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What You Need to Know 1.  Bacteria and viruses are most commonly transmitted on the hands of health care workers 2.

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Presentation on theme: "What You Need to Know 1.  Bacteria and viruses are most commonly transmitted on the hands of health care workers 2."— Presentation transcript:

1 What You Need to Know 1

2  Bacteria and viruses are most commonly transmitted on the hands of health care workers 2

3  The single most important way to prevent the spread of these organisms is good hand hygiene 3

4  Good hand washing  Using alcohol hand gels  Hand care (lotions, cover cuts)  Taking care of dermatitis  Reporting of skins lesions or rashes to your Manager and Employee Health 4

5  When hands are visibly dirty or contaminated  Before and after patient care  Before eating  After using the restroom  Before donning sterile gloves  After removing gloves  If moving from a contaminated body site to a clean body site during patient care  After contact with inanimate objects (including medical equipment) 5

6  When hands are visibly soiled  Before eating  After using the restroom  When caring for patients with C. Difficile 6

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10  Coagulase positive staph/Staph aureus resistant to Oxacillin/Methicillin (MRSA)  Coagulase negative or positive staph resistant to vancomycin  Strep GrD enterococcus resistant to vancomycin (VRE)  Strep pneumoniae highly resistant to penicillin (MIC>2) 10

11  Resistant/Intermediate to:  All aminoglycosides (amikacin, gentamicin, and tobramycin.  All cephalosporins (cefazolin, cefepime, ceftazidime, etc.  All penicillins (ampicillin, pipercillin, pip/tazo, ampicillin/sulbactam, etc.)  Imipenem or meropenem  All isolates of Stenotrophomonas  ESBL producing bacteria 11

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16  MRSA in dry conditions –  Plastic charts – 11 days  Laminated tabletop – 12 days  Cloth curtains – 9 days  VRE  50% survival at 7 days on upholstery, furniture and wall coverings  Could be transferred easily by touching contaminated surfaces Huang et al., Infect Control Hosp Epidemiol 2006; 27: Lankford et al., Am J Infect Control 2006; 34:

17  A patient with a resistant organism is placed on Contact Precautions by nursing staff When lab calls When Infection Control calls By physician order Per isolation guidelines  Patient can be placed on Contact Precautions without a physician order 17

18  Consists of:  Private room  Stop sign and Contact Precautions sign outside the door  Gloves to enter the room  Gown for contact with patient or environment  Dedicated equipment 18

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20  Infection Control places a Precautions Worksheet and a yellow Contact Precautions sticker on the chart  Patient is maintained on precautions until clearance criteria are met  Notify Infection Control before discontinuing Contact Precautions 20

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31  Required for diseases that are spread by:  Small particles of evaporated droplets that remain suspended in the air for long periods of time  Dust particles contaminated with an infectious agent 31

32  Private room with Negative Air Flow  Place blue Respiratory “Airborne” Precautions and Stop Sign on the door  Wear N-95 mask  Put on mask prior to entering the room.  Take off mask after exiting the room.  Must be fit-tested to wear N-95 Mask.  Keep the room door closed 32

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34  Diseases that require Airborne precautions:  Tuberculosis  Chickenpox  Disseminated Shingles  SARS/Avian Flu 34

35  For patients placed on Airborne Precautions, Infection Control will –  Place a Precautions Worksheet and a blue Respiratory “airborne” Precautions sticker on the chart  Respiratory “airborne” Precautions can be initiated without a physician order 35

36  Prevalence in Fresno County = 100 new cases/year  Screening of patients for TB: 36 Signs/Symptoms Cough>3weeks Fever Weight loss Bloody sputum Night sweats Suspicious chest X-ray Risk Factors Immunocompromised History of TB Recent exposure Recent immigration from or travel to an area with a high rate of TB Homelessness Spent time in a correctional facility

37 37 POSITIVE* SYMPTOMS AND HIGH RISK FACTORS NO NEED FOR RESPIRATORY PRECAUTIONS UNLESS ADDITIONAL CONCERNS ARISE INITIATE RESPIRATORY PRECAUTIONS~AND RULE OUT ACTIVE TB CLEAR/NEGATIVE FOR TB: NO NEED FOR RESPIRATORY PRECAUTIONS UNLESS ADDITIONAL CONCERNS ARISE POSITIVE/SUSPIC IOUS FOT TB: INITIATE RESPIRATORY PRECAUTIONS – AND RULE OUT ACTIVE TB*** CHEST X-RAY POSITIVE SYMPTOMS* BUT LOW RISK FACTORS EVALUATE ONLY IF CHANGE EVALUATE CLINICALLY NEGATIVE SYMPTOMS BUT HIGH RISK FACTORS** NEGATIVE SYMPTOMS AND/OR LOW RISK FACTORS REVIEW OF PATIENT INFORMATION REVEALS

38  For patients with a suspicion of TB –  Infection Control will review the medical record  A Tuberculosis Suspect Case Report will be completed by Infection Control and faxed to the Public Health Department (PHD) 38

39  With submission of “Suspect” report form to the PHD, patient will be placed on a Public Health Department “HOLD”  Patient MAY NOT be discharged without written consent of the County TB Controller or designee 39

40  Infection Control will notify the appropriate Case Manager/Discharge Planner when a patient is put on precautions and placed on a PHD “Hold”  Discharge of the patient is arranged through the Discharge Planner in collaboration with the PH D 40

41  If patient wants to leave Against Medical Advice (AMA) –  Try to persuade them to stay  If they insist on leaving, try to get an address, if possible  Notify Infection Control and the PHD or on nights and weekends, call the Sheriff 41

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44  Required for diseases that are spread:  Through the air by large particle droplets  Droplets usually travel short distances, ie less than 3 feet. 44

45  Private room, NO negative air flow.  Put on regular surgical mask before entering the room.  Remove mask before leaving the room. 45

46  Diseases that require Respiratory “Droplet” Precautions  Meningitis  Pertussis (whooping cough)  Influenza 46

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48  Found in your binder  Lists several diseases/conditions with required special precautions and modes of transmission  Need to be familiar with it to comply with Infection Control policies 48

49 DiseasePrecautionsMode of Transmission Comments C.DiffContactFecal-OralCaution with stool. Do Not Use Hand Gel InfluenzaDroplet-duration of illness DropletDoes not require negative airflow room; wear surgical mask Meningitis Hemophilus or Meningo coccal Droplet-for 24 start of effective ABX therapy DropletDoes not require negative airflow room; wear surgical mask; Notify IC and PHD; Contact EHS or ED if exposed to patient prior to initiation of isolation. 49

50  Over 70 reportable communicable diseases  The duty of every health care provider knowing of, or in attendance on, a case or suspected case to report on a Confidential Morbidity Report (CMR) form and fax to PHD  CMR generally completed and faxed by Infection Control 50

51  Anthrax, Botulism, Smallpox, Tularemia  Salmonella, Shigella, Campylobacter, E.coli O157  Sexually Transmitted Diseases: gonococcal infections, syphilis, chlamydia  TB  Meningitis: bacterial, viral, fungal 51

52  MRSA Screening Program – CA State  Central Line Insertion Process – CA State  National Patient Safety Goals - JCAHO  Hand Hygiene  Implement Best Practice Guidelines to decrease central line infections, surgical site infections and hospital-acquired MRSA/VRE  Reporting of hospital-acquired infections – CA State 52

53 Use soap and water for hand hygiene; DO NOT use an alcohol gel Use Contact Precautions for patients with confirmed or suspected C.difficile (i.e., put on gloves upon entering the room; put on gloves and a gown for any contact with the patient or the patient’s environment.) Monitor compliance with Contact Precautions (compliance monitoring for all patient care providers, including physicians, began 2/1/10.) Immediately notify clinical personnel if you suspect a patient has a C.difficile infection. Use bleach (Chlorox wipes or bleach solution) to clean the patient’s room. Prescribe antibiotics only when necessary. Educate the patient and patient’s family about C. difficile infection and prevention strategies. (Education materials soon to be placed on the Patient/Family Education website on the Community Forum.)

54 Utilize the Central Line Insertion Process Bundle:  Perform Hand Hygiene prior to line insertion.  Use Maximal Barrier Precautions: Inserter to wear sterile gown, sterile gloves, mask/eye shield, and cap. Patient to be covered with a full body sterile drape.  Use a chlorhexidine/alcohol antiseptic (ChloraPrep) for patient skin prep.  Place a chlorhexidine impregnated disc (BioPatch) around the line so it touches the skin.  Avoid using the femoral vein for central line access, unless absolutely necessary. Have all the necessary supplies readily available in a central line kit or cart. Complete the Central Line Insertion Process (“CLIP”) form/checklist; this is a CDPH requirement. Daily, assess and document line necessity and remove if nonessential. Disinfect catheter hubs, needleless connectors and injection ports with alcohol before accessing. Use caps to cover hubs/connectors/ports when not in use. Change line dressings/caps per hospital policy. Educate healthcare personnel, patients and their families about central line related bloodstream infections and prevention strategies. (Education is available on the Patient/Family Education website on the Community Forum.)

55 Maintain strict adherence to hand hygiene: “Gel In & Gel Out” Use Contact Precautions for patients who are colonized or infected with MDROs. Immediately notify Clinical Personnel if you suspect a patient has an MDRO. Review the Infection/Isolation tab on the EPIC census to identify readmitted MDRO patients. Implement an MRSA screening program for early detection and isolation of colonized patients. (Program began at CMC in July 2009.) Prescribe antibiotics only when necessary. Follow CMC’s Reserved Antimicrobials guideline. Maintain clean patient care equipment and a clean environment. Educate healthcare personnel, patients and their families about MDROs and prevention strategies. (MRSA education is available on the Patient/Family Education website on the Community Forum.)

56 Deliver IV antimicrobial prophylaxis within 1 hour before incision (2 hours for vancomycin and fluoroquinolones.) Use an antimicrobial prophylactic agent consistent with published guidelines. Discontinue the use of prophylactic antibiotic within 24 hours after surgery (48 hours after cardiothoracic procedures.) Proper hair removal (i.e., remove hair with clippers or do not remove the hair at all; razors are not to be used for hair removal.) Control glucose levels in cardiac surgery patients. Maintain perioperative normothermia in colorectal surgery patients. For Class 1 (“clean”) surgical procedures: Instruct patients to: Shower with 4% CHG the evening before and morning of the procedure. Dry a with fresh, clean, dry towel and don clean clothing after each shower. Screen for MRSA and decolonize if positive Educate the patient and patient’s family about surgical site infections and prevention strategies. (Education materials can be found on the Patient/Family Education website on the Community Forum.)

57  Beverly Kuykendall, Manager, x52047; Cell (CBHC, Dialysis, Cancer Center, CSTCC, Radiology, Lab, OP Clinics, Home Services, Endoscopy, Surgery and “Other” ancillary departments or off site facilities)  Connie Young, RN, ICS, x56553; Cell (CRMC 2C, 2E, 6W, 7W, Step Down Unit, NICU)  Juan Bulgara, RN, ICS, x34436; Cell (4N ICU, 4S ICU, CVU, 5N ICU, 5S ICU, Burn Center, ED )  Melissa Deen, RN, ICS, x57299; Cell (CRMC 1E, 4C, 4E, 8W, 9W, L&D, PNU)  Shelli Ashbeck, RN, ICS, (Clovis) x44033; Cell (CCMC, Oakhurst Urgent Care, )  Karen Stevenson, RN, ICS, CRMC x56508; FHSH ; Cell— ; (CRMC)—5E Ante-partum, 5C Peds, 5C M/S, 5W, (FHSH)—Inpatients, Outpatients and ancillary departments. 57


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