1. Infection Control Annual Update Shands HealthCare, Infection Control
Annual infection control, bloodborne pathogens, and TB education is required by JCAHO, AHCA, and OSHA. It is also important for you to review your role in infection control at this time.
Please read this module (scroll down to read notes when indicated) and complete the test.
Updated 8/2004

2. Learning Objectives
Upon completion of the self-study module, the learner will be able to:
Discuss key elements of the infection control program
Describe the Bloodborne Pathogen Exposure Control Plan
Describe the TB Control Plan
Describe key elements of the Biohazardous Waste Management Plan
Discuss their individual role in Infection Control
Many of the topics included in this self-study module are mandated by either licensing or accrediting agencies. The other topics are important for healthcare infection control and will clarify your role in Infection Control.

3. Infection Control is Everyone’s Business
Clerks
Environmental Services
Family/Visitors
Physicians
Administrators
Patients
Hospital
Ambulatory Care Center
Therapists
Nurses
CNA/PCA/CMA
You are an important part of our Infection Control Program. Your commitment to following proper procedures, hand hygiene, and patient and family teaching can make the difference for you and patients. If you have questions about infection control and patient management, talk to your supervisor or call Infection Control at
(5-0BUG)

4. Infection Control: Basic Elements
Surveillance
Prevention
Control
The basic elements of an infection control program include: policies and procedures for preventing and controlling infections as well as surveillance activities to determine the effectiveness of those policies and procedures.

5. The Infection Control Team
Hospital Epidemiologist:
Lennox K. Archibald, MD, FRCP(Lond.),FRCP(Glasg.)
Infection Control Committee Chairman:
Richard R. Gutekunst, Ph.D.
Infection Control Director:
Loretta L. Fauerbach, MS, CIC
Infection Control Practitioners:
Mary Ann Gross, MT, CIC
Robert Kelly, RN, CIC
Charlene Ruse, MT, CIC
Barbara Graeber BS RN, CIC
YOU play a key role in infection control. Your knowledge of and adherence to infection control standards are the best ways to decrease the risk of infection in our patients, your co-workers, and you.
NOTE: Please scroll down to read note
The Shands at UF Infection Control Staff is responsible for overseeing the infection control program for Shands at UF Hospital, Shands Rehab Hospital, University of Florida Physicians clinics, Florida Surgical Center, outpatient rehab facilities, and Shands HomeCare.

6. Infection Control Policies and Key Contents
Shands at UF Infection Control Policies (PM03) and Department/Clinic-specific Infection Control Policies
available through Shands Intranet - Infection Control website
Biohazardous Waste Management Plan
PM Appendix L and Clinic IC Policy
Bloodborne Pathogen Exposure Control Plan
Clinic IC Policy and PM03-01, Appendix B
TB Control Plan
Clinic IC Policy and PM03-01, Appendix C
The policies provide the overall framework for infection control practice. Also , for areas of identified risk, you will find the infection control policy which has been written specifically for your department, unit, or clinic. The OSHA required Bloodborne Pathogen Exposure Control Plan and TB Control Plan are also covered.

7. Variance Procedure (IC manual PM 03-01, Appendix A)
An Infection Control variance is any observation of an infraction of infection control policy or good infection control practice.
Please report to your supervisor any infection control variance. The supervisor should investigate and help to resolve the problem. Infection Control and the Hospital Epidemiologist will also work to resolve issues identified in variances. PM03-01, Appendix A is the form that should be used to document variances. This form should be promptly sent (within 24 hours), or a report of the variance called to the Shands at UF Infection Control office ( ) for additional follow up and tracking. (You can remain anonymous when reporting a variance.)

8. Your Infection Control Responsibilities
Know and comply with infection control policies and procedures
Every person is responsible for assuring their own compliance with infection control policies.
Recognize potential infection problems, prevent if possible
Report variances
Communicate! Document!
Teach patient and care givers

9. CHAIN OF INFECTION SOURCE HOST Note: scroll down to read notes Vector
Airborne
Vector
PATIENT
Vehicle
Treatment
AGE
EMPLOYEE
Method of Transmission
Nutrition
Immunity
ENVIRONMENT
Underlying Disease
EQUIPMENT
Skin Injury
CONTACT
Sources of Infection: Patient, volunteer, visitor, or employee may have an infection or be colonized with an infectious organism.
Environment -- Bacteria and viruses are all around us.
Equipment -- If not cleaned, disinfected, or sterilized properly,
equipment can be a source of contamination which leads to colonization and/or infection.
Method of Transmission: Infections are spread from the source to the susceptible host in very specific ways. Standard Universal Precautions and isolation can help break the chain of infection.
Host Factors: Many things can lower a person’s resistance to infection.
For example:
Age: The very young and the very old have lowered immune
responses.
Disease: Certain diseases can alter the patient’s immune system
and lower resistance to infection. (e.g., diabetes, cancer, HIV)
Treatment: May affect immune system. For example,
chemotherapy, radiation therapy, certain medications.
Skin injury: Intact skin is the best barrier against infection. If that
barrier is broken, bacteria and viruses can enter the
bloodstream more easily. Burns, trauma and surgery
increase infection risk.
VISITORS
Life Style
Direct
Indirect
Socioeconomics
SOURCE
HOST
Note: scroll down to read notes

10. Methods of Transmission
Contact
Airborne
Direct
Indirect
In hospitals, the most common method of transmission of organisms is by contact, either direct or indirect.
If a healthcare worker’s hands are contaminated and then they touch a patient, direct transmission can occur. (Skin to skin contact, the physical transfer of microorganisms).If a healthcare worker’s hands are contaminated, they handle a piece of equipment that is then used on a patient, in-direct transmission can occur. (Contact with a contaminated intermediate object from the patient’s environment.) Organisms such as MRSA, VRE and C difficle are commonly transmitted through either direct or in-direct contact.
Airborne transmission occurs when organisms are suspended in the air and are breathed in by healthcare workers. Diseases such as TB, SARS and Varicella (chickenpox) are transmitted this way.
Vehicle transmission occurs when contaminated food is eaten. This is commonly called food poisoning.
Vector transmission occurs through tick or mosquito bites. Diseases such as West Nile virus and the encephalitis are transmitted this way.
Vector
Vehicle
Note: scroll down to read note

11. Health Care Associated Infections - tracking infections first started in the 1970’s., now also include home health, outpatient areas and other healthcare settings.
Infections associated with hospitalization are called “nosocomial infections”
“Iatrogenic infections” are related to care provided by medical procedures or physicians
May not be preventable
Not present on admission to hospital or prior to treatment
May be detected after discharge from hospital or after outpatient treatment
Examples: Surgical Site
Urinary Tract
Bloodstream

12. Unfortunate 5% - Patients at high risk for Nosocomial (hospital acquired) Infections
Transplant patients
Chemotherapy patients
Other Immunocompromised patients
Nationally, approximately 5%-10% of people admitted to a hospital will develop a nosocomial infection. Certain patients are at an increased risk for developing a nosocomial or iatrogenic infection because they do not have a “normal” immune system capable of fighting infection.

13. Risk Factors: Devices - Any invasive device increases the risk of infection.
Foley Catheters
Ventilators
Other tubes / drains
IVs/CVLs
Implants
It is very important to follow infection control measures to reduce device-related risks. See PM03-04 for specific strategies for foley , central lines, and ventilators.

14. Consequences of Hospital Acquired Infections
Complicate Treatment
Cause Additional Suffering
Increased Costs ($4.5 billion/yr-nationwide)
prolonged hospital stay
drug treatment
additional surgery
Cause Death
Note: scroll down to read note
Treatment is complicated because many of these patients need to be placed on antibiotics. These drugs may interact with medications the patient is already receiving, and/or cause unpleasant side effects. Infection may cause the patient increased pain, require frequent, uncomfortable dressing changes, necessitate removal/reinsertion of urinary catheters or IV lines, increasing costs and patient suffering. Nosocomial infections can even lead to death!

15. Clean Your Hands!!
Studies have shown that healthcare worker compliance with hand washing/ hand hygiene recommendations is 42% ---- What is your percentage?
Most frequently missed

16. Reasons Healthcare Workers state for poor adherence to hand hygiene:
Handwashing agents cause irritation and dryness
Not enough or poor placement of sinks
Too busy
Patients’ needs take priority
Belief that if you wear gloves, you don’t need to clean hands
Low risk of acquiring infection from patients
Studies have shown that using alcohol based hand gels containing emollients reduced skin irritation and took less time than hand washing. You need to perform hand hygiene after removing gloves because the gloves may have small holes or your hands were contaminated before using gloves. You can also contaminate your hands during removal of gloves.

17. Ability of Hand Hygiene Agents to Reduce Bacteria on Hands
Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.
0.0
1.0
2.0
3.0 60
180
minutes
90.0
99.0
99.9
log %
Bacterial Reduction
Alcohol-based handrub
(70% Isopropanol)
Antimicrobial soap
(4% Chlorhexidine)
Plain soap
Time After Disinfection
Baseline
This graph shows that alcohol-based handrub is better than hand washing with soap and water at killing bacteria.
Shown across the top of this graph is the amount of time after disinfection with the hand hygiene agent.
The left axis shows the percent reduction in bacterial counts.
The three lines represent alcohol-based handrub, antimicrobial soap, and plain soap.
Note: scroll down to read note:

18. Proper hand hygiene is VITAL to infection prevention
Approximately one million skin cells containing living bacteria are shed daily from normal skin - Yours and your patient’s! Patient gowns, bed linen, bedside furniture and immediate environment can easily become contaminated with patient’s bacteria. Wearing gloves and hand hygiene are necessary to stop the spread of infection from you to the patient, from the patient to you and patient to patient. Recommendations for hand hygiene are:
Before patient contact
After contact with anything contaminated
Between contact with different patients
During patient care
before and after invasive procedure
before and after contact with wound
between procedures on different body parts of the same patient
Between glove changes
Immediately, if skin is contaminated or an injury occurs
Wash / disinfect your hands, even if gloves have been worn

19. Hand Hygiene Hand washing:
In non-patient care areas the hospital-approved lotion soap should be used.
For patient care activities, use hospital-approved antimicrobial soap (Hibiclens®, Cida-Stat®, or Endure 420®).
For best results when using soap and water, use friction and lather for seconds
Alcohol gel:to be used when hands are not visibly soiled, between patient care activities
Apply at least one teaspoon onto hands, rub vigorously until dry - about seconds, covering all areas of hands, fingers
12 oz - wall mounted bottle
4 oz - individual
If you experience hand irritation, report to Occupational Health Services for evaluation and recommendations.

20. First remove gross debris and organic matter by cleaning
Key Points for Cleaning & Disinfection of Environmental Surfaces/Patient Care Equipment
First remove gross debris and organic matter by cleaning
When cleaning equipment in your unit or department, use designated cleaning area
Only use disinfectants approved by Infection Control - see PM03-10
Be sure to follow the manufacturer’s directions for use on the container’s label
Bleach is the cheapest & best disinfectant
For 1:10 dilution: make fresh daily
For 1:5 dilution: use for 30 days
Note: scroll down to read note:
Dirt and debris must first be removed by cleaning so the disinfectants can work.
For best results, check the product label for correct dilution instructions. If product is placed in container that is not the original container, the new container must be labeled with the product name, concentration, and date mixed.

21. Bloodborne Pathogens Exposure Control Plan OSHA requires annual education for all employees who have potential for blood and body fluid exposure as part of their routine job tasks
Purpose: To provide a safe working environment and reduce the risk of exposure to bloodborne pathogens
OSHA requires annual education for all employees with the potential of blood or body fluid exposure on the job
Location: Infection Control Policy -- PM03-01, Appendix B (Infection Control website, Shands intranet - Medic IC)
The Shands Bloodborne Pathogen Exposure Control Plan lists the components of our program to provide a safe working environment and to reduce the risk of exposure to bloodborne pathogens. Review the plan and know how to reduce your risk of exposure.

22. Bloodborne Pathogens Exposure Control Plan
Some of the components: The components are multi-faceted and provide information on how to reduce the risk of exposure for healthcare workers.
Personal Protective Equipment
Job Task List
Engineering Controls
Work Practice Controls
Post Exposure Management
Biohazardous Labeling
Waste Management
Bloodborne Pathogen Training

23. Standard Universal Precautions to be used for all patients
Apply to:
Blood
Body fluids, all secretions and excretions regardless of blood
Non-intact skin
Mucous membranes
Designed to reduce the risk of transmission of pathogens
Use Personal Protective Equipment (PPE) to prevent exposure

24. Standard Universal Precautions Know what personal protective equipment (PPE) you should wear for each task you perform
Job Task List:
TO HANDLE THESE
Blood and body fluids, soiled patient care equipment, or used linen
When splashing of blood or body fluid is possible
USE THESE
Gloves
Mask/Eye Protection
Gown

25. Job Task List
Know what PPE (personal protective equipment) you should wear for each task you perform
Review the Job Task List for your department/unit. It can be found in the Infection Control Policies, Section PM03-01, under “PPE - Job Task List”. It is the employee’s responsibility to utilize PPE appropriately and the supervisor/manager’s responsibility to enforce adherence to these precautions.

26. Types of Isolation / Precautions (in addition to Standard Universal Precautions)
Airborne Transmission (requires negative air pressure room)
Strict(spread by both airborne& contact routes -chickenpox)
Respiratory (tuberculosis)
Droplet Transmission:
Droplet/Pediatric Respiratory(RSV and MRSA pneumonia)
Contact Transmission:
Contact (MRSA)
Enteric (Clostridium difficle)
Vancomycin Resistant (VRE)
Note: scroll down to read note
Types of isolation are based on how the disease/infectious organism is spread. Read the isolation signs on the outside of the patient’s door or above the head of the patient’s bed. The signs will tell you what personal protective equipment to put on before entering the room or before initiating any patient care task.
Take off PPE’s when leaving the patients’ room.

27. Communication of Isolation
Notify departments receiving patient for testing, unit to which patient is being transferred, clinics where patient is to be seen (clinics notify inpatient unit and/or admissions when patient being admitted].
If MRSA/VRE, “Resistant Organism” sticker will be placed on chart
Appropriate isolation/precaution sign on door and/or above patient’s bed.
Enter isolation code in “enter/revise patient factors” screen
Good communication is vital to assure that precautions are continuously carried out in all areas of the facility. This is important to protect other patients and/or staff.

28. BE CAREFUL WITH SHARPS Do not recap by hand
Use safety syringes, needle-less IV system and other safety products whenever possible.
Replace sharps containers when 3/4 full
Make sure that the sharps container is not overfilled. Replacing sharps container when it is 3/4 full reduces the risk of getting stuck with needle protruding from over-filled box.
Immediately dispose of sharps in sharps container
Contaminated sharps are lethal weapons! Handle with great caution.

29. ENGINEERING CONTROLS: Sharps containers ,safety needles (self - sheathing)and safety “butterfly”, needle-less IV system, plastic page protectors, CPR face shields and PEVCO tube system
Engineering controls are continually evolving to lower the exposure risk for healthcare workers. The safety devices must be used by the worker to protect themselves and others.
If paperwork that is part of the chart is accidentally contaminated, it should be placed in a plastic sheet protector since this paperwork can not be discarded.
Using a CPR shield while performing mouth to mouth resuscitation reduces the risk of exposure to a host of pathogens.
When using the Pevco® tube system to transport specimens to the lab, make sure tops of sample containers are secure (tight). Also, samples are to be placed in sealed plastic bag before being sent.

30. Work Practice Controls: Adhering to good infection control practice standards, i.e. work practice controls, will also help to protect the employee from exposure.
Hand hygiene: alcohol gel/antimicrobial soap
Do not recap needles by hand
No food/drink in refrigerators with blood or other infectious materials
Do not drink, eat, apply cosmetics/lip balm, or handle contact lenses in areas where blood/body fluids may be present
Keep work area clean and decontaminated
Use proper cleaning/disinfecting/sterilization practices for equipment and work areas

31. Waste Management Biohazardous (red bag) / Regular (clear bag)
The US Department of Transportation (DOT) and Agency for Health Care Administration (AHCA) regulate the handling and transportation of biomedical waste in Florida. Local county landfills can also determine what trash they will accept.
For the Biohazardous Waste Management Plan, see Infection Control Policy, PM03-04 Appendix L
Biohazardous waste (sometimes also called biomedical or infectious waste) is defined as any solid or liquid waste which may present a threat of infection to humans.

32. Method for sealing boxes  
Twist excess bag from the top of the waste to the end of the bag
Remove excess air
from bag
Tape the twisted part of the bag  
Tape the flaps to form a “H” design
Loop the twisted and taped end of bag over itself and tape again
The DOT regulates how biomedical waste bags and boxes must be closed. Pictures and instructions above, demonstrate the correct method for securing the biomedical wastebag/ box.

33. Labeling - DOT Regulations for biomedical waste
Sharps containers
Red bags
Cardboard biomedical waste disposal boxes
Must be labeled with the name and location of the facility generating the waste

34. Biohazard Labeling Is required on:
Refrigerators and freezers used to store lab specimens or any blood/body fluids
Containers used to transport lab specimens

35. Bloodborne Pathogens Hepatitis B Hepatitis C HIV Malaria Syphilis
(Most common)
Arboviruses
Relapsing fever
CJD
HTLV - I & II
Viral hemorrhagic fever
Malaria
Syphilis
Babesiosis
Brucellosis
Leptospirosis
Many pathogens may be transmitted to health care workers through contact with infected blood. The primary bloodborne diseases that affect health care workers are hepatitis B, hepatitis C, and HIV. OSHA regulations require that you review these diseases

36. Hepatitis B Incubation period = 6 weeks - 6 months
May shorten life span years
Reported cases of acute Hepatitis B in US decreased 50% in last decade (21,102 in 1990 to 10,258 in 1998)
Hepatitis B is a serious disease. Similar to other hepatitis viruses, it can cause jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea, and vomiting. It can lead to cirrhosis and liver cancer. One in twenty cases remains chronically infected.
The incidence of Hepatitis B increased through 1985 but has now decreased because of wider use of the Hepatitis B vaccine. The downtrend in new cases is expected to continue with a national strategy for vaccination of children.
Since 1993, increased cases have been observed in only three major risk groups: sexually active heterosexuals with multiple partners, men who have sex with men, and injection drug users.

37. Hepatitis B Transmission
Blood to Blood
Perinatal transmission - (mom to baby)
Sexual contact
Persons at increased risk of acquiring Hepatitis B include:
injection drug users
sexually active heterosexuals with multiple partners
men who have sex with men
infants/children of immigrants from disease-endemic areas
low socioeconomic level
sexual/household contacts of infected persons
infants born to infected mothers
healthcare workers
hemodialysis patients. (increased number of blood products used)

38. Hepatitis B : Prevention
Vaccination Hepatitis B vaccine prevents Hepatitis B disease and its serious consequences. It has been called “the first anti-cancer vaccine” since it prevents the development of liver cancer following Hepatitis B infection.
Heath care workers are trained to use Standard Universal Precautions - barrier protection between the worker and blood or body fluids
Hep B + patients are counseled to use: safer sex practices and no sharing needles
Note: scroll down to read note:
It is recommended to screen pregnant women; to begin treatment of infants born to infected women within 24 hours of birth; to vaccinate infants and year olds, and to vaccinate high-risk groups of all ages.
Screening of blood/organ/tissue donors for Hepatitis B also helps prevent transmission.

39. Hepatitis C (Liver damage due to HCV is the primary reason for liver transplants in the U.S).
16% of viral hepatitis cases are due to Hepatitis C
Incubation Period = average 6-7 weeks
(Range 2-26 weeks)
3.9 million have been infected
2.7 million are chronically infected
70% of infected persons develop chronic liver disease
$600 million annually in medical and work loss expense - - not including transplantation.

40. Hepatitis C Transmission Blood-to-Blood
May cause post transfusion hepatitis
50-60% of cases are associated with IV drug use
2% of cases are Heath care workers infected through occupational exposure to contaminated blood/body fluids
Note: scroll down to read note
Only 30-40% of infected individuals report a clinical illness and only 20-30% have jaundice. The rest of the infected persons have no symptoms, but are still infectious.
Transfusion-associated cases most often occurred prior to Testing is now available to screen donated blood, so new transfusion-associated cases are rare.
Needlestick injuries have been associated with the majority of occupationally-acquired Hepatitis C cases.

41. Hepatitis C Prevention
Heath care workers are trained to use Standard Universal Precautions - barrier protection between the worker and blood or body fluids
Hep C + patients are counseled to use safer sex practices and no sharing needles
NO VACCINE is available

42. People of newly infected with HIV in 2003 4.8 million adults
Worldwide estimates of the HIV/AIDS Epidemic 2003
People of newly infected with HIV in 2003
4.8 million adults
630,000 children (<15 years old)
Number of people living with HIV/AIDS
37.8 million are adults
2 million children(<15 years old)
AIDS deaths year 2003
2.9 million adults
490,000 children(<15 years old)
AIDS deaths since beginning of the epidemic through the end of 2001
9 million women
8.5 million men
4.3 million children (<15 years old)
Scroll down to read notes:

43. States Reporting Highest Number AIDS Cases in USA as of Dec 2002
New York 155,755
California 128,064
Florida 90,233
Texas 59,772
In Florida 1 out of 168 people are HIV +
1: 286 Caucasian (HIV +)
1:127 Hispanics (HIV +)
1:46 African Americans (HIV+)
In Florida there are 32 new cases HIV/AIDS diagnosed per day. Two-thirds of those cases are female.

44. AIDS Epidemiology
Florida is SECOND in the U.S. with reported cases of AIDS in women and children.

45. Transmission of Bloodborne Pathogens - ways the virus is spread
Blood Contact
Healthcare worker exposure - needle sticks, splash to face, spill to non-intact skin
IV drug - needle sharing
Blood transfusion - rare in U.S.
Sexual Contact
Mother to Infant
HIV is not transmitted by casual contact, sharing telephones or computer keyboards, etc.

46. Personal Prevention Measures - Safer sex practices remain an important strategy to decrease the spread of HIV
Abstain from sex with infected person
Discuss sexual history with partners
Reduce number of sexual partners
Always use either a latex male condom or polyurethane female condom
Use only water-soluble lubricants with condoms
Avoid illicit drug use and sharing of needles

47. Positive HIV tests are reported to Florida Department of Health- Shands at UF Infection Control reports positive HIV results for the Shands laboratory, as required by law.
Exceptions to reporting:
tests performed at anonymous test sites
tests of patients performed because of employee blood/body fluid exposure
tests performed on employee following blood/body fluid exposure
certain HIV/AIDS research settings
The Alachua County Public Health Department ( ) is an anonymous test site. Shands Occupational Health Services will perform HIV testing for employees using a confidential numbering system.

48. Informed Consent: Written consent is best, place in chart
Patient must give informed consent to be tested for HIV
When obtaining informed consent, explain the law’s provision for a person’s right to confidentiality of the results of the test and any information which identifies him/her by name.
According to Florida Administrative Code, an explanation of the following information represents a sound and reasonable standard for informed consent:
An HIV test will determine if an individual is infected with the virus which causes AIDS
The potential uses and limitations of the test
The procedures to be followed
HIV testing is voluntary. Consent to be tested can be withdrawn at any time prior to the test being performed
Reportability of positive test.

49. When is informed consent not required?
A bona fide medical emergency that requires knowledge of the patient’s HIV status for medical management
If knowledge of testing would be detrimental to patient and is necessary for medical management purposes to provide appropriate care.
If consent is obtained for autopsy, specific HIV consent not required
If tissue/blood is being donated

50. Exception to Informed Consent Following a Healthcare Worker Exposure
Source patient may be tested without informed consent only when:
There has been a significant exposure
There is existing blood available
The exposed employee consents to be tested or has a documented HIV test within the previous 6 months
The source patient dies during emergency treatment.
The patient has been asked to consent and has refused. Patient must be told that testing will be done under Florida Law.
Results are not placed in patient’s medical record.
Scroll down to read note:
Be sure to work with patient’s physician and Occupational Health Services to make sure the law is followed for post exposure workups.
If a patient has been told of a healthcare worker’s significant exposure and refuses to be tested, the testing is performed on existing serum. The results of this testing are then entered in the employee’s medical record, not the source patient’s medical record.
(A court order can be obtained if the patient refuses testing and there is no existing serum.)

51. Mandatory Offering of Testing to Pregnant Females
Providers of care to pregnant women must offer HIV testing and explain benefits of early treatment of HIV infection in decreasing transmission to infant
Emphasize education for high risk patients
Refer to substance abuse programs as needed
Scroll down to read note:
The transmission of the virus from mother to infant can be reduced from 30% to 8% through the administration of AZT/protease inhibitors to the mother during pregnancy and to the infant for 6 weeks after birth. Therefore, Florida Law requires that a health care provider who cares for a pregnant woman must offer HIV testing and counsel her on the availability of treatment if she tests positive.
If the pregnant women objects to HIV testing, a reasonable attempt must be made to obtain a written statement of objection, signed by the patient, which shall be placed in her medical record.
Act as liaison with other services
Mother’s HIV test results may be noted in child’s medical record

52. United States Healthcare Workers with Documented Occupationally Acquired HIV --
“Documented cases”are healthcare workers who have contracted HIV through work related injury. All other risk factors were ruled out and exposure on the job was documented.
The “possible cases” are healthcare workers have been investigated and are without identifiable behavioral or transmission risks.Although each person had experienced exposure to blood or body fluids or laboratory solutions containing HIV, a specific job related incident resulting in a HIV positive blood test was not documented.

53. Occupationally Acquired HIV in US Healthcare Workers
57 confirmed cases
49 percutaneous
5 mucocutaneous
2 both
1 unknown route
Percutaneous exposure = injury through needlesticks or cuts
Mucocutaneous exposure = splash to eyes and/or mouth or contact with non-intact skin

54. Occupationally Acquired HIV Infection in the US
24 Nurses
16 Clinical lab techs
6 Non-surgical physicians
3 Nonclinical lab techs
2 Surgical tech
1 Dialysis tech
1 Embalmer/morgue tech
1 Home health aids
2 Housekeeper/ maintenance worker
1 Respiratory therapist
Scroll down to read note
Healthcare workers who more frequently handle needles and draw blood have been more likely to have occupationally acquired HIV.
Housekeepers and others who do not perform hands-on patient care are generally exposed through the negligence of others -- such as needles left in patient’s linens or in the trash.

55. HIV Post-exposure Conversion Factors
Hollow bore needle
Deep IM stick
HIV stage of source patient
Gloves not worn
Volume of exposure
Type of body fluid with blood
Lack of post-exposure prophylaxis
The risk of becoming HIV positive after an exposure to blood is dependent on the volume of blood present during exposure. More blood is present with a hollow bore needle and could be transferred during a deep injury. If a needlestick occurs through the glove, gloves can act as a “squeegee” and actually decrease the volume of blood encountered. Patients with a higher number of HIV virus in their blood are more likely to transmit disease.

56. What should I do if an exposure occurs?
Thoroughly wash exposed area
Contact supervisor/access Occupational Health
Optimal time for post-exposure prophylaxis (PEP) is 1-2 hours post exposure
Post-exposure prophylaxis (PEP) for HIV = AZT + 3TC + protease inhibitor
Scroll down to read note:
If an exposure occurs to your skin, wash with soap and water.
If an exposure occurs to your mucous membrane (eyes/mouth), flush with water or saline.
Occupational Health Services (OHS) will evaluate your exposure. If a significant exposure has occurred, PEP (i.e., preventive medications) should be started within 1-2 hours, since earliest therapy is generally most effective.
Note: If there has been a delay in reporting of an exposure, PEP will be evaluated at time of reporting
***During off-hours, contact Nursing Coordinator for evaluation of exposure and possible referral to Emergency Department. (Contact Paging Operator for beeper number.)

57. TB Exposure Control Plan OSHA requires a TB Exposure Control Plan to reduce the risk of transmitting tuberculosis in the healthcare setting.
See PM03-01, Appendix C - Infection Control Policy
Designed to reduce risk of transmission of tuberculosis

58. TB Exposure Control Plan TB control requires early recognition of persons with tuberculosis, and prompt isolation
Early Recognition
Recognize signs and symptoms
Adequate specimen testing
Initiate and maintain appropriate isolation
Isolation: Respiratory Isolation
Masks: 95N respirator masks
Be sure to be fit tested for proper mask size before caring for TB patient.(OSHA requirement)
Engineering Controls
Negative Air Pressure, air exchanges,outside exhaust, hepa filtration (in hospitals)
Post Exposure Management: PPD testing

59. Tuberculosis (TB) Agent -- Mycobacterium tuberculosis Reservoir -- man
Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis. TB usually causes a chronic lung infection,it can also cause infection in other organs of the body.
Agent -- Mycobacterium tuberculosis
(acid fast bacillus -- AFB)
Reservoir -- man
Transmission -- airborne droplet nuclei
Tuberculosis is spread when a patient with the disease in the lung coughs, sneezes, or otherwise expels the organism into the air. The TB bacteria is suspended in droplet nuclei that float in the air and can be inhaled by another person.

60. TB -- Pathogenesis & Transmission
4-12 weeks from infection to demonstrable tuberculin reaction
The initial infection may go unnoticed, and it can take from 4-12 weeks after exposure to a person with TB for the PPD skin test to be positive
first 1-2 years after infection -- greatest risk for developing active disease
When a person develops active TB, the symptoms usually are chronic, meaning that they last longer than four weeks. Active disease is most likely to occur in the first two years after conversion from a negative to a positive PPD.
Patient is considered infectious until their sputum no longer shows the TB organism (3 negative smears, 24 hours apart)

61. TB -- Signs and Symptoms THINK TB…. during patient assessment
TB -- Signs and Symptoms THINK TB…..during patient assessment. It is important to consider TB if a patient has these signs and symptoms and has been ill for 4 weeks or more. Below are some of the symptoms.
Persistent cough
Abnormal chest
X-ray
Fever
Bloody sputum
Weight loss
Loss of appetite
Night sweats

62. Active Tuberculosis Infection
Positive skin test
Abnormal chest x-ray
Symptomatic
Medications to treat disease
Isolation required
Infectious
Infection
Positive skin test
Normal chest x-ray
No symptoms
Medications to prevent active disease
No isolation
Not Infectious
Only people with active pulmonary TB can spread the infection.

63. Groups at Risk for Acquiring TB
Certain populations are at higher risk for developing tuberculosis. Listed below are some of those groups.
close contacts of other TB cases
people without routine medical care
alcoholics and IV drug users
long term care residents
prisoners
people with certain medical conditions
HIV, diabetes, cancer of pharynx, prolonged steroid therapy
foreign born people from TB endemic countries

64. PPD Testing Policy -- Annual requirement of Shands Employees
All employees with negative PPD history receive annual skin testing
All employees with history of positive PPD must fill out form annually, and report to OHS any time they experience prolonged symptoms
Persons who have received BCG vaccine for TB, should discuss skin testing with OHS
Post Exposure Follow-up
Report to OHS if exposed to patient with TB without wearing mask
PPD testing done when exposure reported and repeated weeks after exposure
Scroll down to read note:
A PPD skin test is used to determine if someone has been exposed to the TB bacteria. During testing, a Purified Protein Derivative (PPD) is injected just under the skin. The site of injection is examined 48 to 72 hours later. If there is a reaction, the site is measured. At Shands, a reading of >10 mm based on the induration (swelling or lump) is considered positive. Immunosuppressed individuals must be evaluated using other criteria and are often considered to be positive at 5mm of induration.
Annual PPD testing/screening is required as part of your annual performance evaluation. When your skin test is completed, you will receive documentation from Occupational Health.

65. Report These Conditions To Occupational Health Services
“Weeping” dermatitis and draining lesions
“Pink eye”/conjunctivitis
Rash (possibly infectious)
Fever/nausea/vomiting/
diarrhea
Blood/body fluid exposures
for post exposure prophylaxis
Other infectious disease exposures
It is important that you come to work healthy. Please do not put others at risk. If you have any of the above listed conditions, or other infectious illness, obtain “fitness for duty” clearance from Occupational Health before reporting to work.

66. Influenza - Flu causes an average of 36,000 deaths / year and 114,000 hospitalizations
People are infectious 1-4 days before symptoms start and 5 or more days after onset of symptoms. Patients and co-workers are at risk of getting the flu from you during this time.
Do your part to protect yourself against influenza
get immunized against flu each fall - vaccination reduces severity of disease, risk of complications, risk of death
Practice cough containment by covering nose and mouth with a tissue when you cough or sneeze. Discard tissues and wash hands
Myth = vaccine will cause flu
Fact = vaccine is inactivated virus, can not cause flu

67. IMMUNIZATIONS - help prevent disease It is especially important for healthcare workers to be immune to infectious disease in order to protect patients and their own families as well as themselves.
Required:
MMR
Chicken Pox (Varicella)
Recommended:
Hepatitis B
Influenza
The mandatory Varicella vaccination program has significantly reduced exposure incidents to patients and employees.

68. Some general infection control practices when not at work
Prevent antibiotic resistance
Food/eating safety
Child and elder care considerations
Scroll down to read note:
To prevent antibiotic resistance, remember these points:
Don’t insist on a prescription for an antibiotic if you have a viral infection such as a cold or the flu.
Don’t stop taking antibiotics before you complete your prescription, even if your symptoms are gone.
Follow your doctor’s instructions carefully - - take doses on schedule until all of the pills are gone!
Never share your medication with anyone, and do not take someone else’s medicines.
Most food poisoning occurs after eating food prepared at home.
Thaw frozen food in the refrigerator - - not at room temperature
Keep cold food cold and hot food hot - - not at room temperature.
Wash your hands before, during, and after preparing food.
Use separate cutting boards for meat and fruit/vegetables
Cook meat until well done
Wash sponges and dish clothes frequently in washing machine or dishwasher, or use disposable cloths (use once and throw away).
Children immune systems have not fully developed the ability to fight off infections.
Day care centers, schools, and camps are settings where infectious diseases (such as ear infections) may be spread among children.
Choose your day care carefully. Ask how and how often toys are cleaned, what is the procedure for diaper changes, and what is the policy regarding sick children and staff?
Do not send your child to day care if he/she has diarrhea or is running a fever.
Elderly persons need extra care also. As we age, our immune systems wear down.
Flu and pneumonia are leading causes of death among our older population. Encourage elders to get their flu and pneumonia vaccinations.

69. Remember to do YOUR part for Patient Safety
Follow Good Hand Hygiene Practices !
Please remember hand hygiene is the most important means of preventing infection in you and others

70. Any Questions????? . Talk to your supervisor first
Call Shands at UF Infection Control
(5-0BUG)