Infection Control Update

Infection Control Update Go Gators! Shands HealthCare Infection Control 2001

Learning Objectives • Upon completion of the self-study module, the learner will be able to: • Discuss key elements of the infection control program • Describe the Bloodborne Pathogen Exposure Control Plan • Describe the TB Control Plan • Describe key elements of the Biohazardous Waste Management Plan • Discuss their individual role in Infection Control

Infection Control is Everyone’s Business Family/Visitors Administrators Physicians Hospital Ambulatory Care Center Therapists CNA/PCA/CMA Environmental Services Nurses Clerks Patients

Infection Control: Basic Elements Prevention Surveillance Control

The Infection Control Team • Hospital Epidemiologist: Jennifer White Janelle, MD • Infection Control Committee Chairman: Richard R. Gutekunst, Ph.D. • Infection Control Director: Loretta L. Fauerbach, MS, CIC • Infection Control Practitioners: Mary Ann Gross, MT, CIC Robert Kelly, RN Charlene Ruse, MT, ASCP Kay Stauffer, RN, CIC • Shands Healthcare Staff YOU!!

Infection Control Policy Manual: Location and Key Contents • Shands at UF Infection Control Policies (PM03) • Yellow Infection Control (IC) Manual • Department/Clinic-specific Infection Control Policies • in front of yellow IC manual • Biohazardous Waste Management Plan • PM03-04--Appendix L and Clinic IC Policy • Bloodborne Pathogen Exposure Control Plan • Clinic IC Policy and PM03-01, Appendix B • TB Control Plan • Clinic IC Policy and PM03-01, Appendix C Infection Control Manual

Variance Procedure (IC manual PM 03-01, Appendix A) • An Infection Control variance is any observation of an infraction of infection control policy or good infection control practice.

Your Infection Control Responsibilities • Know and comply with infection control policies and procedures • Recognize potential infection problems • Report variances • Communicate! Document! • Teach patient and care givers

CHAIN OF INFECTION Airborne Vector AGE PATIENT Vehicle Treatment EMPLOYEE Method of Transmission Immunity Nutrition ENVIRONMENT EQUIPMENT DISEASE Skin Injury CONTACT VISITORS Life Style Direct Indirect Socioeconomics SOURCE HOST

Health Care Associated Infections • Infections associated with hospitalization are called “nosocomial infections • “Iatrogenic infections are related to care provided in other health care settings, such as ambulatory surgery centers or clinics. • May not be preventable • Not present on admission to hospital or prior to treatment in ambulatory care • May be detected after discharge from hospital or after outpatient treatment Examples: Surgical Site Urinary Tract Bloodstream

Unfortunate 5% Patients at high risk for NI • Transplant patients • Chemotherapy patients • Other Immunocompromisedpatients

Risk Factors:Devices • Foley Catheters • Ventilators • Other tubes • IVs/CVLs • Implants

Consequences of Hospital Acquired Infections • Complicate Treatment • Cause Additional Suffering • Increased Costs ($4.5 billion/yr) • prolonged hospital stay • drug treatment • additional surgery • Cause Death

Wash Your Hands!! • Studies have shown that healthcare worker compliance with handwashing recommendations is 42% ---- What is your percentage?

Proper handwashing is VITAL to infection prevention Wash your hands, even if gloves have been worn Before patient contact After contact with anything contaminated Between contact with different patients During patient care (per procedures) before and after invasive procedure before and after contact with wound between procedures on different body parts of the same patient Between glove changes Immediately, if skin is contaminated or an injury occurs

How should I wash my hands? • In non-patient care areas and activities, the hospital-approved lotion soap should be used. • For patient care activities, use hospital-approved antimicrobial soap (Hibiclens®, Cida-Stat®, or Endure 420®). • For best results when using soap and water, use friction and lather for 10-15 seconds • As a supplement to or in place of handwashing, use hospital-approved alcohol-based hand rinse. • Squeeze generous amount (at least a teaspoon) into cupped hands. Rub vigorously until dry - - about 10-15 seconds.

Key Points for Cleaning & Disinfection of Environmental Surfaces/Patient Care Equipment • First remove gross debris and organic matter by cleaning • If cleaning equipment in your unit or department, use designated cleaning area • Only use disinfectants approved by Infection Control - see PM03-10 • Be sure to follow the manufacturer’s directions for use on the container’s label • Bleach is the cheapest & best disinfectant • For 1:10 dilution: make fresh daily • For 1:5 dilution: use for 30 days

Bloodborne Pathogens Exposure Control Plan • Purpose: To provide a safe working environment and reduce the risk of exposure to bloodborne pathogens • Location: Infection Control Manual -- PM03-01, Appendix B

Personal Protective Equipment Job Task List Engineering Controls Work Practice Controls Post Exposure Management Biohazardous Labeling Waste Management Bloodborne Pathogen Training Bloodborne Pathogens Exposure Control Plan

Standard Universal Precautions • Consider all blood and body fluids potentially infectious. • Use Personal Protective Equipment (PPE) to prevent exposure. If it is wet and sticky and not yours, DO NOT touch it… without gloves!

Standard Universal Precautions (cont’d) • Handwashing • Gloves • Eye and face protection • Gowns • Pt. Care equipment • Environmental controls • Linens • Occupational Health and bloodborne pathogens exposure reduction

Types of Isolation(in addition to Standard Universal Precautions) • Airborne Transmission(requires negative air pressure room) • Strict (disease spread by both airborne and contact routes) • Respiratory • Droplet Transmission: • Droplet/Pediatric Respiratory • Contact Transmission: • Contact • Enteric • Vancomycin Resistant

Communication of Isolation • Notify departments receiving patient for testing, unit to which patient is being transferred, clinics where patient is to be seen (clinics notify inpatient unit when patient being admitted]. • If MRSA/VRE, “Resistant Organism” sticker will be placed on chart • Appropriate isolation/precaution sign on door and/or above patient’s bed. • Enter isolation code in “enter/revise patient factors” screen

Personal Protective Equipment (PPE) • Gloves • Gown • Protective Eye and Face Shield • Masks • Others • Boots, shoe covers • CPR shield

Job Task List Know what PPE you should wear for each task you perform.

BE CAREFUL WITH SHARPS • Do not recap by hand • Use one-hand technique or a recapping device--only if recapping is unavoidable. • Use safety syringes, needle-less IV system and other safety products whenever possible. • Replace sharps containers when 3/4 full • Immediately dispose of sharps in sharps container

ENGINEERING CONTROLS • Sharps containers • Safety needles (self - sheathing) • Needle-less IV system • Safety “butterfly” • Plastic page protectors • CPR face shields • PEVCO tube system

Work Practice Controls • Handwashing • Do not recap needles by hand • No food/drink in refrigerators with blood or other infectious materials • Do not drink, eat, apply cosmetics/lip balm, or handle contact lenses in areas where blood/body fluids may be present • Keep work area clean and decontaminated • Use proper cleaning/disinfecting/sterilization practices for equipment and work areas

Waste Management Biohazardous vs. Regular

Method for sealing boxes    Twist excess bag from the top of the waste to the end of the bag Remove excess air from bag Tape the twisted part of the bag   Tape the flaps to form a “H” design Loop the twisted and taped end of bag over itself and tape again

Labeling - DOT Regulations for biomedical waste • Sharps containers • Red bags • Cardboard biomedical waste disposal boxes Must be labeled with the name and location of the facility generating the waste

Hepatitis B Hepatitis C HIV Malaria Syphilis Babesiosis Brucellosis Leptospirosis Bloodborne Pathogens • Arboviruses • Relapsing fever • CJD • HTLV - I & II • Viral hemorrhagic fever

Hepatitis B • Incubation period = 6 weeks-6 months • May shorten life span 10-20 years • Reported cases of acute Hepatitis B in US decreased 50% in last decade (21,102 in 1990 to 10,258 in 1998)

Hepatitis B Transmission Blood to Blood Sexual contact Perinatal transmission

Hepatitis BPrevention • Vaccination • Standard Universal Precautions • Safer Sex • No Sharing Needles

Hepatitis C • 16% of viral hepatitis cases • Incubation Period = average 6-7 weeks • (Range 2-26 weeks) • 3.9 million have been infected • 2.7 million are chronically infected • 70% of infected persons develop chronic liver disease • $600 million annually in medical and work loss expense - - not including transplantation.

Hepatitis C TransmissionBlood-to-Blood May cause post transfusion hepatitis 50-60% of cases are associated with IV drug use 2% of cases are HCW* infected through occupational exposure to infected blood

Hepatitis C Prevention • Standard “Universal” Precautions • Reduce risk by personal choices • NO VACCINE

Epidemiology of AIDSAs of December, 1999 World wide, an estimated 33.6 million people are living with AIDS 743,534 reported cases in USA since 1980 43% of new cases are women

States/Territories Reporting Highest Number AIDS Cases in USA(Data as of December, 1999)

AIDS Epidemiology • Florida is SECOND in the US in reported cases of AIDS in women and children. 1980-1999 Pediatric cases-- USA = 11,643; Florida = 1,375 Women-- USA = 115,756; Florida = 16,319

HIV Transmission • Sexual Contact • Mother to Infant • Blood Contact • IV needle sharing • Blood products including transfusion • Healthcare worker exposure to blood and body fluid

Personal Prevention Measures • Abstain from sex with infected person • Discuss sexual history with partners • Reduce number of sexual partners • Always use latex male condoms or polyurethane female condoms • Use only water-soluble lubricants with condoms • Avoid illicit drug use and sharing of needles

All positive HIV tests reported to Florida Department of Health Exceptions to reporting: • tests performed at anonymous test sites • tests of patients performed because of employee blood/body fluid exposure • tests performed on employee following blood/body fluid exposure • certain HIV/AIDS research settings

Informed Consent • Patient must give informed consent to be tested for HIV • Written informed consent is best • Place on chart

When is informed consentnot required? • A bona fide medical emergency that requires knowledge of the patient’s HIV status for medical management • If knowledge of testing would be detrimental to patient and is necessary for medical management purposes to provide appropriate care. • If consent is obtained for autopsy, specific HIV consent not required • If tissue/blood is being donated

Exception to Informed Consent Following a Healthcare Worker Exposure Source patient may be tested without informed consent only when: • There has been a significant exposure • There is existing blood available • The exposed employee consents to be tested or has a documented HIV test within the previous 6 months • The source patient dies during emergency treatment. • The patient has been asked to consent and has refused. Patient must be told that testing will be done under Florida Law. • Results are not placed in patient’s medical record.

Mandatory Offering of Testing to Pregnant Females • Providers of care to pregnant women must offer HIV testing and explain benefits of early treatment of HIV infection in decreasing transmission to infant • Emphasize education for high risk patients • Refer to substance abuse programs as needed • Act as liaison with other services • Mother’s HIV test results may be noted in child’s medical record

United States Healthcare Workerswith Documented Occupationally Acquired HIV --1980-1999

Occupationally Acquired HIV in US Healthcare Workers(through December ‘99) 56 confirmed cases 48 percutaneous 5 mucocutaneous 2 both 1 unknown route

Infection Control Update