Report of the Month

CONTENTS:

NEWS FEATURES

• Chemical Terrorism Agents Wall Chart

REGULATORY/LEGISLATIVE

• New Communicable Disease Report Card

QUESTION OF THE MONTH

• New DOT Rules on Packaging of Suction Canisters

NEWS AND ANNOUNCEMENTS

COURSES FOR THE INFECTION CONTROL PROFESSIONAL

NEWS FEATURES
Chemical Terrorism Agents Wall Chart

The North Carolina Statewide Program for Infection Control and Epidemiology (SPICE), based in the School of Medicine at the University of North Carolina in Chapel Hill, has developed a wall chart on chemical terrorism agents.  The chart provides the following information for the more likely chemical weapons: common presenting signs, symptoms, onset, clinical diagnostic tests, exposure route and treatment, differential diagnosis, and decontamination methods.  The chart also includes critical notification numbers in the event of a suspected case or cases.  Chemical agents listed include nerve agents, cyanides, vesicants/blister agents, pulmonary/choking agents, ricin, and T-2 mycotoxins.

One free copy of the chart has been sent to each hospital in North Carolina.  The large (24 x 32 inches), colorful version designed for display is available for purchase at production cost of $22.50 plus handling. For information about purchasing, call Medical Illustration and Photography (at the University of North Carolina at Chapel Hill) 919-966-4232.  A smaller printer-friendly version of this same information is also available on our web site.
http://www.unc.edu/depts/spice/chemical.html.

The wall chart of bioterrorist agents has been available since 2001.  Information about it is also on our web site.
http://www.unc.edu/depts/spice/bioterrorism.html.
 

REGULATORY/LEGISLATIVE
New Communicable Disease Report Card

By North Carolina State law, attending physicians and other healthcare providers must report communicable diseases that have been designated by state public health officials.  This is accomplished by filling out a communicable disease report card available from the local health department.  In late November, a newly revised report card (goldenrod in color) replaced the former blue card.  This new card requires immediate reporting of all Category A bioterrorist agents (anthrax, botulism, plaque, smallpox, tularemia, and viral hemorrhagic fever).  Added to the list of communicable diseases that must be reported within 24 hours is E. coli shiga toxin-producing infection and Listeriosis.  Added to the list of other communicable diseases that require reporting in 7 days is transmissible spongiform encephalopathies (CJD/vCJD).  There are also some changes in the codes for STDs (e.g., separate code for neurosyphilis).  Completed cards should be sent to the local health department.  Reporting of communicable diseases is protected under state law and does not constitute a breach of patient confidentiality.  It is specifically allowed under HIPAA.
 

QUESTION OF THE MONTH

Q: Has DOT issued new rules regarding the packaging of suction canisters?

A: Yes, on August 14, 2002 DOT published the Final Rule for Hazardous Materials: Revision to Standards for Infectious Substances, 49 CFR Part 171.  These revisions, effective February 2003, impact the packaging of suction canisters in several important ways.

First, the regulations effectively prohibit the placement of suction liners in red bags without first placing the liner in its own rigid packaging.  A liner alone is flexible and can release fluids when compressed.  See Sections 173.196.a.6 and 173.197.a.

Second, every suction canister must be wrapped with sufficient absorbent material to absorb the entire contents of the canister before placing the canister in a rigid, watertight non-bulk outer packaging.  See Sections 173.6.a.4, 173.196.a.2, and 173.196.a.4.

Third, if red bags are used, no more than one full and wrapped 3000cc suction canister can be placed in a single red bag.  See Section 173.6.a.4.ii.

Fourth, wrapped suction canisters must be placed in rigid, watertight non-bulk outer packaging.  Examples of non-bulk outer packaging include reusable plastic boxes or sealable cardboard boxes with heavy duty liners.  See Sections 173.6.a.4.ii and 173.196.a.2.

Fifth, no more than four full and wrapped 3000cc suction canisters can be placed in rigid, watertight non-bulk outer packaging.  See Section 173.6.a.4.B.ii.

Finally, these regulations significantly impact facilities using bulk packaging for the off-site transport of regulated medical waste.  Why?  Because liquids must be packaged in rigid, watertight non-bulk outer packaging while solid regulated medical waste can simply be packaged in red bags before placement in bulk outer packaging (e.g. caster carts or roll-off bins).

The differing requirements for liquid and solid regulated medical waste effectively require facilities to segregate liquid and solid wastes.  Segregation can be avoided if all regulated medical waste is placed in rigid, watertight non-bulk outer packaging.  However, this adds significantly to the total cost of regulated medical waste disposal.

OSHA allows healthcare workers wearing appropriate PPE to pour blood and body fluids from canisters directly into designated sinks.  However, many canisters have liners that are not designed to be opened and poured.  At least one manufacturer (Dornoch) has designed a safety cart system for disposal connected directly to the sewer system that empties, cleans and disinfects reusable canisters.  For more information on the Dornoch Transposal System, call Leighton Bostic, pager 919-983-1283.

The relevant excerpt from The Federal Register, August 14, 2002 is online at
http://www.unc.edu/depts/spice/DOTRegulations.pdf.

New information added on January 15, 2003 (after Report of the Month was distributed):
SPICE is advising facilities NOT to make changes in current practices of canister waste disposal management based on the November/December Report of the Month Question section. Although the article was reviewed by the North Carolina Solid Waste Section, we are seeking clarification from the Department of Transportation. We suggest that newsletter subscribers in other states check with their state officials.

NEWS AND ANNOUNCEMENTS

For information about smallpox vaccination questions see the CDC website at
http://www.bt.cdc.gov/agent/smallpox/index.asp
 

MMWR December 13, 2002.  Exophiala Infection from Contaminated Injectable Steroids Prepared by a Compounding Pharmacy --- United States, July--November 2002.  On November 15, 2002. The Food and Drug Administration (FDA) announced a nationwide alert concerning all injectable drugs prepared by Urgent Care Pharmacy of Spartanburg, South Carolina
(See notice in Report of the Month, September-October 2002)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5149a1.htm
 

MMWR Weekly Report, MMWR Dispatch.  December 18, 2002.  Guidelines for Using the QuantiFERON(r)-TB Test for Diagnosing Latent Mycobacterium tuberculosis Infection
http://www.cdc.gov/mmwr/preview/mmwrhtml/di51cha1.htm
 

December 9, 2002 Update.  Food and Drug Administration Medical Device Class II Recall: Roche Diagnostics Accu Chek Blood Glucose Monitoring System used to monitor blood glucose readings and provide recordkeeping for quality control of blood glucose results. It is sold for professional use only in the U.S. and is used in a hospital setting.  Inaccurate blood glucose readings of up to 35% in either direction might result if the meter has ever displayed the temperature icon when in use.
http://www.fda.gov/cdrh/recalls/recall-080202.html
 

OSHA recently launched a new electronic tool to help reduce workplace injuries and illnesses from legionnaires' disease.  The Legionnaires' disease eTool will help industrial hygienists assess worksites for potential exposure to the disease.
http://www.osha.gov/SLTC/legionnaires_etool/index.html
 

American Journal of Infection Control, December 2002, includes these articles of interest:  National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 to June 2002, issued August 2002 (also available on line at http://www.cdc.gov/ncidod/hip/NNIS/2002NNISReport_AJIC.PDF); Guidelines for the Prevention of Intravascular Catheter-related Infections (also available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm); Guideline for Hand Hygiene in Health-Care Settings (also available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm).

COURSES FOR THE INFECTION CONTROL PROFESSIONAL

"Infection Control in Long-Term Care Facilities" will be held March 17-19, 2003 at The Friday Center in Chapel Hill.

"Infection Control Part I: Clinical Surveillance of Healthcare-Associated Infections will be held May 5-9, 2003 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.

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 2002 Statewide Program for Infection Control and Epidemiology

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