International Infection Prevention Week was celebrated from Oct. 20-26. At my facility, we pushed it back to Halloween and called our event "Spooked by Germs. " The Infection Prevention department co hosted the Fair with the perioperative team because we knew it would increase traffic to the booths and it proved to be a great collaborative effort.
There were flu shots - of course- and we had the Department of Health and Human Services' Partnering to Heal video available. (http://www.hhs.gov/ash/initiatives/hai/training/) Our peri-op nurse educator organized a Jeopardy game with categories such as: hand hygiene, surgical asepsis and personal protective equipment. I'm not sure who scored the most points and won the big prizes but everyone had fun and learned something new. We used educational handouts that were suitable for our staff as well as the visitors who were waiting for their loved ones.
The APIC website had a great variety of crossword puzzles, word search and pamphlets. (http://professionals.site.apic.org/the-week-iipw/resources/rise-to-the-occasion/) Everyone left with a pumpkin faced goodie bag -which I'm sure you know included hand sanitizer among the candy.
This week (Nov. 11-15) is Perioperative Nurses' Week -which gives me a chance to share in their celebration for safe patient care.
When I first began as an Infection Preventionist, staff often asked about terminally cleaning a room by fogging it. This was usually requested after a particularly contaminated case or for patient with lice. The staff was referring to a practice of fogging a room with a chemical or steam in an attempt to destroy any microbes and other living things like a pesky louse.
I'd never actually seen this method. It was abandoned because there was no scientific evidence that it changed the "flora" of the patient room. Additionally, one of the chemicals used - paraformaldehyde - is no longer registered for use with the EPA. And finally, it was inconvenient because the room was unusable for a period of time.
More recently, the recognition that a patient's room can serve as a fomite for transmission of organisms has renewed interest in more encompassing methods of room disinfection. For example, in a 2006 article, Kramer and his colleagues report that Klesbiella species can last from 2 hours - months and C. difficile spores can last for 5 months!
Technologies to address this concern have been introduced in hospitals. One technology is the use of vaporized aqueous hydrogen peroxide. A portable machine is wheeled into a vacated area and the vapor is delivered into this closed space. Another example is the use of ultraviolet radiation to decontaminate a room. The unit is placed in a room and is timed to work while the environmental service staff remains safely outside the room. Both of these technologies have been used in other industries - air handling and water treatment (UV) and pharmaceutical and medical device sterilization (peroxide). Both methods have been shown to reduce microbial contamination.
Rooms must still be physically cleaned before use of these technologies. But traditional cleaning is sometimes ineffective and these technologies have the advantage of disinfecting all surfaces that are exposed to the light or the chemical.
While far from commonplace, these technologies have been successfully implemented for cleaning high risk areas such as OR and isolation room so keep an eye out for them in your facility.
The week of Sept. 8 was designated to recognize health care environmental services workers (EVS). Regardless of your work setting, the patients notice the cleanliness of their rooms and the facility. And of course, we nurses often hype on the job that is done or not done by the environmental care workers.
We should not underestimate the valuable role of these support workers to improving patient safety. There is growing evidence that the environment can be a vector for transmission of pathogens and in my next blog I'll mention some new technology for cleaning and disinfection.
Right now, I'd like to focus on how the patient perceives the housekeeper's job.
The environment is reflected in question 8 of the in the Hospital Consumer Assessment of Health Plans Survey (or Hospital CAHPS®). (www.hcahpsonline.org/surveyinstrument.aspx)
According to Hospital Compare, the current national benchmark is that 73% of patients felt that their room and bathroom were always clean. Because of the importance of room cleanliness, many facilities are implementing programs and practices that help emphasize the work of the EVS department - visual cues like a tent card with the EVS staff's name on the over bed table or a liner on the clean toilet. Staff members are being coached on checking with the patient if there's anything else the EVS team member can do.
On this note I had a funny incident when visiting my father in-law in the hospital. The housekeeper assured him several times that she had cleaned the room, the bathroom and the floors. She asked repeatedly, "Do you need anything else?" Not realizing why she was so persistent in telling what she had accomplished, my father- in-law later asked me, "Did she want a tip?"
So let's hope cleanliness of our facilities speak for themselves - you can check your hospital's scores at the Hospital Compare site. www.medicare.gov/hospitalcompare
In the past 6 months, my local Medical Reserve Corps had been activated twice to help staff a Point of Distribution (POD) clinic to provide prophylaxis for Hepatitis A exposures.
The first episode involved a restaurant worker. The index case in the second incident was a market worker who potentially exposed 2000 people.
Hepatitis A is a virus that is spread by the fecal oral route from either person to person contact or by eating contaminated food or water. For example, the CDC is investigating an outbreak in 10 states that affected more than 150 people who consumed pomegranate berry mix. The disease has an incubation period of approximately 28 days and it usually resolves on its own. Symptoms are more likely to occur in adults whereas the disease is usually asymptomatic in children. A small percentage of people have relapse of their symptoms in the first 6 months.
Treatment is directed at symptoms as there is no specific therapy. Vaccination against Hepatitis A is recommended for all children at age 1 year, for persons who are at increased risk for infection (e.g. travelers to areas where the disease is endemic), for persons who are at increased risk for complications from Hepatitis A (e.g. people with Hepatitis C infection), and for anyone wishing protection.
Have you ever rushed to get CIPRO from the employee health service when you heard you had a patient with meningitis? I'm often asked about patients with meningitis - which ones need isolation, which types of meningitis mean SOME staff members need prophylactic antibiotics? This question tends to arise in the summer because there are more cases of enteroviral meningitis at this time of year in the U.S.
It can be confusing because the term meningitis simply means an inflammation of the membranes surrounding the brain and spinal cord. Several different organisms can cause it - in fact the CDC lists five separate types of meningitis. The symptoms-headache, fever, stiff neck, photophobia - can be similar regardless of the origin.
In general, bacterial meningitis tends to be more severe than viral meningitis. Some bacterial meningitis are spread by close contact with respiratory secretions like when intubating a patient but most are not as contagious as the cold or the flu.
In fact, only meningitis caused by meninogoccus or Haemophilus influenzae type b are indications for preventive antibiotics. And then it should only be used for people who had intimate contact with the sick person. Patients with either of these two types of meningitis should be placed on droplet precautions.
Other preventive strategies include:
- Following the vaccine schedule for yourself and children
- Wash your hands thoroughly and often, especially after changing diapers, using the toilet, or coughing or blowing your nose.
- Clean contaminated surfaces, such as doorknobs or the TV remote control, with soap and water and then disinfect them with a dilute solution of chlorine-containing bleach.
- Avoid kissing or sharing a drinking glass, eating utensil, lipstick, or other such items with sick people or with others when you are sick.
Have healthy summer.
As part of its ongoing mission to eliminate needlestick and sharps injuries in healthcare, Safe in Common (SIC) has issued the "Top 10 Golden Rules of Safety." This set of guidelines was outlined in conjunction with supporters to unify the industry around efforts to fight needlestick injuries and raise awareness about effective prevention techniques.
The outline for the Top 10 Golden Rules of Safety was released at the annual Association for Professionals in Infection Control and Epidemiology (APIC) Convention earlier this month.
The list is predicated on making injuries a "never event" and dictates that personnel using or purchasing sharps consider the following rules:
- The design and activation of the safety mechanism is automatic and will not interfere with normal operating procedures and processes
- The device is intuitive and requires no additional steps for use than equivalent standard/conventional device
- The contaminated, non-sterile sharp will be rendered safe prior to removal or exposure to the environment
- Activation of the safety mechanism does not require the healthcare worker to undertake any additional steps during normal process/protocols providing patient care
- Activation of the safety mechanism will not create additional occupational hazards (such as aerosolization, splatter, exposure to OPIM, etc.)
- Activation of the safety mechanism does not cause additional discomfort or harm to the patient
- The device will be ergonomically designed for comfort, allowing for automatic one-handed use during all stages of patient procedure
- The safer engineering control is available in sizes and iterations appropriate for all areas of use relevant to the patient care needs
- Disposal of safety device will not increase waste disposal volumes but should incorporate designs to reduce waste
- The used safety device will provide convenient disposal and mitigate any risk of reuse or re-exposure of the non-sterile sharp
"For the first time, the most experienced healthcare leaders have joined together to outline the rules for what it takes to keep all healthcare personnel safe and free of injury," said Barbara DeBaun, RN, MSN, CIC and Improvement Advisor for Cynosure HealthCare environments, who helped advise Safe in Common on these guidelines . "With these rules, we're getting the industry thinking about where we are and where we need to go to make safety a priority and injuries a never event."