INFECTION PREVENTION IN THE WORKPLACE

1. INFECTION PREVENTION IN THE WORKPLACE Judith D. Leschek RN, BSN, CIC Director, Infection Control JFK Medical Center

2. HANDWASHING The single most important way to prevent infection!

3. Hand Hygiene • Goal 7 • Reduce the risk of health care associated infections. • NPSG.07.01.01 • Comply with current World Health Organization (WHO) hand hygiene guidelines or Centers for Disease Control and Prevention (CDC) • hand hygiene guidelines. • Compliance with the WHO or CDC hand hygiene guidelines will reduce the transmission by staff to [patient]s of infectious agents,

4. Hand Hygiene

5. Got No Germs Got Germs? Clean your hands before and after contact with the patient or the patient’s environment. University of Pittsburgh

6. Hand Hygiene The CDC recommends that artificial nails or extenders should NOT be worn by healthcare personnel who have direct patient contact.

7. Elements of Prevention • Hand Hygiene • PPE and Safe Work Practices • Standard Precautions • Transmission based precautions • Patient Placement and transport • Environmental measures • Adjunctive measures • Immunization, Visitor management

8. ADULTS / HEALTHCARE PERSONNEL !! ARE YOUR VACCINATIONS UP-TO-DATE? • You should be immune to: • Influenza • Hepatitis B • Measles/Mumps/Rubella (MMR) • Tetanus/Diphtheria/Pertussis • Varicella (Chickenpox)

9. IMMUNIZATION for OLDER ADULTS • SHINGLES (HERPES ZOSTER) VACCINE • PNEUMOCOCCAL VACCINE • INFLUENZA VACCINE • TETANUS, DIPHTHERIA,PERTUSSIS (Tdap) VACCINE • VACCINES ARE NOT JUST FOR KIDS!!!

10. VACCINES ARE NOT JUST FOR KIDS!!!Hepatitis B Vaccine Program

11. Campaign to Prevent Antimicrobial Resistance in Healthcare Settings Key Prevention Strategies • Prevent infection • Diagnose and treat infection effectively • Use antimicrobials wisely • Prevent transmission Clinicians and their patient care partners hold the solution!

12. Standard Precautions • PPE: Constant use of gloves and handwashing for any contact with blood, moist body substances ( except sweat), mucous membranes or non-intact skin. Plus face-shields, masks or gowns if splashes are anticipated) • Gloves are removed and discarded immediately after completion of a task. • Hands are washed every time gloves are removed • Respiratory hygiene and cough etiquette

13. Respiratory Etiquette

14. Transmission-based Precautions Used in addition to Standard Precautions • Airborne • Droplet • Contact

15. OSHA’s Bloodborne Pathogens Standard

16. OSHA’s Bloodborne Pathogens Standard (cont.) • Engineering Controls

17. OSHA’s Bloodborne Pathogens Standard (cont.) • Work Practice Controls MOUTH PIPETTING RECAPPING

18. Hazard Communication – Color Coded System Yellow = Chemotherapeutic Waste Blue and white= Contaminated Laundry Red = Infectious Waste OSHA’s Bloodborne Pathogens Standard (cont.)

19. Red Bag –Regulated Medical Waste (Infectious ) Waste • Items saturated with blood or that have dried or caked blood • All blood transfusion bags and tubing • All intravascular catheters • Wound suction & all drainage systems • Used, disposable suction canisters that have bloody contents (which must be solidified before placing in RMW ) • Foley catheters and drainage bags with visible blood • Dialysis waste

20. Red Bag- Regulated Medical Waste( Infectious) Waste (cont.) • Gloves visibly contaminated with blood or body fluids • Supplies necessary to clean up a blood/body fluid spill • Lab waste • Sharps, needles, syringes and glass test tubes must be disposed of in puncture resistant sharps collection containers

21. OSHA’s Bloodborne Pathogens Standard (cont.) • Spill Clean-up Spill Kits -

22. Post-Exposure Prophylaxis

23. EMPLOYEE HEALTH ISSUES • Pre-employment Physical • TST- Initial (two step) and annually • Immunization • Rubeola, Rubella, Varicella, etc. • Sharps Injury and Post-Exposure Follow-up • Hepatitis B Program

24. TB Exposure Control Plan

25. TB Exposure Control Plan (cont.)

26. Tuberculosis-Mycobacterium tuberculosis-TB • What is it? • Affects lungs primarily • Symptoms: • feelings of sickness or weakness, • weight loss, • fever and night sweats. • TB disease of the lungs also includes coughing, chest pain and coughing up of blood (hemoptysis) • Symptoms of TB disease in other parts of the body depend on the area affected.

27. Tuberculosis-Mycobacterium tuberculosis-TB • Transmission- Airborne • Latent TB infection vs. Active TB infection.

28. TB Treatment • TB meds are taken for 6 – 12 months TB meds include: • Isonazid (INH) • Rifampin(RIF) • Ethambutol • Pyrazinamide • DOT: • Direct Observed Therapy

29. Legionnaires’ Disease – What is it? • Caused by a bacteria – Legionella • In 1976- an outbreak of this disease occurred in people who went to a Philadelphia convention of the American Legion causing a type of pneumonia. • Although present before the outbreak now more illness from the disease is being detected in pneumonia cases. • Each year 8,000-18,000 people are hospitalized with Legionnaires disease in the U.S.

30. Legionnaires’ Disease - Symptoms • Legionnaires’ disease can have symptoms like many other forms of pneumonia. • High fever, chills, cough and in some people, muscle aches and headaches (chest x-rays are needed and other tests on the sputum, as well as blood or urine) • Symptoms begin 12 -14 days after exposure

31. Legionnaires’ Disease - Symptoms • A milder infection caused by Legionella bacteria is called Pontiac Fever with symptoms usually lasting 2-5 days, may include fever, headaches and muscle aches however no pneumonia with no treatment necessary and no further problems. • Pontiac Fever and Legionnaires’ disease may also be called “Legionellosis separately or together.

32. Legionnaires’ Disease- Severity & Treatment • Legionnaires’ disease can be very serious and can cause death in up to 5%to 30% of cases • Most cases can be treated successfully with antibiotics and healthy people usually recover from infection.

33. Legionnaires’ Disease-Transmission • People get Legionnaires’ disease when they breathe in a mist or vapor ( small droplets of water in the air) that has been contaminated with the organism . • One example might be from breathing in the steam from a whirlpool spa that has not been properly cleaned and disinfected. • The bacteria are not spread from one person to another person.

34. Legionnaires’ Disease-Transmission • Outbreaks occur in the hospital and community ( cruise ships and hotels, with most likely sources being whirlpool spas, air conditioning cooling towers, evaporative condensers, humidifiers and decorative water fountains) • People at most risk are those > 65years of age, people with weakened immune systems and those with chronic diseases.

35. Legionnaires’ – Diagnosis • Most people will have pneumonia • Chest X-ray • Clinical Diagnosis • Lab tests: • Urinary Antigen • Lung biopsy culture • Paired sera for antibody levels

36. Meningitis_ Viral & Bacterial • Definition- Meningitis is an infection of the fluid of a person’s spinal cord and the fluid that surrounds the brain. • Often affects children and young adults • Viral meningitis is generally less severe and resolves without treatment. • Bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability. It is important to identify the type of bacteria causing the meningitis because antibiotics can prevent some types of spread and infection

37. Meningitis- Signs and Symptoms • High fever, headache and stiff neck are the common symptoms – developing over several hours, or they may take1-2 days. • Other symptoms may include nausea, vomiting, discomfort looking into bright light, confusion and sleepiness. In newborns and small infants classic symptoms may be absent of difficult to detect and the infant may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly. As the disease progress, patients of any age may have seizures. • Early diagnosis (symptoms and spinal tap) and treatment are very important

38. Meningitis – Transmission & Treatment and Prevention • Some bacterial meningitis are contagious through the exchange of respiratory and throat secretions (intimate contact – coughing and kissing) • Treatment – Antibiotics • Prevention- Antibiotics for close contact • Vaccines -2 MCV4 (Meningococcal conjugate vaccine) –Preferred vaccine for people 2-55 years of age. Given at 11-12 years of age or at the earliest opportunity. MPSV4 (Meningococcal polysaccharide vaccine) may be used when MCV4 is not available and is the only meningococcal vaccine licensed for people older than 55. with immune system disorders

39. Meningitis – Transmission & Treatment and Prevention • Meningococcal vaccine is also recommended for other people at increased risk for meningococcal disease such as college freshman, military recruits, travel to areas where meningococcal diseases, anyone with a damaged or removed spleen and people with immune system disorders

40. C.difficile Discussion • C.difficile What is it? • Transmission • Prevention • Handwashing • Precautions- Gowns & Gloves • Environmental Cleaning • Treatment • Does it come back?

41. BIOTERRORISM PLAN Botulism Anthrax Plague Smallpox

42. Concluding Remarks • Must have an customized Infection Control Plan. • Must have an specialized Emergency Response Plan • Educate, Educate!!!! • Wash Hands!!!! • Clean environment!!! • Cover your Cough!!!!!

43. Infection Prevention & Control Plan/Program • Risk Assessment - each organization unique • Size • Services • Case Mix – Age, Diagnosis, History • Patient Population – Cultural Diversity • Community • Responsibility for Infection Prevention ?? • Infection Prevention and Control Committee • Long Term Care –different • Corporate structure and systems vs individual entities

44. The Infection Prevention and Control Plan • Requires the following: • An assessment of the geographic location and community environment • Delineation of the services provided by the facility • Listing of risk factors related to the patient population and services provided • Strategies implemented to prevent infection • Designation of individuals responsible for implementation of strategies

45. The Infection Prevention and Control Plan • Format Options: narrative, policies, protocols, practice guidelines, clinical pathways, care maps or any combination • Must be comprehensive and flexible to respond to change

46. Infection Prevention & Control Plan/Program • Risk Assessment - each organization unique • Size • Services • Case Mix – Age, Diagnosis, History • Patient Population – Cultural Diversity • Community • Responsibility for Infection Prevention ?? • Infection Prevention and Control Committee • Long Term Care –different • Corporate structure and systems vs individual entities

47. Regulations!!!!!!

48. Questions

49. Resources: • www.cdc.gov • www.nj.state.us/health