1. Department of Hospital Epidemiology and Infection Control New Employee Orientation
Good Afternoon!
I’m so pleased to join you today.
I’m…
I work in the Department of Hospital Epidemiology and Infection Control.
My title is Infection Control Practitioner and I’m also …
I’ve worked at UCSF since…
I’d like to welcome you to UCSF. It is a great place to work and grow your career.
My job today is to get you acquainted with my department, where we are, what we do, why we do it and how you fit into all of it.
Can I see a show of hands for the people who have direct patient care…Indirect patient care…work in waiting rooms or at front desks… Never are in contact with patients? OK for those of you who don’t have any contact with patients don’t fall asleep, the infection control principles apply to home life as well!

2. Infection Control Contact Information
Office
350 Parnassus Ave, Suite 510
Main Office Phone:
Practitioner On-Call:
Website
Infection Control Manual includes all IC policies and other relevant Infection Control related information
First thing – How do you contact Infection Control?
The main Infection Control Office is located at: 350 Parnassus Ave. Not sure where that is? It is also known as the Starbucks building.
Get a latte, come on up to the 5th floor and stop by.
We can be reached during regular business hours by calling the main number or by the on call pager.
Don’t worry, in the evening on weekends when you at work and need to know what type of precautions do you need for a patient being admitted with chickenpox. You simply have to go to the IC Website. (next slide)

3. Infection Control Website
There you will find the link for Isolation Precautions and then you will find the Isolation table listing all the diseases and the type of isolation precautions necessary. (next slide)

4. Infection Control Website – Isolation Table
For example you could scroll down on the isolation table to find chickenpox and see that the patient should be placed on airborne precautions and for how long. In this case until all lesions are crusted over.
You will notice that the isolation types are hyperlinked and will bring you to specifics on each of those precautions.
For example if you click on the “Contact Link” (next slide)

5. Infection Control Website – Isolation Precaution Sign
It will bring you to the precaution sign with information on what you need to remain safe. For Contact Isolation you would need to clean your hands, put on a gown and gloves prior to entering the patients room.

6. Infection Control Website – IC Manual
On the website is also the Infection Control Manual.
The IC Manual is available on the Internet, not just internally at UCSF, so if you ever can’t sleep feel free to log on. You will find:
Infection Control Policies include:
Guidelines for isolation of patients
Exposure control and follow-up plans for staff
Work restriction policies for staff
Dust mitigation measures for construction
All of the policies are based on recommendations and guidelines from:
CDC Recommendations
OSHA (federal/state) & Title 22 (state) laws
The Joint Commission (TJC) Requirements
CMS Conditions of Participation
Other Professional Organization Recommendations
If you work on a unit in the hospital you will notice that no food or drinks are allowed at the nurses station. This is not an arbitrary rule made up by infection control to by annoying. It is based on a regulation from OSHA to protect healthcare workers from blood borne pathogens.

7. Infection Control Program: What is it and why have one?
Surveillance
Identify healthcare associated infections and report as required by law
Prevention and control of infections and infection risks
Provide interventions
Assess effectiveness and modify as needed
Educate staff about infection prevention
Result
A safer Medical Center community
Improved patient care
What do we do in Infection Control?
We do Surveillance – We identify healthcare associated infections and report them as required by law.
We work to prevent these infections and decrease the risks. We do this by providing interventions, working with interdisciplinary teams on bundles and do education like I’m doing today.
The result, hopefully will be a safer medical center community and have improved patient outcomes.

8. The Patients We Serve… Acute care and tertiary referral center
Immunocompromised patients
Premature infants =
Majority of patients vulnerable to infections
Who are the patients we serve?
We are an Acute care and tertiary referral center which means we get the sickest of the sick referred to us.
We do solid organ and blood and bone marrow transplants for adults and peds.
We have a 51 bed intensive care nursery with the itty bitty babies with no real immune system.
These patients need us to do our best to keep them free of diseases that they could acquire just from entering our doors.

9. Standard Precautions
Standard Precautions is the foundation of Infection Control at UCSF
Used for every patient, every encounter
Intended for the protection of the patients and the health care workers
Patients are AT RISK for infection
Patients can be THE SOURCE of infection
How do we keep patients safe?
Standard Precautions is the foundation of Infection Control at UCSF
Used for every patient, every encounter
Intended for the protection of the patients and the health care workers
Patients are AT RISK for infection
Patients can be THE SOURCE of infection

10. Three major components:
Standard Precautions
Three major components:
Hand hygiene
Proper use of personal protective equipment
The 3 components of Standard precations are:
Hand Hygiene before and after contact with a patient.
Proper use of protective equipment based on the activity being preformed.
Surface disinfection for all patient care items before and after use on a patient.
Surface disinfection

11. Oh, perhaps you have washed?
Uh…Yes, perhaps we have.
Uhhhh….
RECENTLY!
But when?
For those of you around kids, your niece or nephew, or your own, You know that kids watch the same movie over and over again. Well on one such occasion, it was discovered that Snow White was the first cartoon Infection Control Practitioner invented in 1937 by Walt Disney.
This is actual dialog from Snow White, and of course it is Doc who can’t quite decide on the right response to Snow White’s questions.
Snow white says… (read slides)

12. YES, RECENTLY!
The problem is that when Doc gets it wrong, the whole team chimes in with the wrong answer!
Even in 1937 it was tough to get Doc to wash his hand – in this case he had to be threatened with NO SUPPER! But we’re sure that if Doc and his colleagues know when they should wash up, they’ll be happy to comply. So, when is hand hygiene indicated?

13. Indications for Hand Hygiene
All personnel involved in direct patient care shall clean hands:
At the beginning of work
Before and after patient contact, including dry skin contact
Before gloving
After removing gloves
Before performing invasive procedures
Before and after contact with wounds
After contact with patients’ body substances
After handling equipment, supplies, or linen contaminated with body substances
Before handling sterile or clean supplies
After using the restroom
After touching or blowing your nose
Before leaving the unit
All personnel involved in direct patient care shall clean hands:
At the beginning of work
Before and after patient contact, including dry skin contact
Before gloving
After removing gloves
Before performing invasive procedures
Before and after contact with wounds
After contact with patients’ body substances
After handling equipment, supplies, or linen contaminated with body substances
Before handling sterile or clean supplies
After using the restroom
After touching or blowing your nose
Before leaving the unit
The ones in red will be 90% of the time.

14. Indications for Hand Hygiene
“Compliance” for IAP Goal based on observations of staff cleaning hands going into and coming out of rooms only.
Goal is 85% compliance for 6 months before June 2012.
Hand Hygiene is once again the IAP Goal for the Medical Center. We reached our goal in 2011 and we have already reached it in 2012.
We have had over 85% compliance for 6 months.
This is great that the Administration is behind this goal. But really we should be doing HH 100% of the time every month!

15. No Hand Hygiene needed standing in the threshold
DOOR SWEEP = threshold
No Hand Hygiene needed standing in the threshold
How do we know our HH compliance rates?
We have HH observer. These are coworkers, managers, modified duty workers and even patients in some ambulatory care areas.
We use the threshold as the indicator and there are different standards applied to different work groups.
For example this picture shows the door sweep as the threshold. You can be in the door sweep and not need to have done HH, but once you go through the threshold you will need to do HH.
In an ICU the sliding door is the threshold. So, know your areas threshold.

16. Here we see the proper way to use the sanitizer on the hands
Here we see the proper way to use the sanitizer on the hands. You will notice the attention given to the nails, inter-digital areas, and wrists. Pay attention to what you are doing. Also, don’t wash off the gel! It takes 15 to 30 seconds to be effective against most common bacteria and viruses.

17. Which product should I use?
USE SOAP AND WATER:
When hands are visibly soiled
Before preparing or eating food
After using the restroom
After caring for a patient who has C. difficile
USE SOAP AND WATER:
When hands are visibly soiled
Before preparing or eating food
After using the restroom
After caring for a patient who has C. difficile
Use one pump of soap, lather well over your entire hands and your wrist and pat dry with paper towel trying not to decontaminate your hands on the dirty faucet handle or dirty door handle.

18. Which product should I use?
Alcohol hand sanitizer
For non visibly-soiled hands
Use after removing gloves
Use after dry skin contact
Quick, effective, kind to skin
More effective than soap and water for killing bacteria
Use Alcohol hand sanitizer
For non visibly-soiled hands
Use after removing gloves
Use after dry skin contact
CDC recommends HH with Alcohol-based hand sanitizer for three reasons:
It is quick!
It is more effective in decontaminating hands. Dead bugs don’t cause disease.
It is easier on your hands than soap and since it has emollients.

19. Personal Protective Equipment (PPE)
Better SAFE than SORRY: PPE is used to protect health care workers from exposure to microorganisms that affect our patients
Whether patient is on isolation precautions or not, PPE use is based on the behavior of the patient and the task to be performed
Gown and/or gloves for wound examination or dressing changes
Mask & eye protection when in close proximity to a coughing patient
Gown, glove and mask use all appropriate when performing a task that may generate aerosols (e.g. intubation, suctioning) or may result in contact with blood or body fluid
Glove use is based on the task and the extent of anticipated contact with the patient or patient’s environment
Dispose of PPE prior to leaving patient care area
The 2nd component of Standard Precautions is: Personal Protective Equipment or (PPE)
Better SAFE than SORRY: PPE is used to protect health care workers from exposure to microorganisms that affect our patients
Whether patient is on isolation precautions or not, PPE use is based on the behavior of the patient and the task to be performed
Mask with eye protection for coughing patient
Gown and gloves for dressing changes or examining a draining wound
Gown, gloves and mask with face shield when performing a task that may generate aerosols (suctioning, intubation) or may result in contact with blood or body fluids.
Glove use is based on the task or the extent of anticipated contact with the patient or patient’s environment

20. Surface Disinfection
All patient care items and surfaces used for multiple patient contacts must be adequately surface disinfected between uses.
Visible soiling must be removed.
A hospital-approved detergent disinfectant must be applied and allowed to air dry before the next patient contact.
Follow label directions for surface contact/air dry time
Items you carry with you and/or use frequently are also targets for surface disinfection
The 3rd part of the Standard Precautions is to use: Surface Disinfection on all patient care items and surfaces used on multiple patients. They must be adequately surface disinfected between uses. Stethoscopes, wheelchairs, walkers, and blood pressure cuffs need to be disinfected after each use.
Also, know that the objects you carry on your person like cell phones, pagers, pens are seldom cleaned. If you just preformed HH and are in a patients room and your pager goes off, you grab it to look at your page, now you have contaminated your hands and you need to do HH again.
Use Sani-Clothes to disinfect these items. Sani-Cloths are available for all patient rooms, procedure rooms, common areas, or wherever necessary for the routine cleaning of patient care items. They can be ordered from Material Services anyone can use them to disinfect surfaces. Wear gloves when using them. These are heavy duty wipes for cleaning equipment, not your hands.

21. Blood-borne pathogens
Approximate risk of transmission following exposure
Hepatitis B – 6 – 30% depending on the hepatitis B e antigen status of the source individual
Hepatitis C –1.8% following needlestick or cut exposure
HIV – 0.3% (percutaneous), 0.09% (mucous membrane)
Following an exposure you should
Wash the area thoroughly with soap and water
Report the injury to the Needlestick Hotline
Inform your supervisor
Needlestick Hotline Pager 353-STIC
Report all needlesticks, lacerations and splashes
24-hour confidential assessment/triage, counseling, testing, treatment and information
Prophylaxis and/or treatment available following work related exposures to blood-borne pathogens
Exposure to Blood-borne pathogens is a risk of working in a hospital.
You are more at risk from Hepatitis B then Hepatitis C or HIV from a needle stick. The good news here is that Hep B vaccines are available for all healthcare workers.
If you are exposed to a blood-borne pathogen from a needle stic or a splash to a mucus membrane:
First thing – thoroughly was area with soap and water if on skin, or if in your eye rinse with water for at least 10 minutes.
Then report the injury to the Needlestick and Exposure Hotline: 353-STIC
Then inform your supervisor.
The Hotline is staffed 24hrs a day and you will get a confidential assessment and triage, along with the next steps for testing and treatment.

22. Occupational Health Issues
Illness and Work Restrictions
Feel ill with fever, muscle aches, vomiting? Stay home from work!
Upper respiratory symptoms that may be contagious? Stay home from work!
Unexplained rash? Stay home from work!
Infection Control Manual Section 3.2
Policy regarding Employees with Infections
Table of Illnesses and Related Work Restrictions
Some units have strict “no tolerance” policies for staff coming to work sick – during “flu” season, you may be sent home if you arrive at work with upper respiratory symptoms!
Illness and Work Restrictions
Feel ill with fever, muscle aches, vomiting? Stay home from work!
Upper respiratory symptoms that may be contagious? Stay home from work!
GI symptoms (Nausea, vomiting, diarrhea) Stay home from work!
Unexplained rash? To clarify I don’t mean if you have dermatitis normally and it is in the same spot as always. I mean if you have a new rash in a new location get it checked out. Stay home from work! It may be scabies and it could be very contagious.
Don’t risk your co-workers health or the health of your patients.
Infection Control Manual Section 3.2
Policy regarding Employees with Infections
Table of Illnesses and Related Work Restrictions
Some units have strict “no tolerance” policies for staff coming to work sick – during “flu” season, you may be sent home if you arrive at work with upper respiratory symptoms!

23. Transmission-based Precautions
Now we will move on to Transmission based precautions.
Transmission based precautions used in addition to Standard Precautions for patients with documented or suspected infection.

24. Transmission-based Precautions
CONTACT PRECAUTIONS
Draining wounds
Diarrhea of unknown origin
C. difficile (soap and water hand hygiene required)
rotavirus
Other organisms at the discretion of Infection Control
Gown and gloves required upon entrance to room AND
Other PPE as required by Standard Precautions
Use CONTACT Isolations PRECAUTIONS for:
Draining wounds
Diarrhea of unknown origin
C. difficile (soap and water hand hygiene required)
rotavirus
Other organisms at the discretion of Infection Control
Gown and gloves required upon entrance to room.
Remember to take off your gown and gloves and throw them out prior to leaving the room.
Then gel your hands or pt has C. diff you need to wash your hands with soap and water since the gel does not kill spores.
Please note that at UCSF we don’t use contact precautions for MRSA or VRE, you may have other practices at other facilities.
We trust you will use good Hand Hygiene to help prevent the spread.

25. Transmission-based Precautions
DROPLET PRECAUTIONS
Coughing, sneezing
RSV
Influenza
Meningococcal meningitis
Mask w/ eye shield required when entering room AND
Other PPE as required by Standard Precautions
Use DROPLET Isolation PRECAUTIONS when pt’s are:
Coughing, sneezing
RSV
Influenza
Meningococcal meningitis
The “droplets” are larger particles that travel about 3 feet, land on surfaces and then those surfaces are then infectious and able to transmit the organism.
Upon entering the room you are required to wear a mask with eye protection (either a eye shield or googles).
Prescription glasses are not proper eye protection.
The eye shields protects your mucous membranes from getting infected.

26. Transmission-based Precautions
AIRBORNE PRECAUTIONS
Chickenpox
Disseminated Varicella (Herpes) zoster
M. tuberculosis (TB), suspected or confirmed
Negative pressure room required, door closed
Fit tested n-95 respirator or PAPR required to enter room AND
Other PPE as required by Standard Precautions
Use AIRBORNE Isolation PRECAUTIONS with:
Chickenpox
Disseminated Varicella (Herpes) zoster
M. tuberculosis (TB), suspected or confirmed
These are very small particles suspended in the air.
If you work in a patient care area, you will be Fit tested for a N-95 mask and your are required to use the correct size.
If you can’t wear an N-95 mask you will need to wear a PAPR (a Powered Air Purifying Respirator).
An Engineering control is the use of a Negative pressure room. When you open the door the air from the hallway goes into the room and the room air goes to an outside vent. So keep the door closed.
Please note that this is the only PPE you leave on until you exit the room. Don’t walk around the halls with the mask around your neck or save it for later. Throw them out after each use.

27. Tuberculosis Transmission by inhalation
Must have active pulmonary disease to transmit
Classic Symptoms
Prolonged productive cough lasting > 3 weeks
Coughing up blood
Weakness
Weight loss
Night sweats
PPD Skin Test Annually (for patient care areas)
PPD is a test for EXPOSURE (latent TB)
90% of PPD positive persons do NOT develop active TB
Let’s talk about Tuberculosis – this is
Transmission by inhalation
Must have active pulmonary disease to transmit
Classic Symptoms
Prolonged productive cough lasting > 3 weeks
Coughing up blood
Weakness
Weight loss
Night sweats
PPD Skin Test Annually (for patient care areas)
PPD is a test for EXPOSURE (latent TB)
90% of PPD positive persons do NOT develop active TB
It is not easy to contract active TB in a hospital setting. Takes prolonged exposure or very direct exposure during a high hazard procedure like suctioning.
If you are exposed to a patient or co-worker with TB, exposure follow-up is conducted by Infection Control in conjunction with Employee Health and the SF Department of Public Health.

28. A parting thought…
This is the amusing part of the presentation…

29. Respiratory Etiquette
In waiting areas:
Provide tissues and no touch receptacles for disposal
Provide alcohol gel and make sure that appropriate supplies are always available in hand washing areas
Offer masks to coughing patients; place immediately in exam rooms if possible
Perform hand hygiene after contact with respiratory secretions and contaminated objects
For any of you that work in a reception area or are front desk staff –
In waiting areas:
Provide tissues and no touch receptacles for disposal
Provide alcohol gel in washing areas
Offer masks to coughing patients; place immediately in exam rooms if possible
Perform hand hygiene after contact with respiratory secretions and contaminated objects

30. The future of Infection Control technology…
coming your way soon!
The most effective way to help people clean their hands has not yet been put into practice, but this might be it!