A decade of nosocomial Acinetobacter

A review of nosocomial infections (NI) from January 1971 to April 1981 was conducted in a university-affiliated hospital to examine NI caused by Acinetobacter and to determine whether a rising trend in rates could be detected. Acinetobacter accounted for 85 of 6115 (1.4%) NI. Sites of infection were respiratory tract (42.2%), blood (17.8%), peritoneum (16.7%), urinary tract (10%), surgical wounds (7.8%), central nervous system (3.3%), and skin or eye (2.2%). All patients who developed NI from Acinetobacter were receiving systemic antimicrobial therapy; 58.8% were in the intensive care unit (ICU). The highest rates of Acinetobacter infection occurred in the early 1970s (2.3%); the lowest occurred from 1978 to 1981 (0.94%), p approximately 0.06. This decrease primarily resulted from two factors: a reduction in cross-infections, probably related to a structural change in the ICU from open-bed ward to single rooms, and the elimination of peritoneal infections traced to contamination of dialysate solution. We conclude that in this institution no rise in the proportion of NI caused by Acinetobacter has occurred over the past decade; if anything, there is a downward trend.

Effects of handwashing agent, handwashing frequency, and clinical area on hand flora

Six hundred twenty-two isolates from 554 samples taken from hands of 103 hospital personnel and 50 controls were obtained over a mean period of 35 days. Eighty-five were obtained immediately before and after handwashing (HW), the remainder after HW only. The relationship of HW agent used, clinical area and job, and frequency of HW to rates of bacterial colonization and numbers and types of organisms isolated, particularly gram-negative bacteria, were evaluated. The HW agent used ( nonantiseptic , hexachlorophene-based, chlorhexidine-based, or iodophor) was significantly correlated with the number of isolates obtained from each sample. Control subjects, all of whom used nonantiseptic soaps, had 1.42 mean isolates per sample; hospital personnel who used nonantiseptic soap had a mean of 1.00 isolates per sample. Other means were 1.25, hexachlorophene; 1.43, iodophor; 0.79, chlorhexidine; and 0.67 for those who used several different antiseptics, p less than 0.0001. The agent was also correlated with the type of organisms isolated (p = 0.002), but not with the counts of colony-forming units (CFU). Frequency of HW was significantly correlated with CFU counts before (p = 0.03) and after (p = 0.001) HW. In general, numbers decreased with increasing HW frequency, but at the higher HW frequencies there was a slight rise. There were significant differences in numbers of isolates per sample according to clinical area, with personnel working in obstetrics and nonpatient areas having the greatest number and those working on neonatal and medical-surgical units having the least (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Job satisfaction. Assumptions and complexities

It has long been assumed that job satisfaction relates to employee turnover and quality of care. In this article the difficulties of measuring job satisfaction are discussed in light of results from a 6-month assessment by nurse employees in a university-affiliated acute care hospital. The authors found that job satisfaction scores were significantly predicted by respondents' job expectations and the importance they placed on various components of the work situation. The authors conclude that job satisfaction measurement is most valid and reliable when these two predictors are taken into account.

Compilance with isolation technique

We found that compliance with isolation precautions was less than optimal. It appeared that personnel were unaware of instances in which they had become contaminated. Increasing such awareness is indicated as an incentive to improve compliance. In addition, there were two areas in which education seemed to be indicated: for housekeeping staff to assure that they understood the need to contain infectious organisms within the isolation room as well as protecting themselves and for all personnel to identify the need for handwashing after removing gloves. Others have found that a careful monitoring program by an ICP can significantly reduce the overuse, but not underuse, of isolation. Such monitoring leads to considerable cost savings. We recommend that compliance with isolation technique be monitored on a periodic basis in other acute care institutions.

Combining nursing quality assurance and research programs

This article discusses the advantages and disadvantages of combining nursing quality assurance and research programs in clinical settings. The intended audiences and scopes of quality assurance and research differ, causing potential conflicts in combined programs. Such conflicts include the methods of disseminating findings, action taken on data obtained, analytic methods used, and issues of territoriality. However, advantages of combining these programs are great. Nursing research can be introduced into the clinical setting via quality assurance; resultant studies are more likely to be of direct clinical relevance; and results are more likely to be integrated into practice when programs are combined rather than separate. Combined programs are also cost efficient.

Factors influencing handwashing behavior of patient care personnel

Factors that are important in influencing individuals to wash or not wash their hands were studied in 193 health care personnel. The most important factor favoring handwashing (HW) was the prevention of spread of infection among patients; the most important factor against HW was busy-ness. Physicians reported HW significantly less frequently than did nurses (p = 0.04). Individuals who washed infrequently, less than eight times per day, placed significantly more value on detrimental effects of frequent HW on their own skin and on the HW practices of their work colleagues than did individuals who washed frequently, more than 16 times per day (p less than 0.005). Frequent and infrequent washers did not differ significantly in their values regarding the factors favoring HW. Identifying factors that are determinants of whether one decides to wash one's hands or not are important in planning intervention strategies to improve practice. It appears that more emphasis should be placed on minimizing deterrents (especially detrimental effects on skin and peer pressure) rather than on emphasizing the importance of HW.

Coexistence of cognitive impairment and depression in geriatric outpatients

The authors diagnosed depression in 20 (23%) of 88 cognitively impaired geriatric outpatients. Three (20%) of these patients had depression only, and 17 (85%) had depression superimposed on an underlying dementia. The rate of coexisting depression decreased significantly with greater severity of the cognitive impairment: 9 (33%) of 27 mildly impaired patients were depressed, compared with 8 (23%) of 35 moderately impaired and 3 (12%) of 26 severely impaired patients. There was a nonsignificant trend for cognitively impaired women to be more likely to be depressed than for similarly impaired men. The authors conclude that although depression must be differentiated from dementia, it is equally important to consider the possibility that the diagnoses coexist.

Treatment results at a multi-specialty clinic for the impaired elderly and their families

Geriatric and Family Services at the University of Washington provides a comprehensive evaluation and treatment program for the impaired elderly, and also offers support, counseling and practical advice for their families. Although most of the 76 patients in this first-year study had cognitive impairment, about one-fourth of them showed unequivocal motor, cognitive and/or affective improvement with treatment for previously undetected illnesses. The rating of "unequivocal improvement" required objective data, as well as corroboration by the patient and family. These therapeutic gains and the increased public interest led to expansion of the program.

A convenient standard for low-field susceptibility calibration

Finely ground mixtures of magnetic iron oxide and glass provide a convenient calibration standard of moderate accuracy (approximately 5%) for low-field (<0.5 kA/m) magnetic susceptibility measurements. The use of powders allows fabrication of standards of nearly any shape and size. For our mixtures, which range from 0.063 to 11.8% iron oxide by weight, the susceptibility values vary from 2.65 x 10(-7) to 5.77 x 10(-5) m3/kg, and are nearly linear with iron oxide concentration.

Assessing the quality of care for urinary tract infection in office practice: a comparative organizational study

As part of a comprehensive evaluation of care received by enrollees in a prepaid community health care project, we studied the process of care for enrollees reported to have a urinary tract infection. The care given to 98 patients enrolled in a large prepaid group practice (PGP) and 69 patients seen by 45 physicians in the independent practice setting (IPP) was analyzed. We found the process of care to be significantly better in the PGP, with a large part of the difference due to more appropriate utilization of urine cultures. This occurred despite a higher visit rate to internists in the IPP, and suggests that the organization of practice strongly affects the process of care received by patients even when all care is fully prepaid.

The epidemiology of Staphylococcus aureus in a newborn nursery from 1970 through 1976

Results of seven years of epidemiologic surveillance for Staphylococcus aureus in a newborn nursery are presented as a follow-up of a study from this same institution published in 1969. Surveillance of the previous study included years 1961 through 1968. A continued rise in S. aureus colonization rates among newborns occurred from 1973 through 1976 as compared to previous years studied. This was related primarily to the discontinuance of hexachlorophene (HCP) bathing. Other contributing factors were the addition in 1972 of the umbilical (as well as anterior nares) site for culturing, potentially doubling the S. aureus retrieval; the use, beginning in 1972, of an HCP-inhibiting medium for staphylococcal culturing; and probably the presence in previous years of the Hawthorne effect. Clinical infection rates with S. aureus also increased significantly (P less than .001)when HCP bathing was in abeyance. Antibiotic sensitivity patterns of S. aureus isolated from 1970 through 1976 have remained the same. Five phage types were recurrent in causing clinical infections throughout the seven years. A recommended program for control of staphylococcal disease in the newborn nursery includes concentration on improvement of each staff member's individual technique, continuous epidemiologic surveillance, and routine umbilical care with triple dye or bacitracin. Bathing of infants with HCP should be considered a temporary treatment to be terminated as acute disease is controlled.