11 Hospitals responded.

6-change daily. 1-q 48h, 1-q 72h, 3-q 7days & prn.

8 members responded.

4 allow volunteers to enter once trained; 4 do not allow to enter.

1. Do you place patients without any other source of infectious process who have positive blood cultures for MRSA into Contact Precautions? 

Same Question for those who have positive Urine Culture only? 

2.  Do you place patients without any other source of infectious

process who have positive blood cultures for MRSE into Contact Precautions?  

Same Question for those who have positive Urine Culture only?   

3.  Do you place patients without any other source of infectious process who have positive blood cultures for VRE into Contact Precautions? 

Same Question for those who have positive Urine Culture only?   

4.  Do you use more than Standard Precautions when dealing with Penicillin Resistant Strep in Cerebral Spinal Fluid?

11 members responded.

1. Place Patients into Contact Precautions-10

Do not place Patients into Contact Precautions-1

Place Patients into Contact Precautions-10

Do not place Patients into Contact Precautions-1

2. Place Patients into Contact Precautions-1

Do not place Patients into Contact Precautions-9

(1 no response included)

Place Patients into Contact Precautions-2

Do not place Patients into Contact Precautions-8

(1 no response included)

3. Place Patients into Contact Precautions-9

Do not place Patients into Contact Precautions-0

(2 no response included)

Place Patients into Contact Precautions-10

Do not place Patients into Contact Precautions-0

(1 no response included)

4. Place Patients into Contact Precautions-1

Place Patients into Standard Precautions-9

(1 no response included)

Would you have a concern about a non-emergency transfer of a newborn to your facility that had not been bathed?

-We do not have newborn deliveries at MCO, except in the emergency room every once in a blue moon. If we had a baby delivered, the baby

would be wrapped, not bathed, and sent with mom to the appropriate facility once they were stable.

-Yes, we would have a concern about a non-emergency transfer of a newborn to our facility that had not been bathed.

-I would definitely have a problem with a non-emergency transfer not being bathed. Infants should be bathed as soon as stable, we use 4 hours as our time to bathe (unless the infant or temp is not stable).

-No. They are always placed into isolation at our facility and whether or not they have been bathed would not alter that placement. This placement into isolation would occur even if the infant was delivered in the Emergency Department of our own hospital.

3. No, we don't have a policy specifically about staff in certain areaswith body piercings. our policy is that body piercings other than the ears must be in a non-visible area or covered. For example, we have a dietary worker with an eyebrow piercing and she must cover it with a bandaid when she is working. We also restrict ear piercings to 3 per ear. Any others must be covered. Body art that might be offensive must also be covered.

4. B...... hospital policy in HR prohibits piercings on visible body parts other than 3 earings per ear.

-One of the 4 stated that is there was an allergy to iodine they use Hibiclens.

1. What is your current Process for tracking and trending employee illnesses that are related to infectious disease processes?

1. Do you require all ill “call-ins” to report symptoms?

3. Do you require all managers (or their representative) to tally ill call-ins along with symptom groupings and report to whom? Infection Control or Employee Health?

4. Do you require Employee Health Clearance for return to work after a specified length of time off due to illnesses related to infectious diseases?  If yes what is the number of days off that places them in position to obtain clearance from Employee Health?

5 members responded

• Supervisors report monthly via e-mail on any absences due to a specific group of communicable diseases

• Request they inform me of fever, N & V, diarrhea

• If an employee is out more than three days there is a form that is completed upon their return to work asking for symptom information to determine communicability and contagiousness

• Monthly form of disease of high impact

• No

• No

• No

• No

• See 1 above

• No

• No

IC gets total #

• Only if supervisor has a question about return to work.  I have a very limited amount of time to track this.  (Position is 9-10 hrs/wk.  And about 180-200 employees.)  I use to get all call-ins but reporting was not consistent and it didn’t provide any useful information.  I have a policy on what needs to be reported and what symptoms to look for r/t return to work. 

• Yes, depending on illness, 3 days

• No, but  -  we do have employee health algorithms for certain diseases to guide employees and EHS on how long individuals may need to be off for certain illnesses, i.e. Exposure to chicken pos in un-immune, etc.

• NA

6 members responded

Three hospitals responded that bronchoscopies are done under negative pressure. One hospital responded that high risk patients are done in negative pressure. One hospital stated that some are done in negative pressure but not all

Done through Endo Department unless done at bedside (If done there they are usually done without much scheduling ahead). One hospital reports that staffing is done by Respiratory Care staff.

Related to Respiratory Care equipment changes, there were many different reports

*Med nebulizers or aerosols are emptied with each treatment and discarded after being dc'd or prn

*All other breathing circuits, pressure monitoring systems changed every 72 hours

*Ballard suction catheters every day

Fingernail Benchmarking

14 responded

10 people (71%) said they did send out letters although 2 of the people responding had qualifiers to that ie - only quarterly, only c-sections.

Four people (29%) said they did not send out letters with one qualifying it with the statement they will send them out if there is a specific break in technique or inadvertent exposure in surgery.

Question  with Responses

Are new or prenatal mothers asked about preserving the placenta?

 NO: 9

¨      Do not have OB patients

¨      Respond if asked but do not ask

¨      No policy

If it is to be preserved by an outside agency, do they sign a release?

¨      Has not happened:  3

¨      Cord blood preserved using kit provided by company, physician or midwife draw, family responsible to ship; no release signed

¨      Cord blood can be preserved; no release signed

¨      Cord blood saved once; arrangements through physician’s office

¨      One instance of cord blood saved, arrangements through physician

¨      Do not have policy in place

¨      NA:  2

Do you allow a mother to take the placenta home?

¨      Happened once;

¨      Has not happened

¨      Occasionally family will take home for cultural reasons  2

¨      NO

¨      NO; if baby transferred, placenta is placed in sealed in container, placed in biohazard bag and sent with baby

¨      Not aware of any instances of placenta being taken home

¨      YES:  2

If so how is it handled to prevent blood exposure?

¨      Plastic container placed in biohazard bag.

¨      Bag it and place in specimen bucket

¨      Placed in container then bagged

¨      Bag in biohazard container that has inner bag and outer bag

¨      Bag as biohazard: 2

¨      Routinely sent to pathology

Do they sign a release?

¨      NO:   5

¨      Sign an informed consent –placed in med. record, copy sent with patient (if contents questioned they will have documentation of removal from hospital); not in place yet. Plan to instruct in safe handling and provide gloves; document education and materials for handling in the record.

APIC RESPONSES ON SSI RISK STRATIFICATION

10 Responses

1)                  Do you risk stratify your SSI data? If so, for all procedures or select ones?

·        5 Stratify by NNIS Risk

-1 all procedures

-3 specific procedures

-1 infections only

2)                  If you do not “Risk stratify”, do you stratify your data by Class or other?

·        4 Stratify by Wound Class

·        1 does not risk stratify

3)                  What benchmark do you use?

·        3            NNIS

·        1            Internal data

·        1            Class 1-<1%, Class 2-<5%, Class 3-<10%, Class 4-<25%

·        1            With similar small hospitals

·        3            No response

·        1            Working on NNIS benchmark

4)                  Do you graph your surveillance data?

·        3            Yes answer only

·        1            Table comparing hosp data to NNIS

·        1            Charts only

·        1            Wound Class

·        1            Run charts/bar graph w/NNIS ranges, means under graph

·        1            Graphs and Excel spreadsheets

·        1             Unknown

·        1            No

10 member facilities responded.

9 facilities do not use any surveillance software. One hospital uses the AICE Program. One member wrote wrote "It does not pull information from the lab, rather I enter information that I gather into the AICE program and it has some report options. "

14 member facilities responded.

Only one uses Rapicide.

10 member facilities responded.

Yes=6, No=4

If yes, how often? Monthly=1, every 2 months=1, quarterly=1, annually=2, not reported=1.

If yes, what methods do you use?

• self assessment supplemented by JCAHO compliance rounds quarterly

• monitor SP by a compliance monitor done by ICN. Also make observations during daily rounds.

• monitors are done by department exposure control trainers

• direct observation annually and during Code Blues.

• all patient care areas monitor compliance in area specific situations and managers send ICN a summary report.

• supervisors complete direct observation forms as part of the annual appraisal and send a copy to ICN to summarize and report.

"No" responders commented:

• do undocumented spot checks by ICN, managers and coordinators

• managers to report non-compliance to ICN

• not formally but do spot checks

• do not do routinely

Do you allow nurses to work with casts on their hands?

Response: 11 individuals responded.

Ten said no. And one said yes but was

concerned because of the inability to complete adequate hand hygiene.

N-95 Fit-testing  Responding:18 (15 hospitals, 1 hospice, 1 Health Department, 1 ECF).

1.      Prior to an initial fit-test do you require employees to go through a physical exam by the Physician?

YES:            3*(2 hospitals and 1 ECF)

NO:            15

*Yes, this is part of their new hire physical.

2.      Prior to an initial fit test, do you require employees to go through a pulmonary

Function test?

YES:   2 (1 Health Department and 1 hospital)

NO:    16

3.      Prior to an initial fit test, do you require that a medical evaluation questionnaire be completed by the employee?

YES:   18

COMMENTS:

·        The questionnaire just asks if employee has any medical problems or symptoms that would limit their ability to wear a respirator, if they were told they needed to be reevaluated or has there been a change in workplace conditions to increase the physical burden on them.

·        If anything is “flagged positive” on the questionnaire then the employee was required to have an examination/follow-up PFT.

·        Only need to go through a physical exam by our OccuHealth doctor if they answered “yes” to any of the questions that are concerning to the doctor. 

If there is any concern on the medical evaluation questionnaire, the employee would be sent for a physician evaluation through Occupational Health Service.

MCO -- uses Chloraprep for cardiac cath sites, but is not aware of any problems with it ( ie. burning at site).
SRMC -- uses Chloraprep, has had numerous c/o burning. Switched back to Betadine for the time being.
St. Luke's -- uses Betadine.
Toledo, Flower, Children's -- uses Betadine.

When IV bags and blood bags are discontinued how are they disposed of?  Red bag or Regular trash?

How do you deal with labels and HIPPA?  Remove labels prior to disposal or black out the identifying information? 

8 responses

One hospital puts the IV and Blood Bags in a solid red trash container and seals it prior to sending with the infectious waste. The other facilities all black out or remove labels prior to disposal of the bags. IV bags go in regular trash and blood bags go in the infectious waste trash.

3 responses

All responders referred to a memo or letter received from the Ohio
Department of Health stating that when a resident is out of a facility for
3 weeks or longer receive a single Mantoux upon return to the facility. A
contact at the Ohio Dept. of Health was not aware of this memo or press
release from 1993 but simply referenced the TB screening requirements in
the Nursing Home Licensing rules Chapter 3701-17 specifically located in
G and H Neither of these at least that I can find mention anything
specific about a leave of 3 weeks requiring re-testing.

Toledo/Flower/Children's -- Cleaning on Home Medical Equipment (HME) not
officially addressed nor done.

St. Luke's -- Don't clean the HME ("just as we don't clean their personal
items from home.")

Baypark Community Hospital -- 1.) Resp. Therapy does a visual inspection of
resp. equipment that is brought in and replaces the tubing and mask if they
are "dirty. 2.) Biomed checks the equipment for safety and general
cleanliness. 3.) Infection control has "not been involved from an
infection control standpoint as all the rooms are private and the potential
that other patients would be exposed is minimal. I am sure if something
came in that was especially dirty, I would be notified."

Bellevue Hospital -- hasn't looked at this. All rooms are private and the
room is cleaned upon discharge.

• We don’t store extra linen in the rooms. We just don’t have the storage capacity.
• We only store 24 hours worth of linen. All linen is to be sent to laundry after each discharge regardless of isolation.
• We do not store linen in the rooms.
• We do not have designated linen storage closets in the rooms. Only linen that will be used is taken into the room shortly before use. If extra linen has been taken in, regardless of where it might be found after patient discharge, it is handled as soiled linen.
• We consider all linen “contaminated” that has been stored in a patient’s room in a closet or drawer, not just those in contact precautions. Therefore, all linen is removed.
• Linen currently remains in the room for all if in cupboard.
• We send it to the laundry as dirty linen for reprocessing.
• We launder it. Try to only take in small amounts.
• Send to laundry. More than likely the staff is handling it without washing their hands first.
• We don’t have closed cupboards, so any clean linen left in room is sent to the laundry.

Regarding computer keyboards and mice in a patient’s room or exam/test room.

1)    What is your procedure for cleaning and disinfecting these?

a.    Do you wipe down with your hospital disinfectant? If so, how often (e.g. between patients)?

PRN (1) Prior to each use and when contaminated (2), Access with clean, non-gloved hands (4), Do not use keyboards in isolation room (1)

Products: Hospital disinfectant (1)  Sanicloth (2) Virex II (1) Disinfectant wipe (2)

Or

b.    Do you use a keyboard cover? If so, how often do you disinfect and with what chemical?

Replacing current keyboards with washable keyboards (1), Covers on order (2),

Key board covers used in OR and clean after each case (2); on patient care units daily (1)

Cover is used on older keyboards (1).

Question:  What is your facility doing about waterless hand sanitizer in C. diff patient rooms?

14 Responses

Hand hygiene policy amended to require soap & water for C. diff pts.,  education

Stickers placed on isolation cards to state “Soap & Water required”

Staff instructed not to use hand sanitizers

There is foam in all patient rooms

Hand sanitizer is removed from C. diff or suspected C. diff pts.  Rooms are terminally cleaned with bleach

Staff are educated on use of soap & water but alcohol sanitizer stays in room

Nothing different as CDC does not recommend changes unless there is an outbreak

Signs placed beside sanitizer stating use soap & water

Separate isolation category and staff instructed to use soap & water. The isolation sign states this

Staff had been encouraged to use soap & water but based on recently read article now being encouraged to use alcohol gel

Magnetized sign next to contact precaution sign stating soap & water only

Alcohol based cleaner is used, soap & water not stressed.  Rooms are not terminally cleaned with bleach either

Laminated sign on alcohol dispenser states “Use soap & water – not hand gel”

Signs are posed stating use traditional hand cleaning instead of Purell®

Staff  educated not to use alcohol sanitizer

Seven facilities responded.

How do you handle TST for clinical students?

• Keep a copy of the school’s student health policy  2

• For each student, receive a checklist from the school documenting that TST & other testing/immunizations were done   2

• Receive individual student testing results/records  2

Other (please describe)

• Receive an electronic statement from schools that they students are up-to-date on student health issues.

• One facility has a combination of the above, depending upon the school involved.

• One facility tells schools the hospital’s standards, and may ask for documentation.

Do you include Mumps screening/testing/vaccination for clinical student requirements?

No  3

Yes  0

Does anyone’s facility have a decorative water wall fountain?  If so, please advise how it is cared for. 

Lima:  We do have a decorative fountain in our out-patient oncology building. Maintenance does regular water tests on it (I think monthly), and adds chemicals, etc. as indicated. We've never had a problem with it!   St. Rita's Medical Center

FRMC:  We have a water fountain on the third floor and maintenance has the manufacture's recommendations for cleaning and bleaching the water which they complete on a weekly basis and randomly water is sampled for bacterial growth. It has always been negative. We found problems as little boys want to pee in it all the time.  We have three new water features in the cancer center, they will be behind walls, but they have not been installed yet so I don't have all of the info needed there yet but they do guarantee no biofilm or bacterial growth if their cleaning and disinfecting recommendations are followed.

BVRHC – in medical building – maintenance per mfg.’s recommendations – it has 3 filters and uses reverse osmosis – water sample obtained weekly and sent directly to Co. for testing (unsure of what is tested) – quarterly P.M.

Mt. Carmel East – not in patient care area – follows mfg’s recommendations

Bellevue has a 9 gal. water wall fountain and has instituted a algaecide to be added when additional water is added.  It is completely drained approx. 4 times yearly and slate will begin to be wiped with alcohol upon next emptying (care is just being established since it was newly installed in early ‘06.)  Bleach will begin to be added if the algaecide product dues not halt bacterial growth. 

2006 flu vaccination APIC survey.xls

Do you perform Hepatitis C prenatal screens?

1. How are you handling admission of known or suspected resistant Acinetobacter patients?

• We are currently not doing anything

• We are doing throat/sputum cultures on all patients admitted to our progressive pulmonary and three of our ICS’s. That is how we have picked up a lot of our patients. The charts are flagged just like they are for any patient with a disease we isolate for and on subsequent admissions they are re-isolated.

• The patient is placed in contact precautions and if they have a trach, they are placed in droplet precautions also.

• After the last meeting I reviewed lab findings for Acinetobacter. We only saw one resistant case in 2006 and that was discovered at discharge. We have established no particular infection control measures since I have not seen any recommendations specific to this organism. Interestingly our ICU Director was deployed to Landstuhl, Germany where he is caring for Iraq victims; the military is taking this very seriously, including colonization cultures and isolation.

• We are using protocol “A” in the emergency room if these are suspected resistant ACBA. These patients are placed into contact precautions, and cultured. We culture, wound if present, blood, respiratory and anticubital fossa.

2. Are you restricting the number of these patients in house at the same time?

• No

• No we are not restricting patients

• Not yet!

• No!

• Yes, 3-4

• We tried, it didn’t work. We have had 7 at one time all community aqcuired

3. Are you cohorting these patients

• No

• We do cohort if necessary but so far since the PPU and ICU’s are all private rooms we have not had to

• No

• Have not had more than one at a time (we have had two total)

• No, we have a hall we can section off and they are all single rooms

• We haven’t yet due to their acuity but will in the future if possible

4. What protocol are you using and would you be willing to share it?

• At this point no differently than any other admission. If they are multiply resistant we place them at least in contact isolation

• We do not have a written protocol-we talked about it but…if we ever get one down on paper we could share it

• Strict (like for VRE) and Droplet (since they have all been trachs)

• When identified, strict contact precautions, gowns, gloves when entering the room, dedicated equipment as much as possible, equipment leaving the rooms disinfected or sent for sterilization. Masks were also required when organism in resp.tract

• We also have started surveillance cultures on all new admissions. Nasal passages, groin area, open wounds and trachs. No pts with positive culture for MDR Acinetobacter are allowed to leave their room at this time. Designated equipment is used and one nurse is caring for our pts with a positive culture

• At UTMC we modified the Johns-Hopkins protocol for resistant ACBA. It is a work in progress because we have limited staffing.

5. Have you done any environmental cultures and have they been helpful to your  process?

• No

• Yes we have done tons of environmental cultures. When a patient is discharged, the room is terminally cleaned and then we culture high touch areas. While we never had a lot of them turn positive, the process was helpful for showing housekeeping the importance of their role in eliminating this problem

• Cultured the 3 rooms that had the 2 patients were in-no Acinetobacter or any other pathogens obtained-helpful to prove those rooms had it removed-not helpful to see if employees spread it to other rooms

• No

• Yes this has helped to ensure housekeeping is doing a good terminal clean at discharge

• Yes we have done both patient surveillance and environmental cultures. We did not find it spread to surrounding patients or their rooms. We did find it on high touch surfaces in the room when the patient was present, even after the nurse had been cleaning because she was bored caring for only one patient. We found it on the underside of the bed rails, TV controls, vent controls and monitor panels.

6. What do you require from other facilities in order to admit to your facility?

• H and P

• we do not require anything different than we did before. We would expect the transferring location to inform us of any concurrent problems or issues but other than that nothing different

• So far we just hope they tell us of present or past history of it

• Have not addressed this but would expect Nursing homes or other health care facility to notify if transferred to us. This is an issue with all resistant organisms

• At the time we just ask for the pts most recent cultures that have been done and of course all the other necessary info for continuum of care

• We are requesting a courtesy call to let us know the patient is coming to us and any labs or other pertinent information faxed to us so we might prepare.

Do you routinely check sterilization records?

14 replies.

7 do not check the logs.

8 do check them in some fashion. (Either receive reports from the departments which do the sterilization or check them themselves. 2 stated that they do not check them routinely, but do get notified if there is a

failure. 4 stated that they have it as a standing report on their Infection Control Committee agendas.)

1 said that they were cited by JC in 2004 for not checking the logs, and they now receive a copy of all sterilization logs for review and monitoring.

Are any of the ICP's working in the long term care setting providing herpes zoster as a

routine vaccine to residents and staff?

Opinion survey: A pharmacy tech, gowned and gloved, preparing admixtures under a laminar flow hood needs to cough/sneeze. She follows cough etiquette by turning her head and coughs/sneezes into the upper sleeve of her gown. Can she go on working, or does she need to change her gown/gloves?

13 responses

Change gown (6)

·    I would prefer seeing the change in the gloves and gown so that no possibility of it having gone on other parts of the gown inadvertently.  

·    Regarding the question, it seems to me that if a cover gown is required because the employee's clothing might be considered too soiled to prepare admixtures, that certainly sneezing on her sleeve or shoulder & introducing respiratory microorganisms, which might include s. aureus, etc, would require a change in PPE. Our procedure also calls for mask use, which would open up another question on if the mask would need to be changed.

·    Good cough etiquette, that need to go one step further, change and wash hands before resuming work

·    Change her gown and gloves after washing her hands again.

·    I would think if that sleeve area was going to be under the laminar flow hood that the gown should be changed. 

·    I think she should change her gown and gloves.

Do not change gown (7)

·    I don't see the need to change gown/gloves

·    I would think that, because the upper arm of the gown should not come into the hood, it would be the best option for containing the cough/sneeze and that she could continue working.

·    She can keep working in the hood without changing gown and gloves.  The air inside the hood remains filtered/ clean/sterile round the clock.  The worker and her gown are on the outside or room air side of the hood.  The laminar hood functions by filtering room air prior to it flowing through the hood.

·    We tossed this question around and even asked our pharmacy director. We decided that they would / could continue to work, since they are under the hood.

·    Do not change the gown.

·    Change gown only if visibly contaminated with body fluid

·    The upper sleeve is not in the ‘sterile’ field. The directional airflow further prevents contaminants outside of this field from penetrating.

Do you allow patients in contact isolation to complete and return their menu to nutrition services? If not, what is your process?

13 responses:

5 - allow menu from isolation rooms to be sent down to nutrition services.

2 - fill the menu out for the isolation patient (the patient does not handle the menu).

6 - have a "room service" type of service where the patient orders their meals over the phone.

1.     What manufacturer of dressing do you use on central/PICC lines?

·        St. Rita’s Lima                           Tegaderm Bio-occlusion

·        Wyandot Memorial, Sandusky    Monolycke

·        Wood County, BG                     Tegaderm

·        Fremont Memorial                      3M Tegaderm

·        Mercy Defiance                          Tegaderm

·        Mercy System-Toledo                Tegaderm

·        UTMC                                        3M Tegaderm

·        St. Luke’s                                   Sorbaview

·        TTH//FH                                     Tegaderm

2.     Do you use a different dressing on jugular sites?

All use the same dressing as the central/PICC with the following

Exceptions: 

·        Fremont Memorial           Tegaderm (larger one)

·        UTMC                            Trialing Sorbaview Jugular

·        St. Luke’s                       Trialing Sorbaview  Jugular

3.     Are you using a securement device?

·        St. Rita’s Lima                      Statlock

·        Wyandot Memorial               None

·        Wood County, BG                Statlock

·        Fremont Memorial                 Statlock

·        Mercy Defiance                     Statlock

·        SVMMC-Toledo                  Statlock on PICCs

·        UTMC                                  Statlock

·        St. Luke’s                              None

·        TTH/FH                                 No, Statlock on PICC insertion only

4.     Are you using a Positive Pressure Cap?

·        St. Rita’s Lima                      Baxter Flowlink

·        Wyandot Memorial               No

·        Wood County, BG                Posiflow

·        Fremont Memorial                 No

·        Mercy Defiance                     Posiflow

·        Mercy System-Toledo           Baxter Flowlink

·        UTMC                                  Braun Ultraset

·        St. Luke’s                              CLC 2000

·        TTH/FH                                 CLC 2000

 5.      Are you using Biopatch?

·        St. Rita’s Lima                      Considering/Home Health & Dialysis

·        Wyandot Memorial               No

·        Wood County, BG                No

·        Fremont Memorial                 No

·        Mercy Defiance                     Yes

·        Mercy System Toledo            Yes

·        UTMC                                   Yes

·        St. Luke’s                               No

·        TTH/FH                                  No, considering

6.     Do you collect line days outside of the ICU?

·        St. Rita’s Lima                      No

·        Wyandot Memorial               No

·        Wood County BG                 Yes

·        Fremont Memorial                 No

·        Mercy Defiance                     Yes

·        Mercy System Toledo            No

·        UTMC                                   No

·        St. Luke’s                               No

·        TTH/FH                                  No, considering

7.     Do you use impregnated catheters?

·        St. Rita’s Lima                      Rarely

·        Wyandot Memorial               No

·        Wood County, BG               Yes, all lines

·        Fremont Memorial                 No

·        Mercy Defiance                     No

·        Mercy System Toledo            No

·        UTMC                                  Yes, silver

·        St. Luke’s                              No

·        TTH/FH                                 FH-No, TTH-Only if physician orders

Regarding "non-safety sharps" in your facility, such as non-blunt suture

needles, lumbar puncture needles, arterial line needles, etc. do you have a

policy stating that it is OK to use these items, or if not, where or how do

you address this?"  I received 8 responses.

3 - do not include a reference in any policy

2 - address it in their bloodborne pathogens policy

1 - their Safety Council does an annual review of all non-safety sharps used at their facility

1 - has a form for physicians to sign if using a non-safety item

1 - only stocks safety-sharps items in their facility (no non-safety sharps)

Do you allow patient care items, such as suction canisters or the

machine for heating pads to be placed on the floor beside the patient's bed, or

must they be up off the floor?

I received 8 replies.

In regards to suction canisters:

5 replied that they do not allow suction canisters to be placed on the

floor. "not suppose to be on the floor".

3 replied that they do not mandate/enforce keeping suction canisters off

the floor.

In regards to patient equipment - 5 replied to this question:

2 replied that they occasionally allow equipment on the floor, if it's

not avoidable.

1 replied that equipment is not allowed on the floor.

2 replied that they do not mandate having suction canisters or equipment

off the floor.

Joint Commission tips included:

Alot of emphasis on emergency preparedness plans, documentation from the

Regional Pan Flu exercise.

Make sure your infection control plan is up to date and accurate, make

sure you have a method in place for monitoring hand hygiene, and that the

staff are aware and following the proper isolation for the signs posted.

Emphasis on the Infection Control risk assessment. Handwashing / hand

hygiene on the units. What you are doing about MDROs.

And the final response: "Get out of town before JC gets there!"

1. If you are considered a vey low risk of TB facility and no longer doing annual TST, are you still (or do you need to) continue to do an annual review of TB symptoms to those that have a history of positive TST?

2. If you are a long term care facility or transitional care unit, do you have alcohol-based hand hygiene products located in your resident/patient rooms?  If so, what do you do about confused residents?  Have you had any problems with ODH saying it could be a risk to your residents regarding it being a hazardous chemical and not stored in a secure location?
    

   Facility Yes	YES	NO	COMMENTS
   1	X		All resident rooms have them, not at eye level for either w/ch or standing (unless really
   			short).  Never had a problem with ODH, the "way I see it, the residents have a greater
   			chance for stff not having clean hands than they do for ingesting the product."  No
   			attempts made by residents to ingest and product has been in place for >2 years.
   2	X		But not in the rooms on the secure care units (dementia/Alzheimer's)- also do not
   			have gloves readily available in secure care unit- under lock & key (not convenient
   			but some will eat/drink anything).
   3	X		In the TCU but not in the LTC unit.
   4	X		In TCU (never a problem with ODH or with confused residents), not available in the
   			nursing home.

1. What infection control training/education, if any, do outside clergy
   or lay ministers/individuals receive at your institutions when they come
   to call?  (Note UTMC treats them as a normal visitor and we do no
   specialized training so we would say none, or No to this question)
   12 responses. Training done for those employed 1 of 12 stated they had a pamphlet that they gave to those who were not employed

2. What training do you give to your in house Pastoral Care staff in
   infection control?
   11 Same orientation as staff receive,  1 stated they did not have clergy employees.

17 facilities responded; 16 acute care, one long-term acute care

Yes  7        No 10     Under consideration 6

If so, what populations do you screen?

• ICU admissions (not transfers), Open heart surgery, planning on all admissions from other hospitals & ECFs

• ICU admissions; pre-admit ortho & OB/GYN, including scheduled C sections; scheduled CABG

• Patients from ECF, transfers from other hospitals (unless only seen in their ED), patients currently receiving cancer/chemo; dialysis patients, any ICU admission, Pre-op open heart & total joint patients.

• ICUs

• ICUs, pre-op total joint replacements

• Pre-op joint replacements

• Cardiac surgery

What type of culture product do you use?

• BD chromagar plates 2

• Routine culture plates 1

• GenXPert 2

• PCR specific for MRSA 1

Do you start isolation precautions immediately for these patients, or do you wait for a positive culture result?

Immediately: 0  Wait:  PCR testing 2; MRSA Plate  2

3 responses

PICC Survey 2008.xls

(NO RESPONSE)

(NO RESPONSE)

If you have boxes of gloves in your rooms, do you discard after a patient in isolation is discharged?

I had 9 APIC members answer my questions:

1. Does anyone have therapy and other disciplines to do the patients care at the end of the day if they have acinetobacter?

            Five facilities try to do the patients care at the end of the day.

            One of the five said only if MDR, two said if only able to otherwise they

            teach them to follow contact precautions with good hand hygiene.

            One facility said has not had the patients to have to do this.

            Three said they do not practice doing acinetobacter patients at the end of the

            day.

2. Does anyone use bleach to kill C Diff? If so, is it premixed and how do you keep track of it?

             Six facilities do not use bleach.

             Of the three that do, one uses 10% bleach that they mix and immediately

             pitch once used. One facility uses Dispatch product. The final facility

             uses premixed bleach and it does not need monitored for expiration.

3. Does anyone use the hand held sensors that identify if a piece of equipment is not cleaned properly vs culturing and waiting for the cultures to come back in 3 days?

            No one uses the hand held sensors . There is information on this product at:

            http://www.hygiena.net/systemsure_plus.html   (if interested)

4. What parts of the ventilator are cultured for infectious agents?

            One facility does not have vents there.

            Six facilites do not culture vents routinely (only if outbreak)

            One facility said if outbreak would culture different parts of the vent.

            One facility cultures the inspiration/expiration ports and the temp sensor.

            One facility said if suspect outbreak, they would culture control panel and the

            attachments for the tubing.

Two APIC members answered the dress code question.

Does anyone have a dress code policy they can share? We need to update ours due to multiple professionals wearing open toed shoes in the clinical areas, etc.

One facility said their policy does not address shoes. Theirs does specify hose or socks are to be worn at all times and no beach wear for shoes. The other facility has  socks/hose to be worn at all times for sanitary purposes. Sandals and open toed shoes can be worn by non-direct caregivers with socks/hose. Clinical employees wear shoes with the top that must be solid, to protect for potential injury or infection in the healthcare environment. Shoes such as crocs are not acceptable.

Do you keep a drawer or cabinet in a patient’s room with nursing supplies (e.g. gauze, alcohol preps, blood tubes, dressings, tape, etc.)?

Yes 4          No 3

a.  If yes, and the patient was in Contact Precautions, do staff access the supplies with their gloves on or is there another process that staff follow?

1.      We do have a drawer in what is considered the healthcare worker area of the patient room with a limited number of supplies.  I am certain the staff access these supplies with their gloves on. 

2.      They would have gloves on unless they appeared contaminated, then they would change gloves.

3.      We have plastic boxes in ICU that contain alcohol swabs, monitor patches, 2X2s, bandaids, and tape. We also have mounted wire baskets with some limited respiratory supplies (cannula, suction tubing, etc). I would think that since we require gloves upon room entry that yes, they would.  I would hope that they would only be accessed with clean gloves, but we can't be assured that is always the case.  And I suspect staff could easily have contact with siderails & equipment before accessing items in the box or bin. 

4.      Entering the nurse server is considered a clean procedure under standard precautions and it is no different when contact precautions are in use. Hand hygiene is performed on entering the room and or when gloves are removed. Hands and or gloves that have touched the pt, environment or equipment must not enter the nurse server without performing hand hygiene first.

5.      We have linen closest in each room and supplies are kept in the ante rooms (e.g. gauze, dressing treatment supplies and tape) We do not keep alcohol preps or blood tubes in the room.  If the pt. is in contact precautions the staff is instructed to remove charge stickers from the packages before placing them in the rooms.

6.      No, we do not keep supplies in patient rooms.  Our Volunteers make up little "kits" that include alcohol pads, 2x2s, band-aids, IV labels, IV caps and the nurse can take a "kit with her/him to use for that patient and leave in there.  The nurses wanted supplies in the room but especially if you have anything that may outdate, who's going to check the dates? Anything left in the room is disposed of (less waste).

b.  If yes, and the patient was in Contact Precautions, what do you do with the supplies at discharge?

1.      The protocol here is a) regardless of isolation status – any “opened” patient care supply either goes home with the patient or is discarded when the patient is discharged.  If items are not opened (loose alcohol preps not opened, an unopened sleeve of gauze, etc.) they can stay in the drawer. BUT  b)if the patient is in contact isolation precautions, all supplies are to either go home with the patient or be discarded.  That is why we try to keep very few supplies in the room. 

2.      Supplies remain in the ‘server’ cabinet – in the past, R Acinetobacter isolation cases required items to be discarded but that has been eliminated.  We tried to implement a system where the server would be locked out when isolation was implemented and a cart would be outside the room with these same supplies, in smaller quantities, but details can’t be worked out.  I try to urge staff to keep levels in server low but they really top fill to excess. 

3.      If the patient is in Contact Precautions, items in the box & bin are discarded at discharge, the box/bin is disinfected and restocked. 

4.      They stay in the nurse server and are used for the next patient.  In the event of known and reported contamination, we discard or disinfect the supplies.  This is also true for medications which are kept in our rooms.

5. I have staff discard all unused supplies.  We try to stock room supplies in sm. amounts in order to contain wastefulness.  All the linens are removed from the closets and sent to be laundered.   We try to send the dressing supplies with them if possible (instructions are given to them of course on not sharing) or discard if not needed. 

How and how often does your Physical Therapy staff clean equipment on in-patient and out-patient equipment?  Examples: walkers or equipment used on several in-patients on the same day or stationary equipment like weight machines in the out-patient setting.

1. After each patient use.

2. Some things are cleaned after each patient, some at the end of the day and some at the end of the week.

3. They use SaniCloth HB wipes.

4. We clean the weight machines in between patient use if needed or are cleaned daily. tables and other stuff are wiped in between use other equipment is done weekly or more if appears soiled. we have sanitizer for patients to use before using the equipment or after and the wipes are placed around for use on all equipment.

5. All tables used (inpatient or outpatient) are disinfected one per day.  They are covered with clean linens between each patient (then discarded and fresh linen put on).

In the “gym” areas, Sani-cloths in dispensers are place at each machine or station and the patients are asked to wipe the equipment down after use – not sure if this is being monitored or not.

Then, once per week in the “gym” areas, the PT staff actually disinfectant each piece of equipment using a hospital approved (quat) disinfectant on all exposed surfaces.

Items such as walkers, canes, etc. are disinfected by PT staff between each patient use using Sani-cloths.

Guide belts used are now disposable (this is new for us – yea!). 

6. Patients are encouraged to do hand hygiene before and after handling physical therapy equipment. All therapy equipment is cleaned and recorded on a set schedule from weekly to monthly depending on the equipment.

7. The equipment is wiped down at the end of the day and after being used by a  patient with a cold, or respiratory infection.  It is also disinfected before being used again if the patient has a history of MRSA, or recent gastroenteritis

8. We clean between patients when something is taken into a patient’s room. In the dept, they have a set cleaning schedule which they document. They now have a walker mounted in every room, so that is cleaned upon DC of the patient.

9. OUR P.T. CLEANS EQUIPEMENT AFTER EACH USE. IF WALKERS OR WHEELCHAIRS ARE USED ON DIFFERENT PTS THESE SUPPLIES ARE CLEANED AFTER EACH PT. BEFORE ANOTHER PT. USES IT.

10. Our cleaning schedule is as follows:

For a mat-clean after each resident use

For other equipment-clean weekly

They use Discide and  Heptagon

For cloth beanbags, they use Lysol

       11. After each treatment:

·         Following each patient’s treatment, the sheets, pillow case, and gown will be changed and disposed of in the proper manner. Clean linen will then be applied to the treatment table.

·         The ultrasound heads will be wiped with alcohol after each use.

·         Whirlpool tanks will be cleaned after every treatment.  See separate policy/procedure.

·         Equipment taken into an isolation room will be items that are able to be cleaned.  Any item not able to be cleaned will be left in the room for patient specific use. 

      Daily: .  All equipment and modalities as well as the linen counters will be wiped with Sani-Master IV at the     end of the day.

Weekly: All stainless steel equipment will be washed down with a solution of Sani-Master IV.

Monthly:  Remove the drain screen from all whirlpool tanks and remove debris. May need to be done more often, depending upon activity.

As needed:

·         The paraffin bath will be cleaned as needed.

·         The treatment bench mats will be sprayed and washed with Sani-Master IV as needed.  If blood or body fluids are involved, mats will be cleaned with Sani-Master IV.

Note:  Separate policies and procedures exist for cleaning of the pool/spa area, whirlpool and the hydrocollator.

6 facilities have not implemented any standing order for urinalysis with C&S if indicated upon Foley insertion.

One hospital – working on u/a prior to insertion but weighing against fear that asymptomatic bacteruria will be treated.

One hospital – conducting a trial including urinalysis with C&S if indicated upon Foley insertion to trend which groups to focus on before implementing universally.

2 hospitals – u/a with C&S if indicated upon Foley insertion (first hospital does not do on straight caths and does not do for patient admitted with Foley but 2nd hospital does).