NEWS FEATURES

The Society for Healthcare Epidemiology of American (SHEA) published the "SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus" in the May issue of the journal, Infection Control and Hospital Epidemiology. This guideline recommends an active surveillance culturing program to identify the unknown MRSA/VRE colonized or infected patient, and then isolation of these patients according to the CDC Contact Precautions. An extensive review of the literature (1966-2002) noted steadily increasing rates of antibiotic-resistant pathogens across the world in the past three decades. The authors cited multiple studies where the use of active surveillance cultures had controlled the cross-transmission of MRSA and ultimately reduced the endemic population in healthcare facilities. Some studies reported reduction of the endemic population in entire regions. Identifying the undetected reservoir is the key to this strategy, and then using that information for appropriate isolation and staff feedback. The CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) is currently revising the isolation/precaution guidelines but current CDC guidelines do not recommend an active surveillance screening program (ICHE 2003;24:362-386). The guideline is available online.

REGULATORY/LEGISLATIVE

The Occupational Safety and Health Administration (OSHA) has officially announced the withdrawal of the proposed TB rule. This rule was projected to be promulgated over the past several years, but lobbying efforts from key healthcare associations (APIC, SHEA) delayed action. In the Tuesday, May 27, 2003, Federal Register, pp 30588-9, OSHA notified the public of its decision to withdraw the proposed rule. Since 1993, when OSHA began considering a standard, TB cases have declined 43.5 percent - largely due to the success of CDC guidelines.

Healthcare facilities will continue to use the 1994 CDC Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Healthcare Facilities (Federal Register October 28, 1994) and 1996 OSHA compliance document, CPL 12.106 Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis (February 9, 1996). The guidelines and enforcement procedures are available online linked from the SPICE web site

QUESTION OF THE MONTH

Q: Can alcohol-based hand gels serve as a suitable alternative to handwashing for retail food service workers?

A: CDC recently issued "CDC Guideline for Hand Hygiene in Health-Care Settings" (Morbidity and Mortality Weekly Reports, October 25, 2002). The guidance document recommends alcohol-based hand gel as a suitable alternative to handwashing for health-care personnel in health-care settings. These guidelines were not intended to apply to food establishments. This exclusion is based on the differences in controlling common nosocomial pathogens in health-care settings and common foodborne pathogens in retail and food service settings. Some significant differences between health-care settings and retail/food service settings include the following. Proper handwashing, as described in the Food Code continues to serve as a vital and necessary public health practice in retail and food service. Using alcohol gel in place of handwashing in retail and food service does not adequately reduce important foodborne pathogens on foodworkers' hands. FDA's concern about the practice of using alcohol-based hand gels in place of handwashing with soap and water in a retail or food service setting can be summarized into the following points.

Alcohols have very poor activity against bacterial spores, protozoan oocysts, and certain nonenveloped (nonlipophilic) viruses; and

Ingredients used in alcohol-based hand gels for retail or food service must be approved food additives, and approved under the FDA monograph or as a New Drug Application (NDA); and

Retail food and food service work involves high potential for wet hands and hands contaminated with proteinaceous material. Scientific research questions the efficacy of alcohol on moist hands and hands contaminated with proteinaceous material.

FDA and CDC continue to work together to review new data and assure the best public health measures are in place for retail and food service establishments. (copied from Food Service Safety Facts, May 2003)

ANNOUNCEMENTS

OSHA PROPOSES REVISED RESPIRATORY PROTECTION STANDARDS
The Occupational Safety and Health Administration published two proposed rules in the June 6, 2003 Federal Register to enhance worker protections from respiratory hazards on the job. OSHA is seeking comments until Sept. 4, 2003, on its proposals to amend the Respiratory Protection Standard to include a new fit testing procedure and incorporate new Assigned Protection Factors (APFs) for respiratory protection programs that are expected to prevent approximately 4,000 injuries and illnesses and prevent about 900 deaths annually from cancer and other chronic diseases. Information is online.

TREATMENT OF TUBERCULOSIS
June 20, 2003. MMWR Recommendations and Reports: Treatment of Tuberculosis, American Thoracic Society, CDC, and Infectious Diseases Society of America is available online in pdf format and html format.

FDA WARNS ABOUT TOXICITY OF LINDANE
In a recent Public Health Advisory, the Food and Drug Administration (FDA) warned health professionals and consumers about the potential toxicity of Lindane when it's used to treat scabies and lice. The FDA has reports of neurologic effects from topical Lindane products, ranging from dizziness to seizures, as well as several deaths. Most of the serious effects were due to misuse of the products, but there have been rare case reports of serious reactions from apparently normal use. The FDA advisory stresses that Lindane is a second-line treatment. It should be prescribed only when the patient doesn't respond to safer treatments, such as permethrin or malathion products, or if the patient can't tolerate these safer products. Many of the serious adverse events reported to FDA occurred when the medication was applied several times. And so the FDA advisory says that patients should be instructed that Lindane products should be applied just once. Patients should understand that itching after treatment may be due to the Lindane itself rather than the scabies or lice, and shouldn't be tempted to reapply the medication. (from FDA notice)

FDA CLEARS RAPID TEST FOR ASPERGILLUS INFECTION
May 16, 2003. The Food and Drug Administration (FDA) cleared for marketing the first rapid laboratory test for a life-threatening invasive fungal infection that occurs in leukemia patients, organ and bone marrow transplant patients, and patients whose immune systems are compromised by illness or chemotherapy. The test will allow doctors to diagnose invasive aspergillus infection quicker and begin treatment with anti-fungal drugs sooner. The new test is Platelia Aspergillus EIA, manufactured by Bio-Rad Laboratories, of Redmond, Washington. Results are available in about three hours. By comparison, the standard culture method of testing for aspergillus takes a minimum of four weeks before results are available. (FDA news)

FDA APPROVES FIRST DRUG IN NEW CLASS OF HIV TREATMENTS FOR HIV INFECTED ADULTS AND CHILDREN WITH ADVANCED DISEASE
March 13, 2003. The FDA recently approved a new type of drug to treat advanced HIV-1 infection in adults and children six and older. The drug is called Fuzeon and it's the first of the so-called “fusion inhibitor” drugs to be approved anywhere in the world. Fusion inhibitors work by inhibiting the fusion of viral and cellular membranes, thus blocking the HIV viruses' ability to infect cells. Fuzeon's generic name is enfuvirtide and it will be distributed by Roche Pharmaceuticals. Consumer Inquiries: 888-INFO-FDA

INTERGEL ADHESION PREVENTION SOLUTION WITHDRAWN April 16, 2003. Audience: Gynecological health-care professionals. GYNECARE Worldwide (a Johnson & Johnson Company) and FDA Center for Devices and Radiological Health (CDRH) announced the voluntary market withdrawal of GYNECARE INTERGEL Adhesion Prevention Solution from the global market and are urging customers to immediately stop using this device. Post-market reports include late-onset post-operative pain and repeat surgeries following the onset of pain, non-infectious foreign body reactions, and tissue adherence. In some patients a residual material was observed during the repeat surgery.

JCAHO 2004 STANDARDS NOW ONLINE
The newly revised 2004 Joint Commission on Accreditation of Healthcare Organizations Joint (JCAHO) pre-publication standards are now posted on the JCAHO website, allowing individuals the opportunity to familiarize themselves with the standards before the accreditation manuals are published in September. A crosswalk is also available to help users navigate between current and new requirements. The standards become effective January 1, 2004, for the ambulatory care, behavioral healthcare, home care, hospital, laboratory and long term accreditation programs. The standards for assisted living, critical access hospitals, healthcare networks and office-based surgery will be revised in 2005. To access the standards, go to JCAHO web site.

McDONALD'S ISSUES ANTIBIOTICS POLICY
June 19, 2003. In response to increasingly dire warnings that widespread use of antibiotics on U.S. farms is making the drugs less effective for treating people, the fast-food chain McDonald’s is directing some meat suppliers to stop using antibiotic growth promoters altogether and encouraging others to cut back. The use of small but regular amounts of antibiotics in animal feed, which helps the animals grow quickly, inevitably leads bacteria in the animals to evolve into forms that are immune to the antibiotics effects. Those resistant bacteria can be transferred to people, who will not be helped by related antibiotics they might need should they become sick (from a story by Marc Kaufman, The Washington Post).

COURSES FOR THE INFECTION CONTROL PROFESSIONAL

"Infection Control in Long-Term Care Facilities" will be held in Chapel Hill October 13-15, 2003.

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