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2Infection Prevention for Patient Care Services 2013 Isolation and PrecautionsBloodborne Pathogen StandardTB Control PlanMultidrug Resistant Organisms
3ObjectivesUnderstand the different types of transmission based precautions and isolationUnderstand the Bloodborne Pathogen StandardUnderstand the TB Control PlanKnow what services are available through Occupation Health ServicesUnderstand what MDR-organisms are and how to prevent transmissionUnderstand contact time with regards to disinfection
4Mandatory Requirements that keep our staff and patients safe Infection Control Education is a Mandatory AnnualRequirement as stated in:OSHA Bloodborne Pathogens StandardApril, 2001 andGuidelines for Preventing the Transmission ofMycobacterium tuberculosis in Healthcare Facilities,2005.
5Isolation and Precautions - More Safety Activities Along with good hand hygiene, Standard Precautionsand disease specific precautions help prevent thetransmission of organisms. There are 6 types ofprecautions used at Karmanos:1. Standard Precautions2. Contact Precautions3. Contact Precautions with Special Cleaning4. Droplet Precautions5. AFB Isolation6. Airborne Precautions
6Standard Precautions Standard Precautions – is used with all patients and assumes that all patients areinfectious.Protective barriers called Personal ProtectiveEquipment (PPE) includes gloves,goggles/eye shields, masks and gowns areused to prevent contact with patients’ blood orbody fluids.The type of activity or task determines the amountand type of PPE to be used. The greater the riskof coming in contact or being splashed with thepatients’ blood or body fluids, the more protectionis needed.
7Standard Precautions Personal Protective Equipment (PPE) -Masks Masks, eyewear and face shields protect your eyes, nose and mouth.from splashes or splatters of blood and body fluidsMake sure to choose PPE that will protect your eyes, nose and mouthif there is any chance of splash.Examples of tasks when you should wear such PPE include:SuctioningIrrigating woundsCleaning contaminated equipmentPlace disposable PPE into general waste container after use.
8Standard Precautions Personal Protective Equipment (PPE) - Gloves Gloves keep potentially infectious materials away from your handsduring contact with patient’s blood, body fluids, mucousmembranes, or broken skin.Gloves also protect you from contact with infectious materials whenhandling contaminated equipment, surfaces, linen or waste.Remove gloves immediately after the task is done. Dispose glovesinto a general waste container.Perform hand hygiene after removing and disposing gloves.NEVER wash gloved hands. NEVER reuse disposable gloves.Change gloves after each procedure; even if performing more thanone procedure on the same patient.Standard exam gloves are latex-free.
9Standard Precautions Personal Protective Equipment (PPE) – Gowns Fluid-resistant gowns prevent blood and body fluids thatsplash or spray from soaking through to your clothes and skin.Dispose gowns after use in general waste container, NOTmedical waste biohazard container.Some situations that may require wearing a gown include:Irrigating a woundPerforming tracheostomy careAny time blood or body fluid contamination to your clothes skin is likely
10Airborne Precautions Place patients in Airborne Precautions if they have a diseasethat is transmitted by theairborne route (exceptTuberculosis).These diseases include:Chicken Pox/VaricellaMeaslesDisseminated Herpes Zoster(Shingles)
11AFB Isolation AFB Isolation is required for all patients with or suspected of havingTuberculosis (TB). TB is spread bythe airborne route.ALL AFB Isolation cases require:- A private, negative air pressure room where the air is exchanged 6-12 times per hour and exhausted to the outside of the hospital.- All healthcare workers must wear a N-95 particulate respirator (N-95 PR) to enter the room. Refer to policy IC 125.NOTE: This is a special mask thatmust be fitted to each individual. Always fit-check your mask before entering the room. Make sure you know what size N-95 you wear.
12AFB IsolationIf you are not able to wear a N-95 mask because you couldn’t be fit tested, you may be trained on the use of a PAPR-Powered Air Purifying Respirator. The PAPR is worn when entering an AFB isolation room. There are PAPR’s on 10WN, 5WN and Radiation Oncology Center.Refer to policy IC 152 or CLN 152 for additional information.
13Contact PrecautionsRequired to prevent transmission of infectious agents such as Multi-drug resistant organisms (i.e. Acinetobacter, Pseudomonas, KPC), and Rotavirus, which are spread by direct or indirect contact with the patient or the patient’s environment.Gown and gloves upon entry to room. Discard PPE before exiting room.Change gown and gloves after preparing patient for transfer out of room and perform hand hygiene. Don new PPE to assist with patient transfer outside of room.
14Contact Precautions with Special Cleaning This is signage for our patients that have C.difficile disease. Contact Precautions are followed PLUS the signage is on the door to remind our Environmental Services staff to use a bleach detergent when cleaning the surfaces in the room.
15Droplet PrecautionsUsed in the care of patients with suspected or confirmed infections such as Pertussis, Influenza, Rhinovirus, Neisseria meningitidis and RSV which are transmitted primarily by droplet route.Surgical mask is required upon entry to room
16Latex Sensitive Patient Patients identified as allergic or at risk of latexallergy are to have the following Latex AllergyPrecautions implemented:A purple allergy band is placed on patient.Patient’s chart is marked “Latex Precautions”.“Latex Sensitive” sign is placed on the patient’sdoor.Latex-free supplies from Central Sterile Processingare used for patient care.Refer to policy CLN 210 on the KCC policy website.
17Bloodborne Pathogen Standard Hospitals are required by the Bloodborne PathogenStandard of MI/OSHA to protect all healthcareworkers (HCWs) from exposure to bloodbornepathogens, while on the job.Assume that all patients could have organismsthat are transmitted by contact with their bloodand/or body fluids. Follow Standard Precautions.The MIOSHA Blood Borne Pathogen ExposureControl Plan is the policy that describes protectionmeasures for staff and patients.Refer to policy IC 110
18Bloodborne Pathogen Standard Epidemiology of Bloodborne Pathogens:Important bloodborne pathogens (disease-causing organisms)that may be present in human blood could include:Hepatitis B Virus (HBV)Hepatitis C Virus (HCV)Human Immunodeficiency Virus (HIV)These same bloodborne pathogens may also be found in otherbody fluids, including:SemenVaginal fluidsFluids around the brain, spine, heart, lungs, abdomen and jointsBloody saliva during certain dental proceduresBloodborne pathogens are NOT found in tears, urine, stool,sweat or saliva unless these body fluids are visibly bloody.
19Bloodborne Pathogen Standard Exposure to Bloodborne Pathogens:HCWs may be exposed to bloodborne pathogens by:Your skin being punctured with a contaminated needle or cut by acontaminated sharp device, such as a lancet or scalpel.Blood or body fluids getting on skin that has cuts, cracks, rashesor burns.Being splashed or sprayed with blood or body fluids into youreyes, nose or mouth.Certain HCWs have a higher risk of exposure to bloodbornepathogens while on the job.Nurses and Patient Care StaffPhysiciansLab StaffEnvironmental Services Staff who handle Regulated Medical WasteDental Staff
20Bloodborne Pathogen Standard Symptoms of Blood Borne Diseases Symptoms of Hepatitis B, C and HIV may include:FeverFatigueFlu-like illnessNauseaVomitingDiarrheaLoss of AppetiteWeight lossJaundiceItchy skinNight SweatsSwollen Lymph GlandsPneumonia
21Bloodborne Pathogen Standard Standard Precautions requires HCWs to treat all bloodand body fluids as if they are infected with disease-causing organisms.ALWAYS using Standard Precautions will prevent thespread of disease to yourself, co-workers, patients andvisitors.Your protection and Safety is important. Know where tofind PPE in your department.
22How to Manage a Blood or Body Fluid Spill Small spills that can be contained by a paper towelwill be cleaned and disinfected by the department. TheSmall Spill Procedure is:Put on PPEContain and absorb spill with paper towelsDispose of the paper towelsAdd approved disinfectant to the spill siteDispose of used supplies in general waste containerRemove gloves and perform hand hygieneLarge spills will be contained by the department with abarrier pad and then disinfected by EnvironmentalServices. See Blood and Body Fluid Spill policy IC 134on the KCC Policy Web Site.
23How is KCC keeping you safe? By evaluating and implementing safer sharps devices.The Infection Control Practitioners and the nurseeducators meet regularly with the Safer Sharpscommittee at Harper Hospital . This groupInvestigates new, safer sharps devicesCoordinate new product trialsDevelop safe work practices for work settingsTrains staff about sharps safetyMonitor injury data after implementation of new devicesCall if you have any concerns about sharps or know of new products we may want to look at.
24Common Causes of Sharps and Splash Exposure Staff not activating safety deviceSudden patient movementUnnecessary manipulation of sharp device by handImproper disposal into sharps containerMislaid sharp in environment such as bed, table,trash, etc.Performing procedure too quicklyNot wearing appropriate PPE during proceduresAlways remember to wear mask and goggles or face shield when an aerosol or splash is likely.Passing sharps to others
25Bloodborne Pathogen Standard Safe Sharps DisposalLocate sharps container close to point of use.After use, immediately activate safety feature,if appropriate, then dispose sharp into anapproved puncture-resistant container.NEVER leave sharps for someone else toclean up.Observe container opening. If sharps areprotruding, do not put your hands near it.NEVER overfill sharps containers.Replace sharps containers when they are ¾full.Lock sharps containers before moving orreplacing them.
26Bloodborne Pathogen Standard Safety DevicesSafety devices available for staff to use:Needleless IV systemSafety butterfly phlebotomy deviceSafety lancetsSafety blood gas syringeSafety IV catheterSafety syringe and needleSafety huber needleBlood transfer safety deviceHemodialysis safety fistulasSafety scalpels utilized outside theoperating roomREMEMBER: Safety devices will protect you only if you activate the safety feature after use.Evaluations and implementation of safer devices is an ongoingKCC commitment.
27Waste disposal Regulated Medical Waste is waste that may contain disease-causingorganisms.Michigan law requires health carewaste to be segregated properly. Pleasedo not use these red containers for yourregular trash.Regulated Medical Waste must beplaced into closeable, leak-proofcontainers that are lined with a red bagand labeled with the biohazard symbol.
28Bloodborne Pathogen Standard What is Regulated Medical Waste? Regulated Medical Waste : Throw these away in the Red Biohazard containerTissue and other pathology lab wasteLab specimens (not urine)Bulk blood and body fluidsBlood and blood-product bagsDressings soaked with bloodPPE soaked with bloodUrinary catheters and collection bagsEmpty drainage containers such assuction canistersDressings stained with bloodPPE stained with bloodDiapersSanitary napkinsGeneral Waste: Throw these away in the regular trash
29Tuberculosis (TB) Control Plan What is TB?TB is a contagious disease caused by the bacteria named Mycobacterium tuberculosis. TB infects primarily the lungs. Signs and symptoms of TB include:FeverWeight lossNight sweatsFatigue, weaknessProlonged cough (cough > 3 weeks) and/or blood-tinged sputumTB is spread when infected people cough or sneeze the bacteria into the air and others inhale the bacteria.
30Tuberculosis (TB) Control Plan Protecting Health Care WorkersMI/OSHA requires that all health care facilities have a TB Control Plan (refer to policy IC 124) to protect health care workers from exposure to TB while on the job.Proper AFB Isolation is a key part of the TB Control Plan. ALWAYS follow AFB/Airborne Isolation policy IC 101 on the KCC policy web site.NEVER enter an AFB Isolation room if you have not been fittested for the N-95 respirator. Staff that have been trained onthe use of the PAPR may use it to enter AFB isolation rooms.ALWAYS fit-check your N-95 respirator before entering an AFBIsolation room.
31Occupational Health Services Infection Control &Occupational Health ServicesKCC manages exposures to infected persons by:Investigating exposure situations.Referring exposed employees to Occupational HealthServices (OHS).Your manager or supervisor will allow immediate releaseof exposed employee to OHS for follow-up.Providing prophylaxis to prevent infection whenappropriate (refer to policy CLN 209 Post ExposureProphylaxis). This would also include the availability offree Hepatitis B vaccination through OHS.
32Providing follow up Management after a Blood or body fluid exposure Clean the area with soap and water; flush eyes withwater.Notify your supervisor.IMMEDIATELY report to Occupational HealthServices for care. After hours report to DRH ED.Treatment options, if necessary will be discussedwith you.You and the source patient will be tested for HepatitisB, Hepatitis C and HIV, if indicated.You will be counseled about your risk of contractingan infection with a bloodborne pathogen.
33Multidrug Resistant Organisms-MDRO MDRO’s are organisms, usually bacteria, that are resistant to at least two classes of antibiotics, but may be resistant to many antibiotics. Treatment options for infections caused by MDRO’s are often extremely limited, which poses a safety risk to our patients. MDRO infections increase length of stay, costs, and mortality. There is evidence that MDRO’s are carried from one person to another on the hands of healthcare workers.
34MDRO’s Some examples of MDRO’s are: Resistant Acinetobacter baumanii, sometimes called ACBAKPC, a term used for certain resistant Klebsiella pneumoniae, or E. coliMultidrug resistant Pseudomonas aeruginosa
35Why all the fuss? Because… Cancer patients are at greater risk of acquiring a resistant organismsCancer patients have indwelling devices like central lines and foley catheters that make them more vulnerable to all organismsCancer patients tend to be on antibiotics for long periods of time which causes the patient to be more susceptible to these organismsPatients admitted from long term acute care centers (LTAC) or nursing homes are at higher risk of acquiring these organisms tooWhen a patient is admitted from a nursing home or LTAC a pathogen screen is ordered to make sure the patient is not colonized with the highly infectious KPC
36What else do you I need to know? Healthcare associated infections (HAI’s) are the 5th leading cause of death in U.S.HAI's are the most common complications affecting hospitalized patientsThere are simple steps that can be followed to prevent HAI’s
37InterventionsMaintain isolation precautions as recommended by Infection Control staff.(Policy #101)Patients will be in Contact Precautions for the duration of their illness.Patients with a KPC may be in isolation for up to one year. So every time the patient is readmitted to the hospital they will be placed in Contact Precautions. Admitting staff and the Infection Control staff keep an updated list of all patients with KPC isolates.
38What else can I do?Practice hand hygiene at every opportunity. Unclean hands will promote the spread of infectious organisms.Teach your patient to ask healthcare workers (HCW’s) to clean their hands before they are being examined or any time a HCW comes in contact with them. PERFORM HAND HYGIENE AS YOU ENTER THE ROOM.Educate your patient and their family on proper precautions.
39Disinfection in the Patient Care Environment Always use approved disinfectantAlways follow manufacturers’ guidelines for disinfecting patient care equipmentAlways follow manufacturers’ required contact times for disinfection-Contact time indicates how long the surface must remain wet with disinfectant.
40References:CDC, Guidelines for Disinfection and Sterilization in Healthcare Facilities, 2008.CDC, Guidelines for Environmental Infection Control in Healthcare Facilities, 2003.CDC, Guidelines for Hand Hygiene in Healthcare Settings, 2002.CDC, Guidelines for Isolation Precautions in Healthcare Settings, 2007.CDC, Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Healthcare Facilities, 2005.CDC, Management of Multidrug Resistant Organisms in Healthcare Setting, 2006.OSHA Bloodborne Pathogen Standards, , April 2001.
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