- Email: [email protected]
Occupational exposures to tuberculosis in two unusual circumstances in a major teaching hospital
Abstracts 11 5
A.IIC Volume 23, Number 2
judgment of the patients' conditions. Nurses may choose to isolate patients which they suspect of having tuberculosis without a physician order. Conflicts about who should be placed in special respiratory isolation are resolved by the Infectious Diseases Fellow. Prospective and retrospective evaluation of all patients with tuberculosis has shown that patients have been appropriately isolated.
AN INTEGRATED ALGORITHM FOR CLASSIFYING NOSOCOMIAL PNEUMONIA. B. Barnard, MPH, CIC,* V. Kennedy, RN, MS, CIC. St. Luke's Episcopal Hospital, Houston, TX, Due to increasing demands for infection control data by various groups within the hospital, infection control professionals must think carefully about how they are going to collect and analyze their data. In addition to intrainstitutional needs for information, anticipated external agency reporting requirements (e.g., J C A H O Indicator Management System) made it imperative that we develop an easy way to "slice" our data in many ways. In order to simplify data collection and classi~cation during participation in the JCAHO Beta Testing Project of infection control indicators for nosocomial postoperative pneumonia and ventilator pneumonia, we developed an algorithm for classifying nosocomial p n e u m o n i a s into one of the following categories: (1) postoperative--aspiration; (2) postoperative--ventilator--aspiration; (3) postoperative--ventilator--other; (4) postoperative--other; (5) ventilator--aspiration; (6) ventilator--other; (7) other--aspiration; (8) other--not classified. The algorithm includes a decision tree which has standardized our classification, analysis, and reporting of nosocomial pneumonia rates. In addition, use of this algorithm has made us responsive to the data needs of other groups' quality improvement projects. 4,4,41,
LACK OF BACTERIAL C O N T A M I N A T I O N OF VENTILAT O R CIRCUITRY CHANGED AT 5-DAY INTERVALS IN NEWBORN INTENSIVE CARE UNIT (NICU). S. Skelton, RN, BSN,* S. Feldman, MD, R. Nolan, MD, FACE H. Stubbs, MBA, RRT. University of Mississippi Medical Center, Jackson, MS. Ventilator circuits in newborn intensive care units (NICU) are usually changed every 48 hours due to concern over bacterial contamination from the circuitry. Less frequent circuit changes would be a net cost savings if rates of nosocomial pneumonia were not increased. We performed cultures of dual heated wire infant ventilator circuits on neonates in our 64-bed NICU at the time of discontinuation of mechanical ventilation or at 5 days to ascertain bacterial contamination. Seventy cultures were performed on 46 patients. Forty-eight cultures were obtained at day 5. Ventilator tubing was changed routinely no later than day 5. One culture obtained on day 1 grew coagulase negative staphylococcus, otherwise all cultures were without growth. At our institution ventilator circuit changes in NICU can be safely extended to 5 days without a.n increased rate of bacterial infection. In addition to decreasing cost, other potential advantages include less manipulation of circuitry with less opportunity for tube displacement or external contamination. Calculation of potential cost savings in our unit is in process.
O C C U P A T I O N A L EXPOSURES TO T U B E R C U L O S I S IN TWO UNUSUAL CIRCUMSTANCES IN A MAJOR TEACHING HOSPITAL. M. D. Agresta, BSN, CIC, E. L. Currie, MS, RN, CIC,* C. A. Killian, RN, E. M. Hanley, R. A. Venezia, PhD. Albany Medical Center, Albany, NY. During the past year, this 600-bed tertiary care hospital experienced occupational TB exposures which occurred due to two unusual circumstances. The first exposure was identified in July 1994, when a correctional guard assigned to this medical center was diagnosed with multidrug-resistant tuberculosis. He worked in the hospital with active disease intermittently over a 4-month period. Contact investigation identified 85 employees and 94 patients as exposed. No PPD conversions have occurred among employees or patients to date. The second TB exposure was identified in November 1994, when two nurses working on the hematology-oncology unit were found to have PPD conversions. This was treated as a duster per the 1994 CDC "Guidelines for Preventing the Transmission of TB in Healthcare Facilities." Further screening identified three additional nurses, a social worker, a medical student, and a nuclear medicine technician with PPD conversions who had exposure to patients on the unit during the previous 3 months. With assistance from the New York State Department of Health, a probable source patient and period of infectivity were identified. The source patient was asymptomatic on admission in July, and subsequently developed cough and fever which were attributed to his diagnosis oflymphoma. He expired in late August. Contact investigation for this exposure is ongoing. In the course of both exposure investigations, a number of issues were identified for improvement. It is essential to develop mechanisms to communicate disease and health status information with external agencies who have individuals assigned to the hospital on a routine basis, thus reducing the chance of avoidable exposures. The second exposure also revealed the importance of maintaining a high index of suspicion for TB in the hematology-oncology patient population especially if there is a change in clinical status. Basdine PPD tests and TB exposure histories should be included in initial screenings. The CDC guidelines, an established, effective employee health screening program, and the prompt follow-up by investigators within the Department of Epidemiology were the keys to identification of these atypical exposures.
CONTROLLING CONSTRUCTION DUST IN THE HOSPITAL ENVIRONMENT: A QUALITY IMPROVEMENT PROJECT. G. Turner, RN, MSN,* R. Sumner, MPH, L. Ornelas, PE, M, Martin, MD. Oregon Health Sciences University Hospitals and Clinics, Portland, OR. Following an adult cluster of disseminated aspergillosis that appeared linked to possible environmental As?ergillm, O H S U Hospitals and Clinics embarked on an intense year-long bioaerosol sampling project to better assess the impact of construction within its South Hospital on those patient populations at greatest risk for developing aspergillosis in the face of environmental As?ergillus exposure. Because the facility was about to embark on a 6-year period of continuous major construction projects, there was much concern over changing previous hospital/construction interactions so that environmental Aspergillus levels were controlled at preconstruction levels. Armed with 12 months of bioaerosol data, OHSU initiated a multidisciplinaty stakeholder QI Group charged with finding collaborative processes: (!) to raise general awareness about control-
A.IIC Volume 23, Number 2
judgment of the patients' conditions. Nurses may choose to isolate patients which they suspect of having tuberculosis without a physician order. Conflicts about who should be placed in special respiratory isolation are resolved by the Infectious Diseases Fellow. Prospective and retrospective evaluation of all patients with tuberculosis has shown that patients have been appropriately isolated.
AN INTEGRATED ALGORITHM FOR CLASSIFYING NOSOCOMIAL PNEUMONIA. B. Barnard, MPH, CIC,* V. Kennedy, RN, MS, CIC. St. Luke's Episcopal Hospital, Houston, TX, Due to increasing demands for infection control data by various groups within the hospital, infection control professionals must think carefully about how they are going to collect and analyze their data. In addition to intrainstitutional needs for information, anticipated external agency reporting requirements (e.g., J C A H O Indicator Management System) made it imperative that we develop an easy way to "slice" our data in many ways. In order to simplify data collection and classi~cation during participation in the JCAHO Beta Testing Project of infection control indicators for nosocomial postoperative pneumonia and ventilator pneumonia, we developed an algorithm for classifying nosocomial p n e u m o n i a s into one of the following categories: (1) postoperative--aspiration; (2) postoperative--ventilator--aspiration; (3) postoperative--ventilator--other; (4) postoperative--other; (5) ventilator--aspiration; (6) ventilator--other; (7) other--aspiration; (8) other--not classified. The algorithm includes a decision tree which has standardized our classification, analysis, and reporting of nosocomial pneumonia rates. In addition, use of this algorithm has made us responsive to the data needs of other groups' quality improvement projects. 4,4,41,
LACK OF BACTERIAL C O N T A M I N A T I O N OF VENTILAT O R CIRCUITRY CHANGED AT 5-DAY INTERVALS IN NEWBORN INTENSIVE CARE UNIT (NICU). S. Skelton, RN, BSN,* S. Feldman, MD, R. Nolan, MD, FACE H. Stubbs, MBA, RRT. University of Mississippi Medical Center, Jackson, MS. Ventilator circuits in newborn intensive care units (NICU) are usually changed every 48 hours due to concern over bacterial contamination from the circuitry. Less frequent circuit changes would be a net cost savings if rates of nosocomial pneumonia were not increased. We performed cultures of dual heated wire infant ventilator circuits on neonates in our 64-bed NICU at the time of discontinuation of mechanical ventilation or at 5 days to ascertain bacterial contamination. Seventy cultures were performed on 46 patients. Forty-eight cultures were obtained at day 5. Ventilator tubing was changed routinely no later than day 5. One culture obtained on day 1 grew coagulase negative staphylococcus, otherwise all cultures were without growth. At our institution ventilator circuit changes in NICU can be safely extended to 5 days without a.n increased rate of bacterial infection. In addition to decreasing cost, other potential advantages include less manipulation of circuitry with less opportunity for tube displacement or external contamination. Calculation of potential cost savings in our unit is in process.
O C C U P A T I O N A L EXPOSURES TO T U B E R C U L O S I S IN TWO UNUSUAL CIRCUMSTANCES IN A MAJOR TEACHING HOSPITAL. M. D. Agresta, BSN, CIC, E. L. Currie, MS, RN, CIC,* C. A. Killian, RN, E. M. Hanley, R. A. Venezia, PhD. Albany Medical Center, Albany, NY. During the past year, this 600-bed tertiary care hospital experienced occupational TB exposures which occurred due to two unusual circumstances. The first exposure was identified in July 1994, when a correctional guard assigned to this medical center was diagnosed with multidrug-resistant tuberculosis. He worked in the hospital with active disease intermittently over a 4-month period. Contact investigation identified 85 employees and 94 patients as exposed. No PPD conversions have occurred among employees or patients to date. The second TB exposure was identified in November 1994, when two nurses working on the hematology-oncology unit were found to have PPD conversions. This was treated as a duster per the 1994 CDC "Guidelines for Preventing the Transmission of TB in Healthcare Facilities." Further screening identified three additional nurses, a social worker, a medical student, and a nuclear medicine technician with PPD conversions who had exposure to patients on the unit during the previous 3 months. With assistance from the New York State Department of Health, a probable source patient and period of infectivity were identified. The source patient was asymptomatic on admission in July, and subsequently developed cough and fever which were attributed to his diagnosis oflymphoma. He expired in late August. Contact investigation for this exposure is ongoing. In the course of both exposure investigations, a number of issues were identified for improvement. It is essential to develop mechanisms to communicate disease and health status information with external agencies who have individuals assigned to the hospital on a routine basis, thus reducing the chance of avoidable exposures. The second exposure also revealed the importance of maintaining a high index of suspicion for TB in the hematology-oncology patient population especially if there is a change in clinical status. Basdine PPD tests and TB exposure histories should be included in initial screenings. The CDC guidelines, an established, effective employee health screening program, and the prompt follow-up by investigators within the Department of Epidemiology were the keys to identification of these atypical exposures.
CONTROLLING CONSTRUCTION DUST IN THE HOSPITAL ENVIRONMENT: A QUALITY IMPROVEMENT PROJECT. G. Turner, RN, MSN,* R. Sumner, MPH, L. Ornelas, PE, M, Martin, MD. Oregon Health Sciences University Hospitals and Clinics, Portland, OR. Following an adult cluster of disseminated aspergillosis that appeared linked to possible environmental As?ergillm, O H S U Hospitals and Clinics embarked on an intense year-long bioaerosol sampling project to better assess the impact of construction within its South Hospital on those patient populations at greatest risk for developing aspergillosis in the face of environmental As?ergillus exposure. Because the facility was about to embark on a 6-year period of continuous major construction projects, there was much concern over changing previous hospital/construction interactions so that environmental Aspergillus levels were controlled at preconstruction levels. Armed with 12 months of bioaerosol data, OHSU initiated a multidisciplinaty stakeholder QI Group charged with finding collaborative processes: (!) to raise general awareness about control-