Management of multidrug-resistant organisms in healthcare settings, 2006

Jane D. Siegel, Emily Rhinehart, Marguerite Jackson, Linda Chiarello; the Healthcare Infection Control Practices Advisory Committee.Multidrug-resistant organisms(MDROs), including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and certain gram-negative bacilli (GNB) have important infection control implications that either have not been addressed or received only limited consideration in previous isolation guidelines. Increasing experience with these organisms is improving understanding of the routes of transmission and effective preventive measures. Although transmission of MDROs is most frequently documented in acute care facilities, all healthcare settings are affected by the emergence and transmission of antimicrobial-resistant microbes. The severity and extent of disease caused by these pathogens varies by the population(s) affected and by the institution(s) in which they are found. Institutions, in turn, vary widely in physical and functional characteristics, ranging from long-term care facilities (LTCF) to specialty units (e.g., intensive care units [ICU], burn units, neonatal ICUs [NICUs]) in tertiary care facilities. Because of this, the approaches to prevention and control of these pathogens need to be tailored to the specific needs of each population and individual institution. The prevention and control of MDROs is a national priority - one that requires that all healthcare facilities and agencies assume responsibility(1) (2). The following discussion and recommendations are provided to guide the implementation of strategies and practices to prevent the transmission of MRSA, VRE, and other MDROs. The administration of healthcare organizations and institutions should ensure that appropriate strategies are fully implemented, regularly evaluated for effectiveness, and adjusted such that there is a consistent decrease in the incidence of targeted MDROs. Successful prevention and control of MDROs requires administrative and scientific leadership and a financial and human resource commitment(3-5). Resources must be made available for infection prevention and control, including expert consultation, laboratory support, adherence monitoring, and data analysis. Infection prevention and control professionals have found that healthcare personnel (HCP) are more receptive and adherent to the recommended control measures when organizational leaders participate in efforts to reduce MDRO transmission(3).Also published as: American journal of infection control. 2007; 35(10 Suppl 2):S165-93.Includes bibliographical references (p. 54-70).Infectious DiseasePrevention and ControlSupersededPrevention and ControlHICPAC1806881

Guideline for isolation precautions preventing transmission of infectious agents in healthcare settings, 2007

Jane D. Siegel, Emily Rhinehart, Marguerite Jackson, Linda Chiarello; the Healthcare Infection Control Practices Advisory Committee.The Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007 updates and expands the 1996 Guideline for Isolation Precautions in Hospitals. The following developments led to revision of the 1996 guideline: 1. The transition of healthcare delivery from primarily acute care hospitals to other healthcare settings (e.g., home care, ambulatory care, free-standing specialty care sites, long-term care) created a need for recommendations that can be applied in all healthcare settings using common principles of infection control practice, yet can be modified to reflect setting-specific needs. Accordingly, the revised guideline addresses the spectrum of healthcare delivery settings. Furthermore, the term \u201cnosocomial infections\u201c is replaced by \u201chealthcare associated infections\u201d (HAIs) to reflect the changing patterns in healthcare delivery and difficulty in determining the geographic site of exposure to an infectious agent and/or acquisition of infection. 2. The emergence of new pathogens (e.g., SARS-CoV associated with the severe acute respiratory syndrome [SARS], Avian influenza in humans), renewed concern for evolving known pathogens (e.g., C. difficile, noroviruses, community-associated MRSA [CA-MRSA]), development of new therapies (e.g., gene therapy), and increasing concern for the threat of bioweapons attacks, established a need to address a broader scope of issues than in previous isolation guidelines. 3. The successful experience with Standard Precautions, first recommended in the 1996 guideline, has led to a reaffirmation of this approach as the foundation for preventing transmission of infectious agents in all healthcare settings. New additions to the recommendations for Standard Precautions are Respiratory Hygiene/Cough Etiquette and safe injection practices, including the use of a mask when performing certain high-risk, prolonged procedures involving spinal canal punctures (e.g., myelography, epidural anesthesia). The need for a recommendation for Respiratory Hygiene/Cough Etiquette grew out of observations during the SARS outbreaks where failure to implement simple source control measures with patients, visitors, and healthcare personnel with respiratory symptoms may have contributed to SARS coronavirus (SARS-CoV) transmission. The recommended practices have a strong evidence base. The continued occurrence of outbreaks of hepatitis B and hepatitis C viruses in ambulatory settings indicated a need to re-iterate safe injection practice recommendations as part of Standard Precautions. The addition of a mask for certain spinal injections grew from recent evidence of an associated risk for developing meningitis caused by respiratory flora. 4. The accumulated evidence that environmental controls decrease the risk of life-threatening fungal infections in the most severely immunocompromised patients (allogeneic hematopoietic stem-cell transplant patients) led to the update on the components of the Protective Environment (PE). 5. Evidence that organizational characteristics (e.g., nurse staffing levels and composition, establishment of a safety culture) influence healthcare personnel adherence to recommended infection control practices, and therefore are important factors in preventing transmission of infectious agents, led to a new emphasis and recommendations for administrative involvement in the development and support of infection control programs. 6. Continued increase in the incidence of HAIs caused by multidrug-resistant organisms (MDROs) in all healthcare settings and the expanded body of knowledge concerning prevention of transmission of MDROs created a need for more specific recommendations for surveillance and control of these pathogens that would be practical and effective in various types of healthcare settings.This document is intended for use by infection control staff, healthcare epidemiologists, healthcare administrators, nurses, other healthcare providers, and persons responsible for developing, implementing, and evaluating infection control programs for healthcare settings across the continuum of care. The reader is referred to other guidelines and websites for more detailed information and for recommendations concerning specialized infection control problems.Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007.Infectious DiseasePrevention and ControlSupersededHICPACEBeltrami/JHageman\u200eMarch \u200e26, \u200e2014

Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)

Since 1989, a rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) has been reported by U.S. hospitals. This increase poses important problems, including a) the lack of available antimicrobial therapy for VRE infections, because most VRE are also resistant to drugs previously used to treat such infections (e.g., aminoglycosides and ampicillin), and b) the possibility that the vancomycin-resistant genes present in VRE can be transferred to other gram-positive microorganisms (e.g., Staphylococcus aureus). An increased risk for VRE infection and colonization has been associated with previous vancomycin and/or multiantimicrobial therapy, severe underlying disease or immunosuppression, and intraabdominal surgery. Because enterococci can be found in the normal gastrointestinal and female genital tracts, most enterococcal infections have been attributed to endogenous sources within the individual patient. However, recent reports of outbreaks and endemic infections caused by enterococci, including VRE, have indicated that patient-to-patient transmission of the microorganisms can occur either through direct contact or through indirect contact via a) the hands of personnel or b) contaminated patient-care equipment or environmental surfaces. This report presents recommendations of the Hospital Infection Control Practices Advisory Committee for preventing and controlling the spread of vancomycin resistance, with a special focus on VRE. Preventing and controlling the spread of vancomycin resistance will require coordinated, concerted efforts from all involved hospital departments and can be achieved only if each of the following elements is addressed: a) prudent vancomycin use by clinicians, b) education of hospital staff regarding the problem of vancomycin resistance, c) early detection and prompt reporting of vancomycin resistance in enterococci and other gram-positive microorganisms by the hospital microbiology laboratory, and d) immediate implementation of appropriate infection-control measures to prevent person-to-person transmission of VRE.September 22, 1995.These guidelines were prepared for publication by the following CDC staff: Ofelia C. Tablan, Fred C. Tenover, William J. Martone, Robert P. Gaynes, William R. Jarvis, Martin S. Favero, J. Shaw, Hospital Infections Program, National Center for Infectious Diseases in collaboration with the Subcommittee on Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals .Includes bibliographical references (p. 10-13)

Updating the guideline methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC)

"The Healthcare Infection Control Practices Advisory Committee (HICPAC) is a federal advisory committee made up of 14 external infection control and public health experts who provide guidance to the Centers for Disease Control and Prevention (CDC) and the Secretary of the Department of Health and Human Services (DHHS) regarding the practice of healthcare infection prevention and control, strategies for surveillance, and prevention and control of healthcare associated infections (HAIs) in United States healthcare facilities. As such, one of the primary functions of the committee is to issue recommendations for preventing and controlling HAIs in the form of guidelines and less formal communications.Currently, HICPAC guidance documents are available on its website for download, and a number of additional documents have been published since HICPAC's inception, most commonly in Morbidity and Mortality Weekly Report (MMWR), Infection Control and Hospital Epidemiology (ICHE), and the American Journal of Infection Control (AJIC)." -p. 1Craig A. Umscheid, Rajender K. Agarwal, and Patrick J. Brennan, for the Healthcare Infection Control Practices Advisory Committee (HICPAC) .Title from title screen (viewed July 30, 2010).Mode of access: World Wide WebText document (PDF)

Guidelines for the prevention of intravascular catheter-related infections, 2011

"These guidelines have been developed for healthcare personnel who insert intravascular catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home healthcare settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, healthcare infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), American Society for Parenteral and Enteral Nutrition (ASPEN), Society of Interventional Radiology (SIR), American Academy of Pediatrics (AAP), Pediatric Infectious Diseases Society (PIDS), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Catheter-Related Infections published in 2002. These guidelines are intended to provide evidence-based recommendations for preventing intravascular catheter-related infections. Major areas of emphasis include 1) educating and training healthcare personnel who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a > 0.5% chlorhexidine skin preparation with alcohol for antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters and chlorhexidine impregnated sponge dressings if the rate of infection is not decreasing despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and >0.5% chlorhexidine preparations with alcohol for skin antisepsis). These guidelines also emphasize performance improvement by implementing bundled strategies, and documenting and reporting rates of compliance with all components of the bundle as benchmarks for quality assurance and performance improvement."- p. 7-8Naomi P. O'Grady, Mary Alexander, Lillian A. Burns, E. Patchen Dellinger, Jeffery Garland, Stephen O. Heard, Pamela A. Lipsett, Henry Masur, Leonard A. Mermel, Michele L. Pearson, Issam I. Raad, Adrienne Randolph, Mark E. Rupp, Sanjay Saint, and the Healthcare Infection Control Practices Advisory Committee (HICPAC).Also available via the World Wide Web as an Acrobat .pdf file (1.05 MB, 36 p.).Includes bibliographical references (p. 59- 82)

Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)

The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions. This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.Introduction -- Recommendations for environmental infection_control in health-care facilities -- Recommendations : Air -- Recommendations : Water -- Recommendations : Environmental services -- Recommendations : Environmental sampling -- Recommendations : Laundry and bedding -- Recommendations : Animals in health-care facilities -- Recommendations : Regulated medical wastes -- References -- Appendix:_ Water sampling strategies and culture techniques for detecting Legionellaeprepared by Lynne Sehulster, Raymond Y.W. Chinn.The material in this report originated in the National Center for Infectious Diseases and the Division of Healthcare Quality Promotion.June 6, 2003Includes bibliographical references (p. 31-42)

Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study.

Recently, the Centers for Medicare & Medicaid Services (CMS) final rule required that nursing homes (NHs) develop an infection control program that includes an antibiotic stewardship component and employs a trained infection preventionist (IP). The objectives of this study were to provide a baseline assessment of (1) NH facility and infection control program characteristics associated with having an infection control deficiency citation and (2) associations between IP training and the presence of antibiotic stewardship policies, controlling for NH characteristics. A cross-sectional survey of 2514 randomly sampled US NHs was conducted to assess IP training, staff turnover, and infection control program characteristics (ie, frequency of infection control committee meetings and the presence of 7 antibiotic stewardship policies). Responses were linked to concurrent Certification and Survey Provider Enhanced Reporting data, which contain information about NH facility characteristics and citations. Descriptive statistics and multivariable regression analyses were conducted to account for NH characteristics. Surveys were received from 990 NHs; 922 had complete data. One-third of NHs in this sample received an infection control deficiency citation. The NHs that received deficiency citations were more likely to have committees that met weekly/monthly versus quarterly ( P \u3c .01). The IPs in 39% of facilities had received specialized training. Less than 3% of trained IPs were certified in infection control. The NHs with trained IPs were more likely to have 5 of the 7 components of antibiotic stewardship in place (all P \u3c .05). The IP training, although infrequent, was associated with the presence of antibiotic stewardship policies. Receiving an infection control citation was associated with more frequent infection control committee meetings. Training and support of IPs is needed to ensure infection control and antibiotic stewardship in NHs. As the CMS rule becomes implemented, more research is warranted. There is a need for increase in trained IPs in US NHs. These data can be used to evaluate the effectiveness of the CMS final rule on infection management processes in US NHs

Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

Introduction -- Key Terms Used In the Guideline -- Abbreviations Used In the Guideline -- -- Part I. Background -- Health-care-associated bacterial pneumonia -- Health-care-associated legionnaires disease -- Health-care-associated pertussis -- Health-care-associated aspergillosis -- Health-care-associated viral infections -- Health-care-associated respiratory syncytial virus infection -- Health-care-associated parainfluenza infection -- Health-care-associated adenovirus infection -- Health-care-associated influenza -- Severe acute respiratory syndrome -- -- [Part II]: Categorization of Recommendations -- Prevention of Health-Care-Associated Bacterial Pneumonia -- Prevention and Control of Health-Care-Associated Legionnaires Disease -- Prevention and Control of Health-Care-Associated Pertussis -- Prevention and Control of Health-Care-Associated Pulmonary Aspergillosis -- Prevention and Control of Health-Care-Associated Respiratory Syncytial Virus, Parainfluenza Virus, and Adenovirus Infections -- Prevention and Control of Health-Care-Associated Influenza -- Severe Acute Respiratory Syndrome -- Part III: Performance Indicators -- Referencesprepared by Ofelia C. Tablan, Larry J. Anderson, Richard Besser, Carolyn Bridges, Rana Hajjeh.Title from title screen (viewed Aug. 14, 2006).Parts II and III also published as:MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports ; v. 53, no. RR-3. March 16, 2004."The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Division of Healthcare Quality Promotion, Denise M. Cardo, M.D., Director, and the Division of Bacterial and Mycotic Diseases, Mitchell L. Cohen, M.D., Director."System requirements: Adobe Acrobat Reader.Mode of access: Internet from the CDC web site. Address as of 08/14/06: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/CDCpneumo%5Fguidelines.pdfElectronic book.Includes bibliographical references (p. 96-178)

Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/ODSS Hand Hygiene Task Force

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.prepared by John M. Boyce, Didier Pittet."October 25, 2002.""The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Director; and the Division of Healthcare Quality Promotion, Steve Solomon, M.D., Acting Director." - p. 1Published also as: American journal of infection control, v. 30, no. 8, suppl 1; and in: Infection control and hospital epidemiology, v. 23, no. 12, suppl.Title from title.Includes bibliographical references (p. 34-44)

Guidelines for the prevention of intravascular catheter-related infections

"This report provides health-care practitioners with background information and specific recommendations to reduce the incidence of intravascular catheter-related bloodstream infections (CRBSI). These guidelines replace the Guideline for Prevention of Intravascular Device-Related Infections, which was published in 1996. The Guidelines for the Prevention of Intravascular Catheter-Related Infections have been developed for practitioners who insert catheters and for persons who are responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group composed of professionals representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatrics, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC). The recommendations presented in this report reflect consensus of HICPAC and other professional organizations." - p. 1-2Introduction -- Intravascular catheter-related infections in adult and pediatric patients: an overview -- Epidemiology and microbiology -- Pathogenesis -- Strategies for prevention of catheter-related infections in adult and pediatric patients -- Replacement of catheters -- Special considerations for intravascular catheter-related infections in pediatric patients -- Recommendations for placement of intravascular catheters in adults and children -- References -- Appendix A: Examples of clinical definitions for catheter-related infections -- Appendix B: Summary of recommended frequency of replacements for catheters, dressings, administration sets, and fluidsprepared by Naomi P. O'Grady...[et al.]."August 9, 2002."The material in this report was prepared for publication by the National Center for Infectious Diseases, James M. Hughes, M.D., Director; Division of Healthcare Quality Promotion, Steven L. Solomon, M.D., Acting Director.Also available via the World Wide Web.Includes bibliographical references (p. 19- 26)