EXPOSURE CONTROL PLAN

1. BLOODBORNE PATHOGEN PLAN TB EXPOSURE CONTROL PLAN ISOLATION EXPOSURE CONTROL PLAN

2. An Exposure Control Plan Manual can be found on every department at PSMH or via the Dovenet policy & procedures infection control

3. BLOODBORNE PATHOGEN PLAN

4. WHAT ARE BLOODBORNE PATHOGENS? viruses and bacteria that require blood or body fluids to live

5. PSMH Bloodborne Pathogen Plan WHAT BACTERIA AND VIRUSES ARE WE TALKING ABOUT? HIV, HEPATITIS C, SYPHILIS, DELTA HEPATITIS, B HEPATITIS, AND MALARIA WE are MAINLY CONCERNED with HIV, HEPATITIS B AND C.

6. These bacteria &viruses can live in these BLOOD & BODY FLUIDS P BLOOD AND BLOOD PRODUCTS P CEREBRAL SPINAL FLUID P PLEURAL FLUID P PERICARDIAL FLUID P PERITONEAL FLUID P SEMEN, VAGINAL FLUID P AMNIOTIC FLUID P SYNOVIAL FLUID

7. How are Bloodborne Pathogen spread? When infected fluids enter the body through: • Cuts, scrapes or other breaks in the skin • Needle-stick injuries • Splashes into the mouth, nose or eyes • Oral, vaginal or anal sex • Using infected drug needles • Pregnant women who are infected with these pathogens may pass them to their babies.

8. HOW DO YOU KNOW IF SOMEONE HAS ONE OF THESE VIRSUS? YOU DON’T! SIGNES AND SYMPTOMS OF HEPATITIS B & HEPATITIS C: (Flu like) Loss of Appetite, Tired feeling Low grade temperature Vague abdominal pain and discomfort Diarrhea or vomiting Yellow skin or eyes Patients with Hepatitis B or C may ormay not have symptoms and will not be diagnosed unless they become jaundiced (yellow) – BUT THEY ARE STILL CONTAGIOUS!

9. Signs & Symptoms of HIV: • Flu-like symptoms in the beginning • May have more frequent bouts of flu, colds • Eventually develop AIDS and will be diagnosed • Fever, diarrhea and fatigue (tired feeling) It can take up to 10 years or longer before a person is sick enough to be diagnosed with HIV. In the mean time they are contagious!

10. WHAT CAN WE DO TO PROTECTHEALTHCARE WORKERS? • STANDARD PRECAUTIONS/UNIVERSAL PRECAUTIONS WERE DEVELOPED BY OSHA AND CDC.

11. PSMH Bloodborne Pathogen Plan STANDARD/UNIVERSAL PRECAUTIONS: A SYSTEM THAT OUTLINES SAFEGUARDS OR BARRIERS DESIGNED TO PROTECT HEALTHCARE WORKERS • Personal Protective Equipment • Engineering control • Housekeeping • Work Practice Controls

12. PSMH Bloodborne Pathogen Plan STANDARD/UNIVERSAL PRECAUTIONS REQUIRE PERSONAL PROTECTIVE EQUIPMENT FOR EACH AND EVERY PATIENT • If there is a possibility that you are going to touch or come in contact with anyone's blood, body fluids or mucous membranes: YOU WILL WEAR GLOVES • If there is a possibility of blood or body fluids splashing or coming in contact with your eyes nose or mouth YOU WILL WEAR A MASK & GOGGLES OR A SHIELDED MASK

13. PSMH Bloodborne Pathogen Plan STANDARD/UNIVERSAL PRECAUTIONS REQUIRE PERSONAL PROTECTIVE EQUIPMENT FOR EACH AND EVERY PATIENT If there is a possibility that you might have your clothing soiled with someone's blood or body fluids YOU WILL WEAR A GOWN • Personal Protective Equipment (PPE) is located in each and every patient room (except in the Psychiatric Unit, 2E) in a beige BSI Box on the wall (gloves, gowns, masks, shielded masks, goggles and AMBU BAGS) • When you use this equipment – REPLACE IT IMMEDIATELY!

14. PSMH Bloodborne Pathogen Plan STANARD/UNIVERSAL PRECAUTONS REQUIRE ENGINEERING CONTROLS • Biohazard Labels and containers • Safety Needles • Needless IV Systems • Sharps containers • Safety scalpels Safety equipment is only as good as the people who use it! When safety equipment is provided use it activate the safety mechanisms as soon as you are done with the procedure.

15. PSMH Bloodborne Pathogen Plan STANDARD/UNIVERSAL PRECAUTONS REQUIRE HOUSEKEEPING: • Proper disposal of SHARPS and broken glass • Never reach into trash • Dispose of sharps containers when 2/3 full • Clean up Blood/Body Fluids using the proper equipment and according to policy

16. PSMH Bloodborne Pathogen Plan STANDARD/UNIVERSAL PRECAUTONS REQUIRE WORK PRACTICE CONTROLS: • NEVER bend, break, or RECAP a Needle • Minimize splashing of fluids during collection or disposal • Don’t eat or drink in work areas • Wash your hands or skin after contact with body fluids or objects that might be contaminated

17. PSMH Bloodborne Pathogen Plan HEPATITIS B VACCINE: • Hepatitis B is the only Bloodborne Pathogen we can protect against! • IF YOU HAVE NOT BEEN VACCINATED FOR HEPATISIS B WE WILL GIVE THE VACCINE FREE OF CHARGE! • See the Employee Health Nurse – Brenda Dearth

18. PSMH Bloodborne Pathogen Plan HEPATITS B VACCINE • CONSISTS OF 3 INJECTIONS • 1- now • 1- one month later • 1- five months after the second • A TITER DRAWN BY THE LABORATORY 2 MONTHS AFTER COMPLETION OF THE SERIES. If you are not immune after the vaccination series you will be offered a repeat vaccine series – if you are not immune after the second vaccination series you will not become immune. IF you are exposed to Hepatitis B you can be given Immune Globulin that will give you temporary immunity for 3 to 6 months

19. PSMH Bloodborne Pathogen Plan WHAT IS AN EXPOSURE? • It’s any time blood or body fluids come in contact with a worker’s eyes, nose, mouth or skin through a needlestick, splash, or other type of exposure

20. PSMH Bloodborne Pathogen Plan WHAT SHOULD YOU DO IF YOU HAVE AN EXPOSURE? FIRST: • WASH THE AFFECTED AREA THROUGHLY WITH WARM WATER AND SOAP AT ONCE! • FOR MOUTH OR EYE EXPOSURE THROUGHLY RINSE OUT YOUR MOUTH WITH WATER OR MOUTHWASH: FLUSH EYES WITH WARM WATER OR A SALINE SOLUTIONS.

21. PSMH Bloodborne Pathogen Plan SECOND: • NOTIFY YOUR IMMEDIATE SUPERVISOR • THEY WILL CALL THE HOUSE OPERATIONS MANAGER (HOM) • THE HOM WILL TEST THE SOURCE FOR HIV, HEPATITS B AND HEPATITIS C. • NOTIFY YOU OF THE HIV TEST RESULTS WITH IN ONE HOUR. • THE HOM WILL FILL OUT A EXPOSURE FORM AND AN EMPLOYEE INJURY FORM

22. PSMH Bloodborne Pathogen Plan • IF THE PATIENT IS KNOWN TO BE HIV POSITIVE OR TESTS HIV POSITIVE. • You will be sent to the ED or the Occupational Health Office for follow-up IMMEDIATELY. And the Infectious Disease Physician will consult with you about your exposure. • If it is a significant exposure and you need medication to help prevent you from turning positive to HIV it will be provided to you immediately. IN ORDER TO PROVIDE YOU WITH THE BEST TREATMENT AVAILABLE IT IS VERY IMPORTANT THAT ALL EXPOSURES ARE REPORTED IMMEDIATLEY.

23. PSMH Bloodborne Pathogen Plan THIRD: • CONTACT THE EMPLOYEE HEALTH NURSE FOR FOLLOW-UP • The Employee Health Nurse will do base line testing on you – this is for your benefit. She will do a HIV, Hepatitis Profile and a Hepatitis B Titer if you have been vaccinated. • If your Hepatitis B titer is below 10 she will offer to revaccinate you. If you do not become immune after the second vaccination • The Employee Health Nurse will provide follow-up on the source testing – HIV, Hepatitis B and Hepatitis C. • The Employee Health Nurse will provide you with a written consultation, and follow-up testing as required.

24. ANY TIME YOU HAVE ANY QUESTONS PLEASE CONTACT THE INFECTION CONTROL COORDINATOR Paula Pourchot RN INFECTION CONTROL DEPARTMENT PHONE 815-937-2235 PAGER 815-279-0561 (Available 24 hours a day on pager or through the HOM. Pager number also available on answering machine)

25. TB EXPOSURE CONTROL PLAN

26. PSMH TB Exposure Control Plan WHAT IS TB? • Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. • The bacteria usually attack the lungs. But, TB bacteria can attack any part of the body such as the kidney, spine, and brain. • If not treated properly, TB disease can be fatal. • TB disease was once the leading cause of death in the United States.

27. PSMH TB Exposure Control Plan • HOW IS TB SPEAD? • TB is spread when a person with active TB, who is infectious (sick with TB) coughs, laughs, talks or sings and expels the small bacteria (particle) into the air and someone near by breaths it into their lungs This bacteria (particle) is so small it can stay in the air for up to 90 minutes.

28. PSMH TB Exposure Control Plan • Patients are screened when they enter the hospital for TB by asking them if they have any signs of Infectious TB. • Cough lasting longer than 2-3 weeks • Low grade temperature • Night Sweats • Cough up blood • Unexplained weight loss • Loss of appetite • Feel weak

29. PSMH TB Exposure Control Plan • When these signs and symptoms are present the patients chest x-ray is checked and their doctor is called and ask if the patient could possible have TB. • If the Doctor feels this patient may have TB or there is a cavitations in their lungs they are transferred to a “Negative Pressure Isolation and placed in “AIRBORNE ISOLATION”

30. PSMH TB Exposure Control Plan • Airborne Isolation requires a room with special ventilation: • The air in the room exit the room through a special filter or directly outside. It is not recirculated. • The Door is kept shut at all times (except when entering or leaving the room.) • Health care workers, visitors and Doctors who enter the room MUST wear an N95 Particulate Filter Respirator Mask. • Healthcare workers MUST be fit tested and passed the fit test in order to wear the mask. • Visitors must be taught how to put the mask on and fit checked by staff before entering the room.

31. PSMH TB Exposure Control Plan • TB SCREENING: • PPD (Mantoux Testing) is done on hire and anytime a healthcare worker or volunteer is exposed to MTB. • Anyone who tests positive for the first time is sent to the Kankakee County Health Department for evaluation and possible treatment • Treatment is provided Free by the Kankakee County Health Department.

32. PSMH Bloodborne Pathogen Plan • A POSITIVE TB TEST (PPD, Mantoux Test) means: • You have come in contact with the TB germ • You are not infectious unless you have signs/symptoms of TB • You cannot give TB to anyone at this stage.

33. PSMH TB Exposure Control Plan • If you come in contact with someone who is infectious in the hospital what happens? • When a patient is placed in Airborne Isolation • the doctor will order 3 AFB Sputum Tests • If the test comes back positive for AFB the patient will be placed on treatment • The specimen is then cultured and if the results are positive for TB you will be contacted and a PPD test will be done approximately 3 months after your exposure

34. PSMH TB Exposure Control Plan • PSMH is considered at LOW Risk for contact with Mycobacterium TB: • Therefore we do not do annual TB testing • Staff/Volunteers will be tested if they are exposed to a patient with active infectious TB.

35. PROVENA ST. MARY’S HOSPITAL ISOLATION GUIDELINES

36. PSMH Isolation Guidelines • How do I know if a patient requires ISOLATION? The first policy under ISOLATION in the Exposure Control Manual is called “ISOLATION GUIDELINES” • This policy lists all the conditions and bacteria requiring Isolation • The type of Isolation required • The duration of Isolation This policy is also in the Infection Control Policy manual on line.

37. PSMH Isolation Guidelines There are Three different types of Isolation are used at PSMH • AIRBORNE • DROPLET • CONTACT

38. PSMH Isolation Guidelines Airborne Isolation • Airborne Isolation is used for TB, Chickenpox (Varicella) and Disseminated Herpes • If or When we see Smallpox, SARS, or Avian Flu it will be used for these also.

39. PSMH Isolation Guidelines Airborne Isolation For TB – requires EVERYONE entering the room to wear an N95 Particulate Filter Mask, HealthCare Workers must be fit tested and have passed the fit test. Visitors must be fit checked to wear the mask.

40. PSMH Isolation Guidelines Airborne Isolation For Chicken Pox (Varicella) and Disseminated Herpes (Shingles in more than one nerve) or Shingles in an immune -compromised patient) • If you are immune to chicken pox you may enter the room without a N95 Particulate Filter Respirator Mask. • If you are not immune have someone who is immune go in the room or wear an N95 Particulate Filter Respirator Mask for which you have been fit tested and passed

41. PSMH Isolation Guidelines • Droplet Isolation: • Used for respiratory infections: • Pertusses (Whooping Cough) • Influenza • Pneumonic plague • Diptheria • Mycoplasma Pneumonia • Mumps • Rubella • Haemophilus influenza type b (pneumonia and sepsis • Bacterial Meningitis

42. PSMH Isolation Guidelines • Airborne Isolation: • Requires a private room equipped with negative air flow. (MICU 346, SICU Rooms 5 & 6, Peds room 225-226, Recovery Room and Room 8 in OR.) • The DOOR MUST REMAINED CLOSED. • Dedicate equipment to the patient (thermometer, B/P Cuff, etc.) use disposable equipment whenever possible • Any equipment used for the patient and taken out of the room must be thoroughly disinfected before it is used again.

43. PSMH Isolation Guidelines Droplet Isolation • Requires that a surgical mask be worn by EVERYONE who enters the room. • This is in addition to Standard Precautions

44. PSMH Isolation Guidelines Contact Isolation • Is used for • Diarrhea infection • Salmonella, Shigella, • Hepatitis A, Roto virus • Clostridium difficile Undiagnosed diarrhea • Respiratory Infections • RSV (Respiratory Synovial Virus) • Enterovial infections in infants/children • Skin Infections • Impetigo Zoster (chicken Pox, Shingles) • Scabies

45. PSMH Isolation Guidelines Contact Isolation • Is used for: • Multidrug Resistant Organisms: - MRSA - VRE - ESBL’s - Clostridium difficile

46. PSMH Isolation Guidelines • Hand Hygiene when caring for a patient with Clostridium difficile requiring Contact Isolation • DO NOT USE WATERLESS ALCOHOL HAND SANITIZER! • DO USE SOAP AND WATER!

47. PSMH Isolation Guidelines • Clostridium difficile is called a spore forming bacteria – it develops a hard coat to prevent alcohol or disinfectants to enter it – so it is very difficult to kill. • The only way to make sure it is not on your hands when you leave a patient who has this bacteria is to wash your hands with soap and water.

48. Contact Isolation for Clostridium difficile: PLACE A SIGN ON THE ALCOHOL DISPENSER IN THE PATIENTS ROOM THAT SAYS: “PLEASE USE SOAP AND WATER FOR HAND HYGIENE. DO NOT USE ALCOHOL GEL!!!”

49. PSMH Isolation Guidelines Contact Isolation: Requires Gown, and gloves be worn by EVERYONE upon entering the room EVERY TIME they enter the room! Healthcare workers Visitors, family members Doctors Volunteers are not to enter any Isolation Room Isolation Education must be documented forallpatients and visitors.

50. HAND HYGIENE IS THE SINGLE MOST IMPORTANT THING YOU CAN DO TO PROTECT YOUR PATIENTS, YOURSELF AND YOUR FAMILY! YOU CANNOT REMEMBER WHERE YOUR HANDS WERE FIVE MINUTES AGO AND YOU DO NOT KNOW WHERE THEY WILL BE FIVE MINUTES FROM NOW!!!!