________________________________________________________
- - - - -
________________________________________________________
---------------------------------------
Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers
Although pandemic and avian influenza are known to be transmitted via human hands, there are minimal data regarding the effectiveness of routine hand hygiene protocols against pandemic and avian influenza. Twenty vaccinated, antibody-positive health care workers had their hands contaminated with 1 mL of 10 7 tissue culture infectious dose (TCID)(50)/0.1 mL live human influenza A virus (H1N1; A/New Caledonia/20/99) before undertaking 1 of 5 hand hygiene protocols (no hand hygiene [control], soap and water hand washing [SW], or use of 1 of 3 alcohol-based hand rubs [61.5% ethanol gel, 70% ethanol plus 0.5% chlorhexidine solution, or 70% isopropanol plus 0.5% chlorhexidine solution] ). H1N1 concentrations were assessed before and after each intervention by viral culture and real-time reverse-transcriptase polymerase chain reaction (PCR). The natural viability of H1N1 on hands for >60 min without hand hygiene was also assessed.
There was an immediate reduction in culture-detectable and PCR-detectable H1N1 after brief cutaneous air drying--14 of 20 health care workers had H1N1 detected by means of culture (mean reduction, 10 3-4 TCID(50)/0.1 mL), whereas 6 of 20 had no viable H1N1 recovered; all 20 health care workers had similar changes in PCR test results. Marked antiviral efficacy was noted for all 4 hand hygiene protocols, on the basis of culture results (14 of 14 had no culturable H1N1; (P< .002) and PCR results (P< .001; cycle threshold value range, 33.3-39.4), with soap and water statistically superior (P< .001) to all 3 alcohol-based hand rubs, although the actual difference was only 1-100 virus copies/microL. There was minimal reduction in H1N1 after 60 min without hand hygiene.
Hand hygiene with soap and water or alcohol-based hand rub is highly effective in reducing influenza A virus on human hands, although soap and water is the most effective intervention. Appropriate hand hygiene may be an important public health initiative to reduce pandemic and avian influenza transmission.
SOURCE: Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PD, Mastorakos T, Birch C. Clin Infect Dis. 2009 Feb 1;48(3):285-91.
Q: When a patient is found to have an infection such as an implant that is documented in January 2009, but the surgery was originally done in June 2008, our current practice is to go back and add this as a healthcare-associated infection for June 2008. When this is done, we must change statistics that have already been completed. Is it appropriate to log the infection for January 2009 but include specifics in the line list?
A: According to the CDC, NNIS and now, NHSN protocols, the infection date is recorded by the first sign or symptom that is part of that sites' infection criteria (i.e., temp spike, purulence, etc.) when it appears documented. This is not the case for readmits because you would have to accept the patient's recollection for the date of when the first signs and symptoms occurred.
In the case of outpatients or readmits, unless you may have clinic or physician office notes, culture reports, or
antibiotic treatment records that document the recognition of the first sign or symptom, you have to use the readmit
date as the HAI date. Most of the time there have been attempts to treat an HAI as an outpatient, thus a patient record exists somewhere as an outpatient before a hospital readmit, but not always.
Remember, the HAI is always the first documented sign or symptom to be used for date the infection is recorded. But the IP should always look for commonalities like a day, week, or month that may be a common surgical date signifying a SSI cluster.
Proposed Legislation concerning Mandatory Reporting in the State of North Carolina
The House Health Committee reviewed HB 296, Funds for Nosocomial Infections Surveillance, by Representative Martha Alexander (D-Mecklenburg), on 3/9/09 and gave the bill a “favorable” report. It has been referred to the Appropriations committee but due to this legislative session's focus on budget cuts, it is not anticipated that the bill will pass.
The bill is summarized in the 3/5/09 edition of the NCHA (NC Hospital Association) Legislative News Daily as follows:
HB 296 requests funds for the State to develop and implement a mandatory statewide hospital-acquired infections surveillance and reporting system, as recommended by the Joint Study Committee on Hospital Infection Control and Disclosure.
The reporting process would initially focus on Central Line-Associated Bloodstream Infection (CLABSI) and work in coordination with current reporting to the Centers for Disease Control and Prevention. The funding would enable the State Public Health Department to train hospitals to gather and report relevant data and to validate the data to ensure that any public reports provide meaningful, useful information.
HB 296 can be viewed here: http://www.ncleg.net/Sessions/2009/Bills/House/PDF/H296v1.pdf
To see the current status of the bill, click here.
A New Web-Based Self-Achievement Recertification Exam: A new SARE exam for recertification is developed and released every other year. The next SARE will be released in February 2009 and will be web based. The eighth edition of the SARE will no longer be available in a paper-and-pencil format. The technology of hand scoring the paper and pencil answer sheets has become obsolete. You will be able to enter and exit the exam as many times as you wish and will be able to access the exam from any computer. CBIC encourages you to purchase the SARE as early in the year as possible. An updated Candidate Handbook will be available with the new web-based SARE information and instructions by early 2009 via the CBIC website or by calling the Executive Office at (913) 895-4607. Please contact the CBIC Executive Office for any additional questions.
SPICE Infection Control Courses in 2009 (All courses held at the Friday Center, Chapel Hill , NC)
(Information on all SPICE courses can be found on the Course page of the SPICE website: http://www.unc.edu/depts/spice/courses.html )
- Infection Control in Long Term Care Facilities will be held March 16 - 18 and November 2 – 4, 2009
- Infection Control Part I: Surveillance of Healthcare-Associated Infections will be held April 27 – May 1, 2009. Registration is now underway.
- Infection Control Part II: The ICP as an Environmentalist will be held September 21 – 25, 2009
- CBIC Review Course (sponsored by SPICE and APIC-NC) will be held August 27 (7-9 PM) and August 28 (8 AM – 5 PM). Registration form will be available on the SPICE website in spring 2009.
SPICE is offering new approved curricula for .0206 Infection Control Courses for the following settings: Dental, Home Health and Hospice and Outpatient. This training is designed to meet the requirements of 10A North Carolina Administrative Code 41A.0206.
Course providers must be approved by the Statewide Program for Infection Control and Epidemiology (SPICE) and purchase the approved curriculum for the particular setting they are qualified to teach.
Contact SPICE (spice@unc.edu or 919-966-3242) for more information.
The Duke Division of Infectious Diseases and International Health presents the 9th Annual Tuberculosis Symposium – The Anatomy of a Contact Investigation, on March 20, 2009, 8:30 AM – 5:00 PM at the Duke University Medical Center 's Searle Conference Center. Link to flyer. To register: http://cmetracker.net/DUKE/Courses.html
The U.S. Centers for Disease Control and Prevention (CDC) recently issued new MRSA materials for patients and healthcare providers. Materials include brochures, factsheets, posters, Web graphics and a treatment algorithm related to MRSA skin and soft tissue infections and are available at this Link.
Healthcare workers likely to be exposed to influenza during a pandemic should receive preventive doses of antiviral medications, according to new guidance from the U.S. Department of Health and Human Services (HHS) titled "Guidance on Antiviral Drug Use during an Influenza Pandemic." The document replaces the 2005 recommendations and provides guidance to planners on antiviral drug use strategies and the number of antiviral regimens that would be needed to support implementation.
Related guidance, "Considerations for Antiviral Drug Stockpiling by Employers in Preparation for an Influenza Pandemic," outlines considerations for antiviral medication stockpiling. This guidance does not establish the requirement or expectation that all employers stockpile antiviral drugs.
An Action Plan to reduce HAIs such as catheter-associated bloodstream (CA-BSI) infection was released on January 6, 2009, by the U.S. Department of Health and Human Services (HHS). HHS sought public input into its plan by February 6 to identify key actions in the prevention of HAIs to better coordinate agency prevention efforts. The document attempts to establish national targets for enhancing and coordinating HHS-supported efforts to prevent and reduce HAIs, a top priority for the department.
The HHS Steering Committee for the Prevention of HAIs was established in July 2008 and set six high priority HAI-related areas within the hospital setting as the initial focus of the HHS effort. Infections in four categories account for over 80 percent of all HAIs and include: surgical site infections (SSI); central line-associated bloodstream infections, or CA-BSIs; ventilator-associated pneumonia (VAP); and catheter-associated urinary tract infections (CA-UTIs). The remaining two additional initial priorities are infections associated with Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA).
HHS has established a set of five-year national prevention targets as well as metrics to assess progress toward these targets. HHS is planning a series of meetings for the spring of 2009 to provide opportunities for public comment on improving and strengthening the plan and stakeholder engagement in its implementation strategy. Comments on the HHS Action Plan to Prevent Healthcare-Associated Infections can be submitted to HAIComments@hhs.gov .
- Draft HAI Action Plan 01 06 09
- Information on submitting comments: http://www.hhs.gov/ophs/initiatives/hai/index.html
- Additional information and resources related to healthcare-associated infections: see Premier Safety module Healthcare-associated infections (HAIs)
At the beginning of January, The Joint Commission changed one of its infection control (IC) standards for 2009, clarifying the responsibilities of the person responsible for the hospital's IC program. The change is part of a series of revisions as the accreditor prepares to submit its application to the Centers for Medicare & Medicaid Services (CMS) for continued deeming authority for hospitals.
The change is to the element of performance (EP) for standard IC.01.01.01, which requires hospitals identify the individual or individuals responsible for the IC program. For hospitals that use Joint Commission accreditation for deemed status purposes (in other words, to demonstrate compliance with CMS' Conditions of Participation ) the individual with clinical authority over the IC program is responsible for the following:
The Joint Commission also announced in its Joint Commission Online December bulletin that there will be no new National Patient Safety Goals (NPSG) developed for 2010. Instead, over the next year, the Joint Commission will review and update current NSPGs, including numerous IC-related issues. To read more, click here.
Unsafe injection practices were responsible for 33 outbreaks of hepatitis B (HBV) or C (HBC) virus infections in U.S. outpatient healthcare settings over the past 10 years, according to an article in the January 6, 2009 issue of the Annals of Internal Medicine.
The outbreaks—12 in outpatient clinics, six in hemodialysis centers, and 15 in long-term care facilities—resulted in 448 people acquiring HBV or HCV infections, the article stated. The infections occurred though patient-to-patient transmission because of the failure of healthcare workers to adhere to fundamental principles of infection control and aseptic technique, such as reuse of syringes or lancing devices, the article indicated.
“Difficult to detect and investigate, these recognized outbreaks indicate a wider and growing problem as healthcare is increasingly provided in outpatient settings in which infection control training and oversight may be inadequate,” the article's authors wrote. For more about the article, click here .
In response to the article, Kathy Warye, CEO of APIC, cited the need for increased infection prevention measures in outpatient settings and said APIC is working with HONOReform, a national coalition formed to halt unsafe needle practices in outpatient centers.
The design and placement of handwashing sinks in the rooms of transplant patients at Toronto General Hospital in Canada were responsible for an outbreak of bacterial infections that killed 12 patients and sickened two dozen others, an investigation has revealed.
The outbreak occurred at the hospital between December 2004 and March 2006, but never received much public attention. However, infection control specialists tracked down the source of the multi-drug resistant bacteria behind the outbreak and found— ironically—that the sinks designed to prevent the spread of infections were the culprit, reported The Canadian Press.
Each single-patient room in the medical and surgical ICU had its own hand hygiene station, with sinks located just about a meter from the head of the patient's bed and adjacent to a countertop healthcare workers used to prepare medication and sterile dressings for the patient, the news service reported. The sinks had shallow basins and high, gooseneck spouts that flowed directly into the drain, so that pressure from the spout splashed water, spraying nearby surfaces.
The sink drain contained Pseudomonas aeruginosa, a bacteria that thrives in drains. It poses no threat to healthy people, but may be a threat to organ transplant patients with weakened immune systems. Testing by use of a commercial fluorescent marker demonstrated that when the sink was used for handwashing, drain contents splashed at least one meter from the sink. The hospital removed the sinks and installed new sinks with a different design and a splash guard. This highlights the importance of sink and patient room design in the propagation of an outbreak .
Results of the investigation were published in the January 2009 issue of the journal Infection Control and Hospital Epidemiology (link to the article).
Congratulations to Dr. Jeffrey P. Engel, formerly the State Epidemiologist, on becoming the new NC State Health Director.
------------------------------------------------------------------------------------
Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC; William A. Rutala, PhD, MPH; David J. Weber, MD, MPH; Eva Clontz, MEd ; Debby Pyatt, BA.
------------------------------------------------------------------------------------
To subscribe to the Report of the Month, send an 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. SPICE is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Posted: March 13, 2009
Copyright 2009 Statewide Program for Infection Control and Epidemiology