Infection Prevention and Control and Isolation Authored by: Infection Prevention and Control Department

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1 Infection Prevention and Control and Isolation 2015 Authored by: Infection Prevention and Control Department

2 Objectives After you complete this Computer-Based Learning (CBL) module, you should be able to: Describe proper techniques for hand hygiene. Describe standard precautions designed to prevent transmission of blood borne pathogens. Discuss Proper disposal of biohazardous waste Describe proper storage of: Food, Medication, Linen, and Clean equipment. Describe appropriate response to potential exposures to infectious disease.

3 When Do I Perform Hand Hygiene? Before touching a patient. Before performing aseptic/clean procedures. After body fluid exposure. After touching a patient. After touching patient surroundings.

4 Step-by-Step Hand Washing 1. Wet hands with comfortably warm running water. 2. Apply soap from the dispenser. 3. Rub hands together for at least 15 seconds, being sure to cover every part of your hands. 4. Rinse hands under running water allowing water to run off the fingertips. 5. Dry hands with a paper towel. Use paper towel to turn off the water.

5 Foam In, Foam Out Clean your hands with waterless alcohol hand rub whenever you enter or leave a patient room. Use soap and water: After using the toilet. Before eating. If hands are visibly soiled. After caring for patients with C. difficile, Norovirus or diarrhea.

6 Respiratory Etiquette Cover your mouth and nose with a tissue when coughing. Place a surgical mask on a coughing patient if the patient can tolerate it. Perform correct hand hygiene after contact with respiratory secretions. In common waiting areas, separate persons with respiratory infections at least 3 feet apart, if possible.

7 Food and Medication Safety Each day, check patient refrigerators used for food and medication for: Cleanliness, Expired food and medication, and Proper temperature. Document your findings on a temperature log. Do not store food or medication or specimens in the same refrigerator. No associate food allowed in clinical areas! Covered drinks are allowed in pre-designated clean zones only.

8 Responsibility for Equipment Cleaning Cleaning patient care equipment is the shared responsibility of: Sterile Processing/Patient Care Equipment, Environmental Services, Patient care associates, and Ancillary services. All users are responsible for ensuring that equipment is clean before using it on a patient. Equipment not identified as clean is considered dirty. Clean it before using it on a patient.

9 Equipment Cleaning: How Often? At a minimum, clean equipment whenever it is visibly soiled. Also, clean patient care equipment before and after use on different patients. Clean equipment at predetermined frequencies (example: weekly), or as determined by hospital policy.

10 Equipment Cleaning: Disinfectants Unless otherwise specified, use PDI (AF3) disposable wipes to clean equipment. Contact time: 3 minutes Other hospital-approved disinfectants include: PDI Bleach Contact time: 4 minutes Virex 256 Used by Environmental Services (EVS) Contact time: 10 minutes Manufacturer s specified disinfectants See label for proper contact time

11 Determining If Equipment is Clean Identify clean equipment by one of three methods: Equipment with a plastic covering is considered clean. Equipment stored in a clean unoccupied patient room is considered clean. Equipment stored in the supply room is considered clean.

12 Other Cleaning Tips Clean your computer at the beginning of your shift by wiping the keyboard and mouse with a disinfectant wipe. Remember to access Stanley carts with clean hands only!

13 Linen Storage Keep clean linen covered at all times. Place soiled linen in blue linen bags. Do not mix soiled linen with sharps or red bag waste. Put nothing other than linen down the linen chute.

14 Biohazard Waste Use red biohazard bags for disposable items that are so saturated with blood that you can squeeze blood from the item. Change sharps containers when 2/3 full. Always use sharp safety devices correctly. Always place biohazardous waste in a biohazard bin, located in the soiled utility room in each department. Never place sharps, bloody items and red bags in patient linen.

15 Standard Precautions GMC uses Standard Precautions for every contact involving a: Patient Resident Volunteer Visitor Associate Treat all blood and body fluids as if they are potentially infectious. If you think you might be exposed to blood or body fluids, put on appropriate PPE before caring for the patient. Standard Precautions includes the use of hand hygiene and appropriate PPE before caring for any patient if you anticipate any exposure to blood or body fluids.

16 Personal Protective Equipment Wear Personal Protective Equipment (PPE) whenever you anticipate contact with blood or body fluids. For example, wear gloves when drawing blood. Don appropriate PPE before beginning the task or entering the patient s room. Remove PPE and perform hand hygiene before moving on to the next patient or task.

17 Safe Injection Practices Adhere to basic principles of aseptic technique when preparing and administering parenteral medications. Use a sterile, single-use, disposable needle and syringe for each injection you give. Never use a single-use needle/syringe to administer intravenous medication to multiple patients. Do not reinsert the same needle into a multiple-dose vial or solution container (e.g., saline bag). This prevents contamination of injection equipment and medication. Do not prepare injectable medications in the same workspace where used needle/syringes are disassembled.

18 Occupational Health Basics Get the Hepatitis B vaccine. It is available at no charge to associates considered at risk. Occupational Health administers it in three doses. It is safe and effective. Just do it! Use safe work practices such as the neutral zone in surgery or a splashguard in the lab. Use engineering controls, such as safety syringes and needleless IV tubing, whenever possible.

19 Blood Borne Pathogen Exposure If you experience a blood borne pathogen exposure, immediately: 1. Stop what you are doing. 2. Clean the affected area. 3. Notify your supervisor. 4. Contact: Occupational Health, if your exposure occurred during normal business hours. The Emergency Department after normal business hours for an immediate medical evaluation.

20 Protect Yourself If you think you may be exposed, contact Occupational Health. If exposure is confirmed, follow up as instructed by the Occupational Health nurse. If you are ill with an infectious disease, don t forget to: Call the confidential sick call line at , or sickcall@gwinnettmedicalcenter.org.

21 Infection Prevention and Control Annual Education Isolation Precautions 2015 Authored by: Infection Prevention and Control Department

22 Objectives After you complete this Computer-Based Learning (CBL) module, you should be able to: Describe Standard Precautions designed to prevent transmission of blood borne pathogens. Describe procedures involved in these Transmission-Based Precautions (categories of isolation): Contact, Droplet, and

23 Standard Precautions GMC uses Standard Precautions for every contact involving a: Patient Resident Volunteer Visitor Associate Treat all blood and body fluids as if they are potentially infectious. If you think you might be exposed to blood or body fluids, put on appropriate Personal Protective Equipment (PPE) before caring for the patient. Standard Precautions includes the use of hand hygiene and appropriate PPE before caring for any patient if you anticipate any exposure to blood or body fluids.

24 Standard Precautions Personal Protective Equipment Wear Personal Protective Equipment (PPE) whenever you anticipate contact with blood or body fluids. For example, wear gloves when drawing blood. Don appropriate PPE before beginning the task or entering the patient s room. Remove PPE and perform hand hygiene before moving on to the next patient or task.

25 Empiric Precautions Apply isolation precautions before a clear diagnosis. Because it is not possible to immediately identify all patients needing specific precautions, certain clinical conditions call for the practical application of isolation precautions while waiting for a more clear diagnosis.

26 Empiric Precautions, continued Examples include: An incontinent or diapered patient with acute diarrhea with a likely infectious cause. Open and draining wounds with no dressing or drainage not contained by a dressing. Cough/fever/upper lobe pulmonary infiltrate in any patient. Enter an order into HEO for each patient placed in isolation.

27 Transmission-Based Precautions Use Transmission-based Precautions when a patient requires more than Standard Precautions. Follow the instructions on the isolation sign on the patient door. The sign lists specific requirements for each precaution. Transmission-based categories include: Contact, Droplet, and Airborne.

28 Transmission-Based Precautions Contact Precautions Contact Precautions Standard Precautions, plus Gowns and gloves for direct contact with patient or patient s environment. Use dedicated equipment or clean equipment thoroughly between patients. Environmental Services cleans room with emphasis on high-touch items. Environmental Services uses bleach to clean all C. difficile rooms.

29 Transmission-Based Precautions Contact Precautions Contact Precautions, continued Use Contact Precautions when caring for patients with: Multi-drug resistant organisms (MDROs), Draining wounds, Scabies, or Viral pathogens. Examples of MDROs include: MRSA (Methicillin-resistant Staphylococcus aureus) VRE (Vancomycin resistant Enterococcus faecalis or faecium) All healthcare workers involved in the care of patients on Contact Precautions must wear gowns and gloves for direct contact with the patient or the patient s

30 Transmission-Based Precautions Contact Precautions Transporting Patients Before leaving a Contact Isolation room: Ensure that the patient s wounds or lesions are covered. Dress the patient in a clean hospital gown. The transporter and patient both must perform hand hygiene immediately prior to leaving the room. The transporter does not wear a gown, gloves or mask in the hallway when transporting patients on Contact Isolation Precautions. The transporting unit and the transporter must notify the receiving department of the impending arrival of the patient.

31 Transmission-Based Precautions Droplet Precautions Droplet Precautions Start empiric (practical) application of Droplet Precautions in the following situations: Influenza Mumps Mycoplasma pneumoniae Pertussis (whooping cough) Rubella (German measles) Suspected bacterial meningitis

32 Transmission-Based Precautions Droplet Precautions Droplet Precautions, continued Droplets are particles of respiratory secretions larger than 5 micrometers. They do not remain suspended in the air for extended periods. They can be transmitted within 3-6 feet from the source patient.

33 Transmission-Based Precautions Droplet Precautions Droplet Precautions, continued You do not have to use special air handling systems and higher level respirator masks to care for patients with diseases capable of droplet transmission. The doors of Droplet Precaution rooms may remain open, unlike with Airborne Precautions. Everyone entering these rooms must wear a surgical mask.

34 Transmission-Based Precautions Droplet Precautions Transporting Patients The patient must wear a surgical mask during transport. If needed, escort the patient while he or she is transported to procedure areas to ensure that the patient does not remove his or her mask during transport. The transporter does not wear a gown, gloves or mask in the hallway when transporting these patients. The transporting unit and the transporter must notify the receiving department of the precautions necessary to reduce the risk of transmission of infectious microorganisms.

35 Transmission-Based Precautions Airborne Precautions Airborne Precautions Airborne nuclei particles are smaller than 5 micrometers that can remain suspended in air for an extended time to create exposure risk for individuals who are susceptible. Patients on Airborne Isolation Precautions require an AIIR or negative air pressure room. The AIIR must be a private room with negative air pressure and a minimum of 6-12 air changes per hour. The door to AIIR isolation rooms must remain closed, except for entering and exiting the rooms. When notified by nursing the Engineering Department does daily checks on all AIIR currently in use. Negative pressure log books are kept on the unit. Everyone entering these rooms must wear an N95 respirator mask.

36 Transmission-Based Precautions Airborne Precautions Airborne Precautions, continued Start empiric (practical) application of Airborne Precautions in the following situations: Suspected or confirmed TB Measles Chickenpox or disseminated zoster, per MD s diagnosis Smallpox

37 Transmission-Based Precautions Airborne Precautions Transporting Patients The patient must wear a surgical mask during transport. If needed, escort the patient while he or she is being transported to procedure areas to ensure that the patient does not remove his or her mask during transport. The transporter does not wear a gown, gloves or mask in the hallway when transporting patients on Airborne Isolation Precautions. The transporting unit and the transporter must notify the receiving department of the precautions necessary to reduce the risk of transmission of infectious microorganisms.

38 Transmission-Based Precautions Discharging Isolated Patients If the patient has not been cleared from a specific isolation prior to discharge, the isolation sign remains posted on the discharged patient s door until EVS terminally cleans the room.

39 Transmission-Based Precautions Reference Refer to Policy #600-02, located on the Intranet, regarding Transmission-Based Precautions.

40 Congratulations! You have completed this Infection Prevention and Control and Isolation modules. Continue on to take the test for both modules. Questions? Contact Infection Prevention and Control Ext