September - October 2004
CONTENTS:
NEWS FEATURES
REGULATORY/LEGISLATIVE
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
NEWS FEATURES
How to Avoid the Flu: Precautions Can Reduce the Risk
UNC Health Care has made the following summary of CDC guidelines available for you to use in educating staff, patients, and visitors about precautions that can be used to reduce the risk of flu.
Given the supply of flu vaccine was cut in half this year, learning how to avoid the flu is especially important this flu season. The main way flu is spread is from person-to-person through coughs and sneezes. This happens when droplets from the cough or sneeze of an infected person travel through the air and reach the mouth or nose of a person nearby. Sometimes flu can be spread when a person touches droplets, nose drainage or saliva from an infected person, or a soiled object or surface, and then touches one's own (or someone else's) eyes, nose or mouth before washing hands.
Several precautions can limit the risk of the flu. If you have the flu, make sure you cover your nose and mouth when you cough or sneeze and teach children to do the same (by using disposable tissues). If possible, stay 3 feet away from a person with the flu as a sneeze or a cough can send flu-contaminated droplets as far as 3 feet from the infected person. Since the flu can be transmitted by touch, don't shake hands with someone who is sick or touch items that the sick person touches. Wash your hands especially before, during and after food preparation, after eating, after using the restroom, and more frequently when someone is sick in your home (e.g., after touching surfaces soiled with saliva or nose drainage). Wash your hands with soap and water or use a waterless, alcohol-based hand rub. When using an alcohol-based hand rub, apply the product to the hands and rub the hands together until the alcohol has dried. Disinfect toys, surfaces and objects that are contaminated by using soapy water, a disinfectant towelette, or a water-bleach solution (mix ¼ cup chlorine bleach with 1 gallon of water). Tissues and paper towels (e.g., towelettes) used to clean up contaminated areas should be thrown away in a wastebasket. Avoid contact with others who have a cold or the flu. If you are sick (respiratory symptoms and fever) stay at home until you have been without a fever for 24 hours. Don't go to communal settings (work, school, day care, etc) where you risk infecting others. When a person, especially with an underlying medical problem (e.g., heart disease, diabetes), has a severe cough, shortness of breath or high fever, contact your physician.
Modified from the Centers for Disease Control and Prevention and The News & Observer, October 2004
REGULATORY/LEGISLATIVE
Rules Changes for North Carolina Reportable Diseases and Conditions
In August 2004 the North Carolina Division of Public Health requested several changes to the administrative rule 10A NCAC 41A.0101, which lists reportable diseases and conditions. The requested changes update the list of reportable diseases and conditions by removing one disease (vancomycin-resistant Enterococcus ) because mandatory reporting has not assisted in public health control measures. Vancomycin-resistant Staphylococcus aureus is added because it is an emerging public health threat. Two vaccine preventable diseases are added (influenza virus infection resulting in death of minors and primary varicella or chickenpox). Leprosy (Hansen's Disease) is added back to the list so that NC remains in alignment with the CDC and WHO reportable diseases list.
Additionally, a test for AIDS is added (CD4 T-lymphocyte count) in order to improve the reporting of AIDS cases.
The proposed changes are published in The North Carolina Register, which may be viewed on the Office of Administrative Hearings website www.ncoah.com/rules/register . Final approval is required by the NC Health Commission and the changes will take effect January 5, 2005 .
From a memorandum by Jeffrey P. Engel, MD, to Public Health Leaders August 20, 2004
QUESTION OF THE MONTH
JCAHO Enforces New Pharmacy Rules
Q: I've heard that there are new rules for the pharmacy department that JCAHO is enforcing. How does this affect infection control?
A: As of July 1, 2004, JCAHO began surveying for compliance with parts of a new chapter in the 2004 United States Pharmacopoeia-National Formulary (USP-NF) entitled “USP Tests and Assays Chapters 797, Pharmaceutical Compounding Sterile Preparations.” Until the end of 2004, JCAHO surveyors will evaluate and score organizations only on sections of the USP Standard Chapter 797 that corresponds to the existing JCAHO Medication Management Standards and elements of performance.
The standards update was made in response to the FDA first becoming aware of more than 55 problems since 1990 with compound preparations, many of which resulted in patient injury and death. A survey from 1995 conducted by the American Society of Health-System Pharmacists (ASHP) of national quality assurance activities for pharmacy-prepared sterile preparations found few pharmacies were equipped adequately or were performing critical Q.A. checks.
By the beginning of 2005, institutions should have determined a risk level using the Risk Level Assessment Checklist and conducted a risk assessment (or gap analysis) of their compliance to all provisions of USP Chapter 797. Institutions should have developed an action plan for each section of the chapter with specific, realistic time frames for compliance approved by the institution's leadership. Results of the action plan and demonstrated improvements in patient care need to be communicated with pharmacy staff and administration. By July 2005, a formal quality assurance plan must be formalized in writing, including revised policy and procedures implemented that address facility practice changes. This includes a description of specific monitoring and evaluation activities (measures identified).
The only specific JCAHO Infection Control Standards are from (IC.4.10) for cleaning and sanitizing of work spaces, following aseptic technique, proper attire (gowns, gloves, etc.) and proper scrubbing (hand hygiene, etc.) with defined standard operating procedures required to be in place by July 2005. Personnel performing compounding will need to meet training and instruction that includes theoretical principles and practical skills (HR.2.30, HR.3.10). Several costly structural changes are included in the environmental design (EC.8.10) of drug preparation rooms (i.e., solid surfaces, furniture, fixtures, anteroom areas, and buffer zones). Institutions must have a renovation plan by July 2005 with a completion date required by January 2008. The Verification of Environmental Controls (EC.7.10, EC.9.10) include the certification of laminar air flow work benches and barrier isolates, and buffer room/zone and anteroom zones every six months. In addition, bacterial monitoring must be done using an appropriate manner at least monthly by January 2006. Equipment used in compounding must have routine maintenance and be calibrated and the personnel receive training in these practices (EC.6.10). Medication Management Standards (MM.4.20) are quality control practices that must include visual confirmation of personnel processes regarding gowning, etc. Quality checks should already include reviewing of orders and packages of ingredients to assure correct identify and amounts of ingredients, along with visual inspection or central sterile processing. Current practices of the finished product should include release checks and tests, physical inspections, compounding accuracy checks of high risk level products for sterility, pyrogen, potency testing (MM.4.20) with written policies and procedures.
References: JCAHO Compliance Expectations for USP Chapter 797, The ASHP Discussion Guide for Compounding Sterile Preparations: Summary and Implementation of USP Chapter<797> (American Society of Health-System Pharmacists)
NEWS AND ANNOUNCMENTS
Change in Numbering of North Carolina Infection Control Law
The North Carolina Infection Control North Carolina is now numbered 10A NCAC 41A.0206. The law was previously numbered 15A NCAC 19A.0206. The law is available online at
http://www.unc.edu/depts/spice/NC-law-.0206-.0207.html
New Control of Communicable Diseases Manual
The 18 th edition of the Control of Communicable Disease Manual edited
by David L. Heymann, MD, published in 2004, is now available. The General
Communicable Disease Section of the North Carolina Department of Health
has adopted the manual as the standard reference for communicable diseases for the state.
http://www.apha.org/media/science.htm
Revised OSHA Document on Catheter Securement Requires Annual Review
August 2004. The Occupational Safety and Health Administration (OSHA)
posted to its Web site a revision to its online “Securing Medical
Catheters” fact sheet. The revision declares that securing catheters with
tape or suture can create potentially hazardous conditions. According to
the OSHA fact sheet: “Catheters used for vascular access must be inserted
with a needle. Inserting a catheter exposes the healthcare worker to the
risk of dislodgment and the necessity of reinsertion with its associated
needlestick risk.” The revised OSHA document now requires all healthcare
facilities to conduct annual reviews of their catheter-securement
processes to ensure the institution is using the safest system possible in
order to reduce or eliminate needlesticks. "
http://www.osha.gov/SLTC/bloodbornepathogens/factsheet_catheters.pdf
New Guide Helps Communities Prepare for Vaccine and Drug Dispensing in the Event of a Bioterrorism or Other Public Health Emergency
September 2004. A new planning guide funded by the Agency for Healthcare Research and Quality is designed to help communities nationwide make sure that all Americans have needed drugs and vaccines in the event of a natural epidemic or bioterrorist attack. The guide complements the Strategic National Stockpile guidebook prepared by the Centers for Disease Control and Prevention, which includes a chapter on dispensing medications and vaccines. The new guide, Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness, is designed to help State, county, and local officials meet Federal requirements for a public health emergency.
The guide is available at www.ahrq.gov/research/cbmprophyl/cbmpro.htm. Printed copies are available by contacting AHRQ's Publications Clearinghouse at 1-800-358-9295 or by sending an E-mail to ahrqpubs@ahrq.gov.
Surgical Care Improvement Partnership
Surgical Care Improvement Partnership ( SCIP) is a national quality partnership of organizations interested in improving surgical care through the reduction of post-operative complications. The partnership was initiated by the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) in recognition that it would take the efforts of many leaders working together to make significant strides toward surgical care improvement. Partners in the Surgical Care Improvement Project believe that a meaningful reduction in surgical complications depends on surgeons, anesthesiologists, perioperative nurses, pharmacists, infection control professionals, and hospital executives working together to intensify their commitment to making surgical care improvement a priority. In summer 2005, the SCIP partnership will launch a multi-year national campaign to substantially reduce surgical mortality and morbidity in four target areas through collaborative efforts. The goal is to reduce nationally the incidence of surgical complications by 25 percent by the year 2010. Quality improvement efforts will focus on reducing perioperative complications in four broad areas where the incidence and cost of complications are high:
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control in Long-Term Care Facilities” will be held in Chapel Hill in the spring of 2005
“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