O BJECTIVES (39 Q UESTIONS ) Develop and review infection prevention and control policies and procedures Collaborate with public health agencies in planning community responses to biological agents (eg, anthrax, influenza) Identify and implement infection prevention and control strategies

P ART I

P OLICIES & P ROCEDURES

P OLICY R EVIEW IP is responsible for development and review of IPC guidelines and policies Purpose is to protect the patient and healthcare workers in a cost efficient environment Use national references such at APIC, SHEA, CDC, HICPAC, AORN CMS requires using nationally recognized guidelines for policy development  National Guideline Clearinghouse

B IOLOGICAL A GENTS

P REPAREDNESS FOR B IOLOGICAL E VENTS Assess hazards and vulnerabilities Develop plans Incorporate syndromic surveillance Educate all involved Practice the plan

M ITIGATION /I NFECTION P REVENTION P ROCEDURES Follow the principles of an outbreak investigation Report unusual infections Triage quickly Quarantine Prophylaxis, vaccination, treatment Decontamination Post mortem care

P OTENTIAL B IOTERRORISM A GENTS Category A Anthrax Botulism Plaque Smallpox Tularemia Viral hemorrhagic fevers Category B have moderate morbidity and low mortality

H AND H YGIENE

Standardized definition of hand hygiene Product standardization, dispenser location, indication for hand hygiene, and technique Surgical hand antisepsis requires persistent activity (CHG and alcohol is best) Develop monitoring programs to comply with accreditation

C LEANING, DISINFECTION & S TERILIZATION

D EFINITIONS Cleaning Removal of visible soil Sanitizing Reduction in microbial population to a safe or relatively safe level Decontamination Rendering the object safe for handling Disinfection Elimination of many or all pathogenic organisms, except bacterial spores Sterilization Complete elimination, destruction of all microbial life

S PAULDING C LASSIFICATION Critical Enters sterile tissue or vascular system Semi-critical Touches mucous membranes or non- intact skin Non-critical Touches intact skin

C LEANING Goal is to render item safe for handling Follow manufacturer’s instructions for use Enzymatic cleaner (dilution) Ultrasonic Washer (quality monitoring)

S TERILIZATION Steam Gravity Pre-vacuum Ethylene Oxide Low-temperature hydrogen peroxide gas plasma Ozone Dry-heat Liquid sterilant (peracetic acid)

M ONITORING OF S TERILIZATION SYSTEMS Mechanical indicators: recording charts Chemical indicators: impregnated paper or strips. The Bowie Dick checks to see if the air has been removed from the chamber and the efficiency of the vacuum pump Biological indicators: use first load of every day but at least once a week and with all implantables

H IGH L EVEL D ISINFECTION Pasteurization (time + heat) Glutaraldyde Stabilized hydrogen peroxide Peracetic acid Ortho-phthalaldehyde (OPA)

H IGH L EVEL D ISINFECTION Assure that the solutions and strips are marked with expiration date after opening Assure that the temperature of the solution is monitored for each soaking Assure that the QC for the strips and the solution are documented

L OW LEVEL DISINFECTION Quaternary Ammonia products QUATs (4 th generation) Most common in hospitals Phenolics Never use in nurseries due to associated neurotoxicity to infants Chlorine-releasing agents Accelerated hydrogen peroxide

R ECALLS

C ONTAMINATED E QUIPMENT /S UPPLIES Intrinsic Contaminated during production Extrinsic Contaminated during use Notify the FDA and CDC if a contaminated or defective product, device, or medication us suspected as the cause of an outbreak Immediately remove from use Initiate an outbreak investigation