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OOregon’sregon’s CommunityCommunity BasedBased CareCare NursingNursing NewsletterNewsletter It’s fl u season in Oregon The state’s fi rst confi rmed infl uenza case of the season has been reported to the Oregon Department of Human Services Public Health Division. “Flu has arrived in Oregon and we expect more cases in the coming weeks,” said Susan Allan, M.D., J.D., M.P.H., state public health director in DHS. “This is a good time to seek vaccination, which is the best protection again infl uenza. Take as household contacts, out-of-home advantage of any opportunity you have to caregivers of children six months and get the vaccine. younger; Vaccination is recommended for anyone » Health care workers; who wants to avoid being sick from fl u, » especially those who are at high risk of School-aged children. complications from infl uenza or are in For many people, the nasal spray vaccine close contact with those at high risk. FluMist is a good alternative to the Priority groups for vaccination are: injectable vaccine if they are healthy and » Children aged six months to fi ve years; between the ages of fi ve and 49. Continue d on page 2 » Pregnant women; » People 50 years of age and older; In this issue » People of any age with a chronic It’s fl u season in Oregon ...... 1 medical conditions; Infection control and hand hygiene ...... 2 MRSA review ...... 5 » People who live in nursing homes and Professional continuing education opportunity — other long term care facilities; Coming soon! ...... 6 Oregon Geriatrics Society wants you!! ...... 7 » People who live with or care for people at high risk for complication, such

Oregon Department of Human Services — Seniors and People with Disabilities Vol. 4 No. 4 2007 Flu season — continued Infl uenza is characterized by Oregonians die of infl uenza every year; abrupt onset of high fever, nationally fl u kills an estimated 36,000 headache, sore throat, cough people every year. and muscle aches. Unlike other Information on clinic locations and date common respiratory illnesses, can be obtained by calling 1-800-SAFENET it is associated with extreme or at the Lung Association’s fl u clinic fatigue and loss of appetite lasting several locator Web site. days. It is estimated that almost 450

Infection control Other than our hands, our medical equipment gets cross contaminated. The and hand hygiene chemical that we use to kill pathogens In October of 2002, the Centers for on surfaces is called a disinfectant. If you Disease Control and Prevention (CDC) soak equipment for 10 minutes (follow the published the guidelines for hand hygiene product instructions) the process is called (www.cdc.gov/handhygiene). The disinfecting. However, when you wipe the guidelines endorse the usage surface and allow immediate of alcohol-based hand rubs air-drying, that process is (gels, foams, sprays) when the called sanitizing. Generally, hands “are not visibly soiled.” we sanitize items more often CDC stated that plain soap than we disinfect them. and water should be used Any disinfectant will work when there is visible soilage well. The goal is to effectively on the hands. Although this Use alcohol-based minimize cross contamination was suggested more than hand rubs (gels, foams, to ourselves, colleagues, three years ago by the CDC, sprays) when the hands and other clients by there is still some distrust “are not visibly soiled.” sanitizing. Sanitizing surfaces and misunderstanding in the Plain soap and water immediately kills multiple- fi eld. Scientifi c studies have should be used when resistant Staphylococcus shown that, if there is no there is visible soilage aureus (MRSA). visible soilage, using alcohol- on the hands. based rubs is preferred over Virus-caused diarrhea has soap and water. Alcohol always plagued humans. evaporates immediately, and, therefore, The majority of virus pathogens begin does not remain as a residue, allowing skin in animals. Once they make the leap bacteria to mutate to become resistant to to humans, the virus becomes a known alcohol. It is well documented that hand pathogen. In Norwalk, Ohio, in 1972, hygiene compliance improves signifi cantly during an outbreak of nausea, vomiting when the rubs are promoted and used. and diarrhea, the suspected causative Continued on page 7 2 Oregon Department of Human Services — Seniors and People with Disabilities Vol. 4 No. 4 2007

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4 Oregon Department of Human Services — Seniors and People with Disabilities Vol. 4 No. 4 2007 MRSA review In addition to Recent news headlines talked about a high health care school student with an antibiotic-resistant associated staph infection who had died and how 21 infections, MRSA schools in Virginia, and surrounding states, can also infect had closed for cleaning to help keep the people in the infection from spreading. community at large. Such The villain in these cases turned out to be infections are generally mild and affect Methicillin-resistant Staphyloccus aureus the skin with pimples or boils that can be (MRSA). MRSA is a type of bacteria that swollen, painful and drain pus. These skin is resistant to certain antiobiotics. MRSA infections often occur in otherwise healthy caused more than 94,000 life-threatening people. infections and nearly 19,000 deaths in the United States in 2005, most of them connected with health care settings. These How MRSA spreads in health care numbers appear in the October 17, 2007 settings edition of the Journal of the American When we talk about the spread of an Medical Association (JAMA) as part of the infection, we talk about sources of most thorough study to date of trends in infection (where it starts) and the way invasive MRSA infections. or ways it spreads (the mode or modes of transmission). In the case of MRSA, What is MRSA? patients who already have a MRSA infection or who carry the bacteria on MRSA stands for methicillin-resistant their bodies but do not have symptoms Staphylococcus aureus. This type of (“colonized” with MRSA bacteria) are the bacteria causes “staph” infections that are most common sources of transmission. resistant to treatment with usual antibiotics. The main mode of transmission to other MRSA occurs most frequently among people is through human hands, especially patients who undergo invasive medical health care workers’ hands. Hands may procedures or who have weakened become contaminated with MRSA bacteria immune systems and are being treated in by contact with infected or colonized hospitals and health care facilities such as patients. If a health care worker doesn’t nursing homes and dialysis centers. MRSA wash with soap and water, or use an in health care settings commonly causes alcohol-based hand sanitizer after contact serious and potentially life-threatening with a patient, the bacteria can be spread infection, such as bloodstream infections when the health care worker touches other or pneumonia. patients. Continued on page 6

Vol. 4 No. 4 2007 Oregon Department of Human Services — Seniors and People with Disabilities 5 MRSA review — continued MRSA infections are becoming more The good news is that MRSA is prevalent in health care settings. According preventable. The ﬁ rst step is to prevent to Centers for Disease Control and health care infections in general. This Prevention (CDC) data, the proportion of can be accomplished by practicing good infections that are antimicrobial-resistant hand washing! Infection control guidelines has been growing. In 1974, MRSA produced by CDC and the Health care infections accounted for two percent of the Infection Control and Prevention Advisory total number of staph infections; in 1995 Committee (HICPAC) are central to the it was 22 percent; and in 2004 it was 63 prevention and control of health care percent. infections and, ultimately, MRSA in health care settings. It is estimated that in 2005 about 94,360 people developed a serious MRSA References infection. About 18,650 persons died Journal of the American Medical Association 2007; during a hospital stay of causes related to 298 (15): 1763-1771 serious MRSA infections. People 65 years Centers for Disease Control and Prevention (CDC): MRSA: Methicillin-resistant Staphylococcus aureus in old or older were most likely to get an Health care Settings; October 17, 2007. invasive infection.

Professional continuing education opportunity — Coming soon!

Seniors and People with Disabilities (SPD) This course is approved for 2.0 continuing Offi ce of Licensing and Quality of Care is education contact hours as granted by pleased to announce the release of the fi rst Seniors and People with Disabilities, a in a series of self study courses for nurses provider approved by the California Board practicing in Oregon’s community based of Registered Nursing. Directions for long term care system. The course, titled obtaining continuing education contact Seniors and People with Disabilities Self- hours are included in the self-study course. Directed Learning Series: Registered Nurse Delegation in Oregon, will be available in All subscribers to this newsletter will January 2008. A PDF download of the self- be notifi ed when the course is available study course will be available at no cost on online. the SPD Nursing Web site.

6 Oregon Department of Human Services — Seniors and People with Disabilities Vol. 4 No. 4 2007 Infection control and hand hygiene — continued virus was termed Norwalk virus. Since for this time period after symptoms then the group of viruses causing similar subside. illness has been re-named norovirus. Every The norovirus is not effectively killed by winter and spring, there are community alcohol. This virus is a rare exception to the and health-care facility outbreaks of both remarkable killing effect of alcohol. During clients and employees. The gastroenteritis an outbreak, it is recommended to switch is acute and outbreaks spread rapidly by back to the primary usage of soap and fecal-oral and person-to-person routes. The water. Continue using alcohol-based rubs major problem is the one-by-one attack also to kill all other pathogens involved in of employees. This not only takes a large your daily work. Simply wash hands ﬁ rst number of health care workers out of the and subsequently use a rub. It’s the best of work site(s), but there is also the problem both worlds. of them taking it home to their families and even re-infecting themselves. Norovirus is not killed by most common household disinfectants. After you The virus has a short incubation period. have thoroughly cleaned the soiled Once you ingest the viruses within contaminated surfaces, you should sanitize 12-48 hours, you begin experiencing the soiled surfaces with bleach (one part the symptoms, which can consist of any bleach to 10 parts of water). Another combination of nausea, vomiting and effective disinfectant for norovirus contains multiple episodes of diarrhea. It generally the active ingredient lasts 12-72 hours in a single person. It may phenol. This is an effective substance to last much longer in the entire household. use on surfaces that are not bleach safe. The person may be able to continue For a complete discussion on this disease spreading the virus for up to three days and infection control, go to: after the symptoms are gone. It is important to continue infection control precautions www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm

RIATRIC GE S Membership in this N SO O C G IE E T Oregon Geriatrics R Y organization entitles you O

Society wants you!! to attend their annual education conference, The Oregon Geriatrics Society (OGS) is held at Sunriver in October a medical society that focuses on seniors each year at a reduced rate, and long term care. It is the ofﬁ cial state opportunities to collaborate with others afﬁ liate of the national organization, the who work in older adults and network American Geriatric Society. This year OGS through personal and email interactions is opening up their membership to nurses, with other members. mainly those involved with elder care. For additional information please visit the OGS Web site at www.omda-ogs.org. Vol. 4 No. 4 2007 Oregon Department of Human Services — Seniors and People with Disabilities 7 Nurse to Nurse – Oregon’s Community Based Care Nursing Newsletter Oregon Department of Human Services Seniors and People With Disabilities 500 Summer Street NE, E-13 Salem, OR 97301

Seniors and People with Disabilities Mission Statement: Assisting seniors and people with disabilities of all ages to achieve individual well- being through opportunities for community living, employment and services that promote choice, independence and dignity.

Nurse-to-Nurse is published by Seniors and People with Disabilities, Ofﬁ ce of Licensing and Quality of Care, Oregon Department of Human Services, 500 Summer Street NE, E-13, Salem, OR 97301-1074 Editorial Team: Deborah Cateora, Health Service Unit Manager and Bernadette Murphy, Health Service Unit. Design and layout by Becki-Trachsel-Hesedahl, Web and Publication Design Team, DHS Ofﬁ ce of Communications