Cleaning reusable equipment in the ICU.

Cleaning is the single-most-important step in making a medical device safe for handling. It is also extremely important as a preparatory step before any subsequent disinfection or sterilization process. This article addresses the rationale for cleaning of medical equipment or devices before any further processing and includes examples of infectious complications associated with inadequate cleaning. In addition, discussion is presented concerning the relationship between cleaning and any subsequent processing before patient use. Guidance relative to the use of various cleaning agents is also provided. Additional emphasis on the necessity of following manufacturer's recommendations on cleaning agents and procedures is noted.

The risk of occupational exposure and infection with infectious diseases: Part 3.

This article is the third of a series devoted to the epidemiology of selected infectious diseases known to be transmitted in health care settings. Part 1 (Home Care Provider 1998;3:251-2) consisted of a brief review of general preventive measures associated with standard and transmission-based precautions. Part 2 (Home Care Provider 1998;3:304-5) included a discussion of specific viral illnesses associated with blood-borne transmission. This article will address cytomegalovirus (CMV) and herpes infections along with influenza and meningitis.

The risk of occupational exposure and infection with infectious disease.

The diversity of potentially infectious agents that frequent the health care environment continues to increase. As a result, healthcare workers are at some degree of risk, for exposure to, and infection by, a variety of infectious diseases or conditions. This article is devoted to the epidemiology of major infectious diseases and conditions known to be transmitted in health care settings. In addition, the relative risk of occupational exposure to and infection by these diseases is also discussed as are general preventive measures associated with Standard and Transmission-based Precautions.

APIC position paper: immunization. Association for Professionals in Infection and Epidemiology, Inc.

The Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) is a multidisciplinary organization of more than 11,000 health care professionals who practice infection control and epidemiology within a variety of health care settings. As an authority in infection control, APIC endorses the Advisory Committee on Immunization Practices (ACIP) recommendations that are published by the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. APIC supports the immunization initiative of the Healthy People 2000: National Health Promotion and Disease Prevention Objectives, which contains a national strategy for significantly improving the health of the nation, including preventing infectious diseases through immunization.

APIC position paper: hepatitis C exposure in the health care setting. Association for Professionals in Infection Control and Epidemiology, Inc.

The Association for Professionals in Infection Control and Epidemiology, Inc (APIC), is a multidisciplinary, voluntary, international organization of professionals who practice infection control and the application of epidemiology in all health settings. APIC is an international leader in prevention and control of infection transmission.

APIC position paper: responsibility for interpretation of the PPD tuberculin skin test. Association for Professionals in Infection Control and Epidemiology, Inc.

The Association for Professionals in Infection Control and Epidemiology, Inc (APIC) is a multidisciplinary, voluntary, international organization of professionals who practice infection control and the application of epidemiology in all health settings. APIC is an international leader in prevention and control of infection transmission.

Management of job-related illnesses and exposures.

Home health agencies are responsible for implementing measures to prevent further transmission of infection, which occasionally requires the exclusion of health care personnel from work or direct patient contact. Decisions on work restrictions should be based on the mode of transmission and the specific epidemiology of the disease or condition in question.

Administering and interpreting the PPD tuberculin skin test.

Early detection and treatment are of paramount importance in our efforts to bring tuberculosis (TB) under control. In this context, screening high-risk populations for active TB and TB infection is crucial. Most individuals who become infected with Mycobacterium tuberculosis do not develop overt disease.

Principles of disinfection.

For more than 150 years, we have known that medical and surgical devices may serve as vehicles for the transmission of infectious agents to a susceptible host. During that time, our knowledge and experience involving microbial inactivation through disinfection have become quite sophisticated. As a result, infectious complications associated with patient care are now the exception rather than the rule.

The risk of occupational exposure and infection with infectious diseases (Part I).

The variety of potentially infectious agents that frequent the health care environment is indeed large. As a result, health care workers are at some degree of risk for exposure to a variety of infectious diseases. However, as healthy individuals, we can protect ourselves quite successfully by following the guidelines that govern personal hygiene and immunization and adhering to accepted infection control standards of patient care, disinfection, antisepsis, and disease isolation. A clear understanding of the mechanisms of disease transmission is also important in this regard.

The risk of occupational exposure and infection with infectious diseases: Part 2.

This article is the second of a series devoted to the epidemiology of selected infectious diseases known to be transmitted in health care settings. In subsequent issues, the relative risk of occupational exposure to and infection with these diseases will be discussed. Part 1 (October 1998 Home Care Provider) consisted of a brief review of general preventive measures associated with standard and transmission-based precautions. This article will address specific viral illnesses associated with blood-borne transmission.

Influenza--it's that time again.

Influenza virus infections regularly increase serious morbidity and mortality in the United States. From 1972 to 1985, between 10,000 and 40,000 deaths were attributed to influenza each year. More than 90% of these deaths were individuals 65 years or older.

Understanding viral hepatitis B.

Epidemic jaundice, known today as viral hepatitis, was described by Hippocrates nearly 2500 years ago. Yet only in the past 20 years or so have the main viruses that cause hepatitis been elucidated. During this short interval, the main modes of transmission and effective methods of prevention also have been described.

Scabies: an itchy problem.

Scabies-a small word that can, and often does, impart great anxiety and apprehension among health care workers (HCWs). Yet the epidemiology associated with this human parasitic infestation is well understood, as are the mechanisms for both its treatment and control.

Clostridium difficile: a microbial enigma.

Nearly 150 years ago, Louis Pasteur introduced the world to the science of microbiology and to the fact that our environment contains microbes capable of causing disease. Subsequent to these discoveries, a pandemic of health care-related staphylococcal infections nearly a century later led to the recognition of hospital-associated (nosocomial) infection. Clearly such infections (nosohusial) now also afflict nursing home residents and patients who receive home health care.

The epidemiology of disease transmission.

As inhabitants of the planet Earth, we live in a veritable sea of microorganisms. Virtually every aspect of our environment is heavily populated with different forms of microbial life. From the air we breathe to the food we eat, our daily existence is in the direct presence of literally billions of microorganisms.

Controlling the spread of antibiotic-resistant organisms.

Gram-negative bacilli (GNB), enterococci, and staphylococci are common members of the human microflora and are often the cause of infectious complications in the elderly, the severely ill, and the immunocompromised patient. In addition, patients with invasive devices (e.g., trachs, feeding tubes, catheters), open wounds, and those whose normal microbial flora have been altered by antimicrobial therapy are also at risk for infection with these microorganisms. Urinary tract infection, bacteremia, and infected wounds are the principal anatomic sites involved.