January-February 2005
CONTENTS:
NEWS FEATURES
REGULATORY/LEGISLATIVE
QUESTION OF THE MONTH
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
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NEWS FEATURES
What Does the New OSHA Fit Testing Legislation Mean for North Carolina Hospitals?
On Wednesday, December 8, 2004, President Bush signed into law the fiscal year 2005 omnibus spending bill, including the Wicker provision prohibiting the Occupational Health and Safety Administration (OSHA) from enforcing the annual fit-testing mandate for occupational exposure to tuberculosis in healthcare facilities for fiscal year (FY) 2005 (through September 30, 2005). The bill also included Wicker-sponsored report language (non-binding, but expressing the “Sense of the Congress”) advising OSHA to take no further action with regard to respiratory protection for occupational exposure to tuberculosis (TB) until such time as the Centers for Disease Control and Prevention (CDC) has completed the ongoing revisions of its TB guidelines.
The CDC released new draft TB guidelines for healthcare setting on its website in early December. www.cdc.gov/nchstp/tb/Federal_Register/default.htm. (See related item in News and Announcements section.)
These guidelines recommend perform fit-testing during the initial respiratory protection program training and periodically thereafter based on the risk assessment for the setting. The guidelines also recommend that risk assessments be completed and documented at least annually and include risk-assessment worksheets to help guide the process.
State plan states like North Carolina (NC) may not use federal funds but may use 100% state funds to enforce the fit-testing rule which remains in place. However, Ed Geddie, representing Occupational Safety and Health North Carolina (OSHNC), has stated that NC is in the process of aligning itself with the federal OSHA mandates and will not be enforcing annual fit tests for TB. The OSHNC enforcement policy regarding the issue is at:
www.nclabor.com/osha/etta/publicopn/opn131A.pdf
However, the Wicker-appropriation legislation affects only annual fit testing of respirators for protection against tuberculosis. All requirements of the respiratory protection standard, including annual fit testing for use against other hazards such as severe acute respiratory syndrome (SARS) or other bioaerosols, remain in effect.
JCAHO may still be expecting compliance with annual fit-testing regardless of federal legislation prohibiting OSHA's enforcement of its own rule.
For further information see the December 22, 2004 , Memo from R. Davis Layne, OSHA Deputy Assistant Secretary. www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=24977
REGULATORY/LEGISLATIVE
CMS Soon to Approve Hand Rubs in Corridors
According to a Centers for Medicare and Medicaid Services (CMS) letter received by the Association of Professionals in Infection Control and Epidemiology (APIC) this fall, the agency is preparing to announce that alcohol-based hand rubs can be safely stored and dispensed in egress corridors. The letter was sent in response to an APIC letter sent in September, urging CMS to reverse its prohibition. The CMS response had stated that an official notice would be forthcoming in the Federal Register on December 23, 2004 . However, according to CMS, the publication process has been delayed. As of December 23, 2004 , the rule is now under review during the next 90 days by the Office of Management and Budget (OMB), and should be published sometime in March in the Federal Register, likely with an official effective date 60 days thereafter. The letter from CMS goes on to mention, however, that until the revised regulation is published, the current regulation does remain in effect.
In the meantime, ICPs should contact their local jurisdiction if their facility is cited for having dispensers in corridors. States vary in their approaches, but CMS has been recommending that if facilities are cited for this, they should request a "temporary waiver" from enforcement action in their plan of correction (December 23, 2004 update from APIC).
Note: See Report of the Month - March-April 2004 for information about the National Fire Protection Association (NFPA) amending its 2000 and 2003 Life Safety Code (LSC) 101 to permit alcohol-based hand rubs in egress corridors when specific conditions are met.
QUESTION OF THE MONTH
Handwashing Sink Required for Modular Unit
Q: A small rural hospital asked, “Can we use hand sanitizer only at a modular MRI located about 50 feet from the main building? We will be seeing inpatients for approximately two years until the main building is modified. We don't want to spend the money for a hand lavatory and associated drainage as required by licensure rules.”
A: All procedure rooms should have a sink available for handwashing in addition to the waterless agents. Several patient-care related events may be expected where a handwashing sink would be needed and where a waterless hand hygiene agent would not be sufficient. Any situation which results in organic material on the hands of healthcare workers would require a sink for washing hands with soap and water. In addition to drainage and secretions events (i.e. vomit, stool, etc.), blood from a wound or IV would require a handwashing sink for compliance with the OSHA Bloodborne Pathogens Rule.
NEWS AND ANNOUNCEMENTS
New Jersey Requires Certification for infection Control Professionals
New Jersey recently revised its hospital licensure regulations to mandate certification by the Certification Board in Infection Control and Epidemiology (CBIC) for all hospital Infection Control Professionals (ICP). Under the new regulations all ICPs must be certified within 5 years of beginning practice. The regulations also mandate an ICP ratio of 1 full-time ICP per 200 adjusted-occupied beds as a minimum standard.
2005 Edition of the APIC Text
Text of Infection Control and Epidemiology, Second Edition, is
now available. The APIC text is the primary source for evidence-based clinical standards for infection prevention and patient safety. This fully revised edition comprises over 120 chapters in two volumes and includes a CD with the full text of the print and many additional resources (guidelines, references and educational pamphlets).
www.apic.org
Core Curriculum on “Tuberculosis: What the Clinician Should Know” Course on CD-ROM
The Division of Tuberculosis Elimination (DTBE) announced the availability of the Interactive Core Curriculum on “Tuberculosis: What the Clinician Should Know” course on CD-ROM. This course was designed to provide clinicians with basic information about TB, including the diagnosis, treatment, and prevention of latent TB infection and TB disease. The course is also available via the Internet at
www.cdc.gov/nchstp/tb/webcourses/corecurr/index.htm
Copies of the CD-ROM can be ordered in the following ways:
- Through the DTBE's on-line ordering system: www.cdc.gov/tb
- By mailing or faxing a DTBE Educational and Training Materials Order Form.
- Through the CDC Voice and Fax Information System by calling, toll-free, 1-888-232-3228 and requesting the Interactive Core Curriculum on “Tuberculosis: What the Clinician Should Know” CD-ROM, order #99-8049.
The revised print version of the Core Curriculum on Tuberculosis will be released in the Fall of 2005.
New Edition of Practical Handbook for Healthcare Epidemiologists
Need a reference book for the Chair of your Infection Control Committee? The new edition of Practical Handbook for Healthcare Epidemiologists is a concise guide for people who work in healthcare epidemiology programs. Extensively updated and revised, this handbook is user-friendly, and will provide practical information regarding many aspects of establishing and managing a healthcare epidemiology program. The Society for Healthcare Epidemiology of America (SHEA) has recruited over 50 recognized leaders in the field to share their expertise. They discuss overarching goals, as well as successful strategies for handling specific situations and problems. There is also extensive information on infection control in the outpatient setting and measures to take after exposure to infectious agents.
Draft Tuberculosis Guidelines
The Centers for Disease Control and Prevention (CDC) has published a notice in the Federal Register (December 6, 2004) requesting public comments on draft revised guidelines entitled "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." the Federal Register notice, draft guidelines, and additional information about the public comment period can be accessed online at
www.cdc.gov/nchstp/tb/Federal_Register/default.htm
The public comment period ends February 4, 2005 .
Current Issues in Infection Control, Disinfection and Sterilization Symposium
The Society for Healthcare Epidemiology of America (SHEA) will be hosting its annual meetings in Los Angeles , California , April 9-12, 2005 . Prior to the meetings, Advanced Sterilization Products and Ethicon Products will offer an educational Symposium entitled Current Issues in Infection Control, Disinfection and Sterilization at the Westin Century Plaza Hotel on Saturday, April 9, 2005 from 6:30 AM to 12:00 PM . The Symposium will feature faculty who will provide a current perspective on infection control issues as well as advances in the sterilization and disinfection sciences. There will be no fee for attending this Symposium, however, pre-registration is required because space is limited. An agenda and registration information are at
www.unc.edu/depts/spice/SHEA2005.doc
Outbreak of Multidrug-Resistant Acinetobacter baumannii Associated with Pulsatile Wound Treatment
The December 22/29, 2004 issue of JAMA reported a healthcare-associated outbreak of multidrug-resistant Acinetobacter baumannii had been traced back to a pulsatile lavage wound treatment (a treatment that uses high-pressure irrigation to debride wounds). The authors recommend that appropriate infection control precautions be taken and that they be included in pulsatile lavage equipment labeling.
New Publication Highlights Protection of Hospital Workers During Emergencies
Helping hospitals safeguard their employees who care for patients during mass casualty incidents is the role of a new OSHA document released in December. "OSHA Best Practices for Hospital-Based Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances" offers critical information to help hospitals create emergency plans based on worst-case scenarios.
www.osha.gov/dts/osta/bestpractices/firstreceivers_hospital.html
(from OSHA Quick Takes January 15, 2004 )
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control in Long-Term Care Facilities” will be held in Chapel Hill March 14-16, 2005
“Infection Control Part I: Clinical Surveillance of Healthcare-Associated Infections” will be held in Chapel Hill May 9-13, 2005 .
“Infection Control Part II: The ICP as an Environmentalist” will be held in Chapel Hill in the fall of 2005.
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. The SPICE is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Copyright 2005 Statewide Infection Control Program