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Infection control: An idea whose time has come
SPECIAL ARTICLE Infection control: An idea whose time has come Christopher E. Laxton Washington, D.C.
Infection control in the United States is less than 50 years old. This important issue has come into the public's attention with the recent onslaught of highly visible public health crises, involving new infectious diseases: HIV and AIDS; global infection transmission crises, such as Dengue hemorrhagic fever in the Americas, the New Mexican hantavirus, Zairian Ebola, and most recently the British so-called "mad cow disease" (bovine spongiform encephalopathy); the Reston Ebola outbreak at the primate facility in Alice, Texas, this past spring; and the reemergence of such old enemies as tuberculosis (TB) in new, multidrug-resistant forms. These crises, along with the general movement of health care delivery out of the acute care setting and into a community-based continuum of care provided by large health care "systems," have pushed the practice of infection control further a n d further beyond its roots. These roots are found in the very specific task of identifying, controlling, and preventing outbreaks of infection originating in the hospital, generally referred to as
nosocomial inflections. Infection control professionals (ICPs) are n o w extending their practice into all health settings-particularly into home care and long-term care, but also into such specialized practice areas as pediatrics and "high-tech," or medical device-related, infections. Increasingly, ICPs are taking on b r o a d pubic health and prevention issues directly, providing education to their communities as well as educating health care professionals a b o u t the basic principles of infection prevention and control. Infection control is an idea whose time has most definitely come. From the Association for Professionals in Infection Control and Epidemiology, Inc., Washington, D.C. Reprinted by permission of the National Association for Home Care, from CARINGmagazine, XV(7):10-7. Not for further reproduction. AJIC Am J Infect Control 1997;25:34-7 0196-6553/97
34
$5.00 + 0
11146111491
A H I S T O R Y OF INFECTION C O N T R O L
Infection control, as a separate and identifiable practice, began in the middle 1950s and 1960s, when severe and extensive epidemics of staphylococcal infections among hospitalized patients, particularly surgical patients and newborn infants, led health care providers to focus on the problem of nosocomial infections. In 1958, the American Hospital Association developed basic r e c o m m e n d a t i o n s for hospitals to use w h e n designing their prevention programs. In 1968, the Centers for Disease Control (now the Centers for Disease Control and Prevention, CDC) began presenting training programs for infection control p e r s o n n e l u n d e r the supervision of Claire Coppage, w h o was at that time Assistant to the Chief for Infection Control Training at the CDC. In 1972, Coppage identified a core group of ICPs who had attended her course, "Surveillance, Prevention and Control of Hospital-Acquired Infections," or 1200-G. At her urging and with her guidance, this group met to form an organization of ICPs free from the political restrictions of a governmental agency. Out of this effort, the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) was born. The 1200-G course was offered until the middle 1980s, when it was discontinued by the CDC as a result of restructuring and budget cuts. In 1989, APIC assumed the responsibility for this training. 1-3 In 1976 the Joint Commission on Accreditation of Hospitals (now the Joint Commission on Accreditation of Healthcare Organizations, JCAHO) published their first extensive standard that dealt specifically with infection control. As JCAHO has evolved, it has intensified the importance of infection control. The surveillance, prevention, and control of infections is one of 11 functions a d d r e s s e d in the JCAHO 1995 Accreditation Manual (or Hospitals, the manual that contains all the standards addressed by JCAHO surveyors during their accreditation surveys. The infection control function is considered equally important as
AJIC Volume 25, Number 1
L,a.,~ton 3 5
Infection Control and Home Care: An Effective Partnership Infection prevention and control has always been important to the home care provider, even though it has not always been formally identified as a separate scientific practice. Nor until recently has infection control been a mandated part of the array of health care services that a provider brings into a client's home. Now, thanks to changes in the way health care is being delivered across the country and around the world and because of new regulatory and accreditation requirements from the JCAHO, state licensing boards, and federal agencies, home care providers are looking at infection control more closely. In fact, there are three very good reasons why infection control has become more important to home care providers. The first is that a solid infection control program, well defined and properly implemented, improves outcomes and quality of patient care. It achieves this through an emphasis on the prevention of nosocomial (or, in the home setting, nosohusiat) infection, by minimizing the risks of infection, and through the early detection of infection. The second has to do with the health and safety of the health care worker--an area that has long been a central focus for the ICP, and one that is readily adaptable to the home setting. The third, as mentioned already, has to do with new federal and state licensure and accrediting agency requirements from the JCAHO, from various state licensing bodies, and increasingly from federal agencies. Naturally, home care agencies are looking for the most effective means of translating infection prevention and control, or clinical epidemiology--a science that began in an acute care environment and until recently remained in the hospital setting--into the unique and highly variable setting of a client's home. This benchmark question is of interest not only to the home care community, facing both regulatory pressure and growing market pressure from managed care organizations to adopt a formal infection control program, but it is also of great interest to ICPs who have participated in the movement of health care delivery from the hospital into the continuum of care. The ICP, along with most health care professionals, has been swept up in the radical reengineering that is taking place as medical treatment evolves from focusing on acuity and acute illness to chronicity and conditions requiring long-term care.
APIC Mission S t a t e m e n t The Association for Professionals in Infection Control and Epidemiology, inc., is a multidisciplinary, voluntary international organization. Our purpose is to influence, support, and improve the quality of health care through the practice and management of infection control and the application of epidemiology in all health settings. APIC is committed to improve patient care, to prevent adverse outcomes, and to minimize occupational hazards associated with the delivery of health care.
the other 10 functions, which also include infection control-related responsibilities. EDUCATION, N E T W O R K I N G , A N D A D V O C A C Y
In 1972, APIC was founded because there was a need for an organized, systematic approach to the control of infections acquired as a result of hospitalization. The n a m e was changed in 1994 to recognize the organization's m a t u r a t i o n and evolution into the broader context of health care delivery in this country, which includes the study of noninfectious adverse outcomes, public health and prevention issues, and the m o v e m e n t of health care outside the traditional acute care system or hospital. The founders established APIC to provide ICPs with job-specific education, networking opportunities, and a unified industry voice to promote and protect the quality of patient care. "Our
www.apic.org: APIC Joins the World Wide Web At the 1996 APIC National Conference, APIC was proud to unveil its World Wide Web site, http://ww~zapic.org/. Featuring an on-line resource center of current practicerelated documents as well as official APIC documents, the site also provides "hotlinks" to other sites of interest on the web. The site is fully interactive, allowing for on-line surveys, applications, and the placement of orders; it also provides a search tool to locate workshop and journal abstracts of articles held in a database and an "on-line advocacy" area in which APIC members may send e-mail messages to their members of Congress. 4 The APIC site takes advantage of the interactivity of the World Wide Web by providing areas where ICPs can post questions and comments in an easy, newsgroup-like format, but closer to real-time discussion. APIC is also considering such high-tech innovations as on-line continuing education credit course offerings and the establishment of a "virtual chapter" for unaffiliated APIC members across the country and around the world.
founders never could have envisioned the changes that have taken place in health care during the past few years," says APIC President Ava D. Lancaster. "While m a n y technologic advances to radically improve patient care were on the horizon, the health care delivery revolution that accompanied them could not have been foreseen." APIC has been an active participant in these changes and has expanded its advocacy role on a
AJIC
36
February 1997
Laxton
T h e C e r t i f i c a t i o n Board of Infection Control (CBIC) The CBIC was established by APIC in 1981 to administer a certification program. CBIC is an autonomous, separately incorporated organization whose role is to conduct ongoing task analysis that enables the infection control profession to understand and keep pace with the changing nature of the practice, to administer the certification examination and award certification to those who successfully complete its requirements, and to recertify those ICPs whose certifications have reached the end of their valid term. The relationship between CBIC and APIC is depicted by the following diagram: CBIC • Perform task analysis • Develop test and administer examination • Administer recertification APIC • Publish Infection Control and Applied Epidemiology:
Principles and Practice • Provide educational offerings • Publish study guides Infection control certification is a voluntary, nongovernmental process of granting recognition to individuals who demonstrate a standard of special competence. CBIC is an independent, voluntary certification board, which promotes control and prevention of disease transmission for users and providers of health care. This is accomplished through CBIC's development and administration of a reliable, valid examination designed to measure the professional knowledge of individuals engaged in the practice of infection control and epidemiology. Certification is accomplished by the administration of a written examination covering identified aspects of the practice of infection control. In order to take the examination, certain standards of eligibility must be met. • Continuing competence will be demonstrated by recertification every 5 years• For more information on the certification process, contact the CBIC Executive Office at 913541-9077.
national level through an effective government affairs program. APIC was established to provide education and science-based information to strengthen and to improve the practice of infection prevention and control and applied epidemiology. True to its founding principles, the organization's top priority remains education, as demonstrated by the wide variety of educational courses, training, and products that APIC has developed and offers on a year-round basis. These courses include basic training, advanced practice, and infection control for the critically ill.
INFECTION CONTROL GUIDELINES AND STANDARDS
APIC established a rigorous scientific development and review process to produce an ongoing series of practice guidelines for ICPs and other health care professionals who have a responsibility for infection control, health care quality, and employee safety. APIC's strategic plan charges its Guidelines Committee--a body of nine volunteers expert in all aspects of infection control practice--with the task of compiling, critiquing, developing, maintaining, and influencing guidelines and standards in infection control. These tasks include recruiting experts in specialized practice areas to serve as APIC guideline authors, evaluating the extent to which institutions and systems implement APIC guidelines in their infection control departments, and collaborating with other organizations to improve and optimize guidelines that have an impact on infection control. APIC's guidelines now cover such key areas as handwashing, long-term care, disinfectants, and flexible endoscopy. A guideline for infection control in the home care setting is being completed now. APIC is an official source of CDC guidelines on infection control practice, including isolation precautions, device-related infections, TB, and pneumonia, and is also a source of Occupational Safety and Health Administration (OSHA) training guides such as the TB control and training guide, which was produced last year by OSHA. ANNUAL EDUCATIONAL CONFERENCE AND INTERNATIONAL MEETING
Both novice and experienced ICPs come together annually to expand their knowledge and establish practical expertise in infection control and epidemiology at APIC's Annual Educational Conference and International Meeting. This conference serves as the time and place for APIC's annual business meeting, as well as other important organizational meetings and activities. The conference also provides unmatched opportunities for networking with experts in infection control and epidemiology. This year's conference offered a great deal of interest to the home care community. Programs included a special preconference on infection control in the home care setting; an infection control surveillance program design workshop that lea-
AJIC
L~to1~l 3 7
Volume 25, Number 1
tured an examination of the unique setting-related considerations in h o m e care; and n u m e r o u s oral and poster sessions that covered the home care arena. G O V E R N M E N T AFFAIRS
The APIC Governmental Affairs Committee is one of the most important and active bodies in the organization. The three major goals of APIC's government affairs program are to establish APIC as an advocate and authority for the practice of epidemiology, infection control, and quality improvement; to establish and m a i n t a i n c o m m u n i c a t i o n with legislators and regulatory agencies; and to m o n i t o r and influence legislation, regulation, and health policy regarding issues prioritized by the APIC Board. "The scope of APIC's influence has grown, with the result that our opinions are now solicited and highly valued by the regulatory agencies," says Lancaster. "Our audible voice, visible role, and past contributions to improving the quality of health care have given us limitless opportunities to increase our sphere of influence. We provide important oral and written testimony during budget appropriations hearings and on regulations that seriously affect the entire health care profession."
W H A T DOES T H E F U T U R E HOLD?
APIC's vision is to lead the field of infection prevention, control, and applied epidemiology in all health settings. The APIC leadership works within the organization with its committees, members, and chapters, as well as through collaboration with organizations, groups, and agencies that share c o m m o n purposes with APIC. APIC's leadership welcomes the growth of similar collaborative relationships with home care providers and the National Association for Home Care. Such partnerships will jointly provide important and needed s u p p o r t - - t h r o u g h educational and informational resources, practice guidelines, and advocacy coalitions--for both the home care service provider and the ICP communities. References
1. Castle M, Klimek JJ. Association for Practitioners in Infection Control and the American Journal of Infection Control after twenty years: a review. AJIC Am J Infect Control 1992;20:I-3. 2. Russell B. The Association for Professionals in Infection Control and Epidemiology, Inc. Infect Control Hosp Epidemiol 1995;16:522-5. 3. Soule B. The evolution of our profession: lessons fcoin Darwin. Am J Infect Control 1991;19:45-57. 4. Harr J. Double-u double-u double-u dot APIC dot org: a review of the APIC world wide web site, AJIC Am J Infect Control 1996;24:454-61.
WHAT'S N E X T FOR AJIC?
Issue
Estimated date to AJIC editorial office
Topic
Guest editor(s)
April June August October December
November January March May July
Surveillance Applied epidemiology Global perspectives Organized systems of care Research
Teresa Horan/Terrie Lee Janet Bundy/William Rutala Barbara Soule/Charles Huskins Jerri Bryant Helen Rosen Kotilainen
Infection control in the United States is less than 50 years old. This important issue has come into the public's attention with the recent onslaught of highly visible public health crises, involving new infectious diseases: HIV and AIDS; global infection transmission crises, such as Dengue hemorrhagic fever in the Americas, the New Mexican hantavirus, Zairian Ebola, and most recently the British so-called "mad cow disease" (bovine spongiform encephalopathy); the Reston Ebola outbreak at the primate facility in Alice, Texas, this past spring; and the reemergence of such old enemies as tuberculosis (TB) in new, multidrug-resistant forms. These crises, along with the general movement of health care delivery out of the acute care setting and into a community-based continuum of care provided by large health care "systems," have pushed the practice of infection control further a n d further beyond its roots. These roots are found in the very specific task of identifying, controlling, and preventing outbreaks of infection originating in the hospital, generally referred to as
nosocomial inflections. Infection control professionals (ICPs) are n o w extending their practice into all health settings-particularly into home care and long-term care, but also into such specialized practice areas as pediatrics and "high-tech," or medical device-related, infections. Increasingly, ICPs are taking on b r o a d pubic health and prevention issues directly, providing education to their communities as well as educating health care professionals a b o u t the basic principles of infection prevention and control. Infection control is an idea whose time has most definitely come. From the Association for Professionals in Infection Control and Epidemiology, Inc., Washington, D.C. Reprinted by permission of the National Association for Home Care, from CARINGmagazine, XV(7):10-7. Not for further reproduction. AJIC Am J Infect Control 1997;25:34-7 0196-6553/97
34
$5.00 + 0
11146111491
A H I S T O R Y OF INFECTION C O N T R O L
Infection control, as a separate and identifiable practice, began in the middle 1950s and 1960s, when severe and extensive epidemics of staphylococcal infections among hospitalized patients, particularly surgical patients and newborn infants, led health care providers to focus on the problem of nosocomial infections. In 1958, the American Hospital Association developed basic r e c o m m e n d a t i o n s for hospitals to use w h e n designing their prevention programs. In 1968, the Centers for Disease Control (now the Centers for Disease Control and Prevention, CDC) began presenting training programs for infection control p e r s o n n e l u n d e r the supervision of Claire Coppage, w h o was at that time Assistant to the Chief for Infection Control Training at the CDC. In 1972, Coppage identified a core group of ICPs who had attended her course, "Surveillance, Prevention and Control of Hospital-Acquired Infections," or 1200-G. At her urging and with her guidance, this group met to form an organization of ICPs free from the political restrictions of a governmental agency. Out of this effort, the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) was born. The 1200-G course was offered until the middle 1980s, when it was discontinued by the CDC as a result of restructuring and budget cuts. In 1989, APIC assumed the responsibility for this training. 1-3 In 1976 the Joint Commission on Accreditation of Hospitals (now the Joint Commission on Accreditation of Healthcare Organizations, JCAHO) published their first extensive standard that dealt specifically with infection control. As JCAHO has evolved, it has intensified the importance of infection control. The surveillance, prevention, and control of infections is one of 11 functions a d d r e s s e d in the JCAHO 1995 Accreditation Manual (or Hospitals, the manual that contains all the standards addressed by JCAHO surveyors during their accreditation surveys. The infection control function is considered equally important as
AJIC Volume 25, Number 1
L,a.,~ton 3 5
Infection Control and Home Care: An Effective Partnership Infection prevention and control has always been important to the home care provider, even though it has not always been formally identified as a separate scientific practice. Nor until recently has infection control been a mandated part of the array of health care services that a provider brings into a client's home. Now, thanks to changes in the way health care is being delivered across the country and around the world and because of new regulatory and accreditation requirements from the JCAHO, state licensing boards, and federal agencies, home care providers are looking at infection control more closely. In fact, there are three very good reasons why infection control has become more important to home care providers. The first is that a solid infection control program, well defined and properly implemented, improves outcomes and quality of patient care. It achieves this through an emphasis on the prevention of nosocomial (or, in the home setting, nosohusiat) infection, by minimizing the risks of infection, and through the early detection of infection. The second has to do with the health and safety of the health care worker--an area that has long been a central focus for the ICP, and one that is readily adaptable to the home setting. The third, as mentioned already, has to do with new federal and state licensure and accrediting agency requirements from the JCAHO, from various state licensing bodies, and increasingly from federal agencies. Naturally, home care agencies are looking for the most effective means of translating infection prevention and control, or clinical epidemiology--a science that began in an acute care environment and until recently remained in the hospital setting--into the unique and highly variable setting of a client's home. This benchmark question is of interest not only to the home care community, facing both regulatory pressure and growing market pressure from managed care organizations to adopt a formal infection control program, but it is also of great interest to ICPs who have participated in the movement of health care delivery from the hospital into the continuum of care. The ICP, along with most health care professionals, has been swept up in the radical reengineering that is taking place as medical treatment evolves from focusing on acuity and acute illness to chronicity and conditions requiring long-term care.
APIC Mission S t a t e m e n t The Association for Professionals in Infection Control and Epidemiology, inc., is a multidisciplinary, voluntary international organization. Our purpose is to influence, support, and improve the quality of health care through the practice and management of infection control and the application of epidemiology in all health settings. APIC is committed to improve patient care, to prevent adverse outcomes, and to minimize occupational hazards associated with the delivery of health care.
the other 10 functions, which also include infection control-related responsibilities. EDUCATION, N E T W O R K I N G , A N D A D V O C A C Y
In 1972, APIC was founded because there was a need for an organized, systematic approach to the control of infections acquired as a result of hospitalization. The n a m e was changed in 1994 to recognize the organization's m a t u r a t i o n and evolution into the broader context of health care delivery in this country, which includes the study of noninfectious adverse outcomes, public health and prevention issues, and the m o v e m e n t of health care outside the traditional acute care system or hospital. The founders established APIC to provide ICPs with job-specific education, networking opportunities, and a unified industry voice to promote and protect the quality of patient care. "Our
www.apic.org: APIC Joins the World Wide Web At the 1996 APIC National Conference, APIC was proud to unveil its World Wide Web site, http://ww~zapic.org/. Featuring an on-line resource center of current practicerelated documents as well as official APIC documents, the site also provides "hotlinks" to other sites of interest on the web. The site is fully interactive, allowing for on-line surveys, applications, and the placement of orders; it also provides a search tool to locate workshop and journal abstracts of articles held in a database and an "on-line advocacy" area in which APIC members may send e-mail messages to their members of Congress. 4 The APIC site takes advantage of the interactivity of the World Wide Web by providing areas where ICPs can post questions and comments in an easy, newsgroup-like format, but closer to real-time discussion. APIC is also considering such high-tech innovations as on-line continuing education credit course offerings and the establishment of a "virtual chapter" for unaffiliated APIC members across the country and around the world.
founders never could have envisioned the changes that have taken place in health care during the past few years," says APIC President Ava D. Lancaster. "While m a n y technologic advances to radically improve patient care were on the horizon, the health care delivery revolution that accompanied them could not have been foreseen." APIC has been an active participant in these changes and has expanded its advocacy role on a
AJIC
36
February 1997
Laxton
T h e C e r t i f i c a t i o n Board of Infection Control (CBIC) The CBIC was established by APIC in 1981 to administer a certification program. CBIC is an autonomous, separately incorporated organization whose role is to conduct ongoing task analysis that enables the infection control profession to understand and keep pace with the changing nature of the practice, to administer the certification examination and award certification to those who successfully complete its requirements, and to recertify those ICPs whose certifications have reached the end of their valid term. The relationship between CBIC and APIC is depicted by the following diagram: CBIC • Perform task analysis • Develop test and administer examination • Administer recertification APIC • Publish Infection Control and Applied Epidemiology:
Principles and Practice • Provide educational offerings • Publish study guides Infection control certification is a voluntary, nongovernmental process of granting recognition to individuals who demonstrate a standard of special competence. CBIC is an independent, voluntary certification board, which promotes control and prevention of disease transmission for users and providers of health care. This is accomplished through CBIC's development and administration of a reliable, valid examination designed to measure the professional knowledge of individuals engaged in the practice of infection control and epidemiology. Certification is accomplished by the administration of a written examination covering identified aspects of the practice of infection control. In order to take the examination, certain standards of eligibility must be met. • Continuing competence will be demonstrated by recertification every 5 years• For more information on the certification process, contact the CBIC Executive Office at 913541-9077.
national level through an effective government affairs program. APIC was established to provide education and science-based information to strengthen and to improve the practice of infection prevention and control and applied epidemiology. True to its founding principles, the organization's top priority remains education, as demonstrated by the wide variety of educational courses, training, and products that APIC has developed and offers on a year-round basis. These courses include basic training, advanced practice, and infection control for the critically ill.
INFECTION CONTROL GUIDELINES AND STANDARDS
APIC established a rigorous scientific development and review process to produce an ongoing series of practice guidelines for ICPs and other health care professionals who have a responsibility for infection control, health care quality, and employee safety. APIC's strategic plan charges its Guidelines Committee--a body of nine volunteers expert in all aspects of infection control practice--with the task of compiling, critiquing, developing, maintaining, and influencing guidelines and standards in infection control. These tasks include recruiting experts in specialized practice areas to serve as APIC guideline authors, evaluating the extent to which institutions and systems implement APIC guidelines in their infection control departments, and collaborating with other organizations to improve and optimize guidelines that have an impact on infection control. APIC's guidelines now cover such key areas as handwashing, long-term care, disinfectants, and flexible endoscopy. A guideline for infection control in the home care setting is being completed now. APIC is an official source of CDC guidelines on infection control practice, including isolation precautions, device-related infections, TB, and pneumonia, and is also a source of Occupational Safety and Health Administration (OSHA) training guides such as the TB control and training guide, which was produced last year by OSHA. ANNUAL EDUCATIONAL CONFERENCE AND INTERNATIONAL MEETING
Both novice and experienced ICPs come together annually to expand their knowledge and establish practical expertise in infection control and epidemiology at APIC's Annual Educational Conference and International Meeting. This conference serves as the time and place for APIC's annual business meeting, as well as other important organizational meetings and activities. The conference also provides unmatched opportunities for networking with experts in infection control and epidemiology. This year's conference offered a great deal of interest to the home care community. Programs included a special preconference on infection control in the home care setting; an infection control surveillance program design workshop that lea-
AJIC
L~to1~l 3 7
Volume 25, Number 1
tured an examination of the unique setting-related considerations in h o m e care; and n u m e r o u s oral and poster sessions that covered the home care arena. G O V E R N M E N T AFFAIRS
The APIC Governmental Affairs Committee is one of the most important and active bodies in the organization. The three major goals of APIC's government affairs program are to establish APIC as an advocate and authority for the practice of epidemiology, infection control, and quality improvement; to establish and m a i n t a i n c o m m u n i c a t i o n with legislators and regulatory agencies; and to m o n i t o r and influence legislation, regulation, and health policy regarding issues prioritized by the APIC Board. "The scope of APIC's influence has grown, with the result that our opinions are now solicited and highly valued by the regulatory agencies," says Lancaster. "Our audible voice, visible role, and past contributions to improving the quality of health care have given us limitless opportunities to increase our sphere of influence. We provide important oral and written testimony during budget appropriations hearings and on regulations that seriously affect the entire health care profession."
W H A T DOES T H E F U T U R E HOLD?
APIC's vision is to lead the field of infection prevention, control, and applied epidemiology in all health settings. The APIC leadership works within the organization with its committees, members, and chapters, as well as through collaboration with organizations, groups, and agencies that share c o m m o n purposes with APIC. APIC's leadership welcomes the growth of similar collaborative relationships with home care providers and the National Association for Home Care. Such partnerships will jointly provide important and needed s u p p o r t - - t h r o u g h educational and informational resources, practice guidelines, and advocacy coalitions--for both the home care service provider and the ICP communities. References
1. Castle M, Klimek JJ. Association for Practitioners in Infection Control and the American Journal of Infection Control after twenty years: a review. AJIC Am J Infect Control 1992;20:I-3. 2. Russell B. The Association for Professionals in Infection Control and Epidemiology, Inc. Infect Control Hosp Epidemiol 1995;16:522-5. 3. Soule B. The evolution of our profession: lessons fcoin Darwin. Am J Infect Control 1991;19:45-57. 4. Harr J. Double-u double-u double-u dot APIC dot org: a review of the APIC world wide web site, AJIC Am J Infect Control 1996;24:454-61.
WHAT'S N E X T FOR AJIC?
Issue
Estimated date to AJIC editorial office
Topic
Guest editor(s)
April June August October December
November January March May July
Surveillance Applied epidemiology Global perspectives Organized systems of care Research
Teresa Horan/Terrie Lee Janet Bundy/William Rutala Barbara Soule/Charles Huskins Jerri Bryant Helen Rosen Kotilainen