DON’T TAKE YOUR WORK HOME!

CARING FOR PATIENTS THAT HAVE CONTAGIOUS DISEASES

Perspectives in Pediatrics Conference

October 21, 2015

Richard A. Van Enk, Ph.D., CIC, FSHEADirector, Infection Prevention and Epidemiology

vanenkr@bronsonhg.org

I have no relevant financial relationships or conflicts of interest to disclose

Disclosures

• At the conclusion of this session, you will be able to:

1. List the most common contagious diseases to which healthcare workers are exposed

2. Classify contagious diseases into three types based on how they are transmitted

3. Select the correct ways to protect yourself from these diseases

4. Review some new things in infection prevention

Objectives

• Can we (or our families) get infections from our patients? At how much risk are we?

• What kinds of diseases can we get from our patients and how do we get them?

• How can we protect ourselves from these infections?

• Are there any new things we can do to make us safer when working with patients?

Outline

Can we (or our families) get infections from our patients?

• Although the proven transmission of infections to healthcare staff or their families from work are rare, they do happen and the potential risk is high– Some infections are

reportable to OSHA and we have some numbers

• Patients with MRSA tend to be colonized in warm, moist spots– Nose, groin, umbilicus, axilla– Not just the site of the infection

• Patients with diarrhea (like C. difficile, norovirus, rotavirus) become covered with a “patina” of microorganisms on their whole body

Contamination of the patient

Contamination of the patient environment

• A study of healthcare workers caring for patients with VRE showed that after care, 70% of staff carried VRE on their hands after touching the patient and 52% carried VRE on their hands after touching only the environment but not the patient

• A study showed that 17% of healthcare workers caring for a patient with MRSA contaminated their gowns during care, more if they manipulated the ET tube

• A study of the coats of doctors going to a Grand Rounds talk showed that 23% carried S. aureus, 18% were MRSA

Contamination of healthcare workers

National survey on healthcare exposures/infections

• A 2009 study from Germany searched their national healthcare system database for documented infections or exposures attributed to work and requiring treatment in healthcare workers

1. Scabies2. Tuberculosis3. Influenza4. MRSA5. Hepatitis C6. Hepatitis B7. HIV8. Pertussis9. Keratoconjunctivitis

• A review discussed the diseases that the CDC thinks healthcare workers are at risk of acquiring:1. Tuberculosis2. Bloodborne pathogens (HBV, HCV, HIV)3. Varicella (chickenpox)4. Methicillin-resistant Staphylococcus aureus5. Influenza6. Pertussis

Reported risks in the US

How do we get diseases from our patients?

• Direct or indirect contact– We touch something

contaminated, either the patient or something that touched the patient (stethoscope, scissors, tape, diaper, urinary catheter)

– Then touch our face or non-intact skin

– Examples; C. difficile, MRSA

How do we get diseases from our patients?

• Droplet– Droplets from the

patient’s respiratory tract from coughing, sneezing

– Common if the patient has a respiratory infection

– Considered to spread 3-4 feet from the patient for a few minutes

– Examples; RSV, influenza

How do we get diseases from our patients?

• A few infections are spread by the airborne route– Microorganisms

from the patient’s respiratory tract stay suspended in the air for hours

– Mainly tuberculosis, a few others in some situations

• Work practices; standard precautions• Engineering controls• Special precautions and personal

protective equipment• Proper laundering of work clothing• Immunizations• Some new ideas

How can we protect ourselves from infections?

• Things we do (or not do) to keep ourselves safe– Hand hygiene correctly for all patient encounters– Avoid risky behaviors with sharps (re-capping,

holding or setting down a used sharp, not activating the safety device, immediate disposal in sharps containers)

– Don’t eat or touch your face in patient care areas– Don’t work sick– Protect yourselves when cleaning spills– Remember; computers and everything at the nursing

station are contaminated

Work practices and standard precautions

Engineering controls

• Things we engineer into the room to enable you to work safely– Hand washing

facilities; sink and sanitizer

– Sharps containers– Laundry bins– Eyewash stations

Special precautions personal protective equipment

• Contact– Gloves, gown

• Droplet– Gloves, gown,

mask, eyes

• Airborne– N95-level

respiratory protection

• Many studies show that healthcare workers’ clothing becomes contaminated with our patients’ pathogens

• Healthcare-laundered scrubs are less contaminated than home-laundered– Significant hospital pathogens survive home

laundering

• Hospital contamination on scrubs spreads to other laundry during washing

Contamination of healthcare clothing and laundry issues

• The issue of laundering work clothing (scrubs) at home has become controversial because of a series of new guidelines

• If your scrubs are contaminated, the employer should launder them using healthcare standards

• Healthcare laundry standards are 160° for 25 minutes with bleach plus a hot drying cycle

Laundering your work clothing at home

• If working in a job where you are contaminated (OR, ED, procedures) use hospital-supplied and laundered scrubs

• Change clothes before leaving work• If you take scrubs home for laundering,

keep them separate from home laundry• Wear a new set of washed scrubs every day• Use hot water, preferably 140° with bleach,

on your work clothes (160° is optimum) and use the hot drying cycle

Recommendations

Problems

• The recommended hot water heater temperature for homes is 120°

• You need >140° for work clothing

• Some washers have internal heaters (the “sanitary cycle”)

• They tend to be newer and high end washers

• This temperature will fade and shrink your clothes faster

The special case of Ebola

• In the case of Ebola, no existing PPE fit the requirements for healthcare worker safety

• We had to design a new system beyond droplet

• Some diseases that we face as healthcare workers are preventable by immunization

• The CDC recommends that all healthcare workers be immune or up to date on the following immunizations:– Hepatitis B– Influenza (annually)– Measles/Mumps/Rubella– Varicella (chickenpox)– Tetanus/Diphtheria/Pertussis– Neisseria meningitidis

Immunizations

• Being immunized should reduce our risk of occupationally-acquired infection to nearly zero

• Bronson requires (and pays for) all staff to be up to date on these recommended immunizations at hire, and stay up to date with annual influenza immunization– I recommend that we all have our other adult

immunizations too, but they are not occupationally required

– This policy has made a big difference in staffing

Immunizations

• Importance of eye protection– New appreciation of the role of eye protection

as part of droplet precautions if the patient is coughing or sneezing

– The eyes are the most common way for viruses to enter the body

• Influenza– Mandatory influenza immunization of

healthcare workers is now the standard (Bronson was first, in 2005)

Are there any new things we can do to make us safer?

• Work attire– A new SHEA guideline this year recommends

short sleeves for all healthcare workers, daily laundering of work clothes, and no neckties

• Airborne respiratory protection; PAPRs– Powered Air Purifying Respirators are superior to

N95 filter respirators– Many hospitals are switching from N95 to PAPR

systems for airborne precautions

Are there any new things we can do to make us safer?

• There are no situations in which a worker should be restricted from working with any infected patient– Used to be for chickenpox, but no longer– No restrictions for pregnancy– No restrictions for immunosuppressed– No automatic restrictions for bloodborne pathogen-

infected workers

• However, there is a responsibility for the employer to counsel and educate the worker on risks

• If the worker is sick, they may be excluded from work

Are there work restrictions for certain workers or patients?

1. Nienhaus, A. et al. 2012. Infectious diseases in healthcare workers—an analysis of the standardized data set of a German compensation board. J. Occ. Med. Tox. 7:1-7.

2. Cloeren, M. and T. M. Perl. 1998. Occupationally acquired infections and the healthcare worker. Inf. Dis. Clin. Practice 10:261-270.

References

3. Bolyard, E. A. et al. Guideline for infection control in health care personnel, 1998. AJIC June, 1998 – http://

www.cdc.gov/hicpac/pdf/InfectControl98.pdf

Thank you!

bronsonhealth.com