Infe

ctio

n P

reven

tion

&

Con

trol

Blood Borne Pathogens (BBP) Standard Precautions Hand Hygiene Transmission Based Precautions Prevention of Healthcare

Associated Infections

Safety & Annual Basics 2012-2013 Part 2

In

fect

ion

Pre

ven

tion

Polic

ies

an

d P

roce

du

res

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

Blo

od

born

e P

ath

og

en

s (B

BP)

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)

Pote

nti

al Tr

an

smis

sion

of

BB

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

BB

P:

Hepati

tis

B o

r 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

BB

P:

Hu

man

Im

mu

nod

efici

en

cy V

iru

s (H

IV)

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

To P

revent

BB

P E

xposu

res

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 P

revent

BB

P E

xposu

res

(con

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

To P

revent

BB

P E

xposu

res

(con

t.)

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

Aft

er

a B

BP E

xposu

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.

Aft

er

an E

xposu

re (

cont.

)

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

Firs

t Li

ne o

f In

fect

ion

Pre

ven

tion

:

Sta

nd

ard

Pre

cau

tion

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

H

an

d H

yg

ien

e:

Th

e m

ost

im

port

an

t

P

reven

tion

Measu

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

H

and H

ygie

ne (

cont.

)

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

OA

P a

nd

WA

TER

How Long?

Wet hands with warm water

Apply Soap

Rub for 15 – 30 seconds, applying friction

Rinse well

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

A

LC

OH

OL-B

AS

ED

S

AN

ITIZ

ER

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

Seco

nd

Lin

e O

f In

fect

ion P

reven

tion

: Tr

ansm

issi

on

Base

d P

reca

uti

on

s

Contact Precautions – Red Sign

Droplet Precautions – Green Sign

Airborne Precautions – Blue Sign

C-Precautions – Brown Sign

C

on

tact

Pre

cau

tions

(red)

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

D

rop

let

Pre

cauti

ons

(gre

en)

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

A

irb

orn

e P

reca

uti

on

s (b

lue)

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)

A

irborn

e T

ran

smis

sion

(co

nt.

)

Must wear fit-tested N95 respirator/

mask when entering room

(perform fit-check prior to entry)

If can’t be fit-tested for N95, 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 N95 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 N95 mask on a patient or visitor

C-P

reca

uti

ons

(bro

wn)

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

Iso

lati

on C

addie

s 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

Isola

tion C

addie

s (c

ont.

)

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

tion

of

Healt

hca

re A

ssoci

ate

d In

fect

ion

s

(H

AI)

: M

DR

s

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 N95 for Airborne

Pre

ven

tion o

f H

ealt

hca

re A

ssoci

ate

d

Infe

ctio

ns:

CLA

BS

I

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

Pre

ven

tion o

f H

ealt

hca

re A

ssoci

ate

d

Infe

ctio

ns:

CA

UTIs

Catheter Associated Urinary Tract Infections

Avoid Urinary Catherization

Must meet criteria for insertion before inserted

Use sterile technique

Secure properly to leg with StatLock®

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 o

f H

ealt

hca

re A

ssoci

ate

d

Infe

ctio

ns:

Pneu

monia

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

Pre

ven

tion o

f H

ealt

hca

re A

ssoci

ate

d

Infe

ctio

ns:

Pneu

monia

(Ven

t. P

t.)

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

Pre

ven

tion o

f H

ealt

h C

are

Ass

oci

ate

d

Infe

ctio

ns:

SS

Is

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

Infe

ctio

n P

reventi

on

: H

ealt

hca

re

Pers

on

nel R

eco

mm

en

ded

Vacc

inati

ons

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)

ALW

AY

S R

EM

EM

BER

……

……

……

…..

The single-most important means of

stopping the spread of infection is:

Infe

cti

on

Pre

ven

tion

an

d C

on

trol

Su

pp

ort

Nancy Buzgan RN BSN CIC

330-830-6953 or ext 6953

pager *60280

or

Directors, Managers, Supervisors, or House Supervisors