Infection Prevention and Control Annual Education 2013 Authored by: Infection Prevention and Control Department
Objectives After you complete this Computer-Based Learning (CBL) module, you should be able to: Describe Transmission-Based Precautions (categories of isolation). Describe standard precautions designed to prevent transmission of blood borne pathogens. Describe the importance of getting the flu vaccine. List examples of products used to clean patient care equipment. Describe measures to stop the spread of tuberculosis.
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.
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.
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-diff.
Get Your Flu Shot Each Fall Each year in the United States, on average: 5% to 20% of the population gets the flu. More than 200,000 people are hospitalized from flu complications. About 36,000 people die from flu each year. You can infect others with the flu beginning one (1) day before you have symptoms. Healthcare workers who do not take the flu vaccine are required to wear a mask during flu season.
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.
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.
Equipment Cleaning: How Often? At a minimum, clean equipment whenever it is visibly soiled. Also, clean patient care equipment before and after use with different patients. Clean equipment at predetermined frequencies (example: weekly), or as determined by hospital policy.
Equipment Cleaning: Disinfectants Unless otherwise specified, use Cavicide disposable wipes to clean equipment. Contact time: 3 minutes Other hospital-approved disinfectants include: Dispatch Contact time: 5 minutes for C. difficile Virex 256 Used by Environmental Services (EVS) Contact time: 10 minutes Manufacturer s specified disinfectants See label for proper contact time
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.
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! When returning medications to Pharmacy from an isolation room, use a clean biohazard bag.
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.
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 3/4 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.
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.
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.
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.
Respiratory Etiquette Cover your mouth/nose with a tissue when coughing. Place a surgical mask on a coughing patient, if they 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.
Empiric Precautions Applying 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. 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.
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 Airborne
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. They also use bleach to clean all C-diff rooms.
Transmission-Based Precautions - Contact Precautions Contact Precautions, cont. Use when caring for patients with multidrugresistant organisms (MDRO), draining wounds, scabies, or viral pathogens. Examples of multidrug-resistant organisms include: MRSA (Methicillin-resistant Staphylococcus aureus) VRE (Vancomycin resistant Enterococcus faecalis or faecium) ESBL (Extended Spectrum beta-lactamase producer) 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 environment.
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.
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
Transmission-Based Precautions Droplet Precautions Droplet Precautions 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. Some organisms, such as some respiratory viruses, can be transmitted by both droplet and contact. Implement both droplet and contact precautions.
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.
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.
Transmission-Based Precautions Airborne Precautions Airborne Precautions Start empiric (practical) application of Airborne Precautions in the following situations: Lung cavity or other reason to suspect tuberculosis (TB). Common TB symptoms include, but are not limited to: Unintentional weight loss Cough Chest pain History of travel outside the U.S. Measles Chickenpox or disseminated zoster, per MD s diagnosis (plus Contact Precautions) Smallpox (plus Contact Precautions)
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. Put patients on airborne isolation precautions in 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. 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.
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.
Mycobacterium Tuberculosis (TB) Mycobacterium tuberculosis (TB): Is transferred through the air when a person coughs, sneezes, sings, talks or breathes. The particles are so small that normal air currents keep them airborne and can spread them throughout a room or building unless isolation measures are used. May cause infection when you inhale the organism exhaled by a person with TB disease.
Mycobacterium Tuberculosis, cont. Mycobacterium tuberculosis (TB): Primarily involves the lungs (pulmonary TB), but the infection can spread to other organs (extrapulmonary TB). Is curable if diagnosed and treated early. Anyone who shares air for an extended period of time with a person who has TB in the lungs or larynx is at risk for TB.
Diagnosing TB AFB Cultures Obtain three sputum cultures. Taken at least eight hours apart. One must be an early morning sputum. Have Respiratory obtain by induction if Have Respiratory obtain by induction if necessary.
TB Illness v. Latent TB Infection With TB illness, the patient: Has signs and symptoms of infection. Is contagious if in the lungs or larynx. Needs to take medications until told they are no longer needed. Needs follow-up by the health department. Needs to wear a surgical mask until told by the health department it is OK not to wear it.
Illness v. Latent TB Infection, cont. With latent TB infection (LTBI), the patient: Has a positive tuberculin skin test (TST, formerly called PPD). Has no signs or symptoms. Is not contagious at this time. Patient could become sick and contagious if not treated appropriately. May require treatment for nine to 12 months. Does not need to wear any mask. Needs follow-up by the health department.
Controlling Tuberculosis Transmission The following groups of controls are used to control TB transmission in healthcare facilities: Administrative Engineering Respiratory
Controlling Tuberculosis Transmission Administrative controls include: Evaluate the risk of TB exposure for associates each year. Evaluate each patient on admission for signs and symptoms of TB. Evaluate all new associates for previous exposure to TB. Investigate all work related TB exposures. Educate associates about TB.
Controlling Tuberculosis Transmission Engineering controls include: Place all patients with suspected or confirmed TB in an AIIR airborne infection isolation room. Perform daily checks of the directional airflow (negative pressure) when a TB patient is using an airborne infection isolation room. Keep the door to the room closed when a TB patient is using an airborne infection isolation room.
Controlling Tuberculosis Transmission Respiratory controls include: All associates who may enter an airborne infection isolation room must be fit-tested for an N95 respirator. The associate MUST wear an N95 respirator when entering an airborne infection isolation room in use for a TB patient. The associate must fit-check the N95 respirator each time worn to ensure proper placement on the face.
Take Action Prevent Transmission: Isolate Early If the patient has two or more symptoms: Place a surgical mask on the patient. If unable to mask the patient, place the patient in an AIIR until cleared. Notify Infection Prevention and Control. Notify the doctor. Give the patient the Patient Information Sheet for TB.
Discontinuing Isolation, TB Ruled Out Prior to removing a suspected TB patient from isolation, you must contact Infection Prevention and Control for clearance to discontinue isolation. After approval from Infection Prevention and Control: Remove the isolation sign. Notify EVS that the patient is ruled out for TB.
Discontinuing Isolation, Confirmed TB Prior to removing a patient with TB from isolation, the patient must meet the following criteria: Three consecutive negative sputum cultures Be on medication for at least 14 days and take all doses Be clinically improved. You must contact Infection Prevention and Control for clearance to discontinue isolation.
Discontinuing Isolation, Confirmed TB, cont. Do not admit a patient to the airborne isolation room for at least 69 minutes after the patient with TB leaves. The door must remain closed during the 69- minute interval. You must leave the isolation sign on the door of the airborne isolation room for EVS. EVS can clean the room during the 69-minute interval, but associates must wear an N-95 respirator mask while in the room.
Congratulations! You have completed this CBL module. Click on Take Test to continue. Questions? Contact the on-call Infection Control practitioner at 770-639-3308.