--------------------------------------------------------------------------------------------------------------------REPORT OF THE MONTH, Volume II, Number 5 – September-October 1998
- - - - from the North Carolina Statewide Program for Infection Control and Epidemiology
--------------------------------------------------------------------------------------------------------------------CONTENTS:
NEWS FEATURES
PET THERAPY
REVIEW OF NEW CHEMICAL STERILANTS USED FOR HIGH-LEVEL
DISINFECTION
REGULATORY/LEGISLATIVE/QUESTION OF THE MONTH
CHANGES IN THE RULES GOVERNING THE CONTROL OF
COMMUNICABLE DISEASES
QUESTION OF THE MONTH
TB SKIN TESTING/ANERGY TESTING
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
PET THERAPY
Animal visitation to hospitalized patients, known as Pet Therapy, is becoming an
increasingly popular activity. Additionally patients may request service animals (e.g.
guide dogs) to stay with them during hospitalization. A review by Weber and Rutala
entitled the "Epidemiology and Prevention of Nosocomial Infections Associated with
Animals" is published in Mayhall's Infection Control and Hospital Epidemiology, 1996.
This chapter discusses the zoonotic diseases with potential for nosocomial
transmission. Safety issues resulting from bites and scratches are also a concern as
approximately 224 strains of bacteria in human and animal saliva-contaminated wounds
have been identified. At the University of North Carolina Hospitals a pet visitation
protocol has been in place since 1992 that specifies what the voluntary pet owners and
dogs must do to participate in the program. This includes a behavioral screening exam
done by the local Animal Protective Services and a medical screening done by
volunteer veterinarians. The medical screen would include up-to-date immunizations
(distemper, parainfluenza, hepatitis, parvovirus, and rabies), fecal and nasal cultures
every 4 months, routine medication for the prevention of heartworm, and a flea
prevention routine. The dogs must also be bathed with a flea shampoo and receive an
antiflea dip on the day before or the day of the hospital visit. The dogs must also wear a
designated shirt to identify them as canine volunteers and to reduce spread of dog hair.
Pets on antibiotic therapy for an infection, with skin or ear infections, wearing a bandage
or experiencing GI upset would be excluded from visitation. Animals positive for any of
the following organisms would be excluded until one negative culture had been obtained
after treatment for the specific organism (Giardia, group A streptococcus, Shigella,
Salmonella, and Campylobacter). Attending physicians must write an order in the
medical record and parents must sign a consent for the child to participate in the Pet
Visitation Program. Hospitalized children with the following ailments are excluded from
participating in the Pet Visitation Program: 1) open sores on exposed skin; 2)
aggressive behavior; 3) neutropenia (WBC <1000); 4) HIV-Infection; and 5)
immunoglobulin deficiencies. Pets are kept on a leash at all times and brought to a
designated area in the hospital that is cleaned with an EPA-registered disinfectantdetergent after the visit.
REVIEW OF NEW CHEMICAL STERILANTS USED FOR HIGH-LEVEL
DISINFECTION
Endoscopes are widely used for the diagnosis and therapy of a variety of
medical disorders and are increasingly used for performing laparoscopic surgery.
Currently, greater than 10,000,000 gastrointestinal endoscopic procedures are
performed each year, Because the endoscope comes into intimate contact with mucous
membranes, high-level disinfection is the current reprocessing standard after each
patient use.
Several new chemical sterilants have recently been developed including 7.5%
hydrogen peroxide (FDA cleared), 0.08% peracetic acid plus 1.0% hydrogen peroxide
(FDA cleared), and 0.55% orthophthalaldehyde (not FDA cleared). Data suggest that
these products and 2% glutaraldehyde are substantially equivalent in their spectrum of
microbiocidal activity, effectiveness in the presence of organic matter, and relative ease
of use. No product possesses all the characteristics of an ideal high-level disinfectant.
Major disadvantages of currently available products include: material incompatibility with
Olympus endoscopes (e.g., peracetic acid with hydrogen peroxide), and human health
toxicity (e.g., glutaraldehyde). Considering all the characteristics of currently available
products, glutaraldehyde and hydrogen peroxide are alternative choices for high-level
disinfection of semicritical items such as endoscopes, The Steris System 1TM (0.2%
peracetic acid) is an alternative choices for endoscope reprocessing which has been
FDA cleared as a sterilization process. Orthophthalaldehyde will be an option when it is
FDA cleared. The hydrogen peroxide plus peracetic acid should be further assessed
when the functional damage to Olympus endoscopes is alleviated.
Readers interested in a more extensive review of this subject are referred to the
following article: Rutala WA, Weber DJ. Disinfection of Endoscopes, "Review of New
Chemical Sterilants for High-Level Disinfection," Infection Control and Hospital
Epidemiology (In press).
REGULATORY/LEGISLATIVE
CHANGES IN THE RULES GOVERNING THE CONTROL OF COMMUNICABLE
DISEASES
On August 1, 1998 several important changes became effective in the North
Carolina Administrative Code rules governing communicable disease control. The most
dramatic changes occurred in sections .0101 and .0102 which govern the list of
reportable diseases. Several diseases were removed from the list of reportable
diseases including: amebiasis, blastomycosis, encephalitis other than arboviral, non-A
and non-B hepatitis, leprosy, viral (aseptic) meningitis, Kawasaki syndrome, and Reye's
syndrome. Diseases added to the list are crytosporidiosis, cyclosporiasis, ehrlichiosis,
arboviral encephalitis, hemolytic-uremic syndrome and thrombotic thrombocytopenic
purpura, acute hepatitis C, congenital toxoplasmosis, and vibrio infections. Isolation or
other specific identification of Group A streptococci, Haemophilus influenza type B,
Neisseria meningitidis, and vancomycin-resistant Enterococcus spp is reportable only if
identified from a normally sterile site (e.g. blood, urine, CSF). The reporting card (form
DHHS 2124) has been revised to reflect the rule changes. The new cards have been
printed "Carolina Blue" in color. They will be distributed as they become available.
Under Section .0203, the hepatitis B control measures were changed by adding a new
paragraph [(e) through (b)] that governs management of hepatitis B-infected children in
day care center and school settings. For a complete copy of the revised rules or for
questions please contact the Communicable Disease Control Section on-call person at
919-733-3419.
QUESTION OF THE MONTH
Q: When should two-step TB skin testing or anergy testing be done on healthcare
workers or patients?
A: Several changes were made in the North Carolina communicable disease rules
regarding tuberculosis control measures effective August 1, 1998. Paragraph (b)
adopts the recommendations in the Diagnostic Standards and Classification of
Tuberculosis, published by the American Thoracic Society, as the required control
measures for evaluation, testing, and diagnosis for TB patients, contacts, and
suspects, except as otherwise provided in this rule. It includes specification on how
often close contacts shall receive a skin test; deletes the requirement for annual
testing of patients and staff in long-term care facilities, but now includes using twostep method on employment and admission; deletes skin testing for Department of
Health and Human Services clients and staff; deletes anergy testing from the rules
because of the lack of standardization for these test and recent CDC
recommendations concerning use of anergy testing; and adds a requirement for
testing using the two-step method for persons with HIV infection or AIDS and, upon
employment, staff in day care centers providing care for HIV infected/AIDS patients.
Paragraphs (c) and (e) adopt, by reference, Treatment of Tuberculosis Infections in
Adults and Children, published by the American Thoracic Society, as the source of
required control measures for testing, treatment, and follow-up of TB patients,
contacts, and suspects.
Source: Dr. Newt MacCormack, Chief, General Communicable Disease Control
Section, North Carolina Department of Health and Human Services
NEWS AND ANNOUNCEMENTS
"Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and
HCV-Related Chronic Disease" was published in the MMWR, October 16, 1998.
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control in Long-Term Care Facilities will be held March 22-23, 1998 in Chapel
Hill at the Sheraton Hotel.
"Infection Control Part I: Clinical Surveillance of Nosocomial Infections" will be held in
May in Chapel Hill.
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Copyright 1998 Statewide Program for Infection Control and Epidemiology