Erlanger Infection Control Program Resident Resident Orientation Orientation and and Bloodborne Bloodborne Pathogen Pathogen Review Review 2008-2009 2009 1
Outline 1. Healthcare associated infections 2. Infection Control Program 3. Exposure Control Plan 4. Tuberculosis Control Plan 5. Isolation Precautions 2
Healthcare Associated Infections Affects 2 million Americans annually Responsible for 90,000 deaths annually Account for 50% of all hospital related complications. 3
Infection Control Program Assess the risks for infection to patients, staff, and visitors Identify opportunities for prevention and control of infection Collaborate with other departments to implement strategies to prevent infection and monitor outcomes 4
Infection Control Program Surveillance activities and management of infection data Resource for information Regulatory compliance TOSHA, FDA, JCAHO, etc. Reporting to Health Departments 5
National & State Initiatives Tenn. Patient Safety Initiatives CMS Core Measures PFP AMI,CAP,CHF,SCIP Institute of Healthcare Improvement Save 5 million lives campaign Leapfrog Group 6
Current Initiatives Prevention of ventilator associated pneumonia Prevention central line related infections Surveying insertion practices (Chloraprep, max. sterile barriers, use of antimicrobial impregnated caths) Preventing the development and transmission of C. diff, MRSA, and other MDROs Prevention of surgical wound infections Preventing occupational needlesticks and other exposures 7
Perform Hand Hygiene Maximum Sterile Barriers Use Chloraprep to prep the skin Use the subclavian site where possible Assess need for line every day 8
Exposure Control Plan Includes: Actions taken by Erlanger to prevent exposures to bloodborne pathogens How Erlanger manages exposures when they do occur 9
Exposure Control Plan Located under the Infection Control folder on the Erlanger intranet Infection Control 10
Bloodborne Pathogens Any pathogen that can be transmitted through contact with blood or items contaminated with blood and body fluid. Hepatitis B, Hepatitis C and HIV 11
Risk of Transmission HIV - 0.3% Hepatitis C - 5-10% Hepatitis B - 30% 12
Hepatitis B Vaccine Free 95% effective Series of 3 shots over 6 months 13
Exposure Prevention Strategies 14
What is an Exposure? Puncture injury from contaminated device. Splash of blood or body fluid into eyes, nose, mouth or onto broken skin. 15
Standard Precautions Used for all patients. All blood, body substances are considered potentially infectious. 16
Personal Protective Equipment (PPE) Gloves Impervious gowns Masks Protective Eyewear 17
Hospital s s Responsibilities Provide adequate supply Conveniently located Correct size Healthcare worker education 18
Your Responsibilities Wear it!! Anytime an exposure can be reasonably anticipated to occur. Notify unit manager if not available. 19
Exposure Incidents Sharps injuries -Most often associated with suturing and blood drawing Blood & Body Fluid Exposures -Most involve blood to eyes -Most not wearing eye protection. -Most occurred during irrigation procedures 20
Management of Exposures Immediately wash the exposed area Notify the unit manager or charge nurse Contact the A-1/House A Supervisor right away Complete an Illness\Injury Injury form (used documentation and follow-up at Workforce) 21
Management of Exposures Labs drawn on the source patient. (Arranged by the A1/House Supervisor on duty) Rapid HIV test on source patient should be available in one hour. You will be notified by the A-1 A 1 of results. If positive, you will be counseled regarding PEP 22
Why don t t I just order the labs myself on the patient? Documentation of occupational exposure for follow-up Assure appropriate labs are ordered. Expenses for exposure work-ups should not be charged to the patient. 23
Documentation for UTCOM File appropriate paperwork for the State s s Workmen s s Compensation Contact the GME Office (Liz McGhee or Pam Scott) regarding the paperwork (Suite 104, Whitehall Building, 778-7442) 7442) 24
Hand washing or using alcohol hand sanitizer is the single most important means of preventing infections in both employees and patients. Hand Hygiene 25
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ERLANGER HEALTH SYSTEM RESIDENT HAND HYGIENE COMPLIANCE RATE March 2007 - May 2008 100% 90% 45 40 % Comp lianc e 80% 70% 60% 50% 40% 30% 20% 10% 35 30 25 20 15 10 5 # Observations 0% Mar-07 Apr May Jun Jul Aug Nov Dec Jan-08 Feb Mar Apr May 0 % compliance # Observations 27
ERLANGER HEALTH SYSTEM PHYSICIAN HAND HYGIENE COMPLIANCE RATE March 2007 - May 2008 100% 90% 80% 100 90 80 % Comp lia n c e 70% 60% 50% 40% 30% 20% 10% 70 60 50 40 30 20 10 # Observations 0% Mar-07 Apr May Jun Jul Aug Nov Dec Jan-08 Feb Mar Apr May 0 % Compliance # Observations 28
Handwashing How? -10-1515 seconds with running water. When? -Before and after all patient contact. -After the removal of gloves. 29
Alcohol Hand Sanitizer Excellent bactericidal activity - rapid kill Must apply properly to be effective Use often - before and after care Improves skin integrity Available in and outside all patient rooms Wash if soil present 30
These hand cultures were taken from one nurse volunteer at Mother-Baby Plates were incubated for 48 hours 31
Don t get offended if someone reminds You to wash or sanitize 32
Tuberculosis 33
Tuberculosis # Cases 2007 # Cases 2006 Tennessee 234 279 Hamilton County 13 7 Erlanger 5 6 Erlanger 2007 2006 HCW Conversion rate 0.2% 0.8% Post-Exposure Conversion rate 0 0 Compliance w/ post-exposure testing 72% 76% 34
Airborne Precautions Stop sign and airborne precaution signs on door. N-95 PR s outside door. Door remains shut. 35
Airborne Precautions Patients with known or suspected TB. Requires a negative pressure room. Requires 3 negative AFB smears to discontinue HIV+ patients with undiagnosed pulmonary illness require Airborne Precautions unless TB has been ruled out. 36
What if I m I m Exposed to TB? Infection Control follows all + AFB s If MTB, the chief of your service as well as all Residents will be notified by letter. PPD should be done 3 months after exposure 37
Pediatric TB Children are usually not contagious but are isolated until evaluated by Infection Control Isolation required until family members ruled out as index case (Health Dept) 38
Fit-testing testing to N95 TB Mask Assure you are fit-tested tested during orientation process Remember your mask size after fitted One N95 mask is to be used for a full shift if patient is not on contact precautions 39
Contact Precautions To decrease the risk for transmission of epidemiologically significant organisms Utilized for patients who are colonized or infected with resistant organisms. Always isolate VRE, C.diff,, multi-drug resistant gram negative organisms, MRSA and patients who have uncontained drainage from any body site regardless of organism cultured. Initiated by the Physician, Infection Control or Nursing. Notify Infection Control before discontinuing 40
Contact Precautions Wear gloves to enter the room Wear a gown for contact with the patient or his environment Good Hand Hygiene. Wash or sanitize. Devices used on the patient must be cleaned before removing from the room (Stethoscopes included!) 41
Key Issues to Prevent Transmission of MRSA in Healthcare Settings Active surveillance = targeted culturing of patient s at high risk for carriage of MRSA and prompt isolation of positives. Barrier use Contact precautions gloves upon entering the room; Gowns when contact with the patient or his environment is anticipated Compulsive Hand Hygiene by all providers Disinfect ALL equipment between patients and use disposables Where available (i.e. thermometers, stethoscopes, BP cuffs pulse ox probes). Maintain PDI sanitizing wipes in hallway holders. Adequate disinfection of the environment by EVS. 42
Miscellaneous Issues Do not come to work if you have a contagious illness such as pink eye, flu, strep throat, fever etc. See UTFP for treatment. 43
Healthy Tips Get a flu shot in the fall. Wash your hands frequently. 44
Questions About Infection Control? Contact the Infection Control Office at ext. 7239 from 7:30 am to 4:30 pm. After office hours, call the A-1 A 1 for assistance Infection Control can be reached 24/7 by A1 as needed. 45