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Broad Street Solutions
James Marx, RN, MS, CIC Editor
P.O. Box 16557
San Diego, CA 92176
(619)563-0274 Voice/FAX
jmarx@concentric.net
Due to the increasing demands for newsletter subscriptions, a fee for this newsletter will begin in January 1998. This fee will only apply to subscribers who are not currently clients of Broad Street Solutions. The annual subscription fee of $24.00 will begin with January 1998 issue. Participants of the Infection Control School for Long Term Care Nurses can receive the first year's subsciption for half the annual fee if they subscribe during the class. A subscription form is now available.
Low level disinfection can be accompished by several methods. In the healthcare environment , we frequently use 70-90% isopropyl alcohol, dilute chlorine (1:500), phenolic detergent, iodophor detergent or quaternary ammonium detergent solution, with 10 or less minute of exposure. Low level disinfection kills vegetative bacteria (e.g. staphylococcus), most fungi and most viruses (e.g. HBV and HIV).
While the housekeeping department in most skilled facilities clean the resident's room, little attention is paid to the bedside items that the resident uses on a daily basis. These items include the wash basin, the bedpan, and the urinal. The sink and the toilet are cleaned daily, but how often is the bedpan disinfected? If these items are not disinfected on a regular basis, they can serve as a reservior of infection.
In order to use a disinfectant properly you need to read the Directions for Use, usually found on the product label. First see that the solution kills bacteria, viruses and fungi. It does not have to be tuberculocidal. Next, look to see if the item needs to be be pre-cleaned before using the disinfectant. If you are using a disinfectant detergent, pre-cleaning is not necessary. Then insure that the disinfectant is diluted properly. Sometimes adjustments are made for areas of the country with hard water. Finally, be sure the disinfectant remains on the surface for the recommended amout of time, usually 10 minutes. This last step is accomplished by allowing the surface to air dry.
To accomplish regular cleaning of bedside items, someone needs to be assigned the responsibility of keeping the items clean. One suggested method is to have the housekeeper or nursing assistant exchange the items daily, such as they already do with water pitchers and glasses.
For a complete Guideline to the Selection and Use of Disinfectants, order it (reprint, 8/96, American Journal of Infection Control) from the APIC National office. The cost is $15 for memebers and $20 for non-members. Call 202-296-2742, or fax you request with credit card number to 202-296-5645. Be sure to include you mailing address and phone number.
The Agency for Health Care Policy and Research (AHCPR) recently published a guideline for assessing pneumonia in the elderly. This guidleine was intended for use outside the hospital, and can be applied to the extended care facility setting.
The clinical prediction model identifies risk factors for developing pneunomia. About 600,000 Americans are hospitalized for commuity acquired pneumonia each year, This includes those transfered from an extended care facility.
The risk factors include:
Currently, Broad Street Solutions is preparing a risk assessment tool to be used in conjunction with the Minimum Data Set (MDS) information already collected on the residents. This risk assessment tool is expected to be ready by the Spring of 1998.