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NEWS FEATURES
Immunization of Healthcare Workers
The Statewide Program for Infection Control and Epidemiology recently surveyed all acute hospitals in North Carolina to ascertain their immunization policies of healthcare workers (HCWs). Overall, 69 hospitals responded. All hospitals included hepatitis B and influenza in their policies; 94-97% of hospitals included mumps, measles, rubella, and tetanus in their policies. Only 86% included varicella in their policy. Hospital policies were designed to assure compliance among nurses, who were almost always included in the policy. Other personnel were frequently not included in the policies including physician, contract workers, volunteers, students, and emergency medical technicians. Frequent areas of noncompliance with current CDC/HICPAC recommendations (see below) were as follows: immunity not required (only recommended); written documentation of physician diagnosed disease, proof of serologic immunity, or previous immunization history not required; measles immunization of HCWs born before 1957; and, testing HCWs for hepatitis B immunity after primary immunization series using a quantitative test.
Current guidelines of the ACIP and HICPAC recommend that all HCWs should be immune to mumps, measles, rubella, varicella, and influenza. OSHA requires that all HCWs with potential blood or body fluid exposure must be offered hepatitis B vaccine. Hospital policies regarding vaccine preventable diseases should include all personnel providing both direct (i.e., nurses, physicians, students, others) and indirect patient care, contract workers, volunteers, and emergency medical personnel. Immunity to mumps, measles, rubella, or varicella may be documented by physician diagnosed disease, positive serology, or proper immunization: mumps - 1 dose live virus vaccine, measles - 2 doses live virus vaccine (1 month apart), rubella - 1 dose live virus vaccine, and varicella - 2 doses live virus vaccine (1 month apart). Birth before 1957 is accepted as evidence for immunity only for mumps. A personal history of infection is accepted as evidence of immunity only for varicella. Written documentation of serologic results, previous immunizations, or physician-diagnosed disease should be required. Proof of immunity (unless vaccine is medically contraindicated) should be required (mandatory). Current guidelines for hepatitis B recommend that all HCWs be tested for immunity using a quantitative test (anti-HBsAg titer <10 mIU/mL) 1-2 months following completion of the primary immunization series. Non-immune HCWs should receive a second hepatitis B immunization series and be retested. Nonimmune HCWs (anti-HBsAg titer <10 mIU/mL) should be considered nonresponders and should receive HBIG in the event of an exposure to blood/body fluid contaminated with HBsAg.
Inactivation of Cryptosporidium parvum Oocyst Infectivity by Disinfection and Sterilization Processes
Researchers at the University of North Carolina at Chapel Hill and UNC Hospitals recently published their findings about inactivation of Cryptosporidium parvum. C. parvum is a common cause of self-limited gastroenteritis in the normal host but may cause severe disease in immunocompromised persons. Person-to-person transmission has been well documented in households, childcare centers, and hospitals. Because contaminated environmental surfaces and medical devices such as endoscopes may play a role in disease transmission the researchers studied the susceptibility of C. parvum to chemical agents commonly used for disinfection and evaluated the efficacy of sterilization processes.
Seven disinfectants were studied at their use dilution using a suspension test. Antimicrobial activity was assessed using a cell infectivity assay. The authors found that all sterilization processes tested (steam, ethylene oxide, Sterrad 100) inactivated 3 logs or greater of C. parvum. The only liquid disinfectant/ sterilant able to inactivate greater than 3 logs of C. parvum was 6% and 7.5% hydrogen peroxide. Agents unable to completely inactivate C. parvum included hydrogen peroxide at lower concentrations or exposure times, peracetic acid, sodium hypochlorite, a phenolic, a quaternary ammonium compound, 2% glutaraldehyde, and ortho-phthalaldehyde.
In conclusion, most high-level disinfectants used on endoscopes have limited efficacy against C. parvum. However, the infectivity of C. parvum on dry surfaces decreases rapidly. Therefore, current cleaning and high-level disinfection guidelines are adequate to prevent nosocomial transmission of C. parvum via endoscopes. (Gastrointestinal Endoscopy 1999; 49:605-611).
REGULATORY/LEGISLATIVE NEWS
JCAHO Random Unannounced Survey Policy
On August 4, 1999, the Joint Commission on Accreditation of Healthcare Organizations approved significant changes to its Random Unannounced Survey Policy. These policy modifications are effective January 1, 2000:
Organizations will receive no advance notice for random unannounced surveys.
The window of time during which random unannounced surveys may be conducted will be 9 to 30 months following the triennial full survey.
The scope and focus of review during an unannounced survey will vary from organization to organization and will be based on information related to recommendations made during the organization's previous triennial survey, known sentinel events, and other relevant information regarding the organization's performance.
QUESTION OF THE MONTH
Fans in Dietary Kitchens
Q: My question regards having fans blowing in the dietary kitchens. Are there any regulations, guidelines, or rules that discuss the use of fans in the kitchen area of healthcare facilities?
A: North Carolina Restaurant Sanitation Rules do not restrict the use of fans and the ventilation section states that equipment should be clean and in good repair. One consideration in addition to the cleanliness of fans is the effect on maintaining appropriate temperatures of food in the direct flow of air. JCAHO surveys facilities for compliance with guidelines and rules that are scientifically supported; therefore, fans may be allowed without restriction.
NEWS AND ANNOUNCEMENTS
Karen Hoffmann Receives Educator of The Year Award
The national trade magazine Infection Control Today has honored Karen K. Hoffmann, a clinical instructor in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill, with its Educator of the Year Award.
Hoffmann, who also is the associate director of the Statewide Program for Infection Control and Epidemiology, was selected by nomination from among thousands of university professors, perioperative educators, infection control hospital epidemiologists, industry educators and heads of infection control hospital committees. Once nominated, she was chosen by the advisory board and publishing staff of Infection Control Today magazine to receive the award.
The magazine recognized Hoffmann for the training courses she offers on infection control to professionals in acute care, long-term care and home health facilities throughout North Carolina. She also gives onsite lectures each year and is a primary contributor to a bimonthly educational electronic newsletter sent to infection control professionals.
In addition, Hoffmann served as the UNC-CH School of Medicine representative on the program planning committee of the American Lung Association Blue Ridge Institute Conference. And she compiled educational materials into a standardized curriculum for a state-approved infection control course and was the editor of the NC Guidelines for Control of Resistant Organisms.
Infection Control Today boasts 30,000 readers whose profession involves infection control in a hospital setting.
OTHER ANNOUNCEMENTS
Bill Rutala has been appointed as a member of the CDC's Healthcare Infection Control Practices Advisory Committee.
On October 23, 1999, the Food and Drug Administration will unveil its regulatory proposal for its reprocessing of single-use medical devices. The American Society for Healthcare Central Service Professionals annual conference in Florida on that date will include debate on the proposal.
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
In the spring of 2000, two infection control training courses will be held in Chapel Hill: "Infection Control in Long-Term Care Facilities" and "Part 1: Clinical Surveillance of Nosocomial Infections." If you would like information about either of these courses, send email to spice@unc.edu or call 919-966-3242.
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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