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West Liberty Health Sciences

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1 West Liberty Health Sciences
OSHA’s Bloodborne Pathogens Standard Prevention of Healthcare Associated Infections and Multidrug Resistant Organism Transmission

2 Bloodborne Pathogen Standard: Exposure Control Plan
The Exposure Control Plan contains policies/procedures for OSHA’s Bloodborne Pathogen Standard Found in each institution’s Library Bloodborne Pathogen Standard You are covered if it is reasonably anticipated that you could be exposed to blood or other potentially infectious body fluids as a result of performing your job duties

3 Exposure Control Plan (cont.)
Details what measures will be taken to minimize your risk of exposure Explains what procedures to follow if there is an exposure incident Includes a method of identifying and evaluating safety devices such as protective sharps.

4 Bloodborne Pathogens Human immunodeficiency virus (HIV)
Attacks the immune system Hepatitis B virus (HBV) Infects the liver Hepatitis C virus (HCV)

5 HIV A number of people infected remain healthy for years
An infected person becomes seriously ill when the immune system loses its ability to fight infections Some infected persons go on to develop Aquired ImmunoDeficiency Syndrome (AIDS)

6 HBV Most people infected by HBV recover and clear the infection
About 6% of those infected become chronically infected for life Each year, people die from chronic liver disease and liver cancer linked to HBV.

7 Hepatitis B Vaccine HBV can be prevented by receiving the hepatitis B vaccine. The vaccine is Highly recommended Given in a series of 3 shots in the arm Safe Very effective

8 HCV Approximately 75% of persons infected will have no symptoms
Up to 85% will be chronically infected Leading indicator for liver transplants No preventative vaccine

9 How Bloodborne Diseases Spread
Bloodborne viruses are spread through contact with blood or other potentially infectious body fluids which includes Semen and vaginal secretions Body fluid containing visible blood Cerebrospinal fluid (fluid around brain/spinal cord) Synovial fluid (fluid in joints) Pleural fluid (fluid around the lung)

10 How Bloodborne Diseases Spread
Peritoneal fluid (fluid in the abdomen) Pericardial fluid (fluid around the heart) Amniotic fluid (fluid in the uterus of a pregnant woman Non-intact skin or organs

11 Transmission To acquire a bloodborne pathogen blood or other potentially infectious body fluids must come in contact With mucous membranes including of the Eyes Nose Mouth By contaminated sharp object puncture Such as a needlestick With non-intact skin Skin abrasion Acne

12 Reducing Your Risk Standard Precautions Engineering Controls
Work Practice Controls Housekeeping Administration of the hepatitis B vaccine

13 Standard Precautions Based on the principle that the following are potentially infectious and must be treated that way Blood and body fluids Secretions and excretions Non-intact skin Mucous membranes Remember: All body fluids pose a potential risk for infection

14 Standard Precautions involves:
Hand hygiene Personal Protective Equipment Respiratory Hygiene/Cough Etiquette Safe Injection Practices

15 Hand Hygiene Single most important practice to reduce the transmission of infectious agents Includes handwashing and use of alcohol based product

16 Handwashing HANDWASHING MUST BE DONE If hands are visibly soiled
Before eating After using the restroom After caring for a patient with diarrhea or on contact precautions for stool Stool may contain Clostridium difficile which forms spores that can only be eliminated by physical removal

17 Hand Hygiene Guidelines
Must be done with soap & water or alcohol handrub Before and after patient contact regardless of glove use After contact with the patient’s environment Immediately before inserting an invasive device When moving from a contaminated body site to a cleaner body site After removing gloves

18 OTHER SITUATIONS FOR HAND HYGIENE
When they look or feel dirty Before preparing food or medication After eating After coughing or sneezing into your hand After blowing or wiping your nose

19 How To Perform Handwashing
Turn faucet on and adjust temperature to warm, not hot Apply soap to hands to allow for sufficient coverage of entire surface Scrub hands for 15 seconds Cover entire hand including fingernails and wrist Rinse hands completely in running water keeping hands lower than elbows Dry hands with paper towel Use a clean, dry paper towel to turn off faucet

20 Alcohol Based Handrub Apply enough product to hands to cover all surfaces of hands and to remain wet for 15 seconds Rub hands, fingernails and wrist area until dry

21 Fingernails Artificial nails and gel products used on nails are not permitted If you provide hands-on patient care Perform diagnostic studies that required direct patient contact Natural nails should be kept short.

22 Hand Hygiene for Patients and Visitors
Proper hand hygiene by patients and visitors will minimize environmental contamination Instruct patient and visitors on hand hygiene including use of alcohol handrub Provide patient with towelettes for use while in bed

23 Personal Protective Equipment (PPE)
Wear gown and gloves whenever you expect to touch blood and body fluids or contaminated surfaces Wear mask and eye protection or face shield to protect from splashes of body fluid Different tasks require different levels of PPE

24 WEARING PPE PUT THE GOWN ON FIRST, THEN MASK, THEN GLOVES
REMOVE IN REVERSE ORDER. AVOID TOUCHING THE OUTER SURFACES OF THE PROTECTIVE GEAR REMOVE GLOVES BY PINCHING FIRST GLOVE AND PEEL BACK. SLIDE UNGLOVED FINGER UNDER CUFF OF SECOND GLOVE AND PEEL BACK

25 WEARING PPE Remove mask by touching the strings
Do not leave mask dangling around the neck! Remove gown by loosening ties, pull down from below the neckline off the arms and roll inside out Dispose of protective wear immediately Perform hand hygiene

26 Gloves Perform hand hygiene before donning gloves
Change gloves between tasks on the same patient Change gloves after contact with material that may contain a high concentration of organisms Change gloves between patients and before touching non-contaminated items and surfaces

27 Gloves (cont.) Discard single use gloves after one use
If a glove tears, punctures, leaks or becomes contaminated, remove it as soon as possible Wash hands to avoid transfer of microorganisms to other patients or environments.

28 Respiratory Hygiene Cough Etiquette
Cover coughs and sneezes Cover coughs and sneezes Perform hand hygiene If unable to perform hand hygiene immediately, cough into arm or jacket Have patients who are not able to comply wear a surgical mask when out of their room

29 Safe Injection Practices
Use aseptic technique to avoid contamination of sterile injection equipment Do not administer medications from a syringe to multiple patients, even if the needle or cannula is changed Use IV bags and other fluid infusion sets for one patient only

30 Safe Injection Practices (cont.)
Do not administer medications from single dose vials to multiple patients or combine leftovers for later use Use single dose vials whenever possible Do not store multiple dose vials in immediate patient treatment area Do not use IV solutions as a common source for multiple patients

31 Engineering Controls Isolate or remove hazards from the workplace and includes: Sharps disposal containers Sharps with engineered sharps injury protections Needleless systems Leakproof trash bags Resuscitation equipment

32 Resuscitative Equipment
Use resuscitative mask or other ventilation devices to avoid mouth to mouth resuscitation Resuscitative masks should be in all patient rooms and care areas Replace as needed from storeroom stock Ventilation equipment is located on crash carts

33 USING SHARPS SAFELY Never recap needles Never bend or break needles
Use safety engineered needles, syringes and scalpel blades Deposit sharps immediately after use in a designated sharps container Sharps containers should not be more than 3/4ths full to avoid accidental needlesticks

34 Work Practice Controls
Procedures you follow to reduce exposure to blood and body fluids such as… Do not eat, drink, smoke, apply cosmetics or lip balms or handle contact lenses where blood or body fluids are present Do not store food or drink in places where blood or body fluids are present Never mouth pipette or mouth suction blood or body fluids Minimize splashing or spraying of blood or body fluids

35 Other Safe Work Practices
Transport lab specimens in closed, leak-proof containers. Do not let contaminated equipment touch your skin, mucous membranes, clothing, other patients, visitors or items in the environment Make sure reusable equipment is not used on another patient until it has been properly cleaned Single-use items should be discarded appropriately

36 Housekeeping Keep linen away from your body to avoid contamination of clothes and arms Clean frequently used surfaces often Bedside stand Clean blood and body spills immediately Do not reach into trash containers or push trash down with your hands or feet. Instead gently shake down

37 Housekeeping (cont.) Carry waste bags by the top, away from your body
Fluorescent orange-red labels, red bags, red containers and warning signs are designed to warn you that the contents contain blood or body fluids.

38 Low Level Disinfection
Performed on items that come in contact with intact skin BP cuffs Mattresses Item must be Dry Visibly clean Free of defects

39 Defective Items Defective items Clean and disinfect item as needed
Mattress with tear or puncture Rough surfaces on wooden chairs arms Clean and disinfect item as needed Place defective sticker on item Remove from service Report to manager

40 Low Level Disinfection Procedure
Use friction to clean item of all visible soil if present Disinfect the surface by applying disinfectant from a clean germicidal wipe or spray bottle (i.e, Cavicide) and a clean towel Wipe disinfectant over all surfaces using friction Friction removes 98% of microorganisms and bacterial spores (Clostridium difficile) that the disinfectant cannot kill

41 Low Level Disinfection Procedure
Make sure surfaces are wet enough to assure proper exposure time required by the manufacturer’s label Rewet if necessary to obtain the required exposure time Cavicide/Caviwipes 3 minutes Red top Sani-Cloth 5 minutes Neither product kills C.diff spores Hand soap is not to be used on inanimate objects.

42 Control Measures to Avoid Contamination of the Disinfectant
Empty and rinse spray bottles before refilling Do not “top off” bottle Do not leave residual water in the bottle Avoid contamination of bottle straw Always read the manufacturer’s label for exposure time and appropriate storage Store in closed container Avoid storing in sunlight

43 What To Do If Exposed to Blood or Other Potentially Infectious Body Fluids
Act quickly, because for some infections, treatment should start right away Post-exposure prophylaxis for HIV should begin within hours (i.e., 4 hrs ) of the exposure Remember that an exposure does not always lead to infection

44 What To Do If Exposed Wash the exposed area with soap and water
If contaminated material gets in your eyes or mucous membranes, flush them with large amounts of water Report the exposure to your supervisor Report to EMSTAR

45 Healthcare-Associated Infections
Infections patients acquire during the course of receiving treatment for other conditions Account for an estimated 2 million infections and 90,000 deaths $26-$33 billion in added healthcare cost 70% can be prevented by implementing what we know for prevention

46 Multidrug-Resistant Organism (MDRO)
MDROs are bacteria resistant to one or more of the best drugs we have to treat them which makes infections difficult treat. Two-thirds of the bacteria that cause HAIs are MDROs

47 MDROs of concern Methicillin resistant Staph aureus (MRSA)
Vancomycin resistant Enterococcus (VRE) Extended spectrum beta-lactamase (ESBL) Occurs with gram negative bacteria E.coli Klebsiella pneumonia Klebsiella producing carbapenemase (KPC) Acinetobacter baumanii

48 Identification of MDROs on culture reports
ESBL ESBL is listed beneath antibiotics on culture Positives are indicated with a (+) sign KPC Comment will be added beneath Klebsiella on the culture report indicating the organism is positive for KPC

49 Most Common HAIs Clostridium difficile associated diarrhea
Catheter associated urinary tract infections Central line-associated bloodstream infections Surgical site infections Ventilator associated pneumonia

50 Clostridium difficile Infection
Most common cause of infectious diarrhea diagnosed in the hospital A virulent strain exists that is causing epidemics with significant mortality Forms spores that can persist in the environment for months Can only be physically removed by Handwashing (do not use alcohol handrub) Friction with environmental cleaning

51 Prevention of Catheter-associated Urinary Tract Infections
Perform hand hygiene immediately before and after any manipulation of the catheter Strict adherence to aseptic technique during insertion and when obtaining urine sample Use urinary catheters only when necessary Catheters left in place only as long as necessary Keep catheter bag below level of the bladder

52 Central line-Associated Bloodstream Infections (CLABSI)
Maximal barrier precautions during insertion includes: Cap Mask Sterile gown Sterile gloves Full body drape

53 CLABSI Prevention Hand hygiene before and after manipulation of the central line Thorough cleaning of access ports prior to entry Approx. 15 seconds or 8 rotations One or two swipes is not sufficient

54 Surgical Site Infections (SSI)
Patient should have a thorough CHG bath (i.e., Hibiclens) at least the night before and the morning of surgery Report any untreated infections to the surgeon UTI URI

55 Ventilator Associated Pneumonia (VAP)
Hand hygiene and glove use before and after contact: With patients and respiratory equipment After handling respiratory secretions and contaminated equipment Between contact with contaminated body site and respiratory devices of the same patient Head of bed elevated 30 degree angle

56 Transmission Based Precautions
Used in addition to Standard Precautions for patients with infection or colonization that spread easily 3 Types of Transmission Based Precautions Contact Droplet Airborne

57 Contact Precautions Used for infection or MDRO colonization that is easily transmitted by direct patient contact or indirect contact with contaminated items Colonization – organism lives on a body site but is not causing an infection Surfaces can remain contaminated with MDROs for days to months

58 Common Contact Precaution Indications
MDROs MRSA VRE Clostridium difficile associated diarrhea Scabies Wound drainage not contained within the dressing

59 Basics of Contact Precautions
Private room Don gown and gloves before entry into patient room Remove gown and gloves before leaving the room Perform hand hygiene immediately

60 Basics of Contact Precautions (cont.)
Make sure clothing and hands do not touch potentially contaminated environmental surfaces or items upon exiting the room Dedicate noncritical patient-care equipment Stethoscope Thermometer Clean and disinfect equipment before use with another patient

61 Multi-Use Electronic Equipment
Includes VS machine and mobile computers Clean and disinfect (i.e., with germicidal wipes) routinely At least daily Preferably at the beginning of each shift Do not take VS machine into contact precaution rooms Clean and disinfect touched surfaces of mobile computer after use on contact precaution patient

62 Droplet Precautions Droplet transmission takes place when large droplets from an infected person are propelled a short distance through sneezing or coughing, thereby reaching another person’s eyes, nose, or mouth Patient should wear a surgical mask over nose and mouth when out of their room

63 Droplet Precautions Healthcare worker should wear surgical mask upon entering the patient’s room Teach patient to cover coughs and sneezes into bent elbow. Indications Pertussis Seasonal influenza H1N1 requires use of respirator

64 Airborne Precautions Involves contact with small droplets or dust particles that suspend the infectious agent in the air Indications Tuberculosis Measles

65 Airborne Precautions Patient wears surgical mask to leave their room
Healthcare worker wears a fit-tested respirator Fit-testing performed by Employee Health (8580) Call for appointment if need fit-testing Patients are placed in negative pressure rooms Door(s) to room must be kept closed tight

66 Tuberculosis 0-2 cases of active TB is diagnosed between Ohio, Marshall, and Belmont Counties each year New employees receive a two step PPD skin test to identify latent TB on employment Repeat PPD required annually on your birth month Preventive therapy available for persons at high risk for active TB that have latent TB identified by PPD testing as recommended by a physician

67 Patient and Family Education
The Joint Commission requires the following patient education be documented C. difficile and MDROs with 48 hours of admission or diagnosis Surgical site prevention prior to the procedure Central line associated bloodstream infection prevention prior to central line insertion

68 INFECTION CONTROL IS A TEAM EFFORT. HELP KEEP YOURSELF AND OTHERS SAFE
INFECTION CONTROL IS A TEAM EFFORT. HELP KEEP YOURSELF AND OTHERS SAFE! PLAY YOUR PART IN REDUCING THE RISK OF INFECTION.

69 Quiz 1. Print the next slide: quiz 2. Complete the written quiz 3
Quiz 1. Print the next slide: quiz 2. Complete the written quiz 3. Turn it in to your clinical instructor/supervisor

70 OSHA/ INFECTION CONTROL
To take the test, go to “File,” “Print,” and change the printing to “Current slide only” and gray scale, then hit “Print” Name_______________________ Dept.________________ Date __________________ True or False Infection control benefits everyone including patients, visitors, and all healthcare workers. True or False Standard precautions include hand hygiene, wearing gloves, and wearing a gown when coming in contact with body fluids. True or False Transmission based precautions include contact, droplet, and airborne. True or False Multidrug resistant organisms are easy to get rid of and respond well to antibiotics. True or False It is OK to use alcohol based hand rub after caring for a patient with C-diff. True or False Hand hygiene is the single most important step in preventing the spread of infection. True or False When using a disinfectant, it is important to make sure a surface is wet enough to assure proper exposure time to kill an organism. True or False Always remember to read the manufacturer’s label for exposure time and appropriate storage when cleaning and disinfecting. True or False The products Cavicide and Sani-cloths used for disinfecting can kill C-diff. True or False Artificial nails and gel products for nails are permitted to be worn by healthcare workers. SCORE: _______________________________


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