Infection Prevention & Infection Prevention & Control PracticesControl Practices

What you need to know…What you need to know…

Reviewed 10/2014

STANDARD PRECAUTIONS STANDARD PRECAUTIONS

1. 1. Used for all patients, regardless of their diagnosis Used for all patients, regardless of their diagnosis

2. Applies to all blood & body fluids except sweat. Use 2. Applies to all blood & body fluids except sweat. Use the right PPE (personal protective equipment) for the right PPE (personal protective equipment) for the jobthe job

* Gloves* Gloves * Face/Eye Protection* Face/Eye Protection * Gowns/Protective Apparel* Gowns/Protective Apparel3. Use Respiratory Etiquette & Cough Hygiene3. Use Respiratory Etiquette & Cough Hygiene to minimize the spread of germsto minimize the spread of germs4. Wear a surgical mask when entering the epidural 4. Wear a surgical mask when entering the epidural

canal to prevent spread of meningococcal canal to prevent spread of meningococcal meningitismeningitis

5. Injection Safety – one needle, one syringe, one time 5. Injection Safety – one needle, one syringe, one time only only

6. Clean & disinfect the environment; use appropriate 6. Clean & disinfect the environment; use appropriate PPE during cleaningPPE during cleaning

STANDARD PRECAUTIONS GUIDELINESSTANDARD PRECAUTIONS GUIDELINES

7. Bloodborne pathogen concerns – 7. Bloodborne pathogen concerns – HIV, HBV, HVC HIV, HBV, HVC

* Handling blood and body fluids with care* Handling blood and body fluids with care to avoid exposure to bloodborne pathogensto avoid exposure to bloodborne pathogens* Cover your “portals of entry” (eyes, nose , * Cover your “portals of entry” (eyes, nose ,

mouth, non-intact skin) when potential mouth, non-intact skin) when potential exposure is possible exposure is possible

* Choose the right gown to protect clothing (paper * Choose the right gown to protect clothing (paper vs fluid-resistant)vs fluid-resistant)

* Use safety devices to reduce risk of needlesticks* Use safety devices to reduce risk of needlesticks* No two-handed recapping of needles* No two-handed recapping of needles* Annual review of safety devices to mitigate risk* Annual review of safety devices to mitigate risk* Always use safe injection practices* Always use safe injection practices

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Hand Hygiene ProtocolHand Hygiene Protocol GGood hand hygiene practices are the single practices are the single

most effective means of preventing the spread most effective means of preventing the spread of infection.of infection.

REMEMBER THIS: Hands must be REMEMBER THIS: Hands must be washed/decontaminated before touching the washed/decontaminated before touching the patient, and after touching the patient or the patient, and after touching the patient or the patient’s environment, whether gloves are patient’s environment, whether gloves are worn or notworn or not

Finger nails should be kept short -- ¼ INCHFinger nails should be kept short -- ¼ INCH No artificial nails in patient careNo artificial nails in patient care areasareas Artificial nails and long natural nails have been Artificial nails and long natural nails have been linked to disease transmission in the linked to disease transmission in the

healthcare setting.healthcare setting.

Proper Hand Washing & Alcohol Gel/Foam Proper Hand Washing & Alcohol Gel/Foam UseUse

Hand Washing:Hand Washing:

Use tepid water, wet hands and apply soap

Use good friction cleaning front and back of hand, paying attention to nails and between fingers for at least 15 seconds

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

Always use hand washing when hands are VISIBLY soiled

Using Alcohol Using Alcohol Gel/FoamGel/Foam:

Apply appropriate amount of foam/gel into palm of hand

Rub hands together using good friction to all surfaces, paying attention to nails and in between fingers

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

Wash with soap & water if hands feel tacky or dirty from hand gel

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

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

Wear PPE when CONTACT with blood or body fluid is anticipated

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

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

Protect clothing, skin, and especially mucous membranes of the eyes, nose and mouth, and open wounds from bloodborne pathogens

Bloodborne Pathogen (BBP) - Exposure Bloodborne Pathogen (BBP) - Exposure Control Plan Control Plan

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

Considerations in BBP Plan include: * Routine disinfection and cleaning * Proper body substance & sharps handling * Safety devices * Safe injection practices * Proper Management of Occupational Exposures

Routine Environmental Disinfection and Routine Environmental Disinfection and CleaningCleaning

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

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

It is not just the Housekeeper’s responsibility

Body Substance & Sharps HandlingBody Substance & Sharps Handling

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

Dispose of all used and unused needles into red rigid biohazard sharps containers; empty container when the content reaches the “fill” line marked on the container

Safe Injection PracticesSafe Injection Practices

Do not use common flush bags

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

Use single dose vials Decontaminate ports/vials

with 70% alcohol solution before use

Observe and monitor injection practices of others

Respiratory Etiquette & Cough Respiratory Etiquette & Cough HygieneHygiene

In waiting areas, signage should be posted requesting patients to inform caregivers of respiratory signs/symptoms

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

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

Healthcare workers should use mask/eye protection to care for respiratory patients that cannot tolerate a mask. Perform hand hygiene before and after.

Proper Management of OccupationalProper Management of OccupationalBBP ExposuresBBP Exposures

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

In the event of a needle stick/sharps injury and/or exposure:

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

In addition to Standard PrecautionsIn addition to Standard Precautions, Use , Use Transmission-Based Precautions for Bad BugsTransmission-Based Precautions for Bad Bugs

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

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

Organism/PathogenOrganism/Pathogen

The “Source”An infected or An infected or

colonized sourcecolonized source

Mode of Mode of TransmissionTransmission

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

Chain of Chain of InfectionInfection

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

with the patient or patient’s with the patient or patient’s environment environment

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

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

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

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

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

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

Dedicated patient care equipmentDedicated patient care equipment Precautions on transportPrecautions on transport HAND WASHING with soap and water HAND WASHING with soap and water

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

Droplet TransmissionDroplet Transmission

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

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

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

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

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

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

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

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

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

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

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

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

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

Airborne PrecautionsAirborne Precautions Examples; Tuberculosis, Examples; Tuberculosis,

Varicella Zoster, Measles, Varicella Zoster, Measles, SARS.SARS.

Requires placement in a Requires placement in a negative pressure room; door negative pressure room; door must remains closedmust remains closed

Must wear an N-95 maskMust wear an N-95 mask User must do “Fit Check” of User must do “Fit Check” of

mask before entering the room; mask before entering the room; if seal is NOT obtained, the if seal is NOT obtained, the room should NOT be enteredroom should NOT be entered

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

Recognizing Tuberculosis…. According to the CDC an estimated 10-15 million people are According to the CDC an estimated 10-15 million people are

infected in the US – 10% will develop the disease at some point in infected in the US – 10% will develop the disease at some point in their lifetime and active T.B. is more common in patients ages 35-their lifetime and active T.B. is more common in patients ages 35-60.60.

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

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

OSHA Requires - TB skin testing in all health care facilities. Frequency OSHA Requires - TB skin testing in all health care facilities. Frequency based on facility risk assessment for TB.based on facility risk assessment for TB.

- N-95 Mask FIT TESTING- N-95 Mask FIT TESTING - Follow up testing on anyone who is exposed- Follow up testing on anyone who is exposed

Multi-Drug Resistant Organisms – Important Considerations

MDRO = Multi-Drug Resistant OrganismsIncludes: - MRSA – Methicillin Resistant Staph Aureus - VRE – Vancomycin Resistant Enterococcus - MDR – GNR – Multi-Drug Resistant Gram Negative Rod - C-Diff – Epidemic strain Clostridium Difficile resistant to Fluoroquinolones

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

Enterococcus are bacteriaEnterococcus are bacteria that are normal flora in/on that are normal flora in/on the body.the body.

These bacteria have These bacteria have developed resistance to developed resistance to antibioticsantibiotics

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

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

Why are MDRO’s clinically significant?

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

and mortality

2. Limit treatment options

3. Alter resistance patterns of other organisms

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

Pandemic Influenza considerations…

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

include pandemic planning in the disaster management plan

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

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

PROPERLY AND PROPERLY AND FREQUENTLYFREQUENTLY

Always observe Always observe Standard PrecautionsStandard Precautions

Wear the correct PPEWear the correct PPE Observe Transmission Observe Transmission

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

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