Incidence of needlestick injuries appears to be lower among employees at retail pharmacy chain

Vaccinations for flu, tetanus and other common vaccines are increasingly taking place in non-medical settings such as supermarkets and drug stores. This added responsibility for pharmacists increases the risk of needlestick injuries (NSIs), puncture wounds often suffered while preparing or after use of a needle. NSIs can transmit bloodborne pathogens, including hepatitis C and HIV, from an infected patient to the person administering the vaccine.

A new report published in the November issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, found 33 NSIs occurred at 31 difference pharmacy locations of a nationwide retail pharmacy chain over an 11-year period. Over the same period of time, the chain administered more than 2 million vaccinations. Researchers calculated that the annual incidence of NSIs ranged from 0 to 3.62 per 100,000 vaccinations and 0 to 5.65 NSIs per 1,000 immunizing pharmacists. This incidence rate may represent an underestimation of NSIs since past studies have found that NSIs are often underreported by healthcare workers.

Most often NSIs were reported to have occurred after use and before disposal of the needle (58% of incidents) and during peak influenza vaccination months (79%).

“Pharmacists have become an emerging occupational group at risk of needlestick injuries,” said Marie de Perio, MD, medical officer in the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention (CDC). “While the incidence of needlestick injuries among employees at this retail pharmacy chain appears to be lower than that found in hospital settings, most of the injuries that did occur were likely preventable by following safe work practices.”

Researchers recommend that the company continue to follow existing CDC guidelines to improve its NSI prevention program and add additional information to track the circumstances of the injury to help determine contributing factors.

Source: Society for Healthcare Epidemiology of America

U.S. says death toll rises to 23 in meningitis outbreak

The U.S. death toll from fungal meningitis linked to potentially contaminated steroid injections has risen by two to 23, with North Carolina reporting its first death, health officials said on Saturday.

Tennessee’s death total in the outbreak rose to eight, the highest state total, the Centers for Disease Control and Prevention (CDC) said on its website.
States reported 13 new cases of fungal meningitis, raising the total to 281. There are also three peripheral infections caused by injections into joints.
The outbreak stems from medications shipped by the New England Compounding Center (NECC) in Massachusetts. The company faces federal and state investigations and lawsuits over the tainted medications.

Indiana and New Hampshire reported two new cases apiece. Virginia, Tennessee and New Jersey each had three new cases, the CDC said.

Health regulators confirmed on Thursday the presence of the deadly Exserohilum fungus in vials of the NECC steroid used for pain injections. They estimate that as many as 14,000 people may have been exposed to the contaminated medication.
NECC and its executives face a civil suit in Massachusetts that seeks to freeze the officers’ personal assets. Florida, which has had three deaths and 17 cases, has barred NECC from doing business in the state.

Courtesy Reuters
What do you think will be the outcome of this problem? Do you think that additional regulations are needed to prevent this type of problem?

Ebola’s Other Victims: Health Care Workers

The Ebola virus continues to strike people in the Democratic Republic of Congo. Since May, the World Health Organization has counted 72 confirmed, probable or suspected cases and 32 deaths.  As usual, a disproportionate share of those cases are health care workers — 23 of them, almost a third.

That’s because, despite elaborate protective garb and other precautions, it’s very hard for doctors, nurses and health aides to avoid virus-laden bodily fluids of Ebola patients or accidental needle sticks. That’s especially true at the beginning of an outbreak, when Ebola symptoms might be mistaken for malaria or something else.

“The repeating story is always that here’s incredible incidence among health care workers,” says Peter Jahrling of the National Institute of Allergies and Infectious Diseases, an expert on Ebola and similarly lethal viruses. “It’s usually the medical staff that bears the brunt of it.”

Apart from the tragedy of caregiver deaths, this has a ripple effect that helps keep an outbreak going.

Dr. Armand Sprecher of Doctors Without Borders says that’s because when health workers don moon suits and avoid all unnecessary contact with Ebola victims, that reinforces the community perception that the hospital is just the place people go to die.

“If you don’t hang IV lines and do things that look medical, if you just put people in beds and walk around in protective gear and don’t touch anybody, well, why would they want to come there?” Sprecher said in an interview with Shots from the Doctors Without Borders operations center in Brussels.

The perception is only fueled when people see health care workers die of Ebola in hospitals.

“We have a horrible time marketing our treatment unit because patients are not seeing a benefit to come in when we don’t produce a lot of survivors,” Sprecher says.

And if infected people stay away from hospitals, that just allows the virus to spread out in the community.

But the grim truth is doctors can’t do anything for Ebola patients except give them fluids and other supportive care. What’s needed, Sprecher says, is an effective treatment.

“If you had something in the refrigerator on standby, it might make it easier for the health care staff to engage with the patients,” he says, “if they knew there was something that might help them in the event of something awful happening.”

That might become possible. Fifty leading experts on Ebola and similar deadly viruses are gathering Wednesday and Thursday at the National Institutes of Health outside Washington, D.C., to assess several promising treatments for these diseases.

“This is really the first time we’ve ever all gotten together and addressed this problem,” says Jahrling, who is running the meeting.

Meanwhile, the Food and Drug Administration has just granted so-called fast-track review to one company for two of its experimental drugs for Ebola and Marburg viruses.

Jahrling says this week’s workshop will hash out what it would take to move one or more of the advanced treatments to the point where it could be tried in humans exposed to Ebola or its cousin Marburg virus.

One big challenge is to get the treatment — a vaccine, a cocktail of monoclonal antibodies or an antisense RNA-based drug — to where it would be needed.

That’s possible when the exposed person is a U.S. laboratory worker who has an accidental needle stick during a monkey experiment. But it’s a different story when Ebola pops up in a remote corner of Africa and no one can be sure when someone got exposed.

Animal experiments suggest that the Ebola antidotes will need to be given within 24 to 48 hours of exposure to the virus, before symptoms appear.

Another hurdle: Officials in the affected country would have to be convinced that giving a drug never used before in people was a safe and ethical experiment.

“These are the kinds of things that are going to come out in our workshop discussion,” Jahrling says, “whether you’re going to treat one occupational exposure or a village.”

The goal is to see if the groundwork can be laid for trying an experimental treatment for Ebola before the next outbreak — or the one after that.

Transcript

RENEE MONTAGNE, HOST:

It’s MORNING EDITION from NPR News. Good morning. I’m Renee Montagne.

STEVE INSKEEP, HOST:

And I’m Steve Inskeep.

An outbreak of the Ebola virus continues in the Democratic Republic of Congo. Since last May, the government says the virus has struck 72 people and killed almost half of them. Although other diseases kill far more people, none is more feared than Ebola. And as NPR’s Richard Knox reports, nobody is more at risk than the health care workers who take care of the victims.

RICHARD KNOX, BYLINE: There was a poignant piece of good news the other day, in the midst of the Congo’s Ebola outbreak. A woman suffering from the disease gave birth in the 20-bed ward set up to isolate and treat victims.

DR. ALFONSO VERDU: It was the first time a pregnant woman was having a baby in an Ebola treatment center.

KNOX: That’s Dr. Alfonso Verdu of Doctors Without Borders. He’s speaking by satellite phone from Isiro, the ramshackle town in northeast DRC that’s the epicenter of the outbreak. Unfortunately, the mother died after giving birth. Her infant survives, but has Ebola. There’ve been five new confirmed cases of the disease this month. So Verdu says everybody in the surrounding area is still being urged to take precautions.

VERDU: We ask the people not to shake hands, not to touch them, not to hug each other. The authorities are respecting that. But also, the people in the shops is respecting that.

KNOX: Nobody is at higher risk of Ebola than the doctors and nurses and health aides who care for its victims. Despite elaborate precautions, Dr. Armand Sprecher says health workers often come into contact with infected bodily fluids or accidentally stick themselves with contaminated needles.

DR. ARMAND SPRECHER: The survival rate of exposure to Ebola is, you know, like a needle stick injury, it’s 100 percent fatal. Nobody’s ever survived one of those.

KNOX: Sprecher works in the operations center of Doctors Without Borders in Brussels. He says the dangers force health workers to don moon suits and avoid all unnecessary contact with Ebola patients. And that just reinforces the perception that hospitals are places where people with Ebola go to die.

SPRECHER: You know, if you don’t hang IV lines and do things that look medical, if you just put people in beds and walk around in protective gear and don’t touch anybody, well, why would they want come there?

KNOX: And if infected people stay away from hospitals, that just keeps the epidemic going because the virus spreads so readily out in the community. But the grim truth is doctors can’t do anything for Ebola patients except give them fluids and other supportive care. What’s needed, he says, is an effective treatment.

SPRECHER: If you had something in the refrigerator, on standby, it might make it easier for the health care staff to engage with the patients, if they knew that there was something that might help them in the event of something awful happening.

KNOX: That might become possible. Fifty leading experts on Ebola and similar deadly viruses are gathering today and tomorrow at the National Institutes of Health outside Washington to assess several promising treatments for these diseases.

PETER JAHRLING: You know, this is really the first time we’ve ever all gotten together and addressed this problem.

KNOX: That’s Peter Jahrling of the N.I.H., who’s running the meeting.

JAHRLING: Whenever there’s an outbreak and we go rushing into the scene to document what’s going on, we’re concerned that we really don’t have anything specific to offer. And if we did have something specific to offer and had reasonable expectation that it would work, I think it would probably be of mutual benefit to try to figure out how to get that material where it needs to be.

KNOX: It’s a big challenge. Animal experiments suggest treatment has to be given within 24 to 48 hours after infection, before symptoms appear. That’s possible when the victim is a U.S. lab worker who has an accidental needle stick during a monkey experiment. But it’s a different story when Ebola pops up in a remote corner of Africa and no one can be sure when someone was exposed.

And if researchers wanted to try a drug that had never been used in people before, officials in the affected country would have to be persuaded it was a safe and ethical experiment.

JAHRLING: These are the kinds of things that are going to come out in our workshop discussion, I think, whether you’re going to, you know, treat one occupational exposure, or a village.

KNOX: The goal is to see if the groundwork can be laid for trying an experimental treatment for Ebola before the next outbreak or the one after that.

Richard Knox, NPR News. Transcript provided by NPR, Copyright National Public Radio.

Copyright 2012 National Public Radio (Source).\\

(Courtesy NPR)

Study: Germs Trump ‘Five Second Rule’

Most people are familiar with the famed “five second rule,” which states that if dropped food is picked up off the floor within five seconds of contact, it is still safe to consume.

Though a popular belief, a new study has found that germs often win the race.

The study, co-funded by Clorox and conducted by researchers at San Diego State University, found that germs do in fact attach themselves to edible items within that amount of time, the McClatchy-Tribune News Service is reporting.

Baby carrots were reportedly deposited on different surfaces, including a countertop, a kitchen sink, a table, and both a carpeted and tiled floor in the interest of testing the theory.

An additional carrot was kept clean, to serve as a constant.

Researchers found that germs affixed themselves to the carrots within five seconds of contact with different surfaces.

The countertop was found to be the dirtiest surface, with the carpeted and tiled floors following closely in second and third place.

According to a survey conducted in tandem with the study by researchers at SDSU, a reported 65 percent of parents admitted to implementing the five second rule in their homes, the News Service learned.

The Centers for Disease Control and Prevention in Atlanta also warns against the dangers inherent in germs contaminating foods.

On their official website, they recommend thorough and frequent cleanings of both surfaces and hands. Germs can also allegedly live in utensils and cutting boards, according to the CDC.

Courtesy CBS

Okay, since we all work in or around hospitals…. answer this question.  Do you practice the ‘5 second rule’ at home? Or if you drop that steak on the floor – do you wash it off and throw it on the grill?

German Doctors Warn Against Internet Trade In Breast Milk

German pediatricians have warned new parents against obtaining breast milk to feed their babies via social networking sites such as Facebook, cautioning the milk could be harmful. The Professional Association of Pediatricians said that although mothers milk was generally the best option for a newborn, mothers unable to breastfeed should not acquire it over the Internet. “Donors can be taking medicines or drugs, have infectious illnesses like AIDS or Hepatitis,” Wolfram Hartmann, president of the association, said in a written statement.
Most body fluids, tissues, and organs—semen, blood, livers, kidneys—are highly regulated by government authorities. But not breast milk. It’s considered a food, so it’s legal to swap, buy, or sell it nearly everywhere in the US. This accounts, in part, for the widely varying quality and safety standards in the online market for milk. For their part, Prolacta and nonprofit milk banks have rigorous screening processes for potential donors, including tests for drugs, hepatitis, and HIV. But Only the Breast and the volunteer sites, which see themselves more as communities than commodity markets, don’t screen donors or assume responsibility for the milk they help disseminate.
Whatever the source of the milk or its channel of distribution, the trend is clear: Human milk is being bought, sold, donated—and gratefully received—on an unprecedented scale. And as demand grows, the competition for every ounce is getting more fierce. Meanwhile, the donation-based milk-sharing sites—particularly Eats on Feets, which attracts a lot of Whole Foods-shopping earth mamas—see what they do as the continuation of an age-old practice. Women have breast-fed one another’s babies for millennia, they point out, and Internet-enabled milk swapping is just a 21st-century update. The FDA doesn’t see it in such benign terms. In November 2010, the agency issued a stern press release warning about the risks of feeding someone else’s bodily fluids to your baby: “When human milk is obtained directly from individuals or through the Internet, the donor is unlikely to have been adequately screened for infectious disease or contamination risk. In addition, it is not likely that the human milk has been collected, processed, tested, or stored in a way that reduces possible safety risks to the baby.”
Screening milk donors turns up a surprising number of infectious agents—pathogens that could be passed on to a baby. A 2010 Stanford University study examined data from 1,091 women who applied to donate milk to a bank in San Jose, California. It revealed that 3.3 percent were rejected after their blood samples tested positive for at least one of five serious infections: syphilis, HIV, hepatitis B, hepatitis C, and human T-cell lymphotropic virus. And if these pathogens are in a donor’s blood, they can be present in the milk, too.
Critics warn that these same disease agents are likely prevalent in milk that’s offered online. “Women are convinced that breast milk is somehow different from blood and that there aren’t any risks in sharing it with another woman’s baby,” says Updegrove, director of the milk bank in Austin. “But it’s an incredibly risky practice. Breast milk is a body fluid. Would you consider cutting open a vein and giving a direct transfusion?”
So what do you think about  the trade or selling of breast milk?   Do you consider it a problem?

More hospitals requiring employees to have Flu Vaccination

Waco, Texas
Hillcrest Baptist Medical Center has adopted a policy requiring employees who have direct contact with patients to be vaccinated against influenza.

Providence Health Center is going even further, requiring virtually every person who works at the hospital to be vaccinated regardless of job description.

The mandates are partly in response to a new state law that took effect Sept. 1. It requires hospitals to establish and enforce written vaccination policies for preventable diseases, though it does not specify which vaccines hospitals must mandate.

But the bigger impetus for the policy changes,, is a growing sentiment within the medical community that health professionals have a duty to get vaccinated.

How are things at your hospital?  Are you expecting your hospital administration to mandate vaccinations?

One in three healthcare workers didn’t bother getting immunized

According to a report in the Morbidity and Mortality Weekly, oOne in three healthcare workers didn’t bother getting immunized against influenza during the 2011–2012 flu season, prompting government and infectious disease organizations to push for more aggressive efforts from healthcare organizations.

Even though last season’s overall healthcare worker immunization rates were 3.4% higher than in 2010–11, in hospitals, nearly one in four (23.1%) workers weren’t immunized, in physician offices one in three (32.3%) were not immunized, and in long-term care facilities, nearly half (47.6%) of workers failed to get their flu shots. That’s according to the Morbidity and Mortality Weekly Report published by Friday by the Centers for Disease Control and Prevention.

How are things at your hospital?  Are you planning on getting immunized?

Kimberly Clark’s Survey about asking Medical Professionals about Hand Hygiene

I hope that you have had an opportunity of looking at the recent survey conducted by Kimberly-Clark concerning hand hygiene.  According to the centers for disease control and prevention (CDC) hand hygiene is one of the most important ways to prevent the spread of infections.

The survey indicated that:

  • Patients do not ask about hand hygiene.  Only 5% of the respondents always ask doctors or staff in hospitals if they have washed were sanitized their hands prior to beginning an exam or procedure.
  • There is a low awareness of risk.  Among Americans who do not ask healthcare professionals about hand hygiene, 40% said they did not ask because they assume healthcare professionals perform hand hygiene before treating any patient.  34% said they simply don’t think about asking about hand hygiene and 21% said they do not feel it is their responsibility.  However, only 30% did not ask because they witnessed their hospital healthcare provider washing or sanitizing their hands.
  • Older patients are more hesitant to ask.
  • Patients are not offered education such as pamphlets or literature outlining proper hand washing techniques.

I have personally experienced the devastating effects of hospital acquired infections.  Because of my personal experience I always ask if a healthcare worker has wash their hands or used alcohol gel prior to touching me.

What about you?  As a clinician, when you are personally being examined or having a procedure performed, do you ask about hand hygiene?

We welcome your comments.

ISIPS introduces new website and Newsletter

After what seems like a full summer of working on the new website, ISIPS is pleased to announce the new ISIPS Website and ISIPS Newsletter.
The new website contains many of the features that you have enjoyed in the past and adds many new ones. We are introducing a blog (innaugaural post today), instructional videos, more news and information that will assist you in promoting sharps injury prevention.