Infection Control Measures

Transcription

1 Infection Control Measures Goals and Objectives Joanne Maniscalco, BSN, MPH, MPA Continue the downward trend Prevent another resurgence Eliminate the threat to health care workers Identify and assess TB patients/suspects for infectiousness Implement measures to reduce risk of exposure for health care workers and others to potentially infectious TB patients Educate TB patients/ suspects by providing information on reducing risk of exposing others to infectious TB Surveillance Benefits of Collaboration To obtain information and review community TB statistics for risk assessment Ensure accurate information of individuals with suspect/confirmed tuberculosis - Enables correct information for required reporting Assist in the prevention and control of TB in the community avert another TB resurgence and eliminate the lingering threat to HCWs from contact with persons having unsuspected and undiagnosed infectious TB CDC. Guidelines for Preventing the transmission of Mycobacterium tuberculosis in Health Care Settings. MMWR 2005;54:2.

2 Collaborative Effort with ICP/Facilities Ensure the continuation of the three levels of an infection control program (administrative controls, environmental controls, and respiratory protection) Prevent the spread of disease to HCW s and patients Consult with health care practitioners to ensure appropriate treatment Facilitate case management Without Collaboration No ability for timely reporting Improper treatment Inappropriate discharge and follow up HCW exposure Patients exposed Rehospitalization Development of MDR-TB Three Levels of a Tuberculosis Control Program* Roles and Responsibilities of a TB Program Administrative most important Environmental Respiratory protection * CDC. Guidelines for Preventing the transmission of Mycobacterium tuberculosis in Health-Care Settings. MMWR 2005;54. Prevent spread of tuberculosis (TB) and assist in eliminating TB Ensure appropriate treatment of suspect/confirmed tuberculosis Identify individuals at high risk for the development of active, infectious TB disease Identify and tuberculin skin test contacts and assure treatment as appropriate Provide consultation on the prevention, diagnosis, and treatment of tuberculosis Ensure that all individuals receive appropriate care, even if unable to pay

3 Health Care Settings - Examples Health Settings - Policies Outpatient clinics Medical/dental offices Correctional facility Medical units Home based health care Long term care Homeless shelters Emergency medical settings Laboratories handling clinical specimens Every health care setting must have a tuberculosis (TB) infection control policy Will differ. Depends on: Type of setting Risk of transmission Specific state regulations which govern the provision of care in that setting Symptom Assessment IS IMPORTANT!! Infection Control in Clinics Any healthcare worker who is the first point of contact with the patient should be trained to ask questions that facilitate early identification of persons with suspected TB disease Triage Nurse should: Rapidly assess for signs and symptoms Quickly isolate and give mask Educate on cough etiquette Send to ED Notify ICP/ED of impending arrival Notify LHD of suspect

4 Scheduling Patients Referred from a hospital/private health care provider with known positive smears on sputum should receive a mask upon arrival to the clinic If patient symptomatic, they should be given priority for medical evaluation and other diagnostic tests Whenever possible, schedule patient with TB disease at the last appointment of the day When there is a minimum number of other patients and health care workers in clinic Have patient enter office or clinic through side or back door entrance. Infection Control in Hospital Administrative most important level Infection Control Practitioner should: Perform daily rounds to assure compliance with isolation and sputum collection. Track the timely collection and processing of sputum specimens for smear results Ensure signage indicating isolation is posted for staff and visitors Conduct staff education on transmission prevention Manage exposure workup Maintaining communication with the LHD continuously updating information Patient has 3 negative smears and is clinically improved- Respiratory isolation discontinued If patient remains smear positive specimen should be fast tracked (if possible) for identification Treatment started and collection of specimens may begin following 14 th day treatment DOH notified of treatment start and dosages Discharge - Immediately notify LHD and send discharge summary Timely Reporting Timely Reporting Outreach staff can conduct chart review and 1st interview in hospital - Assists in determining the period of infectiousness - Assists in determining where patient spent time - Assists in determining the scope of the contact investigation Ability to do home visit while in hospital Facilitates assessment of home situation Assure proper treatment and diagnostic work-up Suggest specimen sent for fast tracking, as appropriate

5 Reporting Criteria May differ by state TB disease is considered a communicable disease in NYS Must be reported within 24 hrs - Facilities may differ in policies for reporting (phone, fax, etc.) Physicians, labs are also mandated reporters Home Assessments Assessments should be done within 24 hours of case assignment Potentially infectious patients who will be discharged home get a HA immediately upon notification from the health care provider Home Assessment Discharge Planning Private home vs. apartment building Single home vs. multiple dwelling Multiple dwelling vs. congregate/communal setting To identify additional contacts Relatives or roommates. Neighbors who visit regularly. To verify patient address Locate/Identify where patient live in the building. Identify whether home is being used as a boarding house. Starts at admission - Must be a collaborative decision 1. Is pt. infectious? 2. Is home environment appropriate? 3. Are there young children? 4. Will pt. agree to home isolation, if necessary? - Can coordinate clinic appointments and continuation of medication

6 Discharge Planning A copy of the discharge summary should be sent to the LHD on all hospitalized TB patients Physicians are required to provide a monthly status report on all TB cases and suspects to the LHD Discharge Criteria Treatment with meds to which the patient is known or likely to be susceptible Shown clinical improvement A specific plan for DOT has been implemented Stable residence has been established Living alone or with others who are immune competent Patient agrees to home isolation while still infectious, to cooperate with plan of care and follows instructions Agree to stay home except for medical appointments No significant contact with infants, young children, or immune compromised persons No home health or social service staff in the home for extended periods every day Discharge Planning Criteria for Discontinuing Home Isolation Discharge planning for any patient with confirmed or suspected MDR-TB must be undertaken in close consultation with state and local health departments to ensure all case management and infection control measures are addressed Demonstrated clinical improvement Treatment with drugs to which the patient is known or likely to be susceptible Three consecutive negative AFB smears taken 8-24 hours apart; one an early morning specimen

7 Remember Web Addresses Symptom assessment Isolation Surveillance Collaboration DOT CDC. Guidelines for Preventing the transmission of Mycobacterium tuberculosis in Health-Care Settings. MMWR 2005;54:2. control.htm Guidelines for Environmental Infection Control in Health-Care Facilities OSHA regulations for fit testing =FEDERAL_REGISTER&p_id=21311