Infection Prevention and Control Infection Prevention and Control Department /

Transcription

1 Infection Prevention and Control 2011 Infection Prevention and Control Department /

2 Purpose To review and update the knowledge and skill necessary for prevention and control of infection through environmental management and appropriate interventions. To review selected Infection Prevention & Control policies and the NYULMC Exposure Control Plan.

3 Objectives NYULMC s personnel will adhere to accepted infection control practices. Identify specific preventative measures utilized in your practice to disrupt the transmission of infection.

4 Objectives Identify specific administrative, engineering, and work practice controls used to prevent exposure to potentially infectious material including bloodborne pathogens Identify medical center personnel s responsibilities for maintaining personal health and safety.

5 Standard Precautions Used for all patients, all the time, regardless of diagnosis. Includes: Performing hand hygiene (soap & water or Purell) before and after contact with all patients & environmental surfaces that may be contaminated Using Personal Protective Equipment (PPE) to avoid contact with secretions, excretions, non-intact skin, mucous membranes Properly placing patients with appropriate roommates Using proper techniques when caring for patients to minimize risk of infection

6 Standard Precautions Standard Precautions includes: Treating all blood & other potentially infectious material (OPIM) as possibly being contaminated with bloodborne pathogens, such as HIV, HBV, & HCV NO artificial nails, OR long natural nails (e.g., 1/4 inch) for all direct patient care givers (and selected other staff) Proper cleaning of environment, medical equipment Handling sharps to minimize risk of injury; placing them in appropriate sharps containers immediately after use, avoid recapping unless absolutely necessary (then use a 1-hand technique)

7 Chain of Infection The spread of infection is like a chain of six links. All the links in the chain must be present for an infection to develop. Infection Prevention & Control procedures are aimed at breaking links from this chain. Pathogen Reservoir Portal of Exit Mode of Transmission Portal of Entry Susceptible Host

8 Hand Hygiene All health experts agree that hand hygiene is the single most important procedure for preventing the spread of infection. Hand hygiene can be done by washing with soap and water or cleaning with an alcoholbased hand sanitizer.

9 Hand Hygiene Use Alcohol-Based Hand Gel Alcohol is an effective means to reduce bacterial counts on hands How to use: Dispense a squirt into your hand. Rub over all surfaces of hands until hands are dry Don t forget fingertips, web spaces, and thumbs You may then use hand lotion if needed.

10 Hand Hygiene Use Soap & Water Handwashing effectively prevents the spread of infection when done correctly! Use Soap and Water for 15 seconds (sing Happy Birthday song twice or Yankee Doodle) Be sure to get backs of hands, around nails, between fingers, scrub up to wrists.

11 Hand Hygiene What s New? The Joint Commission requires us to monitor and improve compliance with hand hygiene Efforts to increase hand hygiene include: Urging PATIENTS and FAMILIES to remind all staff to wash hands before touching patients Changing our culture to accept reminders about hand hygiene practices

12 Hand Hygiene at NYULMC Ask Us If Our Hands Are Clean! Clean Hands Save Lives Look for promotional signage on the nursing units and in the lobbies Thank patients & visitors when they remind us to clean our hands

13 Transmission-Based Precautions Airborne Precautions Help prevent spread of germs that can travel long distances through the air. The airborne particles can be dispersed by air currents. Patients are placed in a private, negative pressure room or a Demistifier tent. The room door must be kept closed at all times. Staff must wear an N95 respirator when in the room. Disease examples: Varicella (Chicken Pox), Measles, Tuberculosis (TB).

14 Transmission-Based Precautions Droplet Precautions Help prevent the spread of germs carried by microscopic droplets released by sneezing, talking, coughing, etc. Patients usually stay in a private room. Staff must wear a standard surgical mask when going close to the patient (within 3-4 feet). Disease examples: Mumps, Bacterial Meningitis (GREEN) & Influenza (ORANGE) For any aerosol-generating procedures, use N95 mask + eye protection within 6 feet of the patient (ORANGE sign).

15 Transmission-Based Precautions Contact Precautions Helps prevent transmission of germs spread by direct or indirect contact. Patients are generally in a private room (but may be in a multi-patient room under some circumstances). Staff must wear gown and gloves when touching the patient or the patient s environment. Disease examples: Methicillinresistant Staphylococcus aureus (MRSA) (yellow sign), Clostridium difficile-associated diarrhea (C. diff) (red sign).

16 Tuberculosis The incidence of tuberculosis in the United States is lower than ever. You can assist in keeping the incidence of TB low by adhering to our facility s guidelines for PPD (TB) skin testing.

17 Tuberculosis The bacteria that causes TB (tuberculosis) is called Mycobacterium tuberculosis. It enters an individual via the respiratory tract. Transmission of tubercle bacilli occurs as individuals with active tuberculosis release the organisms as airborne droplets while coughing, singing or talking.

18 Tuberculosis Signs and Symptoms Cough for greater than 2 weeks Bloody or blood-streaked sputum Chest pain from coughing Unexplained weight loss Night sweats Fever Chills

19 Respirator & Mask Review Staff caring for TB patients (BLUE) Must wear an N95 (must be fit tested) Patient wears a surgical mask when out of room Staff caring for mumps or meningitis patients (GREEN) Must wear a surgical mask Patient wears a surgical mask when out of room Staff caring for FLU patients ORANGE sign Wear a surgical mask for routine patient care Wear N95 & Goggles if aerosol exposure is anticipated Patient wears a surgical mask when out of room

20 Take Home Message Every Patient is someone s family! Treat them like YOU would like to be treated, or have YOUR family treated! If it s dirty, clean it! (hands, equipment, etc.) It IS possible to PREVENT infections

21 Bloodborne Pathogens Standard Enacted by OSHA in 1991 Requires Exposure Control Plan online at: 09_0.pdf -- or ask supervisor or instructor for a copy Bloodborne Pathogens include: HIV (AIDS virus), Hepatitis B virus (HBV), & Hepatitis C virus (HCV) Any worker who could be exposed to blood or other potentially infectious materials is at risk for exposure to bloodborne pathogens

22 Body Fluids that can Transmit Bloodborne Pathogens Primarily in: Blood, Blood tinged fluids Semen and Vaginal Secretions Other potentially infectious materials (OPIM) CSF Pleural fluid Breast milk Pericardial fluid Amniotic fluid Synovial fluid Ascites fluid Fluids of unknown source

23 Hepatitis B and C Viruses that infect the liver Spread primarily through blood and possibly other body fluids People can carry the virus for years without knowing it and unintentionally infect others Signs & symptoms resemble the flu Hepatitis B vaccine is available FREE OF CHARGE from Employee Health Services. Hepatitis C - No vaccine is available!

24 Facts About Hepatitis C (HCV) Most cases of acute HCV are asymptomatic Up to 85% of newly infected persons develop chronic HCV and never clear the virus from their body. Cirrhosis eventually develops in about 25% of people with chronic HCV Treatment for acute and chronic HCV infection is lengthy and difficult, and only effective in a portion of patients.

25 HIV the AIDS virus In the workplace, HIV is transmitted by contact with blood or other potentially infectious materials HIV destroys essential immune system cells (CD4 cells), making person susceptible to a wide variety of infections that can cause serious disease or death There is NO vaccine to prevent HIV. Post-exposure prophylaxis (PEP) is often effective in preventing HIV infection after exposure PEP is most effective when started within 2 hours of exposure

26 Bloodborne Pathogens Control Hepatitis B vaccination free at Employee Health Service for staff with occupational risk of exposure Use proper Engineering Controls to minimize exposure such as safety sharps, sharps containers, needleless IV tubing connectors, mechanical pipetting devices, splash guards, etc. Use PPE such as gloves, gowns, face masks, face shields, goggles, etc. whenever exposure to blood or other potentially infectious materials is anticipated

27 Bloodborne Pathogens Control Label specimens or infectious waste as needed with the Biohazard logo Use proper safety techniques in a laboratory setting to minimize risk of exposure (e.g., use biological safety cabinets, centrifuge safety cups, mechanical pipettes) Clean up spills of blood or other potentially infectious materials promptly. Contain, contact Building Services, use spill kit, etc.

28 Bloodborne Pathogens Control Handle all sharps with great caution Discard all sharps, including safety sharps, in approved sharps containers as soon as possible after use Sharps containers are FULL when they are really 2/3 filled Notify your supervisor or Building/Environmental Services (x35071 or x6721) to report a full sharps container

29 Bloodborne Pathogens Control If a bloodborne pathogen exposure event occurs (e.g., needlestick, splash to non-intact skin or mucous membranes) Wash site promptly and thoroughly Promptly report to your supervisor Seek medical assistance in Employee Health Service (EHS) or ED (if EHS is closed) Document event on hospital s OSHA illness/injury report form Contact EHS next business day if you go to ED Take post-exposure medications if offered; start immediately where indicated (e.g., to prevent HIV infection)

30 Employee Health Service EHS does not provide routine primary healthcare. EHS provides post-exposure management to employees who come into contact with communicable diseases. EHS performs the required PPD (TB) skin testing for all staff; most get skin testing every year. All EHS records are preserved for the duration of employment plus an additional 30 years!

31 Employee Health Service Please note that employees with an unknown rash or contagious disease must inform their supervisors and report to EHS and request to see the nurse immediately. EHS location: 660 First Avenue, Second Floor Hours of operation: 8:00am to 4:30pm, M - F Phone # For medical emergencies: Go to the Emergency Room.

32 Communication Infection Prevention Newsletter Infection Prevention and Control Staff round on many units each day IPC Information is on the Link the intranet Policies Fact Sheets Monthly IPC Newsletter Call us: (TH), 6767 (HJD). After hours: call these extensions for on call pager number.

33 Professional Responsibilities Good personal health habits Correct any improper practices on your unit immediately, and take correction gracefully Make sure you are properly vaccinated by EHS Get FLU shot each year Report communicable disease exposures and concerns: Employee Health Service Infection Prevention and Control

34 Infection Prevention and Control Department Greenberg Hall SC1-165 and HJD C-0126 Phone (212) / hour pager: Director Antibiotic Stewardship Administrative Assistant Dr. Michael Phillips Dr. Sapna Mehta Delia Valentin Practitioners Steven Bock RN Sandra Hardy RN Faith Skeete RN Ranekka Dean RN Alex Rowan-Hazlerigg RN Tania Williams RN