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How to deal with unclear infection prevention guidelines

Written by Tinker Ready at HealthLeaders Media

A team of physicians from the University of Iowa Hospitals and Clinics has put forward a strategy that aims to standardize infection prevention guidelines for procedures performed outside the operating room. The team contends that for most procedures, from skin biopsies to chest tube insertions, there is no authoritative guidance on infection prevention.

Writing in the American Journal of Infection Control, it also notes that there is little published evidence for existing practices.

The strategy emerged from a hospital epidemiology leadership meeting, says Vincent Masse, MD, the study’s lead author.

They discussed a scenario whereby an interventional radiologist had been asked to wear a surgical hat and a mask while doing a fine needle aspiration. The radiologist had not worn the protection in 20 years of doing the procedure.

So the clinician asked what the hospitals policy was.

“Not only were we unable to provide evidence to support this practice, but we also had no comprehensive policy regarding infection prevention practices for medical procedures performed outside an operating room,” the authors write.

Masse and his fellow researchers looked at what kind of research had been done.

“We realized that there is very little data for most procedures and there is no simple model to follow,” he said.

Little Guidance

The researchers reviewed the available literature: textbooks, technical notes, and practice guides, but described them as unhelpful.

The Spaulding Classification guides the disinfection of devices and equipment, but does not go far enough, in the eyes of the study authors. “It would be nice if there were a similar model for outside-the-OR procedures,” says Masse.

“Most of these sources referred, at some point, to ‘your local policy’,” they write.

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Throwback Thursday: Perfecting infection control on everyday items

Editor’s Note: The following is a free Briefings on Accreditation and Quality article from yesteryear! If you like it, check out more of our work covering quality and accreditation! 

After reading this article, you will be able to:

  • Identify everyday items that may require additional thought when it comes to infection control procedures
  • Describe who should be involved when developing policies for cleaning everyday items in the patient room
  • Discuss the development process of disinfection policies for certain challenging items
  • Describe leadership’s role in building an effective policy for patient room equipment cleaning routines

Think back to your last visit to a hospital as a patient or family member. Every patient care area has recognizable, ubiquitous items, such as automated blood pressure pumps, compression pumps, and IV pumps. But how do you know if those items were cleaned and/or disinfected? Were they used with the last patient, or have they sat dormant for weeks? Such items are easy to overlook, but in terms of patient safety and infection control, they need to be addressed in every facility.

One organization, St. Joseph’s Healthcare System-which includes St. Joseph’s Regional Medical Center in Paterson and St. Joseph’s Wayne Hospital in Wayne, N.J.-has implemented a method for cleaning these everyday items and identifying them as clean without adding an additional burden to its staff.

“As you know, in healthcare it can be challenging to change processes,” says Anne Marie Pizzi, M.Ed., RN, HACP, TeamSTEPPS trainer, Six Sigma Green Belt, and performance improvement coordinator with St. Joseph’s. “This began as a work in progress three or four years ago as we were struggling with preventing infection control issues and trying to find a way to make life easier for staff to clearly identify items that were already clean, or that needed to be cleaned.”

So the organization-a regional tertiary medical center and an acute care community hospital-brought together all the key departments, including infection prevention and control, nursing, central sterilization processing, and environmental services, to work collaboratively to improve the process.

“In the beginning, the problem boiled down to a real estate issue,” says Pizzi. “The hardest thing for us to decide when we talked about the equipment was, whose job is it to clean it?”

In addition, the team looked at what type of equipment was involved, how frequently it needed to be cleaned, and what kind of cleaning was necessary.

“Anything requiring more than low-level disinfection is not left to the staff on the unit,” says Pizzi. “So there were specific pieces of equipment that had to go to central supply or to individual departments where staff are trained to clean and care for that equipment.”

The equipment that environmental services or the staff on the units will typically clean include automated blood pressure pumps, Accu-Chek® meters­, pulse oximeters, and IV pumps.

“You may believe that you have designed a solid process when discussing it in a meeting, but when it is rolled out to the staff, change can be a challenge,” says Pizzi. “So it was really important we talked to the staff to determine the processes they were using and the possible solutions they would suggest.”

 [Continued –>]

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Joint Commission and CDC team up on ambulatory infection prevention

The Joint Commission and the Centers for Disease Control and Prevention (CDC) are working on a new initiative to improve infection control in ambulatory care settings. The Adaptation and Dissemination Outpatient Infection PrevenTion (ADOPT) project will promote existing CDC infection prevention (IP) guidance while also making updates and alterations. The collaboration will involve:

•    Evaluating organizations’ infection prevention and control guidelines and materials to find gaps between what’s done in practice and what’s in the CDC materials.
•    Finding new ways and opportunities to raise awareness of IP guidance.
•    Adapting model infection control plans for outpatient-focused professional organizations.
•    Developing new ways of disseminating these materials and models to healthcare organizations to increase their reach, uptake, and adoption in outpatient settings.

There are 12 outpatient-focused professional organizations and 11 ambulatory healthcare systems participating in ADOPT. Other healthcare organizations or state health departments interested in learning more can reach out to Barbara Braun, PhD, at bbraun@jointcommission.org.

For examples of CDC ambulatory-focused infection prevention and control guidance, check out the following links:
•    CDC Guide to Infection Prevention for Outpatient Settings:  Minimum Expectations for Safe Care
•    CDC Outpatient Settings Policy Options for Improving Infection Prevention
•    CDC Basic Infection Control and Prevention Plan for Outpatient Oncology Settings
•    The CDC One and Only Campaign
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Medical devices enter the realm of partisan politics

Duodenoscopes received a lot of publicity in 2015, most of it bad. The final straw was when a Senate committee report linked defective scope designs to 25 infection outbreaks since 2012, 19 of which involved drug-resistant superbugs.

The Food and Drug Administration (FDA) took the brunt of the blame in the Senate report for its handling of the issue. The reports show that while the FDA was aware of the potential risks of dirty scopes, it didn’t warn the public until after a 17-month investigation. By the time the FDA warning was released, there were seven more scope-caused outbreaks, with 68 patients contracting antibiotic-resistant infections.

The report dragged the issue into the public eye and now Democrats and Republicans are both condemning the FDA’s handling of the situation. The Washington Post reports that while both sides agree changes need to be made, they disagree over what needs to be done.

Democrats argue that implementing a bar code system for medical devices would allow hospitals to track what devices are linked to infections or other issues. The Washington Post reports that the bar code program is already being phased in and will cost around $250 million.

Republicans argue that instead of a new system the FDA should simply use the power it  already has, noting that the agency already has the (often unused) power to impose civil and criminal penalties against manufacturers for not reporting injuries or deaths.

You can read the full Senate committee report here,  along with some of our previous coverage on duodenoscopes. 

Drug makers join forces at Davos to fight superbugs

During this year’s World Economic Forum in Switzerland, drug companies from 16 different countries announced a new agreement to fight the rise of drug-resistant infections, sometimes referred to as “superbugs.” Superbugs are an increasing concern for public health, with the United Kingdom government estimating that superbugs could kill up to 10 million annually by 2050.

The “Declaration on Combating Antimicrobial Resistance” was signed by 74 drug makers, 11 diagnostic test manufacturers, and nine industry groups pledging to work with each other and governments to tackle the issue of superbugs. Several big names have signed, including GlaxoSmithKline, Johnson & Johnson, Novartis, Roche Group, and Pfizer.

The declaration calls for steps including:

• Better education of doctors and nurses on appropriate antibiotic use
• Improved infection control through better hygiene, vaccination and preventive treatments
• Reduced used of antibiotics in livestock
• Higher reimbursements for antibiotics and diagnostic tests in developed markets
• More collaboration between researchers at drug makers and those at universities and government
• More access to antibiotics in countries around the world
• Governments committing funding to implement the World Health Organization’s Global Action Plan to create programs ensuring that health systems use antibiotics appropriately, along with increasing use of fast diagnostic tests and boosting reimbursements for them to ensure patients get the correct treatment

Senate panel: 250 confirmed antibiotic-resistant infections now linked to duodenoscopes

In December, the FDA linked 45 antibiotic-resistant infections (ARI) cases to Olympus brand duodenoscopes since 2012, with the infections causing 24 illnesses and 21 deaths.

Now, a new Senate committee report has tripled the number of confirmed Olympus duodenoscopes infections to 142. Industrywide, there have been 250 patients since 2012 who’ve contracted ARIs from duodenoscopes made by various companies. Dirty scopes have been responsible for 25 patient outbreaks in 10 states and four countries. Several of the outbreaks involved Carbapenem-resistant Enterobacteriaceae infections, which can kill up to 50% of those it infects and can sometimes share its drug resistance with other bacteria. 

The three companies singled out in the report were Pentax Medical, Fujifilm Medical Systems, and Olympus Corp. The Senate Health, Education, Labor, and Pensions Committee also placed blame on the FDA, saying the agency’s safety reporting system was too slow and cumbersome.

You can read the full report here. 

 

Joint Commission and CDC team up on ambulatory infection prevention project

In November, The Joint Commission and the Centers for Disease Control and Prevention (CDC) joined forces to create model infection control plans for outpatient settings. The initiative seeks to enhance the CDC’s existing guidance on infection control and prevention in ambulatory care centers.

For the initiative, The Joint Commission will be working with 12 outpatient-focused professional organizations and 10 ambulatory healthcare systems. The Joint Commission and CDC also will engage with local chapters of the professional organizations and state health departments that have an interest in enhancing infection prevention and control in their areas.

The goal of this effort, which is supported through a CDC Safety and Healthcare Epidemiology Prevention Research Development contract, is to create model infection control plans and expand the dissemination and adoption of these and other materials to prevent infections in outpatient settings.
The project will focus on a variety of free-standing ambulatory settings and services. The Joint Commission and CDC will select and work with 12 outpatient-focused professional organizations (e.g., medical specialties that primarily serve ambulatory patient populations), and 10 ambulatory health care systems. They also will engage with local chapters of the professional organizations and state health departments interested in improving infection prevention and control.

Mandatory flu shots for RI healthcare workers

Rhode Island became the first state in the U.S. to adopt a flu immunization requirement for all healthcare workers, students, trainees, and volunteers who may have direct contact with patients. The Rhode Island Department of Health announced that the new amendments to its Rules and Regulations for Immunization and Testing for Healthcare Workers will go into effect by December 15. Healthcare workers may obtain a medical exemption if they have a medical reason for not receiving a flu shot; this exemption must be renewed annually by December 15.

Healthcare workers who are not medically exempt but are opposed to having a flu shot must submit a statement on their refusal by December 15 each year. Those who refuse the shot must wear a surgical face mask for any direct patient contact that occurs at times when the facility determines that the flu is widespread. According to the Rhode Island Department of Health, the measure was put in place to protect patients from influenza and prevent the spread of the infection.

Source: HR.BLR.com

CMS adds patient safety measures to hospital comparison website

Starting in 2011, the Centers for Medicare & Medicaid Services (CMS) plan to add new standards for patient safety measures to its Hospital Compare website in order to enhance the effectiveness of Medicare’s fee-for-service program and monitor healthcare-related diseases and hospital-acquired infections.

The Hospital Compare site aims to improve the quality, efficiency, and transparency of care in the agency’s Medicare fee-for-service program by providing useful information on hospital’s treatment operations that will allow consumers to make knowledgeable decisions about which care providers to use based on the cost and quality of services they offer.

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And we thought doctors’ ties were dirty

Who knew we should be washing our cell phones? According to a recent study in the Annals of Clinical Macrobiology (reports ABCNews.com),  cell phones can–and frequently are–covered in bacteria.

Researchers at Ondokuz Mayis University in Samsun, Turkey tested employee cell phones to discover the following alarming statistic: 94.5 percent of the phones they tested were contaminated with bacteria.

Worse yet–some of these phones were contaminated with drug-resistant “superbugs.”

We’ve known for a while now that certain everyday objects that are not washed or cleaned every day–lab coats and ties, for example–can house bacteria  and help it move around the hospital. But how many hospitals are screening cell phones? Is yours? If so, how do you screen phones? What sorts of policies do you have in place to maintain this practice?