Joint Commission Spotlights Ophthalmology Device Infection Risks

The Joint Commission is calling attention to infection risks associated with several ophthalmology devices.

In a Quick Safety article, The Joint Commission notes that its survey data indicates there is "either a lack of awareness of the requirements or misinterpretation of manufacturer’s instructions — combined with lack of staff training and leadership oversight — related to the disinfection of ophthalmology devices."

The result: multiple immediate health and safety threat declarations.

Lack of reprocessing compliance has been observed with tonometers, YAG laser lens and eye specula. Such devices are used in clinics, procedure rooms, urgent care centers, emergency departments and other areas.

The Joint Commission notes that tonometers are particularly problematic because "disinfectants can dissolve the glue that holds the hollow tip together, causing the tip to swell and crack."

In the article, The Joint Commission shares several safety actions organizations should consider. These include reviewing cleaning and disinfection instructions, using U.S. Food and Drug Administration (FDA)-approved high-level disinfectants and ensuring manufacturer instructions for use are accessible and followed.

Study: Glucocorticoids Raise Infection Risk for Joint Replacement Patients With RA

The results of a new study show that glucocorticoid use significantly increased the risk for infection for patients with rheumatoid arthritis (RA) undergoing joint replacement surgery.

The retrospective cohort study, which was published in Annals of Internal Medicine, examined claims data on nearly 11,000 surgeries — specifically primary or revision hip or knee joint replacement surgery in adults with RA — performed over a nearly 10-year period.

Researchers from the University of Pennsylvania Hospital found that while the risks for hospitalized infection, prosthetic joint infection and readmission following arthroplasty were similar across biologics, glucocorticoid use — particularly when dosages exceeded 10 mg/d — nearly doubled risk for adverse outcomes.

As a news release on the study noted, "According to the researchers, these findings suggest that limiting glucocorticoid use should be a focus of perioperative management."

New York Considering Bill Requiring Infection Prevention Certification

Lawmakers in New York have sponsored a bill that, if passed, would require infection preventionists to be certified in infection prevention and control if they want to practice in New York hospitals, according to a news release from the Association for Professionals in Infection Control and Epidemiology (APIC).

The bill stipulates that infection preventionists in a general hospital would be required to meet one of the following:

• Pass an exam from a nationally accredited infection prevention and epidemiology accrediting organization and hold and maintain certification in infection prevention and control.

• Provide evidence of employment as an infection preventionist for one year or more within four years of the bill's passage.

• Be a student or intern performing the functions of an infection preventionist (within the scope of the student's or intern's training) while serving under direct supervision of appropriately licensed or certified healthcare professional.

If an infection preventionist fails to meet at least one of these requirements, the individual would have three years from the date of hire to obtain an infection preventionist credential.

The bill, A. 3705/S. 5186, is sponsored by Assemblywoman Aileen Gunther (D) and Senator Jen Metzger (D). Gunther previously held an infection control position at Catskill Regional Medical Center. In the release, she is quoted as saying, "I am proud to lead an effort that will enhance patient safety in New York hospitals by ensuring that infection preventionists have appropriate credentials. I hope other states follow this example."

The bill includes a clause to account for hospitals that are unable to contract with an individual(s) who meets the requirements.

Study: Understaffing of Nurses Increases Infection Risk

The results of a new study indicate there is a correlation between nurse understaffing and elevated healthcare-associated infection risk.

The study, published in The Journal of Nursing Administration, analyzed multiple data sets gathered over a period of several years from an urban hospital system.

The key finding: When nurse understaffing occurred (defined as below 80% of unit median) on a unit for both shifts (day and night) in a day, patients on those units were much more likely to develop a healthcare-associated infection (HAI) two days later.

The researchers' conclusions include the following: "… a break of continuous care due to nurse understaffing will directly affect patient outcomes. In addition, a continuous unit staff shortage may also indicate an underlying issue with the working environment. Nurse administrators need to implement effective solutions to ensure adequate nurse staffing and provide safe and reliable care to acutely ill hospitalized patients."

The project received approval from Columbia University Medical Center and Weill Cornell institutional review boards.

Expert Council Pushes for Hospital Antibiotic Stewardship Requirement

The Presidential Advisory Council on Combating Antibiotic Resistant Bacteria (PACCARB), which provides recommendations to Health and Human Services (HHS) on federal programs and policies to combat antibiotic resistance, is urging the finalization of a policy that would make antibiotic stewardship programs a requirement for U.S. hospitals.

In an April letter to HHS Secretary Alex Azar, PACCARB states the following: "There is a critical need for mandatory, not voluntary, implementation of antibiotic stewardship programs in our nation's hospitals to curtail the over-prescription of antibiotics — a lead cause in the rise in antibiotic resistance. We urge the immediate finalization of the proposed Centers for Medicare and Medicaid Services (CMS) conditions of participation (CoP) rule, in advance of the upcoming June 2019 deadline. This rule requires the adoption of antibiotic stewardship programs in hospitals, especially critical access hospitals (CAHs), to help reduce the daunting overtreatment of patients with unnecessary broad-spectrum antibiotics and, thereby, improve the care of patients receiving the appropriate antibiotics.

"… The PACCARB believes that requiring hospitals and CAHs to develop and implement antibiotic stewardship programs will have a direct, positive and immediate impact on antibiotic prescribing practices, thus aiding in the fight against antibiotic resistance and preserving of our nation's health in the face of this increasing public health threat."

As a report from the Center for Infectious Disease Research and Policy (CIDRAP), a center within the University of Minnesota, notes, the Centers for Disease Control and Prevention (CDC) recommended in 2014 that all U.S. hospitals have an antibiotic stewardship program and has published guidelines to support such program implementation. The report also notes that while the Joint Commission has a stewardship program requirement, this covers only about 75% of U.S. hospitals.

PACCARB includes human and animal health experts from a variety of fields, including pharmacy, biomedicine, public health, healthcare and epidemiology. It was established in 2015 and is presently chaired by Martin J. Blaser, MD, Henry Rutgers Chair of the Human Microbiome and author of Missing Microbes: How the Overuse of Antibiotics is Fueling our Modern Plagues.