Infection Control Practices of Audiologists: Are You and Your Patients Being Protected?

Transcription

1 Infection Control Practices of Audiologists: Are You and Your Patients Being Protected? Carrie Sanders, B.S. Ed. Au.D. Student Rush University Medical Center David A. Klodd, Ph.D. University of Illinois-Chicago Valeriy Shafiro, Ph.D. Joanne Schupbach, M.S., M.A. Rush University Medical Center IRB #:

2 Overview Introduction to the Topic of Infection Control Importance of Audiologic Infection Control Infection Control Literature Purpose of the Study Research Methods Results and Discussion Conclusion

3 Introduction Infection control is an important aspect of audiology practice. Implementation of appropriate and consistent infection control practices aids in minimizing or eliminating the potential for disease transmission in healthcare settings. (Clark, Kemp, & Bankaitis; Kemp & Bankaitis, 2000)

4 Introduction Various agencies develop guidelines and regulations for infection control and play a role in the implementation of infection control programs. Occupational Safety and Health Administration (OSHA) 1991:Bloodborne Pathogens Standard

5 Standard Precautions Standard Precautions: treat blood and certain bodily fluids of all patients as potentially infectious for bloodborne pathogens reduce the risk of disease transmission from both recognized and unrecognized sources (CDC, 2007; Clark, Kemp, & Bankaitis, 2003)

6 Standard Precautions Include: Hand hygiene Utilization of personal protective equipment (i.e. gloves, masks, gowns) Proper cleaning and disinfection or sterilization of patient-care equipment and environmental surfaces Education and training

7 Importance of Audiologic Infection Control Physical proximity to patients Manipulation of a variety of instruments and devices Expansion of the scope of audiology practice Patient base (Bankaitis, 2000; Kemp & Bankaitis, 2000)

8 Importance of Audiologic Infection Control Factors which may impact an individual s susceptibility to disease include: Age Underlying disease Nutritional status History of pharmacological interventions Socioeconomic status Kemp & Bankaitis (2000)

9 Modes and Pathways of Disease Transmission Modes of disease transmission: Pathways of disease transmission: Direct contact Patient to clinician Indirect contact Airborne contamination Droplet contamination Clinician to patient Patient to patient Ballachanda, Roeser, & Kemp (1996)

10 New Pathway of Disease Transmission? Recent studies have introduced another potential pathway of disease transmission. Bankaitis (2002) reported the presence of both bacterial and fungal microbial growth on hearing aid surfaces. theorized possibility of individual cross contamination Bankaitis (2002) and Sturguelewski, et al. (2006)

11 New Pathway of Disease Transmission? Sturgulewski et al., (2006) found that the bacterial and/or fungal growth differed between 5/6 hearing aid pairs. Both studies suggested the possibility of individual cross contamination in the hearing aid dispensing environment. But what about other audiologic services?

12 Infection Control Literature Professional literature has emphasized the importance of audiologic infection control. Research regarding actual infection control practices of audiologists is limited.

13 Comparison of Amlani (1999) and Burco (2007) studies Did not believe professional setting was associated with high risk of exposure to communicable disease Aware of written infection control plan based on OSHA standards Amlani (1999) Burco (2007) 69% 47% 51% yes; 44% no 82% yes; 18% no Washes hands after each patient 26% 81% Uses gloves during cerumen management 8% 18% Infection control education should be prerequisite for licensure and certification 55% 43%

14 Limitations of Previous Studies Need more specific questions and answer options i.e. Which instruments/devices to you clean and disinfect after use and prior to reuse? i.e. Do you wash your hands with soap and running water or use no-rinse hand degermers after cerumen management?

15 Why Another Infection Control Study? Determine whether comprehensive infection control practices are being implemented by audiologists Measures to prevent the possibility of individual cross contamination Develop more specific questions and response options Emphasize the importance of infection control

16 Research Methods Illinois audiologists were selected as research participants. invitations were sent through host website Initial: February 13, st Follow-up: February 20, nd Follow-up: February 27, 2008 Survey consisted of 48 questions and took approximately minutes to complete.

17 Subjects 389 potential participants Response rate: 1 st invitation: 89 2 nd invitation: total 3 rd invitation: total 140/158 were considered to be complete resulting in a 35.99% response rate.

18 Demographic and General Practice Information

19 Demographic Information Gender 14% Male Female 86% n=139

20 Terminal Degree Degree Status 1% 55% 3% 41% Master's Degree Au.D. Ph.D. Other n=138

21 Primary Work Setting Primary Work Setting Other Retired Public School Private Practice Manufacturer ENT office Medical School, University VA/Military/Government Clinic Non-teaching hospital Teaching hospital 1.40% 0% 1.40% 3.60% 4.30% 6.50% 7.90% 15.10% 15.80% 19.40% 24.50% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% n=139

22 Services Provided Services Provided Cerumen management Central auditory processing Cochlear implants Hearing aid dispensing Other vestibular testing ENG/VNG Evoked potentials Otoacoustic emissions Otoscopy Immittance audiometry Pure tone audiometry 10.30% 11.00% 8.80% 46.30% 41.20% 41.20% 76.50% 89.00% 94.90% 94.90% 96.30% 0.00% 20.00% 40.00% 60.00% 80.00% % n=136

23 Infection Control Training and Perception of Risk

24 Perception of Risk Reported professional setting had a high exposure to communicable disease: 43.6% (n=140) Indicated professional setting was associated with at least some risk of cross contamination: 83.6% (n=140) Noted risk of individual cross contamination: 76.3% (n=139)

25 Perception of Risk On a monthly basis, do you come into contact with patients who have infections and diseases such as tuberculosis, AIDS, Hepatitis, SARS, MRSA, etc.? 36.5% Yes 45.3% No 18.2% I don t know n=137

26 Infection Control Training Aware of a written mandate incorporating Universal (Standard) Precautions: 71% (n=138) Reported audiology-specific infection control plan was in place: 54% (n=137) Indicated requirement of annual infection control training: 46% (n=139)

27 Infection Control Practices

28 Hand Hygiene Hand Hygiene Practices % 86.90% 83.20% 81.10% 99.30% 94.20% 80.00% 60.00% 58.10% 54.70% 55.40% 40.00% 20.00% Yes No N/A n= % Immediately prior to each patient appointment Immediately after each patient appointment Immediately after cerumen management Immediately after earmold impression procedures Immediately after handling patient s hearing aids with bare hands After glove use After use of the lavatory Pursuant to contact with bodily fluids

29 Personal Protective Equipment GLOVE USE Audiologic Procedures Percentage Otoscopy at all times, no exceptions 2.17% Otoscopy but only in the event in a draining ear 56.93% Insertion and removal of insert earphones 2.17% Cerumen management 15.33% Evoked potential assessment 3.00% Vestibular and balance assessment 2.24% Injection of earmold impression material into ear canal 2.92% Earmold impression removal 2.92% Receipt and/or handling of patient s hearing instrument 17.52% Cleaning instruments 31.11% Disinfecting instruments 36.03% Submerging/removing instruments into/from cold sterilant 38.06% n=138

30 Disposable Devices Disposable Device Use Insert earphones Otoscope specula Real-ear probe tube Immittance and/or OAE tips Headphone covers Evoked potential electrodes Instruments for cerumen removal Otolight tips Caloric Irrigator specula None are applicable 2.90% 18.10% 18.10% 15.90% 41.30% 32.60% 52.20% 73.90% 69.60% 87.70% 0.00% 20.00% 40.00% 60.00% 80.00% % n=138

31 Non-Disposable Devices Non-disposable Device Use Listening Stethoscope Otolight tips Headphones Instruments used for cerumen removal Immittance and/or OAE tips Otoscope specula Caloric irrigator specula (air) Evoked potential electrodes Real-ear probe tube Caloric irrigator tips (water calorics) Insert earphones None are applicable 8.00% 8.00% 2.90% 0.70% 34.80% 30.40% 30.40% 57.20% 51.40% 71.00% 70.30% 87.00% 0.00% 20.00% 40.00% 60.00% 80.00% % n=138

32 Disinfection and Sterilization Practices Disinfection: refers to a process of microbial inactivation using an EPA approved disinfectant that eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms Sterilization: refers to using a physical or EPA approved chemical procedure to destroy all microbial life, including large numbers of highly-resistant endospores

33 Disinfection and Sterilization Practices Disinfection and Sterilization Practices None are applicable 3.10% 11.15% Listening stethoscope tips 21.20% 41.50% Otolight tips 46.50% 63.80% Caloric irrigator tips (water calorics) 9.20% 6.10% Caloric irrigator specula (air calorics) 24.60% 19.20% Evoked potential electrodes Headphones 6.10% 11.10% 23.10% 33.10% Disinfection Sterilization Insert earphones 3.80% 3.00% Immittance and/or OAE tips 45.40% 47.50% Real-ear probe tube 2.00% 7.70% Instruments used for cerumen removal 49.20% 53.50% Otoscope specula 33.10% 37.40% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% n=130

34 Toys: Frequency of Disinfection Frequency of Disinfection Assessment Toys Waiting Room Toys After each patient appointment 26.9% 0.7% At the beginning and/or end of the day 3.0% 5.2% Once a week 3.0% 3.7% Once a month 1.5% 1.5% Discretionary basis 37.3% 19.4% Never 2.2%* 3.0%* Not applicable 26.1% 66.4% 30.1% indicated use of soft-sided toys (i.e. puppets, stuffed animals, cloth books, etc.) n=134

35 Individual Cross Contamination Practices Instruments/Devices Changed Between Ears None are applicable Otolight tips Caloric irrigator tip (water calorics) Caloric irrigator specula (air calorics) Immittance and/or OAE tips Real-ear probe tubes Instruments used for cerumen removal Otoscope specula 2.60% 2.60% 6.90% 4.30% 30.20% 35.30% 44.80% 41.40% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% n=116

36 Individual Cross Contamination Practices Cleaning: refers to removing gross contamination without killing germs Disinfection: refers to a process of microbial inactivation using an EPA approved disinfectant that eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms

37 Individual Cross Contamination Practices Instruments/Devices Cleaned and Disinfected Between Ears Not applicable Electroacoustic couplers Listening stethoscope tip Otolight tips 6.20% 18.60% 17.50% 63.90% Caloric irrigator tips (water calorics) Caloric irrigator specula (air calorics) Immittane and/or OAE tips Real-ear probe tubes Otoscope specula 4.10% 7.20% 4.10% 11.30% 11.30% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% n=97

38 Fun Tac: Frequency of Replacement Frequency of fun tac replacement 10.50% Fun tac may be associated with cross contamination when: 33.30% 15.20% Weekly Monthly Quarterly Hearing aids are not properly disinfected 27.60% 13.30% Yearly Never Audiologist handles hearing aids with bare hands and has not practiced proper hand hygiene n=105

39 Infection Control Terminology Cleaning: refers to removing gross contamination without killing germs Disinfection: refers to a process of microbial inactivation using an EPA approved disinfectant that eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms Sterilization: refers to using a physical or EPA approved chemical procedure to destroy all microbial life, including large numbers of highly-resistant endospores

40 Infection Control Terminology Infection Control Terminology % 82.50% 94.90% 81.80% 80.00% 60.00% 40.00% 20.00% 0.00% 16.80% 15.30% 0.00% 4.40% 2.90% 0.00% Cleaning Sterilization Disinfection Disinfection Cleaning Sterilization n=137

41 Continuing Education Attended an educational course on audiologic infection control over the course of their career: 78.1% (n=137) Attended a course within the past year: 25.4% (n=138) Reported educational course had affected their infection control procedures: 73.3% (n=135) Felt that continuing education should be a mandatory prerequisite to state licensure and national certification: 65.2% (n=138)

42 Conclusion

43 Conclusion Infection control practices of IL audiologists are generally comparable to national infection control practices. IL audiologists are more cognizant of the risk of exposure to communicable disease and the potential for cross contamination in the audiology setting. IL audiologists are still not implementing comprehensive infection control practices, as mandated by OSHA.

44 Conclusion Small percentage of IL audiologists are implementing specific practices to prevent possibility of individual cross contamination. IL audiologists desire more educational sessions regarding infection control in audiology practice. Perhaps if infection control coursework were a requirement for state licensure and/or national certification, implementation would increase.

45 Conclusion The final word Until comprehensive infection control practices are consistently implemented, both the patient and practitioner are at risk of exposure to infection and disease.

46 Comments from Respondents Thanks for doing this. An area that is given too little consideration in busy audiology offices...but certainly a high risk area. Some of the answers are not black/white, and treated on an as needed basis. Interesting set of questions I'll be thinking about for our practice. Continuing education and recommendations should be easily available, but I would not make this a mandatory issue for licensure. This survey is a fantastic idea!!! I am very interested in hearing your results! We were just discussing the need to have more written protocols at the clinic where I work.

47 References Amlani, A.M. (1999). Current Trends and Future Needs for Practices in Audiologic Infection Control. Journal of the American Academy of Audiology, 10, Ballachanda, B.B., Roeser, R.J., and Kemp, R.J. (1996). Control and Prevention of Disease Transmission in Audiology Practice. American Journal of Audiology, 5(1), Bankaitis, A.U. (2002). What s growing on your patients hearing aids? The Hearing Journal, 55(6), Burco, A. (2007) Current Infection Control Trends in Audiology. Unpublished AuD Capstone Project, Washington University. Retrieved October 22, 2007, from CDC (2007). Standard Precautions: Excerpt from the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, Retrieved April 8, 2008 from Clark, J.G., Kemp, R.J., Bankaitis, A.U. (2003). American Academy of Audiology Guideline. Audiology Today, 15(5),

48 References Kemp, R.J. and Bankaitis, A.E. (2000). Infection Control in Audiology. Retrieved September 19, 2007, from audiologyonline.com/articles/ph_article_detail.asp?article_id=214. Jones, J., Hoerle, D., and Riekse, R. (1995). Stethoscopes: A Potential Vector of Infection? Annals of Emergency Medicine, 25(3), Nurkin, S. Is the clinician's necktie a potential fomite for hospital acquired infections?, 104th General Meeting of the American Society for Microbiology, American Society for Microbiology, New Orleans (23 27 May 2004). OSHA (1991). Standard for bloodborne pathogens, Federal Register Sturgulewski, S.K., Bankaitis, A.U., Klodd, D.A., and Haberkamp, T.J. (2006). What s still growing on your patients hearing aids? The Hearing Journal, 59(9),