Excellentia Advisory Group
ImPaCTInfection Prevention and Control Trends for ASC's 
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About the Author
This Month's Training Opportunities
GI Corner
Critter Craze
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Robin Novak, RN, CIC
Director of Infection Prevention

636.875.5088 ext. 101
This Month's Training Opportunities

Employee Health:
the Program and Recommended Vaccinations

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

Over 70 Infection Prevention
 topics/presentations available in our library.
Word on the Streets!
Word on the streets is the CDC has published new guidelines for surgical site infection prevention. Have you seen them?


Highlights of the document include:

*Parenteral Antimicrobial Prophylaxis Guideline

*Nonparenteral Antimicrobial Prophylaxis Guideline

* Glycemic Control



*Antiseptic Prophylaxis

*Prosethetic Joint Arthroplasty Guideline

*Blood Transfusion

*Systemic Immunosuppressive Therapy

*Intra-articular Corticosteroid Injection


*Orthopedic Surgical Space Suit

*Postoperative Antimicrobial Prophylaxis Duration with Drain Use


Volume 1, Number 7
May 2017

Being prepared for a potential malignant hyperthermia event is a costly adventure, but one well worth the effort. If you have never witnessed this crisis, be thankful.  It is a stressful time knowing the ins and outs of why it happens, how to treat it, steps to recognize an event and even preventative activities can help your team be prepared.  It is critical in events like this, that your team is prepared to handle not only the event, but potential infection control issues.  Be sure to catch my webinar in June to see what you can do to be prepared!

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

There have been many questions posed recently regarding scope 
cabinets.  What design is best?  As our facility upgrades, what 
specifications would be critical design elements?
To this date, there has not been any updated guidance in either
SGNA, AORN, or CDC documents.  The CDC guideline for disinfection
and sterilization has the following recommendations: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html#r7


*Hang endoscopes in a vertical position to facilitate drying.


*Store endoscopes in a manner that will protect from damage

 or contamination.


*Develop protocols to ensure that users can readily identify 

an endoscope that has been properly processed and is ready

for patient use.


*Do not use the carrying case designed to transport clean and

reprocessed endoscopes outside of the healthcare environment

to store an endoscope or to transport the instrument within

the healthcare environment.

SGNA guidelines:  Standards of Infection Prevention in Reprocessing

*Endoscopes must be stored in an area that is clean, well-ventilated

and dust-free in order to keep the endoscopes dry and free

of microbial contamination.


*An endoscope that is not dry must be reprocessed before use.


*Endoscopes should hang freely so they are not damaged by

physical impact.


*Endoscppes should be stored in accordance with the endoscope

 and storage cabinet manufacturers' IFU.


*Endoscopes can be stored for 7 days.


*Use storage cabinets that are made of a material that can be disinfected.


*In conventional storage, hang endoscopes in a vertical position

(with caps, valves, and other detachable components removed)

to prevent moisture accumulation and subsequent microbial growth.


*For drying cabinets, follow the cabinet manufacturer's instructions.


*Reusable buttons and valves should be reprocessed and 

stored together with the endoscope as a unique set for 

tracking purposes.

SGNA gives additional guidance in the Standard of Infection

*Storage areas and other critical areas should be clearly labeled.


*Storage cabinets should have doors, and the interior of the

cabinets must be clean, free of debris, and dry.


*The route from the reprocessor machine to the storage to the

storage cabinet should not cross through the soiled processing area.


AORN guidelines add another layer for endoscope storage:

*Cabinets used for storage of flexible endoscopes should be

situated in a secure location.


*Cabinets should have doors and be located at 3 feet from any sink.


*Flexible endoscopes should be stored in accordance with

the endoscope and storage cabinet manufacturer's IFU.


*A drying cabinet should be used.


*If a drying cabinet is not available, flexible endoscopes may be

stored in a closed cabinet with HEPA-filtered air that provides

positive pressure and allows air circulation around the endoscopes.


*Flexible endoscopes should be stored in a cabinet that is eithe

designed and intended by the cabinet manufacturer for horizontal

storage of flexible endoscopes or of sufficient height, width and depth

to allow flexible endoscopes to hang vertically without cooling

and without touching the bottom of the cabinet.


*Flexible endoscopes should be stored with all valves open

and removable parts detached but stored with the endoscopes.


*Endoscopes should be clearly identifiable with distinct visual cue

as processed and ready to use.


*Personnel should wear clean, low-protein, powder-free, natural rubber

latex gloves or latex-free gloves when handling processed

flexible endoscopes and when transporting them to and from the

storage cabinet.


APIC recommendations are:


*When storing the endoscope, hang it in a vertical position to facilitate

drying ( with caps, valves and other detachable components

removed as per manufacturer instructions).


*Protect the endoscope from contamination.  Store the caps and other

equipment linked to the scope together after HLD to ease in look

back investigations when the HLD cannot be assured.

Manufacturer recommendations vary by manufacturer; however, one
has these types of statements:  


*After reprocessing, maintain appropriate transportation and storage

procedures to avoid contamination.


*Store in a cabinet which protects from physical damage.


*Do not store in direct sunlight, at high temperatures, in high humidity

or exposed to X-rays, ultraviolet rays, or ozone.


*Do not store with chemicals or in a gas-generating area.


*Do not coil.


*Make sure adjustable knobs are in the neutral position.


*All equipment must be thoroughly dried prior to storage.


*Keep cabinet doors closed; limit access to stored equipment.


*Store hanging vertically.


*Detach all accessories.

Therefore, you can see although there are some variables to storage conditions, most are in line with the others.  It will be important for your facility to review the manufacturer guidelines, the guideline that your facility follows and resolve any disparities.
Critter Craze
By Robin O. Novak, RN, CIC

Campylobacter Enteritis

Campylobacter jejuni and less commonly Campylobacter coli are the most common causative organisms for Campylobacter diarrhea.  Many may be familiar with this by another name, traveler's diarrhea.  The symptoms may last from several days to two weeks and include diarrhea (sometimes bloody), abdominal pain, fever, malaise, nausea and sometimes vomiting.  

In industrialized countries, campylobacter has the highest occurrence in males and children younger than five years of age.  Although, it can affect any age group and population.  In developing countries, the illness is limited to children younger than two.
  As outbreaks occur, a common source is rarely identified.  However, it is associated with unpasteurized milk, under-cooked poultry, and non-chlorinated water.  Most cases occur during the warmer months.  Are any of these situations or climates familiar?  With the summer months approaching, cook outs and swimming readily came to mind.
Are you familiar with the organism reservoirs?  Animals such as poultry, cattle, puppies, kittens, swine, sheep, rodents, birds and other pets are potential sources.  Are any of these in your environment?
The incubation period is usually 2 - 5 days and can range between 1-10 days.  Can you anticipate the mode of transmission?  Ingestion of undercooked poultry and unpasteurized milk.  Also, direct contact with infected animals and water contaminated with animal feces.  Interestingly, untreated infected persons may shed organisms for 2 - 7 weeks.  However, it is important to note there is limited evidence of person to person transmission.
How do we prevent this infection?  For obvious reasons containment begins at the source.  Prevention and control mechanisms will include 1) pasteurization of milk, 2) validation of appropriate cook for poultry, and 3) hand hygiene.  Especially during the warmer months, water from unreliable sources should be boiled before consuming.

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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