Growing Reports of Hepatitis A: Guidance for Healthcare Facilities

Infection Control Consulting Services (ICCS) has been inundated with concerns from healthcare facilities regarding the increasing reports of hepatitis A in the nation. Florida, where ICCS is based, has seen its department of health recently take action in response.

On August 1, Florida's Surgeon General Dr. Scott Rivkees declared a Public Health Emergency to address the increase in hepatitis A cases in the state, which had reached nearly 2,600 reported cases as of July 27. This declaration builds upon a Public Health Advisory issued by the Florida Department of Health in November 2018 and reemphasizes the importance of the vaccination as the best way to prevent hepatitis A infection. Please note that a "public health emergency" is different from a "state of emergency."

At this time, the Centers for Disease Control and Prevention (CDC) has stated that healthcare workers (HCWs) are not perceived to be at high risk for hepatitis A and, therefore, there is no recommendation for HCWs to be vaccinated. However, it is reported that there is no harm in HCWs choosing to receive the vaccine and the decision should be made on an individual basis.

In terms of screening patients, this is an oral/fecal virus and potentially communicable prior to diagnosis. Some patients may present asymptomatic despite carrying the virus whilst others may show signs of mild to severe illness. Organizations should ask themselves whether it is best for their setting to ask patients if they have hepatitis A or are at risk for it.

While ICCS is not downplaying this viral illness, we need to keep in mind that hepatitis A is not a new infection threat and is still not prevalent in the general population. In fact, CDC is not advocating for food service workers to be vaccinated, which goes to show that CDC does not believe hepatitis A to be a significant general public health threat at this time. It is still of the utmost importance that you share information about hepatitis A with your HCWs. As noted, the cause for concern in the healthcare setting surrounds the handling of stool as well as the need to wash hands with soap and water versus using alcohol sanitizer.

To summarize, ICCS stresses the importance of reviewing current information, providing updates for staff and determining what's best for your setting (and, if necessary, developing policies). ICCS advises that HCWs should make their own decisions about obtaining the vaccine. Finally, ICCS continues to stress the importance of hand hygiene when dealing with all patients, regardless of their diagnoses or health status. 

If you have any questions about infection prevention practices, policies and processes for your organization, contact ICCS.

Study: No Infection Prevention Benefits of Antibiotic Cement for TKA

A study has shown that routine use of antibiotic-loaded bone cement in primary total knee arthroplasty (TKA) has no measurable impact on periprosthetic joint infection rates.

Published in The Journal of Arthroplasty, the study involved review of a consecutive series of patients undergoing cemented primary TKA at two hospitals from 2015 to 2017. More than 2,500 patients were analyzed.

Of the 2,500 patients, about 1,100 received antibiotic-loaded bone cement during their procedure. Researchers found there was no difference in periprosthetic joint infection rates between patients receiving and not receiving antibiotic cement. Furthermore, patients receiving the antibiotic cement had overall high procedure costs — by about $300.

As Healio reports, one of the study's authors — Dr. Michael Yayac — recently presented on the findings at the 29th annual Musculoskeletal Infection Society Annual Open Scientific Meeting. During the presentation, Healio quotes Dr. Yayac as saying, "Routine use of antibiotic cement is not cost effective in preventing infection in primary TKA and should be avoided with value-based alterative payment models that incentivize to reduce unnecessary costs. However, given that this was performed in a relatively healthy population at orthopedic specialty hospitals, further studies would be needed to determine [whether] certain high-risk patients would benefit from its use and would be considered a cost-effective measure."

NY Times Puts Spotlight on Duodenoscope Sterilization Challenges

A recent article in The New York Times examines the difficulty healthcare providers face in properly sterilizing duodenoscopes.

The article — "Why Are These Medical Instruments So Tough to Sterilize?" — begins by noting the tremendous value of using duodenoscopes. It then describes the unusual and sometimes unsatisfactory cleaning process these devices must undergo. When this process comes up short, causing a duodenoscope to retain bacteria, patient safety is jeopardized. Numerous patients have become ill from contracting infections — including antibiotic-resistant infections — from dirty duodenoscopes.

As a result, the article notes, some medical experts have reached out to the U.S. Food and Drug Administration (FDA), pressing the agency to either require manufacturers to develop duodenoscopes that can be properly sterilized or take them off the market. Supporting this request is data that recently showed one in 20 duodenoscopes retained bacteria after undergoing proper cleaning processes.

In the piece, UNC Health Care's Dr. David Jay Weber, medical director for UNC, is quoted as saying, "Would you go on an airplane if the pilot said, 'By the way, there is a 5% chance the engines will fail'? Would you go in a car if the manufacturer said, 'There are airbags, but 5% of the time they won't deploy'?"

Infection Control Consulting Services (ICCS) regularly draws attention to duodenoscope infection prevention challenges. While duodenoscopes are designed differently from colonoscopes and gastroscopes, performing appropriate high-level disinfection that comply with manufacturers' instructions for use (IFUs) and nationally recognized guidelines remains critical for these scopes as well. Any shortcomings in following IFUs and guidelines can significantly increase infection risks. If your organization requires assistance with central sterile processing, learn how ICCS can help.