-----------------------------------------------------------------------------------------------------------------REPORT OF THE MONTH, Volume V, Number 1 - January-February 2001
- - - - from the North Carolina Statewide Program for Infection Control and Epidemiology
-----------------------------------------------------------------------------------------------------------------CONTENTS:
NEWS FEATURE
Improved Handwashing Compliance Reduces Nosocomial Infections
REGULATORY/LEGISLATIVE
NC Division of Facility Services and Acute Care Hospitals
Needlestick Legislation Compliance
Department of Transportation Packaging Rules for Regulated Medical Waste
QUESTION OF THE MONTH
Medical Instruments Used on Patient with Creutzfeldt-Jakob Disease
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
-----------------------------------------------------------------------------------------------------------------NEWS FEATURE
IMPROVED HANDWASHING COMPLIANCE REDUCES NOSOCOMIAL INFECTIONS
Hand hygiene prevents cross infection in hospitals but compliance with recommended
instructions is poor (20-50%). Although some previous interventions to improve
compliance have been successful, none has achieved sustained improvement. Lancet
reported a study that promoted hand hygiene by implementing a hospital-wide program
that included color posters that emphasized the importance of handwashing and special
emphasis on bedside, alcohol-based hand antiseptics. The investigators monitored the
overall compliance with hand hygiene and observed more than 20,000 opportunities for
hand hygiene. Compliance improved progressively from 48% in 1994 to 66% in 1997
(p<0.001). Although handwashing with soap and water remained stable, frequency of
hand antisepsis substantially increased during the study (p<0.001). Hand hygiene
improved significantly among nurses and nursing assistants, but remained poor among
doctors. During the same period, overall nosocomial infection decreased (prevalence
of 16.9% in 1994 to 9.9% in 1998, p=0.04). MRSA transmission rates (2.16 to 0.93
episodes per 10,000 patient days; p<0.001) decreased, and the consumption of
alcohol-based handrub solution increased from 3.5 to 15.4 liters per 1000 patient-days
between 1993 and 1998 (p<0.001). The hospital-wide program produced a sustained
improvement in compliance with hand hygiene, coinciding with a reduction of
nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic
handrub largely contributed to the increase in compliance. (Didier et al., Lancet
2000;356:1307-12)
REGULATORY/LEGISLATIVE
NC DIVISION OF FACILITY SERVICES AND ACUTE CARE HOSPITALS
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Hospitals that stay in good graces with a JCAHO 3-year accreditation will not be visited
for routine inspections by the North Carolina (NC) Division of Facility Services (DFS). In
a Memorandum of Agreement, the two agencies agreed that a second inspection by the
Health Care Financing Administration (HCFA) would not be required unless a complaint
was received about the hospital. However, federal HCFA does require that a small
percentage (approximately 20%) of facilities be inspected for validation. Accreditation
by JCAHO or passing a DFS inspection is required to receive medicare/medicaid
reimbursement for patient care. Only nine hospitals in NC do not use JCAHO for their
inspection and accreditation. DFS inspects hospitals without charging a fee. You can
find a copy of HCFA's Hospitals Interpretive Guidelines for Infection Control linked from
the SPICE web site resources page (www.unc.edu/depts/spice/resource.html) and you
can contact the DFS acute care section at 919-733-1610.
NEEDLESTICK LEGISLATION COMPLIANCE
On January 18, 2001, "Occupational Exposure to Bloodborne Pathogens; Needlesticks
and Other Sharps Injuries; Final Rule," the amended bloodborne pathogens standard
was published in the Federal Register. These revisions were discussed in the
November-December 2000 issue of Report of the Month. States like North Carolina
with their own occupational safety plans have six months to adopt a comparable
standard. North Carolina has not put in place a separate needle safety law.
DEPARTMENT OF TRANSPORTATION PACKAGING RULES FOR REGULATED
MEDICAL WASTE
The US Department of Transportation (DOT) is not uniform nationally as it pertains to
inspecting hospitals for compliance with the DOT packaging rules. The NC DOT has
not been inspecting hospitals, but the Georgia DOT has been inspecting hospitals and
research laboratories. Hospitals should access the DOT pamphlet and ensure
compliance with the regulated medical waste packaging requirements.
Regulated medical waste is classified by the US DOT as a hazardous material. A
pamphlet is available on the DOT web site entitled "Infectious Substances - What You
Need To Know"
http://hazmat.dot.gov/pubtrain/infect.pdf
QUESTION OF THE MONTH
MEDICAL INSTRUMENTS USED ON PATIENT WITH CREUTZFELDT-JAKOB
DISEASE
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Q: I read in the newspaper about a hospital where the instruments used on a patient
with Creutzfeldt-Jakob disease (CJD) were subsequently used on eight other
patients without using the special sterilization procedures required for CJD. This
case obviously generated significant negative publicity and probably legal action.
Since it is likely that such an exposure could occur at any hospital, how have other
hospitals prepared to prevent such an exposure?
A: At UNC Health Care System the following practices are followed to prevent the
exposure of patients to instruments contaminated with CJD. Minimally, Hospital
Epidemiology, Central Processing, and Surgical Services should be notified prior to
any neurosurgical procedure on a patient with known or suspected prion disease. In
all such cases the UNC Health Care System's protocol for sterilization of
instruments contaminated with high-risk tissues (brain, spinal cord, eyes) must be
followed. To minimize the possibility of use of potentially contaminated
neurosurgical instruments from patients later diagnosed with CJD, UNC Health Care
will use the prion sterilization procedures on all contaminated neurosurgical
instruments from patients undergoing brain biopsy when a specific lesion has not
been identified (e.g. via MRI,CT).
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control Part I: Clinical Surveillance of Healthcare-Associated Infections will
be held in Chapel Hill, March 5-9, 2001.
"Infection Control in Long-Term Care" will be held in Chapel Hill, May 15-16, 2001.
-----------------------------------------------------------------------------------------------------------------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 2001 Statewide Program for Infection Control and Epidemiology
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