Report of the Month

REPORT OF THE MONTH, Volume VII, Number 1

January- February 2003

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from the North Carolina Statewide Program for Infection Control and Epidemiology

REGULATORY/LEGISLATIVE

Vaccinia Disease:A Reportable Communicable Disease in North Carolina

Effective February 13, 2003 Vaccinia Disease became a reportable communicable disease in NC. The new rule includes .0101, the updated list of reportable conditions, and .0208 Control Measures for Vaccinia and Smallpox.   They are available online at http://www.unc.edu/depts/spice/03-19A.0101smallpox.doc and http://www.unc.edu/depts/spice/03-19A.0208smallpox.doc. The other Communicable Disease Rules are also online at http://www.unc.edu/depts/spice/NCComDisRulesDec2002.doc.  Listed in .0208 are the major adverse events following smallpox vaccination that require reporting. (Providers must also complete the VAERS form for reporting vaccine-related adverse outcomes to the FDA and CDC.)  Recall that the smallpox vaccine contains live vaccinia virus that is communicable to unvaccinated people by direct contact. In reporting cases of contact vaccinia, include the name of the primary vaccinee in the comments block of the Communicable Disease Report Card (DHHS form 2124, Revised 8/02).

From Jeffrey Engel, MD, NC State Epidemiologist, Head, General Communicable Disease Control Branch

QUESTION OF THE MONTH

New DOT Rules on Packaging of Suction Canisters Update

Note:  Report of the Month November - December 2002 featured a question and answer about the new Department of Transportation (DOT) requirements for transportation of regulated medical waste.  We now have further information from the author of the rule, Sue Gorsky, at the federal DOT.

If a suction canister is a rigid, puncture-resistant container that has been certified to meet DOT design and performance standards, then it may generally be used to transport non-bulk shipments of regulated medical waste (RMW).  If the hospital or medical facility uses a private or contract carrier to transport RMW, then the packaging requirements are less stringent; in that case it is not necessary for the suction canister to be certified to meet DOT design and performance standards.  Instead, the suction canister need only conform to OSHA regulations at 1910.1030, which require RMW to be placed in a closable container that is constructed to prevent leakage of fluids during handling and puncture-resistant if used for sharps.
Sue Gorsky
Senior Regulations Specialist
Office of Hazardous Materials Standards
Research and Special Programs Administration

QUESTION #2

Alcohol Hand Sanitizers

Q: I have been told that alcohol hand sanitizer dispensers are not being approved for use in some hospitals because the contents are a fire hazard and the fire code restricts the placement of the dispensers in hallways.  Does that mean that my hospital should not use the dispensers in the hallways?

A: The 1997 National Fire Protection Association (NFPA) 101 life Safety Code, Ch.13, Sect.13-7.5.4 prohibits combustible (decorations) in any health care occupancy. These alcohol gel dispensers would not only be considered combustible but flammable! Next, the NFPA 30, Flammable and Combustible Liquids Code, Ch.4,would probably be another Code/Chapter to review for this matter. However, there is no chapter and verse specifically addressing these wall-mounted alcohol gel dispensers. My contention is that the typical dispenser is of such a small size and contents of such limited quantities that a hazard of fire development or spread is ‘negligible’. Some authorities having jurisdiction (AHJ’s) disagree and consider these alcohol dispensers as little hand-grenades. There will be tests performed some time in the near future by independent agencies to determine the level of risk involved with these alcohol gel dispensers. We will let our accredited organizations know what the results are. Also see 1996 NFPA 30, Flammable and Combustible Liquids Code, Ch.4, Sect 4-2.3.1,”Medicines, beverages, foodstuffs, cosmetics, and other common consumer products, where packaged according to commonly accepted practices for retail sales, shall be exempt from the requirements of 4-2.1 and 4-2.3. “ I believe this speaks volumes to this matter and perhaps reflects a little ‘common sense’ as well. We want to support the use of these dispensers if they do indeed reduce infection. However, we are advising organizations to mount these in the rooms and not in the egress corridors or along the path of egress. We have made some exceptions on a case-by-case basis. As advised by the JCR [Joint Commission Review] mock surveyors, organizations should write to me, Britt Berek, or Scott Vanderhoof and explain what they have or want to do in this regard and we will provide whatever guidance we can and either accept or reject their proposal. As always, the local and/or state fire marshal should be conferred with as well and the organization must comply with the most stringent requirements should there be a conflict between AHJ requirements. 

Dean Samet, Chief Engineer at the Joint Commission

NEWS AND ANNOUNCEMENTS

CDC Issues Health Alert About Atypical Pneumonia - Severe Acute Respiratory Syndrome (SARS)

March 15, 2003.  In response to reports of increasing numbers of cases of an atypical pneumonia that the World Health Organization (WHO) has called Severe Acute Respiratory Syndrome (SARS), the Centers for Disease Control and Prevention (CDC) announced steps to alert US health authorities at local and state levels.  Information about Severe Acute Respiratory Syndrome is available online at http://www.cdc.gov/ncidod/sars/

Surveillance for Human Cases of Avian Flu Type A

March 4, 2003.  The CDC is requesting enhanced surveillance for human cases of avian flu type A (H5N1) in the United States. This is a result of the human cases and deaths diagnosed in China earlier this month.  The North Carolina Epidemiology Section recommends that you inform your physicians and ambulatory providers of this alert emphasizing the importance of these 3 key points:

1.   obtaining viral cultures on cases of severe atypical pneumonia,

2.   obtaining a travel history to Asia in the 10 days prior to disease onset, and

3.   immediate reporting of unexpected deaths due to respiratory infection.

Please note that there is no evidence that the recent cluster of deaths in children in Virginia and North Carolina is related to avian flu.” 

It is also noteworthy that the WHO released information today that reported there were no human flu genes in the avian flu virus that caused the deaths in China.  Therefore, it is not expected to be transmitted person-to-person.

Steve Cline, Chief of Epidemiology, North Carolina Division of Public Health

New CDC Guideline

The new CDC Guideline for Healthcare-Associated Pneumonia should be published in April. 

Smallpox Vaccination Information

On February 12, 2003, the FDA gave approval that the 100-dose kit of Smallpox Vaccine Dryvax® can be stored for 90 days at 2-8 degrees C after reconstitution even though the product labeling that accompanies the new kits states that reconstituted Dryvax® “may be used for 15 days if stored at 2-8 degrees C when not in actual use. The date of reconstitution should be recorded directly on the vial label in the space provided. Unused vaccine should be discarded if more than 90 days has elapsed since reconstitution.

February 14, 2003. Hospital Smallpox Vaccination Monitoring System (HSVMS) is a voluntary, web-based component of the CDC Smallpox Vaccination Program to assist hospitals or other vaccine monitoring sites in real-time monitoring and tracking of healthcare workers who receive smallpox vaccine.
http://www.bt.cdc.gov/agent/smallpox/vaccination/hsvms

OSHA Launches Electronic Training Tool on Anthrax

To complement its anthrax matrix developed last year, OSHA recently launched a web-based training tool that provides detailed information on anthrax, including its potential impact on the workforce and development and implementation of emergency action plans. The e-Tool also provides a list of links associated with anthrax response. Both tools can assist employers and employees in dealing with possible workplace exposures to anthrax
http://www.osha.gov/SLTC/etools/anthrax/index.html

New Strep B Test for Pregnant Women

November 18, 2002. The Food and Drug Administration cleared for marketing a new laboratory test for Group B Streptococcus in pregnant women. The new test, the IDI-Strep B test, made by Infectio Diagnostic, Inc., of Quebec, can provide results in one hour, if facilities can provide round-the-clock testing. In contrast, the standard method of culture testing takes 18 to 48 hours for results.  Use of this standard screening method has led to a 70 percent decline in the incidence of Group B strep during the past decade. However, because of the time needed to culture samples and the four hours needed for antibiotic treatment, it is only useful for women who are tested at least several days before labor begins—not those who start labor early, or who do not have the advantage of prenatal care. The new IDI-Strep B test, with timely results, could be particularly beneficial for these women when they first go into labor.

COURSES FOR THE INFECTION CONTROL PROFESSIONAL

“Infection Control in Long-Term Care Facilities” was 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.

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 2003 North Carolina Statewide Program for Infection Control and Epidemiology

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