Practice guidelines are proliferating in the era of managed care. Hospital epidemiologists frequently are asked to author guidelines for infection control. The greatest challenge in the process is not writing the guidelines but implementing them. This article offers practical advice on which topic to select and on how to develop and implement guidelines.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has been a major force in shaping the national approach to quality in the healthcare setting. In 1986, the JCAHO announced that it would establish an “Agenda for Change” designed to improve the measurement of quality. The result is that hospitals now are being held to a new set of standards, creating opportunity, uncertainty, and anxiety. This article is designed as a primer to help epidemiologists and infection control practitioners prepare for JCAHO visits.

The best advice is to start early and work continuously to prepare for a JCAHO visit. Most standards require that compliance be documented for at least 1 year prior to the survey. Several resources are available to assist the epidemiologist (Table).

The Comprehensive Accreditation Manual for Hospital, published annually by JCAHO, is an ideal place to begin preparing for a survey.' The accreditation manual contains standards that hospitals are expected to meet, as well as scoring guidelines and rules for accreditation. All sections that apply to the epidemiologist should be read. In some institutions, the epidemiologist's responsibilities are confined to infection control. In other institutions, the responsibilities have been broadened to include most of the functions described in the accreditation manual. It is helpful to go over each standard individually and consider how compliance will be documented.

Arbitrary primed polymerase chain reaction (AP PCR) assays are suited for the discrimination of isolates of all clinically relevant bacterial species. In a hospital setting, this type of DNA amplification test can be used for the timely detection of ongoing nosocomial outbreaks. For rapid screening of isolates of many medically important bacterial species, including Acinetobacter baumannii, Staphylococcus aureus, Serratia marcescens, Xanthomonas maltophilia and others, a single AP PCR assay can be used as a primary typing screen for genetic relatedness. In combination with epidemiological data, AP PCR testing is particularly useful for identifying true outbreaks caused by a single strain.

Gas plasma sterilization is new to the healthcare field. The first such sterilizer has been manufactured by Advanced Sterilization Products (J&J, Irvine, CA). The system uses hydrogen peroxide as the substrate gas and radio frequency emissions to generate plasma. This system is a low-temperature, quick-acting process with no toxic residues. It appears that this sterilizer system holds promise in the healthcare field and could help to reduce the use of ethylene oxide.

This article presents original research findings to illustrate the influence of surveillance definitions oninfection rate. Several definitions for urinary tract infection were applied to clinical and laboratory data from rehabilitation hospital patients, and the effect on sensitivity and specificity examined. We demonstrate that it is essential to take into account the influence of the surveillance definition when interpreting surveillance data, and the importance of ensuring that the surveillance definition is compatible with the surveillance objectives when selecting a definition. Surveillance definitions that serve well in one surveillance program may not serve well in another.

Key decisions regarding the introduction and optimal use of health technologies often are made on an ad hoc basis. Quantitative information on effectiveness, if incorporated into the decision-making process, would establish a reasoned and defensible basis for the introduction and optimal use of therapeutic technologies. Utility measures provide a single summary score of effectiveness which, when combined with cost information, permits the calculation of cost-utility ratios for alternative technologies. A number of techniques have been developed to elicit utilities, including standard gamble, time trade-off, rating scales, the Quality of Well-Being Scale, and the Health Utility Index. No single method has been accepted yet as the gold standard. Selection therefore must be guided by the specific objectives of the assessment.

Hospital employees are at risk for exposure to a variety of communicable diseases, which they may transmit to patients and other workers. The employee health service plays a critical role in an effective infection control program.

In this article, we outline the major responsibilities of the employee health service and summarize key current recom-endations for management of exposures.

In a survey of employees at a chronic care psychiatric facility following an influenza outbreak, previous influenza vaccination (relative risk [RR], 69.7; 95% confidence interval [CI95], 25.2 to 192.4), age ≥ 50 years (RR, 2.4; CI95, 1.3 to 4.5), and knowledge that vaccine does not cause influenza (RR, 2.3; CI95, 1.3 to 3.7) were the factors most predictive of current influenza vaccination. Medical personnel were less likely than nonmedical employees to be vaccinated (RR, 0.5; CI95, 0.3 to 0.9). Educational efforts to address misconceptions about vaccination plus more vigorous administrative measures to vaccinate employees should be considered.