Archive for: Infection Control
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.
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 firstname.lastname@example.org.
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.
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.
Hospital infection preventionists (IP) are generally in agreement as to which practices have strong or weak evidence to support their use, with those IPs certified in infection prevention and control perceiving evidence as strong more often than non-certified IPs, according to a study published recently in the American Journal of Infection Control. Researchers of the VA Ann Arbor & University of Michigan Medical School conducted the study as a means of understanding how those who lead infections prevention activities perceive the strength of evidence supporting practices designed to prevent device- and procedure-associated infections. IPs lead programs to protect patients and healthcare workers alike.
Of the 28 practices included in the study, alcohol-based hand rub, aseptic urinary catheter insertion, and semi-recumbent positioning of patients on ventilators were among those practices perceived to have strong evidence to support their use, according to 90% of respondents. Practices identified as having weak evidence included central catheter changes, the use of silver-coated endotracheal tubes for ventilator-associated pneumonia, and the use of antimicrobials in the urinary catheter drainage bag.
According to researchers, the study’s results suggest that certified IPs may lead to greater evidence-based practice, which would in turn lead to a reduction of healthcare-associated infections and hospital costs.
Does your organization encourage certification for infection preventionists? Do you feel that certification is a necessary step for IPs? Share in the comments sections below.
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An investigation by the Colorado Department of Public Health and Environment indicates that as many as 8,000 dental patients may have been exposed to bloodborne pathogens from unsafe injection practices.
A House subcommittee, on July 18, voted to eliminate all funding for the Agency for Healthcare Research and Quality (AHRQ).
The fight against healthcare-associated infections (HAIs) by Oregon hospitals has yielded impressive results in decreased infection rates and potential cost savings, according to a July 17 announcement from the CDC.
Move over hepatitis B, C, and HIV, and make room for MRSA infections as a consequence of unsafe injection practices.
A July 16 post on the CDC Safe Healthcare blog by Dr. Michael Bell, associate director for infection control at the Division of Healthcare Quality Promotion, discusses two recent outbreaks in Arizona and Delaware where the use of medication from single-dose/single-use vials for multiple patients resulted in “staph/MRSA infections in at least 10 patients receiving injections for pain relief.”
Q: A patient seen by our practice has recently tested positive for tuberculosis and is undergoing treatment. From an OSHA perspective, what follow-up treatment do we need to do for employees who were exposed to him?
Cal/OSHA has imposed an $84,450 fine on Alta Bates Summit Medical Center for failure to warn and protect a hospital worker and an Oakland police officer exposed to an emergency room patient with meningitis, according to the San Jose Mercury News, July 2.
It happens to everyone at some point: you wake up with a cough, a headache, or a stuffy nose, and all you want to do is go right back to sleep. But more often than not, something pulls you out of bed and you force yourself through the daily grind. After all, you can’t afford to miss that meeting or leave your colleagues in the lurch, right?