-----------------------------------------------------------------------------------------------------------------REPORT OF THE MONTH, Volume IV, Number 6 - November-December 2000
- - - - from the North Carolina Statewide Program for Infection Control and Epidemiology
-----------------------------------------------------------------------------------------------------------------CONTENTS:
NEWS FEATURES
Patient Attire in Ambulatory Surgery
Fabric-covered Furniture - a Reservoir for VRE
REGULATORY/LEGISLATIVE
Needlestick Safety Prevention Act
QUESTION OF THE MONTH
Banked Breast Milk Given to the Wrong Baby
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
HOLIDAY FUN
Grinchy Germs in Heelville
-----------------------------------------------------------------------------------------------------------------NEWS FEATURES
PATIENT ATTIRE IN AMBULATORY SURGERY
In the 1990's a dramatic shift in patient-care practices occurred as greater than 65% of
surgery cases were operated on in outpatient settings. In an effort to provide patients
with cost-effective, convenient, efficient care in the ambulatory surgery setting, the
issue of patient attire has become controversial. The expectation and goal of
ambulatory surgery is to send the patients home the same day as the procedure,
usually within hours of their arrival. Therefore, many patients request being able to
keep their clothing on for their surgical procedures. Some healthcare experts are
concerned about the contamination that may be brought in on patients' clothing or the
clothing interfering with care should an emergency arise. No guidelines or studies have
been published addressing the issue of appropriate patient attire in the ambulatory
surgical setting.
In August, 2000, the Statewide Program for Infection Control and Epidemiology
(SPICE) sent a questionnaire by email to North Carolina (NC) infection control
professionals (ICPs) at the 69 NC hospitals on its electronic mailing list. Infection
control professionals at forty-four of the 69 hospitals (64 %) responded to the
questionnaire that asked four questions about practices in their ambulatory surgery
related to patients wearing their own clothing. These 69 hospitals represent
approximately half of the North Carolina facilities that may do outpatient surgery. The
results of the survey were as follows. In response to the question, "Is your facility
allowing any procedures to be done with patients wearing their own clothing in the
operation room (OR) suite?" slightly more than half, 24 of 44 (54%), of the facilities
allowed patients to wear some or all of their own clothing in the OR suite for at least one
type of procedure. Of those 24 responding affirmatively to that question, ten (42%)
facilities allowed patients to wear their clothing for eye or cataract procedures only; six
(25%) facilities for eye, ENT and plastics procedures; four (17%) facilities for all
procedures; two (8%) facilities for pediatric cases only; and two (8%) facilities for
surgery above the waist only. In response to the question "Is your facility allowing any
procedures to be done with the patients wearing their own clothing under a cover gown
supplied by the facility?" eight (33%) required no gown; 15 (63%) required a gown with
no cuffs; and one (4%) facility required a gown with cuffs. As to what clothing facilities
allowed patients to wear in the OR, eleven (46%) facilities allowed all clothing; two (8%)
allowed all clothing but no shoes; six (25%) allowed underwear and socks only; three
(13%) allowed socks only; and two (8%) allowed all clothing below the waist. All
facilities replied that no problems had arisen because of patient clothing being worn in
the OR, although one facility noted it was difficult to enforce the policy. These results
suggest a change from the traditional practice of patients wearing only hospital provided
gowns in the surgical suite and should be monitored for infection control issues.
FABRIC-COVERED FURNITURE - A RESERVOIR FOR VRE
Published studies have reported that vancomycin-resistant enterococci (VRE) can survive on
nonporous surfaces for as long as seven days. Recently, researchers at Northwestern Hospital
examined survivability and transmissibility of VRE on porous cloth-covered (woven, synthetic
fiber) furniture (Am J Infect Control 2000;28:311-3). Cultures were taken from seat cushions in
five randomly chosen rooms by specially-made Rodac impression plates. All rooms in this new
hospital were private. Three of the five rooms were occupied by patients known to have rectal
VRE colonization. The results of the 5 rooms investigated were that VRE was found on 3 of 10
seat cushions (30%) sampled. The investigators also performed simulated inoculation studies
using vancomycin-resistant Enterococcus faecium onto the chair's seat cushion. Testing for
recovery of VRE was accomplished by using a Rodac plate with a 5-second contact time. The
surfaces inoculated included fabric chairs, vinyl chairs and linen (sheet and bath blanket). Of
the 5 simulated samples inoculated onto the fabric and vinyl chair cushions, all were positive for
growth after inoculations and at 72 hours and 7 days with no cleaning performed. Disinfection
with a quaternary ammonium solution was not successful in removing VRE from any of the
fabric chairs; however, this routine disinfection removed VRE from all vinyl surfaces. Cushions
were positive for VRE after inoculating a sheet or bath blanket covering the seat cushion.
However, folding the sheets in quarters or bath blanket in half prevented contamination of the
chair surface. To simulate transmission from the seat cushion to a patient or healthcare
worker, one area on both the fabric and vinyl chairs was inoculated with VRE, then touched 5
minutes later with the palmar surface of the hand, then to a Rodac plate. Hands of healthcare
workers cultured after contact with contaminated cushions (fabric or vinyl) were positive for
VRE. These results demonstrate that porous surfaces cannot be disinfected for VRE and may
serve as a reservoir where VRE could transfer to hands. The authors recommended the
selection of non-porous fabrics that are easily cleaned in health care institutions.
QUESTION OF THE MONTH
Q: What should be done if banked breast milk is given to the wrong baby in the
nursery? Is this an exposure?
A: No guidelines exist specifically for the post-exposure management of infants
accidentally exposed by ingestion of breast milk. However, situations in which
human milk is collected from unrelated donors for infant feeding has prompted the
development of guidelines for appropriate selection and screening of donors as well
as practices for careful collection, processing, and storage of the breast milk.
Currently, U.S. donor milk banks that belong to the Human Milk Banking Association
of North America voluntarily follow guidelines drafted in consultation with the U.S.
Food and Drug Administration and the Centers for Disease Control and Prevention.
These guidelines summarized in the Pediatric Red Book include screening donors
for antibodies to HIV-1, HIV-2, HTLV-I, HTLV-II, HBsAg, hepatitis C, and syphilis.
The Statewide Program for Infection Control and Epidemiology (SPICE)
recommends that it would be prudent to follow these guidelines for the postexposure testing of the source of the human milk, with the exception of syphilis, as
long as these results were already available from the prenatal screening. Also,
SPICE suggests that the source should be tested for HSV if lesions are present on
the donor breast. Of course, a policy that is enforced to rectify the situation from
occurring again is paramount. UNC Healthcare has a protocol that allows only the
nurse assigned to the baby to prepare (i.e., thaw) and deliver the milk to the baby
after carefully cross-checking the infant identification bracelet number to the milk
identification number.
NEWS AND ANNOUNCEMENTS
Dr. Julie Gerberding, Director of the Hospital Infections Program (HIP), CDC,
announced that HIP has changed its name to the Division of Healthcare Quality
Promotion and Infection Prevention (DHQPIP).
The North Carolina Tuberculosis Policy Manual, 8th Edition, 1999, was modified
11/01/00 to reflect new CDC recommendations and is available on the internet at
http://tbnc.mc.duke.edu/manual.htm
These revisions incorporate updated information since the 1995 publication. A new
Chapter V-A. HIV/AIDS has been added to emphasize the unique considerations
necessary for the management of HIV-positive individuals with tuberculosis infection
and/or disease. For additional information about changes, see Report of the Month,
Volume IV, Number 4, July-August 2000.
http://www.unc.edu/depts/spice/rep-iv-4.html
The Occupational Safety and Health Administration (OSHA) "Ergonomics Program;
Final Rule" was published in the Federal Register on November 14, 2000. It is
available online at
http://www.osha-slc.gov/ergonomics-standard/index.html
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control Part I: Clinical Surveillance of Nosocomial Infections will be held in
Chapel Hill in the spring of 2001.
"Infection Control in Long-Term Care" will be held in Chapel Hill in the spring of 2001.
HOLIDAY FUN
GRINCHY GERMS IN HEELVILLE
All the Heels down in Heelville loved Christmas for a reason
And it wasn‘t just because it was basketball season.
They loved the trimmings, the trappings, and friends so dear
But little did they think of the many grinches near!
These grinches are tiny, not big, not tall and
They even don ‘t live near Mt. Crumpet at all.
They come in small sizes, in groups and in pairs
And they live in Heel homes and even Heel hair!
They can hide in their food and their Christmas tree
Oh these little devils are so hard to see!
These germs need no season or even a reason
To make a Heel cough or start a Heel sneezin'.
Their gifts are so grinchy especially the flu
Making every Tarheel in Heelville cry “Boo Hoo"!
What can we do, what can we say
So these germs won ‘t steal our Heel Christmas Day?!
Why, wash your hands and get some sleep
And in a cold refrigerator your feast will keep.
A flu shot will do and lots of fresh air
And pass out those hankies, a few germs they can snare.
Then greet your friends and sing by the tree
And when you toast just remember your Vitamin C!!!
Written by Vickie Brown, an ICP in Chapel Hill (home of the University of North Carolina
Tar Heel teams), North Carolina (the Tar Heel state).
-----------------------------------------------------------------------------------------------------------------Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC; William A.
Rutala, PhD, MPH; David J. Weber, MD, MPH; Eva P. Clontz, MEd.
-----------------------------------------------------------------------------------------------------------------To subscribe to the Report of the Month, send email to
spice@unc.edu
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.
Copyright 2000 Statewide Program for Infection Control and Epidemiology