Infection Prevention & Control Prevention Strategies 1

Isolation Precautions. Used to reduce transmission of microorganisms Designed to protect both staff and individuals from contact with infectious agents Includes: □ Standard precautions □ Transmission-based precautions 2

Standard Precautions Personal Protective Equipment Respiratory Hygiene / Cough Etiquette Cleaning of Care Equipment Hand Hygiene Care of Environment Textiles and Laundry Sharps Injury Prevention

Hand Hygiene: How and When Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Soap and waterAlcohol-based hand rub When to useUse when hands are visibly dirty, contaminated, or soiled Use for routinely decontaminating hands if hands are not visibly soiled How to use (properly) 1.Wet hands with water, apply soap, rub hands together for at least 15 seconds 2.Rinse and dry with disposable towel 3.Use towel to turn off faucet 1.Apply to palm of one hand, rub hands together covering all surfaces until dry 2.Manufacturer will instruct how much to use

Hand Hygiene: Why and When Clean hands are the most important factor in preventing the spread of disease and antibiotic resistance in settings across the continuum of health care. Before and after: ▫ Contact with a patient ▫ Treating a cut or wound (Ex: changing dressings or bandages) Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

Hand Hygiene: When Before: ▫ Putting on gloves ▫ Preparing or eating food* ▫ Touching your eyes, nose, or mouth ▫ Handling/administering medication ▫ Insertion of invasive devices After: ▫ Contact with blood, body fluids, mucous membranes, secretions, excretions, or non-intact skin ▫ Removing gloves ▫ Touching surfaces or objects in the patient’s environment that may be contaminated (bed rails, bedside tables, light switches, etc.) ▫ Handling garbage ▫ Using the restroom* ▫ Blowing your nose, coughing, or sneezing * Wash hands with soap and water

Safe Injection Practices: Fingerstick Devices Single-use devices Disposable Prevent reuse through an auto-disabling feature Appropriate for settings where assisted monitoring of blood glucose is performed Reusable devices Often resemble a pen (“penlet”) Use not recommended due to problems that have been observed, including: Failure to change disposable pieces Failure to clean and disinfect properly Links to multiple outbreaks of hepatitis B Risk for occupational needlestick Only appropriate for people who do not require assistance with blood glucose monitoring (BGM) Reusable Fingerstick Device Source: CDC Single-Use Fingerstick Device Source: CDC

Fingerstick devices should never be used for more than one person ▫ Select single-use devices that permanently retract upon puncture Dedicate blood glucose meters to a single patient, one person, if possible ▫ If shared, the device should be cleaned and disinfected after every use, per manufacturer’s instructions Insulin pens and other medication cartridges and syringes are for single-use only and should never be used for more than one person 8 Blood Glucose Monitoring Best Practices

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OSHA Bloodborne Pathogens Standard The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens (BBP) Standard describes important strategies that can reduce the risk of infection on the job. Exposure Control Plan Engineering Controls Work Practice Controls Standard Precautions / Personal Protective Equipment Housekeeping Hepatitis B Vaccine Occupational Exposure Follow-up Training and Recordkeeping

Respiratory Hygiene/ Cough Etiquette 11 Is used to decrease the transmission of respiratory illness such as influenza & colds by: 1.Education regarding how respiratory illnesses spread and prevention practices including how to “cover your cough” and proper hand hygiene methods 2.Availability and use of tissues and hand hygiene products 3.Use of mask for person who is coughing 4.Spatial separation of the person with a respiratory illness

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Droplet Precautions Are used in addition to standard precautions. Used for illnesses that can be spread to others by speaking, sneezing, or coughing. ▫ Examples: influenza, the common cold These germs may through the air for approximately 3-6 feet and can be breathed into the nose or mouth of another person. Hand hygiene is essential to avoid the spreading of germs. 13

Cleaning of the Environment Our environment contains microorganisms that can cause infection. Cleaning and disinfecting surfaces and objects such as medical equipment can decrease the spread of these organisms to people. 14

Common Terms Clean = remove all visible dust, soil, and any other foreign material Decontaminate = remove disease-producing microbes to make safe for handling Disinfect= kill or destroy nearly all disease- producing organisms, except spores using a chemical or physical agent Sterilize = destroy microorganisms and spores 15 Adapted from the APIC, 2009 Infection Prevention Manual for Long-Term Care Facilities

Breakdown of Cleaning Cleaning is the physical removal of all visible soil and other foreign material (such as dirt, dust bunnies, and body fluids) so you can get to the microbes underneath. You can’t kill microbes if you don’t clean first. One can clean without disinfecting, but one can not disinfect without cleaning, therefore, one must clean first to remove the materials. Transmission of infection may not be a failure of the cleaning and disinfecting agents but rather a failure to completely follow the cleaning and disinfecting process. 16

Cleaning Process Environmental Services should approach cleaning in a orderly, regularly scheduled method. Clockwise or counter-clockwise Working from top to bottom Cleanest to the dirtiest 17

Disinfecting Agents Only use disinfectants registered with the U.S. Environmental Protection Agency (EPA) Cleaners and disinfectants should be reviewed for use, dilution, contact time, and shelf life ▫ Contact time: amount of time needed for the chemical to come in contact with the microorganism so that a significant number of organisms are killed. Use appropriate disinfectant for situation ▫ For example: areas contaminated with C. difficile or norovirus may need different cleaners and disinfectants 18

Preparing a Bleach Solution 1:10 Dilution ▫ 1 part bleach to 9 parts water 1 ½ cups bleach in 1 gallon water 1:100 Dilution 1 part bleach to 99 parts water 1/4 cup bleach in 1 gallon water 19

Vaccinations A vaccine is a preparation that improves immunity to a particular disease. ▫ Examples: influenza, tetanus, or pneumonia The vaccine typically contains an agent that resembles a disease-causing microorganism. The vaccine stimulates the body’s immune response to recognize the foreign invader, destroy it, and "remember" it, so that the immune system can more easily recognize and destroy any of these microorganisms that may be encountered later. 20

Why Vaccinate? Vaccines can help prevent some diseases ▫ Save costs (resource reallocation)  Lost time from work  Treatment expenses ▫ Save lives Long-term protection in the individual Help prevent outbreaks from occurring 21

Vaccination Recommendations May vary based on underlying medical conditions, occupation, and age ▫ Special vaccination recommendations apply to healthcare personnel to protect themselves and their patients against disease Even if you were vaccinated as a child, you may need to get vaccinated as an adult for certain diseases ▫ For example, it is recommended that you get a vaccination for influenza every year Recommendations are updated and published every year CDC website for immunization schedules:

Successful Vaccination Strategies Stress benefits of vaccination. Allay fears and misconceptions. ▫ Vaccines are safe! ▫ Can’t “catch” the disease from the vaccine ▫ Minimal side effects ▫ Benefits outweigh the risks Find creative ways to increase staff influenza vaccination rates. 23

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