Pitfalls in infection control.

To the Editor: We would like to share with you several “pitfalls” in infection control that we have experienced at our 300bed referral center. Despite our education efforts in category-specific isolation, we have observed healthcare students (ie, student nurses or respiratory therapists) violating our isolation guidelines. Healthcare students often are not taught the importance and rationale of isolation, nor of category-specific or body substance isolation. With patient care time constraints, the nursing staff or supervisory personnel often make infection control education a low priority, and these students remain naive to the practice of infection control. Medical residents are taught at orientation but often learn infection control principles by trial and error. Lapses in infection control practices have become particularly problematic for patients in the intensive care unit with organisms resistant to multiple drugs. Nurses and other personnel who have been educated in universal precautions nonetheless occasionally wear gloves while answering the telephone, answering pages, or charting; cross-contamination may 0ccur.l We also have observed patients, in isolation for multiply drug-resistant organisms, transferred to the operating room and returned to the same floor within 24 hours, no longer in isolation. Although we label all the temporary hospital charts of isolated patients with isolation tape, these patients still occasionally “slip” out of isolation. Isolation tape also is affixed to the permanent hospital chart of patients with resistant organisms, to alert all healthcare providers and the admitting office when these patients are readmitted to the hospital. We also have developed patient information brochures for more common drugresistant organisms, written in “lay terms” to educate patients and their families. Finally, we require a direct phone call from the microbiology lab to the infection control nurse, floor nurse, and physician in the event of positive blood cultures or organisms requiring isolation.