Pseudomonas aeruginosa is an aerobic gram negative rod shaped micro-organism. It is well adapted to grow in relatively pure water and has minimal nutritional requirements. It commonly inhabits soil, water and vegetation. P. aeruginosa has been a well-known human pathogen since the 1960s. Infections with P. aeruginosa occur in many different health care settings.

Question: There have been a number of questions recently about accepting patients with MRSA infection or colonization.

The Answer: You probably have unknowingly been accepting patients with MRSA at your facility. Colonization with micro-organisms is frequently asymptomatic, unless your patient has been tested, asymptomatic colonization is a possibility.

Standard precautions have been developed by the CDC to address the risks of caring for patients with known or unknown infection or colonization. The patients with known infection or colonization are only a small part of persons actually infected or colonized with micro-organisms. For this reason, standard precautions which include hand hygiene are to be used during all patient care encounters.

If additional precautions are needed to prevent transmission, then transmission based precautions are implemented in addition to standard precautions. In the case of a draining infection, contact precautions would be implemented.

The guidelines for these precautions also include recommendations about patient transport, about cleaning and disinfection of the health care environment, management of linens, trash, and patient care equipment.

With adherence to standard and transmission based precautions, it is possible to maintain a sanitary environment, and to safely care for and reduce transmission of micro-organisms from infected or colonized persons.

There may be an important reason for not performing a procedure on a patient with an active infection. Spread of the organisms to the surgical site via the blood stream is possible. Infection at a remote body site is known to increase the risk of a surgical site infection. A patient who presents with an active infection should be evaluated for risk by their medical team.

A blanket policy that excludes all patients with MRSA or other organisms is not recommended. Policies that address how to reduce transmission of infectious organisms from any source, the education of employees and patients about transmission prevention, and that address care and how services are provided to each patient based on individual needs and risk factors should be developed and implemented.

CDC: 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings: http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf contains the information you will need to design interventions to prevent transmission of micro-organisms in your facility. This guideline addresses the infection control procedures in a variety of health care settings. The recommendations section does address implementation of transmission based precautions in ambulatory settings.

Other relevant guidelines from CDC:

• Guidelines for Environmental Infection Control in Health-Care Facilities, 2007
• Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006
• The Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

Each month, we provide links to sources of information that will help you provide a written source of the rationale for our infection control interventions. We have all encountered an employee who just has to see it in writing; but it's good to have the resources at your fingertips as you develop and revise your infection control program. Bookmarking resources in your "favorites" folder makes them easy to find. This month, the links will be for resources that can assist you with disaster planning.

• CDC: Emergency Preparedness and Response, Preparedness for All Hazards
• CDC: Emergency Preparedness and Response, Preparation & Planning
• CDC: Health Alert Network: Go here to sign up to receive alerts by e-mail from the CDC
• Federal Influenza Planning Resources
• FEMA: National Incident Management System (NIMS) training

Recently, a hospital discovered that changes in the processing of their laryngeal mask airways had created infection control concerns.

The manufacturer's recommendation was steam sterilization. For several months, the devices underwent a cleaning process that did not include steam sterilization. As a part of the investigation that occurred following an anonymous tip, the hospital was required to find out why the procedure for processing the airways changed.

This happened at a hospital however lessons learned are applicable in all health care settings. Know what is happening at your facility. Be aware of processing procedures that are in use at your facility, the manufacturer's recommendations for processing, and ensure adherence to acceptable practices.

Some points to consider:

1. Policies and procedures for disinfection and sterilization should be in place that have clearly outlined procedures based on nationally recognized guidelines.
2. Require adherence to facility policies for disinfection and sterilization.
3. Establish a process for review and revision of policies and procedures and make sure staff understands the process must be followed.
4. Ongoing training and competencies for sterile processing staff.
5. Keep the manufacturer's instructions on hand for easy reference.
6. Review the manufacturer's instructions with staff.
7. Monitor and audit for adherence to established procedures and manufacturer's recommendations
8. Corrective action for non-adherence to policies and procedures.

Excellentia Advisory Group will be presenting our 2nd Annual Infection Prevention Strategies for ASC's and Perioperative Settings. This event will be:

• September 27 - 28, 2012
• St. Louis, MO
• 8:00am to 5:00pm each day
• 14 Contact Hours of Continuing Education
• BONUS for buying now; you get last year's 2-day seminar on DVD set for free! This normally sells for $960.00
• Discount for 2nd or more persons to attend
• Ambulatory Surgery Center & surgical setting focused presentations.
• Specific information that you can apply to your ASC
• Wonderful opportunity to gain the training material that you need to train your entire staff
• A seminar designed to build-upon last year's 2-day seminar
• All speakers will be CIC's or have Advanced Education in Infection Prevention