Statewide Infection Control Program/Report of the Month

Report of the Month

REPORT OF THE MONTH, Volume II, Number 1 - JANUARY- FEBRUARY 1998

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from the North Carolina Statewide Infection Control Program

GUIDELINES FOR INFECTION CONTROL IN HEALTH CARE PERSONNEL - DRAFT

The CDC Draft Guidelines for Infection Control in Health Care Personnel was published in the Federal Register on September 8, 1997, Vol 62 no 173. UNC Hospitals Department of Hospital Epidemiology has reviewed the document and found the following recommendations to be the most significant practice changes. 1) Employees with herpes zoster with coverable lesions can work except in very high risk areas (e.g., BMT, NICU). Health care workers (HCWs) with herpes simplex on exposed body areas (e.g., hands, head) are excluded from direct patient care of patients who are immunocompromised or have denuded skin (e.g. ER, ICUs). 2) No longer accept those born before 1957 as evidence of immunity for measles. Therefore, measles vaccine should be administered to all HCWs unless they are one of the following: documented physician diagnosed, have positive serology for immunity, or have received two doses of live vaccine after their first birthday. 3) No longer provide post-exposure prophylaxis to persons exposed to ectoparasites (i.e., scabies) in the absence of infestation. 4) For hepatitis B immunization, test all recipients for anti-HBs by a quantitative test 1-2 months after administration of the third dose. For persons who do not respond to HBV vaccine, reimmunize with 3 additional doses and retest for development of protective antibody levels. 5) Obtain a health inventory of all new health care workers and include questions regarding immunosuppressive states, dermatologic conditions, and chronic infections. Those HCWs with medical conditions that render them more likely to a risk of infection should be counseled regarding work assignments. 6) Finally, provide employees with a list of nonlatex glove alternatives, and target areas with high glove use for substitution with nonlatex and/or powder-free latex gloves. Each health care facility should review these new guidelines carefully for changes to consider incorporating in their policies.

WATER AS A RESERVOIR OF NOSOCOMIAL PATHOGENS

Water sources serving as a reservoir for nosocomial pathogens have been reported many times. In an editorial in Infection Control and Hospital Epidemiology (1997;18:609-616), Rutala and Weber reviewed these reports emphasizing methods for prevention and control. Reservoirs of significant importance because of several well-described outbreaks include potable water, ice and ice machines, dialysis water, water baths and tub (hydrotherapy) immersion. Fewer, yet well described, outbreaks have been associated with sinks, faucet aerators, showers, eyewash stations, dental-unit water systems, and ice baths for thermodilution catheters. All of these outbreaks described direct or indirect contact as the means of transmission. Additionally, two outbreaks included droplet contact (ie, sinks and faucet aerators), and one each by inhalation (i.e., showers) and ingestions (i.e., ice and ice machines). Authors of studies investigating the levels of bacterial contamination of toilets found them to be at minimum risk for serving as a reservoir, primarily because an actual infection from these sources has never been demonstrated.

The organisms of greatest concern would be Legionella, particularly in immunocompromised hosts, followed by gram negative bacilli (Pseudomonas, Enterobacter, Acinetobacter). Other organisms that have shown the potential to cause waterborne outbreaks include Mycobacteria, Salmonella, Cryptosporidia, Aspergillus, Staphylococcus, Sphingomonas, and Ameba. Prevention and control focused on routine cleaning of items in contact with water reservoirs and following public health and infection control guidelines.

LEGISLATIVE/REGULATORY NEWS
EPA ISSUES COMPLAINT FOR ILLEGAL CLAIMS THAT PESTICIDE PRODUCT PROTECTS CHILDREN FROM BACTERIAL INFECTIONS

On December 5, 1997, the U.S. Environmental Protection Agency (EPA) issued a civil administrative complaint charging Microban Products Co., Huntersville, N.C., with making unsubstantiated public health claims for its pesticide, Microban Plastic Additive "B." The complaint charges Microban with making claims that certain consumer products treated with the pesticide protect children from infectious diseases caused by bacteria such as E. coli, Staphylococcus and Streptococcus, when in fact the treatment was approved only to protect the plastic in the products from deterioration. The Agency is seeking $160,500 in civil penalties. With this action against Microban, EPA is assuring that registrants limit their claims to those permitted by the product's registration. The use of unapproved public health claims in conjunction with the sale of consumer goods such as sponges, toys and cutting boards may pose a risk to the public. In the case of toys, parents and child care providers could easily conclude from the claims authorized by Microban that the mere presence of Microban in toys provides protection from harmful germs and hence a public health benefit. If parents and child care providers believe that toys are sanitary or self- sanitizing, they may not practice standard hygiene to prevent transmission of harmful germs or be as careful as they should be. The net result may be that children's health is less protected. Microban Plastic Additive "B" is registered by EPA to inhibit bacterial growth in plastic. No public health-related claims have ever been accepted for this pesticide. Under the Federal Insecticide, Fungicide, and Rodenticide Act, it is illegal to make claims for any pesticide which differ from those claims approved in connection with the pesticide's registration. EPA will contact companies that incorporate registered products to emphasize their obligation to comply with the law and to provide such companies with an opportunity to come into compliance.

QUESTION OF THE MONTH

Q: When the water line is disrupted, what infection control measures should be considered?

A: Sometimes it is disasters like hurricanes or flooding, and sometimes it's aging corroded pipes, construction work or just bad luck that result in water line breaks or disruptions. Because of the importance of water to the normal functioning of a hospital, part of a facility's disaster plan should be the means to supply immediately a minimum of two liters of drinking water per person per day. Overall, have a plan for at least three days and estimate the need of 25 gallons/day per person to continue safe operations and care of patients. Even if the water line break is local to a specific area of the facility, water use should be restricted until the water can be tested by laboratory evaluation using public health standards (federal drinking water standards call for only one microbiologic test, a coliform count that must average <1 coliform per 100 ml).

COURSES FOR THE INFECTION CONTROL PROFESSIONAL

"Infection Control Part I: Surveillance of Nosocomial Infections" will be held April 27-May 1, 1998 at the Holiday Inn in Chapel Hill.

"Infection Control in Long-Term Care Facilities" will be held May 19-20, 1998 at the Friday Center in Chapel Hill. (Note change of date.)

APIC Advanced Course - September 14-17 in Charlotte, NC. (For information, call APIC at 202-296-2742.)

NEWS AND ANNOUNCEMENTS

APIC-NC Winter Meeting will be on March 3, 1998 at Bowman Gray School of Medicine in Winston-Salem, NC.

To subscribe to the Report of the Month, send email to spice@unc.edu

Report of the Month is also available on the home page of the Statewide Infection Control Program at http://www.unc.edu/depts/spice

The Statewide Infection Control Program (SICP) is funded by the General Assembly of North Carolina to serve the State. The SICP is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.

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