NEWS FEATURE
AVIAN INFLUENZA OUTBREAKS
An outbreak of avian influenza or bird flu (H5N1 subtype) has been confirmed among poultry in Cambodia, China, Hong Kong, Indonesia, Japan, Laos, South Korea, Thailand and Vietnam. In addition, there have been several (>20) cases of human infection of avian influenza in Vietnam and Thailand. All human cases are believed to have acquired this disease from close contact with infected birds or excretions from infected birds.
Birds that become infected with avian influenza shed the virus in saliva, nasal secretions and feces, which can then spread rapidly among susceptible birds. In order to control this outbreak, birds that are either ill or exposed must be killed, and farms with infected poultry must be isolated in order to prevent transmission between farms via equipment, feed, cages or clothing.
Avian influenza viruses are subtypes of the influenza type A virus. While avian influenza viruses can be very contagious among birds, the virus does not typically circulate among humans. However, influenza viruses are well known for their ability to mutate. If the avian influenza virus exchanged genetic material with another subtype of influenza, it could acquire properties that would allow it to spread from person-to-person.
A limited number of cases of avian influenza have been found among poultry flocks in Delaware (H7N2 subtype) and Pennsylvania (H2N2 subtype), and among poultry at a live bird market in New Jersey (H7N2 subtype). These subtypes are less pathogenic than the H5N1 subtype that is infecting poultry in Asia and do not typically infect humans. To date, there have been no human cases in the United States.
On February 4, 2004, the Centers for Disease Control and Prevention (CDC) issued an immediate ban on the import of all birds and products from birds from Southeast Asian countries including: Cambodia; Indonesia; Japan; Laos; People’s Republic of China, including Hong Kong, SAR; South Korea; Thailand; and Vietnam. In addition, on February 13, 2004, the North Carolina State Veterinarian announced restrictions on imports of poultry and poultry products into North Carolina from any state where flocks have tested positive for avian influenza.
Travelers to countries in Asia with documented H5N1 outbreaks are advised by the CDC to avoid poultry farms, contact with animals in live markets, and surfaces contaminated by poultry.
For more information on these outbreaks and avian flu, visit
www.cdc.gov/flu/avian/outbreak.htm
and
www.fao.org/ag/againfo/subjects/en/health/diseases-cards/avian.html
Article written by Emily Sickbert-Bennett, UNC Health Care.
REGULATORY/LEGISLATIVE
New Information about Disposing of Medical Sharps in the Home Health Care Setting
Many healthcare facilities use an EPA website ( www.epa.gov/epaoswer/other/medical/sharps.htm) to get educational information to provide patients about disposing of used syringes (i.e., diabetics) in the home setting. The EPA pamphlet titled “Disposal Tips for Home Health Care” suggests using a non-recyclable hard-plastic or metal container with a tightly secured screw-on lid. Recently a new brochure appeared on this EPA website that describes a Coalition for Safe Community Needle Disposal, comprised of medical, government, and waste association and private sector companies, that is working with the EPA to evaluate and promote alternative disposal methods for used needles and other medical sharps. This coalition emphasizes in the brochure the health risks associated with improper management of discarded needles to the public and waste workers. The brochure goes on to describe four different alternative disposal methods that are available for sale by these companies. The last portion of the brochure instructs individuals to call the local solid waste department or public health department to determine correct disposal methods.
In all states medical waste disposal is regulated at the state level. Sharps are a medical waste. Therefore, unless a change has occurred in your state’s medical waste rules, this new brochure from the EPA website gives only suggestions, not requirements. No changes in North Carolina medical waste management rules have been made or are anticipated to be made. NC Medical Waste Management rules are at this web site: wastenot.enr.state.nc.us/SWHOME/12RUL.htm
QUESTION OF THE MONTH
Noroviruses
Q: Our facility recently had several patients with vomiting and diarrhea that was identified as norovirus. Are there any special issues about cleaning or disinfection when this virus is recognized?
A: : Noroviruses (formally called Norwalk agent) are a group of nonenveloped viruses that cause acute gastroenteritis in humans. In industrialized countries, noroviruses may be responsible for 70-80% of all outbreaks of gastroenteritis. In the last two years, outbreaks have been recognized more frequently occurring in many settings including restaurants, cruise ships, schools, extended care facilities, and hospitals. Noroviruses are spread primarily by the fecal-oral route, although airborne and fomite transmission might facilitate spread during outbreaks. Frequently during an outbreak, primary cases result from exposure to a fecally contaminated vehicle (e.g., food or water); whereas, secondary and tertiary cases among contacts of primary cases result from person-to-person transmission. Some factors that make control of outbreaks difficult include a low infectious dose (<102 viral particles), prolonged asymptomatic shedding, environmental stability, and lack of lasting immunity resulting in susceptible populations. Practices such as participation of staff and patients in common meals can facilitate outbreaks. However, the environment can play a significant role in institutional settings. Noroviruses are able to survive for days on environmental surfaces and are relatively resistant to disinfectants. Hypochlorite is effective against noroviruses and has been shown to be useful against other resistant pathogens (i.e., Clostridium difficile). Also hand hygiene with soap and water to physically remove rather chemically inactivate with an alcohol-based waterless agent should be used, since non-enveloped viruses such as norovirus present on hands are not inactivated by alcohol.
NEWS AND ANNOUNCEMENTS
AMERICAN HOSPITAL ASSOCIATION LETTER TO OSHA ABOUT TB RULE
January 29, 2004. The American Hospital Association (AHA) strongly recommended that OSHA rescind its decision to apply the General Industry Respiratory Protection Standard (1910.134) to occupational exposure to TB. The letter is available online at
www.hospitalconnect.com/aha/advocacy-grassroots/advocacy/agencyletters/2004/fedag040129Osha.html
OSHA DELAYS ENFORCEMENT OF RESPIRATORY PROTECTION RULE PROVISIONS
January 14, 2004.The Occupational Safety and Health Administration (OSHA) announced that it will delay until July 1, 2004, enforcing several provisions of the respiratory protection standard for establishments required to provide respirators for protection from potential exposure to tuberculosis. The announcement of the six-month period to allow affected employers to come into compliance with the additional requirements, follows OSHA's withdrawal last month of its 1997 proposal on tuberculosis and the revocation of a separate respiratory protection standard for workers exposed to TB.
With the withdrawal of the TB rule, OSHA announced it would begin applying the general industry respiratory protection standard for protection against the disease. This rule includes several requirements which were not as detailed in the revoked rule, such as updating the facility's respirator program, medical evaluation requirements, annual fit testing of respirators, and some training and recordkeeping provisions. During this six month period, OSHA will not cite these new requirements for establishments with workers exposed only to tuberculosis. All elements of the revoked rule continue to be enforced under the corresponding elements of the current respiratory protection standard.
To meet the requirements of the agency's respiratory protection standard, employers will need to revise their respiratory protection program, conduct annual respiratory fit testing, and perform a medical evaluation and annual training for employees using respirators.
This announcement does not affect establishments already covered under the respiratory protection rule where there is exposure to hazardous substances other than tuberculosis. All provisions of the rule will continue to be applied to those employers.
(Press Release from OSHA)
VIRAL HEMORRHAGIC FEVERS NOW ON OSHA SAFETY AND HEALTH TOPICS PAGE
Viral Hemorrhagic Fevers (VHFs) are a group of diseases, such as yellow fever, that has been identified by the Centers for Disease Control and Prevention as likely to be used as biological weapons. OSHA's information on the fevers includes hazard recognition, emergency response, and control and prevention. Links to additional resources are also provided.
www.osha.gov/SLTC/vhf/index.html
JCAHO 2005 PRE-PUBLICATION EDITION INFECTION CONTROL STANDARDS
The pre-publication standards are available online in a PDF format: Ambulatory Care
wwwjcaho.org/accredited+organizations/patient+safety/infection+control/05_ic_std_ahc.pdf
Behavioral Health Care
www.jcaho.org/accredited+organizations/patient+safety/infection+control/05_ic_std_bhc.pdf
Home Care
www.jcaho.org/accredited+organizations/patient+safety/infection+control/05_ic_std_hc.pdf
Hospital
www.jcaho.org/accredited+organizations/patient+safety/infection+control/05_ic_std_hap.pdf
Laboratory
www.jcaho.org/accredited+organizations/patient+safety/infection+control/05_ic_std_lab.pdf
Long Term Care
www.jcaho.org/accredited+organizations/patient+safety/infection+control/05_ic_std_ltc.pdf
JCAHO DISEASE-SPECIFIC CARE NATIONAL PATIENT SAFETY GOALS
February 2004. At its January meeting, the Executive Committee of the Board of Commissioners approved Ambulatory Care, Laboratory, Long Term Care and Disease-Specific Care National Patient Safety Goals (NPSGs) for 2004. This completes Phase I of JCAHO's planned development of program-specific NPSGs to make goals and requirements more relevant to the non-hospital accreditation and certification programs.
www.jcaho.org/About+Us/News+Letters/JCAHOnline/print/jo_02_04.htm
From JCAHO newsletter Feb 26, 2004
ENVIRONMENTAL GUIDELINES SEMINAR
Sensible Strategies for Environmental Infection Control in Healthcare Facilities, sponsored by Duke University Medical Center and the Duke Infection Control Outreach Network (DICON) is scheduled for March 25-26, 2004 at Durham Regional Hospital, Durham, NC. Additional information and online registration for the seminar are available online at the following website:
www.eicconsultants.com/seminars/welcome.html
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control in Long-Term Care Facilities" will be held in Chapel Hill March 22-24, 2004. The course is filled and has a waiting list. It will be offered again in the fall of 2004.
"Infection Control Part I: Clinical Surveillance of Healthcare-Associated Infections" will be held in Chapel Hill May 3-7, 2004. Registration is available online.
"Infection Control Part II: The ICP as an Environmentalist" will be held in Chapel Hill in the fall of 2004.
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. The SPICE is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Copyright 2004 Statewide Program for Infection Control and Epidemiology