Infection Prevention and Control:

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Infection Prevention and Control:




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Presentations text content in Infection Prevention and Control:

Slide1

Infection Prevention and Control:It’s a Lifesaver!

Slide2

Part 1: Video

Chain of infection

Breaking the chain

Bloodborne pathogens

Exposure management

Modes of transmission / precautions

Slide3

Chain of Infection

Slide4

Chain of Infection

Becoming Infected Depends on 3 Variables

Condition or health of susceptible host

Virulence (strength) of the germ

Amount of inoculum – how much did you get?

Slide5

Breaking the Chain: OSHA

OSHA

= Occupational Safety and Health Administration

Purpose:

Regulate employers so your workplace is SAFE

Bloodborne Pathogen Standard

GHS

Exposure Control Plan

Exposure Category I, II, III

Slide6

Breaking the Chain: Your Responsibilities

Hand Hygiene

Wear gloves, gowns, masks, and other barriers

Follow standard and expanded precautions

Have appropriate vaccinations

Disinfect/sterilize patient care equipment and/or instruments

Slide7

Breaking the Chain: Your Responsibilities

Completing the Infection Prevention session during New Employee Orientation

Completing annual Infection Prevention updates as required

Following/adhering to policies and procedures established by GHS

Reporting unsafe practices and hazards

Reporting to Employee Health if you have a disease transmitted by blood or body fluid

Slide8

Breaking the Chain: GHS Responsibilities

Education during orientation, annually, and special programs

Personal protective equipment (PPE)

Free vaccinations

Policies/procedures in place for safe work practices

Documenting exposures on SREO

GHS Infection Prevention Manual available

Slide9

Bloodborne Pathogens

What’s a bloodborne pathogen?

Any disease-producing microorganism (germ) in the form of viruses or bacteria.

These pathogens can be transmitted from one person to another.

Body fluids which can spread pathogens:

Blood

Vaginal secretions

Semen

Wound Exudate

Cerebrospinal fluid

Pericardial fluid

Pleural fluid

Amniotic fluid

Peritoneal fluid

Synovial fluid

Any body fluid with visible blood

Slide10

Bloodborne Pathogens:Three Major Pathogens

HIV/AIDS

Hepatitis B

Hepatitis C

Slide11

Bloodborne Pathogens:

Transmission

Sexual Contact

Blood Contact

Percutaneous

Transfusion

Open wounds

Perinatal

Transplacental

Breast milk

Organ transplant

Standard Precautions are used to prevent transmission

Slide12

Bloodborne Pathogens:Comparison of HBV, HCV, & HIV

Feature

HBV

HCV

HIV

Cumulative Prevalence

(Total # Chronic Carriers)

~1-1.25

Million

~ 3.9

Million

~0.9-1.25

Million

# HCW Infections Per Year

≤400

??

~57

(cumulative)

# HCW Deaths Per Year

Rare

??

~1-2

Risk of HCW Infection After Single Needlestick

~3-30% HBsAb(-)

~0% HBsAb(+)

1.8%

~0.3%

(80% less if PEP given)

Incubation Period

2-6 months

2 weeks – 6 months

2 weeks – 6 months

Post-Exposure Prophylaxis (PEP)

Yes

No

Yes

TreatmentInterferonInterferon & RibavirinAntiviral DrugsPre-Exposure PreventionYesNoNo

Slide13

Bloodborne Pathogens:HCW Exposure

BODY FLUID

Blood

Semen

Vaginal Secretions

Wound Exudate

Cerebrospinal fluid

Pericardial fluid

Pleural fluid

Amniotic fluid

Peritoneal fluid

Synovial fluid

ANY

body fluid with visible blood

Stick, cut, or scratch by needle or other sharp object

Splash into eyes, nose, or mouth

Into open wound, cut, or skin lesion

Onto broken skin (i.e., rash, acne, torn cuticle, or abrasion)

Large amount of skin exposed

REVERSE EXPOSURE – human bite

+ CONTACT =

EXPOSURE

Slide14

Bloodborne Pathogens:Exposure Procedure

Perform first aid

Irrigate eye(s) with normal saline or water for 10-15 minutes

Cleanse affected area with soap & water OR

Slide15

Bloodborne Pathogens:

Exposure Procedure

Report Exposure IMMEDIATELY!

Call phone number and follow instructions

GMMC: 455-4209

NGH: 455-9243

GrMC: 797-8074

HMH: 454-6196

PMH: 797-1069

LCMH: 833-9349 (starting Nov 1

st

)

UMG and PIH: Call nearest hospital

ALL locations: If you have any difficulty reporting,

page (864) 345-6133.

Slide16

Bloodborne Pathogens:

Exposure Procedure

Complete SREO

Hard copy to supervisor / manager

Remaining copies to Exposure RN

Slide17

Modes of Transmission

Slide18

Modes of Transmission:Vector & Common Vehicle

Common Vehicle

Common carrier for the germs, such as people, food, animals, and contaminated instruments

Vector

Carried by plant or animal

Slide19

Modes of Transmission:Contact

Direct Contact

Person-to-person spread

Actual physical contact between source & susceptible host

Indirect Contact

Susceptible host

comes

in contact contaminated object

Germ that is spread is on the item and comes in contact with susceptible host

Slide20

Modes of Transmission:Contact

Diseases spread by contact

Antibiotic-resistant organisms

MRSA

VRE

Pediculosis (lice)

Scabies

Slide21

Modes of Transmission:Contact

Private Room

Gloves

Gowns

Use dedicated equipment OR clean equipment before leaving the room

Slide22

Modes of Transmission:Contact

MUST

wash your hands with

SOAP & WATER

Private Room

Gloves

Gowns

Use dedicated equipment OR clean equipment before leaving the room

Slide23

~

Contaminated surfaces increase cross-transmission

~

Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.

X

represents VRE culture positive sites

Modes of Transmission:

Contact

Slide24

Modes of Transmission:Contact

Transportation of the Patient

Place a clean gown on the patient

Use clean linens to cover patient / stretcher for transport

Ensure all drainage is contained

Assist patient to perform hand hygiene

Wear gloves and gowns as indicated to assist the patient onto a stretcher or wheelchair

If you are assisting with the transport of the patient, after you have moved the patient to the stretcher, remove your PPE and clean your hands before leaving the room.

Slide25

Modes of Transmission:Contact

Transportation of the Patient

Additional steps are required if drainage can

NOT

be contained

2 persons are required to transport the patient

The one who has contact with the patient/bed may wear PPE

The other person is to open doors, push elevator buttons and does NOT wear PPE

Slide26

Modes of Transmission:

Droplet

Large particles that rapidly settle out on flat surfaces, like tables or trays

Germs travel quickly through air (3 ft or less)

Transmission involves contact with your eyes, nose, or mouth

Slide27

Modes of Transmission:Droplet

Disease spread by droplets

Diphtheria

Bacterial meningitis

Mumps

Rubella

Slide28

Modes of Transmission:Droplet

Private Room

Facial Protection within 3 feet of the patient

Slide29

Modes of Transmission:Airborne

Contained within droplet or dust particles

Suspended in air for extended period

May spread through air ducts

May involve varying distances between source and susceptible host

Slide30

Modes of Transmission:Airborne

Disease Spread by Airborne transmission

Pulmonary tuberculosis

Measles

Slide31

Modes of Transmission:Airborne

Negative Pressure Private Room

N95 respirator or PAPR hood

Keep door closed at

ALL

times

Slide32

Pulmonary Tuberculosis

Caused by

Mycobacterium tuberculosis

Symptoms:

Fatigue

Fever

Lethargy

Weakness

Night sweatsWeight loss

Persistent productive cough

Slide33

Outpatients

presenting with cough

Assess patient for symptoms

If patient has cough & 2 or more symptoms:

Immediately mask the patient

Place in negative pressure room (if available) or private room with the door closed

If patient leaves the room, he needs to wear a mask

MD to assess ASAP

If MD suspects pulmonary TB:

Notify Admitting Office to locate negative pressure room

Patient wear mask during transport

Inpatients

assessed to have signs & symptoms of TB

Place patient on Airborne Precautions

Notify Infection Prevention Department

Pulmonary Tuberculosis

Slide34

Modes of Transmission:Multiple

There are multiple diseases that can be spread by more than one route of transmission

Pertussis (contact & droplet)

RSV (contact & droplet)

Chicken pox / disseminated herpes zoster (contact & airborne)

Slide35

Modes of Transmission:Multiple

Follow the sign for correct PPE usage

Clean your hands BEFORE and AFTER the removal of PPE

Slide36

Break the Chain:Communication of Expanded Precautions

Initiating Expanded Precautions

RN’s

MD’s

Infection Prevention Team

If someone other than Infection Prevention initiates precautions, they need to call the Infection Prevention Department

Slide37

Nursing Responsibilities

Sign on door

Sticker on front of chart

Sticker in MD progress notes

Include organism and site

Educate patient/family

Document patient/family education

Document precautions every 24 hours

Break the Chain:

Communication of Expanded Precautions

Slide38

Discontinuing Precautions

ONLY

done by the Infection Prevention Team

If an MD writes an order to discontinue precautions, Infection Prevention

MUST

be consulted to determine if precautions can be discontinued

Break the Chain:

Communication of Expanded Precautions

Slide39

Continuum of Care (Related to Antibiotic Resistance)

The type of precautions required and extent of the level of care a patient receives changes as they move through the healthcare system

Ambulatory Care /

Physician Practice /

Outpatient Treatment

Acute Care

Long Term Care /

Subacute /

Rehab /

Home Care

Slide40

Patient’s risk of contact transmission changes related to:

Number of invasive devices

Activity level

Bowel/bladder control

Existence of body fluid drainage

Continuum of Care

(Related to Antibiotic Resistance)

Slide41

The level of precautions needed for a patient will change related to the varying levels of risk

Ambulatory Care /

Physician Practice /

Outpatient Treatment

Acute Care

Long Term Care /

Subacute /

Rehab /

Home Care

Standard Precautions

Contact Precautions

Standard Precautions

Continuum of Care

(Related to Antibiotic Resistance)

Slide42

Break the Chain:Standard Precautions

To minimize exposure follow:

Work practice controls

Hand hygiene

Engineering controls

PPE

These Controls and Barriers are

STANDARD PRECAUTIONS

and are practiced

AT ALL TIMES

for

ALL PATIENTS

and in

ALL SITUATIONS

.

GHS

considers all blood, body substances and non-intact skin potentially infectious.

Slide43

Treat every patient as if infectious.

Wear Barriers appropriate for care being given.

For Example:

Wear gloves when likely to touch body substances, mucous membranes or non-intact skin.

Wear gown when clothing is likely to become soiled.

Wear facial protection when likely to be splashed with body fluids.

Break the Chain:

Standard Precautions

Slide44

Not sure what PPE is required for a procedure in order to protect yourself?

Section 8 of the Infection Prevention Manual has a table that lists minimum requirements of PPE

The list is not all-inclusive, so use professional judgment to assess the need for additional barrier precautions

Break the Chain:

Standard Precautions

Slide45

Are you awake?

Slide46

Break the Chain: Hand Hygiene

HAND HYGIENE IS A LIFESAVER

Slide47

When was the last time YOU cleaned your hands?

Just because your hands may look clean, doesn’t mean they are clean.

Break the Chain:

Hand Hygiene

Slide48

What’s on YOUR hands?

PCT BEFORE and AFTER hand hygiene

Break the Chain:

Hand Hygiene

Slide49

How?

15 second handwash with soap, water, and friction

Use of waterless handrub. Spread all over surfaces of both hands and allow to dry.

Break the Chain:

Hand Hygiene

Slide50

When MUST

you wash your hands with soap and water?

When your hands are visibly soiled

When your hands are visibly contaminated with blood and body fluids

Before eating

After using the restroom

If the patient has a spore forming bacteria such as C. difficile or Anthrax

Break the Chain:

Hand Hygiene

Slide51

When CAN

you use an alcohol-based hand rub?

BEFORE

having direct contact with a patient

AFTER

having direct contact with a patient or the patient’s skin

AFTER

having contact with body fluids, wounds, or broken skin if your hands are

NOT

visibly soiled

AFTER

touching equipment or furniture near the patient

BEFORE

and

AFTER

removing gloves

Break the Chain:

Hand Hygiene

Slide52

My 5 Moments of Hand Hygiene

Greenville

Health

System has adopted the 5 moments of Hand Hygiene as defined by the World Health Organization as to when hand hygiene should be performed.

Slide53

Nail infections

Fungal

Staph

Pseudomonas

Outbreaks in Healthcare

Facilities have been associated

with Artificial nails.

Nails don’t have to look this bad to cause a problem. In events reported, the nails looked “normal”.

Break the Chain:

Hand Hygiene

Slide54

Are Your Nails Clean?Natural Nails

Break the Chain:

Hand Hygiene

Slide55

Are Your Nails Clean?False Nails

Break the Chain:

Hand Hygiene

Slide56

REMEMBER: Everything you touch has been touched by someone else!

Clean your hands!

Clean patient care equipment!

Break the Chain:

Hand Hygiene

Slide57

Break the Chain:

Cleaning of Equipment

After EACH patient use

Glucometer

Pulse Oximeter

BP cuffs

EVERY shift

Keyboards

in clinical settings (i.e. computer, omnicell, pyxis keyboards)

Phones in clinical areas

Dinamapp machines

Locator badges

Don’t know when / how to clean a piece of equipment?

Refer to the

IP

Manual and/or your department specific

IP

Policy in the front of your

IP

manual

Clorox hydrogen peroxide

wipes are

hospital

approved

to

clean

equipment

Slide58

Break the Chain: Infectious Waste

Classification of infectious waste and recommendations for proper handling are found in Section 8 of the Infection Prevention Manual

Expanded precautions patients

Waste from room of a patient in expanded precautions is handled the same as for ALL patients

Reusable Equipment / Trays

DO NOT

place reusable equipment/trays in red biohazard bags

Use

clear

biohazard labeled bags

Linen

All linen is considered infectious

Slide59

Break the Chain: Infectious Waste

Management of spills

Follow procedure for management of spills found in Section 8 of the Infection Prevention Manual

Follow standard precautions when managing spills of blood/body fluid

Spill kits are available in the Omnicell and soiled utility rooms

Use shovel/scrapper if sharp objects. Use disposable towels to clean up. Dispose of in biohazard container.

Slide60

Other Resources:Infection Prevention Manual

Every department or at GHSNet

Disease Specific Table

Exposure Control Plan

TB Protection Plan

Infection Prevention & Control Precautions

Personal Protective Equipment Use

Animals in Healthcare

Sterilization

Cleaning patient care equipment

Slide61

Other Resources:Department Specific IP Policy

If a clinical department has a department specific infection control policy, it is found:

FRONT

of their IP Manual

Infection Prevention Website

Unit/department specific information

How to handle contaminated clothing

Cleaning of equipment

Location of PPE for your unit/department

Special infection control procedures or concerns for your area

Slide62

Other Resources: Educational Materials

Fact sheets

MRSA

Community acquired MRSA

VRE

C diff

Tuberculosis

Lice

Scabies

RSV

Meningitis

Bioterrorism agents

Influenza (seasonal & pandemic flu)

Disaster Family Plan

Hand hygiene

Pertussis

Expanded Precautions Kit (Every nurses’ station)

Steps for initiating precautions

Precautions signs

Precautions stickers

Fact sheets

How to reorder precaution signs and fact sheets

Slide63

Other Resources: IP Website

Slide64

Infection Prevention:

It’s a Lifesaver!

Protect Your Family

Protect Yourself

Protect Your Patient

Slide65

Slide66


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