Infection Control Today: Featured at APIC 06

What is the most important way to fight the transmission of infectious agents in the healthcare environment, and through what kind of specifi c strategies can this be accomplished?

Leading up to the Association for Professionals in Infection Control and Epidemiology (APICs) 2006 Annual Conference, ICT posed this question to a number of industry vendors. Included in their responses below are a number of suggestions on approaching this crucial effort.

John Phillips, director of sales and marketing for Colby Manufacturing Corp., contends that preventing transmission of infectious agents is the most important strategy that healthcare employers can use today. A proactive approach to prevention can help keep staff and patients safe from possible exposure to these potentially hazardous agents. Many options are available to assist in the prevention of exposure when faced with the challenge of managing hazardous fluid waste during surgery. To be efficient and effective in preventing transmission of infection, employers should utilize products and a process that will control the spread of fluid waste, contain fluid waste so that staff does not come in contact with it, and make it ready for disposal.

Handwashing is the single most important means for prevention of the spread of infection, says Anna Cepeda-Mays, marketing manager for PDI. When handwashing facilities are not available or accessible to healthcare workers, patients big and small and the community, antimicrobial alcohol gel hand wipes are a convenient way to clean and sanitize hands with one product. PDI offers Sani-Dex® ALC and Sani-Hands® for Kids 65.9 percent alcohol gel formulation (meeting Centers for Disease Control and Prevention [CDC] hand hygiene recommendations) on a wipe. The friction created by using the pre-moistened wipe delivery system removes soil and bacteria AND kills 99.99 percent of germs.

Steve Bierman, MD, founder and chief medical officer of Venetec International, cites the importance of combating catheter-related bloodstream infections (CRBSIs). All of the CDC-recommended measures to reduce CRBSIs are important, he notes. But if you ask, What one, single measure has demonstrated the greatest reduction in CRBSIs? the answer is simple: replacement of suture securement with StatLock. Dr. Dennis Maki performed a metaanalysis of two randomized, prospective trials and found a 93 percent reduction in CRBSIs (p = <.01) using StatLock.1 The CDC states: 'Sutureless securement devices can be advantageous in preventing CRBSIs.' INS (Infusion Nurses Society) no longer includes suture as a legitimate securement method in their new Standards of Practice.

When are we going to protect ourselves and our patients by giving up the habit-based practice of placing festering foreign bodies within millimeters of intracutaneous tracts that lead directly to the central circulation? The sooner the better for all involved.

Optimizing healthcare workers respiratory protection is critical to combating the transmission of infectious agents, according to Michael Wang, product manager for Bio-Medical Devices Intl. Infection control practitioners (ICPs) should consider several factors when evaluating respiratory protection, he offers. Infection control personnel should be looking for respirators that provide increased freedom of movement, wide-angle visibility, the ability to quickly don and doff the equipment, and reduced decontamination time. The MAXAIR® PAPR (powered air purifying respirator) systems offer this and more to provide optimum protection from airborne pathogens.

Positive pressure respirators such as PAPRs may be worn by the majority of ICPs to optimize protection levels as compared to negative pressure disposable face masks, which require time-consuming, expensive fi t-testing and do not offer HEPA-level protection of 99.97 percent filtration efficiency, Wang continues. As an alternative to current respirators available to ICPs, the MAXAIR hose-free PAPR provides increased freedom of movement, shields workers from splashes, airborne and bloodborne pathogens, and provides HEPA-level protection with an APF (assigned protection factor) of 1,000. In addition to its unique, hose-free technology, MAXAIRs self monitoring technology incorporates two LED indicators cautioning the user of low battery and low airflow change-out.

One way to minimize infections diseases in the healthcare environment is to exercise proper protocol when cleaning surgical instruments and scopes, notes Vic Preston, senior account executive at Ruhof Healthcare. One must implement very strict and effective cleaning protocols to successfully undergo the sterilization or disinfection process. Clinically speaking, the importance of choosing an enzymatic detergent capable of removing each component of bio-burden (blood, fat, protein, carbohydrates, and starches) cannot be overstressed. Single- and dual-enzyme detergents that dominate the market today fall short of removing all bioburden, creating clean-looking instruments and a false sense of security. Although invisible to the naked eye, undigested residue left on instruments after cleaning can harbor lingering pathogens, endangering patients and technicians. Only a multi-enzyme detergent, synergistically designed to remove all bio-burden, will result in safe instruments, hence a safer work environment.

Dan J. Dwyer, healthcare marketing director for Raven Biological Laboratories, stresses the importance of complying with existing policies and procedures. The most important way to fight the transmission of infectious agents in the healthcare environment is to accurately and consistently follow the programs already in place at the facility, he says. Although this sounds simple and elementary, most infections are caused not because of poor policies or standards, but through poor training and technique. Whether it be proper handwashing or instrument cleaning and sterilization, most healthcare professionals are not looked at as being on the front lines battling nosocomial infections. Appropriate compensation and certification not only rewards those who adhere to hospital policies, it makes the industry more attractive to those who are adhering to policies for someone else.

There are many critical factors in preventing the transmission of infectious agents, so it is difficult to identify the single most important method, says David Parks, general manager of global infection control products for Kimberly-Clark Health Care. However, any infection control program starts with basic handwashing. The most common mode of transmission of pathogens is via the hands, so certainly compliance with good hand hygiene practices contributes to the reduction of cross-infection. This should be followed by the proper use of disposable personal protective equipment (PPE) such as gloves, masks, and gowns. Antibiotic resistance continues to be a concern as well. The CDC has set forth guidelines as a means of preventing resistance to systemic antibiotics. The use of appropriate topical antimicrobial agents in conjunction with a variety of other tactical measures comprising a holistic infection control program may contribute to a reduced need for systemic antibiotics, which fits well with the CDCs guidelines for preventing resistance due the over use of systemic antibiotics, says Dave Brett, science and technology manager for Smith & Nephew Wound Management Division. For instance, Fong et al. demonstrated how the use of Acticoat (a topically applied nanocrystalline silver-based antimicrobial dressing), among other attributes, drastically reduced antibiotic use (57 percent to 5.2 percent) over a one-year period.2 Strohal et al. demonstrated that Acticoat is highly effective for controlling the penetration and spread of MRSA (Methicillin-resistant Staphylococcus aureus) in wounds.3 A non-silver option would be Iodofl ex or Iodosorb dressings. Both the Acticoat and Iodosorb/Iodofl ex dressings are considered 'barriers' to microbes entering and/or leaving the wound.

Alaine Anhalt, marketing coordinator for IKEY Industrial Peripherals, points out that as technology continues to improve in hospitals, and more facilities transition to electronic databases, infection control practices must progress. Locations such as patient carts, nurses stations, and operating rooms are exposed to potentially harmful microorganisms and must be carefully managed, she says. Units such as hospital keyboards harbor unmonitored pathogens including as methicillin-resistant MRSA, E.coli, and hepatitis C. Hospitals can combat the unnecessary spread of infections by installing units that can be properly disinfected. Research indicates that soap and water are not sufficient, and the best cleaning procedure involves wiping down all surfaces with a 10 percent bleach solution or other approved hospital germicidal wipes.

By taking precautions such as wearing gloves, washing hands before and after each patient, installing sealed units, and thoroughly cleaning all surfaces, hospitals can successfully fight the transmission of infectious diseases.

It is important that healthcare professionals carefully evaluate the safety and infection control risks of the many IV connectors in the marketplace, says Michelle Olivo, international marketing manager for ICU Medical Inc. Recent clinical studies have identified the CLAVE® Connector to reduce the risk of transmission of infectious agents and contamination of catheter hubs. The CLAVE connector has more than 10 years of proven history and is used worldwide. The unique technology utilizing a split-septum design and the dedicated internal fl uid path of the CLAVE, have proven to protect patients by minimizing the risk of blood stream infections.

Proper scientific evidence should be obtained in order to recommend the utilization of any type of IV connector and to identify whether the device will provide an effective barrier against contamination, adds Eric Glover, marketing manager for ICU Medical.

He also notes the following as important steps for healthcare workers in implementing infection control programs:

  • Clearly understand if the needle-free connector reduces the risk of infection 
  • Evaluate and examine the manufacturers product design 
  • Carefully analyze all product clinical studies 
  • Evaluate current literature regarding the products impact in reducing catheter- related infections 

Microbes that can lead to healthcare-associated infections (HAI) such as MRSA, are commonly transmitted by surface-to-surface contact and are a growing concern in healthcare, according to Jill Buck, product manager for blood collection tubes & accessories at BD Diagnostics Preanalytical Systems. One product that can address this is the BD Vacutainer® Stretch Latex- Free Tourniquet, which facilitates a single-use tourniquet policy while also preventing latex exposure to sensitive individuals, she says. BD Vacutainer Alcohol Swab is another product that we offer. Its small dispenser fi ts easily in a phlebotomy tray and is filled with 150 swabs moistened with 70 percent isopropyl alcohol for antiseptic preparation of a patients skin prior to blood collection or injection. 


References:

1. Crnich CJ, Maki DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection. II. Long-term devices. Clin Infect Dis. 2002 May 15;34(10):1362-8. Epub 2002 Apr 17.

2. Fong J, Wood F, Fowler B. A silver coated dressing reduces the incidence of early burn wound cellulitis and associated costs of inpatient treatment: comparative patient care audits. Burns. 2005 Aug;31(5):562-7. Epub 2005 Feb 17.

3. Strohal R, et al. Nanocrystalline silver dressings as an efficient anti-MRSA barrier: a new solution to an increasing problem. J Hosp Infect. 2005 Jul;60(3):226-30.


Two out of Four Disinfectants for Cleaning Eye Exam Equipment are Ineffective, Study Reveals

Two of four disinfectants recommended for cleaning eye exam equipment are ineffective, a new study concludes. Many people who have had eye exams are familiar with the applanation tonometer, a medical instrument pen that is used to check the pressure in a patients eyes. After the patient is given numbing eyedrops, an applanation tonometer is applied gently to the front surface of the eye and provides a pressure reading to check for glaucoma. Healthcare workers are required to disinfect the applanation tonometer after each use. However, a new study conducted by the University of North Carolina Health Care System has found that two of four disinfectants recommended for this purpose by the Centers for Disease Control and Prevention (CDC) are ineffective at inactivating adenovirus type 8, which is a common cause of epidemic keratoconjunctivitis outbreaks in eye clinics.

Two disinfectants recommended by the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC) 70 percent ethyl alcohol and 5,000 parts per million chlorine were found to be effective in removing a test virus after 1 minute of contact.

While adenovirus type 8 is relatively resistant to disinfectants, it is fortunate that these two disinfectants work well, says Dr. William A. Rutala, UNC Health Cares director of hospital epidemiology and a professor in the UNC School of Medicine. The two disinfectants that did not inactivate adenovirus type 8 3 percent hydrogen peroxide and 70 percent isopropyl alcohol should no longer be used for disinfecting applanation tonometers.

These results were published in the April issue of the journal Antimicrobial Agents and Chemotherapy. Large outbreaks of epidemic keratoconjunctivitis have been documented in eye clinics and hospitals. In such settings it is typically transmitted by the hands of medical caregivers or contaminated eye exam equipment, such as tonometers and slit lamps, or contaminated ophthalmic solutions. However, only one prior study examined the effectiveness of a single germicide in removing adenovirus type 8, which can survive on plastic and metal surfaces for more than 30 days.

Against this backdrop, Rutala and colleagues set out to determine the effectiveness of 21 germicides against adenovirus type 8 under various test conditions. They contaminated metal disks with the virus and tested each germicide under five separate conditions: with the germicide mixed with hard water and contact times of 1 minute and 5 minutes, with the germicide mixed with hard water plus 5 percent fetal calf serum and contact times of 1 minute and 5 minutes, and with the germicide mixed with sterile water for a contact time of 1 minute.

Based on their results, the researchers recommended that eye exam equipment be disinfected with 70 percent ethyl alcohol or 5,000 parts per million chlorine. In addition, healthcare workers who handle the equipment should wash their hands with antimicrobial soap and water instead of alcohol-based hand rubs. Previous research conducted at UNC Health Care found that alcohol-based hand rubs are not as effective as soap and water against viruses such as adenovirus type 8.

Rutala was lead author of the study. His co-authors were Jeffrey E. Peacock, a second-year medical student at Wake Forest University; Maria F. Gergen, a medical technologist at UNC Hospitals; Mark D. Sobsey, professor of environmental sciences and engineering in the UNC School of Public Health; and Dr. David J. Weber, medical director of Hospital Epidemiology for the UNC Health Care System. Weber is also a professor in the UNC Schools of Medicine and Public Health. 

Source: University of North Carolina at Chapel Hill School of Medicine

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