NEWS FEATURES

The following UNC Hospitals memorandum regarding the shortage of N95 respirators indicates how UNC Hospitals is responding to the shortage. You will note that the memorandum reflects consultation with North Carolina OSHA. This information is provided for your information as a example.

April 16, 2003. Due to the ongoing worldwide epidemic of Severe Acute Respiratory Syndrome (SARS) the United States is facing a shortage of N95 respirators. Effective immediately, N95 respirators should be used by healthcare workers only when entering the rooms of patients with known or suspected pulmonary tuberculosis, or SARS. When entering the rooms of patients with other diseases requiring droplet precautions (e.g., meningococcus, pertussis) or airborne precautions (i.e., varicella, zoster), wear a standard surgical mask. In order to conserve our N95 masks, healthcare workers are encouraged to reuse the same mask. The mask should be stored in a manner to prevent it from being crushed or torn. The same mask may be used until such time it no longer provides a tight fit.

In the event that the current N95 respirator used at UNC Hospitals (3M product) is not available from Central Distribution, N95 (or N99s or N100s from 3M) respirators from other vendors will be distributed to floors. In consultation with North Carolina OSHA, it has been decided that these products may be used without fit testing. (This is not a long-term waiver for fit testing, but is allowed while we use multiple vendors to meet our need for N95 respirators.) Healthcare workers using these products should read and follow manufacturer's guidance on how to use the respirator. As always, healthcare workers should select the proper-sized respirator (i.e., small, medium, large). If N95s (or N99s or N100s) are unavailable, healthcare workers should use a tight-fitting surgical mask. The proper use of a surgical mask will prevent the acquisition of droplet and airborne diseases (e.g., SARS, tuberculosis, varicella, meningococcus).

REGULATORY/LEGISLATIVE

President Bush has signed into law the Smallpox Emergency Personnel Protection Act of 2003, American Hospital Association-backed legislation that allows hospitals to provide vaccinations without fear of liability if someone they vaccinate should become ill. The legislation (H.R. 1770) also includes a compensation fund that pays up to $50,000 a year for those sustaining a disability after vaccination and a death benefit of $262,000. Congress has approved $43 million to help fund the bill. (from the American Hospital Association)

QUESTION OF THE MONTH

Q: I have a physician at my facility who wants to begin performing BCG bladder instillation for cancer of the bladder. What infection control issues are there with this procedure?

A: Bacillus Calmette-Guerin (BCG) is an attenuated tubercle bacilli. Intravesicular instillation of BCG in patients with superficial bladder carcinoma has prolonged disease-free intervals, probably as a result of immunologic mechanisms. Because BCG is a biologically active material it must be managed with caution. Transfer of BCG mixture should be via a chemical block vent (filter) to vials of preservative-free saline. The procedures must be followed vigorously and care exercised to eliminate the possibility of exposure. In case of an inadvertent exposure during BCG instillation procedure, healthcare workers should contact Occupational Health to be evaluated for a TB exposure. Exposure is defined as aerosol formation with persons in the room not wearing masks or contact with non-intact skin. BCG is generally less pathogenic than MTB. However, some immunocompromised patients can get disseminated disease. BCG should not be handled by persons with a known immunologic deficiency. Healthcare workers should have appropriate PPE (i.e., N95 respirator, gown and gloves). BCG need not be done in a negative pressure room. No cases have been documented of BCG transmission when appropriate PPE has been worn. Patients should be instructed to retain the BCG mixture for 2 hours. Upon completion of the procedures, patients should void in a seated position for safety reasons. Contaminated urine voided after instillation should be poured into a toilet or hopper. Urine should be disinfected by adding equal volume of undiluted household bleach. Allow to stand 15 minutes before flushing. Contaminated items should be disposed of as biohazardous materials in a red bag and the area cleaned with alcohol or EPA germicidal-disinfectant.
(Modified from UNC Health Care System Infection Control Policy 2002.)

ANNOUNCEMENTS

SEVERE ACUTE RESPIRATORY SYNDROME (SARS) WEB PAGE
In the fall of 2002, there were reports from Guangdong Province in southern China of cases of highly contagious and very severe atypical pneumonia of unknown cause. On March 13, 2003, as the condition began to spread from China, the World Health Organization (WHO) issued a global alert about the outbreak and instituted worldwide surveillance. In March the U.S. Centers for Disease Control and Prevention (CDC) termed this condition the severe acute respiratory syndrome (SARS) and provided a clinical case definition. (New England Journal of Medicine; May 15 2003; 348:1977-1985)

The North Carolina Statewide Program for Infection Control and Epidemiology has added a SARS page to its web site. There is rapidly increasing information about SARS on the internet and the SPICE page has links to important internet sites. In addition, slides sets by Dr. David J. Weber and Dr. William A. Rutala can be downloaded. http://www.unc.edu/depts/spice/SARS.html

POCKET GUIDE TO BIOTERRORISM
Bioterrorist Agents: A Pocket Guide to Signs and Symptoms provides the same information that is in the Bioterrorist Agents wall chart in a small, folding format that fits in a pocket. Information about ordering is available online at http://www.unc.edu/depts/spice/bioterrorism.html

OSHA ERGONOMICS GUIDELINE FOR NURSING HOMES
March 13, 2003. OSHA issued an ergonomics guideline for the nursing home industry. OSHA's Guidelines for Nursing Homes focuses on practical recommendations for employers to reduce the number and severity of workplace injuries by using methods found to be successful in the nursing home environment. The guidelines are available online. http://www.osha.gov/ergonomics/guidelines/nursinghome/index.html

COURSES FOR THE INFECTION CONTROL PROFESSIONAL

"Infection Control Part II: The ICP as an Environmentalist" will be held September 8-12, 2003, 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 Program 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 2003 North Carolina Statewide Program for Infection Control and Epidemiology