Infection Control Today

JUN 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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22 ICT June 2019 APHA also recommended the term "infection" be replaced as much as possible with the phrase "occupational infection and illness." As Mitchell advises the CDC, "Include 'occupational Infection and Illness' where appropriate and as frequently as possible together throughout the entire document. Infection is often associated with more of a healthcare associated infection (HAI), and illness is consistent with OSHA terminology. It makes the document stronger and more consistent with OHS IPC professionals. Either could occur – occupational MRSA, occupational fu, occupational HIV, etc." In addition, APHA also recommended that a clear distinction be made between a facility's occupational health and safety (OHS) program and its employee health (EH) program. As the group explained in its public comments, "Typically, an OHS program is managed by industrial hygienists, safety professionals, EH&S staff who are responsible for tasks such as hazard evalu- ations, respirator ft testing, and ergonomic assessments. In contrast, occupational health nurses and physicians are typically responsible for a facility's EH programs and handle tasks such as vaccinations and post-exposure prophylaxis." A P H A a d ds that emphasis sh ould be placed on employee involvement, as OSHA's Safety and Health Program Guidelines include "worker involvement" as an essential element of an effective OHS program. The group advises, "We recommend that the guidelines integrate best-practice guidelines to involve staff and their union representative in the design and implementation of an occupational infection and illness control plan." The organization identifed a lack of information on the role of environmental controls as a critical means to prevent occupational infection and illness and note, "We recommend that the guidelines include information, such as high effciency par ticulate air (HEPA) filtration, other ventilation, UV systems, and ante rooms." It also recommends that the guidelines include information on safe and effective cleaning, decontamination, disinfection and sterilization. These are essential components of an effective occupational infection and illness control plan. ANA T he A m eric an N ur s e s A s s o ciation (ANA), through its public comments signed by Debbie Dawson Hatmaker, PhD, RN, FA AN, the ANA's chief nursing officer/ executive vice president, addressed greater protection of healthcare workers from sharps injuries. As it noted, "Current terminology used throughout the industry, scientifc community, government regulatory agencies as well as accreditation bodies to refer to safety engineered sharps devices are varied and confusing. That includes the SESIPs acronym utilized by OSHA, NIOSH and CDC which remains unclear in its meaning for many who utilize sharps. The ANA Sharps Injur y Prevention Stakeholder Group, composed of sharps safety experts across the country, has been engaged in efforts for more than a year to simplify safety device terminology and proposes Sharps with Injury Protection (SIP) for universal use throughout this updated guideline." (Parenthetically, the APHA says it concurs that the term "SIP" should replace the various terms used in the document, such as safer devices and safety-engineered devices.) The ANA asked for the CDC to consider bolstering language in the document related to the reporting and surveillance of occupational exposure incidents; and providing access to appropriate safety technology and PPE. As the group explained, "EPINet and Massachusetts data indicate that continued use of non-safety devices where SESIPs or SIPs are available and appropriate remains widespread despite since NSPA enactment in 2001. It falls to leadership and management to ensure compliance with current requirements re: use of SIPs wherever appropriate within clinical settings." The ANA also suggested that "specifc mention of annual updates of Exposure Control Plans as integral to OHS leaders' responsibility for promoting reduction in sharps injuries," and requested language providing for "...the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard requirement s for provision of exposure management services to employees, annual updates of Exposure Control Plans, and the Personal Protective Equipment (PPE) Standard requirements for PPE training." The group advocated inserting language to "…identifcation and mitigation of barriers to success, such as access to care, access to appropriate safety technology and PPE, quality of services, or other factors, such as staff awareness of when to seek OHS care." Joint Commission Of special note to infection preven- tionists, in its public comments signed by Margaret VanAmringe, MHS, executive vice president for public policy and government relations, the Joint Commission said the document "could be strengthened by greater emphasis on collaboration with infection prevention and control (IPC) staff and the interrelationship between worker safety and patient safety." As the Joint Commission explained, "The current version may inadvertently reinforce siloing of safety issues, which is increasingly recognized as contradictory to promoting a safety culture. To strengthen the guideline, CDC might consider adding a new section devoted to the intersection of worker safety and patient safety. Many national groups are now promoting this integration including the Institute for Healthcare Improvement, the National Patient Safety Foundation, and the National Academies of Sciences, Engineering, and Medicine. Relevant topics for this section could include infectious diseases, needlestick injuries, injury and exposure reporting system, tools to enhance communication such as daily huddles, and tools for risk assessment and incident analysis." Additionally, the Joint Commission e m p h a s i z e d t h e i m p o r t a n c e o f t h e assessment of competence in addition to training and education: "It is well known that training does not always result in proper implementation. For example, Examples of Performance Measures that Might Be Used to Assess the Effectiveness of Occupational Infection Prevention and Control Services includes a measure around the completion of initial and annual occupational IPC education and training as well as several measures to track HCP exposure events but does not include any measures around competency or use of personal protective equipment (PPE). The Joint Commission also asserts that exposures will continue to happen unless expectations related to engineering controls and use of PPE are standardized. It is imperative that healthcare personnel follow the same practices to prevent exposure as they move through the continuum of care." The Joint Commission adds that it understands that the CDC does not seek to be too prescriptive in listing performance measures that might be used to assess the effectiveness of infection prevention and control services, but it recommends that Ò We recommend that the guidelines integrate best-practice guidelines to involve staf and their union representative in the design and implementation of an occupational infection and illness control plan.

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