Sepsis Awareness Month Shines Spotlight on Infection Complication That Kills Thousands

September is Sepsis Awareness Month, which provides an opportunity to share some information and best practices concerning this life-threatening condition.

Sepsis occurs when an infection triggers a chain reaction in a patient's body, resulting in tissue damage, organ failure and even death. The Centers for Disease Control and Prevention (CDC) reports that more than 1.7 million people develop sepsis every year, with about 270,000 Americans dying from it. One in three patients who die in a hospital have sepsis, CDC states.

Some key facts to know about sepsis:

• Almost any infection can lead to sepsis. Certain people are at higher risk: adults 65 or older, people with chronic medical conditions (e.g., diabetes, lung disease, cancer, kidney disease), people with weakened immune systems and children younger than one.

• The most frequently identified pathogens that cause infections turning into sepsis include Staphylococcus aureus, Escherichia coli and some types of Streptococcus.

• The four types of infections most often linked with sepsis: infections of the lungs, urinary track, skin and gut.

• To help patients avoid sepsis, healthcare professionals should follow best practices, including practicing good hand hygiene and proper catheter removal.

• Signs to watch for that may indicate an infection has developed into sepsis include confusion or disorientation; shortness of breath; high heart rate; fever, shivering and/or feeling very cold; extreme pain or discomfort; and clammy or sweaty skin.

• Healthcare professionals need to know their facilities' guidelines for diagnosing and managing sepsis. Any delays in recognition and treatment can cause significant harm.

Here are a few, free resources from the CDC that can help you raise awareness of sepsis:

• Protect Your Patients from Sepsis: Infographic

• Protect Your Patients from Sepsis: Poster

• Protect Your Patients from Sepsis: Fact Sheet

• Stay Healthy. Protect Yourself from Sepsis (patient poster)

Learn more about Sepsis Awareness Month.

Joint Commission Infection Control Standards Challenge Home Care Providers, Nursing Care Centers

As we recently reported, ambulatory healthcare organizations and office-based surgery practices accredited by The Joint Commission have struggled mightily to comply with some infection control standards. This is apparent from The Joint Commission's release of its most challenging requirements for the first half of 2019.

These organizations are not alone. Home care providers and nursing care centers also had infection control requirements identified most frequently as "not compliant" during Joint Commission surveys and reviews from January through June.

For home care providers, IC.02.01.01 (The organization implements the infection prevention and control activities it has planned.) had the second highest non-compliance percentage at 43%. It only trailed PC.01.03.01 (The organization plans the patient's care.), which had a reported 58% non-compliance.

For nursing care centers, IC.02.01.01 (The organization implements its infection prevention and control plan.) came in third at 29% non-compliance. It only trailed HR.02.01.04 (The organization permits licensed independent practitioners to provide care, treatment and services.) at 36% and MM.03.01.01 (The organization safely stores medications.) at 30% non-compliance.

If your organization requires assistance with CMS and/or accreditation survey preparation, call on the expert consultants at Infection Control Consulting Services (ICCS). If your organization recently underwent a survey that revealed deficiencies, contact ICCS to learn about our services for developing a plan of correction.

Study: Surgical Masks Match Respirators for Respiratory Virus Protection

The results of a new study indicate that surgical masks are as effective as respirator-type masks in protecting healthcare workers from influenza and other respiratory viruses.

The randomized clinical trial involving more than 2,800 healthcare personnel at 137 outpatient sites compared the use of surgical/medical masks to N95 respirators.

The results, which were published in JAMA, revealed no significant difference in the incidence of laboratory-confirmed flu between the pieces of protection.

Dr. Trish Perl, chief of the Division of Infectious Diseases and Geographic Medicine at UT Southwestern Medical Center and the report's senior author stated in a news release, "This finding is important from a public policy standpoint because it informs about what should be recommended and what kind of protective apparel should be kept available for outbreaks.”

Furthermore, as the news release noted, the mask only costs about a dime while N95 costs around $1. 

The study was performed at multiple medical settings in several U.S. cities, including Houston, Denver, Washington and New York. Participating researchers came from the University of Texas, the Centers for Disease Control and Prevention (CDC), Johns Hopkins University, the University of Colorado, Children's Hospital Colorado, the University of Massachusetts, the University of Florida and several Department of Veterans Affairs hospitals.

Researchers collected data during four flu seasons between 2011 and 2015.

Outpatient Facilities Struggling With Joint Commission Infection Control Standards

The Joint Commission has released its top 10 challenging standards through the first half of 2019 for accredited ambulatory healthcare organizations and office-based surgery practices. High on both lists are multiple infection control standards.

These are requirements identified most frequently as "not compliant" during surveys and reviews from January through June.

For ambulatory healthcare organizations, infection control standards take two of the top three spots on the list. IC.02.02.01 (The organization reduces the risk of infections associated with medical equipment, devices and supplies.) is first with a reported 60% non-compliance. Coming in third is IC.02.01.01 (The organization implements infection prevention and control activities.) with 52% non-compliance.).

The non-infection control standard rounding out the top three is LS 03.01.35 (The organization provides and maintains equipment for extinguishing fires.), which came in second with a reported 56% non-compliance.

The same infection control standards in the top three for ambulatory healthcare organizations are in the top three most challenging for office-based surgery practices. IC.02.02.01 is second with a reported 56% non-compliance. Coming in third is IC.02.01.01 with 30% non-compliance.

HR.02.01.03 (The organization grants initial, renewed, or revised clinical privileges to individuals who are permitted by law and the organization to practice independently.) took the first spot with 61% non-compliance.

Two other infection control standards appear on the office-based surgery practices list and are tied with several other standards as the sixth most challenging with a reported 22% non-compliance: IC.01.03.01 (The organization identifies infection risks based on the following: Its geographic location, community and population served.) and IC.02.04.01 (The organization facilitates staff receiving the influenza vaccination.).

It comes as no surprise to see infection control standards proving difficult for outpatient organizations. These requirements were also some of the most challenging from 2018 and reflect ongoing observations made by ICCS infection control consultants during on-site visits.

FDA: Facilities Should Transition to Duodenoscopes With Disposable Parts

The U.S. Food and Drug Administration (FDA) has issued a safety communication advising hospitals and endoscopy facilities to transition away from fixed endcap duodenoscopes and begin using duodenoscopes with disposable components that help with or even eliminate the need for reprocessing.

In the communication, the FDA states it believes the most effective solution to reducing the risk of disease transmission by duodenoscopes is through "innovative device designs that make reprocessing easier, more effective or unnecessary." 

As an example, FDA highlights duodenoscopes that incorporate disposable components. Such components, FDA states, can "facilitate cleaning, reduce contamination and reduce disease transmission following reprocessing. Disposable designs may reduce between-patient duodenoscope contamination by half as compared to reusable, or fixed, endcaps."

To date, FDA has cleared two duodenoscopes with disposable endcaps that facilitate reprocessing: Fujifilm's duodenoscope model ED-580XT and Pentax Medical's duodenoscope model ED34-i10T.

FDA shared the following recommendations for hospitals and endoscopy facilities:

• Use duodenoscopes that have disposable components, if available.

• Ensure staff always follow reprocessing instructions.

• Institute a quality control program that includes sampling, microbiological culturing and other monitoring methods.

• Consider reprocessing with supplemental measures, such as sterilization or use of a liquid chemical sterilant processing system consistent with the device's labeling.

• Monitor reprocessing procedures.

• Develop schedules for routine inspection and periodic maintenance in accordance with duodenoscope manufacturer's instructions.

FDA acknowledged that transitioning to newer duodenoscope designs will take time due to cost and market availability challenges, stating, "We encourage healthcare facilities purchasing new duodenoscopes to begin developing a transition plan and work to replace their conventional duodenoscopes with newer models."

In the meantime, FDA noted it is encouraging and working with manufacturers to increase supply of disposable cap duodenoscopes and develop new designs that can further minimize or eliminate patient infection risk.

The safety communication comes just a few weeks after a New York Times article examined the difficulty providers face in properly sterilizing duodenoscopes. The article prompted multiple gastroenterology societies to issue a joint statement challenging points in the piece.