Thursday, September 15, 2021
DR EPIC Newsletter
For Arizona SNFs - Emergency Preparedness Infection Control
DR EPIC Website - All New and Improved!
The Emergency Preparedness and Infection Control (EPIC) website has been enhanced and revised to better serve you. Check it out: here. You will find a comprehensive clinical and regulatory section of resources and an online Infection Preventionist Tool Kit. There are also excellent resources for improving industrial hygiene and addressing disaster scenarios. Please take a look and know that your feedback is welcome! If you have thoughts or questions, please contact Krysten Dobson at kdobson@azhca.org.
Celebrate Environmental Services / International Housekeepers Week!
September 13-18
Held every year during the second full week of September, Environmental Services Week (EVSW)/International Housekeepers Week (IHW) is dedicated to recognizing the efforts of hard-working custodial staff members. The true heroes of any building operation, cleaning employees have one of the toughest jobs in a building, but also one of the most important. Buildings that aren't properly cleaned can lead to illness and productivity loss for the people who visit, eat, live, and work there! Check out these ideas on Pinterest to recognize these important members of your team.
DR EPIC Infection Control Training (FREE)
The Disaster Ready Emergency Preparedness Infection Control (EPIC) program is offering two FREE infection control training courses. The Infection Preventionist Specialized Training (IPCO) is a specialized course of study for health care professionals who desire to serve as Infection Preventionists (IPs). Individuals taking this course will be specially trained to effectively implement and manage an Infection Prevention and Control Program in a nursing center. This is a comprehensive 23-hour program that serves to assist in “certifying” Infection Preventionists.

In addition, we're offering The Infection Prevention & Control in the Post-COVID-19 World. This provides a review of the basics of infection prevention and control practices and will look at the future of infection prevention and control. This three-hour course also describes the process for cohorting practices and will look at how to conduct self-assessment processes to continually evaluate and improve the infection prevention and control program in long term care. This course is targeted to any and all staff providing hands-on care. For more detailed information on these trainings click here or contact Kay Huff at Khuff@azhca.org.

These two courses can either be taken by one person or you can separate them out and allow two people from one facility to take each of the trainings. If you are interested in receiving one of these trainings, click on the buttons below to complete the interest forms. Once we have your contact information from the forms, you will receive an email from the EPIC team with further instructions on registration. There will be no fees associated with these two trainings because it is a grant funded program. Slots are limited for these free courses, so don’t hesitate… complete the interest forms below and sign up now!
Compliance and Infection Control: Summary of E-Tag 0001 - Establishment of a Facilities Emergency Program

An emergency preparedness program describes a facilities comprehensive approach to meeting the health, safety and security needs of the facility its staff and the resident population and community prior to and after an emergency or disaster.

The emergency preparedness program must encompass 4 core elements:
  • Risk Assessment (Hazard Vulnerability Assessment)
  • An Emergency Plan
  • Policies and Procedures
  • Communication Plan and the Training and Testing Program

CMS requires a facility to include in its Hazard Vulnerability Assessment (HVA) Emergent Infectious Disease as a vulnerability. Please take some time to review and update other plans, policies and procedures to include infection control procedures and the role an Infection Preventionist/Infection Control officer might play during an emergency. It is also important to include infection control into your facilities Integrated Preparedness Plan (training and testing). Check out Appendix Z for more information.
Life Safety 101 and Storage of Infection Control Supplies - Compliance
with K-Tag 211
 
Important to know…you cannot use the means of egress (hallways) in your facility to store the over-abundance of supplies you have received for infection control measures. This includes service corridors. Having toured several facilities recently, our Disaster Ready Life Safety team observed multiple instances of non-compliant storage within the means of egress that will automatically trigger a deficiency (K-211). Storage is required to be in a protected area. Storage rooms are considered hazardous areas and require higher levels of fire protection including fire-rated walls and fire-rated doors that are self-closing. Simply using the rationale that you do not have any room in your storage rooms is not an acceptable reason to place storage of any type in your hallways; even if it is confined to one side. Besides the deficiency, the presence of storage within the means of egress represents a safety hazard, risk exposure and may compromise your team's ability to effectively evacuate the building during an emergency. Contact Stan Szpytek, DR/EPIC/Life Safety Consultant with any specific questions at Stan@azhca.org or call him at (708) 707.6363.
Incident Management During a Pandemic

While it is clear that incident management protocols apply to emergent events like an internal fire, damage from a monsoon storm, evacuation or other perils identified in your facility's Hazard Vulnerability Assessment, a protracted incident like the management of COVID-19 is certainly an emergency that should be managed with the Nursing Home Incident Command System (NHICS). Consider brushing up on your team's knowledge of NHICS by sharing a copy of the NHICS Guidebook to serve as a good refresher on how this standardized, emergency management system can be used to control all types of internal and external threats and perils. NHICS can also be used to manage non-emergent events like vaccination distribution. Someone needs to be in charge of every incident and NHICS is the way to take command and control!  For more information about access to NHICS training, contact Krysten Dobson, Disaster Ready / EPIC Coordinator at kdobson@azhca.org.
Join us for the ADHS HAI LTC Subcommittee Calls

Please join us for the ADHS Health Care Associate Infections (HAI) Long Term Care Subcommittee call scheduled Monday September 20, 2021, from 2- 3 pm. This committee meets to discuss issues pertinent to infection control in LTC and to create informational tools facilities can use to improve their efforts in infection prevention. The agenda for this call includes:
  • Emergency regulation requiring staff vaccinations
  • CRE NDM on the Rise
  • DR EPIC Program
  • LTC Antibiotic Stewardship Toolkit
  • University of Arizona LTC Antibiotic Stewardship Project
  • ADHS ICARs Update

The “google meet” information to participate virtually is:

HAI LTC Subcommittee Meeting
Monday September 20, 2021, from 2 – 3 pm.
COVID-19 Fact From Fiction
Q & A from our DR EPIC Industrial Hygienist, Derrick A. Dennis CIAQP, CIEC, CEOP

Q: What’s a HEPA filter? 
A: HEPA filters are a staple in infection control, both in respirators and in mechanical equipment. We hear over and over again…"HEPA filters capture 99.97% of particles DOWN TO a size of 0.3 microns.”
SURPRISE...THIS IS FALSE. HEPA filters capture 99.97% of 0.3 micron monodispersed particles (the most difficult particle size to capture).But, they are even more efficient at capturing both LARGER and SMALLER particles. HEPA Filters CAN filter out individual SARS-CoV2 viral particles (~ > or = 0.07 to 0.12 microns).These viral particles can also be agglomerated or carried on larger dust particles or sputum particles, which can also be filtered by HEPA technology. Sieving/straining is not the only mechanism for capturing particulates.

Q: What's an N95 really?
A: N95s are disposable single use respirators (tight fitting filtering facepieces). The “N” in N95 means the filter media is not oil resistant. They should not be used in environments with oil mist like a machine shop. This should not be an issue for SNFs. The “95” in N95 means the filter media is rated to remove 95% or monodispersed particles at the most difficult particle size to capture, which is 0.03 microns in size. It will filter larger particles more efficiently. Counterintuitively it will also filter out smaller particles more efficiently. This is important since individual SARS-CoV2 viral particles are smaller than 0.3 microns (~ > or = 0.07 to 0.12 microns). Most will adhere to other larger particles such as sputum. According to OSHA, N95s are indeed “respirators.” Why is this important? All respirators require compliance with the Federal Respiratory Protection Standard 29CFR.1910.134.If you require employees to wear a respirator, such as an N95 this standard requires you to have a Respiratory Protection Program (RPP) which must include:

  • A completed medical questionnaire and eligibility approval for the individual to wear a respirator from a Physician or licensed healthcare professional (PLHCP)
  • Annual respirator training and fit testing for all respirators (make, model, size) the employee will wear N95s are proven by NIOSH to offer protection to the wearer as claimed. A KN95 is not the same as an N95. KN95s are not respirators and are not to be used in COVID-19 positive rooms or quarantine rooms.  

Q: How can a safety device make you less safe? What to know about N95s...
A: N95s are safety devices, but it important to realize that wearing an N95 does not make you a superhero. First, it needs to fit the wearer. If air bypasses the face-to-facepiece seal, the respirator is not protecting the wearer. Fit testing is not just an OSHA compliance exercise, fit testing is critical to ensure a specific N95 device is actually offering protection to the uniquely shaped wearer. Second, N95s are merely particulate filters. They DO NOT filter gasses like (ammonia gas, chlorine gas, carbon monoxide gas, VOCs, etc.). They also DO NOT add oxygen, so you cannot use them in oxygen deficient environment (< 19.5 % oxygen).Third, they impede communication by obstructing the mouth and muffling the voice of the wearer. This makes communicating with coworkers and often hearing impaired residents a significant challenge. Fourth, the combination of strap pressure and retention of heat and humidity in the cup of the device can result in the breakdown of skin on the nose, ears and cheeks, etc. This can be painful and can result in infections of damaged skin. These devices can also result in fatigue and overheating of the wearer, due to the extra effort required to draw air through the filter media and the heat and humidity kept in the respirator cup. This is especially the case since COVID19 protocols prevent wearers from using N95s with exhalation valves that would otherwise mitigate this heat and humidity buildup. Lastly, these devices impede peripheral vision and can result in slips, trips, needle sticks and other injuries. These are just a few of the potential hazards you need to teach your team in the required annual fit testing and respirator training.

Want to learn more? Reach out to the EPIC Industrial Hygiene team through Derrick at DerrickDenis@csceng.com.
Check out our DR EPIC Helpline!
To submit questions, email the DR EPIC online Help Center at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you.

Don’t forget to utilize our DR EPIC website for valuable infection prevention resources! Go to: EPIC.DisasterReadyaz.org to explore these tools.
Questions? Contact EPIC@azhca.org |This program is funded by ADHS
The Disaster Ready Emergency Preparedness Infection Control (DR EPIC) program provides education and technical assistance for skilled nursing providers throughout the state. Individual providers will need to exercise their independent discretion in how to apply this information and technical assistance to the unique operation of each facility. For that reason, a facility’s of its professional judgment and due diligence in utilizing the program for infection control and risk management practices is solely within the facility’s control for which it is entirely responsible. 
Copyright 2021.