Elephant-to-Human Transmission of Tuberculosis, R. Murphree et al.

Recent Clonal Origin of Cholera in Haiti, A. Ali et al.

Tuberculosis Outbreak Investigations in the United States, 2002–2008, K. Mitruka et al.

Drug-Resistant Pandemic (H1N1) 2009, South Korea, S.Y. Shin et al.

Duties of the Infection Control Preventionist and the Infection Control Team

Many people do not understand what the role of the Infection Control (IC) Preventionist (ICP) and his or her team is so here is a list of just some of the duties performed by your facilities IC Team.

1. Develop written policies and procedures for the prevention and control of infectious or communicable diseases within the facility.
2. Assist in the development of the content and scope of the employee health program and disseminate current information on health practices to all employees.
3. Develop written policies and procedures for techniques and systems for identifying infections within the facility.
4. Notify appropriate government agencies of contagious or infectious diseases.
5. Review food handling practices, laundry practices, waste disposal, pest control, traffic control, visiting rules for high-risk areas, and sources of airborne infection.
6. Evaluate job classifications and facility procedures to determine their risk exposure potential to blood, body fluids or other potentially infectious materials.
7. Review and observe techniques used in maintenance of equipment, ice machines, water fountains, etc.
8. Develop written policies and procedures for the care of patients/residents who have contagious, infectious or communicable diseases.
9. Monitor the health status of all employees, ensuring that all personnel receive (as necessary) appropriate skin tests, chest x-rays, physical, etc., prior to, and during employment as outlined in our personnel policies and in accordance with federal and state guidelines.
10. Ensure that employees with an infectious or communicable disease are not assigned patient/resident care services.
11. Ensure that the facility is maintained in a sanitary environment.
12. Maintain written accounts of meetings conducted and action taken by the IC committee.
13. Ensure infection control orientation and in-service training programs are provided to employees on a timely basis.
14. Review isolation technique and procedures to assure that all personnel, residents, and visitors are following established procedures/precautions.
15. Review all written infection control policies, techniques, and procedures at least annually for necessary revisions or updating.
16. Review cleaning procedures, agents, and schedules and recommend any major changes in cleaning products or techniques.
17. Evaluate the disposal systems for all liquid and solid waste.
18. Assure that an adequate amount of protective supplies (i.e., gowns, gloves, masks, etc.), are on hand and readily accessible for handling infectious wastes, blood and/or body fluids.
19. Others as required including quality assurance, or that may become necessary to ensure that the prevention and control of communicable diseases can be at all times.

TRAINING AND EDUCATION
It is the responsibility of the Infecton Control Team and the Education Department to exstablish an initial and periodic training program for all employees who may have the potential for exposure to blood, or to body fluids containing visible blood during the course of their workday. OSHA requires instructions on the prevention of bloodborne diseases to include, as a minimum, information on:
1. Disease transmission and prevention
The modes of transmission of Hepatitis B, C and HIV viruses
3. How to recognize and determine the difference between tasks that involve exposure to blood/body fluids and those that do not involve exposure
4. The types of barrier equipment (i.e., gowns, gloves, masks, etc.) that are necessary for use when performing tasks that may involve the exposure to blood/body fluids
5. How to select appropriate barrier equipment
6. Appropriate actions to take if unplanned potential exposure to blood occurs, or is anticipated
7. Procedures to follow when protective barriers are used
8. Where protective barrier equipment is maintained in the facility, how it is to be used, decontaminated , and disposed of
9. Limitations of protective barrier equipment (i.e., needlestics will occur through gloves)
10. Corrective action to take if blood spills occur
11. Procedures to use to decontaminate blood spills
12. Proper action to follow should be bona-fide exposure to blood occur (i.e., emercy procedures, reporting measures, follow-up monitoring, medical treatment, counseling, etc)

RECORDKEEPING
OSHA requirements:
1. Training recors, indicating the dates of training sessions, the content of those training sessions along with the names of all persons conductiong the training, and the names of all those receiving training should be kept and readly accessible in the facility.

NEW UPDATE: Egg Allergy and Influenza Vaccine

A recent statement put out by the American Academy of Allergy, Asthma and Immunology (AAAAI), the AAP is updating its guidance for administering influenza vaccine to children with presumed egg allergy. These recommendations ARE NOT appropriate for the egg allergic person with a history of anaphylaxis or server allergy.

1) Skin testing is no longer necessary
2) Use the lowest ovalbumin-containing influenza vaccine (Ovalbumin content is listed on the vaccine package inserts)
3) Utilize one of the following 2 methods for administration
a) Two-step graded challenge-administer 1/10th of the vaccine dose followed by 30 minutes of observation; if no symptoms emerge, administer the remainder of the dose followed by another 30 minutes of observation
b) Single age-appropriate dose followed by 30 minutes of observation

Appropriate resuscitative equipment must be available when employing either of the previous mentioned methods.

More details can be foun in the AAP News article December 2010. Additional information is in the “Guidelines for the Diagnosis and Management of Food Allergy in the United States” published in Dec by the National Institute of Allergy and Infectious Diseases.

Flu Vaccine and Pregnancy

  September 15, 2010

Advice from a healthcare provider plays an important role in a pregnant and postpartum woman’s decision to get vaccinated against seasonal influenza. The American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Nurse-Midwives (ACNM), American College of Obstetricians and Gynecologists (The College), American Medical Association (AMA), American Nurses Association (ANA), American Pharmacists Association (APhA), Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), March of Dimes, and Centers for Disease Control and Prevention (CDC) are asking for your help in urging your pregnant and postpartum patients to get vaccinated against seasonal influenza.

The Advisory Committee on Immunization Practices (ACIP) recommends that pregnant and postpartum women receive the seasonal influenza vaccine this year, even if they received 2009 H1N1 or seasonal influenza vaccine last year. Lack of awareness of the benefits of vaccination and concerns about vaccine safety are common barriers to influenza vaccination of pregnant and postpartum women. To overcome these barriers, some key points have been provided below.

c. Vaccination during pregnancy has been shown to protect both the mother and her infant (up to 6 months old) from lab-confirmed influenza. Influenza hospitalization rates in infants <6 months of age are more than 10 times that of older children.

d. Pregnant women represented 5% of 2009 H1N1 influenza deaths in the U.S., while only about 1% of the population was pregnant. Severe illness in postpartum women was also documented. 2009 H1N1 is expected to continue to circulate this influenza season and is included in the seasonal trivalent influenza vaccine this year.

President

American Academy of Family Physicians

Judith S. Palfrey, MD, FAAP

President American Academy of Pediatrics

Holly Powell Kennedy, CNM, PhD,

FACNM, FAAN

President

The American College of Nurse-Midwives

Ralph W. Hale, MD, FACOG

Executive Vice President

The American College of Obstetricians and

Gynecologists

Michael D. Maves, MD, MBA

Executive Vice President/Chief Executive

Officer

American Medical Association

Marla Weston, PhD, RN

Chief Executive Officer

American Nurses Association

Thomas E. Meninghan, Pharmacist, BS

Pharm, MBA, ScD, FAPhA

Executive Vice President and CEO

American Pharmacists Association

Karen Peddicord, RNC, PhD

Chief Executive Officer

Association of Women’s Health, Obstetric

and Neonatal Nurses

Jennifer L. Howse, PhD

President

March of Dimes

Anne Schuchat, MD

RADM, United States Public Health Service

Assistant Surgeon General

Director, National Center for Immunization

and Respiratory Diseases

Salmonella

For an update on the current Salmonella Enteritidis Outbreak visit http://www.cdc.gov/salmonella/enteritidis

Enteritidis, can be found on both the outside and inside of eggs that appear normal.  If eggs are eaten raw or undercooked, the bacterium can cause a person to become ill.

Photo: cdc.gov

Salmonella

Eggs, like meat, poultry, milk, and other foods, are safe if they are properly handled.  Shell eggs are the safest when stored in the refrigerator, individually and thoroughly cooked, and eaten immediately.  The larger the number of Salmonella present in the egg, the more likely you could become ill.  Refrigerating eggs prevents Salmonella that may be present on the egg from multiplying.

Cooking reduces the number of bacteria present in an egg; however, an egg with a runny yolk still poses a greater risk when eaten than does a completely cooked egg.  Eggs that have undercooked egg whites and yolks have been linked to outbreaks of infection.  Eggs should be consumed immediately and not kept warm or at room temperature for more than 2 hours.

1. Keep eggs refrgerted at ≤45° F (≤7° C) at all times.
2. Discard cracked or dirty eggs.
3. Wash hands, cooking utensils, and food preparation surfaces with soap and water after contact with raw eggs.
4. Eggs should be cooked until both the white and the yolk are firm and eaten promptly after cooking.
5. Do not keep eggs warm or at room temperature for more than 2 hours.
6. Refrigerate unused or leftover egg-containing foods promptly.
7. Avoid eating raw eggs.
8. Avoid restaurant dishes made with raw or undercooked, unpasteurized eggs.  Restaurants should use pasteurized eggs in any recipe (such as Hollandaise sauce or Caesar salad dressing) that calls for raw eggs.
9. Comsumption of raw or undercooked eggs should be avoided, especially by young children, elderly persons, and persons with weakened immune systems or debilitating illness.

Individuals at risk for getting SalmonellaEnteritidis are the elderly, infants, and those with impaired immune systems. 

Individuals who become infected usually experience fever, abdominal cramps, and diarrhea beginning 12 to 72 hours after consuming a contaminated food or beverage.  The illness usually lasts 4 to 7 days, and most persons recover without antibiotic treatment.  Diarrhea can be severe, and the person may be ill enough to require hospitalization.

Reference: CDC.gov

Colonization vs Infection

Colonization vs Infection

Colonization is the presence, growth, and multiplication of the organism without observable clinical symptoms or immune reaction.

 1. MRSA – Colonization may occur in: the nares; axillae; chronic wounds or decubitus ulcer surface; perineum; around gastrostomy and tracheostomy sites; in the sputum or urine; and on healthy skin. One of the most common sites of colonization in both patients and employees is the nose (anterior nares). While healthcare workers may become colonized with MRSA (as they may with susceptible S. aureus), they rarely develop infections.

 2. Enterococci – Are normally found in the bowel, the female genital tract, and the mouth. Strains resistant to vancomycin (VRE) may survive and multiply, resulting in a colonization of the bowel.

 3. C. difficile – Commonly found in the gastrointestinal tract, the organism including drug-resistant and “epidemic strains” can asymptomatically colonize the bowel of individuals. Patients receiving antimicrobial therapy may be especially susceptible to developing CDI. Generally, there are more asymptomatic carriers than CDI patients. Though no symptoms may be evident, the colonized patient may test positive for the organism or its toxin(s).

 4. Multidrug-Resistant Gram-Negative Bacilli (MDR-GNB) – Colonization may occur on the skin (healthy skin and wounds) and the respiratory tract of both healthcare workers and patients. Colonization may also occur in the bowel where these organisms may occur as normal intestinal flora. As with other MDROs, infection of healthcare workers is rare.

        a. A. baumannii – Colonization may occur on multiple areas of the skin including the axillae and groin, as well as the respiratory tract of both patients and healthy individuals. Patients may also be colonized in wounds and occasionally the bowel. Colonization is particularly heavy during outbreaks.

       b. K. pneumoniae and other Enterobacteriaceae – May colonize wounds, healthy skin, the bowel, and the respiratory tract of patients and healthcare workers.

Infection refers to the invasion of bacteria into tissue with replication of the organism. Infection is characterized by isolation of the organism accompanied by clinical signs of illness such as fever, elevated white blood count, purulence (pus), and clinical expression of disease such as pneumonia, bloodstream infections, urinary tract infections, gastrointestinal infections, and skin infections.

Typhoid Fever

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi.  In the United States about 400 cases occur each year, and 75% of these are acquired while traveling internationally.  Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year.

Typhoid fever can be prevented and can usually be treated with antibiotics. 

Salmonella Typhi lives only in humans.  Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract.  In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria.  Both ill persons and carriers shed S. Typhi in their stool.

You can get typhoid fever if you eat food or drink beverates that have been handled by a person who is shedding S. Typhi or if sewage contaminated with S. Typhi bacteria gets into the water you use for drinking or washing food.  Therefore, thyphoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage.

Only S. Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream.  The body reacts with fever and other signs and symptoms.

Typhoid fever is common in most parts of the world except in industrialized regions such as the United States, Canada, western Europe, Australia, and Japan.  Therefore, if you are traveling to the developing world, you should consider taking precautions.  Over the past 10 years, travelers from the United States to Asia, Africa, and Latin America have been especially at risk.

Two basic actions can protect you from typhoid fever:

• Avoid risky foods and drinks
• Get vaccinated against typhoid fever.

Watching what you eat and drink when you travel is as important as being vaccinated.  This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers’ diarrhea, cholera, dysentery, and hepatitis A.

Even if your symptoms seem to go away, you may still be carrying S. Typhi. If so, the illness could return, or you could pass the disease to other people.  In fact, if you work at a job where you handle food or care for small children, you may be barred legally from going back to work until a doctor has determined that you no longer carry any typhoid bacteria.

Treatment consists of taking the prescribed antibiotics for as long as the doctor has asked you to take them.  Wash your hands carefully with soap and water after using the bathroom, and do not prepare or serve food to other people.  Have your doctor perform a series of stool cultures to ensure that no S. Typhi bacteria remain in your body.

Reference: www.cdc.gov

For the most current updates about typhoid fever visit: www.nc.cdc.gov/travel/content/diseases.aspx#typhoid