A major problem involved internet sales of unapproved products with bogus claims and of fake products with real names e. This discussion includes two areas of controversy related to infection control product evaluation: 1 low technology and 2 high technology products.
The fallacy of adopting copper for infection control purposes, beyond the incremental costs, is that strategies like this create the impression that they are a substitute for the infection control fundamentals, especially hand hygiene, environmental maintenance, and isolation precautions. Management and prevention of transmission of antibiotic-resistant pathogens is the best example. In this case, guidelines and expert consensus support the strategy of implementing a program of active surveillance cultures linked to contact precautions to control the spread of epidemiologically significant antibiotic-resistant pathogens in health care, in particular methicillin-resistant Staphylococcus aureus MRSA.
The controversy lies in how this guidance is implemented, beyond traditional low-tech, and often retrospective, traditional surveillance. In the end, this flexibility to develop an individualized program underscores the importance of the ICPs role in product evaluation, program development and implementation. The product evaluation process impacts all areas of health care delivery and infection control. Evaluation of low-tech products such as hand hygiene products and disinfectants are fairly straightforward.
High tech products are receiving more attention in health care lately. Some of these high technology products, such as molecular-based, rapid tests for MRSA screening, are linked directly to infection control activities, such as isolation and surveillance of infection. There are no clinical trials or meta-analyses directly related to the product evaluation process.
In most cases, the decision to evaluate standard infection control items such as disinfectants and hand hygiene products requires a simple value analysis and common sense that avoids decision-making based on marketing claims.
One important advance involves the use of new diagnostic technologies that impact isolation utilization for emerging infections, such as methicillin-resistant Staphylococcus aureus MRSA. While there is universal agreement that some kind of surveillance for MRSA prevention is necessary, there is no agreement regarding the nature of the prevention program. While these studies are not directly comparable, they build on each other, and some authors think provide evidence to support a more pro-active approach to MRSA prevention.
In the study by Chaix et al. It quantifies their experience with culture-based methodology for screening patients to determine the need for contact precautions, and. It uses the excess cost data from Chaix to drive their own assumptions for the excess costs of screening. Walsh et al. While the results are impressive e. Finally, Harbeth et al.
Studies such as these have direct impact on infection control practices in health care; in this case the more appropriate use of isolation activities. One important unsettled issue relates to cost-effective analysis CEA.
While experts agree that some kind of CEA is needed, there is no agreement as to the extent of the analysis, other than to keep it simple. In the case of purchases that represent cost savings or are cost-neutral, the analysis can be brief. For product evaluations that are linked to program changes or interventions, CEA assessment in terms of cost per infection prevented is preferred, although costs avoided per patient per month with an intervention is equally acceptable, depending on the product and intervention being reviewed.
In either case, a business case can be made using local cost figures combined with results from published studies. Studies of complex purchases linked to infection control interventions that do not assess costs are probably the least desirable. Many studies of this type are important and relevant, but generally lack a strong business case to support widespread adoption. Beyond costs, infection control product evaluation can be classified into three major areas as shown below.
In other words, the fundamentals of infection control should not be overlooked in favor of marketing claims without evidence to support them. For example, the role of copper as an antimicrobial has received some attention over the years as an infection control product in hospitals. Clinical trials data are limited and show only that copper reduces bacterial burden. Obviously, this is an attractive concept. However, there are no trials to show its impact on reducing infection rates.
On the other hand, some facilities have taken the paucity of evidence for copper and replaced door hardware and other metal objects, or used copper-based paints as an infection control tool. There is general agreement that ultraviolet UV light kills M.
The use of this type of product needs to be put into context with the nature of the individual facility, the frequency with which tuberculosis patients are seen in the facility, and tuberculin PPD conversion rates of employees. In other words, despite recent data on the effectiveness of UV light in preventing transmission of M.
In this case, UV light is not a substitute for the infection control fundamental of adequate air handling systems. This discussion moves beyond disinfectants and hand hygiene products and discusses an evaluation of new technologies and strategies for methicillin-resistant Staphylococcus aureus MRSA prevention. Open All Close All. Tools by Setting. Tools by Infection.
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The value of using such a clinically based audit will be discussed. Abstract In today's competitive market infection control teams are under increasing pressure from purchasing authorities to provide hard data on quality issues. Publication types Comparative Study.
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