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Blood and body fluid exposures at Boston City Hospital 1988–1994
AJIC April Jgg5
"132 Abstracts
rinse for each subject before and after a 10-second hand wash. Standard laboratory procedures were followed for quantitation and identification of bacteria. T-test analysis showed no significant difference between the bioload on hands of HCWs with tings compared to HCWs without rings either before handwashing (p = 0.12) or after handwashing (/, = 0.07). There was a significant decrease in bioload after handwashing for both groups (both p < 0.05). A timed handwashing procedure significantly reduces the number of bacteria on the hands of HCWs even in the presence of hand jewelry. ~ee INVESTIGATION AND INTERVENTION TO ERADICATE PERSISTENT C O L O N I Z A T I O N OF WATER IN A HEMODIALYSIS UNIT, A. Dikon, RN, BSN, CIC,* D. Burton, RN, BSN, CIC, M. Arboite, RN, BSN, J. Huck, RN, BSN, CNN, J. Michaels. Albert Einstein Medical Center, Philadelphia, PA.
Routine sampling, to fulfill state requirements, of water for hemodialysis yielded positive results exceeding allowable colony counts. Initially, positive results were intermittent; however, later samples persistently yielded Pseudomonas pickettii. The hemodialysis unit is an eightbed acute unit based in an urban community teaching hospital. The dialysis water is treated by a reverse-osmosis (RO) process. There were no patient illnessesor sequelae associated with the colonized water. Review of protocols, practices and systems did not reveal any obvious contributory breaks in technique or the water treatment process. Environmental cultures failed to identify a possible source of contamination. Meetings were held with nursing staff, biomedical engineering, environmental services, maintenance and microbiology to determine a possible source of the colonization. The process for terminal cleaning of dialysis machines was changed to peracetic acid, the frequency of sanitizing the RO system and supply lines was increased. All cleaning protocols an d policies were reviewed and reinforced with the staf£. In conclusion, the persistence of colonization identified the need for specific written protocols and adherence to same as well as the necessity of knowing all aspects of a system. The multidisciplinary team resolved that the problem was not colonization of specific machines as originally thought, rather the source was associated with the water supply itself. Actions implemented by the team resulted in improved patient care, increased interdepartmental collaboration, and resolution of the problem. 4,e4, BLOOD A N D BODY FLUID EXPOSURES AT BOSTON CITY HOSPITAL 1988-1994. G. M. Garvin, RN, MEd,* C. A. Sulis, MD. Boston City Hospital, Boston, MA.
Boston City Hospital (BCH) is a 350-bed municipal teaching hospital with 200,000 ambulatory visits and 15,000 admissions a year. In 1992 we described a decrease in the number of reported occupational blood and body fluid exposures over 4 years in three groups: environmental services,laboratoryworkers, and emergency medical service personnd. We now describe the distribution of all 1172 exposures reported to the Occupational Health Service between 1/88 and 12194. Over this period 81% of exposures were percutaneous and 17% were from a source known to be HIV positive. The overall number of reported exposures decreased from 223 to 133 a year. When the rate of exposures for each job category was calculated, nursing was the only group that demonstrated a decreased rate of
exposures (11.4 to 8.3 episodes/100 employees/year). Over the same period there was a significant decrease in occurrence of exposures due to recapping (17% to 4%) but an increase in injuries from sharps left in trash or in the work environment (15% to 25%). Many safety devices and risk reduction strategies for health care workers (HCW) have been introduced: universal precautions, inroom sharps disposal, a product task force to clinically evaluate products with incorporated safety features, a training program to facilitate site specific infection control education, and around the clock counseling for all HCWs with unprotected exposures. In spite of these efforts we have been unable to effect a decrease in exposures among physicians, or in HCWs performing certain tasks such as phlebotomy or insertion of IVs. We are now collaborating with physicians and nurses to identify strategies to reduce exposures. e,e DEVELOPING GUIDELINES FOR THE USE OF DISINFECTING AGENTS IN HEMODIALYSIS SYSTEMS. C. M. Paine, BS, MT,* J. A. Viola, SBMET, M. Spencer, RN, CIC, MPH, J. Nardini, RN. Massachusetts General Hospital, Boston, MA.
The Infection Control Unit of a 900+ bed acute care hospital conducts monthly bacterial cultures of hemodialysis fluids. High bacterial counts resulted in a collaborative study with the six-station Hemodialysis Unit (HU) to investigate procedures to disinfect hemodialysis machines (HM) and sanitation procedures of the Reverse Osmosis system (RO). The clinical and sometimes emergent nature of the HU made routine disinfection of the HMs by manufacturer's recommended practice (prior to patient use) difficult. The Association for the Advancement of Medical Instrumentation (AAMI) proposes Microbiologic Standards for Hemodialysis Fluids (MSHF) which limit the bacterial colony forming units (CFUs) in a sample to be <2000 and <200 for HMs and ROs respectively. A new disinfection and sanitation procedure was proposed which included disinfecting the HMs at the end of each day and weekly sanitation of the RO. This new procedure was designed to (1) manage the increased patient volume of the unit, (2) coincide with stai~g schedules, (3) assure disinfecting procedures are done routinely, and (4) maintain high quality control on the hemodialysis fluids. Samples were taken of the dialysis fluids in the evenings after disinfection and in the morning just prior to patient use. Results indicated a slight increase of CFUs between evening cultures (range = 0-110 CFUs) and morning cultures (range = 0-270 CFUs), but results were well within AAMI's MSHE The new disinfection procedure of the HMs conducted up to 48 hours prior to patient use meets AAMI's MSHF and was successfully implemented by the HU. eee COMPARISON OF MICROBIAL CONTAMINATION RATES IN OPEN VERSUS CLOSED W O U N D D R A I N A G E DEVICES. M. Spencer, RN, MEd, CIC,* C. Paine, BS, MT, K. Kovack, BS, N. Vogt, C. Hopkins, MD. Massachusetts General Hospital, Boston, MA.
Microbial contamination of wound drainage devices is a potential reservoir for retrograde ingress of microorganisms through wound drains and into wound cavities. Open wound drainage devices (OWDD) are attached to wound drains during surgery and left in place for approximately 1-3 days. The tops of these devices
"132 Abstracts
rinse for each subject before and after a 10-second hand wash. Standard laboratory procedures were followed for quantitation and identification of bacteria. T-test analysis showed no significant difference between the bioload on hands of HCWs with tings compared to HCWs without rings either before handwashing (p = 0.12) or after handwashing (/, = 0.07). There was a significant decrease in bioload after handwashing for both groups (both p < 0.05). A timed handwashing procedure significantly reduces the number of bacteria on the hands of HCWs even in the presence of hand jewelry. ~ee INVESTIGATION AND INTERVENTION TO ERADICATE PERSISTENT C O L O N I Z A T I O N OF WATER IN A HEMODIALYSIS UNIT, A. Dikon, RN, BSN, CIC,* D. Burton, RN, BSN, CIC, M. Arboite, RN, BSN, J. Huck, RN, BSN, CNN, J. Michaels. Albert Einstein Medical Center, Philadelphia, PA.
Routine sampling, to fulfill state requirements, of water for hemodialysis yielded positive results exceeding allowable colony counts. Initially, positive results were intermittent; however, later samples persistently yielded Pseudomonas pickettii. The hemodialysis unit is an eightbed acute unit based in an urban community teaching hospital. The dialysis water is treated by a reverse-osmosis (RO) process. There were no patient illnessesor sequelae associated with the colonized water. Review of protocols, practices and systems did not reveal any obvious contributory breaks in technique or the water treatment process. Environmental cultures failed to identify a possible source of contamination. Meetings were held with nursing staff, biomedical engineering, environmental services, maintenance and microbiology to determine a possible source of the colonization. The process for terminal cleaning of dialysis machines was changed to peracetic acid, the frequency of sanitizing the RO system and supply lines was increased. All cleaning protocols an d policies were reviewed and reinforced with the staf£. In conclusion, the persistence of colonization identified the need for specific written protocols and adherence to same as well as the necessity of knowing all aspects of a system. The multidisciplinary team resolved that the problem was not colonization of specific machines as originally thought, rather the source was associated with the water supply itself. Actions implemented by the team resulted in improved patient care, increased interdepartmental collaboration, and resolution of the problem. 4,e4, BLOOD A N D BODY FLUID EXPOSURES AT BOSTON CITY HOSPITAL 1988-1994. G. M. Garvin, RN, MEd,* C. A. Sulis, MD. Boston City Hospital, Boston, MA.
Boston City Hospital (BCH) is a 350-bed municipal teaching hospital with 200,000 ambulatory visits and 15,000 admissions a year. In 1992 we described a decrease in the number of reported occupational blood and body fluid exposures over 4 years in three groups: environmental services,laboratoryworkers, and emergency medical service personnd. We now describe the distribution of all 1172 exposures reported to the Occupational Health Service between 1/88 and 12194. Over this period 81% of exposures were percutaneous and 17% were from a source known to be HIV positive. The overall number of reported exposures decreased from 223 to 133 a year. When the rate of exposures for each job category was calculated, nursing was the only group that demonstrated a decreased rate of
exposures (11.4 to 8.3 episodes/100 employees/year). Over the same period there was a significant decrease in occurrence of exposures due to recapping (17% to 4%) but an increase in injuries from sharps left in trash or in the work environment (15% to 25%). Many safety devices and risk reduction strategies for health care workers (HCW) have been introduced: universal precautions, inroom sharps disposal, a product task force to clinically evaluate products with incorporated safety features, a training program to facilitate site specific infection control education, and around the clock counseling for all HCWs with unprotected exposures. In spite of these efforts we have been unable to effect a decrease in exposures among physicians, or in HCWs performing certain tasks such as phlebotomy or insertion of IVs. We are now collaborating with physicians and nurses to identify strategies to reduce exposures. e,e DEVELOPING GUIDELINES FOR THE USE OF DISINFECTING AGENTS IN HEMODIALYSIS SYSTEMS. C. M. Paine, BS, MT,* J. A. Viola, SBMET, M. Spencer, RN, CIC, MPH, J. Nardini, RN. Massachusetts General Hospital, Boston, MA.
The Infection Control Unit of a 900+ bed acute care hospital conducts monthly bacterial cultures of hemodialysis fluids. High bacterial counts resulted in a collaborative study with the six-station Hemodialysis Unit (HU) to investigate procedures to disinfect hemodialysis machines (HM) and sanitation procedures of the Reverse Osmosis system (RO). The clinical and sometimes emergent nature of the HU made routine disinfection of the HMs by manufacturer's recommended practice (prior to patient use) difficult. The Association for the Advancement of Medical Instrumentation (AAMI) proposes Microbiologic Standards for Hemodialysis Fluids (MSHF) which limit the bacterial colony forming units (CFUs) in a sample to be <2000 and <200 for HMs and ROs respectively. A new disinfection and sanitation procedure was proposed which included disinfecting the HMs at the end of each day and weekly sanitation of the RO. This new procedure was designed to (1) manage the increased patient volume of the unit, (2) coincide with stai~g schedules, (3) assure disinfecting procedures are done routinely, and (4) maintain high quality control on the hemodialysis fluids. Samples were taken of the dialysis fluids in the evenings after disinfection and in the morning just prior to patient use. Results indicated a slight increase of CFUs between evening cultures (range = 0-110 CFUs) and morning cultures (range = 0-270 CFUs), but results were well within AAMI's MSHE The new disinfection procedure of the HMs conducted up to 48 hours prior to patient use meets AAMI's MSHF and was successfully implemented by the HU. eee COMPARISON OF MICROBIAL CONTAMINATION RATES IN OPEN VERSUS CLOSED W O U N D D R A I N A G E DEVICES. M. Spencer, RN, MEd, CIC,* C. Paine, BS, MT, K. Kovack, BS, N. Vogt, C. Hopkins, MD. Massachusetts General Hospital, Boston, MA.
Microbial contamination of wound drainage devices is a potential reservoir for retrograde ingress of microorganisms through wound drains and into wound cavities. Open wound drainage devices (OWDD) are attached to wound drains during surgery and left in place for approximately 1-3 days. The tops of these devices