Showing posts with label CDC Guidelines. Show all posts
Showing posts with label CDC Guidelines. Show all posts

Feb 24, 2015

CDC and The Joint Commission Present FREE Continuing Education Webinar Tomorrow - Your Lab and Ebola: click here

CDC and The Joint Commission Present FREE Continuing Education Webinar Tomorrow - Your Lab and Ebola: What you Need to Know
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Feb 3, 2015
What is personal protective equipment?
Personal protective equipment, commonly referred to as "PPE", is equipment worn to minimize exposure to serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards. Personal protective equipment may include items such as gloves, safety glasses and shoes, earplugs or muffs, hard hats, respirators, or coveralls, vests and full body suits.
What can be done to ensure proper use of personal protective equipment?
All personal protective equipment should be of safe design and construction, and should be maintained in a clean and reliable fashion. It should fit well and be comfortable to wear, encouraging worker use. If the personal protective equipment does not fit properly, it can make the difference between being safely covered or dangerously exposed. When engineering, work practice, and administrative controls are not feasible or do not provide sufficient protection, employers must provide personal protective equipment to their workers and ensure its proper use. Employers are also required to train each worker required to use personal protective equipment to know:
  • When it is necessary
  • What kind is necessary
  • How to properly put it on, adjust, wear and take it off
  • The limitations of the equipment
  • Proper care, maintenance, useful life, and disposal of the equipment
If PPE is to be used, a PPE program should be implemented. This program should address the hazards present; the selection, maintenance, and use of PPE; the training of employees; and monitoring of the program to ensure its ongoing effectiveness.
Personal protective equipment is addressed in OSHA standards for Construction, General Industry, Shipyard Employment,Marine Terminals, and Longshoring. OSHA requires that many categories of personal protective equipment meet or be equivalent to standards developed by the American National Standards Institute (ANSI).
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May 14, 2011

H1N1 - Information For Nurses


H1N1 - Information For Nurses
ARCHIVED INFORMATION
H1N1 cases and deaths have decreased, and most indicators show that influenza activity on the whole is down to normal levels for mid-spring.  The latest estimates by the Centers for Disease Control and Prevention (CDC) show about 130 million Americans - almost half the entire U.S. population - have been estimated to have either been infected with H1N1 or been vaccinated.
The monovalent H1N1 vaccine is safe, effective, and the best way to be protected from H1N1 influenza.  Nurses should be vaccinated to protect themselves, their families, their patients, and their communities. 

Vaccine is still available in many places, however emphasis now will be on the influenza vaccine campaigns for the 2010-11 influenza season that begins in September.  The H1N1 strain will be a part of the trivalent seasonal influenza vaccine that nurses are urged to get every year. 

All nurses - in any position of authority and any workplace - should advocate for and help develop a comprehensive plan for pandemic flu, know their role in those plans, and if interested in becoming a volunteer responder, should register now with an organized emergency response system. 

ANA is working for nurses from the national perspective to ensure they are fully educated on the public health and medical implications and interventions.  But ANA is also monitoring issues affecting nurses on the job, such as adequate protective equipment, available vaccines, surge capacity and ethical concerns, and reporting and sharing this with our national organization and government partners.  ANA needs to hear from nurses on what will make their jobs easier, and how patients can be better served during the pandemic.

On this website, the ANA has consolidated some of the most pertinent information for nurses, including CDC's clinical guidance.  Unless otherwise specified, all clinical guidance and recommendations are from the CDC.


 See the Inside menu at the top of the column to the left for more about the 2009 H1N1 Pandemic.
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CDC Vaccine Basics.......

Vaccines

Monitoring health problems after vaccination is essential to ensure vaccines are held to the highest standard of safety. Years of testing are required by law before a vaccine can be licensed. Once licensed and in use, vaccines are continuously monitored for safety and efficacy.
Scientist

Vaccines

Frequently Asked Questions (FAQs)

Scientific Articles


Davis RL, Kolczak M, Lewis E, Nordin J, Goodman M, Shay DK, Platt R, Black S, Shinefield H, Chen RT. Active surveillance of vaccine safety: a system to detect early signs of adverse events.External Web Site Icon Epidemiology 2005;16(3): 336–341.
Chen RT, DeStefano F, Davis RL, Jackson LA, Thompson RS, Mullooly JP, Black SB, Shinefield HR, Vadheim CM, Ward JI, Marcy SM. The Vaccine Safety Datalink: immunization research in health maintenance organizations in the USA. Adobe PDF file [PDF--312.49 KB]External Web Site Icon Bulletin of the World Health Organization 2000;78(2):186–194.
Iskander J, Pool V, Zhou W, English-Bullard R; The VAERS Team. Data mining in the US using the Vaccine Adverse Event Reporting System.External Web Site Icon Drug Safety 2006;29(5):375–384.
Lieu TA, Black SB, Ray P, Chellino M, Shinefield HR, Adler NE. Risk factors for delayed immunization among children in an HMO.External Web Site Icon American Journal of Public Health 1994;84(10):1621–1625.
Varricchio F, Iskander J, Destefano F, Ball R, Pless R, Braun MM, Chen RT. Understanding vaccine safety information from the Vaccine Adverse Event Reporting System.External Web Site Icon Pediatric Infectious Disease Journal 2004;23(4):287-294.
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Questions and Answers about MMRV Vaccine Safety from CDC site.....

This page addresses questions related to the combined measles, mumps, rubella, and varicella (MMRV) vaccine.

What is ProQuad?


ProQuad® is the trade name for a vaccine made up of measles, mumps, rubella, and varicella (chickenpox) components (MMRV). It was licensed in 2005 for use among children ages 12 months to 12 years. It is a single shot that can be used in place of two other shots--the measles, mumps, and rubella (MMR) vaccine and the varicella vaccine. Using it lowers the number of shots a child needs to receive to be protected from these diseases.
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Is the MMRV vaccine available in the United States?


Very little MMRV vaccine is available in the United States due to manufacturing issues unrelated to vaccine safety. MMRV vaccine is not expected to be available again until 2009. However, some clinics may have some MMRV vaccine in stock.
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What adverse events were reported among children following MMRV vaccination before the vaccine was licensed?


Mild adverse events have been found, including--
  • Soreness or swelling where the shot was given (about 1 child out of 5)
  • Fever (about 1 child out of 5)
  • Rash (about 1 child out of 5)
The MMRV vaccine, compared with MMR and varicella vaccines given separately, has been associated with higher rates of fever and a measles-like rash during the 5-12 days after vaccination.
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What is a febrile seizure?


"Febrile" means "relating to a fever." In some children, having a fever can bring on a seizure. During a febrile seizure, a child often has spasms or jerking movements--larger or small--and may lose consciousness. Febrile seizures usually last only a minute or two. They are most common with fevers that go up fast and reach 102;° F (38.9;° C) or higher, but can also occur when a fever is going back down. Febrile seizures may happen with any condition that causes a fever, including common childhood illnesses like ear infections and, rarely, vaccination.
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Who is at risk for febrile seizures?


Most febrile seizures occur in children between the ages of 6 months and 5 years. The peak age is 14 to 18 months, which overlaps with the ages when first doses of the MMRV, MMR, and varicella vaccines are recommended. If a member of a child's immediate family has febrile seizures, that child is more likely to have a febrile seizure.
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Are children more likely to have a febrile seizure after getting the MMRV vaccine than after getting MMR and varicella (chickenpox) vaccines?


Early findings from an ongoing CDC study show that children who get an MMRV vaccine may be twice as likely to have a febrile seizure 7-10 days after getting the shot than children who get MMR and varicella vaccines (2 shots) at the same health care visit.
During the 7-10 days after vaccination, about one additional febrile seizure would be expected to occur among every 2,000 children vaccinated with MMRV vaccine, compared with children vaccinated with MMR and varicella administered at the same visit.

Is the study completed?


No. This study shows early results only. CDC and the Food and Drug Administration will continue to assess this information. Continue to visit this page for updated information.
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Does the MMR vaccine cause febrile seizures?


Children who receive the MMR vaccine are more likely to have febrile seizures 8-14 days after vaccination than children who are not vaccinated at all. 1 During the 8-10 days after vaccination, about one additional febrile seizure occurs among every 3,000-4,000 children who receive MMR vaccine, compared with children who do not receive any vaccines.
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Does a varicella vaccine cause febrile seizures?

Varicella vaccine is not known to cause febrile seizures. A study among nearly 90,000 children who received varicella vaccine showed no increased risk of febrile seizures due to varicella vaccine.
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How serious is a febrile seizure?


Although febrile seizures can be frightening for the child's caregivers, most are harmless. The majority of children who have febrile seizures recover quickly and have no lasting effects. Up to half of children who have one febrile seizure will have at least one other febrile seizure. But children with simple febrile seizures--the most common form--have no greater chance of getting epilepsy or brain damage than children who do not have febrile seizures. A study 1 showed that children who have febrile seizures after receiving an MMR vaccine are no more likely to have more seizures, epilepsy, or learning or developmental problems than children who have febrile seizures that are not associated with a vaccine.
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Can febrile seizures after vaccination be prevented?


In general, febrile seizures cannot be prevented. Some health care providers recommend aspirin-free fever-reducing medications to make the child more comfortable. However, these medications have not been shown to prevent febrile seizures. To avoid choking, children should not be given medication or anything else by mouth during a seizure.
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1 Barlow WE, Davis RL, Glasser JW, Rhodes PH, Thompson RS, Mullooly JP, Black SB, Shinefield HR, Ward JI, Marcy SM, DeStefano F, Immanuel V, Pearson JA, Vadheim CM, Rebolledo V, Christakis D, Benson PJ, Lewis N, Chen RT, for the Centers for Disease Control and Prevention Vaccine Safety Datalink Working Group. The risk of seizures after receipt of whole-cell pertussis or measles, mumps, and rubella vaccine.* The New England Journal of Medicine 2001;345(9):656–661.

** click on links to view more.......
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Frequently Asked Questions (FAQs) regarding Assisted Blood Glucose Monitoring and Insulin Administration

The following FAQs summarize inquiries from healthcare personnel received by CDC regarding best practices for performance of assisted blood glucose monitoring and insulin administration, including questions related to cleaning, disinfection, and storage of blood glucose monitoring equipment.
These FAQs are not intended as a comprehensive resource for all issues related to blood glucose monitoring, and insulin administration and additional considerations may be necessary for certain clinical situations or settings. View more detailed information related to assisted blood glucose monitoring and insulin administration. Visit CDC's Injection Safety website for additional information regarding injection safety and CDC's Sharps Safety website information related to sharps safety and safe disposal of sharps in healthcare settings.
Healthcare personnel are also encouraged to consult guidance provided by the Food and Drug Administration (FDA) (links provided in responses below) as well as the manufacturers of the devices (blood glucose meters, fingerstick/lancing devices, insulin pens) in use at their facilities.

General

  1. What is the difference between “self-monitoring of blood glucose” (SMBG) and “assisted monitoring of blood glucose” (AMBG)? With self-monitoring of blood glucose, individuals perform all steps of monitoring for themselves.  With assisted monitoring of blood glucose, the same steps are followed but testing is performed for an individual or multiple persons by someone else (e.g., a caregiver or healthcare professional) [1, 2].  Assisted monitoring of blood glucose is typically performed in healthcare settings such as clinics, hospitals, and long-term care settings (e.g., skilled nursing facilities and assisted living facilities).
    Individuals who perform blood glucose monitoring either for themselves or on others must be aware of basic safe practices to protect against infection transmission.  These include the following infection control requirements:
    • Fingerstick devices, also called lancing devices, should never be shared, even with close family and friends. This guidance includes both the lancet (i.e., the sharp instrument that actually punctures the skin) and the pen-like device that houses the lancet.  Neither should be used for more than one person.
    • Whenever possible, blood glucose meters should not be shared.  If they must be shared, the device should be cleaned and disinfected after every use, per manufacturer’s instructions.  If the manufacturer does not specify how the device should be cleaned and disinfected then it should not be shared.









Fingerstick/Lancing Devices

  1. My facility uses reusable fingerstick devices.  If we change the lancet and disposable components and clean and disinfect the device after use, is it okay to use this device for multiple patients? Single-use, auto-disabling lancets are more expensive.No.  Fingerstick devices must never be used for more than one person.
    Due to failures to change the disposable components, difficulties with cleaning and disinfection of reusable components after every use, and their link to multiple hepatitis B virus (HBV) infection outbreaks [3-5], CDC and FDA recommend that these devices never be used for more than one person [6, 7].
    Use of fingerstick devices for more than one person unnecessarily compromises patient safety, as demonstrated by numerous HBV infection outbreaks and resulting deaths [4, 8].  Despite perceived cost-savings from multi-patient use of reusable fingerstick devices, facilities should also consider the additional costs of testing, treatment, and legal action that result from such outbreaks and patient notifications.
  2. Some of the newer fingerstick devices come with cartridges that have multiple lancets preloaded. Is it acceptable to use this type of device for multiple patients so long as you remember to advance to a new lancet each time?No. These devices are not approved nor safe for use on multiple patients. Even if the device is advanced and a new lancet is used for each fingerstick procedure, unused lancets could become contaminated through contact with blood remaining on the end cap or the device barrel [9].  At least one outbreak of HBV infection resulting from multi-patient use of these devices has occurred in recent years [9].
  3. My facility uses reusable fingerstick devices.  However, we dedicate them for single-patient use.  Is this acceptable?CDC recommends the use of single-use, auto-disabling fingerstick devices in settings where assisted blood glucose monitoring is performed.  This practice prevents inadvertent reuse of fingerstick devices for more than one person.  Additionally, the use of single-use, auto-disabling fingerstick devices protects healthcare personnel from needlestick injuries.
    If reusable fingerstick devices are used for assisted monitoring of blood glucose then they should be treated in a manner similar to other personal care items (e.g., razors and toothbrushes) and must never be shared.  Facilities must take steps to assure that fingerstick devices are clearly labeled and stored in a manner to prevent inadvertent use for the wrong patient and cross-contamination from the surface of one fingerstick device to another (see Question 3 under Blood Glucose Meters for additional information on storage).
  4. Residents at our assisted living facility do their own blood glucose monitoring and prefer to use the reusable fingerstick devices.  Is this acceptable? Reusable fingerstick devices are appropriate for individuals who perform all steps of testing themselves.  However, this equipment should be labeled with their name and these individuals should be educated that this equipment should be treated like other personal care equipment (e.g., razors, toothbrushes) and must never be shared.  Transmission of HBV infection has been described in residential settings when individuals shared their personal blood glucose monitoring equipment with friends or family [10, 11].

Blood Glucose Meters

  1. How can hepatitis B virus (HBV) be transmitted through the meter? If the blood glucose meter never touches the patient, why does it need to be cleaned and disinfected after each use?Infectious agents, such as HBV, can be transmitted through indirect contact transmission, even in the absence of visible blood [4]. Indirect contact transmission is defined as the transfer of an infectious agent (e.g., HBV) from one patient to another through a contaminated intermediate object (e.g., blood glucose meter) or person (e.g., healthcare personnel hands) [12].
    With some blood glucose meters that require pre-loading of the test strip, the device may come into direct or close contact with the patient’s fingerstick wound.  If blood is transferred from the patient to the meter, and the meter is not cleaned and disinfected after use, subsequent patients can be exposed to this blood when the meter is used on them.
    Indirect contact transmission can also occur even if the patient never directly contacts the meter. Healthcare personnel hands can become contaminated with blood at various points while performing assisted blood glucose monitoring including pricking the patient’s finger or handling the test strip.  Blood can then be transferred to the meter when healthcare personnel handle the meter to obtain the reading.  If the meter is not cleaned and disinfected after use, the blood remaining on the meter can be transferred to subsequent patients via healthcare personnel hands when they handle the meter and then assist with fingerstick procedures.  Numerous outbreaks have implicated this mechanism in the spread of HBV infections [3, 4].
    Contamination of equipment and transmission of HBV can also occur if healthcare personnel fail to change their gloves and perform hand hygiene between patients.
    A multi-hospital study of blood glucose meters found that 30% were contaminated with blood; contamination was identified at the test strip insertion site as well as on the outside surfaces of meters [13].  Further, HBV has been demonstrated to remain infectious in dried blood on environmental surfaces for at least 7 days [14].  For these reasons, blood glucose meters should be cleaned and disinfected after each use, unless they are dedicated to a single patient and appropriately stored to prevent inadvertent contamination (See Question 3 under Blood Glucose Meters).
  2. What products are acceptable for cleaning and disinfection of blood glucose meters? FDA has recently released guidance for manufacturers regarding appropriate products and procedures for cleaning and disinfection of blood glucose meters.  This guidance, including a link to the Environmental Protection Agency (EPA) website can be found at FDA's WebsiteExternal Web Site Icon.
    An excerpt from this guidance reads:
    “The disinfection solvent you choose should be effective against HIV, Hepatitis C, and Hepatitis B virus. Outbreak episodes have been largely due to transmission of Hepatitis B and C viruses. However, of the two, Hepatitis B virus is the most difficult to kill. Please note that 70% ethanol solutions are not effective against viral bloodborne pathogens and the use of 10% bleach solutions may lead to physical degradation of your device. View a list of Environmental Protection Agency (EPA) registered disinfectants effective against Hepatitis B Adobe PDF fileExternal Web Site Icon”
    Healthcare personnel should consult the manufacturers of blood glucose meters in use at their facilities to determine what products, meeting the criteria specified by the FDA, are compatible with their meter prior to using any EPA-registered disinfectant for disinfection purposes.  If manufacturers are unable to provide this information then the meter should not be used for multiple patients.
  3. If blood glucose meters are dedicated for single-patient use, where should they be stored? Blood glucose meters dedicated for single-patient use should, ideally, be stored in the patient’s room in a manner that will protect against inadvertent use for additional patients and cross-contamination via contact with other meters or equipment.
    An evaluation of instrument storage areas in hospital found that 20% of areas where blood glucose meters were stored were contaminated with blood [13].  If facilities are not able to safely store meters in patient rooms, they need to take steps to ensure that meters are not inadvertently used for the wrong patient and that cross-contamination from the surface of one meter to another does not occur.
    If the blood glucose meter becomes contaminated through inappropriate storage, subsequent patients could be exposed to infectious agents, even if the meter itself does not have direct patient contact (see Question 1 under Blood Glucose Meters).
  4. If blood glucose meters are dedicated for single-patient use, do they need routine cleaning and disinfection?  If so, how often? If meters are dedicated for single-patient use and facilities have taken steps to assure that they are stored in a location to prevent inadvertent use for the wrong patient and/or cross-contamination (see Question 3 under Blood Glucose Meters), then meters should be cleaned and disinfected according to manufacturer’s instructions and, at a minimum, anytime they are being reassigned to a different patient.  Facilities are reminded, however, that if the manufacturer of the device in use does not specify how the device should be cleaned and disinfected, then it should not be shared or reassigned to a different patient (see Question 1 under General and information at the page on CDC's Injection Safety website titled Infection Prevention during Blood Glucose Monitoring and Insulin Administration).
    Care must be taken by personnel handling meters, whether designated for multi- or single-patient use, to remove gloves and perform hand hygiene after each patient use and after cleaning and disinfecting meters.
Insulin Pens and Insulin Administration

 

 

 

  1. My facility uses insulin pens.  If we change the needle and/or insulin cartridge, is it okay to use this device for multiple patients? No. Insulin pens are approved and labeled only for single-patient use. Under no circumstances may they be used for more than one person. Part of safe injection practices includes never using the same syringe for more than one patient [12].  Changing only the needle and reusing the cartridge of an insulin pen is a form of syringe reuse that represents a serious medical error. Changing the cartridge does not protect against contamination and does not make these devices safe for multi-patient use [15].
    If insulin pens are in use in a facility, they should be clearly labeled with the patient’s name and stored in a manner to prevent inadvertent use for more than one person and/or cross-contamination. Failure to do so has resulted in large scale patient notifications and an alert from FDA reminding consumers and healthcare personnel that these devices must never be used for more than one person [16].
  2. My facility uses multi-dose vials of insulin.  Can these vials be used for more than one person?Multi-dose vials should be dedicated to a single patient whenever possible.  If they must be used for more than one person, they should not be stored or accessed in the immediate patient treatment area.  This is to prevent inadvertent contamination of the vial through direct or indirect contact with potentially contaminated surfaces or equipment that could then lead to infections in subsequent patients.  If a multi-dose vial enters the immediate patient treatment area (e.g., patient room), it should be dedicated to that patient only.
    Additional information related safe injection practices and handling of multi-dose vials.

References

  1. Infection prevention during blood glucose monitoring and insulin administration.
  2. Klonoff DC, Perz JF. Assisted monitoring of blood glucose: Special safety needs for a new paradigm in testing glucose. Adobe PDF file [PDF - 5 pages]External Web Site Icon J Diabetes Sci Technol 2010;4(5):1027-1031
  3. Centers for Disease Control and Prevention. Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long-term-care facilities–Mississippi, North Carolina, and Los Angeles County, California, 2003-2004. MMWR 2005;54:220-223.
  4. Thompson ND, Perz JF. Eliminating the blood: Ongoing outbreaks of hepatitis B virus infection and the need for innovative glucose monitoring techniques. Adobe PDF file [PDF - 6 pages]External Web Site Icon J Diabetes Sci Technol 2009;3(2):283-288.
  5. Polish LB, Shapiro CN, Bauer F, Klotz P, Ginier P, Roberto RR, Margolis HS, Alter MJ. Nosocomial transmission of hepatitis B virus associated with a spring-loaded finger-stick device. N Engl J Med 1992;326:721-5.
  6. CDC Clinical Reminder: Use of fingerstick devices on more than one person poses risk for transmitting bloodborne pathogens.
  7. FDA Communication: Use of fingerstick devices on more than one person poses risk for transmitting bloodborne pathogens.External Web Site Icon
  8. Centers for Disease Control and Prevention. Notes from the field: Deaths from acute hepatitis B virus infection associated with assisted blood glucose monitoring in an assisted-living facility – North Carolina, August-October 2010. MMWR 2011;60:182.
  9. Gotz HM, Schutten M, Boorsboom GJ, Hendriks B, van Doornum G, de Zwart O. A cluster of hepatitis B virus infections associated with incorrect use of a capillary blood sampling device in a nursing home in the Netherlands, 2007. Eurosurveillance 2008;13:1-5.
  10. Farkas K, Jermendy G. Transmission of hepatitis B infection during home blood glucose monitoring. Diabetic Medicine 1997;14:263.
  11. Stapleton J. Transmission of hepatitis B during blood glucose monitoring. JAMA 1985;253:3250.
  12. Centers for Disease Control and Prevention (CDC). Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007. Adobe PDF file [PDF - 225 pages] Atlanta (GA): US Department of Health and Human Services. CDC; 2007.
  13. Louie RF, Lau MJ, Lee JH, et al. Multicenter study of the prevalence of blood contamination on point-of-care glucose meters and recommendations for controlling contamination. Point of Care 2005;4:158-163.
  14. Bond WW, Favero MS, Petersen NJ, et al. Survival of hepatitis B virus after drying and storage for one week.  Lancet 1981;1(8219):550-1.
  15. CDC Injection Safety Frequently Asked Questions
  16. FDA: Information for Healthcare Professionals: Risk of transmission of blood-borne pathogens from shared use of insulin pensExternal Web Site Icon.
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