Author Archive for: Peggy Luebbert

Never prefill syringes, even in a dental practice

June 9th, 2010 Email This Post Print This Post

A recent comment posted under my last blog post “Prefilling and storage considerations for insulin, flu clinics,” asked the following question:

I work in a dental practice and the hygienist prefill syringes with chlorhexidine to be used as irrigation following soft tissue management procedures. These syringes are often prefilled and stored 1 – 2 weeks at a time. I am requesting comments on this practice. Thank you.

Best practice is to NEVER prefill any syringes ahead of time. If necessary, you must first check with both the manufacturer of the chlorhexidine and the syringes for compatibility, stability and storage environment (room temp, refrigeration, etc). Many syringe manufacturer’s note that with time some drugs/chemicals could interact with the syringe itself. The chlorhexidine manufacturer will give you guidance as to how long it can be stable in the syringe environment as well.

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TB precautions for volunteers, students, and contract workers

May 26th, 2010 Email This Post Print This Post

Q: What kind of TB precautions should we take for non-employees, such as volunteers, students, contract workers, and contract construction workers who perform services in our hospital? For example, is it necessary to require a TB skin test for all these categories, and would the hospital have to provide it free of charge?

A: Although OSHA guidelines only apply to employer-employee relationships, from an infection control standpoint it comes down to common sense. Anyone who regularly “breathes” in your facility – including students, volunteers – are at the same risk as your own employees and therefore should be managed as such. These healthcare workers should at least have a skin test upon entering service in your facility. That test can be conducted by healthcare facility, or by the contracted service, school, or program.

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Prefilling and storage considerations for insulin, flu clinics

April 21st, 2010 Email This Post Print This Post

Last week’s post on prefilling and storing syringes drew a number of comments from the home health crowd, expressing concern that insulin is often drawn up and stored for patients in that setting. Others wondered what the best-practice is during flu clinics where several syringes at a time are filled to speed the process.

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Prefilling and storing syringes can implicate IC, patient safety

April 14th, 2010 Email This Post Print This Post

I recently received a question from a facility about how long you can store a prefilled syringe before administration.

Not long, is the short and simple answer to this question; not at all, to be more precise.

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Hands-free sinks make hand hygiene compliance easier, but they aren’t required

February 10th, 2010 Email This Post Print This Post

Q: Are hands-free sinks required by OSHA? Are they recommended by the CDC?

A: This is a relatively unregulated subject of healthcare, which may be surprising considering the endless effort put into hand hygiene compliance.

OSHA does not have any standard or regulation that makes hands-free sinks a requirement, most likely because hand hygiene has more to do with patient safety and infection control, which goes beyond the employee safety scope of OSHA oversight.

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Brooms won’t sweep away infections

January 27th, 2010 Email This Post Print This Post

Q: Are we allowed to use brooms in a medical facility? Are there any restrictions or guidelines for doing so?

A: In just about any other workplace, brooms are a quick and easy way to clean up clutter or sweep away dust.

The problems with brooms however, is they may appear to “clean” an area, but they are actually just pushing dust and dirt out of the way, and spreading it around rather than eliminating it entirely.

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What is the optimal instrument cleaning procedure between patients?

December 30th, 2009 Email This Post Print This Post

Q: What are the best options for instrument cleaning for our outpatient hand clinic? We see a variety of infections on a consistent basis and perform debridement frequently as well. What is the optimal method for instrument cleaning between patients: Use of an instrument soak, disposable instruments, or use of an autoclave after each use or after a specified period of time with soaking in between patients?

A: Any reusable instrument that comes in contact with open tissue or blood must be sterilized between patient usages. Sterilization can be done many ways such as the ones you noted: by use of steam sterilization (autoclave) or with a chemical soak. All of these methods are appropriate as long as you:

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Quick IC tips on FDA recommendations for the Steris System 1 processor

December 9th, 2009 Email This Post Print This Post

By now you’ve likely heard about the Food and Drug Administration (FDA) warning urging users of the STERIS System 1 Processor (SS1) to find an alternative method. If you don’t have a replacement processor, you should take measures to find one as soon as possible.

The FDA said it “received some reports of malfunctions of the SS1 that had the potential to cause or contribute to serious injuries to patients, such as infections.” However infections are particularly difficult to trace back to the SS1, and may go unreported. The FDA has also received reports of injuries to healthcare workers, including burns from exposure to the sterilant solution.

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FDA, CDC, and VA release recommendations for endoscope reprocessing

December 2nd, 2009 Email This Post Print This Post

Given recent incidents of  improper endoscope reprocessing procedures, the U.S. Food and Drug Administration (FDA), CDC, and the Department of Veterans Affairs (VA) have released a joint communication cautioning healthcare facilities about the risk of improper disinfection and sterilization procedures.

The recommendations have been reviewed by The Joint Commission, the accrediting agency that recently tweaked its IC standards. Because flexible endoscopes are difficult to clean, the release urges healthcare facilities, including hospitals, ambulatory care facilities, and private physician practices, to develop a quality system program that covers all aspects of endoscopy procedure management.

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H1N1 vaccine demand clogs hotline

November 4th, 2009 Email This Post Print This Post

Healthcare facilities around the country are feeling the effects of a decreased supply of H1N1 vaccines. Here in Nebraska an Iowa public health clinics are dealing with long lines of frightened people looking for protection this winter.

In the months before flu season began, many experts suggested setting up influenza hotlines, to mitigate the surge of patients, particularly in smaller facilities where isolation precautions are harder to adhere to.

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CMS says wrap it up before you flash

October 21st, 2009 Email This Post Print This Post

Last week the Centers for Medicare and Medicaid Services (CMS) released a memo to state survey directors clarifying its position on flash sterilization for ambulatory surgery centers (ASC).

According to the memo, state survey agencies using the new Infection Control Survey Worksheet, have experienced challenges evaluating the use of flash sterilization. The clarification states that, “utilization of a short sterilization cycle of a wrapped/contained load may no longer be a concern so long as the ASC is following ALL manufacturers’ instructions for the devices involved.”

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Droplet precautions, car waiting rooms, and other H1N1 tips from the field

October 7th, 2009 Email This Post Print This Post

Many of you are probably already experiencing some increase of H1N1 cases in your community whether you work in a small outpatient facility or a large hospital.

In Omaha, NE, I have seen a number of issues arise with H1N1 including hospitalization of pediatric patients. Other hospitals are limiting visitation rights, especially children, in NICUs and ICUs, because there is such a high risk there. Many other facilities are setting up more respiratory etiquette stations and emphasizing infection control best practices among visitors.

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