Your Role In Infection Prevention & Control

1. Your Role In Infection Prevention & Control Campus Orientation Presentation

2. Objectives Upon completion of this presentation, associates will be able to: • Recognize why hand hygiene (HH) is important to control the spread of organisms • Identify best practices for HH to control the spread of organisms and improve patient safety • Recognize when and how Personal Protective Equipment (PPE) should be used in the healthcare setting • Describe best practices for cleaning and disinfection of reusable patient care equipment • Identify types of isolation precautions • Describe respiratory hygiene practices

3. Infection causing germs are everywhere. We need to make certain that we protect our patients and ourselves. Each “X” in the picture below represents an area that cultured positive for a drug resistant bacteria.

5. Hand Hygiene

6. Hand Hygiene (HH) • Germs are everywhere and are spread when you touch something that is contaminated and then touch your eyes, nose, or mouth without performing HH • HH with soap and running water or hand sanitizer is the most effective way to prevent the spread of organisms in the hospital • The use of gloves does not replace the need for cleaning your hands • Always use soap and water when your hands are visibly soiled and/or if the patient is on Special/C Diff Isolation Precautions

7. Perform hand hygiene regularly throughout the day, especially: When first arriving at work and before leaving Before and after treating a patient Before and after putting on or removing gloves After touching blood or any other body fluid or substance, broken skin or mucous membranes After touching anything in the patient’s environment As soon as you remove your Personal Protective Equipment (PPE) Before and after eating, drinking, smoking and after using the restroom When to perform hand hygiene… GEL IN AND GEL OUT!

8. Hand Hygiene Soap and Water Hand Wash: Wet hands and keeping hands lower than your elbows, apply the soap Wash for at least 20 seconds, working up a lather Cover all surfaces of the hand, paying close attention around fingernails and between fingers Rinse well under running water, pat dry with a paper towel Turn faucet off with paper towel How to Use Alcohol Hand Rub: Dispense metered dose Rub the gel or foam on all surfaces of the hand, paying close attention around fingernails and between fingers Allow to air dry

9. Why are alcohol-based hand rubs so great? • Alcohol-based hand rubs (foam or gel) kill more effectively and more quickly than handwashing with soap and water. • They are less damaging to skin than soap and water, resulting in less dryness and irritation. • They require less time than handwashing with soap and water. • Bottles/dispensers can be placed at the point of care so they are more accessible

10. Hand Lotions Hand lotions are important to prevent skin dryness and irritation. You should use only hospital-approved hand lotions. Other lotions may: • make hand hygiene less effective • cause breakdown of gloves • become contaminated with bacteria if dispensers are refilled

11. Personal Protective Equipment

12. What is the purpose of Personal Protective Equipment (PPE)? • PPE is used to prevent and control infections. Specific types of PPE include: • Gloves – remember to perform hand hygiene before donning (putting on) and after removal • Gowns – if it’s possible that clothing might come in contact with infectious material (urine, stool, blood, vomit) • Goggles/Eye Shields – If splash or splatter is a possibility • Masks –if splash or splatter is a possibility • Always: • Appropriately wear the PPE (gown tied in the back) • Remove items before exiting the room, and • Change after having contact with infectious material

13. Correct Use of Gowns • Wear a gown during procedures that are likely to generate splashes or sprays of blood, bodily fluids, secretions, or excretions. • Secure gown appropriately. • Remove a soiled gown as soon as possible, and practice hand hygiene after removing the gown.

14. N-95 Respirators • Depending upon your job duties you may be fitted in your pre-employment physical and annually to wear the proper sized N-95 Respirator mask • Only employees fit tested for N-95 masks are allowed to enter the room of a patient on Airborne Isolation • AHMCEGV and AHMCHE ONLY: • If you cannot be fitted for N-95, a Powered Air Purifying Respirator (PAPR) should be obtained from your department

15. Personal Protective Equipment (PPE) Cabinets or Isolation Carts • PPE Cabinets or Isolation Carts are placed on or near Isolation room doors • PPE cabinets or Isolation Carts should be checked for adequate supplies every shift • PPE (including N95 respirators) are one time use

16. Standard and Transmission Based Precautions

17. Standard Precautions • Standard precautions were developed by the Centers for Disease Control and Prevention (CDC). • They apply to every patient from newborns to geriatric • They apply to every department from Admitting to the OR • Standard Precautions are the minimum infection prevention practices that apply to all patients, regardless of suspected or confirmed infection, in any setting where healthcare is delivered. • Standard Precautions include: • Hand hygiene, • Use of PPE (e.g., gloves, gowns, masks), • Safe injection practices, • Safe handling of potentially contaminated equipment or surfaces in the patient environment • Respiratory hygiene/cough etiquette.

18. Why Isolation Precautions? Isolation precautions are used to prevent the spread (transmission) of pathogens (germs) from a known or potential source to another patient or health care worker. We want to keep the “bugs” in the room! Types of precautions we use: Contact, Special Contact, Droplet, Airborne

19. Contact Precautions • Contact precautions help to prevent spread ofinfectious diseases transmitted by touching body substances/environment contaminated with the infectious material • Gloves and gown must be worn by everyone entering the patient’s room. Be prepared for the unexpected! • HH, along with proper handling and disposal of contaminated items and disinfection of reusable patient care equipment, is essential. • Some conditions that need Contact Precautions: • MRSA - colonized or infected • VRE – colonized or infected • Major or minor draining wounds (unable to be contained by dressing) • RSV • Scabies • Impetigo - Pediculosis

20. Special Precautions Special Precautions are used for patients with suspected or confirmed Clostridium difficile (Cdiff, CDI) and Norovirus Patients must have a private room Privacy curtains must be removed at discharge or room transfer prior to cleaning the room Perform hand hygiene with soap and water ONLY BLEACH must be used for cleaning and disinfecting of the environment and reusable patient care equipment Remember to leave the isolation sign in place until the room has been made ready for the next patient!

21. Droplet Precautions • Droplet precautions prevent the spread of infectious diseases that are transmitted by coughing or sneezing • Requires the use of masks within 3 feet of the infectious patient • HH, along with proper handling and disposal of contaminated items and disinfection of reusable patient care equipment, is essential • Conditions that require Droplet Precautions: • Influenza (Flu) • Streptococcus pharyngitis (strep throat), bacterial pneumonia, scarlet fever • Haemophilus influenza / Neisseria Meningitis • Pertussis (whooping cough) • Rubella (German Measles) • Mumps

22. Airborne Precautions • Airborne precautions prevent the spread of infectious diseases such as Chicken Pox* Varicella, Disseminated Herpes Zoster (shingles), and Tuberculosis • They are spread by airborne pathogens that are breathed, sneezed, or coughed into the environment and can remain suspended in the air for prolonged periods of time. • Requires the use of N-95 respirator or PAPR when entering the room. • Requires negative-pressure with 6-12 air changes per hour. The door must be kept closed to maintain the air pressure balance between the isolation room, the hallway and anteroom. • Visitors should be kept to a minimum and only wear a surgical mask!

23. Transportation of a Patient on Isolation Precautions For all isolation patients: • Alert receiving department of patient’s isolation status • Equipment (bed, IV pole) leaving a patient’s room must be cleaned with the hospital approved disinfectant before exit • Remove PPE BEFORE leaving the room and perform hand hygiene Contact Precaution Patients: • Change patient’s gown, cover patient with clean linens, and instruct patient to perform hand hygiene prior to leaving his/her room Droplet Precaution Patients: • Place simple mask on patient before transport • Change patient’s gown, cover patient with clean linens, and instruct patient to perform hand hygiene prior to leaving his/her room Airborne Precaution Patients: • Place simple mask on patient before transport

24. Respiratory Hygiene

25. Respiratory / Cough Etiquette • Respiratory hygiene and cough etiquette are infection prevention measures to decrease the transmission of respiratory illness such as influenza or cold viruses in healthcare facilities – part of STANDARD PRECAUTIONS • Educate patients, families, and visitors about respiratory infections and how they are transmitted • Use posted signs with pictures about how to cover your cough • Provide anyone who is coughing with a mask • Physical separation (3 feet) between symptomatic and non symptomatic individuals • Hand hygiene after contact with respiratory secretions

26. If you are sick, stay home!

27. Additional Safety Measures for Infection Prevention and Control

28. Cleaning and Disinfection • Cleaning and disinfection is part of STANDARD PRECAUTIONS • When possible, restrict the use of non-critical patient care equipment to a single patient to avoid cross-contamination (i.e. gait belts, walkers, blood pressure cuffs) • Always follow manufacturers directions for cleaning and disinfection • All reusable patient care equipment must be cleaned with a hospital approved disinfectant between every patient! • Leave the equipment wet for the specified contact time as indicated on the product labeling

30. Specimen Handling • Specimen Transport • Place the specimen container in a biohazard bag • If the outside of the bag is contaminated, the specimen must be double bagged • Specimen bags should be placed in red biohazard trash • AHMCEGV and AHMCHE Associates ONLY: • Junior Volunteers (under 18 years of age) may not transport specimens. • Volunteers will bring a red transport box and put the specimen in the box to be transported.

31. Additional Information for Associates • Infection prevention policies are on the intranet under your designated facility • Refer to the policies when you have questions about “type and duration” of precautions/isolation needed for selected infections and conditions • You will also find your facility’s exposure control plan, hand hygiene policy, TB policy, etc.

32. Employee Health

33. Blood-borne Pathogens • Blood-borne pathogens are infectious microorganisms in human blood that can cause disease in humans. • Blood-borne pathogens include, but are not limited to: • Hepatitis B Virus (HBV) • Hepatitis C Virus (HCV) • Human Immunodeficiency Virus (HIV) • Anyone who works in a healthcare environment is at risk for exposure to blood-borne pathogens. You may not know, just by looking at a patient, that they have a blood-borne infection.

34. Needlestick / Blood-borne Pathogen ExposureWhat do I do now?

35. Needlestick / Blood-borne Pathogen ExposureWhat do I do now? • Immediately cleanse the area with soap and water. If your eyes or other mucus membranes are involved, thoroughly flush the area with water. • Promptly and accurately report the exposure or injury to your manager/nursing supervisor. • Immediately report to the Emergency Department (ED) to be seen by a physician. Take the SOURCE patient identification and location information to the ED. • If the SOURCE is outpatient, do not send the patient home until their blood is drawn. • Complete a Sedgwick/Employee Safety Event report within 24 hoursof incident. • Attend a follow-up evaluation appointment with Employee Health within 72 hours.

36. Go to the Emergency Department (ED) • You will have baseline blood tests drawn for Hepatitis B, Hepatitis C, and HIV 1/2. • You may receive a tetanus toxoid booster, if indicated. • The SOURCE patient will be tested for Hepatitis B, Hepatitis C, and a stat Rapid HIV. • The Lab will release the SOURCE patient’s HIV status to the ED physician. • The ED will notify you of those results. • Prophylactic medication needs to be given within 2 hours, if needed. • Follow up with Employee Health within 72 hours.

39. Sharps Safety Practices Using Sharps Containers • Never overfill a sharps container. • Never force a sharp into a sharps container. • Never reach into a sharps container. • Never open, empty or reuse a sharps container. Handling Sharps • DO NOT use a needle that you are unfamiliar with. • Activate the safety device immediately after use. • Never throw a sharp into the trash. • DO NOT set aside a used sharp. • Dispose of it in a marked sharps container immediately after use.

40. Sharps Safety Practices • Be prepared • Be aware • Dispose with care www.cdc.gov/SharpsSafety/PPT/4PreventingNeedlesticksPartIII.ppt

41. Thank you!