---------------------------------------------------------------------------REPORT OF THE MONTH, Volume XII, Number 3 - 2008
----from the
North Carolina Statewide Program for Infection Control and Epidemiology
----------------------------------------------------------------------------CONTENTS:
NEWS FEATURE
 CDC Guideline for Disinfection and Sterilization in Healthcare
Facilities, 2008
QUESTION OF THE MONTH
 What is NC DETECT?
COURSES FOR THE INFECTION PREVENTIONIST
NEWS AND ANNOUNCEMENTS
 New IP Consultant Joins SPICE
 APIC Study Shows Clostridium difficile Infection Rates Greater than
Previous Estimates
 Infectious Diseases the Number Two Killer Worldwide
 Drugs in the Pipeline May Fight MRSA
 New Compendium of Strategies for Preventing Healthcareassociated Infections Provide Practical Guidance
 Checklist Outlines Legal Issues of Pandemic Flu Planning
 GAO Report says 23 states Now Require Public Reporting of HAIs
RECOGNITIONS
-----------------------------------
NEWS FEATURE
CDC Guideline for Disinfection and Sterilization in Healthcare Facilities,
2008
A new evidenced-based guideline from the Centers for Disease Control and
prevention (CDC) provides guidance on key issues on reprocessing medical and
surgical instruments. The last CDC guideline on disinfection and sterilization was
in 1985 and it was 6 pages with 7 references. This new guideline has
considerable more information (over 150 pages with >1000 references) about the
chemical disinfectants and the sterilization processes used in health care to
include an overview, mode of action, microbicidal activity and uses. In general, it
complements but does not conflict with AORN or AAMI recommendations.
Additionally, there are a number of sections that should aid healthcare
professionals such as: reprocessing of endoscopes and other semicritical items
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(e.g., endocavitary probes); emerging pathogens; inactivation of bioterrorist
agents; toxicological, environmental and occupational concerns; surface
disinfection; bioburden on surgical devices; effects of cleaning on disinfection
and sterilization efficacy; factors that affect the efficacy of disinfection and
sterilization; sterilization practices (such as validation, physical facilities, cleaning,
packaging, loading, storage, and monitoring); advantages and disadvantages of
high-level disinfectants and sterilization methods used commonly in healthcare;
and susceptibility of antibiotic-resistant bacteria to disinfectants.
The authors (William A. Rutala, David J. Weber, and the Healthcare Infection
Control Practices Advisory Committee [HICPAC]) deeply regret that the CJD
recommendations had to be pulled from the guideline after the CJD
recommendations were cleared by HICPAC in February 2003. This issue and
the time-temperature recommendations for glutaraldehyde use in healthcare
(e.g., 20 minutes at 20oC versus 45 minutes at 25oC) were the two issues that
delayed publication of the guideline. In regard to CJD, the prion disease program
at CDC objected to the inclusion of the CJD section in the MMWR publication
because it contradicts CDC’s current recommendations for disinfection and
sterilization of prion-contaminated devices. The CDC position is that optimal
sterilization of prion-contaminated devices will be achieved by a decontamination
protocol that combines chemical treatment (such as NaOH) with autoclaving as
recommended by a prion disease meeting convened by the World Health
Organization (WHO) in 1999. Unfortunately, the WHO recommendations are not
referenced and do not include the research that was done in the past 10 years.
For example, since 1999 there have been 25 or more peer-reviewed publications
by many different laboratories and authors that have evaluated the ability of
disinfectants, sterilants, and detergents (alkaline/enzymatics) to inactivate prions.
Many of these studies were done using methodology that more closely mimics
reprocessing of instruments in healthcare. The CJD section of the guideline has
been updated, is now being reviewed and then will be endorsed by the
Association for Professionals in Infection Control and Epidemiology (APIC) and
the Society of Healthcare Epidemiology of America (SHEA) as a new guideline
for reprocessing prion-contaminated medical/surgical instruments.
The guideline does not discuss the Class 6 indicator because the guideline was
prepared before the Class 6 indicator was offered. The guideline does say to use
biological indicators to monitor the effectiveness of sterilizers at least weekly with
spores intended for the type of sterilizer. Thus, Class 6 emulating indicators are
not a substitute for a biological indicator. No professional organization has
recommended the use of Class 6 emulating indicators as a substitute for
biological indicators and there are no data that demonstrate that a Class 6
indicator mimics a biological indicator at suboptimal sterilization times.
The Guideline can be downloaded from the CDC website:
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf
To view Frequently Asked Questions about the guideline:
http://disinfectionandsterilization.org/FAQ.html
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QUESTION OF THE MONTH
Q:
What is NC DETECT?
A:
NC DETECT is a statewide program funded by the North Carolina Division
of Public Health that provides free reports to hospital users. Hospital users are
able to view and customize both aggregate reports and line listing emergency
department information in a secure, user-friendly Web portal. All but two
hospitals are sending emergency department data at least twice daily to NC
DETECT. Key data elements sent to and analyzed by NC DETECT include
arrival date and time, basic demographics, chief complaint, triage notes, final
diagnosis and injury codes Users are able to customize reports and view
information specific for their hospitals and also compare these results to
aggregate trends by county, region and statewide. With NC DETECT, users can:
 Monitor disease trends in the hospital, county, region and state, for influenzalike illness, gastrointestinal illness and others.
 Identify potential disease clusters in the community and in the hospital via the
emergency department data.
 Monitor ED visits by symptom-based syndromes and final diagnosis.
 Monitor prevention activities, including immunization against communicable
diseases.
 Communicate with local health departments.
 Satisfy JCAHO requirements for emergency management planning.
NC DETECT is designed, developed and maintained by staff at the UNC Chapel
Hill Department of Emergency Medicine in partnership with NC DPH. To request
an account, go to http://www.ncdetect.org and click on “Account Request.” For
more information or to request free training on NC DETECT, please contact Amy
Ising, NC DETECT Program Director, at isina@med.unc.edu or (919) 966-8853.
COURSES FOR THE INFECTION PREVENTIONIST
SPICE Infection Control Courses in 2009
(All courses held at the Friday Center, Chapel Hill, NC)
(Information on all SPICE courses can be found on the Course page of the
SPICE website: http://www.unc.edu/depts/spice/courses.html)
- Infection Control in Long Term Care Facilities will be held March 16 - 18
and November 2 – 4, 2009.
- Infection Control Part I: Surveillance of Healthcare-Associated
Infections will be held April 27 – May 1, 2009. Registration for the spring
2009 course will begin in January 2009.
- Infection Control Part II: The ICP as an Environmentalist will be held
September 21 – 25, 2009.
- CBIC Review Course (sponsored by SPICE and APIC-NC) will be held
August 27 (7-9 PM) and August 28 (8 AM – 5 PM). Registration form will be
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available on the SPICE website in 2009
(http://www.unc.edu/depts/spice/apicnc.html)
NEWS AND ANNOUNCEMENTS
 New IP Consultant Joins SPICE
SPICE is pleased to announce that Evelyn Cook, CIC, will be joining the program
in a part-time capacity to assist Karen Hoffmann in training, education, and
consultation to hospitals, long-term care facilities, and other medical facilities to
prevent and control healthcare-associated infections. Evelyn and Karen will
share responsibility for addressing infection control inquiries. In order to receive
the most timely response to your questions, SPICE now requests that all
infection control inquiries be addressed to spice@unc.edu. Your inquiry will then
be forwarded to whomever is available at the time.
Evelyn Cook is a Nurse Clinician and Nurse Liaison with the Duke Infection
Control Outreach Network (DICON) for the Department of Medicine and PDC,
PLLC at Duke University Medical Center. In this position, she serves as a liaison
with community infection control practitioners and assists them in developing a
surveillance program that is driven by a collaborative network-based approach,
where statistically validated data is collected, analyzed and routinely provided to
practicing physicians and infection control staff to motivate and reduce the rates
of nosocomial infections in community hospitals. Evelyn, who is also a
Registered Nurse and has National Board Certifications in Infection Control and
Healthcare Quality, has been active in several professional organizations
including North Carolina Association for Professionals in Infection Control
(President 2005-06), National Association for Professionals in Infection Control
and Epidemiology, National Association for Professionals in Healthcare Quality
and North Carolina Association for Professionals in Healthcare Quality. She was
named Practitioner of the Year in 2002 by the North Carolina Association of
Professionals in Infection Control.
Prior to accepting a position at Duke University Medical Center, Evelyn held the
position of Director of Infection Control at Wake Forest University Baptist Medical
Center in Winston-Salem, North Carolina from 2001 to 2005. Prior to 2001, she
held other positions including Director of Quality Management and Safety at
Lexington Memorial Hospital in Lexington, North Carolina, Clinical Research
Assistant at Bowman Gray School of Medicine in Winston-Salem, North Carolina,
ICU Head Nurse at the VA Hospital in Salisbury, North Carolina and ICU Head
Nurse at Thomasville Medical Center in Thomasville, North Carolina.
Evelyn received her nursing diploma from Cabarrus Memorial Hospital School of
Nursing in Concord, North Carolina in 1968.
SPICE looks forward to this new collaboration with Evelyn and her contribution to
the SPICE mission to support the IPs of NC.
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
APIC Study Shows Clostridium difficile Infection Rates Greater than
Previous Estimates
November 2008. The life-threatening bacterium that causes diarrhea and more
serious intestinal conditions, Clostridium difficile, is sickening many more patients
than previously estimated, according to a new study released November 11,
2008, by the Association for Professionals in Infection Control and Epidemiology
(APIC). “The National Prevalence Study of Clostridium difficile in U.S. Healthcare
Facilities” indicates that 13 out of every 1,000 inpatients were either infected or
colonized with C. difficile. Based on this rate, it is estimated that there are at least
7,178 inpatients on any one given day in American healthcare institutions with an
associated cost of $17.6 to $51.5 million. The rate is 6.5 to 20 times greater than
previous incidence estimates, according to the survey, released at APIC’s
conference, “Clostridium difficile: A Call to Action,” in Orlando, Florida.
To reduce the risk of transmission, APIC has published a “Guide to the
Elimination of Clostridium difficile in Healthcare Settings.” APIC
recommendations include a risk assessment to identify high-risk areas for CDI
within the institution; surveillance program to outline activities and procedures to
provide early identification of CDI cases; adherence to CDC hand hygiene
guidelines; use of contact precautions (e.g., gloves, gowns and separating CDI
patients from other patients); environmental and equipment cleaning and
decontamination, especially items that are close to patients such as bedrails and
bedside equipment; and antimicrobial stewardship programs with focus on
restriction of antibiotics associated with CDI and unnecessary antimicrobial use.
APIC’s evidence-based elimination guides translate CDC recommendations into
practice.
The APIC National Prevalence Study of Clostridium difficile in U.S. Healthcare
Facilities will be published in the American Journal of Infection Control. For more
information about the study, visit www.apic.org. [From APIC press release]

Infectious Diseases the Number Two Killer Worldwide
Infectious diseases are the second most dangerous killer, leading to 16.2 percent
of worldwide deaths, according to the World Health Organization (WHO). Heart
disease, infectious diseases, and cancer remain the world’s top three killers, the
WHO said in a report, released October 27, 2008, on the global burden of
disease. Only heart attacks and related problems kill more people than infectious
diseases, claiming 29 percent of people who die each year, reported the
Associated Press (AP). Cancer claims 12.6 percent of global deaths.
[From Infection Control Weekly Monitor - October 29, 2008]

Drugs in the Pipeline May Fight MRSA
As physicians and other healthcare professionals clamor for drugs that can fight
MRSA, two experimental antibiotics appear to work safely against the infections,
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researchers say. An experimental antibiotic manufactured by Paratek
Phamaceuticals Inc., a Boston company, cleared up MRSA infections in 98
percent of patients treated and had no serious, drug-related adverse events,
researchers said at an October 26, 2008, news conference as part of a joint
meeting of the American Society for Microbiology and the Infectious Diseases
Society of America. A Swiss drug company Arpida also announced that its
intravenous drug iclaprim cured MRSA infections in 92.3 percent of patients.
[From Infection Control Weekly Monitor - October 29, 2008]

New Compendium of strategies for preventing healthcare-associated
infections provide practical guidance
The newly released "SHEA-IDSA Compendium of Strategies to Prevent
Healthcare-Associated Infections in Acute Care Hospitals" provides practical
guidance on how to prevent infections and measure progress and include patient
guides developed by CDC. The compendium has been published by The Society
for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases
Society of America (IDSA). Other partnering organizations in this effort include
the Association for Professionals in Infection Control and Epidemiology (APIC),
the American Hospital Association (AHA) and the Joint Commission.
Science-based and practical strategies addressed in the compendium include the
four major device-related or procedure-related healthcare-associated infections
(HAIs): catheter-associated bloodstream infections; catheter-associated urinary
tract infections, ventilator-associated pneumonia; surgical site infections; and two
major pathogens of current concern – Methicillin-resistant S.aureus (MRSA) and
Clostridium difficile. Each strategy is based on CDC/HICPAC guidelines for each
of these topics.
In addition to the strategies, the organizations also partnered with CDC to publish
patient guides for each of the six infections addressed by the compendium. The
guides identify strategies that hospitals, patients and family members can all take
to prevent infections.
The Compendium is available free in the October 2008 Supplement to the
Journal of Infection Control and Hospital Epidemiology (Supplement of: Volume
29, Number 10, October 2008, pp. 901-994) at
http://www.journals.uchicago.edu/toc/iche/2008/29/s1
Patient Guides download: http://www.shea-online.org/about/patientguides.cfm
[From October 2008 Premier Safety Share]

Checklist Outlines Legal Issues of Pandemic Flu Planning
There’s an extensive list of legal issues to consider when developing a pandemic
flu plan, according to the American Health Lawyers Association. To get
healthcare officials thinking about those concerns, the group has released
Community Pan-Flu Preparedness: A Checklist of Key Legal Issues for
Healthcare Providers. The project, co-sponsored by the CDC, details the legal
challenges hospitals could face during an influenza pandemic.
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The checklist includes issues regarding patient consent, avoiding malpractice
liability, building a plan that prevents criminal and civil liability, government
authority during an emergency, tracking prescription drugs and privacy of health
information, and state regulatory issues. Free download:
http://www2.cdc.gov/phlp/docs/Pan-Flu08.pdf
[Infection Control Weekly Monitor - October 29, 2008]

GAO Report says 23 states Now Require Public Reporting of HAIs
The Government Accountability Office (GAO) has turned its spotlight on
hospitals’ efforts to prevent healthcare-associated infections (HAI). Twenty-three
states have now established mandatory public reporting systems on HAIs,
according to a report released October 2 by the GAO. Most states designed their
reporting programs to focus on a few measures developed or endorsed by the
CDC and a majority have chosen to adopt the CDC’s National Healthcare Safety
Network to collect data. When it comes to the MDRO that has gained the most
public attention recently, only three states collect data on MRSA infections.
The GAO also reviewed a sample of 14 hospitals and healthcare systems with
MRSA-reduction initiatives. All use routine testing for MRSA, although they chose
different patient populations to test and used various test methodologies, the
GAO said. These hospitals reported changing their general IC policies and
practices as part of their respective initiatives—with all 14 making changes in
hand hygiene compliance and more than half making changes to their contact
precautions or disinfection of environmental surfaces.
To read the report “Healthcare-Associated Infections in Hospitals: An Overview
of State Reporting Programs and Individual Hospital Initiatives to Reduce Certain
Infections” click here: <http://www.gao.gov/new.items/d08808.pdf>
[From Infection Control Monitor -October 8, 2008]
RECOGNITIONS
Congratulations to two IPs who have recently passed the CBIC exam!
 Kate Gledhill, RN, BSN, MS, CIC, of Piedmont Infection Control &
Epidemiology Services (PICES) in Winston-Salem, NC
 Mary Jones, RN, BSN, CIC, of Alleghany Memorial Hospital in Sparta, NC
-----------------------------------------------------------------------------------Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC; William
A. Rutala, PhD, MPH; David J. Weber, MD, MPH; Eva Clontz, Med; Debby Pyatt,
BA.
-----------------------------------------------------------------------------------To subscribe to the Report of the Month, send an email to spice@unc.edu.
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Report of the Month is also available on the home page of the Statewide
Program for Infection Control and Epidemiology at
http://www.unc.edu/depts/spice/.
The Statewide Program for Infection Control and Epidemiology (SPICE) is
funded by the General Assembly of North Carolina to serve the State. SPICE is
not a regulatory agency but provides education and consultation to North
Carolina healthcare facilities.
Posted: December 16, 2008
Copyright 2008 Statewide Program for Infection Control and Epidemiology
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