Infection control in dental radiology

Although exposure to blood is rare in oral and maxillofacial radiology, contact with saliva occurs. Thus the spread of infectious diseases is possible through cross-contamination, and specific infection control protocols and unit dosing of items are needed. This article outlines rationale for implementing state-of-the-art infection control procedures; and explains federal standards and guidelines with an impact on infection control and occupational safety in dental radiology procedures.     

Instrument design and cross-infection

This article reviews recently reported patient-to-patient transmission of disease during endoscopic procedures and discusses several important instrument reprocessing issues. In addition, the author offers several infection control recommendations to minimize the risk of patient infection during endoscopic procedures.     

Basics of surveillance--an overview

Surveillance of nosocomial infections is the foundation of an infection control program. This article describes components of a surveillance system, methods for surveillance, methods for case-finding, and data sources. We encourage the epidemiology team to use this background information as they design surveillance systems that meet the goals of their individual institution's infection control program.     

Magnitude and prevention of nosocomial infections in the intensive care unit

Nosocomial infections among intensive care unit (ICU) patients usually are related to the use of invasive devices (e.g., mechanical ventilators, urinary catheters, or central venous catheters). This article discusses the impact of these devices and other risk factors for nosocomial infection in ICU patients. Data on etiologic pathogens and device-related infection rates from the National Nosocomial Infection Surveillance System are presented, general infection control guidelines for ICUs are reviewed, and special infection control problems encountered in ICUs are discussed.     

Forum: trauma and infection: considerations for patient and health care professional

Trauma and infection are leading causes of morbidity, mortality and health care expenditures despite remarkable advances in treatment over the past two decades. Numerous research studies report that in those trauma patients who survive the initial injury, infections account for over one-third of the deaths. While the immediate resuscitation of trauma patients is based on the principles of management for restoring airway, breathing, and circulation, long-term survival requires prevention of infection. Additionally, infection of the health care professional has long been known as a possible complication of caring for acutely ill and injured patients. This article reviews the risk of infection, the pathogenesis of infection, prevention, antimicrobial therapy and infection control for health care professionals.     

Prevention of infection in the orthopedic surgery patient

A surgical site infection in an orthopedic surgery is a dreaded and often catastrophic complication. This article provides an overview of the incidence, pathogenesis, financial impact, as well as a discussion of patient and operation-related risk factors for orthopedic surgical site infections. The reader is provided insight into infection control interventions intended to minimize surgical site infections in orthopedic patients. Some of these practices are evidence-based and others exist only because of theoretical benefit.     

Clinical and radiobiologic evaluation of radiation dosage in radiotherapy of vaginal cancer

In line with the dramatic revolution in healthcare delivery within the last decade, the role of the infection control nurse (ICN) as first described by Brendan Moore (1959) must change to meet today's expectations. This article suggests that ICNs should function as clinical nurse specialists (CNS). The author shows how this change in role can be used to implement research-based practice by using the example of changing ventilator tubing change times.     

Nurses' knowledge of infection control

The article is based on a research study examining infection control in nurse education and practice. A survey of a large population was carried out to establish the perceived importance of microbiological knowledge to nurses and to ascertain whether this knowledge was present. The results suggest that although microbiological knowledge is considered necessary for safe infection control practice, nurses' actual knowledge falls far short of the level required for 'informed' practice. What this implies in relation to patient care, and recommendations regarding education and practice, are discussed.     

Infectious complications: prevention and strategies for their control

Despite major advances in burn wound management and other supportive care regimens, infection remains the leading cause of morbidity in the thermally injured patient. Changes in nursing practices and patient isolation have played a significant role in reducing the incidence of burn wounds and other infections, particularly those that result from cross-contamination in the hospitalized burn patient. This article focuses on the sources of the most common infections seen in burn centers today and on the infection control strategies developed for their prevention and treatment.     

Prolonged asymptomatic dense deposit disease in Chinese. Report of 2 cases in Taiwan

Clinical laboratory investigations used to aid antimicrobial chemotherapy of serious infection include routine sensitivity testing and, in the case of those drugs with a narrow therapeutic range, routine assays for therapeutic monitoring to assist with dosage individualization. Tests must be of a sufficiently high quality to be clinically useful. Laboratories ensure quality through standard operating procedures, internal quality control procedures, and participation in external quality assessment (EQA) programs. This article demonstrates how EQA returns to the United Kingdom National External Quality Assessment Scheme for Antibiotic Assays and the activity of the United Kingdom National Quality Assurance Advisory Panel showed marked improvement in the technical quality of assays as exemplified by gentamicin assays. The article also highlights additional quality concerns not subject to EQA.     

Pathophysiology, prevention, and management of prosthetic infections in hernia surgery

Because hernias are repaired increasingly with mesh and plugs, surgeons performing these operations should make an extended effort to prevent infection, and, when infections occur, to treat them expeditiously. This article discusses bacterial binding, infection reduction, the patient-doctor relationship during the care of an infected wound, and other related topics.     

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 versus colonization in the critical care unit

Serious infections in the critical care unit are commonplace. However, distinguishing true infection from mere colonization is a difficult and often uncertain process that has been shown to result in both over- and under-treatment of patients. Antimicrobial agents used in the CCU setting are expensive and not without toxicities. This article discusses methods to differentiate colonization from infection.     

Decontamination of equipment and the environment

This article explains the various ways decontamination of equipment and the environment can be carried out and highlights the importance of nurses being familiar with such methods so to reduce the possibility of infection.     

Clinical complications of HIV infection

HIV infection results in a profound weakening of the immune system that leaves the patient vulnerable to a bewildering array of clinical complications. Understanding of the pathogenesis of these clinical complications, knowledge of the current stage and treatment of HIV infection, and recognition of certain clinical syndromes can help the clinician sort through these potential complications, prioritize them, and formulate a plan for diagnosis and treatment. This article provides a summary of the clinical presentation, diagnosis, treatment, and prevention of the most common complications of HIV infection.     

Wedding rings and hospital-acquired infection

Some theatre nurses are reluctant to remove their wedding rings when scrubbing up. This article reviews the literature and concludes that keeping rings on may put the patient at risk of nosocomial (hospital-acquired) infection.     

Pediatric lumbar disc surgery: 20 patients under 15 years of age

Thermal injury is one trigger for pulmonary neutrophil recruitment. This article describes the time course of neutrophil recruitment after scald injury. Mice aged 8 to 10 weeks were anesthetized and subjected to 15% topical scald injury. Animals were put to death at 6 hours, 24 hours, 3 days, and 7 days after injury, and the pulmonary tissue harvested for staining with hematoxylin and eosin and neutrophil esterase. Cell counts for neutrophil accumulation were obtained. Control animals were handled in a comparable manner apart from the scald injury. Animals killed at 6 hours demonstrated significant neutrophil recruitment relative to the control. This difference had resolved at 24 hours. Animals killed at 3 and 7 days again demonstrated neutrophil accumulation despite normal behavior and absence of weight change from the control. Quantitative cultures of burn wounds failed to disclose infection. Scald injury was associated with significant pulmonary neutrophil recruitment that resolved at 24 hours. The presence of an untreated wound was associated with neutrophil recruitment beyond 24 hours despite outward normal behavior.     

The living canvas

In the United States, body art has gradually moved from the fringes of society into the mainstream. This article focuses on the health issues surrounding this practice. The literature cites numerous infectious diseases and complications resulting from or linked to body art. Tattoos have been linked to skin neoplasms, piercing has been associated with hepatitis B and C risk, and branding is strongly associated with infection. Although it is a theoretical risk, no documented cases of HIV have been acquired from a tattoo or piercing. In general, tattooing, piercing and branding are unlicensed and unregulated industries. In many communities, tattoo artists and establishments are not subject to health inspections, body art practitioners are not required to be trained in anatomy, infection control or universal precautions, and the contents of tattoo dyes have never received FDA approval. Healing times for body art are variable, depending on type and location. Obtaining body art is a long-term commitment, and patients should be fully aware of this.     

AIDS-related knowledge and sex behavior: a review of Italian studies of young people

To plan further AIDS health promotion programmes information is needed about knowledge and attitudes relating to HIV infection among the general public. This article reviews the results of Italian studies conducted from 1990 to 1994 on young's knowledge and behaviour related to HIV infection. Eighteen studies were identified. The results show a good level of knowledge of the means of transmitting the virus, but suggest that the information does not necessarily involve a change in attitude and behaviour.     

Appropriate use of antibiotics for URIs in children: Part II. Cough, pharyngitis and the common cold. The Pediatric URI Consensus Team

This article summarizes the principles of judicious antimicrobial therapy for three of the five conditions--cough, pharyngitis, the common cold--that account for most of the outpatient use of these drugs in the United States. The principles governing the other two conditions, otitis media and acute sinusitis, were presented in the previous issue. This article summarizes evidence against the use of antibiotic treatment for illness with cough or bronchitis in children, unless the cough is prolonged. Although empiric treatment may be started in patients with pharyngitis when streptococcal infection is suspected, the authors recommend withholding antibiotic treatment until antigen testing or culture is positive. There is never any indication for antibiotic treatment of the common cold; it is important to understand the natural history of colds, because symptoms such as mucopurulent rhinitis or cough, even when they persist for up to two weeks, do not necessarily indicate bacterial infection.