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Blood contamination of reusable needle holders
j 04
Abstracts
AEROMlCROBlAL CONTROL IN AN EXTENSIVELY DAMAGED HOSPITAL USING A LONGLASTING. SURFACE-AfllVE, SILANE ANTIMICROBIAL. L. Ayers, MD, B. Fox. MD, C. Jacobson,* RN, C. Smith, PhD. R. Kernper. C. White. The Ohio State University, Columbus. OH and the Kemper Research Foundation, Gincionati, OH. Just prior to the opening of a cancer hospital and research institute, a major water pipe fmre and ruptured at the roof level of the building, flooding all twelve floors with an estimated 5lXl.Mx) gallons of water. Ceilings, walls, carpeted floor and upholstered &miture were either directly wet or exposed to high humidity. Localized odors began to develop in the building and sampling of wet carpeting showed heavy growth of water-associaled bacteria. Aemmicrobial sampling pmduced >2800 CFUs of fungus per cubic meter of air on most floors despite traditional techniques of surface disinfection and high efliciency air filtration. The lower floors which had greater water damage and a greater delay in moisture control developed visible colonies of fungi on damaged surfaces. Restoration of this building to its intended use as a cancer treatment center required the elimination of microbial reservoirs and the control of fungi on all exposed surfaces. Included in the exposed surfaces were carpeting, upholstered furniture. ceiling lile and wall board. A long acting silane modified organofunctional antimicrobial (Aegism, 3.trimethoxysilylpropyldimethyloctadecyl ammonium chloride by Aegis Environmental Management, Milford, Ohio) was selected to treat all surfaces throughout reconstruction. This product is odorless, colorless, non-volatile and may be applied to all dry environmental surfaces. Antimicrobial activity continues for several years Reevaluation of the facility at 7 months following restoration showed 45% of the facility environment to be free of aitirnc fungi; 36% with fewer than 5 CFUs per cubic meter of air. 8% with fewer than 10 CFUs. 5% with fewer than 15 CRTs and 6% with over I5 CFUS. Presently the facility is free of odor and has the appearance of a new building. These data show that this surf&xactive antimicrobial can be used succe&tdly for aemmicmbial control of a water damaged building without harm to the building environment or furnishings or health risks to patients or personnel.
BLOOD CONTAMINATION OF REUSABLE NEEDLE HOLDERS. S.A. Weinstein,* MT (ASCP). MPH, CIC. V. Hamrahi, A. Popat. J. Auto. MLT (ASCP), N.M. Gantz, MD. Universily of Massachusctts Medical Center, Worcester, MA. Needle holders (e.g., Vacutaine?) for “se with evacuated blood tubes during phlebotomy are usually considered reusable. The objective of this study was to evaluate the frequency of Mood comamination of these devices and the potential for cross-contamination, The blood drawing system comprises three basic elemen&. a sterile blood collection needle, a holder used to secure both ihe needle and the evacuated tube, and an evacuated tube lbat contains premeasured vacuum. In the Arst phase of the study, used needle holder hubs (place at which the needle is threaded into the hoIder) were tested for the presence of blood. In phase Il. 260 hubs were artificially inoculated with blood and then blood drawing was simulated by placing a needle in the holder and using a specimen tube to draw sterile water from a second tube (simulating a palient’s vein). AU three sites were then tested for the presence of blood by the orthotolidine assay. in phase 111. new needles were threaded into used holders and subsequcntly tcsled for blood. The frequency of blood detection of used holders was ah follows: after single pat&t USC - 48% (n=llO); after two patients - 49% (n=53): after Ave patients - 62% (n=51): and random number of patients (e.g.. taken from phlebotomy trays) - 66% (n=222). In phase 11. blood was detected in 10% of the specimens, 2% of the “veins” and 3% of the needles. In phase Ill, blood wa detected m I of 145 needles (0.7%). Needle holders can be easily contaminated with blood and may pose the theoretical risk of transmitting blood-borne pathogens if mused. We recommend that these devices should be considered for use with only one patient and either be discarded or appropriately disinfected after each USC.
SURVEY OF FIRST-YEAR MEDICAL RESIDENTS: HEPATITIS B VACCINE USAGE, NEEDLESTICK EXPOSURE AND FAMILIARITY WITH INFEClTON CONTROL PRECAUTIONS. A. Goetz,’ RN, MNEd. R.R. Muder, MD, CM. Yu. VA Medical Center, Piusburgh, PA. NEW INSIGHTS INTO DESTRUmlON OF MICROBEAD BOUND BACTERIA IN AN AIR FLUIDlZED BED MODEL. W. Winters, PhD. University of Texas Health Science Center, San Antonio, TX. The purpose of this study was to determine the effects of incrcasing levels of Ruidization and mechanical abrasive forces on the morphology and survival of challenge bacteria bound in micmbead clumps within an air Ruidized ted (AFB). operating at normal (31-33’C) and decontamination (49-50°C) temperatures. Growth and preparation of the gram stain positive challenge bactetia. B. subtilis. the challenge of the AFB. the collection of microbead samples and end point dilution and streak plate assays for viable bacteria were performed as recently described (Am I Infect Control 18:307-315, 1990). The morphology of bacteria associated with micmbeads was evaluated by differential stains with light and phase microscopy and by special stains with scanning electron microscopy @EM). Micmbead clumps were collecti and evaluated at 0. 0.25, 1. 2. 4, 6. 12 and 24 hrs after each bacterial challenge of an AFB operating at 3l-33°C and at Ruidization levels of 50, 60, 70, 80, 90 and 100%. respectively, as well as at l@.?% lluidization at 49-50°C. Clumps were weighed and divided into equal portions for morphology, SEM and viability assays. Results indicated that the percent of intact challenge organisms decreased and the percent of gram negative organisms increased steadily with time at 70% or greater, but not at 50% or 60% levels of Ruidization at 31-33’C. The greatest percentages of gram negative organisms were detected at 12 and 24 hrs under 49-50°C-100% fltddization conditions. When the AFB was operating at 31-33’C and at 5C-80% fluidization levels, motphologitally destroyed organisms were not regularly observed by SEM over the 24-hr time course. However, 65% and 80% of the challenge organisms were found to be completely destroyed at 90% and 100% fluidization levels, respectively. at 24 hrs by SEM. At 49-5O”C-100% lluidization conditions. SEM showed that 95% of the bacteria wen: dexmyed by 24 hn. Viability assays confirmed that maximum destruction of bacteria occurred at 24 hrs under 49-5O”C-lCO% fluidization conditions. In conclusion, the close correlation between increasing bacteriai destruction and morphoIogicaJ changes and increasing levels of lluidization at both test temperatures in an AFB confirmed our prior observations that mechanical abrasive forces generated by the levels of Auidization are very important, if not the most essential. factors infhtencing bacterial survival in an AFB.
A 15.item Infection Control questionnaire was administcrcd to I49 first-year residents at four university-affiliated hospitals (University of Pittsburgh and Medicat College of Pennsylvania). Specialties included medicine (60). surgery (29). pediatrics (ZO), obstetrizs (11). and other (29). The first 3 questions addressed actual experience; the remaining 12 questions tested general infection contml knowledge. 40% (60/149) experienced a needlestick injury during medical Echo+! whereas only 58% (35/60) rcpxted the mishap. 93% (139/149) residents had received the hepatitis B vaccine and 83% (123/149) completed the series. Of those reporting a needlestick injury, 95% (57/60) had received at least one dose of the hepatitis B vaccine. Universal precautions instructions were reported by 74% (11 l/149). There was a trend for those residents who received the hepatitis B vaccine to also have received universal precautions iostruclions 76% (106/139). p=O.O66. The overall test score ranged fmm 4-l 1 correct (mean= 8). Scores for the AIDS/hepatitis B questions (n=6) ranged from I to 6 (mean=3.9). Scores for the general infection control questions (n=6) ranged from 0 to 6 (mean=4). There was no statisti& si@Iicance between the scores of the AIDS/hepatitis questions of those instructed on universal precautions to those who received no instruction. Type of residency program was not associated with test score We conclude medical schools atz doing an adequate job in protecting their students against hepatitis B. however students should be encouraged to complete the series of 3 injections and report needlestick injuries. An average score of 8 (66%) indicates that standard infection control practices and their rationale should be integrated into medical school lectures and housestaff training.
Abstracts
AEROMlCROBlAL CONTROL IN AN EXTENSIVELY DAMAGED HOSPITAL USING A LONGLASTING. SURFACE-AfllVE, SILANE ANTIMICROBIAL. L. Ayers, MD, B. Fox. MD, C. Jacobson,* RN, C. Smith, PhD. R. Kernper. C. White. The Ohio State University, Columbus. OH and the Kemper Research Foundation, Gincionati, OH. Just prior to the opening of a cancer hospital and research institute, a major water pipe fmre and ruptured at the roof level of the building, flooding all twelve floors with an estimated 5lXl.Mx) gallons of water. Ceilings, walls, carpeted floor and upholstered &miture were either directly wet or exposed to high humidity. Localized odors began to develop in the building and sampling of wet carpeting showed heavy growth of water-associaled bacteria. Aemmicrobial sampling pmduced >2800 CFUs of fungus per cubic meter of air on most floors despite traditional techniques of surface disinfection and high efliciency air filtration. The lower floors which had greater water damage and a greater delay in moisture control developed visible colonies of fungi on damaged surfaces. Restoration of this building to its intended use as a cancer treatment center required the elimination of microbial reservoirs and the control of fungi on all exposed surfaces. Included in the exposed surfaces were carpeting, upholstered furniture. ceiling lile and wall board. A long acting silane modified organofunctional antimicrobial (Aegism, 3.trimethoxysilylpropyldimethyloctadecyl ammonium chloride by Aegis Environmental Management, Milford, Ohio) was selected to treat all surfaces throughout reconstruction. This product is odorless, colorless, non-volatile and may be applied to all dry environmental surfaces. Antimicrobial activity continues for several years Reevaluation of the facility at 7 months following restoration showed 45% of the facility environment to be free of aitirnc fungi; 36% with fewer than 5 CFUs per cubic meter of air. 8% with fewer than 10 CFUs. 5% with fewer than 15 CRTs and 6% with over I5 CFUS. Presently the facility is free of odor and has the appearance of a new building. These data show that this surf&xactive antimicrobial can be used succe&tdly for aemmicmbial control of a water damaged building without harm to the building environment or furnishings or health risks to patients or personnel.
BLOOD CONTAMINATION OF REUSABLE NEEDLE HOLDERS. S.A. Weinstein,* MT (ASCP). MPH, CIC. V. Hamrahi, A. Popat. J. Auto. MLT (ASCP), N.M. Gantz, MD. Universily of Massachusctts Medical Center, Worcester, MA. Needle holders (e.g., Vacutaine?) for “se with evacuated blood tubes during phlebotomy are usually considered reusable. The objective of this study was to evaluate the frequency of Mood comamination of these devices and the potential for cross-contamination, The blood drawing system comprises three basic elemen&. a sterile blood collection needle, a holder used to secure both ihe needle and the evacuated tube, and an evacuated tube lbat contains premeasured vacuum. In the Arst phase of the study, used needle holder hubs (place at which the needle is threaded into the hoIder) were tested for the presence of blood. In phase Il. 260 hubs were artificially inoculated with blood and then blood drawing was simulated by placing a needle in the holder and using a specimen tube to draw sterile water from a second tube (simulating a palient’s vein). AU three sites were then tested for the presence of blood by the orthotolidine assay. in phase 111. new needles were threaded into used holders and subsequcntly tcsled for blood. The frequency of blood detection of used holders was ah follows: after single pat&t USC - 48% (n=llO); after two patients - 49% (n=53): after Ave patients - 62% (n=51): and random number of patients (e.g.. taken from phlebotomy trays) - 66% (n=222). In phase 11. blood was detected in 10% of the specimens, 2% of the “veins” and 3% of the needles. In phase Ill, blood wa detected m I of 145 needles (0.7%). Needle holders can be easily contaminated with blood and may pose the theoretical risk of transmitting blood-borne pathogens if mused. We recommend that these devices should be considered for use with only one patient and either be discarded or appropriately disinfected after each USC.
SURVEY OF FIRST-YEAR MEDICAL RESIDENTS: HEPATITIS B VACCINE USAGE, NEEDLESTICK EXPOSURE AND FAMILIARITY WITH INFEClTON CONTROL PRECAUTIONS. A. Goetz,’ RN, MNEd. R.R. Muder, MD, CM. Yu. VA Medical Center, Piusburgh, PA. NEW INSIGHTS INTO DESTRUmlON OF MICROBEAD BOUND BACTERIA IN AN AIR FLUIDlZED BED MODEL. W. Winters, PhD. University of Texas Health Science Center, San Antonio, TX. The purpose of this study was to determine the effects of incrcasing levels of Ruidization and mechanical abrasive forces on the morphology and survival of challenge bacteria bound in micmbead clumps within an air Ruidized ted (AFB). operating at normal (31-33’C) and decontamination (49-50°C) temperatures. Growth and preparation of the gram stain positive challenge bactetia. B. subtilis. the challenge of the AFB. the collection of microbead samples and end point dilution and streak plate assays for viable bacteria were performed as recently described (Am I Infect Control 18:307-315, 1990). The morphology of bacteria associated with micmbeads was evaluated by differential stains with light and phase microscopy and by special stains with scanning electron microscopy @EM). Micmbead clumps were collecti and evaluated at 0. 0.25, 1. 2. 4, 6. 12 and 24 hrs after each bacterial challenge of an AFB operating at 3l-33°C and at Ruidization levels of 50, 60, 70, 80, 90 and 100%. respectively, as well as at l@.?% lluidization at 49-50°C. Clumps were weighed and divided into equal portions for morphology, SEM and viability assays. Results indicated that the percent of intact challenge organisms decreased and the percent of gram negative organisms increased steadily with time at 70% or greater, but not at 50% or 60% levels of Ruidization at 31-33’C. The greatest percentages of gram negative organisms were detected at 12 and 24 hrs under 49-50°C-100% fltddization conditions. When the AFB was operating at 31-33’C and at 5C-80% fluidization levels, motphologitally destroyed organisms were not regularly observed by SEM over the 24-hr time course. However, 65% and 80% of the challenge organisms were found to be completely destroyed at 90% and 100% fluidization levels, respectively. at 24 hrs by SEM. At 49-5O”C-100% lluidization conditions. SEM showed that 95% of the bacteria wen: dexmyed by 24 hn. Viability assays confirmed that maximum destruction of bacteria occurred at 24 hrs under 49-5O”C-lCO% fluidization conditions. In conclusion, the close correlation between increasing bacteriai destruction and morphoIogicaJ changes and increasing levels of lluidization at both test temperatures in an AFB confirmed our prior observations that mechanical abrasive forces generated by the levels of Auidization are very important, if not the most essential. factors infhtencing bacterial survival in an AFB.
A 15.item Infection Control questionnaire was administcrcd to I49 first-year residents at four university-affiliated hospitals (University of Pittsburgh and Medicat College of Pennsylvania). Specialties included medicine (60). surgery (29). pediatrics (ZO), obstetrizs (11). and other (29). The first 3 questions addressed actual experience; the remaining 12 questions tested general infection contml knowledge. 40% (60/149) experienced a needlestick injury during medical Echo+! whereas only 58% (35/60) rcpxted the mishap. 93% (139/149) residents had received the hepatitis B vaccine and 83% (123/149) completed the series. Of those reporting a needlestick injury, 95% (57/60) had received at least one dose of the hepatitis B vaccine. Universal precautions instructions were reported by 74% (11 l/149). There was a trend for those residents who received the hepatitis B vaccine to also have received universal precautions iostruclions 76% (106/139). p=O.O66. The overall test score ranged fmm 4-l 1 correct (mean= 8). Scores for the AIDS/hepatitis B questions (n=6) ranged from I to 6 (mean=3.9). Scores for the general infection control questions (n=6) ranged from 0 to 6 (mean=4). There was no statisti& si@Iicance between the scores of the AIDS/hepatitis questions of those instructed on universal precautions to those who received no instruction. Type of residency program was not associated with test score We conclude medical schools atz doing an adequate job in protecting their students against hepatitis B. however students should be encouraged to complete the series of 3 injections and report needlestick injuries. An average score of 8 (66%) indicates that standard infection control practices and their rationale should be integrated into medical school lectures and housestaff training.