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Microbiologic job safety analysis: A structured approach to prevent and control occupational biologic exposures
136 Abstracts
This paper reports the bacteriological and subjective effects of sequential handwashing by clinical staff with two commercial hand wash products over a 16-month period. Four percent chlorhexidine gluconate hand disinfectant (Hibiclens, ICI Australia Pty Ltd) was compared with 1% irgasan (Novaderm R, Johnson and Johnson Medical Pty Ltd) in an open, crossover trial in a 30-bed vascular surgical ward. Two 12-week periods of handwashing with Hibiclens were separated by a continuous 34-week period when Novaderm R was the only hand wash product in use. Each staff member completed a hand care diary during the study period and at the same time a nurse researcher maintained an independent diary monitoring the same parameters. The standardized glove juice method was used to collect samples for bacterial counts. Samples were collected immediately prior to and after supervised, standardized 30-second handwashing performed prior to commencement of duty, prior to lunch break and prior to completion of daily duty. The bacterial flora on the hands were grouped into gram negative organisms, MRS& coagulase negative staphylococci, Bacillus sp and other skin organisms. When compared with the two Hibiclens periods, use of Novaderm R resulted in a significant reduction (p > 0.05) in the MRSA carriage rate on staff hands. There was no significant difference between the carriage rate of gram negative bacteria on the hands during either the Hibiclens or Novaderm R periods. The volumes of hand wash product used per week were significantly increased between the first Hibidens period and subsequent Novaderm R and Hibidens periods (p > 0,05). Scoring of the subjective hand diaries revealed that the majority of subjects found the Novaderm R to leave the hands feeling soft, to be less drying and to lather more easily than the Hibiclens product. The observer records revealed fewer skin problems with Novaderm R compared to Hibiclens particularly during the second Hibiclens period. This study has shown that although Hibidens usage results in a low total bacterial count, the sensitizing effect on the skin reduces the amount of product used. Novaderm R effectivelylowered the numbers of staff with MRSA on their hands.
MICROBIOLOGIC JOB SAFETY ANALYSIS: A STRUCTURED APPROACH TO PREVENT AND CONTROL OCCUPATIONAL BIOLOGIC EXPOSURES. S. A. Weinstein, MT (ASCP), MPH,
CIC.* MetroWest Medical Center, Framingham, MA. Job safety analysis is a widely used technique applied in industry by safety and health professionals for identifying, controlling or eliminating workplace hazards (e.g., chemical, physical, ergonomic). Microbiologic Job SafetyAnalysis (MJSA) is an adapted technique that utilizes a structured approach to analyze the jobs health care workers do each day that may put them at risk for not only infectious diseases, but for any injury or occupational hazard. MJSA is best applied through a team approach with member selection dependent on the job to be examined (e.g., in analyzing laboratory procedures such as phlebotomy or specimen handling/processing, the ream may indude an infection control practitioner, laboratory supervisor and laboratory worker). Step I is to select the specific job to be analyzed. Possible choices are jobs with a high accident frequency and/or severity. In step II, breaking down the job includes describing the work schedule, sketching the workstation layout, listing equipment used, and describing the work method step by step. In step III, we identify potential hazards (e.g., needlestick, body fluid splash, contaminated glass puncture) associated with each step. In step IV, plans for corrective action and controls (e.g., engineering controls, safe work practices, administrative, personal protective equipment) are developed and implemented.
AJIC April 1995 MJSA is a simple, effective technique for controlling or eliminating occupational hazards and preventing injuries and diseases. Indirect benefits of utilizing MJSA may include increased productlvity and quality of work.
A COMPARISON OF HOSPITAL INFECTION RATES IN THE LONDON SOUTH THAMES REGION. M. West, Senior Nurse,
Control Infection.* Guy's Hospital, London, United Kingdom. There are fewer resources for infection control in the United Kingdom than in the United States, The government recommends but does not enforce surveillance. Prevalence studies were conducted in 1991 and 1992 at Guy's Hospital in London to assess infection rates for the purpose of allocating scarce resources. As a consequence of the second study, funds were made available through the South Thames Regional Health Authority to assess the prevalence of patient risk factors and infection rates among the hospitals in the region. Fixed &finitions were used m standardize results on data collection forms. Data induded demographics, diagnosis, drug therapy and the presence or absence of infection and actions taken. This presentation will compare the results of these studies and the actions taken. The table below compares risk factors in several categories for hospital acquired infections before and after intervention (1992-1993) in a 570-bed hospital.
Urine catheter IV catheter Surgery
1992 (%)
1993 (%)
21 14 12
15 13 6.8
ERCP OUTBREAK OF PSEUDOMONAS INFECTION IN GI CLINIC. H. K. Crouch, BSN, BS, MPH, CIC,* N. B. Bjerke,
BSN, MEcl, MA, CIC. Wilford Hall AFB Medical Center, Lacldand AFB, TX. Endoscopic retrograde cholangiopancreatography (ERCP) is associated with the highest risk of infectious complications. Several epidemics of Pseudomonas aeruginosa infections have been traced to extrinsic contamination of instruments used for ERCE The Gastro Intestinal Clinic at an 800-bed teaching facility performs approximately 240 procedures (ERCP) per year. In 1992 there were two documented nosocomial infections. In 1993, over a 6-month period, four cases of nosocomial infections were attributed to the ERCE Pseudomonas aeruginosa was the pathogen isolated in all four cases. Three were documented as bacteremias and one as acute cholangitis. All of the identified patients were treated with intravenous antibiotics. An outbreak investigation demonstrated that the source of infections were attributed to several aspects of the cleaning process which included insufficient cleaning or disinfection of endoscope channels and accessories, rinsing of disinfected endoscopes with tap water, and inadequate cleaning of the automated disinfection machines. Cultures taken revealed that one of the tanks where the glutaraldehyde is stored grew out Pseudomonas aeruginosa and Citrobacter. All the other areas showed no growth. The investigation revealed conflicting procedures for cleaning
This paper reports the bacteriological and subjective effects of sequential handwashing by clinical staff with two commercial hand wash products over a 16-month period. Four percent chlorhexidine gluconate hand disinfectant (Hibiclens, ICI Australia Pty Ltd) was compared with 1% irgasan (Novaderm R, Johnson and Johnson Medical Pty Ltd) in an open, crossover trial in a 30-bed vascular surgical ward. Two 12-week periods of handwashing with Hibiclens were separated by a continuous 34-week period when Novaderm R was the only hand wash product in use. Each staff member completed a hand care diary during the study period and at the same time a nurse researcher maintained an independent diary monitoring the same parameters. The standardized glove juice method was used to collect samples for bacterial counts. Samples were collected immediately prior to and after supervised, standardized 30-second handwashing performed prior to commencement of duty, prior to lunch break and prior to completion of daily duty. The bacterial flora on the hands were grouped into gram negative organisms, MRS& coagulase negative staphylococci, Bacillus sp and other skin organisms. When compared with the two Hibiclens periods, use of Novaderm R resulted in a significant reduction (p > 0.05) in the MRSA carriage rate on staff hands. There was no significant difference between the carriage rate of gram negative bacteria on the hands during either the Hibiclens or Novaderm R periods. The volumes of hand wash product used per week were significantly increased between the first Hibidens period and subsequent Novaderm R and Hibidens periods (p > 0,05). Scoring of the subjective hand diaries revealed that the majority of subjects found the Novaderm R to leave the hands feeling soft, to be less drying and to lather more easily than the Hibiclens product. The observer records revealed fewer skin problems with Novaderm R compared to Hibiclens particularly during the second Hibiclens period. This study has shown that although Hibidens usage results in a low total bacterial count, the sensitizing effect on the skin reduces the amount of product used. Novaderm R effectivelylowered the numbers of staff with MRSA on their hands.
MICROBIOLOGIC JOB SAFETY ANALYSIS: A STRUCTURED APPROACH TO PREVENT AND CONTROL OCCUPATIONAL BIOLOGIC EXPOSURES. S. A. Weinstein, MT (ASCP), MPH,
CIC.* MetroWest Medical Center, Framingham, MA. Job safety analysis is a widely used technique applied in industry by safety and health professionals for identifying, controlling or eliminating workplace hazards (e.g., chemical, physical, ergonomic). Microbiologic Job SafetyAnalysis (MJSA) is an adapted technique that utilizes a structured approach to analyze the jobs health care workers do each day that may put them at risk for not only infectious diseases, but for any injury or occupational hazard. MJSA is best applied through a team approach with member selection dependent on the job to be examined (e.g., in analyzing laboratory procedures such as phlebotomy or specimen handling/processing, the ream may indude an infection control practitioner, laboratory supervisor and laboratory worker). Step I is to select the specific job to be analyzed. Possible choices are jobs with a high accident frequency and/or severity. In step II, breaking down the job includes describing the work schedule, sketching the workstation layout, listing equipment used, and describing the work method step by step. In step III, we identify potential hazards (e.g., needlestick, body fluid splash, contaminated glass puncture) associated with each step. In step IV, plans for corrective action and controls (e.g., engineering controls, safe work practices, administrative, personal protective equipment) are developed and implemented.
AJIC April 1995 MJSA is a simple, effective technique for controlling or eliminating occupational hazards and preventing injuries and diseases. Indirect benefits of utilizing MJSA may include increased productlvity and quality of work.
A COMPARISON OF HOSPITAL INFECTION RATES IN THE LONDON SOUTH THAMES REGION. M. West, Senior Nurse,
Control Infection.* Guy's Hospital, London, United Kingdom. There are fewer resources for infection control in the United Kingdom than in the United States, The government recommends but does not enforce surveillance. Prevalence studies were conducted in 1991 and 1992 at Guy's Hospital in London to assess infection rates for the purpose of allocating scarce resources. As a consequence of the second study, funds were made available through the South Thames Regional Health Authority to assess the prevalence of patient risk factors and infection rates among the hospitals in the region. Fixed &finitions were used m standardize results on data collection forms. Data induded demographics, diagnosis, drug therapy and the presence or absence of infection and actions taken. This presentation will compare the results of these studies and the actions taken. The table below compares risk factors in several categories for hospital acquired infections before and after intervention (1992-1993) in a 570-bed hospital.
Urine catheter IV catheter Surgery
1992 (%)
1993 (%)
21 14 12
15 13 6.8
ERCP OUTBREAK OF PSEUDOMONAS INFECTION IN GI CLINIC. H. K. Crouch, BSN, BS, MPH, CIC,* N. B. Bjerke,
BSN, MEcl, MA, CIC. Wilford Hall AFB Medical Center, Lacldand AFB, TX. Endoscopic retrograde cholangiopancreatography (ERCP) is associated with the highest risk of infectious complications. Several epidemics of Pseudomonas aeruginosa infections have been traced to extrinsic contamination of instruments used for ERCE The Gastro Intestinal Clinic at an 800-bed teaching facility performs approximately 240 procedures (ERCP) per year. In 1992 there were two documented nosocomial infections. In 1993, over a 6-month period, four cases of nosocomial infections were attributed to the ERCE Pseudomonas aeruginosa was the pathogen isolated in all four cases. Three were documented as bacteremias and one as acute cholangitis. All of the identified patients were treated with intravenous antibiotics. An outbreak investigation demonstrated that the source of infections were attributed to several aspects of the cleaning process which included insufficient cleaning or disinfection of endoscope channels and accessories, rinsing of disinfected endoscopes with tap water, and inadequate cleaning of the automated disinfection machines. Cultures taken revealed that one of the tanks where the glutaraldehyde is stored grew out Pseudomonas aeruginosa and Citrobacter. All the other areas showed no growth. The investigation revealed conflicting procedures for cleaning