WHAT ARE BLOODBORNE PATHOGENS? viruses and bacteria that require blood or body fluids to live
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.
THESE BACTERIA & VIRUSES CAN LIVE IN THESE BLOOD & BODY FLUIDS BLOOD AND BLOOD PRODUCTS CEREBRAL SPINAL FLUID PLEURAL FLUID PERICARDIAL FLUID PERITONEAL FLUID SEMEN, VAGINAL FLUID AMNIOTIC FLUID SYNOVIAL FLUID
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. HOW ARE BLOODBORNE PATHOGEN SPREAD?
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!
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!
STANDARD PRECAUTIONS/UNIVERSAL PRECAUTIONS WERE DEVELOPED BY OSHA AND CDC. WHAT CAN WE DO TO PROTECT HEALTHCARE WORKERS?
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
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
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!
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.
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
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
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
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
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
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.
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
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.
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.
ANY TIME YOU HAVE ANY QUESTONS PLEASE CONTACT THE INFECTION CONTROL COORDINATOR Paula Pourchot RN INFECTION CONTROL DEPARTMENT PHONE 815-937-2235 PAGER 815-279-0561 (Available 24 hours a day on pager or through the HOM. Pager number also available on answering machine)
PSMH TB EXPOSURE CONTROL PLAN WHAT IS TB? Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. 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 causeof death in the United States.
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.
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
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”
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.
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.
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.
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
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.
PROVENA ST. MARY’S HOSPITAL ISOLATION GUIDELINES
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.
PSMH ISOLATION GUIDELINES There are Three different types of Isolation are used at PSMH 1.AIRBORNE 2.DROPLET 3.CONTACT
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.
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.
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
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
PSMH ISOLATION GUIDELINES Airborne Isolation: Requires a private room equipped with negative air flow. (MICU 346, SICU Rooms 5 & 6, Peds room 225-226, 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.
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
PSMH ISOLATION GUIDELINES Contact Isolation Is used for Diarrhea infection Salmonella, Shigella, Hepatitis A, Roto virus Clostridium difficileUndiagnosed diarrhea Respiratory Infections RSV (Respiratory Synovial Virus) Enterovial infections in infants/children Skin Infections ImpetigoZoster (chicken Pox, Shingles) Scabies
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!
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.
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!!!”
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.
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!!!!
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
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
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 ALL EQUIPMENT MUST BE CLEANED AFTER USE BETWEEN PATIENTS.
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
FOR QUESTIONS PLEASE CONTACT: Paula Pourchot RN Infection Control Preventionist Phone 815-937-2235 Pager 815-279-0561