- Email: [email protected]
A nosocomial outbreak of hepatitis a among nursing staff on a medical unit
116
Absiructs
A NOSOCOMIAL OUTBREAK OF HEPATlTIS A AMONG NURSING STAFF ON A MEDICAL UNIT. A. Earl,* RN, J.P. O’Keefe, MD, M. Huston, MD, R. Larson, RN. Loyola University Medical Center, Maywood, II..
INFEmION CONTROL SURVEILLANCE IN A U.S. DEPART MENT OF VECERANS AFFAIRS NURSING HOME CARE UNIT. M. Maglalang,* RN, MN, D. Potts, RNC, CIC. MS. VA Medical (‘enter, Palo Alto, CA.
In October, 1990. four nurses and a nurse’s aide on a medical nuning unit developed HAV infection over a l2-day period. The outbreak was traced to an icteric patient admitted with confusion, fecal incontinence and poor hygienic practices including deliberate fecal contamination of the environment. The admitting diagnosis was alcoholic hepatitis. He was placed in enteric precautions on the 11th hospital day. Four of the five infected employees had directly participated in his care. One infected nurse denied any patient contact, although secondary cases occurred in her daughter and husband. Of the 42 “nit and off-unit hospital staff contacts, 20 were semnegative to HAV and were considercd susceptible. All 42 were given immune globulin before test results were available. No subclinical cases were found. A questionnai= seeking information on contact exposure to the index patient and his body fluids was administered to 49 nurses and nurse’s aides on the ““it. Sixty-one percent of the staff who cared for the index case had contact with urine or stool. Thirty-nine percent (half of those with hepatitis) cleaned the room. Sixty-three percent noted contamination of the envimnment with the patient’s feces. No significant differences in exposure behaviors were noted between the group who developed hepatitis (N=4) and those who had contact with the patient but did not develop hepatitis (N=45). The entire unit staff 1X=80) was surveyed about general behaviors in the workplace. Eighty percent eat on the ward and fifty-eight percent share food. Frequency of these behaviors was not significantly increased in employees with hepatitis. The survey indicated that there was fecal contamination of the envimnment which resulted in significant occupational exposure. The pattern of cases points to Ihe patient’s mom as the focus. Transmission to the one nurse with no contact is unexplained. We now require that patients admitted with diarrhea and fecal incontinence be placed in enteric precautions until the diagnosis is determined. We also encourage all staff in patient care areas to eat off the ““it and not share food.
In America, the most rapidly increasing population segment is individuals over age 85. As this becomes more evident, it is likely that there will be a corresponding increase in the number of nursing bvmc residents. It is well known that nursing home residents arc generally frail, functionally disabled with multiple chronic medical problems. and possibly with cognitive, psychiattic, or behavioral disorders Multiple risk factors, together with age-related physiological changes. make this group at high risk for contracting infectious diseases ami nosocomid infections. Infectious morbidity in nursing home care ““its (NHCLJ) ia” lx quite different from that in acute care facilities. Current literature does not precisely indicate the incidence and impact of nosocomial it&ctions in NHCU settings. Clinical manifestations of inrections I” this population may be atypical, non-specific, or absent. Therefore, development of criteria for dete”nining infections has been and still IS a challenge for the infection control practitioner. In a” attempt to establish a baseline infection rate lor the Palo Alto VA NHCU, a surveillance method was established and implemented. The NHCU consists of I50 beds and has a 95% occupancy rate. 130 beds are for patients who require skilied nursing care. There is also a IO-bed respite ““it, 5-bed hospice, and Wed transitional unit. Prior lo data collection, criteria were estabiished for determining nosocomial infections. This was accomplished through iiterature review, collaborative efforts with NHCU and Infectious Disea~t: Scction physicians. and analysis of CDC guideiines. infections were reported as: (a) UTI. sutxlivided into patients with chronic catheters and oncatheterized or newly-catheterized patients; @) URI; (c) LRI; (fij skin and sofl tissue infections; and (e) other infections. An infecrio” control surveillance form was designed to collect the data, including major (hctors predisposing to inFections in this patient population. Data will be presented on OUT infection fates during a one-year surveillance period. Recommendations for policy/procedural changes following the period of surveillance will also be shared.
NURSE-PREPARED MlJLTlSTlX AND LAB URINALYSIS IN EXTENDED CARE PATIENTS. V. Pritchard.* RN, MSN, CIC, I. Levemier. RN. BSN. Depanment of Veterans Affairs Medical Center, Chillicothe. OH.
BSI - THE LONG ISLAND EXPERIENCE: SIMPLiFYlNG EVERYONE’S LIFE. K. Fnaitoff; RN, BS. CIC. 9. Charles Hospital and Rehabilitation Center, Port Jefferson, NY. A. Means. RN. Suffolk 1nIi”“at-y. Yaphank NY. S. Robyn. RN, BSN, CIC. HEALTHCARE INTERFACE, Smithtown, NY. E. Schacffer. RN, MS, CIC. Southampton Hospital. Southampton, NY.
Often the institutionalized frail elderly and sometimes those patients who have had indwelling bladder catheters for a” extended period of time do not display definite signs of urinary tract infection. Routine laboratory urine studies can have a lag time of 24 to 72 hours depending on the type of institution and the particular lab methods. Early suspicion/implication of the possibility of infection by use of a multitix leukocytes and nitrites dipstick test could lead to early treatment and the prevention of severity of complications. This early indication could be of particular use to extended care Facilities where d&y in lab results is usually most extreme. The purpose of this study was to determine whether or not a nurse-prepared urine study, multistix leukocytes and nitrites, correlates with laboratory urine analysis and cul[“It. The study procedures used were relatively simple. Thirty-seven patients who were either 60 years old having spent at least three months in an extended care facility, or of any age if they had a bladder catheter for at least four weeks weTe studied. The study wards were three extended care “nits of a Veterans Affairs Medical Center. A nurse researcher obtained routine specimens, performed the multistix urine tests on the patient’s ward, and also sent urine to the labxatoly for analysis and culture. A data sheet was used to record results and a computer statistical correlation matrix was used to determine if the multistix test identified urinary tract infection as a accurately as laboratory analysis. The question, “Do nurse-prepared multistix compare favorably with the results of laboratory mine analysis?” was answered yes for the nitrite test only (at the 0.1 level; a correlation matrix was 0.884). The question. “Can nurse-prepared multistix be a useful early indicator of urinary tract infection in this study group?” was tentatively answered yes for the nitrite test (at the 0.1 level, a correlation matrix was 0.679). Further. larger studies that include females are needed for ease of “se and nursing work flow, but this small study indicates a definite “se for bedside nitrite mine studies to help guide treaVnent when urinary tzxt infection is a possibility.
In September, 1987, APIC Long Island, Chapter 38. formed a Task Force to Standardize Infectious Waste DeR”itio”s. In evaluating the impact of isolation practices on infectious waste, it became clear that Body Substance Isolation (BSl) provided the most rational approach to a cohere”t system. However, it had to be fully imcgrated into all areas of both the hospital, aid community-based services which interfaced with the hospital. Over an 1%month period, the Task Force diagnosed both gc”eral and institution-specific policies and pmccdures. Three institutions implemented Integrated BSI Programs. I.
Nursing standards were revised to incorporate BSI principles, providing compliance monitoring tools. 2. Patient education pmgranu wet-e developed to present the facts 01 disease transmission and the rationale For stafF prdcticcs implcmented for BSI. 3. Outreach education programs for OSHA and the NY State &pa”merit of Health were implemented to incorporate ESf principles into their survey standards. 4. Extra-aural heal&are provider education in BSl was provldcd for emergency medical services, police and fire. departments, “using homes, morticians, etc., to integrate their activities within the hospital’s BSI framework. One benefit of this Integrated BSI approach is that the concepts for reducing patient nosocomial a”d healthcam worker 0cLvpational infections are unified. This greatly simplifies new-him and inservice training. Related areas, such as housekeeping and waste handling, also benefit from this conceptual integration. Objective measures of the beneftts of Integrated BSI have been established. For example. si@iicant imptoveme”ts in employee ioservice perfommnce were demomxrabd. These and other ~swlts will be discussed. Tools for use in implementing Integrated BSI will also be preanted.
Absiructs
A NOSOCOMIAL OUTBREAK OF HEPATlTIS A AMONG NURSING STAFF ON A MEDICAL UNIT. A. Earl,* RN, J.P. O’Keefe, MD, M. Huston, MD, R. Larson, RN. Loyola University Medical Center, Maywood, II..
INFEmION CONTROL SURVEILLANCE IN A U.S. DEPART MENT OF VECERANS AFFAIRS NURSING HOME CARE UNIT. M. Maglalang,* RN, MN, D. Potts, RNC, CIC. MS. VA Medical (‘enter, Palo Alto, CA.
In October, 1990. four nurses and a nurse’s aide on a medical nuning unit developed HAV infection over a l2-day period. The outbreak was traced to an icteric patient admitted with confusion, fecal incontinence and poor hygienic practices including deliberate fecal contamination of the environment. The admitting diagnosis was alcoholic hepatitis. He was placed in enteric precautions on the 11th hospital day. Four of the five infected employees had directly participated in his care. One infected nurse denied any patient contact, although secondary cases occurred in her daughter and husband. Of the 42 “nit and off-unit hospital staff contacts, 20 were semnegative to HAV and were considercd susceptible. All 42 were given immune globulin before test results were available. No subclinical cases were found. A questionnai= seeking information on contact exposure to the index patient and his body fluids was administered to 49 nurses and nurse’s aides on the ““it. Sixty-one percent of the staff who cared for the index case had contact with urine or stool. Thirty-nine percent (half of those with hepatitis) cleaned the room. Sixty-three percent noted contamination of the envimnment with the patient’s feces. No significant differences in exposure behaviors were noted between the group who developed hepatitis (N=4) and those who had contact with the patient but did not develop hepatitis (N=45). The entire unit staff 1X=80) was surveyed about general behaviors in the workplace. Eighty percent eat on the ward and fifty-eight percent share food. Frequency of these behaviors was not significantly increased in employees with hepatitis. The survey indicated that there was fecal contamination of the envimnment which resulted in significant occupational exposure. The pattern of cases points to Ihe patient’s mom as the focus. Transmission to the one nurse with no contact is unexplained. We now require that patients admitted with diarrhea and fecal incontinence be placed in enteric precautions until the diagnosis is determined. We also encourage all staff in patient care areas to eat off the ““it and not share food.
In America, the most rapidly increasing population segment is individuals over age 85. As this becomes more evident, it is likely that there will be a corresponding increase in the number of nursing bvmc residents. It is well known that nursing home residents arc generally frail, functionally disabled with multiple chronic medical problems. and possibly with cognitive, psychiattic, or behavioral disorders Multiple risk factors, together with age-related physiological changes. make this group at high risk for contracting infectious diseases ami nosocomid infections. Infectious morbidity in nursing home care ““its (NHCLJ) ia” lx quite different from that in acute care facilities. Current literature does not precisely indicate the incidence and impact of nosocomial it&ctions in NHCU settings. Clinical manifestations of inrections I” this population may be atypical, non-specific, or absent. Therefore, development of criteria for dete”nining infections has been and still IS a challenge for the infection control practitioner. In a” attempt to establish a baseline infection rate lor the Palo Alto VA NHCU, a surveillance method was established and implemented. The NHCU consists of I50 beds and has a 95% occupancy rate. 130 beds are for patients who require skilied nursing care. There is also a IO-bed respite ““it, 5-bed hospice, and Wed transitional unit. Prior lo data collection, criteria were estabiished for determining nosocomial infections. This was accomplished through iiterature review, collaborative efforts with NHCU and Infectious Disea~t: Scction physicians. and analysis of CDC guideiines. infections were reported as: (a) UTI. sutxlivided into patients with chronic catheters and oncatheterized or newly-catheterized patients; @) URI; (c) LRI; (fij skin and sofl tissue infections; and (e) other infections. An infecrio” control surveillance form was designed to collect the data, including major (hctors predisposing to inFections in this patient population. Data will be presented on OUT infection fates during a one-year surveillance period. Recommendations for policy/procedural changes following the period of surveillance will also be shared.
NURSE-PREPARED MlJLTlSTlX AND LAB URINALYSIS IN EXTENDED CARE PATIENTS. V. Pritchard.* RN, MSN, CIC, I. Levemier. RN. BSN. Depanment of Veterans Affairs Medical Center, Chillicothe. OH.
BSI - THE LONG ISLAND EXPERIENCE: SIMPLiFYlNG EVERYONE’S LIFE. K. Fnaitoff; RN, BS. CIC. 9. Charles Hospital and Rehabilitation Center, Port Jefferson, NY. A. Means. RN. Suffolk 1nIi”“at-y. Yaphank NY. S. Robyn. RN, BSN, CIC. HEALTHCARE INTERFACE, Smithtown, NY. E. Schacffer. RN, MS, CIC. Southampton Hospital. Southampton, NY.
Often the institutionalized frail elderly and sometimes those patients who have had indwelling bladder catheters for a” extended period of time do not display definite signs of urinary tract infection. Routine laboratory urine studies can have a lag time of 24 to 72 hours depending on the type of institution and the particular lab methods. Early suspicion/implication of the possibility of infection by use of a multitix leukocytes and nitrites dipstick test could lead to early treatment and the prevention of severity of complications. This early indication could be of particular use to extended care Facilities where d&y in lab results is usually most extreme. The purpose of this study was to determine whether or not a nurse-prepared urine study, multistix leukocytes and nitrites, correlates with laboratory urine analysis and cul[“It. The study procedures used were relatively simple. Thirty-seven patients who were either 60 years old having spent at least three months in an extended care facility, or of any age if they had a bladder catheter for at least four weeks weTe studied. The study wards were three extended care “nits of a Veterans Affairs Medical Center. A nurse researcher obtained routine specimens, performed the multistix urine tests on the patient’s ward, and also sent urine to the labxatoly for analysis and culture. A data sheet was used to record results and a computer statistical correlation matrix was used to determine if the multistix test identified urinary tract infection as a accurately as laboratory analysis. The question, “Do nurse-prepared multistix compare favorably with the results of laboratory mine analysis?” was answered yes for the nitrite test only (at the 0.1 level; a correlation matrix was 0.884). The question. “Can nurse-prepared multistix be a useful early indicator of urinary tract infection in this study group?” was tentatively answered yes for the nitrite test (at the 0.1 level, a correlation matrix was 0.679). Further. larger studies that include females are needed for ease of “se and nursing work flow, but this small study indicates a definite “se for bedside nitrite mine studies to help guide treaVnent when urinary tzxt infection is a possibility.
In September, 1987, APIC Long Island, Chapter 38. formed a Task Force to Standardize Infectious Waste DeR”itio”s. In evaluating the impact of isolation practices on infectious waste, it became clear that Body Substance Isolation (BSl) provided the most rational approach to a cohere”t system. However, it had to be fully imcgrated into all areas of both the hospital, aid community-based services which interfaced with the hospital. Over an 1%month period, the Task Force diagnosed both gc”eral and institution-specific policies and pmccdures. Three institutions implemented Integrated BSI Programs. I.
Nursing standards were revised to incorporate BSI principles, providing compliance monitoring tools. 2. Patient education pmgranu wet-e developed to present the facts 01 disease transmission and the rationale For stafF prdcticcs implcmented for BSI. 3. Outreach education programs for OSHA and the NY State &pa”merit of Health were implemented to incorporate ESf principles into their survey standards. 4. Extra-aural heal&are provider education in BSl was provldcd for emergency medical services, police and fire. departments, “using homes, morticians, etc., to integrate their activities within the hospital’s BSI framework. One benefit of this Integrated BSI approach is that the concepts for reducing patient nosocomial a”d healthcam worker 0cLvpational infections are unified. This greatly simplifies new-him and inservice training. Related areas, such as housekeeping and waste handling, also benefit from this conceptual integration. Objective measures of the beneftts of Integrated BSI have been established. For example. si@iicant imptoveme”ts in employee ioservice perfommnce were demomxrabd. These and other ~swlts will be discussed. Tools for use in implementing Integrated BSI will also be preanted.