Archive for: Infection Control

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:

https://www.osha.gov/Publications/OSHA3767.pdf

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.

Thanks!

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 jpalmer@hcpro.com.

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.

Certification of infection preventionists could yield better practices

By: February 20th, 2013 Email This Post Print This Post

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.

Poll: Hand washing in healthcare settings

By: January 23rd, 2013 Email This Post Print This Post

Create your free online surveys with SurveyMonkey, the world’s leading questionnaire tool.

State advises 8,000 dental patients to be tested for hepatitis, HIV

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

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.

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Should Fed funding for patient safety go bye-bye?

By: July 23rd, 2012 Email This Post Print This Post

A House subcommittee, on July 18, voted to eliminate all funding for the Agency for Healthcare Research and Quality (AHRQ).

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