Infection Control PracticesInfection Control PracticesWhat you need to know…What you need to know…

STANDARD PRECAUTIONS GUIDELINESSTANDARD PRECAUTIONS GUIDELINES

1. Good Hand Hygiene - consistent and appropriate 1. Good Hand Hygiene - consistent and appropriate 2. Use the right PPE for the job2. Use the right PPE for the job * Gloves* Gloves * Face/Eye Protection* Face/Eye Protection * Gowns/Protective Apparel * Gowns/Protective Apparel 3. Clean & disinfect the environment; use of PPE 3. Clean & disinfect the environment; use of PPE

during cleaningduring cleaning4. Know and use Transmission-based Precautions4. Know and use Transmission-based Precautions5. Blood borne pathogen concerns – 5. Blood borne pathogen concerns – HIV, HBV, HVC HIV, HBV, HVC

* Handling body substances & sharps with care* Handling body substances & sharps with care to avoid exposure to bloodborne pathogensto avoid exposure to bloodborne pathogens * Annual review of safety devices to mitigate risk * Annual review of safety devices to mitigate risk * Use Respiratory Hygiene & Cough Etiquette* Use Respiratory Hygiene & Cough Etiquette to minimize the spread of germsto minimize the spread of germs

Hand Hygiene ProtocolHand Hygiene Protocol

WHO – Anyone who may come into contact with blood or body fluids– Anyone who may come into contact with blood or body fluids WHAT - Use or Alcohol based gel or hand-washing with antimicrobial soap - Use or Alcohol based gel or hand-washing with antimicrobial soap WHEN - Always before/after patient contact, wear gloves when - Always before/after patient contact, wear gloves when performing invasive procedures, or before making performing invasive procedures, or before making contact with patient skin (if in precautions) andcontact with patient skin (if in precautions) and before contact with non-intact skin or before contact with non-intact skin or contaminated inanimate objects/surfaces – contaminated inanimate objects/surfaces – Always wash hands after removing glovesAlways wash hands after removing gloves WHEREWHERE – Anywhere there is risk of coming into – Anywhere there is risk of coming into contact with blood or body fluidscontact with blood or body fluids WHYWHY - Because - Because good hand hygiene practices practices are the single most effective means of preventing are the single most effective means of preventing the spread of infection.the spread of infection.

Finger nails should be kept short Finger nails should be kept short No artificial nails in patient careNo artificial nails in patient care areasareas

Proper Hand Washing & Alcohol Gel/Foam UseProper Hand Washing & Alcohol Gel/Foam Use

Hand Washing:Hand Washing:

Use tepid water, wet hands and apply antimicrobial soap

Use good friction cleaning front and back off hand, paying attention to nails and between finger for 15 – 20 seconds

Pat hands day with paper towel and turn off faucet with a paper towel.

Always use hand washing when hands are VISIBLY soiled

Using Alcohol Gel/FoamUsing Alcohol Gel/Foam: Apply appropriate amount of

foam/gel into palm of hand Rub hands together using good

friction to all surfaces, paying attentions to nails and in between fingers

Rub hands together until product is evaporated and hands are completely dry

CDC recommends that after 4 uses of the gel/foam, that hand washing be done.

Personal Protective EquipmentPersonal Protective Equipment It is important to use the appropriate

personal protective equipment (PPE) for the job to be done

Wear PPE when with bloodborne pathogens (BBP) is anticipated

When removing PPE, avoid exposure by removing most contaminated to least contaminated

Dispose of PPE properly and ALWAYS wash hands after removing PPE.

Protect clothing, skin, and especially mucous membranes of the eyes, nose and mouth from BBP

Bloodborne Pathogen- Exposure Control PlanBloodborne Pathogen- Exposure Control Plan

OSHA requires hospitals to have a BBP Plan to mitigate the risk associated with BBPs; of particular concern are HIV, Hepatitis B (HBV) & Hepatitis C (HCV)

Considerations in BBP Plan include: * Routine disinfection and cleaning * Proper body substance & sharps handling * Safe injections practices * Respiratory Hygiene and Cough Etiquette * Proper Management of Occupation Exposures

Routine Environmental Disinfection and CleaningRoutine Environmental Disinfection and Cleaning

Routine disinfection and cleaning of environmental surfaces with hospital approved sanitizers is crucial in preventing spread of contaminants and pathogens

Staff who do environmental cleaning should wear the appropriate PPE during cleaning.

Body Substance & Sharps HandlingBody Substance & Sharps Handling

Dispose of contaminated items into appropriate containers, avoiding contact with clothing and environmental surfaces

Considers all needles and catheters and sharp and dispose of into red rigid biohazard sharps containers; empty container when the content reaches the “full” line marked on the container

Safe Injection PracticesSafe Injection Practices

All parenteral medications via single patient use sets

Use disposable single use syringes; never re-use or re-cap

Use single dose vials Decontaminate ports/vials with

70% alcohol solution before use Treat all needles and catheters

as sharps and dispose of properly

Respiratory Hygiene & Cough EtiquetteRespiratory Hygiene & Cough Etiquette

In waiting areas, signage should be posted requesting Patients to inform care givers of respiratory signs/symptoms

It is recommended that asymptomatic visitors not stay in the same area and that symptomatic patients be at least 3 feet from patients without respiratory symptoms

Patients with symptoms should be provided a mask, tissues, and alcohol hand gel and be asked to use clean hands, cover mouth when coughing and dispose of tissues properly

Healthcare workers should use mask and use hand gel before and after caring for respiratory patients.

Proper Management of OccupationalProper Management of OccupationalBBP ExposuresBBP Exposures

OSHA requires all healthcare facilities to provide care and follow-up in the event exposure or sharp injuries involving bloodborne pathogens

In the event of a needle stick/sharps injury and/or exposure: 1. Clean the area well with soap and water 2. Seek the necessary medical attention according to the institutions policy & procedure; you may receive counseling and prophylactic treatment might be offered if indicated 3. Complete the proper documentation according to the facility and/or your school’s policy & procedure; All facilities require some sort of an “occurrence report” or “incident report or notification” to be completed at the time of the event 4. Follow up according to the appropriate policy & procedure; these will vary by facility and by school; it is important to make yourself familiar with the process at your clinical location

Why Transmission-based Precautions?Why Transmission-based Precautions?

Understanding the Chain of Infection is the Key to Understanding the Chain of Infection is the Key to Understanding Transmission-Based PrecautionsUnderstanding Transmission-Based Precautions

The “Bug”The “Bug”An Infectious An Infectious

Organism/PathogenOrganism/Pathogen

The “Source”An infected or An infected or

colonized sourcecolonized source

Mode of Mode of TransmissionTransmission

The “Host”The “Host”A person with a A person with a compromised compromised immune responseimmune response

Chain of Chain of InfectionInfection

Contact TransmissionContact Transmission Person to person touchPerson to person touch Direct or Indirect contact Direct or Indirect contact

Transmitted by inanimate Transmitted by inanimate

objects….needles, objects….needles, unwashed hands… gloves unwashed hands… gloves that were not changed that were not changed between contact….between contact….

Contact PrecautionsContact Precautions Examples: MRSA, VRE, Herpes, Examples: MRSA, VRE, Herpes,

Impetigo, Scabies, RSV, and C-DiffImpetigo, Scabies, RSV, and C-Diff Use on patients known or suspected Use on patients known or suspected

to be “infected” or “colonized.”to be “infected” or “colonized.” Personal Protective Equipment Personal Protective Equipment

(PPE) is worn to prevent contact (PPE) is worn to prevent contact (i.e., Gloves & Gown)(i.e., Gloves & Gown)

Place in a private room or cohort Place in a private room or cohort cases of “same” organismcases of “same” organism

Dedicated patient care equipmentDedicated patient care equipment Precautions on transportPrecautions on transport HAND WASHING recommended HAND WASHING recommended

with C-Diff – alcohol gel is not with C-Diff – alcohol gel is not effective.effective.

Droplet TransmissionDroplet Transmission

Droplets carry infectious Droplets carry infectious organism – propelled organism – propelled through air – 3 feet.through air – 3 feet.

Through coughing, Through coughing, sneezing, talking, sneezing, talking, suctioning, singing.suctioning, singing.

Can involve direct contact Can involve direct contact or indirect contact….or indirect contact….

Droplet PrecautionsDroplet Precautions Examples: Influenza, Meningitis, Examples: Influenza, Meningitis,

PneumoniaPneumonia Use on patients known or suspected Use on patients known or suspected

to have infections caused by to have infections caused by microorganism transmitted in microorganism transmitted in “droplets” (“droplets” (large particles > 5microns)large particles > 5microns)

Droplets are propelled Droplets are propelled approximately 3 feet - mask should approximately 3 feet - mask should be worn if within 3 ft of the patient.be worn if within 3 ft of the patient.

Dedicated Patient Care EquipmentDedicated Patient Care Equipment Precautions on transportPrecautions on transport Special Ventilation is Special Ventilation is NOT NOT requiredrequired Place in private room or cohort Place in private room or cohort

infections of “same” organism.infections of “same” organism.

Airborne TransmissionAirborne Transmission Tiny particles (<5 Tiny particles (<5

MicronsMicrons) ) evaporated in evaporated in air or on dust particlesair or on dust particles

Can Stay suspended in air Can Stay suspended in air for long periods of time.for long periods of time.

Can be inhaled by Can be inhaled by susceptible host and cause susceptible host and cause infection.infection.

Airborne PrecautionsAirborne Precautions Examples; Tuberculosis, Varicella Examples; Tuberculosis, Varicella

Zoster, Measles, SARS.Zoster, Measles, SARS. Requires placement in a negative Requires placement in a negative

pressure room; door must remains pressure room; door must remains closedclosed

Must wear and N-95 OSHA Must wear and N-95 OSHA compliant Mask, Gown and Glovescompliant Mask, Gown and Gloves..

User must to “Fit Check” of mask User must to “Fit Check” of mask before entering the room; if seal is before entering the room; if seal is NOT obtained, the room should NOT obtained, the room should NOT be enteredNOT be entered

Signs/Symptoms of TB can appear Signs/Symptoms of TB can appear months or years after initial months or years after initial exposureexposure

Recognizing Tuberculosis….

According to the CDC an estimated 10-15 million people are infected in the US According to the CDC an estimated 10-15 million people are infected in the US – 10% will develop the disease at some point in their lifetime and active T.B. is – 10% will develop the disease at some point in their lifetime and active T.B. is more common in patients ages 35-60.more common in patients ages 35-60.

SymptomsSymptoms:: ** Cough lasting more than 3weeks Cough lasting more than 3weeks

* Loss of Appetite* Loss of Appetite * Unexplained Persistent Weight Loss * Unexplained Persistent Weight Loss * Coughing up Blood * Coughing up Blood * Profound Fatigue & Weakness* Profound Fatigue & Weakness * Nights Sweats* Nights Sweats

OSHA Requires - Annual PPD testing in all health care facilitiesOSHA Requires - Annual PPD testing in all health care facilities - N-95 Mask FIT TESTING- N-95 Mask FIT TESTING - Follow up testing on anyone who is exposed- Follow up testing on anyone who is exposed

About MRSA & VREAbout MRSA & VRE Staph Aureus and Staph Aureus and

Enterococcus are bacterial Enterococcus are bacterial that are normal flora in/on that are normal flora in/on the body.the body.

These bacteria have developed These bacteria have developed resistance to antibioticsresistance to antibiotics

People with MRSA or VRE People with MRSA or VRE are considered “colonized” are considered “colonized” even in the absence of even in the absence of infection, and can pass the infection, and can pass the organism on to others.organism on to others.

MRSA/VRE require special MRSA/VRE require special isolation precautions which isolation precautions which vary depending on where the vary depending on where the organism is isolated.organism is isolated.

Multi-Drug Resistant Organisms – Important Considerations

MDRO- Defined as – any microorganism that is resistant to one or more classes antimicrobials.

Includes: - MRSA – Methicillan Resistant Staph Aureus - VRE – Vancomycin Resistant Enterococcus - MDR – GNB – Multi-Drug Resistant Gram Negative Bacilli - C-Diff – Epidemic strain Clostridium Difficile resistant to Flurquinolones

Why are MDRO’s clinically significant?

MDRO’s:1. Increase the length of stays; increased cost and

mortality

2. Limit treatment options

3. Alter resistance patterns of other organisms

4. Encourage development of colonization in those exposed to these pathogens

Pandemic Influenza considerations… Pandemic influenza is a global concern All health care organizations are required to

include pandemic planning in the disaster management plan

The proper application of Respiratory Etiquette and appropriate use of PPE are considered the best means of mitigating the negative effects of pandemic influenza by limiting transmission

In Summary…..In Summary….. WASH YOUR HANDS WASH YOUR HANDS

PROPERLY AND PROPERLY AND FREQUENTLYFREQUENTLY

Always observe Standard Always observe Standard PrecautionsPrecautions

Wear the correct PPEWear the correct PPE Observe Transmission Observe Transmission

based Precautionsbased Precautions Know where to look for Know where to look for

additional Infection additional Infection Control InformationControl Information