INFECTION CONTROL SAFETY-TOUR

1. INFECTION CONTROL SAFETY-TOUR • The following is the content of the safety tour for your annual required material. • You will be tested on the contents • For questions call extension #2599 or #4099 Thank you

2. What are Bloodborne Pathogens? • They are viruses, bacteria and other micro-organisms that are: “borne” ( or carried) in a person’s bloodstream and can cause disease. • Other body fluids may also spread bloodborne pathogens such as: blood products, fluids in the chest and abdomen, fluids in the uterus of a pregnant woman, fluids surrounding the brain, spine, heart and joints, vaginal secretions, semen, saliva in dental procedures and other fluids containing visible blood.

3. Hepatitis B Virus (HBV) • HBV can cause: • active Hepatitis B - a flu-like illness that can last for months • a chronic carrier state - the person may have no symptoms, but can pass HBV to others • cirrhosis, liver cancer - and death • Fortunately, vaccines are available to prevent HBV infection through Employee Health Services • Even if you are vaccinated against HBV, you must still follow STANDARD PRECAUTIONS to stay SAFE on the job.

4. Hepatitis C Virus (HCV) • Also attacks the liver • Symptoms of active infection are milder that those of HBV - or may not even be present • HCV is more likely to cause: • A chronic carrier state • Cirrhosis, liver cancer - and death • There is no vaccine to prevent HCV infection, but with prompt and proper treatment, most cases can be treated successfully

5. Human Immunodeficiency Virus (HIV) • …causes AIDS • A person with HIV may carry the virus without developing symptoms for several years, however will eventually develop AIDS • They may suffer flu-like symptoms such as fever, diarrhea, fatigue, sore throat, weakness, rapid weight loss, headache and swollen lymph glands • There is no vaccine to prevent this infection • It is not spread by touching, feeding, or caring for a patient who carries the disease

6. STANDARD PRECAUTIONS • ALL HEALTHCARE WORKERS MUST FOLLOW STANDARD PRECAUTIONS • IT’S THE LAW • The bloodborne pathogens standard was established by the Occupational Safety and Health Administration (OSHA) • Standard precautions means treating everyone’s blood and body fluid as infectious at all times! • All kinds of people may have bloodborne diseases, people of all ages, races, including both males and females. You may not be able to tell which patients carry a bloodborne pathogen merely by taking a history or performing a physical.

7. Personal Protective Equipment(PPE) • Includes gloves, gowns, masks, aprons, lab coats, face shields, goggles, disposable resuscitation devices and ambu bags. • You should wear as much or as little as you anticipate you will need to keep blood and other infectious materials off your skin, mucous membranes or clothing.

8. Work Practice Controls • HANDWASHING is a basic but very important work practice to decrease your risk of infection. If infectious material gets on your hands, the sooner you wash it off, the less your chance of infection. • Handle SHARPS with care. Do not bend, recap using two hands, shear or break needles or other sharps. (NHHN allows the use of a recapping device or a one-handed scoop method for recapping only if absolutely necessary) • Immediately after use, dispose of contaminated sharps in an appropriate puncture-resistant, leak proof container. • Do not eat, drink, smoke, apply cosmetics or lip balm or handle contact lenses in work areas where exposure may occur.

9. HEED THESE WARNINGS! • To make sure you know what you are handling, OSHA requires containers of potentially infectious material to be RED or labeled clearly in orange or orange- red with this symbol or both

10. TUBERCULOSISWhat is TB? • Tuberculosis is an infectious disease that spreads through the air (airborne) when a person with infectious TB of the lungs or throat talks, coughs, sneezes, sings or yells. • Common sites of TB disease are: lungs (85% of all cases), brain, kidneys, bones, milliary (spread throughout the body)

11. TB disease (active TB) • In this case, signs of illness are usually present and the person may cough (for three weeks or more), feel weak, have a fever, have weight loss, lose his or her appetite, have night sweats, cough up blood and/or have chest pain when coughing. • People in close contact with persons with active TB are at the highest risk of being infected.

12. Latent TB • To be infected with TB (latent TB) means that the person carries the TB germs BUT: • does not look or feel sick (no symptoms) • cannot infect others • has a positive TB skin test • may need preventative treatment

13. Factors that contribute to the increase of TB incidence • HIV • Increased immigration from countries where there is a lot of TB • Close contact in crowded settings such as prisons, shelters, substance abuse centers, hospitals, nursing homes, workplaces and schools • Failure to quickly identify, isolate and treat TB properly

14. How can TB transmission be prevented? • Quick identification: this means helping to identify persons suspected or known to have TB disease quickly • Unidentified TB poses a risk to you, your patients, and other staff members • Prompt isolation • Patients suspected or known to have TB will be placed in negative pressure isolation (Airborne Precautions). This means that the door to their room is closed tightly and the air is vented directly to the outside • Verify and document negative pressure daily • Notify Nurse Epidemiologist

15. Prevention of TB transmission (continued) • Approved respirators must be worn by all staff entering the room - we use the Air-Mate 12 (the hood) or N-95 mask (must be fit-tested). The Air-Mate belt, power pack and tubing must be wiped down with germicidal wipe every time you leave the patient room • Prompt and complete treatment • After completing 1-3 weeks of treatment, many patients do not spread TB germs. However, this does not mean they are cured. The only way to cure TB is to take a full course of therapy with several drugs EVERY DAY FOR 6-12 MONTHS, possibly longer • Drug resistance to the common TB medicines can occur. When this happens, patients may remain infectious longer and alternative drugs may be more expensive and less effective

16. TB Skin Testing (PPD) • Healthcare workers regularly fill out a questionnaire about possible exposure to TB and have a TB skin test if indicated • The area of the arm where the skin test was administered must be checked within 48-72 hours by a health-care professional • The test result helps identify the presence of TB bacteria in your body,but does not determine whether you are infectious to others

17. Problem Pathogen Partnership Initiative Wilmington, NC

18. Problem Pathogen Partnership Initiative Goal:To decrease the incidence of resistant organisms throughout both North Carolina and Virginia FYI:Resistant Organisms =  Morbidity, Mortality, & Hospital Costs  Nationally 54% of Staphylococcus aureus cultures are resistant  Nationally 25% of Enterococcus cultures are resistant  Both infected and colonized patients pose a risk for transmission to other patients (We isolate both) Wilmington, NC

19. Reservoir for the Spread of Antibiotic Resistant Pathogens Clinical Infections Colonized Patients Wilmington, NC

20. MRSA Methicillin Resistant Staphylococcus Aureus Wilmington, NC

21. VRE Vancomycin Resistant Enterococcus Wilmington, NC

22. Protocol: • Full barrier precautions (mask, gown, gloves) for every MRSA patient = Contact Level 1 • Gown and gloves for every entrance to VRE patient rooms = Contact Level 2 • Institution of alcohol waterless soap in every patient room, for handwashing when sink is unavailable Wilmington, NC

23. Admission: • Notify central sterile for isolation cart • Place precaution sticker on chart • Place contact precaution sign on both sides of • the door • Explain education sheet to patient and family Wilmington, NC

24. Surveillance Cultures: • Surveillance cultures on pts at highest risk: • a) ICU pts e) Rehab pts • b) PCU pts f) Long Term Care pts • c) Pts that require frequent hands on care • d) Dialysis pts • To be done within 2 hrs after admission to the unit by nursing • Nares, peri-rectal, and other sites as indicated • Patient will not be isolated until final culture received…48 hrs • Repeat cultures on all patients whose initial screens were negative with a length of stay greater than 7 days. Wilmington, NC

25. Readmission: • The Infection Control Dept. will place an “I” in the P/H box on the face sheet of patient chart. *We are in the process of further clarifying this to “M” for MRSA, “V” for VRE, or “B” for both. • Admitting will notify patient care unit of need for isolation and private room. • Nursing staff is responsible to check the face sheet of patient chart when a patient is admitted to their unit. • IC will remove the patient from the isolation database when a patient is no longer infected or colonized. Wilmington, NC

26. Patient Care Equipment: • Dedicate equipment to a patient who is on Contact Level 1 or Contact Level 2 precautions ( ie. blood pressure cuff, thermometer, IV pole) and thoroughly clean and disinfect following use with isolation patient and prior to use on another patient Wilmington, NC

27. What Are Your Responsibilities to the Problem Pathogen Partnership Initiative? • Be conscious of precaution signs on patient doors. • Personnel using lab coats and warm-up jackets are to remove those items before donning gown. • Don PPE (personal protective equipment) just prior to entrance of patient room. • Replenish PPE if supplies are found to be low. Don’t let it wait for the next person! • Do not take unnecessary supplies into room. Wilmington, NC

28. Responsibilities cont…. • Dietary will not be entering precaution rooms. Please remember to provide patient with tray as soon as possible. • Make sure Environmental Services is notified of precautions so patient soap dispenser can be changed to CV med. lotion soap. • Alcohol based waterless soap will be in every patient room. Please use upon leaving patient room in addition to traditional handwashing techniques. • Visitors are to be limited to 2 at a time. • Visitors must be instructed in proper PPE and handwashing requirements. Wilmington, NC

29. Responsibilities cont…. • Children <12 are not allowed in precaution rooms. • Make sure to notify receiving departments/facility for any testing/transfers. • Remember to allow Environmental Services sufficient time for thorough cleaning of room before next patient is admitted. All hospital approved disinfectants need 10 minutes of surface contact to work effectively. • Medical Record Binder should not enter patients room and must be cleaned with hospital approved disinfectant when precaution sticker is removed. Wilmington, NC

30. Removing a patient from isolation • MRSA - 3 negative cultures (not screens) obtained 24 hours apart on three consecutive days, 48 hours after the discontinuation of antibiotics. • VRE - 3 negative cultures (not screens) obtained 7 days apart, 48 hours after the discontinuation of antibiotics. • Please consult Infection Control when removing a patient from isolation.

31. Discharge of Patient: • Upon patient discharge, nursing personnel are to disinfect the chart with hospital approved disinfectant • The Contact Precaution door sign will be removed after the room has been terminally cleaned by Environmental Services • Terminal disinfection by Environmental Services will also include the use of hydrogen peroxide for privacy curtains Wilmington, NC

32. CONGRATULATIONS to the staff for making the Problem Pathogen Partnership A SUCCESS!!