Report of the Month

REPORT OF THE MONTH, Volume V, Number 6

November - December 2001

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from the North Carolina Statewide Program for Infection Control and Epidemiology

CONTENTS:

NEWS FEATURES

• Guideline for Environmental Infection Control in Healthcare Facilities
• Draft Guideline for Hand Hygiene in Healthcare Settings

REGULATORY/LEGISLATIVE

• HICPAC Guidelines in Process of Revision

QUESTION OF THE MONTH

• Refrigeratro/Freezer Monitoring

NEWS AND ANNOUNCEMENTS

COURSES FOR THE INFECTION CONTROL PROFESSIONAL

The "Guideline for Environmental Infection Control in Healthcare Facilities, 2002" is due to be published in the Federal Register in early 2002. This guideline updates the "Guidelines for Handwashing and Hospital Environmental Control, 1985" sections on cleaning and disinfection of environmental surfaces, environmental sampling, laundry and bedding, and regulated medical waste. It incorporates discussions of air and water from the "Guideline for the Prevention of Nosocomial Pneumonia." The new guideline also consolidates relevant environmental measures from other Centers for Disease Control and Prevention (CDC) guidelines (i.e., Mycobacterium tuberculosis [mTB], vancomycin resistance, immunocompromised patients, surgical site, and isolation precautions). Two new topics discussed in a CDC guideline for the first time include issues related to the presence of animals in health facilities and infection control during construction. The document does not discuss: 1) industrial hygiene concerns of a non-infectious nature (e.g., "sick building syndrome" from chemicals and fumes, allergies); 2) environmental issues in the home; 3) home healthcare; 4) bioterrorism; and 5) foodborne illness acquired in healthcare facilities. The two-part document uses the first part to review background information that summarizes the major issues related to environmental infection control. Major attention is given to engineering and infection control concerns during construction, demolition, renovation, and repairs of healthcare facilities. The infection control measures used to recover from catastrophic events (e.g., flooding, sewage spills, loss of electricity and ventilation, and disruption of the water supply) are reviewed. Part II contains the recommendations that are based on data from well-designed studies when available. This guideline, however, includes an acknowledgement that some studies cited have a narrow focus, and therefore cannot be made applicable to all patient settings or populations (e.g., immunocompromised patients and hospitals versus long-term care facilities). Many recommendations come from industry standards rather than evidence-based science. Some of the recommendations come from existing federal construction regulations or for ethical or logistical reasons cannot be tested. Finally, the guideline identifies key process measurement elements to assist facilities in monitoring compliance with Category IA or IB recommendations (e.g., risk and ventilation assessments prior to construction/renovation projects, establishing and maintaining pressure differentials for special care areas [e.g., operating rooms, isolation rooms], evaluating non-mTB cultures for possible environmental sources, and implementing infection control procedure to prevent environmental spread of antibiotic-resistant organisms).

This lengthy guideline is a compilation of recommendations for the prevention and control of infectious diseases that are linked to healthcare environments.

The Centers for Disease Control and Prevention "Draft Guideline for Hand Hygiene in Healthcare Settings" was made available online and is available for public comment until December 24, 2001. The guideline provides a literature review of the evidence that handwashing and hand antisepsis can reduce transmission of microorganisms in healthcare facilities. The guideline puts an emphasis on promoting new strategies (e.g., alcohol-based handrubs) to improve poor hand hygiene practice compliance in healthcare settings. New studies of the in vivo efficacy of alcohol-based handrubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand hygiene promotion programs and the potential role of alcohol-based handrubs in improving compliance with hand hygiene practices are summarized.

The guideline recommends the use of alcohol-based waterless handwashing antiseptic agents for routine hand hygiene when hands are not visibly soiled. These agents replace soap and water as the leading recommended tool for hand decontamination. Healthcare workers will be advised that for surgical hand antisepsis preparation either an alcohol handrub or antimicrobial soap may be used. Further, to reduce the bacteria release and minimize the skin damage from surgical hand antisepsis, the guideline allows decontaminating hands without using a brush.

Other recommendations deal with related issues such as the skin care of healthcare workers. The Healthcare Infection Control Practices Advisory Committee (HICPAC) recommends providing hand lotions or creams that are compatible with the antiseptic agents used. The guideline makes a strong recommendation that healthcare workers do not wear artificial nails or nail extenders when providing patient care.

Finally, recommendations are made to monitor healthcare workers' adherence to hand decontamination and to provide feedback of their performance with hand hygiene practices. It is recommended that administrators of healthcare facilities make hand hygiene a priority among healthcare providers. The guideline suggests outcome or process measurements be developed to accomplish these recommendations.

In addition to the "Guideline for Environmental Infection Control in Healthcare Facilities, 2002" and "Draft Guideline for Hand Hygiene in Healthcare Settings," three other important guidelines are in the process of being revised by the Healthcare Infection Control Practices Advisory Committee (HICPAC). The "Draft Guideline for Prevention of Healthcare-Associated Pneumonia" and the "Draft Guideline for the Disinfection and Sterilization of Healthcare Equipment" will be published in late 2001 or in 2002. The "Guideline to Prevent Transmission of Infectious Agents in Healthcare Settings" will be published in 2002 and will replace the "Guideline for Isolation Precautions in Hospitals."

Q: I have been told that the staff in our freestanding medical offices should document freezer checks on Monday to ensure that there was no loss of electrical power over the weekend. Presently we test by placing a coin on top of ice in a cup. Staff members check the coin to see if it has moved downward. Is this documentation a JCAHO regulation?

A: Yes, JCAHO requires documentation that a check for outages has been made. The reason is to know if the power was temporarily off and medications were affected. JCAHO requires that temperatures of refrigerators be checked in all areas daily. Facilities that close for time periods must use a mechanism to check for outages.

David J. Weber, M.D., M.P.H., professor at the University of North Carolina at Chapel Hill, has developed a PowerPoint Slide Presentation on "Recognition and Management of Bioterrorism Agents and Exotic Diseases" (209 slides) that is available online at www.unc.edu/depts/spice/slides1.html

The HICPAC "Draft Guideline for Hand Hygiene in Healthcare Settings" is available for public comment until December 24, 2001. The draft document was not published in the "Federal Register." The draft guideline, the "Federal Register Notice of availability and request for comment", and on-line request and comment pages are available at the following web site:
http://www.cdc.gov/ncidod/hip/hhguide.htm

The CDC "Interim Smallpox Response Plan and Guidelines" (November 2001) is available online at
http://www.bt.cdc.gov/DocumentsApp/Smallpox/RPG/index.asp

"Additional Options for Preventive Treatment for Persons Exposed to Inhalational Anthrax" were announced by the Department of Health and Human Services, December 18, 2001. This information is available online at
http://www.unc.edu/depts/spice/anthrax2.html

The Statewide Program for Infection Control and Epidemiology "Guidelines and Recommendations" page
http://www.unc.edu/depts/spice/new.html
provides a list of guidelines relevant to infection control and has a link that goes directly to each guideline.

"Infection Control in Long-Term Care Facilities" will be held April 15-16, 2002 at The Friday Center in Chapel Hill.

"Infection Control Part I: Clinical Surveillance of Healthcare-Associated Infections" will be held May 6-10, 2002 at the Holiday Inn 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 2001 North Carolina Statewide Program for Infection Control and Epidemiology

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