RSSAll Entries in the "CDC/infection control" Category

Mac’s Safety Space: Linens in the ENT clinic

Q: We have been having a discussion about the linens in our ear, nose, and throat (ENT) clinic. This clinic has an esthetician who uses spa wraps and smocks on the patients. Wouldn’t these linens have to be laundered the same as the hospital, as our clinics are under our hospital accreditation and license?

Steve MacArthur: I guess the question I’d have at this point is how are those items being laundered at the moment? It is possible to do a low-temperature wash (<160 degrees F) if appropriate chemicals are used. I’m thinking that we’re generally not dealing with an immune-compromised patient population in this context and maybe a risk assessment and a blessing from Infection Control would suffice.

The other thought I had is to either go with disposable wraps and smocks or perhaps the patients could keep their smocks, maybe as a marketing strategy. As I think about it, is the esthetician providing services under the auspices of the hospital’s accreditation or is it more like when they have hairdressers come in for patients in long-term care, which is sort of like a concession? I think the place to start is finding out what’s happening currently and working from there.

I think a credible risk assessment under the guidance of IC should be able to address any concerns that might come up during survey. Strictly speaking, this probably functions as an offshoot of palliative homeopathic care. I think as long as you approach the whole process in a thoughtful, methodical way, the surveyors will only be impressed at the level of service you are providing to patients. The IC standards all revolve around assessing risk and implementing prudent strategies for managing those risks, so why should this be any different. In fact, the acid test would be for you to submit the question to the SIG—and I bet you’ll get the same “figure it out for yourself” answer.

Mac’s Safety Space: Joint Commission standards on mop and rag laundering

Q: We’re concerned about whether the way our mops and rags are laundered are up to Joint Commission standards. At this point, we’re laundering them ourselves in bleach in our washer. The temperatures are hot, but not 160 degrees. Are these mops and rags considered “linen” and do they have to be washed up to the same standards as the rest of the linen?

Steve MacArthur: The quick and dirty response (small pun intended) is that The Joint Commission has no standards relative to the processing of mops and rags, and even the CDC Guidelines for Environmental Infection Control make no specific mention of these items, and as far as a time and temperature equation (temperatures greater than 160 degrees F for more than 25 minutes), they indicate that that applies only when hot-water laundry cycles are used.

They do make chemical detergents for warm-water laundry cycles (less than 160 degrees), so that might be a consideration as well. That said, as they nominally do not come into contact with patients, I don’t think that there would be a compelling reason to consider mops and rags as “linen,” so they could probably tolerate a somewhat lesser level of sanitization, but what that level is would have to be determined.

A couple of things spring to mind. One avenue would be to contact the vendor from whom you obtain mops and see whether there are manufacturer recommendations for laundering the mops. The rags, unless you are purchasing them as a specific consumable, are probably the vestiges of patient linens past their usefulness in that context.

Not being sure what type of washing machine you are using for this process, it might be of value to consider the purchase of a commercial-grade washer. From personal experience, few things “kill” a household-grade washing machine faster than washing mops, particularly in bleach. Also, with a commercial washer, you can probably provide a sufficient time and temperature mix that would perhaps even suspend the need for bleach (bleach is no friend to fabric, I can tell you). Certainly the commercial route is an expensive start-up, but you can probably figure out whether the return on investment is worth it.

Mac’s Safety Space: When equipment retires …

I was doing some work recently when I came upon an interesting situation. During the course of the building tour, we came upon a couple of syringe pumps that had been due for inspection in January, 2010, so they were a little past due. Of course, these devices were in a variety of locations: a staff locker room, a cabinet in a soiled utility room, and one (at least at the time of my visit) was hiding in plain sight, right next to the only one of these beauties that had an up-to-date inspection. So, we contacted the folks in clinical engineering who gathered up the offending items and whisked them away for preventative maintenance (PM). So far, no really big deal, but here’s where things got a little interesting.

One of my favoritest things to do is to look through the Environment of Care Committee (EC) meeting minutes to see what’s been going on, what challenges have been faced, etc. In looking at the minutes from early in 2010, I noted an item regarding the retirement of the very same syringe pumps we had found because the manufacturer was no longer supporting the device. So, in follow-up discussion, it was noted that the pumps that had been found were PM’ed and returned to service, which on the face of it seemed OK.

But then I got to thinking—if the EC Committee had officially retired these devices, should they not also have a say in their reinstatement? From an operational standpoint, probably no big deal, but once again donning my risk management hat, the question in my mind becomes this: if something not-so-good happens with a patient using one of these pumps, whether it is directly related to pump function or not, what kind of liability does the organization assume in having returned them to service without at least going back through the process that determined they were worthy of retirement to start with?

I stewed on it for a couple of days and eventually contacted these folks to encourage them to remove the pumps from service until they could really “look under the hood” and make an informed decision. Again, maybe no big deal, but you have to be careful in this extraordinarily litigious world.

Understanding the nuances of isolation rooms

Q: I’ve got some questions about what rooms are required to be isolation rooms and what ones are negative pressure rooms.  Also, we seem to have a lot of confusion here about the difference between the two, so I really need some help defining them and understanding what the requirements for each are.

A: Let’s cover a couple of basic things first; strictly speaking, when we are talking about air pressure differentials, the “brass tacks” revolve around negative pressure and positive pressure.

Negative pressure is used when you have something in a space that you don’t want to get out (say a contagion) and positive pressure is used when you have something outside of the space that you don’t want to get in (say you have an immunocompromised patient). Both differentials can serve as isolative or protective environments, it’s basically a question of what you’re dealing with – are you protecting the patient or are you protecting everyone else? [more]

An OSHA Q&A on an infectious disease standard

Our sister blog, OSHA Healthcare Advisor has an interesting “web-exclusive” that partners with an article that was featured in the latest issue of Medical Environment Update.

The newsletter submitted questions directly to OSHA regarding the possibility of an infectious disease standard. Here’s one of the answers they got back: [more]

Even sharps containers can benefit from a risk assessment

It’s not uncommon to see large floor model sharps containers in areas that are secured from the public, and there is certainly no regulation prohibiting these containers.

I recently received a question from a facility that had one of these sharps containers in their cardiac vascular lab, which was secured from the public. The container was open and didn’t have a feature to prevent someone from sticking their hand in or stop it from overfilling. During a survey the facility was cited for improper medical waste storage.

The manufacturer’s recommendations stated: “Store medical waste in such a manner that prevents putrefaction and also prevents infectious agents from coming in contact with the air or with individuals.”

This person wondered if this quote pertained to the storage of waste after it was removed from the room, if it was okay to leave sharps containers open in a secured area, and did the sharps containers in the lab need lids in this case?

This citation definitely falls under the realm of surveyor preference as there is no regulatory statute whatsoever that specifically prohibits the condition identified as deficient; in fact, if the condition identified were legitimately deficient, probably 75% (and perhaps more) of the sharps disposal containers used in healthcare today would be considered deficient. [more]

Meeting requirements for proper air quality monitoring during construction

Q: One of our sister hospitals recently received a fine from OSHA as result from a whistle blower incident for not properly monitoring air quality during a construction project. Do know the requirements for what is needed for proper air quality monitoring as it pertains to construction projects from OSHA?

A: Without knowing the exact verbiage involved with the citation, there’s only so much we have to go on with this kind of situation. OSHA compliance requirements for construction can be found in section of 29 CFR 1926 Safety & Health Regulations for Construction. 1926.55 applies to the management of gases, vapors, fumes, dusts, and mists. As you can see there really isn’t much in the way of specifically required anything beyond “avoided,” which is as about a broad-based descriptor as you might want. [more]

Steris SS1 fans have new alternative to consider that is FDA-cleared

Those of you who have been fans of the maligned Steris System 1 (SS1) processor may be interested in knowing that the FDA has approved an alternative to that product from Steris.

The new item is called [more]

New CDC numbers indicate mandatory flu shot policies noticeably increase vaccination rates among employees

The CDC posted an interesting report yesterday, based on a Web survey the agency conducted, that you should read if you’re at all involved with seasonal and H1N1 flu vaccination efforts.

Here are the highlights [more]

How goeth your respirator fit-testing?

While it does appear that a bullet was dodged when the supremacy of the N-95 respirators in regards to managing staff exposures to H1N1 wasn’t quite roundly validated, the thought did occur to me that [more]