Infection control for house officers at the Omaha VA Medical Center Infection Control Practitioner Pager ext MRSA Prevention Coordinator Pager ext Hospital Epidemiologist Ext. 5606

Omaha VA uses Standard and Transmission-Based Precautions Based on current guideline of the Centers for Disease Control and Prevention (CDC)

Standard Precautions Protective barriers for ALL potential contact with: All body fluids Blood All secretions All excretions (except sweat) Mucus membranes Non intact skin

Follow CDC 2002 hand hygiene guideline No artificial nails, no chipped nail polish Natural nail no longer than 0.25 inch Wash hands with antimicrobial soap and water if visibly soiled or after caring for Clostridium difficile patients Hand hygiene before and after patient contact, including after removal of gloves. Generally use alcohol handrub.

Personal Protective Equipment (PPE) What is available for your use? Surgical masks N-95 respirators (must be fit tested) Gloves Gowns Eye protection

Alcohol dispensers often near sinks & in every patient room

Purell alcohol handrub

Transmission based Precautions Contact Enhanced contact Airborne Droplet

Contact precautions Examples of Diseases in this category: Drug-resistant organisms (eg MRSA, VRE) SARS (also needs airborne precautions, eye protection)

Contact precautions includes Gown Gloves Hand hygiene Dedicated equipment in the room (including stethoscope, blood pressure cuff) Terminally clean room on discharge of patient from the room

Isolation Cart

Find a gown in an isolation cart

Remove gown from cart

Put on the gown, fasten- ing it in back

Remove it after seeing the patient, turning it inside-out

Place the used gown in the trash can

Enhanced contact precautions Examples of diseases in this category: Clostridium difficile Norovirus

Actions: Enhanced contact precautions Disinfect hands with antimicrobial soap and water (rather than alcohol gel) Housekeeping staff use special cleaning methods involving bleach

Airborne precautions Fit-tested N95 mask Room with negative air flow Door closed

Airborne Precautions Examples of Diseases in this category: Tuberculosis Varicella Measles SARS (also needs contact precautions and eye protection)

Common questions on airborne precautions: PPD Q. “My patient has a positive tuberculin skin test (PPD test). Is this an indication for airborne precautions?” A. No, only patients suspected of having active tuberculosis or proven to have active tuberculosis need airborne precautions.

Common questions on airborne precautions: AFB Q. “My patient has a laboratory test showing acid-fast bacilli (AFB) in the sputum. Does this mean the patient has tuberculosis?” A. Not always. So-called atypical mycobacteria that are not causing tuberculosis can result in a lab report of AFB in the sputum and isolation is not indicated.

Rooms for airborne precautions 8 rooms available (includes 2 each in Emergency, ICU, 6E, and 7E) Specially equipped to maintain negative flow Reduces risk of pathogens drifting in air currents from infected patient to other patient rooms

Check alarm outside negative air flow room Alarm should be off with the door closed If not, contact nurse

Droplet precautions Regular mask Door may be open or closed for known or suspected

Droplet Precautions Examples of disease in this category: Influenza Pertussis Neisseria meningitidis

Employee Health Issues Blood and body fluid exposure Immediately notify supervisor Immediately call Occupational Health (5825) during day hours or go to Urgent Care area after hours Do so immediately since post exposure prophylaxis for HIV should be started, ideally within an hour FREE influenza vaccine provided for all Tuberculin skin test annually at host institution: CUMC or UNMC Hepatitis B vaccine at host institution

All blood and body fluid exposures are important Sharps Injuries Needle stick Scalpel cut Pipette break Any injury that breaks the skin in the presence of body fluids Mucous membrane exposure

If a Blood Exposure Occurs: Clean the exposed area with soap and water. For exposed mucous membranes, flush with water. DO NOT use bleach or surface disinfectants. Report incident to supervisor immediately. Report to Employee Health or Urgent Care area as previously described. Fill out an Incident Report via the electronic reporting system - ASISTS

Follow-up of blood or body fluid exposure Follow-up after initial visit to Urgent Care Occupational health nurse practitioner Call 3209 to schedule visit

Safety needles can prevent some blood exposures Be sure to use these devices correctly.

Sharps disposal containers in each room

Needle/Sharps Disposal DO activate safety device DO locate the disposal container closest to your work area DO look to be sure that the opening of the box is clear of sharps Do NOT recap by hand Do NOT bend, clip or break

Check to be sure disposal box is not overfilled

Aims of OSHA bloodborne pathogensstandard To protect employees from Occupational exposure to blood or other potentially infectious materials Transmission of bloodborne diseases

Bloodborne diseases of concern Human immunodeficiency virus (HIV) Hepatitis B (HBV) Hepatitis C (HCV)

Transmission in the workplace occurs by: Parenteral Exposure Needle stick, blood transmission Mucous Membrane Exposure Mouth, eyes In the community, they may be transmitted through IV drug use and from mother to baby.

Human Immunodeficiency Virus (HIV) Virus that causes AIDS Attacks the immune system May be no obvious signs of infection Can transmit virus before illness known

Hepatitis B (HBV) Symptoms if liver damage develops: Poor appetite Fatigue Abdominal discomfort Jaundice 125,000 people infected yearly in US 5-10% become chronic carriers 5-10% of those advance to liver disease Hepatitis B Vaccine is available to prevent disease

Hepatitis C (HCV) Symptoms same as Hepatitis B Antibodies may not provide immunity Up to 85% will develop chronic hepatitis 3.9 million chronically infected in US Sexual transmission uncertain

Respiratory etiquette to prevent transmission Cover your cough or sneeze Deposit tissues directly into the trash Clean hands after use of tissues or cough/sneeze Offer tissues or mask to others with coughing or sneezing Remind them to clean hands

Infection Control is Everyone’s Responsibility!