Infection Prevention Harry S. Truman VA Monica Brugmann BSN CIC Infection Control Nurse Kathy Kormann BSN MDRO Coordinator

Infection Control Policy HPM 36 on the SharePoint Site

Hand Hygiene Hand Hygiene is the number one most efficient way to prevent Healthcare Acquired Infections (HAI) It is essential that patient care providers wash their hands with every patient every time. Soap and H20 and Hand Sanitizer is readily available.

Transmission Based Precautions Contact Precautions usually used for patients with MRSA and other infections listed in the Infection Control Policy (HPM 36). Contact Plus Precautions used for patients with C- diff. Please note directions are on the signs. You don’t need to memorize them.

Red Tape A clean zone may be established within the room of patients on Contact Precautions or Contact Precautions + using red tape. The clean zone should be considered an extension of the hallway. No equipment, chairs, trash cans, etc. should be within the clean zone. Red tape should always be used in conjunction with Contact Precautions and Contact Precautions + even if it is only at the doorway. This serves as a reminder to all entering the room.

Transmission Based Precautions Droplet Precautions Used for infections spread by respiratory secretions in droplet form like the flu. Airborne Precautions Used for infections spread in the air like Tuberculosis. A N-95 mask or PAPR must be used to enter the patients room. Neutropenic Precautions Used to protect an immune compromised patient.

Transmission Based Precautions CLC Precautions Used for residents with MDRO’s. Staff are required to gown/glove prior to touching the resident or environment in their bedrooms but not in the common areas. Outpatient and Behavioral Health Use Standard Precautions.

PPE & Isolation Precautions ~ Final Thoughts PPE and Isolation Precautions are available to protect you and the patients we care for from exposure to infectious agents in the healthcare setting. USE THEM! It only takes a couple seconds to protect yourself and your patients! It is your responsibility to know what type of PPE is necessary for the duties you perform and to use it correctly.

PPE – Respiratory Protection Program Staff that may be exposed to airborne organisms, such as TB, are required to participate in the Respiratory Protection Program The Respiratory Protection program includes Medical evaluation N-95 fit testing or Positive Air Pressure Respirator (PAPR) training Training on use and storage Remember – PAPRs require annual training. N95’s require annual training and annual fit testing. Contact Industrial Hygienist x56307 for fit testing.

Respiratory Protection Program Resources

Environmental Management It is important to make sure all non-critical Reusable Medical Equipment is cleaned before and after it is used for a patient! Examples of non-critical RME include Stethoscopes Thermometers Blood Sugar machines Vital Sign machines Wheelchairs Any piece of equipment that is shared between patients.

Environmental Management Sani-wipes are used for the cleaning of high touch areas and of non-critical reusable medical equipment except as identified below. Dwell time is 2 minutes. Housekeeping supplies them. Dispatch Bleach Wipes are used for C-diff isolation and Ebola Preparedness. Dwell time is 5 minutes. Logistics supplies them and they are in floor supply. Use Gloves when handling cleaners!

“ZEROing in on MRSA.”

MRSA Bundle Hand Hygiene Before and after every patient contact Alcohol hand sanitizer, wash if visibly soiled Monitor: peer data collection Active Surveillance Culture Applies to all admissions to acute care and the CLC Provide educational handout Swab on admission, transfer and discharge Contact Isolation Private room or cohort Cultural Transformation Staff – own and operate solutions Leaders – set direction, create freedom and opportunities for staff to co-create and implement solutions, remove barriers

MRSA Screening Guidelines Educate veterans prior to screening. They have a right to refuse. 2) Screen observation and acute admissions to all areas except behavioral health. Screen even if there is a history of MRSA. Do not screen outpatients. 3) If the patient is being admitted from the ED or clinic, the nurse from that location should screen as soon as possible. 3) If the patient is negative and it has been over 24 hours since the previous test, repeat the screen upon transfer to another unit, discharge and death. The transferring nurse is responsible for completing the screen. 4) Orders for screening are a part of admission, transfer and discharge order sets. If the order does not get entered, an RN can enter per policy.

2 Different Types of MRSA Screening Tests Use swab with red cap (think red for “rapid”) on admission and transfer when a quick result is important to determine room placement. Use a swab with blue cap (think blue for “bye bye”) when a patient is being discharged or has expired. These are less costly and are completed within 48 hours.

IC enters a note to identify patients with MDROs IC enters a note to identify patients with MDROs. This can be found by clicking on the “Postings” box in the patient electronic record.

MRSA Posting Note

C difficile Posting Note

Regulated Medical (red bag)Waste *Wring – Fling – Sling* Waste that is contained can be disposed of in the regular trash. Bulk infective waste must be bagged in red or biohazard labeled bags and placed in biohazard containers Regulated Infective Waste: Bulk blood, suctioned fluids, excretions, and secretions may be carefully poured down a drain connected to a sanitary sewer. Blood and bodily fluids that cannot be contained or tissue must be disposed of in Red Bag waste.