---------------------------------------------------------------------------REPORT OF THE MONTH, Volume VII, Number 2 – March-April 2003
- - - - from the North Carolina Statewide Program for Infection Control and Epidemiology
----------------------------------------------------------------------------CONTENTS:
NEWS FEATURES
Shortage of N95 Respirators
REGULATORY/LEGISLATIVE
President Bush Signs Smallpox Compensation
QUESTION OF THE MONTH
Infection Control for Bacillus Calmette-Guerin (BCG) Bladder Instillation for
Cancer
NEWS AND ANNOUNCEMENTS
CDC Criteria for Defining Nosocomial Pneumonia
Severe Acute Respiratory Syndrome (SARS) Web Page
Pocket Guide to Bioterrorism
OSHA Ergonomics Guideline for Nursing Homes
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
NEWS FEATURES
SHORTAGE OF N95 RESPIRATORS
The following UNC Hospitals memorandum regarding the shortage of N95 respirators
indicates how UNC Hospitals is responding to the shortage. You will note that the
memorandum reflects consultation with North Carolina OSHA. This information is
provided for your information as a example.
April 16, 2003. Due to the ongoing worldwide epidemic of Severe Acute Respiratory
Syndrome (SARS) the United States is facing a shortage of N95 respirators. Effective
immediately, N95 respirators should be used by healthcare workers only when entering
the rooms of patients with known or suspected pulmonary tuberculosis, or SARS. When
entering the rooms of patients with other diseases requiring droplet precautions (e.g.,
meningococcus, pertussis) or airborne precautions (i.e., varicella, zoster), wear a
standard surgical mask. In order to conserve our N95 masks, healthcare workers are
encouraged to reuse the same mask. The mask should be stored in a manner to
prevent it from being crushed or torn. The same mask may be used until such time it no
longer provides a tight fit.
In the event that the current N95 respirator used at UNC Hospitals (3M product) is not
available from Central Distribution, N95 (or N99s or N100s from 3M) respirators from
other vendors will be distributed to floors. In consultation with North Carolina OSHA, it
has been decided that these products may be used without fit testing. (This is not a
long-term waiver for fit testing, but is allowed while we use multiple vendors to meet our
need for N95 respirators.) Healthcare workers using these products should read and
follow manufacturer's guidance on how to use the respirator. As always, healthcare
workers should select the proper-sized respirator (i.e., small, medium, large). If N95s
(or N99s or N100s) are unavailable, healthcare workers should use a tight-fitting
surgical mask. The proper use of a surgical mask will prevent the acquisition of droplet
and airborne diseases (e.g., SARS, tuberculosis, varicella, meningococcus).
REGULATORY/LEGISLATIVE
PRESIDENT BUSH SIGNS SMALLPOX COMPENSATION
President Bush has signed into law the Smallpox Emergency Personnel Protection Act
of 2003, American Hospital Association-backed legislation that allows hospitals to
provide vaccinations without fear of liability if someone they vaccinate should become
ill. The legislation (H.R. 1770) also includes a compensation fund that pays up to
$50,000 a year for those sustaining a disability after vaccination and a death benefit of
$262,000. Congress has approved $43 million to help fund the bill. (from the American
Hospital Association)
QUESTION OF THE MONTH
INFECTION CONTROL FOR BACILLUS CALMETTE-GUERIN (BCG) BLADDER
INSTILLATION FOR CANCER
Q: I have a physician at my facility who wants to begin performing BCG bladder
instillation for cancer of the bladder. What infection control issues are there with this
procedure?
A: Bacillus Calmette-Guerin (BCG) is an attenuated tubercle bacilli. Intravesicular
instillation of BCG in patients with superficial bladder carcinoma has prolonged
disease-free intervals, probably as a result of immunologic mechanisms. Because
BCG is a biologically active material it must be managed with caution. Transfer of
BCG mixture should be via a chemical block vent (filter) to vials of preservative-free
saline. The procedures must be followed vigorously and care exercised to eliminate
the possibility of exposure. In case of an inadvertent exposure during BCG
instillation procedure, healthcare workers should contact Occupational Health to be
evaluated for a TB exposure. Exposure is defined as aerosol formation with
persons in the room not wearing masks or contact with non-intact skin. BCG is
generally less pathogenic than MTB. However, some immunocompromised patients
can get disseminated disease. BCG should not be handled by persons with a
known immunologic deficiency. Healthcare workers should have appropriate PPE
(i.e., N95 respirator, gown and gloves). BCG need not be done in a negative
pressure room. No cases have been documented of BCG transmission when
appropriate PPE has been worn. Patients should be instructed to retain the BCG
mixture for 2 hours. Upon completion of the procedures, patients should void in a
seated position for safety reasons. Contaminated urine voided after instillation
should be poured into a toilet or hopper. Urine should be disinfected by adding
equal volume of undiluted household bleach. Allow to stand 15 minutes before
flushing. Contaminated items should be disposed of as biohazardous materials in a
red bag and the area cleaned with alcohol or EPA germicidal-disinfectant.
(Modified from UNC Health Care System Infection Control Policy 2002.)
ANNOUNCEMENTS
CDC CRITERIA FOR DEFINING NOSOCOMIAL PNEUMONIA
The latest CDC Criteria for Defining Nosocomial Pneumonia have not been published
and are in use in some healthcare settings. SPICE has made this document available
online in a downloadable document at
<http://www.unc.edu/depts/spice/resource.html>
SEVERE ACUTE RESPIRATORY SYNDROME (SARS) WEB PAGE
In the fall of 2002, there were reports from Guangdong Province in southern China of
cases of highly contagious and very severe atypical pneumonia of unknown cause. On
March 13, 2003, as the condition began to spread from China, the World Health
Organization (WHO) issued a global alert about the outbreak and instituted worldwide
surveillance. In March the U.S. Centers for Disease Control and Prevention (CDC)
termed this condition the severe acute respiratory syndrome (SARS) and provided a
clinical case definition. (New England Journal of Medicine; May 15 2003; 348:19771985)
The North Carolina Statewide Program for Infection Control and Epidemiology has
added a SARS page to its web site. There is rapidly increasing information about
SARS on the internet and the SPICE page has links to important internet sites. In
addition, slides sets by Dr. David J. Weber and Dr. William A. Rutala can be
downloaded.
<http://www.unc.edu/depts/spice/SARS.html>
POCKET GUIDE TO BIOTERRORISM
Bioterrorist Agents: A Pocket Guide to Signs and Symptoms provides the same
information that is in the Bioterrorist Agents wall chart in a small, folding format that fits
in a pocket. Information about ordering is available online at
<http://www.unc.edu/depts/spice/bioterrorism.html>
OSHA ERGONOMICS GUIDELINE FOR NURSING HOMES
March 13, 2003. OSHA issued an ergonomics guideline for the nursing home industry.
OSHA's Guidelines for Nursing Homes focuses on practical recommendations for
employers to reduce the number and severity of workplace injuries by using methods
found to be successful in the nursing home environment. The guidelines are available
online.
<http://www.osha.gov/ergonomics/guidelines/nursinghome/index.html>
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control in Long-Term Care Facilities” will be held October 13-15, 2003, in
Chapel Hill.
"Infection Control Part II: The ICP as an Environmentalist” will be held September 8-12,
2003, in Chapel Hill.
-----------------------------------------------------------------------------------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.
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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 2003 Statewide Program for Infection Control and Epidemiology