Evidence-Based Strategies to Fight Infection

The AHA and four other health care organizations today released on Oct. 8 a compedium of strategies to help prevent the most dangerous infections that hospitals face. Distilled from the latest guidelines and scientific evidence, the compendium identifies what hospitals should be doing, and how, to prevent staph and C. difficile infections, ventilator-associated pneumonia, bloodstream infections caused by central-line catheters, and urinary tract and surgical site infections.

“As of today, the nation’s infection control team has a common ‘play book’ − one that harnesses the latest authoritative information in a clear and concise manner for everyone’s benefit …especially the patient,” said AHA President and CEO Rich Umbdenstock at a Washington, DC, press event. In addition to the AHA, the partnership includes the Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Association for Professionals in Infection Control and Epidemiology, and The Joint Commission.

The full text of The Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals is available here.

ref. AHANews.com

Nashua, NH Dental Office Faces $75k OSHA fine

"Whopper of a fine!

OSHA cites Allcare Dental Nashua office for allegedly violating occupational health standards after an employee suffered a needlestick injury. The office faces $76,500 in proposed fines.
The OSHA inspection, conducted by OSHA's Concord area office, found that the Allcare office did not provide the injured employee with no-cost, post-exposure medical evaluation and follow-up and did not have the blood of the source individual tested, as required under OSHA's bloodborne pathogens standard.

Although the alleged needle stick incident took place back in November 2007, OSHA did not become aware of it until about 31 1/2 months later when they received a complaint. [So, where do you think that OSHA received a complaint from? It is important to follow guidelines to protect your healthcare workers for their sake and for the sake of your business!]

Allcare was cited with one willful citation, with a proposed $63,000 fine because the source individual's blood was not tested, although required. In addition six serious citations, with $13,500 in proposed fines, were issued for not providing the post-exposure evaluation and follow-up; not annually reviewing and updating the exposure control program; training deficiencies; and not using sharps with engineered sharps protection."

ref. International Sharps Injury Prevention Society Newsletter, Sept. 26, 2008

It is incredible that there are about 1 million needlestick and other sharps injuries that continue to occur each year among healthcare workers in the United States. This is unacceptable! Healthcare employers are obligated to provide a safe workplace for their employees and provide annual bloodborne pathogens training and implemention of sharps safety devices.

For information on how to comply with OSHA Standards and compliance to sharps safety, please contact safetyDRs, tel. (888) 669 - 8846, x703

Recommendations for 'Flu Control & Prevention

MMWR
Recommendations and Reports
Volume 57, No. RR-7 August 08, 2008

PDF of this issue: http://www.cdc.gov/mmwr/PDF/rr/rr5707.pdfhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5707a1.htm?s_cid=rr5707a1_e

Prevention and Control of Influenza Recommendations of the AdvisoryCommittee on Immunization Practices (ACIP), 2008. This report updates the 2007 recommendations by CDC's AdvisoryCommittee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control ofinfluenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2007;56[No. RR-6]). The 2008 recommendations include new and updated information.

Principal updates and changes include 1) a new recommendation that annual vaccination be administered to all children aged 5--18 years, beginning in the2008--09 influenza season, if feasible, but no later than the 2009--10 influenza season; 2) a recommendation that annual vaccination of all children aged 6 months through 4 years (59 months) continue to be aprimary focus of vaccination efforts because these children are athigher risk for influenza complications compared with older children;3) a new recommendation that either trivalent inactivated influenzavaccine or live, attenuated influenza vaccine (LAIV) be used when vaccinating healthy persons aged 2 through 49 years (the previous recommendation was to administer LAIV to person aged 5--49 years); 4) a recommendation that vaccines containing the 2008--09 trivalentvaccine virus strains A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Florida/4/2006-like antigens be used; and, 5) new information on antiviral resistance among influenza viruses in the United States. Persons for whom vaccination is recommended are listed in boxes 1 and 2.

These recommendations also include a summary of safety data for U.S. licensed influenza vaccines.This report and other information are available at CDC's influenza website (http://www.cdc.gov/flu), including any updates or supplementsto these recommendations that might be required during the 2008--09influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.

Emerging Infectious Disease (EID) Journal

Emerging Infectious Diseases (EID) journal provides recognition of new and re-emerging infections and understanding of factors involved in disease emergence, prevention, and elimination. It also represents the scientific communications component of CDC's efforts against the threat of emerging infections.

See the August 2008 issue of the EID journal at the following link: http://www.cdc.gov/ncidod/EID/index.htm

Mass Casualty Events

Mass Casualty EventsRecommendations for Postexposure Interventions to Prevent Infection with Hepatitis B Virus, Hepatitis C Virus, or Human Immunodeficiency Virus, and Tetanus in Persons Wounded During Bombings and Other Mass-Casualty Events - CDC - MMWR Recommendations and Reports - Aug 1

This report outlines recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or tetanus in persons wounded during bombings or other events resulting in mass casualties. Persons wounded during such events or in conjunction with the resulting emergency response might be exposed to blood, body fluids, or tissue from other injured persons and thus be at risk for bloodborne infections.

This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass-casualty event. The recommendations contained in this report represent the consensus of U.S. federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5706a1.htm <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5706a1.htm?s_cid=rr5706a1_e>

ref. CDC Updates for Clinicians: July 28-August 4, 2008

2008 Study of Nurses' Views on Workplace and Needlestick Injuries

The 2008 Study of Nurses' Views on Workplace Safety and Needlestick Injuries, an independent survey of more than 700 U.S. nurses, sponsored by the American Nurses Association (ANA) and Inviro Medical Devices revealed that needlestick injuries and bloodborne infections remain concerns for nearly two-thirds (64%) of nurses. The research also highlights that safety concerns influence the decisions made by the vast majority of nurses (87%) about the type of nursing they do, and that nearly two-thirds of nurses (64%) have been accidentally stuck by a needle while working.

The study is sponsored by the American Nurses Association. Research results can be downloaded at: www.nursingworld.org.

OSHA Offers Guide to Stockpiling Masks, Respirators

US Department of Labor (DOL) yesterday released proposed guidance on stockpiling respirators and facemasks in the workplace, which encourages employers to stockpile the items because of the likelihood that they will run short during an influenza pandemic.

The proposed guidance lists stockpiling estimates for individual employees in a range of medium- to very high-risk jobs, listing numbers of masks or respirators by work shift and a theoretical pandemic duration (about 120 work days). For example, a retail-store employee might need two masks per shift and 240 for the duration of a pandemic, whereas a nurse in a medical office or clinic classified has high risk might need four N95 respirators per shift and 480 to cover the whole pandemic. Dental professionals are classified as high risk due to performing aerosol generating procedures and recommended to have 960 masks available per employee .

It is important to note that healthcare workers must be first fit-tested for N95 respirators for proper sizing and use.

See: Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza: http://www.osha.gov/dsg/guidance/stockpiling-facemasks-respirators.html

Ref. Center for Infectious Disease Research & Policy Academic Health Center -- University of Minnesota

Please contact safetyDRs at (888) 669 - 8846 x 701 for low cost, on-site, N95 respirator fit-testing.

Employers Must Post OSHA Illness/Injury Summaries Beginning Feb. 1, 2008

SafetyDRs would like to reminded employers that beginning Feb. 1, they must post a summary of the total number of job-related injuries and illnesses that occurred during 2007. Employers are only required to post OSHA Form 300A (summary), not the OSHA 300 log.

The summary must be posted from Feb. 1 to April 30, 2008. The summary must list the total number of job-related injuries and illnesses that occurred in 2007 and were logged on the OSHA 300 form. Information about the annual average number of employees and total hours worked during the calendar year is also required to assist in calculating incidence rates. Companies with no recordable injuries or illnesses in 2007 must post the form with zeroes on the total line. All summaries must be certified by a company executive.

The form is to be displayed in a common area wherever notices to employees are usually posted. Employers with ten or fewer employees and employers in certain industry groups are normally exempt from federal OSHA injury and illness recordkeeping and posting requirements.

Copies of the OSHA Forms 300 and 300A are available on the OSHA Recordkeeping Web page in either Adobe PDF or Microsoft Excel Spreadsheet format.

New Respirator Fit-Testing Protocol

OSHA recently published a Notice of Proposed Rulemaking for a new respirator fit-testing protocol—the Abbreviated Bitrex® Qualitative Fit-Testing (ABQLFT) protocol. The proposed rule would add the ABQLFT protocol as an alternative to the current OSHA-approved qualitative fit-test procedures. The ABQLFT protocol for the seven exercises listed in the existing OSHA-approved Bitrex fit-test procedure in the Respiratory Protection standard would shorten the duration of each of the seven fit-test exercises from one minute to 15 seconds. Comments are being accepted until Feb. 25, 2008.

Do you have N95 respirators for your staff? N95 respirators should be used for contact with known or suspected patients with certain airborne infectious disesases (e.g. Tuberculosis, SARS, Pandemic Influenza). SafetyDRs can come to your office and fit-test applicable staff. It only takes about 10 minutes per employee and the required written OSHA Respiratory Protection Plan is included. Access to low cost N95 respirators are also available. Please contact safetyDRs at: (888) 669 - 8846, 701

Norovirus spreads via keyboard and mouse

The CDC reports an outbreak of acute gastroenteritis in an elementary school associated with contaminated computer keyboards. Norovirus causes the majority of acute gastroenteritis outbreaks in the United States. Person-to-person spread through the fecal-oral route, contaminated food and water, and aerosolized vomitus are known to transmit norovirus; contact with contaminated environmental surfaces also has been implicated in transmission.

Laboratory studies have demonstrated that fingers contaminated with norovirus can transfer the virus to environmental surfaces, which can subsequently contaminate clean fingers with detectable amounts of norovirus. Because of shared computer use in health-care facilities, schools, and workplaces, certain researchers have suggested that computer equipment might be a route of bacterial disease transmission.

Proper washing with soap and water can eliminate norovirus from hands; alcohol-based sanitizers may also be effective. Potentially (but nonvisibly) soiled surfaces are best disinfected with a solution of 1:50 to 1:10 concentration of household bleach in water (1,000--5,000 ppm chlorine) by vigorous wiping for >10 seconds. Disposable towels used to clean visibly soiled surfaces should be discarded appropriately after use because they can transfer norovirus to fingers and other surfaces

Care should be taken when cleaning computer equipment. Washable keyboards and mice are available.

Ref. MMWR, January 4, 2008 / 56(51);1340-1343

New Year Safety Resolutions!

Let 2008 be the year that you and your staff work towards a positive safety culture. OSHA has acknowledged that those facilities that have a total safety culture have less employee injuries and increased work productivity. Here are some tips to consider:

- Ensure that you accomplish required education and training (i.e. annual bloodborne pathogens training).

- Conduct a survey to identify where you are using sharps in your office. Identify potential sharps safety devices (engineering controls) and have your staff evaluate them and implement as applicable.

- Get everyone involved. Share the responsibility to check eyewash stations, fire extinguishers, maintain material safety data sheets, labelling secondary chemical containers, etc.

Let safetyDRs (formally Dynamic Dental Safety) help you with all your office safety compliance and training. We provide a comprehensive and cost-effective solution of becoming your partner in maintaining safety and risk management in your facility. The program includes all required manuals, on-site safety surveys and assistance with ensuring your facility is in complete regulatory compliance and on-site training for your staff including continuing education credit and 24/7 telephone support. Contact safetyDRs at: (888) 669-8846 x703 or visit us at safetyDRs.com.