1. INFECTION CONTROL UPDATE Make A Difference Give Healing a Hand

2. To complete this module you must: Read the required module Take the post test and score no less than 100% Complete the evaluation of the module Takes approximately 20 minutes to complete module

3. OBJECTIVES: Understand the healthcare worker’s role in prevention of patient infections Recognize symptoms of contagious diseases such as Norovirus or Pertussis Know steps to take to protect your health and the health of PRMCE patients from infection and contagious diseases

4. HAND HYGIENE

5. Hand Hygiene Healthcare-associated microorganisms or germs are often transferred from one patient to another on the hands of healthcare workers Hand hygiene before and after patient contact is the most important measure for preventing the spread of germs in healthcare settings

6. How You Can Become Exposed to Germs Pulling patients up in bed Taking a blood pressure or pulse Touching a patient’s hand Touching the patient’s gown or bed Touching equipment like bedside rails, over-bed tables, IV pumps

7. Percent of Surfaces Contaminated Frequency of Environmental Contamination of Surfaces in the Rooms of Patients with Methicillin-Resistant S. aureus (MRSA) How You Can Become Exposed to Germs

8. How the Patient Can Be Exposed to Germs People often carry bacteria on many areas of their skin, even when they have no wounds or broken skin 13-25% 40% 30-39%

9. Sample of Germs from a Nurse’s Hand Culture plate showing growth of germs 24 hours after a nurse placed her hand on the plate

10. We are not reaching our goal of providing care with clean hands every time for every patient! 2005 Results- 46%

11. When they are visibly soiled or dirty Hands have touched blood or body fluids After contact with patient in Contact Enteric Precautions Before eating After using the restroom Wash Hands with Soap & Water/Antimicrobial Soap

12. Wet hands first with warm water Apply a quarter-sized amount of soap to hands Rub hands together for at least 15 seconds Cover all surfaces of the hands, including areas around fingers and under nails Washing Your Hands Effectively

13. Rinse hands with water and dry thoroughly with a paper towel Use paper towel to turn off water Washing Your Hands Effectively

14. Use when: Before and after direct contact with patients Hands are not visibly soiled or dirty Hands have not touched blood or body fluids Before putting on gloves After removing gloves After touching equipment or furniture near patient Alcohol-Based Hand Rubs

15. Apply quarter-sized amount of alcohol rub to palm of one hand, and rub hands together Cover all surfaces of your hands, including areas around fingers and under nails Continue rubbing hands together until alcohol dries (10-15 seconds) Using Alcohol-Based Hand Rubs Effectively

16. Takes less time to use than washing hands More accessible than sinks Causes less skin irritation and dryness More effective in reducing the number of germs on hands Advantages of Alcohol Based Hand Rubs

17. NOROVIRUS Recognition and Prevention

18. What is it? A highly contagious illness often known as viral gastroenteritis, stomach flu, or food poisoning Most common symptoms are nausea, vomiting, stomach pain and diarrhea The most common cause of acute gastroenteritis in the United States. Norovirus

19. How do you get it? Transmitted directly from person-to-person or from food or water contaminated with feces. Also transmitted by droplets from vomitus Illness occurs 12-48 hours after exposure Contagious from the moment of feeling ill for at least 3 days and up to 2 weeks Symptoms may last from 24-60 hours and dehydration can be a serious complication for hospitalized patients Norovirus

20. When was Norovirus a Problem at PRMCE? PRMCE experienced an outbreak of Norovirus in April 2011 26 cases of community associated GI illness 20 cases of healthcare associated illness 50% of the healthcare associated infections occurred in roommates Norovirus was a contributing factor in the death of two patients with confirmed healthcare associated Norovirus. Norovirus

21. When was Norovirus a Problem at PRMCE? (cont’d) 73 staff members were identified with a gastrointestinal illness during the time period. Before the healthcare associated cases were identified, 0 employees reported their illness to the Employee Health Sickline Many of the ill staff cared for patients on the same patient care unit Norovirus

22. What to do if a patient has symptoms Initiate Contact Enteric Precautions Assure patient is in private room If patient is not already in a private room, minimize potential transmission until patient transfer is complete (no toilet sharing between roommates) Norovirus

23. CONTACT ENTERIC PRECAUTIONS

24. What do I do if I have symptoms? Report all gastrointestinal symptoms ( such as diarrhea or vomiting) to the Employee Health sick line immediately at (425) 261-3099 Stay home from work until cleared to return by Employee Health Be alert for employee updates through email Norovirus

25. PERTUSSIS A Disease Preventable by Vaccination

26. What is it? A very contagious disease spread by coughing or sneezing, aka “whooping cough” May start like a cold but progress to include fits of severe coughing, followed by a whooping sound, exhaustion, and vomiting Adults and older children often have mild symptoms, but it may be far more serious in infants Pertussis http://www.pkids.org/diseases/pertussis.html

27. How do you get it? Symptoms may develop up to 21 days after exposure to infection, which spreads through droplets from coughing Contagious until treated with antibiotics for five days or have had cough for 21 days Pertussis

28. Are there more Pertussis cases? Pertussis

29. When was Pertussis a problem at PRMCE? Many of the Snohomish county cases have been seen at PRMCE including a newborn who died from complications related to Pertussis infection in August 2011. One of our staff members was diagnosed with Pertussis in October 2011. This staff member unintentionally and unknowingly exposed others through close proximity contact while having an active cough. Pertussis

30. What can I do to prevent Pertussis? Vaccination is the best prevention in infants, children, teens and adults Vaccination is available free to ALL PRMCE employees First, do no harm Pertussis

31. What to do if a patient has symptoms Mask all coughing patients Consider Pertussis when evaluating all patients, regardless of age, presenting with respiratory symptoms Place patients with suspected or confirmed Pertussis in Droplet Precautions Pertussis

32. DROPLET PRECAUTIONS

33. What do I do if I have symptoms? Report all respiratory symptoms ( such as coughing and congestion) to the Employee Health sick line immediately at (425) 261-3099 Stay home from work until cleared to return by Employee Health Be alert for employee updates through email Pertussis

34. Infection Prevention Infection Control and Employee Health will work with you to prevent the spread of Norovirus, Pertussis and other contagious diseases Promptly respond to requests from Infection Control or Employee Health for information or your participation in the investigation or response plan

35. Partnering to Heal Video Insert Video: “Partnering to Heal”

36. Summary All PRMCE staff share the role of infection prevention Practicing good hand hygiene is the most important step in preventing infections Report all potentially communicable diseases to Employee Health Stay home from work when you are sick Get vaccinated to protect yourself, your family, and PRMCE patients

37. For More Information or Additional Resources Call: Infection Prevention and Control Gary Preston, PhD, Epidemiologist Carla Ward, CIC, Infection Preventionist Theresa Caton, CIC, Infection Preventionist (425) 261-4487 Employee Health at (425) 261-4486