Infection Prevention Education October 2012 Peggy DeBacco, RN, CIC

1. Infection Prevention Education October 2012 Peggy DeBacco, RN, CIC

2. Objectives • After completing this training the learner will be able to: • Discuss the chain of infection • Discuss when to use Hand Hygiene and Gloves • List 3 Bloodborne Pathogens (BBP) • List the steps to follow after an Exposure to BBP • Identify symptoms of TB • List 2 reasons to receive the flu vaccine

3. Bacteria, viruses, fungi,parasites Infectious Agent Humans, Animals, Inanimate objects Susceptible Host Reservoir Lacks Immunity or Physical Resistance Chain of Infection Mouth, nose or infected bowel Portal of Exit Portal of Entry Body orifices, Mucus Membranes, Breaks In the skin The hands of a healthcare worker Mode of Transmission

4. How Can You Break the Chain of Infection? • Perform Hand Hygiene • Use Standard Precautions

5. Indications for Hand Hygiene • When hands are visibly dirty, contaminated, or soiled, wash with antimicrobial soap and water. • Before eating or after using the restroom • If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

6. When To Do Hand Hygiene Before: • Patient contact • Gloving After: • Contact with a patient’s skin • Contact with body fluids or excretions, non-intact skin, wound dressings • Removing gloves

7. Hand Hygiene Technique Handwashing • Wet hands with water, apply soap, rub hands together for at least 15 seconds • Rinse and dry with disposable towel • Use towel to turn off faucet

8. Hand Hygiene Technique Handrubs • Apply to palm of one hand, rub hands together covering all surfaces until dry • Volume: based on manufacturer

9. Skin Care • Use approved hand lotions

10. Key Points About PPE • Put on before contact with the patient • Use carefully – don’t spread contamination • Remove and discard carefully, either at the doorway or immediately outside (site of use) • Immediately perform hand hygiene

11. Gloves • Use gloves for any contact with blood, moist body substances (except sweat), mucous membranes or non-intact skin. • Blood Draw • FSBS (Fingerstick Blood Sugar) • Handling Urine specimen • Changing a dressing. It is not necessary to wear gloves to take vital signs

12. Gloving Do’s and Dont’s • Limit opportunities for “touch contamination” • Protect yourself, others, and the environment. • Think….why are you using gloves? • Don’t touch your face or adjust Personal Protective Equipment (PPE) with contaminated gloves • Remove and discard gloves immediately after completion of a task. • Perform Hand Hygiene every time gloves are: • Put on • Removed

13. Gowns Yellow, fluid resistant, disposable gowns are available on each unit. • Wear when there is a possibility of contamination during the specific job you are doing. • Patient on contact precautions • Patient who is spitting

14. Face Protection • CRC supplies masks and masks with shields • Masks – protect nose and mouth • Should fully cover nose and mouth and prevent fluid penetration • Mask with shield – protects face, nose, mouth, and eyes

15. Safe Injection Practices • Use aseptic technique to avoid contamination of sterile injection equipment. • Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. • Needles, cannulae and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient.

16. Safe Injection Practices • Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use. • If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile. • Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations; discard if sterility is compromised or questionable.

17. Preventing Infections…. Easier Than Controlling Them!

18. Respiratory Hygiene and Cough Etiquette Respiratory Etiquette stations are placed in the Lobby and Waiting rooms If an individual presents to the CRC with a cough or signs of respiratory illness: • Have individual wait in an area away from others • Ask individual if they would put on a mask • Notify the house supervisor

20. Transmission-based PrecautionsUsed in addition to Standard Precautions • Airborne--TB, Measles • (CRN/SA does not have negative air pressure room nor N-95 masks. Someone suspected of having TB or measles would be sent to another facility) • Droplet--influenza, Neisseria meningitidis, pertussis (infections spread by large droplets generated by coughs, sneezes, etc.) • Contact--MRSA, c-diff, scabies

21. Droplet Precautions • A surgical mask is worn to prevent droplets reaching the mucous membranes of the nose and mouth when < 3 feet of the individual. • Individuals should be separated by 3-6 feet, or be grouped with other individuals with the same infection/colonization status. • Individual should wear a surgical mask when outside of the individual room/area. • In some cases mask with shield is used to protect eyes

22. Contact Precautions For infections spread by direct or indirect contact with patients or patient-care environment • Limit Individual’s movement • Private room preferred • Cohort individuals with the same infection status • Don gown and gloves before entering the patient room/area • Remove gown and gloves at the site and carry to Soiled Utility Room • Hand hygiene immediately after leaving the patient room/area • Emphasis on cleaning, esp.. frequently touched surfaces (Recliner, bedside table, lavatory surfaces, etc.). • Dedicated equipment (Stethoscopes/BP cuff/Thermometer)

23. C-Diff (Clostridium difficile) • C. Diff is an anaerobic (doesn’t need oxygen), gram-positive bacteria (spores can live for 7 months or longer) • C. difficile is shed in feces. Any surface, device, or material (e.g., toilet, sink) that becomes contaminated with feces may serve as a reservoir for the C. difficile spores. • C. difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item.

24. Environmental Cleaning and Disinfection • Ensure adequate cleaning and disinfection of environmental surfaces and reusable devices, especially items likely to be contaminated with feces and surfaces that are touched frequently. • Use an Environmental Protection Agency (EPA)-approved germicide for routine disinfection during non-outbreak situations. • Use 10% sodium hypochlorite if there is evidence of ongoing transmission of c-difficile

25. Disinfecting Medical Equipment • Clean and Disinfect after each use: • Glucometer • Pulse Oximeter • Thermometers (ear, oral, frontal) • Clean and Disinfect each shift and if visibly soiled: • BP Cuffs • Keep a canister of Sani-Wipes on the Vital Signs Monitor Stand.

26. Bloodborne Pathogens • HBV--Hepatitis B • HCV--Hepatitis C • HIV--Human Immunodeficiency Virus • AIDS--Acquired Immunodeficiency Syndrome

27. Hepatitis B (HBV) • Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. • Estimated 38,000 new infections in 2009 • Estimated 804,000 - 1.4 million people with chronic HBV infection • Transmission: Needlesticks or other sharp instrument injuries • For a susceptible person, the risk from a single needlestick or cut exposure to HBV-infected blood ranges from 6-30%. • The best way to prevent Hepatitis B is by getting vaccinated

28. Hepatitis B Vaccination • A safe and effective vaccine against Hepatitis B is available to all “potentially at risk” CRC individuals. • You are “potentially at risk” if you have direct contact with blood and other potentially infectious body fluids. It doesn’t matter how frequently you have contact or that you take precautions when you do. • The vaccine is free. • Contact Human Resources (301-2275) • If you initially declined, you may change your mind and receive the vaccination.

29. Hepatitis C • Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. • Estimated 17,000 new infections in 2007 • Estimated 3.2 million people with chronic HCV infection • Transmission: Less commonly through needlestick or other sharp instrument injuries • There is no vaccine available • The average risk for infection after a needlestick or cut exposure to HCV-infected blood is about 1.8%

30. HIV • Virus that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. • 48,000 were infected with HIV in 2009 • More than 1 million are living with HIV in US • Between 1981 and 2006 AIDS killed more than 25 million people • The average risk of HIV infection after a needlestick or cut exposure to HIV-infected blood is 0.3%.

31. What If I Have An Exposure? • Wash the exposed area immediately with soap and water. Water only for eye exposure. • Eye wash is kept with PPE • Immediately notify the Administrator or person in charge • You will be directed to an occupational health clinic or urgent care

32. Exposure Control Plan (ECP) • Located on the Crisis Response Intranet • CRC.4.06.IC Exposure Control Plan • A written plan will be made available upon request.

33. Spill Kits • Used to clean up a spill of blood, urine, feces, vomit. • The kit contains everything to safely clean up a spill and includes directions • Located in each Soiled Utility Room and with PPE • If necessary, larger containers of absorbent are kept with the spill kits in the Soiled Utility Rooms

34. Sharps • Safety Lancets and Safety Sharps with either passive or single-handed user activation technique are used at CRC • Disposal of Sharps • Syringes with needles, fingerstick lancets, safety razors, and glass ampules only • Sharps containers mounted at eye level • Do not over fill • Replace when 3/4 full • Contact RN for replacement (replacements are located in soiled utility and medication rooms on each unit) • Take filled containers to the Adult Observation Soiled Utility Room and place in the Steri-Cycle Container

35. Regulated Waste OSHA Bloodborne pathogens standard defines “regulated waste” as • “liquid or semi-liquid or other potentially infectious materials (OPIM); • contaminated items that would release blood or OPIM in a liquid state if compressed; • items that are caked with dried blood or OPIM • OPIM: • blood and blood products, serum and plasma, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid

36. Urine, Feces, Vomit are Not Regulated Waste • Unless It contains visible blood

37. Linen • Use Standard Precautions when handling soiled or contaminated linen • Hold linen away from your body • Promptly dispose of all soiled linen in linen hamper located in the soiled utility rooms • Replace blue plastic linen bag when 2/3 full

38. * OPIM (Other Potentially Infectious Materials) Semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, body fluids visibly contaminated with blood 9

39. Tuberculosis (TB) • TB disease is caused by a bacterium 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. 

40. How TB Spreads • TB is spread through the air from one person to another. • The TB bacteria are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. • People nearby may breathe in these bacteria and become infected.

41. The Difference Between Latent TB Infection and TB Disease

42. Differences cont’d

43. Patients with TB Symptoms Actions to Take • If a patient presents with signs and symptoms of TB disease ask patient to wear a mask • Immediately separate the patient from others • Arrangements will be made to transfer patient for follow up

44. TB Skin Testing • Performed on patients admitted to SubAcute • Performed Healthcare Workers on hire and annually • Test is given and then read within 48 -72 hours • Those who test positive (or have in the past) will be given a TB questionnaire to complete

45. Flu Facts • On average more than 200,000 persons are hospitalized • 3,000 to 49,000 people die each year • Influenza is highly contagious. • The strains of virus that cause influenza infection change almost every year, which is why influenza vaccine is recommended each year. • The most common side effect of influenza vaccination is a sore arm, which is generally short-lived. • By declining to be vaccinated, you could put your own health and the health of those with whom you have contact, including CRC patients, coworkers, and members of your household, at risk.

46. Who should get vaccinated against influenza? Annual vaccination is recommended for all people ages 6 months and older who do not have a contraindication to the vaccine.

47. Did You Know? • Droplets from a sneeze or cough can travel 3 feet or more. • You can shed flu virus 24 to 48 hours before you feel sick. • You cannot get the flu from a flu shot. • All health care workers should get vaccinated every year • 63.5% of U.S. health care workers got vaccinated for the 2010-2011 season.

48. Vaccination Rates • The Healthy People 2020 objective is a 90 percent vaccination rate. • What will the Crisis Response Network of Southern Arizona rate be for 2012/2013? Last season it was 17%

49. It’s Never Too Early or Too Late! Month of Peak Influenza Activity United States, 1976-2006

50. I can’t cover my shift Flu doesn’t fight fair • Even if you’re healthy, you can get sick and spread the flu to your co-workers, patients, or even bring it home to your family. Fight Back • Don’t get the flu. • Don’t spread the flu. • Get vaccinated.