170. Reduction in Bloodborne Pathogen Splash Exposures After Implementation of Universal Masking and Eye Protection for COVID-19

Abstract Background While splashes to the eyes, nose and mouth can often be prevented through appropriate personal protective equipment (PPE) use, they continue to occur frequently when PPE is not used consistently. Due to the COVID-19 pandemic, we implemented universal masking and eye protection for all healthcare personnel (HCP) performing direct patient care and observed a subsequent decline in bloodborne pathogen (BBP) splash exposures. Methods Our healthcare system, employing >12,000 healthcare personnel (HCP), implemented universal masking in April 2020 and eye protection in June 2020. We required HCP to mask at all times, and use a face shield, safety glasses or goggles when providing direct patient care. Occupational Safety tracked all BBP exposures due to splashes to the eyes, nose, mouth and/or face, and compared exposures during 2020 to those in 2019. We estimated costs, including patient and HCP testing, related to splash exposures, as well as the additional cost of PPE incurred. Results In 2019, HCP reported 90 splashes, of which 57 (63%) were to the eyes. In 2020, splashes decreased by 54% to 47 (36 [77%] to eyes). In both years, nurses were the most commonly affected HCP type (62% and 72%, respectively, of all exposures). Physicians (including residents) had the greatest decrease in 2020 (10 vs. 1 splash exposures [90%]), while nurses had a 39% decrease (56 vs. 34 exposures). Nearly all of the most common scenarios leading to splash exposures declined in 2020 (Table). We estimated the cost of each BBP exposure as &2,940; this equates to a savings of &123,228. During 2020, we purchased 65,650 face shields, safety glasses and goggles (compared to 5303 similar items in 2019), for an additional cost of &238,440. Specific activities identified as leading to bloodborne pathogen splash exposures, 2019 vs. 2020. Conclusion We observed a significant decline in splash-related BBP exposures after implementing universal masking and eye protection for the COVID-19 pandemic. While cost savings were not observed, we were unable to incorporate the avoided pain and emotional trauma for the patient, exposed HCP, and coworkers. This unintended but positive consequence of the COVID-19 pandemic exemplifies the need for broader use of PPE, particularly masks and eyewear, for all patient care scenarios where splashes may occur. Disclosures All Authors: No reported disclosures

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Assessment of a Mandatory Tetanus, Diphtheria, and Pertussis Vaccination Requirement on Vaccine Uptake over Time

Infection Control and Hospital Epidemiology ◽

10.1086/663337 ◽

2012 ◽

Vol 33 (1) ◽

pp. 81-83 ◽

Cited By ~ 13

Author(s):

David J. Weber ◽

Stephanie A. Consoli ◽

Emily Sickbert-Bennett ◽

William A. Rutala

Keyword(s):

Patient Care ◽

Infect Control Hosp ◽

Vaccine Uptake ◽

University Hospital ◽

Healthcare Personnel ◽

Direct Patient Care ◽

Tdap Vaccine ◽

Newly Hired ◽

Termination Date ◽

Over Time

Tetanus, diphtheria, and pertussis (Tdap) vaccine is recommended for all healthcare personnel who provide direct patient care unless medically contraindicated. Our university hospital made employment conditional upon receipt of Tdap vaccine. Implementation for newly hired employees quickly resulted in complete compliance, but achieving adherence among current workers required setting a termination date for noncompliance.Infect Control Hosp Epidemiol 2012;33(1):81-83

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Patient to healthcare personnel transmission of MRSA in the non–intensive care unit setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.10 ◽

2020 ◽

Vol 41 (5) ◽

pp. 601-603

Author(s):

Gita Nadimpalli ◽

Lyndsay M. O’Hara ◽

Lisa Pineles ◽

Karly Lebherz ◽

J. Kristie Johnson ◽

...

Keyword(s):

Intensive Care Unit ◽

Staphylococcus Aureus ◽

Intensive Care ◽

Patient Care ◽

Transmission Rate ◽

Intensive Care Unit Setting ◽

Healthcare Personnel ◽

Direct Patient Care ◽

Methicillin Resistant ◽

Contact Precautions

AbstractThe transmission rate of methicillin-resistant Staphylococcus aureus (MRSA) to gloves or gowns of healthcare personnel (HCP) caring for MRSA patients in a non–intensive care unit setting was 5.4%. Contamination rates were higher among HCP performing direct patient care and when patients had detectable MRSA on their body. These findings may inform risk-based contact precautions.

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Assessment of Self-Contamination During Removal of Personal Protective Equipment for Ebola Patient Care

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.169 ◽

2016 ◽

Vol 37 (10) ◽

pp. 1156-1161 ◽

Cited By ~ 30

Author(s):

Lisa M. Casanova ◽

Lisa J. Teal ◽

Emily E. Sickbert-Bennett ◽

Deverick J. Anderson ◽

Daniel J. Sexton ◽

...

Keyword(s):

Hand Hygiene ◽

Patient Care ◽

Personal Protective Equipment ◽

Ebola Virus ◽

Virus Disease ◽

Healthcare Personnel ◽

Protective Equipment ◽

Dominant Hand ◽

Enveloped Virus ◽

Standardized Protocol

OBJECTIVEEbola virus disease (EVD) places healthcare personnel (HCP) at high risk for infection during patient care, and personal protective equipment (PPE) is critical. Protocols for EVD PPE doffing have not been validated for prevention of viral self-contamination. Using surrogate viruses (non-enveloped MS2 and enveloped Φ6), we assessed self-contamination of skin and clothes when trained HCP doffed EVD PPE using a standardized protocol.METHODSA total of 15 HCP donned EVD PPE for this study. Virus was applied to PPE, and a trained monitor guided them through the doffing protocol. Of the 15 participants, 10 used alcohol-based hand rub (ABHR) for glove and hand hygiene and 5 used hypochlorite for glove hygiene and ABHR for hand hygiene. Inner gloves, hands, face, and scrubs were sampled after doffing.RESULTSAfter doffing, MS2 virus was detected on the inner glove worn on the dominant hand for 8 of 15 participants, on the non-dominant inner glove for 6 of 15 participants, and on scrubs for 2 of 15 participants. All MS2 on inner gloves was observed when ABHR was used for glove hygiene; none was observed when hypochlorite was used. When using hypochlorite for glove hygiene, 1 participant had MS2 on hands, and 1 had MS2 on scrubs.CONCLUSIONSA structured doffing protocol using a trained monitor and ABHR protects against enveloped virus self-contamination. Non-enveloped virus (MS2) contamination was detected on inner gloves, possibly due to higher resistance to ABHR. Doffing protocols protective against all viruses need to incorporate highly effective glove and hand hygiene agents.Infect Control Hosp Epidemiol 2016;1–6

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Proactive Risk Assessment for Ebola-Infected Patients: A Systematic Approach to Identifying and Minimizing Risk to Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.78 ◽

2016 ◽

Vol 37 (7) ◽

pp. 867-871 ◽

Cited By ~ 1

Author(s):

Rosemarie Fernandez ◽

Steven Mitchell ◽

Ross Ehrmantraut ◽

John Scott Meschke ◽

Nancy J. Simcox ◽

...

Keyword(s):

Risk Assessment ◽

Patient Care ◽

Personal Protective Equipment ◽

Systematic Approach ◽

Healthcare Providers ◽

Healthcare Personnel ◽

Protective Equipment ◽

Watery Stool ◽

Mode Effects ◽

High Level

Performing patient care while wearing high-level personal protective equipment presents risks to healthcare providers. Our failure mode effects analysis identified 81 overall risks associated with providing hygienic care and linen change to a patient with continuous watery stool. Implementation of checklists and scheduled pauses could potentially mitigate 76.5% of all risks.Infect Control Hosp Epidemiol 2016;37:867–871

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Economic evaluation in telemedicine – still room for improvement

Journal of Telemedicine and Telecare ◽

10.1258/jtt.2010.009008 ◽

2010 ◽

Vol 16 (5) ◽

pp. 229-231 ◽

Cited By ~ 18

Author(s):

Trine S Bergmo

Keyword(s):

Economic Evaluation ◽

Cost Savings ◽

Evaluation Methodology ◽

Direct Patient Care ◽

Economic Evaluations ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Life Years ◽

The Cost ◽

Study Context

It has been reported that economic evaluations of telemedicine are less adherent to methodological standards than economic evaluations in other fields. Systematic reviews also show that most studies evaluate benefits in terms of the cost savings, with no assessment of the health benefits for patients. In a recent review of economic evaluations, I found 33 articles that measured both costs and non-resource consequences of using telemedicine in direct patient care. This represents a considerable increase compared to previous reviews. The articles analysed were highly diverse in both study context and applied methods. Most studies used multiple outcome measures, such as diagnostic accuracy, blood glucose levels, wound size or quality-adjusted life-years gained. The effectiveness measures appeared more consistent and well reported than the costings. Objectives, study design and choice of comparators were mostly well reported. However, most studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis. These shortcomings in economic evaluation methodology are relatively common and have been found in other fields of research.

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Sustainable oral healthcare and the environment: challenges

Dental Update ◽

10.12968/denu.2021.48.6.493 ◽

2021 ◽

Vol 48 (6) ◽

pp. 493-501

Author(s):

Steven Mulligan ◽

Lucy Smith ◽

Nicolas Martin

Keyword(s):

Climate Change ◽

Supply Chain ◽

Environmental Impact ◽

Patient Care ◽

Carbon Emissions ◽

Personal Protective Equipment ◽

Clinical Relevance ◽

Direct Patient Care ◽

Protective Equipment ◽

Single Use

Oral healthcare has an environmental impact that is specific to the profession and is currently unsustainable. This impact results in unwanted and difficult-to-manage waste, carbon emissions and other environmental impacts that contribute to climate change. Contributions to this pollution come from the supply chain that provides the required materials and sundries, patient and staff commuting/travelling, direct patient care, the use and end-of-life management of restorative materials and single-use plastics (SUPs) such as personal protective equipment (PPE). This article explores these various contributors to pollution arising from oral healthcare. CPD/Clinical Relevance: The provision of oral healthcare has an environmental impact that requires consideration and action in order to become sustainable.

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Exploring practice site contributions and professionalization impact of engaging student pharmacists on hematology-oncology advanced pharmacy practice experience rotations

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220985579 ◽

2021 ◽

pp. 107815522098557

Author(s):

Matthew J Yacobucci ◽

Christina L Lombardi ◽

Laurie L Briceland

Keyword(s):

Patient Care ◽

Pharmacy Practice ◽

Healthcare Personnel ◽

Direct Patient Care ◽

Self Awareness ◽

Patient Counseling ◽

Student Activities ◽

Self Reflection ◽

Oncology Practice ◽

The Impact

Introduction Student pharmacists contribute meaningfully to patient care during Advanced Practice Pharmacy Experiences (APPEs) in varied settings. We aimed to characterize and evaluate the impact of student participation in hematology-oncology (hem-onc) APPEs on the practice site, and on student professionalization. Methods For students completing hem-onc APPEs during 2016–2019, rotation activities and post-APPE self-reflections describing meaningful impact were reviewed; activities were categorized into direct and indirect patient care, and up to three reflection themes of professionalization impact were extracted from each self-reflection. Hem-onc preceptor cohort was surveyed to assess impact of student contributions on the practice site. Results 171 students completed hem-onc APPEs in ambulatory care (133) and/or inpatient (38) settings. Of 932 student-reported activities, the most common were: evaluating patient pharmacotherapy (209), providing education to medical staff (132), patient counseling [non-chemotherapy (99); chemotherapy (82)], and providing drug information (96); 89% involved direct patient care/education. Survey results from 16 of 33 preceptors identified the most impactful student activities as evaluating pharmacotherapy, medication education/adherence resources, and in-service presentations. Of 392 student self-reflections, themes of impact focused on professionalization/self-awareness (39.3%), counseling/communication skills (27.8%), practice skills development (20.4%) and collaborative teamwork (12.5%). Conclusion Pharmacy students make significant direct patient care contributions to hem-onc practice settings by evaluating pharmacotherapy and providing education to patients and healthcare personnel. Participation in hem-onc APPEs is highly influential to the professionalization of students, particularly in developing skills in oncology practice, patient interactions/communications, and developing self-awareness.

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2015. Minimal Impact of Blood Culture Contaminants on Patient Care Decisions May Limit Cost-Effectiveness of Interventions to Reduce Contamination Rates

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1695 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S676-S676 ◽

Cited By ~ 1

Author(s):

David Augusto. Terrero Salcedo ◽

Margaret Powers-Fletcher ◽

Alan G Smulian

Keyword(s):

Cost Effectiveness ◽

Blood Culture ◽

Patient Care ◽

Antimicrobial Therapy ◽

Hospital Admissions ◽

Cost Savings ◽

Minimal Impact ◽

Admission Status ◽

Definition Of ◽

The Cost

Abstract Background High blood culture (BC) contamination rates have been associated with increased healthcare cost, antimicrobial use, and extended length of stay. Interventions using blood culture diversion devices (BCDD) reduce contamination rates, but often increase equipment costs compared with traditional collection techniques. Cost savings will only be achieved, therefore, if contaminated BCs do in fact lead to expensive care decision. The purpose of this study was to define the actual impact of contaminated BCs on patient care as a means of determining the cost-effectiveness of implementing BCDD at our institution. Methods A retrospective review of all contaminated BCs collected in our Emergency Department (ED) from July 2018 to December 2018 was completed. Data including antimicrobial therapy, admission status, laboratory orders, and co-morbidities for patients with contaminated cultures, as defined by the College of American Pathologist (CAP), were recorded. Laboratory costs included rapid molecular assays performed for patients admitted from the ED, as well as technologist effort and media costs for BC work-up. Results During this study period, out of a total of 4,176 blood draws, there were 118 BCs (2.8%) that met the CAP definition of contamination. Of all contaminated cultures, only 12.7% (n = 15) of patients were treated because of a positive BC, while 68.6% were given antibiotics due to other comorbidities; A total of 22 patients (18.6%) did not receive any antibiotics during the encounter. The most common therapy for treated contaminants was vancomycin (14/15, 93.34%) for an average of 5.2 days. No patients with contaminated BCs were admitted to the hospital because of a positive result; 92.3% of patients with contaminated BCs were admitted, however, for a different diagnosis. Based on average treatment and laboratory costs, the total costs per contaminant were estimated at $170 USD. Conclusion Contamination of BCs collected in the ED does not routinely lead to antimicrobial therapy or hospital admissions at our institution. This minimal impact of BC contaminants on patient care decisions and healthcare costs limits the cost-effectiveness of interventions such as BCDD at our institution. These findings may be specific to our institution based on our clinical practice and unique patient population. Disclosures All authors: No reported disclosures.

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Development of a Flexible, Computerized Database to Prioritize, Record, and Report Influenza Vaccination Rates for Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/596043 ◽

2009 ◽

Vol 30 (4) ◽

pp. 361-369 ◽

Cited By ~ 15

Author(s):

Michael Melia ◽

Sarah O'Neill ◽

Sherry Calderon ◽

Sandra Hewitt ◽

Kelly Orlando ◽

...

Keyword(s):

Influenza Vaccination ◽

Patient Care ◽

Medical Center ◽

Tertiary Care ◽

The United States ◽

Healthcare Personnel ◽

Direct Patient Care ◽

Vaccination Rates ◽

Tertiary Care Medical Center ◽

The Status

Objective.To describe the method used to develop a flexible, computerized database for recording and reporting rates of influenza vaccination among healthcare personnel who were classified by their individual levels (hereafter, “tiers”) of direct patient contact.Design.Three-year descriptive summary.Setting.Large, academic, tertiary care medical center in the United States.Participants.All of the medical center's healthcare personnel.Methods.The need to develop a computer-based system to record direct patient care tiers and vaccination data for healthcare personnel was identified. A plan that was to be implemented in stages over several seasons was developed.Results.Direct patient care tiers were defined by consensus opinion on the basis of the extent, frequency, and intensity of direct contact with patients. The definitions of these tiers evolved over 3 seasons. Direct patient care classifications were assigned and recorded in a computerized database, and data regarding the receipt of vaccination were tracked by using the same database. Data were extracted to generate reports of individual, departmental, and institutional vaccination rates, both overall and according to direct patient care tiers.Conclusions.Development of a computerized database to record direct patient care tiers for individual healthcare workers is a daunting but manageable task. Widespread use of these direct patient care definitions will facilitate uniform comparisons of vaccination rates between institutions. This computerized database can easily be used by infection control personnel to accomplish several other key tasks, including vaccination triage in the context of shortage or delay, prioritization of personnel to receive interventions in times of crisis, and monitoring the status of other employee health or occupational health measures.

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Evaluation of Healthcare Personnel Exposures to Patients with SARS-CoV-2 Associated with Personal Protective Equipment Use

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.219 ◽

2021 ◽

pp. 1-14

Author(s):

Vishal P. Shah ◽

Laura E. Breeher ◽

Caitlin M. Hainy ◽

Melanie D. Swift

Keyword(s):

Personal Protective Equipment ◽

Medical Center ◽

Tertiary Care ◽

Healthcare Personnel ◽

Protective Equipment ◽

Critical Aspect ◽

Eye Protection ◽

Post Exposure ◽

Healthcare Settings ◽

Tertiary Care Medical Center

Abstract Objective: Personal Protective Equipment (PPE) is a critical aspect of preventing transmission of SARS-CoV-2 in healthcare settings. We aimed to identify factors related to lapses in PPE usage that may influence transmission of SARS-CoV-2 from patients to healthcare personnel (HCP). Design: Retrospective cohort study Setting: Tertiary care medical center in Minnesota Participants: A total of 345 HCP that sustained a significant occupational exposure to a patient with Coronavirus Disease 2019 (COVID-19) from May 13th, 2020 through November 30th, 2020 were evaluated. Results: Eight HCP (2.3%) were found to have SARS-CoV-2 infection during their 14-day post-exposure quarantine. A lack of eye protection during the care of a patient with COVID-19 was associated with HCP testing positive for SARS-CoV-2 by RT-PCR during the post-exposure quarantine (RR 10.25 (95% Confidence Interval (CI) 1.28-82.39), p=.009). Overall, the most common reason for a significant exposure was the usage of a surgical facemask instead of a respirator during an aerosolizing generating procedure (AGP) (55.9%). However, this was not associated with HCP testing positive for SARS-CoV-2 during the post-exposure quarantine (RR 0.99 (95% CI 0.96-1), p=1). Notably, transmission primarily occurred in units that did not regularly care for patients with COVID-19. Conclusions: The use of universal eye protection is a critical aspect of PPE to prevent patient to HCP transmission of SARS-CoV-2.

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