-----------------------------------------------------------------------------------------------------------------REPORT OF THE MONTH, Volume VI, Number 4 – July-August 2002
- - - - from the North Carolina Statewide Program for Infection Control and Epidemiology
-----------------------------------------------------------------------------------------------------------------CONTENTS:
NEWS FEATURES
AORN Opposed to Home-Laundered Surgical Scrubs
REGULATORY/LEGISLATIVE
OSHA Targets Nursing Facilities
QUESTION OF THE MONTH
Removal of Contaminated Needles from Blood Tube Holders/Phlebotomy
Devices Prohibited
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
-----------------------------------------------------------------------------------------------------------------NEWS FEATURES
AORN Opposed to Home-Laundered Surgical Scrubs
Responding to a quote attributed to Peggy Camp, RN, MSN, in the article, "Cost
Savings in the Operating Room is a Difficult Business," (Healthcare Purchasing News,
May 2002, page 22) is a letter to the editor in the July edition by Dorothy Fogg, RN,
BSN, MA, from the Association of Perioperative Registered Nurses (AORN) Center for
Nursing Practice. Ms. Fogg clarified the following statements regarding laundering of
surgical scrubs in the 2002 edition of the AORN Standards, Recommended Practices
and Guidelines, page 199.
Approved, clean and freshly laundered attire made of multi-use fabric or
limited-use nonwoven fabric should be worn within the semi-restricted and
restricted areas of the surgical environment. After daily use, reusable
surgical attire should be laundered in a facility-approved and monitored
laundry. Laundered surgical attire should be protected from
contamination during transfer and storage. Laundering of surgical attire in
home laundries is not recommended. Surgical attire becomes
contaminated with microorganisms during wear. Taking soiled surgical
attire into the home can result in the potential spread of contamination to
the home environment. The difficulties in implementing a program to
monitor transportation practices preclude home laundering as an
acceptable method of cleaning surgical attire.
In conclusion, Ms. Fogg stated, "AORN continues to oppose laundering and surgical
scrub attire by any means other than a facility-approved, commercial laundry in which
1) the laundry formula is defined, monitored, and controlled to achieve the greatest
possible elimination/reduction of microorganisms from the laundered fabric and 2) the
surgical attire is transported to and from the healthcare facility in a controlled manner."
REGULATORY/LEGISLATIVE
OSHA Targets Nursing Facilities
Recognized for having one of the highest reported injury rates in all of industry, nursing
facilities have become a new focus for the Occupational Safety and Health
Administration (OSHA). On July 15, 2002 OHSA announced a plan called the National
Emphasis Program to direct efforts and inspections primarily on hazards most prevalent
in nursing homes such as ergonomics related to patient handling. Other areas of
interest will be exposure to blood and other infectious materials, exposure to
tuberculosis, and slips and falls. OSHA is planning to inspect 1000 facilities under the
program. OSHA will focus on nursing facilities that have 14 or more injuries or illnesses
resulting in lost work days or restricted activity for every 100 full-time workers.
http://www.osha.gov/media/oshnews/july02/trade-20020715.html
OSHA released a draft Ergonomics for the Prevention of Musculoskeletal Disorders Guidelines for Nursing Homes. A notice in the August 30, 2002, Federal Register has
information on procedures to review and comment on the draft. The guidelines are
arranged into three segments: management practices, worksite analysis, and control
methods, and include examples of best practices in the nursing home industry. The
draft guidelines are available online.
http://www.osha.gov/ergonomics/guidelines.html
QUESTION OF THE MONTH
Removal of Contaminated Needles from Blood Tube Holders/Phlebotomy Devices
Prohibited
Q:
Our facility has always reused blood tube holders used during phlebotomy. The
product we use is labeled for reuse. Our facility reuses to control costs and the amount
of biohazard waste. Can our facility continue to reuse blood tube holders if labeled for
reuse?
A:
In a news release dated June 1, 2002, OSHA discusses a letter of interpretation
issued to clarify its policy on the prohibition of removing contaminated needles from
blood tube holders and the reuse of those holders. OSHA explained that removing
needles in order to reuse blood tube holders exposed workers to unnecessary hazards
and risks. OSHA administrators cited the revised Bloodborne Compliance Directive
CPL 2-2.69 from November 2001, which suggested removing needles from a used
blood drawing/phlebotomy is rarely, if ever required by a medical procedure. Because
these devices involve the use of a double-ended needle, removing the needle exposes
the employee to additional risk, as does the increased manipulation of a contaminated
device.
In the recent letter of interpretation, OSHA requires (all) blood tube holders with needles
attached to be immediately discarded into a sharps container after the device's safety
feature is activated. The letter of interpretation is available on the OSHA website.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIO
NS&p_id=24040
The Bloodborne Compliance Directive CPL 2-2.69, November 2001, is online
http://www.osha.gov/OshDoc/Directive_pdf/CPL_2-2_69.pdf
NEWS AND ANNOUNCEMENTS
Infection Control Week is October 21-27, 2002.I
Guidelines for the Prevention of Intravascular Catheter-Related Infections was
published in the August 9, 2002, edition of the MMWR Recommendations
and Reports is now available in on the internet
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm
http://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf
FDA Public Health Web Notification: Cochlear Implant Recipients may be at Greater
Risk for Meningitis was issued July 24, 2002, and updated August 29, 2002.
http://www.fda.gov/cdrh/safety/cochlear.html
http://www.fda.gov/cdrh/safety/cochlear.pdf
OSHA recently revised fact sheets on Formaldehyde (identifies what employers and
workers should know to prevent harmful exposures, and also highlights recordkeeping
requirements) and Ethylene Oxide (addresses permissible exposure limits for workers
and respirator use).
http://www.osha.gov/OshDoc/data_General_Facts/formaldehyde-factsheet.pdf
http://www.osha.gov/OshDoc/data_General_Facts/ethylene-oxide-factsheet.pdf
Agency for Healthcare Research and Quality (AHRQ) announced a new bioterrorism
tool, a needs survey that hospitals can download and use as a checklist for assessing
their capacity to handle potential victims of bioterrorist attacks or for evaluating existing
emergency plans. The 42 questions in AHRQ's Bioterrorism Emergency Planning and
Preparedness Questionnaire for Healthcare Facilities cover subjects such as biological
weapons training for their personnel, procedures to permit rapid recognition of
credentialed staff from other facilities, on-call nursing policies, and designated areas of
emergency overflow for patients. The survey also asks hospitals about matters such as
their supply of selected antibiotics and the diagnostic capability of their in-hospital
laboratory. The questionnaire can be viewed at
http://www.ahrq.gov/about/cpcr/bioterr.pdf
August 14, 2002, notice: the Food and Drug Administration (FDA) ordered Cryolife, Inc.
("Cryolife") of Kennesaw, Ga., a human tissue-processing firm, to recall distributed
human tissue processed from October 3, 2001, to the present. Under the order, the firm
must also withhold from the market or destroy tissue processed after that date. FDA is
taking this action because it has determined that Cryolife cannot ensure that the human
tissue it processes for transplantation is free from fungal and bacterial contaminants.
http://www.fda.gov/bbs/topics/NEWS/2002/NEW00827.html
Federal Register Notice: Determining Hospital Procedures for Opened-But-Unused,
Single-Use Medical Devices; Request for Comments and Information, August 28, 2002.
http://www.fda.gov/OHRMS/DOCKETS/98fr/082802a.pdf
On August 30, 2002 the Food and Drug Administration (FDA) announced that Abbott
Laboratories, Inc., initiated a worldwide recall of 32 lots of laboratory kits used to
diagnose gonorrhea. The kits have been shown to be unreliable because they may give
false negative results. These test kits were distributed to hospitals and laboratories from
January 11 to June 24 2002.
On September 6, 2002, the CDC announced availability of the draft guideline for
"Prevention of Healthcare-Associated Pneumonia" for public comment at
http://www.cdc.gov/ncidod/hip/pnguide.htm
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control Part II: The Infection Control Professional as an Environmentalist" will
be held October 28, 2002 - November 1, 2002 at the Holiday Inn 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.
-----------------------------------------------------------------------------------------------------------------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 2002 Statewide Program for Infection Control and Epidemiology