Q: How can I sign up for the next SPICE infection control course for my setting?

A: SPICE infection control courses are offered in a variety of ways: classroom, on-line and webinar. For more information about class formats, and schedules, click here: dental, home health / hospice, outpatient, long term care, acute care.

Q: How can I be certified in infection control?

A: Passing the national Certification in Infection Control (C.I.C) exam certifies a person in infection control. Infection control professionals who meet specific educational and practice requirements may apply for the exam. For information about certification, visit www.cbic.org or contact:

Certification Board of Infection Control and Epidemiology, Inc.
555 E. Wells Street, Suite 1100
Milwaukee, WI 53202
Phone: 414-918-9796
Fax: 414-276-3349
Email:info@cbic.org

Q: What special infection control training does North Carolina require?

A: North Carolina 10A NCAC 41A.0206 (previously numbered 15A NCAC 19A.0206) requires that each health care organization that performs invasive procedures shall implement a written infection control policy and designate one on-site staff member for each noncontiguous facility to direct infection control activities. That designated staff member shall have successfully completed a course in infection control approved by the State Health Department.

SPICE offers courses for health care workers in acute care (two 1-week long courses) and long-term care facilities (2.5 day course). For information on these courses click here. For information on the approved 1-day course for other healthcare settings (Outpatient, Dental, Home Health) click here, or contact the Statewide Program for Infection Control and Epidemiology at spice@unc.edu.

Q: Who is qualified to be the designated staff member to direct infection control activities?

A: The staff member should be a licensed or certified health care professional (i.e., LPN, RN, CMA, MD, DO, MT, EMT, RT, OT, PT, Pharm-D) and have attended an approved .0206 infection control course for their health care setting. This is similar to the OSHA requirements for being a trainer and ensures that the designated person have the education and background to implement an infection control program.

The .0206 rule requires that there be a designated infection control staff member at each non-contiguous (or free-standing) facility. Non-contiguous is defined as not physically connected and means that each free standing facility not physically connected is required to have a designated staff member assigned solely to work only at that location.

In the case of an office practice with 2 locations, it is acceptable to have the one designated person for both locations if only one location is open at a time and the designated infection control person works at both locations when open.

Q: What is the difference between OSHA and .0206 requirements?

A: Although there is considerable overlap in OSHA and .0206 infection control course, they are governed by different portions of North Carolina law and address different issues. Both programs include important infection control practices and require a designated staff member for infection control. However, .0206 requirements focus on the safety of the patient, while OSHA requirements focus on the safety of the employee.

The law mandates that someone in your office is designated to direct Infection Control activities. This person must take an approved .0206 infection control course at least once. However, it is good information and many offices send multiple staff more often, for refresher training and to learn about any new information on infection control requirements. This is different from the OSHA annual update requirement.
• Federal OSHA laws are enforced in North Carolina by the NC Division of Occupational Safety and Health (NC OSH) and require each health care organization to have in place an Exposure Control Plan to protect workers from hazardous chemicals and from infectious agents, including bloodborne pathogens.
• SPICE (North Carolina’s Statewide Program for Infection Control and Epidemiology) is charged with investigating and controlling healthcare associated infections in all healthcare facilities. As such, they developed the approved curriculum for courses that satisfy NC Infection Control Rule10A NCAC 41A.0206. This rule requires all health care organizations that perform invasive procedures to adopt a written infection control policy, practice universal precautions (Standard Precautions), and designate a staff member to be trained in infection control by completing a state approved SPICE course.
• There is significant overlap in content of SPICE and OSHA, and the infection control practices and personal protective equipment (PPE) are basically the same for both. Both require a designated staff member for infection control. The OSHA training also covers reporting requirements, forms, and record keeping.
• OSHA requires an annual update for all staff. The SPICE course is required only once, for the designated person in each practice, or when a new person takes over infection control activities. However, it is good information and many offices send multiple staff more often, for refresher training and to learn about any new information on infection control requirements.
• The office’s designated OSHA person may also be the SPICE trained person for the office. This person can teach the annual OSHA update (approximately a 1-hour course) to the rest of the staff.
• Both SPICE and OSHA are complaint driven systems. There is no place to officially register that the designated staff member has been trained. However, if a complaint were to be filed with either NC OSH or the NC Communicable Disease Section, documentation of appropriate training will need to be on hand.

Q: What topics should be covered in an infection control policy?

A: A written infection control policy should include infection control strategies intended to break the chain of infection:

  • Immunization of health care workers
  • Hand hygiene
  • Barrier precautions
  • Cleaning, disinfection, sterilization
  • Medical Waste
  • Practices to reduce the risk of exposure to blood, body fluids or infectious agents
  • Safe injection practices

Specific questions on infection control

Q: We have a small battle here today…can you please help us regarding   what is mandated for glucometer cleaning? I think bleach wipes are required between patients but is this in the 2008 CDC guidelines? Thanks so much, we have a heated discussion between point of care, accreditation, and IP.

A: Actually, any EPA registered disinfectant with an HIV and HBV claim, or bleach is sufficient to clean a glucometer.  Here is the link to SPICE recommendations.  They are consistent with CDC, FDA and CMS guidance. 

Q: If HCWs who give direct patient care have symptoms but are not tested /confirmed to have Norovirus, just some symptoms mainly diarrhea,  should they be restricted from work for 3 days after symptoms resolve?  Not seeing any clusters or outbreaks among staff – just occasional absences.  What is your recommendation?

A: If you have healthcare workers who are out for nausea and diarrhea, it is likely they have norovirus given the prevalence of the disease in the state.  It is best to have folks that are having diarrhea and/or vomiting to stay out at least 48 hours because the disease is highly contagious and difficult to disinfect.  I have attached the CDC guidance on this issue for your use.  It is best to have a few staff out longer than have to many staff and patients ill.

Q: We just recently hired a new provider whose hepatitis B titer was < 5 and who has received all immunizations. What should I do about this titer? Can you assist me with an answer?

A: Thanks for your question. A low titer from a distant vaccination is expected.  There is evidence that vaccine induced anti-HBs levels drop over time.  That being said, immune memory remains intact indefinitely following vaccination.  Folks who have received three doses of the hepatitis B vaccine and have protective anti-HBs titers that decline to less than 10mlU/ml are still protected and will respond to an exposure.  There is no need to give a booster dose or continue testing titers.

Q: If an employee cannot recall where they left off in their previous hepatitis B vaccination schedule, does not have proof, etc, do we restart the series? Thank you.

A: Thanks for your question.  If an employee cannot show proof of vaccination and cannot recall where in the series they left off, the series should be repeated and post vaccination titer should be drawn 1-2 months following the 3rd vaccination.

Q: I need a question answered.  Is there any recommendation for using electric hand dryer vs paper towels in hospital setting related to infection issues?

A: Thanks for your question.  The CDC guideline for Hand Hygiene recommends disposable paper towels for hand drying.  There are numerous studies supporting this as it aids in the further removal of bacteria. Please let me know if SPICE can assist you further.

Q: For the inpatient wound care program, there are times when the physician wants to debride the wound at bedside. We have a debridement bag that is carried by the inpatient wound nurse that assists the physician. This is like a tackle box. If a barrier is placed under the bag, can the bag be available in the patient’s room for the physician and nurse, with the exception of isolation rooms?

A: If a barrier is placed between the bag and a surface, it would be fine to carry the bag into the room.  The only concern is that the nurse or physician is not re-entering the bag with contaminated hands should they require additional materials.  They should set out all of the items they anticipate needing prior to starting a procedure.

Q: Can you tell me if it is acceptable for our Emergency Department to pre-spike IV bags of normal saline, date and time them with caps on end of tubing for use on patients that may come in for the next 24 hours?  They are kept in a secure area. If they haven’t used them in 24 hours, they are discarded. Thank you for your help.

A: The best practice is to spike an IV bag as close to administration as feasible.  USP 797 says the time frame is 1 hour from spiking to administration.  Both CMS and Joint Commission utilize these guidelines and can potentially cite your facility. 

Q: Regarding PDI SaniCloth Bleach Wipes: Does the presence or suspicion of C. difficile change the recommendation of 1 minute for non-critical surfaces listed on Dr Rutala’s website, http://disinfectionandsterilization.orgfor these patients?

A: When using a sporocidal agent such as 5000ppm chlorine, C. difficile spores will require longer contact times of 4-5 minutes to kill high numbers (106) of spores. However, since the C. difficile spore load  on environmental surfaces is generally low (<10 colonies from a sample of a contaminated surface) and C. difficile spores are physically removed by wiping, the normal wet time for surface disinfection when using a chlorine-containing product of 1-3 minutes should be adequate. 

Q: What are the rules governing the cleaning of bedpans?

A: The following is excerpted from SECTION .1300 – SANITATION OF HOSPITALS, NURSING HOMES, ADULT CARE HOMES, AND OTHER INSTITUTIONS, 15A NCAC 18A .1312 of the NC Department of Environment and Natural Resources:

(c) Institutions where bedpans, urinals or emesis basins are used shall provide facilities for emptying, cleaning, and disinfecting bedpans, urinals and emesis basins. Bedpans, urinals and emesis basins shall be cleaned after each useand shall be disinfected before use by other patients. Where bedpans are cleaned in patient rooms, bedpan cleaning facilities shall consist of a water closet with bedpan lugs or spray arms. Where facilities for cleaning bedpans are not provided in patient rooms, bedpans shall be taken to a soiled utility room and be cleaned and disinfected using an EPA registered hospital disinfectant after each use. Where disposable bedpans are reused, they shall be labeled with the patient’s name and date and shall not be used by more than one patient. Bedside commodes shall be cleaned after each use and shall be cleaned and disinfected before use by successive patients. Hand sinks shall not be used for cleaning bedpans or bedside commodes.

Q: I have been told that health care facilities should have splash guards built next to sinks in some situations. Can you clarify the rationale and provide references?

A: During an outbreak investigation in an ICU setting, the soiled utility sink was strongly implicated as the inanimate reservoir for HAI pathogens. Rodac samples from sterile items on the counter and environmental surfaces near the soiled utility sink demonstrated a variety of gram-negative bacilli similar to those recovered from the patients.(1) In another study, Holder demonstrated that contaminated splash from a sink reached a distance of 48 inches from the sink.(2) Therefore, it has been recommended that sinks should be situated to avoid splashing at a minimum of 36 inches from patients or clean supplies, or supplied with a splash guard made of nonporous materials to avoid splash contamination.(3)

References
1. Dandalides PC, WA Rutala and FA Sarubbi, Jr. Postoperative infections following cardiac surgery: Association with an environmental reservoir in a cardiothoracic intensive care unit. Infect Control Hosp Epidemiol 1984;5:378-384.
2. Holder, IA: Epidemiology of Pseudomonas aeruginosa in a burns hospital. In: Young VM (ed): Pseudomonas aeruginosa: Ecological Aspects and Patient Colonization. New York, Raven Press, 1977:77-95.
3. Bartley J, APIC State-of-the-Art Report: The role of infection control during construction in health care facilities. AJIC 2000;28:156-169.

Q: Where can I find information on Sterilants and High Level Disinfectants for processing Reusable Medical and Dental Devices that are cleared by the FDA?

A: The FDA maintains a list of FDA-Cleared Sterilants and High Level Disinfectants with General Claims for Processing Reusable Medical and Dental Devices, noting the Manufacturer, Active Ingredient(s), Sterilant Contact Conditions, and High Level Disinfectant Contact Conditions.

Q: What is the North Carolina rule that says supplies must be eight inches off the floor?

A: The rule is found in the document: Rules Governing the Sanitation of Hospitals, Nursing Homes, Adult Care Homes and Other Institutions T15A NCAC 18A.1300, which can be viewed here: http://www.deh.enr.state.nc.us/ehs/images/rules/t15a-18a.13.pdf

The reference to the 8-in rule is on page 9, Section 15A NCAC 18A .1318 MISCELLANEOUS, item (a):
It reads – “Suitable rooms or spaces shall be provided for the storage of all necessary equipment, furniture and supplies, and kept clean. All patient care or consumable items shall be stored at least eight inches above the floor to prevent water contamination from cleaning floors and shall not be stored below exposed sewer lines.”


Date of last updated: 5/18/12