Health Occupation Student Orientation Module 3: Infection Prevention

STANDARD PRECAUTIONS Section 1

Infection Prevention Chain of Infection How to Break the Chain of Infection 1. Perform hand hygiene. 2. Surface disinfection 3. Follow transmission based precautions. 4. Practice injection safety. 5. Practice safe respiratory hygiene and cough etiquette.

When to Clean Your Hands: use hand sanitizer or soap and water -  Each time you enter or exit a threshold in a patient care environment  Before and after patient contact  Before donning and after removing gloves – gloves do not replace hand hygiene  After touching your face or hair  After using the rest room – must use soap and water! Infection Prevention Standard Precautions - Hand Hygiene

How To Wash Your Hands 1.Wet hands with warm running water. 2.Apply soap. 3.Rub hands for 20 seconds (If necessary, use a nail brush to clean nails. However, the brush must be kept clean and sanitary.) 4.Rinse hands thoroughly 5.Dry hands with a paper towel 6.Turn off the tap with the paper towel Infection Prevention Standard Precautions – Hand Hygiene

How to Apply Hand Sanitizer Infection Prevention Standard Precautions - Hand Hygiene

Infection Prevention Standard Precautions – Surface Disinfection When to Clean Equipment:  Wipe down re-useable equipment after each patient use  Clean High touch objects daily such as bedrails, over bed table, call light/TV remote What to Use:  Germicidal wipe such as CaviWipes. Alert: be sure to wear gloves with use.  Bleach Wipe for patients with clostridium difficile and Norovirus. Alert: be sure to wear eye protection and gloves with use.

Infection Prevention Standard Precautions – Surface Disinfection. Use this Cleaning Product Wearing this Required PPE To Clean this Equipment Contact Time (wet time) Sani Cloth GlovesOximeter WOW’s Wheelchair Gurney Dynamap IVAC Bed 1 Bleach wipes Gloves Safety glasses Alert: Equipment for patients with C. dif or Norovirus Alert: Alaris pumps, glucometers can only be cleaned with this product 3

Injection Safety Guidelines From CDC Never administer medications from the same syringe to more than one patient, even if the needle is changed. After a syringe or needle has been used to enter or connect to a patient’s IV it is contaminated and should not be used on another patient or to enter a medication vial. Never enter a vial with a used syringe or needle. Do not use medications packaged as single-dose vials for more than one patient. Assign medications packaged as multi-dose vials to a single patient whenever possible. Do not use bags or bottles of intravenous solution as a common source of supply for more than one patient. Follow proper infection control practices during the preparation and administration of injected medications. Infection Prevention Standard Precautions – Injection Safety

Infection Prevention Hospital Influenza Plan – Your Role 1. Use respiratory etiquette education (Cough and/or sneeze into your sleeve) 2. Practice Hand Hygiene. 3. Get Influenza vaccinations for seasonal flu (October to March)  Vaccinated students must wear colored plastic tag identifier.  Unvaccinated staff: Sign a Declination form as required by state law and Cal/OSHA During flu season (October to March), wear a surgical mask if within six feet of a patient.

Infection Prevention Hospital Influenza Plan – Your Role Vomiting Diarrhea related to Gastroenteritis Sore throat with fever Fever of 100 or higher and cough Draining wound and/or open wound infection for staff that provide direct patient care Stay Home if Sick:

TRANSMISSION-BASED PRECAUTIONS Section 2

Infection Prevention Transmission Based Precautions Personal Protective Equipment Health care workers wear PPE in patient’s room Patient wears PPE when outside the room Staff and volunteers are NOT to wear PPE (including gloves) in the hallway unless providing critical care during transport Tie BOTH neck and waist ties on the gown PPE is disposed in regular trash unless grossly contaminated with a patient’s body fluids Wrong!

Infection Prevention Transmission Based Precautions How to Put On PPE Alert: Both neck and waist of gown must be tied.

Infection Prevention Transmission Based Precautions How to Remove PPE Alert: Do NOT Wear PPE outside the Patient Room

Infection Prevention Transmission Based Precautions Contact Precautions : (example diseases: MRSA, VRE, Scabies, Lice) Wear Personal Protective Equipment: gloves, gowns upon entry to patient room; remove before leaving the room: PPE NOT required in arc of the door

Infection Prevention Transmission Based Precautions Droplet Precautions : (example diseases: Influenza, Bacterial Meningitis) Wear Personal Protective Equipment: mask upon entry to patient room; remove before leaving the room N95 or PAPR for high hazard procedures N95 Mask PAPR

Infection Prevention Transmission Based Precautions Airborne Precautions : (example diseases: TB, Novel or Unknown Disease) Wear Personal Protective Equipment:  N95 mask- must be fit tested  PAPR* for high hazard procedures such as Bronchoscopy, suctioning, SVN etc. * PAPR = Powered Air Purifying Respirator N95 Mask PAPR

Infection Prevention Other Measures  No food or drink in patient care areas (includes nurses’ station)  Food and drink items must be covered when carried through hospital hallways  Hand hygiene before entering a patient room every time  Educate patients, family, and visitors about hand hygiene (entering and exiting)  Clean up! – examples: wrappers on floor, spilled beverages in pantry

Students may NOT perform the following standardized procedures:  Vaccinations  MRSA screening Students may NOT care for patients in Airborne Isolation Infection Prevention Student Restrictions

COMMUNICABLE DISEASES Section 3

Infection Prevention Communicable Diseases ESBL – Extended Spectrum Beta Lactamase  A newly emerging MDRO (enzymes produced by certain bacteria that provides resistance to certain antibiotics) Clostridium Difficile Survival (Not a MDRO but “Other Organism of Concern”)  C. diff spores can live and infect up to 5 months on environmental surfaces  special requirements for hand hygiene and environmental cleaning MRSA Survival (Methacillin Resistant Staph Aureus)  Formica surfaces = 14 days  Cotton blanket material = 6-9 weeks  S. aureus (MRSA) can remain virulent and capable of causing an infection for 10 days after exposure to dry surfaces VRE Survival (Vancomycin Resistant Enterococcus)  Bedrails = 24 hours  Telephones = 60 minutes  Gloved and ungloved hands > 60 minutes Superbugs” live on surfaces…also known as Multidrug Resistant Organisms (MDROs). Note the survival rates for each.

Infection Prevention Other Communicable Diseases About Pulmonary tuberculosis (TB)  A contagious bacterial infection that mainly involves the lungs. State of California has a high incidence  Annual testing (TB skin Test) for exposure is required Student are not allowed to provide care of patients in Airborne Isolation Precautions. Type of Isolation Precautions: Airborne  N95 respirator {fit tested}  Negative air pressure – contact engineering to turn on alarm, conduct daily pressure testing

Infection Prevention Other Communicable Diseases About Meningitis:  Meningitis is among the ten most common infectious causes of death  The major causes of community-acquired bacterial meningitis in adults in developed countries are Streptococcus pneumoniae and Neisseria meningitidis  The classic symptom triad of acute bacterial meningitis consists of fever, nuchal rigidity, change in mental status Type of Isolation Precautions: Droplet  Wear PPE until 24 hours after initiation of effective treatment

AEROSOL TRANSMISSIBLE DISEASE Section 3 Students DO NOT Take Care of Patients with Airborne Infection

Aerosol Transmissible Disease What is an Aerosol Transmissible Disease?  A disease transmitted by aerosols (gaseous suspension of fine solid/liquid particles) through sneezing or coughing

Aerosol Transmissible Disease Smallpox Tuberculosis (Suspect/Confirmed) Measles (Rubeola) Novel or Unknown pathogen Any other disease or pathogen for which the State or local Health Department recommends Airborne Infection Isolation Airborne spore release (anthrax) Avian influenza Varicella disease  Chicken pox  Shingles  Herpes zoster  Varicella-zoster (disseminated disease) Monkeypox Severe Acute Respiratory Syndrome (SARS) What Diseases Spread via Airborne Infection Isolation (AII)?

Diphtheria Influenza (seasonal) Meningococcal disease Mumps Mycoplasma pneumonia Pertussis Plague (pneumonic ) Rubella Viral hemorrhagic fevers Any other disease or pathogen for which the State or local Health Department recommends Droplet Precautions What Diseases are Spread by Droplets? Aerosol Transmissible Disease

Respiratory Protection When entering an “Airborne” Isolation room wear a N95 respirator  When assisting with High Hazard Procedures on patients in “Airborne” Isolation diseases, wear a PAPR during procedure and 35 minutes after while in room When entering a “Droplet” Isolation room wear a Surgical or Isolation Mask  When assisting with High Hazard Procedures on patients in Droplet precautions, wear a N95 respirator and eye protection or PAPR during the procedure (door to remained closed during the procedure) Students DO NOT Take Care of Patients with Airborne Infection

Aerosol Transmissible Disease What are Considered High Hazard Procedures:  Any clinical, surgical & lab procedure that may aerosolize pathogens  Sputum induction  Intubation & bronchoscopy  Open circuit suctioning  Aerosolized administration of meds  Pulmonary function testing  Autopsies