- Email: [email protected]
Infection control considerations following a natural disaster: Earthquake
Volume
18 Number
2
Abstracts
April 1990
INFECTION CONTROL IN A NEW PULMONARY ANALYSIS OF THE RISKS. D. McCullough,* B. Moody, Seton Medical Center, Austin TX.
UNIT: L. Lewis.
A new Pulmonary Intermediate-Care Unit (PICU) was opened for long-term ventilated patients to create mom acute-care beds and to reduce costs. Intensive surveillance was planned to assess the risks since there was little published data on outcome from such units. The PICU is a 720~square foot, open room with four beds. Only two handwashing sinks am available. The area is crowded with ventilators and accessory equipment. The infection control concern was the high potential for cross-transmission of infection. Admission criteria included pre-screening for transmissible infections and excluded patients with methicillin-resistant Stnphykxoccus aureus, C. difticile, H. Zoster and Respiratory or Strict Isolation cases. Of 35 total admissions, 24 patients were present over 48 hours; their average age was 69; average stay was 22 days (range 3-135). There were 21 totalnosocomial infections (53% per total admissions); 10 urinary tract infections (UTI) and seven lower respiratory infections (LRI). Only 4 of the 13 intubated patients developed LRI. However, 1 patient had 9 infections (3 UTI; 4 LRI). Excluding that patient, infection rates were somewhat higher than our ICU rates. Estimated cost of the nosocomial infections was S50,ooO. Despite fears, and doubling of the census in the second 6 months, this tit has not been the source of outbreaks or frequent infection control problems. It has successfully provided greater access to criticalcare beds and reduced the non-reimbursable costs of long-term ventilated patients. However, the costs of increased nosocomial infections should be considered when a unit of this type. is planned.
INFECTION CONTROL NATURAL DISASTER: M. Maglalang, C. Valdon. Center, Palo Alto, CA.
MEASURING APPLICATION OF STANCE PRECAUTIONS. J. Thnm. Rochester, MN.
149
STANDARD BODY SUBRochester Methodist Hospital,
With the implementation of Standard Body Substance Precautions in a large teaching hospital, the need to develop a method to assure an understanding and an appropriate application of the policy was identified. Following housewide education of the policy, a three-part quality assurance tool was developed. The audit tool consisted of three parts: 1. A written test to measure knowledge of the policy’s main principles. 2. A “protective equipment” checklist to assure availability of supplies in work areas. 3. A “peer observation” tool to assess appropriate application of knowledge. Parts of the audit were completed by all departments whose work involves a potential for body substance exposure. Supervisors coordinated collection of data with assistance from the Infection Control Staff. Data were analyzed by the Infection Control Department with staff feedback given on a unit basis. Results of the written test for Central Supply, Nursing and Surgical Services were 935, 92% and 88% respectively. Protective equip ment was available in Centml Supply work areas 100% of the time; Nursing Units 94% of the time; and Surgical Service work areas 100% of the time. The mults of peer observation reflected positive responses with the following frequencies: Central Supply 97%; Nursing 84%. and SurgicaI Services 80%. A cooperative effort by a variety of resources haa resulted in an effective method for measuring appropriate application of Standard Body Substance Precautions in our facility.
CONSIDERATIONS FOLLOWING A EARTHQUAKE. D. Potts,* M. Salem, M. Vutek. P. O’Hanley. VA Medical
On a day-today basis, the Infection Control Practitioner (ICP) is faced with many challenging epidemiologic issues. Most infection contml programs in this country are well established and meet the requirements of such organizations as the JCAHO, local and state public health departments. The hospital environment is organized to meet basic infection contml requirements. Items such as sinks. air flow. formal isolation moms, patient space considerations, clean and dirty storage and work areas, water supply and sewage disposal, am things we take for granted and check only when identified problems arise. But how does the role of the ICP change following a natural disaster7 How do our priorities change and what am “safe” compromises to make? On October 17, 1989, a 7.1 earthquake struck the San Francisco Bay Area. The two main buildings of our Medical Center received major damage and remain closed. The 232 patients were. immediately evacuated following the quake. 142 acute med/surg patients and 19 acute psychiatric patients were relocated to an undamaged 76-bed building which housed 45 spinal cord/rehabilitation patients. 71 additional psychiatric patients were transferred to additional psychiatric wards at our second division seven miles away. The weeks and months following the quake continue to be an infection contml challenge. This presentation will focus on areas of consideration when the ICP is faced with a natural disaster. A stepby-step process outlining immediate, interim and long-term intervention strategies following a natural disaster will be offered.
EFFECT OF BLOOD ON NOSOCOMIAL COCCUS AUREUS R.R. Muder. Veterans
AND BODY SUBSTANCE PRECAUTIONS METHICILLIN-RESISTANT STAPHYLO(MRSA) INFECI-ION. A.M. Goetz,* Administration Medical Center, Pittsburgh, PA.
No strategy for control of nosocomial MRSA infection has been found to be entirely satisfactory. We monitored the incidence of MRSA distribution under two different isolation systems in an acute care hospital with endemic MRSA and a high rate of admission of MRSA colonixed of infected patients originating from long-term care facilities. Prior to 1988, we used a system of modified strict isolation for patients colonized or infected with MRSA. On 2/l/88. our hospital adopted universal blood and body substance precautions (BBSP); other categories of isolation (except respiratory and strict) were discontinued. In the two-year period preceding adoption of BBSP, the average monthly number of nosocomial MRSA infections was 2.8; an average of 4.8 patients/month were admitted with MRSA. In the first two quarters after institution of BBSP, MRSA nosocomial infections declined to 1.8/month despite an increase in the number of patients carrying MRSA on admission to 6.3/month. We have completed 21 months of monitoting. Average number of MRSA nosocomial infections has ranged from 1.3Anonth to 4.7/month in subsequent quartets. MRSA nosocomial infections for the entire period of BBSP averaged 2.8Anontb. equal to the control period; the. number of patients admitted with MRSA increased to 6.l/month We conclude that BBSP is comparable to modified strict isolation in the effect on nosocomial MRSA infection. We note that an initial decline in MRSA infections was not sustained, and that overall, incidence of MRSA infection was identical under both isolation systems. Our results demonstrate that prolonged follow-up is necessary in the evaluation of ongoing infection control measums. Studies repotting short term success in MRSA control should be reassessed.
18 Number
2
Abstracts
April 1990
INFECTION CONTROL IN A NEW PULMONARY ANALYSIS OF THE RISKS. D. McCullough,* B. Moody, Seton Medical Center, Austin TX.
UNIT: L. Lewis.
A new Pulmonary Intermediate-Care Unit (PICU) was opened for long-term ventilated patients to create mom acute-care beds and to reduce costs. Intensive surveillance was planned to assess the risks since there was little published data on outcome from such units. The PICU is a 720~square foot, open room with four beds. Only two handwashing sinks am available. The area is crowded with ventilators and accessory equipment. The infection control concern was the high potential for cross-transmission of infection. Admission criteria included pre-screening for transmissible infections and excluded patients with methicillin-resistant Stnphykxoccus aureus, C. difticile, H. Zoster and Respiratory or Strict Isolation cases. Of 35 total admissions, 24 patients were present over 48 hours; their average age was 69; average stay was 22 days (range 3-135). There were 21 totalnosocomial infections (53% per total admissions); 10 urinary tract infections (UTI) and seven lower respiratory infections (LRI). Only 4 of the 13 intubated patients developed LRI. However, 1 patient had 9 infections (3 UTI; 4 LRI). Excluding that patient, infection rates were somewhat higher than our ICU rates. Estimated cost of the nosocomial infections was S50,ooO. Despite fears, and doubling of the census in the second 6 months, this tit has not been the source of outbreaks or frequent infection control problems. It has successfully provided greater access to criticalcare beds and reduced the non-reimbursable costs of long-term ventilated patients. However, the costs of increased nosocomial infections should be considered when a unit of this type. is planned.
INFECTION CONTROL NATURAL DISASTER: M. Maglalang, C. Valdon. Center, Palo Alto, CA.
MEASURING APPLICATION OF STANCE PRECAUTIONS. J. Thnm. Rochester, MN.
149
STANDARD BODY SUBRochester Methodist Hospital,
With the implementation of Standard Body Substance Precautions in a large teaching hospital, the need to develop a method to assure an understanding and an appropriate application of the policy was identified. Following housewide education of the policy, a three-part quality assurance tool was developed. The audit tool consisted of three parts: 1. A written test to measure knowledge of the policy’s main principles. 2. A “protective equipment” checklist to assure availability of supplies in work areas. 3. A “peer observation” tool to assess appropriate application of knowledge. Parts of the audit were completed by all departments whose work involves a potential for body substance exposure. Supervisors coordinated collection of data with assistance from the Infection Control Staff. Data were analyzed by the Infection Control Department with staff feedback given on a unit basis. Results of the written test for Central Supply, Nursing and Surgical Services were 935, 92% and 88% respectively. Protective equip ment was available in Centml Supply work areas 100% of the time; Nursing Units 94% of the time; and Surgical Service work areas 100% of the time. The mults of peer observation reflected positive responses with the following frequencies: Central Supply 97%; Nursing 84%. and SurgicaI Services 80%. A cooperative effort by a variety of resources haa resulted in an effective method for measuring appropriate application of Standard Body Substance Precautions in our facility.
CONSIDERATIONS FOLLOWING A EARTHQUAKE. D. Potts,* M. Salem, M. Vutek. P. O’Hanley. VA Medical
On a day-today basis, the Infection Control Practitioner (ICP) is faced with many challenging epidemiologic issues. Most infection contml programs in this country are well established and meet the requirements of such organizations as the JCAHO, local and state public health departments. The hospital environment is organized to meet basic infection contml requirements. Items such as sinks. air flow. formal isolation moms, patient space considerations, clean and dirty storage and work areas, water supply and sewage disposal, am things we take for granted and check only when identified problems arise. But how does the role of the ICP change following a natural disaster7 How do our priorities change and what am “safe” compromises to make? On October 17, 1989, a 7.1 earthquake struck the San Francisco Bay Area. The two main buildings of our Medical Center received major damage and remain closed. The 232 patients were. immediately evacuated following the quake. 142 acute med/surg patients and 19 acute psychiatric patients were relocated to an undamaged 76-bed building which housed 45 spinal cord/rehabilitation patients. 71 additional psychiatric patients were transferred to additional psychiatric wards at our second division seven miles away. The weeks and months following the quake continue to be an infection contml challenge. This presentation will focus on areas of consideration when the ICP is faced with a natural disaster. A stepby-step process outlining immediate, interim and long-term intervention strategies following a natural disaster will be offered.
EFFECT OF BLOOD ON NOSOCOMIAL COCCUS AUREUS R.R. Muder. Veterans
AND BODY SUBSTANCE PRECAUTIONS METHICILLIN-RESISTANT STAPHYLO(MRSA) INFECI-ION. A.M. Goetz,* Administration Medical Center, Pittsburgh, PA.
No strategy for control of nosocomial MRSA infection has been found to be entirely satisfactory. We monitored the incidence of MRSA distribution under two different isolation systems in an acute care hospital with endemic MRSA and a high rate of admission of MRSA colonixed of infected patients originating from long-term care facilities. Prior to 1988, we used a system of modified strict isolation for patients colonized or infected with MRSA. On 2/l/88. our hospital adopted universal blood and body substance precautions (BBSP); other categories of isolation (except respiratory and strict) were discontinued. In the two-year period preceding adoption of BBSP, the average monthly number of nosocomial MRSA infections was 2.8; an average of 4.8 patients/month were admitted with MRSA. In the first two quarters after institution of BBSP, MRSA nosocomial infections declined to 1.8/month despite an increase in the number of patients carrying MRSA on admission to 6.3/month. We have completed 21 months of monitoting. Average number of MRSA nosocomial infections has ranged from 1.3Anonth to 4.7/month in subsequent quartets. MRSA nosocomial infections for the entire period of BBSP averaged 2.8Anontb. equal to the control period; the. number of patients admitted with MRSA increased to 6.l/month We conclude that BBSP is comparable to modified strict isolation in the effect on nosocomial MRSA infection. We note that an initial decline in MRSA infections was not sustained, and that overall, incidence of MRSA infection was identical under both isolation systems. Our results demonstrate that prolonged follow-up is necessary in the evaluation of ongoing infection control measums. Studies repotting short term success in MRSA control should be reassessed.