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---------------------------------------------------------------------------REPORT OF THE MONTH, Volume X, Number 2 - 2006
- - - - from the North Carolina Statewide Program for Infection Control and Epidemiology
----------------------------------------------------------------------------CONTENTS:
NEWS FEATURES
 Change of Practice - Check Your Practice: Two of four disinfectants
recommended for cleaning eye exam equipment are ineffective according to
UNC Health Care study
QUESTION OF THE MONTH
 Microfiber Cleaning
REGULATORY/LEGISLATIVE
 Amendments to North Carolina Reportable Diseases and Conditions Rule
NEWS AND ANNOUNCEMENTS
 JCAHO Clarifies Position on Alcohol Hand Sanitizers
 Influenza Vaccination of Health-Care Personnel Recommendations
 Preventing Tetanus, Diphtheria and Pertussis Among Adolescents
 CDC’s Advisory Committee Recommends New Vaccine to Prevent Rotavirus
 Prevention of Hepatitis A Through Active or Passive Immunization
 FDA-Requested Recall - Cytosol Laboratories, Inc.
 FDA Recall of Some Lots of Cefazolin
 New OSHA Handbooks on Glutaraldehyde and Mold
 FDA Licenses New Vaccine to Reduce Older Americans’ Risk of Shingles
 New Antibiotic Active Against Resistant Hospital Pathogens
 Boca Medical Products, Inc. Issues Nationwide Recall of Insulin Syringe Product
COURSES FOR THE INFECTION CONTROL PROFESSIONAL
______________________________________________________________________
NEWS FEATURES
Change of Practice - Check Your Practice: Two of four disinfectants
recommended for cleaning eye exam equipment are ineffective according to UNC
Health Care study
Applanation tonometers are standard equipment used to measure pressure in eyes in
ophthalmology clinics, an important procedure. Tonometers lightly placed on the front
surface of the eye can determine if glaucoma is present. Healthcare workers are
required to disinfect the applanation tonometer after each use. A recently published
study conducted by the University of North Carolina Health Care System found that two
of the four disinfectants recommended for this purpose by the Centers for Disease
Control and Prevention (CDC) and the Association for Professionals in Infection Control
and Epidemiology (APIC) were ineffective. Both 70% isopropyl alcohol and 3%
hydrogen peroxide were found to be ineffective for eliminating adenovirus type 8 from
ophthalmic instruments. Adenovirus type 8 is a common cause of epidemic
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keratoconjunctivitis, a self-limited infection known as pink eye. These documented
outbreaks have occurred mostly in clinics and hospitals. Adnovirus is a hardy
environmental survivor for up to 30 days on metal surfaces and is transmitted on
contaminated eye equipment or hands. Based on their results, the authors concluded
that only the two disinfectants that demonstrated effective killing of adenovirus, 70%
ethyl alcohol and 5000 parts per million chlorine, should be used for eye exam
equipment disinfection. The immersion time should be 5-10 minutes. This article was
published in the Journal of Antimicrobial Agents and Chemotherapy, April 2006, vol 50,
pages 1419-1424.
QUESTION OF THE MONTH
Microfiber Cleaning
Q: Our healthcare facility is evaluating options for surface cleaning and floor mops.
What are the advantages and disadvantages of microfiber products versus the standard
cotton products?
A: There are many advantages to the microfiber products currently available on the
market for healthcare facilities. Microfiber pads contain a combination of polyester and
polyamide that provide a cleaning surface 40 times greater than conventional string
mops. A major advantage of the microfiber products is a reduction in the amount of
chemical disinfectant used as well as disposal of it since a clean microfiber is used for
each room. Microfiber products have a long washing lifetime of 500 to 1000 washings.
Microfiber products are ergonomically superior since they are approximately five pounds
lighter than a standard string mop and reduce cleaning times. Most importantly,
microfiber has been found to provide the same or better removal of microorganisms on
surfaces.
REGULATORY/LEGISLATIVE
Amendments to North Carolina Reportable Diseases and Conditions Rule
Effective June 1, 2006, Novel Influenza Virus will become a reportable communicable
disease in North Carolina (NC) under 10A NCAC 41A 0101. The addition is temporary
and will become permanent by the end of the year. This will bring NC in line with the
federal list of quarantinable diseases since President Bush added novel influenza virus
on April 1, 2005.
See the Executive Order at:
http://www.whitehouse.gov/news/releases/2005/04/20050401-6.html
which adds: "(c) Influenza caused by novel or reemergent influenza viruses that are
causing, or have the potential to cause, a pandemic." Physicians who suspect a patient
with this condition must report immediately to their local or state health department. In
the coming months, the General Communicable Disease Control Branch will be adding
an Appendix to the NC Pandemic Influenza Response Plan
(http://www.epi.state.nc.us/epi/gcdc/pandemic.html) that will assist healthcare providers
on evaluating and reporting suspect cases.
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The General Communicable Disease Control Branch is requesting the following
additional amendments to 10 NCAC 41A .0101 Reportable Diseases and Conditions
Rule:
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The category A bioterrorism diseases which include anthrax, botulism, plague,
smallpox, tularemia, and viral hemorrhagic fever should be reported immediately
rather than within 24 hours because mass casualties may result and law
enforcement needs to be notified by public health authorities;
Thrombotic thrombocytopenic purpura needs to be deleted since this condition is
no longer considered communicable;
Congenital toxoplasmosis should be deleted because it is no longer considered a
public health threat with only 1 case reported in NC since 1991; and
Novel influenza virus infection should be reported immediately since an influenza
pandemic is overdue and initial cases need to be reported so that containment
measures can be enforced to prevent further transmission, illness, and death.
(from Dr. Jeffrey Engel, NC Department of Health)
NEWS AND ANNOUNCEMENTS
JCAHO Clarifies Position on Alcohol Hand Sanitizers
March 15, 2006. Corridor location of alcohol-based hand rub (ABHR) dispensers has
been viewed as a key strategy to improved access and adherence to hand hygiene.
Following concerns expressed by multiple stakeholders, JCAHO clarified its December
2005 interpretation that restricted foam dispensers to patient rooms; the new guidance
treats gels and foams the same and now permits foam dispensers in corridors. This
clarification was published in the March 2006 issue of Joint Commission Perspectives.
This new interpretation removes what is hoped to be one of the last barriers to hallway
placement of dispensers with alcohol-based hand sanitizers because of fire safety
concerns.
Recent changes in national and international fire codes lifted previous restrictions for
corridor placement of alcohol-based hand rub (AHBRs) dispensers, in part, because fire
modeling studies on gel formulations showed a low risk for fire hazards if proper
guidelines are followed (e.g., permissible placement and volumes).
Key points of the JCAHO clarification include:
*
Foam dispensers are allowed in corridors if they meet the same conditions
required for gel dispensers (Note: JCAHO states that this position may be modified if
safety concerns arise in the future.)
*
There must be at least six inches from the center of a dispenser to an ignition
source (e.g., electrical outlets).
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*
An equivalent level of safety may be achieved (if all specific requirements
cannot be met) by performing a product-specific risk assessment and determining
alternative methods for managing the risks.
Download a FAQ on placement of dispensers near ignition sources: FAQ on placement
of dispensers <http://lyris.premierinc.com/t/71671/79224/493/0/> (.doc)
For background and more information, go to Premier's Safety Share article archives
<http://lyris.premierinc.com/t/71671/79224/67/0/> and locate "Hand Hygiene" in the
alphabetical index.
This bulletin is a service of Premier Safety Share.
Influenza Vaccination of Health-Care Personnel Recommendations
February 24, 2006. Influenza Vaccination of Health-Care Personnel Recommendations
of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the
Advisory Committee on Immunization Practices (ACIP). This report summarizes
recommendations of HICPAC and ACIP concerning influenza vaccination of health-care
personnel (HCP) in the United States. These recommendations apply to HCP in acute
care hospitals, nursing homes, skilled nursing facilities, physician's offices, urgent care
centers, and outpatient clinics, and to persons who provide home health care and
emergency medical services. The recommendations can assist health-care facility
administrators, infection control professionals, and occupational health professionals in
optimizing influenza vaccination programs and influenza infection control programs in
their institutions. HICPAC and ACIP recommend that all HCP be vaccinated annually
against influenza.
MMWR Recommendations and Reports, Volume 55, No. RR-2, February 24, 2006
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htm
Preventing Tetanus, Diphtheria and Pertussis Among Adolescents
March 24, 2006. Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents:
Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines
Recommendations of the Advisory Committee on Immunization Practices (ACIP). In
2005, two tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap)
vaccine products were licensed for use in adolescents in the United States.
Prelicensure studies documented the safety and efficacy of these products as a single
booster dose. This report summarizes the Advisory Committee on Immunization
Practices recommendations regarding the new vaccine; reviews tetanus, diphtheria, and
pertussis vaccination policy in the United States; and describes the clinical features and
epidemiology of pertussis. MMWR Recommendations and Reports, Volume 55, No
RR-3, March 24, 2006.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5503a1.htm
http://www.cdc.gov/mmwr/pdf/rr/rr55e223.pdf
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CDC’s Advisory Committee Recommends New Vaccine to Prevent Rotavirus
February 21, 2006. Rotavirus is the leading cause of gastroenteritis in infants and
young children in the United States and worldwide. The Advisory Committee on
Immunization Practices (ACIP) to the Centers for Disease Control and Prevention
(CDC) recommend a newly licensed vaccine to protect against rotavirus, a viral infection
that can cause severe diarrhea, vomiting, fever and dehydration (gastroenteritis) in
infants and young children. The ACIP recommendation is for infants to receive three
doses of the oral vaccine at two, four, and six months of age. Children should receive
the first dose of the vaccine by 12 weeks of age and should receive all doses of the
vaccine by 32 weeks of age. There is insufficient data on safety and efficacy outside of
these age ranges. The new vaccine, RotaTeq™ (marketed by Merck and Company), is
the only vaccine approved in the United States for prevention of rotavirus gastroenteritis
(vomiting and diarrhea).
Recommendations of the ACIP become recommendations of CDC once they are
accepted by the director of CDC and the Secretary of Health and Human Services and
are published in the Morbidity and Mortality Weekly Report. For more information on
rotavirus and the rotavirus vaccine, visit www.cdc.gov.
http://www.cdc.gov/nip/pr/pr_rotavirus_feb2006.pdf
Prevention of Hepatitis A Through Active or Passive Immunization
May 19, 2006. Prevention of Hepatitis A Through Active or Passive Immunization
Recommendations of the Advisory Committee on Immunization Practices (ACIP).
Routine vaccination of children is an effective way to reduce hepatitis A incidence in the
United States. Since licensure of hepatitis A vaccine during 1995-1996, the hepatitis A
childhood immunization strategy has been implemented incrementally, starting with the
recommendation of the ACIP in 1996 to vaccinate children living in communities with
the highest disease rates and continuing in 1999 with ACIP's recommendations for
vaccination of children living in states, counties, and communities with consistently
elevated hepatitis A rates. These updated recommendations represent the final step in
the childhood hepatitis A immunization strategy, routine hepatitis A vaccination of
children nationwide.
This report updates ACIP's 1999 recommendations concerning the prevention of
hepatitis A through immunization (CDC. Prevention of hepatitis A through active or
passive immunization: recommendations of the Advisory Committee on Immunization
Practices [ACIP]. MMWR 1999:48[No. RR-12]:1-37) and includes 1) new data on the
epidemiology of hepatitis A in the era of hepatitis A vaccination of children in selected
U.S. areas, 2) results of analyses of the economics of nationwide routine vaccination of
children, and 3) recommendations for the routine vaccination of children in the United
States. Previous recommendations for vaccination of persons in groups at increased
risk for hepatitis A or its adverse consequences and recommendations regarding the
use of immune globulin for protection against hepatitis A are unchanged from the 1999
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recommendations. MMWR Reports and Recommendations Vol 55, No RR-7, May 19,
2006.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.htm
FDA-Requested Recall - Cytosol Laboratories, Inc.
February 13, 2006. The U.S. Food and Drug Administration (FDA) delivered a letter to
Cytosol Laboratories, Inc., of Braintree, MA, to request a recall of all brands and sizes of
Balanced Salt Solution (BSS) that the firm manufactures. BSS is a solution used by
health professionals to irrigate a patient's eyes, ears, nose and/or throat during a
variety of surgical procedures including cataract surgery. FDA requested the recall
because product lots were found to have elevated levels of endotoxin. The BSS
products subject to the recall order were manufactured by Cytosol Laboratories, Inc. for
distribution under 3 labels: "AMO Endosol" distributed by Advanced Medical Optics, Inc.
(AMO), Santa Ana, Calif.; "Cytosol Ophthalmics" distributed by Cytosol Ophthalmics,
Lenoir, NC; and "Akorn" distributed by Akorn, Inc., Buffalo Grove, Ill.
http://www.fda.gov/bbs/topics/news/2006/NEW01315.html
FDA Recall of Some Lots of Cefazolin
March 2, 2006. Hanford Pharmaceuticals and the Food and Drug Administration (FDA)
notified healthcare professionals about the recall of four lots (379,975 vials) of Cefazolin
for Injection, USP, 1 g/10 mL vials, an antibiotic used in a hospital environment to treat
skin and skin structure, respiratory and other infections. The product was distributed by
Sandoz, Inc. of Broomfield, CO and Watson Pharmaceuticals, Inc. of Corona, CA.
Certain lots of the active ingredient used to manufacture the product have been shown
to contain microbial contamination (Bacillus pumilus, Staphylococcus hominis,
Propionibacterium acnes, or Micrococcus luteus) which may pose a serious or lifethreatening risk for some patients. Hospitals, clinics, and users should stop using the
affected lots immediately.
http://www.fda.gov/medwatch/safety/2006/safety06.htm#Cefazolin
New OSHA Handbooks on Glutaraldehyde and Mold
OSHA recently posted to its Web site two new handbooks. Best Practices for the Safe
Use of Glutaraldehyde in Health Care helps employers and employees understand and
control exposures to glutaraldehyde, a toxic chemical used to disinfect and clean heatsensitive medical, surgical and dental equipment. Preventing Mold-Related Problems in
the Indoor Workplace offers recommendations to owners, managers, and occupants on
how to fix mold problems in buildings.
http://www.osha.gov/Publications/glutaraldehyde.pdf
http://www.osha.gov/Publications/preventing_mold.pdf
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FDA Licenses New Vaccine to Reduce Older Americans’ Risk of Shingles
May 25, 2006. The Food and Drug Administration (FDA) licensed Zostavax, a new
vaccine to reduce the risk of shingles (herpes zoster) for use in people 60 years of age
and older. Shingles is a disease caused by the varicella-zoster virus, the same virus
that causes chickenpox. After an attack of chickenpox, the virus lies dormant in certain
nerve tissue. As people age, it is possible for the virus to reappear in the form of
shingles, which is estimated to affect 2 in every 10 people in their lifetime. Shingles is
characterized by clusters of blisters, which develop on one side of the body and can
cause severe pain that may last for weeks, months or years after the virus reappears.
Zostavax is manufactured by Merck & Co., Inc., of Whitehouse Station, New Jersey.
http://www.fda.gov/bbs/topics/NEWS/2006/NEW01378.html
New Antibiotic Active Against Resistant Hospital Pathogens
May 2006. Researchers have discovered a new antibiotic with a unique mechanism of
action that allows it to eradicate several hospital pathogens for which other agents are
often ineffective, such as methicillin-resistant Staphylococcus aureus (MRSA) and
vancomycin-resistant enterococcus (VRE). The antibiotic, named platensimycin, is a
member of a formerly unknown class of antimicrobials produced by Streptomyces
platensis. Nature 2006;441:358-361
(from Reuters Health)
Boca Medical Products, Inc. Issues Nationwide Recall of Insulin Syringe Product
May 19, 2006. Boca Medical Products, Inc., of Coral Springs, Florida initiated a recall of
41 boxes of Closercare Insulin Syringe 29g 1cc product lot number 5JCZ1 as displayed
on the inner case and 2320 boxes of Ultilet Insulin Syringe 30g 1/2cc product lot
number 5KEO1 as displayed on the inner case. The products are being recalled
because of bacterial contamination with Paenibacillus. This presents a risk of local
infection due to soft tissue injection with a contaminated syringe as well as a risk of
introduction of contaminating organisms into a previously sterile vial. The introduced
contamination may degrade the insulin, which could lead to problems maintaining
insulin levels. Previous recalled lot was 5GEX1.
Consumers who have product lots 5JCZ1 and 5KEO1, should stop usage and return the
specific products. Wholesalers should stop retail and return the product lots. For any
question related to the case; consumers should call 1-800-354-8460.
http://www.fda.gov/medwatch/safety/2006/closercare_recall.htm
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COURSES FOR THE INFECTION CONTROL PROFESSIONAL
“Infection Control Part II: The ICP as an Environmentalist” will be held in Chapel Hill
September 18-22, 2006. Registration and course information are available online.
http://fridaycenter.unc.edu/pdep/icii/
"Infection Control in Long-Term Care Facilities” will be held October 23-25, 2006 in
Chapel Hill. Information about the March 2006 course is available online.
http://fridaycenter.unc.edu/pdep/iclong/
“Infection Control Part I: Clinical Surveillance of Healthcare-Associated Infections” will
be held in the spring of 2007. Information about the May 2006 course is online.
http://fridaycenter.unc.edu/pdep/ici/
-----------------------------------------------------------------------------------Contributors to Report of the Month: Karen K. Hoffmann, RN, MS, CIC; William A.
Rutala, PhD, MPH; David J. Weber, MD, MPH; Jennifer MacFarquhar, RN, BSN, CIC;
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.
Sent July 2006
Copyright 2006 Statewide Program for Infection Control and Epidemiology