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AORN Journal, August, 2004 by Susan Bakewell, Joan Blanchard

The Eighth Conference on Infectious Diseases was held at the Kimberly-Clark corporate facility in Roswell, Ga, Dec 8-10, 2003. An elegant reception and dinner, sponsored by Kimberly-Clark, was held Monday evening to welcome participants and provide them with an opportunity to network with internationally known speakers to discuss critical infectious disease concerns.

The conference addressed a range of infectious disease issues of interest to perioperative and infection control practitioners. Speakers challenged participants to consider their infection control practices; provided current information on familiar, emerging, and resistant organisms; and discussed infection prevention, disinfection and sterilization issues, and how integrating human factors training can improve infection control.

SEVERE ACUTE RESPIRATORY SYNDROME

John A. Jernigan, MD, MS, chief of the interventions and evaluations section of the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention's (CDC's) National Center for Infectious Diseases, Atlanta, explored the recent severe acute respiratory syndrome (SARS) outbreak. He reviewed initial signs of the worldwide outbreak of SARS and lessons learned. To prevent future outbreaks, early recognition is absolutely necessary. This will depend on the ability of the health care community to combine clinical and epidemiological features to make a diagnosis.

Early recognition is important, said Dr Jernigan, because simple infection control measures can reduce transmission. Recognizing and isolating patients with SARS can contribute to reduced transmission rates. The incubation period for SARS is two to 10 days. Early symptoms commonly reported by patients include fever, chills or rigors, headaches, myalgias, and malaise. Fever may resolve before respiratory symptoms appear. Respiratory symptoms often begin three to seven days after the onset of symptoms and peak in the second week, according to Dr Jernigan.

HAND HYGIENE

Elaine L. Larson, RN, PhD, CIC, FAAN, professor of pharmaceutical and therapeutic research at the Columbia University School of Nursing, New York, provided the background evidence on which the CDC hand hygiene guideline is based, including research on skin condition, surgical hand preparation, and general hand washing. Dr Larson also reviewed the hand hygiene guideline, which was released in October 2002, and identified areas of change from the previous recommendation.

Skin hygiene is a critical factor in preventing transmission of infectious organisms. The new guideline promotes the use of alcohol-based products, which have been found to be less damaging to skin and easier to use. This results in higher hand-washing compliance among health care workers. The guideline encourages the use of an appropriate hand lotion after using an alcohol-based product because the lotion acts as a glue to help prevent skin cells from shedding, thus promoting skin health.

Dr Larson reported one interesting occurrence about the use of alcohol-based products--the occurrence of skin irritation in a small segment of young females. This reaction was resolved after the women did not use an alcohol-based product for a few weeks and then switched to a different alcohol-based product. Dr Larson reported that there was no known reason for this occurrence in this small segment.

ANTIBIOTIC-RESISTANT ORGANISMS

Barry M. Farr, MD, MSc, professor of medicine and epidemiology at the University of Virginia Health System, Charlottesville, Va, provided insight into preventing the spread of antibiotic-resistant organisms. High frequency of antibiotic use in hospitals provides a selective advantage for antibiotic-resistant pathogens, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, to survive, proliferate, and spread.

Dr Farr reviewed mechanisms for development of antibiotic resistant organisms that health care providers need to consider, including

* random genetic mutation;

* plasmid swapping during conjugation;

* movement of transposons to plasmids or chromosomes;

* transduction by bacteriophages (ie, acquisition of resistant genes from a recently killed cell and incorporation into a chromosome or plasmid); and

* binary fission (ie, replication).

Possible control measures to prevent the occurrence of resistant organisms include preventing their spread via appropriate hand hygiene, controlling the use of antibiotics, identifying colonized patients with active surveillance cultures, and using barrier precautions.

Dr Farr detailed initiatives that contributed to the University of Virginia Health System's success in reducing or eliminating outbreaks of infections caused by resistant organisms. The organization succeeded by implementing active surveillance of cultures; strict contact precautions, including using gowns and gloves; meticulous hand hygiene; and isolation of patients found to have positive cultures for resistant organisms.

DESIGNING ERROR-FREE SYSTEMS

Gina Pugliese, RN, MS, vice president of Premier Safety Institute, Oak Brook, Ill, presented the latest information on players who are driving the patient safety movement, how their requirements and activities overlap and conflict, the role of evidence-based practices, and what is working in health care. Pugliese said that consumers want safe and quality health care and expect health care facilities to improve their practices.