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Robin Novak, RN, CIC
Director of Infection Prevention

636.875.5088 ext. 101
This Month's Training Opportunities

Measures Used to Evaluate a Compounding Pharmacy 

Emergency Preparedness Rule / Emergency Operations Plan

Over 70 Infection Prevention
 topics/presentations available in our library.
Volume 1, Number 11
September 2017

Hurricane Harvey
            My prayers go out to those impacted by Hurricane Harvey.  The images of the devastation and the pictures being sent to me from family is beyond what I can imagine.  Their lives have been turned upside down and rebuilding will not occur overnight. 

When natural disasters happen, we must keep in mind basic infection prevention principles.  Since the areas hit by Hurricane Harvey are experiencing flooding, let's focus on some of the key points.  I am only giving a brief re-cap of CDC recommendations.  I encourage you to seek additional guidance https://www.cdc.gov/disasters/floods/sanitation.html .  These will be for immediate home environment.
  • Waters may/will be contaminated with everything from litter to raw sewage.  Try to stay out of the waters. 
  • Hand hygiene is a must with clean water and soap.  If the tap water is not safe to use, use boiled or disinfected water.  This will be the best way to reduce the number of germs on your hands.
  • If soap and water is not available, alcohol based hand sanitizer with at least 60% alcohol can help some.  They will NOT eliminate all germs.  Hand sanitizers are not effective when hands are visibly soiled.
  • Bathing should only be done with clean, safe water
  • Brushing teeth should only be done with clean, safe water
  • Wounds should be kept clean and covered.  Keep them as clean as possible by washing with soap and clean, safe water.
  • Once waters have receded and you have returned to your homes and work places, surfaces must be cleaned.  First things to remember is this will be a TWO-STEP process. 
    • Wash surfaces with soap and warm water to remove dirt and debris.
    • Next, sanitize surfaces with use of household bleach.  (follow manufacturer instructions for use).  Wear rubber or non-porous boots, gloves and eye protection.
For those responsible and tasked with the clean up in their ASC, there will be additional considerations before patient care can resume.  Excellentia can assist in the evaluating damages and determining solutions.

Here are some key thoughts for impacted ASC's:
  • Risk of mold:  anytime water has invaded a structure, there is a concern of mold development. With the temperatures in Texas this will be an even greater risk.  A professional water/ mold remediation company is the best option.  Ideally, someone that is familiar with healthcare environments would be optimal.
  • Risk of interrupted water supply:  not only may the supply be interrupted, but it may be contaminated.  It will need to be evaluated and found safe before running autoclaves or any equipment which uses water
  • Risk of Electrical failure:  If water has invaded your structure, the electrical system should be professionally evaluated to validate there is no damage.
  • Anything from walls, flooring, furniture, wood etc., that has been wet beyond 48 hours must be removed. 
    • Wallboard will need to be cut away at least 12 inches above the water line to confirm there is no mold.
    • Flooring will need to be closely evaluated.  Adhesives that have been exposed to water for extended periods of time will loosen.  These areas will need to be removed and the sub-floor examined for further deterioration
    • Furniture, based boards, cabinetry, bookshelves, etc.  that is made of wood are best to be replaced.  If legs are made of metal or plastic, disinfection will need to occur using a bleach solution.
  • Surfaces:  once waters have receded, all surfaces will need to be cleaned and disinfected using a bleach solution.  The invading waters were likely contaminated with fecal material and chemicals.
  • HVAC:  look at your air duct systems.  If water invaded those areas, they will need to be dried and disinfected
  • Equipment:  check with manufacturers before proceeding with clean up.  Have the professional technicians come out and service these and to validate proper functioning.
  • PPE's.  even if you are only there to assess the situation, please wear appropriate PPE's to protect yourself.  If you are the one performing wet vacuuming and cleaning at minimum wear gown, gloves and mask.
  • Documentation:  Do a risk assessment.  Document every step that is taken, phone calls made, resources utilized include dates, times, names etc.  Document everything you have done to protect staff, patients and visitors.  When everything is said and done, write a formal summary of activities, actions and evaluation.  Include what went well, what could use some fine tuning.  Use this as a just in time training and drill for your teams.
Remember, if you are unsure, reach out to your resources.

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.
Antimicrobial Stewardship
Did you hear?  Missouri became the first state to require ASC's to have an antimicrobial stewardship program, effective 8/28/17.  Although the guidance is limited as to components of the program, the groundwork is being laid.

How are you preparing for the inevitable implementation in your state?  Have you initiated efforts to monitor antibiotic administration?  Do you have a formal team?  In addition to our educational on-demand webinar regarding antibiotic stewardship, Excellentia can assist in developing your program.  You can reach us at 636-875-5088. Robin ext 101.

Subscriber Question &  My Answer
The Question: 
We are having a discussion in our GI lab regarding suction canister content disposal.   Can we pour the contents untreated into the sewage system?
  • Per Bloodborne Pathogens Standard, liquid waste that contains visible blood or other potentially infectious materials as defined in the Standard, are considered biohazardous waste. Liquid waste suctioned into canisters that does not contain blood or OPIM can be discarded in a toilet or clinical sink (hopper), the canister rinsed and placed in the regular trash. For canisters with bloody liquids, it's probably safer to use a solidifier disinfectant, then place in the regular trash. 

    There is no evidence that trash causes disease- there is no science behind segregating waste, but it's the law.  
  • If use solidifier, then place into regular trash. 
    • READ the instructions!!  
    •  Solidifier is sold in various quantities to treat 1000, 1500 or 3000 cc of fluid.  Make sure you are using the correct ratio of solidifier to fluid. 
    • Some MIFU specify to add it first to an empty canister, others, you add it last.  Then, dispose in regular trash.  

Critter Craze
By Robin O. Novak, RN, CIC
Who am I? -
  • Gram positive cocci in grapelike clusters
  • I cause common bacterial skin infections such as impetigo, abscesses, and infected wounds.
  • I can lead to pneumonia, endocarditis and sepsis
  • I can be community or healthcare acquired
  • Disease can occur sporadically, and as small epidemics in sports teams, summer camps, and families
  • Reservoir = human however cases are increasing in farm pigs, horses and companion animals.
  • Incubation period= variable
  • Major site of colonization is nasal passages
  • Transmission is through contact.  Hands are the important instrument for transmission.  Contaminated equipment can also be a transmission route
  • Hand hygiene is vital for prevention
  • Considered a Category B for bioterrorist agent
  • I can be resistant to multiple antibiotics
Email Robin at robin@excellentiagroup.com with your response.  You will receive a personalized reply with validation of the correct answer.
Word on the Street
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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