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Volume 16 - February 1995

Contents

Page 8 of 17

Practical Healthcare Epidemiology

  • OSHA Inspections

  • August J. Valenti, Michael D. Decker
  • Published online by Cambridge University Press:
    02 January 2015, pp. 478-482

  • The Occupational Safety and Health Act of 1970 requires that every worker be provided with a safe and healthful workplace and authorizes the Occupational Safety and Health Administration (OSHA) to conduct workplace inspections. OSHA conducts workplace inspections in hospitals and checks for compliance with the Bloodborne Pathogens Standard, the Enforcement Policy and Procedures for Occupational Exposure to Tuberculosis, and the Hazardous Chemicals Standards, among others. The hospital epidemiologist bears considerable responsibility for developing and implementing plans to protect employees from occupational exposures to infectious hazards such as bloodborne pathogens and tuberculosis. To prepare for an inspection, the hospital epidemiologist must understand the basis on which OSHA operates and must proceed in a thoughtful, coordinated manner.

Original Articles

  • Evaluation of a Rapid Readout Biological Indicator for 121°C Gravity and 132°C Vacuum-Assisted Steam Sterilization Cycles

  • Donald Vesley, Melissa A. Nellis, Paul B. Allwood
  • Published online by Cambridge University Press:
    02 January 2015, pp. 281-286
  • Objective:

    A biological indicator (BI), based on fluorescent detection of a spore-associated enzyme, has been developed. We evaluated the new BI against five conventional self-contained BIs in a 121°C gravity-displacement sterilizer and, packaged in towel packs and disposable steam test packs, in a 132°C vacuum-assisted sterilizer.

    Design:

    In the 121°C gravity-displacement sterilizer, rapid readout BIs and conventional BIs were tested together in an otherwise empty chamber. Exposure times were 5, 10, and 15 minutes. In the 132°C vacuum-assisted steam sterilizer, BIs were contained in towel packs or disposable steam test packs. Surgical packs were added to represent a full load. Exposure times were 0, 1, and 2 minutes.

    Result:

    In gravity-displacement 5-minute cycles, the rapid readout BIs yielded 100% positive results within 30 minutes. The conventional BIs ranged from 72% to 100% positive in 48 hours. At 10 minutes, the rapid readout BIs were 83% positive after 3 hours, whereas the conventional BIs ranged from 0% to 37% positive after 48 hours. All indicators were negative after 15-minute exposures. In vacuum-assisted cycles, all indicators were negative after 3 minutes. After 1-minute exposures, the rapid readout BIs were 40% to 60% positive, whereas the conventional BIs were 15% to 20% positive.

    Conclusion:

    The rapid readout BIs are a more sensitive indicator of marginal steam sterilization cycles than conventional selfcontained BIs. They yield results within 3 hours, as compared to 24 to 48 hours for the conventional BIs.

Symposium: Nosocomial Colonization

  • Nosocomial Colonization and Its Impact on Hospital-Acquired Infections

  • C. Glen Mayhall
  • Published online by Cambridge University Press:
    02 January 2015, p. 647

  • We are pleased to bring to our readership the contents of a symposium on nosocomial colonization held on January 14-16, 1994, in Clearwater, Florida, under the aegis of the University of South Florida College of Medicine and the National Foundation for Infectious Diseases.

    The symposium was developed with the following goals: (1) to provide an up-to-date over view of the factors important in microbial colonization of human nonsterile surfaces or tissues, especially skin, nose, oropharynx, and gastrointestinal tract; (2) to provide an understanding of the impact of colonization upon the development of nosocomial infections; and (3) to provide an appreciation of how to control or manage colonization to prevent nosocomial infections.

Special Report

  • Recommendations for Preventing the Spread of Vancomycin Resistance

  • Hospital Infection Control Practices Advisory Committee (HICPAC)
  • Published online by Cambridge University Press:
    02 January 2015, pp. 105-113

  • A rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (WE) has been reported from U.S. hospitals in the last 5 years. This increase poses several problems, including: a) the lack of available antimicrobials for therapy of infections due to VRE, since most VRE are also resistant to multiple other drugs, e.g., aminoglycosides and ampicillin, previously used for the treatment of infections due to these organisms, and b) the possibility that the vancomycin resistance genes present in VRE may be transferred to other gram-positive microorganisms such as Staphylococcus aureus.

    An increased risk of VRE infection and colonization has been associated with previous vancomycin and/or multi-antimicrobial therapy, severe underlying disease or immuno-suppression, and intra-abdominal surgery. Because enterococci can be found in the normal gastrointestinal or female genital tract, most enterococcal infections have been attributed to endogenous sources within the individual patient. However, recent reports of outbreaks and endemic infections due to enterococci, including VRE, have shown that patient-to-patient transmission of the microorganisms can occur either via direct contact or indirectly via hands of personnel or contaminated patientcare equipment or environmental surfaces.

    Prevention and control of the spread of vancomycin resistance will require coordinated, concerted effort from various departments of the hospital, and can only be achieved if each of the following elements is addressed: 1) prudent vancomycin use by clinicians, 2) education of hospital staff regarding the problem of vancomycin resistance, 3) early detection and prompt reporting of van-comycin resistance in enterococci and other gram-positive microorganisms by the hospital microbiology laboratory, and 4) immediate implementation of appropriate infection-control measures to prevent person-to-person transmission of VRE.

Practical Healthcare Epidemiology

  • The Computer-Based Patient Record: The Role of the Hospital Epidemiologist

  • David C. Classen, John P. Burke
  • Published online by Cambridge University Press:
    02 January 2015, pp. 729-736

  • Despite advances in computers and software for data analysis, hospital epidemiologists still must use manual methods for data collection. To automate infection control surveillance fully, healthcare institutions need computerized medical records; however, very few institutions currently have such a system. Healthcare institutions appreciate the need for automation, but frequently do not see a clear path to the desired outcome. In this article, we outline the important issues that hospital epidemiologists must understand if they wish to help their institutions to computerize their medical records.

Medical News

  • HIV Transmission Reported in Dialysis Center

  • Gina Pugliese
  • Published online by Cambridge University Press:
    02 January 2015, p. 482
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Concise Communications

Medical News

  • TB Cases Decline in New York City for Second Year in a Row

  • Gina Pugliese
  • Published online by Cambridge University Press:
    02 January 2015, p. 286
    • Article
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Special Report

  • The Future of the Hospital Epidemiologist in the 1990s: Presidential Address, SHEAAnnual Meeting, April 1994

  • Peter A. Gross
  • Published online by Cambridge University Press:
    02 January 2015, pp. 179-182

  • While the Democrats and the Republicans debate the Health Care Reform Bill and how we are going to pay for universal coverage, a revolution in healthcare delivery already is taking place right under our eyes. Even if the federal government doesn't pass legislation on healthcare this term, the healthcare delivery system will have been changed so dramatically that it will be unrecognizable from what we knew just a couple of years ago. Consolidation of hospitals, cost reduction, and the quality of care are themes that will be evident in medical delivery for the next few years. Among these three, cost reduction is and will be the engine of change.

Book Reviews

Symposium: Nosocomial Colonization

  • Molecular Aspects of Bacterial Colonization

  • Alan L. Bisno
  • Published online by Cambridge University Press:
    02 January 2015, pp. 648-657

  • Bacteria have developed a wide variety of molecular mechanisms that permit firm adherence to a biologic surface. This review summarizes basic principles involved in this process, as exemplified by adherence of the group A streptococcus to oral epithelium, staphylococci to indwelling prostheses, and Escherichia coli to uroepithelium and enterocytes.

Medical News

  • Newly Identified Virus Kills Trainer and 14 Horses in Australia

  • Gina Pugliese
  • Published online by Cambridge University Press:
    02 January 2015, p. 347
    • Article
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  • Senate Votes on Ryan White Act

  • Gina Pugliese
  • Published online by Cambridge University Press:
    02 January 2015, p. 511
    • Article
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  • GAO Releases Report on VA Hospitals and Use of Safer Needle Devices

  • Gina Pugliese
  • Published online by Cambridge University Press:
    02 January 2015, p. 235
    • Article
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Original Articles

  • Control of Methicillin-Resistant Staphylococcus Aureus in a Hospital and an Intensive Care Unit

  • Alan I. Hartstein, Mark A. Denny, Virginia H. Morthland, Ann M. LeMonte, Michael A. Pfaller
  • Published online by Cambridge University Press:
    02 January 2015, pp. 405-411
  • Objective:

    To describe methicillin-resistant Staphylococcus aureus (MRSA) control in a hospital, including a surgical intensive care unit (SICU) outbreak.

    Design:

    Prospective surveillance of newly identified patients with MRSA. Barrier isolation (disposable gloves for direct contact with patient or immediate environment) was used for the routine care of hospitalized MRSA patients as of October 1991. Begirming in 1992, MRSA isolates were typed by restriction endonuclease enzyme analysis of plasmid DNA (REAP) and/or pulsed-field gel electrophoresis of genomic DNA (PFGE). Surveillance information and MRSA typing were used concurrently to identify nosocomial case clustering, confirm cross-infection, and support a need for additional outbreak control interventions.

    Setting:

    University-affiliated public hospital.

    Participants:

    Patients with newly identified MRSA colonization or infection from 1991 through 1993 and epidemiologically associated staff providing care to eight SICU patients in an outbreak.

    Interventions:

    Barrier isolation for affected and unaffected patients in and admitted to the SICU institution when the outbreak was identified and cross-infection confirmed. Anterior nares cultures of staff in contact with outbreak cases for detection of MRSA colonization.

    Results:

    Fifty-six hospitalized patients with community-acquired MRSA and 80 patients with nosocomial MRSA colonization or infection were identified during the 3 years. After the introduction of barrier isolation, the annual frequency of new nosocomial MRSA cases decreased and only one outbreak (eight cases in the SICU) caused by type-related isolates occurred, The other 35 nosocomial cases of MRSA during 1992 and 1993 were not epidemiologically related or were caused by isolates with different types. The SICU outbreak ended after instituting barrier isolation for all patients (with and without MRSA) in and admitted to the unit. Six colonized SICU staff were identified. All outbreak cases had identical or related MRSA types by PFGE and REAP. Staff isolates were different from case isolates by typing, and staff were not restricted and not given treatment for colonization. After more than 6 months of follow up, no further outbreaks of MRSA in the SICU or elsewhere in the hospital occurred despite returning to barrier isolation for affected patients only.

    Conclusion:

    MRSA in hospitals and outbreaks of MRSA in ICUs can be controlled by surveillance and minimal barrier interventions. REAP or PFGE typing of MRSA can be used to support or refute the presence of cross-transmission. Typing also may be helpful when planning and assessing the effectiveness of interventions directed at endemic, as well as outbreak, MRSA control.

Healthcare Agencies Pertinent to Infection Control

  • Joint Commission on Accreditation of Healthcare Organizations

  • Carole H. Patterson
  • Published online by Cambridge University Press:
    02 January 2015, pp. 36-42

  • The Joint Commission on Accreditation of Healthcare Organizations was founded in 1951 as a private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations. In 1987, the JCAHO launched its Agenda for Change to create a more modem and sophisticated accreditation process to place primary emphasis on actual performance. Coincident with this new emphasis, a number of task forces were established, including two for infection control standards.

Original Articles

  • Impact of the Bloodborne Pathogens Standard on Vaccination of Healthcare Workers with Hepatitis B Vaccine

  • Tracy B. Agerton, Francis J. Mahoney, Louis B. Polish, Craig N. Shapiro
  • Published online by Cambridge University Press:
    02 January 2015, pp. 287-291
  • Objectives:

    To evaluate the impact of Occupational Safety and Health Administration (OSHA) regulations on the vaccination of healthcare workers (HCWs), to assess interpretation of these regulations, and to evaluate changes in hospital vaccination policies.

    Design:

    Between June 1, 1992, and August 15, 1992, a telephone survey was conducted among 150 hospitals selected randomly from participants in the American Hospital Association 1991 annual survey.

    Results:

    Of the 150 hospitals, 96 (64%) provided information on hepatitis B vaccination coverage of their employees. Of the 103,419 employees in these hospitals, 77,302 (75%) were eligible to receive the hepatitis B vaccine, and 38,850 (51%) of these were vaccinated completely (had received 3 doses of vaccine). Following issuance of the final regulations, 73% of hospitals reported greater employee acceptance of hepatitis B vaccine, and hospitals were more likely to offer hepatitis B vaccine to maintenance workers, security personnel, dietary staff, and clerical personnel. Seventy-five hospitals (59%) reported conducting postvaccination serologic testing on all hospital employees, 12 (8%) as a result of OSHA regulations. Twenty-three hospitals (16%) reported administering routine booster doses of hepatitis B vaccine at 3, 5, or 7 years.

    Conclusions:

    The new OSHA standard resulted in a greater awareness of risk for HBV infection among HCWs and an increase in the number of HCWs receiving hepatitis B vaccine; however, vaccination coverage remained suboptimal. Postvaccination serologic testing of employees with negligible risk and the routine administration of vaccine booster doses may be diverting resources and preventing comprehensive coverage of high-risk employees.

Medical News

  • CDC Reports a Decline in TB Cases for Second Year in a Row

  • Gina Pugliese
  • Published online by Cambridge University Press:
    02 January 2015, p. 411
    • Article
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Bulletins

Practical Healthcare Epidemiology

  • Infection Control in Long-Term-Care Facilities

  • Lindsay E. Nicolle, Richard A. Garibaldi
  • Published online by Cambridge University Press:
    02 January 2015, pp. 348-353

  • Although patients in long-term-care facilities are at increased risk of infection, little is known about how to practice infection control in this setting. This article reviews risk factors for infection, the components of an infection control program, and particular infections that are important in long-term care facilities. In addition, special characteristics of long-term-care facilities that challenge the individuals charged with conducting effective infection control programs will be discussed.

Page 8 of 17