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MCN Healthcare: StayAlert! - Immediate Regulatory Updates Icon

StayAlert! Headlines

Oct 1 2014
First Confirmed Case of Ebola in United States

The Centers for Disease Control and Prevention (CDC) has confirmed through laboratory testing that the first case of Ebola has been diagnosed in the United States in a person who had traveled to Dallas,Texas from Liberia. According to the CDC, the patient did not have symptoms when leaving West Africa, but developed symptoms approximately four days after arriving in the U.S. on Sept. 20th. 

According to several news reports, the infected person first sought treatment on September 26th at an emergency room but was sent home.  On September 28th he was brought back to the hospital via ambulance and placed in isolation.  The CDC confirmed the Ebola infection on September 30th.  

The CDC and public health officials in Texas are taking precautions to identify people who have had close personal contact with the ill person, and health care professionals have been reminded to use meticulous infection control practices at all times.  Health care professionals should also remember that the spread of Ebola is stopped through case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms.   Healthcare providers should be alert for and evaluate suspected patients for Ebola virus infection who have both consistent symptoms and risk factors as follows:

  • Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND
  • Epidemiologic risk factors within the past three (3) weeks before the onset of symptoms, such as contact with blood or other body fluids of a patient known to have or suspected to have ebola virys disease (EVD); residence in-or travel to-an area where EVD transmission is active; or direct handling of bats, rodents, or primates from disease-endemic areas. Malaria diagnostics should also be a part of initial testing because it is a common cause of febrile illness in persons with a travel history to the affected countries.

Further, the CDC recommends testing for all persons with onset of fever within 21 days of having a high-risk exposure. A high-risk exposure includes any of the following:

  • Percutaneous or mucous membrane exposure or direct skin contact with body fluids of a person with a confirmed or suspected case of EVD without appropriate personal protective equipment (PPE),
  • Laboratory processing of body fluids of suspected or confirmed EVD cases without appropriate PPE or standard bio-safety precautions, or
  • Participation in funeral rites or other direct exposure to human remains in the geographic area where the outbreak is occurring without appropriate PPE.

On September 10th StayAlert! published a notice that included a checklist created by the CDC highlighting key areas for hospital staff - especially hospital emergency management officers, infection control practitioners, and clinical practitioners - to review in preparation for a person with EVD arriving at a hospital for medical care.  Now is the time for hospitals to review infection control policies and procedures and incorporate plans for administrative, environmental, and communication measures, as well as personal protective equipment (PPE) and training and education. Hospitals should also define the individual work practices that will be required to detect the introduction of a patient with EVD or other emerging infectious diseases, prevent spread, and manage the impact on patients, the hospital, and staff.

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Sep 30 2014
CMS – Categorical Waiver for Power Strips Use in Patient Care Areas

CMS published a Memorandum on September 26, 2014 addressing a categorical waiver for power strips use in patient care areas.

CMS has determined that the 2000 edition of the National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) contains provisions on the use of power strips in health care facilities that may result in unreasonable hardship for providers or suppliers. Further, an adequate alternative level of protection may be achieved by compliance with the 2012 edition of the LSC, which has extended allowances on the use of power strips in patient care areas.

CMS is permitting a categorical waiver to allow for the use of power strips in existing and new health care facility patient care areas, if the provider/supplier is in compliance with all applicable 2012 LSC power strip requirements and with all other 2000 LSC electrical system and equipment provisions and only if the waiver does not adversely affect the health and safety of patients.

Resident rooms in long-term care or other residential care facilities that do not use line-operated electrical appliances for diagnostic, therapeutic, or monitoring purposes are not subject to the more restrictive NFPA 99 requirements regarding the use of power strips in patient care areas/rooms. Resident rooms using line-operated patient care-related electrical equipment in the patient care vicinity must comply with the NFPA 99 power strip requirement and may elect to utilize this categorical waiver.

Individual waiver applications are not required.   Providers and suppliers are expected to have written documentation that they have elected to use the waiver.  A provider or supplier must notify the LSC survey team at the entrance conference that it has elected to use the waiver permitted under this guidance and that it meets the applicable waiver requirements. The survey team will review the information and confirm the facility meets the conditions for the waiver.

Requirements:

  • Patient bed locations in new health care facilities, or in existing facilities that undergo renovation or a change in occupancy, shall be provided with the minimum number of receptacles as required by section 6.3.2.2.6.2.
  • Power strips may be used in a patient care vicinity to power rack-, table-, pedestal-, or cart mounted patient care-related electrical equipment assemblies, provided ALL of the following conditions are met, as required by section 10.2.3.6:
    • The receptacles are permanently attached to the equipment assembly
    • The sum of the ampacity of all appliances connected to the receptacles shall not exceed 75 percent of the ampacity of the flexible cord supplying the receptacles
    • The ampacity of the flexible cord is suitable in accordance with the current edition of NFPA 70, National Electric Code
    • The electrical and mechanical integrity of the assembly is regularly verified and documented through an ongoing maintenance program
    • Means are employed to ensure that additional devices or nonmedical equipment cannot be connected to the multiple outlet extension cord after leakage currents have been verified as safe
  • Power strips may not be used in a patient care vicinity to power non-patient care-related electrical equipment (i.e., personal electronics).
  • Power strips may be used outside of the patient care vicinity for both patient care-related electrical equipment and non-patient-care-related electrical equipment.
  • Power strips providing power to rack-, table-, pedestal-, or cart-mounted patient care-related electrical equipment assemblies are not required to be an integral component of manufacturer tested equipment. Power strips may be permanently attached to mounted equipment assemblies by personnel who are qualified to ensure compliance with section 10.2.3.6.
  • Resident rooms in long-term care or other residential care facilities that do not use line operated patient-care-related electrical equipment are not subject to the more restrictive NFPA 99 requirements regarding the use of power strips in patient care areas/rooms
  • Resident rooms using line-operated patient-care-related electrical equipment in the patient care vicinity must comply with the NFPA 99 power strip requirement and may elect to utilize this categorical waiver.
  • If power strips are used in any manner, precautions as required by the LSC and reference documents are required, including but not limited to: installing internal ground fault and over-current protection devices; preventing cords from becoming tripping hazards; connecting devices so that tension is not transmitted to joints or terminals; no "daisy chaining" power strips; using power strips that are adequate for the number and types of devices, and no overloading power strips with high load devices. In addition, the use of ground fault circuit interruption (GFCIs) may be required in locations near water sources to prevent electrocution
  • Power strips providing power to patient care-related electrical equipment must be Special purpose Relocatable Power Taps (SPRPT) listed as UL 1363A or UL 60601-1
  • Power strips providing power to non- patient-care-related electrical equipment must be Relocatable Power Taps (RPT) listed as UL 1363.

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Sep 29 2014
Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children

The Centers for Disease Control and Prevention (CDC) is working closely with the Colorado Department of Public Health and Environment (CDPHE) and Children's Hospital Colorado to investigate a cluster of nine pediatric patients hospitalized with acute neurologic illness of undetermined etiology. The illness is characterized by focal limb weakness and abnormalities of the spinal cord gray matter on MRI. These illnesses have occurred since August 1, 2014 coincident with an increase of respiratory illnesses among children in Colorado.

The purpose of this HAN Advisory is to provide awareness of this neurologic syndrome under investigation with the aim of determining if children with similar clinical and radiographic findings are being cared for in other geographic areas. Guidance about reporting cases to state and local health departments and CDC is provided.

The United States is currently experiencing a nationwide outbreak of EV-D68 associated with severe respiratory disease. The possible linkage of this cluster of neurologic disease to this large EV-D68 outbreak is part of the current investigation. CDC is seeking information about other similar neurologic illnesses in all states, especially cases clustered in time and place. CDC has particular interest in characterizing the epidemiology and etiology of such cases.

Recommendations:

  • Patients who meet the following case definition should be reported to state and local health departments:
    • Patients 21 years of age and younger with:
      • Acute onset of focal limb weakness occurring on or after August 1, 2014 AND
      • An MRI showing a spinal cord lesion largely restricted to gray matter
  • State and local health departments should report patients meeting the case definition to CDC using a brief patient summary form (www.cdc.gov/non-polio-enterovirus/investigation/). State health departments should send completed summary forms to CDC by email at limbweakness@cdc.gov.
  • Providers treating patients meeting the above case definition should consult with their local and state health department for laboratory testing of stool, respiratory, and cerebrospinal fluid specimens for enteroviruses, West Nile virus, and other known infectious etiologies.
  • Health departments may contact CDC for further laboratory and epidemiologic support by phone through the CDC Emergency Operations Center (770-488-7100), or by email at limbweakness@cdc.gov. Confirmation of the presence of EV-D68 currently requires typing by molecular sequencing.

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MCN Healthcare: Policy Library - Customizable Policy Documents Icon

Featured Policy Library Manuals

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Ambulatory Surgical Center and Outpatient Surgery Department Policy and Procedure Manual

MCN's NEW Ambulatory Surgical Center/Outpatient Surgery Department Policy and Procedure Manual is cross referenced to TJC standards, AAAHC standards and CMS regulations. Policies and procedures meet AORN and CDC recommendations and guidelines. This comprehensive reference guide has over 290 policies and procedures that are ready to customize to your organization. See also the Administrative Manual for Ambulatory Care Facilities and the Ambulatory Services EOC Manual.

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MCN's Central Service Policy and Procedure Manual provides over 200 proven, up-to-date policies and procedures in a ready-to-customize format. This manual is cross referenced to federal regulations, as well as Joint Commission and NIAHO standards. References used include AAMI Recommended Practices, IAHCSMM Central Service Technical Manual, ASHCSP Training Manual for Health Care Central Service Technicians and AORN Recommended Practices.

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Policy Library Manuals: Post Anesthesia Care Policy and Procedure Manual Icon
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