Your Hospital: One Giant Petri Dish for Human Pathogens
Lyn Mehlberg
5:00 PM: Get ready, and get set to get serious about infection control in your radiology department or outpatient imaging center. Lyn M. Mehlberg, BS, CNMT, FSNMTS, self-described regulations junky, predicts that regulators and oversight agencies—including the Joint Commission, CDC, OSHA, and CMS—are poised to come down hard on radiology on this front. Mehlberg, quality and safety specialist for cardiovascular, diagnostic, and radiation oncology services, Aurora BayCare Medical Center, Green Bay, Wis, pointed out the fault lines and advised attendees on how to develop a sound infection control policy in a Sunday afternoon session entitled, The Next Big Thing: Infection Prevention & Control in the Imaging Department. When Mehlberg asked the audience how many were up to speed on quality and infection control and ready to go into the next Joint Commission inspection, not one hand was raised. “Infection control has been an afterthought in health care, especially in areas outside surgery, ICU patient units, and interventional radiology,” she qualifies. “IR does a great job, but how many of you have transferred those same infection control measures into MRI and CT biopsies? Some of these things should be applied in opening PICC lines. “Most of the standards have been written for general nursing or general surgery, Mehlberg explains. “We have to translate what that means for imaging.” While everything from the phone, to the glove box, to the keyboard is teeming with germs, the good news is that for the most part, the cure is as low tech as soap and water. Mehlberg cited studies that show most dedicated health care professionals spend 5 seconds washing their hands, although hands must be washed for 15 seconds and must have rapid hand motion with soap in order to be effective. “The Joint Commission is coming out with stopwatches and timing how long your staff is washing their hands,” Mehlberg advises. Statistics suggest that regulators are not targeting infection control just to make your life miserable. Mehlberg says health care-acquired infections (HAIs) have a devastating impact on patients and can burden entire hospital system: • 5% to 10 % of all patients come down with HAIs • 2 million HAIs are reported annually • HAIs are responsible for 100,000 deaths annually • HAIs cost $5 billion a year The Joint Commission has made reducing HAIs a 2009 National Provider Standard Goal, asking that hospitals do the following: • Institute guidelines for hand hygiene • Report sentinel events involving infections • Prevent multi-drug resistant organisms • Prevent central line infections “This will be a big push for the next five years,” Mehlberg predicts. She reports that the following violations were found during recent visits to imaging departments/centers: • Lack of US Pharmacopeia (USP) Gap Analysis USP is not a regulator but the federal government has charged it with setting practices for the pharmacy world. The Joint Commission is recognizing that there are no exemptions for any specialties and they are going to start asking how you are preventing sterility breeches anywhere pharmaceuticals and radiopharmaceuticals are used. Including the radiology, nuclear medicine, and cardiology departments. • Poor Hand Hygiene 1. Staff did not use hand gel between each time it touched equipment and patients. 2. Two hospitals were cited because staff did not use a paper towel to turn off the faucet. 3. One surveyor wanted to see many more hand gel stations. 4. A lack of formal hand hygiene monitoring. • Equipment Violations 1. Staff did not clean surfaces of equipment between patients. With the rise in public infectious outbreaks, radiology departments need to recognize the importance of cleaning the inside of the bore. 2. Failures to clean lead aprons/lead pigs/syringe shields. The Joint Commission is asking how often you are cleaning them and what you do if you get blood on them. 3. Tears, holes, and no protective covers on positioning aids. • Unsecured Sharps Containers How can you bring your department up to speed? At the very least, get a plan to address the following issues: • Develop a medications management policy. Access the ASHP Discussion Guide on USP online and get together with staff to think about whether there is anything else you can do to make your medications processes safer for patients. • Take a close look at your nuclear medicine department. Until 1991, radiation hazard took precedent over the biohazard component of regulated mix. But OSHA came up with guidelines for occupational exposure to blood borne pathogens (29 CFR Part 1910.1030) in October of 2001, creating a de facto federal mandate: every facility must come up with a blood-bourne pathogen policy. You need to make sure that your nuclear medicine department is included in your facility’s blood-bourne pathogen plan. Mehlberg advised replacing outdated needle assist systems that force a spray to remove that risk in the hot lab. She also suggested inviting the pharmacy director to the department to ensure compliance. Many states fall under federal OSHA jurisdiction, so find out if your state is one of them. • Get into compliance with The Centers or Disease Control and Prevention 2007 guidelines for performing lumbar punctures. Everyone performing a lumbar puncture must wear a face mask to prevent oropharyngeal flora. When this gets in spinal column, it bypasses the immune system and can cause bacterial meningitis, Mehlberg explains. This impacts myelograms, spinal and epidural anesthesia, and intrathecal chemotherapy. • Be sure your staff is in compliance with the CDC fingernail recommendations: clean, and ¼ inch in length. Artificial nails, long nails, and chipped polish harbor and support bacteria, so if your staff cant keep fingernails clean and polish unchipped, they can’t wear polish. • Have a medication management policy. Download the ASHP Discussion Guide on USP and get together and think about whether there is something else you can do to make your patients safer. • Develop a formal hand hygiene program (even if your staff howls) and monitor it. Always remove gloves when using a common work station, and remember that the glove box is a source of germs. • Have solid procedures for cleaning between patients. Door handles, sinks, faucets, wheel chairs are all sources of human pathogens. • Limit/control food and beverage in the department. • Toss ripped positioning aids. • Appoint an infection control liaison. Find a tech who is good about this. “In summary, the rampant spread of infection is seriously burdening our health care system,” Mehlberg concluded. There is also a major new financial incentive to be compliant: CMS is no longer paying for care associated with certain HAIs.