INFECTION CONTROL ORIENTATION TRAINING 2006

Transcription

1 INFECTION CONTROL ORIENTATION TRAINING 2006

2 INFECTION CONTROL OSHA BLOODBORNE PATHOGEN STANDARD STANDARD PRECAUTIONS RISK OF EXPOSURE TO CONTAMINATED MATERIALS USE OF PROTECTIVE EQUIPMENT FOLLOW-UP OF CONTAMINATED EXPOSURES HEPATITIS VACCINE

3 INFECTION CONTROL SPECIFIC ISSUES GLOVES: LATEX ALLERGIES AVAILABILITY/USE OF PROTECTIVE EQUIPMENT USE OF SAFETY DEVICES SYRINGES NEEDLELESS IV TUBING SAFETY PERIPHERAL IV CATHETERS

4 INFECTION CONTROL TUBERCULOSIS CURRENT INFECTION CONTROL GUIDELINES FROM CDC OSHA STANDARD WITHDRAWN (5/2003) USE OF SPECIAL AIRFLOW ISOLATION ROOMS HEALTHCARE WORKERS MUST USE N95 RESPIRATORS (annual fit test required)

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6 INFECTION CONTROL: COST $4.5 BILLION PER YEAR (1996) 88,000 DEATHS PER YEAR

7 What are the 10 most common causes of infection?

8 What are the 10 most common causes of infection?

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10 STUDY DESIGN OBSERVATIONAL EVALUATE OPPORTUNITIES FOR HAND HYGIENE BEFORE/DURING/AFTER PATIENT CARE EVALUATE ADEQUACY OF HAND HYGIENE ADEQUATE: >15 SECOND WASH OR USE OF ALCOHOL HANDRINSE INADEQUATE: <15 SECOND WASH NON-COMPLIANT: NO HAND HYGIENE OBSERVED

11 STUDY FRAMEWORK CENTERS FOR DISEASE CONTROL GUIDELINE FOR HAND HYGIENE IN HEALTHCARE SETTINGS (OCTOBER 2002) HANDWASHING WHEN HANDS VISIBLY SOILED ALCOHOL HANDRINSE IF NOT VISIBLY SOILED DECONTAMINATE HANDS BEFORE PATIENT CONTACT DECONTAMINATE HANDS BEFORE DONNING STERILE GLOVES DECONTAMINATE HANDS BEFORE PATIENT CARE PROCEDURES DECONTAMINATE HANDS AFTER PATIENT CONTACT DECONTAMINATE HANDS IF MOVING FROM CONTAMINATED SITE TO CLEAN SITE DURING PATIENT CARE DECONTAMINATE HANDS AFTER CONTACT WITH EQUIPMENT DECONTAMINATE HANDS AFTER REMOVING GLOVES DECONTAMINATE HANDS BEFORE EATING AND AFTER USING RESTROOM

12 LITERATURE REVIEW OBSERVATIONAL STUDIES ( ) OVERALL POOR COMPLIANCE BY HEALTHCARE WORKERS MEAN BASELINE RATES 5%-81% OVERALL AVERAGE: 40% INTERVENTIONAL ACTIONS INSERVICE FEEDBACK DISTRIBUTION OF INFORMATION IMPLEMENTATION OF ALCOHOL HANDRINSES COMPLIANCE AFTER INTERVENTIONS INCREASED BY 15-20%

13 RESULTS FROM CURRENT EVALUATION TOTAL OF 480 OBSERVATIONS OF OPPORTUNITIES FOR HAND HYGIENE ADEQUATE HAND HYGIENE: 28% (136) INADEQUATE HAND HYGIENE: 18% (85) NON-COMPLIANT: 54% (259)

14 RESULTS FROM CURRENT EVALUATION COMPLIANCE BY DISCIPLINE RN STAFF ADEQUATE HAND HYGIENE: 28% INADEQUATE HAND HYGIENE: 24% NON-COMPLIANT: 48% LVN STAFF ADEQUATE HAND HYGIENE: 24% INADEQUATE HAND HYGIENE: 6% NON-COMPLIANT: 70% TECH STAFF ADEQUATE HAND HYGIENE: 9% INADEQUATE HAND HYGIENE: 9% NON-COMPLIANT: 82%

15 RESULTS FROM CURRENT EVALUATION COMPLIANCE BY DISCIPLINE PHYSICIAN STAFF ADEQUATE HAND HYGIENE: 33% INADEQUATE HAND HYGIENE: 8% NON-COMPLIANT: 59%

16 IT S ALL IN YOUR HANDS WASH THEM

17 And do not wear artificial nails "No artificial nails or nail polish for direct patient care providers which includes the residents and medical students.

18 INFECTION CONTROL EQUIPMENT AS A SOURCE OF NOSOCOMIAL INFECTION THE STETHOSCOPE??? 11 GENERA & SPECIES OF BACTERIA WERE ISOLATED STAPH EPI- 100% STAPH AUREUS- 38% ISOPROPYL ALCOHOL IS AN EFFECTIVE CLEANING AGENT WHEN APPLIED TO THE STETHOSCOPE DIAPHRAGM ARCH. INTERN MED. 1997;157:

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22 INFECTION CONTROL ISOLATION CATEGORIES CONTACT ISOLATION DIRECT CONTACT TRANSMISSION ISSUES WOUND/DRESSING ISOLATION ENTERIC PATHOGENS RESISTANT ORGANISM ISOLATION VRE ISOLATION PROTOCOLS: PATIENT MUST REMAIN ON ISOLATION FOR ALL ADMISSIONS CHICKENPOX (ALONG WITH AIRBORNE )

23 INFECTION CONTROL Contact Precautions (In addition to Standard Precautions) Visitors Report to Nurses Station Before Entering Room PRIVATE ROOM When a private room is not available, cohort with patient(s) who has active infection with the same microorganism but with no other infection. GOWN AND GLOVES ALWAYS wear gown and gloves when entering the room, regardless of the reason for entering the room. If the patient is in Contact Precautions, any type of patient care requires gown and gloves until the patient has been taken out of Contact Precautions either by the Charge Nurse, Physician or Infection Control Practitioner. Remove gown and gloves before leaving patient s room. WASH HANDS with antimicrobial agent immediately after glove removal and before leaving the patient s room. TRANSPORT Limit the movement/transport of patients from room to essential purposes only. During transport, ensure that all precautions are maintained at all times. When possible, dedicate the use of noncritical patient-care equipment to a single patient. If common equipment is used, clean and disinfect between patients.

24 INFECTION CONTROL ISOLATION CATEGORIES CONTACT ISOLATION Always wear gown and gloves when entering the room, regardless of the reason for entering the room

25 INFECTION CONTROL ISOLATION CATEGORIES DROPLET ISOLATION MENINGITIS MENINGOCOCCAL H. FLU INFLUENZA PERTUSSIS RUBELLA

26 INFECTION CONTROL Droplet Precautions (In addition to Standard Precautions) Visitors Report to Nurses Station Before Entering Room PATIENT PLACEMENT Private Room: When a private room is not available, cohort with patient(s) who has active infection with the same microorganism but with no other infection. Maintain spatial separation of at least 10 feet from other patients and visitors if cohorting or private room is not available. RESPIRATORY PROTECTION Mask required when working within 10 feet of patient (or when entering room). Everyone entering the room will wear a surgical mask, and then discard it when exiting the room. Do Not hang the mask on the doorknob, lay on a shelf, etc. after wearing into the room of a patient on droplet isolation. A new mask is worn each time you enter the room. PATIENT TRANSPORT Limit the movement/transport of patients from room to essential purposes only. During transport, place surgical mask on the patient, if possible.

27 INFECTION CONTROL ISOLATION CATEGORIES DROPLET ISOLATION PRIVATE ROOM REGULAR AIRFLOW WEAR REGULAR MASK FOR PATIENT CARE USUALLY 24 HOUR DURATION

28 INFECTION CONTROL ISOLATION CATEGORIES AIRBORNE ISOLATION TUBERCULOSIS CHICKENPOX (WITH CONTACT ISOLATION)

29 INFECTION CONTROL Airborne Precautions (In addition to Standard Precautions) STOP Report to Nurses Station Before Entering Room Patient Placement Private Room that has: Monitored negative air pressure 6-12 air changes per hour Discharge of air outdoors or HEPA filtration before air is re-circulated. KEEP THE ROOM DOOR CLOSED AND PATIENT IN THE ROOM. Respiratory Protection - Always wear an N95 respirator mask that was fittested for you by Employee Health for known or suspected AFB disease. Susceptible persons should not enter the room of patients with known or suspected measles (rubeola) or varicella (chicken pox) if immune caregivers are available. The patient wears a surgical mask if leaving the room for any reason. Patient Transport - Limit the movement/transport of patients from room to essential purposes only. During transport, place surgical mask on the patient, if possible.

30 INFECTION CONTROL ISOLATION CATEGORIES AIRBORNE ISOLATION PRIVATE ROOM WITH NEGATIVE AIRFLOW OR HEPA FILTERED AIR FOR TUBERCULOSIS: MUST WEAR SPECIAL N-95 RESPIRATOR FOR CHICKENPOX MASK IF NON-IMMUNE... CDC RECOMMENDS THAT ONLY IMMUNE PERSONNEL CARE FOR PATIENTS WITH VARICELLA INFECTION...

31 INFECTION CONTROL INFECTION CONTROL PLAN CDC ISOLATION RECOMMENDATIONS ISOLATION QUICK REFERENCE TB CONTROL PLAN OSHA EXPOSURE CONTROL PLAN CLINIC PLAN/AMBULATORY PLAN **AVAILABLE ON INTRANET

32 INFECTION CONTROL WASTE MANAGEMENT PROPER DISPOSAL OF CONTAMINATED MATERIALS ALL MEDICAL WASTE- AUTOCLAVE BAGS SHARPS WASTE- NEEDLEBOXES LINEN- ALL CONSIDERED CONTAMINATED USE BLUE PLASTIC BAGS at S&W USE pink bags with white liners at VAMC

33 INFECTION CONTROL EMPLOYEE HEALTH ISSUES TB SKIN TESTING N-95 RESPIRATOR FIT TESTING HEPATITIS B VACCINE OTHER IMMUNIZATION INFORMATION HEPATITIS A VARICELLA FOLLOW-UP CONTAMINATED EXPOSURES

34 INFECTION CONTROL INFECTION CONTROL S&W OFFICE X X44917 INFECTION CONTROL S&W PAGERS #0426 #1220 INFECTION CONTROL VAMC x or cell phone

35 Isolation Signs VAMC Acute care

36 Nutrition & Food Service Employees: May Enter STOP Wash Hands on Entering and Leaving Room Gloves To Enter the Room Visitors: Report to Nurses Station Before Entering Room Gown For Contact with Patient, Environmental Surfaces or Items in Room Visitantes: Favor de Presentarse a La Sala De Enfermeras antes de Entrar al Cuarto

37 STOP Wash Hands on Entering and Leaving Room N95 or HEPA Respirator to Enter Negative Air Pressure Keep Door Closed Visitors: Report to Nurses Station Before Entering Room Visitantes: Favor de Presentarse a La Sala De Enfermeras antes de Entrar al Cuarto

38 Nutrition & Food Service Employees: May NOT enter STOP Wash Hands on Entering and Leaving Room Mask to Enter Room Visitors: Report to Nurses Station Before Entering Room Visitantes: Favor de Presentarse a La Sala De Enfermeras antes de Entrar al Cuarto

39 Isolation Signs VAMC Long Term Care And Nursing Home Care Units

40 DROPLET ISOLATION Use in Long Term Care Nursing Home Care Units Mask is required to enter The Red Dot is to alert Nutrition and Food Service staff not to enter the patient s room. Nursing will take the food tray to the patient DROPLET ISOLATION Use in LTC/NHCUs Back of Sign with Red Dot

41 STOP Staff & Visitors Before Entering Room Visitors: Report to Nurses Station for Instructions ALTO! Antes de Entrar al Cuarto Visitantes: Favor de Presentarse a La Sala de Enfermeras Nutrition & Food Service Employees: May Not enter

42 CONTACT ISOLATION For Use in LTC/NHCUs The Green Dot is to inform Nutrition and Food Service employee it is OK to deliver the food tray to the patient s room CONTACT ISOLATION Use in LTC/NHCUs Back of sign with green dot

43 STOP Before Entering Room All Staff & Visitors: Report to Nurses Station for Instructions ALTO! Antes de Entrar al Cuarto Visitantes: Favor de Presentarse a La Sala de Enfermeras Nutrition & Food Service Employees: May Enter

44 The End Proceed to the Post Test Down load the Post Test Complete the Post Test Return the post test to Dr. Sandra Oliver at 407i TAMUII

45 Post test Question 1 What is the single most important thing that you can do to prevent the spread of infection?

46 Post Test Question 2 CDC recommends that a nonimmune health care worker may take care of an isolated patient with Chicken Pox as long as a surgical mask is worn by the Health care worker. True False

47 Post Test Question 3 What is a common organism that requires contact isolation A. TB B. VRE C. Bacterial Meningitis D. Measles