2 Bloodborne Pathogen (BBP) Standard: MI/OSHA BBP standard requires hospitals toprotect healthcare workers (HCWs) from exposureto bloodborne pathogens while on the job.Assumes that any patient could have organismsthat may be transmitted by contact with their bloodand/or body fluids.The Exposure Control Plan is the policy thatoutlines the protection measures in place at theDMC (See DMC policy 2 IC 008).
3 Transmission of Bloodborne Pathogens: Important bloodborne pathogens (disease-causing organisms)that may be present in human blood could include:Hepatitis B Virus (HBV)Hepatitis C Virus (HCV)Human Immunodeficiency Virus (HIV)These same bloodborne pathogens may also be found in otherbody fluids, including:SemenVaginal fluidsFluids around the brain, spine, heart, lungs, abdomen and jointsBloody salivaBloodborne pathogens are NOT found in tears, urine, stool,sweat or saliva unless these body fluids are visibly bloody.
4 Exposure to Bloodborne Pathogens: HCWs can become exposed to bloodbornepathogens by:Puncturing of the skin with a contaminated needleor a contaminated sharp device, such as a lancet orscalpelBlood or body fluids getting on skin that has cuts,cracks, rashes or burnsBeing splashed or sprayed with blood or body fluidsinto the eyes, nose or mouth
5 Standard Precautions: Requires HCWs to treat all blood and body fluids (B/BF)as if they are infected with disease-causing organisms.Using Standard Precautions will prevent the spread ofdisease to yourself, co-workers, patients and visitors.Personal Protective Equipment (PPE) is a key part ofStandard Precautions. PPE includes gloves, gowns,masks, protective eyewear, and face shields.PPE is provided by the DMC, it is easily available in allwork areas where it is needed. Know where to locatePPE in your department.
6 PPE - Gloves:Gloves keep infectious materials away from your hands duringcontact with patient’s blood, mucous membranes, rashes,broken skin or body fluids as well as when handling contaminatedequipment, surfaces, linen or waste.Perform hand hygiene before donning and after removing anddisposing gloves.NEVER wash gloved hands – NEVER reuse disposable gloves.Change gloves after each procedure when performing more than oneprocedure on the same patient.Remove gloves immediately after the task is done; dispose of glovesinto a general waste container.NOTE: Always wear gloves as outlined above. Standard exam gloves are latex-free.
7 PPE - Face Protection: Masks, eyewear and face shields protect your eyes, nose and mouth from splashesor splatters of blood and body fluids.Make sure to choose PPE that covers all threeof these areas on your face.Examples of tasks when you should wearsuch PPE include:SuctioningIrrigating woundsEndoscopyCleaning contaminated equipmentHandling wastePlumbing repairsPlace disposable PPE into general waste container after eachuse.
8 PPE - Gowns: Fluid-resistant gowns prevent blood and body fluids that splash or spray from soaking throughyour clothes to your skin.Some situations that require wearing a gowninclude:Emergency department trauma casesCentral Services decontamination areaAny time blood or body fluid contamination to yourclothes or skin is likelyDisposable lab coats are another type of PPE used in the lab whenlight spattering of blood or body fluids might contaminate clothing.Dispose gowns after use in general waste container, NOT in medicalwaste biohazard container.
9 Blood and Body Fluid Spills: Small spills that can be contained by a paper towelwill be cleaned and disinfected by the department. Thesmall spill procedure is:Put on PPEContain and absorb spill with paper towelsDispose of the paper towelsAdd DMC approved disinfectant to the spill siteDispose of used supplies in general waste containerRemove gloves and perform hand hygieneLarge spills will be contained by the department with abarrier pad and then disinfected by EnvironmentalServices (See DMC policy 2 IC 044).
10 What is DMC Doing to Protect YOU? Federal law and MI/OSHA requires that health care facilitiesactively evaluate and implement safer sharps devices.The DMC Safer Sharps committee is a multidisciplinarygroup that meets monthly to:Review employee injury dataSearch for new, safer sharps devicesCoordinate trials and implementation of new safetydevicesDevelop safe work practices for work settingsTrain HCWs about sharps safetyMonitor injury data after implementation of new devicesPlease contact Epidemiology if you have ideas to improve employee sharps safety, or if you would like to participate in the Safer Sharps Committee.
11 Common Causes of Sharps & Splash Exposure: Failure to activate safety device.Patient movement.Unnecessary manipulation of sharp device by hand.Improper disposal into sharps container.Mislaid sharp in the environment (i.e., bed, table, trash).Performing procedure too quickly.Not wearing appropriate PPE during procedures.Passing sharps to others.Not familiar with the device or procedure (Speak toyour manager/supervisor before attempting to usedevice).
12 Bloodborne Pathogen Standard – Safe Sharps Disposal:Locate sharps container closest to point ofuse.After use, immediately activate safety feature,if appropriate, then dispose sharp into anapproved puncture-resistant container.NEVER leave sharps for someone else toclean up.Observe container opening. If sharps areprotruding, DO NOT put your hands near it.Replace sharps containers when they are ¾full; never overfill sharps containers.Lock sharps containers before moving orreplacing them.
13 Regulated Medical Waste: Regulated Medical Waste is wastethat may contain disease causingorganisms.Michigan law requires health carefacilities to identify and separateRegulated Medical Waste fromgeneral waste.Regulated Medical Waste must beplaced into closeable, leak-proofcontainers or bags that are colorcoded red and/or labeled with thebiohazard symbol.
14 What is Regulated Medical Waste? REGULATED MEDICAL WASTE includes:Tissue and other pathology lab wasteLab specimensBulk blood and body fluidsAll sharps (use puncture-proof container)Blood and blood-product bagsDressings soaked with bloodPPE soaked with bloodGENERAL WASTE includes:Urinary cathetersEmpty drainage containersDressings stained with bloodPPE stained with bloodDiapersSanitary napkinsSoiled linen (place in soiled linen hamper)Red Biohazardwaste containerGeneral Trashcontainer
15 Isolation: Good hand hygiene and Standard Precautions help prevent the spread of organisms in the hospital.Isolation Precautions are added when needed--there arefour isolation Precaution categories:1 - AFB Isolation2 - Airborne Precautions3 - Contact Precautions4 - Droplet PrecautionsThere are two additional precautionary measures:1 - Protective Environment2 - Respiratory/Cough Etiquette
16 AFB Isolation:AFB is required for all patients with suspected or confirmedtuberculosis (TB). TB is spread by the airborne route.ALL AFB cases require the following:A private, negative air pressure room where the air is exchanged 6-12times per hour and exhausted to the outside of the hospitalAn “AFB Isolation Stop” sign is placed on the patient’s door;the patient’s door must remain closed at all timesAll healthcare workers must wear a N-95 particulate respirator (N95PR)to enter the room. NOTE: This is a special mask that must be fitted toeach health care workerIf the patient leaves the room for an exam, the patient must wear asurgical mask
18 Airborne Precautions: Airborne precautions prevent transmission of infectious agentsthat remain infectious over long distance when suspended in theair.It is important that the room is under negative pressure and thedoor is to be kept closed at all times.A surgical mask is to be worn by healthcare workers and visitorsprior to room entry.Hand hygiene before and after patient contact.Examples of diseases that would require the patient to be placedin airborne precautions include:ChickenpoxDisseminated herpes zoster (Shingles)Measles (Rubeola)
20 Contact Precautions:Contact Precautions is used to prevent transmission ofinfectious agents which are spread by direct or indirect contactwith the patient or the patients environment.A private room is required or a cohort procedure as directed byEpidemiology.Gowns and gloves are required when direct care will beprovided. PPE must be discarded before exiting the room.Hand hygiene before and after patient contact.Examples for appropriate use of contact precautions:Wound drainage that cannot be containedRotavirusScabiesChickenpox (as well as airborne precautions)
22 Droplet Precautions:Droplet precautions are used in the care of patients withsuspected or confirmed infection with an agent transmittedprimarily by the droplet route.A private room is required and or cohort measure.A surgical mask must be worn upon room entry.Hand hygiene before and after patient contact.Examples of appropriate use of droplet precautions:Epiglottitis due to Haemophilus Type BInfluenzaMeningitis (Neisseria meningitides, Haemophilus influenzae Type BMumpsGerman Measles (Rubella)
24 Protective Environment: Protective environment is used in the care of patientsundergoing an allogeneic hematopoeitic stem celltransplant or an AML patient undergoing inductiontherapy.A private room is required with positive pressure air.Hand hygiene before and after patient contact.Patients should remain in their rooms for all but essentialprocedures.No potted plants, dried flowers or live flower arrangementsshould be in the room.
26 Respiratory Etiquette is for Everyone: To help prevent colds and flu in both patients andstaff, please use tissues to contain secretions whencoughing or sneezing and then throw the tissues inthe trash.Perform hand hygiene after disposing of tissues.“Respiratory Etiquette” signs are posted in the DMCEmergency Departments and in clinic receptionareas for patient information.Get your flu shot annually to protect your patients,your family and yourself.
28 In Addition To Isolation Signs, You May See A “NO Latex” Sign: Implement the following latex allergy precautionsin patients identified as allergic or at risk of latexallergy:Place an allergy band on the patientMark patient’s chart with “Latex Precautions”Place a purple“No Latex” sign on the patient’s doorUse latex-free supplies on PAR Can be also obtained from Logistics.NOTE: See DMC policy 1 CLN 012 for additional information or clarification.
29 What is TB?TB is a contagious disease caused by the bacteria Mycobacterium tuberculosis. TB primarily infects the lungs. Signs and symptoms of TB include:FeverWeight lossNight sweatsFatigue, weaknessProlonged cough (cough > 3 weeks)Blood-tinged sputumTB is spread when infected people cough or sneeze the bacteria into the air and others inhale the bacteria.
30 Protecting Health Care Workers from TB: MI/OSHA requires that all health care facilities have a TB Control Plan to protect health care workers from exposure to TB while on the job.Proper AFB Isolation is a key part of the TB Control Plan. ALWAYS follow AFB Isolation (See DMC policy 2 IC 005).Putting on the proper PPE and wearing it correctly is a very important part of the TB Control Plan.NEVER enter an AFB airborne infection isolation room if you havenot been fit tested for the N-95 respiratorALWAYS fit-check your N-95 respirator before entering anAFB airborne infection isolation room
31 DMC Epidemiology Partners with DMC Occupational Health Services (OHS) to: Prevent transmission of infections between patients andemployees.Manage employees exposed by infected persons.Provide follow-up management of bloodborne pathogen andother contagious disease exposures.Provide annual TB assessments.Manage skin sensitivity issues for employees (i.e., latexallergy, irritation from glove use).
32 Occupational Health Services Provides Free Immunizations for: InfluenzaChickenpoxHepatitis BMeaslesRubellaPertussisMumpsTetanusNOTE: Hepatitis B vaccine is offered by OHS to new employees prior to work assignment; it is highly effective and strongly recommended. If a new employee declines the vaccine, they can change their mind and receive it free of charge at anytime during their employment.
33 Exposures to (coming in contact with) Contagious Diseases or Infections that Occur Outside of Work May Affect Your Patientsand Co-workers:Let your manager know if you acquire a contagious disease.Let your manager know if you have been exposed to acontagious disease.The following are some important contagious diseases you need to tell your manager about:ChickenpoxTuberculosisSalmonellaScabiesStrep throatNOTE: Managers must allow immediate release of exposed employee(s) to OHS for follow-up.
34 Follow-up Management of Bloodborne Pathogen Exposures When a Blood/Body Fluid Exposure Occurs: Clean the area with soap and water; flush eyes with water.Notify your supervisor immediately.Fill out an employee injury/illness report.Include the type and brand name of the device that caused yourinjury.IMMEDIATELY report to your designated site for care; managersMUST release employees to get immediate treatment.Treatment options will be discussed with you.Both the employee and the source patient will be tested forHepatitis B, Hepatitis C and HIV, if indicated.Employee will be counseled about their risk of becoming infectedwith a bloodborne pathogen.
35 When Occupational Health Services is Closed for the Day You Should Report to the Following Site for Exposure Follow-up:Central Region Facilities: Detroit Receiving Hospital AmbulatoryReception Center (ARC)/EDDMC Surgery Hospital: Emergency DepartmentHuron Valley-Sinai Hospital: Contact Nursing SupervisorSinai-Grace Hospital: Sinai-Grace Emergency Department orExpress CareAmbulatory sites: Follow-up at the site designated by yourpolicy/supervisor
36 Hand Hygiene -Healthcare-Associated Infections Are Preventable:“Performing hand hygiene before and after contact with a patient is one of the most important measures for preventing the spread of bacteria in healthcare settings.”**U.S. Centers for Disease Control and Prevention (CDC)
37 Hand Hygiene – Is So Important That: The DMC expectation is that HCWs cleanse their hands infront of the patient, so the patient can see that handhygiene has been performed.Every DMC HCW is empowered to speak-up and remindco-workers to cleanse hands appropriately.DMC through customer survey asks patients if theyobserved HCWs cleansing their hands.Patients and families are encouraged to speak-up andremind us to cleanse our hands.Hand hygiene is a Joint Commission National PatientSafety Goal.
38 Hand Hygiene: Healthcare workers’ hands frequently become contaminated duringpatient care activitiesIf hand hygiene is NOTperformed, bacteria canbe transferred from thehands of the HCW to thenext patientCulture plate showing growth of many bacteria 24 hours after a healthcare worker placed their hand on the plate
39 Hand Hygiene: In this study, each X Healthcare workers’ hands can also become contaminated by contact with thepatient care environment.Hand hygiene should also be performed after touching surfaces in the room thatare close to the patient.In this study, each Xshows where bacteria were cultured in a room that had been occupiedby a patient with an infection
40 Hand Hygiene:Every year 5 to 10 percent of hospital patients develop infections resulting in 98,000 deaths nationally--98,000 deaths equal:More deaths than those causedby breast cancer, colon cancerand stroke combinedEquivalent to a 747 plane crashkilling all passengers and thecrew every other dayOne death every 6 minutes
41 HCWs Should Perform Hand Hygiene: Before and after direct contact with patientsBefore donning and after removing glovesBefore handling an invasive device used for patient careAfter contact with blood, body fluids or excretions, nonintact skin mucous membranes, or wound dressingsAfter contact with contaminated items such as medicalequipment, medical waste and soiled linenAfter contact with objects in the immediate vicinity of thepatient (i.e., bedside trays, bedrails, phone, call lights,etc.)
42 HCWs Should Perform Hand Hygiene: After sneezing, coughing, or disposing of tissuesBefore and after handling medicationBefore and after preparing or eating foodBefore and after using the restroomBefore and after applying makeup or inserting contactlenses
43 Hand Hygiene – Using Alcohol-Based Hand Sanitizer: Waterless alcohol hand rubs have been shown to:Be effective in reducingbacteria on handsRequire less time to useReduce hand irritation anddryness with repeated useNOTE: Before container disposal, remove container from holder and shake to assure it is empty. If container is NOT empty, replace in holder and continue to use.
44 Hand Hygiene – Using Soap And Water: Required when hands are visibly dirty or visibly soiled with blood or other body fluids:Remove jewelry and wet hands with warm waterAdd soap to palms and rub hands together to create alather, covering all surfaces of the hands and fingersClean knuckles, back of hands, fingers, space betweenthumb and index fingerWork the finger tips into the palms to clean under thenailsRinse well under warm running water and dry with asingle-use towel and then use a dry towel to turn off thetapMinimum wash time = 15 seconds
45 Hand Hygiene – Use DMC-Approved Products: Use ONLY DMC-approved hand soaps, alcohol rubs and lotions:To assure that the products you use are effective inreducing bacteria on your handsTo assure that products DO NOT damage gloves andcause leaksTo reduce hand irritation and drynessTo assure that lotions DO NOT interfere withantiseptic products
46 DMC Fingernail Policy (2 IC 000): Artificial nails hide can harbor bacteria and increase the risk of spreading bacteria to patients:Artificial nails (including gels and wraps) areNOT allowed in high-risk areas such as ICU,NICU, OR and other areas where invasiveprocedures are routinely performedAll nails should be nicely trimmed and shouldNOT be more than ¼ inch longJewels or ornaments should NOT be attachedto the nailsNail polish should NOT be chippedFASHION STATEMENTSCAN HARM PATIENTS
47 HAND HYGIENE ... it's the RIGHT THING TO DO! Got 15 secondsto save a life?HAND HYGIENE ... it's the RIGHT THING TO DO!
48 2009 National Patient Safety Goal: NPSGImplement evidence-based practices to prevent health care-associated infections due to multi-drug resistant organisms (MDRO).These organisms are not transmitted by air. They are spread by contact via hands or contaminated environment.- MRSA (Methicillin Resistant Staph Aureus)- C. difficile- VRE (Vancomycin Resistant Enterococcus)- MDR gram negative bacteria
49 Risk Factors for Colonization and/or Infection with MDROs: Admission to an ICU.Recent surgery or increased # surgical procedures.Instrumentation, Invasive devices (trach, IV catheter).Prolonged or frequent hospitalization.Antibiotic exposure, especially to extended spectrum -lactamantibiotics.HemodialysisClose proximity to others infected or colonized with MDRO.
50 Spread of MDROs Can Be Controlled By: Good infection controlpractices.Meticulous hand hygienefor contact with patient andpatient’s environment ofStandard Precautions.Good environmental andequipment cleaningHCW knowledge regardingthese organisms and howthey are spread.Judicious use of antibiotics.Teaching patient and family.
51 2009 National Patient Safety Goal: NPSGImplement best practices or evidence-based guidelines toprevent central line-associated bloodstream infections:Catheter checklist and standardized protocol for central line insertion.Hand hygiene before catheter insertion or manipulation.Choose optimal site for catheter location.Standardized supply cart or kits for catheter insertion.Maximum sterile barrier precautions during insertion.Chlorhexidine-based antiseptic skin prep for insertion in patients over 2 monthsof age, unless contraindicated.Standardized protocol to disinfect catheter hubs and injection portsbefore accessing.Evaluate all central lines routinely and remove non-essential catheters.Teach the patient and family if applicable prior to insertion regarding preventionof line infection.
52 2009 National Patient Safety Goal: NPSGImplement evidence-based practices to prevent surgical siteinfections:- Choose appropriate antibiotics for prophylaxis.- Administer IV antibiotic prophylaxis within 1 hour before incision (2hours allowed for Vancomycin and Fluoroquinolones).- Discontinue antibiotic prophylaxis within 24 hours post-op(48 hours forcardiothoracic procedures).- Use clippers when hair removal is necessary. NO shaving!- Maintain hand hygiene practices with patient care and sterile techniquewith dressing changes.- Teach the patient and family about surgical site infection prevention.
53 Epidemiology Coordinators: For further information or clarification, you may contact the Epidemiology representative at your site:DMC Corporate: Pager: 5729Children’s Hospital of Michigan: Pager: 9672Detroit Receiving Hospital: Pager: 5268Harper/Hutzel Hospital: Pager: 6424Huron Valley-Sinai Hospital: Pager:Karmanos Cancer Center: Pager: 94393DMC Surgery Hospital: Pager: 9344Rehabilitation Institute of MI: Pager: 5711Sinai-Grace Hospital: Pager: 6784
54 Thank You:We hope this NetLearning course has been both informative and helpful. Please feel free to review this course until you are confident about your knowledge of the material presented.Click the Take Test button, located on the left side of the screen, to complete the requirements for this course.For future reference this module is available on the NetLearning Library under the 2010 Core Compliance category. The NetLearning Library is found on the DMC Intraweb screen under the NetLearning drop-down list.