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Occupational exposures to blood and body fluids in a small community hospital
120
Abstracts
AN EPIDEMIOLOGIC STUDY OF METHICILLIN RESISTANT SThPHYLOCOCCUS @fItSA): COMPARISON OF ANTIBIOGRAMS WITH RESTRICTION FRAGLENGT‘fI POLYMORPHISMS ANALYSIS GIFP) OF TGTAL DNA IN AN OUTBREAK INVESTIGATION. N. Spina, MT(ASC$hi; M. George, PbD, M. Raffexty, RN, MS, CIC; R. Vawia, PhD, M. McCormick, MD. sbatto” VAMC and Albany Medical calm, Allmy, NY. SUIVin OUT400 bed acute cplc institution disclosed a 1.7 fold bweasc in the number of w (SA) infaica during a 9 month period of 1992, ascanparcdto1991. Ihcblcre.asecultcrcdalQl”ldo”e.~cal\wdwhenthnewas a 2.7 fold inaaw. in the number of MRSA isolated. Sii out of 10 MRSA patients had isolatea witi similar antibiognms suggesting “osocamial mnsmission. A” invcstigatio” was UndestaLcn to validate this suppwitlon and included, medical record review of surgical patients with SA infcctio”s,~&eai”g cultures on healthcare workers (HCWS), and both RFP and plasmid patter” aalysis @‘PA) on MRSA isolates. Chart review identitied that all MRSA patients had wmmd debridements wf”r”& by a camnon group of HCWS. How&, no MRSA were isolated from scre&i”g of H&S. A “tea” of 27 inpatient days preadal the first is&&i”” of SA in MRSA patients as compared 10 2 days for SA isolation in nwhicti sensitive V WSSA) tntients @=&Ol). The average “umber of antibiotics received by MRSA patientstefo~ ihe first titive ctdturc was 2.8 as cornwed to 0.4 for MSSA Datients 1”=0.03). RFP pnd PPA &alysis of 13 MRSA isol& disclosed 7 unique $tww. “AM&h a”tibiograms sugsestcd a” MRSA wtb&, RFA yld PPA results did not suppmt the origbul theory of noscati trantisslon. Prolonged iwspitaIizado” and antibiotic therapy probably provided selective pressure for the emergence of MRSA.
OCCUPATIONAL EXPOSURES TO BLOOD AND BODY FLUIDS IN A SMALL COMMUNITY HOSPITAL. S. D&&man. MD. MPH.* J. Decker. RPb. MS. T. Buda, MS, a”d M. Petema. PbD. Nat&al I&& ior O~~~pati&“al spfetya”d Iiealdt, C!mtm for Disease Control and Prewati~, Atlanta, GA and Ciid, OH. ~Ihc~ofoccupntioru~expcwrrtobloodmdbodyfluidr,udthesbility of employks to comply with univesspl pmxdio”a guidelines, was evaluabzd in a smpll hospital serving P rural community. A retmpectivc quatimmaire survey wps administa-ed to 2n UnDkV‘XS DOWtiaOv at risk fm 0CcumtiO”al CxDoQuR to blood “I body fluids, and &: iwldk of c&q&mal up&w to b&d or body fluids, p?sceaNge of exp&wra rePorta to enlployee heal* leaw”s for ““t rej&i”g; knowledge of universal precautions; and difficulties in complying with universal pn-ecautim. E”lpkyee.9 tqmted 0.34 exp”.suru per person-ycer. The nunlbcr of repaid expcdurrs was nc4 rebated to gender, job gnwp, years of apuimce, or wortift. The most fRaumtlY stakd reasm.9 for not lword”g were: exDosure not perceived as health risk, c&c& about cexpalonal disc&ii&. yld c&em abwt co”tidcntiplity. workers expow to sharps were “lore l&sly to lqoa exposurw. Ihe moat frqumtly stated difticulti~ with univezsal precauti”“s were: not mougb time; inby protaxive equipment; protective motuialr ““t available; prdiat ~~FCZX& to be at hmer risk for hepatitis B w HIV, and forgetti”g to use precautions. The number of reported exposures wa Iw signiticandy aswciatcd with Lnowledge of, or pc.rceivcd aity t” CmnpIy with, univd preca”tio”s. Des@ the diffembxa i” patient pnpukbs. tk r&.ms for noncompliace with universal precaticms in this amallrurrl~~prcmuchlih~~i”lPrgCurbnnMdiCpl~~. Ihe-SfOr undempolting, however, differ from tbse in urban centus.. This may reflect cnvbvnmenkI differences and differing employee paceptio”a of risk.
April
AJIC 1994
PRENATAL TB SCREENING: A MULTIDISCIPLINARY APPROACH. S. Simpldns, MSN, CIC; C. Hen&, BSN, CIC, D. Haiduve”, RSN, MSN, CIC, D. Stevens, MD. Santa Clan Valley Medical Center. San Jose, CA. Incomplete prenatal +xeening for Nbcrculosis (TB) in a high risk obstetric populvion may cause mmcwary inpatient work-ups, delayed discharges. and separation of the nwthas and infanta at the time of delivery. Sata Clam Valley Medical Center is a 692 bed county h@al which has OVCI300 deliveriw monthly and serves P minority and foreign born p”pulado” with high risk for TB. A mtwpccdve review of 5 months Ofprrnntnlrccordlio1993rhowcdthpt80%Ofaztcmitypnt*ntrWncscrravdwith purified pmt.& derivative (PPD) for TB. and 24% WQC positive. Thexefore, apjmximately 60 ptients per month had inoomplete TB information at the time of delivery, uld 15 of ibex patients uuld be u\ticiIated to be PPD positive. Ixk of czcmdadon of outpatient and inpatient services, delays in scheduling cliic appointments, patbxts’ failure to keep rhedukd p~poinbnents, and incomplete medical records were all contributing factors. A multidisciplinary committee was formed to evaluate the issues and improve the wwdbutio” of services. A special clinic to evaluate PPD positive patients for iscalazid @NH) prophylaxis was used. A multiliigual form kiter was give” to patimts to stress the importa”ce of compliance with scheduled appoinNxnts. Patients with positive or qucstio”abk chest x-rays wae given priority clinic pppointments. Physician cducption was conducted to provide a standard approach to swxning. An improved system of routing cheat x-ray results was established by the Medical Remrds De+rtmcnt. Our expzience suggests that a multidisciplbmty tan effort is essential to coordinate services and provide complete prenatal screening information.
IMPACTING INFECITON CONTROL PRACI’ICES THROUGH EDUCATIONAL PROGRAMMING OF DEPARTMENTAL TRAINBRS. P. Gr”ta. RN. MSN. CPHO: AudieL. Murphy MenwialHospital, Sa”A”t&o,TX. _ Issuet Regldatory agulciw such w die Joint commis9io” of Healthcare 01ghdi0~ (JCAHO) M.3 Occupntionnl S&Q pod H&h Adkistntion (OSHA) a mdily incrcrcing their focus on effective, deputmatal blfectio” amtml (IC) kai”i”g. To assure compliance with their standa&, thia cmnpkx v-’ pdminishatio” medical facility d&m&d dut employee(s) from cab dcpamDent would be trained as facilitators for lequirKl IC tnbdng. Sabatha: Asixhour~grpmwra~focudnOMconlyanICtopicsbut also m adult leaning principles and effecdve trabdng wies. Topics in IC included imlatiion &log&, NbaUksi~, and blmdbome patbogms. An 2ducatk”al rcsxrce center which included exanplu of IC hnndouts, &tem. and tiovkual “Werial. amI an IC Train-the-Tnincr “otebmk e&mced the tmininn. The pmgla”lw&designedto&- the we of presentation media a”d ev&lation wbodologks ps IC content Was pressed. Leamblg w evalwated thrwgb witten bat3 and nal ptt-scntatl~~~s. Fouwring the Uainii class, Tmi”us will &ve new IC informado” im”Kdiitely through elearonic nuilmpn and biamually through fomul ckmes. Raultm llllrty-five employeea represcnti”g 16 deparwnts have mmplaed trpining, with 40 more employees fmm 28 depmbnats &cd&d in January 1994. The pmgrunhrcbanratedasex&lc”tby99%oftheTmi”era. Rumcanofpost-tt scorn impmved by 4% over the pretest scores. Statistically, there have been margbml improve”wd.5 shown in each topic, except Tubcrculasis. Cm&sion: True~ofthetrainingisbexdonUlcapplicationofleaming at the practice level. This is de&mbwd thmugh tindings of the quality improvement plugram, perfomunce evahLatk”a, and IC rounds.
Abstracts
AN EPIDEMIOLOGIC STUDY OF METHICILLIN RESISTANT SThPHYLOCOCCUS @fItSA): COMPARISON OF ANTIBIOGRAMS WITH RESTRICTION FRAGLENGT‘fI POLYMORPHISMS ANALYSIS GIFP) OF TGTAL DNA IN AN OUTBREAK INVESTIGATION. N. Spina, MT(ASC$hi; M. George, PbD, M. Raffexty, RN, MS, CIC; R. Vawia, PhD, M. McCormick, MD. sbatto” VAMC and Albany Medical calm, Allmy, NY. SUIVin OUT400 bed acute cplc institution disclosed a 1.7 fold bweasc in the number of w (SA) infaica during a 9 month period of 1992, ascanparcdto1991. Ihcblcre.asecultcrcdalQl”ldo”e.~cal\wdwhenthnewas a 2.7 fold inaaw. in the number of MRSA isolated. Sii out of 10 MRSA patients had isolatea witi similar antibiognms suggesting “osocamial mnsmission. A” invcstigatio” was UndestaLcn to validate this suppwitlon and included, medical record review of surgical patients with SA infcctio”s,~&eai”g cultures on healthcare workers (HCWS), and both RFP and plasmid patter” aalysis @‘PA) on MRSA isolates. Chart review identitied that all MRSA patients had wmmd debridements wf”r”& by a camnon group of HCWS. How&, no MRSA were isolated from scre&i”g of H&S. A “tea” of 27 inpatient days preadal the first is&&i”” of SA in MRSA patients as compared 10 2 days for SA isolation in nwhicti sensitive V WSSA) tntients @=&Ol). The average “umber of antibiotics received by MRSA patientstefo~ ihe first titive ctdturc was 2.8 as cornwed to 0.4 for MSSA Datients 1”=0.03). RFP pnd PPA &alysis of 13 MRSA isol& disclosed 7 unique $tww. “AM&h a”tibiograms sugsestcd a” MRSA wtb&, RFA yld PPA results did not suppmt the origbul theory of noscati trantisslon. Prolonged iwspitaIizado” and antibiotic therapy probably provided selective pressure for the emergence of MRSA.
OCCUPATIONAL EXPOSURES TO BLOOD AND BODY FLUIDS IN A SMALL COMMUNITY HOSPITAL. S. D&&man. MD. MPH.* J. Decker. RPb. MS. T. Buda, MS, a”d M. Petema. PbD. Nat&al I&& ior O~~~pati&“al spfetya”d Iiealdt, C!mtm for Disease Control and Prewati~, Atlanta, GA and Ciid, OH. ~Ihc~ofoccupntioru~expcwrrtobloodmdbodyfluidr,udthesbility of employks to comply with univesspl pmxdio”a guidelines, was evaluabzd in a smpll hospital serving P rural community. A retmpectivc quatimmaire survey wps administa-ed to 2n UnDkV‘XS DOWtiaOv at risk fm 0CcumtiO”al CxDoQuR to blood “I body fluids, and &: iwldk of c&q&mal up&w to b&d or body fluids, p?sceaNge of exp&wra rePorta to enlployee heal* leaw”s for ““t rej&i”g; knowledge of universal precautions; and difficulties in complying with universal pn-ecautim. E”lpkyee.9 tqmted 0.34 exp”.suru per person-ycer. The nunlbcr of repaid expcdurrs was nc4 rebated to gender, job gnwp, years of apuimce, or wortift. The most fRaumtlY stakd reasm.9 for not lword”g were: exDosure not perceived as health risk, c&c& about cexpalonal disc&ii&. yld c&em abwt co”tidcntiplity. workers expow to sharps were “lore l&sly to lqoa exposurw. Ihe moat frqumtly stated difticulti~ with univezsal precauti”“s were: not mougb time; inby protaxive equipment; protective motuialr ““t available; prdiat ~~FCZX& to be at hmer risk for hepatitis B w HIV, and forgetti”g to use precautions. The number of reported exposures wa Iw signiticandy aswciatcd with Lnowledge of, or pc.rceivcd aity t” CmnpIy with, univd preca”tio”s. Des@ the diffembxa i” patient pnpukbs. tk r&.ms for noncompliace with universal precaticms in this amallrurrl~~prcmuchlih~~i”lPrgCurbnnMdiCpl~~. Ihe-SfOr undempolting, however, differ from tbse in urban centus.. This may reflect cnvbvnmenkI differences and differing employee paceptio”a of risk.
April
AJIC 1994
PRENATAL TB SCREENING: A MULTIDISCIPLINARY APPROACH. S. Simpldns, MSN, CIC; C. Hen&, BSN, CIC, D. Haiduve”, RSN, MSN, CIC, D. Stevens, MD. Santa Clan Valley Medical Center. San Jose, CA. Incomplete prenatal +xeening for Nbcrculosis (TB) in a high risk obstetric populvion may cause mmcwary inpatient work-ups, delayed discharges. and separation of the nwthas and infanta at the time of delivery. Sata Clam Valley Medical Center is a 692 bed county h@al which has OVCI300 deliveriw monthly and serves P minority and foreign born p”pulado” with high risk for TB. A mtwpccdve review of 5 months Ofprrnntnlrccordlio1993rhowcdthpt80%Ofaztcmitypnt*ntrWncscrravdwith purified pmt.& derivative (PPD) for TB. and 24% WQC positive. Thexefore, apjmximately 60 ptients per month had inoomplete TB information at the time of delivery, uld 15 of ibex patients uuld be u\ticiIated to be PPD positive. Ixk of czcmdadon of outpatient and inpatient services, delays in scheduling cliic appointments, patbxts’ failure to keep rhedukd p~poinbnents, and incomplete medical records were all contributing factors. A multidisciplinary committee was formed to evaluate the issues and improve the wwdbutio” of services. A special clinic to evaluate PPD positive patients for iscalazid @NH) prophylaxis was used. A multiliigual form kiter was give” to patimts to stress the importa”ce of compliance with scheduled appoinNxnts. Patients with positive or qucstio”abk chest x-rays wae given priority clinic pppointments. Physician cducption was conducted to provide a standard approach to swxning. An improved system of routing cheat x-ray results was established by the Medical Remrds De+rtmcnt. Our expzience suggests that a multidisciplbmty tan effort is essential to coordinate services and provide complete prenatal screening information.
IMPACTING INFECITON CONTROL PRACI’ICES THROUGH EDUCATIONAL PROGRAMMING OF DEPARTMENTAL TRAINBRS. P. Gr”ta. RN. MSN. CPHO: AudieL. Murphy MenwialHospital, Sa”A”t&o,TX. _ Issuet Regldatory agulciw such w die Joint commis9io” of Healthcare 01ghdi0~ (JCAHO) M.3 Occupntionnl S&Q pod H&h Adkistntion (OSHA) a mdily incrcrcing their focus on effective, deputmatal blfectio” amtml (IC) kai”i”g. To assure compliance with their standa&, thia cmnpkx v-’ pdminishatio” medical facility d&m&d dut employee(s) from cab dcpamDent would be trained as facilitators for lequirKl IC tnbdng. Sabatha: Asixhour~grpmwra~focudnOMconlyanICtopicsbut also m adult leaning principles and effecdve trabdng wies. Topics in IC included imlatiion &log&, NbaUksi~, and blmdbome patbogms. An 2ducatk”al rcsxrce center which included exanplu of IC hnndouts, &tem. and tiovkual “Werial. amI an IC Train-the-Tnincr “otebmk e&mced the tmininn. The pmgla”lw&designedto&- the we of presentation media a”d ev&lation wbodologks ps IC content Was pressed. Leamblg w evalwated thrwgb witten bat3 and nal ptt-scntatl~~~s. Fouwring the Uainii class, Tmi”us will &ve new IC informado” im”Kdiitely through elearonic nuilmpn and biamually through fomul ckmes. Raultm llllrty-five employeea represcnti”g 16 deparwnts have mmplaed trpining, with 40 more employees fmm 28 depmbnats &cd&d in January 1994. The pmgrunhrcbanratedasex&lc”tby99%oftheTmi”era. Rumcanofpost-tt scorn impmved by 4% over the pretest scores. Statistically, there have been margbml improve”wd.5 shown in each topic, except Tubcrculasis. Cm&sion: True~ofthetrainingisbexdonUlcapplicationofleaming at the practice level. This is de&mbwd thmugh tindings of the quality improvement plugram, perfomunce evahLatk”a, and IC rounds.