-----------------------------------------------------------------------------------------------------------------REPORT OF THE MONTH, Volume IV, Number 5 – September-October 2000
- - - - from the North Carolina Statewide Program for Infection Control and Epidemiology
-----------------------------------------------------------------------------------------------------------------CONTENTS:
NEWS FEATURES
Plant Engineering Must Work Closely with Infection Control
Lower Latex Content Linked to Higher Glove Leakage
REGULATORY/LEGISLATIVE/QUESTION OF THE MONTH
Amended NC State Law Requires Influenza and Pneumococcal Immunization in
Long-Term Care Setting
QUESTION OF THE MONTH
More than One Method Used for Reprocessing Scopes
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
_____________________________________________________________________
NEWS FEATURES
PLANT ENGINEERING MUST WORK CLOSELY WITH INFECTION CONTROL
Effective January 1, 2001, the JCAHO revises the Utility Management standard
(EC.1.9) to include strategies to minimize the threat of air- and water-borne
contaminants such as Aspergillus and Legionella. Presumably, surveyors will ensure
that your Utility Management Plan describes how to reduce the potential for
organization-acquired illness such as policies to minimize Legionella or Aspergillus in
immunocompromised patients. You may already be in compliance with the standard as
many facilities work closely with Plant Engineering. If that is the case at your facility,
you may just need more documentation (e.g., maintaining air changes, pressure
relationships, and filtration efficiencies for ventilation systems serving areas specially
designed to control airborne contaminants [e.g., bone marrow, operating rooms,
airborne communicable diseases], and managing pathogenic biological agents in
cooling towers, domestic hot water, decorative water fountains).
LOWER LATEX CONTENT LINKED TO HIGHER GLOVE LEAKAGE
With the introduction of Universal Precautions in 1987 and the OSHA Bloodborne
Pathogen Standard in 1991, glove use increased from 1 billion pairs per year in the
United States in 1987 to 10 billion pairs in 1996 with latex accounting for a large
majority of the increase. Between 1988 and 1992 there were more than 1000 reports to
the Food and Drug Administration of allergic reactions to latex-containing products that
included 15 deaths. Due to concern about the risk of allergic reactions and concern
that the increased use of latex gloves could have resulted in increased rates of
sensitization, the National Institute for Occupational Safety and Health published an
alert in June 1997 recommending the use of nonlatex gloves for activities unlikely to
involve contact with infectious materials, the use of powder-free latex gloves with
reduced latex protein content if latex gloves were chosen for protection against
potentially infectious materials, and of nonlatex gloves for patients or health care
workers with latex allergy.
Researchers at the University of Virginia showed that leakage rates were greater for
examination than for surgical gloves, for manipulated than for unused gloves, and for
low latex content surgical gloves or nonlatex content surgical gloves than for high latex
content surgical gloves. While high latex gloves were associated with significantly lower
leakage rates than the low latex and nonlatex brands tested, some nonlatex and low
latex gloves were very resistant to leakage and should provide an effective barrier for
preventing exposure to bloodborne pathogens. (Muto CA et al. Arch Surg
2000;135:982-985)
REGULATORY/LEGISLATIVE
AMENDED NC STATE LAW REQUIRES INFLUENZA AND PNEUMOCOCCAL
IMMUNIZATION IN LONG-TERM CARE SETTING
Amended NC General Statute 131D.9 requires that adult care homes and nursing
homes (facilities) ensure that residents and employees are immunized against influenza
virus and that residents are also immunized against pneumococcal disease. Effective
September 1, 2000 long-term care facilities must screen new admission for
documentation of pneumococcal immunization and notify the resident of the
immunization requirements of this law. Long-term care facilities are to request that the
resident agree to be immunized. Immunization and documentation of pneumococcal
vaccination by long-term care facilities shall occur no later than November 30 of each
year. The law further states that effective September 1, 2001 employees and residents
of long-term care facilities shall be requested to receive the influenza vaccine on an
annual basis no later than November 30 of each year. Long-term care facilities must
document immunization status. According to the law, "No individual shall be required to
receive vaccine under this section if the vaccine is medically contraindicated, or if the
vaccine is against the individual's religious beliefs, or if the individual refuses the
vaccine after being fully informed of the health risks of not being immunized."
QUESTION OF THE MONTH
MORE THAN ONE METHOD USED FOR REPROCESSING SCOPES
Q: In my hospital bronchoscopy suite scopes are reprocessed by soaking in 2%
glutaraldehyde between cases but at the end of the day they are ETO gas
sterilized. In another area of the hospital for outpatient procedures the
bronchoscopes are reprocessed in an automated washer/sterilizer. Is it a problem
to use the different reprocessing techniques?
A: In the "APIC Guideline for Selection and Use of Disinfectants," by WA Rutala and
the APIC Guidelines Committee (1996) this practice is discussed as follows.
Semicritical equipment (e.g., endoscopes) should be high-level disinfected between
patients. However, some institutions choose to sterilize semicritical equipment when
used on certain infectious patients or as part of a routine process at the beginning or
the end of each day. This may lead to a "double standard" of patient care and is
inconsistent with the principle of universal precautions when equipment used on
patients with known specific infectious diseases (e.g., tuberculosis, HIV infection) is
sterilized, but the same equipment is only high-level disinfected for other patients.
Under these circumstances, sterilization should not be performed in the belief that it
is providing a greater margin of safety. In contrast, it is not a double standard of
patient-care to sterilize endoscopes in one hospital area (e.g., operating room) and
high-level disinfect in another area (e.g., gastroenterology clinic) because the
outcome is equivalent from an infectious disease transmission perspective.
NEWS AND ANNOUNCEMENTS
In a letter dated October 18, 2000, Abbott Diagnostics informed their customers that the
Abbott/Murex Single Use Diagnostic System (SUDS) HIV test will not be available for
an undetermined period of time due to manufacturing problems. The Federal Drug
Administration (FDA) suggests several possible interim measures. For more
information, see the FDA web site
http://www.fda.gov/cber/infosheets/abbsuds101800.htm
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.
-----------------------------------------------------------------------------------------------------------------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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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