We recently began to explore the genus of bacteria known as Clostridium. Bacteria in this genus are rod shaped, gram positive, and form endospores. Clostridia are found in anaerobic habitats such as soil, aquatic sediments and the intestinal tracts of humans and animals. They usually do not grow under aerobic conditions. Because they release potent toxins and form spores which can persist in the environment for long periods of time, some Clostridia have serious consequences for humans. Over the next few months, we will look at the species of Clostridia that may have an impact in our work environments, C. difficile, C. perfringens, and C. tetani. Click to read more...

• Question: Is it all right to take the syringes out of the packages the night before to save time preparing medications in the morning?
Answer: This is not safe practice. If the syringe has been removed from the packaging for later use, sterility of the syringe cannot be guaranteed.


• Question: Can we have food and beverages in the Nurse's station?
Answer: Accrediting organizations usually do not directly address this question. The OSHA Blood borne pathogen standard would apply. The standard prohibits eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses in work areas where there is a reasonable likelihood of occupational exposure. A non-enclosed nurse's station that is situated in a patient area would be an area of risk for occupational exposure. For a nurse's station that is walled or glassed in from floor to ceiling, has closable door and no specimens or used equipment present occupational exposure risk would be minimal. Consider the possibility of spillage on paper documents or electronic devices. Inform employees where they may store and consume food and beverages in your facility.

Do you need to know how to find information about isolation procedures? How about basic infection control precautions? This is the link to the CDC 2007 Guidelines for Isolation Precautions Preventing Transmission of Infectious Agents in Health Care Facilities
http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

This document has information about standard precaution and transmission based precaution implementation in a variety of health care settings. There is a lot of information about the rationale for the precautions.

Have you wondered what precautions are necessary for a specific disease o or a particular pathogens?

Look no further, Appendix A to the 2007 Guidelines for Isolation Precautions has what you are looking for. http://www.cdc.gov/hicpac/2007IP/2007ip_appendA.html

Do you need to find the OSHA Blood borne Pathogen Standard?
Look Here:
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

Where are the US Public Health Service Guidelines mentioned in the Blood borne Pathogen standard? They can be found here: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm and here http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm

An infection preventionist who enters a health care facility may look at the environment with a sharper eye than the average patient or visitor even patients or visitors who are health care providers.

Do most patients observe whether each employee has done hand hygiene? Maybe so because of increased awareness of health care associated infections our patients are paying attention.

What some patients might not notice is a large number of pre-spiked IV bags in a pre-operative area. Or the patient may not be aware this is not an acceptable practice. What about a tray of pre-drawn syringes left unattended in an examination room without labeling of contents or when they were drawn? The patient might not be aware that medications and solutions are not to be pre drawn, left unattended, and un-labeled.

These are things I have personally observed in health care settings, very nice and highly respected health care settings. We are all busy. We may be under pressure to be more productive, to shorten the minutes between procedures or surgeries, or just get more done; shortcuts to optimize work flow or to save time may be tempting. Unfortunately, those short cuts can increase the risks for our patients.

USP 797 has clear guidelines about sterile medications, IV fluids, and sterile medications we may mix or draw up into syringes to administer to our patients. During patient care, we may prepare injectable medications, IV infusions and other sterile products we provide to our patients but we don't do those activities in a "clean room" environment. In fact, preparation for immediate use can be done outside a clean room environment.

A clean room environment for compounding sterile medications is highly controlled, it requires cleanable sealed surfaces, cleaning and disinfection, air filtration, controlled air flow, special attention to hygiene for the employees and requirements to wear garments that cover hair and clothing and masking to prevent respiratory droplet contamination.

Sterile medications, IV fluids etc. for immediate use are to be administered within an hour of preparation. The rationale for this time frame is to limit any growth of bacteria that results from accidental contamination before the product is given to the patient. We normally don't prepare IVs for administration, re-constitute sterile medication or draw sterile medication into syringes in a clean room environment. We do these things in a medication room, a nurse's station, or a surgery suite. There is particulate matter in the air and while we are doing these activities we are not masked so there is a possibility of respiratory droplet contact. It is easy to see why the one hour time frame is required by USP 797 guidelines.

So, whenever we pre-spike our IVs or pre-draw medications; we are putting our patients at risk for illness, and infection.

Medications that are drawn or prepared require labeling with the name of the medication, the strength of the medication, the expiration date for the medication, the date and time prepared and who prepared the medication. To prevent tampering, the medication should not be left unattended.

Of course, we must do hand hygiene first and prepare medications on a clean dry surface. It is necessary to always follow safe injection, infusion and medication vial handling practices outlined by the CDC.

We all strive for efficiency of work flow, and in the process, we want a safe environment for our patients. Short cuts will not achieve both outcomes. If you are tempted to take a short cut, instead resist that temptation and set up the IVs and prepare medications as close to the time of use as possible so they can be used within the 1 hour time frame. And don't forget to label what you have prepared.

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