July - August 2004
CONTENTS:
NEWS FEATURES
REGULATORY/LEGISLATIVE
QUESTION OF THE MONTH
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
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NEWS FEATURES
Disinfection of Computer Keyboards
The increased use of computers in patient care areas has led to concern that microbial contamination of keyboards serves as a reservoir for pathogens. A study was performed to examine the efficacy of different germicides in removing and/or inactivating potential pathogens from keyboards. In addition, we evaluated the effect of the germicides on the computer's keyboard; that is, whether the germicides affected the functionality of the computer or altered the appearance of the keyboard (e.g., removed key lettering). Seven IBM laptops were used to evaluate the effectiveness of six different disinfectant wipes (e.g., three quaternary ammonium compounds, chlorine-containing wipe [80 ppm], 70% isopropyl alcohol, phenolic [at manufacturer's recommended use-dilution]) in removing contaminates (i.e., MRSA, VRE, P. aeruginosa ). All tested products were effective (>95%) in removing and/or inactivating the test pathogens. There was no functional damage or cosmetic changes to the computer keyboards after 300 applications of the disinfectants. At UNC Hospitals, we recommend that keyboards be disinfected daily (5 seconds application time) and when visibly soiled.
New Edition of North Carolina Tuberculosis Policy Manual
The North Carolina (NC) Tuberculosis Policy Manual, 9th edition, 2004 (revised July, 2004) is now available on the internet for downloading and printing. The introduction states, “ The goal of the North Carolina TB Control program is to eliminate tuberculosis disease (a case rate of less than one per million population) by the year 2010.”
In the previous online edition of the policy manual, some specific pages were updated and the revised pages could be printed and substituted for the out-of-date ones in the manual. However, the July 2004 edition provides for printing a complete new manual. As in the past, future revisions to the 2004 NC Tuberculosis Policy Manual will be available on the web site.
The manual text is available on the internet atThe North Carolina 2003 Annual Tuberculosis Statistical Summary is now available online. Healthcare personnel can find the tuberculosis rates in the table that list tuberculosis incidence by county.
www.epi.state.nc.us/epi/tb/pdf/tbannual2003.pdf
REGULATORY/LEGISLATIVE
OSHA Fit Testing for Tuberculosis Mandate Update
In January 2004, OSHA determined that it would enforce the general industry respiratory protection rule to protect workers against occupational exposure to TB. The agency delayed enforcement of those provisions through July 1, 2004 . In response to lobbying efforts by the American Hospital Association and others, an amendment was offered by Representative Roger Wicker (R-Mississippi) that would restrict OSHA from enforcing requirements that respirators be tested annually for fitness after the initial fit testing. On July 14, 2004, by party-line vote of 35-27, the House Appropriations Committee approved the amendment to the 2005 Labor Department funding bill. This bill must now pass the Senate if it is to become a federal law that will prevent OSHA from enforcing annual fit testing of respirators. In North Carolina, the Department of Labor has delayed enforcement until January 1, 2005 . The University of North Carolina Health Care System is currently proceeding as though implementation will be required. A solution to the problem in the future is a better respirator being developed and evaluated that will prevent the need for fit testing all together.
See related item “OSHA Respiratory Protection Revised Standard Adds A New Fit-Testing Protocol” in the News and Announcements section later in this newsletter
QUESTION OF THE MONTH
Patient Custody of Internal Body Tissues or Organs (Body Parts)
Q: Patients occasionally request that they be allowed to take custody of body parts, tissues, or organs that have been removed (e.g., placenta, fetal remains, appendix). What are the legal regulations and acceptable practices for healthcare facilities (HCF) to transfer requested body parts to their patients?
A: Patients may request for cultural, religious, or individual preference to have the removed body tissues/part returned to them at discharge. State and county laws vary and should be investigated so HCF policy is compliant with all applicable laws. Under North Carolina law, because all human tissues, organs, and body parts are considered “Pathological waste,” and thus “Regulated Medical Waste,” no human tissues, organs or body parts removed during a medical procedure (e.g., placenta, fetal remains, appendix, amputated limbs) may be released to a patient except as provided pursuant to 15A NCAC 13B.1207.
However, a patient may request that the hospital deliver certain of his/her tissues, organs or body parts removed during a medical procedure to a licensed funeral home to bury or to store in accordance with applicable NC regulations for burial with the patient at the time of the patient's death. The types of tissues, organs and body parts required to be released in this manner include: deceased bodies, fetal remains if the fetus is >20 weeks gestation, recognizable body parts (e.g., leg, arm, hand), and body tissues required for diagnostic procedures. The patient would be responsible for making arrangements with the funeral home. A release form should be developed that the patient would be required to sign allowing transfer of the tissue/body part to a licensed funeral home. Secondly, patients may be allowed to obtain other types of tissues, organs or body parts (those not required to be released to a funeral home such as appendix, placentas) for display or private burial. Patients should first be provided appropriate counseling by the patient's primary care provider prior to obtaining such tissues/body parts. Patients could be offered a choice to have the tissue, organ or body part “fixed” (so that the patient could display the tissue on a long-term basis) or “unfixed” (to enable the patient to bury the tissue). “Fixed” tissue option requires that tissue be appropriately immersed in formalin in a sealed, leak-proof container (e.g., specimen bottle). The container must be labeled with a chemical hazard symbol and the patient must be provided with the appropriate MSDS form. The patient should be instructed regarding the hazards to others of contact with tissue (e.g., transmission of bloodborne pathogens such as HIV, HBV, and HCV). The patient should be instructed that he/she must follow local laws regarding burial or disposal of the tissue.
NEWS AND ANNOUNCMENTS
NEW DISINFECTION AND STERILIZATION WEB SITE
William A. Rutala, Ph.D., University of North Carolina (UNC) at Chapel Hill and UNC Health Care, has developed a new web site about disinfection and sterilization. The web site includes slide sets that can be downloaded, an extensive chapter on disinfection and sterilization, and links to useful web sites.
disinfectionandsterilization.org
NEW CONTRAINDICATION FOR CIDEX OPA SOLUTION
April 2004. Advanced Sterilization Products (ASP) issued a notification that in rare instances CIDEX OPA Solution has been associated with anaphylaxis-like reactions in bladder cancer patients undergoing repeated cystoscopies. Therefore, ASP is contraindicating the use of CIDEX OPA Solution for the reprocessing of any urological instruments to be used on patients with a history of bladder cancer.
FLU RECOMMENDATIONS
MMWR Recommendations and Reports Volume 53, No. RR-06 May 28, 2004 . Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP) is available online at
www.cdc.gov/mmwr/PDF/rr/rr5306.pdf
CDC ISOLATION DRAFT GUIDELINE
Draft Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2004 was available and open for public comment. Comments were due by August 13, 2004
OSHA REPIRATORY PROTECTION REVISED STANDARD ADDS A NEW FIT-TESTING PROTOCOL
August 4, 2004 . The Occupational Safety and Health Administration announced an addition to the approved fit testing protocol in its Respiratory Protection Standard (Federal Register, August 4, 2004 ). The revision adds a new quantitative fit-testing procedure to assist workers and employers in the proper fit and selection of respirators. The new fit-testing protocol, referred to as the Controlled Negative Pressure (CNP) REDON protocol, requires three different test exercises followed by two redonnings of the respirator. The three test exercises, listed in order of administration, are normal breathing, bending over, and head shaking.
www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=10965
NEW AHRQ EVIDENCE REPORT HELPS HOSPITALS RESPOND TO BIOTERRORISM OR OTHER PUBLIC HEALTH EMERGENCIES
As part of its public health and emergency preparedness portfolio, Agency for Health Care Research and Quality (AHRQ) has released the new evidence report, Training of Hospital Staff to Respond to a Mass Casualty Incident. Developed by AHRQ's Johns Hopkins University Evidence-based Practice Center in Baltimore, the new report identifies key elements to be used in evaluating hospital disaster drills. The new evidence report provided the science behind another recently released AHRQ tool entitled Evaluation of Hospital Disaster Drills: A Module-Based Approach. The evidence report and the evaluation modules are online at
www.ahrq.gov/clinic/epcsums/hospmcisum.htm
FDA APPROVES RAPID ANTHRAX BLOOD TEST
June 7, 2004 . The Food and Drug Administration (FDA) has the first commercially available test to help diagnose an anthrax infection in less than an hour. Unlike other tests that can take up to four hours, the new process can quickly detect antibodies produced by the body to fight the infection, according to CDC officials.
www.cdc.gov/od/oc/media/pressrel/r040607.htm
FDA CLEARS MEDICINAL LEECHES FOR MARKETING
June 28, 2004 . The Food and Drug Administration (FDA) has for the first time cleared the commercial marketing of leeches for medicinal purposes. Leeches can help heal skin grafts by removing blood pooled under the graft and restore blood circulation in blocked veins by removing pooled blood.
http://www.fda.gov/bbs/topics/answers/2004/ANS01294.html
RENEWED FOCUS ON SAFETY AND HEALTH GUIDCANCE FOR AVIAN FLU
OSHA posted information on its website in March about the hazards of avian flu, a virus that primarily impacts birds, but can also affect humans. Because of continued potential for worker exposure, the agency is reminding workers and employers of those hazards. Guidance for Protecting Workers Against Avian Flu provides specific recommendations for farm workers and animal handlers, laboratory workers, medical personnel, food handlers, airline flight crews and travelers. The safety and health page also includes links to additional sources of information, including the Centers for Disease Control and Prevention (CDC) and the World Health Organization.
www.osha.gov/dsg/guidance/avian-flu.html
FDA APPROVES LEVAQUIN ANTIBIOTIC FOR RESISTANT PNEUMONIA
July 15, 2004. Johnson & Johnson said U.S. regulators widened the approved use of its Levaquin antibiotic (levofloxacin) to include treatment of pneumonia-causing Streptococcus bacteria that have become resistant to other antibiotics. The drug is already approved to treat mild-to-severe community-acquired pneumonia caused by Streptococcus bacteria, as well pneumonia caused by a variety of other bacteria, including Staphylococcus aureus.
TaqMan and TaqMan 48 ANALYZERS RECALLED BY FDA
May 24, 2004 . The U.S. Food and Drug Administration (FDA) recalled Cobas TaqMan and TaqMan 48 analyzers (made by Roche Molecular Systems, Inc.) due to reports of falsely elevated test results. The analyzers are intended for use by laboratory professionals in the measurement of hepatitis B and C viruses and for other in-house diagnostic testing.
www.fda.gov/cdrh/recalls/recall-052404.html
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control in Long-Term Care Facilities” will be held in Chapel Hill October 25-27, 2004 .
“Infection Control Part I: Clinical Surveillance of Healthcare-Associated Infections” was held in Chapel Hill May, 2004, and will be offered in the spring of 2005.
“Infection Control Part II: The ICP as an Environmentalist” will be held in Chapel Hill November 8-12, 2004.
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 Infection Control Program