The emergence of an intermediate vancomycin-resistant coagulase- negative staphylococcus isolated from a patient in nearby Reston, VA may be a greater concern than the case in Japan. Although susceptible to vancomycin by the disk diffusion method (16-17 mm), the isolates were intermediate by MIC (8-16 ug/ml). The patient was a 49 year-old woman with carcinoma, who had a bloodstream infection with the vancomycin-resistant coagulase- negative staphylococcus further identified by the CDC as S. epidermidis. She later died of her underlying disease and no healthcare workers were found to be colonized. This is the first report in the US of a bloodstream infection with an intermediate vancomycin-resistant CNS and provides reason for clinical laboratories to continue routinely looking for vancomycin resistance in S. aureus isolates.
Memorandum:
The National office sent a memorandum dated November 1, 1996, on the same subject matter as stated above. It concerned recent inquiries from companies who manufacture and/or supply a disinfectant product(s) approved by the EPA as a disinfectant for Human Immunodeficiency Virus (HIV) and Hepatitis B virus (HBV). These companies had asked whether EPA-registered products with the new EPA label would be an "appropriate disinfectant" under OSHA's Bloodborne Pathogens standard. The earlier memo stated the product could be used under limited conditions, where HIV and HBV were the only pathogens of concern.
Following receipt of materials offering further support for use of these products, OSHA has reconsidered the limitations in the memorandum of November 1, 1996, and has decided that the policy that requires the use of EPA-registered tuberculocidal disinfectants and/or a diluted bleach solution to decontaminate contaminated work surfaces will be expanded to include EPA- registered disinfectants that are labeled as effective against HIV and HBV, provided such surfaces have not become contaminated with agent(s) or volumes of or concentrations of agents(s) for which higher level disinfection is recommended.
As is true with all disinfectant products, the effectiveness is governed by strict adherence to the instructions on the label. For example, the EPE-approved label on one of these products has a section titled "SPECIAL INSTRUCTIONS FOR CLEANING AND DECONTAMINATION AGAINST HIV-1 AND HBV OF SURFACES/OBJECTS SOILED WITH BLOOD/BODY FLUIDS." These instructions required: 1) personal protection devices for the worker performing the task, 2) that all blood must be cleaned thoroughly before applying the disinfectant, 3) that the disposal of the infectious waste be in accordance with federal state, or local regulations, and 4) that the surface is left wet with the disinfectant for 30 seconds for HIV-1 and 10 minutes for HBV.
If you have further questions, please contact Wanda Bissell of my staff at (202) 219-8036 ext. 36.
"Part II, The Infection Control Practitioner as an Environmentalist" is scheduled for October 20-24, 1997 at the Holiday Inn in Chapel Hill.
"Prevention and Control of Nosocomial Infections" will be held November 14-16, 1997 at the Carolina Inn in Chapel Hill, NC. It is an intensive training program for physicians, epidemiologists, Infection Control Committee Chairs, infectious disease specialists and may serve as an intensive review for the experienced infection control practitioner. If you received a "Save these dates" post card about this conference, you are on our mailing list to receive the course brochure with more details later.
Report of the Month is also available on the home page of the Statewide Infection Control Program at http://www.unc.edu/depts/spice/
The Statewide Infection Control Program (SICP) is funded by the General Assembly of North Carolina to serve the State. The SICP is not a regulatory agency but provides education and consultation to North Carolina healthcare facilities.
Copyright 1997 Statewide Infection Control Program