1 - Special Issue Nosocomial Infection Update Robert A....

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416 Emerging Infectious Diseases Vol. 4, No. 3, July–September 1998 Special Issue As we enter the next millennium of infection control, we stand on the shoulders of giants— Jenner, Semmelweis, Nightingale, Oliver Wendell Holmes, and my own personal favorite, Thomas Crapper, the father of indoor plumbing. Modern infection control is grounded in the work of Ignaz Semmelweis, who in the 1840s demonstrated the importance of hand hygiene for controlling transmission of infection in hospitals. However, infection control efforts were spotty for almost a century. In 1976, the Joint Commission on Accreditation of Healthcare Organizations pub- lished accreditation standards for infection control, creating the impetus and need for hospitals to provide administrative and financial support for infection control programs. In 1985, the Centers for Disease Control and Prevention’s (CDC’s) Study on the Efficacy of Nosocomial Infection Control reported that hospitals with four key infection control components—an effective hospital epidemi- ologist, one infection control practitioner for every 250 beds, active surveillance mechanisms, and ongoing control efforts—reduced nosocomial infec- tion rates by approximately one third (1). Over the past 25 years, CDC’s National Nosocomial Infections Surveillance (NNIS) sys- tem has received monthly reports of nosocomial infections from a nonrandom sample of United States hospitals; more than 270 institutions report. The nosocomial infection rate has remained remarkably stable (approximately five to six hospital-acquired infections per 100 admissions); however, because of progressively shorter inpatient stays over the last 20 years, the rate of nosocomial infections per 1,000 patient days has actually increased 36%, from 7.2 in 1975 to 9.8 in 1995 (Table 1). It is estimated that in 1995, nosocomial infections cost $4.5 billion and contributed to more than 88,000 deaths—one death every 6 minutes. Nosocomial Infection Update Robert A. Weinstein Address for correspondence: Robert A. Weinstein, Cook County Hospital, Division of Infectious Diseases, 129 Durand, 1835 W. Harrison St., Chicago, IL 60612, USA; fax: 312-572- 3523; e-mail: rweinste@rush.edu. Historically, staphylococci, pseudomonads, and Escherichia coli have been the nosocomial infection troika; nosocomial pneumonia, surgical wound infections, and vascular access–related bacteremia have caused the most illness and death in hospitalized patients; and intensive care units have been the epicenters of antibiotic resistance. Acquired antimicrobial resistance is the major problem, and vancomycin- resistant Staphylococcus aureus is the pathogen of greatest concern. The shift to outpatient care is leaving the most vulnerable patients in hospitals. Aging of our population and increasingly aggressive medical and surgical interventions, including implanted foreign bodies, organ transplantations, and xenotransplantation, create a
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This note was uploaded on 05/04/2010 for the course EDUC 22331 taught by Professor Feev during the Spring '10 term at The School of the Art Institute of Chicago.

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1 - Special Issue Nosocomial Infection Update Robert A....

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