Infection Prevention: Full Series

Transcription

1 Infection Prevention: Full Series Title: Infection Prevention: Full Series Course Code: ICFS Course Outline Section 1: Introduction A. Course Host B. Course Overview C. Learning Objectives D. Reflect Section 2: Transmission of Disease A. Meet Mary B. The Chain of Infection C. Standard Precautions D. Sources of Infectious Agents E. Susceptible Hosts F. Methods of Transmission 1. Direct Contact Transmission 2. Indirect Contact Transmission 3. Droplet Transmission 4. Airborne Transmission 5. Bloodborne Transmission 6. Review: Bloodborne Transmission G. Meet Sara H. Safe Work Practices I. Remember Mary? Section 3: Hand Hygiene A. Breaking the Chain of Infection B. Top Ten Hand Hygiene C. When Should You Wash? D. Five Steps of Hand Hygiene E. Three Steps to Using a Alcohol Hand Rub F. Other Means of Protection Essential Learning, LLC.

2 G. Hand Hygiene Campaigns H. Let's Review I. Remember Sara? Section 4: Preventing Transmission A. Tiers of Precautions B. Standard Precautions C. Personal Protective Equipment (PPE) a. Gloves b. Gown c. Mask/Respirator and Eye Protection (goggles/face shield) D. Precautions to Meet Circumstances E. Needlesticks F. Needlestick Prevention G. Respiratory Hygiene/Cough Etiquette H. Safe-Injection Practices I. Transmission-Based Precautions J. Type of Transmission Based Practices K. Contact Precautions: Direct and Indirect L. Droplet Precautions M. Airborne Transmission Precautions N. Let's Review Precautions O. Meet Peter Section 5: Bio-hazardous Waste A. What is Biohazardous Waste? B. Handling C. Red Bags D. Sharps Containers E. Contaminated Laundry F. Let's Review: Biohazardous Waste G. Meet Laura Section 6: Hepatitis A. Definition B. Symptoms C. Transmission D. OSHA E. Hepatitis Review Essential Learning, LLC.

3 F. Meet Joe Section 7: HIV/AIDS A. Overview B. What is HIV? C. What is AIDS? D. Facts E. How is HIV Transmitted? F. How is HIV Actually Spread? a. Contributing Behaviors b. Blood Exposure c. Contaminated Needles d. Mother to Child e. Saliva f. Contact G. At Risk For HIV Infection H. Sexually Transmitted Infections (STI) I. Most Common HIV Transmission Methods J. Symptoms a. More About Symptoms K. Complications L. What Is AIDS? M. Opportunistic Infection N. How Did Jerry Contract HIV Section 8: Tuberculosis A. What Is TB? B. Why Is Tuberculosis A Problem Today? C. How Is TB spread? D. Latent TB Infection E. Active TB Disease F. Weak Immune System G. Symptoms of TB H. Other Symptoms of TB I. MDR TB J. Precautions K. Testing for Healthcare Workers L. Meet Sharon Section 9: H1N1 Swine Flu Essential Learning, LLC.

4 A. Meet Sarah B. A New Flu C. Protecting Yourself D. Let s Review-H1N1 Flu E. Remembering Sarah? Section 10: Multiple-Drug Resistant Organisms A. Multiple Drug Resistant Organisms B. Infection Prevention Plan C. MRSA: The Growing Problem with a Cure D. How MRSA Spreads in Health Care Settings E. Antimicrobial Resistance F. Expensive Results of Antimicrobial Resistance G. Let's Review: MDRO's H. Meet Mel Section 11: Blood-borne Pathogens A. What You Need To Know B. Define: Bloodborne Pathogens C. VRE D. Exposure E. Preventing Occupational Exposure F. Responding to Exposure G. Post-Exposure H. Risk of Infection I. Reported Cases J. Exposure Follow Up K. Unknown Infection L. Recommended Drug Treatment M. Treatment Timing N. Drug Side Effects O. Treatment During Pregnancy P. Exposure Follow Up Q. Follow-up Precautions R. Preventing Occupational Infections S. Occupational Infections T. Let's Review: FAQ U. Meet Josie Section 12: Summary Essential Learning, LLC.

5 A. Summary B. References C. CONGRATULATIONS! Section 1: Introduction Course Host Hi, I m your host Richard and today you will see me periodically throughout this course, particularly at the start of each section. As we explore infection control, it s critical that we first understand how diseases are actually spread or communicated. So let s get started with section 1, Transmission of Disease. Also, keep in mind that if you are viewing this course via Essential Learning s flash player then when you see me on screen or when you see a video playing, you will want to make sure your speakers are on, so you can hear important content. Course Overview Did you know that diseases are transmitted every day? Do you know how you can prevent the transmission of infections at your workplace? Many health care organizations and staff are unprepared for virus or other disease outbreaks. This course explains the definition, purpose and benefits of infection control in health care settings. From the basics of how diseases are transmitted to specific guidelines on how to prevent illnesses such as H1N1, Hepatitis B and C, Tuberculosis, and HIV, this course will provide you the knowledge you need to be armed against the most powerful and deadliest diseases of our time. Using a hands-on approach, this course will provide you with detailed examples and step-by-step instructions of how to apply these guidelines at your own workplace. The information in this course is appropriate for any health care worker who would like to learn more about how to prevent the spread of diseases, so even if you are familiar with good hygiene, from this course you will gain a whole new understanding of standardized precautions to take to effectively prevent and treat diseases in health care settings. The information in this training includes content from the Center for Disease Control and Prevention, OSHA, as well as Medline Plus Essential Learning, LLC.

6 Learning Objectives Upon completion of this course you will be able to: Apply standard- and transmission-based precautions to prevent the transmission of disease. Define protective measures to protect yourself and others from the spread of illnesses such as Hepatitis B, Hepatitis C, HIV, Tuberculosis, MRSA, VRE, and H1N1. Describe the steps to take if an occupational exposure occurs. Reflect Before you begin this course, take a moment to reflect on the following questions How do you imagine you would react in a situation where you are exposed to the blood of a patient? 2. How is disease transmitted? 3. How can you prevent the transmission of infections? 4. What is the single most important practice you can employ to prevent infection? Section 2: Transmission of Disease Meet Mary I d like to tell you a little bit about Mary. Mary is a nurse who works at a critical care unit at a local hospital. Even though Mary knows she has the flu, she still shows up to work sick because she does not have any more sick days to take. That day at work, Mary tries her best to not spread her germs. Unfortunately, Mary feels so awful that she cannot even remember to wear gloves, wash her hands in between patients, or after she sneezes. The next day, two of Mary s coworkers also get the flu, as do four of the patients Mary treated. Upon her return to work, Mary finds out that two of those patients died from complications associated with the flu and their critical conditions. With this in mind, take a moment and ask yourself, What might Mary have done differently to Essential Learning, LLC.

7 prevent these illnesses and deaths? In this course you will learn about the various aspects of infection control, including how Mary unknowingly transmitted her flu to her coworkers and patients. The Chain of Infection Transmission of infectious agents within a health care setting requires three elements: A source of infectious agents A susceptible host or receiver A method of transmission for the agent This is known as the chain of infection. Standard Precautions How do these elements work together to create a Health care Acquired Infection (HAI)? Sources of infectious agents Susceptible hosts Methods of transmission Sources of Infectious Agents Infectious agents (germs) transmitted during health care are primarily from human beings, but inanimate environmental sources also are implicated in transmission. Human reservoirs (where germs reside) include patients, health care personnel, household members, and other visitors. These individuals may have active infections or may be in the asymptomatic (having no symptoms) and/or incubation period of an infectious disease. Susceptible Hosts Infection is the result of a complex inter-relationship between a potential host and an infectious agent. The host is the place where germs grow, usually a human being. Germs grow in blood, sputum, infected wounds and other bodily fluids. Methods of Transmission Infections can be caused by: Essential Learning, LLC.

8 Bacteria Viruses Fungi Parasites The methods of transmission vary by type of organism. Some infectious agents may be transmitted by more than one route; some are transmitted primarily by direct or indirect contact. Contact transmission is the most common method of transmission. It is divided into two subgroups: direct contact and indirect contact. Direct Contact Transmission Direct transmission occurs when germs are transferred from one infected person to another person without a contaminated intermediate object or person. Opportunities for direct contact transmission between patients and health care personnel include: Blood or other blood-containing body fluids from a patient directly enters a caregiver s body through contact with a mucous membrane or breaks (i.e., cuts, abrasions) in the skin. Mites from a scabies-infested patient are transferred to the skin of a caregiver while s/he is having direct ungloved contact with the patient s skin. A health care provider develops a sore on a finger after contact with Herpes Simplex Virus (HSV) when providing oral care to a patient without using gloves, or HSV is transmitted to a patient from an infection on an ungloved hand of a health care worker. Indirect Contact Transmission Indirect transmission involves the transfer of an infection through a contaminated intermediate object or person. In the absence of a point-source outbreak, it is difficult to determine how indirect transmission occurs. However, extensive evidence cited in the Guideline for Hand Hygiene in Health-Care Settings suggests that the contaminated hands of health care personnel are important contributors to indirect contact transmission. Examples of opportunities for indirect contact transmission include: Essential Learning, LLC.

9 Hands of health care personnel may transmit germs after touching an infected body site on one patient or a contaminated inanimate object, if hand hygiene is not performed before touching another patient. Patient-care devices (e.g., electronic thermometers, glucose monitoring devices) may transmit pathogens if devices contaminated with blood or body fluids are shared between patients without cleaning and disinfecting between patients. Shared toys may become a vehicle for transmitting respiratory viruses among children. Clothing, uniforms, laboratory coats, or isolation gowns used as personal protective equipment (PPE), may become contaminated with potential pathogens after care of a patient colonized or infected with an infectious agent. Although contaminated clothing has not been implicated directly in transmission, the potential exists for soiled garments to transfer infectious agents to successive patients. Droplet Transmission Droplet transmission is, technically, a form of contact transmission. Respiratory droplets are generated when an infected person coughs, sneezes, or talks. If another person breathes in these droplets, an infection can occur. Examples: Common Cold Flu SARS Airborne Transmission Airborne transmission occurs by distribution of either airborne droplets or small particles, which can be breathed in by another person. These airborne germs are lighter than droplets and can live for a long time in the air. Examples: tuberculosis, measles, chicken pox, smallpox and aspergillus (a certain type of mold). Germs 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 Essential Learning, LLC.

10 Bloodborne Transmission Germs can live in the bloodstream and in other body fluids that contain blood components, such as seminal fluid. A person's skin prevents germs from entering into the body, but if the skin is broken because of even a tiny cut, it is possible for infected blood of another individual to enter. Mucous membranes, found in the mouth, vagina, or rectum may also allow germs to spread through contact with blood and/or secretions containing blood. Unprotected sexual contact can lead to this method of transmission. Examples: HIV, Hepatitis B, Hepatitis C. Review: Bloodborne Transmission How do germs travel? Droplet Airborne routes Bloodborne Contact transmission via direct contact (without a contaminated object), or indirect contact (through an object or person) What three elements are required to transmit infections, known as the Chain of Infection? A source of infectious agents. A susceptible host or receiver. A method of transmission for the agent. Meet Sara Sarah is an infection preventionist for an inpatient unit and a day treatment program for older adults. A patient has just been diagnosed with a MRSA infection. She notices that the staff are cleaning their hands with a hand rub before and after contact with the patient. She praises the staff for effective hand hygiene. Since the patient has dementia and can t follow directions, she recommends that the patient be moved to a private room, and she places a Contact Precautions sign and gathers personal protective equipment for the staff to use Essential Learning, LLC.

11 Safe Work Practices Safe work practices to prevent the spread of infection include: Keep hands away from your face Limit surfaces touched Use personal protective equipment when required Change gloves when torn or heavily contaminated Perform hand hygiene frequently Remember Mary? Looking back at nurse Mary now and applying the information you learned in this section, which of the following ways could Mary have infected her coworkers and patients? A. By sneezing or coughing on them. B. By breathing on them. C. By not wearing gloves or washing her hands in between patients. D. By touching surfaces with her hands after she covered her cough. E. All of the above. Incorrect Feedback: Not exactly. Although this is one of the ways Mary may have transmitted her germs to her coworkers and patients, all of the other methods of exposure listed may have spread her germs just as well. Correct Feedback: Correct! All of the above methods of exposure may have transmitted Mary s germs to her coworkers and patients. Section 3: Hand Hygiene Breaking the Chain of Infection How do we break the chain of infection? Through thorough hand hygiene! Hand hygiene is the single most important practice to reduce the transmission of infections in health care settings and is an essential element of Standard Precautions. The term hand hygiene includes both hand-washing with, either plain or antimicrobial Essential Learning, LLC.

12 containing, soap and water, and use of alcohol and non-alcohol based products (sprays, gels, rinses, foams) that do not require the use of water. If your hands are visibly soiled you should always wash your hands with soap and water. Soap and water should always be used when working with someone who has a Clostridium Difficile infection (handrub eliminates the organism but not the spores; the mechanical action of washing combined with the chemical action of soap eliminates both). Top Ten Top Ten Reasons Health care Workers Don t Wash Their Hands. According to the Joint Commission Center for Transforming Health care, these are the top reasons health care workers do not practice hand hygiene: Ineffective placement of dispensers or sinks. Hand hygiene compliance data are not collected or reported accurately or frequently. Lack of accountability and just-in-time coaching. Safety culture does not stress hand hygiene at all levels. Ineffective or insufficient education. Hands full. Wearing gloves interferes with process. Perception that hand hygiene is not needed if wearing gloves. Health care workers forget. Distractions. When Should You Wash? Hand rub or wash before and after every contact with a client. Before putting gloves on and after taking them off. Before preparing or eating food. Before preparing medication. After using the toilet. After sneezing or coughing into hands. After contact with objects that might be contaminated. After any accidental exposure to body fluids, mucous membranes, or skin with cuts and sores. After handling an animal or animal waste Essential Learning, LLC.

13 Before and after treating a cut or wounds. Five Steps to Proper Hand-Washing 1. Hands should be washed using soap and warm, running water. 2. Hands should be rubbed vigorously during washing for at least 20 seconds with special attention paid to the backs of the hands, wrists, between the fingers and under the fingernails. 3. Hands should be rinsed well while leaving the water running. 4. With the water running, hands should be dried with a single-use towel. 5. Turn off the water using a paper towel, covering washed hands to prevent re-contamination. Three Steps to Using a Alcohol Hand Rub When using a hand rub: 1. Apply product to the palm of one hand. 2. Rub hands together. 3. Rub the product over all surfaces of hands and fingers until hands are dry. Other Means of Protection To protect yourself from mosquito borne diseases, use the five D's: DUSK and DAWN: don't go out at dawn and dusk when mosquitoes are feeding. DRESS: so that your skin is covered when you do have to go out. DEET: use mosquito repellents with DEET or pyrethrins. DRAIN: eliminate standing water where mosquitoes can lay eggs Essential Learning, LLC.

14 Hand Hygiene Campaigns Want to be a hand hygiene champion in your facility and increase hand hygiene compliance? No need to start from scratch. There are consensus-driven, evidence-based toolkits available for free in the following locations: Measuring Hand Hygiene Adherence: Overcoming the Challenges ( Centers for Disease Control and Prevention: Hand Hygiene in Health care Settings ( World Health Organization Save Lives: Clean Your Hands Campaign ( Review Click the following numbers to review statements about steps and routines that prevent the transmission of disease. 1. Alcohol hand rub: Pour the alcohol hand-rub in the palm of one hand (use the amount recommended by the manufacturer); rub both hands together; rub all parts of the wrist, hand, and fingers; rub until completely dry. 2. Hand hygiene: Required before eating; before and after client contact and putting on gloves; after using the toilet; after sneezing or coughing; after any accidental contact with contaminated objects, body fluids, mucous membranes, and skin with cuts or sores. 3. Soap and water hand-washing: Wet hands under running water; lather with soap; wash all areas with friction for 20 seconds; rinse thoroughly under running water; dry hands thoroughly with paper towel; use the paper towel to turn off the tap. Remember Sarah Remember Sarah? Sarah ended up using a hand hygiene monitoring-tool to determine hand hygiene compliance at her wing of the hospital. She found that her staff were not washing their hands after they were taking off their gloves. She met with the administrator and a group of staff. Together, they developed a Hand Hygiene Poster Campaign hand hygiene posters from the WHO and the CDC were made available in high traffic places throughout the clinic. The posters will be changed every month. Sarah will continue to monitor hand hygiene compliance to evaluate the effectiveness of this intervention Essential Learning, LLC.

15 From what you learned in this section, how might you now implement hand hygiene compliance at your workplace? Section 4: Preventing Transmission Precautions to Prevent Transmission of Infectious Agents There are two tiers of precautions to prevent transmission of infectious agents: 1. Standard Precautions and 2. Transmission-Based Precautions. Standard Precautions Standard Precautions should be used in the care of all clients in all health care settings, regardless of the suspected or confirmed presence of an infectious agent. You cannot tell by looking at someone that they have an infection. Implementation of Standard Precautions constitutes the primary strategy for the prevention of health-care-associated transmission of infections among clients and health care personnel. Standard Precautions are designed to protect people from diseases carried by the blood and other bodily fluids. They are called standard because they apply to everyone. Standard Precautions include a group of infection prevention practices that apply to all clients, regardless of suspected or confirmed infection status, in any setting in which health care is delivered. These include: Hand hygiene. The use of Personal Protective Equipment (PPE) including o gloves o gown o mask o eye protection, or face shield Essential Learning, LLC.

16 Personal Protective Equipment (PPE) PPE refers to a variety of barriers and respirators used alone or in combination to protect mucous membranes, airways, skin, and clothing from contact with infectious agents. The selection of PPE is based on the nature of the patient interaction and/or the likely methods of transmission. Gloves Wear gloves (clean, non-sterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and non-intact skin. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching non-contaminated items and environmental services, and before going to another patient. Wash hands immediately to avoid transfer of microorganisms to other patients or environments. Gown Wear a gown (a clean, non-sterile gown is adequate) to protect skin and to prevent soiling of clothing during procedures and patient-care activities that are likely to generate splashes or sprays of blood, bodily fluids, secretions or excretions. Select a gown that is appropriate for the activity and amount of fluid likely to be encountered. Remove a soiled gown as promptly as possible and wash hands to avoid transfer of microorganisms to other patients or environments. Mask/Respirator and Eye Protection (goggles/face shield) Wear a mask and eye protection (goggles or face shield) to protect mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. In certain circumstances, you may be required to wear a N95 Respirator (H1N1 for example). If your facility requires use of the respirator, you will be fit tested to ensure that the mask is fitted to your face for maximum effectiveness Essential Learning, LLC.

17 Precautions to Meet Circumstances The application of Standard Precautions during patient care is determined by the nature of the HCW-patient interaction and the extent of anticipated blood, body fluids, secretions or excretions. Standard Precautions also protect clients by ensuring that health care personnel do not carry infectious agents to patients on their hands or via equipment used during patient care. There is a specific way that PPE should be donned and taken off. Click here to review the correct process of donning PPE. Needlesticks How to prevent exposure to bloodborne pathogens through needlesticks: Health care workers are at risk for exposure to bloodborne pathogens, including Hepatitis B virus (HBV), Hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Exposures occur through needlesticks or cuts from other sharp instruments contaminated with an infected patient's blood or through contact of the eye, nose, mouth, or skin with a patient's blood. Prevention How can needlesticks be prevented? Many needlesticks and other cuts can be prevented by using safer techniques which include: Not recapping needles by hand. Disposing of used needles in appropriate sharps disposal containers. Using medical devices with safety features designed to prevent injuries. Using appropriate barriers when contact with blood is expected, including: o Gloves o Eye and face protection o Gowns Respiratory Hygiene/Cough Etiquette The transmission of Severe Acute Respiratory syndrome (SARS) in emergency departments by patients and their family members during the widespread SARS outbreaks in 2003 highlighted the need for vigilance and prompt implementation of infection control measures at the first point of encounter within a health care setting Essential Learning, LLC.

18 This is called Respiratory Hygiene/Cough Etiquette and is a new component of Standard Precautions. Respiratory Hygiene/Cough Etiquette Includes: Cover the nose/mouth when coughing or sneezing. Use tissues to contain respiratory secretions and dispose of them in the nearest waste receptacle after use. Perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic hand wash) after having contact with respiratory secretions and contaminated objects/materials. Respiratory Hygiene/Cough Etiquette Healthcare facilities should ensure the availability of materials for adhering to Respiratory Hygiene/Cough Etiquette in waiting areas for patients and visitors by: Providing tissues and no-touch receptacles for used tissue disposal. Providing conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e., soap, disposable towels) are consistently available. Safe-Injection Practices Safe-Injection practices to prevent patient-to-patient transmission of bloodborne pathogens. Hand hygiene and gloves. Wear gloves during finger stick glucose monitoring and during any other procedure that involves potential exposure to blood or body fluids. Change gloves between patient contacts. Change gloves that have touched potentially blood-contaminated objects or finger stick wounds before touching clean surfaces. Remove and discard gloves in appropriate receptacles after every procedure that involves potential exposure to blood or body fluids, including finger stick blood sampling Essential Learning, LLC.

19 Perform hand hygiene (i.e., hand washing with soap and water or use of an alcohol-based hand rub) immediately after removal of gloves and before touching other medical supplies intended for use on other residents. If you experience a needlestick, wash the affected area with soap and water immediately. Contact your Supervisor and seek medical attention as soon as possible for post-exposure treatment. Transmission-Based Precautions Transmission-based precautions are always used along with Standard precautions. Transmission-based precautions are for clients who are known or suspected to be infected. Transmission-based precautions are practices used in health care to help prevent the spread of diseases that can be transmitted without contact with body fluids. Types of Transmission-Based Precautions There are three types of transmission-based precautions (click on the links below): Droplet Precautions Airborne Precautions Contact Precautions. Contact Precautions: Direct and Indirect Examples of such illnesses that require contact precautions include: MRSA (Methicillin Resistant Staphylococcus Aureus) Scabies Chickenpox Herpes Lice How do you institute contact precautions? A. Disposable gloves and gowns must be worn for all personnel upon entering the room. B. Remove gloves and gown before exiting the room Essential Learning, LLC.

20 C. Practice strict hand washing after removal of gloves and after removing all other personal protective equipment. Designated patient equipment must be provided. The equipment should not be shared (unless it is properly disinfected) between patients. Examples of patient designated equipment include, but are not limited to: electronic thermometer, blood pressure cuff, portable manometer, stethoscope, oximeter, etc. Following discharge, the patient's equipment should be thoroughly cleaned and disinfected with an EPA- approved disinfectant before use on another patient. Droplet Precautions Droplets infected with germs can cause infections. They can come from a sneeze or a cough and talking. The germs are not carried very far because droplets are heavy. Infections that can be spread through droplets and require droplet transmission-based precautions include: Pneumonia Influenza Meningitis Mumps Transmission via large droplets requires close contact (within 3 feet or less) between the source patient and the susceptible individual. Droplets (due to their large size) do not remain suspended in air and travel short distances, three feet or less. Droplet Precautions require the use of a standard surgical mask within three feet of the patient. However, it is prudent to wear a mask upon entering the room of a patient on Droplet Precautions to avoid any inadvertent exposure. Airborne Transmission Precautions Airborne germs are found in tiny droplet nuclei much smaller than droplets that are spread by coughing, sneezing, talking, or breathing. Droplet nuclei are so small that they can travel long distances, remain in the air for a long time, and are tiny and light enough to travel through a ventilation system. Infections that can be spread through the air and require airborne transmission-based precautions include: Tuberculosis Chicken pox Measles (rubella) Shingles Essential Learning, LLC.

21 Airborne Transmission Precautions Wear respiratory protection (N95 respirator) when entering the room of a patient with known or suspected pulmonary tuberculosis. Susceptible persons should not enter the room of patients known or suspected to have measles (rubella) or varicella (chickenpox) if other caregivers are available. If susceptible persons must enter the room of a patient known or suspected to have measles or chickenpox, they should wear respiratory protection (N95 respirator). Let's Review: Precautions What are the tiers of precautions to prevent the spread of infections? Standard Precautions and Transmission Based Precautions Meet Peter Peter is a 17 year-old male who has been in a horrific car accident. He now needs his right leg amputated and his face completely reconstructed. To prevent the spread of infection, the orthopedic and craniofacial surgeons who are about to perform his surgeries should probably wear several forms of personal protective equipment (PPE). Given his types of surgeries, which of the following PPE is probably not necessary for the surgeons to don? A. Mask and Eye Protection (Incorrect: The surgeons should wear a mask and eye protection (goggles or face shield) to protect mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions.) B. Gloves (Incorrect: During any procedure that involves potential exposure to blood or bodily fluids, the surgeons should be wearing gloves the entire time.) C. Gown (Incorrect: It is important for the surgeon to wear a clean, sterile gown to protect skin and to prevent soiling of clothing during procedures and patient-care activities that are likely to generate splashes or sprays of blood, bodily fluids, secretions or excretions.) D. Lab Coat (Correct: A lab coat should not be necessary for the surgeons to wear if they are already wearing sterile gowns. It is important to select a gown that is appropriate for the activity and amount of fluid likely to be encountered and to remove a soiled gown as promptly as possible and wash hands to avoid transfer of microorganisms to other patients or environments.) Essential Learning, LLC.

22 Section 5: Bio-hazardous Waste In this section you will learn the nuts and bolts of biohazardous waste, including what it is and how to handle it. Let s get started. What is Biohazardous Waste? Biohazardous waste is waste material from a facility or medical office that involves blood or body fluids that contains or may reasonably be expected to contain enough germs that exposure to the waste by an individual could result in the transmission of an infectious disease. Biohazardous waste includes: Used sharps (needles, syringes, blades, pipettes, broken glass, and blood vials), body fluids or materials mixed with body fluids, bandages, and other materials that have come in contact with body fluids such as personal protective equipment. Handling How Should I Handle Biohazardous Waste? Any trash that has been in contact with blood or other body fluids must be placed in "biohazard" bags. These bags are usually red, are marked "Biohazard" and labeled with the facility's mailing address, and are specially designed to be leak proof. They are referred to as Red Bags. Red Bags Red Bags should NOT be used for regular trash and should NEVER be discarded with regular trash. For example, a defective Red Bag should be disposed of as biohazardous waste even if it has not been used. Handle it as little as possible. Always hold it away from your clothing. If laundry is visibly soiled, use gloves when removing it so that you do not touch any blood or other material. Always put soiled laundry into laundry bags with lids. Wash your hands frequently. There are special procedures for disposing of any materials that may contain blood or other sources of germs so that these germs are not spread to others. If the clinic or facility uses Essential Learning, LLC.

23 cloths, towels or other laundry, you should treat all facility laundry as if it contains germs. Sharps Containers Sharps containers must be closable, puncture resistant, leak proof on sides and bottom. Each sharps container must either be labeled with the universal biohazard symbol and the word "biohazard" or be color-coded red. Sharps containers shall be maintained upright throughout use, replaced routinely, and not be allowed to overfill. Contaminated Laundry Contaminated laundry should be handled as little as possible with a minimum of agitation. Contaminated laundry shall be bagged or at the location where it was used and shall not be sorted or rinsed in the location of use. Other requirements include: Contaminated laundry shall be placed and transported in bags containers labeled or color-coded. When a facility utilizes Standard Precautions in the handling of all soiled laundry, alternative labeling or color-coding is sufficient if it permits all employees to recognize the containers as requiring compliance with Universal Precautions. Whenever contaminated laundry is wet and presents a reasonable likelihood of soak-through or leakage from the bag or container, the laundry shall be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior. Employees who have contact with contaminated laundry should wear protective gloves and other appropriate personal protective equipment. Let's Practice! Biomedical waste is waste material that contains blood or body fluids and presents a risk of death, injury, or illness to people who handle it. A. True (That is correct! Examples of biohazardous waste include: human blood, personal protective equipment, laboratory samples or cultures, the instruments used to work with them, the containers used to contain them, and sharps. Biohazardous waste must Essential Learning, LLC.

24 be packaged in red bags or sharps containers and labeled with the biohazard symbol and with the name and address of the facility.) B. False (incorrect) Meet Laura Laura is a newly licensed phlebotomist who is trying her best to adhere to all her facility s policies for proper sharps biohazard disposal. Laura just drew a patient s blood and her lab coat got a wet spot of blood on it. What should Laura do? Should she consider her lab coat biohazardous waste as well? A. She should continue wearing her lab coat because it will protect her from being contaminated by other patients blood. (Incorrect, Laura should handle this lab coat as little as possible with protective gloves and should use universal precautions to bag the contaminated laundry at the location where it was used.) B. She should handle the lab coat as little as possible with protective gloves. (That s partially correct. Laura s lab coat is considered biohazardous waste and should thus be bagged at the location where it was used, and not sorted or rinsed in the location of use.) C. She should use universal precautions to place the contaminated laundry in a soak-free bag. (That s partially correct. Whenever contaminated laundry is wet and presents a reasonable likelihood of soak-through or leakage from the bag or container, the laundry should be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior.) D. A & B (Not quite. Laura should handle the lab coat as little as possible with protective gloves and should use universal precautions to bag the contaminated laundry at the location where it was used.) E. B & C (That s right! Laura s lab coat is considered biohazardous waste and should thus be bagged at the location where it was used, and not sorted or rinsed in the location of use. Laura should handle the lab coat as little as possible with protective gloves.) Essential Learning, LLC.

25 Section 6: Hepatitis In this section you will learn about Hepatitis in all its forms, common symptoms, how it s transmitted, and how it may be prevented. Definition What is Hepatitis? Hepatitis is an inflammation of the liver that makes it stop working well. Viruses cause most cases of Hepatitis. The type of Hepatitis is named for the virus that causes it; for example: Hepatitis A ( Hepatitis B ( Hepatitis C ( Hepatitis B (HBV) and Hepatitis C (HCV) are the two most serious kinds of Hepatitis and are similar types of infections caused by different viruses. 30% of people with Hepatitis B do not have symptoms during the acute stage of the infection or even for years afterwards. An even higher percentage of people with Hepatitis C show no symptoms. Symptoms When symptoms are present, they include: Jaundice Fatigue Abdominal pain Loss of appetite Nausea Diarrhea Fever Transmission The viruses are transmitted through blood and infected bodily fluids Essential Learning, LLC.

26 This can occur through: Needlestick with infected blood Direct blood to blood contact Unprotected sex Use of unsterile needles From an infected woman to her newborn during childbirth These viruses can also be transmitted by sharing razors, toothbrushes, nail clippers or earrings. If sterile needles are not used, it is possible to transmit Hepatitis B through body piercing, tattooing, drug injection and acupuncture. Health care workers are at great risk for Hepatitis. The best treatment is prevention. OSHA The Occupational Safety and Health Administration (OSHA) requires that the Hepatitis B vaccine by offered to health care workers who have a reasonable expectation of being exposed to blood on the job. The employer must provide all health care workers with the vaccine at no cost if they are not immune to the virus. The vaccine does not contain any live virus. Let's Review! Examples of how the Hepatitis virus can be transmitted: (Answer True or False) 1. Unprotected sex can transmit Hepatitis. (TRUE) 2. Not using the appropriate sharps disposal boxes. (TRUE) 3. Sharing my nail clippers, razors, toothbrush, or earrings with family members. (TRUE) 4. Needlesticks cannot transmit Hepatitis (FALSE) 5. Not wearing protective personal equipment when indicated. (TRUE) Essential Learning, LLC.

27 How to Protect Yourself Always use standard precautions: Do not recap needles. Use appropriate sharps disposal boxes. Wear protective personal equipment when indicated. Know and follow your facilities infection prevention plan. The best treatment is prevention! Meet Joe Joe is a new father of a beautiful 2 month-old baby boy. He is changing his son s diaper when the phone rings. It s his wife, who tells him to come pick her up at work because her car battery died. Joe quickly finishes up his baby s diaper change and heads out the door. What is Joe putting himself and his family at risk for? A. Hepatitis A (That s correct! Hepatitis A is one type of Hepatitis a liver disease caused by the Hepatitis A virus (HAV). The disease is spread primarily through food or water contaminated by stool from an infected person. One way of contracting HAV is from not washing your hands after changing a diaper.) B. Hepatitis B (Incorrect. Hepatitis B is one type of Hepatitis a liver disease caused by the Hepatitis B virus (HBV). Hepatitis B spreads by contact with an infected person's blood, semen or other body fluid. An infected woman can give Hepatitis B to her baby at birth.) C. Hepatitis C (Incorrect. Hepatitis C is one type of Hepatitis a liver disease caused by the Hepatitis C virus (HCV). It usually spreads through contact with infected blood. It can also spread through sex with an infected person and from mother to baby during childbirth.) D. All types of Hepatitis (Not quite. Hep A is spread primarily through food or water contaminated by stool from an infected person. Hep B spreads by contact with an infected person's blood, semen or other body fluid, but an infected woman can give Hep B to her baby at birth. Hep C usually spreads through contact with infected blood, but it can also spread through sex with an infected person and from mother to baby during childbirth. By not washing his hands after diapering his baby, Joe is putting himself and his family at risk for contracting Hepatitis A.) E. None of the above (Incorrect. By not washing his hands after diapering his baby, Jo is putting himself and his family at risk for contracting Hepatitis A.) Section 7: HIV/AIDS Now we are going to talk about HIV and AIDS. Many of you have heard these terms thrown around, but this section will give you a solid understanding of what these two distinct illnesses are and who they truly affect Essential Learning, LLC.

28 Overview AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981 and has since become a major worldwide epidemic. AIDS is caused by HIV (human immunodeficiency virus). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infections, which are caused by microbes such as viruses or bacteria that usually do not make healthy people sick. Opportunistic infections are life-threatening diseases that usually do not make healthy people sick, but represent a risk to people with AIDS. What is HIV? Human Immunodefciency Virus (HIV) is the virus that causes AIDS. HIV kills specific white blood cells (T cells), which are an important part of our immune systems. Without treatment, HIV gradually destroys the body's defenses against disease (it takes an average of 8-10 years), leaving it vulnerable to many infections and cancers. But treatment with antiretroviral drugs can slow or stop the harmful effects of retroviruses like HIV, so that many people with HIV are living longer and healthier lives. What is AIDS? AIDS (Acquired Immune Deficiency Syndrome) is a medical condition resulting from HIV infection, usually after many years. By the time a person is given an AIDS diagnosis by a doctor, HIV has seriously damaged the body's immune system. There are effective treatments to prevent, as well as treat these serious illnesses. Facts The Centers for Disease Control and Prevention (CDC) reports that 1.2 million Americans now carry the HIV virus but do not yet have symptoms. An estimated 56,300 Americans are newly infected with HIV each year Essential Learning, LLC.

29 The CDC estimates that 21% of HIV-positive people don t know they are infected-meaning they may be transmitting HIV without knowing it. People of color are at disproportionate risk for HIV infection. Nearly half of new infections (49%) were among African Americans, who make up only 13% of the U.S. population. Hispanics accounted for 18% of new HIV infections-and make up only about 15% of the U.S. population. More than half of new cases (57%) were among those aged In 2007, the largest estimated proportion of HIV/AIDS diagnoses among adults and adolescents were men who have sex with men (MSM). This category accounted for 53% of the overall diagnoses and 71% among men. High-risk sexual contact (sexual contact with persons known to have HIV infection or have a higher risk of contracting HIV infection) accounted for only 11% of the overall diagnoses. How is HIV Transmitted? HIV can be transmitted when blood, semen (including pre-seminal fluid), vaginal fluids, or breast milk from an infected person enters the body of an uninfected person. HIV must get into the bloodstream or body in order to cause infection. Transmission most often occurs during unprotected sex or during injection drug use when equipment is shared. An infected woman who becomes pregnant can transmit HIV to her baby during pregnancy or during birth, but this risk is significantly less if the woman takes antiretroviral drugs. She can also pass HIV to her newborn if she breastfeeds. Anyone infected with HIV can transmit it, whether or not they appear sick, have an AIDS diagnosis, or are successfully treating their infection with antiretroviral drugs. How is HIV Actually Spread? Unprotected anal, vaginal or oral sex. HIV can enter the body during sex through the anus, vagina, opening at the end of the penis or mouth and through cuts, sores and abrasions on the skin. Unprotected anal and vaginal sex have the highest risk of infection. There are a growing number of reported cases where HIV has been transmitted during oral sex, but oral sex is much less risky than anal or vaginal sex Essential Learning, LLC.

30 Contributing Behaviors What are Risky Behaviors that May Contribute to the Transmission of HIV? Sharing drug needles or syringes. Having sexual contact, including oral, with an infected person without using a condom. Having sexual contact with someone whose HIV status is unknown. Blood Exposure Blood Exposure HIV is also spread through contact with infected blood. Before donated blood was screened for evidence of HIV infection and before heat-treating techniques to destroy HIV in blood products were introduced, HIV was transmitted through transfusions of contaminated blood or blood components. Today, because of blood screening and heat treatment, the risk of getting HIV from such transfusions is extremely small. The risk of acquiring HIV from a blood transfusion is approximately 1 in 2,000,000. Contaminated Needles Sharing needles or drug injection equipment can transmit HIV and other viruses like Hepatitis. After use, small amounts of blood can remain in the used needles, syringes, cookers, cottons, and water. This remaining blood can enter the body of the next user if any of these items are shared. If this blood is HIV-infected, transmission can easily occur. There is a very small but real risk of health care workers getting HIV from infected patients as a result of a needlestick accident or when blood gets into a worker's open cut or mucous membranes in their eyes, mouth or nose. The risk for health care workers is greatly reduced when Standard/Universal Precautions are carefully followed. This includes: safe disposal of sharps, wearing gloves, and wearing other personal protective equipment as needed. Mother to Child Can HIV Be Transmitted From Mother to Child? If a woman is infected with HIV, she can give it to her baby during pregnancy, during birth, or by breast feeding. Early in the epidemic, 25% (1 out of 4) of babies born to HIV-infected women in this country Essential Learning, LLC.

31 became infected with HIV. Now in developed countries where early detection of HIV is possible, treatment with the latest antiretroviral medications can reduce this rate to about 1% (1 out of 100). All pregnant women should see a doctor, be tested for HIV and if infected, obtain the best treatment. Saliva Can HIV be transmitted through saliva? Although researchers have found HIV in the saliva of infected people, there is no evidence that the virus is spread by contact with saliva. Laboratory studies reveal that saliva has natural properties that limit the power of HIV to infect, and the amount of virus in saliva appears to be very low. Research studies of people infected with HIV have found no evidence that the virus is spread to others through saliva by kissing. The lining of the mouth, however, can be infected by HIV, and instances of HIV transmission through oral intercourse have been reported. Scientists have found no evidence that HIV is spread through sweat, tears, urine, or feces. Contact Can HIV be transmitted by casual contact? HIV is a fragile virus outside the body. It quickly becomes inactive when exposed to air, soap and common disinfectants such as bleach. There is no risk of getting HIV from: Donating blood Mosquito bites Toilet seats Shaking hands or hugging Sharing eating utensils or drinking containers Food or objects handled by people with HIV or AIDS Spending time in the same house, business or public place with people who have HIV or AIDS Essential Learning, LLC.

32 At Risk Who is at risk for HIV infection? Anyone. Anyone can get HIV if they have unprotected sex or share injection drug equipment with someone who is infected. The virus does not discriminate-it can infect males, females, babies, teens, adults or senior citizens. You cannot look at someone and know they have HIV. In fact, as many as 1 out of 4 people who have HIV (25%) have no idea they are infected. Sexually Transmitted Infections STI What about sexually transmitted infections? If you have a sexually transmitted infection (STI) such as syphilis, genital herpes, chlamydial infection, gonorrhea, or bacterial vaginosis appears, you may be more susceptible to getting HIV infection during sex with infected partners. Most Common HIV Transmission Methods What are the most common methods of transmission? Having unprotected sex with an infected partner. Sharing a needle with an infected person. From mother to child during pregnancy or birth. Symptoms What Are the Symptoms of a New HIV Infection? Between 50-90% of people with new HIV infections have mild to severe flu-like symptoms within 2 weeks to 3 months from the time of HIV exposure. Others have no symptoms at all. In general symptoms are not a reliable way to tell if someone has been infected with HIV; the only way to know for sure is to get tested. Many of the symptoms of early HIV infection are the same as for other less serious illnesses. People who have been exposed to HIV should see a doctor promptly if the following symptoms occur: A persistent fever of over 101 degrees that lasts for more than 2 days without a known cause Essential Learning, LLC.

33 Headache. Constant tiredness. Night sweats that soak your pajamas or sheets. A persistent rash of unknown cause. Persistent swollen glands (lumps under the skin) which occur in several places at once, especially in the neck, armpits and groin. Sore throat More About Symptoms These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids. More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. This period of "asymptomatic" infection varies greatly in each individual. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years. Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The virus can also hide within infected cells and lay dormant. Complications As the immune system worsens, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes or "swollen glands" that may be enlarged for more than 3 months. Other symptoms often experienced months to years before the onset of AIDS include: Lack of energy Weight loss Frequent fevers and sweats Persistent or frequent yeast infections (oral or vaginal) Persistent skin rashes or flaky skin Pelvic inflammatory disease in women that does not respond to treatment Short-term memory loss Some people develop frequent and severe herpes infections that cause mouth, genital, or anal Essential Learning, LLC.

34 sores, or a painful nerve disease called shingles. Children may grow slowly or be sick a lot. What Is AIDS? The term AIDS applies to the most advanced stages of HIV infection. The Center for Disease Control (CDC) developed official criteria for the definition of AIDS and is responsible for tracking the spread of AIDS in the United States. All HIV-infected people who have CD4 + cells (a special type of white blood cell that fights infection) that have fallen to a certain level and/or the virus in their body has reached a certain level. People with HIV infection who have at least one or more of the two dozen AIDS associated conditions that are the result of the HIV's attack on the immune system. AIDS associated conditions include opportunistic infections by bacteria, fungi and viruses. Opportunistic Infection What does opportunistic infection mean? These are infections that are rarely seen in healthy people but occur when a person's immune system extremely weakened. Symptoms of opportunistic infections common in people with AIDS include: Coughing and shortness of breath Seizures and lack of coordination Difficult or painful swallowing Mental symptoms such as confusion and forgetfulness Severe and persistent diarrhea Fever Vision loss Nausea, abdominal cramps, and vomiting Weight loss and extreme fatigue Severe headaches Coma How Did Jerry Contract HIV? Peter is a heterosexual male who has had multiple sexual partners in his lifetime. Peter got tested for HIV and found out he was, in fact, HIV positive and, thus, has AIDS. Peter had always Essential Learning, LLC.

35 used a condom during sexual intercourse, so he is quite disturbed to find out this information. When the doctor asked him about his other recreational activities, he found out the likely method that Peter was transmitted the virus. Which of the following possibilities is the most likely cause? A. Peter revealed that even though he has never shared needles, he has shared drug injection equipment. (That s right. Sharing needles or drug injection equipment can transmit HIV and other viruses like Hepatitis. After use, small amounts of blood can remain in the used needles, syringes, cookers, cottons and water. This remaining blood can enter the body of the next user when any of these items are shared. If this blood is HIV infected, transmission can easily occur.) B. Peter revealed that he may have kissed someone who is HIV positive. (Not quite. Although researchers have found HIV in the saliva of infected people, there is no evidence that the virus is spread by contact with saliva. Laboratory studies reveal that saliva has natural properties that limit the power of HIV to infect, and the amount of virus in saliva appears to be very low. Research studies of people infected with HIV have found no evidence that the virus is spread to others through saliva by kissing. The lining of the mouth, however, can be infected by HIV, and instances of HIV transmission through oral intercourse have been reported.) C. Peter revealed that he recently received a blood transfusion from a top-notch hospital. (Probably not today, because of blood screening and heat treatment, the risk of getting HIV from such transfusions is extremely small. The risk of acquiring HIV from a blood transfusion is approximately 1 in a million.) D. Peter revealed that he may have shared eating utensils with someone who is HIV positive. (Not likely HIV is a fragile virus outside the body. It quickly becomes inactive when exposed to air, soap and common disinfectants such as bleach. There is no risk of getting HIV from: sharing eating utensils or drinking containers, or from food or objects handled by people with HIV or AIDS.) Section 8: Tuberculosis What Is TB? Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs. 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. (website: Did you know that TB disease was once the leading cause of death in the United States? Essential Learning, LLC.

36 Why Is Tuberculosis A Problem Today? Starting in the 1940s, scientists discovered the first of several medicines now used to treat TB. As a result, TB slowly began to decrease in the United States. But in the 1970s and early 1980s, the country let its guard down and TB control efforts were neglected. As a result, between 1985 and 1992, the number of TB cases increased. However, with increased funding and attention to the TB problem, we have had a steady decline in the number of persons with TB since But TB is still a problem; more than 14,000 cases were reported in 2005 in the United States. How Is TB spread? TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain. TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious. Visit to learn more. How Is TB spread? People with active TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers. However, not everyone infected with TB bacteria becomes sick. People who are not sick have what is called latent TB infection People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. But, some people with latent TB infection go on to get TB disease. People with active TB disease can be treated if they seek medical help. Even better, most people with latent TB infection can take medicine so that they will not develop active TB disease. Visit (website: to learn more Essential Learning, LLC.

37 (website: Latent TB Infection What is latent TB infection? In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection. People with latent TB infection: Have no symptoms Don't feel sick Can't spread TB to others Usually have a positive skin test reaction May develop active TB disease if they do not receive treatment for latent TB infection Many people who have latent TB infection never develop active TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active and cause TB disease. Active TB Disease What is active TB disease? TB bacteria become active if the immune system can't stop them from growing. The active bacteria begin to multiply in the body and cause active TB disease. The bacteria attack the body and destroy tissue. If this occurs in the lungs, the bacteria can actually create a hole in the lung. Weak Immune System Some people develop active TB disease soon after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick later, when their immune system becomes weak for another reason. Babies and young children often have weak immune systems. People infected with HIV, the virus that causes AIDS, have very weak immune systems Essential Learning, LLC.

38 Symptoms of TB What are the symptoms of TB? Symptoms of TB depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs. TB in the lungs may cause symptoms such as: A bad cough that lasts 3 weeks or longer Pain in the chest Coughing up blood or sputum (phlegm from deep inside the lungs) Other Symptoms of TB Other symptoms of active TB disease are: Weakness or fatigue Weight loss No appetite Chills Fever Sweating at night MDR TB What is Multidrug-resistant Tuberculosis (MDR TB)? Multidrug-resistant TB (MDR TB) is TB that is resistant to at least two of the best anti-tb drugs, isoniazid and rifampicin. These drugs are considered first-line drugs and are used to treat all persons with TB disease. Multidrug-resistant TB occurs when medication is stopped too early. Precautions What are the precautions to prevent the spread of Tuberculosis in a Health Care setting? Airborne Transmission-Based Precautions Airborne Precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air including tuberculosis Essential Learning, LLC.

39 Patients in a hospital who require Airborne Precautions should be placed in an airborne infection isolation room (AIIR). An AIIR is a single-patient room that is equipped with special air handling and ventilation. In settings where Airborne Precautions cannot be implemented due to limited engineering resources (e.g., physician offices), masking the patient, placing the patient in a private room (e.g., office examination room) with the door closed, and providing N95 or higher level respirators or masks if respirators are not available for health care personnel, will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned to the home environment, as deemed medically appropriate. Health care personnel caring for patients on Airborne Precautions wear a mask or respirator. Tuberculosis is caused by airborne bacteria; to protect yourself from contracting tuberculosis, always follow your facility s infection control plan. Testing for Health Care Workers Health Care workers and persons exposed to TB need to have a tuberculin skin test (TST) or a chest X-ray. Positive test results indicate the person is infected with TB, but may not have TB disease. S/he may be given preventive therapy to kill germs that are not doing any damage now, but could break out later. TST testing (or chest X-ray) can determine whether medication is necessary to prevent incidence of Active TB. Your facility may require you to have a routine TST or chest X-ray at specified intervals or on exposure to TB. Most health care facilities require that every employee be tested at least once a year. However, testing may be more or less frequent depending on the risk of exposure to patients with tuberculosis. Meet Sharon Sharon s parents are from a third-world country. She goes to visit them quite often. Upon return from her most recent visit, her job requires that she has her annual TB test. Even though it has always come up negative, this time it indicates a positive result. After a follow-up chest X-ray that was negative, it is determined that Sharon most likely has: A. Active TB Disease Probably not TB bacteria become active if the immune system can't stop them from growing. The active bacteria begin to multiply in the body and cause active TB disease. The bacteria attack the body and destroy tissue. If this occurs in the lungs, the bacteria can actually create a Essential Learning, LLC.

40 hole in the lung. In Sharon s case, because her chest X-ray was normal, she probably possesses the latent form of the disease. B. Latent TB Disease That s right! Many people who have latent TB infection usually have a positive skin test reaction, but never develop active TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. In other people, especially people who have weak immune systems, the bacteria become active and cause TB disease. C. Hep B Not quite many people who have latent TB infection usually have a positive skin test reaction, but never develop active TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. In other people, especially people who have weak immune systems, the bacteria become active and cause TB disease. D. MDR TB Probably not Multidrug-resistant TB is TB that is resistant to at least two of the best anti-tb drugs, isoniazid and rifampicin. MDR TB occurs when medication is stopped too early. In Sharon s case, because her chest X-ray was normal, she probably possesses the latent form of the disease. Section 9: H1N1 Swine Flu Meet Sarah At the hospital where Sarah s friend works, an outbreak of H1N1 flu took their staff by storm. Being an outpatient pharmacist, Sarah knew she would come into contact with many sick patients as well. Sarah made sure her staff would not fall prey to poor prevention measures. She continuously mandated that her employees to stay home if they were sick and to encourage patients to do the same. This seemed to help her wing of the hospital remain germ-free during the outbreak. In this section, you will learn about the new strain of flu and what measures you can take at your facility to protect yourself and your staff from it. A New Flu In the Spring of 2009, a new flu virus spread quickly across the United States and the world. The US government coordinated a public health emergency response within the states that saved lives and helped limit the impact of the outbreak. H1N1 flu is spread in the same way that seasonal flu spreads. Flu viruses are spread mainly Essential Learning, LLC.

41 from person to person through coughing or sneezing by infected persons. Sometimes people may become infected by touching something such as a surface or object with flu viruses on it and then touching their mouth or nose. People infected with the seasonal or H1N1 flu shed virus may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children or people with weakened immune systems. Similar to the seasonal flu, H1N1 may be accompanied by vomiting and diarrhea. Protecting Yourself What You Can Do To Protect Yourself From H1N1? Follow these guidelines and teach your patients these prevention measures. Practice good cough and respiratory hygiene. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you don t have a tissue, cough or sneeze into your sleeve, not your hands. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. Avoid touching your eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people. Stay home if you are sick until at least 24 hours after you no longer have a fever (100 F or 37.8 C) or signs of a fever (without the use of a fever-reducing medicine, such as Tylenol ). Read detailed information about how long to stay away from others. Follow state and federal public health advice regarding school closures, avoiding crowds and other social distancing measures. Let s Practice! People infected with the seasonal or H1N1 flu may be able to infect others from day(s) before getting sick to day(s) after. A. 5; 5 Incorrect, People infected with the seasonal or H1N1 flu shed virus may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially Essential Learning, LLC.

42 children or people with weakened immune systems. Similar to the seasonal flu, H1N1 may be accompanied by vomiting and diarrhea. B. 3; 5 Not quite. People infected with the seasonal or H1N1 flu shed virus may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children or people with weakened immune systems. Similar to the seasonal flu, H1N1 may be accompanied by vomiting and diarrhea. C. 2; 5 Almost! People infected with the seasonal or H1N1 flu shed virus may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children or people with weakened immune systems. Similar to the seasonal flu, H1N1 may be accompanied by vomiting and diarrhea.) D. 1; 5 That s right! People infected with the seasonal or H1N1 flu shed virus may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children or people with weakened immune systems. Similar to the seasonal flu, H1N1 may be accompanied by vomiting and diarrhea. Remembering Sarah Taking what you have now learned from this section, let us take a moment to remember our friend, Sarah. During an H1N1 outbreak at her facility, Sarah told staff to encourage patients who reported influenza-like illness to stay home if they were feeling sick. She provided guidelines to outpatient staff on how long a patient should stay out of the program (at least 24 hours after no sign of fever). Sarah provided just-in-time fit testing for inpatient staff. She taught staff to place H1N1 patients on Droplet Precautions, and made sure that PPE was available for staff use. She also kept track of all the sick calls from staff and from patients. She reported these numbers to the Infection Prevention Committee. Which of the above steps likely helped prevent her wing of the hospital from experiencing the H1N1 outbreak? A. By providing her staff easy access to medications. While access to medications is a great help when battling an influenza outbreak, this is only one piece of the larger puzzle that Sarah provided her staff. Try again! B. By teaching her staff and patients proper prevention techniques of covering their cough and Essential Learning, LLC.

43 washing their hands. Proper hygiene is crucial to preventing the spread of disease, but Sarah also provided other crucial items to keep her wing of the hospital from experiencing the H1N1 outbreak. C. By keeping staff and patients at home if they were experiencing influenza-like symptoms. People infected with the seasonal or H1N1 virus may be able to infect others from 1 day before getting sick to 5-7 days after. That s why it s important to stay home if you are sick until at least 24 hours after you no longer have signs of a fever. Think about what else Sarah did to prevent the outbreak in her wing of the hospital. D. By educating her staff on how influenza spreads. Education about how disease spreads is a must for prevention, but Sarah also did a few other things to help prevent the spread of disease. E. All of the above. That s right! By performing all of the above tasks, Sarah was able to keep her wing of the hospital germ-free! Section 10: Multiple-Drug Resistant Organisms Multiple-drug Resistant Organisms What are MDROs? According to the CDC, Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE) and certain gram-negative bacilli have increased in prevalence in U.S. hospitals over the last three decades, and have important implications for patient safety. A primary reason for concern about these multidrug-resistant organisms (MDROs) is that options for treating patients with these infections are often extremely limited, and MDRO infections are associated with increased lengths of stay, costs, and mortality. Although transmission of MDROs is most frequently documented in acute care facilities, all health care settings are affected by the emergence and transmission of antimicrobial-resistant microbes. Infection Prevention Plan Your facility s infection prevention plan will have a strategy for addressing MDRO infections. Review your infection prevention plan for specifics. In general, facilities employ the following prevention strategies to prevent and identify MDRO infections: Essential Learning, LLC.

44 Screening for MRSA on admission (acute care facilities in several states are required by law to perform screening on admission) Placing behavioral health patients with known infection and/or colonization in Contact Precautions only if they are unable to keep the area covered and/or are unable to perform hand hygiene Cohorting inpatients (placing patients who have a current infection with another patient with the same infection) Use of PPE and frequent hand hygiene Covering the affected area Education of patients and families regarding MDRO prevention. MRSA: The Growing Problem with a Cure MRSA is becoming increasingly prevalent in health care settings. According to CDC data, the proportion of infections that are antimicrobial-resistant has been growing. In 1974, MRSA infections accounted for two percent of the total number of staph infections; in 1995 it was 22%; in 2004 it was 63%. MRSA occurs most frequently among patients who undergo invasive medical procedures or who have weakened immune systems and are being treated in hospitals and health care facilities such as nursing homes and dialysis centers. MRSA in health care settings commonly causes serious and potentially life-threatening infections, such as bloodstream infections, surgical site infections, or pneumonia. In addition to health-care-associated infections, MRSA can also infect people in the community at large, generally as skin infections that may look like pimples or boils. They also can be swollen, painful and have draining pus. These skin infections often occur in otherwise healthy people. How MRSA Spreads in Health Care Settings When we talk about the spread of an infection, we talk about sources of infection - where it starts, and the way or ways it spreads - the mode or modes of transmission. In the case of MRSA, patients who already have an MRSA infection or who carry the bacteria on their bodies but do not have symptoms (colonized) are the most common sources of transmission. The main method of transmission to other clients is through human hands, especially health Essential Learning, LLC.

45 care workers' hands. Hands may become contaminated with MRSA bacteria by contact with infected or colonized patients. If appropriate hand hygiene such as washing with soap and water or using an alcohol-based hand sanitizer is not performed, the bacteria can be spread when the health care worker touches other clients. Antimicrobial Resistance Along with MRSA, many significant infection-causing bacteria in the world are becoming resistant to the most commonly prescribed antimicrobial treatments. What causes this and what does it mean? Antimicrobial resistance occurs when bacteria change or adapt in a way that allows them to survive in the presence of antibiotics designed to kill them. In some cases bacteria become so resistant that no available antibiotics are effective against them. At this time, treatment options still exist for health care-associated MRSA. People infected with antibiotic-resistant organisms like MRSA are more likely to have longer and more expensive hospital stays, and may be more likely to die as a result of the infection. When the drug of choice for treating their infection doesn t work, they require treatment with second-or third-choice medicines that may be less effective, more toxic and more expensive. So this means that if you or I get a MRSA infection, we may suffer more, and we may pay more for our treatment; yet, American society as a whole suffers more and pays more too because of the increased burden and expense in the health care system. MRSA: Expensive Results CDC Appropriate Antibiotic Use Campaign: CDC launched the National Campaign for Appropriate Antibiotic Use in the Community in In 2003, this program was renamed Get Smart: Know When Antibiotics Work in conjunction with the launch of a national media campaign. This campaign aims to reduce the rate of rise of antibiotic resistance by: Promoting adherence to appropriate prescribing guidelines among providers. Decreasing demand for antibiotics for viral upper respiratory infections among healthy adults and parents of young children. Increasing adherence to prescribed antibiotics for upper respiratory infections Essential Learning, LLC.

46 Let's Practice! The proportion of infections that are antimicrobial resistant has been growing; in 2004 it was 22%. True Actually in 2004, 63% of infections were antimicrobial resistant; in 1995 it was 22%. False Yes, that statement is incorrect as 63% of infections were antimicrobial-resistant in 2004; in 1995 it was 22%. Good job! Meet Mel Mel is an old-fashioned man who enjoys shaking hands with everyone he meets. When his doctor comes to visit him at his nursing home, he is sure to greet him and all his nursing staff along the way with a warm, friendly handshake. Everyone at the nursing home loves to see Mel wheeling around in his wheelchair because he is such a pleasure to be around. Unfortunately, Mel recently contracted MRSA. He now suffers from 2 large-sized boils that are quite painful to the touch. Recalling what you just learned in this section, what is the likely culprit of how Mel contracted MRSA? He may have caught it from his friend in the neighboring room, who he wheels by every morning to say hello to. Mel does not have any physical contact with his neighbor, so this is not likely. The main method of MRSA transmission to other clients is through human hands, especially health care workers' hands. Thus, answer D is the best choice. He may have caught it from using the bathroom facilities in his room. Mel is the only one who uses the bathroom in his single-occupancy room, so this is unlikely. Plus, the main method of MRSA transmission to other clients is through human hands, especially health care workers' hands. Thus, answer D is the best choice. He may have caught it during B-I-N-G-O night when he sat next to one of his friends Essential Learning, LLC.