Table of Contents - steubencony.org · Web viewThe containment system shall be leak-proof, have tight-fitting covers, and be kept clean and in good repair. The containers may be

Table of ContentsPage

Tab 1 Infection Control Exposure Overview 1

Tab 2 Definitions 7

Tab 3 Federal Guidelines for Employees and Classifications 10

Tab 4 Hand Hygiene and Other Ways to Control Infection 11

Tab 5 Personal Protective Equipment 13 Worksite Influenza Vaccination Policy 15

Tab 6 Sharps and Needleless Devices 17

Tab 7 Specimen Collection 18

Tab 8 Environmental Control (Housekeeping) 19

Tab 9 Blood and Body Fluid Spill-Cleanup 22

Tab 10 Regulated Medical Waste Disposal and Transporting 23Regulated Waste

Tab 11 Staff Education/Training 28

Tab 12 Bloodborne Pathogens: Pre- and Post-Exposure Prophylaxis 29

Tab 13 References 30

S2AY Network Infection Control Exposure PlanOrigination: April 2003

Last Update: 04/18/17Latest Updated: 04/17/18

INFECTION CONTROL EXPOSURE OVERVIEW

POLICYPrevention is an important aspect of the care provided by the Local Health Department (LHD). It is the policy of the Health Department to accurately identify and prevent the transmission of infection for patients and all Health Department employees. The LHD uses National Institute of Health, Centers for Disease Control and Prevention and OHSA guidelines to develop the program, and to properly identify at-risk patients and employees. The LHD supports the use of performance improvement methods as a means to target, analyze and improve infection control activities. Employees will be taught to take every opportunity to deliver preventive services, especially to those with limited access to care.

Based upon patient diagnosis and the nurse’s assessment, the Nurse will implement precautions and instruct ancillary health care workers (i.e., LPN, Therapists, Medical Social Worker, Nutritionist, etc.), the patient and primary caregivers.

PURPOSE (S): To define what constitutes an infection To properly target risk factors associated with agency-acquired and community acquired

infections. To identify types, volume, and locality of patients serviced and employees that are at risk for

infections. To implement surveillance activities that properly identify, track and trend infections To implement a systematic means of performance improvement that targets at risk patients

and Health Department employees and reducing the risk or preventing infections. To provide staff at time of employment and annual personnel development programs on the

use of protective equipment, preventive practices. To define circumstances which represent a significant risk for all personnel whose job-related

tasks involve, or may involve, exposure to significant risk of body substances To educate patients and/or caregivers in techniques and preventative practices that reduce the

risk of infection and/or which may cause puncture injuries. Protect the community from potentially infectious/contaminated materials and equipment. To report infections to the appropriate authorities

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The S2AY Network’s Public Health Committee may serve as the LHD Infection Control Committee, which shall be responsible for establishing policies and procedures for investigating, controlling and preventing infections. The LHD Directors will approve all policies and procedures. The Committee will incorporate changes in policies and procedures as necessary to comply with Article 28 survey findings.

COLLABORATION WITH OTHER COUNTY PARTIES:Responsibility for the performance of tasks associated with infection prevention and control is shared with the County Buildings and Grounds Department or contracted staff.

PROCESS OVERVIEWThe supervisory personnel, in coordination with Disease Control staff, will introduce the tools and the process for Infection Prevention and Control listed below: Planning and setting goals for the implementation process Coordinating implementation activities Ensuring good communication between all involved staff members Helping to establish a performance improvement process Facilitating creative problem solving Providing summaries of findings to administration and appropriate regulatory agencies.

General Preventive Principles: Initial and annual employee orientation will include training on Infection Control. The Health Department will instruct and observe all health care workers demonstrate infection control practices. Patients and the primary caregivers will be taught the applicable procedures regarding infection control.

Infection Control Surveillance:The LHD administration supports a systematic approach to surveillance activities that accurately identify, track, and trend infectious diseases.

LHD staff are trained on proper identification of specific infectious diseases; LHD staff identify patients/caregivers at-risk of disease, will have access to a list of

reportable diseases, and report suspected reportable diseases to the Disease Control staff; LHD staff will provide patient and caregiver with disease/transmission specific

information to prevent the spread of infection/disease; LHD Nurse, in consultation with Disease Control staff, will educate patient/family

regarding symptoms of infection and when to consult with their primary care provider. Disease Control staff will follow NYS DOH disease specific requirements for

surveillance reporting and follow-up.(See Appendix A for NYS DOH list of reportable communicable diseases.)

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Standard Precautions:

Standard Precautions are the basic level of infection control precautions which are to be used in the care of all patients. These practices are designed to both protect the health care worker and to prevent the health care worker from spreading infections among patients. Standard Precautions include:

Hand Hygiene Use of Personal Protective Equipment (PPE) (i.e. gloves, gowns, masks, etc.) Safe handling of potentially contaminated equipment or surfaces Respiratory Hygiene/Cough Etiquette

Standard precautions apply to blood; all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood; non-intact skin; mucous membranes and airborne droplet nuclei. Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection.

While blood is the most efficient vehicle for the spread of blood-borne pathogens, other body substances (feces, semen, vaginal secretions, breast milk, tissues and internal body fluids) also have been implicated in the transmission of the Hepatitis C virus (HCV), human immunodeficiency virus (HIV) and Hepatitis B virus (HBV). Saliva is a known transmitter of HBV.

Certain infections require more than one type of precaution (See Appendix B for link to: Type and Duration of Precautions Needed for Selected Infections and Conditions. Source: CDC: 2007 Guideline for Isolation Precautions)

Airborne Precautions:

DefinitionAirborne droplet nuclei are 5µm or smaller and may be able to be transmitted in evaporated droplets or dust particles. The microorganisms can remain suspended in the air and can be widely dispersed by air currents within a room or over a long distance. In addition to Standard Precautions, airborne precautions should be used for those patients with known or suspected infections transmitted via airborne droplet nuclei.

Diseases which require airborne precautions include but are not limited to the following: Measles Varicella (including disseminated zoster) Tuberculosis (active pulmonary or laryngeal) Smallpox SARS(See Appendix C for Types of Precautions and Patients Requiring Them.)

Personal Protective Equipment for Airborne Precautions

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If the patient is diagnosed or suspected to be actively infected with laryngeal or pulmonary TB or smallpox, the LHD staff having contact with patient should wear a fit tested National Institute for Occupational Safety and Health and OHSA certified N95/N100 respiratory protective device as long as the patient’s disease is potentially contagious. With diseases other than TB or smallpox, susceptible staff who are in contact with the patient should wear a regular surgical mask.

Patient Placement for Airborne PrecautionsSee the LHD’s disease specific plan/manual for guidance regarding patient isolation/quarantine.

Duration of Airborne PrecautionsThe precautions should be maintained for the known period of communicability specific to the disease.

Contact Precautions:

DefinitionIn addition to the Standard Precautions which are used for every patient, Contact Precautions will be used for those patients who are known or suspected to have serious illnesses easily transmitted by direct patient contact or contact with items in patient’s environment.

Diseases which require contact precautions include but are not limited to the following: Gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug

resistant bacteria judged by the infection control program, based on current state, regional or national recommendations, to be of special clinical and epidemiologic significance;

Enteric infections with low infectious dose or prolonged environmental survival: Clostridium difficile infection For diapered or incontinent patients, enterohemorrhagic Escherichia coli 0157:H7,

Shigella, hepatitis A, or rotavirus infection; Respiratory syncytial virus, parainfluenza virus, or enteroviral infections in infants and

young children; Skin infections that are highly contagious or that may occur on dry skin:

Diphtheria (cutaneous) Herpes simplex virus (neonatal or mucocutaneous) Impetigo Major (noncontained) abscesses, cellulitis, or decubiti Pediculosis Scabies Staphylococcus furunculosis in infant and young children Zoster (disseminated or in the immunocompromised host) Varicella Smallpox

Viral hemorrhagic conjunctivitis Viral hemorrhagic infections (Ebola, Lassa, or Marburg)* ORSA, VRE and MRSA (see definitions – Tab 2) SARS(See Appendix C for Types of Precautions and Patients Requiring Them.)

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Strategies to decrease the risk of transmission to other patients: Schedule infected patient for the last visit of the day when possible; Leave reusable patient care items in patient’s home (i.e. blood pressure cuff and stethoscope)

if possible. If this is not possible, use disposable blood pressure cuff sleeves and stethoscope diaphragm covers or decontaminate reusable equipment well with disinfecting solution;

Minimize the number of items taken into a patient’s home. Carry necessary items in plastic bag, which can be disposed of in the home;

Minimize the amount of patient care supplies in home that require eventual disposal; Perform daily cleaning and disinfection of contaminated patient care items and frequently

touched horizontal surfaces.

GlovesWear gloves when entering a patient/clinic room if patient is infected or colonized with multidrug resistant organism. Otherwise gloves should be worn with all patient contact. While providing care, staff should change gloves after contact with patient or with objects which might have high concentration of organisms.

GownWear clean non-sterile disposable gown when there is substantial patient contact, contact with environmental surfaces, or items in clinic room/patient home, or if such contact is anticipated. After removal of gown, caution should be taken to prevent contact with potentially contaminated surfaces with clothing.

Discontinuing Contact PrecautionsThe precautions should be maintained for the known period of communicability specific for disease/infection.

*There are special considerations for Viral hemorrhagic infections (Ebola) – See Appendix J for County-specific Ebola Policy.

Droplet Precautions:

DefinitionIn addition to Standard Precautions, Droplets Precautions should be used for a patient known or suspected to be infected with microorganisms transmitted by large-particle respiratory droplets (5µm or larger). Large droplets do not remain suspended in the air and do not travel more than 3 feet from the patient. Droplets may be spread to others who are physically close to the patient (closer than 3 feet) as a result of the patient coughing, sneezing or talking or during a clinical procedure such as suctioning.

Diseases which require Droplet Precautions include but are not limited to the following:

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Invasive Hemophilus influenzae type b disease, including meningitis, pneumonia, epiglottitis, and sepsis;

Invasive Neisseria meningitis disease, including meningitis, pneumonia, and sepsis; Other serious bacterial respiratory infections spread by droplet transmission:

Diptheria (pharyngeal) Mycoplasma pneumonia Pertussis Pneumonic plague Streptococcal (group A) pharyngitis, pneumonia, or scarlet fever in infants and young

children

Serious viral infections spread by droplet transmission: Adenovirus Influenza Mumps Parvovirus B19 Rubella, Varicella (Shingles) SARS Viral hemorrhagic infections (Ebola)*

(See Appendix C for Types of Precautions and Patients Requiring Them.)

Personal Protective EquipmentIndividual who will be within 3 feet of a patient diagnosed with or suspected of having one of the above conditions should wear a surgical mask. A mask does not need to be worn when the staff member will not have close (within 3 feet) contact with the patient.


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DEFINITIONS

BLOOD – human blood, human blood components, and products made from human blood.

BLOODBORNE PATHOGENS – pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV)

CONTAMINATED – the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

CONTAMINATED SHARPS – any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

DECONTAMINATION – the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

EMPLOYEES – all Health Department staff, volunteers, interns and contracted personnel.

ENGINEERING CONTROLS - controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.

EXPOSURE INCIDENT – a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee’s duties.

HANDWASHING FACILITIES – a location providing an adequate supply of running potable water, soap and single use towels or hot air drying machines.

HAND HYGIENE – A general term that applies to handwashing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis.

HAV – hepatitis A virus (See Appendix D for NYS DOH Fact Sheet on Hepatitis A).

HBV – hepatitis B virus (See Appendix D for NYS DOH Fact Sheet on Hepatitis B).

HCV – hepatitis C virus (See Appendix D for NYS DOH Fact Sheet on Hepatitis C).

HIV – human immunodeficiency virus (See Appendix D for CDC Fact Sheet on HIV and Its Transmission).

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MRSA – Methicillin Resistant Staphylococcus Aureus.

N95 MASK – A N95 respirator is a respiratory protective device that blocks at least 95 percent of very small (0.3 micron) particles, individually fitted to designated employees.

NEEDLELESS SYSTEMS – a device that does not use needles for (1) the collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established; (2) the administration of medication or fluids; (3) any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps.

OCCUPATIONAL EXPOSURE – reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.

ORSA – Oxacillin Resistant Staphylococcus Aureus.

OTHER POTENTIALLY INFECTIOUS MATERIALS – (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from human (living or dead); (3) HIV-containing cell or tissue cultures, organ cultures, and HIV – or HBV – containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV; and (4) airborne droplet nuclei.

PARENTERAL – piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions.

PERSONAL PROTECTIVE EQUIPMENT (PPE) – is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts or blouses), not intended to function as protection against a hazard, are not considered to be personal protective equipment.

PROPHYLAXIS – medication that aides in the prevention of or protection from disease.

SARS – Severe Acute Respiratory Syndrome

SHARPS WITH ENGINEERED SHARPS INJURY PROTECTIONS – a non-needle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

SOURCE INDIVIDUAL – any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.

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STERILIZE - the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores.

STANDARD PRECAUTIONS – is an approach to infection control. According to the concept of standard Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

TB – Tuberculosis (See Appendix D for NYS DOH Fact Sheet on TB).

URI – Upper Respiratory Infection

VRE – Vancomycin Resistant Enterococci

WORK PRACTICE CONTROLS – controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique; using safety engineering devices whenever available).

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DEPARTMENT OF LABOR/DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL GUIDELINES FOR EMPLOYEES AND CLASSIFICATIONS

As a first step in determining what actions are required to protect worker’s health, every employer must evaluate all working conditions and identify and document employee tasks where occupational exposure to blood/body fluid may occur. This determination must be made without regard to use of personal protective equipment.

NOTE: the Federal Department of Labor/Department of Health and Human Services for determining an employee’s exposure category has issued the following guidelines.

Exposure Categories to Blood and Body FluidsCategory I Category II Category III

Tasks involving exposure to blood, body fluids or tissues.

Tasks that involve no exposure to blood, body fluids or tissues but employment may require performing unplanned Category I tasks.

Tasks that involve no exposure to blood, body fluids or tissues and Category I tasks are not a condition of employment.

All procedures or other job-related tasks that involve an inherent potential for mucous membrane or skin contact with blood, body fluids or tissues or a potential for spills or splashes of them, are Category I tasks.

The normal work routine involves no exposure to blood, body fluids or tissues, but exposure may be required as a condition of employment.

The normal work routine involves no exposure to blood, body fluids or tissues. Persons who perform these duties are not called upon, as part of their employment, to perform or assist in emergency medical care or first aid, or to be potentially exposed in some other way.

Public Health Nurses (SPHN and PHN)

Registered Nurses Public Health Director Medical Director Nurse Practitioners/PAs Licensed Professional Nurses Public Health Specialists Home Health Aides

EI Service Coordinators Community Health

Workers Sanitarians Medical Social Worker Family Support Workers

Clerical/Billing Staff Public Health Educator Officer Managers/

Administrators Environmental Health Staff Special Children’s Services

Staff (Children with Special Healthcare Needs, Pre-school)

Quality Assurance Coordinator

Volunteers*The Federal Department of Labor/Department of Health and Human Services guidelines involve only Category I and II employees. However, it is recommended that Category III employees receive the same training and follow the same guidelines that have been established for Categories I and II because there may be occasion for such staff to perform Category I or II tasks.

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HAND HYGIENE AND OTHER WAYS TO CONTROL INFECTION

Hand HygieneHand hygiene is the single most important means of preventing the spread of infection.Hands must be washed upon entering each home and just before exiting the home. If there is no visible soiling of hands, a waterless, antimicrobial hand cleansing product containing at least 60% alcohol should be used.

Hand hygiene is indicated: before performing any invasive procedure, such as venipuncture and fingerstick blood

sampling before taking care of any patient between patients between tasks and procedures on the same patient before and after touching a wound, whether surgical or associated with an invasive device after gloves are removed after situations in which microbial contamination of hands occurred or is likely to occur (e.g.,

after contact with contaminated items, secretions, excretions, or blood and body fluids whether or not gloves are worn)

after touching inanimate sources that are potentially contaminated after taking care of a patient who is infected or colonized with a multi drug-resistant

microorganism when hands are visibly soiled after using the toilet, blowing the nose, or covering a sneeze after changing diapers before eating, drinking or handling food before handling medications or vaccinesWhen in doubt, decontaminate your hands.

Hand Decontamination Procedure: When decontaminating hands with an alcohol-based hand rub, apply product to palm of one

hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Follow the manufacturer’s recommendations regarding the volume of product to use.

If the staff member’s hands are visibly soiled and there is no running water available, single use antiseptic towelettes must be used first to remove the physical dirt, and then the hands can be cleaned with the waterless handwashing product.

Washing hands with soap and water:1. Remove jewelry and take steps to prevent clothing from becoming wet during hand washing

(wedding rings may be left on).2. Use soap and warm running water. Soap suspends easily removable soil and

microorganisms. Allowing them to be washed off. Dispenser-style liquid soap is recommended.

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3. Wet hands thoroughly under warm running water and dispense soap into wet hands.4. Rub and scrub hands together for approximately 20 seconds to work up lather.5. Scrub knuckles, back of hands, nails, between fingers.6. Rinse hands under warm running water. Running water is necessary to carry away debris

and dirt.7. Use paper towels to thoroughly dry hands.8. After drying hands, use the towel to turn off the faucet.9. Discard paper towels into appropriate plastic lined waste receptacle.

Additional Ways to Control Infections

Cover mouth with tissue or crook of arm; Dispose of used tissues in plastic-lined waste receptacle; Keep fingers out of eyes, nose and mouth; Stay home when sick i.e. fever, diarrhea, vomiting, excessive sneezing, coughing. Consider

reporting signs and symptoms of infectious disease to Communicable Disease staff. Refrain from sharing personal care items (i.e. combs, brushes, makeup, razors and

toothbrushes); Cover open, draining lesions; Maintain updated immunizations; Refrain from sharing eating utensils, drinking cups or water bottles; Avoid use of artificial fingernails or extenders for direct care providers; Avoid excessive hand jewelry.

Staff making home visits refer to Bag Technique Procedures (Appendix E).

NOTE: It is the policy of this LHD that no birds, turtles, dogs, cats or other animals exclusive of those required for laboratory purposes shall be allowed in the clinic area. Guide dogs or service dogs may accompany persons as needed.

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PERSONAL PROTECTIVE EQUIPMENT (PPE)*There are special considerations for Viral hemorrhagic infections (Ebola) – See Appendix J for County-specific Ebola Policy.

PROVISIONWhen there is potential for occupational exposure, the LHD shall provide, at no cost to the employee, appropriate personal protective equipment. Personal protective equipment will be considered “appropriate” only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.

ACCESSIBILITYThe LHD shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued to employees. Employee is responsible for checking their PPE for proper fit and integrity prior to planned use.

GlovesHypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided.

Health care personnel with open wounds or exudative lesions on their hands must use gloves when having direct patient contact.

Gloves must be used for touching blood, body fluids, secretions, excretions, contaminated items, mucous membranes and non-intact skin or when providing direct care for a patient with an open wound, fecal incontinence or diarrhea.

Gloves are not routinely needed for administering an injection (see Appendix G)

Masks and Eye ProtectionMasks, including N95/N100, and eye protection/face shield should be worn during procedures and patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, excretions. Pocket masks with one way valves and/or mannequin shield are provided to designated staff for use in administering CPR.

Agency workforce will comply with Public Health Law regarding the prevention of influenza transmission by wearing a mask if declining a flu vaccination. See Workforce Influenza Vaccine Policy at the end of the PPE section.

If the staff member has an URI, surgical masks should be worn when in contact with patient. Designated employees will be fit tested by a qualified individual for N95/N100 masks initially and per OSHA regulations as follows:

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Fit testing. This paragraph requires that, before an employee may be required to use any respirator with a negative or positive pressure tight-fitting facepiece, the employee must be fit tested with the same make, model, style, and size of respirator that will be used. This paragraph specifies the kinds of fit tests allowed, the procedures for conducting them, and how the results of the fit tests must be used.1910.134(f)(1) The employer shall ensure that employees using a tight-fitting facepiece respirator pass an appropriate qualitative fit test (QLFT) or quantitative fit test (QNFT) as stated in this paragraph.1910.134(f)(2) The employer shall ensure that an employee using a tight-fitting facepiece respirator is fit tested prior to initial use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least annually thereafter.1910.134(f)(3) The employer shall conduct an additional fit test whenever the employee reports, or the employer, PLHCP, supervisor, or program administrator makes visual observations of, changes in the employee's physical condition that could affect respirator fit. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight.

Refer to manufacturer’s instructions for proper use, maintenance, cleaning and care, and warnings regarding the respirators limitations.

GownsDisposable gown should be worn during procedures and patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, excretions.

Safety engineered devices should be used whenever possible and/or available.

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http://www.osha.gov/pls/oshaweb/owalink.query_links?src_doc_type=STANDARDS&src_unique_file=1910_0134&src_anchor_name=1910.134(f)(3)

http://www.osha.gov/pls/oshaweb/owalink.query_links?src_doc_type=STANDARDS&src_unique_file=1910_0134&src_anchor_name=1910.134(f)(2)



WORKFORCE INFLUENZA VACCINATION POLICY

POLICY:Agency workforce will comply with Public Health Law regarding the prevention of influenza transmission.

PURPOSE: To prevent transmission of influenza between clients and healthcare personnel (HCP). HCP

related to this policy shall include all persons employed or affiliated with the Public Health Department whether paid or unpaid. This includes, but is not limited to, employees, members of medical and nursing staff, contract staff, students and volunteers who engage in activities such that if they were infected with influenza they could potentially expose clients to the disease.

For licensed professionals, failure to adhere to Infection Prevention standards is considered professional misconduct in New York State.

REFERENCES: NYS Public Health Law, Sections 225, 2800, 2803, 3612 and 4010. Title 10 NYCRR amended Section 2.59

DEFINITIONS:Influenza Season: For the purpose of this policy, the influenza season shall mean the period of time during which influenza is prevalent as determined by the NYS Commissioner or by the Public Health Director if more stringent. The end date is subject to change pending the influenza prevalence in the geographic area.

Healthcare Personnel (HCP): Healthcare personnel shall include all persons employed or affiliated with the Agency whether paid or unpaid. This includes, but is not limited to, employees, members of the medical and nursing staff, contract staff, students and volunteers who engage in activities such that if they were infected with influenza, they could potentially expose clients to the disease. Workforce in the Early Intervention and Preschool Special Education Programs are not included as Healthcare Personnel for the purpose of this policy.

PROCEDURE:1. During the influenza season, all Agency workforce not vaccinated against influenza for the

current influenza season shall wear a surgical or procedural mask while in areas where clients may be present. The Agency will supply such masks to workforce free of charge.

2. When wearing masks under this regulation, masks are to be changed when wet, torn or compromised. Masks must also be changed according to established transmission based precautions.

3. Prior to October 31 annually, all HCP will be offered the influenza vaccine at no cost. If HCP decline the influenza vaccine, they must sign a declination form (see Appendix I for the Influenza Vaccine Declination Form). A HCP may change his/her declination at any time, and receive the influenza vaccine at no cost to them, provided vaccine is available. If a HCP has a medical exemption, proper documentation from their provider must be brought to your supervisor for inclusion in the HCP health assessment record (see Appendix I for the Influenza Vaccine Medical Exemption from Health Care Personnel Form).

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4. Any HCP receiving influenza vaccine outside of the Agency shall provide adequate vaccination documentation to their supervisor.

5. The Agency will maintain influenza vaccination status (vaccinated, declined or medical exemption) of all workforce in their individual health file. The aggregate data on personnel influenza vaccination (numbers and percentages) will be made available to NYS Department of Health or other reporting agencies upon request.

6. The Agency will establish a process for ensuring that unvaccinated HCP are monitored for compliance with this policy. It is the responsibility of Administration, Supervisors and ALL healthcare workforce to enforce compliance with this New York State regulation.

7. Discipline policies will be utilized to enforce this policy.

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SHARPS AND NEEDLELESS DEVICES

All staff will take precautions to prevent injuries by needles, broken glass and any other sharp instruments or devices that have potential for penetrating the skin. Needleless and safety engineered devices shall be used whenever available and appropriate.

Mandatory infection control training will be provided at the time of initial employment and annually thereafter, for all employees.

Anytime new devices are considered by the LHD, clinical staff input will be solicited and documented. If available, evidence-based data on why the device is safer will be provided to the clinical staff. (See Appendix F for Sample Employee Analysis and Feedback Form.)

Used sharps must be placed in an OSHA approved sharps container. To prevent needle stick injuries, needles should not be recapped, purposely bent or broken by hand. Razor blades or broken glass shall be cleaned using mechanical means, such as brush and dust pan, tongs or forceps.

OSHA’s approved sharps containers will be provided and must meet the following criterion: Located as close as feasible to the immediate area where sharps are used. Maintained upright throughout use. Replaced routinely and not allowed to overfill. Closed immediately prior to removal or replacement. Container must be: Dated at first use; Color coded or labeled as biohazardous; Labeled with Agency name and address Able to be closed; Leak proof; Puncture resistant

Under no circumstances shall a sharps container be filled beyond the fill line indicated on the container. Sharps containers shall be removed from patient care areas to a room or area designated for regulated medical waste storage, whenever the container has reached the fill line indicated on the container. Sharps containers shall be removed from patient care areas within 30 days or upon the generation of odors or other evidence of putrification, whichever occurs first, without regard to fill line per NYSDOH Title 10: Section 70-2.2 - Containment and storage regulations.

Once containers are sealed, return to the LHD and store in a “red-bagged” covered container, which is clearly marked “Biohazard” medical waste. They will then be disposed of by LHD arrangement with local disposal unit adhering to all waste transporter guidelines. If primary puncture resistant container leaks, the leaking container will be placed in a secondary puncture resistant container. If outside contamination occurs, place contaminated containers in biohazardous waste bag.

During transport, sharps containers should be placed upright in the trunk or in the backseat of the vehicle, separate from clean items.

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SPECIMEN COLLECTION

Blood specimens will be placed in a leak proof bag marked with a red-orange BIOHAZARD label, then placed into an unbreakable, leak proof container with ice, if indicated, and transported to the local laboratory facility or other agency approved unit.

All other specimens will be collected per laboratory requirements and placed in a leak proof container marked with a BIOHAZARD label and transported to the laboratory or other agency approved unit.

Transportation of Specimens:

In a vehicle, the container should be placed in location that will not cause injury to passenger(s) or the driver in the event of an accident.

Specific cases may require additional precautions, please see Appendix B: Type and Duration of Precautions Needed for Selected Infections and Conditions and Appendix C: Types of Precautions and Patients Requiring Them.

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ENVIRONMENTAL CONTROL (HOUSEKEEPING)


EPA Approved Disinfectants:Select an intermediate-level disinfectant, which will kill vegetative bacteria, fungi, tubercle bacillus and virus. Select an agent that is registered with the U.S. Environmental Protection Agency (EPA) for use as a disinfectant. Use all products according to the manufacturer’s instructions. The listing of EPA-registered disinfectants may be found at:

http://www.epa.gov/oppad001/chemregindex.htm

Store all disinfectants inaccessible to the public, properly labeled and below eye level.

Cleaning: Cleaning will be the responsibility of the County’s Buildings and Grounds Department,

contracted staff or facility maintenance staff and shall be conducted in compliance with OSHA guidelines and Title X Section 702.2 of the Public Health Law.

Cleaning of equipment and environmental surfaces may be the responsibility of clinical staff.

Garbage and Waste Receptacle: All garbage cans and waste paper baskets should have plastic liners and must be emptied regularly. Biohazardous waste needs to be placed in appropriately labeled liners. If outside contamination of bag occurs, place contaminated bag in second bag. All garbage and waste shall be disposed of in a manner that will prevent the transmission of disease and not create a nuisance or fire hazard, nor provide a breeding place for insects or rodents.

Dishes:No special precautions are required. A dishwasher or soaking and cleaning in hot, soapy water is adequate.

Equipment and Environmental Surfaces: Cleaning of equipment and environmental surfaces may be the responsibility of clinical staff. Any materials, tools, equipment or surfaces used must be disinfected immediately following use

with an EPA approved solution. Disposable examination paper can be used to cover exam tables, baby scales, etc. Maintain storage areas for equipment and disposable items. These areas must be separate from

areas used for storage of soiled items. Use spill kit to clean up spills if needed. Contact Buildings and Grounds Department to assist if

needed.

Non-invasive Reusable Equipment: Non-invasive reusable equipment should be cleaned with an EPA-registered solution.

19

http://www.epa.gov/oppad001/chemregindex.htm



Personal Articles:Personal articles should not be shared with others. Sharp objects should be disposed of in a puncture and leak proof container.

Decontaminating Soiled Patient Care Equipment:Soiled patient care equipment should be handled in a manner that prevents contamination or transfer of microorganisms to others and environment. All patient equipment should be decontaminated in accordance with manufacturer’s recommendations.

Thermometer (not including digital)Oral or rectal - Patient should have their own oral or rectal thermometer. If the patient is known to have an infectious disease (TB, HIV, etc.), wash with warm soapy water and soak in 70% alcohol for 10 minutes prior to drying and storage.

Tympanic or Digital Thermometer-Utilize a new protective probe cover at each use, disposing of the used cover per protocol. Do not wipe with alcohol and follow manufacturer’s recommendation for cleaning.

SphygmomanometerIf skin is intact and the patient is not diagnosed or suspected of having a diagnosis of an infectious illness, the cuff can be utilized without covering the arm. If lesions are present, place a leak proof barrier over the patient’s arm. If patient has a diagnosis of MRSA or ORSA then a disposable sleeve and diaphragm cover should be used and “Contact Precautions” protocol should be followed.

Reusable EquipmentAny materials, tools or equipment used must be disinfected immediately following use. See EPA approved disinfectant list.

Disposable EquipmentSoiled tissues and flushable waste can be flushed in a toilet. Discard paper towels into a plastic bag, seal and dispose of appropriately.

CLIA Waived TestsFor equipment used for CLIA waived tests, see S2AY Network Equipment and Supplies Manual.

Work Practice Controls:No eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses is allowed in a work area where there is a reasonable likelihood of occupational exposure.

No food or drinks shall be kept in refrigerators, freezers, shelves, cabinets or on counter tops or bench tops where blood or other potentially infectious materials are present.

Workforce will perform all procedures involving blood or potentially infectious materials in a manner that minimizes splashing, spraying, or the generation of droplets.

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Handling Contaminated Clothing:Workforce clothing soaked with blood/body fluids should be rinsed wearing gloves and removed as soon as possible. Workforce should take precautions to prevent further exposure. Instruct workforce to wash linens, uniforms and launder in normal laundry cycles according to manufacturer’s instructions.

If unable to launder personal clothing or non-disposable items, dispose of as medical waste. (See Section 10 of this Manual: Regulated Medical Waste Disposal and Transporting Regulated Waste.)

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BLOOD AND BODY FLUID SPILL CLEANUP*There are special considerations for Viral hemorrhagic infections (Ebola) – See Appendix J for County-specific Ebola Policy.

Blood/Body fluid clean-up guidelines and materials should be readily accessible to any employee who may be faced with a situation that would involve handling or cleanup of blood/body fluid spills.

Equipment/Supplies for Clean-up Appropriate Mask and Eye Protection Gown, if applicable Disposable Gloves Disposable paper towels Sanitary absorbent material (optional) Plastic bags Liquid soap packet or alcohol towelettes Alcohol-based hand rub EPA-registered disinfectant

Procedure Ensure that all necessary equipment/supplies are available when caring for patient; See Personal Protective Equipment Section (Tab 5 of this Manual) for need for and appropriate

use of equipment; If un-anticipated contact occurs, hands and all other affected areas should be washed with soap

and water immediately after contact followed by an alcohol-based hand rub. If blood or body fluids are spilled on another person, use the following procedures:

When the skin is intact, have the person decontaminate using a disposable soap or alcohol towelette or soap under running water. Towels should be discarded in a sealable plastic bag. The person must wash hands using proper procedure.

If open lesions or wounds have come in contact with blood from another person cleanse with soap and water and refer for medical treatment.

If an individual gets blood in the eyes, flood exposed area with running water at room temperature for 1-2 minutes. Take individual to eye wash station if one is available. If in mouth, rinse with water for 1-2 minutes and spit out. See S2AY Network Administrative Manual – Accident/Incident Reporting Policy for Bloodborne Pathogens Post-Exposure Procedures.

For cleaning and disinfecting all soiled, washable surfaces see Tab 8: Environmental Controls Sections of this Manual.

If equipment cannot be cleaned or cleaning is not feasible, contact your immediate supervisor for instructions.

22



REGULATED MEDICAL WASTE DISPOSAL AND TRANSPORTING REGULATED WASTE*There are special considerations for Viral hemorrhagic infections (Ebola) – See Appendix J for County-specific Ebola Policy.

Regulated Medical Waste Disposal:

The LHD Director/Designee is responsible for monitoring compliance of the Agency waste management.

Under New York State Law, some medical wastes have become regulated and therefore require special handling for their disposal. It is important for the staff to understand how their activities may produce medical waste, both regulated and unregulated. So they can comply with these standards accordingly.

The Medical Waste Tracking Act defines medical waste as any solid waste which is generated in the diagnosis, treatment (i.e., provision of medical services) or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals.

Unregulated medical waste is material that has come in contact with body fluids that can normally be disposed of in a sanitary sewer and/or by a local waste hauler. Examples of unregulated medical waste are: disposable towels, gowns and paper sheet, blood-stained bandages, gauze, cotton swabs and tongue depressors.

Regulated medical wastes are materials that belong in the following categories:

Items that are saturated and/or dripping with human blood or have been caked with dried human blood.

Sharps or needles, syringes, used blades, broken or unbroken glass or plastic ware. Any additional waste material that has come in contact with infectious material that the LHD

believes may pose a risk.

Medical Waste Generated In Patient’s HomeThe State of New York does not consider medical waste (e.g., sharps, IV bags, etc.) generated in the home to be included in the definition of regulated medical waste. However, if a home healthcare provider generates medical waste in the home, they are encouraged to transport it (or use an authorized courier service that complies with the Part 364 regulations) to their office or an Article 28 facility for proper packaging for disposal. Note: Upon consolidation, such home generated medical waste is no longer exempt and must be packaged, labeled and transported in accordance with Part 364. Also, if the medical waste generated in the home is separated and collected from multiple residences and then consolidated, such as an apartment building or dormitory, it is suggested that such regulated medical waste be packaged, labeled and transported as regulated medical waste.

Patients who have prescriptions for medications and syringes in their homes for long-term needs, i.e. insulin, may be instructed to dispose of their syringes in a rigid container, i.e. coffee can or plastic

23



laundry detergent bottle. When ¾ full, they may seal the lids and dispose of the containers along with their other household waste. It is recommended that the container used for medical waste disposal be visibly labeled as “NOT FOR RECYCLING”. There are State designated Community Sharps Collection Sites in each County for use by the general public (see website below for Sharps Collection Sites). Nurses should advise patients of locations for sharps disposal in the community. http://webcache.googleusercontent.com/search?q=cache:http://www.health.ny.gov/sharps-collection

Medical Waste Generated by the LHDThe procedures for storage and disposal of LHD regulated medical wastes are as follows:

1. Regulated medical waste shall be separated from other waste as practicable. Regulated medical waste storage shall be in areas used exclusively for waste storage. Such areas shall:

have an appropriate sign, prevent unauthorized access,

protect waste from the elements (hold waste at a temperature that prevents rapid decomposition and resultant odor generation),

prevent access by vermin, should be ventilated to the outdoors, unless waiver obtained.

Regulated medical waste shall not be stored for a period exceeding 30 days, except that a site generating under 50 pounds of regulated medical waste per month and not accepting regulated medical waste for treatment from other facilities, may store waste for a period not exceeding 60 days. (Use Medical Waste Tracking Form as verification of compliance).

2. All sharps must be placed in a special puncture-proof container. Mark clearly with biohazard label. Place all other materials except sharps, such as materials saturated and dripping or dried and

caked with human blood into a “red bag” and mark with a biohazard label. The bag shall be impervious to moisture and have strength sufficient to resist ripping, tearing or bursting under normal conditions of usage and handling. The bags shall be secured so as to prevent leakage during storage, handling or transport. Tag or mark with indelible ink the County’s/Health Department’s name and address on all containers and bags. All sharps containers must be dated at first use.

3. Regulated medical waste contained in bags or sharps containers for storage or handling, will be placed in disposable or reusable rigid pails, cartons, drums, carts, dumpsters or portable bins. The containers shall be labeled “infectious” or “regulated medical waste”. The container system shall be leak proof, have tight-fitting covers, and be kept clean and in good repair. If the containers are to be re-used, they shall be thoroughly washed and decontaminated each time they are emptied unless the surfaces of the containers have been completely protected from contaminated by disposable liners, bags or other devices removed with the waste, except that in clinical laboratories containers shall be decontaminated after each use.

24

http://webcache.googleusercontent.com/search?q=cache:http://www.health.ny.gov/sharps-collection



4. The materials listed in number 1 above are then placed into a secondary container (i.e., rigid cardboard box) for proper disposal. The box should then be labeled containing the following information:

LHD name LHD address date shipped transporter’s name and permit number identification of contents as “medical waste”

5. Once materials are determined as “infectious” or “regulated medical waste” the LHD CANNOT remove them from their containers. From this point the LHD is considered a generator of medical waste and must comply with proper disposal procedures.

6. Before it is transported from the generator’s facility, regulated medical waste contained in disposable containers shall be placed for storage or handling in disposable or reusable pails, cartons, drums or portable bins. The containment system shall be leak-proof, have tight-fitting covers, and be kept clean and in good repair. The containers may be of any color and shall be conspicuously labeled with the word “infectious” or the words “regulated medical waste”. All regulated medical waste leaving the LHD should be accompanied with a Medical Waste Tracking Form (MWTF) (see last page of this section for sample form). The LHD should retain a copy of the MWTF.

The County will have a written agreement with a licensed medical waste service agency about potentially hazardous regulated medical wastes that need to be transported for disposal.

The required forms for disposal must be filed annually and maintained for three (3) years.

KEEPING RECORDS, FILING ANNUAL REPORTS:The County will keep copies of the tracking forms and exception reports in accordance with record management and retention regulations. If you hire a permitted transporter, also keep the signed copy of the tracking form returned to you from the disposal facility. These records must be available for inspection.

SUMMARY OF MEDICAL WASTE MANAGEMENT REQUIREMENTS:

Annual Register Fill out Report to w/DEC as Tracking

DEC a Generator FormsSmall quantity generators who transport own wastes Yes Yes Yes

Small quantity generators who hire a hauler No Yes Yes Large quantity generators No Yes Yes

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FINES AND PENALTIES:Improper or illegal storage, transport, or disposal of medical wastes could result in civil or criminal fines and penalties. Mismanagement of regulated medical wastes is punishable by a maximum of seven years in prison and fines up to $150,000.

QUESTIONS:For a copy of the regulations and answers to specific questions on transporting and disposing of regulated medical wastes or about registering your facility and filling out paperwork, write or call your regional DEC office or write:

Waste Transporter Permit Section NYSDEC, 50 Wolf Road, Albany, NY 12233-7252

26



GE

NE

RA

TO

R

1. Generator’s Name and Mailing Address 2. Tracking Form Number

INST

RU

CT

ION

S

INSTRUCTIONS FOR COMPLETING MEDICAL WASTE TRACKING FORM

Copy 1 – GENERATOR COPY: Mailed by Destination Facility to GeneratorCopy 2 – DESTINATION FACILITY COPY: Retained by Destination FacilityCopy 3 – TRANSPORTER COPY: Retained by TransporterCopy 4 – GENERATOR COPY: Retained by GeneratorAs required under 40 CFR Part 259:1. This multicopy (4-page) shipping document must accompany each shipment of regulated

medical waste generated in a Covered State.2. Items numbered 1-14 must be completed before the generator can sign the certification.

Items 4, 7, 10, 11c & 19 are optional unless required by the State. Item 22 must be completed by the destination facility.

For assistance in completing this form, contact your nearest State office or Regional EPA office or call (800) 424-9346.

7. State Transporter Permit or ID No.

EPA Med. Waste ID No.8. Destination Facility Name and Address 9. Telephone Number

( )

TR

AN

SPO

RT

ER

16. Transporter 1 (Certification of Receipt of Medical Waste as described in items 11, 12 & 13)10. State Permit or ID No.

Printed/Typed Name Signature Date

11. US EPA Waste Description 12. Total No. Containers

13. Total Weight or Volume

17. Transporter 2 or Intermediate Handler (name and address)

18. Telephone Number ( )

a. Regulated Medical Waste (Untreated)

b. Regulated Medical Waste (Treated) 19. State Transporter Permit or ID No. c. State Regulated Medical Waste EPA Med. Waste ID No.

14. Special Handling Instructions and Additional Information

20. Transporter 2 or Intermediate Handler (Certification or Receipt of Medical Waste as described in items 11, 12 & 13)


21. New Tracking Form Number (for consolidated or remanifested waste)

DE

STIN

AT

ION

22. Destination Facility (Certification of Receipt of Medical Waste as described in items 11, 12 & 13)

Received in accordance with items 11, 12 & 1315. Generator’s Certification:

Under penalty of criminal and civil prosecution for the making or submission of false statements,

representations, or omissions, I declare, on behalf of the generator

that the contents of this consignment are fully and accurately described above and are classified, packaged,

marked, and labeled in accordance with all applicable State and Federal laws and regulations, and that I have

been authorized, in writing, to make such declarations by the person in charge of the generator’s operation.


(If other than destination facility, indicate address, phone, and permit or ID no. in box 14)

23. Discrepancy Box (Any discrepancies should be noted by item number and initials)

Print/Typed Name Signature Date

MEDICAL WASTE TRACKING FORM27



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Staff Education/Training

The LHD will provide training for new employees and provide an annual update for all staff at no cost to the employee and during normal working hours. Such training programs will strive to help individuals recognize the importance of routine use of appropriate infection control practices and protective equipment/materials in protecting the health of all. Material utilized shall be appropriate in content and vocabulary or educational level, literacy, and language of employees. No staff member shall engage in any Category I or II tasks before receiving training in standard operation procedures, work practices and protective equipment required for the task.

The training will include:

An explanation of the infection control plan and infection control procedures covering general and standard precautions to prevent transmission of all infectious diseases.

An overview of potentially infectious diseases. An explanation of bloodborne disease, specifically Hepatitis/HIV, their modes of

transmission and signs/symptoms. A hands-on explanation of protective measures, equipment and materials and how to use

them. Staff should also know where equipment and materials will be stored and how to clean or dispose of contaminated materials.

Provide education to employees regarding latex sensitivity. A review of standard operating procedures that will ensure that all staff are prepared to take

corrective action when the potential for exposure to bloodborne pathogens or other infectious agents exists.

Information on the Hepatitis B vaccine to ensure that staff is aware of its efficacy and safety as well as its benefits when applicable.

Information will be provided regarding the CDC and NYSDOH recommendations for health care workers to be immunized with influenza vaccine. The influenza vaccine will be offered annually to health care workers providing direct care/services to LHD clients. An influenza declination may be signed annually by any health care workers providing direct care/services to LHD clients who decline the influenza vaccine (see Appendix I for Influenza Declination Form).

Information about exposure incidents, the appropriate reporting procedures and the medical monitoring recommended in cases of suspected parenteral exposure.

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Bloodborne Pathogen: Pre- and Post-Exposure Prophylaxis

A. Pre-Exposure Prophylaxis

The LHD shall make available to at least category I and II employees (see page 10 for listing) that have occupational exposure, the Hepatitis B vaccination series, lab testing and follow-up, including, prophylaxis and boosters (if ordered at some future date) in accordance with the following: Provided at no cost to employee; Given at a reasonable time and place; Performed under supervision of a licensed healthcare professional; All lab tests are accredited and at no cost to employee; Procedures are according to the current recommendations of US Public Health

Service; Made available after employee receives training; Provided within 10 days of assignment; Follow OSHA algorithm for hepatitis B vaccination (See Appendix H)

A complete Hepatitis B vaccination series will be provided unless one or more of the following are present: The employee previously received a complete series Antibody testing has revealed that the employee is immune The vaccine is contraindicated for medical reasons The employee exercises his/her right to decline the prophylactic vaccine. In these

cases, the employee will be required to sign the “Hepatitis B Declination Statement” form (See Appendix I for sample copy of the Hepatitis B Declination Statement). The employee who has declined the Hepatitis B vaccination series is responsible for requesting the Hepatitis B vaccination series at a later date if they so desire.

Documentation of the complete Hepatitis B series or of the reason the series was withheld is filed in the employee’s medical file.

B. Post-Exposure Prophylaxis (PEP): See S2AY Network Administrative Manual: Accident/Incident Reporting Policy for guidance.

29



REFERENCE(S): National Institute of Health’s, “Clinician’s Handbook of Preventative Services”,

2nd edition Center for Disease Control Infection Control Guidelines CDC Guidelines for Isolation Precautions: Preventing Transmission of Infectious

Agents in Health Care Settings 2007 www.cdc.gov/ncidod/dhqp/guidelines/isolation2007.pdf

NYSDOH Adopted OSHA compliance directive (CPL 2-2.44D), November 5, 1999 and as summarized in the July 5, 1999 correspondence

OSHA Bloodborne Pathogens Standards 29 CFR 1910.1030 MMWR: Updated U.S. Public Health Service Guidelines for the Management of

Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis

OSHA Regulations: Bloodborne Pathogens – 1910.1030 CDC’s Guidelines for Preventing the Transmission of Tuberculosis in Health-

Care Facilities. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm

MMWR – Guideline for Hand Hygiene in Health-Care Settings: Recommendation of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force October 25, 2002/51(RR16);1-44

S2AY Rural Health Network Tuberculosis Manual S2AY Rural Health Network Administrative Policies Manual S2AY Rural Health Network Nursing Procedures, Equipment and Supplies

Manual

30

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm

http://www.cdc.gov/ncidod/dhqp/guidelines/isolation2007.pdf

APPENDIX A

NYS DOH LIST OF REPORTABLE COMMUNICABLE DISEASES

APPENDIX B

2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

GO TO:

https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html

https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html

APPENDIX C

TYPE OF PRECAUTIONS AND PATIENTS REQUIRING THEM

TYPE OF PRECAUTIONS AND PATIENTS REQUIRING THEM

Standard PrecautionsUse standard precautions for the care of all patients

Airborne PrecautionsIn addition to standard precautions, precautions for patients suspected to have serious illnesses transmitted by airborne droplet nuclei:1. Measles2. Varicella (including disseminated zoster)*3. Tuberculosis (active pulmonary or laryngeal)**4. SARS

Droplet PrecautionsIn addition to standard precautions, use droplet precautions for patients known or suspected to have serious illnesses transmitted by large particle droplets:1. Invasive Hemophilus influenzae type b disease, including meningitis, pneumonia, epiglottitis,

and sepsis2. Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and sepsis3. Other serious bacterial respiratory infections spread by droplet transmission:

Diphtheria (pharyngeal) Mycoplasma pneumonia Pertussis Pneumonic plague Streptococcal (group A) pharyngitis, pneumonia, or scarlet fever in infants and young

children4. Serious viral infections spread by droplet transmission:

Adenovirus* Influenza Mumps Parvovirus B19 Rubella SARS Viral hemorrhagic infections (Ebola)

Contact PrecautionsIn addition to standard precautions, use contact precautions for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient’s environment:1. Gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug

resistant bacteria judged by the infection control program, based on current state, regional, or national recommendations, to be of special clinical and epidemiologic significance

2. Enteric infections with a low infectious dose or prolonged environmental survival: Clostridium difficile infection

* Certain infections require more than one type of precaution.** See the CDC’s Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities.Source: APIC: Infection Control in Home Care

For diapered or incontinent patients, enterohemorrhagic Escherichia coli 0157:H7, Shigella, hepatitis A, or rotavirus infection

3. Respiratory syncytial virus, parainfluenza virus, or enteroviral infections in infants and young children

4. SARS5. Skin infections that are highly contagious or that may occur on dry skin:

Diphtheria (cutaneous) Herpes simplex virus (neonatalor mucocutaneous) Impetigo Major (noncontained) abscesses, cellulites, or decubiti Pediculosis Scabies Staphylococcus furunculosis in infants and young children Zoster (disseminated or in the immunocompromised host)

6.Viral hemorrhagic conjunctivitis7.Viral hemorrhagic infections (Ebola, Lassa, or Marburg)

* Certain infections require more than one type of precaution.** See the CDC’s Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities.Source: APIC: Infection Control in Home Care

APPENDIX D

NYS DOH FACT SHEETS

HEPATITIS A: https://www.health.ny.gov/publications/1859/index.htm

HEPATITIS B: https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_b/fact_sheet.htm

HEPATITIS C: https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/fact_sheet.htm

TB: https://www.health.ny.gov/diseases/communicable/tuberculosis/fact_sheet.htm

HIV: https://www.health.ny.gov/diseases/aids/consumers/hiv_basics/index.htm

https://www.health.ny.gov/diseases/aids/consumers/hiv_basics/index.htm

https://www.health.ny.gov/diseases/aids/consumers/hiv_basics/index.htm

https://www.health.ny.gov/diseases/communicable/tuberculosis/fact_sheet.htm

https://www.health.ny.gov/diseases/communicable/tuberculosis/fact_sheet.htm

https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/fact_sheet.htm

https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/fact_sheet.htm

https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_b/fact_sheet.htm

https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_b/fact_sheet.htm

https://www.health.ny.gov/publications/1859/index.htm

APPENDIX E

Infection Control ProceduresBag Technique

POLICY: Agency clinical staff will receive an approved agency bag containing designated supplies and equipment at the time of hire.

PURPOSE(S): To protect the patient/family from contamination from outside the home To protect staff from contamination from within the home, and To protect clients from contamination and spread of infection between home settings.

Special Circumstances When Bag Should Not Be Carried Into Home:Exceptions may include, but not be limited to: Gross neglect of sanitation in the environment Evidence of rodent/insect infestation Field staff deems environment unsafeWhen any of the above occurs, a zip lock bag or other suitable container should be used as a “bag” which can contain needed supplies/equipment.

Vehicle transport and storage:When not in use, staff will store the bag securely in a protected and clean area of the vehicle trunk. If the vehicle has no trunk, staff will cover the bag with a clean cover to prevent it from being visible.

Supplies/equipment: Will be checked regularly Are to be kept to a minimum and are to be kept clean. Be sure that all dates, as listed on the supplies, are current and not expired. Be sure that all packaging is intact and not torn, wet or contaminated. Be sure that stored supplies and equipment, such as catheters, are replaced periodically, at

least every six months. Any contaminated supplies, equipment or materials that are not disposed of in the home, are

separated from the vehicle’s designated clean area. (See the Infection Control Exposure Plan for disposal and decontamination of supplies and equipment.)

Medications/solutions, specific to a patient, when transported on an emergency basis, are separated from bags or totes and are in their own container.

General Principles for Infection Control: A purse is never to be taken into a patient’s home. If using a laptop computer, keep on a clean, hard surface using a barrier if not used solely on

your lap. Upon entering the home, remove coat or jacket and place it on the back of a hard chair

(unless patient/family offers another place). Never place the bag on the floor.

Supplies and Equipment for the Bag:

Equipment or supplies belonging to the patient should be used whenever possible. Families should be encouraged to provide equipment and supplies regularly used in giving patient care. There is less likelihood of contamination and spread of infection when the bag contains fewer supplies. The equipment/supplies listed below are suggested for staff making home visits:

Contents of Clean Area of the Bag may include: Sterile drapes Sterile gloves Paper tape measures Thermometer Plastic sheaths for thermometer Disposable non-sterile gloves Gown Syringes (various sizes) Disposable plastic aprons in plastic bags Lubricating jelly Alcohol pads Disposable masks Tongue depressors

Tape Sterile cotton tip applicators Pen light Pulse Oximeter 2 X 2s 4 X 4s ABD Pads Scissors and forceps Blood pressure cuff and stethoscope Biohazard collection bags Pocket respirator and goggles Plastic bags for disposal of soiled

dressings

The following must be easily accessible: Soap for cleansing hands Paper towels Antiseptic towelettes

Antimicrobial, waterless cleanser Clean barrier material (newspaper, paper

towel, paper drape, etc.)

Sharps container in separate outside pocket, by itself, or attachment to bag.

Phlebotomy supplies (in inside pocket or in separate container): Adhesive strips Butterfly needles Various tubes Tourniquet Needle holders Blood collection needles Biohazard transport bags

Procedure: Place bag on a clean, hard surface using a barrier. Avoid placement on upholstered furniture

when possible. If using a wheeled bag, retract handle of bag at the door, carry bag into the home and place

on a clean hard surface using a barrier. Cleanse hands per Agency approved policy before entering or re-entering bag. Remove all items anticipated for use and place on barrier. Cleanse hands after procedure. Cleanse supplies for return to bag if indicated or dispose of supplies. Cleanse hands before returning supplies to bag. Dispose of bag barrier appropriately. Cleanse hands prior to leaving home.

Care of the Bag:The bag is considered a piece of equipment. Staff will protect it from soiling, contamination, damage, loss or theft.

The bags are hand washable using warm water and a mild detergent when they become soiled. If the bag becomes contaminated with blood or body fluids, it should be cleaned immediately with a 1:10 solution of bleach.

Clean out the inside part of the bag periodically, to be sure that needed supplies and equipment are in place. Also, be sure that the bag is well organized and that extra wrappers, opened but unused supplies, outdated supplies, etc. are discarded.

If the bag is damaged, do not attempt to have the bag repaired. Ask your supervisor for a replacement bag.

Never leave bags in an unlocked, parked vehicle or in a locked vehicle over night.

Avoid exposing bag to prolonged temperature extremes.

APPENDIX F

SAMPLE EMPLOYEE ANALYSIS AND FEEDBACK FORM

Safety Feature Evaluation Form

VACUUM TUBE BLOOD COLLECTION SYSTEMS

Employee Name: Title: Date:

Product: Number of times used:

Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.

agree………………disagree

1. The safety feature can be activated using a one-handed technique……… 1 2 3 4 5 N/A2. The safety feature does not interfere with normal use of this project…… 1 2 3 4 5 N/A3. Use of this product requires you to use the safety feature……………….... 1 2 3 4 5 N/A4. This product does not require more time to use than a non-safety device 1 2 3 4 5 N/A5. The safety feature works well with a wide variety of hand sizes………… 1 2 3 4 5 N/A6. The safety device works with a butterfly………………………………….. 1 2 3 4 5 N/A7. A clear and unmistakable change (either audible or visible) occurs when the safety feature is activated…………………………………………………… 1 2 3 4 5 N/A8. The safety feature operates reliably………………………………………… 1 2 3 4 5 N/A9. The exposed sharp is blunted or covered after use and prior to disposal 1 2 3 4 5 N/A10. The inner vacuum tube needle (rubber sleeved needle) does not present a danger of exposure 1 2 3 4 5 N/A4. The product does not need extensive training to be operated correctly… 1 2 3 4 5 N/A

Of the above questions, which three are the most important to your safety when using this product?

Are there other questions which you feel should be asked regarding the safety/utility of this product?

© June 1993, revised August 1998Training for Development of Innovative Control Technology Project

Safety Feature Evaluation Form

SAFETY ENGINEERED SYRINGES

Employee Name: Title: Date:

Product: Number of times used:

Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.

DURING USE: agree………………disagree

1. The safety feature can be activated using a one-handed technique………. 1 2 3 4 5 N/A2. The safety feature does not obstruct vision of the tip of the sharp..……… 1 2 3 4 5 N/A3. Use of this product requires you to use the safety feature……………….......... 1 2 3 4 5 N/A4. This product does not require more time to use than a non-safety device 1 2 3 4 5 N/A5. The safety feature works well with a wide variety of hand sizes………… 1 2 3 4 5 N/A6. The device is easy to handle while wearing gloves…………………………. 1 2 3 4 5 N/A7. This device does not interfere with uses that do not require a needle……. 1 2 3 4 5 N/A8. This device offers a good view of any aspirated fluid……………………… 1 2 3 4 5 N/A9. This device will work with all required syringe and needle sizes………… 1 2 3 4 5 N/A10. This device provides a better alternative to traditional recapping……… 1 2 3 4 5 N/AAFTER USE:11. There is a clear and unmistakable change (audible or visible) that occurs when the safety feature is activated………………………………………… 1 2 3 4 5 N/A12. The safety feature operates reliably………………………………………... 1 2 3 4 5 N/A13. The exposed sharp is permanently blunted or covered after use and prior to disposal…………………………………………………………………. 1 2 3 4 5 N/A14. This device is no more difficult to process after use than non-safety devices 1 2 3 4 5 N/ATRAINING: 1 2 3 4 5 N/A15. The user does not need extensive training for correct operation………… 1 2 3 4 5 N/A16. The design of the device suggests proper use……………………………… 1 2 3 4 5 N/A17. It is not easy to skip a crucial step in proper use of the device…………… 1 2 3 4 5 N/A

Of the above questions, which three are the most important to your safety when using this product?

Are there other questions which you feel should be asked regarding the safety/utility of this product?June 1993, revised August 1998

Training for Development of Innovative Control Technology Project

APPENDIX G

NYS Department of Health Position Statement: Use of Gloves During Injection Procedure

And

2005 OSHA Review and Update: Infection Control and Sterile Technique

Position Statement: Use of Gloves During Injection Procedure

BACKGROUND

Periodically, the Department of Health is asked to comment on whether gloves are needed during the administration of injections and, if needed or used, whether they must be changed between patients during immunizations clinics when multiple injections are being performed. The following reflects the Department’s current position on this subject.

POSITION STATEMENT

Are gloves routinely needed for administering an injection?

The answer is NO. The Centers for Disease Control and Prevention’s (CDC) AdvisoryCommittee on Immunization Practices has stated, “Gloves are not required when administering vaccinations, unless the persons who administer the vaccine will come into contact with potentiallyinfectious body fluids…”1

The Department of Health supports this ACIP position and believes it applies to administration of other medicants by injection. The primary hazard from giving an injection is needlestick injury, for which gloves offer little protection. In addition, most injections involve minimal blood loss which is easily contained with gauze or cotton ball and controlled with pressure.

Is the administration of an injection an “invasive procedure”?

The answer is NO. This question arises from the 1987 CDC recommendations for UniversalPrecautions which specify, “Gloves and surgical masks must be worn for all invasive procedures.”2

While technically an injection is invasive, in the sense that it breaks the skin barrier, the CDC limited its definition of “invasive procedure” to surgical (including oral) and obstetrical/gynecological procedures where there is bleeding, and cardiac catheterizations and angiographic procedures. In thiscontext, giving an injection does not meet these criteria.

If gloves are worn for administering an injection, must they be changed between patients?

Gloves, when worn, should always be changed between patients. Latex or vinyl gloves forpatient care are donned either to protect the health-care worker from contact with potentially infectious material3 and/or to protect the patient from contamination, otherwise they are not needed.

When health-care workers wear gloves as personal protective equipment, they become a surrogate for hand contamination. There have been several reports in the literature where failure to change gloves between patients has contributed to transmission of pathogenic organisms.

In immunization clinic settings where multiple patients are receiving injections, must hands be washed between every individual?

This question cannot be answered easily. Handwashing is an essential component of infection prevention which should not be undermined. The ACIP General Recommendations onImmunization states, “Hands should be washed before each new patient is seen.”1

(OVER)

February 1996

We recommend that hands be washed at the start of an immunization clinic and betweenindividuals if contamination occurs (i.e., there is inadvertent contact with body fluid or hands are visibly soiled). If other clinical services are being performed, i.e., physical examinations, or thepatient must be physically handled by the clinician, i.e. infants and young children, then hands shouldbe washed between patients. If handwashing facilities are not conveniently located, an alcohol-baseddegerming agent can be used to decontaminate the hands and safely continue patient care until theworker can access a sink with running water.

The administration of an injection, properly performed with good aseptic technique, shouldnot result in direct hand contact with the injection site or touch contamination of a sterile needle. While hands may touch intact skin, the site for an injection is prepared with alcohol or otherantiseptic and equipment is handled using aseptic technique. For this reason, we do not believe it is routinely necessary to wash hands between patients during immunization clinics in which the onlypatient care event is administering an injection.

REFERENCES

1. CDC. General recommendations on immunization: Recommendations of the AdvisoryCommittee on Immunization Practices. MMWR 1994;43:RR-1.

2. CDC. Recommendations for prevention of HIV transmission in health-care settings. MMWR1987:36(2S).

3. Department of Labor, Occupational Safety and Health Administration. Occupationalexposure to bloodborne pathogens; final rule (29CFR 1910.1030). Federal Register,December 6, 1991:64004-64182.

2005 REVIEW & UPDATE

INFECTION CONTROL AND STERILE TECHNIQUE

Persons administering vaccines should follow necessary precautions to minimize risk for spreading disease. Hands should be washed with soap and water or cleansed with an alcohol-basedwaterless antiseptic hand rub between each patient contact. Gloves are not required when administering vaccinations, unless persons administering vaccinations are likely to come into contact with potentially infectious body fluids or have open lesions on their hands.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5102a1.htm

FROM OSHA

httpZ://www.osha.gov/pls/oshaweb/owadisp.show document?p table=INTERPRETATIONS&P ID=21010

Q33. Are gloves required when giving an injection?

A33. Gloves are not required to be worn when giving an injection as long as hand contact with blood or other potentially infectious materials is not reasonably anticipated.”

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5102a1.htm

APPENDIX H

OSHA FACT SHEET FOR HEPATITIS B VACCINATION PROTECTION

APPENDIX I

INFLUENZA IMMUNIZATION DECLINATION FORM

AND

MEDICAL EXEMPTION STATEMENT FOR HEALTH CARE PERSONNEL

AND

HEPATITIS B DECLINATION STATEMENT FORM

Influenza Immunization Declination Form

The purpose of this form is to provide influenza facts, and to encourage staff to receive influenza vaccine each year. Please take the time to fill it out and return it to your supervisor if you choose to decline the influenza vaccination. Thank you in advance for your cooperation.

INFLUENZA FACTS

Influenza is a serious respiratory disease that kills an average of 36,000 persons and hospitalizes more than 200,000 persons in the United States each year.

Influenza vaccine is recommended for healthcare workers to prevent influenza disease and its complications, including death.

The influenza virus shed for 24-48 hours before influenza symptoms appear. Even with a mild case, symptoms can be spread to others. You cannot get influenza from the vaccine. Will you be in contact with any of the following people in the next eight months?

They are at higher risk for complication from the flu!!o An infant less than 6 months of age (there is no vaccine for this age group)o A person 50 years or oldero A child 6 months to 18 years of ageo Anyone 6 months to 18 years on chronic aspirin therapyo A woman who will be pregnant during flu seasono Anyone with a weakened immune systemo Anyone with muscle or nerve disordero A resident of nursing home or other long term care facilityo Anyone with long term health problems such as heart disease, lung disease,

asthma, kidney disease, diabetes, anemia or other blood disorders.

You protect yourself, your family, and others you come in contact with by receiving the flu vaccine.

Anyone who wants to be protected from influenza should receive the influenza vaccine. No one will be denied the flu shot due to inability to pay. If you have insurance covering the vaccine, we will be billing it.

I decline to receive the flu vaccine. I understand by declining flu vaccine, I agree to wear a mask whenever in client contact in the time specified by the NYSDOH Commissioner or by the Public Health Director if more stringent.

Name Date

Signature

THANK YOU FOR COMPLETING THIS FORM

Hepatitis B Vaccine Declination

I understand that due to my occupational exposure to blood or other infectious materials that I

may be at risk of acquiring Hepatitis virus infection. I have been given the opportunity to be

vaccinated with the Hepatitis B vaccine at no charge to myself. However, I decline the

Hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to

be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have

occupational exposure to blood or other potentially infectious materials and I want the

Hepatitis B vaccine, I can receive the vaccination series at no charge to me.

Print Name

Title

Signature

Date

APPENDIX J

COUNTY-SPECIFIC EBOLA POLICY

Documents

Table of Contents - steubencony.org · Web viewThe containment system shall be leak-proof, have tight-fitting covers, and be kept clean and in good repair. The containers may be