CDC Warns of Serious Adverse Events From Methanol-Based Hand Sanitizers

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The Centers for Disease Control and Prevention (CDC) has issued a health advisory concerning the potential for serious adverse health events associated with the use of methanol-based hand sanitizer products (sanitizers or rubs).

Most commercially available alcohol-based hand sanitizer products contain ethanol or isopropanol as active ingredients. In June, the U.S. Food and Drug Administration (FDA) advised consumers not to use any hand sanitizer manufactured by "Eskbiochem SA de CV" due to the potential presence of methanol as an active ingredient. Methanol, considered a "toxic alcohol," can cause blindness and/or death when absorbed through the skin or when swallowed. The FDA has since identified additional alcohol-based hand sanitizer products that contain methanol and is working on a voluntary recall of these products.

In the health advisory, CDC provided the following recommendations for clinicians and public health officials:

  1. Clinicians should advise patients to immediately seek medical treatment if they have been exposed to methanol-containing alcohol-based hand sanitizers on the "FDA's testing and manufacturer's recalls" list and are experiencing symptoms.

  2. Clinicians should have a high index of suspicion for methanol poisoning when a patient presents with a history of alcohol-based hand sanitizer product ingestion or repeated use of these products on the skin. Signs and symptoms include headache, blurred vision or blindness, nausea, vomiting, abdominal pain, loss of coordination, decreased level of consciousness, and laboratory findings (e.g., anion gap metabolic acidosis).

  3. Clinicians and public health practitioners should educate patients and the public to use alcohol-based hand sanitizer products only for hand hygiene.

  4. Clinicians and public health practitioners should educate patients and the public on the serious adverse health risks of ingesting alcohol-based hand sanitizer products.

  5. Clinicians and public health practitioners should educate patients and the public that some alcohol-based hand sanitizer products may contain a significant amount of methanol and using these products may result in the serious adverse health events noted above.

  6. Clinicians should contact the local poison center (800-222-1222) to report cases and to obtain specific medical management advice of methanol poisoning.

Infection Prevention Standards Challenge AAAHC-Accredited Facilities

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Infection prevention and safe injection practice standards are among those with high deficiency percentages for organizations accredited by the Accreditation Association for Ambulatory Health Care (AAAHC).

This is according to the 2020 AAAHC Quality Roadmap, the accreditor's annual review and analysis of AAAHC standards compliance. The 2020 report reflects data from nearly 1,500 surveys conducted against AAAHC's 2018 standards, which were applied in 2019. Surveyed organizations include Medicare deemed status ambulatory surgery centers (ASCs), office-based surgery practices, and primary care settings.

Medicare Deemed Status Ambulatory Surgery Centers

For the 360 Medicare deemed status ambulatory surgery centers included in the surveys, standards rated as deficient on at least 15% of the surveys were identified. The following infection prevention and safe injection practice standards met this parameter (with approximate % deficient included in parentheses):

  • 7.I.C.2 (27%) — The infection control and prevention program reduces the risk of healthcare-acquired infection as evidenced by education and active surveillance, consistent with: (2) Centers for Disease Control and Prevention (CDC) or other nationally recognized guidelines for safe injection practices.

  • 9.S (24%) — A safe environment for providing anesthesia services is ensured through the provision of adequate space, equipment, supplies, medications, and appropriately trained personnel. Written policies must be in place for safe use of injectables and single-use syringes and needles. All equipment should be maintained, tested, and inspected according to the manufacturer's specifications. A log is kept of regular preventive maintenance.

  • 11.J (22%) — The organization must have policies in place for safe use of injectables and single-use syringes and needles that, at minimum, include the CDC or comparable guidelines for safe injection practices. [416.51(a)]

  • 11.B.1 (18%) — Pharmaceutical services are provided in accordance with ethical and professional practice and applicable federal and state laws. [416.48(a)] (1) Drugs are prepared and administered according to established policies and acceptable standards of practice. [416.48(a)]

  • 7.I.C (17%) — The infection prevention and control program is under the direction of a designated and qualified healthcare professional with training and current competence in infection prevention and control.

  • 11.M (16%) — If look-alike or sound-alike medications are present, the organization identifies and maintains a current list of these medications, and actions to prevent errors are evident.

Office-Based Surgery Practices

For the 138 office-based surgery practices included in the surveys, standards rated as deficient on at least 10% of the surveys were identified. The following infection prevention and safe injection practice standards met this parameter (with approximate % deficient included in parentheses):

  • 7.II.E (14%) — All products, including medications, reagents, solutions, and supplies that have a manufacturer's printed expiration date are monitored and disposed of in compliance with facility policy and manufacturers' guidelines.

  • 11.F (10%) — Procedures are in place to prevent errors from look-alike, sound-alike and high-alert medications, if present.

  • 7.I.B (10%) — The written infection prevention and control program describes how infections and communicable diseases are prevented, identified, and managed.

  • 7.I.C (10%) — The infection prevention and control program is under the direction of a designated and qualified healthcare professional with training and current competence in infection prevention and control.

Primary Care Settings

For the 161 primary care organizations included in the surveys, standards rated as deficient on at least 10% of the surveys were identified. The following infection prevention and safe injection practice standards met this parameter (with approximate % deficient included in parentheses):

  • 7.II.E (14%) — All products, including medications, reagents, solutions, and supplies that have a manufacturer's printed expiration date are monitored and disposed of in compliance with facility policy and manufacturers' guidelines.

  • 7.I.C (11%) — The infection prevention and control program is under the direction of a designated and qualified healthcare professional with training and current competence in infection prevention and control.

Noel Adachi, president and CEO of AAAHC, states in a news release, "The AAAHC Standards focused on infection prevention and control have never been more important. Today, healthcare organizations need to be even more vigilant about adherence to these practices to promote employee and patient safety."

The 2020 report is available for free download after filling out a form here.

Infection Control Consulting Services (ICCS), a national infection control and prevention consulting firm, reports that its findings during onsite visits and review of written programs in the outpatient setting, including ambulatory surgery centers and outpatient clinics, are generally consistent with this report.

Patient and Staff Safety During COVID-19: Waiting and Break Room Tips

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As healthcare facilities are reopening, Infection Control Consulting Services is receiving questions from clients concerning recommended practices for waiting rooms and break rooms. Here we provide guidance for both areas.

8 Waiting Room Infection Prevention Tips

In the early stages of reopening, facilities were asking visitors to wait in their cars in facility parking areas as patients underwent procedures and receive treatment. Now that summer has arrived, facilities are concerned about asking visitors to wait in cars that will become hot and potentially unsafe.

If you are located in an area whereby visitors cannot go home and wait for your call after care is completed or are unable to go to an indoor place such as a coffee shop, mall, or restaurant, you may have no choice but to allow visitors in your waiting rooms.

Consider implementing the following in your waiting room:

1. No children allowed.

2. Only one visitor per patient. However, if there are extenuating circumstances, these tips are suggestions, not mandates. You will ultimately need to decide how many visitors to allow under such circumstances.

3. Patient is required to wear a face covering (preferably a medical mask, and if you have enough, you could provide one). Nobody is permitted to enter the facility without faces covered. If you will be providing the visitor with a mask, the patient should receive the mask from you and take it outside to the visitor before the visitor is permitted to enter.

4. When screening patients for symptoms and temperature, consider asking the visitor if he/she is feeling ill. You may want to do a quick thermal scan of the visitor to check for a temperature. You do not want anyone sitting in your facility who is not well. You may want to mention to the patient during the telephone screening that their accompanying visitor will be waiting in the facility, and will not be permitted if they are not feeling well. Also mention that if the visitor is staying, they need to wear a face covering before entering and for the duration of their visit.

5. Spatial separation including chair placement should include grouping two chairs together: one for patient waiting to be taken back, if you are not taking them back immediately upon arrival, and one for the visitor. If you are not having patients sit in the waiting room, single chairs are acceptable as long as they are at least 6 feet apart. For facilities with large waiting rooms, it is best to space chairs out further than 6 feet apart, if possible. Removing chairs from the waiting room to make space for separating chairs may be necessary.

6. Place alcohol hand sanitizer dispensers in the waiting room. The number of dispensers should depend upon how many people can be accommodated. As part of proper respiratory hygiene prior to COVID-19, you should have made tissues and trash cans available in the waiting room. However, people who are visibly ill, especially with runny noses or sneezing, should not be in the waiting room even if they are wearing a mask.

Surveyors will look for the tissues and trash cans. If you are concerned that tissues will be "stolen," you may need to keep them at the receptionist's desk and post notices in your waiting area about the availability of tissues at the desk.

7. Remove all reading material.

8. Assign staff to sanitize the room, particularly chairs, doorknobs, and other high-touch surfaces, and increase the amount of times they perform sanitizing. Each facility is different and will need to determine a feasible and appropriate rotation for disinfection.

6 Break Room Infection Prevention Tips

1. Depending on the size of your break room, you may want to stagger breaks and assign times to staff to take breaks, if possible, taking into consideration their assignment schedules. If your break room is very small, permit only one person in at a time.

2. In larger break rooms, keeping people 6 feet away from each other at a minimum and limiting the number of employees in the room at one time is advisable. Block off seats or remove chairs to encourage such practices.

3. Advise employees to do their best to socially distance themselves when masks are off for eating and drinking.

4. Encourage staff to keep their masks on until they are sitting down and ready to eat. Heating up food, going to the refrigerator, and moving around the break room for other various reasons before sitting down is best performed while wearing a mask. Staff should be advised to remove their masks as little as possible and for as short amount a time as possible.

5. Ask each employee to wipe down the space they came into contact with while in the break room, including the table and chair, upon completing their break. Provide wipes for this purpose.

6. If possible, keep the break room door open to allow for circulation of air, if safe to do so. Some facilities have their break room within visual range of patients or located in other areas that may not be desirable for an open door. The virus will not be pushed out of the room as the break room is not under positive pressure but allowing air in to circulate is a good idea.

Joint Commission Resuming Survey and Review Activities: Key Takeaways

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The Joint Commission recently announced it was resuming some survey and review activities beginning this month. Here are key takeaways:

  • Surveyors will work to conduct a thorough assessment that seeks to understand how organizations adapted to the health crisis and will review current practices to assure the provision of safe care in a safe environment.

  • Surveys will not retroactively review compliance.

  • An organization's emergency operations plan will not be the focus of this survey activity.

  • Low-risk organizations where surveyors can go in safely will be prioritized.

  • Organizations will be expected to provide masks and/or other personal protective equipment (PPE) to surveyors and reviewers during on-site visits.

  • Technology will be used to reduce the number of people required to sit next to one another for an extended time (e.g., conducting electronic medical record reviews using screensharing or projecting the record, simulating an activity if surveyors are unable to access a high-risk space, interviewing patients/staff by phone).

  • Organizations can ask to use audio and/or video conferencing if they want to expand their number of attendees participating in the process.

The Joint Commission is holding regular webinars to share updates on its survey and review activity plans. At least one or more members of the Infection Control Consulting Services (ICCS) team participants in these programs. Any significant updates issued by The Joint Commission and other accreditation agencies will be shared via the ICCS LinkedIn page. ICCS encourages facilities to reach out to their account executive to discuss survey schedules and upcoming visits, if applicable.

CMS Increases Infection Control Noncompliance Penalties for Nursing Homes

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The Centers for Medicare & Medicaid Services has announced it is increasing the civil penalties for nursing homes that fail to comply with infection control requirements.

The federal agency stated it was enhancing enforcement for facilities with persistent infection control violations and imposing enforcement actions on lower level infection control deficiencies to help ensure they are addressed with greater urgency.

CMS also announced it has implemented a new COVID-19 reporting requirement for nursing homes. Furthermore, the agency is partnering with CDC's federal disease surveillance system to quickly identify problem areas and inform future infection control actions.

The announcement from CMS included several other developments, including the tying of some Coronavirus Aid, Relief and Economic Security (CARES) Act funding to state completion of focused infection control nursing home surveys, requiring states to implement revised and expanded survey activities, and refocusing the approach of quality improvement organizations (QIO) to assist in combating COVID-19 within nursing homes.

These changes took effect when they were issued on June 1.

The announcement from CMS comes following the release of U.S. government data showing that nearly 26,000 nursing home residents have died from COVID-19 and more than 60,000 have fallen ill.