Disinfection of environmental surfaces has been proposed as a means to decrease or eliminate potential pathogens and thereby decrease potential acquisition of disease. In addition to commercial products, a variety of home products are also used for disinfection by the public.
Studies recently conducted at UNC demonstrated excellent antimicrobial activity (>5.6 log reduction) at both 30 second and 5 minute exposure for Clorox (1:10 dilution, ethanol (70%), and Lysol Antibacterial Spray. A second household disinfectant, Mr. Clean, eliminated 4 to >6-logs of pathogenic bacteria while a third household disinfectant, Lysol, consistently eliminated 4- logs of bacteria. Two natural products, vinegar and baking soda, were in general much less effective than the commercial products. In conclusion, the home products were less effective than commercial disinfectants. A variety of commercial disinfectants were highly effective against bacterial pathogens such as E. coli 0157:H7, Salmonella, Staphylococcus aureus, Enterococcus, and Pseudomonas aeruginosa.
To analyze hepatitis B disease trends, risk factor data from the national Viral Hepatitis Surveillance Program suggested the number of hepatitis B virus (HBV) infections among HCWs declined from 17,000 in 1983 to 400 in 1995. The 95% decline in incidence observed among HCWs is 1.5 fold greater than the reduction in the general US population.
Finally, a medical literature review was conducted on 9 studies related to long-term protection after hepatitis B vaccination. All studies demonstrated a decline in antibody titers to surface antigen over time. Antibody to HBsAg declined to <10 mIU/ml in 7% to 50% of respondents 5 years after vaccination and in 30%-60% of those vaccinated by 9 to 11 years. No studies reported acute cases of hepatitis B among vaccine responders. Among 1,786 persons followed up for 5 to 11 years, 70 (2.6%) developed antibody to hepatitis core antigen. No one had evidence of symptomatic or chronic infection. Therefore, the studies demonstrate induced protection at least 11 years even when titers of antibody decline below detectable levels. (Arch Intern Med 1997;157:2601-2605)
In the area of infection control, OSHA found that the Bloodborne Pathogen Exposure Control Plan was appropriate. The plan includes information about offering hepatitis B vaccine and requiring a declination form if the employee refuses the vaccine. When the employees receive the first vaccination, they are given the dates for receiving the second and third vaccinations. OSHA inspectors said that the health care facility must do more than just inform employees of the dates for return vaccinations; the facility should send reminders to the employees. In addition, if the employees do not receive the second or third dose of hepatitis B vaccination in the appropriate time frame, a signed declination must be placed in the employees' records.
Recently, the SICP became aware of a practice whereby physicians were ordering vancomycin to be administered by the aerosol route to hospital patients colonized with MRSA for the purpose of obtaining negative nasal cultures to facilitate transfer to long- term care facilities. This treatment was initially described in the Japanese medical literature. However, aerosolized vancomycin is not advised for the following reasons: (1) it has an irritant effect on the lungs of patients; (2) it induces added risk for resistance of MRSA to vancomycin, (3) the recommended treatment that has demonstrated efficacy is mupirocin ointment for 5 to 7 days; and (4) long-term care facilities should follow the transfer recommendations from NC State Guidelines for Resistant Organisms.
"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 202-296-2742)
NEW COURSE: "Infection Control in Home Health and Hospice" will be held September 28, 1998 at the Omni Chapel Hill Hotel.
"Infection Control Part II: The ICP as an Environmentalist will be held October 12-16, 1998 at the Holiday Inn in Chapel Hill.
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.
Copyright 1998 North Carolina Statewide Infection Control Program