Restricted accessResearch articleFirst published online 2004-12
The epic project. Updating the evidence-base for national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England: a report with recommendations
The evidence underpinning infection prevention and control guidelines requires updating at regular intervals as advances in technology and new research findings may influence guideline recommendations. The evidence-base for national guidelines published in 20011 for preventing healthcare-associated infections in hospitals in England has recently been updated using systematic review methods. A critical assessment of the updated evidence indicates that the current guidelines remain robust, relevant and appropriate, but that adjustments need to be made to some guideline recommendations. Periodically updating the evidence base and making necessary adjustments to guideline recommendations is essential, in order to maintain their validity and authority.
Pratt RJ, Pellowe C., Loveday HP, Robinson N., Smith GW, and the guideline development team ( 2001) The epic project: developing national evidence-based guidelines for preventing healthcare associated Infections. Phase 1: guidelines for preventing hospital-acquired infections. J Hosp Infect47(Supplement): S1-S82.
2.
Cluzeau F., Littlejohns P., Grimshaw J., Feder G. (1997) Appraisal instrument for clinical guidelines (version one). St. George's Hospital Medical School: London.
3.
Centers for Disease Control and Prevention. ( 1996) Centers for Disease Control and Prevention guidelines: improving the quality. Centers for Disease Control and Prevention:Atlanta: 179.
4.
Pellowe CM, Pratt RJ, Harper P., Loveday HP, Robinson N., Jones S., MacRae ED, and the Guideline Development Group. ( 2003) Infection control: prevention of healthcare -associated infection in primary and community care. J Hosp Infect55(Supplement 2): 1-127.
5.
Oie S., Hosokawa I., Kamiya A. (2002) Contamination of room door handles by methicillin - sensitive/methicillin-resistant Staphylococcus aureus. J Hosp Infect51: 140-3.
6.
Griffith CJ, Malik R., Cooper RA, Looker N., Michaels B. (2003) Environmental surface cleanliness and the potential for contamination during handwashing. Am J Hosp Infect31(2): 93-6.
7.
Schultz M., Gill J., Zubairi S., Huber R., Gordin F. (2003) Bacterial contamination of computer keyboards in a teaching hospital. Infect Control Hosp Epidemiol24(4): 302-3.
8.
Griffith CJ, Cooper RA, Gilmore J., Davies C., Lewis, M. (2000) An evaluation of hospital cleaning regimes and standards. J Hosp Infect45: 19-28.
9.
Griffiths R. , Fernandez R., Halcomb E. (2002) Reservoirs of MRSA in the acute hospital setting: a systematic review. Contemp Nurs13: 38-49.
10.
Sampling A. , Wiseman S., Davis L., Hyett AP, Walbridge AN, Payne GC, Cornaby AJ (2001) Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect49: 109-16.
11.
Brooks SE, Walczak MA, Hameed R. (2002) Chlorhexidine resistance in antibiotic resistant bacteria isolated from the surfaces of dispensers of soap containing chlorhexidine . Infect Control Hosp Epidemiol23(11): 692-5.
12.
Malik R.E., Cooper R.A., Griffith C.J. (2003) Use of audit tools to evaluate the efficacy of cleaning systems in hospitals. Am J Infect Control31(3): 181-7.
13.
Rampling A. , Wiseman S., Davis L., Hyett AP, Walbridge AN, Payne G.C., Cornaby AJ (2001) Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect49(2): 109-16.
14.
Fitzpatrick F., Murphy OMBrady A., Prout S., Fenelon LE (2000) A purpose-built MRSA cohort unit. Journal ofHospital Infection46(4): 271-9.
15.
French GL, Otter JA, Shannon KP, Adams Nmt, Watling D., Parks MJ (2004) Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination . J Hosp Infect57(1): 31-7.
16.
Lucet JC, Rigaud MP, Mentre F., Kassis N., Deblangy C., Andremont A., Bouvet E. (2002) Hand contamination before and after different hand hygiene techniques: a randomised clinical trial. J Hosp Infect50(4): 276-80.
17.
Winnefeld M. , Richard MA, Drancourt M., Grob JJ (2000) Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Brit J Dermatol143: 546-50.
18.
Larson E., Aiello AE, Bastyr J., Lyle C., Stahl J., Cronquist A., Lai L., Della-Latta P. (2001) Assessment of two hand hygiene regimens for intensive care unit personnel. Crit Care Med29(5): 944-51.
19.
Girou E., Loyeau S., Legrand P., Oppein F., Brun-Buisson C. (2002) Efficacy of handrubbing with alcohol-based solution versus standard handwashing with antiseptic soap: randomised clinical trial . BMJ325: 362-5.
20.
Zaragoza M., Salles M., Gomez J., Bayas JM, Trilla A. (1999) Handwashing with soap or alcoholic solutions? A randomized clinical trial of its effectiveness. Am J Infect Control27(3): 258-61.
21.
Herruzo-Cabrera R., Garcia-Caballero J., Martin-Moreno JM, Graciani-Perez-Regadera MA, Perez-Rodriguez J. (2001) Clinical assay of N-duopropenide alcohol solution on hand application in newborn and pediatric intensive care units: control of an outbreak of multiresistant Klebsiella pneumoniae in a newborn intensive care unit with this measure. Am J Infect Control29(3): 162-7.
22.
Herruzo-Cabrera R., Garcia-Caballero J., Fernandez-Acenero MJ (2001 ) A new alcohol solution (N-duopropenide) for hygienic (or routine) hand disinfection is more useful than classic handwashing: in vitro and in vivo studies in burn and other intensive care units. Burns27: 747-52.
23.
Larson E., Silberger M., Jakob K., Whittier S., Lai L., Latta PD, Saiman L. (2000) Assessment of alternative hand hygiene regimens to improve skin health among neonatal intensive care unit nurses. Heart and Lung29(2): 136-42.
24.
Kramer A., Rudolph P., Kampf G., Pittet D. (2002) Limited efficacy of alcohol-based hand gels. Lancet359: 1489-90.
25.
Moadab A., Rupley KF, Wadhams P. (2001) Effectiveness of a non-rinse alcohol-free antiseptic hand wash. JAPMA91(6): 288-93.
26.
Guilhermetti M., Hernandes Sed, Fukushigue Y., Garcia LB, Cardoso CL (2001) Effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from contaminated hands. Infect Control Hosp Epidemiol22(2):105-8.
27.
Paulson DS, Fendler EJ, Dolan MJ, Williams RA (1999) A close look at alcohol gel as an antimicrobial sanitizing agent. Am J Infect Control27(4): 332-8.
28.
Cardosa CL, Pereira HH, Zequim JC, Guilhermetti M. (1999) Effectivieness of hand-cleansing agents for removing Acinetobacter baummannii strain from contaminated hands. Am J Infect Control27(4): 327-31.
29.
Kampf G., Jarosch R., Ruden H. (1998) Limited effectiveness of chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect38: 297-303.
30.
Dyer DL, Gerenraich KB, Wadhams PS (1998) Testing a new alcohol-free hand santitizer to combat infection. AORN Journal68(2): 239-51.
31.
Dharan S., Hugonnet S., Sax H., Pittet D. (2003) Comparison of waterless hand antisepsis agents at short application times: raising the flag of concern. Infect Control Hosp Epidemiol24(3): 160-4.
32.
Faoagali JL , George N., Fong J., Davy J., Dowser M. (1999) Comparison of the antibacterial efficacy of 4% chlorhexidine gluconate and 1% triclosan handwash products in an acute clinical ward. Am J Infect Control27(4): 320-6.
33.
Boyce JM, Pittet D. (2002) Guideline for hand hygiene in healthcare settings: recommendations of the healthcare infection control practice advisory committee and the HICPAC/SHEA/APIC/IDSA hygiene task force. MMWR51(RR16): 1-44. See: www.cdc.gov/handhygiene/ (accessed 23 November 2004).
34.
Gustafson DR , Vetter EA, Larson DR, Ilstrup DM, Maker MD, Thompson RL, Cockerill FR (2000) Effects of four hand-drying methods for removing bacteria from washed hands: a randomised trial. Mayo Clinic Proceedings75(7): 705-8.
35.
Trick WE, Vernon MO, Hayes RA (2003) Impact of ring-wearing on hand contamination and comparison of hand hygiene agents in a hospital. Clin Infect Dis36(1): 1383-90.
36.
Clark L., Smith W., Young L. (2002) Protective clothing: principles and guidance. ICNA: London: 39.
37.
Tenorio AR, Badri SM, Sahgal NB, Hota B., Matushek M., Hayden MK, Trenholme GM, Weinstein RA (2001) Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant enterococcus species by healthcare workers after patient care. Clin Infect Dis32(5): 826-9.
38.
Kim PW, Roghmann M-C., Perencevich EN, Harris AD (2003) Rates of hand disinfection associated with glove use, patient isolation, and changes between exposures to various body sites . Am J Infect Control31(2): 97-103.
39.
British Standards Institution. (2000) Medical gloves for single use part 1: specification for freedom from holes BS-EN 455-1. British Standards Institution: London.
40.
British Standards Institution. (2000) Medical gloves for single use part 2: specification for physical properties BS-EN 455-2. British Standards Institution: London.
41.
British Standards Institution. (2000) Medical gloves for single use part 3: requirements and testing for biological evaluation BS-EN 455-3. British Standards Institution:London.
42.
Korniewicz DM, El-Masri M., Broyles JM (2002) To determine the effects of gloves stress, type of material (vinyl, nitrile, copolymer, latex) and manufacturer on the barrier effectiveness of medical examination gloves. Am J Infect Control30(2): 133-8.
43.
Perry C., Marshall R., Jones E. (2001) Bacterial contamination of uniforms. J Hosp Infect48: 238-41.
44.
Puzniak LA, Leet T., Mayfield J., Kollef M., Mundy LM (2002) Top gown or not to gown: the effect on acquisition of vancomycin-resistant Enterococci. CID35(July): 18-25.
45.
Srinivasan A., Song X., Ross T., Merz W., Brower R., Perl TM (2002) A prospective study to determine whether cover gowns in addition to gloves decrease nosocomial transmission of vancomycin-resistant Enterococci in an intensive care unit. Infect Cont HospEpidemiol23(8): 424-8.
46.
Zachary KC, Bayne PS, Morrison VJ, Ford DS, Silver LC, Hooper DC (2001) Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant Enterococci. Infect Cont HospEpidemiol22(9): 560-4.
47.
Seto WH, Tsang D., Yung Rwh, Ching TY, Ng TK, Ho M., Ho LM, Peiris JS, Advisors of expert SARS group of hospital authority. (2003) Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet361(9368):1519-20.
48.
Lacey S., Flaxman D., Scales J., Wilson A. (2001) The usefulness of masks in preventing transient carriage of epidemic methicillin-resistant Staphylococcus aureus by healthcare workers. J Hosp Infect48: 308-11.
49.
Winson L. (2001) Catheterisation: a need for improved patient management : In: Pope-Cruickshank J, Woodward S. (Ed.). Management of continence and urinary catheter care. MarkAllen: Bath: 53-62.
50.
Brosnahan J., Jull A., Tracy C. (2004) Types of urethral catheters for management of short-term voiding problems in hospitalised adults (Cochrane Review). The Cochrane Library (Issue 1). John Wiley and Sons: Chichester.
51.
Saint S., Veenstra DL, Sullivan SD, Chenoweth C., Fendrick M. (2000) The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection. Arch Intern Med160: 2670-5.
52.
Saint S., Elmore JG, Sullivan SD, Emerson SS, Koepsell TD (1998) The efficacy of silver alloy-coated catheters in preventing urinary tract infection: a meta-analysis. Am J Med105: 236-41.
53.
Stickler DJ , Clayton CL, Chawla JC (1987) Assessment of antiseptic bladder washout procedure using a physical model of the catheterised bladder . Brit J Urol60: 413-8.
54.
Getliffe K. (1994) The use of bladder-washouts to reduce urinary catheter encrustation. Brit J Urol73: 696-700.
55.
Daschner F., Chiarello LA, Dettenkoffer M., Fabry J., Francioli P., Knopf H-J.,Mehtar S., Murphy C. (2001) Hygiene and infection control of nosocomia catheter-associated urinary tract infection: In: Naber KG, Pechere JC, Kumazawa J, KhouryS, Gerbeding JL, Schaeffer AJ (Eds.). Nosocomial and healthcare associated infections in urology. Health Publication: London: 105-19.
56.
Stickler DJ, Jones GL, Russell AD (2003) Control of encrustation and blockage of Foley catheters . Lancet361:1435-7.
57.
Pearson ML (1996). Hospital infection control practices advisory committee. guideline for prevention of intravascular-device-related infections . Infect Control Hosp Epidemiol17(7): 438-73.
58.
Centers for Disease Control and Prevention. (2002) Guidelines for the prevention of intravascular-catheter-related infections. MMWR51(RR-10): 1-29. See: www.cdc.gov/mmwr/PDF/rr/rr5110.pdf (accessed 23 November 2004).
59.
The Agree Collaboration. (2001) Appraisal of guidelines for research and evaluation (AGREE) instrument. St Georges' Hospital Medical School: London. See: www.agreecollaboration.org (accessed June 2001).
60.
Darouiche RO, Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A., Berg J., Khardori N., Hanna H., Hachem R., Harris RL, Mayhall G. (1999) A comparison of two antimicrobial-impregnated central venous catheters: catheter study group. N Engl J Med340(1): 1-8.
61.
Mermel LA (2000) Prevention of intravascular catheter-related infections . Ann Intern Med132: 391-402.
62.
Darouiche RO , Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A., Berg J., Khardori N., Hanna H., Hachem R., Harris RL, Mayhall G. (1999) A comparison of two antimicrobial-impregnated central venous catheters: catheter study group. N Engl J Med340(1): 1-8.
63.
Walder B., Pittet D., Tramer M. (2002) Prevention of bloodstream infections with central venous catheters treated with anti-infective agents depends on catheter type and insertion time: evidence from a meta-analysis. Infect Control Hosp Epidemiol23(12): 748-56.
64.
Shorr AF, Humphreys CW, Helman DL (2003) New choices for central venous catheters. Chest124: 275-84.
65.
Marciante KD , Veenstra DL, Lipsky BA, Saint S. (2003) Which antimicrobial impregnated central venous catheter should we use? Modeling the costs and outcomes of antimicrobial catheter use. AJIC31: 1-8.
66.
Mermel LA, McCormick RD, Springman SR, Maki DG ( 1991) The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med91(suppl): S197-S205.
67.
Heard SO, Wagle M., Vijayakumar E., McLean S., Brueggemann A., Napolitano LM, Edwards LP, O'Connell FM, Puyana JC, Doern GV (1998) Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia. Arch Intern Med158(1): 81-7.
68.
Richet H., Hubert B., Nitemberg G., Andremont A., Buu-Hoi A., Ourbak P., Galicier C., Veron M., Boisivon A., Bouvier AM, et al. (1990) Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. J Clin Microbiol28(11): 2520-5.
69.
Goetz AM, Wagener MM, Miller JM, Muder RR (1998) Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol19: 842-5.
70.
Trottier SJ , Veremakis C., O'Brien J., Auer AI (1995) Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med23: 52-9.
71.
Merrer J., De Jonghe B., Golliot F., Lefrant JY, Raffy B., Barre E., Rigaud JP, Casciani D., Misset B., Bosquet C., Outin H., Brun-Buisson C., Nitenberg G.; French catheter study group in intensive care. ( 2001) Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA286: 700-7.
72.
Joynt GM, Kew J., Gomersall CD, Leung VY, Liu EK ( 2000) Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients. Chest117: 178-83.
73.
Mian NZ, Bayly R., Schreck DM, Besserman EB, Richmand D. (1997) Incidence of deep venous thrombosis associated with femoral venous catheterization. Acad Emerg Med4: 1118-21.
74.
Durbec O., Viviand X., Potie F., Vialet R., Albanese J., Martin C. (1997) A prospective evaluation of the use of femoral venous catheters in critically ill adults. Crit Care Med25: 1986-9.
75.
Randolph AG , Cook DJ, Gonzales CA, Pribble CG (1996) Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med24: 2053-8.
76.
National Institute for Clinical Excellence. ( 2002) Ultrasound locating devices for placement of central venous catheters: no. 49. See: www.nice.org.uk (accessed September 2002).
77.
Maki DG, Ringer M., Alvarado CJ (1991) Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet338: 339-43.
78.
Mimoz O., Pieroni L., Lawrence C., Edouard A., Costa Y., Samii K., Brun-Buisson C. (1996) Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med24(11): 1818-23.
79.
Chaiyakunapruk N., Veenstra DL, Lipsky BA, Saint S. (2002) Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis . Ann Intern Med136(11):792-801.
80.
Raad I., Luna M., Khalil SA, Costerton JW, Lam C., Bodey GP (1994) The relationship between the thrombotic and infectious complications of central venous catheters. JAMA271(13): 1014-6.
81.
Randolph AG , Cook DJ, Gonzales CA, Andrew M. (1998) Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomized controlled trials. Chest113(1): 165-71.
82.
Passannante A., Macik BG (1998) Case report: the heparin flush syndrome: a cause of iatrogenic hemorrhage. Am J Med Sci296: 71-3.
83.
Randolph AG , Cook DJ, Gonzales CA, Andrew M. (1998) Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials. BMJ316: 96975.
84.
Goode CJ, Titler M., Rakel B., Ones DS, Kleiber C., Small S., Triolo PK (1991) A meta-analysis of effects of heparin flush and saline flush: quality and cost implications. Nurs Research40(6): 324-30.
85.
Peterson FY , Kirchoff KT (1991) Analysis of the research about heparinized versus nonheparinized intravascular lines. Heart and Lung20: 631-40.
86.
Bern MM, Lokich JJ, Wallach SR, Bothe A. Jr, Benotti PN, Arkin CF, Greco FA, Huberman M., Moore C. (1990) Very low doses of warfarin can prevent thrombosis in central venous catheters: a randomized prospective trial. Ann Intern Med112(6): 423-8.
87.
Hoar PF, Wilson RM, Managano DT, Avery GJ 2nd, Szarnicki RJ, Hill JD ( 1981) Heparin bonding reduces thrombogenicity of pulmonary-artery catheters. New Engl J Med305(17): 993-5.
88.
Chastre J., Comud F., Bouchama A., Viau F., Benacerraf R., Gibert C. (1982) Thrombosis as a complication of pulmonary-artery catheterisation within the internal jugular vein. New Engl J Med306: 278-81.
89.
Valerio D., Hussey JK, Smith FW (1981) Central venous thrombosis associated with intravenous feeding: a prospective study. Journal of Parenteral and EnteralNutrition5: 240-2.
90.
Andrew M., Marzinotto V., Pencharz P., Zlotkin S., Burrows P., Ingram J., Adams M., Filler R. (1995) A cross-sectional study of catheter-related thrombosis in children receiving total parenteral nutrition at home. Journal ofPediatrics126(3): 358-63.
91.
Krafte-Jacobs B., Sivit CJ, Mejia R., Pollack MM (1995) Catheter-related thrombosis in critically ill children: comparison of catheters with and without heparin bonding. Journal ofPediatrics126(1): 50-54.
92.
Talbott GA, Winters WD, Bratton SL, O'Rourke PP (1995) A prospective study of femoral catheter-related thrombosis in children. Archives of Pediatric and Adolescent Medicine149(3):
