Dentist Infection Control

Infection Control Consulting Services Blog


Research Shows Bronchoscope Cleaning Remains Challenging

An article in Infection Control Today discusses the difficulty organizations face in eliminating potentially harmful contaminants from used bronchoscopes.

Author Kelly Pyrek analyzes research on the cleaning and disinfection of bronchoscopes and shares insight presented by a prominent researcher on the topic at the most recent Association of Professionals in Infection Control and Epidemiology (APIC) annual meeting.

A few key takeaways are as follows:
  • Several years ago, numerous infections were associated with contaminated bronchoscopes in a short period. 
  • At the time, the Food and Drug Administration (FDA) issued a safety communication about microbial transmission and infection associated with bronchoscopes. The agency urged adherence to sterile processing guidelines, noting that inadequate cleaning could lead to failure of high-level disinfection (HLD) or sterilization. 
  • FDA also advised that bronchoscopes with signs of damage be repaired or replaced.
  • Research published earlier this year detailed the work of researchers examining 24 used bronchoscopes that underwent reprocessing in accordance with institutional practices. After manual cleaning, the researchers reported that all bronchoscopes had residual contamination. Protein was detected in samples from all bronchoscopes post-manual cleaning and post-HLD. Microbial growth was found in 58% of fully reprocessed bronchoscopes.
  • Visible irregularities (e.g., retained fluid, scratches, damaged insertion tubes and distal ends) were observed in all bronchoscopes.
  • The researchers wrote the following: "Inadequate reprocessing practices may have contributed to bioburden found on bronchoscopes. However, even when guidelines were followed, HLD was not effective. A shift toward the use of sterilized bronchoscopes is recommended. In the meantime, quality management programs and updated reprocessing guidelines are needed."
Pyrek's article takes a deep dive into this challenging matter and offers some valuable guidance on what organizations should do to improve compliance and reduce infection risks. Access the article by clicking here.

For additional insight, read the ICCS blog on Bronchoscopes: A Risk for Infection?, which discusses the FDA's safety communication and a Centers for Disease Control and Prevention (CDC) Health Advisory issued around the same time concerning reprocessing practices. The blog also shares FDA recommended precautions for facilities reprocessing flexible bronchoscopes.


CDC Free CE Webinar Focuses on Outpatient Oncology Infectious Outbreaks (August 9)

The Centers for Disease Control and Prevention (CDC) is hosting a free continuing education (CE) webinar to discuss infectious outbreaks in outpatient oncology settings linked to breaches in safe injection practices and sterile compounding standards.

The program, scheduled for Thursday, Aug. 9, 2018, from noon - 1:00 PM EDT, will also discuss key considerations for safe handling of sterile medications during compounding and administration.

Titled "Outbreaks in Outpatient Oncology Settings: Lessons Learned and Key Considerations for Handling Sterile Medications," the webinar's objectives are as follows:
  • Identify unsafe injection and compounding practices that have been linked to healthcare-associated infection (HAI) outbreaks in outpatient oncology and other clinic settings.
  • Identify the minimum standards for safe injection practices and when standards for sterile compounding are applicable.
  • Describe the importance of early recognition and notification of potential HAI outbreaks to public health authorities.
Scheduled speakers are as follows:
  • Nadine Shehab, PharmD, MPH, senior scientist, Division of Healthcare Quality Promotion, CDC
  • Joseph Coyne, RPh, director of field operations, Clinical IQ
  • Martha Polovich, PhD, RN, AOCN, assistant professor, College of Nursing and Health Professions, Georgia State University
  • Lisa Richardson, MD, MPH, director, Division of Cancer Prevention and Control, CDC
The webinar is accredited for CME, CNE, CECH, CPE and CPH.

Register for this oncology infection prevention program by clicking here. Pre-registration is available until the start of the webinar.


Study: Multidrug-Resistant Bacterium Shows Increasing Tolerance to Handwash Alcohols

A study indicates that a multidrug-resistant bacterium has shown increasing tolerance to the alcohols used in handwash disinfectants.

Researchers analyzed 139 bacterial samples of Enterococcus faecium from two Australian hospitals over 19 years. They found that after 2010, the samples were 10-fold more tolerant to killing by alcohol than the older isolates, suggesting that E. faecium could be adapting to the alcohol-based hand rubs (ABHR).

The researchers believe their findings, published in Science Translational Medicine, may provide an explanation for an increase in healthcare-associated infections caused by the bacterium. An NPR report notes that enterococcal infections, which are caused by bacteria that affect the digestive tract, bladder, heart and other parts of the body, started increasing globally as hand sanitizers grew in popularity.

As the researchers state, "These findings suggest that bacterial adaptation is complicating infection control recommendations, necessitating additional procedures to prevent E. faecium from spreading in hospital settings."

As with any single or preliminary study, healthcare providers should exercise caution when making decisions based on early findings until strong evidence consistently points to a possible need for change in practice. Whilst this study shows increasing resistance of ABHR by multi-drug resistant bacteria, healthcare providers should continue to strive for prevention of infections through all means possible. Healthcare organizations across the continuum of care should continue to use hand rubs and other alcohol-based disinfectants as part of their infection prevention programs.


FDA Publishes Infection Control Guidance for Dental Unit Waterlines

The U.S. Food & Drug Administration (FDA) has published a new webpage discussing the importance of infection control in dental unit waterlines and offering guidance to prevent infection, according to a California Dental Association report.

As the webpage notes, while dental unit waterlines typically cannot be sterilized, they should be regularly cleaned and disinfected. Proper cleaning and disinfection can help prevent the collecting of waterborne microorganisms in the dental unit waterline, which can form a biofilm. If dislodged, this biofilm can enter the water stream.

Contaminated dental unit waterlines present a patient infection risk, particularly during surgical procedures by direct exposure of waterborne pathogens. Dental professionals are also at risk due to inhalation of aerosols.

FDA provides a series of tips, dos and don'ts for dental practitioners, including the following:

  • Establish written standard operating procedures to guide dental personnel in performing infection control procedures for dental unit waterlines.
  • Implement use of equipment and procedures such as separate reservoirs, chemical treatment protocols, use of filtration systems and sterile water delivery systems.
  • Discharge water and air lines for a minimum of 20-30 seconds after each patient to physically flush out patient material that might have entered the dental water system during treatment.
  • Watch for signs that may indicate biofilm formation and clogging of lines.
  • For surgical procedures, use sterile irrigating solutions. Use appropriate delivery devices to deliver sterile irrigating solutions during surgery. 
  • Follow recommended service life and maintenance of the dental operative unit and its components and accessories.
  • Follow the manufacturer's instructions to clean and disinfect the dental unit at recommended intervals.
  • Do not attach dental handpieces or dental instruments to dental unit waterlines that have not been cleaned or disinfected per the manufacturer's instructions.
FDA also provides several recommendations for dental unit waterline manufacturers.

Access the FDA webpage on dental unit waterlines.

If your dental office or oral surgery center needs infection control services, contact the experts at Infection Control Consulting Services. These experienced, knowledgeable dental infection control advisors can provide your facility with a wide range of services, including the development of a comprehensive written dental infection prevention plan, on-site assessments and staff education.


CDC Offers Free Antibiotic Stewardship Continuing Education

The Centers for Disease Control and Prevention (CDC) has launched the second of a four-part web-based training course about antibiotic stewardship and is offering free continuing education credits (CEs) for participants.

Section 2 is broken down into four modules. Topics covered include the following:

  • Background and errors in outpatient antibiotic use in the United States.
  • Inappropriate antibiotic use and opportunities for improvement.
  • The Core Elements of Outpatient Antibiotic Stewardship.
  • Communication training to improve clinician-patient communication about appropriate antibiotic use.
Section 1 was released in February and was comprised of three modules, which includes information on the following:

  • Antibiotic resistance and threats and a detailed explanation of the benefits of antibiotic stewardship. 
  • Risks and benefits of antibiotics, with a focus on the microbiome, adverse drug events and Clostridium difficile infections. 
  • How clinicians can better optimize patient care by integrating antibiotic stewardship program activities into outpatient care. 
Sections 3 and 4 will be released later this year.

Overall course objectives include the following:
  • Optimizing antibiotic prescribing and use to protect patients and combat the threat of antibiotic resistance.
  • Informing healthcare professionals about proper antibiotic prescribing.
  • Encouraging open discussion among physicians and patients.
While this particular course is primarily for clinicians who prescribe antibiotics, physicians, nurse practitioners, physician assistants, certified health education specialists, nurses, pharmacists and public health practitioners with a master's degree in public health are all eligible to receive up to eight hours of free CE.

To learn more about the CDC's Antibiotic Stewardship Training Series and the different types of CEs available, click here.


CDC Funds Dialysis Bloodstream Infection Research Led By American Society of Nephrology

The American Society of Nephrology (ASN) has announced that its Nephrologists Transforming Dialysis Safety (NTDS) initiative has received a contract from the Centers for Disease Control and Prevention (CDC) to study barriers to implementation of recommended practices intended to help reduce dialysis-related infections.

NTDS will partner with researchers from Virginia Polytechnic Institute and State University to focus on the following four areas of patient safety:

  1. central venous catheter access and care; 
  2. dialysis station disinfection; 
  3. hand hygiene; and 
  4. injection safety.
Human factors researchers will observe six diverse dialysis facilities beginning this summer, targeting a conclusion in July 2019.

The CDC contract will fund work that expands NTDS's current infection prevention efforts. In 2016, CDC awarded ASN a three-year contract to spearhead the NTDS project, which was launched to help prevention infection in dialysis facilities.


Study: High Hospital Occupancy Not Linked to Higher Patient Infection Risk

The surprising results of a new study indicate that there is no correlation between increased risk of hospital-acquired infection and increased hospital occupancy.

Researchers analyzed more than 558,000 patient discharges from 327 acute care hospitals in California between 2008–2012. They specifically examined data on patients who had contracted a Clostridium difficile infection (CDI), of which there were a little over 2,000. 

The researchers found that patients were most likely to acquire CDI when inpatient occupancy was between 25% and 75% full. In fact, when patients were admitted to a unit with between 25% and 75% capacity, they had an over three-fold increase in odds of acquiring CDI when compared to patients in units at below 25% or above 75% capacity.

As the researchers note, "These findings suggest that an exploration of the processes associated with hospitals accommodating higher occupancy might elucidate measures to reduce CDI. How do staffing, implementation of policies and routine procedures vary when hospitals are busy or quiet? What aspects of care delivery that function well during high and low occupancy periods breakdown during intermediate occupancy? Hospital policies, practices and procedures during different phases of occupancy might inform best practices."

They continue, "These data suggest that hospital occupancy level should be a routinely collected data element by infection control officers and that this should be linked with protocols triggered or modified with high or low occupancy that might affect hospital-acquired conditions."

The study was conducted by the University of Michigan and RAND Corp. and published in the Journal of Hospital Medicine.