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

2. Infection Control Policy HPM 36 on the SharePoint Site

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. Respiratory Protection Program Resources

11. 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.

12. 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!

13. “ZEROing in on MRSA.”

14. 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

15. 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.

16. 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.

17. 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.

18. MRSA Posting Note

19. C difficile Posting Note

20. 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.