Keeping the “Bugs” out!

1. Keeping the “Bugs” out! Credit: CDC Sharon Kortas, RN, CIC

2. Standard Precautions • Every patient • All blood • All body fluids, secretions and excretions • Non-intact skin (including rashes) • Mucous membranes • Assess the situation • Use the appropriate personal protective equipment (PPE) • Gloves • Gowns • Masks • Eye protection • Hand hygiene http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

3. Hand Hygiene • Follow the Centers for Disease Control and Prevention (CDC) Hand Hygiene Guidelines • Hand Washing with antibacterial soap and water • Alcohol-based hand sanitizer http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf

4. Limitations of Glove use • Hand contamination may occur as a result of small, undetected holes in examination gloves • Contamination may occur during glove removal • Wearing gloves does not replace the need for hand hygiene • Failure to remove gloves after caring for a patient may lead to transmission of microorganisms from one patient to another http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf

5. Effectiveness of Alcohol Based Hand Sanitizers • Alcohol-based products are more effective for standard handwashing or hand antisepsis by HCWs than soap or antimicrobial soaps • Ethanol 60%–95% generally safe and effective for use in antiseptic handwash or HCW hand-wash products • Alcohols are not appropriate for use when hands are visibly dirty or contaminated with proteinaceous materials. • The efficacy of alcohol-based hand-hygiene products is affected by several factors, including the type of alcohol used, concentration of alcohol, contact time, volume of alcohol used, and whether the hands are wet when the alcohol is applied. http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf

6. http://www.cdc.gov/HAI/pdfs/bbp/Exp_to_Blood.pdf

7. The National Surveillance System for Healthcare Workers (NaSH) 1995-2007 http://www.cdc.gov/nhsn/PDFs/NaSH/NaSH-Report-6-2011.pdf

8. Bloodborne Pathogen Exposures http://www.cdc.gov/nhsn/PDFs/NaSH/NaSH-Report-6-2011.pdf

9. Bloodborne Pathogen Exposures Exposure: Transmission of blood and/or body fluid that might place a HCW at risk for HBV, HCV or HIV. Transmission can occur via any of the following routes: Percutaneous Mucous membrane Non-intact skin Human bite Risk: Exposure to infected blood with a single needle stick or cut HBV: 6-30% HCV: 1.8% HIV: 0.3% (1:300) Since Hep B vaccine (1982), Annual # Occupational HBV >10,000 1983 to < 400 in 2001 <100 in 2009 http://www.cdc.gov/mmwr/pdf/rr/rr6103.pdf

10. Prevent Bloodborne Pathogen Exposure Hepatitis B Vaccine Assess the situation Personal Protective Equipment Attention to task at hand Carry trash away from your body

11. Contact Precautions • Contact precautions are in addition to standard precautions • Used for MRSA, VRE and other Multi-Drug Resistant organisms, drainage that cannot be contained, scabies, chicken pox, lice, C-diff, diarrhea

12. Contact Precautions When touching the patient, patient equipment, or environmental surfaces in the patient’s room, wear a gown and gloves

14. Colonized or Infected:What is the Difference? www.cdc.gov/handhygiene/download/hand_hygiene_supplement.ppt

15. Image: Two lice viewed under an electron microscope. Note the claws used to grasp onto individual hairs. Credit: CDC http://www.cdc.gov/parasites/lice/head/index.html Images from CDC

16. Multi Drug Resistant Organisms • Multi Drug Resistant Organisms (MDRO) require contact isolation. Examples of MDRO’s include: • MRSA- Methicillin (or Oxacillin) Resistant Staphylococcus Aureus – colonizes the skin • VRE - Vancomycin Resistant Enterococcus- Colonizes the skin • ESBLs - Extended - Spectrum Beta Lactamases most common organisms: Klebsiella pneumoniae, E. coli and Klebsiella oxytoca • CRE-Carbapenem-resistant Enterobacteriaceae-Klebsiella species, Enterobacter species, E. coli

17. The Inanimate Environment Can Facilitate Transmission Xrepresents VRE culture positive sites ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.

18. Droplet Transmission What every healthcare worker should know Photos from www.cdc.gov

19. Droplet Precautions • Patients with suspect or confirmed- Influenza, bacterial meningitis, rubella (German measles), pertussis, etc. are to be placed in droplet precautions in addition to standard precautions. • Surgical or procedure mask is required. Upon leaving room, remove mask and perform hand hygiene.

20. Airborne Transmission • Small particles containing infectious agents that remain infective over time and distance • Microorganisms carried in this manner may be dispersed over long distances by air currents and may be inhaled by susceptible individuals who have not had face-to-face contact with (or been in the same room with) the infectious individual • Preventing the spread of pathogens that are transmitted by the airborne route requires the use of special air handling and ventilation systems (e.g., AIIRs) to contain and then safely remove the infectious agents • Infectious agents to which this applies include Mycobacterium tuberculosis , rubeola virus (measles) , and varicella-zoster virus (chickenpox)  http://www.cdc.gov/hicpac/2007IP/2007ip_part1.html

21. AFB/Airborne Precautions • This sign is used for diseases such as TB, chicken pox (varicella-zoster), disseminated shingles (herpes zoster), SARS, and Smallpox that require airborne isolation N-95 respirator • Patients are placed in a negative pressure room and the door is kept closed. The patient wears a surgical mask when they must leave their room. PAPR-Hood

22. Questions?