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1 SJMHS Infection Prevention and Control Information: Standard and Transmission-Based Precautions, Hand Hygiene, Respiratory Hygiene, BBP, and MDRO 7/2017

2 2 This Course Includes... Healthcare Associated Infections (HAI) Chain of Infection Hand Hygiene Respiratory Hygiene/Cough Etiquette Cleaning and Disinfection of Reusable Medical Instruments and Equipment Standard Precautions Personal Protective Equipment (PPE) Bloodborne Pathogens MDRO (multiple drug resistant organisms) Transmission-Based Precautions (Airborne, Contact, and Droplet) Blood and Body Fluid Exposure and What to Do if You are Exposed

3 3 The Overall Goal is for You to... Identify how infections spread Know your responsibilities for infection prevention and control Use methods to prevent the spread of disease in the healthcare setting Know what to do if you have an exposure

4 4 Objectives Upon completion of this course you should be able to: Discuss healthcare acquired infections (HAI) List the Chain of Infection elements Identify how to break the Chain of Infection Utilize proper hand hygiene Use proper respiratory hygiene/cough etiquette Select and use the appropriate approved cleaner/disinfectant for medical instruments and equipment per unit and policy Discuss Standard Precautions, including when they are used State an example of a bloodborne pathogen and an MDRO Discuss each type of patient transmission-based special precaution, including required PPE State what to do if you have been exposed to a blood or body fluid

5 5 Healthcare Associated Infections (HAI) HAI Facts Healthcare-associated infections (HAI) are infections that a patient acquires while staying in a healthcare setting that he or she did not already have when admitted. Community-acquired Infections are infections acquired outside of the hospital or are present on admission. Here are a few HAI examples: SSI VAP = Surgical Site Infections = Ventilator Associated Pneumonia CLABSI = Central Line Associated Blood Stream Infection CAUTI = Catheter Associated Urinary Tract Infection

6 6 Healthcare Associated Infections (HAI) In recent decades HAIs have increased. Patients are coming into the hospital sicker, which puts them at greater risk. Antibiotic resistant infections have become more common. Infections can spread rapidly in a healthcare setting. Approximately 1.7 million hospital patients develop an HAI each year. That is about 1 in every 20 patients admitted to hospitals in the United States. Death from an HAI may be as high as 99,000 patients per year.

7 7 Healthcare Associated Infections (HAI) Caring for patients with HAI runs as high as $45 billion each year. A good infection prevention program can help protect patients, staff, and visitors from infection. Everyone who works in healthcare needs to do his or her part to prevent the spread of infections: Know the infection prevention and control policies in our facility Carefully follow those policies

8 8 The Chain of Infection The Chain of Infection is the process of spreading infections from person to person to person. Susceptible Host Portal of Entry Infectious Agent Chain of Transmission Mode of Transmission Reservoirs Portal of Exit

9 9 The Chain of Infection - Elements Infectious Agent Any disease-causing germ (pathogen). This includes viruses (Influenza, colds), fungi (athlete s foot), bacteria (E. Coli, C-difficile, MRSA, VRE), and parasites (Hookworms, Pinworm). Reservoir Where the pathogen lives or comes from. Reservoir examples: an infected person, food, water, an animal, bed rails, telephones, keyboards, doorknobs, counter tops or any other contaminated surfaces (blood/dirt, etc.).

10 10 The Chain of Infection - Elements Portal of Exit The way the pathogen leaves its reservoir. For example, suppose the reservoir is a person, And the pathogen is a cold virus. The pathogen can exit the person's nose or mouth through a sneeze or a cough. Mode of Transmission How the pathogen moves from the reservoir to the susceptible host. Examples: infected skin touching non-infected skin or mucous membranes, sneeze droplets, needle stick, or sexual contact.

11 11 The Chain of Infection - Elements Portal of Entry Where the pathogen enters the body of the susceptible host. In the sneeze example, the sneeze droplets could land on the susceptible host's eyes, nose, or mouth. Any of these areas could be the portal of entry. Broken skin is another common portal of entry for pathogens. Susceptible Host The person who could get sick with a particular infection. In the sneeze example, almost everyone is a susceptible host when it comes to cold viruses. Some people are susceptible to a particular infection, and others are not. Factors such as weak immunity or lack of vaccination Can make a host susceptible to disease.

12 12 Hand Hygiene Did you know that hand hygiene is one of the most effective ways to prevent the spread of infections? Hand hygiene applies to handwashing, antiseptic hand wash, alcohol-based hand rub, or surgical hand hygiene/ antisepsis.

13 13 Hand Hygiene When should you use Hand Hygiene? When hands are visibly soiled, wash with soap and water Before and after patient contact Before and after wearing gloves Before handling food or food trays After contact with environmental surfaces in patient's area Entering/leaving a patient s room After using the bathroom or blowing your nose

14 14 Hand Hygiene How should you wash your hands? Wet your hands with warm water and apply soap Work up a lather and wash your hands using friction for at least 15 seconds Rub all parts of your hands including wrists, palms, fingers, and between fingers Rub your fingertips against your palms for friction to clean around your nails Rinse well and dry with paper towels or air dyer Use the paper towels to turn off the water

15 15 Hand Hygiene How should you use alcohol-based hand gels/rubs? Press the pump lever 1 time to dispense gel in the palm of your hand Rub the gel all over your hands, between your fingers and 2 inches above your wrists Rub the tips of your fingers against your palms to clean your nail beds Continue rubbing until the gel is dry.

16 16 Respiratory Hygiene Cough/Sneeze Etiquette What should you do when you cough or sneeze? Cover your nose/mouth with a tissue and dispose of it in a no-touch receptacle Cough or sneeze into your sleeve if facial tissues are not readily available Remember to perform Hand Hygiene after contact with respiratory secretions

17 Cleaning and Disinfection of Reusable Medical Instruments and Equipment 17 Always follow instructions for use provided on disinfectant wipes label. Don disposable gloves and other PPE as needed. Remove visible soil if present with first wipe and discard wipe. Disinfect with a new wipe. Thoroughly wet surface with disinfectant in wipe. Treated surface must remain visibly wet for times listed for type of wipe used. Use additional wipes if needed. Let air-dry. Dispose of used wipe in regular trash and Do Not dispose of in sewer system.

18 18 Standard Precautions Standard Precautions are basic tasks health care workers MUST do to prevent and control the spread of infection to patients, visitors, staff and their families. These tasks help prevent exposure to blood and other potentially infectious materials and Includes proper Hand Hygiene Requires the use of personal protective equipment (PPE) Includes sharp disposal containers, red medical waste containers, safety needles, and needleless IV systems Must be used for all patients when coming in contact with blood, body fluids, or other potentially infectious materials (OPIM) regardless of the patient s diagnosis.

19 19 Standard Precautions Wear gloves when handling blood, body fluids, secretions, excretions, mucous membranes or non-intact skin Wear a mask, protective eye-wear, and a gown to protect yourself from splashes of blood or body fluids Do NOT recap needles; handle sharps carefully and dispose in approved sharp containers Perform hand hygiene as required

20 20 Personal Protective Equipment (PPE) PPE protects against infectious agents in the healthcare setting. PPE provides a barrier to minimize the risk of exposure to blood or body fluids. These agents can be bacterial or virus in/on: Blood or other body fluids Respiratory secretions Environmental surfaces And/or in the Air

21 Personal Protective Equipment (PPE) PPE must be removed and/or changed when soiled, torn or wet. Different types of PPE provide different types of protection. Wear... Gloves for contact with mucous membranes and body fluids Masks for respiratory droplets Eye shields to protect face and eyes Goggles to protect eyes Gowns to protect the clothing Respirators for infectious materials in the air 21

22 22 Bloodborne Pathogens Healthcare workers routinely come in contact with human blood and other body fluids. Therefore, they are at risk for an exposure to bloodborne pathogens. Important Bloodborne pathogens include: Hepatitis B virus (HBV) Hepatitis C virus (HCV) Human immunodeficiency virus (HIV)

23 23 Bloodborne Pathogens Healthcare workers are at a higher risk for HBV, HCV or HIV infection from needle-sticks or other sharps injuries. HBV and HCV affect the liver causing long-term liver disease which could become life threatening. Hepatitis B vaccine is available through Employee Health Services for all healthcare workers that have direct patient contact. HIV affects the immune system. This causes the disease known as Acquired Immunodeficiency Syndrome (AIDS). There is no vaccination for HIV.

24 24 Bloodborne Pathogens Bloodborne diseases can be transmitted by: Non-intact skin exposure to infectious blood or body fluids Needle-stick or other sharps injury Sharing dirty needles Mucous membrane (eyes, nose, mouth) contact with infectious blood or body fluids Unprotected sex Mother-to-baby exchange of body fluids

25 25 MDRO - Multi-Drug Resistant Organisms Definition Multi-drug resistant organisms (MDRO) are resistant to one or more classes or antibiotics Examples Methicillin-Resistant Staphylococcus aureus (MRSA) Vancomycin Resistant Enterococcus (VRE) Clostridium difficile Certain gram negative bacteria such as -Acinetobacter baumannii -Stenotrophomonas maltophilia Clinical Importance Options for treating patients with MDRO infections are extremely limited. MDROs can be transmitted from patient to patient if proper prevention strategies are not used.

26 26 MDRO - Multi-Drug Resistant Organisms What can I do to prevent the spread of MDRO? ØHand Hygiene ØStandard and Contact Precautions -private room, gowns and gloves for contact with the patient or items in the room ØCleaning and disinfection of the environment and patient care equipment ØRemoval of invasive devices, i.e. urinary and vascular catheters, when no longer needed

27 27 Transmission-Based Precautions Patients with certain diseases require additional precautions based on how each disease is transmitted. The designated rooms to stop the spread of disease include: Airborne Precautions Contact Precautions Droplet Precautions Standard Precautions are always used along with the specific precaution sign that will be posted on the patient s door. Now let s look at each one of these special precautions

28 Transmission-Based Precautions Airborne 28 Patient Placement Masks and Eyewear Transport Negative air pressure Keep doors closed at all times except when entering or leaving room N95 respirator mask or PAPR* must be worn by all individuals before entering room *PAPR = Positive Air Purifying Respirator Patient will be asked to wear a standard mask if leaving the room N95 respirators must be fit tested by Employee Health Services (EHS) upon employment and as designated by your hospital. Respirators are primarily used to protect against exposure to TB.

29 Transmission-Based Precautions Airborne Airborne Precautions Examples Mycobacterium tuberculosis Chicken pox Measles Other Considerations Negative pressure room, including bronchoscopy In-room portable chest X-rays In-room dialysis as needed MRI, CT or other radiologic procedures: have patient don surgical mask if able and notify receiving area Use dedicated equipment (stethoscopes, thermometer) 29

30 Transmission-Based Precautions Contact 30 Patient Placement Door may be left open Gloves Wear gloves when entering the room and for ALL CONTACT of patient, patient items, equipment, and body fluids Gown Before entering the room if you will have contact with the patient, patient touched surfaces and patient equipment

31 Transmission-Based Precautions Spread by environmental contamination Difficult to treat organisms Skin-to-Skin Contact Skin-to-Skin Contact Contact Examples C. Diff (Clostridium difficile) RSV (Respiratory Syncytial Virus) MDRO (Multidrug-resistant organism) VRE (Vanco resistant Enterococcus) MRSA (Methicillin-resistant Staphylococcus aureus) Lice (Pediculosis) Scabies 31

32 32 Transmission-Based Precautions Other Considerations Contact Make sure to always use gloves even if you are just checking the IV! Gloves - upon entering and remove when exiting Hand Hygiene - after glove removal Gowns - with contact of patient, patient touched surfaces and/or patient equipment

33 Transmission-Based Precautions Droplet 33 Patient Placement Mask Door may be left open In addition to Standard Precautions use Mask and Eyewear: Wear mask when in patient s room. Add eye protection if splash or spray to face could happen Have patient wear a surgical mask when outside of room.

34 Transmission-Based Precautions Droplet 34 Influenza (Flu) Meningitis, bacterial Large organisms are spread by coughing or sneezing up to 3 feet away Mumps Pertussis (Whooping Cough) Rubella (German Measles)

35 35 Blood/Body Fluid & Sharps Exposure: puncture, abrasion, bloody splash or laceration with the following: Blood Semen, Vaginal secretions Cerebral Spinal fluid Synovial fluid Pericardial fluid Amniotic fluid Breast milk Saliva involving dental procedures Body fluid visibly contaminated with blood or if difficult to differentiate between body fluids No Exposure:No bloody body fluid present, no blood contact, intact skin Clean sharps or objects contaminated with any body fluid NOT listed on the left, such as urine, stool, or emesis IVPB needle not in contact with blood Needle from urine culture transport kit

36 36 Blood/Body Fluid & Skin Exposure Cutaneous exposure to blood or contaminated body fluids when the worker s skin is chapped, abraded or otherwise not intact. X No Exposure X Patient superficially bites or scratches healthcare worker and the source person s mouth and hands are not bloody Any blood or contaminated body fluid exposure to intact skin

37 Blood/Body Fluid & Mucous Membranes Exposure X No Exposure X 37 Blood or any contaminated body fluid splash to the eye, nasal mucosa or mouth Urine or saliva NOT contaminated with blood splash to the eye, nasal mucosa or mouth. Note: If you are not sure if it is contaminated contact EHS.

38 38 What should you do if you are exposed? Follow the WIN acronym: Wash the exposed area immediately with soap and water. Identify the source of the exposure, if possible. Notify your manager and Employee Health Services (EHS) immediately. Call Employee Health Services or report to the Emergency Department (ED) based on your facility's policy And complete an incident report (EHS will help). EHS or ED will: Evaluate details of your exposure Provide/arrange for the care you need Provide expert advice Coordinate confidential testing Provide counseling And provide follow-up services as needed

39 39 Summary Standard Precautions always apply to all patient contact! Know your Infection Prevention and Control responsibilities. Transmission-Based Precautions are an additional level of prevention to stop the spread of infection in the healthcare setting. Wear your PPE! Hand hygiene is one of the most effective ways to prevent the spread of disease and to ensure patient safety. Be the one to break the Chain of Infection.

40 40 You have completed: SJMHS IPCS: Infection Prevention and Control Information If you have questions/feedback on this course contact: Your Manager, EHS, or SJMAA, SJMC, SJML: Janice Rey, Director IPCS SJMO: Deborah Reid, Director IPCS SMML: Rebecca Mayer, IPC Specialist Publisher: Kathleen Hay, MS, MT(ASCP), E-Learning Consultant, SJMAA,

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