Journal Review C hristine Blackmore BSN MPHCIC Department of Epidemiology 021716 1 Month Day Year 2 Journal of the American Society of Radiologic Technologists ID: 759083
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APIC Greater New YorkChapter 13Journal ReviewChristine Blackmore, BSN, MPH,CICDepartment of Epidemiology
02/17/16
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Slide2Month Day, Year
2
Journal
of
the
American
Society
of
Radiologic
Technologists
D
I
R
EC
TE
D
R
E
ADI
NG
AR
TICLES
Prostate
Brachytherapy
PAGE 137
Anal
Cancer
PAGE 165
PE
E
R-
R
E VI E WE D AR TICLES
Surface Dose Effects of Linen
Coverings for Breast and Chest
Wall Patients
PAGE 119
Risk of Patient Infection From
Heating Appliances Used
to Produce Thermoplastic
Immobilization Devices
PAGE 125
Volume 23, Number 2
Fall 2014
Slide3Thermoplastic Immobilization Device use promotes improved treatment accuracy and reproducibility in radiation therapy. Customized thermoplastic devices are widely used for a variety of pathologies, allowing extremely accurate treatment delivery, particularly when coupled with image-guided techniques.What has not been determined is the potential for disease transmission due to contamination of form-heating equipment such as water baths.
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide4Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
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Slide5Article Purpose: To determine whether heating appliances used to fabricate customized thermoplastic immobilization devices carry a disease transmission risk.To examine maintenance and use of appliances to determine if potential risk exists.Background: Current literature provides ample evidence that water baths in health care settings are potential reservoirs for microorganisms associated with patient infections.
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide6Methods: On-site surveys of equipment and procedures in several medical facilities. Sampled heating devices for microbial content and analyzed data for growth trends over 30 day period.Participants: 14 radiation therapy facilities in 3 states invited by random sampling, within ~200 mile radius. Practical limitation-distance. 2 sites didn’t participate. Informed consents, interview and immediate water bath sampling.
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide7Mesophilic bacteria grow best in temperatures between 25ᵒ C and 4ͦ0ᵒ C (77ᵒ-104ᵒ F). Most human pathogens grow at around 37ᵒ C (98.6ᵒF).Some mesophiles exhibit increased heat tolerance if exposed to higher temps for short periods.Water for thermoplastic forms must be heated to 70ᵒ C-90ᵒ C (158ᵒF-194ᵒF)Bacillus species is heat tolerant- 1 study done –needed 75ᵒC-121ᵒC (167ᵒ-250ᵒ F)
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide8Hypothesis: Water bath temperatures of 74ᵒC could preclude growth of most microorganisms, thereby minimizing infection risk.
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide9Table 1Survey ChecklistSection Title Items/QuestionsFacility informationPerson authorizing study.Date of authorization.Average number of patients treated daily.Culture results.Sample collectionDate and time of collection.Date and time of delivery to lab.Time between collection and lab delivery.
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide10Interview questionsDate of interview.Name of the person answering questions.Date water bath was put in use.Is a written policy in place?Can you provide a copy of that policy? Can you provide a copy of the operator manual for the appliance?Is a water change included on the quality control checklist?Type of water used (eg, distilled, tap).Is the bath turned off after hours?Is it left on all day during business days?How often is the water bath typically used?When was the water bath last used? How long before the bath is ready to use (ie, warm-up delay)?What signals to staff that it is ready for use?When was water last added?Is the water emptied between uses?When was the water bath last emptied? Is the bath drained at the current location?How do you describe water bath maintenance (ie, water depth maintenance, cleaning, water change)?Is disinfectant used for cleaning?Is a growth inhibitor added (eg, algaecide)?Is the water bath completely emptied and dried when cleaned?
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide11Water bath information. Brand Model.Location of water bath. What is the current digital temperature reading?What is the actual water temperature when measured with a thermometer?Is there visible debris in the water?Is there visible film on sides or top?Is rust visible in the tank?
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide12Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Water depth in milliliters.Tank depth in millimeters.Are there lid locks on the heating appliance?Is an instruction label present on the appliance? Comments.
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide14G. E covered electric skilletVollrath food warmer
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide15Results:Appliance use varied from daily use to weeklyAppliance warm up times ranged from 5-30 minutes at 11 sites, one never turned off appliance.Water depth varied.None had established written protocols specifying heating appliance use.3 sites indicated that water baths were emptied between use.
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide16Month Day, Year
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12 heating devices sampled. 7 Med/Tec CIVCO water baths, 5 G.E covered skillets 1 Vollrath food warmerResults: Lid, base, or bothFive (42%) –lidCoag-neg Staphylococcus (25%)Coag-neg Staphylococcus and Corynebacterium species (~8%)Bacilllus species (~8%)*4 /12 appliances not designed for immobilizing form preparation.
Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
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Table 2 Brewer, Ravine, BruCulture Results SiteApplianceLidBaseDigital Temperature Reading (°C)Thermometer Reading (°C)Water Appearance1MedTec/CIVCO water bathNN7870Film-like substance2MedTec/CIVCO water bathNN6970Clear3MedTec/CIVCO water bathCNS and CorynebacteriumN76aNASediment, cloudy water 4MedTec/CIVCO water bathCNSN7674Sediment, cloudy water5MedTec/CIVCO water bathNN7372Clear6MedTec/CIVCO water bathNN7477Clear7Vollrath food warmerBacillus speciesBacillus speciesbNA68Clear8GE skilletNNbNA98Whitish scale9GE skilletNNbNA76Clear10MedTec/CIVCO water bathNN7484Clear11GE skilletCNSNbNA75Whitish scale12GE skilletCNSCNSbNA84Clear
Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide19Limitations:Authors believe that this is the first attempt to examine potential disease transmission from contaminated water baths.Small sample size is inherent in any initial study.Participating sites represented a diverse group within the 200 mile radius with a combined average treatment volume of 500 patients, thus the research contributes valuable new information to radiation therapy literature.Extrapolating results to other facilities warrants caution.
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide20Discussion: Lids contaminated with commensal flora suggest ungloved or unclean hands.Warm up times and water temperatures varied across the devices and water appearance didn’t always correlate with results.Absence of written protocols for use and maintenance of appliances at all sites suggest opportunities for Q . I.
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide21Conclusion:This research demonstrated that proper hand hygiene and water bath maintenance are important to minimize infection risk to radiation therapy patients.Therapists should follow guidelines and apply recommended I.C policies and procedures.Timely and effective routine maintenance and scheduled cleaning, adequate warm up.Minimizing infection helps patients battling serious disease.Consult with I.P or I.D for further concerns
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Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices
Slide22Month Day, Year
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Thank You