1. Infection Control Practices What you need to know…

2. STANDARD PRECAUTIONS GUIDELINES 1. Good Hand Hygiene - consistent and appropriate 2. Use the right PPE for the job * Gloves * Gloves * Face/Eye Protection * Face/Eye Protection * Gowns/Protective Apparel * Gowns/Protective Apparel 3. Clean & disinfect the environment; use of PPE during cleaning 4. Know and use Transmission-based Precautions 5. Blood borne pathogen concerns – HIV, HBV, HVC * Handling body substances & sharps with care * Handling body substances & sharps with care to avoid exposure to bloodborne pathogens to avoid exposure to bloodborne pathogens * Annual review of safety devices to mitigate risk * Annual review of safety devices to mitigate risk * Use Respiratory Hygiene & Cough Etiquette * Use Respiratory Hygiene & Cough Etiquette to minimize the spread of germs to minimize the spread of germs

3. Hand Hygiene Protocol  – Anyone who may come into contact with blood or body fluids  WHO – Anyone who may come into contact with blood or body fluids - Use or Alcohol based gel or hand-washing with antimicrobial soap  WHAT - Use or Alcohol based gel or hand-washing with antimicrobial soap - Always before/after patient contact, wear gloves when  WHEN - Always before/after patient contact, wear gloves when performing invasive procedures, or before making performing invasive procedures, or before making contact with patient skin (if in precautions) and contact with patient skin (if in precautions) and before contact with non-intact skin or before contact with non-intact skin or contaminated inanimate objects/surfaces – contaminated inanimate objects/surfaces – Always wash hands after removing gloves Always wash hands after removing gloves  WHERE – Anywhere there is risk of coming into contact with blood or body fluids contact with blood or body fluids  WHY - Because practices  WHY - Because good hand hygiene practices are the single most effective means of preventing are the single most effective means of preventing the spread of infection. the spread of infection.  Finger nails should be kept short  No artificial nails in patient care areas areas

4. Proper Hand Washing & Alcohol Gel/Foam Use Hand Washing:  Use tepid water, wet hands and apply antimicrobial soap  Use good friction cleaning front and back off hand, paying attention to nails and between finger for 15 – 20 seconds  Pat hands day with paper towel and turn off faucet with a paper towel.  Always use hand washing when hands are VISIBLY soiled Using Alcohol Gel/Foam Using Alcohol Gel/Foam:  Apply appropriate amount of foam/gel into palm of hand  Rub hands together using good friction to all surfaces, paying attentions to nails and in between fingers  Rub hands together until product is evaporated and hands are completely dry  CDC recommends that after 4 uses of the gel/foam, that hand washing be done.

5. Personal Protective Equipment  It is important to use the appropriate personal protective equipment (PPE) for the job to be done  Wear PPE when with bloodborne pathogens (BBP) is anticipated  When removing PPE, avoid exposure by removing most contaminated to least contaminated  Dispose of PPE properly and ALWAYS wash hands after removing PPE.  Protect clothing, skin, and especially mucous membranes of the eyes, nose and mouth from BBP

6. Bloodborne Pathogen- Exposure Control Plan  OSHA requires hospitals to have a BBP Plan to mitigate the risk associated with BBPs; of particular concern are HIV, Hepatitis B (HBV) & Hepatitis C (HCV)  Considerations in BBP Plan include: * Routine disinfection and cleaning * Proper body substance & sharps handling * Safe injections practices * Respiratory Hygiene and Cough Etiquette * Proper Management of Occupation Exposures

7. Routine Environmental Disinfection and Cleaning  Routine disinfection and cleaning of environmental surfaces with hospital approved sanitizers is crucial in preventing spread of contaminants and pathogens  Staff who do environmental cleaning should wear the appropriate PPE during cleaning.

8. Body Substance & Sharps Handling  Dispose of contaminated items into appropriate containers, avoiding contact with clothing and environmental surfaces  Considers all needles and catheters and sharp and dispose of into red rigid biohazard sharps containers; empty container when the content reaches the “full” line marked on the container

9. Safe Injection Practices  All parenteral medications via single patient use sets  Use disposable single use syringes; never re-use or re-cap  Use single dose vials  Decontaminate ports/vials with 70% alcohol solution before use  Treat all needles and catheters as sharps and dispose of properly

10. Respiratory Hygiene & Cough Etiquette  In waiting areas, signage should be posted requesting Patients to inform care givers of respiratory signs/symptoms  It is recommended that asymptomatic visitors not stay in the same area and that symptomatic patients be at least 3 feet from patients without respiratory symptoms  Patients with symptoms should be provided a mask, tissues, and alcohol hand gel and be asked to use clean hands, cover mouth when coughing and dispose of tissues properly  Healthcare workers should use mask and use hand gel before and after caring for respiratory patients.

11. Proper Management of Occupational BBP Exposures  OSHA requires all healthcare facilities to provide care and follow-up in the event exposure or sharp injuries involving bloodborne pathogens In the event of a needle stick/sharps injury and/or exposure: 1. Clean the area well with soap and water 2. Seek the necessary medical attention according to the institutions policy & procedure; you may receive counseling and prophylactic treatment might be offered if indicated 3. Complete the proper documentation according to the facility and/or your school’s policy & procedure; All facilities require some sort of an “occurrence report” or “incident report or notification” to be completed at the time of the event 4. Follow up according to the appropriate policy & procedure; these will vary by facility and by school; it is important to make yourself familiar with the process at your clinical location

12. Why Transmission-based Precautions? Understanding the Chain of Infection is the Key to Understanding Transmission-Based Precautions The “Bug” An Infectious Organism/Pathogen The “Source” An infected or colonized source Mode of Transmission The “Host” A person with a compromised immune response Chain of Infection

13. Contact Transmission  Person to person touch  Direct or Indirect contact  Transmitted by inanimate objects….needles, unwashed hands… gloves that were not changed between contact….

14. Contact Precautions  Examples: MRSA, VRE, Herpes, Impetigo, Scabies, RSV, and C-Diff  Use on patients known or suspected to be “infected” or “colonized.”  Personal Protective Equipment (PPE) is worn to prevent contact (i.e., Gloves & Gown)  Place in a private room or cohort cases of “same” organism  Dedicated patient care equipment  Precautions on transport  HAND WASHING recommended with C-Diff – alcohol gel is not effective.

15. Droplet Transmission  Droplets carry infectious organism – propelled through air – 3 feet.  Through coughing, sneezing, talking, suctioning, singing.  Can involve direct contact or indirect contact….

16. Droplet Precautions  Examples: Influenza, Meningitis, Pneumonia  Use on patients known or suspected to have infections caused by microorganism transmitted in “droplets” ( large particles > 5microns)  Droplets are propelled approximately 3 feet - mask should be worn if within 3 ft of the patient.  Dedicated Patient Care Equipment  Precautions on transport  Special Ventilation is NOT required  Place in private room or cohort infections of “same” organism.

17. Airborne Transmission  Tiny particles (<5 Microns ) evaporated in air or on dust particles  Can Stay suspended in air for long periods of time.  Can be inhaled by susceptible host and cause infection.

18. Airborne Precautions  Examples; Tuberculosis, Varicella Zoster, Measles, SARS.  Requires placement in a negative pressure room; door must remains closed  Must wear and N-95 OSHA compliant Mask, Gown and Gloves.  User must to “Fit Check” of mask before entering the room; if seal is NOT obtained, the room should NOT be entered  Signs/Symptoms of TB can appear months or years after initial exposure

19. Recognizing Tuberculosis….  According to the CDC an estimated 10-15 million people are infected in the US – 10% will develop the disease at some point in their lifetime and active T.B. is more common in patients ages 35-60.  Symptoms : * Cough lasting more than 3weeks * Loss of Appetite * Loss of Appetite * Unexplained Persistent Weight Loss * Unexplained Persistent Weight Loss * Coughing up Blood * Coughing up Blood * Profound Fatigue & Weakness * Profound Fatigue & Weakness * Nights Sweats * Nights Sweats  OSHA Requires - Annual PPD testing in all health care facilities - N-95 Mask FIT TESTING - N-95 Mask FIT TESTING - Follow up testing on anyone who is exposed - Follow up testing on anyone who is exposed

20. About MRSA & VRE  Staph Aureus and Enterococcus are bacterial that are normal flora in/on the body.  These bacteria have developed resistance to antibiotics  People with MRSA or VRE are considered “colonized” even in the absence of infection, and can pass the organism on to others.  MRSA/VRE require special isolation precautions which vary depending on where the organism is isolated.

21. Multi-Drug Resistant Organisms – Important Considerations  MDRO- Defined as – any microorganism that is resistant to one or more classes antimicrobials. Includes: - MRSA – Methicillan Resistant Staph Aureus - VRE – Vancomycin Resistant Enterococcus - MDR – GNB – Multi-Drug Resistant Gram Negative Bacilli - C-Diff – Epidemic strain Clostridium Difficile resistant to Flurquinolones

22. Why are MDRO’s clinically significant? MDRO’s: 1. Increase the length of stays; increased cost and mortality 2. Limit treatment options 3. Alter resistance patterns of other organisms 4. Encourage development of colonization in those exposed to these pathogens

23. Pandemic Influenza considerations…  Pandemic influenza is a global concern  All health care organizations are required to include pandemic planning in the disaster management plan  The proper application of Respiratory Etiquette and appropriate use of PPE are considered the best means of mitigating the negative effects of pandemic influenza by limiting transmission

24. In Summary…..  WASH YOUR HANDS PROPERLY AND FREQUENTLY  Always observe Standard Precautions  Wear the correct PPE  Observe Transmission based Precautions  Know where to look for additional Infection Control Information