Volume 27, Number 2
CONCLUSIONS: Administrative support is vital for "buy-in" to enforce handwashing for all associates and patients. A multidisciplinary team is a useful means for improving handwashing compliance. Educational programs and activities are essential to heighten handwashing awareness. Positive effects of improved handwashing behaviors improve the quality of patient care.
MULTIDISCIPLINARY TEAM APPROACH IN DEVELOPING TOOLS TO EVALUATE COMPLIANCE OF HANDWASHING AND GLOVE USAGE IN HEMODIALYSIS UNIT. G. H6bert, RN, BSC, DSA, CIC,* C. Bertrand RN, BSN, CIC, P. Rose RN, MSC(A), R. Beauchemin RN, BSC, M.Gatto RN, E Esquerra RN, BA. McGill University Health Center (MUHC) Royal Victoria Hospital, Montreal, Quebec, Canada.
OBJECTIVE: To develop a questionnaire and observation data sheet for an audit regarding compliance with blood and body substance precautions (BSP) and proper usage of gloves of healthcare workers (HCWs) in a hemodialysis unit. METHODS: The infection control practitioner (ICPs) met with the HCWs, physicians, and nurses) of the hemodialysis unit to investigate the problem and to develop a strategy. The ICPs performed a literature review focused on handwashing and BSP compliance and distributed articles to selected representatives of the hemodialysis unit. The delegates conferred with their co-workers and listed chronologically all procedures performed for a patient from his arrival to his d e p a r t u r e from the hemodialysis unit. RESULTS: A questionnaire and observation data sheet was developed with the delegates regarding BSP, glove usage, and handwashing in a hemodialysis unit. The questionnaire and observation data sheet were easy to use and 100% of the HCWs responded to the questionnaire. CONCLUSION: Enlisting the p a r t i c i p a t i o n of hemodialysis HCWs in a development of a questionnaire and observations data sheet resulted in a high response to the q u e s t i o n n a i r e . F u r t h e r m o r e , t h e i r p a r t i c i p a t i o n allowed them to define their specific needs and to target their problems.
Alternative Settings BACTERIA SUSCEPTIBILITY PATTERNS IN CENTRAL ARIZONA SKILLED N U R S I N G FACILITIES. M.
Reich, RN,* J. Marx, RN, MS, CIC. BioTech Medical Laboratories, Inc, Scottsdale, AZ. Emerging antimicrobial drug resistance in bacterial pathogens continue to be a p r o b l e m in all levels of health. Resistance patterns have been identified in acute care hospitals, b u t few studies have been done on a large n u m b e r of skilled nursing facilities. Over 1,000 culture
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and sensitive reports for over 35 skilled nursing facilities in central Arizona were reviewed. All cultures from all sites were used. Quarterly antimicrobial sensitivity figures were graphed and the resulting patterns were analyzed. P r o b l e m a r e a s were i d e n t i f i e d as 6.8% of Enterococcus feacalis were resistant to Vancomycin; more than 50.8% of Staphylococcus aureus were resistant to Oxacillin; E. coli s h o w e d a 43.5% r e s i s t a n t to Ampicillin and 5% resistance to Ciprofloxicin. Antibiotic resistance bacteria are a p r o b l e m in skilled nursing facilities. Causes of resistance include over prescribing of antibiotics by physicians with inadequate laboratory and physical assessment by the bedside health professional, limited r e i m b u r s e m e n t for therapies, and inadequate education of the resident or healthcare decision m a k e r about antibiotic use and resistance.
INFECTION CONTROL N U R S E LIAISON: OUR LINK TO THE 1990s EXPANDING "HOSPITAL" ENVIRONMENT. J. Oher, RN, BSN, CIC,* M. Wong, MD, M. Hodson,
RN, CIC, L. Reynolds, RN, CIC, M. Richard, RN, CIC, M. Edmond, MD, MPH. Medical College of Virginia Hospitals, Richmond, VA. JCAHO e x p a n d e d surveys a n d p u r c h a s e of private/clinic practices have given the infection control professional a unique challenge, particularly in an era of decreasing resources. Performing needs assessments, a p p r o p r i a t e e d u c a t i o n , a n d p r o v i d i n g t i m e l y while a p p r o p r i a t e infection control resources increases the challenge. The Medical College of Virginia hospitals JCAHO survey in March 1997 included newly p u r c h a s e d physician m a n a g e d practices and university m a n a g e d clinics. Geographically, the locations varied from locations on the hospital campus to 11/2hours away. Constant p h o n e calls and pre-JCAHO "infection control walkthroughs" led to developing onsite contact or "Infection Control Nurse Liaison." Each office was asked to identify one person, with an interest in infection control. An educational conference was conducted by the hospital e p i d e m i o l o g i s t s and infection control professionals. Topics included: (1) basic infection control, (2) isolation precautions and empiric use, (3) tuberculosis precautions in the a m b u l a t o r y care setting, (4) conducting educational inservices, (5) surveillance programs, and (6) disinfection and sterilization. Reference material including disease fact sheets, institution policies, and guidelines were also distributed. Case scenarios provided a review of the i n f o r m a t i o n with a c t u a l a p p l i c a t i o n . Several positive outcomes were noted: daily phone calls were reduced to occasional questions, and a face was attached to the name enhancing communication. The successful venture has led to developing a hospital-based nurse liaison for all acute care units. Annual meetings provide educational updates and will serve as the basis for establishing an a m b u l a t o r y surveillance plan.