Infection Prevention

Isolation of Patients for MRSA: Policy Change

Posted on Feb 3, 2015 in Infection Prevention | 0 comments

The hospital’s policy for isolation of patients with MRSA has changed. Specifically, patients are already, by law-driven policy, screened at admission with a swab of the nares to determine the presence or absence of MRSA.  The change in policy is that patients who have only that positive screen for MRSA, but no other evidence of disease due to it, are not to be placed in Contact Isolation, as previously they were.  It’s important for physicians to know this change so that, if questions arise, all MDs, RNs, etc., are “on the same page.”

Note that screening for pre-operative patients occurs in the Pre-Op Clinic (under the supervision of Dr. Tessa Collins), where at present only pre-operative orthopedics patients are being seen, and where in coming months other pre-operative patients also will be seen.  Results of screening these patients go to the clinic, where interventions are in place to manage patients whose screening results are positive for MRSA.  For questions, please call Infection Control at 510-869-8363.

By Roger Phelps, M.D.

Transfer of Suspected or Confirmed Infectious Aerosol Transmissible Disease Patients

Posted on Feb 3, 2015 in Infection Prevention | 0 comments

Patients with potential or confirmed Aerosol Transmissible Disease that requires airborne isolation should be placed in an Airborne Infection Isolation Room (AIIR). (An AIIR is a room, area, booth, tent or other enclosure that is maintained at negative pressure to adjacent areas in order to control the spread of aerosolized M. tuberculosis and other airborne infectious pathogens.)

Upon identification of a potential or confirmed ATD, the patient will be placed into airborne isolation. If transfer to an AIIR room within the facility is required, this shall occur within five hours.

In the new patient care pavilion at Summit, we have several AIIRs equipped with negative pressure systems. However, in our Critical Care Units, we have none that have negative pressure.

When providing care for Summit patients who require Critical Care and require Airborne Isolation, the physician must transfer the patient to a facility that has fully functional AIIRs.

Exception:

Where the treating physician determines that transfer would be detrimental to the patient’s condition, the patient need not be transferred.

  •  Employees who enter the room or area housing the individual are provided with and use, appropriate personal protective equipment and respiratory protection in accordance with 5144 (g).5199(e) (5) (B) (as above)
  •  The physician must document daily in the medical record the patient’s inability to tolerate transport.

By Joseph B. Marzouk, M.D., Chair Infection Control Committee &
Fred Deneau, CMS, CIC Manager Infection Control ABSMC

Ebola Update

Posted on Jan 5, 2015 in Infection Prevention | 0 comments

Preparations for the arrival here of a patient suspected of having Ebola virus disease are part of greater planning efforts Sutterwide and more generally in coordination with public health authorities at the local, state and federal levels. Our efforts here at Summit fall into two categories, policies and equipment.

A bi-campus Ebola Steering Committee, including physicians and representatives of the hospital, has formed and met to guide activities, as has a physician-specific task-force. The major areas of organizational effort are:

  • Hospitals nationwide will be in one of three tiers: front line, assessment and treatment. Locally, if current plans play out, UCSF and Oakland’s Kaiser will be the treatment facilities. Summit will be in the front line, that is, where a patient who on presentation meets criteria as a “person under investigation” for Ebola will be isolated, and from which the patient will be transported to an assessment facility, that is, where the patient will reside for the anticipated 3-5 days needed to confirm or exclude the diagnosis of Ebola. (Planning is underway for Alta Bates to be an assessment facility, but the authority for that decision is the public health sector’s, not the hospital’s or Sutter’s, and the decision is at the time of this writing pending.) The ultimate site for management of a patient confirmed to have Ebola will be a treatment facility.
  • Policies are in a state of refinement, materials and equipment are being obtained and updated, and training (and confirmatory drills) are proceeding to accommodate the isolation, initial management, and subsequent transport of the suspected patient, regardless where the patient presents (ER, registration, etc.).

By Roger Phelps, M.D. and Merrilee Newton, R.N.

 

 

Aerosol Transmitted Disease Policy Update

Posted on Dec 1, 2013 in Infection Prevention | 0 comments

Purpose: In order to fully implement the guidelines as outlined in CalOSHA Standard 5199

TB/AFB testing:

  • As previously, if sputum for AFB are ordered, that patient requires placement in Airborne Precautions.
  •  Rooms dedicated for Airborne Precautions are called Airborne Infection Isolation Rooms – AIIRs.
  •  Summit  has 3 AIIRs–3342, 5024 & 5026; these rooms have telemetry capabilities
  • NO AIIR room
  1. Transfer patient to another facility where there is AIIR capability, within 5 hours.
  • UNSTABLE patient who cannot transfer
  1. Physician needs to document in the chart, DAILY,  that the patient is unstable for transfer.
  2. Patient will be placed in a private room, door closed, Hepa Filter.
    1. In ICU, placement must include a room with solid walls.
    2. HCW must wear N-95 mask or PAPR,  as well as all other PPE when entering the room. Read More

Greetings from the ABSMC Infection Prevention Department

Posted on May 30, 2013 in Infection Prevention | 0 comments

The Department Plan Evaluation for 2012 was presented at the Sutter East Bay Quality Council last month. Our ICU metrics at Summit were outstanding for ZERO ventilator associated pneumonia. The prevention bundle has proven effective and is followed by the ICU nursing staff and Respiratory Therapy. Our CLABSI rate has maintained at 0.6/1000 line days. Surgical Site Infection (SSI) rates for our selected procedures are all at or below the National Healthcare Safety Network (NHSN) pooled mean. Even our C. difficile hospital acquired rates have decreased by 13 percent. However, this is an infection that requires vigilance with hand washing with soap and water, Contact Precautions (gowns and gloves when entering the room) and environmental cleaning with bleach.

A new National Patient Safety Goal was introduced by JC to prevent catheter related UTIs. Practice and maintenance are monitored for correctness; however, the best practice is to remove the foley when no longer necessary. The 2011-2012 influenza vaccine season had nearly 90 percent of employees receiving vaccines! There was a slight increase in physicians, as well.  Read More

Novel Influenza A (H7N9) Health Alert

Posted on May 1, 2013 in Infection Prevention | 0 comments

The World Health Organization Report on Cases of Novel Influenza A (H7N9) in China reports there has been 51 laboratory confirmed cases, 11 deaths and no person-to-person transmission or epidemiological link of any cases to date.

Consider the possibility of novel influenza A (H7N9), if a patient is ill and has had: 1) recent travel to countries with human cases, especially those with close/direct contact with animals and/or 2) recent contact with a known human case of infection with novel influenza A (H7N9).

In the RARE event that we have a possible case of novel influenza A (H7N9), please do the following:

  • Implement Standard plus Droplet, Contact, and Airborne precautions including eye protection, negative pressure or AIIR
  • Collect nasopharyngeal specimen and send to CCPH Lab
  • Order novel influenza A (H7N9) PCR test and send to CCPH lab
  • Antiviral treatment with neuraminidase inhibitors should be started as soon as possible after the onset of illness (preliminary data suggest that the virus is susceptible).
  • Cases of influenza due to novel viruses are reportable on California.

Additional information can be found at: WHO Situation Updates @ http://www.who.int/csr/don/en/ and the CDC Health Advisory (April 5, 2013) and CDC avian influenza A (H7N9) information page http://www.cdc.gov/flu/avianflu/h7n9-virus.htm.

By Alta Bates Summit Medical Center, Infection Prevention Department