Chapter 15 Infection Control

Introduction Major way of spreading pathogens is by blood and body fluids 3 pathogens of major concerns - HBV - HCV - HIV

Bloodborne Pathogens Standard Established in 1991 by OSHA Must be followed by all health care workers Civil penalties if not implemented by employer and followed by employees

Bloodborne Pathogens Standard Develop written exposure control plan Identify all employees with occupational exposure Provide hepatitis B vaccines free of charge Provide personal protective equipment (PPE)

Bloodborne Pathogens Standard Provide adequate handwashing facilities and supplies Ensure worksite is maintained in a clean, sanitary condition Follow measures for immediate decontamination of surfaces when contaminated Dispose of infectious waste correctly

Bloodborne Pathogens Standard Enforce rules on limited activities (eating, drinking, etc.) in any potentially contaminated area Provide appropriate, color-coded, and labeled containers for contaminated sharps and other infectious or biohazard wastes

Bloodborne Pathogens Standard Post signs at entrance to work areas with exposure to biohazardous materials Label biohazard items with red biohazard symbol (refer to Figure 15-16 in text) Confidential medical evaluation and follow-up for employee after exposure incident Provide employee training Set text in lowercase

Needlestick Safety Act Passed by Congress in 2000 Centers for Disease Control and Prevention (CDC) estimated 600,000 to 800,000 needle- sticks per year OSHA revised Bloodborne Pathogens Standard to requirements of this act

Needlestick Safety Act Employer requirements Identify and use effective and safer medical devices Incorporate changes in annual update of exposure control plan

Needlestick Safety Act Employer requirements Solicit input from nonmanagerial employees who are responsible for direct patient care Maintain a sharps injury log

Standard Precautions Rules developed by the CDC to prevent spread of infection Every body fluid considered potentially infectious All patients considered potential sources of infection Refer to Figure 15-18 in text

Standard Precautions Use in any situation where you might contact Blood or any fluid that contains blood Body fluids, secretions, and excretions, etc., etc. Mucous membranes Nonintact skin Tissue or cell specimens

15:3 Washing Hands Major aspect of standard precautions Most important aseptic technique Most effective method of infection control Hands are perfect medium for spread of pathogens

CDC Recommendations Regular handwashing with plain soap and water Antiseptic handwashing with antimicrobial soap and water Antiseptic hand rub with alcohol-based cleaner (waterless)

My 5 Moments for Hand Hygiene World Health Organization (WHO) on when to wash hands Before patient contact Before clean or aseptic procedure After body fluid exposure After contact with a patient’s skin After touching patient surroundings

15:3 Washing Hands Also wash hands On arrival at facility After contact with a patient’s intact skin Before moving from contaminated body site to clean body site during patient care If hands become contaminated during a procedure

15:3 Washing Hands Also wash hands Before applying and immediately after removing gloves When gloves are torn or punctured Before and after handling specimens After contact with soiled or contaminated item

15:3 Washing Hands Also wash hands After picking up any item off the floor After personal use of the bathroom Following a cough, sneeze, or using a tissue Before and after contact with mouth or mucous membranes

15:3 Washing Hands Use soap as a cleansing agent Use warm water Use friction Clean all hand surfaces Point fingertips downward Use dry paper towels to turn faucet on and off

15:3 Washing Hands Clean nails during handwashing Waterless hand cleaning with alcohol-based gel, lotion, or foam Use if hands are not visibly dirty or contaminated with blood or body fluids After 6 to 10 cleanings hands must be washed with soap and water

Gloves must be worn….. Handwashing before and after patient contact For possible contact with blood, bodily fluids, secretions, excretions, mucous membranes, tissue specimens, or nonintact skin Handling and cleaning contaminated items or surfaces

Standard Precautions Gloves When performing invasive procedures When performing venipuncture or blood tests Hands must be washed immediately after removal of gloves Gloves must not be washed or disinfected for reused

Standard Precautions Gowns For procedures that cause splashing or spraying Help prevent contamination of clothing or uniform Contaminated gowns must be handled per policy Hands must be washed immediately after gown removal

Standard Precautions Masks and eye protection For procedures that cause splashing or spraying Prevent exposure of mucous membranes of mouth, nose, and eyes to pathogens Use masks once and discard; change every 30 minutes if needed

Standard Precautions Masks and eye protection Protective eyewear and face shields protect front, top, bottom, and sides of eyes If not disposable, must be cleaned and disinfected before reuse

Sharp Objects Needles Use extreme caution to avoid cuts and punctures When possible, use safe needles or needleless devices Place in sharps containers immediately after use Leave uncapped and attached to syringe Follow laws regarding disposal of sharp objects

Standard Precautions Spills or splashes Wipe up with disposable cleaning cloths Wear gloves when wiping up Use disinfectant such as 10-percent bleach solution Clean all contaminated surfaces Absorbent powder can be used for large spills

Mouthpieces CPR Devices Resuscitation devices Use to avoid need for mouth-to-mouth resuscitation Place in convenient location, have readily accessible Must be disinfected between patients if device is nondisposable

Waste & Soiled Linen Waste and linen disposal Wear gloves, follow agency policy Use biohazard bags appropriately Soak in disinfectant prior to laundered if soiled with blood, body fluids, secretions, or excretions

Cuts & Injuries Injuries Immediately report cut or injury, needlestick, or splashing of blood or body fluids Follow agency policy Report any incidents ** Standard Precautions must be followed at all times by all health care workers**