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2. Infection Preventionfor Patient Care Services2013 Isolation and Precautions Bloodborne Pathogen Standard TB Control Plan Multidrug Resistant Organisms

3. Understand the different types of transmission based precautions and isolation Understand the Bloodborne Pathogen Standard Understand the TB Control Plan Know what services are available through Occupation Health Services Understand what MDR-organisms are and how to prevent transmission Understand contact time with regards to disinfection Objectives

4. Mandatory Requirements that keep our staff and patients safe • Infection Control Education is a Mandatory Annual • Requirement as stated in: • OSHA Bloodborne Pathogens Standard 1910.1030 • April, 2001 and • Guidelines for Preventing the Transmission of • Mycobacterium tuberculosis in Healthcare Facilities, • 2005.

5. Isolation and Precautions - More Safety Activities • Along with good hand hygiene, Standard Precautions • and disease specific precautions help prevent the • transmission of organisms.There are 6 types of • precautions used at Karmanos: • 1. Standard Precautions • 2. Contact Precautions • 3. Contact Precautions with Special Cleaning • 4. Droplet Precautions • 5. AFB Isolation • 6. Airborne Precautions

6. Standard Precautions • Standard Precautions – is used with • all patients and assumes that all patients are • infectious. • Protective barriers called Personal Protective • Equipment(PPE) includes gloves, • goggles/eye shields, masks and gowns are • used to prevent contact with patients’ blood or • body fluids. • The type of activity or task determines the amount • and type of PPE to be used. The greater the risk • of coming in contact or being splashed with the • patients’ blood or body fluids, the more protection • is needed.

7. Standard Precautions Personal Protective Equipment (PPE) -Masks • Masks, eyewear and face shields protect your eyes, nose and mouth. • from splashes or splatters of blood and body fluids • Make sure to choose PPE that will protect your eyes, nose and mouth • if there is any chance of splash. • Examples of tasks when you should wear such PPE include: • Suctioning • Irrigating wounds • Cleaning contaminated equipment • Place disposable PPE into general waste container after use.

8. Standard Precautions Personal Protective Equipment (PPE) - Gloves • Gloves keep potentially infectious materials away from your hands • during contact with patient’s blood, body fluids, mucous • membranes, or broken skin. • Gloves also protect you from contact with infectious materials when • handling contaminated equipment, surfaces, linen or waste. • Remove gloves immediately after the task is done. Dispose gloves • into a general waste container. • Perform hand hygiene after removing and disposing gloves. • NEVER wash gloved hands. NEVER reuse disposable gloves. • Change gloves after each procedure; even if performing more than • one procedure on the same patient. • Standard exam gloves are latex-free.

9. Standard Precautions Personal Protective Equipment (PPE) – Gowns • Fluid-resistant gowns prevent blood and body fluids that • splash or spray from soaking through to your clothes and skin. • Dispose gowns after use in general waste container, NOT • medical waste biohazard container. • Some situations that may require wearing a gown include: • Irrigating a wound • Performing tracheostomy care • Any time blood or body fluid contamination to your clothes skin is likely

10. Airborne Precautions • Place patients in Airborne • Precautions if they have a disease • that is transmitted by the • airborne route (except • Tuberculosis). • These diseases include: • Chicken Pox/Varicella • Measles • Disseminated Herpes Zoster • (Shingles)

11. AFB Isolation • AFB Isolation is required for all • patients with or suspected of having • Tuberculosis (TB). TB is spread by • the airborne route. • ALLAFB Isolation cases require: • - A private, negative air pressure room where the air is exchanged 6-12 times per hour and exhausted to the outside of the hospital. • - All healthcare workers must wear a N-95 particulate respirator (N-95 PR) to enter the room. Refer to policy IC 125. • NOTE: This is a special mask that • must be fitted to each individual. Always fit-check your mask before entering the room. Make sure you know what size N-95 you wear.

12. If you are not able to wear a N-95 mask because you couldn’t be fit tested, you may be trained on the use of a PAPR-Powered Air Purifying Respirator. The PAPR is worn when entering an AFB isolation room. There are PAPR’s on 10WN, 5WN and Radiation Oncology Center. Refer to policy IC 152 or CLN 152 for additional information. AFB Isolation

13. Contact Precautions • Required to prevent transmission of infectious agents such as Multi-drug resistant organisms (i.e. Acinetobacter, Pseudomonas, KPC), and Rotavirus, which are spread by direct or indirect contact with the patient or the patient’s environment. • Gown and gloves upon entry to room. Discard PPE beforeexiting room. • Change gown and gloves after preparing patient for transfer out of room and perform hand hygiene. Don new PPE to assist with patient transfer outside of room.

14. Contact Precautions with Special Cleaning • This is signage for our patients that have C.difficile disease. Contact Precautions are followed PLUS the signage is on the door to remind our Environmental Services staff to use a bleach detergent when cleaning the surfaces in the room.

15. Droplet Precautions • Used in the care of patients with suspected or confirmed infections such as Pertussis, Influenza, Rhinovirus, Neisseria meningitidis and RSV which are transmitted primarily by droplet route. • Surgical mask is required upon entry to room

16. Latex Sensitive Patient • Patients identified as allergic or at risk of latex • allergy are to have the following Latex Allergy • Precautions implemented: • A purple allergy band is placed on patient. • Patient’s chart is marked “Latex Precautions”. • “Latex Sensitive” sign is placed on the patient’s • door. • Latex-free supplies from Central Sterile Processing • are used for patient care. • Refer to policy CLN 210 on the KCC policy web • site.

17. Bloodborne Pathogen Standard • Hospitals are required by the Bloodborne Pathogen • Standard of MI/OSHA to protect all healthcare • workers (HCWs) from exposure to bloodborne • pathogens, while on the job. • Assume that all patients could have organisms • that are transmitted by contact with their blood • and/or body fluids. Follow Standard Precautions. • The MIOSHA Blood Borne Pathogen Exposure • Control Plan is the policy that describes protection • measures for staff and patients. • Refer to policy IC 110

18. Bloodborne Pathogen Standard Epidemiology of Bloodborne Pathogens: • Important bloodborne pathogens (disease-causing organisms) • that may be present in human blood could include: • Hepatitis B Virus (HBV) • Hepatitis C Virus (HCV) • Human Immunodeficiency Virus (HIV) • These same bloodborne pathogens may also be found in other • body fluids, including: • Semen • Vaginal fluids • Fluids around the brain, spine, heart, lungs, abdomen and joints • Bloody saliva during certain dental procedures • Bloodborne pathogens are NOT found in tears, urine, stool, • sweat or saliva unlessthese body fluids are visibly bloody.

19. Bloodborne Pathogen Standard Exposure to Bloodborne Pathogens: • HCWs may be exposed to bloodborne pathogens by: • Your skin being punctured with a contaminated needle or cut by a • contaminated sharp device, such as a lancet or scalpel. • Blood or body fluids getting on skin that has cuts, cracks, rashes • or burns. • Being splashed or sprayed with blood or body fluids into your • eyes, nose or mouth. • Certain HCWs have a higher risk of exposure to bloodborne • pathogens while on the job. • Nurses and Patient Care Staff • Physicians • Lab Staff • Environmental Services Staff who handle Regulated Medical Waste • Dental Staff

20. Symptoms of Hepatitis B, C and HIV may include: Fever Fatigue Flu-like illness Nausea Vomiting Diarrhea Loss of Appetite Weight loss Jaundice Itchy skin Night Sweats Swollen Lymph Glands Pneumonia Bloodborne Pathogen StandardSymptoms of Blood Borne Diseases

21. Bloodborne Pathogen Standard • Standard Precautions requires HCWs to treat all blood • and body fluids as if they are infected with disease- • causing organisms. • ALWAYS using Standard Precautions will prevent the • spread of disease to yourself, co-workers, patients and • visitors. • Your protection and Safety is important. Know where to • find PPE in your department.

22. How to Manage a Blood or Body Fluid Spill • Small spills that can be contained by a paper towel • will be cleaned and disinfected by the department. The • Small Spill Procedure is: • Put on PPE • Contain and absorb spill with paper towels • Dispose of the paper towels • Add approved disinfectant to the spill site • Dispose of used supplies in general waste container • Remove gloves and perform hand hygiene • Large spills will be contained by the department with a • barrier pad and then disinfected by Environmental • Services. See Blood and Body Fluid Spill policy IC 134 • on the KCC Policy Web Site.

23. How is KCC keeping you safe? • By evaluating and implementing safer sharps devices. • The Infection Control Practitioners and the nurse • educators meet regularly with the Safer Sharps • committee at Harper Hospital . This group • Investigatesnew, safer sharps devices • Coordinate new product trials • Develop safe work practices for work settings • Trains staff about sharps safety • Monitor injury data after implementation of new devices Call 576-8083 if you have any concerns about sharps or know of new products we may want to look at.

24. Common Causes of Sharps and Splash Exposure • Staff not activating safety device • Sudden patient movement • Unnecessary manipulation of sharp device by hand • Improper disposal into sharps container • Mislaid sharp in environment such as bed, table, • trash, etc. • Performing procedure too quickly • Not wearing appropriate PPE during procedures • Always remember to wear mask and goggles or face shield when an aerosol or splash is likely. • Passing sharps to others

25. Bloodborne Pathogen Standard Safe Sharps Disposal • Locate sharps container close to point of use. • After use, immediatelyactivate safety feature, • if appropriate, then dispose sharp into an • approved puncture-resistant container. • NEVER leave sharps for someone else to • clean up. • Observe container opening. If sharps are • protruding, do not put your hands near it. • NEVER overfill sharps containers. • Replace sharps containers when they are ¾ • full. • Lock sharps containers before moving or • replacing them.

26. Bloodborne Pathogen Standard Safety Devices • Safety devices available for staff to use: • Needleless IV system • Safety butterfly phlebotomy device • Safety lancets • Safety blood gas syringe • Safety IV catheter • Safety syringe and needle • Safety huber needle • Blood transfer safety device • Hemodialysis safety fistulas • Safety scalpels utilized outside the • operating room REMEMBER: Safety devices will protect you onlyif you activate the safety feature after use. • Evaluations and implementation of safer devices is an ongoing • KCC commitment.

27. Waste disposal • Regulated Medical Waste is waste • that may contain disease-causing • organisms. • Michigan law requires health care • waste to be segregated properly. Please • do not use these red containers for your • regular trash. • Regulated Medical Waste must be • placed into closeable, leak-proof • containers that are lined with a red bag • and labeled with the biohazard symbol.

28. Bloodborne Pathogen Standard What is Regulated Medical Waste? Regulated Medical Waste : Throw these away in the Red Biohazard container • Tissue and other pathology lab waste • Lab specimens (not urine) • Bulk blood and body fluids • Blood and blood-product bags • Dressings soaked with blood • PPE soaked with blood • Urinary catheters and collection bags • Empty drainage containers such as • suction canisters • Dressings stained with blood • PPE stained with blood • Diapers • Sanitary napkins General Waste: Throw these away in the regular trash

29. Tuberculosis (TB) Control Plan What is TB? TB is a contagious disease caused by the bacteria named Mycobacterium tuberculosis. TB infects primarily the lungs. Signs and symptoms of TB include: • Fever • Weight loss • Night sweats • Fatigue, weakness • Prolonged cough (cough > 3 weeks) and/or blood-tinged sputum TB is spread when infected people cough or sneeze the bacteria into the air and others inhale the bacteria.

30. Tuberculosis (TB) Control Plan Protecting Health Care Workers • MI/OSHA requires that all health care facilities have a TB Control Plan (refer to policy IC 124) to protect health care workers from exposure to TB while on the job. • Proper AFB Isolation is a key part of the TB Control Plan. ALWAYS follow AFB/Airborne Isolation policy IC 101 on the KCC policy web site. • NEVERenter an AFB Isolation room if you have not been fit • tested for the N-95 respirator. Staff that have been trained on • the use of the PAPR may use it to enter AFB isolation rooms. • ALWAYS fit-check your N-95 respirator before entering an AFB • Isolation room.

31. Infection Control & Occupational Health Services • KCC manages exposures to infected persons by: • Investigating exposure situations. • Referring exposed employees to Occupational Health • Services (OHS). • Your manager or supervisor will allow immediate release • of exposed employee to OHS for follow-up. • Providing prophylaxis to prevent infection when • appropriate (refer to policy CLN 209 Post Exposure • Prophylaxis). This would also include the availability of • free Hepatitis B vaccination through OHS.

32. Providing follow up Management after a Blood or body fluid exposure • Clean the area with soap and water; flush eyes with • water. • Notify your supervisor. • IMMEDIATELY report to Occupational Health • Services for care. After hours report to DRH ED. • Treatment options, if necessary will be discussed • with you. • You and the source patient will be tested for Hepatitis • B, Hepatitis C and HIV, if indicated. • You will be counseled about your risk of contracting • an infection with a bloodborne pathogen.

33. Multidrug Resistant Organisms-MDRO MDRO’s are organisms, usually bacteria, that are resistant to at least two classes of antibiotics, but may be resistant to many antibiotics. Treatment options for infections caused by MDRO’s are often extremely limited, which poses a safety risk to our patients. MDRO infections increase length of stay, costs, and mortality. There is evidence that MDRO’s are carried from one person to another on the hands of healthcare workers.

34. Some examples of MDRO’s are: MDRO’s • Resistant Acinetobacter baumanii, sometimes called ACBA • KPC, a term used for certain resistantKlebsiella pneumoniae, or E. coli • Multidrug resistant Pseudomonas aeruginosa

35. Because… Cancer patients are at greater risk of acquiring a resistant organisms Cancer patients have indwelling devices like central lines and foley catheters that make them more vulnerable to all organisms Cancer patients tend to be on antibiotics for long periods of time which causes the patient to be more susceptible to these organisms Patients admitted from long term acute care centers (LTAC) or nursing homes are at higher risk of acquiring these organisms too When a patient is admitted from a nursing home or LTAC a pathogen screen is ordered to make sure the patient is not colonized with the highly infectious KPC Why all the fuss?

36. Healthcare associated infections (HAI’s) are the 5th leading cause of death in U.S. HAI's are the most common complications affecting hospitalized patients There are simple steps that can be followed to prevent HAI’s What else do you I need to know?

37. Maintain isolation precautions as recommended by Infection Control staff. (Policy #101) Patients will be in Contact Precautions for the duration of their illness. Patients with a KPC may be in isolation for up to one year. So every time the patient is readmitted to the hospital they will be placed in Contact Precautions. Admitting staff and the Infection Control staff keep an updated list of all patients with KPC isolates. Interventions

38. Practice hand hygiene at every opportunity. Unclean hands will promote the spread of infectious organisms. Teach your patient to ask healthcare workers (HCW’s) to clean their hands before they are being examined or any time a HCW comes in contact with them. PERFORM HAND HYGIENE AS YOU ENTER THE ROOM. Educate your patient and their family on proper precautions. What else can I do?

39. Always use approved disinfectant Always follow manufacturers’ guidelines for disinfecting patient care equipment Always follow manufacturers’ required contact times for disinfection-Contact time indicates how long the surface must remain wet with disinfectant. Disinfection in the Patient Care Environment

40. CDC, Guidelines for Disinfection and Sterilization in Healthcare Facilities, 2008. CDC, Guidelines for Environmental Infection Control in Healthcare Facilities, 2003. CDC, Guidelines for Hand Hygiene in Healthcare Settings, 2002. CDC, Guidelines for Isolation Precautions in Healthcare Settings, 2007. CDC, Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Healthcare Facilities, 2005. CDC, Management of Multidrug Resistant Organisms in Healthcare Setting, 2006. OSHA Bloodborne Pathogen Standards, 1910.1030, April 2001. References:

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