Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-05T02:59:40.888Z Has data issue: false hasContentIssue false

Requirements for Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report

Published online by Cambridge University Press:  02 January 2015

William E. Scheckler*
Affiliation:
Society for Healthcare Epidemiology of America (SHEA) Consensus Panel
Dennis Brimhall
Affiliation:
University of Colorado Hospital, Association for Professionals in Infection Control and Epidemiology, Inc (APIC)
Alfred S. Buck
Affiliation:
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Barry M. Farr
Affiliation:
Society for Healthcare Epidemiology of America (SHEA) Consensus Panel
Candace Friedman
Affiliation:
University of Colorado Hospital, Association for Professionals in Infection Control and Epidemiology, Inc (APIC)
Richard A. Garibaldi
Affiliation:
American Hospital Association (AHA)
Peter A. Gross
Affiliation:
Infectious Diseases Society of America (IDSA)
Jo-Ann Harris
Affiliation:
Pediatric Infectious Diseases Society (PIDS)
Walter J. Hierholzer Jr
Affiliation:
Hospital Infection Control Practices Advisory Committee (HICPAC)
William J. Martone
Affiliation:
National Foundation of Infectious Diseases (NFID)
Linda L. McDonald
Affiliation:
University of Colorado Hospital, Association for Professionals in Infection Control and Epidemiology, Inc (APIC)
Steven L. Solomon
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention (HIP-CDC)
*
Society for Healthcare Epidemiology of America, 19 Mantua Rd, Mt Royal, NJ 08061; e-mail [email protected].

Abstract

The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.

Type
SHEA Position Paper
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. American Hospital Association: Prevention and control of Staphylococcus infections in hospitals, in US Public Health Service—Communicable Disease Center and National Academy of Sciences-National Research Council. Proceedings of the National Conference on Hospital-Acquired Staphylococcal Disease. Atlanta, GA: Communicable Disease Center; 1958:XXIIIXXVI.Google Scholar
2. Garner, JS, Bennett, JV, Scheckler, WE, Maki, DG, Brachman, PS. Sur veillance of nosocomial infections, in Centers for Disease Control. Proceedings of the International Conference on Nosocomial Infections. Atlanta, GA: Centers for Disease Control; 1970:277281.Google Scholar
3. Joint Commission on Accreditation of Hospitals. Accreditation Manual for Hospitals. Chicago, IL: Joint Commission on Accreditation of Hospitals; 1976.Google Scholar
4. Haley, RW, Culver, DH, White, J, Morgan, WE, Amber, TG, Mann, VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.Google Scholar
5. Haley, RW, Tenney, JH, Lindsey, JO II, Garner, JS, Bennet, JV. How frequent are outbreaks of nosocomial infection in hospitals? Infect Control 1985;6:233236.CrossRefGoogle Scholar
6. Haley, RW, Morgan, WE, Culver, DH, White, J, Amber, TG, Mosser, J, et al. Update from the SENIC project. Hospital infection control: recent progress and opportunities under prospective payment. Am J Infect Control 1985;13:97108.CrossRefGoogle ScholarPubMed
7. Wenzel, RP. The economics of nosocomial infections. J Hosp Infect 1995;31:7987.Google Scholar
8. Crede, W, Hierholzer, WJ. Linking hospital epidemiology and quality assurance: seasoned concepts in a new role. Infect Control Hosp Epidemiol 1988;9:4244.Google Scholar
9. Joint Commission on Accreditation of Health Care Organizations. 1997 Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission on Accreditation of Health Care Organizations; 1997.Google Scholar
10. Farr, BM. Organization of infection control programs. In: Abrutyn, E, ed. Saunders Infection Control Reference Service. Philadelphia, PA: WB Saunders Co; 1997:1315.Google Scholar
11. Epidemiology and prevention of nosocomial infections of organ systems. Section III. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins; 1996:139269.Google Scholar
12. Perspectives. Section 1. In: Wenzel, RP, ed: Prevention and Control of Nosocomial Infections, 3rd ed. Baltimore, MD: Williams & Wilkens; 1997:154.Google Scholar
13. Miller, PJ, Farr, BM, Gwaltney, JM Jr. Economic benefits of an effective infection control program: case study and proposal. Reviews of Infectious Diseases 1989;11:284288.Google Scholar
14. Nyström, B. Impact of handwashing on mortality in intensive care: examination of the evidence. Infect Control Hosp Epidemiol 1994;15:435436.Google Scholar
15. Peter, JE, Cruse, MB, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin N Am 1980;60(1):2740.Google Scholar
16. Condon, RE, Schulte, WJ, Malangoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg 1983;118:303307.Google Scholar
17. Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Eng J Med 1992;326:281286.CrossRefGoogle ScholarPubMed
18. Diekema, DJ, Doebbeling, BN. Employee health and infection control. Infect Control Hosp Epidemiol 1995;16:292301.Google Scholar
19. Polder, JA, Tablan, OC, Williams, WW. Personnel health services. In: Bennett, JV, Brachman, PS, eds: Hospital Infections, 3rd ed. Boston, MA: Little, Brown and Co; 1992:3161.Google Scholar
20. Falk, P. Infection control and employee health service. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MA: Williams & Wilkins; 1996:10941099.Google Scholar
21. Anglim, AM, Collmer, JE, Loving, TJ, Beltran, KA, Coyner, BJ, Adai, K, et al. An outbreak of needlestick injuries in hospital employees due to needles piercing infectious waste containers. Infect Control Hosp Epidemiol 1995;16:570576.CrossRefGoogle ScholarPubMed
22. Faoagali, JL, Davey, D. Chickenpox outbreak among the staff of a large urban adult hospital: costs of monitoring and control. Am J Infect Control 1995;23:247250.Google Scholar
23. Haley, RW, White, JW, Culver, DH, Hughes, JM. The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system. An empirical determination from a nationally representative sample. JAMA 1987;257(12):16111614.Google Scholar
24. Ehrenkranz, NJ. The efficacy of a Florida hospital consortium for infection control, 1975-1982. Infect Control 1986;7:321326.CrossRefGoogle Scholar
25. Shewhart, WA. Statistical method from the viewpoint of quality control. Washington, DC: Graduate School of the Department of Agriculture; 1939. Reprinted New York, NY; Dover; 1986.Google Scholar
26. Garibaldi, RA, Burke, J. Surveillance and control of antibiotic use in the hospital. Am J Infect Control 1991;19:164170.Google Scholar
27. National Nosocomial Infection Surveillance Systems. Nosocomial infection rate for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 1991;12:609621.Google Scholar
28. The Quality Indicator Study Group. An approach to the evaluation of quality indicators of outcome of care in hospitalized patients, with a focus on nosocomial infection indicators. Infect Control Hosp Epidemiol 1995;16:308316.Google Scholar
29. Keita-Perse, O, Gaynes, RP. Severity of illness scoring systems to adjust nosocomial infection rates: a review and commentary. Am J Infect Control 1996;24:429434.CrossRefGoogle Scholar
30. Gaynes, RP, Solomon, S. Improving hospital-acquired infection rates: the CDC experience. Journal on Quality Improvement 1996;22:457467.Google ScholarPubMed
31. Brennan, PJ, Abrutyn, E. Developing policies and guidelines. Infect Control Hosp Epidemiol 1995;16:512517.Google Scholar
32. Abrutyn, E, Goldmann, DA, Scheckler, WE, eds. Saunders Infection Control Reference Service. Philadelphia, PA: WB Saunders Co; 1997.Google Scholar
33. Kaunitz, KRK, Kaunitz, AM. Legal aspects of hospital infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston: Little, Brown & Co; 1992:533573.Google Scholar
34. Bobinski, MA. Legal issues in hospital epidemiology and infection control. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins; 1996:11381145.Google Scholar
35. McDiarmid, M, Gamponia, MJ, Ryan, MAK, Hirshon, JM, Gillen, NA, Cox, M. Tuberculosis in the workplace: OSHA's compliance experience. Infect Control Hosp Epidemiol 1996;17:159164.CrossRefGoogle ScholarPubMed
36. Valenti, AJ, Decker, MD. OSHA inspections. Infect Control Hosp Epidemiol 1995;16:478482.Google Scholar
37. Nettleman, MD. Preparing for and surviving a JCAHO inspection. Infect Control Hosp Epidemiol 1995;16:236239.CrossRefGoogle ScholarPubMed
38. Centers for Disease Control and Prevention. Draft guideline for infection control in healthcare personnel, 1997, Centers for Disease Control. Federal Register 09 8, 1997;62:4727547327.Google Scholar
39. Nichol, KL, Lind, A, Margolis, KL, Murdoch, M, McFadden, R, Hauge, M, et al. Effectiveness of vaccination against influenza in healthy working adults. N Engl J Med 1995;333:889893.Google Scholar
40. McGowan, JE Jr, Metchock, BG. Basic microbiologic support for hospital epidemiology. Infect Control Hosp Epidemiol 1996;17:298303.CrossRefGoogle ScholarPubMed
41. Beck-Sague, C, Jarvis, WR, Martone, WJ. Outbreak investigations. Infect Control Hosp Epidemiol 1997;18:138145.CrossRefGoogle ScholarPubMed
42. Barg, NL. An introduction to molecular hospital epidemiology. Infect Control Hosp Epidemiol 1993;14:395396.Google Scholar
43. Jarvis, WR. Usefulness of molecular epidemiology for outbreak investigations. Infect Control Hosp Epidemiol 1994:15:500503.CrossRefGoogle ScholarPubMed
44. Ehrenkranz, NJ, Richter, EI, Phillips, PM, Shultz, JM. An apparent excess of operative site infections: analysis to evaluate false-positive diagnosis. Infect Control Hosp Epidemiol 1995;16:712716.CrossRefGoogle Scholar
45. Hoffmann, KK, Clontz, EP. Education of health care workers in the prevention of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins; 1996:10861094.Google Scholar
46. Haley, RW. The development of infection surveillance and control programs. In: Bennett, JV, Bachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little, Brown & Co; 1992:6377.Google Scholar
47. Centers for Disease Control. Public health focus: surveillance, prevention and control of nosocomial infections. MMWR 1992;41:783787.Google Scholar
48. Wong, ES. Surgical site infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins; 1996;154175.Google Scholar
49. Certification Board of Infection Control. CBIC Candidate Handbook. Lenexa, KS: Certification Board of Infection Control; 1996:128.Google Scholar
50. Institute of Medicine. Dick, RS, Steen, EB, eds. The Computer-Based Patient Record: An Essential Technology for Healthcare. Washington, DC: National Academy Press; 1991.Google Scholar
51. Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Infect Control Hosp Epidemiol 1997;18:426439.Google Scholar
52. Massanari, RM, Wilkerson, K, Swatzendruber, S. Designing surveillance for infectious outcomes of medical care. Infect Control and Hosp Epidemiol 1995;16:419426.Google Scholar
53. Wenzel, R, Carlson, B. Hospital epidemiology: beyond infection control and toward quality assurance. Clinical Microbiology News 1988;10:79.Google Scholar
54. Rose, RC III. Infection control to quality improvement: the right time, the right place, the work to be done. Clinical Performance and Quality Health Care 1997;5:1619.Google Scholar
55. Rutala, WA, Weber, DJ. Epidemiology: a critical tool for infection professionals. Am J Infect Control 1997;25:193194.Google Scholar
56. Brewer, JH, Gasser, CS. The affinity between continuous quality improvement and epidemic surveillance. Infect Control Hosp Epidemiol 1993;14:9598.Google Scholar
57. Sellick, JA Jr. The use of statistical process control charts in hospital epidemiology. Infect Control Hosp Epidemiol 1993;14:649656.CrossRefGoogle ScholarPubMed
58. Gross, PA, Barrett, TL, Dellinger, EP, Krause, PJ, Martone, WJ, McGowan, JE, et al. Infectious Diseases Society of America quality standards for infectious diseases. Purpose of quality standards for infectious diseases. Clin Infect Dis 1994;18:421.Google Scholar
59. Pearson, ML, the Hospital Infection Control Practices Advisory Committee. Guideline for prevention of intravascular-device-related infections. Infect Control Hosp Epidemiol 1996;17:438473.Google Scholar