Professional Documents
Culture Documents
\s=b\To assess the extent to which US hospitals have established employee the completion of this survey, addi¬
health services with infection control functions, we analyzed information tional, more detailed guidelines for
obtained in the SENIC Project (Study on the Efficacy of Nosocomial Infection implementing an employee health
Control) from interviews with hospital officials and staff nurses in a service have been published.3 In this
5
representative sample of 433 hospitals. Sixty-eight percent of hospitals had article we describe the frequency and
a formal employee health service. The percentage routinely screening distribution of formal employee
employees varied widely from the more common tests, such as the yearly health services in US hospitals and
chest roentgenogram (89%) and skin test (83%), to less common tests, the procedures used to screen employ¬
including stool cultures (43%) and blood testing for hepatitis B (41%) and ees for potentially contagious infec¬
rubella (33%); 40% routinely obtained cultures of personnel. Although most tions. In a future article we will
hospitals appear to screen adequately, a sizeable minority either fail to describe the methods used to manage
employ recommended screening tests or continue unnecessary, expensive employees who have such infections.
ones.
MATERIALS AND METHODS
(JAMA 1981;246:844-847)
The information presented in this arti¬
cle was collected in phase II of the SENIC
Project, the Hospital Interview Survey.
AN IMPORTANT responsibility of a employee health service, either de¬ The details of the study design have been
hospital's infection surveillance and voted mainly to the control of conta¬ described elsewhere67 and will only be
control program is the monitoring gious illnesses or as part of a more summarized here. The Hospital Interview
and prevention of infection trans¬ comprehensive program of employee Survey consisted of interviews with
mitted to and from its personnel.1 health care. The employee health ser¬ selected hospital personnel involved in
Since its first edition in 1968, the vice may consist of only a part-time various aspects of infection surveillance
American Hospital Association's2 physician or may be a formal clinic or and control in a sample of 433 hospitals
(AHA) Infection Control in the Hospi¬ department, depending on the size of representing the SENIC target population:
tal has provided guidelines for an the hospital and the number of full- all general medical and surgical hospitals
time employees. that are short term, not federally or state
As part of the SENIC Project owned, have at least 50 beds, and are
From the Hospital Infections Branch, Bacterial located in the contiguous 48 United
Diseases Division, Center for Infectious Diseases, (Study on the Efficacy of Nosocomial States.' The interviews were conducted at
Centers for Disease Control, Atlanta. Infection Control), we evaluated the the hospitals by Centers for Disease Con¬
Reprint requests to Attn: SENIC Project, Hospi- extent to which US hospitals have trol (CDC) staff members from October
tal Infections Branch, Bacterial Diseases Division,
Center for Infectious Diseases, Centers for Dis- implemented programs to control 1976 to July 1977. The information pre¬
ease Control, Atlanta, GA 30333 (Dr Haley). infection through such services. Since sented in this article was obtained from
References
1. Accreditation Manual for Hospitals. Chica- 5. Werdegar D: Guidelines for infection con- 9. Preventive therapy of tuberculous infec-
go, Joint Commission on Accreditation of Hospi- trol aspects of employee health. J Assoc Pract tion, American Thoracic Society. Am Rev Respir
tals, 1976, pp 49-56. Infect Cont 1977;5(December):15-22. Dis 1974;110:371.
2. Infection Control in the Hospital, ed 3. 6. Haley RW, Quade D, Freeman HE, et al: 10. Guidelines for Prevention of TB Trans-
Chicago, American Hospital Association, 1974, Study on the Efficacy of Nosocomial Infection mission in Hospitals. Atlanta, Centers for Dis-
pp 30-36. Control (SENIC Project): Summary of study ease Control, 1975.
3. Kaslow RA, Garner JS: Hospital personnel, design. Am J Epidemiol 1980;111:472-485. 11. Rubella virus vaccine, Public Health Ser-
in Bennett JV, Brachman PS (eds): Hospital 7. Quade D, Culver DH, Haley RW, et al: The vice Advisory Committee on Immunization Prac-
Infections. Boston, Little Brown & Co, 1979, pp SENIC sampling process: Design for choosing tices. Morbidity Mortality Weekly Rep 1971;
27-52. hospitals and patients and results of sample 20:304.
4. Werdegar D: Guidelines for infection con- selection. Am J Epidemiol 1980;111:486-502. 12. Perspectives on the control of viral hepati-
trol aspects of employee health. J Assoc Pract 8. Guide to the Health Care Field. Chicago, tis, type B. Morbidity Mortality Weekly Rep
Infect Cont 1977;5(September):17-22. American Hospital Association, 1977, pp 10-13. 1976;25(suppl):1.
JAMA
such an important feature in public health unless we can be fairly sure that its
work, and holding it of equal value with occupants are not propagating the germs
isolation. of disease. In diphtheria we can have no
Another thing to be borne in mind in reasonable assurance of this without get¬
75 YEARS AGO connection with this subject is that a good ting at least two negative cultures from
deal of disinfection does not disinfect. the nose and throat of every member of
Until eight or nine years ago sulphurous the family. To require such cultures is
anhydrid was the chief disinfectant, and impracticable. Disinfection, however, is
Au g 25, 1906 this is now considered to be entirely refused after diphtheria, unless the above-
unreliable. Then formaldehyd came into named reasonable conditions are met,
The Fetich of Disinfection use and at first most of the disinfection which very rarely happens, or unless it is
with it did not accomplish more than the especially requested after a death. During
[Original Article, pp 574-580] sulphur. Even now a great deal of formal¬ the last year the warning card has been
dehyd disinfection is inefficient, and at the removed 258 times without disinfection,
Futility of Disinfection best only exposed surfaces can be disin¬ and there has been a recurrence in the
If then, as all evidence tends to show, fected. As the larger part of the clinical family within two months in four cases, or
contagious diseases usually extend by evidence of the value of disinfection dates 1.55 per cent. In 87 instances in which
means of pretty direct contact between the from a time when the process was very disinfection was practiced during that
infected and non-infected, and transmis¬ imperfect, the value of that evidence is period or a few months preceding it, there
sion by fomites has little influence on such much impaired. was a recurrence in 2.3 per cent, of the
extension, it follows that even the most In Providence we have been making a cases. The total number of cases of diph¬
thorough disinfection will have little practical test of the value of disinfection theria fell, however, from 780 in 1904 to
checking these diseases. There is
effect in by omitting it entirely in some cases. It 562 in 1905.