2. INFECTION CONTROL

3. THE INFECTION CONTROL STAFF INTEGRIS BAPTIST INTEGRIS SOUTHWEST V. Ramgopal, M.D., Hospital Epidemiologist Gwen Harington, RN, BSN, CIC, Infection Control Specialist Kathy Knecht, RN, Surveillance Coordinator D. Chansolme, M.D., Hospital Epidemiologist Becky Lewis, RN, Infection Control Specialist

4. Who can Place a Patient in Isolation Attending MD to order isolation as indicated by the Centers for Disease Control Guidelines. Hospital Epidemiologist and Infection Control Specialist have authority to isolate and/or transfer any patient to a private room as indicated. By using CDC Guidelines, the licensed nurse responsible for the patient can institute isolation if notified that the patient has a positive culture for resistant organisms, i.e., MRSA, VRE, or Clostridium difficile. Physician order is necessary for the discontinuation of isolation.

5. Criteria for Placing Isolation Patients diagnosed with resistant organisms need to remain in the same location unless they are occupying a semi-private room, need to be transferred to an ICU bed, or need to be transferred from an ICU bed to a patient-care floor. Patients previously admitted with a positive culture of a resistant organisms should be placed in isolation immediately upon readmission. Reference: Policy #IC-112 Readmissions with Resistant Organisms.

6. PERSONAL PROTECTIVE EQUIPMENT This equipment is located in Barrier Boxes throughout each medical center and in the each patient room. The equipment is provided to protect employees against exposure to blood and body fluids.

7. BLOODBORNE EXPOSURE Report IMMEDIATELY to your supervisor. Complete exposure incident report. Go to Employee Health Services ASAP. – If after hours or on weekend, contact House Supervisor. – If regular clinic hours and unable to go immediately, contact EHS by phone to report incident and begin patient testing.

8. BLOODBORNE PATHOGENS & TUBERCULOSIS EXPOSURE CONTROL PLANS These plans are updated annually and are located in the following places: – Infection Control Master Manual – Integris Intranet – Infection Control website – The Public Folders

9. PATIENT PLACEMENT FOR TUBERCULOSIS PATIENT PLACEMENT FOR TUBERCULOSIS Any patient with positive AFB smear, probable or known Tuberculosis, must be placed in negative pressure room. IBMC Negative pressure rooms are located on East Tower floors 7, 8, 9, & 10 East; there are two rooms in 901 ICU. The only exception on the West Tower is in the 9West Cardiac suites; this area has one negative pressure room. ISMC Negative pressure rooms are on floors 6, 7, and 10 and in the ICU. Jim Thorpe Rehab Hospital has one isolation room on the 2 nd and 3 rd floors. Contact Infection Control or Environmental Health and Safety for any problems or questions.

10. FIT TESTING OF TUBERCULOSIS MASKS Must be fit-tested for mask when entering the room for patients with known or suspected Tuberculosis. All fit testing is done by employee health.

11. ISOLATIONPRECAUTIONS IN A NUTSHELL

12. STANDARD PRECAUTIONS Use with ALL patients regardless of diagnosis or presumed infection. Use when there’s a chance of contact with: – blood – any body secretions or excretions – broken skin – mucous membranes

13. STANDARD PRECAUTIONS Hand Washing Hand Washing – BEFORE and AFTER patient contact – BEFORE putting on or taking off gloves – AFTER touching blood or other body substances, contaminated patient equipment, broken skin, or mucous membranes – BETWEEN different procedures on the same patient – BEFORE leaving the patient’s room – Wash your hands for if using soap and water. – Wash your hands for 15 seconds if using soap and water. –When using alcohol foam rub your hands together until hands are completely dry. –http://www.hhs.gov/ash/initiatives /hai/training/http://www.hhs.gov/ash/initiatives /hai/training/

14. STANDARD PRECAUTIONS Wearing Gloves Wearing Gloves – BEFORE any procedure that may involve contact with blood or other body substances, broken skin, or mucous membranes. – BEFORE touching any potentially contaminated object. – CHANGE gloves after touching infective material such as fecal material and wound drainage.

15. STANDARD PRECAUTIONS Wearing Face and Eye Protection Wearing Face and Eye Protection –Use a mask and face and eye protection when the possibility exists that blood or other body fluids may be splashed or sprayed

16. STANDARD PRECAUTIONS Wearing Gowns Wearing Gowns –Use a gown if splashing or spraying of blood, body fluids, secretions or excretions is possible.

17. STANDARD PRECAUTIONS Handling Patient-Care Equipment Handling Patient-Care Equipment – Handle patient-care equipment that is 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 micro- organisms to other patients and the environment. –Appropriately dispose of single-use equipment. – Sterilize or disinfect reusable equipment according to policy. –Properly clean and disinfect equipment that is shared by more than one patient.

18. Standard Precautions Any piece of contaminated equipment that will not be immediately cleaned as part of room turnover should be covered with a blue bag labeled as “soiled”. Equipment that has been cleaned and decontaminated should be covered with a clear bag. Even if it will be used within a short time.

19. STANDARD PRECAUTIONS Sharps Sharps – Never recap used needles – Deposit sharps in the sharps container immediately after use – Call housekeeping to come and replace the sharps container when it is half full

20. STANDARD PRECAUTIONS Handling Linen Handling Linen –Do not put linen on the floor. –Drape an open plastic bag over a chair and place dirty linen in the bag. –After removing bag with dirty linen from a patient’s room place it in the covered dirty linen bin on your unit.

21. 3 CATEGORIES OF ISOLATION PRECAUTIONS TO BE USED IN ADDITION TO STANDARD PRECAUTIONS

22. CONTACT PRECAUTIONS This category is used for patients known to be infected or colonized with important microorganisms that can be transmitted by direct contact with the patient.

23. CONTACT PRECAUTIONS Common Conditions That Require Contact Isolation: MRSA (all body sites) VRE (all body sites) C. DIFFICILELICE MAJOR ABSCESSESSCABIES CELLULITIS, DECUBITIRSV

24. CONTACT PRECAUTIONS Private room necessary. Gloves MUST be worn when entering patient’s room. Gown MUST be worn when entering patient’s room, if you anticipate your clothing will have substantial contact with patient, environmental surfaces, or items in patient’s room. Transport: limit movement and transport of patient from the room for essential purposes only. Patient-Care Equipment: dedicate the use of non- critical patient-care equipment to a single patient to avoid sharing between patients. In unavoidable, clean and disinfect before using on another patient.

25. AIRBORNE PRECAUTIONS This category is used to prevent the spread of infectious small particles that remain suspended in the air and can be widely dispersed by air currents.

26. AIRBORNE PRECAUTIONS Common Conditions That Require Airborne Isolation: TUBERCULOSIS VARICELLA (Chickenpox)

27. AIRBORNE PRECAUTIONS Private room with NEGATIVE air pressure. KEEP DOOR CLOSED. Wear respiratory protection when entering the room of those patients with known or suspected pulmonary tuberculosis. YOU MUST HAVE BEEN FIT-TESTED BEFORE YOU WEAR RESPIRATORY PROTECTION AND ENTER THE ROOM OF A PATIENT WITH KNOWN OR SUSPECTED PULMONARY TUBERCULOSIS. Patient transport: limit transport and movement to essential purposes only. If moving patient is necessary, place a SURGICAL MASK on the patient.

28. DROPLET PRECAUTIONS This category is used to prevent the spread of large particles that can be created by certain medical procedures or by coughing, sneezing, or talking.

29. DROPLET PRECAUTIONS Common Diagnosis That Require Droplet Isolation: INFLUENZAPERTUSSIS HAEMOPHILUS INFLUENZAE B MENINGITIS, PNEUMONIA AND SEPSIS NEISSERIA MENINGITIDIS MENINGITIS, PNEUMONIA AND SEPSIS

30. DROPLET PRECAUTIONS Private room necessary Mask MUST be worn when working within 3 feet of the patient Patient transport: limit transport and movement to essential purposes only. If moving patient is necessary, patient MUST wear a SURGICAL MASK

31. IF YOU HAVE ANY QUESTIONS, PLEASE CALL INFECTION CONTROL IBMC @ 949-3785 ISMC @ 636-7614