1. BLOODBORNE PATHOGEN PLAN TB EXPOSURE CONTROL PLAN ISOLATION
THE EXPOSURE CONTORL PLAN IS COMPRISED OF 3 AREAS
THE BLOODBORNE PATHOGEN PLAN
THE TB EXPOSURE CONTROL PLAN
AND OUR ISOLATON PROCEDURES

2. can be found on every department at PSMH or via the
An Exposure Control Plan Manual
can be found on every department at PSMH
or via the
Dovenet policy & procedures infection control
EXPOSURE CONTROL MANNUALS ARE LOCATED on Dovenet under policy and procedures Infection Control!
OSHA SAYS IT WILL BE AVAILBLE TO EVERYONE.

3. BLOODBORNE PATHOGEN PLAN
THE FIRST ONE WE WILL DISCUSS IS THE BLOODBORNE PATHOGEN PLAN

4. WHAT ARE BLOODBORNE PATHOGENS?
viruses and bacteria that require blood
or body fluids to live
WHAT ARE BLOODBORNE PATHOGENS?
THEY ARE VIRSUES AND BACTERIA THAT REQUIRE BLOOD OR BODY FLUIDS TO LIVE.

5. PSMH Bloodborne Pathogen Plan
WHAT BACTERIA AND VIRUSES ARE
WE TALKING ABOUT?
HIV, HEPATITIS C, SYPHILIS, DELTA HEPATITIS,
B HEPATITIS, AND MALARIA
WE are MAINLY CONCERNED with
HIV, HEPATITIS B AND C.
VIRSIS AND BACTERIA THAT REQUIRE BLOOD/BODY FLUIDS TO LIVE ARE
HIV, HEPATITIS B AND C, SYPHILIS, EBOLA, HEMMORAGIC FEVER, AND SEVERAL
OTHERS
THE ONES WE SEE MOST COMMONLY AND WORRY ABVOUT THE MOST
ARE HIV, HEPATITIS B & C. NO ONE WALKS AROUNG WITH A MAJIC “H”
THEIR FOREHEAD THAT WARNS US TO BE CAREFUL.

6. These bacteria & viruses can live in these BLOOD & BODY FLUIDS
P BLOOD AND BLOOD PRODUCTS
P CEREBRAL SPINAL FLUID
P PLEURAL FLUID
P PERICARDIAL FLUID
P PERITONEAL FLUID
P SEMEN, VAGINAL FLUID
P AMNIOTIC FLUID
P SYNOVIAL FLUID
WHICH BLOOD AND BODY FLUIDS CAN THESE BACTERIA AND VIRSUS LIVE IN?

7. How are Bloodborne Pathogen spread?
When infected fluids enter the body through:
Cuts, scrapes or other breaks in the skin
Needle-stick injuries
Splashes into the mouth, nose or eyes
Oral, vaginal or anal sex
Using infected drug needles
Pregnant women who are infected with these pathogens may pass them to their babies.

8. HOW DO YOU KNOW IF SOMEONE HAS ONE OF THESE VIRSUS?
YOU DON’T!
SIGNES AND SYMPTOMS OF HEPATITIS B & HEPATITIS C: (Flu like)
Loss of Appetite, Tired feeling
Low grade temperature
Vague abdominal pain and discomfort
Diarrhea or vomiting
Yellow skin or eyes
Patients with Hepatitis B or C may or may not have symptoms and will not be diagnosed unless they become jaundiced (yellow) – BUT THEY ARE STILL CONTAGIOUS!

9. Signs & Symptoms of HIV:
Flu-like symptoms in the beginning
May have more frequent bouts of flu, colds
Eventually develop AIDS and will be diagnosed
Fever, diarrhea and fatigue (tired feeling)
It can take up to 10 years or longer before
a person is sick enough to be diagnosed
with HIV. In the mean time they are
contagious!

10. WHAT CAN WE DO TO PROTECT HEALTHCARE WORKERS?
STANDARD PRECAUTIONS/UNIVERSAL PRECAUTIONS WERE DEVELOPED BY OSHA AND CDC.
HOW CAN WE PROTECT HEALTHCARE WORKERS WHO COME IN CONTACT WITH PATIENTS EVERYDAY AND ARE AT RISK TO COME IN CONATACT WITH THESE BLOOD/BODY FLUIDS?
OSHA AND CDC GOT TOGETHER AND DEVELOPED STANDARD TO PROTECT HCW.

11. PSMH Bloodborne Pathogen Plan
STANDARD/UNIVERSAL PRECAUTIONS:
A SYSTEM THAT OUTLINES SAFEGUARDS OR BARRIERS DESIGNED TO PROTECT HEALTHCARE WORKERS
Personal Protective Equipment
Engineering control
Housekeeping
Work Practice Controls

12. PSMH Bloodborne Pathogen Plan
STANDARD/UNIVERSAL PRECAUTIONS REQUIRE
PERSONAL PROTECTIVE EQUIPMENT
FOR EACH AND EVERY PATIENT
If there is a possibility that you are going to touch or come in contact with anyone's blood, body fluids or mucous membranes:
YOU WILL WEAR GLOVES
If there is a possibility of blood or body fluids splashing or coming in contact with your eyes nose or mouth
YOU WILL WEAR A MASK & GOGGLES OR A SHIELDED MASK
STANDARD UNIVERSALPRECAUTIONS SAY: IF THERE IS APOSSIBILITY THAT YOU WILL COME N CONTACT WITH SOMEONE ELSES’ BLOOD OR BODY FLUIDS YOU WILL PROTECT YOURSELF
IF THERE IS A CHANCE YOU MIGHT TOUCH SOME ELSES BLOOD/BODY FLUIDS OR MUCOUS MEMBRANES YOU WILL WEAR GLOVES.
IF THERE IS ACHANCE YOU MIGHT BE SPLASHED BY BLOOD/BODY FLUIDS YOUR WILL
WEAR A MASK AND GOGGLES OR A SHIELDED MASK.

13. PSMH Bloodborne Pathogen Plan
STANDARD/UNIVERSAL PRECAUTIONS REQUIRE
PERSONAL PROTECTIVE EQUIPMENT
FOR EACH AND EVERY PATIENT
If there is a possibility that you might have your clothing soiled with someone's blood or body fluids
YOU WILL WEAR A GOWN
Personal Protective Equipment (PPE) is located in each and every patient room (except in the Psychiatric Unit, 2E) in a beige BSI Box on the wall (gloves, gowns, masks, shielded masks, goggles and AMBU BAGS)
When you use this equipment – REPLACE IT IMMEDIATELY!
IF THERE IS A CHANCE THAT YOUR CLOTHING MIGHT COME IN CONTACT WITH BLOOD OR BODY FLUIDS YOU WILL WEAR A GOWN.
YOU ARE THE ONLY PERSON WHO CAN PROTCT YOU!
YOU HAVE TO PUT THE PROTECTIVE EQUIPMENT ON!
YOU HAVE TO THINK ABOUT WHAT YOU ARE GOING TO DO AND PROTECT YOURSELF-
IN ANY SITUTATION YOU ARE THE MOST IMPORTANT PERSON THERE.!!! AND THE ONLY ONE WHO CAN PROTECT YOU.

14. PSMH Bloodborne Pathogen Plan
STANARD/UNIVERSAL PRECAUTONS REQUIRE
ENGINEERING CONTROLS
Biohazard Labels and containers
Safety Needles
Needless IV Systems
Sharps containers
Safety scalpels
Safety equipment is only as good as the
people who use it!
When safety equipment is provided use it
activate the safety mechanisms as soon as
you are done with the procedure.

15. PSMH Bloodborne Pathogen Plan
STANDARD/UNIVERSAL PRECAUTONS REQUIRE
HOUSEKEEPING:
Proper disposal of SHARPS and broken glass
Never reach into trash
Dispose of sharps containers when 2/3 full
Clean up Blood/Body Fluids using the proper equipment and according to policy

16. PSMH Bloodborne Pathogen Plan
STANDARD/UNIVERSAL PRECAUTONS REQUIRE
WORK PRACTICE CONTROLS:
NEVER bend, break, or RECAP a Needle
Minimize splashing of fluids during collection or disposal
Don’t eat or drink in work areas
Wash your hands or skin after contact with body fluids or objects that might be contaminated

17. PSMH Bloodborne Pathogen Plan
HEPATITIS B VACCINE:
Hepatitis B is the only Bloodborne Pathogen we can protect against!
IF YOU HAVE NOT BEEN VACCINATED FOR HEPATISIS B WE WILL GIVE THE VACCINE FREE OF CHARGE!
See the Employee Health Nurse – Brenda Dearth

18. PSMH Bloodborne Pathogen Plan
HEPATITS B VACCINE
CONSISTS OF 3 INJECTIONS
1- now
1- one month later
1- five months after the second
A TITER DRAWN BY THE LABORATORY 2 MONTHS AFTER COMPLETION OF THE SERIES.
If you are not immune after the vaccination series you will be offered a repeat vaccine series – if you are not immune after the second vaccination series you will not become immune. IF you are exposed to Hepatitis B you can be given Immune Globulin that will give you temporary immunity for 3 to 6 months

19. PSMH Bloodborne Pathogen Plan
WHAT IS AN EXPOSURE?
It’s any time blood or body fluids come in contact with a worker’s eyes, nose, mouth or skin through a needlestick, splash, or other type of exposure

20. PSMH Bloodborne Pathogen Plan
WHAT SHOULD YOU DO IF YOU HAVE AN EXPOSURE?
FIRST:
WASH THE AFFECTED AREA THROUGHLY WITH WARM WATER AND SOAP AT ONCE!
FOR MOUTH OR EYE EXPOSURE THROUGHLY RINSE OUT YOUR MOUTH WITH WATER OR MOUTHWASH: FLUSH EYES WITH WARM WATER OR A SALINE SOLUTIONS.

21. PSMH Bloodborne Pathogen Plan
SECOND:
NOTIFY YOUR IMMEDIATE SUPERVISOR
THEY WILL CALL THE HOUSE OPERATIONS MANAGER (HOM)
THE HOM WILL TEST THE SOURCE FOR HIV, HEPATITS B AND HEPATITIS C.
NOTIFY YOU OF THE HIV TEST RESULTS WITH IN ONE HOUR.
THE HOM WILL FILL OUT A EXPOSURE FORM AND AN EMPLOYEE INJURY FORM

22. PSMH Bloodborne Pathogen Plan
IF THE PATIENT IS KNOWN TO BE HIV POSITIVE OR TESTS HIV POSITIVE.
You will be sent to the ED or the Occupational Health Office for follow-up IMMEDIATELY. And the Infectious Disease Physician will consult with you about your exposure.
If it is a significant exposure and you need medication to help prevent you from turning positive to HIV it will be provided to you immediately.
IN ORDER TO PROVIDE YOU WITH THE BEST
TREATMENT AVAILABLE IT IS VERY
IMPORTANT THAT ALL EXPOSURES ARE
REPORTED IMMEDIATLEY.

23. PSMH Bloodborne Pathogen Plan
THIRD:
CONTACT THE EMPLOYEE HEALTH NURSE FOR FOLLOW-UP
The Employee Health Nurse will do base line testing on you – this is for your benefit. She will do a HIV, Hepatitis Profile and a Hepatitis B Titer if you have been vaccinated.
If your Hepatitis B titer is below 10 she will offer to revaccinate you. If you do not become immune after the second vaccination
The Employee Health Nurse will provide follow-up on the source testing – HIV, Hepatitis B and Hepatitis C.
The Employee Health Nurse will provide you with a written consultation, and follow-up testing as required.

24. ANY TIME YOU HAVE ANY QUESTONS PLEASE CONTACT THE INFECTION
CONTROL COORDINATOR
Paula Pourchot RN
INFECTION CONTROL DEPARTMENT
PHONE
PAGER
(Available 24 hours a day on pager or through the
HOM. Pager number also available on answering machine)

25. TB EXPOSURE CONTROL PLAN

26. PSMH TB Exposure Control Plan
WHAT IS TB?
Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis.
The bacteria usually attack the lungs. But, TB bacteria can attack any part of the body such as the kidney, spine, and brain.
If not treated properly, TB disease can be fatal.
TB disease was once the leading cause of death in the United States.

27. PSMH TB Exposure Control Plan
HOW IS TB SPEAD?
TB is spread when a person with active TB, who is infectious (sick with TB) coughs, laughs, talks or sings and expels the small bacteria (particle) into the air and someone near by breaths it into their lungs
This bacteria (particle) is so small it can stay in the air for up to 90 minutes.

28. PSMH TB Exposure Control Plan
Patients are screened when they enter the hospital for TB by asking them if they have any signs of Infectious TB.
Cough lasting longer than 2-3 weeks
Low grade temperature
Night Sweats
Cough up blood
Unexplained weight loss
Loss of appetite
Feel weak

29. PSMH TB Exposure Control Plan
When these signs and symptoms are present the patients chest x-ray is checked and their doctor is called and ask if the patient could possible have TB. If the Doctor feels this patient may have TB or there is a cavitations in their lungs they are transferred to a “Negative Pressure Isolation and placed in “AIRBORNE ISOLATION”

30. PSMH TB Exposure Control Plan
Airborne Isolation requires a room with special ventilation:
The air in the room exit the room through a special filter or directly outside. It is not recirculated.
The Door is kept shut at all times (except when entering or leaving the room.)
Health care workers, visitors and Doctors who enter the room MUST wear an N95 Particulate Filter Respirator Mask.
Healthcare workers MUST be fit tested and passed the fit test in order to wear the mask.
Visitors must be taught how to put the mask on and fit checked by staff before entering the room.

31. PSMH TB Exposure Control Plan
TB SCREENING:
PPD (Mantoux Testing) is done on hire and anytime a healthcare worker or volunteer is exposed to MTB.
Anyone who tests positive for the first time is sent to the Kankakee County Health Department for evaluation and possible treatment
Treatment is provided Free by the Kankakee County Health Department.

32. PSMH Bloodborne Pathogen Plan
A POSITIVE TB TEST (PPD, Mantoux Test) means:
You have come in contact with the TB germ
You are not infectious unless you have signs/symptoms of TB
You cannot give TB to anyone at this stage.

33. PSMH TB Exposure Control Plan
If you come in contact with someone who is infectious in the hospital what happens?
When a patient is placed in Airborne Isolation
the doctor will order 3 AFB Sputum Tests
If the test comes back positive for AFB the patient will be placed on treatment
The specimen is then cultured and if the results are positive for TB you will be contacted and a PPD test will be done approximately 3 months after your exposure

34. PSMH TB Exposure Control Plan
PSMH is considered at LOW Risk for contact with Mycobacterium TB:
Therefore we do not do annual TB testing
Staff/Volunteers will be tested if they are
exposed to a patient with active infectious TB.

35. PROVENA ST. MARY’S HOSPITAL ISOLATION GUIDELINES

36. PSMH Isolation Guidelines
How do I know if a patient requires ISOLATION?
The first policy under ISOLATION in the Exposure Control Manual is called “ISOLATION GUIDELINES”
This policy lists all the conditions and bacteria requiring Isolation
The type of Isolation required
The duration of Isolation
This policy is also in the Infection Control Policy manual on line.

37. PSMH Isolation Guidelines
There are Three different types of
Isolation are used at PSMH
AIRBORNE
DROPLET
CONTACT

38. PSMH Isolation Guidelines
Airborne Isolation
Airborne Isolation is used for TB, Chickenpox (Varicella) and Disseminated Herpes
If or When we see Smallpox, SARS, or Avian Flu it will be used for these also.

39. PSMH Isolation Guidelines
Airborne Isolation
For TB – requires EVERYONE entering the room to wear an N95 Particulate Filter Mask, HealthCare Workers must be fit tested and have passed the fit test.
Visitors must be fit checked to wear the mask.

40. PSMH Isolation Guidelines
Airborne Isolation
For Chicken Pox (Varicella) and Disseminated Herpes (Shingles in more than one nerve) or Shingles in an immune -compromised patient)
If you are immune to chicken pox you may enter
the room without a N95 Particulate Filter
Respirator Mask.
If you are not immune have someone who is
immune go in the room or wear an N95 Particulate
Filter Respirator Mask for which you have been fit
tested and passed

41. PSMH Isolation Guidelines
Droplet Isolation:
Used for respiratory infections:
Pertusses (Whooping Cough)
Influenza
Pneumonic plague
Diptheria
Mycoplasma Pneumonia
Mumps
Rubella
Haemophilus influenza type b (pneumonia and sepsis
Bacterial Meningitis

42. PSMH Isolation Guidelines
Airborne Isolation:
Requires a private room equipped with negative air flow. (MICU 346, SICU Rooms 5 & 6, Peds room , Recovery Room and Room 8 in OR.)
The DOOR MUST REMAINED CLOSED.
Dedicate equipment to the patient (thermometer, B/P Cuff, etc.) use disposable equipment whenever possible
Any equipment used for the patient and taken out of the room must be thoroughly disinfected before it is used again.

43. PSMH Isolation Guidelines
Droplet Isolation
Requires that a surgical mask be worn by EVERYONE who enters the room.
This is in addition to Standard Precautions

44. PSMH Isolation Guidelines
Contact Isolation
Is used for
Diarrhea infection
Salmonella, Shigella,
Hepatitis A, Roto virus
Clostridium difficile Undiagnosed diarrhea
Respiratory Infections
RSV (Respiratory Synovial Virus)
Enterovial infections in infants/children
Skin Infections
Impetigo Zoster (chicken Pox, Shingles)
Scabies

45. PSMH Isolation Guidelines
Contact Isolation
Is used for:
Multidrug Resistant Organisms:
- MRSA
- VRE
- ESBL’s
- Clostridium difficile

46. PSMH Isolation Guidelines
Hand Hygiene when caring for a patient with Clostridium difficile requiring Contact Isolation DO NOT USE WATERLESS ALCOHOL HAND SANITIZER! DO USE SOAP AND WATER!

47. PSMH Isolation Guidelines
Clostridium difficile is called a spore forming bacteria – it develops a hard coat to prevent alcohol or disinfectants to enter it – so it is very difficult to kill. The only way to make sure it is not on your hands when you leave a patient who has this bacteria is to wash your hands with soap and water.

48. Contact Isolation for Clostridium difficile:
PLACE A SIGN ON THE ALCOHOL DISPENSER IN THE PATIENTS ROOM THAT SAYS:
“PLEASE USE SOAP AND WATER FOR HAND HYGIENE. DO NOT USE ALCOHOL GEL!!!”

49. PSMH Isolation Guidelines
Contact Isolation:
Requires Gown, and gloves be worn by
EVERYONE upon entering the room
EVERY TIME they enter the room!
Healthcare workers
Visitors, family members
Doctors
Volunteers are not to enter any Isolation Room
Isolation Education must be documented for all patients and visitors.

50. HAND HYGIENE IS THE SINGLE MOST IMPORTANT THING YOU CAN DO TO PROTECT YOUR PATIENTS, YOURSELF AND YOUR FAMILY! YOU CANNOT REMEMBER WHERE YOUR HANDS WERE FIVE MINUTES AGO AND YOU DO NOT KNOW WHERE THEY WILL BE FIVE MINUTES FROM NOW!!!!

51. HAND HYGIENE Perform Hand Hygiene:
Before patient contact as you walk into the patients’ room
Before doing invasive tasks (Starting IV s)
Before taking care of newborn, touching all wounds, touching non intact skin or mucous membranes, starting your shift,
Before doing vital signs
Before dispensing oral or IV medications and nutritional substances

52. HAND HYGIENE Perform Hand Hygiene:
After contact with wounds, mucous membranes, blood and body fluids, secretions and excretions and other potentially infectious material
After contact with equipment, inanimate objects, or surfaces that are likely to be contaminated (over bed table, phone, chart, TV, Call light, IV, Door handle, etc.)
After leaving an isolation room
After removing gloves and other Personal Protective Equipment
After giving patient’s Medications or feeding them
As you leave the patient’s room
After your shift before leaving work

53. All equipment must be cleaned after use between patients.
Germicidal Wipes
- need to have wet contact time of 2 minutes on the surface, then be allowed to air dry to kill the bacteria and viruses
Virasept - Broad Spectrum Disinfectant
comes in a spray bottle
- need to have wet contact time of 10 minutes on the surface, then be allowed to air dry to kill the bacteria and viruses
** must be used for all patients with diarrhea

54. use a germicidal wipe to:
Clean equipment after patient use (lift equipment, glucometer)
Clean room (bedside tables etc.)
Clean Stethoscopes, blood pressure cuffs and data scopes
Clean medication pass area prior to preparing medication
Clean pill crushers
Clean crash cart
Clean counters, keyboards, mouse
Clean telephone, pens and highlighters at nurses station
Clean patient kitchen, counter, microwave, refrigerator
Clean isolation binders

55. For questions please contact:
Paula Pourchot RN
Infection Control Preventionist
Phone
Pager