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Inf ect ion Pre ve nti on & Co ntr ol Blood Borne Pathogens Inf ect ion Pre ve nti on & Co ntr ol Blood Borne Pathogens (BBP) Standard Hand Precautions Hygiene Transmission Based Precautions Prevention of Healthcare Associated Infections Safety & Annual Basics 2012 -2013 Part 2

Infection Prevention Policies and Procedures Administrative Manual: Section 4 Infection Control contains: OSHA Bloodborne Infection Prevention Policies and Procedures Administrative Manual: Section 4 Infection Control contains: OSHA Bloodborne Pathogen Exposure Control Plan OSHA Bloodborne Pathogens Management Plan Contact, Droplet, and Airborne Transmission Precautions Hand Hygiene Prevention of various health care associated infections

b or n e P at h o ge n s (B B P) b or n e P at h o ge n s (B B P) Health Care workers are at risk for exposure to bloodborne pathogens such as: Hepatitis B virus (HBV) Hepatitis C virus (HCV) Human Immunodeficiency virus (HIV)

al T r a n s m is si o n of B B al T r a n s m is si o n of B B P Occurs through: Needle stick or any sharps injury Blood-to-blood Splash to eyes, nose, mouth or open areas on the skin Blood/Body Fluid-to-Mucous Membranes

B P: H e p at iti s B or C Causes serious liver B P: H e p at iti s B or C Causes serious liver disease Influenza-like symptoms plus jaundice, abdominal pain, loss of appetite, nausea and vomiting No cure for Hepatitis B or C Vaccine available for prevention of Hepatitis B but not for Hepatitis C

m m u n o d ef ic ie n c y V ir m m u n o d ef ic ie n c y V ir u s ( H I V ) Attacks the immune system so a person cannot fight infections Influenza-like or mono-like symptoms 2 out of 3 persons with HIV develop Acquired Immunodeficiency Syndrome (AIDS) No Vaccination No Cure, treat symptoms

nt B B P E x p o s u re s Follow Standard nt B B P E x p o s u re s Follow Standard Precautions at all times on all patients Do not bend, break, or recap needles Dispose of all sharps in a sharps container with hazardous label Do not eat or drink where exposures could occur (includes nurses stations)

To Pr ev en t B BP Ex po su re s (c on To Pr ev en t B BP Ex po su re s (c on t. ) Wear correct personal protective equipment (PPE): gloves, gowns, masks, eye protection (facial shields, goggles) PPE is “specialized clothing or equipment worn by an employee for protection against infectious materials” Perform Hand Hygiene Frequently (use soap & water after contact with blood & body fluids) Get Hepatitis B Vaccinations Use safety products correctly

ev en t B B P E xp os ur es (c o nt. ev en t B B P E xp os ur es (c o nt. ) Dispose of infectious waste in red bag trash “disposable items saturated with blood or body fluids” Clean equipment before sending for repair Carry used linen away from you and place in linen bag Report all exposures immediately

r a B B P E x p o s u re First Aid r a B B P E x p o s u re First Aid Wash area with soap & water Rinse eyes, nose, mouth with water at least 10 minutes Notify Director/Manager/House Supervisor Complete paperwork found on AMC intranet for source and victim (next slide) Seek Medical Attention immediately in Occupational Health Services (OHS) or triage area in ED after OHS hours, weekends and holidays. Don’t wait till end of shift for medical care.

n E x p o s u re (c o n t. ) Paperwork n E x p o s u re (c o n t. ) Paperwork Found Under Needle stick Protocol on Intranet page. Click on Source and follow protocol to order blood tests on source/patient. HIV consent should be obtained if possible. Call lab to draw the blood Click on victim/employee, complete forms and take to OHS and OHS will order necessary blood tests on the victim/employee

S t a n d a r d P r e c a u S t a n d a r d P r e c a u t i o n s Applies to all patients all of the time Begins with good personal hygiene Includes: Hand Hygiene Personal Protective Equipment (PPE) Base what to wear on whether a spill or splash could occur Safe Injection Practices Infectious Waste Disposal Linen Handling Respiratory Etiquette

Ha nd Hy gie ne: The mo st im por tan t Pre ven Ha nd Hy gie ne: The mo st im por tan t Pre ven tio n Me asu re Use either soap & water or alcohol hand sanitizer Before and after contact with patient & patient surroundings Before and after contact with any patient equipment Before & after removing gloves After contact with mucous membranes, blood or body fluids

n d H y gi e n e (c o n t. ) Artificial n d H y gi e n e (c o n t. ) Artificial nails cannot be worn by patient care, food preparation, or Operating Room or Central Services staff Defined as anything that did not grow naturally Everyone’s nails should be clean and no longer than ¼ inch

S O A P a n d W A T E R How Long? S O A P a n d W A T E R How Long? Apply Soap Rub for 15 – 30 seconds, applying friction Rinse well Wet hands with warm water Turn faucet off with a paper towel Always use when spores could be present (c-diff) Always use when hands are visibly soiled Be sure to rub between fingers and finger tips & thumbs

B A S E D S A N I T I Z E R B A S E D S A N I T I Z E R S Quickly kills virus & bacteria, not spores Still need 15 – 30 seconds of friction Use when hands not visibly soiled Most find skin condition improves Rub till dry before doing next task

ecti on Pre ven tio n: Tra ns mis sio n Ba sed Pre ecti on Pre ven tio n: Tra ns mis sio n Ba sed Pre ca uti ons Contact Precautions – Red Sign Droplet Precautions – Green Sign Airborne Precautions – Blue Sign C-Precautions – Brown Sign

Co nt ac t Pr ec au tio ns (re d) Used for patients Co nt ac t Pr ec au tio ns (re d) Used for patients with resistant organisms (MRSA, VRE, ESBLs), or diarrhea Gown and Gloves required upon room entry regardless of planned activity Discard Gown and Gloves before leaving room Wash hands with soap & water or alcohol hand sanitizer

Dr op let Pr ec au tio ns (gr ee n) Used for patients Dr op let Pr ec au tio ns (gr ee n) Used for patients with influenza, meningitis, diphtheria, whooping cough, scarlet fever Wear procedure/surgical mask when entering room Discard mask before leaving room Wash hands with soap and water or alcohol hand sanitizer Place surgical/procedure mask on patient for transport

Ai r b or n e P re c a u ti o n Ai r b or n e P re c a u ti o n s (b lu e) Used for patients with suspected or confirmed TB, measles, chicken pox Notify Plant Engineering prior to placing patient in a negative air pressure room so they can be sure that the negative air pressure is working (rooms 2214, 2224, 2126, ICU 8, ED 4 & 5) Keep room door closed at all times to maintain negative air pressure Notify Infection Control when placing a patient in Airborne precautions (ext 6953)

n e Tr a n s m is si o n (c o nt. n e Tr a n s m is si o n (c o nt. ) Must wear fit-tested N 95 respirator/ mask when entering room (perform fit-check prior to entry) If can’t be fit-tested for N 95, must wear a PAPR (Positive Air Pressure Respirator) or CAPR (Controlled Air Purifying Respirator) Annual TB skin tests only required if results of Annual TB Risk Assessment indicates the need. Not required since 2012 Annual fit testing for N 95 masks is required for employees who may need to enter a negative air pressure room Fit test completed in OHS or by trained tester Patient to wear a surgical/procedure mask for transport Never put a N 95 mask on a patient or visitor

Pr ec a ut io n s (b ro w n) Used for patients Pr ec a ut io n s (b ro w n) Used for patients with C-difficle infection (diarrhea) Follow “Contact Precautions” with added cleaning protocols Soap & water for Hand Hygiene Do Not use Alcohol Hand Sanitizer Bleach & bleach wipes for disinfection Gown and gloves required upon room entry

Is ol at io n C a d di es Obtain caddy with initial Is ol at io n C a d di es Obtain caddy with initial supplies from Central Sterile Services Obtain additional gowns and gloves from Materials Management Post “Stop Sign” near door Post “Correct transmission” sign near door Post “Visitor Information” Sign for the correct transmission near door

at io n C a d di es (c o n t. ) Pockets at io n C a d di es (c o n t. ) Pockets contain gowns, masks, signs and educational pamphlets for patients Use disposable equipment in top pockets (stethoscope, BP cuffs, thermometers) If must use equipment used for other patients, clean the equipment before and after use with Sani-cloth wipes (wear gloves when using wipes) Contact time for Sani-wipe AF is 3 minutes Contact time for Sani-wipe Bleach is 4 minutes Must remain wet that long & allowed to dry in order to be effective

Pre ven tio n of He alt hca re Ass oci ate d Inf Pre ven tio n of He alt hca re Ass oci ate d Inf ecti ons (HA I): MD Rs Prevent the transmission of Multidrug Resistant Organisms (MRSA, VRE, MDR) Follow Standard Precautions Hand Hygiene, PPE, Clean Equipment Follow Transmission-based Precautions Wear gowns and gloves for Contact Wear mask for Droplet Wear N 95 for Airborne

Preve ntion of Healt hcare Asso ciate d nfec ions CLA BSI Catheter-Associated Blood Preve ntion of Healt hcare Asso ciate d nfec ions CLA BSI Catheter-Associated Blood Stream Infections Follow Central Line Checklist for Insertion Stop Insertion if a step is not completed Daily Maintenance of central lines Sterile dressing changes Hand Hygiene before touching Review daily for need & discontinue as soon as possible Follow correct procedure when drawing blood Use swab caps or scrub the hub before access to the ports

tio n of He alt hca re Ass oci ate d Inf ecti ons tio n of He alt hca re Ass oci ate d Inf ecti ons : CA UTI s Catheter Associated Urinary Tract Infections Avoid Urinary Catherization Must meet criteria for insertion before inserted Use sterile technique Secure properly to leg with Stat. Lock® Use closed drainage system Keep drainage bag below the level of the bladder Cleanse perineal area at least once a day Prevent kinks in tubing Assess daily to determine continued need – remove as soon as possible

Pre ven tion of Hea lthc are Ass ocia ted Infe ctio ns: Pne Pre ven tion of Hea lthc are Ass ocia ted Infe ctio ns: Pne um oni a In all patients Walk patients: regular moving & exercise Position head of bed at > 30° Hand Hygiene before touching patient or equipment Cough and deep breath patient Manage patient’s pain (so can cough) Mouth Care twice a day with tooth and gum brushing

alt hca re Ass oci ate d Inf ecti ons : Pn eu mo alt hca re Ass oci ate d Inf ecti ons : Pn eu mo nia (Ve nt. Pt. ) Wean patient from ventilator as soon as possible (daily assessment) Hand Hygiene prior to touching patient or equipment Head of bed elevated >30° Prevent contamination of respiratory equipment Mouth care every 4 hours with tooth and gum brushing twice a day

tio n of He alt h Car e Ass oci ate d Inf ecti tio n of He alt h Car e Ass oci ate d Inf ecti ons : SSI s Surgical Site Infections Antibiotic 1 -2 hours prior to surgery Discontinue in 24 hours or 48 hours (cardiac OR) Prepare skin with antiseptic agent Use clippers for hair removal Use appropriate scrub for surgical team Wear appropriate surgical attire All hair covered, mouth & nose covered Minimize traffic in & out, keep doors closed Clean room with hospital grade disinfectant Aseptic technique for dressing changes

n: He alt hca re Per son nel Rec om me nd ed Va n: He alt hca re Per son nel Rec om me nd ed Va cci nat ion s Hepatitis B (series of 3) Influenza (annually) MMR (measles, mumps, rubella) (2 doses) Or show immunity with blood test Varicella (chickenpox) (2 doses) Or show immunity with blood test Tetanus, diphtheria, pertussis (1 dose of Tdap if have not received & Tetanus (Td) booster every 10 years Meningococcal (1 dose to microbiologists who are routinely exposed)

Y S R E M B E R … … … …. . The Y S R E M B E R … … … …. . The single-most important means of stopping the spread of infection is:

Inf ect ion Pr ev en tio n an d Co ntr ol Su Inf ect ion Pr ev en tio n an d Co ntr ol Su pp ort Nancy Buzgan RN BSN CIC 330 -830 -6953 or ext 6953 pager *60280 or Directors, Managers, Supervisors, or House Supervisors