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Background The authors surveyed adults in military and civilian dental practices about infection-control procedures and clinical attire to see if patients' attitudes had changed with the alteration of infection-control procedures over the last two decades. Methods The authors surveyed 1,500 adults, using a written questionnaire at two military hospital dental practices and at four civilian dental offices, which included two general practices, one periodontal practice and one orthodontic practice. Results The authors found that the use of name tags and patient safety glasses during treatment were preferred by 52.0 percent and 53.4 percent, respectively, of respondents in military facilities. Respondents had no preference about dentists' clothing, use of protective glasses for examinations or head cover use. A majority of respondents preferred that dentists wear glasses when performing treatment (54.1 percent), and 77.4 percent of respondents preferred that dentists wear masks when providing their care. Respondents preferred the use of plastic barriers, and 63.0 percent said it made them feel confident that proper infection-control procedures were followed. A majority of respondents (52.3 percent) said they would be concerned if barriers were not used. Conclusions Military and civilian respondents had similar perceptions of infection-control procedures. Respondents said they preferred that dentists wear name tags in group practices and use masks and protective glasses when performing treatment. The use of plastic barriers made respondents feel confident that proper infection-control procedures were being followed. Practice Implications This study can be used by dental practices to review their infection-control procedures and how patients perceive them. Dentists may decide to implement some of these procedures, especially those that are not required, and that improve customer satisfaction.

Strains of Staphylococcus aureus with reduced susceptibility to glycopeptides have been reported from Japan, the United States, Europe, and the Far East. Although isolates with homogeneous resistance to vancomycin (MICs = 8 microg/mL) continue to be rare, there are increasing reports of strains showing heteroresistance, often with vancomycin MICs in the 1-4 microg/mL range. Most isolates with reduced susceptibility to vancomycin appear to have developed from preexisting methicillin-resistant S. aureus infections. Many of the isolates with reduced susceptibility to glycopeptides have been associated with therapeutic failures with vancomycin. Although nosocomial spread of the vancomycin-intermediate S. aureus (VISA) strains has not been observed in U.S. hospitals, spread of VISA strains has apparently occurred in Japan. Broth microdilution tests held a full 24 hours are optimal for detecting resistance in the laboratory; however, methods for detecting heteroresistant strains are still in flux. Disk-diffusion tests, including the Stokes method, do not detect VISA strains. The Centers for Disease Control and Prevention and other groups have issued recommendations regarding appropriate infection control procedures for patients infected with these strains.

Objective: To describe infection control practices used by technicians doing manicures and pedicures in an urban setting in Ontario. Methods: A random sample of 120 establishments was selected from a sampling frame. A survey was designed and administered to technicians through face-to-face interviews. Results: Technicians in 72 establishments were interviewed, representing a 60% response rate. Twenty-nine (40%) of these technicians indicated that they had been immunized against hepatitis B. Technicians re-used almost all instruments even if this was not the intent of the manufacturer. Isopropyl alcohol was the most commonly used disinfectant. Many technicians did not wear gloves while performing procedures. Most did not follow universal precautions when asked how they would react to incidental cuts on either the client or themselves. Conclusion: There is a need for the development of infection control protocols for manicure and pedicure establishments since the potential for transmission of infectious diseases does exist.

Objective: The purpose of this study was to examine the infection control procedures used in general dental practices in the Republic of Ireland. Design: Postal survey. Setting: The Republic of Ireland. Participants: 250 general dental practices. Methods: Postal questionnaire. Main outcome measures: Use of infection control procedures; gloves, masks, sterilisation of instruments, staff training. Results: A 74% response rate (n = 177), with 162 wearing gloves for all patients, 97% of whom used latex gloves. Routine glove use by 69% of dental nurses. Approximately one third of respondents complained of hand skin irritation attributed to the wearing of latex gloves. Routine mask wearing during treatment was reported by 68% of respondents. The method of choice for sterilising instruments was the steam autoclave for 97%. Time spent on surgery cleaning between patients was less than one minute in 12 per cent of practices. Conclusions: Cross-infection control procedures practised by a high proportion of the respondents to the survey conform to guidelines suggested by various authorities. Further education may be appropriate in a number of areas such as mask wearing and the need to change gloves between patients.

Summary On 11 June WHO announced that the spread of H1N1 had reached pandemic phase 6. Since then countries around the world have increased their planning and preparedness for the continuing pandemic. Guidelines have been issued and circulated but confusion continues over their interpretation. We need to remind ourselves of the principles behind control measures and educate and reinforce standard infection control procedures in the acute hospital setting.

A prevalence study of methicillin-resistant Staphylococcus aureus (MRSA) colonization was carried out in 17 nursing homes in Northamptonshire over a 20-month period. Thirteen of 275 residents swabbed (4.7%) were found to be colonized and six of the 17 homes (35%) had colonized residents. Only two homes had more than one colonized resident. Individual risk factors for colonization were gender (male) and the presence of skin ulcers and sores. There were no significant risk factors identified for homes. Spread may have occurred in the two homes which had more than one colonized resident. Both these homes had the epidemic strain EMRSA-15 whereas three of the four homes with a single colonized resident had EMRSA-16. It is suggested that homes with residents colonized with EMRSA-16 may be able to prevent spread by adherence to good infection control procedures but that this may not be adequate to prevent spread of EMRSA-15.

The authors conducted a study using surveillance monitoring methodology to identify operatory contamination and to evaluate the effectiveness of infection control procedures. Viridans streptococci were evaluated as biological indicators of oral contamination. Viridans streptococci, abundant in human saliva, were detected on operatory surfaces after dental treatments were finished and surfaces were disinfected. The findings validate current concepts of infection control as demonstrated in barrier methods.

The authors of previous studies have reported an increasing percentage of orthodontists complying with infection-control procedures in their offices, yet compliance was found to be less than ideal. In this study we surveyed Illinois orthodontists to evaluate their compliance with the infection-control guidelines established by the American Dental Association and the Centers for Disease Control and Prevention. This study is an addition to a small number of studies in the field of orthodontics on infection-control procedures. The study population was taken from the World Directory of Orthodontists, which contains 374 listings for the state of Illinois. Responses were received from 140 orthodontists, for a response rate of 37%. Thirty-two percent of the responding orthodontists stated that they always wear masks; 13% said they never do. Almost 97% of the orthodontists said they always wear gloves, and no orthodontist reported never wearing gloves. Nearly 64% of the orthodontists reported always using eyewear, and 34% said they wear gowns, whereas only 5% do not wear eye protection and 35% never wear gowns. With regard to instruments and pliers, most of the orthodontists reported using dry-heat ovens (72% and 80%, respectively), whereas nearly 58% said they use chemical disinfection to some extent on instruments and 39% said they use chemical disinfection on pliers. Only 51% of the orthodontists surveyed in our study reported using a steam autoclave to sterilize handpieces, whereas 27% said they use dry-heat ovens, 11% reported using chemical vapor, and 37% said they use chemical disinfection. In conclusion, compliance with infection control procedures among orthodontists has improved from recent studies but is still less than full compliance.

Objective The aim of this study was to verify the practices and attitudes of senior dental students about infection control procedures. Methods A cross-sectional survey was performed during the 1st semester of 2003. Open- and close-ended questions were given to 196 students in 6 universities. Results Overall, 90.8% of students had been vaccinated for hepatitis B. Only 25.0% have been assessed for anti-HBs. A total of 99.5% students reported always using gloves for all procedures. Eye protection were always used by 84.2% of students, and all the students used face masks for all procedures. Caps or hair covers were used by 92.3% of students and 87.8% reported no objection to treating patients with infectious diseases. Among instructors, the students observed that 60.2% of them did not use gloves for all procedures, 43.4% of those didn't change gloves between patients. Conclusions These results address the need for an improved quality assurance, in order for the students and faculty to improve their practices and attitudes on infection control measures.

Objectives : The aim of this study was to assess the awareness of Hepatitis B Virus(HBV) infection among Dental Surgeons in Lagos state and to identify preventive measures adopted against HBV infection. Materials and Methods: 220 structured self-administered questionnaires about knowledge of HBV and infection control measures were distributed to Dentists in Lagos University Teaching Hospital; Lagos State University Teaching Hospital; Military Hospital, Yaba, Lagos; Military Hospital, Bonny Camp, Victoria Island, Lagos; Randle General Hospital, Surulere, Lagos; General Hospital Lagos and 12 Private Dental Clinics. The response rate was 85 percent. Results: A high level of awareness and knowledge of HBV infection was demonstrated in this study compared to previous studies.22 15 This however did not translate into a commensurate increase in crossinfection control practices. 71 percent of Dentists usually took a detailed medical history of their patients. 66.3 percent had been vaccinated against Hepatitis B Virus; 94.5 percent wore and changed gloves during treatment and 100 percent in between patients; 36 percent wore and changed face masks during treatment and in between patients. 66.9 percent used autoclaves for sterilization, 62 percent had special containers for sharps disposal while 50% always used sterilization wrappers. Only 26 percent always disinfected working surfaces in between patients. Based on these responses, only a small percentage of Dentists in this sample were considered to be compliantwith an inventory of standard infection control procedures. Conclusions: There is a great need in Lagos, perhaps in Nigeria as a whole for the adoption and implementation of standard infection procedures and the provision of formal and obligatory infection control courses and guidelines for Dental Surgeons by the Ministry of Health and the Dental Association, in addition to distribution of standard infection control manuals that incorporate current infection control recommendations. Keywords: Hepatitis B Virus (HBV), Occupational Hazard, Cross Infection, Post Exposure prophylaxis (PEP), Dental Surgeons.

Nurses could be set objectives to ensure all staff entering their ward follow infection control procedures, a nurse consultant has suggested.

Introduction: Infection control practices are crucial and important elements in clinical dentistry as there is an enormous increase in the prevalence of infectious diseases among dental patients. This necessitates the application of recommended procedures for infection control in the dental schools and clinics. Aim: The aim of this study was to assess patients' perception toward the use of protective barriers (such as gloves, face masks, and eye goggles) by working dentists in a private dental teaching school in Jabalpur, Madhya Pradesh (India). Materials and Methods: A cross-sectional descriptive study of a convenient sample of patients visiting the dental school of RDU was conducted in 2015. A structured, close-ended, self-administered questionnaire was distributed among 700 patients and a response rate of 89% was obtained. The questionnaire consisted of a series of questions related to awareness, knowledge, attitude, and perception of patients toward infection control measures. Data analysis included frequency distribution tables. Results: Of 664 patients (298 males and 366 females), 97.7%, 93.5%, and 43.6% of the patients believed that dentist should wear gloves, face masks, and eye goggles, respectively, when treating patients. The majority of them (95.3%) refused to undergo treatment if the dentist is not wearing gloves and face masks. More than two-thirds (73.3%) denied receiving treatment from a dentist, who is not immunized against hepatitis B. Nearly 79.2% of patients refused to attend school if they knew that human immunodeficiency virus (HIV) and hepatitis B virus (HBV) patients treated there. The majority of patients (92.7%, 72.3%, and 23.1%) believed that gloves, facemasks, and eye goggles protect both dentist and patient, respectively. Only 44.9% said that autoclave is the best method of sterilization. A significantly higher knowledge of infection control was observed among the previous dental visitors compared to the first-time visitors ( P Conclusions: Patients revealed adequate knowledge toward the use of gloves, face masks, and eye goggles by a dentist. However, their knowledge regarding the use of autoclave was poor. This documentation will serve in planning more effective interventions to enhance public awareness about infection control in dentistry in Jabalpur city, India.

The purpose of this study was to focus attention on the need to adopt infection control procedures in dentistry. The quantitative and qualitative bacterial contamination of dental healthcare workers' faces and other surfaces in dental practice was determined. Oral fluids become aerosolized during dentistry and oral microbes have been used as the markers of their spread that may carry blood-borne pathogens.

This prospective interventional study aimed at increasing knowledge and adherence to 4 infection control standards by visitors to a neonatal intensive care unit. Visitors were interviewed and observed for knowledge of and adherence to the standards pre- and postinstallation of an audiovisual display monitor, which demonstrates handwashing and delivers an auditory and written list of the standards. Handwashing adherence and watch removal improved from 79.2% to 100% and 67% to 89.7%, respectively. Recall of the standards increased from 19% to 81%.

Facility-specific guidelines need to be developed to address certification requirements for therapy dogs, practical logistics of therapy dog visits, and infection control issues. Policies should be developed using expertise from volunteer coordinators, risk management, infection control specialists, veterinarians, and therapy dog handlers. Outside agencies are used to train, test, and certify therapy dogs. Insurance is generally provided through these agencies. Dogs can become colonized with some human pathogens. Implementing infection control procedures and controlling dog behavior during visits reduce risks for dogs becoming colonized. Established programs incorporating therapy dogs as complementary treatment for cancer patients offer role models for the development of new programs.

Human immunodeficiency virus (HIV) infection in women is on the rise. Approximately 80,000 women in the United States are currently infected, and the majority of them are of reproductive age. It is estimated that health professionals working in obstetrics will begin to see more women with symptoms of HIV infection. Trends in obstetric research include clinical trials of treatment of HIV-infected pregnant women with zidovudine and the potential use of ultrasound-guided invasive testing of the fetus to determine fetal infection status. Sonographers working in obstetrics should be educated about the transmission of HIV, its potential impact on maternal and fetal health, and appropriate infection control procedures.

In October 1990 there was a severe outbreak of Escherichia coli O157 in two psychogeriatric wards of a large psychiatric hospital in Lanarkshire. There were 11 cases (eight patients and three staff), of whom four died (all patients). Two cases, one staff and one patient (the likely index case) were identified serologically after the outbreak was over. E. coli O157 was not cultured from any food, water or milk samples, and the evidence suggests that the index case had eaten food brought into the hospital. The results also suggest that the incubation period of the organism may be longer than is currently recognized, particularly for person-to-person spread. A Fatal Accident Inquiry was held into the deaths, and the Sheriff's Determination is discussed together with the implications of the results for infection control procedures.

Wounds will readily acquire bacteria, unless protective measures are taken. The bacterial protection afforded by conventional absorbent cellulose dressings has been shown to be limited, particularly in the presence of serous exudate that may compromise dressing integrity. In addition, dressings may shed particles that remain in the wound. By contrast, many modern dressings are impermeable to bacteria, are removed completely, have been found to optimize reepithelialization rates and reduce the incidence of wound sepsis. Recently, it has been found that they could also play a role in preventing cross-contamination. Removing conventional cellulosic dressings from bacterially colonized wounds liberates wound bacteria into the air, and the numbers are slow to decline. However, using an in vitro wound model, use of the hydrocolloid dressing Granuflex (ConvaTec, Skillman, NJ) on experimentally colonized wounds resulted in significantly fewer numbers of airborne bacteria. Dispersal from wet conventional dressings was lower than from dry dressings; nevertheless, the numbers of bacteria per liter of air following removal of the hydrocolloid dressing were approximately 20% of those observed for gauze. These findings have also been confirmed in the clinic. To reduce the incidence of complications, wound care in general, and infection control procedures in particular, requires carefully disciplined team work.

Summary. This paper presents the current status of school health policy at US medical schools and discusses implications for medical students with respect to physical health and occupational risks. The authors discuss the responsibility of schools to ensure that students are healthy and fit, both for their own benefit and to provide models of good health maintenance for their future patients. Schools have an obligation to monitor public safety issues, particularly in cases of chemical impairment, student mistreatment, and infection control procedures.

Universal precautions and general infection control measures need to be considered when undertaking any clinical procedure, but when administering intravenous (IV) therapy (medicines and/or maintenance fluids), specific measures need to be considered. This is especially important for vulnerable patients or if administering IV therapy in the home environment. There are many reasons why patients may need to receive IV therapy in the community, and these will all present nurses with specific problems. This article discusses some of the infection control procedures one must undertake when administering IV therapy to patients in the community.

Summary With concerns about the potential for the aerosol and airborne transmission of infectious agents, particularly influenza, more attention is being focused on the effectiveness of infection control procedures to prevent hospital-acquired infections by this route. More recently a number of different techniques have been applied to examine the temporal–spatial information about the airflow patterns and the movement of related, suspended material within this air in a hospital setting. Closer collaboration with engineers has allowed clinical microbiologists, virologists and infection control teams to assess the effectiveness of hospital isolation and ventilation facilities. The characteristics of human respiratory activities have also been investigated using some familiar engineering techniques. Such studies aim to enhance the effectiveness of such preventive measures and have included experiments with human-like mannequins using various tracer gas/particle techniques, real human volunteers with real-time non-invasive Schlieren imaging, numerical modelling using computational fluid dynamics, and small scale physical analogues with water. This article outlines each of these techniques in a non-technical manner, suitable for a clinical readership without specialist airflow or engineering knowledge.

A review of the immunologic benefits of human milk is presented, with emphasis on the antiviral properties of human milk. These properties are so important to infant health that the World Health Organization has restated its recommendation. "In all populations, irrespective of HIV infection rates, breast-feeding should continue to be protected, promoted, and supported." Infection control procedures are described for human milk banking, which should be supported as an immunologically beneficial feeding alternative for infants.

As of 1992, approximately 1,000,000 Americans are infected with HIV. The natural history of the illness includes a relatively long latent period (about 10 years) between infection and development of AIDS. Surgeons are called on to participate in the management of these patients, usually for diagnostic biopsies, supportive measures, or intraabdominal events. Precautions and safe surgical practices will minimize the risk of HIV transmission from patient to surgeon (or surgeon to patient).

Infectious diseases kill more people worldwide than any other single cause, according to the U.S. National Library of Medicine. With Ebola raising its ugly head, combined with the mysterious enterovirus D68 and the fact that we're heading into cold and influenza season, hospital pharmacists continue to play key roles in infectious disease control, antimicrobial stewardship programs, and managing antibiotics.

Recent efforts to reduce infections have been focused within the hospital setting. Early hospital discharge, shorter inpatient stays, day surgery and the movement of patients between acute and long-stay care facilities is likely to make community-acquired infection an increasing problem. There are, or course, universal precautions and general infection control issues to consider when undertaking any clinical procedure, both in hospital and the community, but when administering intravenous therapy (medicines and/or maintenance fluids) specific measures need to be considered. This is especially important if a patient is receiving intravenous therapy at home. There are many reasons why patients may need to receive intravenous therapy in the community and these will all present with specific problems. This paper will discuss some of the infection control procedures one must undertake when administering intravenous therapy to patients in the community.

Many healthcare-associated infections (HCAIs) are preventable by infection control procedures designed to interrupt the transmission of organisms from a source. Commodes are in use constantly throughout healthcare facilities. Therefore commode surfaces are constantly handled, and any pathogens present have the potential to be transferred to not only other surfaces but also, more importantly, to patients, thus compromising patient safety. In order to examine the effectiveness and thoroughness of cleaning commodes an audit was undertaken to assess compliance with evidence-based practice. This audit demonstrates a cycle which includes defining best practice, implementing best practice, monitoring best practice and taking action to improve practice. The audit results confirmed an issue that the authors had long suspected. That is, that commodes allocated to individual patients are not always cleaned after every use. Using adenosine triphosphate (ATP) bioluminescence as an indicator of organic soiling also demonstrated that commodes that were considered clean were not always cleaned to a high standard. Implementing the audit recommendations improves staff knowledge through education, standardises cleaning procedures and ultimately improves patient safety.

We develop a compartmental mathematical model to address the role of hospitals in severe acute respiratory syndrome (SARS) transmission dynamics, which partially explains the heterogeneity of the epidemic. Comparison of the e ffects of two major policies, strict hospital infection control procedures and community-wide quarantine measures, implemented in Toronto two weeks into the initial outbreak, shows that their combination is the key to short-term containment and that quarantine is the key to long-term containment.

BACKGROUND: In the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission. METHODS: A retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission. RESULTS: 45 laboratory-confirmed intubated SARS patients were identified. Of the 697 HCWs involved in their care, 624 (90%) participated in the study. SARS-CoV was transmitted to 26 HCWs from 7 patients; 21 HCWs were infected by 3 patients. In multivariate GEE logistic regression models, presence in the room during fiberoptic intubation (OR = 2.79, p = .004) or ECG (OR = 3.52, p = .002), unprotected eye contact with secretions (OR = 7.34, p = .001), patient APACHE II score > or = 20 (OR = 17.05, p = .009) and patient Pa0(2)/Fi0(2) ratio < or = 59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients. CONCLUSION: Close contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients.

Force field analysis, a technique promulgated by Lewin 50 years ago, is an aid to infection control practice in situations where it is necessary for individuals to substitute new routines for previously accepted practice, as in the required used of personal protective equipment as part of Universal Precautions. By providing a way to link the multiple factors that may be determinants of an individual's behavior, force field analysis offers a way to uncover salient issues and to identify potentially fruitful avenues for intervention to promote the desired behavior change.Force field analysis directs attention to the goal(s) to be achieved through the behavior and to the forces that drive or restrain the individual in the performance of the behavior being examined. Viewed in relation to use of personal protective equipment as part of infection control procedures, using force field analysis involves becoming clear about the purpose(s) of using personal protective equipment, factors that motivate and make easy the use of personal protective equipment, and factors that act as barriers or deterrents to using personal protective equipment. Recent commentaries in this journal have addressed these issues separately: Jackson and Lynch described the differing purposes of systems of infection control commonly referred to as Universal Precautions and their consequently differing procedures, pointing out potentials for confusion owing to goal; Campbell, 3 reviewing theories of motivation and power, suggested that infection control practitioners attend to these in addition to the technical aspects of practice. Force field analysis brings together these and others of the myriad elements that influence behavior, allowing the practitioner to think creatively about why and why not particular behavior occurs and then to think about what might help make the behavior more likely to occur.

Dental hospital staff and students were observed during clinical work for their compliance with infection control procedures, as recommended by the British Dental Association. A total of 183 contacts between health care worker and patient were scrutinised during December 1990. Nearly all health care workers (96%) wore gloves to carry out dental treatment, but in some cases gloves were neither changed nor hands washed between patients. Only one half wore protective eyewear and about one third (38%) wore no mask. Some dental surgery assistants used heavy duty gloves and some even scrubbed dirty dental instruments without wearing any gloves. Strict audit is clearly needed in every clinical setting in order to ensure compliance with infection control.

The past couple of years have given U.S. dentists a lot to think about. OSHA regulations, a declining economy, lingering concerns about fluoridation, dental amalgam and safety in health care settings have captured the attention of dentists everywhere.

This paper reviews infection control procedures with the related regulations and recommendations. Procedures for processing contaminated instruments include presoaking, cleaning, packaging, sterilization, spore-testing and hand-piece asepsis. Surface asepsis techniques include surface covering, surface precleaning and surface disinfection.

Long term care facilities (LTCFs) are being considered for the care of PWAs. To better understand the level of preparedness for accepting residents with AIDS, a survey of policies, attitudes, and infection control procedures was sent to randomly selected LTCFs in California, New Jersey, Georgia, and Nebraska. Despite the different prevalence rates of AIDS cases across the four states, there was general agreement on most of the questionnaire items. Over half of the respondents reported having a written policy regarding AIDS (54 percent); also, more respondents expected problems with confidentiality issues (78 percent) and staff attitudes (82 percent). The mean ratings of anticipated attitudes ranged from neutral for management level staff to negative for direct care staff and residents' families. Overall, the respondents rated their LTCFs most prepared in specific infection control procedures and least prepared in areas such as education and psychosocial support. The cost to prepare facilities was estimate...

Approximately 15% of nosocomial infections in the ICU result from spread of bacteria on caregivers' hands. The routine chest radiograph provides an unexamined opportunity for bacterial spread: close contact with each patient and sequential examination of ICU patients. This study examined infection control procedures performed during routine chest radiographs, assessed whether resistant bacteria were transferred to the radiograph machine, and determined whether improved infection control practices by radiograph technicians could reduce bacterial transfer.Radiograph technicians were observed performing chest radiographs on all ICU patients. Culture specimens were taken from the radiograph machine. An educational intervention directed at technicians was instituted, and its effect on infection control and machine contamination was measured.Surveillance of 173, 113, and 120 chest radiographs during observation, intervention, and follow-up periods was performed. Adequate infection control was practiced during the performance of 2 of 173 observation period radiographs (1%), 48 of 113 intervention period radiographs (42%; p0.001), and 12 of 120 follow-up period radiographs (10%; (p0.001) [follow-up vs intervention and observation periods]. Radiograph machine surface culture samples yielded resistant Gram-negative bacteria on 12 of 30 occasions (39%), 0 of 29 occasions, and 7 of 14 occasions (50%), respectively, for the observation, intervention, and follow-up periods (p0.001).Multiresistant bacteria are frequently transferred from patients to the radiograph machine in the presence of poor infection control practices, and may be a source of cross-infection/colonization. Improved infection control practices decrease the occurrence of resistant organisms on the radiograph equipment. Radiograph technicians should be included in efforts to improve infection control measures.

Staphylococci are still the most common agents implicated in hospital-acquired infections. In addition to Staphylococcus aureus, coagulase-negative staphylococci have attracted widespread interest, since they have emerged as the most frequent pathogen in foreign-body related infections. The emergence of methicillin-resistant S. aureus has resulted in increasing use of potentially toxic and extremely expensive antibiotics. To prevent hospital-acquired staphylococcal infections only control measures proven to be effective should be implemented and the cost of infection control procedures should always be considered. Handwashing as the simplest, cheapest, and still the most effective measure should constantly be stressed. In this article, effective procedures for the prevention of hospital-acquired staphylococcal infections are summarized, with special emphasis on cost-saving measures.

Objectives: To assess whether dentists in Jordan are employing recommended infection techniques in their clinics and to identify the level of compliance of dentists with the recommended infection techniques commonly found in western countries. Participants: Dentists in Jordan (n=300). Methods: A questionnaire incorporating information regarding: infection control practices, vaccination, personal barrier protection, instrument sterilisation and disinfection, were distributed to 300 dentists in private and public practices. Results: A (93%) response rate (n=279) was available for analysis. Gloves were used by 73.3% of dentists; masks by 69.5%, protective eye wear by 43.8% and white coats worn by 75.9%. About 25% recorded patient medical histories. Offices in Jordan were found to be in compliance with respect to the use of disposable anaesthetic needles and carpules but only 27% use plastic containers for sharps; 72.6% of dentists had been vaccinated against hepatitis B viruses; approximately 70% use an autoclave for sterilisation but only 15% always use plastic bags for packing sterilised instruments. Conclusions: The majority of dental practitioners were found to be in compliance with most of the recommended infection control regulations. In this study the overall compliance with infection control procedures was 61.17% among dentists in Jordan. Further education may be appropriate in taking a medical history of each patient before treatment, wearing of masks and protective glasses and the use of plastic bags to wrap sterilised instruments.

And so it begins – barely 2 months into 2008 and already the number of newspaper column inches racked up by a selection of NHS Trusts regarding shoddy infection control procedures and meticillinresistant Staphylococcus aureus (MRSA) rates is snowballing. Happy New Year! And unfortunately, everyone involved has been lightening quick to apportion blame – the Government now blames patients for being too pushy when asking for antibiotics, patients blame hospital staff and cleaners for not doing their jobs properly, hospital staff apparently blame the cleaners and upper management, and management blame everyone but themselves. Is it not time for everyone involved, including patients, to realize that it is everyone’s responsibility?

Infection is a common cause of admission to the ICU and is also commonly acquired on the ICU. Appropriate, early treatment improves outcome but choice of therapy is often empiric because of the delay in processing most microbiological specimens. This encourages the use of broad spectrum agents which leads to the selection of multiresistant bacteria, setting up a vicious circle of antibiotic use and resistance. The problem is enhanced by poor adherence to infection control procedures and the most intensive use of antibiotics anywhere in the hospital. Current resistant problems are greater than ever experienced and herald the dawn of untreatable infections. This comes during a period of reduced pharmaceutical company research on developing new agents. The author reviews the various strategies that can be employed to improve the quality of antibiotic prescribing in order to both improve patient outcome and reduce the selection of resistant strains. The use of the microbiological laboratory is explored in particular detail as are new pharmacodynamic concepts which guide dosing schedules. Particular attention is paid to combination therapy, stewardship strategies, and empiric treatment choices.

Public awareness of cross infection has grown in the wake of hepatitis B and HIV. Sandra Ilott puts forward measures to help nurses keep their knowledge of infection control procedures up to standard.

In the event of an infectious disease outbreak, home health nurses are called upon to care for patients who have been placed on isolation precautions. To protect themselves, patients, and caregivers, nurses must be knowledgeable about infectious diseases and infection control procedures. A checklist is provided to assist the nurse and caregiver with guidance in performing the patient's care.

It is essential to monitor the utilisation of antibacterial drugs in order to establish appropriate measures for their control. The pattern of usage of antibacterial drugs, and its association with indicators of hospital infection, has been investigated in a non-specialized adult intensive care unit (ICU) located in Santa Luzia Hospital (Brasília, DF, Brazil). The study was conducted between January 2001 and June 2004. Data concerning the utilisation of systemic antibacterial drugs, classified according to the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) system, and indicators of hospital infection, defined according to the National Nosocomial Infections Surveillance (NNIS) system, were obtained from appropriate hospital archives. During the study period, the average utilisation of antibacterial drugs was 1918.5 DDD units per 1000 patient-day (DDD(1000)). The three most used drugs were penicillins/beta-lactamase inhibitors (535.3 DDD(1000)), third generation cephalosporins (239.1 DDD(1000)) and quinolones (212.5 DDD(1000)). The total utilisation of antibacterial drugs was correlated significantly with the incidence of hospital infection (R = 0.62; p0.01) and the index of invasive procedures (R = 0.41; p0.01). Furthermore, the latter two indicators were significantly and positively correlated with the use of recently commercialized, broad spectrum antibacterial drugs (except for carbapenems). It is concluded that improved infection control procedures, together with more rigorous criteria regarding the use of invasive procedures, should be implemented by the ICU studied in order to diminish the utilisation of antibacterial drugs.

Background: Dentists have a responsibility to provide HIV-infected patients, particularly because oral lesions are common among these patients. It is obvious that having adequate knowledge about HIV/AIDS enhances confidence in ability to manage infected patients.The present study was conducted to assess self-reported knowledge and attitude toward the treatment of HIV/AIDS infected individuals by the Dental Practitioners working in a public sector institute. Materials and Method: The present study was a Questionnaire based study which studied the factors associated with Self-reported knowledge and Attitude toward the treatment of HIV/AIDS infected individuals by the Dental Practitioners working in a public sector institute. Results : The willingness to treat patients with HIV was satisfactory (72.0%) among the dental practitioners in the present study but 64% of the dentists thought that treating an HIV patient would have an effect on the other patient's attitude in rendering treatment/dental care. Also, majority (70.0%) of the dentists thought that infection control procedures necessary for the treatment of the patients with HIV is not a financial burden for the practice. Conclusion : The level of knowledge regarding HIV and AIDS was acceptable in the present study. However, the dental school curriculum must be updated and improved in order to enhance the knowledge of students as well teachers in those aspects.

This paper presents an overview of three of the most commonly encountered 'superbugs; with a comment on the implications of each for the dental practitioner. The origins of antibiotic resistant micro-organisms lie in the acquisition of resistance genes and selection pressures, with their spread facilitated by inappropriate prescribing and inadequate infection control. Dentists should attempt to rationalize their antibiotic prescribing and ensure that they and other dental staff adhere to standard infection control procedures.Many dental practitioners will treat a wide range of patients in a variety of healthcare settings ranging from general practices to hospital in-patients. It is increasingly likely that they will either knowingly or unknowingly come into contact with people colonized or infected with drug-resistant micro-organisms. This article explains the background to some commonly occurring antibiotic-resistant bacteria.

This paper reports a cross-sectional questionnaire study that investigated perceived stress and psychological responses to the SARS outbreak in healthcare students at the height of the outbreak in Hong Kong in 2003. Non-healthcare university students served as controls. All the groups reported high levels of perceived stress. Despite being similarly confident in infection control procedures, nursing students were significantly more stressed than medical students, possibly reflecting a perceived higher risk of infection due to more prolonged contact with patients. Non-healthcare students also had high stress levels due to the perceived risks of dying from SARS, reflecting a fear of the unknown. Suitable psychological and occupational support services should be made available in case of future outbreaks.

To determine the prevalence of Burkholderia cepacia from the environment in a regional adult cystic fibrosis (CF) care centre.Two hundred and eighty-five environmental samples were taken from inpatient and outpatient environments within the CF centre. Following a non-selective enrichment step, broths were plated onto a selective medium and B. cepacia isolates were confirmed by phenotypic tests and also genotypically by species specific 16S rRNA PCR.B. cepacia was not detected from commonly shared items of equipment, staff hands, staff uniforms or toilets. In addition, the organism was not detected in toilet bowls, even in the B. cepacia unit. With regard to positive environments for B. cepacia, 4/10 (40%) of the outside surfaces and inner rims of patients' plastic disposable sputum collection containers and 4/17 (23.5%) of air from patients' rooms, following physiotherapy, were positive.All positive samples originated in the B. cepacia segregation area of the inpatient wards and B. cepacia was not detected in the non-cepacia area of the CF centre. Consequently, these two positive sites should therefore be treated as high risk, where organisms may be potentially transmitted from environment to patient. As there is now evidence to suggest differences in the virulence and hence clinical outcome of certain of the genomovars of this organism, this study may be important in highlighting the areas that patients who are B. cepacia positive should avoid, to minimise the risk of transmission and acquisition of this organism within the CF cepacia population. These results indicate that effective infection control procedures are required in patients' rooms following physiotherapy, for prevention of B. cepacia transmission and to avoid the transmission of different genomovar types within CF patients, who are already colonised with this pathogen.

An elderly patient dies from septic shock in the intensive care unit. This is perhaps not an unusual scenario, but in this case the sepsis happens to have been due to methicillin-resistant Staphylococcus aureus, possibly related to a catheter, and possibly transmitted from a patient in a neighbouring room by less than adequate compliance with infection control procedures. The family decides to sue. We present how experts from four different countries assess the medicolegal issues involved in this case.

Objectives: To survey the infection control procedures used by dental practitioners in Khartoum, Sudan. Methods: Questionnaires were distributed to 150 randomly sampled dentists practising in Khartoum state. Each questionnaire comprised 17 questions about basic infection control procedures. Results: A 100% response rate to the questionnaire showed that 92% of dentists routinely wore gloves when treating patients, 50% face masks, 61% a gown and 14.7% protective eye wear. Furthermore 52% of the practitioners had been immunised against Hepatitis B. The majority of practitioners (72%) used dry heat as their method of instrument sterilisation, 22% used an autoclave, 2% used boiling water and the remainder used chemical sterilisation. Safe disposal of clinical waste was undertaken by only 23% of dentists although 47% of practitioners stored sharp items in closed containers. All respondents used disposable dental needles, but only a few used other disposable items. There was a significant difference in the implementation of cross infection control procedures between salaried and private dental practitioners, especially with regard to handpiece sterilisation, use of disposables, the wearing of face masks and the availability of additional sets of instruments. Conclusion: There is a clear need to improve the existing situation particularly with regard to immunisation of dentists against Hepatitis B, the safe disposal of clinical waste and instrument sterilisation in Khartoum.

Background: Infection control procedures are essential for modern dental practice and they are continually evolving to meet the dental profession’s high standards. The present study evaluated the efficacy of two cleaning procedures to reduce bacterial numbers on endodontic files, and evaluated the effect of biological debris on the subsequent sterilization of files. Methods: Stainless steel and nickel-titanium (NiTi) files were examined upon removal from the manufacturer’s packaging, after instrumentation in root canals of human teeth inoculated with a broth containing two anaerobic species and one facultative anaerobic species of bacteria, and after instrumentation and cleaning with either an ultrasonic bath or a thermal disinfector. For each file, the bacterial numbers were quantified using routine microbiological techniques in an anaerobic chamber. Results: No bacteria were detected from files direct from their packets. The size, taper and type of file did not affect the ability of either of the cleaning procedures to reduce bacterial numbers. However, an absence of bacteria was more likely when files were cleaned in the thermal disinfector. No bacteria were detected from files that were subjected to steam sterilization irrespective of the type of prior cleaning procedure. Conclusions: Steam sterilization eliminated all bacteria from the endodontic files irrespective of the presence of biological debris. The majority of bacteria were eliminated from endodontic files after either ultrasonic cleaning or using a thermal disinfector.