West Liberty Health Sciences

1. West Liberty Health Sciences OSHA’s Bloodborne Pathogens Standard Prevention of Healthcare Associated Infections and Multidrug Resistant Organism Transmission

2. Bloodborne Pathogen Standard:Exposure Control Plan • The Exposure Control Plan contains policies/procedures for OSHA’s Bloodborne Pathogen Standard • Found in each institution’s Library • Bloodborne Pathogen Standard • You are covered if it is reasonably anticipated that you could be exposed to blood or other potentially infectious body fluids as a result of performing your job duties

3. Exposure Control Plan (cont.) • Details what measures will be taken to minimize your risk of exposure • Explains what procedures to follow if there is an exposure incident • Includes a method of identifying and evaluating safety devices such as protective sharps.

4. Bloodborne Pathogens • Human immunodeficiency virus (HIV) • Attacks the immune system • Hepatitis B virus (HBV) • Infects the liver • Hepatitis C virus (HCV) • Infects the liver

5. HIV • A number of people infected remain healthy for years • An infected person becomes seriously ill when the immune system loses its ability to fight infections • Some infected persons go on to develop Aquired ImmunoDeficiency Syndrome (AIDS)

6. HBV • Most people infected by HBV recover and clear the infection • About 6% of those infected become chronically infected for life • Each year, people die from chronic liver disease and liver cancer linked to HBV.

7. Hepatitis B Vaccine • HBV can be prevented by receiving the hepatitis B vaccine. • The vaccine is • Highly recommended • Given in a series of 3 shots in the arm • Safe • Very effective

8. HCV • Approximately 75% of persons infected will have no symptoms • Up to 85% will be chronically infected • Leading indicator for liver transplants • No preventative vaccine

9. How Bloodborne Diseases Spread • Bloodborne viruses are spread through contact with blood or other potentially infectious body fluids which includes • Semen and vaginal secretions • Body fluid containing visible blood • Cerebrospinal fluid (fluid around brain/spinal cord) • Synovial fluid (fluid in joints) • Pleural fluid (fluid around the lung)

10. How Bloodborne Diseases Spread • Peritoneal fluid (fluid in the abdomen) • Pericardial fluid (fluid around the heart) • Amniotic fluid (fluid in the uterus of a pregnant woman • Non-intact skin or organs

11. Transmission • To acquire a bloodborne pathogen blood or other potentially infectious body fluids must come in contact • With mucous membranes including of the • Eyes • Nose • Mouth • By contaminated sharp object puncture • Such as a needlestick • With non-intact skin • Skin abrasion • Acne

12. Reducing Your Risk • Standard Precautions • Engineering Controls • Work Practice Controls • Housekeeping • Administration of the hepatitis B vaccine

13. Standard Precautions • Based on the principle that the following are potentially infectious and must be treated that way • Blood and body fluids • Secretions and excretions • Non-intact skin • Mucous membranes • Remember: All body fluids pose a potential risk for infection

14. Standard Precautions involves: • Hand hygiene • Personal Protective Equipment • Respiratory Hygiene/Cough Etiquette • Safe Injection Practices

15. Hand Hygiene • Single most important practice to reduce the transmission of infectious agents • Includes handwashing and use of alcohol based product

16. Handwashing • HANDWASHING MUST BE DONE • If hands are visibly soiled • Before eating • After using the restroom • After caring for a patient with diarrhea or on contact precautions for stool • Stool may contain Clostridium difficile which forms spores that can only be eliminated by physical removal

17. Hand Hygiene Guidelines • Must be done with soap & water or alcohol handrub • Before and after patient contact regardless of glove use • After contact with the patient’s environment • Immediately before inserting an invasive device • When moving from a contaminated body site to a cleaner body site • After removing gloves

18. When they look or feel dirty Before preparing food or medication After eating After coughing or sneezing into your hand After blowing or wiping your nose OTHER SITUATIONS FOR HAND HYGIENE

19. Turn faucet on and adjust temperature to warm, not hot Apply soap to hands to allow for sufficient coverage of entire surface Scrub hands for 15 seconds Cover entire hand including fingernails and wrist Rinse hands completely in running water keeping hands lower than elbows Dry hands with paper towel Use a clean, dry paper towel to turn off faucet How To Perform Handwashing

20. Alcohol Based Handrub • Apply enough product to hands to cover all surfaces of hands and to remain wet for 15 seconds • Rub hands, fingernails and wrist area until dry

21. Fingernails • Artificial nails and gel products used on nails are not permitted • If you provide hands-on patient care • Perform diagnostic studies that required direct patient contact • Natural nails should be kept short.

22. Hand Hygiene for Patients and Visitors • Proper hand hygiene by patients and visitors will minimize environmental contamination • Instruct patient and visitors on hand hygiene including use of alcohol handrub • Provide patient with towelettes for use while in bed

23. Personal Protective Equipment (PPE) • Wear gown and gloves whenever you expect to touch blood and body fluids or contaminated surfaces • Wear mask and eye protection or face shield to protect from splashes of body fluid • Different tasks require different levels of PPE

24. WEARING PPE • PUT THE GOWN ON FIRST, THEN MASK, THEN GLOVES • REMOVE IN REVERSE ORDER. AVOID TOUCHING THE OUTER SURFACES OF THE PROTECTIVE GEAR • REMOVE GLOVES BY PINCHING FIRST GLOVE AND PEEL BACK. SLIDE UNGLOVED FINGER UNDER CUFF OF SECOND GLOVE AND PEEL BACK

25. WEARING PPE • Remove mask by touching the strings • Do not leave mask dangling around the neck! • Remove gown by loosening ties, pull down from below the neckline off the arms and roll inside out • Dispose of protective wear immediately • Perform hand hygiene

26. Gloves • Perform hand hygiene before donning gloves • Change gloves between tasks on the same patient • Change gloves after contact with material that may contain a high concentration of organisms • Change gloves between patients and before touching non-contaminated items and surfaces

27. Gloves (cont.) • Discard single use gloves after one use • If a glove tears, punctures, leaks or becomes contaminated, remove it as soon as possible • Wash hands to avoid transfer of microorganisms to other patients or environments.

28. Respiratory HygieneCough Etiquette • Cover coughs and sneezes • Perform hand hygiene • If unable to perform hand hygiene immediately, cough into arm or jacket • Have patients who are not able to comply wear a surgical mask when out of their room • Cover coughs and sneezes

29. Safe Injection Practices • Use aseptic technique to avoid contamination of sterile injection equipment • Do not administer medications from a syringe to multiple patients, even if the needle or cannula is changed • Use IV bags and other fluid infusion sets for one patient only

30. Safe Injection Practices (cont.) • Do not administer medications from single dose vials to multiple patients or combine leftovers for later use • Use single dose vials whenever possible • Do not store multiple dose vials in immediate patient treatment area • Do not use IV solutions as a common source for multiple patients

31. Engineering Controls • Isolate or remove hazards from the workplace and includes: • Sharps disposal containers • Sharps with engineered sharps injury protections • Needleless systems • Leakproof trash bags • Resuscitation equipment

32. Resuscitative Equipment • Use resuscitative mask or other ventilation devices to avoid mouth to mouth resuscitation • Resuscitative masks should be in all patient rooms and care areas • Replace as needed from storeroom stock • Ventilation equipment is located on crash carts

33. USING SHARPS SAFELY • Never recap needles • Never bend or break needles • Use safety engineered needles, syringes and scalpel blades • Deposit sharps immediately after use in a designated sharps container • Sharps containers should not be more than 3/4ths full to avoid accidental needlesticks

34. Work Practice Controls • Procedures you follow to reduce exposure to blood and body fluids such as… • Do not eat, drink, smoke, apply cosmetics or lip balms or handle contact lenses where blood or body fluids are present • Do not store food or drink in places where blood or body fluids are present • Never mouth pipette or mouth suction blood or body fluids • Minimize splashing or spraying of blood or body fluids

35. Other Safe Work Practices • Transport lab specimens in closed, leak-proof containers. • Do not let contaminated equipment touch your skin, mucous membranes, clothing, other patients, visitors or items in the environment • Make sure reusable equipment is not used on another patient until it has been properly cleaned • Single-use items should be discarded appropriately

36. Housekeeping • Keep linen away from your body to avoid contamination of clothes and arms • Clean frequently used surfaces often • Bedside stand • Clean blood and body spills immediately • Do not reach into trash containers or push trash down with your hands or feet. Instead gently shake down

37. Housekeeping (cont.) • Carry waste bags by the top, away from your body • Fluorescent orange-red labels, red bags, red containers and warning signs are designed to warn you that the contents contain blood or body fluids.

38. Low Level Disinfection • Performed on items that come in contact with intact skin • BP cuffs • Mattresses • Item must be • Dry • Visibly clean • Free of defects

39. Defective Items • Defective items • Mattress with tear or puncture • Rough surfaces on wooden chairs arms • Clean and disinfect item as needed • Place defective sticker on item • Remove from service • Report to manager

40. Low Level Disinfection Procedure • Use friction to clean item of all visible soil if present • Disinfect the surface by applying disinfectant from a clean germicidal wipe or spray bottle (i.e, Cavicide) and a clean towel • Wipe disinfectant over all surfaces using friction • Friction removes 98% of microorganisms and bacterial spores (Clostridium difficile) that the disinfectant cannot kill

41. Low Level Disinfection Procedure • Make sure surfaces are wet enough to assure proper exposure time required by the manufacturer’s label • Rewet if necessary to obtain the required exposure time • Cavicide/Caviwipes 3 minutes • Red top Sani-Cloth 5 minutes • Neither product kills C.diff spores • Hand soap is not to be used on inanimate objects.

42. Control Measures to Avoid Contamination of the Disinfectant • Empty and rinse spray bottles before refilling • Do not “top off” bottle • Do not leave residual water in the bottle • Avoid contamination of bottle straw • Always read the manufacturer’s label for exposure time and appropriate storage • Store in closed container • Avoid storing in sunlight

43. What To Do If Exposed to Blood or Other Potentially Infectious Body Fluids • Act quickly, because for some infections, treatment should start right away • Post-exposure prophylaxis for HIV should begin within hours (i.e., 4 hrs ) of the exposure • Remember that an exposure does not always lead to infection

44. What To Do If Exposed • Wash the exposed area with soap and water • If contaminated material gets in your eyes or mucous membranes, flush them with large amounts of water • Report the exposure to your supervisor • Report to EMSTAR

45. Healthcare-Associated Infections • Infections patients acquire during the course of receiving treatment for other conditions • Account for an estimated 2 million infections and 90,000 deaths • $26-$33 billion in added healthcare cost • 70% can be prevented by implementing what we know for prevention

46. Multidrug-Resistant Organism (MDRO) • MDROs are bacteria resistant to one or more of the best drugs we have to treat them which makes infections difficult treat. • Two-thirds of the bacteria that cause HAIs are MDROs

47. MDROs of concern • Methicillin resistant Staph aureus (MRSA) • Vancomycin resistant Enterococcus (VRE) • Extended spectrum beta-lactamase (ESBL) • Occurs with gram negative bacteria • E.coli • Klebsiella pneumonia • Klebsiella producing carbapenemase (KPC) • Acinetobacter baumanii

48. Identification of MDROs on culture reports • ESBL • ESBL is listed beneath antibiotics on culture • Positives are indicated with a (+) sign • KPC • Comment will be added beneath Klebsiella on the culture report indicating the organism is positive for KPC

49. Most Common HAIs • Clostridium difficile associated diarrhea • Catheter associated urinary tract infections • Central line-associated bloodstream infections • Surgical site infections • Ventilator associated pneumonia

50. Clostridium difficile Infection • Most common cause of infectious diarrhea diagnosed in the hospital • A virulent strain exists that is causing epidemics with significant mortality • Forms spores that can persist in the environment for months • Can only be physically removed by • Handwashing (do not use alcohol handrub) • Friction with environmental cleaning