March-May 2005
CONTENTS:
NEWS FEATURES
QUESTION OF THE MONTH
REGULATORY/LEGISLATIVE
NEWS AND ANNOUNCEMENTS
NEWS FEATURE
Prevention of Transmission of Hepatitis B Virus Among Persons Undergoing Blood Glucose Monitoring in Long-Term Care Facilities
The Immunization Branch and the General Communicable Disease Control Branch, released a memorandum on May 19, 2005 , directed to long-term care, adult home, and hospital administrators regarding the recent CDC change of practice recommendations for the practice of blood glucose monitoring using glucometers. The following information was in the memorandum.
The purpose of this memorandum is to inform you about recently published recommendations related to hepatitis B virus prevention in diabetes care procedures in long-term care (LTC) settings. On March 11, 2005 , the Centers for Disease Control and Prevention (CDC) published an article describing three hepatitis B virus (HBV) outbreaks that were attributed to shared devices and other breaks in infection control practices related to blood glucose monitoring.
Findings from these outbreak investigations indicate the need for education and training on standard bloodborne precautions, as well as the need for specific infection control recommendations targeting diabetes care procedures in LTC settings. Some of the recommended practices for preventing patient-to-patient transmission of HBV during diabetes care procedures include:
The CDC article describing these outbreaks is available online at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5409a2.htm
The recommendations for cleaning glucometers from the NC Statewide Program for Infection Control and Epidemiology are available online at
http://www.unc.edu/depts/spice/glucometer.pdf
QUESTION OF THE MONTH
Revision to TB Skin-Testing Requirements in North Carolina Long-Term Care Facilities
Q: What are the rules or requirements for TB skin-testing (TST) frequency in North Carolina long-term care facilities?
A: As of January 2005, the requirements for all NC long-term care facilities (LTCF) to do mandatory TB skin tests on all residents and employees annually has been revised. The NC rule 13D .2209 governing LTCF states, “the facility shall ensure tuberculosis screening annually for patients and staff as required by 10 NCAC 41A, Communicable Disease Control Rule.” This NC Communicable rule is consistent with the 1994 CDC TB Guidelines as mandated by the 1996 OSHA TB Compliance Document CPL 2.106 requiring the frequency of healthcare facility TB skin testing programs be based on an annual facility risk assessment. The CDC initial risk assessment for TB includes obtaining information on TB in the local community (available from local Health Department), evaluating data on TB patients in the facility, evaluating data on PPD conversions in healthcare workers, and ruling out person-to-person transmission. Most LTCF risk assessments fall into the category of “very low” risk. The very low-risk category is defined by the CDC as where no TB patients are admitted as inpatients to a facility during the preceding year and a plan to refer patients with confirmed or suspected TB to a collaborating facility if inpatient care is required. Because very low-risk facilities do not admit patients who may have active TB to inpatient areas, most healthcare workers in such facilities do not need routine follow-up PPD after baseline PPD is done. While facilities can choose to do more than local, state, or federal law proscribes, facilities may not do less. The NC Division of Facility Services (DFS) LTCF section has revised the definition in rule .2209 for “annual screening” to mean a “verbal elicitation of symptoms such as can be found in the NC Tuberculosis Manual.” The NC DFS LTC Certification and Licensure Section has stated that facilities must have a written record that such an evaluation was completed. The new definition for annual TB screening appears in the NC DFS Regulatory Focus Bulletin provided in March 2005.
http://facility-services.state.nc.us/infeccontb.pdf
REGULATORY/LEGISLATIVE
New Card for Reporting Communicable Diseases in North Carolina
The North Carolina Communicable Disease Report Card was revised December 2004. This new pink card should be used for reporting communicable diseases in North Carolina .
Additions at this time were:
Deletion at this time:
NEWS AND ANNOUNCEMENTS
Updates to NC TB Policy Manual
Updates and revisions to the 2004 NC TB Policy Manual are now posted on the internet. The list of revisions provides the details of what has been changed to facilitate downloading the new pages.
NC Tuberculosis Policy Manual
List of revisions
http://www.epi.state.nc.us/epi/gcdc/tb/revisions.html
New Expert Panel Report Examines Standards of Care During Mass Casualty Events
May 12, 2005 . Guidelines for officials on how to plan for delivering health and medical care in a mass casualty event are outlined in a new report from an expert panel convened by the HHS Agency for Healthcare Research and Quality and Office of Public Health Emergency Preparedness.
The report, Altered Standards of Care in Mass Casualty Events, offers a framework for how to provide optimal care during a potential bioterrorism or other public health emergency involving thousands, or even tens of thousands, of victims.
The report can be found online.
http://www.ahrq.gov/research/altstand/index.html
First Combination Vaccine Approved to Help Protect Adolescents Against Whooping Cough
May 3, 2005 . The Food and Drug Administration (FDA) approved the first combination vaccine that provides a booster immunization against pertussis (whooping cough) in combination with tetanus and diphtheria for adolescents. The vaccine will be marketed as Boostrix by GlaxoSmithKline (GSK) in Philadelphia , Pa. In the last 20 years, rates of pertussis infection have been increasing in very young infants who have not received all their immunizations and in adolescents and adults.
http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01354.html
N C TB Institute
Collaborative Relationships: The Future of TB Elimination, the 55 th annual TB/RD Institute will be July 22-24, 2005 , in Black Mountain , NC . Additional information is available on line at
Rubella No Longer Major Public Health Threat in the United States
A major public health milestone has been achieved in the United States - the rubella virus, a major cause of serious birth defects such as deafness and blindness, also known as congenital rubella syndrome (CRS), is no longer considered to be a major public health threat in the United States, Dr. Julie Gerberding, Director, Centers for Disease Control and Prevention, announced at the National Immunization Conference in Washington, DC. But Americans still must vaccinate their children, and women who might get pregnant must still be sure they are immune, because the disease exists elsewhere, the Centers for Disease Control and Prevention said.
See MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a5.htm
Alcohol-Based Hand Rub Solutions Allowed in Egress Corridors
March 25, 2005 . A notice from the Centers for Medicare and Medicaid
Services (CMS) in the Federal Register announced that alcohol-based hand
rubs will be allowed in egress corridors. This policy goes into effect automatically in 60 days ( May 24, 2005 ).
See Federal Register http://www.unc.edu/depts/spice/handrub.pdf
OSHA Recordkeeping Handbook Available Online
OSHA has a new publication on its website to aid employers and workers
in understanding the agency's recordkeeping policies, procedures and
requirements. The OSHA Recordkeeping Handbook combines information from the agency's recordkeeping rule, the recordkeeping policies and procedures manual, as well as tools and guidance materials from throughout the agency's website.
http://www.osha.gov/Publications/recordkeeping/index.html
(from OSHA Quick Takes February 1, 2005 )
OSHA Updates Bloodborne Pathogens and Needlestick Prevention Web Site
OSHA has updated its safety and health topics page for Bloodborne
Pathogens and Needlestick Prevention. A mouse click will provide the
reader information on related standards, recognizing bloodborne and needlestick hazards, recommended solutions to those hazards, important exposure information, and a list of additional resources. The enhanced information on the page is a byproduct of the agency's Alliance with the American Biological Safety Association.
http://www.osha.gov/SLTC/bloodbornepathogens/index.html
(from OSHA Quick Takes March 15, 2005 )
Hospital Report Cards on the Internet
April 1, 2005 . Federal health officials announced that hospital report
cards will be available at a new consumer web site. The new reports are
the latest in a series of attempts to measure how well hospitals provide care, and to provide consumers with helpful information when making health care decisions.
http://www.hospitalcompare.hhs.gov
Hand Hygiene Study
March 2005. The largest, most comprehensive study ever done comparing the effectiveness of hand hygiene products shows that nothing works better in getting rid of disease-causing viruses than simply washing one's hands with good old-fashioned soap and water. Researchers at UNC-CH and UNC Health Care System studied the efficacy of 14 different hand hygiene agents in reducing bacteria and viruses from the hands. A report on the findings appears in the March issue of the American Journal of Infection. (from UNC News Service)
Bush Order Allows Isolation of Those with Bird Flu
April 4, 1005 . President Bush issued a directive allowing authorities to detain or isolate any passenger suspected of having avian flu when arriving in the United States aboard an international flight. White House spokesman Trent Duffy called the directive a precautionary measure. Quarantine and isolation were last used during the outbreak of SARS in 2003.
CDC Advisory Committee Offers Guidance to States on Developing Systems for Public Reporting of Healthcare-Associated Infections
February 28, 2005 . The Centers for Disease Control and Prevention's (CDC) Healthcare Infection Control and Prevention Advisory Committee (HICPAC) released recommendations for policymakers who are seeking to create mandatory public reporting systems of healthcare-associated infections. The recommendations include the use of established surveillance methods and regular, confidential feedback to healthcare providers for performance improvement.
To view the guidance document, go to
http://www.cdc.gov/ncidod/hip/PublicReportingGuide.pdf
Bayer Gets FDA Approval for Hepatitis C Test
January 2005. Bayer AG received approval from the U.S. Food and Drug Administration for its automated assay for hepatitis C virus (HCV).
Bayer Gets FDA Approval for Hepatitis A Blood Test
March 30, 2005 . German drugs and chemicals group Bayer received the U.S. Food and Drug Administration's approval for its Hepatitis A Total Assay, a diagnostic blood test. The assay measures anti-hepatitis A antibodies in blood, and can be used to aid diagnosis or to identify susceptible individuals for vaccination.
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control in Long-Term Care Facilities” will be held in Chapel Hill October 3-5, 2005
“Infection Control Part I: Clinical Surveillance of Healthcare-Associated Infections” will be held in Chapel Hill in the spring of 2006.
“Infection Control Part II: The ICP as an Environmentalist” will be held in Chapel Hill October 31- November 4, 2005 .