Archive for: Infection Control

New HHS fact sheet gives guidance for handling long-term patient surge

By: February 27th, 2018 Email This Post Print This Post

One of the deadliest flu seasons in recent memory has prompted the Department of Health & Human Services (HHS) to release a fact sheet that gives guidance on handling an influx of patients flocking to healthcare facilities for treatment of the flu and other seasonal illnesses.

While the latest briefing from the CDC suggests that this flu season has peaked, the fact sheet provides useful information healthcare facility emergency planners should consider when developing plans to deal with a similar surge of sick patients in the future. Note that this fact sheet states “these considerations are different than those of planning to handle surge from a no-notice, short duration event” like the recent mass shootings in Orlando, Las Vegas, and Parkland, Florida.

The HHS fact sheet states that “all hospitals must have an emergency operations plan” to deal with a long-term surge. Among the strategies it recommends are expanding normal clinic hours to limit the number of clinic patients coming to the ED, rescheduling elective procedures to free up beds, and setting up “surge sites” such as tents or mobile units located next to the ED.

It also recommends preventive steps that could minimize the surge during a severe flu season, including the use of telehealth, telephone prescribing, virtual information, community paramedicine programs, and risk communications and creating media campaigns encouraging vaccinations, handwashing, and other infection control practices.

The HHS fact sheet states that “there is little an individual hospital or health system can do to prevent patient surge from seasonal illness, but a region or healthcare coalition, in partnership with public health, can use coordinated strategies to help provide situational awareness to support patient surge management throughout the community.”

To download the fact sheet from the HHS website, click right here.

Pentax duodenoscopes voluntarily recalled for design and labeling updates

By: February 7th, 2018 Email This Post Print This Post

The FDA announced today that it has cleared the updated design and labeling for Pentax ED-3490TK duodenoscopes and that the scopes will be recalled so the manufacturer can make design changes meant to reduce leakage of patient fluids — thus limiting the spread of infection — and update product operations manuals.

In 2015, the FDA issued a safety warning against Pentax and two other duodenoscope companies. The warning stated that a design flaw prevented the scopes, which are designed to be used on multiple patients, from being cleaned properly, creating an infection risk. Duodenoscopes are flexible, lighted tubes that threaded through the mouth, throat and stomach into the top of the small intestine (duodenum).

A subsequent Senate investigation revealed that dirty scopes were the direct cause of 25 infection outbreaks, sickening dozens of patients and leading to the death to at least 21 people. The FDA bore some of the blame for deciding to not alert the public to the threat until after its 17-month investigation into the matter.

After the manufacturers revised their reprocessing instructions, the FDA in 2016 deemed the duodenoscopes safe for healthcare facilities to use again.

The FDA stated in today’s news release that since then it has been working with the manufacturers to “modify and validate their reprocessing instructions to further enhance the safety margin of their devices,” and “show with a high degree of assurance that their reprocessing instructions, when followed correctly, effectively clean and disinfect the duodenoscopes.”

Specifically, the FDA asked that Pentax reduce the potential for leakage of patient fluids into ED-3490TK’s closed elevator channel and under the distal cap.

Now that Pentax has done this, the FDA recommends that facilities acknowledge their Urgent Medical Device Correction and Removal notification disclaimer icon and identify affected products, return the field correction response form, and indicate if they do not have any affected duodenoscopes or operations manuals, and remove and dispose of older operations manuals once the new ones are received.

For more information on today’s news, check out the FDA’s official release here.

High-reliability healthcare, ‘preoccupation with failure’ and a valuable workshop

By: February 1st, 2018 Email This Post Print This Post

Gary L. Sculli, MSN, ATP, brings a unique perspective to safety in healthcare. In addition to being a registered nurse for more than three decades, he has served as an officer in the United States Air Force Nurse Corps and for many years worked as a pilot for a major U.S. airline.

Three years ago, Sculli shared some of his experiences and many of the insights gained during a diverse career in an HCPro book, “Building a High-Reliability Organization: A Toolkit for Success,” which was coauthored by Douglas E. Paull, MD, MS, FACS, FCCP, CHSE. Below is a book excerpt from a chapter on failure, in which the authors urged healthcare leaders, in the pursuit of high reliability, to embrace the concept of “preoccupation with failure.”

At the core, much of patient safety is dealing with uncertainties and unexpected events, the cardiac arrest being a prime example. In moments like these, not only do organizations rely on the technical expertise of staff and best practice guidelines, but also benefit from teams that are flexible, can adapt, and in essence, are resilient. Organizations themselves must be resilient to deal effectively with the changing face of healthcare.

Let’s examine a disaster from forest firefighting history—the Mann Gulch Fire in 1949. Young firefighters parachuted into Mann Gulch, near Helena, Montana, to combat what they believed was a rather routine forest fire. They were led by foreman Wag Dodge. But when the fire jumped from the south to the north side of the gulch, the firefighters were trapped and isolated from their escape route to the Missouri River. There were two possible routes for survival; either join Wag Dodge in his newly devised “circle of fire” or run to the top of the north ridge. This was the first time the circle of fire had been utilized during forest firefighting. Essentially, Dodge lit the grasslands on fire depriving the oncoming fire of any fuel to spread, thus protecting anyone within the circle. Whether due to a lack of trust, leadership, or communication, none of the other firefighters joined Dodge within the circle, despite his efforts to encourage them to do so. In addition, the young firefighters would not drop their heavy backpacks, slowing their ascent to the top of the north ridge. Thirteen firefighters died with their backpacks on and within sight of safety in the circle of fire or beyond the ridge. Dodge survived because he was able to pivot and adjust to rapidly changing and unexpected conditions.   

Several authors have discussed resilience, flexibility, innovation, and adaptability as attributes of successful organizations, including those in healthcare. Healthcare organizations must be able to learn from their mistakes. They must be able to face reality, “drop their old tools,” and accept the fact that the landscape can and will change suddenly and that unexpected events will occur. They must also accept that the best solutions to navigate the unexpected may be found in high-reliability industries. When viewed in this manner, leaders are not afraid to actively demand, even when faced with obstacles, such things as perpetual team training, mass standardization, briefings and handoffs, situational awareness support, just culture, staffing increases, and other patient safety initiatives. Leaders model open-mindedness and embrace innovation when unforeseen or novel situations arise. They talk with and listen to staff at the frontline when it comes to identifying and solving systemic challenges and failures. In many ways, current healthcare leaders are in a position similar to Wag Dodge. They must be resilient, prepared to build a circle of fire, and change course in order to solve unexpected and complex problems.

This spring, Sculli is again partnering with HCPro to give healthcare leaders the needed tools and guidance to create a culture of high reliability and safety within their organizations.

On April 16, Sculli will lead an intensive one-day workshop at Renaissance Orlando at SeaWorld® in Orlando, Florida. For more information on this upcoming HCPro workshop — which targets healthcare safety professionals, CEOs, COOs, VPMAs, risk managers, and quality/performance improvement professionals — please check out the event page at

WHO: Antibiotic resistance a ‘serious situation’ worldwide

By: January 29th, 2018 Email This Post Print This Post

While releasing surveillance data from 40 countries, the World Health Organization (WHO) on Monday declared antibiotic resistance a “serious situation” in both high- and low-income countries.

In a press release, WHO said the data, collected as part of its new Global Antimicrobial Surveillance System, “revealed widespread occurrence of antibiotic resistance among 500,000 people with suspected bacterial infections across 22 countries.” Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, and Salmonella spp were the most commonly reported resistant bacteria. Antibiotic resistance has led to the increase in healthcare-associated infections in recent years.

According to WHO, 25 high-income, 20 middle-income and seven low-income countries are enrolled in its Global Antimicrobial Surveillance System. Forty of those countries shared data about their national surveillance systems for this report, the release said.

“The report confirms the serious situation of antibiotic resistance worldwide,” said Dr. Marc Sprenger, director of WHO’s Antimicrobial Resistance Secretariat, in the release. “Some of the world’s most common — and potentially most dangerous — infections are proving drug-resistant. And most worrying of all, pathogens don’t respect national borders. That’s why WHO is encouraging all countries to set up good surveillance systems for detecting drug resistance that can provide data to this global system.”

WHO is encouraging other countries to establish antimicrobial resistance surveillance systems that “produce reliable, meaningful data,” and pointed to “solid” drug resistance surveillance programs already helping to battle tuberculosis, HIV and malaria.

“The report is a vital first step towards improving our understanding of the extent of antimicrobial resistance,” stated Dr. Carmem Pessoa-Silva, who coordinates the new surveillance system at WHO. “Surveillance is in its infancy, but it is vital to develop it if we are to anticipate and tackle one of the biggest threats to global public health.”

SHEA offers needed guidance for ending treatment of multi-drug resistant bacteria

By: January 12th, 2018 Email This Post Print This Post

So far, a good amount of clinical research has been dedicated to establishing protocols for starting and continuing treatment of patients battling multi-drug resistant bacteria. But until Thursday, there had not been much guidance for healthcare facilities on when their personnel can safely cease contact precautions for these patients.

Addressing that need, the Society for Healthcare Epidemiology of America (SHEA) published in their journal, Infection Control and Hospital Epidemiology, new expert guidance giving recommendations on how long personnel should use contact precautions to reduce the spread of potentially deadly organisms within the healthcare setting, which the study’s authors say “in most cases” ranges from one to three negative cultures before ceasing.

Their recommendations for the duration of contact precautions — including gowns, gloves, and masks — are, according to a SHEA press release, “specific to key multi-drug resistant organisms,” such as MRSA, Clostridium difficile infections (CDIs), Carbapenem-resistant Enterobacteriaceae (CRE), and Vancomycin-resistant enterococci (VRE).

One of the study’s authors, David Banach, MD, MPH, a hospital epidemiologist at the University of Connecticut Health Center, stated in a press release that “because of the virulent nature of multi-drug resistant infections and C. difficile infections, hospitals should consider establishing policies on the duration of contact precautions to safely care for patients and prevent spread of these bacteria. Unfortunately, current guidelines on contact precautions are incomplete in describing how long these protocols should be maintained. We outlined expert advice for hospitals to consider.”

Per that guidance document — which SHEA says has been endorsed by the Association for Professionals in Infection Control and Epidemiology (APIC), the Society of Hospital Medicine (SHM), and the Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada) — personnel should consider how much time has passed since the most recent positive culture when evaluating whether transmission is likely.

The guidance also advises on patient characteristics that could determine for how long contact precautions should remain in place. For example, the recommendation for CDIs is to continue precautions for at least 48 hours after the resolution of diarrhea, possibly extending that if CDI rates are elevated.

The press release stated that “any guidance should be overseen and revisited by infection prevention and control leadership, especially in outbreak situations” and that the study’s authors recommend facilities “carefully assess their institutional risks, priorities, and resources prior to adopting a new policy on the duration of contact precautions, as well as weigh the cost and feasibility of implementation.”

“The duration of contact precautions can have a significant impact on the health of the patient, the hospital, and the community,” another of the authors, Gonzolo Bearman, MD, MPH, the chairman of the Division of Infectious Diseases at Virginia Commonwealth University, stated in the release. “This guidance is a starting point, however stronger research is needed to evaluate and optimize the use.”

Joint Commission to increase hand hygiene focus

By: December 21st, 2017 Email This Post Print This Post

The Joint Commission (TJC) will soon be scrutinizing hand hygiene more closely.

Starting in 2018, if a surveyor from the accrediting organization witnesses an individual who directly cares for patients fail to perform required hand hygiene, the person’s healthcare organization will receive a citation under TJC’s Infection Prevention and Control (IC) standard IC.02.01.01, element of performance 2, which requires organizations to use precautions such as hand hygiene to reduce infection risk. In addition, healthcare facilities must meet National Patient Safety Goal (NPSG) 07.01.01, which requires them to implement and maintain a hand hygiene program.

The change, announced Thursday, will go into effect on January 1, 2018.

Previously, healthcare organizations were not penalized for an individual failure to perform proper hand hygiene if that organization had an otherwise compliant hand hygiene program. But under this change, if a surveyor spots an individual who does not properly wash his or her hands, the surveyor will cite the organization for a deficiency resulting in a Requirement for Improvement.

In 2004, TJC first required all healthcare organizations to implement hand hygiene programs and keep track of individual performance within that plan. Proper hand hygiene, of course, is critical for preventing infections in a healthcare setting.

Jobs report: American healthcare sector keeps growing amid uncertainty

By: July 7th, 2017 Email This Post Print This Post

While the number of people working in construction, manufacturing, and several other major industries held steady last month, the American healthcare sector continued to grow, adding 37,000 jobs in June, the U.S. Bureau of Labor Statistics (BLS) announced today.

That figure outperformed the average number of healthcare jobs gained monthly all of last year and so far this year, the BLS announcement noted. (The economy added 32,000 healthcare jobs per month, on average, in 2016 and 24,000 jobs per month in the first half of 2017.)

The number of people working in hospitals grew by 12,000 in June, but employment in ambulatory healthcare services grew even faster, with 26,000 jobs added. This reflects a decades-long shift in how and where physicians and their staffs care for patients. More services are being offered in outpatient settings, and some community hospitals, especially in rural areas, have fallen on hard times.

The shifting landscape impacts everything from the way clinics ensure basic environmental cleaning to how health systems strategize with regard to employment and market share. And, of course, it impacts the way OSHA and other regulatory bodies go about protecting workers and the public.

Across all industries, the U.S. economy added 222,000 jobs in June, beating both expectations and recent monthly averages. This bird’s-eye view of the economy, however, misses much of the nuance on the ground level, where many hiring managers are on unsure footing. Healthcare employers, especially, are watching Washington, where the Republican-controlled Congress and White House are struggling to finalize a budget and healthcare plan, as The New York Times reported.

“This is an unprecedented level of political uncertainty,” William E. Spriggs, chief economist for the AFL-CIO union, told the Times. “That is creating a drag on the economy.”

Hiring at medical labs and nursing homes, for instance, has been on the decline, Spriggs said, attributing the slowdown to the number of unknowns in the future of the U.S. healthcare system.

For the latest news and advice in healthcare safety and compliance, be sure to follow HCPro’s line of products to keep you informed and thriving.

Sign up for our July 14 GI Scopes webinar!

By: June 17th, 2015 Email This Post Print This Post

Endoscopes and other diagnostic GI scopes are crucial devices that can save the lives of the nearly 500,000 patients every year who need the procedures they were designed for.

But if they aren’t properly cleaned and disinfected afterwards, the instruments can expose future patients to antibiotic-resistant diseases such as carbapenem-resistant Enterobacteriaceae, or CRE, that can kill up to 50% of infected patients, according to some experts.

You’ve heard the horror stories from hospitals who have dealt with recent outbreaks—don’t let your facility be the next statistic. Let infection control experts Peggy Prinz Luebbert, MS, (MT)ASCP, CIC, CHSP, CBSPD, and Terry Micheels, MSN, RN, CIC, show you everything your organization needs to know to ensure proper GI scope disinfection and protect the lives of your patients.

Register for “Proper GI Scope Disinfection: How to Avoid Becoming a Statistic,” a 90-minute webcast that will cover the critical steps of high-level disinfection that must be met each and every day. Don’t miss out on this opportunity to ensure your organization complies with requirements set by The Joint Commission and CMS.

For more information or to register, check out the HCPro Marketplace.

Is OSHA being sneaky?

By: June 4th, 2015 Email This Post Print This Post

Hi folks –

Boy, it’s fun to watch how sneaky OSHA can be. If you’ve been paying attention, you know that the agency has quietly passed changes to a few pretty important rules in the healthcare industry.

First, there was an upgrade to the Workplace Violence Prevention rule (3148), which basically is a rule that requires employers to have a plan in place. There was also a very well-done manual that went with it to help you out.

Then, in May, OSHA and NIOSH teamed up to provide a Respiratory Protection Toolkit for employers, which essentially is a warning that if you don’t already use respirators to help protect your workers against infections, you better start. And here’s the handy toolkit published to help you out:

I don’t doubt that these are great things. We all want a safer work environment. But what’s going on here? Well, in the opinion of one lawyer who I read in an online blog:

“The bottom line is that OSHA is coming. Accordingly, employers in the health care industry should act now to ensure that their employees are working in the safest possible conditions and that, when OSHA appears at their door, they can demonstrate their commitment to employee health and safety.”

Interestingly, the Joint Commission is taking note of these changes, and has issued their own recommendations right about the same time that OSHA is doing so.

I’d like to know what you think. Is OSHA about to get tough on the healthcare industry? Good luck getting them to say so.

The feeling out there is that OSHA doesn’t have enough inspectors, so they probably won’t inspect. Will that change? And will you do anything different in your job because of it?

Please drop me a line and let me know your opinions.


John Palmer

C. diff infections linked to medical clinics

By: May 20th, 2015 Email This Post Print This Post

A February 25 report from the CDC suggests that the prevalence of Clostridium difficile, or C. diff, a bacterial infection of the gastrointestinal system primarily found in hospitals, is much higher than once thought, affecting up to half a million people annually.

Perhaps even more disturbing is the study’s revelation that up to 150,000 people who had not previously been in the hospital came down with C. diff in 2011. Of those, about 80% had visited a doctor’s or dentist’s office in the 12 weeks before their diagnosis. CDC officials say the revelation is so concerning that they’re starting a series of “case control studies” to try to assess nationally whether people are getting C. diff in medical offices.

If you’re a safety professional or someone in charge of infection control at a medical clinic, by now you’re asking yourself what you can do to help reduce the risk of an outbreak of C. diff. Our safety experts have shared a list of things you can do to prepare.

Know your audience. Not all medical clinics are the same, and therefore neither will your patients. In order to know what your risk is, it helps to do an assessment. A gastroenterologist’s office, for example, is more likely to have a higher likelihood that a patient with C. diff could walk through the doors, says McDonald. Also, do your patients have ties to local hospitals—that is, are they likely to have been in a hospital recently, and maybe they are visiting you as a follow up? That’s an immediate red flag.

Ask the tough questions. You’ve heard this one before: in order to know who’s coming through your doors, you have to ask what they have. Ideally, this is done on the phone when making an appointment for the patient. Have they been hospitalized recently? Are they experiencing diarrhea? Are they on antibiotics or other medication? These questions can help you assess the situation very quickly, and too often intake procedures are lacking in thoroughness.

Schedule wisely. This is where having this advance notification can be handy. While you can’t necessarily turn away patients who may be a C. diff hazard, you can try to keep them away from other patients. These patients can be scheduled as the first or last appointment of the day, and extra precautions can be taken to make sure the room is wiped down afterwards and any staff seeing these patients should take care to wear proper PPE, such masks and gloves. Even better, have someone go through the patient treatment rooms several times a day disinfecting high-tough areas.

Use the proper disinfectant. That being said, you can’t use just any household cleaner and expect it to kill C. diff. Proper procedures include using a sporicidal disinfectant approved by the EPA, not Lysol or another household disinfectant found on the shelves at Home Depot. Another thing to consider is contact time indicated by the manufacturer of cleaning solutions. If it says to keep it wet for two minutes, it has to stay wet for two minutes or it won’t be as effective. Also, if you have disinfectant wipes in a container that is left open the wipes can dry out and won’t keep the surface wet.

Assume everything is infected. You may think your infection control is, well, under control. Sure, maybe you do a good job of treating surfaces in your patient care areas. But take a walk around your waiting room and you’ll see carpets, upholstered couches, water dispensers, and magazines that can easily be contaminated with C. diff spores from a patient—some of which are not easily wiped down and cleaned.

That’s not to say you shouldn’t make your clinic look presentable, but you should definitely be wiping down everything that is considered high-touch—rails, doorknobs, faucets in the bathroom, books in the waiting area.


Guest Column: Be Personally Protected

By: July 8th, 2014 Email This Post Print This Post

The following is an occasional series of guest blogs by experts in the medical clinic safety field. If you would like to be featured in this blog as a guest columnist, please email Managing Editor of Safety John Palmer at

In some laboratories, the use of Personal Protective Equipment (PPE) may be confusing to staff. However, a look at OSHA’s Bloodborne Pathogens and Chemical Hygiene Standards should make clear the requirements for proper PPE selection and use.

Both standards speak clearly to the necessity of PPE when working in the laboratory. Different PPE is needed for different tasks. Lab coats are always necessary in the lab for protection against blood and body fluid splashes or chemical splashes. Plastic aprons may also be used as extra protection in areas where gross tissue work is performed. Lab coats should be buttoned, the sleeves should not be rolled up, and they should be knee-length.

Gloves are needed when handling blood, body fluids, or chemicals, but different gloves may be used for different tasks. Many labs are turning away from using latex gloves because of allergic reactions by staff. Nitrile gloves have become the norm in recent years. However, make sure you have the correct gloves for the duties being performed. Some manufacturers make nitrile gloves that act as a barrier against blood and body fluids, but they do not provide protection against chemicals.  While these will be fine while running a CBC in hematology, they won’t provide enough protection when changing the stainer. Be sure to use chemical-resistant gloves for this and other tasks (gram stains, handling chemistry reagents, pouring acids, etc.). Check the package if you are not sure about the proper use of gloves.

Goggles or face protection is important PPE that is widely under-utilized. Do you carry open specimens in the lab? What about carrying a rack of specimen tubes to or from an analyzer? That is a task that creates a risk for exposure, and face protection should be used. Are you pouring a chemical? Protection is necessary. Help your staff avoid all exposures to the eyes or mucous membranes.

The OSHA standards mentioned above also require that PPE is removed before leaving the laboratory. Do not wear lab coats or gloves to another location outside the laboratory. Does a procedure need to be performed in another area that requires PPE? If so, bring fresh PPE with you for use in the treatment area and dispose of it before returning to the lab.

In a laboratory, all areas should be considered hazardous, bio-hazardous, or contaminated. Do you have a desk area in the lab where only paperwork is done? I have always said that if there is an area in the lab where there are no patient specimens or chemicals, then one could consider the area “clean.” However, that does not mean that food or drink can be consumed there or that no PPE is needed. Remember, you are still in the walls of a laboratory, and accidents may occur. It is acceptable to label the area as “clean” so that gloves are not needed for the computer or phone, but a lab coat would still be required.

Remember, if an OSHA inspector arrives, he will be looking to see that all aspects of safety regulations are being followed. Keep your employees safe and keep your facility from unnecessary fines by using PPE where and whenever needed.

Dan Scungio, MT (ASCP), SLS, also known as “Dan the Lab Safety Man,” is a Laboratory Safety Officer for Sentara Healthcare, a multi-hospital system in the Tidewater region of Virginia.

Robot disinfects hospital rooms with a touch of a button

By: March 4th, 2013 Email This Post Print This Post

Imagine if you could hit a button and have a patient room disinfected within 10 minutes? Thanks to Mark Stibich, a Texas-based epidemiologist, that concept has become a reality. Stibich co-founded Xenex Healthcare Services and developed a germ-fighting robot that uses UV light to kill viruses, bacteria, and spores.

More than 100 hospitals have purchased or rented the robots, and for good reason. Studies have found that the robot cuts bacterial contamination by a factor of 20 and kills more than 75% of the pathogen C. difficile. Stibich told BusinessWeek that he got the idea to sanitize hospital rooms with UV light several years ago while working in Russia, where he learned that a UV lamp was being used to kill airborne tuberculosis germs.

To use the robot, hospital housekeepers simply wheel it into the room, close the door, and use a remote to operate it. Each robot costs $125,000 or a monthly fee of $3,700. While it seems pricey, the average cost of a hospital-acquired infection can be close to $30,000, making the robot a worthwhile investment. Stibich notes that the robots can be used in staff areas as well as patient rooms, adding to their value in creating a safe hospital environment.

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