Association For Practitioners In Infection Control Research Articles

Needleless and Needle Protection Devices: A Second Look at Efficacy and Selection

Needlestick injuries (NSI) in healthcare workers (HCWs) are an increasingly common and costly problem. Approximately 800,000 NSI occur in the United States per year, which cost the institutions in which they occur an estimated $405 per injury.1 Of these costs, 60% are attributed to hepatitis B virus (HBV) screens, 23% to human immunodeficiency virus (HIV) screens, and 9% to employee health personnel time.1 This cost does not include the possible costs of zidovudine (AZT) prophylaxis or the direct and indirect costs of seroconversion to acquired immunodeficiency syndrome (AIDS). Several studies have examined these costs and found the price tag for the direct cost of medication, evaluation, and follow-up for AZT to range from $900 to $2,000; personal medical care for an AIDS patient to be $32,000; and the indirect cost of morbidity and mortality to total $13,000 and $210,000, respectively.2 Because of the AIDS epidemic, NSI in HCWs have been well described in the literature and are becoming an important subject of epidemiologic research. NSI frequently have been related to needle recapping, heparin lock and intravenous (IV) medication administration, IV set-up, and improper disposal of needles. Nurses (particularly in the emergency room and intensive care unit), medical students, house staff, attending physicians, and even housekeeping personnel and emergency medical technicians are at increased risk for NSI. Although the literature suggests that many HCWs are at risk for NSI in the healthcare setting, underreporting of NSI makes the true magnitude of the problem difficult to assess. Several researchers have concluded that accidental needlesticks represent the single greatest threat of exposure to HBV and HIV among HCWs. The risk of an HCW contracting HBV at work is much greater than the risk of acquiring HIV; however, the cost of AIDS, if it develops, is much greater in both human suffering and healthcare dollars. Increasing pressure from healthcare worker union organizations and the Occupational Safety and Health Administration (OSHA) for safety in the workplace has escalated the marketing, purchase, and use of expensive devices for needle protection in the healthcare setting. Many organizations, including The Society for Hospital Epidemiology of America (SHEA) and the Association for Practitioners in Infection Control (APIC), are calling for safety devices that both reduce and prevent risk of puncture injuries to HCWs.3 They urge healthcare facility decision-makers to move expeditiously to implement devices that incorporate technology-based approaches that prevent injuries by the nature of the design of the devices. Many organizations and individuals have contributed to the effort to protect HCWs and reduce risk from NSI. The American Hospital Association (AHA), Service Employees International Union (SEIU), the Centers for Disease Control and Prevention, OSHA, and the Food and Drug Administration (FDA) all have collaborated to provide healthcare facilities with the necessary support to move toward needle-safe and needle-free devices. Congressmen Pete Stark and Ronald Wyden each have expressed increasing support for adoption of safer medical devices. Many manufacturers have introduced needleless and needle protection devices in order to reduce the

Needleless and Needle Protection Devices: A Second Look at Efficacy and Selection

Needlestick injuries (NSI) in healthcare workers (HCWs) are an increasingly common and costly problem. Approximately 800,000 NSI occur in the United States per year, which cost the institutions in which they occur an estimated $405 per injury.1 Of these costs, 60% are attributed to hepatitis B virus (HBV) screens, 23% to human immunodeficiency virus (HIV) screens, and 9% to employee health personnel time.1 This cost does not include the possible costs of zidovudine (AZT) prophylaxis or the direct and indirect costs of seroconversion to acquired immunodeficiency syndrome (AIDS). Several studies have examined these costs and found the price tag for the direct cost of medication, evaluation, and follow-up for AZT to range from $900 to $2,000; personal medical care for an AIDS patient to be $32,000; and the indirect cost of morbidity and mortality to total $13,000 and $210,000, respectively.2 Because of the AIDS epidemic, NSI in HCWs have been well described in the literature and are becoming an important subject of epidemiologic research. NSI frequently have been related to needle recapping, heparin lock and intravenous (IV) medication administration, IV set-up, and improper disposal of needles. Nurses (particularly in the emergency room and intensive care unit), medical students, house staff, attending physicians, and even housekeeping personnel and emergency medical technicians are at increased risk for NSI. Although the literature suggests that many HCWs are at risk for NSI in the healthcare setting, underreporting of NSI makes the true magnitude of the problem difficult to assess. Several researchers have concluded that accidental needlesticks represent the single greatest threat of exposure to HBV and HIV among HCWs. The risk of an HCW contracting HBV at work is much greater than the risk of acquiring HIV; however, the cost of AIDS, if it develops, is much greater in both human suffering and healthcare dollars. Increasing pressure from healthcare worker union organizations and the Occupational Safety and Health Administration (OSHA) for safety in the workplace has escalated the marketing, purchase, and use of expensive devices for needle protection in the healthcare setting. Many organizations, including The Society for Hospital Epidemiology of America (SHEA) and the Association for Practitioners in Infection Control (APIC), are calling for safety devices that both reduce and prevent risk of puncture injuries to HCWs.3 They urge healthcare facility decision-makers to move expeditiously to implement devices that incorporate technology-based approaches that prevent injuries by the nature of the design of the devices. Many organizations and individuals have contributed to the effort to protect HCWs and reduce risk from NSI. The American Hospital Association (AHA), Service Employees International Union (SEIU), the Centers for Disease Control and Prevention, OSHA, and the Food and Drug Administration (FDA) all have collaborated to provide healthcare facilities with the necessary support to move toward needle-safe and needle-free devices. Congressmen Pete Stark and Ronald Wyden each have expressed increasing support for adoption of safer medical devices. Many manufacturers have introduced needleless and needle protection devices in order to reduce the

Infection control programs for long-term care.

1. Many infection control concerns are the same for both hospitals and long-term care facilities (LTCFs), but some are unique to LTCFs. The unique concerns seem to be in the area of "caring." 2. The Association for Practitioners in Infection Control (APIC) offers many educational opportunities for infection control practitioners (ICPs) in LTCFs. 3. The APIC Guideline for Infection Prevention and Control in the Long-Term Care Facility and interpretive assistance for implementing the Guideline in a variety of LTCF settings are available for ICPs.

National survey of infection control practitioners' educational needs

The purpose of this study was to conduct a nationwide survey to determine the number of master's-prepared infection control practitioners (ICPs) and those eligible for admission to graduate programs. Continuing education needs also were assessed to determine whether they might best be met through formal education or in a continuing education format. ICPs at 3765 health care facilities listed by the American Hospital Association as having more than 100 beds were invited to participate, and 2197 usable responses were received. Respondents' perceived educational needs were categorized into the eight sections outlined by the Educational Committee of the Association for Practitioners in Infection Control (APIC). Whenever possible, demographic characteristics of subjects were compared with the findings of the 1976-1977 Study on the Efficacy of Nosocomial Infection Control; apparent shifts have occurred in age, basic educational preparation, and numbers of practitioners with advanced degrees. The major perceived educational needs of the respondents were in the areas of Management and Communication, followed by Infectious Diseases and Epidemiology and Statistics. Nationwide generalization of the results may be hampered by the skewed regional distribution of responses. ICPs, however, expressed a multiplicity of perceived educational needs in each of APIC's eight sections, which may indicate that many ICPs believe that their performance and effectiveness are hampered by knowledge deficits.

The inner voice

Laboratories and clinics that collect airflow data typically use either a standard pneumotachograph or the Rothenberg face mask. Because subjects and patients breathe through these masks and because these masks come into contact with skin, some procedure should be followed to prevent cross infection. Sterilization is not required since the masks do not normally come into contact with mucous membranes or the blood stream or other body fluids. However, simple procedures for disinfecting the masks should be followed to reduce or eliminate the risk of transmission of air-borne organisms and/or skin problems. Occasionally, saliva and/or sputum collect on the mask surfaces. These should be removed before the mask is disinfected. Rutala (1990) has described guidelines for infection control as adopted by the Association for Practitioners in Infection Control (APIC). Disinfection refers to procedures designed to eliminate many or all microorganisms with the exception of bacterial spores. There are three levels of disinfection. High level disinfection refers to items that come into contact with mucous membranes or nonintact skin. It is designed to destroy all microorganisms with the exception of bacterial spores in large concentrations. Intermediate level includes items such as bedpans, blood pressure cuffs, linens, utensils etc. At this level, vegetative bacteria, most viruses and fungi are eliminated but it does not kill bacterial spores. Low level items are those that come into contact with intact skin. Low level disinfection kills most bacteria, some viruses and some fungi. There are several potential chemical agents which can be used to disinfect smooth, hard-surfaced noncritical items, such as respiratory face masks. These agents include ethyl or isopropyl alcohol (at least 70%), sodium hypochlorite, iodophor germicidal solutions, or quaternary ammonium solutions. The latter three agents may be harmful to the cushion and/or wire mesh of the Rothenberg mask. Because they are potentially flammable, alcohols can be dangerous to use on a routine basis. Sodium hypochlorite is present in household bleach and although it should be handled with care, it can be an inexpensive and effective disinfectant. I t is also possible to use solutions designed for higher level disinfection such as glutaraldehyde, a solution commonly used to disinfect the laryngoscope. We use the Rothenberg face mask for the collection of airflow data, and the Smitheran and Hixon (1981) procedure for the estimation of lung pressure. In the latter procedure, a small-length tube is used to sense the pressure in the oral cavity. This tube is disposed of after use and does not need to be disinfected. It is possible to use household bleach as a disinfectant. The bactericidal component (5.25%) of bleach is sodium hypochlorite. The bleach should be diluted to produce a concentration of about 500-1000 ppm, or approximately a 25:1 ratio. According to Rutala, it is an effective bactericide, fungicide, tuberculocide, sporicide, and virucide. The solution will lose about 50% of its effectiveness after 30 days. Thus, a sufficiently strong solution should be prepared for it to be effective at 30 days. Since bleach is inexpensive, a proper concentration could be prepared weekly. Disposable gloves should be used when handling materials to be cleaned. First, the mask is washed in a solution of warm water and liquid detergent (Hibiclens, Stuart Pharmaceuticals). This is an important step to remove any material that may have been coughed or spat on the surfaces of the mask. The rubber cushion surrounding the mask is removed and both are immersed into a diluted bleach solution for 10 minutes. The mask and cushion are then rinsed thoroughly and allowed to dry. Bleach has a very strong odor that may be especially potent in the small mask space. However, the potency of the diluted solution should produce little residual odor. Occasionally, if another subject is waiting, the mask and cushion are dried with a common hair dryer. The diluted bleach solution appeared to have no harmful effects on the various components of the mask.

APIC and the 1985 position paper: “Listen to the music”

The Association for Practitioners in Infection Control (APIC), in existence now for 16 years, is still considered to be a relatively young professional organization. During that time its many accomplishments include membership growth to more than 7500 persons, establishment of a national office, annual revenues of more than $700,000, publications of a bimonthly scientific journal, publication of the standard reference work for infection control practice, establishment of the process leading to a certifying examination in infection control, an annual educational conference attended by more than 1000 persons, and increasing recognition by other professional groups, state and federal agencies, and the scientific community as a leading voice that represents professionals involved in infection control practice in the United States. These accomplishments have been due in large part to the dedication and hard work of its members, especially the hundreds of persons who have filled local and national positions of leadership. However, APIC now finds itself at a crossroads; changes in the current health care climate and publication of the results of a national study on the efficacy of infection control practice have contributed to a reassessment of infection control programs and the role and scope of persons involved in the field. The purpose of this editorial is to review the background of our two position papers, to comment on an expanded role of hospital epidemiology, and to examine the response of APIC to our membership in terms of commitments identified in the two papers.

Revisions and commonly asked questions regarding the infection control certification examination

The Certification Board of Infection Control (CBIC) was established by the Association for Practitioners in Infection Control (APIC) in 198 1 to provide its membership with a certification process that would measure knowledge necessary for the practice of infection control.* The first certification examination was given in 1983 to more than 900 infection control practitioners (ICPs). Since that time approximately 250 persons have become certified each year, which means a current total of about 25% of the APIC membership. The CBIC is structured to comply with standards set by the National Commission for Health Certifying Agencies (NCHCA)? This agency, NCHCA, is, as of September 1987, a special section of the National Organization for Competency Assurance (NOCA). The CBIC is a member of NOCA. The NCHCA standards stip-

Liaison Report—Association for Practitioners in Infection Control (APIC)

Liaison Report—Association for Practitioners in Infection Control (APIC)

Training needs of the infection control practitioner: Development of practice standards and internship programs

The main mission of the Association for Practitioners in Infection Control (APIC) is to help its practitioners develop and improve the practice of infection control through education, communication, research, standardization, and professional relations (APIC bylaws, 1985). In only 13 years, most of these objectives have been realized. Although educational standards have been clearly defined and a certification process has been established for the infection control practitioner (ICP), infection control practice lacks standards. In the face of increasing .expectations for ICPs, the need intensifies to define what the entry-level ICP should be able to do, what the prospective employer should look for in hiring an ICP, and what standards, in both preparation and demonstrated competence, can help to assure that these expectations are met. Infection control practice standards should enable ICPs to determine the essential elements of an effective infection control program by providing a systematic and organized approach to consistent practice regardless of the setting in which they practice. The purpose of this commentary is to challenge our profession and APIC to develop practice standards and, more important, to devise a practical and accessible mechanism to implement them. Virtually all ICPs have been asked by both the lay public and various health professionals the following questions: (1) What is an epidemiologist? (2) What do you do in your day-today activities? (3) How do you become an ICP?