INFECTION CONTROL ORIENTATION TRAINING 2009

Transcription

1 INFECTION CONTROL ORIENTATION TRAINING 2009

2 STANDARD PRECAUTIONS BASICALLY. If it s WET and NOT YOURS, don t get any on you!! PPE And Safety Devices Are Provided!! Use them correctly to protect yourself!!

3 STANDARD PRECAUTIONS Wash hands before & after examining patients or contact with blood, body fluids or contaminated items Wear gloves when contact with blood, body fluids, mucous membrane and broken skin Wear mask, eye protection, gown if splashes/sprays are expected

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

5 What are the 10 most common causes of infection? Your fingers!

6 Wash your hands before & after touching patients or contaminated material

7 The Gap Between Perception and Reality Self-reported rate Handwashing after patient Contact/n 105/123 % compliance 85 Estimate of co-workers rates 63/ Observed rate 48/ CDC Emerging Infectious Diseases Vol. 7, No. 2, Mar-Apr 2001: Robert A Weinstein Controlling Antimicrobial Resistance in Hospitals

8 CDC Guidelines for Hand Hygiene HANDWASHING WHEN HANDS VISIBLY SOILED (at least 15 seconds) Alcohol hand rinse 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

9 Hand Hygiene by S&W Employees 100% 2006 (YTD) Handwashing Compliance by Group 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% RN LVN Aide student MD Other compliance rate Overall Rate

10 100% Hand Hygiene Compliance Rates by Hospital Unit 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 7 SOUTH 7EAST 7WEST 6SOUTH 6EAST 6WEST 5SOUTH 5WEST 4SOUTH 4WEST 3SOUTH NURSERY L&D STC2 STC3 STC4 STC5 CICU SICU PICU MICU ED STC1 SF2N SF3N SF3S 2006 OVERALL UNIT RATE S&W 2004 OVERALL HOSPITAL RESULTS S&W 2006 OVERALL HOSPITAL RESULTS S&W 2005 OVERALL HOSPITAL RESULTS

11 HAND HYGIENE RECOMMENDATIONS All health care providers will perform hand hygiene before and after all patient encounters. Use of the alcohol hand rinse is an acceptable alternative to soap and water when hands are not visibly soiled. Soap and water must be used after potential exposure to Clostridium difficile. S&W Quality Council 2006

12 IT S ALL IN YOUR HANDS WASH THEM USE ALCOHOL HANDRINSE

13 Proper Glove Removal Contain the Contamination

14 Do Not Wear Artificial Nails "No artificial nails or nail polish for direct patient care providers which includes the residents and fellows.

15 SOURCES OF NOSOCOMIAL INFECTION STETHOSCOPES & BP Cuffs Staph epi - 100% Staph aureus- 38% Pseudomonas ARCH. INTERN MED. 1997;157:786790

16

17 Clean stethoscope s diaphram between patients Even with isopropyl alcohol, which is an effective cleanser, you must pay attention to the edges of the stethoscope s diaphram

18 OTHER SOURCES OF NOSOCOMIAL INFECTION

19 Same Room, More contamination After pulling up the bed rail, the HCP checked the IV bag before turning to wash his/her hands bed rail IV Site IV bag

20 Computer Keyboards Spread More Than Words PSAE VRE MRSA Reinberg, S. April HealthDay Reporter. accessed April 3, 2006.

21 ISOLATION CATEGORIES CONTACT ISOLATION Direct Contact Transmission Issues: Wound/Dressing Isolation Standard precautions if not draining Contact precautions if draining Resistant Organism Isolation Isolate new positive cultures Isolate with history of infection or colonization Isolate on readmission unless documentation for removal has been met

22 ISOLATION CATEGORIES CONTACT ISOLATION MRSA Diarrhea enteric pathogens Rotavirus C. Difficile VRE Hepatitis A RSV Chickenpox (along with airborne isolation) Viral Meningitis (only if stool incontinent)

23

24 MODIFIED CONTACT PRECAUTIONS VRE Infections (Vancomycin Resistant Enterococcus) * Commonly found in the GI tract * Easily transmitted by HCP s on hands and clothing * MUST wear gown and gloves!!

25

26 EXTENDED CONTACT PRECAUTIONS C DIFF INFECTIOUS DIARRHEA (Clostridium Difficile) * Spore forming bacteria * ONLY washed off with soap and water!! * Alcohol NOT effective against C Diff

27

28 ISOLATION CATEGORIES DROPLET ISOLATION MENINGITIS (Bacterial) Meningococcal Haemophilus influenzae INFLUENZA PERTUSSIS RUBELLA (German measles)

29 DROPLET PRECAUTIONS STOP HAND HYGIENE Before Entering Room Surgical Mask REQUIRED To Enter Room HAND HYGIENE After Exiting Room

30 Isolation Categories Airborne Isolation TUBERCULOSIS Active or Rule Out MEASLES **CHICKEN POX **Zoster (Shingles) In An Immune Compromised Patient **Contact Precautions in addition, if there are any lesions that have not ruptured and crusted over.

31 AIRBORNE PRECAUTIONS STOP Nutrition & Food N95 Service or HEPA Employees: May NOT Negative Air Pressure Enter HAND HYGIENE HAND HYGIENE Respirator Mask Before Entering After Exiting REQUIRED REQUIRED Room Room To Enter Room Keep Door Closed

32 MUST BE FIT TESTED BEFORE ENTERING AN AIRBORNE PRECAUTION ROOM!!

33

34 All Precaution Signs

35 Precautions Armbands CONTACT PRECAUTIONS MODIFIED CONTACT PRECAUTIONS EXTENDED CONTACT PRECAUTIONS DROPLET PRECAUTIONS AIRBORNE PRECAUTIONS Place appropriate precaution bracelet on patient when Precautions are ordered or are deemed necessary. Refer to Infection Control Policies located on the Intranet for specific Precaution procedures.

36

37 Target MDROs Microorganisms resistant to one or more classes of antimicrobials Vancomycin-resistant Enterococcus (VRE) Methicillin-resistant Staphylococcus aureus (MRSA) Vancomycin-intermediate Staphylococcus aureus (VISA) Vancomycin-resistant Staphylococcus aureus (VRSA) Multidrug-resistant Gram-negative Bacilli (MDR-GNB) Multidrug-resistant Streptococcus pneumoniae (MDRSP) Clostridium difficile (C. diff)

38 Not The Same Old Bugs Provided with global transportation Continuously adapting to new conditions New hosts rat to man; bird to man; cow to man New drugs selection of survivor pathogens: resistance

39 Methods to prevent transmission of MDROs Standard precautions Contact precautions Healthcare Transmission criteria for initiation criteria for discontinuation modifications for various patient care settings patient and visitor fact sheets

40 Methods to prevent transmission of MDROs Explicit instruction for cleaning environmental surfaces Assessing cleaning adequacy via environmental culturing Capturing the need for isolation prior to admission on Hospital Bed Request Notification of healthcare facilities and personnel prior to transfer of colonized/infected MDRO patients within or between facilities

41 INFECTION CONTROL To remove patients from resistant organism isolation Maintain Standard Precautions MRSA Negative culture from original site No current infection or treatment VRE 3 negative rectal swab cultures over 3 weeks Negative original source No current infection or treatment

42

43 INFECTION CONTROL PLAN CDC Isolations recommendations Isolations Quick Reference TB Control Plan OSHA Exposure Control Plan Clinic plan/ambulatory care Plan

44 INFECTION CONTROL WASTE MANAGEMENT Proper disposal of contaminated materials All medical waste Autoclave bags Sharps waste needle boxes All soiled linen considered contaminated USE blue plastic bags at S&W USE pink bags with white liners at VAMC

45 INFECTION CONTROL EMPLOYEE HEALTH ISSUES TB skin testing on employment, postexposure, and as requested N-95 RESPIRATOR fit testing on employment, annually as necessary Hepatitis B vaccine complete series Immunization Documentation up to date VARICELLA - history of chickenpox or complete series Follow up contaminated exposures Employee health x 45520

46 Exposure means any Exposure to Blood or Body Fluids Active acne Atopic dermatitis Bug bites Burns Cuts, scratches, abrasions Chapped skin Dermatitis/rash Eczema Fresh shave (razor burn) Hang nails Psoriasis Needle stick Splash

47 Personal Protective Equipment - PPE Don PPE before contact with the patient, generally before entering the room Use carefully don t spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene PPE Use in Healthcare Settings

48 Sequence* for Donning PPE Gown Mask first or respirator Goggles or face shield Gloves *Combination of PPE will affect sequence be practical PPE Use in Healthcare Settings

49 Contaminated and Clean Areas of PPE Contaminated outside front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism PPE Use in Healthcare Settings

50 Sequence for Removing PPE Gloves Face shield or goggles Gown Mask or respirator PPE Use in Healthcare Settings

51 NO Eating in Patient Care Areas Do not eat, drink, smoke, apply cosmetics or lip balm, shave, or handle contact lenses in any area where there is a reasonable potential for pathogen or body fluid exposure. Eating and/or drinking is limited to private offices, staff break rooms, conference rooms, the cafeteria, and designated outside picnic areas. And Yes This Includes Bottled Drinks At Nurses Stations

52 INFECTION CONTROL DEPARTMENT S&W S IC OFFICER IS: John Loden Carpenter, MD Hospital Epidemiologist, Chairman of Infection Control DIRECTOR: Shirley Jeandron, MSN, MBA Phone: Pager: IC PRACTITIONERS: Karen Yates Ext Pager: Callie Wilde Ext Pager: Martha Land Ext Ext FOR MORE INFORMATION ABOUT INFECTION CONTROL, CONTACT: Dept. Ext or

53 Isolation Signs VAMC Acute care

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

55 AIRBORNE ISOLATION 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 Nutrition & Food Service Employees: May NOT enter

56 DROPLET ISOLATION 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 Nutrition & Food Service Employees: May NOT enter

57 Isolation Signs Central Texas Veterans Health Care System Long Term Care and Nursing Home Care Units

58 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

59 Before Entering Room Staff & Visitors: 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

60 CONTACT ISOLATION Use in Long Term Care & Nursing Home Care Units The Green Dot is to inform Nutrition and Food Service employee it is OK to deliver the food tray to the patient s room

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

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

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

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

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