Infection Prevention Tip: Whether to Allow Staff to Launder Scrubs At Home

The Infection Control Consulting Services (ICCS) team has been asked on multiple occasions whether organizations should allow staff members to take their scrubs home and wash them. To answer this question, we think it's best to look to the guidelines from the Association of periOperative Registered Nurses (AORN).

To summarize, AORN recommends that after each daily use, scrub attire should be laundered at a healthcare-accredited laundry facility, by the organizations themselves and following state regulatory requirements, or by the organizations themselves and following Centers for Disease Control and Prevention (CDC) guidelines if no state requirements exist.

AORN also includes guidance about how staff should launder scrubs at home if an organization goes that route. These guidelines are available to current AORN members.

ICCS recommends organizations query their accreditation agency about standards concerning scrub laundering and try to determine whether their state's department of health makes scrub laundering an area of focus.

With all of that said, ICCS is not in favor of home-laundered scrubs. Among the reasons why: How will the organization control the laundering? Who will monitor the process in individual homes? Organizations must ultimately decide whether to permit home-laundered scrubs and develop a policy that reflects their decision.

COVID-19 Update: Use of Masks

The information in this post is now outdated. Please go to this post for the latest update from ICCS.

This update from Infection Control Consulting Services (ICCS) concerning the new coronavirus (i.e., COVID-19) focuses on the use of personal protective equipment (PPE), more specifically masks in the surgical setting.

ICCS has received several queries from ambulatory surgery center (ASC) clients regarding the use of surgical masks and possible shortages. In addition, we recently received a query morning from an ASC asking whether to attempt purchasing N95 respirator masks as the number of COVID-19 cases increase.

Before we dive into these issues, we want to emphasize the following: Screen, screen and screen your patients prior to them arriving at the surgery center and once they arrive. Every facility should be asking patients pertinent questions on the phone and when they arrive at the desk. Procedures should be postponed on patients with respiratory symptoms. Besides concerns about COVID-19, we're going through a new wave of influenza B infections that are far more dangerous at this juncture than COVID-19 as influenza is in every state.

What to Know About Masks in the Surgical Setting 

N95 respirator masks are not indicated for use in the ASC setting to date as per CDC’s interim guidance. Typically, they are used mainly in the hospital setting for patients with tuberculosis (TB) and other airborne infections and are part of a respiratory program with specific requirements before use. Avoid purchasing them for the purpose of stockpiling because of concern that you may encounter a coronavirus patient as this will create unnecessary issues with supplies. However, if you run short on surgical masks and can only obtain N95, then they can be used in place of surgical masks in the context of covering the nose and mouth during sterile procedures.

In the event you are experiencing issues with supplies, use surgical masks judiciously. If you need to change practices temporarily, make sure your staff understand the need to amend policy until supplies are readily available. Here is a helpful infographic explaining the differences between a surgical mask and N95 respirator.

We encourage providers to review the areas we have highlighted in this document from the Centers for Disease Control and Prevention (CDC).

Here are some additional thoughts from the ICCS team, followed by a few resources worth reviewing

1. Media sensationalism creates fear, even among us healthcare professionals. While we need to remain alert at all times, the U.S. is taking extraordinary precautions to contain the virus, and so far, so good. Cases reported in the U.S. are from close contacts or patients having been in China themselves. Patients from the cruise ship in Japan were placed at a military base for at least two weeks after the last case is identified. They will not be allowed home and into the public until they are deemed no longer communicable. Several patients on the flight from Japan have been admitted to a hospital in Nebraska with special isolation units after testing positive.

2. CDC, together with state and local authorities, learned from SARS and particularly EBOLA, so we are remaining optimistic that we will effectively contain COVID-19. However, it's too soon to tell. At this point, no need to panic. COVID-19 may be around for a while.

3. Suppliers of masks in the U.S. are notifying customers that N95 respirator masks may be available. That is good news for acute care hospitals as it can help them plan for potential influx of patients down the line and for other N95 mask needs. American manufacturers are stepping up to provide what we have typically relied upon China to give us. This includes prompt manufacturing of surgical masks.

Resources:

• OSHA Respiratory Protection Program (for use in hospitals)

• CDC Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings

• Other types of respirator masks that are not advocated in the outpatient setting as per CDC to date but are from the respirator family and can be used in the hospital setting: N99, N100, R95, P95 and P100

Study: Unsafe Injection Practices Endanger Thousands of Patients

A new study reveals that nearly 67,000 patients were notified about potential exposure to unsafe injection practices by healthcare personnel between 2012 and 2018.

As the Mayo Clinic Proceedings study notes, these patients were part of 38 notification events. Of these events, 25 involved syringe and/or needle reuse in the context of routine patient care while 11 involved drug tampering by a healthcare provider.

Furthermore, outbreak-associated hepatitis B virus and/or hepatitis C virus infections were documented for 11 of the events, eight involved patient-to-patient transmission and three involved provider-to-patient transmission.

The total number of U.S. patients who have been notified of potential exposures to blood-contaminated medications or injection equipment since 2001 is nearly 200,000. The Mayo Clinic Proceedings study notes, "The total number notified is staggering, considering the anxiety and uncertainty faced by patients while they awaited their test results, as well as other effects and costs borne by patients, healthcare providers, facilities and health departments."

February 2020 marks the 10-year anniversary of the Safe Injection Practices Coalition and its "One & Only Campaign," a public health effort to eliminate unsafe medical injections.

It is the responsibility of healthcare providers to ensure adherence to safe injection practices. Providers should never administer medications from the same syringe to more than one patient, and never enter a vial with a used syringe or needle.

Infection Control Consulting Services (ICCS) consultants regularly witness unsafe injection practices during on-site visits with clients. In a 2018 special report, we shared seven examples of unsafe injection practices identified during a client visit, included "opened multi-dose vials left on anesthesia carts" on our list of the scariest healthcare infections and threats and noted the addition of safe injection practices in the "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007" in our recent standard precautions special report.

CMS: Review Infection Prevention and Control Policies and Practices Now

The Centers for Medicare & Medicaid Services (CMS) has issued a memo reminding healthcare facilities about the importance of compliance with infection control practices.

The memo was released as the spread of the novel coronavirus (2019-nCoV) continues. As of February 13, the number of confirmed deaths surpassed 1,350 and confirmed cases exceeded 60,000. There are close to 600 confirmed cases of the coronavirus in more than 25 countries and territories outside mainland China. World Health Organization announced an official name for the disease causing the outbreak: COVID-19.

CMS makes the intent of its memo clear from the beginning, stating, "Every Medicare participating facility in the nation's healthcare system must adhere to standards for infection prevention and control in order to provide safe, high quality care."

CMS goes on to encourage facilities to review the various coronavirus-related materials produced by the Centers for Disease Control and Prevention (CDC) — including these recommendations — and reminds facilities of the guidance CMS issued last year concerning emergency preparedness.

CMS then highlights several requirements and expectations. These include the following:

• Complying with basic infection control practices.

• Adherence to standard, contact and airborne precautions, including the use of eye protection.

• Adherence to CDC recommendations on standard hand hygiene practices, including using alcohol-based hand rub/hand sanitizer as the preferred method of hand hygiene in most clinical situations.

• Ensuring appropriate personal protective equipment (PPE) use and availability.

• Ensuring PPE measures and protocols are included in emergency plans.

To assist facilities in self-assessment and review of practices, CMS concludes the memo by sharing the following resources:

• CMS Emergency Preparedness Website

• CMS Hospital Infection Control Self-Assessment Tool

• CMS Universal Infection Control Training Course

• CMS Nursing Home Infection Preventionist Training

• Nursing Home Infection Control Worksheet

• CDC Clean Hands Count for Safe Healthcare

FDA Approves New Pandemic Influenza Vaccine

The U.S. Food and Drug Administration (FDA) has approved a new vaccine designed to protect against pandemic influenza A (H5N1).

Developed by Seqirus, Audenz is the first-ever adjuvanted, cell-based influenza vaccine designed to protect against H5N1 in the event of a pandemic. It was approved for children aged 6 months or older.

The World Health Organization states that an influenza pandemic occurs when "a new influenza virus emerges and spreads around the world, and most people do not have immunity."

Seqirus notes in a news release that Audenz is designed to be deployed rapidly and can be stockpiled for first responders in the event of pandemic.

The vaccine combines two technologies: MF59 adjuvant and cell-based antigen manufacturing.

The MF59® adjuvant and formulated prefilled syringes used in the Audenz vaccine are produced in a Seqirus production facility built and supported through a public-private partnership between the company and the Biomedical Advanced Research and Development Authority (BARDA). BARDA is part of the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services.

In the Seqirus release, BARDA Director Dr. Rick Bright states, "Pandemic influenza viruses can be deadly and spread rapidly, making production of safe, effective vaccines essential in saving lives. With this licensure – the latest FDA-approved vaccine to prevent H5N1 influenza – we celebrate a decade-long partnership to achieve health security goals set by the National Strategy for Pandemic Influenza and the 2019 Executive Order to speed the availability of influenza vaccine. Ultimately, this latest licensure means we can protect more people in an influenza pandemic."