*Some policies and procedures may be facility specific. Infection Control *Some policies and procedures may be facility specific.

Healthcare - Associated Infections Healthcare-Associated Infections are infections that patients aquire during the course of receiving treatment for other conditions within a healthcare setting. Healthcare-Associated infections are one of the top ten leading causes of death in the United States. 1.7 million patients develop Healthcare-Associated infections and 99,000 die Healthcare-Associated infections cost up to $45 billion annually At least 60% of Healthcare-associated Infections are caused by Drug Resistant Organisms 20% of these are preventable.

Chain of Events Three Elements must be present for an infection to spread to hospital patients: Source of Pathogen – Causative Agent Susceptible Host – Patients and/or Care Providers Mode of Transmission - Transmission route for microorganisms from person to person or object to person

Chain of Infection Causative Agent Susceptible Reservoir Host Portal of Entry Portal of Exit Mode of Transmission

Breaking The Chain Infection control policies exist to help break the chain of events that leads to the spread of infection. Infection Control Activities Include: Handwashing Isolation Techniques Use of Personnel Protective Equipment Occupational Exposure Plan

HANDWASHING Handwashing is the most important activity you can do to prevent the spread of infection. 15-20 seconds of friction Rinse from wrist to fingertips Turn faucet off with paper towel Wash before and after each patient contact or contact with patient room environment. Wash after removing gloves Wash after using the restroom Wash before eating Alcohol handrinse should be used if hands are not visibly soiled

Artificial Nails CDC advisory – do not wear artificial nails, tips, overlays or decorations on nails for healthcare workers who have direct contact with patients Do not wear old or chipped nail polish Keep nails short. Scientific studies indicate increased fungal and bacterial colonization in healthcare workers with artificial nails

Isolation Precautions Currently there are two types of Isolation Precautions: Standard Precautions: Used when caring for all patients, also known as Universal Precautions Transmission Based Precautions: Used in addition to standard precautions for specific disease processes. Contact Droplet Airborne Protective

Standard or Universal Precautions The Key Principle Treat all Blood, Body Fluid, Secretions and Excretions as if potentially infectious for HIV (the virus that causes AIDS), Hepatitis B, Hepatitis C, or other blood borne pathogens

BloodBorne Pathogens Hepatitis B, Hepatitis C and Human Immunodeficiency Virus (HIV) are the most commonly known bloodborne pathogens. The main ways to become infected with these pathogens is through sexual contact and contact with blood and other body fluids. Since we can’t look at a person and tell if they have HIV or HBV, we have to treat everyone as if they are infected, and follow standard precautions at all times. The average risk of infection after accidental exposure is: HIV –0.3% HBV-5-30% - There is a HBV vaccine series that is available to reduce healthcare workers risk of infection. HCV- 3%

Standard Precautions Wash hands between patient contact Use Alcohol hand gel when hands are not visibly soiled Use proper Personal Protective Equipment (PPE) Clean up spills with proper technique and disinfectants Never re-cap needles using two hands Discard Sharps in approved puncture resistant containers only Keep food away from possible infectious materials Never pick up glass with bare hands Identify places in your work area for eye and face washing if contamination occurs

Personal Protective Equipment PPE PPE is specialized clothing or equipment used to prevent exposure to health and safety hazards Gloves should be worn anytime you could potentially come in contact with blood, body fluids or other potentially infectious materials Gowns, Masks, Face Shield / Eyewear should be worn anytime a splash of body fluids is possible Any contaminated PPE should be disposed of properly in biohazard waste containers PPE is supplied by the hospitals PPE should be in the correct size You should know where PPE is located Gloves - latex free and powder free are available

Handling of Needles Never recap needles using 2 hands Never bend or break needles Dispose of all needles in nearest sharp’s disposal container Replace sharps containers when 2/3 – 3/4 full Must use safety devices when available

Cleaning Bloodspills PPE – Wear gloves. Also gown and eye goggles if a large spill Contain spill with paper towels or cover; clean with 1:10 fresh bleach / water solution, or EPA approved germicidal cleaner then place in red bag Disinfect by applying 1:10 bleach / water solution ; let air dry

All used linens are to be put in soiled linen containers / bags without separating

The biohazard symbol should be used to identify anything or any area                                                                          The biohazard symbol should be used to identify anything or any area that may present possible exposure to Blood and Body Fluids

Transmission Based Isolation Precautions Contact Precautions – Used to reduce transmission of microorganisms via the contact route. Examples include Antibiotic Resistant Organisms Droplet Precautions – Used to reduce transmission of microorganisms by coughing, sneezing and talking. Examples include Bacterial Meningitis, Flu, Mumps and Rubella. Airborne Precautions – Used to reduce transmission via the airborne route. Examples include TB, Smallpox, SARS and Chicken Pox – Do not allow non-immune to go in this room Protective Precautions – For immune-compromised patients with less than 1000 white blood cells.

Contact Precautions Follow Standard Precautions . Follow instructions posted on the door. Always wear gloves when entering the room. A gown should be worn if you anticipate that your clothing will come into contact with the patient or room environment. Patients with MRSA, VRE, and C.Difficile are examples of patients who should be placed in Contact Isolation. Students must be supervised by their preceptor the first time they enter a Contact Precautions room.

MRSA (Methicillin Resistant Staph Aureus) MRSA is transmitted via direct contact between people or contaminated objects. S. aureus produces an ENZYME, betalactamase, which allows it to become RESISTANT to penicillins In 1960, Methicillin became available for treating penicillin resistant S. aureus S. aureus developed strains resistant to Methicillin and by the mid 1970’s MRSA became a problem MRSA are resistant to many antibiotics, but can be treated with Vancomycin, some VRSA (Vancomycin Resistant Staph Aureus) are now being reported. 75-78% of S. aureus isolated from lab cultures are resistant to methicillin.

ENTEROCOCCUS Located in normal flora of the GI and female reproductive tract, also transmitted via the contact route. Third most common cause of hospital acquired infections. Infection occurs in: urinary tract, wounds, central lines VRE – Enterococcus has acquired vancomycin resistance VRE – 70% from urinary site – nursing home residents VRE – Reportable to state from sterile body sites

Risk Factors for Developing Antibiotic Resistance ICU Patients Patients with extended length of stay Patients with previous admissions Overuse and misuse of antibiotics Nursing home residents

Preventing The Spread of Drug Resistant Organisms Wash hands between each patient contact Place patient in Contact Isolation Precautions Use and dispose of PPE correctly Follow strict isolation technique Use antibiotics appropriately

Droplet Precautions Follow Standard Precautions. Follow Instructions Posted on the Door. Wear an Isolation Mask if coming within 3-6 feet of the patient. Some hospitals may require a mask upon entering the patient room. Patients with the flu should be placed in Droplet Precautions. Students must be supervised by their preceptor the first time they enter a Droplet Precautions room.

Influenza 10% to 20% of U.S. population will get the flu annually. 36,000 will die, 114,000 will be hospitalized Most who die will be over 65, but children younger than 2 will be as likely as elderly to be hospitalized Healthcare employee vaccination rate has been about 65%, CDC goal is to vaccinate all HCW (who have no contraindications to flu vaccine). CDC recommends vaccination against seasonal flu and 2009 H1N1 flu. *Per CDC current data

Airborne Precautions Standard Precautions should be followed Place patient in a negative pressure room Door remains closed Personnel entering room must wear an N95 Particulate Respirator *Employees must be medically screened and fit tested to wear the respirator. Due to the fit test requirement, students are not to enter the room of patients in TB isolation. Visitors/Family are encouraged to refrain from entry to the TB patient’s room. If entry is elected these individuals are strongly encouraged to wear an approved dust-mist mask, supplied by the hospital. *Students have not been screened and fit tested and will not be allowed to care for patients in Airborne Precautions.

Airborne Pathogens TB Chicken Pox Measles Disseminated Herpes Zoster Smallpox SARS (Severe Acute Respiratory Syndrome)

TB Mycobacterium tuberculosis One third of the world has been infected with TB TB Infection: Body holds the germ in check, but PPD is positive TB Disease: 10% of persons infected will develop active disease, half within 2 years of exposure Active disease is defined as having the bacteria, being contagious, and symptomatic. A person can be infected with TB but not be symptomatic or contagious. 40-50% of TB patients have a delayed diagnosis an average of 6 days resulting in exposure of 25-45 workers for each undiagnosed patient Health Care Workers should have annual PPD testing done

QUESTIONS to detect TB Have you been coughing for over 3 weeks? Have you been coughing at all and have any of the following: a. Coughing up blood? b. Sweats at night? c. Loss of weight without trying? d. Persistent fever?

Exposure Control Plan OSHA requires that all hospitals develop an Exposure Control Plan designed to: Reduce your risk of exposure to blood and body fluids Provide the use of PPE (Personal Protective Equipment) Provide the use of Engineering Controls – ex. Negative pressure rooms for TB patients, sharps disposal containers Provide a Hepatitis B vaccine program The plan is located in the Epidemiology Manual (Infection Control) in your area

Needlestick or Blood Exposure “Actions to Take if Exposure Occurs” First Aid – thoroughly wash area If your eyes get splashed, flush them with water Notify supervisor immediately Notify Occupational/Employee Health Complete Needlestick/Exposure forms- this will allow for testing of the source patient Counseling HIV source - begin post -exposure prophylaxis within 2 hours