Draft CDC flu guide unmasks N95s
'The current circumstances justify an update.'
The Centers for Disease Control and Prevention – which erred on the side of caution and consternation for infection preventionists during the flu pandemic – now concedes surgical masks are sufficient to protect health care workers against H1N1 influenza A. Draft guidelines for seasonal influenza downgrade the controversial recommendation to wear N95 respirators.
The widespread availability of vaccine and the end of the pandemic made the decision a no-brainer. On the other hand, those who thought the CDC would endorse mandatory flu vaccination of health care workers will be disappointed. Always cautious on regulatory matters, the agency seems content to let individual hospitals and states fight that battle.
"When the interim infection control guidance for 2009 H1N1 was posted, substantial uncertainties existed regarding the severity of disease and health impact of the novel H1N1 influenza strain, a high proportion of the population was susceptible to the new virus, and the vaccine was not available," the CDC states. "Circumstances have changed significantly since then. First, a safe and effective vaccine has become widely available. Second, we now have information about the number of cases of disease, hospitalizations, and deaths caused by 2009 H1N1, which can be compared to historical seasonal influenza data. The current circumstances justify an update of the recommendations. Further, recommendations for prevention of seasonal flu in healthcare facilities are currently found throughout the influenza section of the CDC web site. In updating this particular guidance, CDC will consolidate recommendations into a comprehensive, easily accessible document."
The CDC draft flu guidelines are in the June 22, 2010 Federal Register at: http://edocket.access.gpo.gov/2010/2010-15015.htm.
CDC targets ambulatory care in new guidelines
Single dose vials reused in outpatient care
Though Centers for Disease Control and Prevention infection control guidelines are supposed to generally apply to all settings, something has been lost in translation beyond the hospital. Addressing that issue after a spate of national hepatitis outbreaks, the CDC's Healthcare Infection Control Practices Advisory Committee is developing a guide to Standard Precautions specifically for ambulatory care facilities. The guidance will be styled to the outpatient setting, with the essential recommendations based on existing infection control guidelines used in hospitals.
"It will be a more abbreviated guide that hits the high points every setting should be using," says Melissa Schaefer, MD, a medical officer in the CDC's Division of Healthcare Quality Promotion. "I still feel like we have a lot of work to do in this area. We are paying a lot more attention to these ambulatory surgery centers."
In findings that will come as little surprise to infection preventionists, Schaefer was the lead author of a recent study that found infection common lapses occur frequently in ambulatory care settings.1 In one particularly striking finding – given the highly publicized 2008-2009 outbreak in a Las Vegas endoscopy clinic – researchers found that 28% of the sites studied were using single-dose medication vials for more than one patient. A total of 68 ambulatory surgical centers were assessed. Overall, two-thirds had at least one lapse in infection control. Other common lapses included failing to adhere to recommended practices regarding reprocessing of equipment (28.4%) and improper handling of blood glucose monitoring equipment (46.3%).
The Centers for Medicare & Medicaid Services (CMS) piloted an infection control audit tool in a sample of ambulatory surgical centers (ASC) inspections to assess facility adherence to recommended practices. The infection control audit tool used was designed by the CDC then piloted by CMS surveyors who received CDC training on the use of the tool. Of the 68 ASCs assessed, 32 were in Maryland, 20 in Oklahoma and 16 in North Carolina. Assessments focused on five areas of infection control: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment.
Editor's note: The CMS audit tool is available at: http://totalsol.vo.llnwd.net/o29/data/1080/infection_control_surveyor_worksheet.pdf
- Schaefer MK, Jhung M, Dahl M, et al. Infection control assessment of ambulatory surgical centers. JAMA. 2010; 303:2273-2279.
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