EPIC Newsletter
For Arizona SNFs - Emergency Preparedness Infection Control
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Antibiotic Stewardship Training to be held in Flagstaff | Wednesday, May 25
EPIC Consultant, Dr. Peter Patterson, will present a morning seminar on antibiotic stewardship. This topic is especially important in infection prevention and control. It will be held on May 25th at the Twin Arrows Casino Hotel in Flagstaff.
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CMS COVID-19 Community Transmission Level
CMS instructs facilities to use the COVID-19 Community Transmission Level to determine how often staff, who are not up-to-date, are to be tested for COVID-19. To determine the current COVID-19 Community Transmission Level, facilities should go to Finding Community Transmission Levels (cms.gov). The instructions direct the user to first select the state and county and then to scroll down to the map, use the drop down for data type and select County Transmission. Facilities should not use the COVID-19 Community Level section directly above the map to determine routine testing frequency. The Finding Community Transmission Levels (cms.gov) also provides instructions to find past, or historical, community transmission levels. It instructs providers to scroll down to “County Level Timeseries Data for [State]” and click it to expand the list and view previous community transmission levels. To download past community transmission levels, Click on “Download Data.” This will download all-time series data for the selected county.
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SNF Infection Control Citations Continue
The F880 tag for Infection Control is currently the second most frequently cited deficiency in Arizona and in the nation, according to CMS. In Arizona, it continues to be most frequently cited for failing to consistently screen staff prior to entry and for failing to don appropriate PPE when caring for residents on transmission-based precautions. However, with the return of standard/annual surveys, we are starting to see changes in the rationale for citing F880. There has been an increase in citations for the following:
- Failing to perform hand hygiene as specified in the facility’s policy during wound care and catheter care.
- Failing to provide catheter care in a manner to prevent infection and in accordance with facility policy.
- Failing to perform hand hygiene after resident care and doffing gloves in accordance with facility policy.
- Touching medications/tablets with ungloved hands during medication administration.
- Improper linen handling, failing to follow facility policy when handling soiled linen.
Facilities can use Survey Resources which includes the critical element pathways to improve compliance in infection control. More information about F880 can be found in Appendix PP.
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Being “Up to Date” on Vaccinations
Nearly 83% of the United States have received at least one dose of the COVID-19 vaccine, yet the confusion about being “up-to-date” or “fully vaccinated” seems to be widespread. This can be particularly challenging when the question of testing guidance in our healthcare and long-term care systems comes into play. Per the CDC, adults 18 years and older are considered up to date with their COVID-19 vaccines when they have received all doses in the primary series and one booster when eligible.
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Pfizer-BioNTech Primary Series: 2 doses of Pfizer-BioNTech given 3–8 weeks apart
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Boosters: 1 booster of either Pfizer-BioNTech or Moderna COVID-19 vaccine is recommended at least 5 months after the final dose in the primary series.
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Moderna Primary Series: 2 doses of Moderna given 4–8 weeks apart
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Boosters: 1 booster of either Pfizer-BioNTech or Moderna COVID-19 vaccine is recommended at least 5 months after the final dose in the primary series.
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Johnson & Johnson’s Janssen Primary Series: 1 dose of Johnson & Johnson’s Janssen
- Boosters: 1 booster of either Pfizer-BioNTech or Moderna COVID-19 vaccine is recommended at least 2 months after a J&J/Janssen COVID-19 vaccine
Anyone who received a J&J/Janssen COVID-19 vaccine for both their primary dose and booster may receive a 2nd booster of either Pfizer-BioNTech or Moderna COVID-19 vaccine at least 4 months after their 1st booster.
Per CMS, staff, who are up to date, do not have to be routinely tested. For health care personnel who work in the facility infrequently, please refer to the CDC’s testing guidance and they should ideally be tested within the 3 days before their shift (including the day of the shift). Those not up to date would be tested per the CMS Community Transmission Level, noted in the above article on Community Transmission.
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Hazards Associated with Wildfire Smoke
While your facility may not be directly impacted by a wildfire, there are other issues to consider including indoor air quality and the potential for the presence of contaminants within the built-environment of a health care facility It is important for your team to understand the danger that wildfire smoke represents to the vulnerable population of a long term care facility and the measures that should be implemented to mitigate threats to health and safety. Here is an informative video produced by the DR/EPIC Team focused on the hazards associated with wildfire smoke and what your facility can do to ensure an appropriate response during these types of incidents.
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The Pathogens you Cannot see: Airborne Diseases
In a recent article by Megan Henken, Vice President of Medline featured in McKnights Long Term Care News, cleaning and disinfection priorities in health care settings often focus on surfaces. And yet, many life-threatening pathogens are spread through the air requiring different protocols, equipment, and considerations. With healthcare-acquired infections rising significantly during the pandemic, there’s a renewed focus on preventing the spread of pathogens: primarily viruses, bacteria and fungi. The challenge is that not all pathogens are alike, and different organisms transmit differently to humans. So how do you eliminate the pathogens that you are not killing through your normal cleaning practices? First, it’s important to recognize that cleaning a surface does not necessarily equate disinfection. People are more attuned to visible cleaning than disinfection. And even on surfaces, it tends to be tricky. Cleaning removes dirt and organic matter from surfaces while disinfecting focuses on killing pathogens such as viruses and bacteria on surfaces. When a surface is cleaned with a cloth, the pathogen remains on the cloth. Actually killing a pathogen requires a disinfectant. This concept applies to the air as well. Most standard air purifiers remove particles from the air, but they don’t necessarily eliminate the particles or pathogens. For example, some electronic air purifiers utilize ionization to break down molecular contaminants and move them out of the “breathing zone,” which is the area immediately surrounding a worker’s nose and mouth where the majority of air is drawn into their lungs. However, this method simply moves pathogens and does not kill them. In fact, this method has been found to emit harmful organic compounds, such as acetone, ethanol and toluene – substances commonly found in paint strippers, aerosol sprays and pesticides – as well as ozone, which can cause throat irritation, coughing, chest pain and shortness of breath. Using other technologies in conjunction with a HEPA filter, such as (ultraviolet) UV radiation, will assist with actually killing and destroying aerosolized pathogens. It’s also critical that the purifier can absorb extremely small particles, and has the capacity to cover the full area of a room or facility. It is possible to manage and destroy airborne pathogens in your healthcare setting with an appropriate filtration system or air purifier. As the number and type of pathogens continue to evolve, having a comprehensive cleaning and disinfection protocol that takes into consideration all of the ways that pathogens spread will be critical to avoiding and managing the next big disease outbreak.
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It’s a Jungle out There | Monitor Your Aviaries
Indoor aviaries may be filled with beautiful birds. Outdoor bird feeders may attract native species that are inspiring to watch. These living creatures can stimulate and bring joy to residents. But, community-maintained or community-fed birds can produce indoor environmental quality issues and on rare occasions may cause human illnesses. In addition to potential odors issues, perhaps one of the most common concerns associated with pet birds is their ability to trigger allergies in some people. The usual sources of allergens are bird dander and byproducts of the dust mites that can collect in the bird feathers. Occupants can also be exposed to pathogens from birds through inhalation, ingestion or through cuts and abrasions on their skin. The CDC lists the following four diseases associated with pet birds, although they may not occur frequently in the U.S.:
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Cryptococcosis (Cryptococcus neoformans)
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People get cryptococcosis by breathing in contaminated dust or getting it in open wounds. In humans, symptoms resemble pneumonia and include shortness of breath, coughing, and fever.
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Histoplasmosis (Histoplasma capsulatum)
- Histoplasmosis is a fungal disease that is spread to people, when they breathe in dust from pigeon or bat droppings.
- Mycobacterium avium complex (MAC, Avian Tuberculosis) –
- MAC is a bacterial disease spread to people from birds and other animals through the environment, though it is not clear exactly how the bacteria are transmitted.
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Psittacosis (Chlamydiophila psittaci) or Parrot Fever –
- Parrot fever is a bacterial disease that people can get after accidentally breathing in the secretions of infected birds, including parrots and parakeets, or poultry and wild birds.
In addition to the potential hazards posed by birds and bird wastes, other concerns include the attraction of various unwanted pests (e.g. nuisance birds like pigeons, rodents like mice, insects like ants, etc.) that are attracted to the seed, water, and shelter provided to the birds of interest. These unwanted pests can damage the building and can bring on environmental quality issues of their own. Questions? Contact EPIC consultant Derrick A. Denis at derrickdenis@csceng.com.
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“Broken” by Dr. Buffy - Check it out!
Many of you know and have worked with Dr. Buffy Lloyd-Krejci. If you haven’t yet seen her new book, check it out! The title is BROKEN: How the Global Pandemic Uncovered a Nursing Home System in Need of Repair and the Heroic Staff Fighting for Change. The book describes a health care system that has been operating far below infection prevention and control best practices and also shares the stories of many of our health care heroes. You can buy the book on Amazon.
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Airtime for Antibiotic Stewardship Concerns
The EPIC monthly Infection Preventionist calls are now giving equal time to antibiotic stewardship along with infection prevention and regulatory updates. On each call, Dr. Peter Patterson reviews one segment of EPIC’s results-oriented stewardship protocol. On the April 28th call, Dr. Patterson emphasized the importance of syndrome-focused data collection and reporting and how attention to action-compelling formatting works to gradually alter the prescriber’s mindset in a repeated cycle of improvement. So join the call to learn more about the latest in antibiotic stewardship! Also make time to attend the EPIC workshop on antibiotic stewardship in May!
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Join the Infection Preventionist Call
Each month EPIC hosts a Zoom call targeted to infection preventionists in skilled nursing facilities. If you are interested in participating please send your contact information to Kay Huff and we will send you a link to the call. The call will be held Thursday, May 26th at 1:00 pm.
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Check out our DR EPIC Helpline!
To submit questions, email the DR EPIC online helpline at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you. or valuable infection prevention resources! Go to: EPIC.DisasterReadyaz.org to explore these tools.
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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 2022.
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