Infection Control in Home Care.Although home care has expanded in scope and intensity in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. in the past decade, infection surveillance, prevention, and control efforts have lagged behind. Valid and reliable definitions and methods for surveillance are needed. Prevention and control efforts are largely based upon acute-care practices, many of which may be unnecessary, impractical, and expensive in a home setting. Infectious disease Infectious disease A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. control principles should form the basis of training home-care providers to assess infection risk and develop prevention strategies. Efforts to decrease length of hospital stay and shift care to ambulatory settings, as well as patient and family preference to receive care at home, have contributed to the substantial growth of home care in the past decade. As life expectancy Life Expectancy 1. The age until which a person is expected to live. 2. The remaining number of years an individual is expected to live, based on IRS issued life expectancy tables. in the U.S. population continues to increase and patients with chronic illnesses live longer, home care will continue to expand. Home care has also broadened in type and scope in the past decade. Most patients are elderly and have chronic conditions requiring skilled nurses and aides. High-tech home care is provided to patients of all ages and may include home infusion therapy home infusion therapy The IV administration of therapeutics–analgesics, antibiotics, chemotherapy, parenteral nutrition–outside of a formal healthcare environment. See Hyperalimentation, Patient-controlled analgesics, TPN. , tracheotomy tracheotomy (trākēŏt`əmē), surgical incision into the trachea, or windpipe. The operation is performed when the windpipe has become blocked, e.g., by the presence of some foreign object or by swelling of the larynx. care and ventilator support, dialysis, and other highly invasive procedures. In addition, home-care nurses provide assessment, education, and support to post-acute-care patients who might have spent several additional days in the hospital but are now discharged to cut costs. This category of patient may include postoperative patients, postpartum postpartum /post·par·tum/ (post-pahr´tum) occurring after childbirth, with reference to the mother. post·par·tum adj. Of or occurring in the period shortly after childbirth. mothers and their newborns, and patients with acute medical conditions See carpal tunnel syndrome, computer vision syndrome, dry eyes and deep vein thrombosis. such as newly diagnosed diabetes and recent strokes. In the United States, 9,655 agencies (1998 data) (1) provide home care to patients. Infection control and healthcare epidemiology have not kept up with the needs of the home-care providers or their patients. As this segment continues to expand and services provided in the home increase, the infection control community must address the risks and needs of home care. Infection Surveillance, Prevention, and Control in Home Care Infection surveillance, prevention, and control have constituted a discipline that has been acute-care based and oriented for the past 40 years. However, as the health-care system continues to shift delivery of care from hospitals to other settings, surveillance, prevention, and control programs must respond. Since efforts to measure the incidence of homecare acquired infections, study the associated risk factors, and adapt prevention and control measures for home care are nascent, available studies provide minimal information and little guidance. A few articles have appeared in non-U.S. publications. Overall, the literature is sparse, but expanding slowly (2-22). Systems of Surveillance: Definitions and Methods Without valid data on the incidence of home-care acquired infection and analysis of risk factors, developing control efforts is difficult. Thus, initial resources must be directed toward developing measurement systems. Definitions and methods for the surveillance of nosocomial infection Nosocomial infection An infection that can be acquired in a hospital. ABPA is a nosocomial infection. Mentioned in: Allergic Bronchopulmonary Aspergillosis, Hospital-Acquired Infections, Pseudomonas Infections cannot be readily applied to home care. First, definitions, such as those developed by the Centers for Disease Control and Prevention's (CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation ) National Nosocomial Infection Surveillance (NNIS NNIS National Nosocomial Infection Surveillance System ) system (23), rely heavily on laboratory data, including cultures and serologic tests. In home care, the diagnosis of infection for clinical purposes is frequently made on an empiric basis with substantial reliance upon physical signs and symptoms. In fact, physicians routinely rely on the assessment skills of home-care nurses and may not see a patient before making a presumptive pre·sump·tive adj. 1. Providing a reasonable basis for belief or acceptance. 2. Founded on probability or presumption. pre·sump diagnosis and writing prescriptions. The current reimbursement system does not support the use of cultures and laboratory tests used for hospitalized patients. For example, cultures are not routinely obtained to diagnose or confirm infections of the urinary tract, respiratory tract respiratory tract n. The air passages from the nose to the pulmonary alveoli, including the pharynx, larynx, trachea, and bronchi. Respiratory tract , or wound or skin sites. Cultures are more frequently obtained to confirm and appropriately treat bloodstream infection in patients undergoing home infusion therapy. Definitions of home-care acquired infection developed for surveillance will need to rely more heavily on clinical signs and symptoms and tests that can be performed by the homecare nurse at the bedside (e.g., urine dipstick testing Urine dipstick test A test using a small, chemically treated strip that is dipped into a urine sample; when testing for protein, an area on the strip changes color depending on the amount of protein (if any) in the urine. Mentioned in: Preeclampsia and Eclampsia ). A scheme that includes probable home-care acquired infection (i.e., clinical signs and symptoms of pneumonia) as well as definite home-care acquired infection (i.e., confirmed by chest X ray and sputum culture Sputum Culture Definition Sputum is material coughed up from the lungs and expectorated (spit out) through the mouth. A sputum culture is done to find and identify the microorganism causing an infection of the lower respiratory tract such as pneumonia ) may be considered. Once developed, definitions must be examined for validity, sensitivity, and specificity. However, methods to identify patients at risk and apply the definitions are also critical. Surveillance methods routinely used in acute care, such as cultures and other laboratory tests, are not practical in home care (24) so other sources of information and methods of screening must be developed. In addition, a system that relies on a designated person(s) to review medical records and assess patients for infection, such as infection control professionals do in hospitals, is impractical in home care because of the logistics of patients, staff, and medical records. A more suitable approach is a two-tiered system two-tiered system Social medicine The existence of 2 levels of health benefits and care, depending on whether the Pt can afford to pay or not , which relies on home-care nurses to identify and report patients with clinical signs and symptoms of infection and on an infection control nurse to review evidence and ascribe a definition (Table). Screening criteria for home-care nurses would include fever, new antibiotic order, purulent drainage purulent drainage Wound care A drainage of material chock full of PMNs; pus-laden discharge from a wound, change in color or odor of urine, change in consistency or color of sputum sputum /spu·tum/ (spu´tum) [L.] expectoration; matter ejected from the trachea, bronchi, and lungs through the mouth. sputum cruen´tum bloody sputum. , respiratory rales and rhonchi Rhonchi is the "coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways". Rhonchi is the plural form of the singular word "rhonchus". , and increased serum leukocytes. Once made aware of these patients, a designated nurse can review the evidence (e.g., clinical signs and symptoms, available laboratory data, nursing and physician progress notes) and apply the definition of home-care acquired infection. This approach should enhance both sensitivity (more nurses observing and reporting patients with clinical signs and symptoms of infection) and specificity (one nurse applying the definition of infection). The use of a single infection control nurse should also improve the reliability of data.
Table. Criteria for inclusion in definitions of home-care-acquired
infection(a)
Site of infection Clinical data
Catheter-related UTI(b) Change in characteristics of
urine, fever, pain
Postoperative pneumonia Change in character of sputum,
decreased breath sounds,
increase in rales and rhonchi,
fever, shortness of breath, pain
Catheter-related bloodstream Fever with chills and rigors,
infection redness, tenderness, or pain at
insertion site, purulent drainage
at site
Skin and soft tissue infection Pain, swelling, tenderness at site,
inflammation and warmth,
purulent drainage, fever
Endometritis in postpartum Uterine tenderness and abdominal
patients pain, purulent vaginal drainage
(lochia), foul-smelling lochia, fever
Site of infection Laboratory data
Catheter-related UTI(b) Elevated serum leukocytes,
evidence of UTI in urinalysis,
evidence of leukocytes in urine
dipstick test, positive urine
culture (> [10.sup.5] CFU of a
single organism per mL urine)
Postoperative pneumonia Elevated serum leukocytes,
sputum Gram-stained smear
with evidence of respiratory
infection, positive sputum culture,
positive chest X ray
Catheter-related bloodstream Elevated serum leukocytes, positive
infection blood culture, positive catheter
culture (after catheter removal)
Skin and soft tissue infection Gram-stain smear with leukocytes
and organisms, positive culture,
elevated serum leukocytes
Endometritis in postpartum Positive Gram-stain smear of
patients lochia, positive culture of lochia,
remarkably elevated serum
leukocytes
(a) Source: Rhinehart E, Friedman M. Infection control in home care.
Gaithersburg (MD): Aspen Publishing, Inc.; 1999 (22).
(b) UTI = urinary tract infection.
What Is Needed To achieve a system to measure and study the incidence and risks for home-care acquired infection, infection control must develop valid definitions for home-care acquired infection and practical methods for surveillance. These definitions and methods must be developed through a broad, national effort that includes participation by home-care professionals as well as infection control practitioners. These professionals must take a very practical approach to this endeavor and may have to forego rigid application of epidemiologic techniques for a more suitable surveillance system. The Association for Professionals in Infection Control and Epidemiology has recently published draft definitions for surveillance in home care (25). In parallel, home-care professionals must engage in learning the epidemiologic principles of surveillance systems (26) and apply or adapt them as faithfully as possible. Once consensus is reached on definitions and methods and we describe the epidemiology of home-care acquired infections, we can study specific risk factors for infection. Home-care professionals need the assistance, support, and practical guidance of infection control professionals. Because of substantial financial challenges in home care, one nurse is often responsible for quality improvement, safety, risk management, and infection control. These professionals can apply and manage surveillance systems but will need substantial guidance and support in developing them. Efforts to initiate surveillance systems do exist. The Missouri Home Care Alliance began a program in 1997 to develop definitions and collect; data from home-care agencies in that and other states. With assistance from CDC's Hospital Infections Program, the alliance has made progress in developing a surveillance system and sharing data. The Florida Hospital Association also sponsored a surveillance project for hospital-based home-care agencies (6) in which they studied the incidence of urinary tract infections urinary tract infection (UTI), n infection in one or more of the structures that make up the urinary system. Occurs more often in women and is most commonly caused by bacteria. and central-line infections. The Arizona Association for Home Care also described its methods and results in a cooperative study to measure and compare rates of urinary tract infections (7). Similar efforts were undertaken in a collaborative effort to determine device-related rates of urinary tract and bloodstream infections in California, Kentucky California is a city in Campbell County, Kentucky, United States. The population was 86 at the 2000 census. Geography California is located at (38.919144, -84.263381)GR1. , and Indiana (8). These studies provide initial descriptions of incidence of home-care acquired infections. Authors report catheter-related urinary tract infection rates of 2.8 per 1,000 catheter days (6) to 4.5 per 1,000 catheter days (8). Measures of intravenous catheter-related bloodstream infections range from 1.1 per 1,000 catheter days (8) to 4.2 per 10,000 catheter days (2). Data from these studies must be interpreted with caution, however, since surveillance in this area is in its initial stages and definitions and methods are not uniform. More studies are in progress, and eventually there will be consensus on such issues. Prevention and Control of Home-Care Acquired Infection Even without reliable surveillance data, we know that infection prevention and control in home care is quite different from that in acute care. In acute care, a patient's risk for nosocomial infection is related not only to the severity of illness and exposure to invasive interventions and devices but also to environmental risks, including exposure to other patients and inanimate inanimate /in·an·i·mate/ (-an´im-it) 1. without life. 2. lacking in animation. in·an·i·mate adj. reservoirs of nosocomial nosocomial /noso·co·mi·al/ (nos?o-ko´me-il) pertaining to or originating in a hospital. nos·o·co·mi·al adj. 1. Of or relating to a hospital. 2. pathogens. The home-care patient may have less clinical "acuity" (i.e., intensity or degree of care needed) but may have substantial host risk factors, including advanced age, chronic illness, or immunosuppression immunosuppression Suppression of immunity with drugs, usually to prevent rejection of an organ transplant. Its aim is to allow the recipient to accept the organ permanently with no unpleasant side effects. . Much of home care is provided by family members in a setting that is much less structured and controlled than the hospital environment. Plumbing, sanitation, and ventilation may be poor or absent. Nonetheless, basic principles of prevention and control can be adapted and applied with large doses of realistic risk assessment and common sense. Because written resources for home-care practice are lacking, many home-care providers have adopted unnecesssary infection control practices to reduce risk for patients, including the ritual of nursing bag technique (i.e., placing a newspaper under the nursing bag), policies that require the routine disinfection disinfection, n the process of destroying pathogenic organisms or rendering them inert. disinfection, full oral cavity, n a procedure used to reduce active periodontal disease, usually completed within a certain short time frame. of noncritical devices (e.g., stethoscopes and blood pressure cuffs) after every use, and procedures that require handwashing based on seemingly arbitrary criteria (e.g., upon entering the home). Some of these practices are not only unnecessary but also costly (e.g., routine changing of urinary drainage bags every 30 days). Patient-care practices to reduce the risk for home-care acquired infection must be based on the basic science embodied in the chain of infection model. Actual risk and appropriate prevention and control strategies must be incorporated in recommendations for policy and procedure. Using this simple approach to determine actual risk and implement the appropriate prevention and control strategies will lead to more reasonable and less ritualistic rit·u·al·is·tic adj. 1. Relating to ritual or ritualism. 2. Advocating or practicing ritual. rit practices for patient care and use of precautions to prevent the spread of infections to others. Infection control professionals should approach their responsibility to guide home-care providers by first addressing educational needs. Knowledge of infection control principles enables home-care providers to develop their own approaches to patient care and make decisions about infection risk and its reduction. Patient-Care Practices Infection prevention strategies in home care should focus on home infusion therapy, urinary tract care, respiratory care, wound care, and enteral therapy Enteral Therapy is nutrition administered to patients via tubes. Typically administered to patients who have functioning intestines, but who are unable to swallow. . Most recommended practices on intravenous therapy Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip. (27) do not require adaptation for the home. However, in care involving other sites, the risk may be lower, allowing for adaptation of practices designed for hospitalized patients. For example, use of indwelling indwelling /in·dwell·ing/ (in´dwel-ing) pertaining to a catheter or other tube left within an organ or body passage for drainage, to maintain patency, or for the administration of drugs or nutrients. urinary catheters creates an inherent risk for infection. In the hospital, considerable efforts are exerted to maintain an intact, closed urinary drainage system Noun 1. drainage system - a system of watercourses or drains for carrying off excess water system - instrumentality that combines interrelated interacting artifacts designed to work as a coherent entity; "he bought a new stereo system"; "the system consists of a (28); however, in home care the system is frequently interrupted when an ambulatory patient uses a leg bag. Drainage bags may also be disinfected Disinfected Decreased the number of microorganisms on or in an object. Mentioned in: Isolation in the home, a procedure rarely (if ever) seen in a hospital. Guidance provided to accomplish this procedure is empiric (21,22). Similarly, empiric approaches have been developed for home wound care. Surgical site infection should rarely, if ever, be a home-care acquired infection if the wound is primarily closed and no drains are left in place. However, if a surgical patient is sent home with drains, a surgical site infection may develop, and wound-care procedures must address this risk. More frequently, homecare patients have other types of wounds, such as stasis stasis /sta·sis/ (sta´sis) 1. a stoppage or diminution of flow, as of blood or other body fluid. 2. a state of equilibrium among opposing forces. ulcers and pressure sores, which are commonly colonized Colonized This occurs when a microorganism is found on or in a person without causing a disease. Mentioned in: Isolation with gram-negative fora and may become infected with the patient's own organisms. Again, procedures for care of these wounds must be based on the genuine potential for contamination and infection. Arbitrary instructions to discard irrigation irrigation, in agriculture, artificial watering of the land. Although used chiefly in regions with annual rainfall of less than 20 in. (51 cm), it is also used in wetter areas to grow certain crops, e.g., rice. fluids at set intervals (e.g., every 24 or 48 hours) are not helpful. Procedures must be practical, with guidance to use containers of fluid that will be used up in two to three visits (i.e., no more than a 500-mL bottle) and incorporate methods to avoid contamination of fluids (e.g., proper handling of the cap, storage away from children and pets) (22). Many home-care patients receive enteral therapy, introducing the risk for gastrointestinal infection. Again, to reduce this risk, focus must be placed on refrigeration refrigeration, process for drawing heat from substances to lower their temperature, often for purposes of preservation. Refrigeration in its modern, portable form also depends on insulating materials that are thin yet effective. of the enteral enteral /en·ter·al/ (en´ter'l) enteric. en·ter·al adj. 1. Within or by way of the intestine, as distinguished from parenteral. 2. Enteric. feeding and meticulous care of kitchen appliances and tools, such as blenders, used in its preparation. Cleaning blender parts, measuring cups, and spoons in a dishwasher after use is probably sufficient; sterilizing them is probably not necessary (22). Use of Barrier Precautions barrier precautions Infection control A general term referring to any method or device used to ↓ contact with potentially infectious body fluids, including facial masks, doubled gloves and fluid-resistant gowns. See Isolation, Reverse isolation, Universal precautions. The rationale and strategy for use of precautions in home care differ substantially from those applied in hospitals (29). In most cases, the use of gowns, gloves, and masks in the care of homebound home·bound adj. Restricted or confined to home, as of an invalid. patients is recommended to protect the health-care provider, not the patient. In addition to standard precautions, care givers in the home may need to use masks only when caring for patients with pulmonary tuberculosis pulmonary tuberculosis n. Tuberculosis of the lungs. pulmonary tuberculosis Infectious disease Infection by Mycobacterium tuberculosis . The exception to this rule may be the home-care patient who is colonized or infected with multidrug-resistant organisms (16,30). Although these organisms are not known to be a risk to providers, they may be transmitted to other home-care patients through inanimate objects Inanimate Objects abiology the study of inanimate things. animatism the assignment to inanimate objects, forces, and plants of personalities and wills, but not souls. — animatistic, adj. or hands. Thus, homecare patients known to have a multidrug-resistant organism should be cared for through use of appropriate barriers. Reusable equipment such as stethoscopes and blood pressure cuffs should remain in the home. If practical, such patients should be seen as the last appointment of the day. If this is not possible, visits should be scheduled to avoid seeing patients at risk, such as those requiring wound care, after seeing a patient with multidrug-resistant organisms. The Future of Infection Control in Home Care The next several years will be critical for developing surveillance systems for home care. Additional studies and reports are needed to improve knowledge of the risk factors for home-care acquired infections. We also need to study the effects of the current empiric practices for preventing such infections. Hospital-based infection control professionals must support and guide their home-care colleagues to develop an evidence-based approach to infection control in home care. A scientific approach will help identify valid risks and successful risk-reduction strategies, as well as improve the quality of care and preserve resources. References (1.) Basic statistics about home care. Washington: National Association for Home Care; 1999. (2.) White MC, Ragland KE. Surveillance of intravenous catheter-related infections among home care clients. Am J Infect Control 1994;22:213-35. (3.) White MC, Ragland KE. Urinary catheter-related infections among home care patients. Journal of Wound, Ostomy ostomy Surgical opening in the body, or the operation creating it, usually to allow discharge of wastes through the abdominal wall. It may be temporary, to relieve strain on damaged organs, or permanent, to replace normal channels congenitally missing or surgically removed and Continence continence /con·ti·nence/ (kon´tin-ens) the ability to control natural impulses.con´tinent con·ti·nence n. 1. Self-restraint; moderation. 2. Nursing 1995;22:286-90. (4.) Rosenheimer L. Establishing a surveillance system for infections acquired in home healthcare. Home Healthcare Nurse 1995;13:20-6. (5.) Zimay DL. Standardizing the definition and measurement of catheter-related infection in home care: a proposed outcome measurement system. J Med Syst 1999;23:189-99. (6.) Luehm D, Fauerbach L. Task force studies infection rates, surgical site management and Foley catheter Fo·ley catheter n. A catheter held in the bladder by an inflatable balloon. Foley catheter A two-channel catheter with a balloon on the bladder end of one channel. infections. Caring 1999;18:30-4. (7.) Woomer N, Long C, Anderson CO, Greenberg EA. Benchmarking in home health care: a collaborative approach. Caring 1999;18:22-8. (8.) Rosenheimer L, Embry FC, Sanford J, Silver SR. Infection surveillance in home care: device-related incidence rates. Am J Infect Control 1998;26:359-63. (9.) Goldberg P, Lange M. Development of an infection surveillance project for home healthcare. Home Care Magazine 1997;1:1,4-9. (10.) Rhinehart E. Developing an infection surveillance system. Caring 1996;15:26-8, 31-2. (11.) Danzig L, Short L, Collins K, Mahoney M, Sepe S, Bland L, et, al. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAMA JAMA abbr. Journal of the American Medical Association 23;1995:1862-4. (12.) Kellerman S, Shay shay n. Informal A chaise. [Back-formation from chaise (taken as pl. )] Noun 1. D, Howard J, Goes C, Feusner J, Rosenberg J, et al. Bloodstream infections in home infusion patients: the influence of race and needleless intravascular intravascular /in·tra·vas·cu·lar/ (in?trah-vas´ku-lar) within a vessel. in·tra·vas·cu·lar adj. Within one or more blood vessels. access devices. J Pediatr 1996;129:711-7. (13.) Tokars JI, Cookson ST, McArthur MA, Boyer CL, McGeer AJ, Jarvis WR. Prospective evaluation of risk factors for bloodstream infections in patients receiving home infusion therapy. Ann Intern Med 1999;131:340-7. (14.) Do AN, Ray BJ, Banerjee SN, Illian AF, Barnett BJ, Pham MH, et al. Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting. J Infect Dis 1999;179:442-8. (15.) Friedman M, Rhinehart E. Putting infection control principles into practice in home care. Nurs Clin North Am 1999:34:463-82. (16.) Friedman M. Preventing and controlling the transmission of antibiotic-resistant microorganisms in the home care setting. Caring 1999:18:6-11. (17.) Davis PL, Madigan EA. Evidence-based practice and the home care nurse's bag. Home Healthcare Nurse 1999;17:295-9. (18.) Hanchett M. Implementing standard precautions in home care. Home Care Manager 1998;2:16-20. (19.) Friedman M. Designing an infection control to meet JCAHO JCAHO Joint Commission on Accreditation of Healthcare Organizations, see there standards. Caring 1996;15:18-25. (20.) Smith PW, Roccaforte JS. Epidemiology and prevention of infections in home healthcare. In: Mayhall CG, editor. Hospital epidemiology and infection control. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 1999. p. 1483-8. (21.) Garofalo K. Home health. In: Olmsted R, editor. APIC (Advanced Programmable Interrupt Controller) A circuit that handles the priority of interrupts in a computer. Designed to support symmetric multiprocessing (SMP), the APIC handles more interrupts and is more flexible than the programmable interrupt controller infection control and applied epidemiology. St. Louis: Mosby; 1996. p. 90-190-11. (22.) Rhinehart E, Friedman M. Infection control in home care. Gaithersburg (MD): Aspen Publishers, Inc.; 1999. (23.) Garner J, Jarvis WR, Emori TG, Horan T, Hughes J. CDC definitions for nosocomial infections Nosocomial infections Infections that were not present before the patient came to a hospital, but were acquired by a patient while in the hospital. Mentioned in: Enterobacterial Infections, Staphylococcal Infections . Am J Infect Control 1988;16:28-40. (24.) Emori TG, Culver D, Horan T. National Nosocomial Infections Surveillance System (NNIS): Description of surveillance methods. Am J Infect Control 1991;19:259-67. (25.) APIC Home Care Membership Section. Draft definitions for surveillance of infections in home health care. Am J Infect Control 2000;28:449-53. (26.) Lee T, Baker O, Lee J, Scheckler W, Steele L, Laxton C. Recommended practices for surveillance. Am J Infect Control 1998:26:277-88. (27.) Pearson M. Guideline for prevention of intravascular device-related infections. Infect Control Hosp Epidemiol 1996;17:438-73. (28.) Wong ES. Guideline for prevention of urinary tract infection. Am J Infect Control 1983;11:28-31. (29.) Garner J. Guideline for isolation precautions in hospitals. Am J Infect Control 1996;17:53-80. (30.) Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. . Recommendations for preventing the spread of vancomycin vancomycin (văn'kōmī`sĭn), antibiotic resembling penicillin in the way it acts. It is derived from the bacterium Streptomyces orientalis, which was isolated from soil of India and Indonesia. resistance. Am J Infect Control 1995;23:87-94. Ms. Rhinehart, vice president of quality management for AIG AIG addressee indicator group (US DoD) AIG American International Group, Inc AiG Answers in Genesis (religious group in defense of Scripture) AIG Artificial Intelligence Group AIG Australian Industry Group Consultants, Inc., is a full-time health-care consultant. She is one of the principal authors of the revision of CDC's Guidelines for Isolation Precautions in Hospitals (in progress), which will be more applicable to home-care and other ambulatory-care settings. Address for correspondence: Emily Rhinehart, AIG Consultants, Inc., 1200 Abernathy Rd., NE, Suite 800, Atlanta, GA 30328, USA; fax: 770399-4161; e-mail: emily.rhinehart@aig.com |
|
||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion