1. GBMC Agency Nurse Orientation
Infection Control
GBMC Agency Nurse Orientation

2. Infection Control Nurse Orientation
Objectives:
Describe the role of isolation in preventing the spread of certain infections
Describe each type of isolation with examples of diseases
Understand significance of correct sequence of donning and removing PPE.
ISOLATION – foundation for preventing transmission of infectious agents associated w/healthcare delivery
Role – creates a protective environment that is required to contain the transmission of infectious agents

3. Infection Control Nurse Orientation
Objectives:
Understand the significance of antibiotic resistant organisms seen in hospitals
Understand how surveillance for hospital acquired (nosocomial) infections is performed and the significance of surveillance data
Antibiotic Resistant – Global Health Problem
Increasing morbidity
contributes to increasing mortality
increase hc costs – nosocomial pathogens est to exceed 1.3 Billion annually

4. Chain of Infection Break The Chain
Pathogen
Susceptible Host
Reservoir
Break The Chain
Portal of Entry
Portal of Exit
Break the chain - pathogen – appropriate antibiotics
Reservoir – patients – frown when we get rid of them
portal of exit – Mask
mode of transmission – isolation
portal of entry – N-95 resp
susceptible host - immunizations
Mode of
Transmission
Why Isolation?.. because transmission is easier to control than the source / host!

5. What is Infection Control?
Identifying and reducing the risk of infections developing or spreading

6. Nosocomial Infections
Develops when a patient is staying at a healthcare facility AND was not present when the patient was admitted to the facility
At least 5% of patients hospitalized each year in the United States develop nosocomial infections. Many are preventable

7. Standard Precautions
Guidelines for preventing exposure to blood, body fluids, secretions, excretions (except sweat), broken skin, or mucous membranes
Based on the concept that body fluids from ANY patient can be infectious
Should be used on every patient
Use necessary PPE for protection
CDC guidelines requires us to use category-specific isolation (ex – TB isolation) in addtion to Standard Precautions when a patient is known or suspected to have an infection
The front of the mask is considered contaminated and should not be touched. Remove by handling only the ties or elastic bands starting with the bottom then top tie or band. Lift the mask or respirator away from the face and discard it into the designated waste receptacle.

8. Antibiotic Resistant Microorganisms normal flora gone bad!
Problem exists because of overuse and inappropriate use
Resistant to multiple antibiotics
Reduced options for treatment
Require isolation precautions
Examples: MRSA, VRE, MDR TB
Solutions: more appropriate antibiotic use, better infection control and prevention

9. CONTACT ISOLATION
used to prevent transmission of microorganisms spread by direct/indirect contact with the source
examples:
MRSA
VRE
C. diff
contagious skin infections… Lice & Scabies
Contact infection control re: shampoo for lice/scabies – ok have found lack of contact for VRE/MRSA

10. GBMC’s Contact Isolation Precautions Sign – ORANGE Inform Families to WASH THEIR HANDS!

11. CONTACT ISOLATION BASIC COMPONENTS: gloves fluid impervious gown
HANDWASHING

12. HAND WASHING
Proper hand washing is the single most important ay to prevent and reduce infections
Wash and rinse hands for 15 seconds, using a dry paper towel to turn off faucet
Avagard alcohol based hand wash is also available in all patient care areas
Hands should be washed:
Before and after patient contact
Before putting on gloves and after taking them off
After touching blood and body substances (or contaminated patient-care equipment), broken skin, or mucous membranes (even if you wear gloves)
Between different procedures on the same patient

13. DROPLET ISOLATION
used to prevent transmission of microorganisms spread by large, moist droplets inhaled by or landing on the mucous membranes of the susceptible host
examples:
Influenza
Neisseria meningitidis
some pneumonias
vaccine preventable diseases:
rubella, mumps, pertussis
Anytime pt arrives and order to R/O MENIGITIS – PLACE IN ISOLATION IF YOU THINK YOU HAVE IT – ISOLATE!
IF viral – ZERO isolation required
IF BACTERIAL – will do gram stain/bacterial latex antigen testing
GPC – CHAIN STREP
GPC – Clusters/pairs STAPH
ONLY IF NEISSERIA MENINGITIDIS GNDC REMAIN IN ISOLATION

14. GREEN

15. DROPLET ISOLATION BASIC COMPONENTS surgical mask within 3 foot zone
HANDWASHING

16. AIRBORNE ISOLATION
used to prevent transmission of microorganisms spread on very small particles that drift on air currents (droplet nuclei, dust)
examples:
pulmonary Tuberculosis
varicella
measles
BLUE – IF YOU THINK YOU HAVE IT – ISOLATE
TB – AFB – ACID FAST BACILLI 3 NEG’S = CLEAR
A + AFB DOESN’T MEAN TB - THAT’S WHY WE DO 3 – SENT FOR CULTURE TAKES 6-8 WKS
40% OF +AFB ARE NEGATIVE
STANDARD – 3 AFB SPECIMENS – 1ST THING IN THE MORNING
CXR – “CAVITATIONS” +TB

17. Shingles vs. Chicken Pox
Both are caused by the varicella virus
Shingles remain along nerve roots and appear on a single dermatome
Shingles involving multiple dermatomes or an immunocompromised patient (WBC <4.0) consider this to be systemic and isolate just like chicken pox (airborne)

18. blue

19. AIRBORNE ISOLATION BASIC COMPONENTS:
negative air pressure isolation room
door remains closed
fit-tested N95 respirator
Call Engineering (ext. 2060) with room # to check negative pressure.
yes… HANDWASHING!

20. Surveillance Activities
Operative Procedures
Critical Care Units (MICU, SICU, NICU)
Targeted Surveillance
Outbreak Investigation

21. Benchmarking Hospital Acquired Infections
CDC’s Hospital Infections Program
Submit monthly data on ICU infections
Benchmarking with similar hospitals
Networking opportunities
Annual reports

22. You can help by reporting suspected HAI
Surveillance Data
USES
Improve patient outcomes by
modifying patient care practices
reducing length of stay
Identify education needs
Evaluate new products
Identify new opportunities for improvement
You can help by reporting suspected HAI
on the infoweb!

23. Latex Allergy
Latex can cause allergies in some healthcare workers and patients
All of our non-sterile gloves are latex free
If you have any type of skin or other reaction to wearing latex gloves, tell the Charge Nurse

24. Key Points About PPE
Don before contact with the patient, generally before entering the room
Use carefully – don’t spread contamination
Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room
Immediately perform hand hygiene
There are four key points to remember about PPE use. First, don it before you have any contact with the patient, generally before entering the room. Once you have PPE on, use it carefully to prevent spreading contamination. When you have completed your tasks, remove the PPE carefully and discard it in the receptacles provided. Then immediately perform hand hygiene before going on to the next patient.

25. Sequence for Donning PPE
Gown first
Mask or respirator
Goggles or face shield
Gloves
The gown should be donned first. The mask or respirator should be put on next and properly adjusted to fit; remember to fit check the respirator. The goggles or face shield should be donned next and the gloves are donned last. Keep in mind, the combination of PPE used, and therefore the sequence for donning, will be determined by the precautions that need to be taken.

26. How to Safely Use PPE Keep gloved hands away from face
Avoid touching or adjusting other PPE
Remove gloves if they become torn; perform hand hygiene before donning new gloves
Limit surfaces and items touched
In addition to wearing PPE, you should also use safe work practices. Avoid contaminating yourself by keeping your hands away from your face and not touching or adjusting PPE. Also, remove your gloves if they become torn and perform hand hygiene before putting on a new pair of gloves. You should also avoid spreading contamination by limiting surfaces and items touched with contaminated gloves.

27. “Contaminated” and “Clean” Areas of PPE
Contaminated – outside front
Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside
Clean – inside, outside back, ties on head and back
Areas of PPE that are not likely to have been in contact with the infectious organism
To remove PEP safely, you must first be able to identify what sites are considered “clean” and what are “contaminated.” In general, the outside front and sleeves of the isolation gown and outside front of the goggles, mask, respirator and face shield are considered “contaminated,” regardless of whether there is visible soil. Also, the outside of the gloves are contaminated.
The areas that are considered “clean” are the parts that will be touched when removing PPE. These include inside the gloves; inside and back of the gown, including the ties; and the ties, elastic, or ear pieces of the mask, goggles and face shield.

28. Sequence for Removing PPE
Gloves
Face shield or goggles
Gown
Mask or respirator
The sequence for removing PPE is intended to limit opportunities for self-contamination. The gloves are considered the most contaminated pieces of PPE and are therefore removed first. The face shield or goggles are next because they are more cumbersome and would interfere with removal of other PPE. The gown is third in the sequence, followed by the mask or respirator.

29. Where to Remove PPE
At doorway, before leaving patient room or in anteroom*
Remove respirator outside room, after door has been closed*
The location for removing PPE will depend on the amount and type of PPE worn and the category of isolation a patient is on, if applicable. If only gloves are worn as PPE, it is safe to remove and discard them in the patient room. When a gown or full PPE is worn, PPE should be removed at the doorway or in an anteroom. Respirators should always be removed outside the patient room, after the door is closed. Hand hygiene should be performed after all PPE is removed.
* Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

30. Removing Isolation Gown
Unfasten ties
Peel gown away from neck and shoulder
Turn contaminated outside toward the inside
Fold or roll into a bundle
Discard
Unfasten the gown ties with the ungloved hands. Slip hands underneath the gown at the neck and shoulder, peel away from the shoulders. Slip the fingers of one hand under the cuff of the opposite arm. Pull the hand into the sleeve, grasping the gown from inside. Reach across and push the sleeve off the opposite arm. Fold the gown towards the inside and fold or roll into a bundle. (Only the “clean” part of the gown should be visible.) Discard into waste or linen container, as appropriate.

31. Removing a Mask Untie the bottom, then top, tie Remove from face
Discard
The front of the mask is considered contaminated and should not be touched. Remove by handling only the ties or elastic bands starting with the bottom then top tie or band. Lift the mask or respirator away from the face and discard it into the designated waste receptacle.

32. Removing a Particulate Respirator
Lift the bottom elastic over your head first
Then lift off the top elastic
Discard
The bottom elastic should be lifted over the head first. Then remove the top elastic. This should be done slowly to prevent the respirator from “snapping” off the face.

33. Hand Hygiene Perform hand hygiene immediately after removing PPE.
If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE
Wash hands with soap and water or use an alcohol-based hand rub
Hand hygiene is the cornerstone of preventing infection transmission. You should perform hand hygiene immediately after removing PPE. If your hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE. Wash your hands thoroughly with soap and warm water or, if hands are not visibly contaminated, use an alcohol-based hand rub.
* Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

34. Handling Patient Care Equipment
Handle patient care equipment soiled with blood, other body fluids, secretions, or excretions in a way that prevents contact with skin and mucous membranes
Handle patient care equipment in a way that prevents contamination of clothing and the spread of microorganisms to other patients
Appropriately dispose of single use equipment (suction canisters, etc)
Clean and disinfect reusable equipment. Place clean instruments in biohazard bag for transport to Central Sterile Supply and re-sterilization

35. In addition, contact precautions require that you:
Don’t share non-critical equipment (such as stethoscopes and thermometers) between patients
If a piece of equipment is used with a patient in contact isolation, then the equipment must be properly cleaned and disinfected prior to use on another patient
Place a patient on airborne, contact, or droplet precautions in a private room, if possible
If a private room is not available, the patient may be placed with another patient who has the same (but no other) infection

36. What to do if exposed to blood / body fluids
Puncture wounds should be washed immediately and the wound should be caused to bleed
If skin contamination should occur, wash the area immediately
Splashes to the nose or mouth should be flushed with water
Eye splashes require irrigation with clean water, saline, or a sterile irritant
Most importantly: Complete a GBMC Employee Incident Report. Report exposure to charge nurse and Agency immediately

37. Need Infection Control?
Office - 5th floor.
InfoWeb:
- Contact Us
- How to Enter
Isolation into
Meditech
- Frequently
Asked ???
- Policies &
Procedures
- And..so much
more!

38. InfoWeb…….

39. Finished!
Please complete the Infection Control post-test and print out the certificate of completion for your agency