July-August 2003
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NEWS FEATURES
REGULATORY/LEGISLATIVE
QUESTION OF THE MONTH
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
NEWS FEATURES
SPICE and APIC-NC
Survey About the Location of Alcohol-Based Hand Rub Dispensers in Healthcare
Facilities
In 2002 the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC) "Guideline for Hand Hygiene in Health-Care Settings" recommended the use of alcohol-based antiseptic hand rubs in instances where hand antisepsis is indicated and no visible soiling is present on the hands. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) endorsed these revised CDC hand hygiene guidelines. However, due to concerns regarding the flammability potential of the alcohol-containing products, some regulatory authorities are prohibiting placement of the products in egress corridors (exit corridors or areas open to exit corridors).
The Association for Professionals in Infection Control and Epidemiology-North Carolina (APIC-NC) and North Carolina Statewide Program for Infection Control and Epidemiology (SPICE) conducted this survey in an effort to learn more about the location of alcohol-based hand rub dispensers in egress corridors and any problems that may be associated with them in healthcare settings. The goal is to have information to share with North Carolina infection control professionals and to present to authorities having jurisdiction (AHJ) in North Carolina.
In May 2003 SPICE sent a five-question questionnaire (a joint APIC-NC and SPICE project) to its electronic mailing list of North Carolina infection control professionals in 147 of the 166 North Carolina hospitals. (SPICE does not have email addresses for all NC hospitals). SPICE received 58 responses.
Ninety-five percent (55 of 58) of the hospitals responded that their facility uses alcohol-based hand-rubs. An additional hospital planned to purchase them within a month and mount them in patient rooms.
Forty (73%) of the 55 hospitals who use an alcohol-based hand rub have dispensers mounted in hospital egress corridors. However, one of the hospitals was in the process of removing the dispensers from the corridors. Of the 15 that do not have alcohol-based hand rub dispensers mounted in hospital egress corridors, six had not had discussion about them; six had consulted with the fire marshal. The fire inspector, healthcare system administration, NC Division of Facility Services, American Society for Healthcare Engineering (ASHE), and the internet were each consulted by a hospital in making the decision.
Of the forty hospitals who use alcohol-based hand rub dispensers mounted in hospital egress corridors, 10 have had them 6 months or less, 3 have had them one year to one and one-half years; 10 have had them 2 years; 13 have had them 3 to 5 years; 3 have had them 7 years; one did not respond to this question. Thirty-five of the forty hospitals report no problems related to the presence of alcohol-based hand rub dispensers mounted in egress corridors. Responders commented that problems included destroying the painted surface, pumps plugging up at site where solution is dispensed, visitor squirting product into eyes, product dripping, and concern about facility complying with fire code.
Of the forty hospitals who use alcohol-based hand rub dispensers mounted in hospital egress corridors, 21 had not had discussion with any local or state regulatory agency about placement of the dispensers; 14 had discussion with the fire marshal, one with JCAHO, and two with the NC Division of Facility Services.
An update on a National Stakeholders Meeting on alcohol-based hand rubs follows in the next article.
Alcohol-based Hand Rubs and Fire Safety in
HealthCare Facilities
On July 22, 2003, the American Hospital Association (AHA) and CDC co-hosted a National Stakeholders Meeting on alcohol-based hand rubs. At this meeting the American Society for Healthcare Engineering (ASHE) reported on the results of their study of how hand rubs containing greater than or equal to 60% alcohol by weight would react to a fire in a typical patient care environment. The study used a computerized fire modeling protocol on various points in a healthcare facility. The results indicate that installing hand rub dispensers is acceptable in both corridor and patient room locations. The results also showed the spacing of dispensers at or near each patient room not to be significant risk for additional ignition or involvement of more than one dispenser. Based on these results, ASHE has made specific recommendations for the use and storage of alcohol-based hand rub solutions that should be discussed with the local fire marshal and/or local building officials to address compliance with prevailing building and fire codes. Information about the meeting and the recommendations are posted on the ASHE website at:
http://www.hospitalconnect.com/ashe/currentevent/abhi.html
REGULATORY/LEGISLATIVE
JCAHO Announces 2004 National Patient Safety
Goals
JCAHO's 2004 National Patient Safety Goals include all of the 2003 Goals and a new Goal that focuses on reducing the risk of healthcare-acquired infections. The 2003 Requirement to "read back" verbal and telephone orders in order to confirm their accuracy also has been expanded for 2004 to include the read-back of critical test results that are communicated verbally.
The added Goal and its Requirements are: Goal 7 - Reduce the risk of healthcare-acquired infections.
- Comply with current CDC hand-hygiene guidelines.
- Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a healthcare-acquired infection.
For more information, see
http://www.jcaho.org/news+room/news+release+archives/npsg_04.htm
QUESTION
OF THE MONTH
FLUMIST
NOT RECOMMENDED FOR HEALTHCARE WORKERS
Q: Are there any recommendations for healthcare workers regarding the use of the newly approved influenza vaccine that is inhaled instead of being given by injections?
A.: FluMist is a live, attenuated influenza vaccine that is administered intranasally and was approved by the Food and Drug Administration on June 17, 2003. The Advisory Committee on Immunization Practices (ACIP) recently published recommendations that this vaccine should not be used by persons who are unable to avoid close contact with immunocompromised hosts (e.g., household, healthcare workers) for at least 21 days after receiving this vaccine. There is a theoretical risk of cross-contamination of influenza virus per infectious respiratory secretions to a susceptible individual. Others who are recommended to avoid the live vaccine (FluMist) include those with underlying medical conditions that may predispose to severe reactions (asthma, reactive airway disease or other chronic disorders of pulmonary or cardiovascular system, diabetes, renal dysfunction and hemoglobinopathies, or persons with known or suspected immunodeficiency diseases), egg allergies, pregnancy or being less than 5 years or greater than 50 years of age.
INFLUENZA
VACCINE RECOMMENDATIONS
Using
Live, Attenuated Influenza Vaccine for Prevention and
Control of Influenza: Supplemental Recommendations of the Advisory Committee on
Immunization Practices (ACIP)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5213a1.htm
http://www.cdc.gov/mmwr/PDF/rr/rr5213.pdf
NEWS AND Announcements
SPICE
INTERNET - UPDATED SARS RESOURCES
The SPICE web site at http://www.unc.edu/depts/spice/ provides resources and links to information for infection control professionals. Dr. David Weber has updated his SARS slide set and it is available for downloading from the SARS Resources page
http://www.unc.edu/depts/spice/SARS.html. The UNC Health Care Practice Improvements for Management of SARS and an updated isolation sign are new additions to the SARS Resources page.
OSHA Issues Final Rule on Recordkeeping Form
June 30, 2003. The Occupational Safety and Health Administration (OSHA) 300 form (used to record workplace injuries and illnesses) will not be modified to include a separate column for musculoskeletal disorders. The agency's decision not to modify the form, published in the June 30, 2003, Federal Register, was based on the conclusion that an additional column would not improve the national injury statistics, nor would it be of benefit to employers and workers because the column would not provide additional information useful to identifying possible causes or methods to prevent injury. Repetitive stress injuries and musculoskeletal disorders must continue to be reported; however, the OSHA 300 form will not include a separate column.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=10281
FDA Clears First
Test for West Nile Virus
July 9, 2003. The Food and Drug Administration (FDA) cleared the first test for use as an aid in the clinical laboratory diagnosis of West Nile virus infection. The West Nile virus IgM Capture ELISA, manufactured by PanBio, is intended for use in patients with clinical symptoms consistent with viral encephalitis/meningitis. Although the PanBio test is a valuable aid in the diagnosis of West Nile virus encephalitis, due to similarities with other viruses in the same family, there is a need to confirm positive results by an additional test or by using the current CDC diagnostic guidelines for diagnosis of this disease.
http://www.fda.gov/bbs/topics/NEWS/2003/NEW00920.html
New Model Helps
Hospitals and Health Systems Better Respond to Potential Bioterrorism
June 26, 2003. The U.S. Department of Health and Human Services announced the availability of a new computer model to help hospitals and health systems plan antibiotic dispensing and vaccination campaigns to respond to bioterrorism or large-scale natural disease outbreaks. Funded by the Agency for Healthcare Research and Quality, this new resource is the nation's first computerized staffing model that can be downloaded as a spreadsheet and used to calculate the specific needs of local healthcare systems based on the number of staff they have and the number of patients they would need to treat quickly in a bioterrorism event. The downloadable software program is at
http://www.ahrq.gov/research/biomodel.htm
In addition, the University of Alabama at Birmingham recently updated its AHRQ-sponsored website to include reference sections on anthrax and smallpox and added new continuing education modules for internal medicine and pediatrics at http://www.bioterrorism-uab.ahrq.gov
New topics Added
to OSHA's Safety and Health Topics Page
OSHA's Safety and Health Topics Page has added hantaviruses and pneumonic plague. Hantaviruses are usually transmitted to humans from the dried droppings, urine, or saliva of mice and rats living in the wild. This page includes commonly asked questions and links to resources that provide useful safety and health information about the virus. Pneumonic Plague has claimed the lives of millions in a series of epidemics throughout the world's history. This page includes commonly asked questions and links to resources that provide useful safety and health information, and discusses how a bioterrorist release of plague could result in a rapid spread of the pneumonic form of the disease.
http://www.osha.gov/SLTC/hantavirus/index.html
http://www.osha.gov/SLTC/pneumonicplague/index.html
Comment Period Extended on Revisions to OSHA
Respiratory Protection Standard
OSHA
extended until
Interested parties have requested additional time to comment on those numbers, as well as changes to several substance-specific standards.
Assigned Protection Factors
www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=17969
OSHA Publishes New Safety and Health Information
Bulletins
Two new safety and health information bulletins are now available on OSHA's website. The bulletin entitled "Chemical, Biological, Radiological, and Nuclear (CBRN) Warfare Agents Escape Respirators," was developed to provide employers with information on helping to protect workers from injuries and illnesses resulting from possible terrorist incidents related to chemical, biological, radiological, or nuclear incidents. The agency has also published a bulletin to help protect workers who may be exposed to the West Nile Virus. Workplace Precautions against West Nile Virus discusses symptoms of the virus, what occupations are at risk, and various safeguards employers can take to combat workplace exposure.
http://www.osha.gov/dts/shib/revCBRN_EscapeRespirators_8-29-03.html
http://www.osha.gov/dts/shib/WestNileVirus_8-29-03.html
COURSES FOR THE
INFECTION CONTROL PROFESSIONAL
"Infection
Control in Long-Term Care Facilities" will be held in Chapel Hill
Hospital infection control training courses will be held in 2004 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
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