Report of the Month

REPORT OF THE MONTH, Volume IV, Number 1

January - February 2000

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from the North Carolina Statewide Program for Infection Control and Epidemiology

CONTENTS:

NEWS FEATURE

• Revised Bloodborne Pathogens Compliance Directive Issued

REGULATORY/LEGISLATIVE

• Tuberculosis in North Carolina: Epidemiology and New Therapy Guidelines - Part 2
• North Carolina Ergonomics Rules in the News

QUESTION OF THE MONTH

• Attaching Needleboxes to Walls

NEWS AND ANNOUNCEMENTS

COURSES FOR THE INFECTION CONTROL PROFESSIONAL

On November 5, 1999, OSHA disseminated instructions to their surveyors that established policies and provided clarification to ensure uniform inspection procedures are followed when conducting inspections to enforce the OSHA regulations for preventing exposure to bloodborne pathogens. This 263-page directive may require healthcare professionals to make modifications in their institutional programs. Significant changes may include the following. First, OSHA requires hospitals to move aggressively to introduce engineering controls such as needleless IV systems and protected needle devices. Second, postexposure evaluation for hepatitis C is now required. Third, hepatitis B vaccine must be provided during the employees' normal working hours and if travel from the site of employment to another site is required, the employer must pay for the travel. Fourth, the rule requires that there be an opportunity for interactive questions and answers with a person knowledgeable about the OSHA standards. Fifth, the employer must monitor engineering controls to ensure their effectiveness. Sixth, regulated medical waste containers must be labeled with the biohazard symbol (or color-coded) to warn employees who may have contact with the containers of the potential hazard posed by their contents. Sixth, employees must be trained in how to remove a blood-contaminated pullover scrub suit without allowing skin contact. Finally, hand-to-hand transfer of sharps should be eliminated. All infection control professionals are encouraged to read the entire document since OSHA fines may result from failure to implement these standards. Compliance Directive CPL 2-2.44D is available online at www.osha.gov

Identification and treatment of persons with latent tuberculous infection provides significant health benefits to the infected person and is an important public health intervention designed to decrease the incidence of tuberculosis by reducing the number of persons with active tuberculosis (TB). Approximately 10% of persons with latent tuberculosis will develop active disease during their lifetime but many factors increase the risk (Table 1).

Table 1. Incidence of Active TB in Persons With Positive Tuberculin Test by Selected Risk Factor

Treatment of latent tuberculous has been shown to decrease the risk of developing active disease ~90%. Single drug therapy with INH for 6-9 months has been the mainstay of therapy. Based on new studies the State has recently expanded the possible drug regiments. isoniazid (INH) daily or twice daily for 6 months is the preferred therapy. Rifampin plus pyrazinamide (PZA) daily or twice daily for 2 months is an accepted alternative. If intolerance to PZA develops, treat with rifampin for a total of 4-6 months.

Baseline alanine transaminase (AST) testing is indicated for the following persons recommended for INH therapy: >35 years of age, average alcohol intake of >3 drinks per day, injecting drug user or crack cocaine user, previous INH adverse reaction, chronic liver disease, or pregnant women. For persons recommended for rifampin plus PZA the following baseline tests are recommended: CBC with platelets and AST. If the baseline AST is equal to or above 3 times the upper limit of normal, a physician should be consulted before beginning therapy.

Labor Commissioner Harry Payne has challenged the decision of the Rules Review Commission that he has no authority to adopt ergonomics rules for NC businesses. The NC General Assembly passed legislation during 1999 to bar the Department of Labor from adopting new ergonomics standards. Commissioner Payne chose to proceed with final Department action on the rules and submitted them to the Rules Review Commission for approval. The Commission determined that based on legislative action the rules could not be approved until after 2001. Commissioner Payne appeared before the Commission last week asking that they reconsider their vote, arguing that NC has the opportunity to pass rules ahead of Federal regulations. Opponents disagreed, stating that there is no guarantee the Federal government will adopt the proposed regulations. The Commission took no final action on this issue which leaves it pending for the next meeting.

Q: Our facility has chosen a new needlebox container. Are there written requirements for how these boxes should be attached to walls?

A: Yes, NIOSH has made recommendations in the directive "Selecting and Evaluating Needleboxes in Healthcare." The goal is to install a container at an appropriate height for the user that will reduce sharps-related injuries. The following criteria should be used for determining installation height: (1) users should have a clear, unobstructed view of the container inlet opening and (2) the fixture height should be below the eye level of 95% of adult female workers. These requirements yield an optimal installation range of 52 to 56 inches at a standing work station and 38 to 42 inches for a seated workstation. (US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health Selecting, Evaluating and Using Sharps Disposal Containers. Atlanta, Georgia, January 1998.) Available online at www.cdc.gov/niosh/healthpg.html

The Food and Drug Administration Center for Devices and Radiological Health announced three items regarding reprocessing and reuse of single-use devices that may be of interest to infection control professionals. All three documents are available online.

1. Federal Register Notice: Reprocessing and Reuse of Single-Use Devices: Review Prioritization Scheme; and Enforcement Priorities for Single-Use Devices Reprocessed by Third Parties and Hospitals - Availability.
www.fda.gov/OHRMS/DOCKETS/98fr/021100g.txt

2. Reprocessing and Reuse of Single-Use Devices: Review Prioritization Scheme
www.fda.gov/cdrh/reuse/1156.pdf

3. Enforcement Priorities for Single-Use Devices Reprocessed by Third Parties and Hospitals
www.fda.gov/cdrh/reuse/1029.html
www.fda.gov/cdrh/reuse/1029.pdf

"Infection Control Part I: Clinical Surveillance of Nosocomial Infections" will be held April 10-14, 2000 at the Holiday Inn in Chapel Hill.

"Infection Control in Long-Term Care Facilities" will be held April 26-27, 2000 at The Friday Center in Chapel Hill.

Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC; William A. Rutala, PhD, MPH, David J. Weber, MD, 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 2000 North Carolina Statewide Program for Infection Control and Epidemiology

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