Build an Isolation Cart: and they will use it CEDEP │ Healthcare Associated Infections and Antimicrobial Resistant Infections Division

Goals Review the following concepts: Categories/types of personal protective equipment (PPE) Appropriate use for each piece of PPE Review hand hygiene Basic environmental cleaning Setting up a contact isolation cart https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html

Standard Precautions Primary strategy for the prevention of healthcare associated transmission of infectious agents Applied to ALL patients/residents in ALL healthcare settings, regardless of the suspected or confirmed presence of an infectious agent Based on the principle that all blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes may contain infectious agents

Standard Precautions vs. Contact Precautions IF you anticipate contact with something that has a high degree of infectivity, protect yourself and other patients/residents Contact Precautions You WILL contact something with a high degree of infectivity, protect yourself and other patients/residents PPE for both situations is essentially the same

Types of PPE Used in Healthcare Settings Gloves – protects hands Gowns/aprons – protects skin and/or clothing Masks and respirators – protects mouth/nose Respirators – protect respiratory tract from airborne infectious agents Goggles – protect eyes Face shields – protect face, mouth, nose, and eyes

What Factors Influence PPE Selection? Type of exposure anticipated Splash/spray versus touch Category of isolation precaution Durability and appropriateness for the task Fit

The Most Basic Concept Hand hygiene Avoid unnecessary touching of surfaces in close proximity to the patient/resident When hands are visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or body fluids, wash hands with soap and water If hands are NOT visibly soiled or after removing visible material with nonantimicrobial soap and water, decontaminate hands with an alcohol based hand rub (ABHR)

When to Perform Hand Hygiene Before and after direct contact with patients Before and after contact with the patient’s environment If hands will be moving from a contaminated body site to a clean body site during care of the same patient After removing gloves

My 5 Moments of Hand Hygiene http://www.who.int/gpsc/5may/background/5moments/en/

So what about artificial nails? Do not wear artificial nails/extenders if duties include direct contact with patients/residents at high risk for infection and associated adverse outcomes Develop an organizational policy on wearing of non-natural nails by healthcare personnel who have direct contact with patients/residents https://www.cdc.gov/handhygiene/providers/index.html

Dedicated Patient Care Equipment In addition to PPE, what should be considered for the contact isolation cart? Dedicated Patient Care Equipment BP cuff, stethoscope, thermometer Consider additional equipment on an individual basis Cleaning supplies Disinfectant wipes to be used as needed Consider the type of isolation to provide an appropriate product Ensure your disinfectant is appropriate for the situation, e.g., sporicidal for C. diff. or Candida auris Hand hygiene product May need additional ABHR on the cart Have signage available to alert and educate staff/visitors

Please see nurse before entering the room

Egress Must be maintained in case of an emergency situation Most healthcare facility corridors are at least 8 feet wide - Must be able to maintain at least 5 feet of clearance in case of an emergent situation Day-to-day operations could require keeping some patient care equipment near patient rooms for safety but does NOT allow equipment to be stored in the hallway such as fax machines, files cabinets, etc. Check with your Facilities Manager, either local or corporate, before making a decision on egress issues http://www.ashe.org/compliance/ls_02_01_20/01_obstructions.shtml

Environmental Cleaning Intended to remove blood, body fluids, and other contaminants from objects and surfaces Disinfection a process that kills many or all remaining infection-causing germs on clean objects and surfaces Use an EPA-registered hospital disinfectant Follow label instructions for proper dilution and proper contact or treatment time NOT the sole responsibility of EVS https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines.pdf

Environmental Cleaning (cont.) All cleaners/disinfectants are NOT created equal! Be sure your facility is using an EPA registered disinfectant Tuberculocidal – a benchmark to measure germicidal potency Tuberculosis is NOT transmitted via environmental surfaces If a product is “tuberculocidal”, it is capable of inactivating a broad spectrum of pathogens, including less resistant organisms such as bloodborne pathogens if used as directed When needed, ensure sporicidal disinfectants are available EPA has other categories of efficacy claims https://www.epa.gov/pesticide-registration/selected-epa-registered-disinfectants https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a2.htm

Counters at nurses’ station High-touch surfaces, common areas Item Nursing Secretary Housekeeping When Glucose meter X After every use Phones Beginning of shift Kiosks Once each shift Med cart Beginning of shift/prn Counters at nurses’ station High-touch surfaces, common areas 1x each shift; increase to 2x each shift during flu season Computers-on-wheels Beginning of shift & after potential contamination

https://iaspub.epa.gov/apex/pesticides/f?p=PPLS:1

Thank You! Enjoy the rest of your lunchbreak! HAI contact: (615) 741-7247 HAI.Health@tn.gov All Outbreaks are Reportable Enjoy the rest of your lunchbreak! Thank You!