1. For Internal Use Only Annual Infection Control Training Hospice of the Bluegrass

2. For Internal Use Only Objectives At the end of this program the learner will be able to:  Define what an MDRO is and explain how to prevent their spread  Describe proper cleaning and disinfecting procedures  Identify a blood borne pathogen and what to do in case of an exposure  Explain the process for disposal of biohazardous waste and sharps

3. For Internal Use Only What is Infection Prevention? Infection prevention describes ways we can prevent the spread of infection.

4. For Internal Use Only Why is infection prevention important to HOB? Infections can cause pain, suffering and even death for our patients. They cause extra days in the hospital and lead to higher costs for patients and their families.

5. For Internal Use Only What is an MDRO? An MDRO (Multi Drug Resistant Organism) is a strain of bacteria that is resistant to common antibiotics (1 or more classes) used to treat infections. Infections can vary, depending on the organism. MDRO’s can cause skin infections (boils, abscesses), urinary tract infections, blood stream infections, and pneumonia, and they can infect wounds, the respiratory tract and surgical sites.

6. For Internal Use Only Who can get an MDRO? Anyone is susceptible to contracting an MDRO. Patients are more likely to get an MDRO infection if they have: Received multiple antibiotics or treatments with antibiotics Transferred from another health care facility/agency or unit with a high colonization/infection rate Prolonged hospital stays Frequent hospital admissions Critically ill and in an ICU-type unit Immunocompromised

7. For Internal Use Only How are they spread? They can be spread by: Person to person via skin-to-skin contact with someone diagnosed with an MDRO Sharing a personal care item The environment contaminated with an MDRO (MDRO’s can live in the environment anywhere from 24 hours to a week, depending on the organism)

8. For Internal Use Only Colonization vs. Infection Colonization means that the organism is present in or on the body but is not causing illness. An employee who has been colonized can become a carrier and spread infection to other health care workers and patients. Infection means that the organism is present and is causing illness.

9. For Internal Use Only Cleaning and Disinfecting When items such as bedside tables and bed rails are touched with dirty hands, it is very easy to spread germs to patients and employees if they are not cleaned properly Medical equipment and environmental surfaces should be cleaned with a disinfectant such as a Super Sani-cloth HOB provides Super Sani-cloths to all staff members in the home care setting as well as the inpatient facilities

10. For Internal Use Only Contaminated Equipment Reusable equipment should be used with only one patient and cleaned after each patient use Wipe off reusable equipment such as BP cuffs, stethoscope, scales, etc., with Super Sani-cloth and allow to dry before reuse. (You must follow the contact time printed on each chemical in order to disinfect properly). Cleaning reusable equipment, such as IV pumps, tube feeding pumps and oxygen equipment, should be done according to manufacturer or DME guidelines. This equipment is typically cleaned by the DME staff or the CNA’s cleaning the Oxygen Concentrators.

11. For Internal Use Only Laptops KEYBOARDS should be cleaned daily or when visibly soiled using a Super Sani- cloth SCREENS should be wiped with a dry microfiber cloth

12. For Internal Use Only Cross Contamination Wiping surfaces with dirty cloths can contaminate hands, equipment, and other surfaces and can easily spread germs.

13. For Internal Use Only Tuberculosis Control Plan Where can I find the plan? On the hospice intranet: hospice documents/ manuals/ clinical policy and procedure manual/surveillance prevention and control of infections

14. For Internal Use Only Tuberculin Skin Testing/Screening When: Every January for all clinical staff and volunteers that see patients Why: To comply with requirements while working with our patients in hospitals and long term care facilities

15. For Internal Use Only Bloodborne Pathogens Bloodborne pathogens are infectious materials in the blood or other body fluids that can cause disease in humans

16. For Internal Use Only Bloodborne Pathogen Exposures Include Exposures to: Blood or Serum Visibly Bloody Urine Frank bloody drainage Bloody Tissue Semen/Vaginal Fluids

17. For Internal Use Only Bloodborne Pathogens Exposure What is an exposure? Needlesticks or cuts from sharp instruments contaminated with blood Contact of the eye, nose mouth, or non-intact skin with blood or bloody fluids Human bite with exposure to patient’s blood, i.e., broken skin and bleeding gums/lips

18. For Internal Use Only What to do if you have a blood exposure? Immediately cleanse the area thoroughly with soap and water, flush mucous membranes and/or eyes with clean water (eye wash stations are available for the inpatient units) Report the incident immediately to your supervisor Your supervisor will ask you to go to the local HOB healthcare provider for evaluation and screening – they will follow our protocol

19. For Internal Use Only Blood Exposures Give the name of the patient (if known) to your supervisor so the patient’s blood can be tested Your supervisor may have you draw the patient’s blood for testing before you leave the home You or your supervisor will need to contact the patient’s attending MD or an HOB Physician for lab orders Your supervisor will initiate with you an Employee Accident/ Occurrence Report Form and Analysis Form.

20. For Internal Use Only Blood Exposures Your supervisor will notify HR and the Employee Health Coordinator who will give you a report of testing results for both you and the patient (if tested). If follow-up testing is required, you will be notified at this time. All results are considered confidential and are filed separately in HR.

21. For Internal Use Only Personal Protective Equipment Gowns –when splashes to the skin or clothing are likely. Masks/ Protective Eye Wear - required when contamination to mucous membranes, eyes or mouth may occur CPR Equipment/micro-shields - provided in case there is a need to do CPR

22. For Internal Use Only Bio-hazardous Materials Lab Specimens - should be transported in zip lock bags or bags provided by the lab for specimens and should be temperature controlled in a soft or hard shell cooler designate only for transport of lab specimens Labels - biohazard labels should appear on hazardous material Body Fluids - blood and body fluids should be mopped up or wiped up using disposable gloves –A solution of diluted bleach should be used of 1:100

23. For Internal Use Only Waste Disposal Flushable Waste - Blood and Body wastes should be flushed down the toilet Non-flushable waste in the home should be placed in a leak proof plastic bag which is tied securely at the neck. The trash should then be placed with the home trash receptacle. Do not leave it on the floor of the patient’s home. Be sure it fits in a trash receptacle. Red biohazard bags are provided for the inpatient units only.

24. For Internal Use Only Sharps are instrument capable of producing injury including: contaminated needles, syringes, scalpels, and disposable sharp instruments. Sharp’s containers are available to staff for these items listed above. Sharp’s containers should rarely be left in the home setting. If a container is left in the home for the hospice staff to use it MUST be removed from the home by the hospice staff at discharge or at the time of death. It should be brought back to the hospice office for disposal. Syringe/Sharp Disposal

25. For Internal Use Only Syringe/Sharp Disposal If a patient is using syringes for a medication such as insulin, they can use a container such as a bleach bottle or coffee can for the syringe. They can tape the bottle close and dispose in their home trash. Never re-cap a syringe Each syringe will be used on only one patient