fujirebio). So foram considerados positivos os soros que resultaram positivos nos tres testes sorologicos. Dentre as amostras de sangue examinadas, 15 (14,8 pr cento )foram positivas nos tres testes,enquanto cinco deram resultados indeterminados e estao sendo reestudados. O proposito dessa investigacao foi: 1) Saber da prevalencia dos HTLV entre comunidades de imigrantes Okinawas,reconhecidos como portadores desses virus,em altas percentagens; 2) Caracterizar o tipo de virus(I ou II) e sua sequencia genetica; 3) Iniciar medidas preventivas junto aqueles que portam o virus, principalmente para evitar a transmissao intrafa, iliar(vertical e horizontal) e em bancos de sangue; 4) Alertear a saude publica do Brasil sobre a importancia de endemia.