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At the recent APIC Annual Conference in Ft Lauderdale, the proposal was made by the Board of Directors to change the organization's name. This recommendation, made at the membership business meeting, retains the acronym APIC but proposes the organization's name now be “Association for the Prevention of Infections, Inc.”, instead of “Association for Professionals in Infection Control and Epidemiology, Inc.
The rationale for the change was presented in the 2009 Annual Business Meeting Agenda Packet as a Bylaws change and reads as follows:
In an effort to make APIC more inclusive, diverse, and welcoming to other healthcare related disciplines, the APIC Board of Directors has recommended the adoption of a new name that better reflects its mission and more easily conveys the purpose of the organization.
This name change proposal will be voted on by the membership this fall.
Q: Could you please help us clarify what type of PPE is recommended for healthcare workers caring for patients with suspected/confirmed H1N1? We received the guidance from N.C. Division of Public Health speaking to Droplet Precautions but then the CDC guidance of May 13, 2009 appears to go back to making the minimal requirement a "respirator". Advice?
A: State Public Health Guidelines are generally in agreement with CDC recommendations. However, the science is not there to support the routine use of N95 respirators for exposures by HCWs to patients with the novel influenza A (H1N1). The novel H1N1 strain currently circulating has demonstrated to be similar to seasonal influenza in the means of transmission being droplet and contact.
SHEA, with APIC and IDSA signing on (see the News and Announcements below), have released a position paper that states, after review of the current epidemiology, these organizations support the WHO novel influenza A (H1N1) Guidelines which recommend the use of a N95 only for high aerosol generating procedures. NC Interim novel influenza A (H1N1) Guidelines are consistent with the WHO and SHEA Position paper.
At the APIC Annual Conference last week, Dr Michael Bell, Associate Director for Infection Control at the CDC's Division of Healthcare Quality Promotion, gave the attendees an update on CDC's position stating the CDC is not in opposition with states who have chosen to follow the WHO Guidance for use of N95 respirators for only high aerosol generating procedures. Dr Bell further stated that HICPAC was meeting in the following week with the Labor Unions, NIOSH and OSHA and he anticipated some change in CDC's position may be forth coming that is in alignment with the current science of novel influenza A (H1N1) transmission.
NOTE: As of June 16, 2009, the “Interim Guidance on Prevention of Novel H1N1 Influenza Virus Infections in Long-Term Care Facilities” has been revised to be consistent with the May 22, 2009 “Interim Infection Control Guidance for Healthcare Workers” (issued by the NC Division of Public Health). Current Influenza guidance is posted on the SPICE website Flu page.
Effective May 18, 2009, the Centers for Medicare and Medicaid Services (CMS) now require that Medicare-certified ambulatory surgery centers (ASC) meet the 2009 Conditions for Coverage (CfC) .
Copied below is the text from CMS Statute § 416.5 Conditions for coverage—Infection Control:
The ASC must maintain an infection control program that seeks to minimize infections and communicable diseases.
(a) Standard: Sanitary environment. The ASC must provide a functional and sanitary environment for the provision of surgical services by adhering to professionally acceptable standards of practice.
(b) Standard: infection control program. The ASC must maintain an ongoing program designed to prevent, control, and investigate infections and communicable diseases. In addition, the infection control and prevention program must include documentation that the ASC has considered, selected, and implemented nationally recognized infection control guidelines. The program is—
1. Under the direction of a designated and qualified professional who has training in infection control;
2. An integral part of the ASC's quality assessment and performance improvement program; and
3. Responsible for providing a plan of action for preventing, identifying, and managing infections and communicable diseases and for immediately implementing corrective and preventive measures that result in improvement.
The proposal to change the NCAC .0206 Infection Control rule will be heard by the NC Commission for Public Health in August. The proposed rule still includes the following language:
The health care organization shall designate one on-site staff member for each noncontiguous health care facility to direct the (infection control) activities. The designated staff member in each health care facility shall complete a course in infection control approved by the Department.
If approved, this change (along with others) will go into affect in early 2010.
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.)
- CBIC Review Course (sponsored by SPICE and APIC-NC) will be held August 27 (7-9 PM) and August 28 (8 AM – 5:30 PM). Registration form is available on the SPICE website APIC-NC page.
- Infection Control Part II: The IP as an Environmentalist will be held September 21 – 25, 2009
- Infection Control in Long Term Care Facilities will be held November 2 – 4, 2009
Epidemiologists who first advised respirator use for the current flu pandemic now say it is not necessary.
After examining the transmission characteristics of novel influenza A (H1N1) - what was commonly called swine flu - the Society for Healthcare Epidemiology of America (SHEA) recommends that healthcare workers follow droplet precautions, not airborne precautions, according to its position paper .
This means that healthcare workers who are now treating patients for novel influenza A (H1N1) can follow the same precautions as for seasonal flu. Placing patients in negative pressure rooms and having workers wear N95 respirators is not necessary except when performing aerosol inducing procedures, according to SHEA. SHEA cautions that this recommendation could change with different evidence of transmission dynamics during the flu season.
Taken from May 22, 2009 HHS News Release: HHS Secretary Kathleen Sebelius announced on May 22, 2009 that the department will take important steps necessary to prepare for potential commercial-scale production of a candidate vaccine for the novel influenza A ( H1N1). The Secretary is directing approximately $1 billion in existing funds that will be used for clinical studies that will take place over the summer and for commercial-scale production of two potential vaccine ingredients for the pre-pandemic influenza stockpile. Link to news release: http://www.hhs.gov/news/press/2009pres/05/20090522b.html
During the summer of 2008, a point prevalence survey of C difficile in inpatients at US health care facilities was distributed to APIC members. The results of the survey were reported in a major article in the May 2009 issue of AJIC: National point prevalence of Clostridium difficile in US health care facility inpatients, 2008.
The May 8, 2009 APIC news release reported the following: …the survey “indicates that 13 out of every 1,000 inpatients were either infected or colonized with C. difficile . The rate is 6.5 to 20 times greater than previous incidence estimates, according to the survey. Based on this rate, it is estimated that there are at least 7,178 inpatients on any one given day in American healthcare institutions with an associated cost of $17.6 to $51.5 million. Of those who responded, 82% reported that C. difficile infection rates had not decreased over the past three years.” Link to the news release.
Article reference: Jarvis WR, Schlosser J, Jarvis AA, Chinn RY. National point prevalence of Clostridium difficile in US health care facility inpatients, 2008. AJIC. 2009;37 [4]: 263-270.
Reference for Guide to the Elimination of Clostridium difficile in Healthcare Settings: Dubberke ER, Gerding DN, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiology 2008;29:S81-92.
A recent JAMA article ( Vol. 300 No. 24, December 24/31, 2008 ) examines the implications of a new resistance threat to public health: the global spread of carbapenem-resistant Enterobacteriaceae (CRE). The dangers of this new infection are described, and recommendations are provided for treating and mitigating the spread of CRKP. Link to article. Link to CDC Guidance: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5810a4.htm
This analysis finds that the initial response to the H1N1 outbreak showed strong coordination and communication and an ability to adapt to changing circumstances from U.S. officials, but it also showed how quickly the nation's core public health capacity would be overwhelmed if an outbreak were more severe or widespread. The brief includes 10 early lessons, 10 recommendations, and financing options.
Here is the list of 10 early lessons learned from the 2009 H1N1 outbreak:
Download the complete report.
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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.
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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: June 19, 2009
Copyright 2009 Statewide Program for Infection Control and Epidemiology