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NEWS FEATURES
LEGISLATIVE/REGULATORY NEWS
QUESTION OF THE MONTH
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
NEWS FEATURES
Patient Injury From Flash Sterilized
Instruments
The recommended use of flash sterilization is for the emergency sterilization of unwrapped, nonporous metal items in a gravity displacement sterilizer for three minutes at 132oC. Flash sterilization is commonly used in the operating room for emergency sterilization of dropped or otherwise contaminated instruments, instruments unintentionally left out of a surgical tray or, inappropriately, to compensate for inadequate inventories of instruments of implantable devices.
We are aware of two patients who suffered clinically significant burns from the immediate use of flash sterilized equipment which had not had time to cool. Skin grafting was not required but did result in permanent scarring.
After these incidents the following corrective actions were undertaken. First, additional surgical instruments were purchased in order to reduce the need for flash sterilization. Second, a policy was instituted which requires that all instruments following flash sterilization be cooled prior to use by the surgeon. This was accomplished by either air cooling or immersion in sterile saline. Third, all staff were educated regarding the need to cool flash sterilized instruments prior to use. No additional burns have occurred in the one year since these incidents.
The Effect of Blood on the Antivial Activity of Disinfectants
Sharp injury with contaminated blood has led to transmission of more than 20 diseases, but of greatest concern are hepatitis B virus (HBV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV). For this reason the CDC recommends that blood spills be decontaminated with a 1:100 dilution of household bleach. Staff associated with the Statewide Program for Infection Control and Epidemiology conducted a study to determine the virucidal activity of three disinfectants in the presence and absence of blood; sodium hypochlorite, a phenolic, and a quaternary ammonium compound (QAC). The test organisms were the vaccine strain of poliovirus type 1 (prototype for relatively resistant hydrophilic virus) and herpes simplex virus (HSV) type 1 (prototype for relatively susceptible lipophilic virus). Disinfectants at varying dilutions were added to create either saline or a blood suspension (final concentration 80% or 20% blood) and then virus was added. Viral survival was tested at room temperature at the following times (min): 0, 0.25, 0.50, 1, 2, 5, and 10. In the absence of blood complete inactivation of HSV was achieved within 30s with 5,000 (1:10 dilution of bleach) and 500 (1:100 dilution of bleach) ppm chlorine, 1:10 and 1:128 diluted phenolic (use dilution), and 1:10 and 1:128 diluted QAC (use dilution). In the presence of 80% blood only 5,000 ppm hypochlorite, 1:10 phenolic, and 1:10 or 1:128 diluted QAC were effective. In the absence of blood complete inactivation of polio was achieved within30s by 5,000 and 500 ppm chlorine and 1:10 diluted QAC. In the presence of 80% blood no solution tested was capable of completely inactivating polio within 10 minutes. These data suggest that blood spills should be minimally decontaminated with a 1:10 hypochlorite (final concentration).
REGULATORY/LEGISLATIVE
NC Unveils Ergonomics
Proposal
On November 10, 1998, the North Carolina (NC) Department of Labor issued a draft ergonomics standard; that is scheduled for entry into the NC Register for public comment in February 1999. This draft standard would require NC employers with over 10 employees to provide training in identifying and reducing musculoskeletal disorders (MSD) within 90 days of employment when employees' work activity "routinely exposes them" to one or more ergo stressors (e.g., repitition, force, etc.). Employers with 10 or fewer employees would be required either to provide training or to provide written materials to employees about avoiding MSD problems. Citations would not be given if an active program is in place identifying ergo stressors with prevention and control strategies (i.e., engineering, work place, and administrative). In addition, Federal OSHA is predicting a proposed ergonomics standard will be ready by the summer of 1999.
QUESTION OF THE MONTH
Laser
Safety
Q: I am reviewing my safety manual and have concerns about what is required by regulation (OSHA) and what is recommended for protection of healthcare workers (HCW) during laser or electro-cautery procedures that produce smoke. Could you provide me with information about this?
A: During surgical procedures using a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. Research studies have confirmed that this smoke plume can contain toxic gases and vapors, bioaerosals, and live cellular material (including blood fragments), and viruses. At high concentrations the smoke causes ocular and upper respiratory tract irritation in healthcare personnel and can create visual problems for the surgeon. The smoke has unpleasant odors and has been shown to have mutagenic potential. Therefore the protection of HCWs and patients from smoke fumes is essential and can be accomplished through the following means. NIOSH recommends the use of a smoke evacuation system with a high efficiency filter (HEPA) for trapping particulates. Room or central wall suction systems are designed to capture primarily liquid and if used to capture smoke must have an appropriate in-line filter (HEPA) attached. The AORN suggests that low velocity wall suction devices should be used only for minimal smoke producing procedures. Procedures using either system need to keep the inlet as close as possible or within 2 inches of the surgical site to be effective in capturing contaminants. The various filters and absorbers used in smoke evacuation require monitoring and replacement on a regular basis and should be handled with appropriate protective equipment and disposed of as biohazard waste. Smoke evacuators and suction devices used as engineering controls should be the primary means to control exposure. Additionally, a high filtration (HEPA) mask capable of filtering viruses to a size of less than 0.1 micron has been recommended by the American National Standards Institute. The use of a laser (HEPA) mask does not replace the need for a smoke evacuation system. OSHA does not have a standard addressing smoke fume. However OSHA has responded that the General Duty Clause of 1970 applies to all employers to provide employees with a place of employment that is free of recognized hazards. Recently, in March 1998, OSHA sent a draft of its guidelines document "Information for Health Care Workers Exposed to Laser and Electrosurgical Smoke" to external reviewers. This document is intended to offer guidance for all HCWs with exposure to smoke by-products.
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"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 May 3-7, 1999 at the Holiday Inn in Chapel Hill
Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC;
William A. Rutala, PhD, MPH,
Eva P. Clontz, MEd.
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 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 1999 North Carolina Statewide Program for Infection Control and Epidemiology
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