October 2018 Issue of Infection Prevention & Control Newsletter Published

The October 2018 issue of the ICCS Infection Prevention & Control Newsletter has published.

The issue identifies some of the most pertinent infection prevention and control news from October. Stories included in this issue include Joint Commission scoring changes, progress report on healthcare-associated infection improvement efforts, outpatient antibiotic overprescribing, total hip and knee infections, a deadly adenovirus outbreak and a new flu medication.

Access the issue by clicking here.

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AORN Previews Changes to Surgical Attire Guideline

The Association of periOperative Registered Nurses (AORN) has published a preview of four likely changes to its guideline on surgical attire.

In this Periop Today article, Lisa Spruce, AORN director of evidence-based practice and lead author of the forthcoming guideline update, highlights the following proposed updates:

  • Covering of arms. AORN is likely to recommend that arms only be covered when performing patient skin antisepsis.

  • Wearing clothing under scrubs. AORN is considering allowing facilities to dictate the types of clothing perioperative staff may wear under scrubs and how such clothing should be laundered.

  • Choice of head and facial hear cover. AORN expects to add a recommendation allowing facilities to determine the type of head coverings healthcare professionals can use to cover their head and facial hair during perioperative care.

  • Practices for covering ears. AORN will likely recommend interdisciplinary teams establish their own practices for ear covering and safe earring wear in the perioperative setting.

The article notes that AORN is also considering changes in several other areas, including scrub attire, changing attire, wearing dresses or leggings and storing scrubs in lockers.

The current guideline was published in 2015. The updated guideline goes up for public comment in January 2019.

Learn about the series of events that led to AORN revising its surgical attire guideline and the possible implications of these changes in this special report from Infection Control Consulting Services (ICCS).

Small Progress Made in Reducing Hospital Infections

A survey funded by the Centers for Disease Control and Prevention (CDC) reveals that hospitals have made some progress in reducing their number of healthcare-associated infections (HAIs).

The 2015 survey of more than 12,000 patients in 199 hospitals showed that 3.2% of patients experienced a HAI. That's down from a 2011 survey of about 11,300 patients in 183 hospitals which revealed a 4% HAI rate — a reduction of 16%.

While that is a noteworthy improvement, it still means hundreds of thousands of hospitalized patients experience a HAI every year, which could lead to sepsis or death.

The 2015 survey results indicated that the improvement achieved between 2011 and 2015 was largely attributable to reductions in the prevalence of surgical-site infections (SSIs) and urinary tract infections (UTIs), with pneumonia, gastrointestinal infections and SSIs as the most common HAIs reported.

Surveyors advocate for increased prevention strategies against Clostridium difficile infections and pneumonia. Hospitals must also remain diligent in their efforts to consistently follow evidence-based protocols that can help reduce HAIs, such as those associated with hand hygiene, standard and other precautions, and medical device disinfection and sterilization.

In addition, hospitals should ensure that they implement formal antimicrobial stewardship programs. The Centers for Medicare & Medicaid Services (CMS) require, as part of its Conditions of Participation (CoP), implementation of such programs in all hospitals and critical access hospitals participating in Medicare and Medicaid programs. These programs are critical to reducing antibiotic-resistant threats that can contribute to HAIs.

Joint Commission Revises Infection Control Scoring

The Joint Commission recently announced it is reevaluating the way it scores high-level disinfection (HLD) and sterilization to focus more closely on those process steps that pose the highest risk to patients and safety were they to fail.

More specifically, the revisions concern infection control standard IC.02.02.01, which requires organizations to reduce the infection risk associated with medical equipment, devices and supplies.

The decision comes following analysis by the Joint Commission of its survey data that indicated 72% of surveyed hospitals and critical access hospitals were found to be noncompliant with IC.02.02.01 while 79% of percent of ambulatory health care organizations and nearly 81% of office-based surgery centers practices surveyed in 2017 had at least one finding in the infection prevention and control chapter.

Areas of scoring that were revised are as follows:

  • Visible bioburden and dried blood found on instruments

  • Enzymatic solution was not applied to maintain moisture on instruments

  • Instruments were not transported from the point of use in a leak-proof puncture-resistant container with the biohazard symbol or color red

  • Instruments in the closed position

  • Instruments are released prior to the biologic indicator being read

  • Items in the high level-disinfected area that are stored in drawers

  • Stored scopes exceeded the hang time

View the new scoring revisions in the table on the bottom of this webpage.

The revised scoring took effect Sept. 1, 2018, with the Joint Commission noting that IC.02.02.01 findings recorded before that date will not be removed.

It is important to note that Joint Commission standards are applicable to all healthcare facilities providing services that require HLD and sterilization. Inpatient and outpatient facilities that are accredited by the Joint Commission are required to follow these standards if they are performing HLD and/or sterilization, regardless of setting. This includes hospitals, outpatient surgery centers, office-based surgery practices and outpatient clinics. In addition, dental clinics that are located within a health system accredited by the Joint Commission will be held accountable to these standards.

Study: Widespread Antibiotic Overprescribing by Outpatient Clinics

A new study reveals that outpatient clinics are prescribing antibiotics at an unwarranted rate, according to a news release from the Infectious Diseases Society of America. 

The research, which was presented at IDWeek 2018 and funded by the Agency for Healthcare Research and Quality, examined more than half a million prescriptions given to nearly 280,000 patients by more than 500 outpatient clinics from November 2015 through October 2017.

Key takeaways from the study are as follows:

  • 46% of antibiotics were prescribed without an infection-related diagnosis.

  • 20% of prescriptions were provided without an in-person visit.

  • For those antibiotics prescribed outside of an in-person visit, most were by phone, with others completed through electronic health record system.

  • 29% of prescriptions noted something other than an infection diagnosis (e.g., high blood pressure, annual visit).

  • 17% percent of prescriptions were written without a diagnosis indicated.

  • For those prescriptions without a diagnosis, researchers speculated that while some may be tied to poor diagnosis coding, much of it likely reflects prescribing for vague or inappropriate reasons (e.g., infections caused by viruses).

In the release, Jeffrey Linder, MD, MPH, lead author of the study, said, "We looked at all outpatient antibiotic prescribing and results suggest misuse of these drugs is a huge problem, no matter the symptom. We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics, or don't provide a reason at all. When you consider about 80% of antibiotics are prescribed on an outpatient basis, that's a concern."

The results of this study echo those of many others pointing to antibiotic misuse as a significant issue. Prescribing the correct dose of the correct antibiotic at the appropriate time and for the correct duration can help fight antibiotic resistance, protect patients from unnecessary side effects and help ensure antibiotics will work when they are needed. 

If your organization requires expert assistance with developing and maintaining an antimicrobial stewardship program, contact Infection Control Consulting Services (ICCS). ICCS is a national consulting firm providing services to healthcare facilities including outpatient clinics, ambulatory surgery centers, hospitals and nursing homes.