NEWS FEATURES
REGULATORY/LEGISLATIVE
QUESTION OF THE MONTH
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
Animal visitation to hospitalized patients, known as Pet Therapy,
is becoming an increasingly popular activity. Additionally patients may
request service animals (e.g. guide dogs) to stay with them during
hospitalization. A review by Weber and Rutala entitled the "Epidemiology
and Prevention of Nosocomial Infections Associated with Animals" is
published in Mayhall's Infection Control and Hospital Epidemiology,
1996. This chapter discusses the zoonotic diseases with potential for
nosocomial transmission. Safety issues resulting from bites and scratches
are also a concern as approximately 224 strains of bacteria in human and
animal saliva-contaminated wounds have been identified. At the University
of North Carolina Hospitals a pet visitation protocol has been in place
since 1992 that specifies what the voluntary pet owners and dogs must do
to participate in the program. This includes a behavioral screening exam
done by the local Animal Protective Services and a medical screening done
by volunteer veterinarians. The medical screen would include up-to-date
immunizations (distemper, parainfluenza, hepatitis, parvovirus, and
rabies), fecal and nasal cultures every 4 months, routine medication for
the prevention of heartworm, and a flea prevention routine. The dogs must
also be bathed with a flea shampoo and receive an antiflea dip on the day
before or the day of the hospital visit. The dogs must also wear a
designated shirt to identify them as canine volunteers and to reduce
spread of dog hair. Pets on antibiotic therapy for an infection, with skin
or ear infections, wearing a bandage or experiencing GI upset would be
excluded from visitation. Animals positive for any of the following
organisms would be excluded until one negative culture had been obtained
after treatment for the specific organism (Giardia, group A
streptococcus, Shigella, Salmonella, and
Campylobacter). Attending physicians must write an order in the
medical record and parents must sign a consent for the child to
participate in the Pet Visitation Program. Hospitalized children with the
following ailments are excluded from participating in the Pet Visitation
Program: 1) open sores on exposed skin; 2) aggressive behavior; 3)
neutropenia (WBC <1000); 4) HIV-Infection; and 5) immunoglobulin
deficiencies. Pets are kept on a leash at all times and brought to a
designated area in the hospital that is cleaned with an EPA-registered
disinfectant-detergent after the visit.
Several new chemical sterilants have recently been developed including 7.5% hydrogen peroxide (FDA cleared), 0.08% peracetic acid plus 1.0% hydrogen peroxide (FDA cleared), and 0.55% orthophthalaldehyde (not FDA cleared). Data suggest that these products and 2% glutaraldehyde are substantially equivalent in their spectrum of microbiocidal activity, effectiveness in the presence of organic matter, and relative ease of use. No product possesses all the characteristics of an ideal high-level disinfectant. Major disadvantages of currently available products include: material incompatibility with Olympus endoscopes (e.g., peracetic acid with hydrogen peroxide), and human health toxicity (e.g., glutaraldehyde). Considering all the characteristics of currently available products, glutaraldehyde and hydrogen peroxide are alternative choices for high-level disinfection of semicritical items such as endoscopes, The Steris System 1TM (0.2% peracetic acid) is an alternative choices for endoscope reprocessing which has been FDA cleared as a sterilization process. Orthophthalaldehyde will be an option when it is FDA cleared. The hydrogen peroxide plus peracetic acid should be further assessed when the functional damage to Olympus endoscopes is alleviated.
Readers interested in a more extensive review of this subject are referred to the following article: Rutala WA, Weber DJ. Disinfection of Endoscopes, "Review of New Chemical Sterilants for High-Level Disinfection," Infection Control and Hospital Epidemiology (In press).
On
August 1, 1998 several important changes became effective in the North
Carolina Administrative Code rules governing communicable disease control.
The most dramatic changes occurred in sections .0101 and .0102 which
govern the list of reportable diseases. Several diseases were removed from
the list of reportable diseases including: amebiasis, blastomycosis,
encephalitis other than arboviral, non-A and non-B hepatitis, leprosy,
viral (aseptic) meningitis, Kawasaki syndrome, and Reye's syndrome.
Diseases added to the list are crytosporidiosis, cyclosporiasis,
ehrlichiosis, arboviral encephalitis, hemolytic-uremic syndrome and
thrombotic thrombocytopenic purpura, acute hepatitis C, congenital
toxoplasmosis, and vibrio infections. Isolation or other specific
identification of Group A streptococci, Haemophilus influenza type
B, Neisseria meningitidis, and vancomycin-resistant Enterococcus
spp is reportable only if identified from a normally sterile site
(e.g. blood, urine, CSF). The reporting card (form DHHS 2124) has been
revised to reflect the rule changes. The new cards have been printed
"Carolina Blue" in color. They will be distributed as they become
available.
Under Section .0203, the hepatitis B control measures were changed by adding a new paragraph [(e) through (b)] that governs management of hepatitis B-infected children in day care center and school settings. For a complete copy of the revised rules or for questions please contact the Communicable Disease Control Section on-call person at 919-733-3419.
Q: When should two-step TB skin testing or anergy testing be done on healthcare workers or patients?
A: Several changes were made in the North Carolina communicable disease rules regarding tuberculosis control measures effective August 1, 1998. Paragraph (b) adopts the recommendations in the Diagnostic Standards and Classification of Tuberculosis, published by the American Thoracic Society, as the required control measures for evaluation, testing, and diagnosis for TB patients, contacts, and suspects, except as otherwise provided in this rule. It includes specification on how often close contacts shall receive a skin test; deletes the requirement for annual testing of patients and staff in long-term care facilities, but now includes using two-step method on employment and admission; deletes skin testing for Department of Health and Human Services clients and staff; deletes anergy testing from the rules because of the lack of standardization for these test and recent CDC recommendations concerning use of anergy testing; and adds a requirement for testing using the two-step method for persons with HIV infection or AIDS and, upon employment, staff in day care centers providing care for HIV infected/AIDS patients. Paragraphs (c) and (e) adopt, by reference, Treatment of Tuberculosis Infections in Adults and Children, published by the American Thoracic Society, as the source of required control measures for testing, treatment, and follow-up of TB patients, contacts, and suspects.
Source: Dr. Newt MacCormack, Chief, General Communicable Disease Control Section, North Carolina Department of Health and Human Services
"Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease" was published in the MMWR, October 16, 1998.
"Infection Control in Long-Term Care Facilities will be held March 22-23, 1999 in Chapel Hill at the Sheraton Hotel.
"Infection Control Part I: Clinical Surveillance of Nosocomial Infections" will be held in May 1999 in Chapel Hill.
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Report of the Month is also available on the home page of the Statewide Program for Infection Control and Epidemiology at http://www.unc.edu/depts/spice/
The Statewide Program for Infection Control and Epidemiology (SPICE) is funded by the General Assembly of North Carolina to serve the State. SPICE is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Copyright 1998 Statewide Program for Infection Control and Epidemiology