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Robin Novak, RN, CIC
Director of Infection Prevention

636.875.5088 ext. 101
This Month's Training Opportunities

Malignant Hyperthermia

Emergency Preparedness Rule / Emergency Operations Plan
Webinar is now on View upon Demand

Employee Health
Webinar is now on View Upon Demand

Over 70 Infection Prevention
 topics/presentations available in our library.
Word on the Streets!
Minnesota Measles Outbreak: 70 cases identified, 66 unvaccinated, 67 cases in children and 3 cases in adults. Learn more, CLICK HERE.
Nationwide Outbreak, Learn more,

Antibiotic Stewardship:
Some states are now requiring an antibiotic stewardship policy and procedure and plan.  What does your State require?
Do you need help developing your policy? I can assist in your needs.

Volume 1, Number 8
June 2017

Last month, I began a conversation about Malignant Hyperthermia and how to become prepared for such a scary and harmful event.  Well this month I have created and will present a webinar on Malignant Hyperthermia that I hope you will attend.

Malignant hyperthermia is a life-threatening event.  It is a syndrome in which there is an increased rate of metabolic activity in the skeletal muscles, also known as hypermetabolism.  This condition is associated with the combination of inhalation anesthetic agents and succinylcholine in susceptible individuals.  

If the thoughts of a malignant hyperthermia crisis bring chills running down your spine, then our upcoming educational opportunity may assist in allaying some of the anxiety.

Registered Nurse, Certified Infection Preventionist dedicated to disease prevention and high quality healthcare.  Strong decision maker who understands the importance of patient, visitor and staff safety following evidence based best practices.
Driven and compassionate healthcare professional with 30 years hands-on experience in fast-paced ambulatory surgery center and hospital environments.  Accountable and responsible with an additional focus on Quality Assurance Process Improvement .
In the past, Robin has served as the SGNA Carolina Chapter President, involved in SGNA Practice Committee as well as a Regional Committee member.  Robin has been active with APIC and is a current member of APIC PALMETTO. Robin was prior employed at the Ambulatory Surgery Center of Spartanburg since 2004 and held roles of Endoscopy Nurse, Endoscopy Charge Nurse and most recently the Quality Assurance Process Improvement Coordinator.  Robin has worked on several infection prevention projects for Excellentia Advisory Group including a key role as a faculty speaker at our annual Infection Prevention Strategies for ASC's conference in Las Vegas.  Robin is now Excellentia's Director of Infection Prevention & Endoscopy.
By Robin O. Novak, RN, CIC

Recently, I have had many conversations about enzymatic cleaners.  I thought I would share some of the important qualities to keep in mind.  As we know, enzymatic cleaners are an important part of cleaning processes from the endoscopy setting to the sterile processing department.

Enzymatic cleaners are composed of varying elements.  One of which is enzymes.  Enzymes are a class of compound known as a protein.  Proteases, lipases, amylases and cellulases are the type of enzymes found in enzymatic cleaners.  Each of these enzymes plays a vital role in breaking down the soils found on medical instrumentation.
Multi-enzymatic cleaners have additional chemistries known as surfactants and solvents.  The use of the additional chemistries ensures cleaning activities are aimed at broad-spectrum soils found on surgical instruments. Surfactants help to "wet" and penetrate soils by emulsifying lipids.  The most suitable surfactant will inhibit soils from re-adhering to the instrument surface after removal.
Here are some things to keep in mind in preparing the enzymatic bath.  Is the enzymatic chemistry being used at the recommended concentration?  How is that validated?  Is there a fill mark in the sink to validate the amount of water?  Is the pump on the enzymatic chemistry solution container validated to dispense the amount required?  Is the validation documented?  Is the water temperature correct?  Are the instruments and all instrument surfaces being exposed for the recommended time?

Compatibility of enzymatic solutions is another concern.  First, is the enzymatic solution compatible with stainless steel, soft metals like aluminum, plastics, and endoscope materials?   One thing I see frequently is a facility will utilize one type of "pre-mixed sponge" enzymatic solution at the point of use, a different enzymatic in the decontamination room, a third enzymatic formulation in the automated washers and AER.  Is the combination of differing enzymatic cleaning chemistries compatible?  Essentially, are there any concerns of potential unfavorable chemical reaction?  Is there sufficient rinsing of all internal and external components?  Is the combination enzymatic cleaning chemistry causing premature degradation of instrumentation? 
Critter Craze
By Robin O. Novak, RN, CIC
Who am I?
  1. This spirochete, Borrelia burgdorferi was discovered after lab tests from several people suspected of a disease caused by a similar bacteria returned with unusual results.
  2. Worldwide, the disease associated with this bacteria is typically caused by one of three main species in the US, Europe, and Asia.
  3. This new species is genetically distinct from the previous three species and is the only other bacteria known to cause a certain disease in North America.
  4. Be on the look out for Ixodes scapularis!  Transmission usually does not occur until I have been attached for 36 hours or more.
  5. Occurs more frequently when nymphal ____________ are most active in late spring or in the summer.  Peak times are June and July.
  6. Deer serve as a reservoir host and are resistant to infection.
  7. S/S include: A red macule or papule that expands slowly with a central clearing, known as Erythema migrans.  With or without Erythema migrans, symptoms may include malaise, fatigue, fever, headache, stiff neck, myalgia, arthralgias or lymphadenopathy.  All the symptoms may last for several weeks in untreated patients.
  8. Incubation period:  3-32 days after exposure with a mean of 7-10 days.
  9. Testing may be done with a two-tier testing. The spirochetes of this organism may also be seen on a blood smear. 
  10. TX: 2-4 week course of doxycycline. Other antibiotics used may be amoxicillin, ceftriaxone, and cefuroxime.
  11. Reporting:  obligatory in some countries.
  12. Prevention is education. 
a.       Avoid wooded areas or areas with high grass or leaf litter.  Minimize exposure by wearing light-colored clothing that covers legs and arms.  Utilize repellents to skin, sleeves, and trouser legs. 
b.     Shower soon after being outdoors.  Check for Ixodes scapularis daily, examining the entire body including hair.
c.      Remove Ixodes scapularis by using gentle, steady traction with tweezers applied close to the skin.  Following removal, clean the site with soap and water.

Email Robin at robin@excellentiagroup.com 
with your response.  You will receive a personalized reply with validation of the correct answer.

If you are in need of assistance with your infection prevention program, Robin will be able to assist with everything from setting up your program, training your Infection Preventionist, writing or editing Policies & Procedures or just simple telephonic consultation.  Robin is taking on-site requests for 2017 at this time.  Secure a date on her calendar now.

Please let us know how we can help.

Cathy Montgomery, RN, CASC                Robin Novak, RN, CIC
636-875-5088 extension 102                    636-875-5088 ext. 101

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