Disaster/Outbreak Preparedness

Disaster/Outbreak Preparedness / en Thu, 21 Nov 2024 21:52:52 -0600 Tue, 18 Jun 24 13:17:15 -0500 The Joint Commission: New and Revised Requirements for the Infection Prevention and Control (IC) Chapter – Analysis and Next Steps /joint-commission-new-requirements-infection-prevention-and-control-chapter-2024 <h1>ANALYSIS AND NEXT STEPS The Joint Commission: New and Revised Requirements for the Infection Prevention and Control (IC) Chapter</h1><h3>The Joint Commission approved new and revised requirements for infection prevention and control (IC) standards, effective July 1, 2024.</h3><h3>Your current program is valid, but it needs expanding.</h3> Tue, 18 Jun 2024 13:17:15 -0500 Disaster/Outbreak Preparedness Webinars: Disaster Outbreak Preparedness /ahe-demand-webinars-disaster-outbreak-preparedness Mon, 08 Aug 2022 13:26:20 -0500 Disaster/Outbreak Preparedness 91��2018 Webinar: Hepatitis A Webinar /education/hepatitis_a_webinar <h1>2018 91��Webinar</h1> <h2>Hepatitis A: An Ongoing Multi-State Outbreak and its Importance to Environmental Services in Health Care Settings</h2> <hr /> Release Date: Wednesday, June 6, 2018 Cost:&nbsp;Free <a class="btn btn-primary btn" href="https://ams.aha.org/EWEB/?ahabu=AHE&amp;Action=Add&amp;ObjectKeyFrom=1A83491A-9853-4C87-86A4-F7D95601C2E2&amp;WebCode=ProdDetailAdd&amp;DoNotSave=yes&amp;ParentObject=CentralizedOrderEntry&amp;ParentDataObject=Invoice%20Detail&amp;ivd_formkey=69202792-63d7-4ba2-bf4e-a0da41270555&amp;ivd_prc_prd_key=dbb16576-e928-43d6-a913-fcfe69bcebff&amp;_ga=2.192604130.954988668.1559568848-620121517.1547669993" role="button">Register</a> Kentucky and Indiana have become the latest states to experience Hepatitis A outbreaks in 2018 joining Utah, California and Michigan. Both states have historically had about 20 cases of Hepatitis reported in a typical year. However, the Kentucky Department for Public Health has reported more than 400 cases of Hepatitis A since August 2017, and Indiana, 69, since January 2018. Both states are taking measures to address the outbreak emphasizing high-risk groups including those who are homeless or housing insecure, injection and non-injection drug users, and men who have sex with men. Recent cases have been identified among food service workers resulting in the inclusion of those handling food in targeted vaccination efforts.&nbsp; Join Ruth Carrico, PhD DNP to learn more about this outbreak and its impact on health care workers and those responsible for environmental service and food service departments in health care settings. Presenter: <img alt="Ruth Carrico" data-entity-type="" data-entity-uuid="" src="http://www.ahe.org/Shared_Images/Headshots/carrico_ruth_150.jpg" /> Ruth Carrico, PhD DNP Fri, 01 Jun 2018 00:00:00 -0500 Disaster/Outbreak Preparedness Asymptomatic Clostridium Difficile Carriers: Transmission of an Infectious Pathogen /asymptomatic-clostridium-difficile-carriers-transmission-infectious-pathogen <h4>By Rosie D. Lyles, MD, MHA, MSc; Head of Clinical Affairs, Clorox Healthcare</h4>May 22, 2017 |&nbsp;Formats:&nbsp;White Paper |&nbsp;Content Areas:&nbsp;Environmental Sanitation Operations&nbsp;|&nbsp;Tags:&nbsp;Disaster/Outbreak Preparedness, Environmental Hygiene and Sanitation, Infection Prevention and Epidemiology<hr>The Centers for Disease Control and Prevention (CDC) describe C. difficile as a pathogen of significant public health interest which warrants urgent attention, with an estimated 453,000 C. difficile infection (CDI) cases in the US on an annual basis. Currently, preventative measures for CDI include control bundles focused on infection control measures surrounding symptomatic patients. Despite these measures, C. difficile associated disease still remains a problem. Antibiotic stewardship is now at the forefront of CDI prevention efforts because of the growing national focus on proper antibiotic use to avoid unnecessary consequences of hospitalization due to inappropriate or excessive antibiotic therapy.This paper takes a close look at asymptomatic C. difficile carriers and provides recommendations for effective infection control. &nbsp; Mon, 22 May 2017 15:45:26 -0500 Disaster/Outbreak Preparedness Pulling Back the Sheets on the Bed Bug Controversy /pulling-back-sheets-bed-bug-controversy <h4>By Ron Harrison, Ph.D., B.C.E. and Bill Lawrence, Ph.D., B.C.E.</h4>May 22, 2017&nbsp;|&nbsp;Formats:&nbsp;White Paper&nbsp;|&nbsp;Content Areas:&nbsp;Administration, Environmental Sanitation Operations, Regulatory Compliance&nbsp;|&nbsp;Tags:&nbsp;Beds, Chemicals , Contracting, Cost Management, Disaster/Outbreak Preparedness, Environmental hygiene and sanitation, Infection Prevention and Epidemiology, Laundry and Textiles, Linen , Pest Control, Process Improvement<hr>Bed bugs exhibit a number of unique characteristics that make them problematic pests: parasites that are almost exclusive to humans; bites that frequently produce no reaction; nocturnal feeders that stay out of sight during the day, making them difficult to detect. The severity of the risk presented to humans is inconclusive. Clearly, further research is needed to define the degree of the the threat that bed bugs pose. Until then, prevention and early detection are the best practices.Health care providers will need to rely on their staff for an effective monitoring and prevention strategy. Working hand in hand with your pest management professional, staff education and cooperation is essential to identifying and reporting potential bed bug infestations. Your pest management professional can educate employees about the pests, harborage points and signs of their presence. They can also train staff on sanitation practices and monitoring activities that will reduce the risk of a bed bug infestation and ensure that if bed bugs do enter your facility, they don't take up residence.As the debate around bed bug continues to evolve and further research brings to light new information about these pests, the prevention and management practices will also evolve. In the meantime, rest easy with a proactive approach and the advice of a trained pest management professional.&nbsp; &nbsp; Mon, 22 May 2017 09:27:20 -0500 Disaster/Outbreak Preparedness Preparing for a Chemical or Biological Emergency /preparing-chemical-or-biological-emergency <h1>Preparing for a Chemical or Biological Emergency</h1> <h4>By Sheryl S. Jackson</h4> May 29, 2016&nbsp;|&nbsp;Formats:&nbsp;Article&nbsp;|&nbsp;Content Areas:&nbsp;Administration&nbsp;|&nbsp;Tags:&nbsp;Communication, Disaster/Outbreak Preparedness, Management <hr /> While chemical or biological incidents might not be among the top three hazards identified by hospitals in their emergency preparedness plans, environmental services professionals should be aware of the special preparation needed for chemical or biological events. “In any event, the environmental services department is part of the facility emergency response team to identify current inventory and location of personal protection equipment (PPE) as well as decontamination supplies and tools, and coordinate the purchase of additional items needed,” says Greg May, CHESP, system director of environmental services and linen service at Swedish Medical Centers in Seattle. While serving as environmental services director at her previous facility, Lisa Ford,&nbsp;BS, CHESP, district manager for Sodexo, was an integral member of the hospital’s emergency preparedness planning committee. “The 100-page plan included detailed descriptions of each department’s scope of responsibility before, during and after an emergency,” she explains. “As director of environmental services, I was responsible for purchasing and maintaining the inventory of emergency supplies — everything from cots to respirators to traffic cones and a decontamination tent.” Hospitals are required to have local, immediate access to 48 to 72 hours of supplies and equipment to handle an emergency, which gives time for state and federal agency assistance to arrive, explains May. “Most hospitals should have a cache of PPE and other supplies onsite for significant events, and at my hospital, my department has its own smaller cache that we can access for small events,” he says. “We also have a supply of HEPA [high&nbsp;efficiency particulate arresting] vacuums and filters for my staff that can be used in specific situations.” Although it is critical to have supplies on hand, there are some items or some quantities that cannot be stored onsite. In these situations, be sure to have a memo of understanding with suppliers that will enable shipment of additional supplies in the event of a larger than expected patient exposure, suggests Ford. Agreements with other specialty vendors may also be necessary for items that will only be needed in specific events. “For example, in my previous position, I had an agreement with a company to provide a refrigerated trailer for use as a morgue if needed,” she says. “Other suppliers agreed to deliver specific amounts of items such as masks and gowns, if needed. Remember, too, that some supplies, such as hand sanitizers, have expiration dates so they can’t be purchased and stored indefinitely — be sure suppliers are available to deliver them.” When establishing agreements, include suppliers outside your local area&nbsp;or suppliers with national resources, suggests May. “In the case of a catastrophic event in one area, local supplies may disappear quickly, so your suppliers need the ability to pull from other areas of the region or country.” Don’t forget to contract with a company to handle waste created by decontamination, suggests May. “Once you decontaminate patients exposed to hazardous materials, you have water that must be disposed of properly. Hospitals are responsible for the waste recovered, so you must make sure the containment, removal, transport and disposal are handled according to Environmental Protection Agency guidelines.” However, even if a third-party provider is handling the actual disposal process, the hospital environmental services staff must have the equipment on hand to contain the water and be able to move it to a collection area for pickup. “You will have 55-gallon barrels of water to move, so employees will need carts or other equipment to enable movement,” says May. With 500 environmental services employees, May is able to train about 50 people to handle emergencies and schedule them so that a team of people who have undergone proper training and practiced techniques through drills is on duty for all three shifts, seven days a week. “It’s not practical to train the full staff, but focusing on a smaller emergency response team who have the knowledge to handle situations is important,” he explains. Finally, remember that purchasing emergency supplies is not a one-and-done event. “Be sure to perform a routine inspection and inventory of all emergency supplies,” says May. “My department serves as the spill response team so we do have a variety of absorbents for different types of spills.” Employees don’t always document use of a small amount. “The same thing happens with HEPA filters for our vacuums — they are ‘borrowed’ and not returned to their original location and filters are used. The only way to make sure you are prepared is to be sure your inventory is accurate.” <a href="http://www.nxtbook.com/naylor/AHEQ/AHEQ0216/index.php?startid=6#/14">http://www.nxtbook.com/naylor/AHEQ/AHEQ0216/index.php?startid=6#/14</a> Sun, 29 May 2016 15:40:28 -0500 Disaster/Outbreak Preparedness Fighting Antimicrobial Resistant Bugs as Part of the Team /fighting-antimicrobial-resistant-bugs-part-team <h4>By Sheryl S. Jackson</h4> February 29, 2016&nbsp;|&nbsp;Formats:&nbsp;Article&nbsp;|&nbsp;Content Areas:&nbsp;Environmental Sanitation Operations&nbsp;|&nbsp;Tags:&nbsp;Disaster/Outbreak Preparedness, Emerging Pathogens, Environmental hygiene and sanitation, Infection Prevention and Epidemiology <hr /> Antimicrobial resistance and its relationship to hospital acquired infections (HAIs) and the development of “superbugs” has been an issue for decades — with the majority of efforts directed at strategies to ensure that antibiotics are properly prescribed to prevent creation of an antibioticresistant bug. In April 2016, new guidelines from the Infectious Diseases Society of America and Society for Health Epidemiology of America were released. Recommendations for effective antibiotic stewardship programs include preauthorization and prospective review of antibiotics, physician and pharmacist leadership and program design that focuses on the specific problems and resources of the healthcare facility. While the new guidelines focus on the clinical practice related to diagnosis&nbsp;of infection and appropriate prescription of antibiotics, antimicrobial stewardship also applies to environmental services, says Timothy L. Wiemken, PhD, MPH, CIC, assistant professor of medicine and director of the healthcare epidemiology and patient safety program at the University of Louisville. “Physicians must accurately identify the right bug as well as the right drug and the right dose to fight the bug. If you think about environmental services staff as the healthcare provider for the environment, then they must prescribe the right disinfectant in the right concentration for the area they are cleaning,” he says. “Changing the way we think about our role in preventing the spread and further development of resistant organisms leads to better and more consistent practices.” A flurry of news headlines several years ago claimed that disinfectants used in hospitals were also creating resistant strains&nbsp;of bacteria, but the studies focused on results obtained in laboratory settings versus real-life settings. “The CDC [Centers for Disease Control and Prevention] does not consider the use of disinfectants a cause of antimicrobial resistance,” says Peter Teska, infection prevention application expert at Diversey Care, a division of Sealed Air. While antibiotics fight microorganisms with a targeted approach, disinfectants are more of a “sledgehammer,” he explains. “A disinfectant used correctly will kill the microorganisms on a surface — there won’t be enough of any microorganisms left to survive to develop resistance.” The most important role environmental services plays is preventing the spread of microorganisms that are brought into the facility by patients, visitors and hospital staff. To prevent this transmission, environmental services staff must select the proper disinfectant cleaner for each&nbsp;circumstance, says Teska. “There is a hierarchy of resistance to disinfectants, so in high-risk areas such as patient rooms or the intensive care unit, the products must be capable of killing the higher-level organisms that contribute to HAIs or are difficult to kill,” he said. “Lower-risk areas such as the lobby or public corridors may not require the same level of disinfectant.” Teska points to an article in the July 2014 issue of Infection Control and Hospital Epidemiology that describes the types of pathogens most environmental services professionals encounter and offers guidance on how to select the best product as an excellent resource when evaluating disinfectants for use.1 “Each hospital is different, so there is no one product that works for every situation,” he adds. Because there is no “magic bullet” that works in all cases for every facility, Wiemken reminds environmental&nbsp;services leaders to keep the goal in mind while developing a targeted approach. “Clostridium difficile (C. difficile) spores require a sporicidal disinfectant while other bacteria may not,” he points out. “You also need to evaluate how well the product works on different surfaces.” Moving to disinfectants versus cleaners is essential to environmental services’ role in preventing the spread of resistant pathogens, says Teska. “A study2 of the use of disinfectant wipes when the compliance rate was over 80 percent showed a significant decrease in the incidence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and C. difficile,” he says. Get a seat at the table Targeting products for specific needs requires understanding the facility’s needs. For this reason, Teska recommends working with the infection prevention department to create a strong relationship between the two departments. “Be proactive and seek feedback that will improve environmental services’ contribution to the healthcare organization,” he says. “We’ve seen relationships between infection prevention and environmental services become stronger in the past 10 years.” This relationship is not surprising, as hospital quality metrics related to infection rates and patient satisfaction become linked to reimbursement, says Teska. “The focus is on quality rather than just the dollars spent, so environmental services leaders who can demonstrate an improvement in quality in terms of those metrics will be able to justify additional investment in products, equipment and training,” he adds. “In fact, the infection prevention team can become advocates if they can see that the environmental services department understands and accepts their role in prevention of HAIs.” Staying up to date on the latest issues and product research related to antimicrobial-resistant pathogens is one way to add value to infection prevention’s efforts, as is taking steps to ensure your staff training and procedures protect patients and other personnel from infection. One way is to have a third party conduct an audit, says Teska. “Employees behave differently when their boss is watching, but an outside consultant will be able to assess how they really perform their jobs,” he says. While suppliers will often provide this service on a limited basis for free, Teska recommends environmental services leaders budget for a full, third-party assessment periodically. “That extra pair of eyes from a secret shopper gives you an unvarnished view of what is happening day to day.” Improper hand hygiene, incomplete cleaning due to interruptions or changes in routines, and different interpretations of high-touch areas are the areas of improvement most often observed by outside assessors. Improved procedures and training can improve performance in all of these areas, says Teska. Best practices decrease spread of resistant organisms In the case of antimicrobial-resistant pathogens, it is critical to make sure employees don’t spread them from&nbsp;surface to surface. Making sure staff know not to use the same cloth on multiple surfaces, and even choosing disposable disinfectant wipes over re-usable cloths is one best practice adopted by more healthcare organizations, says Teska. “The wipes are especially effective with C. difficile because they are used on one surface and disposed. When the cloth and bucket method is used, the spores may not be washed out during laundering, which can allow the spores to re-contaminate surfaces when used after laundering.” Wiemken co-authored a study on the benefits of disposable disinfectant wipes and found that added benefits included a higher rate of compliance with cleaning processes over use of the cloth and bucket, as well as a faster, more efficient cleaning and disinfection process.3 “Removing the human element from the process leads to more consistent practice,” he explains. Employee training is also getting a close evaluation as the role of environmental services becomes more critical to patient safety. In addition to developing detailed&nbsp;descriptions of procedures — such as defining “light switch” as the toggle switch, the switch plate and a specific amount of wall surrounding the switch plate — training is becoming more comprehensive. The old way of having a new employee work with an experienced employee as the sole method of training is no longer acceptable, says Teska. “This approach ensures that bad habits are passed from one person to another.” Instead, a combination of classroom training including a formal review of procedures and shadowing an employee who demonstrates compliance is more effective. Ultraviolet light or fogging with hydrogen peroxide vapor or mist are two new methods used when patient rooms are empty, but both must be preceded by cleaning to remove organic material or debris from surfaces. While there are advantages, cost and the length of time to use these technologies can be barriers to use for some healthcare organizations. Evaluating new technologies and new products can be overwhelming, says&nbsp;Wiemken. “Learn who are the experts in disinfection and ask their opinions,” he suggests. “Test a new product in your facility on a small scale to see if it works well and if employees will use it consistently.” Although environmental services’ contribution to hospital operations and patient safety is typically undervalued, Wiemken believes this is changing. With reimbursement affected by hospital HAI rates, environmental services leaders are in an excellent position to speak up and demonstrate their value, he adds. “Environmental services staff ensure a safe environment for the patient, which means they are a critical part of the infection prevention team.” References 1. Rutala, WA, Weber DJ. Selection of the Ideal Disinfectant. Infect Control Hosp Epidemiol Vol. 35, No. 7 (July 2014), pp. 855-865. 2. Alfa, MJ, Lo E, Olson N, et al. Use of a daily disinfectant cleaner instead of a daily cleaner reduced hospital acquired infection rates. Am J Infect Control 43 (2015) 141-6. 3. Wiemken TL, Curran DR, Pacholski EB, et al. The value of ready-to-use disinfectant wipes: Compliance, employee time, and costs. Am J Infect Control 42 (2014) 329-30. Mon, 29 Feb 2016 13:11:32 -0600 Disaster/Outbreak Preparedness Quick Tips for Critical Partnerships /quick-tips-critical-partnerships <h4>By Gail Fraine, RN, MMHC, BSN, CIC</h4> November 29, 2015&nbsp;|&nbsp;Formats:&nbsp;Article&nbsp;|&nbsp;Content Areas:&nbsp;Environmental Sanitation Operations&nbsp;|&nbsp;Tags:&nbsp;Communication, Disaster/Outbreak Preparedness, Emerging Pathogens, Employee Safety , Environmental hygiene and sanitation, Infection Prevention and Epidemiology, Leadership, Management <hr /> As director of infection prevention at Ascension Health St. Thomas Midtown in Nashville, I describe the relationship between our team of infection preventionists (IPs) and environmental services as minimizing risk and increasing safety when it comes to preventing disease transmission. Environmental Services and Infection Prevention Somewhat rare in the industry, the environmental services team reports to infection prevention and serves on its committee. David Cope, director of Environmental Services at St. Thomas, and the system’s director in the city, Michael Martin, work closely with our infection prevention team. We are very collaborative and discuss issues and changes to processes or products. For instance, ATP testing is performed on all positive C. difficile discharge patient rooms and other random samplings. The team is notified of any positive results. Rooms that are positive are re-cleaned, retested, and must pass before releasing the room for the next patient. Tip: ATP testing is a good educational and validation tool to identify how well a room has been cleaned. Environment-of-Care Rounds Together these teams do weekly Environment of Care rounds joined by safety, facilities, nursing, and pharmacy representatives striving for continuous improvement. As with many facilities nationwide, priorities include cleanliness and maintenance of the facility, proper trash removal, safety, and other environmental concerns. The team made a huge difference in OR turn-around times between cases by appointing one environmental services lead to oversee proper cleaning and turning of the room. Our focus on training, monitoring, and inspecting rooms with a ready resource keeps things on track and improves the overall environment. Tip: Environment of Care rounds are best performed as a team due to the collaborative nature of consensus building, educational opportunities, and immediate attention to issues that are identified. Preventing Disease Transmission An example of helping to decrease transmission of disease to patients is preventing&nbsp;C. difficile on the front end with a bundle that includes: <ul> <li>Hand hygiene</li> <li>Antimicrobial stewardship</li> <li>Isolation</li> <li>Proper Decontamination of the environment</li> <li>Proper decontamination of the equipment</li> <li>Early recognition of patients with potential for C. difficle</li> </ul> On the back end, ATP testing immediately lets teams know how they are doing related to environmental cleaning. It educates and breeds competition between members to keep passage rates high (95 percent or greater). St. Thomas Health extends the test to hands, cell phones, thermometers, and other equipment to make sure the importance of the environmental services’ role in getting rooms ready and the severity of results is well understood. Tip: Testing of additional items offers immediate feedback on performance and can be an eye-opener on ways that the environment can become contaminated. It should include transparency of passage rates that can spark a healthy competition between teams getting rooms ready. Preventing Sharps Injuries Minimizing disease transmission at St. Thomas also focuses on what ECRI lists as a “top 10 health technology hazard—sharps injuries (SI).” A proactive exchange of reusable sharps containers allows hospitals to&nbsp;minimize disposal SIs. The facility changed to a sharps management service and saw a 10 percent decrease in needle sticks. The burden was eased on the environmental services and health care personnel (HCP) teams to monitor containers because the sharps management service took care of it for us. Only during periods of high volume, environmental services teams may be asked to change a container, but this is infrequent. There have been no issues, and&nbsp;the exchange of reusable sharps containers frees HCP and environmental services to focus on their main work. Tip: Taking HCP away from the handling of sharps containers has helped reduce sharps injuries and potential for disease transmission. C. difficile and Sharps Container Considerations Recently a survey (found at <a href="https://www.bd.com/en-us">https://www.bd.com/en-us</a>) attempted to associate reusable sharps containers with transmission of C. difficile. There are several reasons I believe that there is a very low probability that reusable sharps containers play any role in disease transmission. If a container is full, environmental services will change it, but not HCP who has patient contact. Following care of our C. difficile-positive patients, HCP use a hand-washing technique with soap and water for 15 seconds before leaving the room and seeing the next patient. This step lessens the chance for cross-contamination to the environment and to themselves or others. This facility has not had any correlation in C. difficile infections related to reusable sharps containers, which have been used for more than five years. Tip: Follow stringent IP practices and policies like hand hygiene, isolation, equipment disinfection, and sharps practices that are intended to keep HCP and patients safe. Creating a collaborative atmosphere between environmental services and infection prevention teams, including the shaping of Environment-of-Care Rounds to include multiple departments and having a best-practice bundle, highlights the various ways to prevent disease transmission. Using reusable sharps containers not only prevents sharps injuries, as a service managed by a third party partner, but they may help minimize disease transmission. Sun, 29 Nov 2015 10:51:57 -0600 Disaster/Outbreak Preparedness Beyond Disinfection /beyond-disinfection <h4>By J. Hudson Garrett Jr., PhD, MSN, MPH, FNP, CSRN, CHESP, PLNC, VA-BC</h4> June 23, 2015&nbsp;|&nbsp;Formats:&nbsp;Article&nbsp;|&nbsp;Content Areas:&nbsp;Environmental Sanitation Operations&nbsp;|&nbsp;Tags:&nbsp;Disaster/Outbreak Preparedness, Emerging Pathogens, Environmental hygiene and sanitation, Infection Prevention and Epidemiology, Management, Process Improvement <hr /> According to the U.S. Centers for Disease Control and Prevention (CDC), it is estimated that one out of every 25 hospitalized patients will contract a health-care-associated infection (HAI). Each year HAIs are a documented source of increased mortality and morbidity, significant costs for care delivery, and have a negative impact on the patient experience. HAIs are typically preventable through the implementation of recommended evidence-based practices. The CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) has authored numerous guidelines and guidance statements that directly reduce the risk for transmission of HAIs such as multi-drug resistant organisms (MDROs) and other emergent pathogens such as Ebola Virus Disease. Impact of Antimicrobial Resistance on the Health Care System and Patients Today’s environmental services professionals are caring for an environment for a far more acutely ill patient than ever before, and some of these acutely ill patients may be infected with antibiotic resistant bacteria. These bacteria are resistant to the stockpile of antimicrobial agents that are available to us today. According to the CDC, there are at least 2 million illnesses and 23,000 deaths in the U.S. annually due to these deadly microorganisms. These microorganisms can be found in all health care settings, both inpatient and outpatient care environments, and are particularly prevalent in long-term care settings where the residents are exposed routinely to antibiotics in some cases. The CDC is working aggressively with the Food and&nbsp;Drug Administration to address the drug pipeline for antibiotics, but environmental services professionals play an instrumental role in reducing the risk for development of these deadly pathogens by carefully collaborating with the patient’s provider team and also clinical pharmacy personnel to determine the most appropriate treatment for the patient. A New Class of Deadly Emergent Microbes: CRE CRE, which stands for carbapenemresistant Enterobacteriaceae, are a family of germs that are difficult to treat because they have high levels of resistance to antibiotics. Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacteriaceae, a normal part of the human gut bacteria that can become carbapenem-resistant. Types of CRE are sometimes known as KPC (Klebsiella pneumoniae carbapenemase) and NDM (New&nbsp;Delhi Metallo-beta-lactamase). KPC and NDM are enzymes that break down carbapenems and make them ineffective. Both of these enzymes, as well as the enzyme VIM (Verona Integron-Mediated Metallo-β-lactamase) have also been reported in Pseudomonas. CRE has been the subject of news stories and outbreak investigations recently in the state of California due to an outbreak associated with duodenoscopes. Many CRE bacteria within the microbial class have been pan resistant to all known antibiotics, and others are quickly on a similar path for developing resistance. It is estimated that CRE microbes can contribute to death in up to 50 percent of patients who become infected. This leads unnecessary mortality and morbidity of the patients. Prevention Steps for CRE <ol> <li>Work with your medical laboratory and determine if patients with CRE are hospitalized within your facility. Closely monitor CRE infections for potential outbreaks and collaborate with your infection preventionist, infectious disease physician, environmental services professionals, and medical laboratory team to establish a system for monitoring for potential CRE outbreaks.</li> <li>Place patients currently or previously colonized or infected with CRE on contact precautions immediately. Whenever possible, dedicate patient rooms, equipment, and staff to CRE patients to reduce the risk for potential transmission.&nbsp;</li> <li>Wear an impervious gown and gloves when caring for patients with suspected or confirmed CRE.</li> <li>Perform hand hygiene using an alcohol-based hand rub or wash hands with soap and water before and after contact with the patient or their environment.</li> <li>Ensure the facility’s medical laboratory&nbsp;immediately notifies the patient’s provider and environmental services professionals when CRE is identified and confirmed.</li> <li>Administer antibiotics only when clinically indicated.</li> <li>Discontinue devices such as urinary and rectal catheters as soon as they are no longer medically necessary.</li> </ol> Impact of Clostridium difficile Infection A recent report released from the CDC has estimated that roughly 500,000 C. difficile&nbsp;infections occurred in the U.S. in 2011, of which 29,000 of those patients died as a complication of the infectious disease within 30 days of the initial diagnosis while hospitalized. Eighty-three thousand of the patients with infection experienced at least one recurrence within 30 days of the initial diagnosis. The major risk factor that contributes to the development of this disease is the overuse or inappropriate use of antibiotics. Antibiotics kill the natural, protective flora found in the patient’s gut, which can then allow the C. difficile flora to overtake the bowel and result in infection. CDC studies have demonstrated that 30 to 50 percent of antibiotics prescribed in U.S. hospitals are unnecessary or clinically incorrect. C. difficile is a tremendous source of mortality and morbidity to the health care delivery system. Prevention Steps for Clostridium difficile <ol> <li>Work with prescribers and the clinical pharmacist to ensure that antibiotics are indicated for the patient’s condition, and carefully taken by the patient according to the prescribed directions. It is important to discontinue antibiotics as soon as they are not medically necessary.</li> <li>Order a C. difficile test if the patient has had three or more unformed stools within a 24 hour time period.</li> <li>Isolate patients with suspected or confirmed C. difficile disease immediately.&nbsp;</li> <li>Follow isolation precaution guidelines when caring for patients with suspected or confirmed C. difficile (i.e., wearing gloves and a gown) even during short visits.</li> <li>Wash hands with soap and water to manually remove the spores from the hands. Alcohol-based hand rubs are not effective for removing spores from the hands.</li> <li>Collaborate with the facility’s environmental services professionals to ensure room surfaces are cleaned thoroughly on a daily basis and also upon discharge. It is important to use an EPA-approved, spore-killing disinfectant for units where there is potential transmission.</li> </ol> Emergent pathogens and antimicrobial&nbsp;resistance continue to plague the global health care system, however basic infection prevention and control practices can greatly assist environmental services professionals and the entire health care delivery team in reducing the risk for transmission of these pathogens. Maintaining a clean and sanitary environment, reducing the overuse of antibiotics, performing hand hygiene often, and keeping the patient’s own skin intact will reduce the potential risk for transmission of many emergent pathogens such as CRE, Ebola Virus Disease, and Clostridium difficile. In addition, environmental services professionals should carefully follow the evidence-based recommendations from the CDC for isolation precautions, use of personal protective equipment, disinfection and sterilization, and hand hygiene. These core recommendations will guide the clinical environmental services professionals, their teams, and other health care personnel in the adherence to well studies interventions that will significantly reduce the overall incidence of HAIs and also occupational exposure to the environmental services professionals. Tue, 23 Jun 2015 15:02:34 -0500 Disaster/Outbreak Preparedness Advisory: 91��Member Communication Regarding Ongoing CRE Outbreak Investigation /advisory-ahe-member-communication-regarding-ongoing-cre-outbreak-investigation <h1>91��Member Communication Regarding Ongoing CRE and Shigella sonnei Outbreak Investigations</h1>We have two very important updates for you regarding two different outbreak investigations.**This information is current as of publication date of April 9,2015**<hr><h4>Communication Regarding Ongoing CRE Outbreak</h4>Background on CRE:<ul><li>CRE, stands for carbapenem-resistant Enterobacteriaceae, a family of germs that are difficult to treat because they have high levels of resistance to most antibiotics. Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacteriaceae, a normal part of the human gut bacteria, which can become carbapenem-resistant. Types of CRE organisms are sometimes known as KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase). KPC and NDM are enzymes that break down carbapenem antibiotics and render them ineffective.</li><li>CRE is not a single microorganism, but rather several microorganisms such as the ones identified above that fall into a family of dangerous pathogens.</li><li>Carbapenem is an antibiotic used to treat severe infections.</li><li>Currently the US Centers for Disease Control and Prevention (CDC) is investigating an outbreak of Carbapenem-resistant Enterobacteriaceae (CRE) associated with inadequate cleaning and disinfection of duodenoscopes</li><li>Duodenoscopes are medical devices that are inserted down the patient’s throat and used in a variety of procedures, and in the case of this outbreak for a specific type of procedure called an endoscopic retrograde cholangiopancreatography (ERCP).</li><li>CRE organisms are resistant to multiple and in some cases all known antibiotic therapies, and therefore pose a risk to both the patient and the health care team including the environmental services technician.</li></ul>Environmental Impact of CRE in Health Care Settings:<ul><li>CRE can be spread via the hands of the patient and health care personnel</li><li>CRE organisms are transmitted in the same manner as many other Multi-Drug Resistant Microorganisms (MDRO’s), and core infection prevention and control measures such as hand hygiene, environmental cleaning and disinfection with an EPA registered, hospital-grade disinfectant for environmental surfaces, patient and staff cohorting and appropriate use of isolation precautions will mitigate risk for transmission of CRE organisms and most MDRO’s.</li><li>When not used correctly and according to manufacturer’s instructions, hospital-grade disinfectants may not have full efficacy against CRE organisms. It is important to completely follow all manufacturer’s instructions for use including dilution, contact time, etc. in accordance with the EPA Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA).</li></ul>Recommended Actions for Mitigation of CRE in Health Care Settings:Process duodenoscopes according to manufacturer's instructions for use with a minimum of a high-level disinfection process.For Environmental Services Professionals:<ul><li>Collaboration between infection preventionists, infectious disease/epidemiology staff, biomedical engineering and facilities teams to understand CRE organisms, how to manage the environmental impact</li><li>Diligent hand hygiene, proper glove and PPE use</li><li>Collaborate with the medical laboratory to monitor any environmental cultures collected from the patient care environment for potential identification of CRE organisms</li><li>Employ an EPA-registered, hospital-grade disinfectant for environmental cleaning and disinfection with clinically relevant claims for MDRO’s.</li><li>Infection prevention measures for MDRO’s such as CRE microorganisms should be treated in the same manner as other pathogens such as MRSA</li><li>Collaborate with your facility’s infection disease, epidemiology, and infection prevention departments and conduct a risk analysis to evaluate potential action items necessary to respond to and/or mitigate risk for transmission of CRE organisms.&nbsp;</li></ul>The CDC recommends several core measures for health care settings to follow to mitigate risk for transmission of CRE. These recommendations are the same as those for many other pathogens and include:<ul><li>Hand Hygiene for the Health Care Team and Patient: Hand hygiene is the single most important infection prevention intervention to reduce the risk for transmission of Health Care Associated Infections (HAI’s) including CRE.</li><li>Contact Precautions: Health care professionals and Technicians should receive adequate training on the proper use of contact precautions and personal protective equipment (PPE).&nbsp;</li><li>Provide Health Care Personnel Education: Health care personnel &nbsp;should be educated about the modes of transmission of CRE organisms and evidence-based mitigation recommendations. Use the CDC Vitals Signs Report (see webpage link below) to educate health care personnel on the risk of CRE and basic prevention strategies.</li><li>Cohort &nbsp;Health Care Staff with Suspected or Confirmed CRE Infections: This will reduce the risk for potential transmission between staff members and also other patients and environmental surfaces.&nbsp;</li><li>Create a System for CRE Screening: Proactive screening for potential CRE infections at the time of admission should be conducted in collaboration with Infection Prevention, the Emergency Department, and Medical Laboratory teams to facilitate rapid identification and isolation of potential cases, and timely communication to the health care team about necessary isolation precautions.</li></ul>What actions is 91��taking to keep environmental services professionals informed about developments associated with this outbreak:<ul><li>91��is closly monitoring the situation in collaboration with our partners at both the FDA and CDC.</li><li>91��has provided resource documents on its website that are available for environmental services professionals to download for reference at their facilities, and to facilitate conversations with internal partners such as the biomedical engineering and infection prevention departments</li><li>91��will provide input on environmental disinfection and the potential environment of care impact of CRE as requested by the FDA</li></ul>Additional Information and Resources<ul><li><a href="http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm434871.htm">US Food and Drug Administration Resource Center on CRE:</a></li><li><a href="http://www.cdc.gov/hai/outbreaks/cdcstatement-LA-CRE.html">US Centers for Disease Control and Prevention Resource Center on CRE:</a></li><li><a href="http://www.cdc.gov/vitalsigns/hai/cre">US Centers for Disease Control and Prevention CRE Vital Signs Report</a></li></ul>References<ul><li>US Food and Drug Administration (FDA)</li><li>US Centers for Disease Control and Prevention (CDC)</li><li>The Joint Commission&nbsp;</li><li>US Centers for Medicare and Medicaid Services (CMS)</li></ul><hr><h4>Communication Regarding Ongoing Shigella sonnei Outbreak</h4>Background of Shigella sonnei and Current Outbreak:<ul><li>Currently the US Centers for Disease Control and Prevention (CDC) is investigating an outbreak of Shigella sonnei bacteria in 32 states and Puerto Rico with a total of 157 cases from May 2014-February 2015. Half of these cases were associated with international travel.</li><li>This microorganism causes an estimated 500,000 cases of diarrhea in the United States annually according to CDC estimates.</li><li>The bacteria is transmitted easily from person to person and through contaminated food and recreational water sources.</li><li>The bacteria can become resistant to commonly used antibiotic therapies for the infection.</li><li>The bacteria can cause severe and in some cases fatal infections in immunocompromised people.</li><li>Shigellosis is the infection caused by the bacteria, and the infection will typically resolve on its own within 5-7 days. &nbsp;</li></ul>Environmental Impact of Shigella sonnei in Health Care Settings:&nbsp;<ul><li>Shigella sonnei can be spread via the hands of the health care providers, environmental services professionals and technicians, or the patients themselves, as well as thru contaminated environmental surfaces.</li><li>When not used correctly and according to manufacturer’s instructions, hospital-grade disinfectants may not have full efficacy against Shigella sonnei organisms. It is important to completely follow all manufacturers’ instructions for use including dilution, contact time, etc. in accordance with the EPA Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA).</li></ul>Recommended Actions for Prevention of Shigella sonnei in Health Care Settings:&nbsp;<ul><li>Regularly practice hand hygiene as indicated using a soap and water or an alcohol-based hand rub according to facility protocol. When the hands are visibly soiled, the CDC recommends the use of soap and water for hand hygiene purposes.&nbsp;</li><li>For environmental cleaning and disinfection, use an EPA-registered, hospital-grade disinfectant with clinically relevant claims for organisms such as Shigella sonnei and other MDRO’s.&nbsp;</li><li>Promptly clean and disinfect any patient bathrooms contaminated with diarrhea using an EPA-registered, hospital-grade disinfectant as previously noted.</li><li>It is important for the Environmental services technician to wear appropriate PPE per facility protocol to safely dispose of soiled diapers as significant amounts of the microorganism can be found in the fecal material and lead to transmission.</li><li>The CDC recommends several core measures for health care settings to follow to mitigate risk for transmission of Shigella sonnei. These recommendations include:<ul><li>Hand Hygiene for the Health Care Team and Patient: Hand Hygiene is the single most important infection prevention intervention to reduce the risk for transmission of Health Care Associated Infections (HAI’s).</li><li>Contact Precautions: Health care personnel should receive proper training on the correct use of contact precautions and personal protective equipment (PPE).</li></ul></li></ul>Additional Information and Resources:<ul><li><a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6412a2.htm?s_cid=mm6412a2_x">US Centers for Disease Control and Prevention MMWR-Importation and Domestic Transmission of Shigella sonnei Resistant to Ciprofloxacin-United States, May 2014-February 2015</a></li><li><a href="http://www.cdc.gov/media/releases/2015/p0402-multidrug-resistant-shigellosis.html">US Centers for Disease Control and Prevention Resources for Shigella infection</a></li><li><a href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=75">US Centers for Disease Control and Prevention Drug Resistant Threat Report</a></li></ul>References:<ul><li>US Centers for Disease Control and Prevention (CDC)</li></ul> Thu, 09 Apr 2015 11:29:09 -0500 Disaster/Outbreak Preparedness