Archive for: January, 2012
Norovirus is number one on the list of infection outbreaks in U.S. hospitals and was responsible for 65% of unit closures, according to a study published in the February issue of the American Journal of Infection Control.
“Frequency of outbreak investigations in U.S. Hospitals: Results of a national survey of infection preventionists,” was conducted to determine how often outbreak investigations are initiated in U.S. hospitals, as well as the triggers for investigations, types of organisms, and control measures including unit closures.
The study found that one quarter of the hospitals surveyed had experienced an outbreak during a two year period and that four organisms were the source of almost 60% of the outbreaks:
- Norovirus (18.2 percent)
- Staphylococcus aureus (17.5 percent)
- Acinetobacter spp(13.7 percent)
- C. diff. (10.3 percent)
Investigators also discovered that only 52.2% of the outbreaks were reported to an external agency. “In most states, reporting to the state health department is required and can provide hospitals with expertise to expedite and expand their outbreak investigations,” according to the Association for Professionals in Infection Control and Epidemiology, which helped produce the study along with researchers from Chartis, Main Line Health System and Lexington Insurance Company.
The CDC, within the last year, released updated guidelines for the prevention and control of norovirus outbreaks in healthcare settings.
Read more about the study by clicking here.
A Canadian study indicates that long-term care residents are especially prone to infections after a visit to the emergency department.
The study appeared in January Canadian Medical Association Journal and investigated the rates of new respiratory and gastrointestinal infections among 1,269 elderly residents aged 65 years and older of 22 long-term care facilities.
The results show “more than a threefold increased risk of acute infection among elderly people” after 424 emergency department visits.
Long-term care facilities should consider additional precautions for elderly residents from five to seven days after returning from an emergency department visit, the study advises.
The Colorado State Board of Health will vote next month on whether to mandate flu shots for healthcare workers.
The board is considering a recommendation by state health officials requiring influenza immunizations “for nearly all hospital and nursing-home employees, with no religious or other personal exemptions, saying patient protections outweigh individual choice,” reports The Denver Post, January 26.
The proposed rule would work in concert with state and national goals to increase healthcare worker influenza immunizations to 90% by 2014.
High-risk facilities that did not reach required immunization rates would have to switch to a mandatory flu shot policy, according to the Post. Lower risk businesses, such as assisted living and home health, would have more leeway on establishing flu shot policies for workers.
The rule would not affect medical and dental practices since the state does not license those types of healthcare facilities, the Post reports.
The much-anticipated chemical labeling change to the Hazard Communication Standard will take a bit longer.
OSHA submitted the change to the Office of Management and Budget (OMB) on October 25 and approval was expected last week, but the review process has been extended, reports National Safety Compliance, Inc, January 25.
“This extension of the review period is an extremely common action from the OMB and now allows them to almost indefinitely extend the time frame,” according to the National Safety Compliance, Inc, notice.
Approval would incorporate the Globally Harmonized System (GHS) for classifying and labeling chemicals into the Hazard Communication Standard. The change would bring sections of the standard on material safety data sheets and the labeling of hazardous substances in line with regulations used world-wide.
No information was given for a new review date on the OMB List of Regulatory Actions Currently Under Review.
A recent recommended practice for medication safety by the Association of periOperative Registered Nurses (AORN) says not to use multidose vials because of the risk of cross contamination, even though they are a recognized cost-saving measure. Do you agree with the AORN recommended practice to discontinue the use of multidose medication vials? Take our OSHA Healthcare Advisor Weekly Poll and let us know.
Q: Is an ambulatory surgery center required to keep an MSDS file for the medications that are used in the facility?
A: If a drug is identified as hazardous and there is potential for exposure under normal working conditions, then the Hazard Communication Standard (HCS) applies, including the requirement to have an MSDS.
OSHA’s Hazard Communication FAQ explains:
The HCS only applies to pharmaceuticals that the drug manufacturer has determined to be hazardous and that are known to be present in the workplace in such a manner that employees are exposed under normal conditions of use or in a foreseeable emergency. The pharmaceutical manufacturer and the importer have the primary duty for the evaluation of chemical hazards. The employer may rely upon the hazard determination performed by the pharmaceutical manufacturer or importer.
An OSHA letter of interpretation, however, provides an important exemption:
“Drugs, as defined in the Federal Food, Drug and Cosmetic Act, in solid, final form for direct administration to the patient (i.e., tablets, pills, capsules) are exempt from coverage under Section 1910.1200(b)(6)(viii) of the HCS. MSDSs are required for all other hazardous drugs.”
This applies to all businesses, including ASCs.
If you struggle with when you need an MSDS and when you don’t, download the “Determining when an MSDS is necessary” decision chart from the Tools page.
The Association of periOperative Registered Nurses (AORN) hopes two new recommendations will prompt healthcare facilities to rethink medication practices for safety’s sake.
The recommended practices (RP) involve:
- Puncturing intravenous solution containers as close as possible to time of use
- Discontinuing use of multidose vials
“According to Ramona Conner, MSN, RN, CNOR, manager of AORN‟s standards and recommended practices, the recommendation that intravenous solution containers be punctured as close as possible to time of use is controversial because it may impact efficiency. She also anticipates that some OR personnel may disagree with the recommendation against the use of multidose vials because they are a cost-saving measure, but with the new RP, evidence indicates they pose a risk of cross contamination,” according to a January 11 AORN news release.
Other AORN recommendations include:
- Taking a multidisciplinary team approach that includes pharmacist involvement in the perioperative medication management process.
- Developing systems to evaluate compliance with safe practices at each step in the medication use process.
- Assessing patients before and after administering medication.
- Using aseptic technique when transferring medications to the sterile field and during incremental injections.
The RPs appear in “Recommended practices for medication safety,” which is part of the 2012 edition of Perioperative Standards and Recommended Practices.
Nurses exposed to cancer treatment drugs or chemicals used to sterilize medical devices may be at higher risk of spontaneous abortions, according to a study appearing in the American Journal of Obstetrics and Gynecology, reports Reuters, January 13.
That exposures to some chemicals are tied to lost pregnancies is not surprising, but Christina Lawson of NIOSH and the lead author of the study told Reuters: “What surprised me the most was that (chemotherapy) drugs are something we’ve been trying to educate nurses on, about the hazards, and we’re still finding exposures during the first trimester.”
“Occupational exposures among nurses and risk of spontaneous abortion” investigated self-reported exposure to antineoplastic drugs, anesthetic gases, antiviral drugs, sterilizing agents (disinfectants), and X-rays in 7482 U.S. nurses.
The study found “antineoplastic drug exposure was associated with a 2-fold increased risk of spontaneous abortion, particularly with early spontaneous abortion before the 12th week … sterilizing agents [were] associated with a 2-fold increased risk of late spontaneous abortion.”
How important is workplace safety in the written performance evaluations for employees in your healthcare facility? Take our OSHA Healthcare Advisor Weekly Poll and let us know.
CDC releases infection prevention plan for outpatient oncology setting—Medical Environment Update, January 2012
A new ‘plug and play’ infection control plan that allows oncology clinics to get up to speed on basic infection prevention policies and procedures is the focus of January issue of Medical Environment Update.
Here is an excerpt:
Last week MacArthur tackled emergency eyewash stations with the seductive headline: “In your eyes – the light, the heat … the chemicals?” This week: The intricacies of TB screening for contract staff and OSHA compliance.
Here is the post, courtesy of Mac’s Safety Space:
From the muddy banks of compliance
Let’s break from form a little bit and start with a question:
How often are you (and by you, I mean your organization) screening contracted staff, including physicians, physician assistants, nurse practitioners, etc.?
A recent TJC survey resulted in a finding under the HR standards because the process was being administered on a biannual cycle. The finding vaguely referenced OSHA guidelines in identifying this deficiency, but the specific regulatory reference point was not provided (though apparently a call to Chicago validated that this was the case). Now, anyone who’s worked with me in real time knows that I have an exhaustive (and, at times, exhausting) curiosity about such matters. The deficiency “concepts” are usually sourced back to a “they;” as in, “they told me I had to do this” “they told me I had to that.” I am always, always, always curious as to who this “they” might be and whether “they” were good enough to provide the applicable chapter and verse. The answer, more often than not, is “no.” Perhaps someday we’ll discuss the whimsical nature of the” Authority Having Jurisdiction” (AHJ) concept, but we’ll save that for another day.
At any rate, I did a little bit of digging around to try and locate a regulatory source on this and in this instance, the source exists; however, the standard is not quite as mandatory as one might first presume (If you’re thinking that this is going to somehow wrap around another risk assessment conversation, you are not far from wrong). So, a wee bit of history:
Back in 1994, the CDC issued their Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, (http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf) which, among other things, advises a risk-based approach to screening (Appendix C speaks to the screening requirements for all healthcare workers, regardless of who they work for. The guidance would be to include contract folks. The risk level is determined via a risk assessment (Appendix B of the Guidelines is a good start for that). So, for a medium exposure risk environment, CDC recommends annual screening, but for a low exposure risk environment, they recommend screening at time of hire, with no further screening required (unless your exposure risk increases, which should be part of the annual infection control risk assessment).
But, in 1996, OSHA issued a directive that indicates annual screening as the minimum requirement , even for low-risk exposure risks, and even while referencing the CDC guidance: (http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=DIRECTIVES&p_id=1586) with medium risk folks having semi-annual screening and high-risk folks being screened on a quarterly basis. So, friends, how are you managing folks in your environment, particularly the aforementioned contracted staff? Do you own them or is it the responsibility of their contracted employer? Does this stuff give you a headache when you think about it too much? It sure gives me one…occupational hazard, I guess. At any rate, it’s certainly worth checking to see whether a risk assessment for TB exposure has been conducted. The OSHA guidance document clearly indicates that if you haven’t, it’s the responsibility of the surveyor to conduct one for you, and I don’t know that I’d be really keen on having that happen.
I especially liked the they references. Do you encounter the vague but seemingly ominpotent and omniscient they reference? If so, or for other observations, post a comment below.
The “Ask the Expert” posts, which appear on this web site, in addition to being real questions posed by safety professionals in healthcare facilities, are some of the most popular features of the Medical Environment Update newsletter.
Readers tell us that the posts are also good as discussion starters for safety committee meetings or staff training session.
Here are the top ten most popular posts from 2011.