Hospital Infection Control

Vandy breaks flu-shot world record, wildly sings “The Guinness is in us!”

January 31, 2012 – 9:51 am | By Gary Evans | No comments yet

Well, perhaps that’s a bit overstated, but how often do you accomplish a feat worthy of recognition of the Guinness Book of World Records? There is only one Rolf Bucholz, for example, the world's most pierced man, who sports 453 punctures in his body. I think we can all be thankful for that. Vanderbilt University in Nashville was looking to puncture only one person at a time, and managed to do so in the form of flu shots to 12,850 students, faculty, staff and medical center employees in eight hours. (No truth to the rumor that Bucholz showed up and got back in line three times.) It’s official: Vandy has the new one-day world record for flu shots, breaking the mark by some pikers at Kaiser Permanente of 6,215 vaccinations in eight hours. Still, not to beckon drizzling clouds over this glorious parade, but do we really want to be setting world records for something involving syringes, needles and vaccines? I mean, the record for the most creative use of multidose vials and syringe reuse is already held by a certain endoscopy clinic in Las Vegas, which also holds the follow-up record for how many tens of thousands of people can be advised to be tested for hepatitis and HIV. May those marks never be broken. OK, we’ll cut Vanderbilt some slack since they did this in the context of running their emergency response vaccination plan, which would not be a drill should a deadly biologic or pandemic emerge. It didn’t hurt that they gave the record attempt a name fitting to market it to students and generally raise morale about a task many think must now be mandated: “Flulapalooza.”

The ethics of health care worker surveillance

January 30, 2012 – 9:58 am | By Gary Evans | No comments yet

“Big Brother is Watching You,” wrote George Orwell in his classic cautionary novel 1984. The increasingly high-tech solutions to the historic problem of hand hygiene (HH) compliance raise this familiar specter, as health care workers are being tagged, badged, beeped, viewed and videotaped in the name of patient safety. Some of this is working, and with a surprising lack of pushback from the staff. For example, in a recently published study the use of video cameras and real-time electronic feedback dramatically improved and sustained HH compliance rates on a 17-bed unit at North Shore University Hospital in Manhasset, NY.(1) The hospital did several things right when it comes to answering ethical questions before they are raised, we are told. “I am impressed by the transparency and candor with which they designed this intervention,” says Lauris C. Kaldjian, MD, PhD, Director of Bioethics in the Department of Internal Medicine University of Iowa Carver College of Medicine. Asked to review the study for Hospital Infection Control & Prevention, Kaldjian says North Shore set up the program with a wise commitment to full transparency from the onset. “Healthcare workers were aware that HH was a condition of employment, signed an annual HH contract, and were informed that cameras were being installed to monitor HH to generate aggregate data only," he says. "One of the key elements in these sort of interventions has to be a straight forwardness so that care workers know what’s going on and they know why it’s going on.” Using electronic displays to give direct aggregate feedback to staff is both equitable and fair as long as all parties agree on the definitions of the observed behavior, he adds. “If there is no dispute there, this kind of approach seems to be a very impressive attempt to try and reflect what is actually happening and show that to the people who are the actors on the stage,” he says. [They are using] this as not only an incentive to try harder but also congratulate them for doing well.” Of course, extending such surveillance into other areas potentially involving patients would open up a new set of ethical and disclosure questions. However, in the current study one could certainly argue that it is better to know cameras are monitoring you than a lurking “secret shopper” of the human variety. Reference 1. Armellino D, Hussain E, Schilling ME, et al. Using high-technology to enforce low-technology safety measures: The use of third-party remote video auditing and real-time feedback in healthcare. Clin Infect Dis Published online on November 21, 2011.

Get ready to rumble on mandatory flu shots

January 25, 2012 – 9:49 am | By Gary Evans | No comments yet

You may want to get a ringside seat to what promises to be a lively meeting of the National Vaccine Advisory Committee (NVAC) Feb. 7-8, 2012 in Washington, DC. NVAC is an advisory committee to the Department of Health and Human Services (HHS). Flu recommendations drafted by NVAC’s Healthcare Personnel Influenza Vaccination Subgroup, which are expected to be discussed at this meeting, have drawn the wrath of OSHA and emboldened health care unions. Why? Because these presumably rational and responsible individuals serving in the aforementioned “subgroup” have dared to put mandatory influenza vaccinations for health care workers on the table at the federal level. The comment period ended Jan. 16th on the recommendations, but the HHS declined a request by HIC to release all the submitted documents. From what we have gathered by hook and crook it looks like the traditional infectious disease groups in a melee match with occupational health types, public health policy makers, vaccine researchers and at least one guy who showed up at the wrong meeting. If you’re keeping score, the recommendations under consideration include these: 1: Healthcare facilities should establish comprehensive influenza infection prevention programs as recommended by the CDC as an essential step to achieve the Healthy People 2020 influenza vaccine coverage goal of 90%. 2: Healthcare facilities should integrate influenza vaccination programs into their existing infection prevention programs or occupational health programs. 3: The CDC and the Centers for Medicare and Medicaid Services (CMS) should continue efforts to standardize the methodology used to measure healthcare personnel (HCP) influenza vaccination rates across settings, linking vaccine coverage levels and quality improvement activities. The HHS should also work with CMS to implement incentives, penalties, or requirements that facilitate adoption of this recommendation. 4: Facilities that have implemented the aforementioned recommendations 1, 2 and 3, but cannot achieve the 90% influenza goal in an efficient and timely manner, should strongly consider an employer requirement for influenza immunization. 5: The HHS should encourage ongoing efforts to develop new and improved influenza vaccines and vaccine technologies. This includes support for research, development, and licensure of influenza vaccines with improved immunogenicity and duration of immunity, as well as steps that improve the immunogenicity and rapid production of existing influenza vaccines. Editor’s note: To review the full NVAC draft hit the link.

Flu mask policies: Patient safety or punitive measure?

January 24, 2012 – 9:38 am | By Gary Evans | No comments yet

[caption id="attachment_226" align="alignleft" width="100" caption="AHA: Get the shot or don the mask"][/caption] As part of its mandatory flu vaccination policy, the Association for Professionals in Infection Control and Epidemiology recommends that health care workers that cannot be immunized should wear a surgical mask when caring for patients or working with susceptible staff. This practice, which is already in place at some hospitals, was singled out for criticism by worker union officials in comments to recent National Vaccine Advisory Committee (NVAC) recommendations on influenza. The committee did not take a position on such masking policies, as it did not specifically recommend the individual conditions that should be used by hospitals adopting mandatory policies. “The ‘vaccinate or mask’ option some hospitals and county health departments (including San Francisco, Sacramento and Yolo counties in California) are requiring is…not based on evidence of effectiveness,” stated Margaret Robbins, MPH, National Director of the Occupational Safety and Health Coalition of Kaiser Permanente Unions, in comments to NVAC. “There is no scientific evidence that the routine wearing of surgical masks by unvaccinated healthcare workers protects either patients or the wearer of the mask from getting the flu. We believe this practice is intended to coerce and intimidate workers into getting vaccinated, and is not grounded in thoughtful analysis of whether the practice of daily mask wearing protects anyone.” Robbins coalition is comprised of 28 local unions representing some 95,000 frontline employees of the Kaiser Permanente health system. Since a recent study showed that the flu vaccine is typically only 59% effective in a given flu season, and since there are many influenza like illnesses (ILI) that cannot be prevented by the flu vaccine then many workers who are vaccinated can and will get the flu or other ILIs, Robbins argued. “The logic of the situation tells us that it is not ‘just’ unvaccinated workers who are at risk of being a pre-symptomatic case of ILI (one of the justification we’ve been given for such policies),” she said in the comments to NVAC. "Both vaccinated and unvaccinated HCW could be a pre-symptomatic ILI case. By this logic every health care worker should be masked every day during flu season. We are not claiming this is a path that should be followed, but this is the direction logic leads us if we accept that the vaccinate-or-mask policy makes sense. “ Robbins also expressed concern that the masking policies actually could contribute to transmission if a worker never changes the mask throughout the course of patient care. “We wish the report and recommendations had reviewed and commented upon the safety and appropriateness of this type of requirement for vaccine refusal,” she noted.

OSHA crashes mandatory flu shot party

January 18, 2012 – 9:30 am | By Gary Evans | 4 comments

The federal agency most directly charged with protecting health care workers has come out against mandating that they be immunized against seasonal influenza. The Occupational Safety and Health Administration (OSHA) --- which likely would be charged with enforcing any such edict -- cited “serious policy concerns” in arguing against a draft federal initiative that would clear the way for mandatory flu shots at hospitals that cannot achieve 90% flu vaccination rates. “OSHA believes that there must be a very high burden of proof that mandatory … programs are not just desirable, but also necessary to protect the public health before the government promotes such a controversial policy that may result in employment termination. At this time, OSHA believes there is insufficient evidence for the federal government to promote mandatory influenza vaccination programs that may result in employment termination.” The National Vaccine Advisory Committee (NVAC) recommendations were drafted by its Healthcare Personnel Influenza Vaccination Subgroup. An advisory committee to the Department of Health and Human Services (HHS), NVAC is scheduled to meet Feb. 7, 2012. The key recommendations in the draft includes the point that is generating considerable controversy: Facilities “that cannot achieve the 90% influenza goal in an efficient and timely manner, should strongly consider an employer requirement for influenza immunization.” For more on this important development see the Feb. 2012 issue of Hospital Infection Control & Prevention.

Flu vaccination rates rise overall, but 24% of nurses decline

January 16, 2012 – 5:22 pm | By Gary Evans | 1 comment

UPDATE and Correction: In a CDC survey on flu immunization the number of nurses immunized was 76%, meaning 24% declined. In the category of "other” health care personnel 41% declined. That latter percentage was incorrectly attributed to the nurses category in a previous version of this post. With the “M” word (mandate) now part of the national conversation, health care workers appear to be overcoming their historical apathy toward seasonal influenza vaccinations. A national survey by the Centers for Disease Control and Prevention revealed that that by mid-November last year, about 78% of respondents had been vaccinated — a rate that is almost double the estimated rates of about five years ago. The highest vaccination rates were among physicians and dentists (78%), nurse practitioners and physician assistants (77%). Nurses followed with a 76% immunization rate. The online survey of about 2,500 health care workers took place in early to mid-November 2011. Pressure continues to build for hospitals to boost their rates higher. Influenza vaccination rates will be publicly reported as a quality measure by the Center for Medicare and Medicaid Services starting in 2013. And the Joint Commission accrediting agency revised its influenza vaccination standard to require hospitals to improve vaccination rates annually with a goal of achieving the 90% rate established in the national influenza initiatives for 2020. The push for a 90% flu vaccination rate has led a growing number of hospitals to implement mandatory policies. About one in six (17.3%) of all health care workers responding to the CDC survey said their employers required them to receive the vaccine.

Feds put mandatory flu shot policies on the table in draft guidelines

January 12, 2012 – 10:40 am | By Gary Evans | No comments yet

[caption id="attachment_413" align="alignleft" width="150" caption="To Get A Flu Shot "][/caption]Infection preventionists and employee health professionals have through this Monday Jan. 16th to submit comments on new federal draft guidelines designed to increase flu immunization rates of health care workers to 90%. The recommendations are more forceful than those typically issued by the Centers for the Disease Control and Prevention, recommending facilities with lagging rates “strongly consider” mandatory policies. The National Vaccine Advisory Committee (NVAC) recommendations were drafted by its Healthcare Personnel Influenza Vaccination Subgroup. An advisory committee to the Department of Health and Human Services (HHS), NVAC is scheduled to meet Feb. 7, 2012. The key recommendations in the draft are summarized as follows: 1: Healthcare facilities should establish comprehensive influenza infection prevention programs as recommended by the CDC as an essential step to achieve the Healthy People 2020 influenza vaccine coverage goal of 90%. 2: Healthcare facilities should integrate influenza vaccination programs into their existing infection prevention programs or occupational health programs. 3: The CDC and the Centers for Medicare and Medicaid Services (CMS) should continue efforts to standardize the methodology used to measure healthcare personnel (HCP) influenza vaccination rates across settings, linking vaccine coverage levels and quality improvement activities. The HHS should also work with CMS to implement incentives, penalties, or requirements that facilitate adoption of this recommendation. 4: Facilities that have implemented the aforementioned recommendations 1, 2 and 3, but cannot achieve the 90% influenza goal in an efficient and timely manner, should strongly consider an employer requirement for influenza immunization. 5: The HHS should encourage ongoing efforts to develop new and improved influenza vaccines and vaccine technologies. This includes support for research, development, and licensure of influenza vaccines with improved immunogenicity and duration of immunity, as well as steps that improve the immunogenicity and rapid production of existing influenza vaccines.

Flu outbreak kills 7 even though residents were immunized

January 6, 2012 – 9:32 am | By Gary Evans | No comments yet

After the flu deaths of seven immunized patients with severe neurological conditions, the Centers for Disease Control and Prevention is emphasizing today that rapid administration of antivirals may prevent similar deadly infections in high-risk people. The CDC report published today details an acute outbreak of respiratory infection that occurred in February 2011 in a Ohio residential facility for children and young adults with severe neurological and neurodevelopmental conditions. Among the 130 residents, 76 (58%) developed respiratory illness, and 13 became severely ill; seven of those patients died. All 13 patients who became severely ill had neurological and neurodevelopmental conditions (i.e., intellectual disability, epilepsy, cerebral palsy). These conditions had the dual detrimental effect of complicating diagnosis and worsening disease. Thus, if influenza is suspected in such patients, antiviral treatment should be given as soon as possible after symptom onset -- ideally within 48 hours. “Treatment should not wait for laboratory confirmation of influenza,” the CDC emphasized. Strikingly, all 13 severely ill residents reportedly were vaccinated with the influenza vaccine recommended for the 2010−11 influenza season. “Although vaccination is the best method for preventing influenza and its complications, its effectiveness varies depending on vaccine virus match and the age and health of the person vaccinated,” the CDC states. “Preliminary data for the 2010−11 influenza season indicate that influenza vaccine effectiveness was approximately 60% for all age groups combined. … Vaccine effectiveness, however, can be considerably lower in immunosuppressed persons or those with underlying medical conditions.” The CDC investigation found that while 62% of the severely ill patients did receive antiviral treatment, but in half of the cases treatment fell outside the optimal 48-hour window. In addition, the first regimen of antiviral drug prophylaxis was not administered until 18 days after the first case of flu was confirmed. Clinicians caring for patients with neurologic and neurodevelopmental conditions should be vigilant for signs and symptoms that might indicate early respiratory illness and should initiate influenza antiviral treatment as soon as warranted, especially during influenza season. The CDC advised: o Prompt testing for influenza and empiric antiviral treatment for these patients when influenza is suspected. o Antiviral chemoprophylaxis also should be provided to all eligible residents of long-term–care facilities during influenza outbreaks. o Health-care personnel should be vaccinated, and clinicians should continue to encourage influenza vaccination in these patients, given the challenges posed by diagnosis and their increased risk for severe influenza-related outcomes.

FDA addresses consumer infection concerns

January 4, 2012 – 9:27 am | By Gary Evans | No comments yet

Addressing rising patient concerns about the infection risk of outpatient procedures like endoscopy, the Food and Drug Administration is urging patients to ask questions while providing a general tone of reassurance of safety. The agency has created a new website with information about these medical tools. To report a problem, the site also provides a link to MedWatch, the FDA Safety Information and Adverse Event Reporting Program.

The FDA has received reports of patients being exposed to microscopic amounts of blood, body fluids and tissue from other patients that may have occurred because the reusable devices were inadequately reprocessed and these contaminants were not removed. “Transmission of infection was extremely rare, but the potential for becoming infected by an inadequately processed device was there," the FDA states. Some medical devices are reused many times in common surgical and diagnostic procedures, and have been for years. They include instruments used in surgery (like clamps and forceps), and endoscopes (like bronchoscopes and colonoscopes) used to visualize areas inside the body. The FDA is working with healthcare providers, manufacturers, organizations that set standards, and other government agencies to reduce the risk of infection from the inadequate “reprocessing” of these durable devices designed for repeated use. Reprocessing means cleaning and high-level disinfection or sterilization, the agency clarified. So if you’re scheduled to have a medical procedure, how worried should you be about this? Not worried enough to cancel or delay your plans, says the FDA. That said, there are questions you can ask your healthcare providers, including: What precautions are in place to ensure that the procedure will be done safely? The FDA states that it is working with manufacturers and healthcare providers to: • Make sure that the makers of these devices are providing reprocessing instructions that are clear and scientifically validated. • Make sure that staff at hospitals and other healthcare facilities understand and are following the manufacturers’ instructions. • Identify device designs that facilitate optimal cleaning, disinfecting and sterilization.

Money talks: IPs getting results, raises

January 3, 2012 – 9:27 am | By Gary Evans | No comments yet

With rapidly expanding duties in the hospital and a wealth of consulting opportunities beyond, infection preventionists have long had job security at a somewhat stressful price. Federal and state regulators are demanding health care associated infection (HAI) data while consumers have the increasing expectation that all infections are preventable. Such forces have ratcheted up the pressure, but IPs have responded with a powerful bottom-line result: rates of key HAIs are falling nationally. This success has positioned the profession as a “winner” in healthcare reform and economic discussions, but is that translating down to the individual program level? Though perhaps not to the degree deserved, there are some good signs for IPs. For one, 65% of those responding to the annual Hospital Infection Control & Prevention salary survey reported they received a raise in the last year. Not bad when one is working in a badly bruised economy, though it must be said that the vast majority of the wage hikes were of the modest variety. Overall 59% reported an increase of 1% to 3%, while 6% were compensated an additional 4% to 6%. Unfortunately, another 28% of IPs reported no raises and 7% suffered a pay cut. Our 2011 survey found that that IPs were drawing a median salary in the $70,000 to $79,999 range. For more details see our annual salary survey and economic report as a special supplement in the January 2012 issue of HIC.