--------------------------------------------------------------------------------------------------------------------REPORT OF THE MONTH, Volume III, Number 2 – March-April 1999
- - - - from the North Carolina Statewide Program for Infection Control and Epidemiology
--------------------------------------------------------------------------------------------------------------------CONTENTS:
NEWS FEATURES
HAND PROTECTANT DEMONSTRATES CLINICAL BENEFITS
MRSE/MRSA ISOLATION PRECAUTIONS UPDATE
REGULATORY/LEGISLATIVE
JCAHO SURVEY EXPERIENCE
QUESTION OF THE MONTH
SKIN PREP AROUND EYES
NEWS AND ANNOUNCEMENTS
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
NEWS FEATURES
HAND PROTECTANT DEMONSTRATES CLINICAL BENEFITS
Clinicians at the NC Special Care Center in Wilson with assistance from the Statewide
Program for Infection Control and Epidemiology studied a novel Skin Protectant product
registered by the FDA. This HP formulation active ingredients include Triclosan, an
antimicrobial used frequently in antiseptic handwashing products. Numerous
publications have demonstrated Triclosan antimicrobial effectiveness. When Triclosan
is used in the HP, an extended contact time allows this product to exhibit persistent
antimicrobial activity unlike many antimicrobial handwashing products. Independent
(unpublished) laboratory tests have demonstrated up to 4 hours of repeated challenge
test effectiveness against S. aureus and E. coli. The HP also contains numerous
emollients including glycerol sterate, beeswax, and paraffin that have been used in
cosmetics to help retain the skin moisture preventing dermatitis. Finally HP contains
Allantoin, a relatively new agent cleared by the FDA in order to have the skin protectant
claim as listed in the Code of the Federal Register.
The results of this pilot cross-over study of a HP versus no lotion found the HP was
efficacious in each clinical measure. First, the HP significantly reduced (25%) transient
bacterial hand contamination. Secondly, MRSA colonization of residents demonstrated
no cross-transmission in the population as evidenced by anterior nasal cultures
collected before and after use of the HP. Third, significant improvement was observed
in the numbers of documented allergic HCWs able to tolerate powdered latex gloves in
conjunction with the use of the HP. Fourth, during the study period with the HP, a
clinically significant reduction of nosocomial infection rates was observed, with the most
dramatic reductions in eye, skin/wound infections. Finally an evaluation of user
satisfaction by the study participants was extremely favorable for the HP.
These authors believe that antiseptic emollients hand lotions marketed as hand
protectants may provide a clinical benefit by preventing the recolonization of hands,
subsequently reducing the numbers of bacteria that result in cross-transmission. An
added benefit is that the hand protectants may improve the condition of skin, resulting in
less dermatitis and latex allergic reactions. This pilot study should be repeated on a
larger scale to verify its many observed benefits.
MRSE/MRSA ISOLATION PRECAUTIONS UPDATE
CDC authors suggest a change to the isolation precautions guidelines in a recent
publication, "Prevention of Methicillin-Resistant Staphylococcus epidermidis (MRSE),
Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant
Enterococci (VRE) Colonization/Infection" (Antibiotics for Clinicians 1998;2:33-38). This
article, co-authored by Dr. William Jarvis, has the following recommendation: "Standard
precautions, as described in the HICPAC Guideline for Isolation Precautions in
Hospitals, should control the spread of MRSE and MRSA in most instances." The CDC
continues to recommend contact precautions in addition to standard precautions for all
culture-positive patients with VRE. However, only MRSA or MRSE defined as "clinically
or epidemiologically significant" would additionally need contact precautions.
REGULATORY/LEGISLATIVE
JCAHO SURVEY EXPERIENCE
UNC Hospitals was surveyed by JCAHO in January. The following infection control (IC)
questions were addressed to the Hospital Epidemiology staff. (1) What involvement do
you have in ensuring safe foods (i.e., IC rounds)? (2) Describe education of your
healthcare workers regarding IC, bloodborne pathogens, and tuberculosis. (3) What
surgical site infection monitoring is done in Day-Op (i.e., rates)? (4) How do you
integrate employee health into IC? (5) How do you make sure surveillance is working
(e.g., minimizing infections)? (6) What outbreaks or clusters have you had and what
happened? (7) Do you assess employees who return to work after several days off?
(8) What performance improvement projects have you done?
JCAHO inspected for the following: (9) outdated/expired sterile items (i.e.,
manufacturers' dates), (10) refrigerator temperature monitoring, (11) separate staff and
patient refrigerators, (12) surface dust on patient-care equipment, (13) infection rate
confidence intervals (preferred graphs to narratives), (14) sanitation procedure for
decorative water fountain, (15) flash sterilization records, (16) glutaraldehyde
monitoring, (17) dating multi-dose vials (i.e., insulin only). (18) In addition, the nurse
managers were expected to know infection rates.
QUESTION OF THE MONTH
SKIN PREP AROUND EYES
Q:
What can my facility use for the skin prep around eyes? We are currently using
Zephiran but are having trouble with purchasing it.
A:
Zephiran (benzalkonium chloride) has been associated with several outbreaks of
infection associated with in-use contamination. Since 1983 the CDC has
recommended against the use of this product as an antiseptic on skin and tissue.
The "APIC Guideline for Handwashing and Hand Antisepsis in Health Care
Settings" advises against chlorhexidine gluconate (CHG) because corneal damage
can result from instillation in the eye. Betadine applied first to clean the skin
followed by alcohol is one method. Betadine-allergic patients could alternatively be
prepped with non-CHG antibacterial soap and water followed by alcohol.
NEWS AND ANNOUNCEMENTS
OSHA has issued the Working Draft of a Proposed Ergonomics Program Standard. It
can be found at the OSHA web site
http://www.osha-slc.gov/SLTC/ergonomics/ergoreg.html
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
"Infection Control Part I: Clinical Surveillance of Nosocomial Infections" will be held May
3-7, 1999 at the Holiday Inn in Chapel Hill
"Infection Control Part II: The ICP as an Environmentalist" will be held September 27October 1, 1999 at the Holiday Inn in Chapel Hill.
"Infection Control in Home Health and Hospice" will be held October 11, 1999 at The
Friday Center in Chapel Hill.
-------------------------------------------------------------------------------------------------------------------Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC; William A.
Rutala, PhD., 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 1999 Statewide Program for Infection Control and Epidemiology