Archive for: February, 2012

Ask the expert: Storing specimens with medications

By: February 29th, 2012 Email This Post Print This Post

Q: We are aware that specimens cannot be stored with food, but is it okay to store blood, urine, and other specimens in the same refrigerator and/or freezer with medications?

A: No. “Store patient food, medications, and specimens in separate, labeled refrigerators,” according to the APIC’s Infection Control in Ambulatory Care.

“Glucose beverages may be stored in the medication or the patient food refrigerator, but never in the specimen refrigerator,” the book adds.

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Checking podiatry clinics for bioaerosol exposures

By: February 29th, 2012 Email This Post Print This Post

Yes, there are occupational hazards for caregivers working on feet.

A study done by Irish researchers and appearing in the January 23 issue  Annals of Occupational Hygiene surveyed 250 podiatrist clinics to assess personal exposure knowledge and conducted tests in 15 podiatry clinics for concentrations of airborne bacteria, fungi, yeasts, and molds.

“Workplace Exposure to Bioaerosols in Podiatry Clinics” reports that 32% of care providers surveyed had a respiratory condition. Asthma was the most common condition reported.

Gloves (73.3%) and respiratory protective equipment (34.6%) were the most common personal protective equipment used during patient treatments.

“Refresher health and safety training focusing on health and safety hazards inherent in podiatry work and practical control measures is warranted,” the study concluded.

MRSA screening beneficial before pediatric surgery

By: February 28th, 2012 Email This Post Print This Post

Before conducting open-airway surgery on children, healthcare facilities should screen and treat for MRSA, according to U.S. News and World Report, February 20.

The study, which appeared in Archives of OtolaryngologyHead & Neck Surgery examined 197 open-airway operations at the Cincinnati Children’s Hospital Medical Center.

While MRSA was present in 32.5 percent of patients, “no MRSA-associated postoperative infections in patients who received antibiotics before, during and after surgery,” according to the report.

The researchers recommend instituting MRSA screening and treatment protocols for patients undergoing airway surgery.

Sidestepping healthcare worker flu shot mandates

By: February 28th, 2012 Email This Post Print This Post

The issue of mandatory flu shots for healthcare workers continues to be a hot topic, with federal vaccination-expert panels making recommendations and professional healthcare associations opining in on both side of the argument. Below is a thoughtful article from HealthLeaders Media weighing voluntary versus mandatory vaccinations.


How to sidestep hospital flu shot mandates

Alexandra Wilson Pecci, for HealthLeaders Media, February 14, 201

Should vaccinations against influenza be mandatory for healthcare workers?

A debate is currently raging about whether the decision to get a flu shot should be made by a nurse, or by his or her employer. In Massachusetts, one in five employees at acute care hospitals declined to be vaccinated last fall.

Last week, the National Vaccine Advisory Committee (NVAC) recommended that hospitals, physician practices, and other healthcare organizations “strongly consider” imposing a flu shot mandate among employees if they fail to achieve 90% voluntary immunization.

Organizations such as the American Hospital Association and American Academy of Family Physicians support mandatory flu vaccines for healthcare workers, with exceptions in the case of health or religious opposition. But nurses have provided some of the most vocal opposition to such mandates; just read some of the individual comments and the summary of public comments about the issue.

Although the nurses’ union National Nurses United “maintains the position that every RN should be vaccinated against the flu,” it opposes vaccine mandates, saying that such programs “engender distrust and resistance among employees; offer a disincentive to providing vaccination education to employees, and raise ethical and legal questions about the personal employment rights of employees.”

The union also argues that “issues such as vaccination supply and efficacy make it such that the vaccine cannot be relied upon to exclusively provide adequate protection from the flu virus.”

In its written policy provided to HealthLeaders Media, the American Nurses Association “urges all registered nurses to get vaccinated every year to protect themselves, their families, and the patients they serve.”  However, it “does not support mandatory influenza vaccination requirements for healthcare workers unless they adhere to certain guidelines to ensure they are fair, equitable and nondiscriminatory.”

The ANA believes a mandate should be implemented only if:

  • The mandatory policy comes from the highest level of legal authority, ideally state government
  • Suitable exemptions, such as for those allergic to components of the vaccine, are included
  • Discriminating against or disciplining nurses who choose not to participate is prohibited
  • The policy is part of a comprehensive infection control program that includes personal protective equipment, such as N95 respirators, to increase safety
  • Vaccinations are free and provided at convenient times and locations to foster compliance
  • The employer negotiates with worker union representatives to resolve any differences when the policy is implemented at a health care facility

But voluntary measures don’t seem to work as well. According to the CDC, “during the 2010-2011 influenza season, coverage for influenza vaccination among healthcare workers was estimated at 63.5%.” However, “coverage was 98.1% among healthcare workers who had an employer requirement for vaccination.”

I personally feel very conflicted about this issue. On one hand, I totally understand nurses’ resistance to vaccine mandates as a condition of employment. Something seems very wrong with being forced to inject something into your body.

But I’m also the mom of a little girl who had surgery twice before she was five months old. It was late autumn, and the hospital was heavily restricting visitors because of a local flu outbreak. Only immediate family—and absolutely no kids—could visit my daughter after her surgery.

Our pediatrician vehemently insisted that I, my husband, our parents, and any other adult who came into contact with her be vaccinated against the flu. I personally harangued my relatives—who had no health or religious reasons for not getting the vaccine—until they complied. Not only was I worried about her surgical complications, I was worried that my unvaccinated infant would be exposed to a flu outbreak.

I knew that the flu vaccine would not be 100% effective, but I still felt better about having that extra level of protection. A heavy padlock might not keep a determined intruder out of your home for long, but locking the door is safer than leaving it open.

At the end of the day, no one should be forced to get a flu vaccine as a condition of employment; there are too many legal and ethical problems with doing so. However, mandates with provisions and conditions such as those outlined by the ANA seem warranted.

In the meantime, healthcare groups that oppose a mandate, but support vaccinations should take much stronger action to achieve higher voluntary vaccination rates.

Source: HealthLeaders Media



Watching for delirium during contact precautions

By: February 27th, 2012 Email This Post Print This Post

A study shows that contact ­precautions—utilized as a safety and infection control tool to protect other patients—can be added to the list of factors that may cause patient delirium.

“Association between contact precautions and delirium at a tertiary care center” s conducted at the ­University of Maryland Medical Center (UMMC) and appeared in the ­January issue of Infection Control and Hospital ­Epidemiology. The study indicates that patients moved to isolation during a hospital stay are nearly twice as likely to develop ­delirium. Patients beginning begin their stays in ­isolation do not share this increased risk.

The March issue of  Briefings on Hospital Safety reported on the study and interviewed experts on relationship between isolation precautions, patient delirium and healthcare worker safety. Here is an excerpt from that article.

Isolation precautions are typically used for patients who test positive for multidrug-resistant ­organisms such as MRSA. These patients are placed in their own room, and healthcare workers are required to wear gowns, gloves, and masks when entering (see a full list of the Centers for Disease Control and Prevention’s contact precaution recommendations on p. 12).

Hannah Day, MD, a graduate research assistant at the University of Maryland School of Medicine in Baltimore and lead author of the study, is quick to point out that contact precautions are certainly not the primary cause for delirium, but they may be a contributing factor. Patients who are put on contact precautions are generally sicker, making them predisposed to delirium to begin with.

“Unfortunately, with our study we can’t really say where it’s coming from or what is causing what,” Day says. “But a lot of delirium actually goes undetected, so having an additional infection preventionist in there knowing that they should look out for this can be helpful. It may be kind of outside their expertise, but they can keep that in the back of their mind since so much of it goes undetected.”

Recognizing delirium is as much a factor in worker safety as patient safety. Patients who become delirious may wander from their beds, or in extreme cases lash out at employees. Being able to identify some of the key factors that contribute to delirium can also help workers with patient care.

The article also cover why workers need to be cognizant of the psychological harm of contact precautions, patient and family education, room design, and CDC recommendations for contact precautions.

To read the article in its entirety, which appears on the Hospital Safety Center,  login, subscribe, or try out HSC for 30 days.

Weekly poll: Healthcare as a dangerous job

By: February 27th, 2012 Email This Post Print This Post

According to the U.S. Bureau of Labor and Statistics on workplace injuries and illnesses in 2010, healthcare workers experienced an injury/illness incidence rate of 5.2 out of every 100 ­full-time workers, a number well ahead of the private construction sector (4.0), manufacturing (4.4), and natural resources and mining (3.7). Do you consider healthcare jobs as dangerous? Take the OSHA Healthcare Advisor Weekly Poll and let us know.

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Ask the expert: OSHA bloodborne pathogens fines for hospitals

By: February 24th, 2012 Email This Post Print This Post

Q: In a hospital what is the most frequent OSHA bloodborne pathogens citation and fine?

A: Last year the most common OSHA Bloodborne Pathogens standard citation issued to hospitals was for not providing employee training at the appropriate time or at no cost, section 1910.1030 (G)(2), according to a report appearing in the October 2011 Briefings on Infection Control.

The average initial fine for that violation was $132.

Not using engineering and work practice controls to eliminate or minimize  employee exposure, section 1910.1030 (D)(2), $508, and not having have a written exposure control plan, section 1910.1030 (C)(1), $2,353, were the next most frequent citations.


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Click here for the advice from the OSHA Healthcare Advisor.

Lobbying for HAI legislation

By: February 22nd, 2012 Email This Post Print This Post

“If you broke it, you fix it, and you pay for it,”  is the attitude of a couple who are lobbying the Virginia legislature for a law “that would make hospitals financially responsible for the treatment of all hospital-acquired infections,” according to The Daily Progress (Charlottesville), February 21.

As a result of his near death experience from an HAI from spinal surgery, John Muncie and his wife Jody Jaffe hope to acquire support for “John’s Law” which would require Virginia hospitals to cover the treatment costs for all HAIs and serve as an incentive to lower infection rates in healthcare.

The infectious disease specialist at Martha Jefferson Hospital where the surgery was performed says that the infection rate is in line with the national average.

Even though the federal government requires hospitals “to pay for treatment of some hospital-acquired infections for Medicare and Medicaid patients,” Muncie’s proposal would require hospitals to pay for the treatment covered by private insurance, according to the news report.

Doctor, don’t dump thyself!

By: February 22nd, 2012 Email This Post Print This Post

A doctor in Bonita Springs, FL, disposed of medical waste … the problem is it wasn’t at his practice.

Stephen J Kaskie was arrested and charged with disposing of hazardous waste without a permit for allegedly dropping off five red bags of regulated medical waste at the door of Bonita Community Health Center, where he once, but no longer, rents space, according to WBBH-TV, February 10.

In addition to general medical waste, the red bags also contained contaminated needles, according to the report.

“I think it’s absolutely disgusting that a doctor would do something like that – a doctor of all people!” patient Ellen Stewart told WBBH-TV. “There’s no telling what kind of diseases, what kind of infections might have been present in those materials.”

To assess you regulated medical waste policy, download the Regulated Medical Waste Checklist from the Tool page.

Safety officer tip: Play it safe with the general duty clause

By: February 22nd, 2012 Email This Post Print This Post

Sometimes there will be a danger in the workplace that OSHA hasn’t drafted a particular standard to address. This is the case with hazards such as MRSA, TB, ergonomics, and workplace violence.

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Needlesticks law accounts for drop in injuries

By: February 20th, 2012 Email This Post Print This Post

Law and order has led to a decrease in needlestick injuries among hospital workers.

A multihospital sharps-injury database maintained by the International Healthcare Worker Safety Center at the University of Virginia shows a 38% decline in percutaneous injuries since passage of the Needlestick Safety and Prevention Act (NSPA) on November 6, 2000 and stronger enforcement by OSHA according to “Percutaneous Injuries before and after the Needlestick Safety and Prevention Act,” appearing in the correspondence section of the of the New England Journal of Medicine, February 16.

Along with the decrease, researchers from the safety center tracked “a steep market shift from conventional to safety-engineered devices,” suggesting additional effects from the NSPA.

“Our findings provide evidence that the NSPA contributed to the decline in percutaneous injuries among U.S. hospital workers. They also support the concept that well-crafted legislation bolstered by effective enforcement can be a motivating factor in the transition to injury-control practices and technologies, resulting in a safer work environment and workforce,” conclude researchers Elayne K. Phillips, B.S.N., Ph.D.; Mark R. Conaway, Ph.D.; Janine C. Jagger, M.P.H., Ph.D.


Weekly poll: Progress from Needlestick Safety and Prevention Act

By: February 20th, 2012 Email This Post Print This Post

With the report of a 38% decrease in needlesticks, has the passage and enforcement of the Needlestick Safety and Prevention Act met your expectations? Take the OSHA Healthcare Advisor Weekly Poll and let us know.

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