INFECTION CONTROL NEWSLETTER

Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619)656-7887 Voice/FAX
jmarx@concentric.net

• Include vaccination orders in the physician's orders. Establish admission orders to vaccine all new admissions for influenza. Include vaccination for all current residents during the month of October
• Promote influenza and pneumococcal vaccines. Include paycheck stuffers, bulletin board notices.
• The one-time pneumococcal vaccine can be given at any time during the year.
• Designate staff to sustain vaccination systems. Include vaccination activities as part of the CQI process. Provide staff inservice education on the benefits of vaccination and dispel the myths.
• Establish a vaccination goal, such as >90% of the residents and >80% of the staff will be vaccinated by December 1, 1998.
• Talk to family and residents about the benefits of vaccination. Speak at the Resident and Family Council about the importance of vaccination.

Influenza is solely a respiratory disease. It does not cause gastrointestinal problems. The hallmarks of true influenza are sudden onset of fever accompanied with dry cough, chills, headache, myalgia, malaise, loss of appetite, and sore throat. The influenza vaccine can not cause influenza. The vaccine is made of an inactivated virus.

The following hints about the administration of the influenza vaccine will help you from wasting valuable staff time.

• You have the option of either a physician's order OR the resident/family consent. If you use vaccine provided by the State of California, this is clearly stated on the Agreement letter you get when you apply for vaccine. Check with your local immunization program for more details.
• Use FREE promotional materials. Call California Medical Review, Inc. for information 877-363-5555.
• Limit post-vaccination vital signs to 6 hours after the vaccine is given. Read the vaccine insert which states that adverse reactions will occur with 6 hours of vaccine administration. Taking vital signs after that period increases work for the staff. In addition, a fever after that period may indicate a true infection, such as urosepsis or pneumonia.

Other Facts:

Influenza and Pneumococal vaccine can be given at the same time. They must be given at different sites.

Most common side effects last 1-2 days and are: soreness, redness or swelling at the injection site; fever; aches.

The vaccine is protective 1-2 weeks after administration and lasts up to one year.

The U.S. influenza season lasts from Decem- ber to April. The influenza strains

Infection surveillance programs usually include definitions of infection. This is a list of signs/ symptoms associated with infection. This should be used as the sole criteria when counting infections as facility acquired. While counting residents on antibiotics is easier, it is a poor surveillance method.

Improving your case finding-
If you rely on the licensed staff to complete a line list of residents with infections, you know the lists are inaccurate and incomplete. If you want a list of residents on antibiotics, ask the pharmacy. Case finding requires you to collect or delegate collection of data. The following sources are suggested:

- Change of condition or 24 hour log
- Telephone order sheets
- Laboratory specimen log book
- Temperature logs
- Weight logs

Don't forget to check the transfer/discharge list for residents who may have been transferred out of the facility due to infection (sepsis or pneumonia). Plus review any expirations for possible infections associated with the death.

Finally, include the culture summary report provided by your laboratory. Note unusual organisms, such as MRSA or VRE. Be sure you know how to properly identify these organisms. MRSA is a coagulase positive Staphylococcus resistant to oxacillin. It is also resistant to all cephalosporins (Keflex, Ancef) despite how the sensitivities are reported. VRE is Enterococcus feacium or faecalis which is resistant to Vancomycin. Make sure your laboratory reports the species, not just Enterococcus.

Future Trends-
As the JCAHO begins collecting data on nosocomial infections through the ORYX System, there may be a way to develop a benchmarks for long term care facilities. Until then, you must rely on your facility's historical data to make infection rate comparisons.