CDC guidelines for the prevention and control of nosocomial infections. Guideline for infection control in hospital personnel

Shock volume: Patient-specific cumulative hypoperfusion predicts organ dysfunction in a prospective cohort of multiply injured patients

BACKGROUND

Multiply injured patients are at risk of developing hemorrhagic shock and organ dysfunction. We determined how cumulative hypoperfusion predicted organ dysfunction by integrating serial Shock Index measurements.

METHODS

In this study, we calculated shock volume (SHVL) which is a patient-specific index that quantifies cumulative hypoperfusion by integrating abnormally elevated Shock Index (heart rate/systolic blood pressure ≥ 0.9) values acutely after injury. Shock volume was calculated at three hours (3 hr), six hours (6 hr), and twenty-four hours (24 hr) after injury. Organ dysfunction was quantified using Marshall Organ Dysfunction Scores averaged from days 2 through 5 after injury (aMODSD2-D5). Logistic regression was used to determine correspondence of 3hrSHVL, 6hrSHVL, and 24hrSHVL to organ dysfunction. We compared correspondence of SHVL to organ dysfunction with traditional indices of shock including the initial base deficit (BD) and the lowest pH measurement made in the first 24 hr after injury (minimum pH).

RESULTS

SHVL at all three time intervals demonstrated higher correspondence to organ dysfunction (R = 0.48 to 0.52) compared to initial BD (R = 0.32) and minimum pH (R = 0.32). Additionally, we compared predictive capabilities of SHVL, initial BD and minimum pH to identify patients at risk of developing high-magnitude organ dysfunction by constructing receiver operator characteristic curves. SHVL at six hours and 24 hours had higher area under the curve compared to initial BD and minimum pH.

CONCLUSION

SHVL is a non-invasive metric that can predict anticipated organ dysfunction and identify patients at risk for high-magnitude organ dysfunction after injury.

LEVEL OF EVIDENCE

Prognostic study, level III.

Infection control concepts in critical care

Patients with critical illnesses requiring aggressive medical intervention are at risk of acquiring serious nosocomial infection that may lead to increases in medical expenditures, morbidity, and mortality. Infection control in this population entails continuous surveillance for hospital-acquired infection, with investigation of outbreaks. Policies for effective antibiotic utilization, disinfection of medical devices and hospital environment, and patient isolation may limit nosocomial infection in this population. Finally, an effective infection control program should protect the health care worker from hospital-acquired infections through educational programs, routine health surveillance, vaccinations, and post-exposure care.

Prevalence of use of infection control rituals and outdated practices: Education Committee survey results

BACKGROUND

To better serve APIC membership, the National APIC Education Committee periodically conducts educational needs assessments.

METHODS

In the July/August 1995 issue of APIC News, the committee published a survey on the prevalence of infection control "sacred cows," practices considered to be outdated and ritualistic. A response was requested only from ICPs working in inpatient facilities. We asked ICPs which of the listed practices were part of their facility's infection control program, and whether they were interested in changing those that were. We also asked about the certification status of the program's manager (CIC vs non-CIC).

RESULTS

A total of 506 survey forms were completed and returned, with 74% from acute care only, 7% from long-term care only, 10% from acute and long-term care, and 8% from other types of facilities. Mean number of beds was 226. Infection control programs had existed for a mean of 15 years. Most respondents' facilities still engaged in infection control rituals. Fifty-eight percent of respondents were still doing total surveillance, 43% were still using reverse or protective isolation, and 11% were still subjecting employees with positive reactions to purified protein derivative of tuberculin testing to annual chest radiographs, to name a few. Certified respondents were significantly less likely to include outdated practices than were non-CICs for 11 of 15 practices (73%). CICs were no more likely than non-CICs, however, to be interested in changing any current rituals.

CONCLUSION

The Education Committee will use this information to plan future educational offerings.

Cytomegalovirus: epidemiology and infection control

Cytomegalovirus (CMV) causes asymptomatic infection in most individuals but can produce devastating illness in immunocompromised hosts and in a small proportion of congenitally infected babies. New techniques in molecular biology have provided insights into the epidemiology and transmission of CMV. Children in day care, their parents, and sexually active individuals, especially homosexual men, are now known to be at particular risk for acquiring CMV. Recent studies show that the risk of CMV acquisition by health care workers is similar to the risk to the general public. Health care workers should be aware of the wide range of clinical manifestations, methods of laboratory diagnosis, and current limitations of treatment of CMV. Careful handwashing and avoidance of excretions and secretions are recommended to decrease the transmission of CMV in the hospital.