CRE and NHSN LabID Event Webinars

There were two webinars held in mid-July by our good friends at the NC Department of Public Health.  They are currently available for viewing on the SPICE website.  

CRE Webinar

In addition to viewing the webinar, users may download the webinar slides, recommendations for CRE Infection Prevention in Acute Care and Long Term Care Facilities, templates for a transfer form, and a CRE education power point template based on the webinar.

NHSN LabID Webinar

Users can also download the webinar slides

Current Principles and Practices; New Research; and New Technologies in Disinfection, Sterilization and Antisepsis: A Special Edition of the American Journal of Infection Control, May 2013;41:S1-S114

Bill Rutala

by William A. Rutala, PhD, MPH and David J. Weber, MD, MPH

Healthcare-associated infections are an important source of morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths annually in the United States.  The major source of healthcare-associated pathogens is thought to be the patient’s endogenous flora, but an estimated 20% being due to other transmission routes such as the environment and 20-40% attributed to cross-infection via the contaminated hands of healthcare personnel [1].

David Weber

A Special Editor of the American Journal of Infection Control, which was primarily developed from a symposia presented at the APIC annual meeting in 2012, provides concise reviews of the scientific literature and current guidelines in three important areas of infection control.  First, the role that the contaminated room environment plays in the transmission of several important healthcare-associated pathogens (e.g., methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus spp. [VRE], Clostridium difficile, and Acinetobacter spp.).  Second, an update of issues regarding skin antisepsis including hand hygiene.  Finally, reviews of new current issues in sterilization and disinfection of medical devices and instruments including new technologies. 

In the past decade, substantial scientific evidence has clearly demonstrated that contaminated room surfaces are an important component in the transmission of key healthcare-associated pathogens.  Evidence supporting this view includes that these pathogens persist in the environment for prolonged periods of time (hours, days, months), frequent contamination occurs of the hands/gloves of healthcare personnel, contact with the environment is equally likely to lead to hand/glove contamination, and admission to a room previously occupied by a patient colonized or infected with one of these pathogens increases the risk the subsequent patient will develop an infection with one of these pathogens.

Brief Report: Measles Outbreak Associated with a Traveler to India—North Carolina, April-May 2013

Kristin Sullivan

On April 14, 2013, local and state public health officials were notified of suspected measles infections among unvaccinated members of a family residing in Stokes County, North Carolina. The index patient had developed symptoms after returning to the US from a 3-month visit to India. Measles was not suspected until two weeks later when two unvaccinated household contacts sought evaluation for similar symptoms. Measles was first confirmed by laboratory testing at the State Laboratory of Public Health on April 16, 2013.

Overall, 23 cases of measles were identified in 3 NC counties as part of this outbreak, with the last onset occurring on May 7, 2013. Patients ranged in age from 1-59 years. Two patients were hospitalized, including the index patient and one other adult patient with respiratory complications. Eighteen cases (78%) occurred among unvaccinated persons, with a majority of these being members of the index patient’s community. Three patients (13%) had documentation of a complete 2-dose series of MMR vaccination. Vaccination status could not be determined for 2 patients (9%).

Measles and Appropriate Infection Prevention Precautions

Connie Jones

The first measles outbreak to occur in North Carolina in more than 20 years began on April 4, 2013 (described above).During this outbreak, questions were raised as to the appropriate type of Infection Prevention Precautions to follow. According to the Centers for Disease Control and Prevention (CDC), airborne precautions should be used in the healthcare setting for patients known or suspected to be infected with diseases transmitted via the airborne route.  These diseases include Measles, Severe Acute Respiratory Syndrome (SARS), Varicella (chickenpox), and Mycobacterium tuberculosis.

Precautions should be initiated and maintained for all patients suspected of having measles.  Persons with measles are contagious from 4 days prior to rash onset through 4 days after rash onset.

Airborne isolation precautions consist of:

1. Standard Precautions, including appropriate:

·                 Hand hygiene

          Gloves

·                 Gowns

·                 Mask, face shield, eye protection

2. Personal respiratory protection:

·                  N95 Respirator OR Powered Air-Purifying Respirator (PAPR)

3. Airborne Infection Isolation Room (AIIR)

It is important to note that there are no CDC recommendations for patient care outside of the healthcare setting. SPICE and APIC-NC support the suggestion that public health staff or other persons enter housing areas where patients suspected of having measles (e.g., under quarantine) are located may use these same precautions.

CDC Recommendations for Use of Pneumococcal Conjugate Vaccine-13 valent (PCV13) in Adults

David Weber

Streptococcus pneumoniae (pneumococcus) remains a leading cause of serious illness, including bacteremia, meningitis, and pneumonia among adults in the United States.  An estimated 4,000 deaths occur in the United States each year because of S. pneumoniae, primarily among adults. The incidence of invasive pneumococcal disease (IPD) ranges from 3.8 per 100,000 among persons aged 18-34 years to 36.4 per 100,000 persons among those aged >65 years.  For adults aged 18-64 years with hematologic cancer, the IPD in 2010 was 186 per 100,000, and for persons with HIV the rate was 173 per 100,000.  The disease rated for adults in these groups can be more than 20 times those for adults without high-risk medical conditions.

There are currently two vaccines available to prevent IPD and pneumonia in adults: 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23, Merck & Co.) and 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar 13, Pfizer).  Each vaccine is ONLY effective against the serotypes in the vaccine.  Both vaccines are FDA approved for all adults >50 years.  PPSV23 is also FDA approved for high-risk adults aged >18 years. 

CMS - Relative Humidity (RH): Waiver of Life Safety Code (LSC) Requirements for Anesthetizing Locations

On April 19, 2013 CMS Center for Clinical Standards and Quality Survey and Certification group released S&C Letter 13-25-LSC and ASC.   The topic of this letter was CMS issuing a categorical waiver to allow relative humidity (RH) of ≥ 20 percent in anesthetizing locations.  The summary is a follows:

• RH of ≥ 20 percent permitted in anesthetizing locations:  CMS is issuing a categorical Life Safety Code (LSC) waiver permitting new and existing ventilation systems supplying hospital and critical access hospitals (CAH) anesthetizing locations to operate with a RH of ≥ 20 percent, instead of ≥ 35 percent.  CMS is also recommending that RH not exceed 60 percent in these locations.

Fiscal Year 2014 CMS Inpatient Rehabilitation Facilities (IRF) Prospective Payment System (PPS) Proposed Rule Changes

On May 8^th, the Centers for Medicare and Medicaid Services (CMS) released the IRF PPS proposed rule changes for Fiscal Year 2014.  Among provisions in this year’s proposed rule that are of interest to infection prevention are:

• Reporting of CAUTI through NHSN (Pages 103 in proposed rule FR 26909, online p. 31):  This measure was first adopted for FY 2012 before it was endorsed by the National Quality Forum (NQF) for IRF settings, and updated last year once the measure was NQF-endorsed.  The reporting requirement for the IRF Quality Reporting Program (QRP) remains unchanged this year, but the measure has been renamed “National Healthcare Safety Network (NHSN) Catheter-Associated Urinary Tract Infection (CAUTI) outcome measure (NQR #0138).

SPICE : We’re here to serve you!

          The Statewide Program for Infection Control and Epidemiology (SPICE) promotes prevention and control of health care associated infections in North Carolina and beyond by providing evidence based education and consultation across the healthcare spectrum. Located at the University of North Carolina School of Medicine, SPICE has provided infection control education and consultation for more than 30 years under the direction of Dr. Bill Rutala. 

          SPICE is charged with administering the education component of 10A North Carolina Administrative Code 41A.0206 which requires all healthcare facilities that perform invasive procedures to designate a staff person to be trained in infection control. The SPICE website (spice.unc.edu) serves as an infection control information clearinghouse, and also highlights SPICE educational programming.

          In calendar 2012, SPICE provided 554 phone/email consultations. We encourage your infection control questions, and respond promptly by email or phone. The best communication route is to click on the Ask SPICE link on our home page.   

          Other SPICE activities include four classroom courses on infection control for long term care and acute care settings, development of an on-line infection control curriculum for all nursing home staff, and currently, revision of SPICE .0206 on-line courses for outpatient, dental, and home health/hospice settings.