New Employee Orientation. Infection Control and Prevention 2016 Authored By: Sandra Webb BSN RN CIC

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1 New Employee Orientation Infection Control and Prevention 2016 Authored By: Sandra Webb BSN RN CIC

2 Infection Control Purpose The purpose of Infection Control has historically been to reduce the risk of spreading germs and infections among patients, visitors, associates and volunteers. Now we are moving toward PREVENTING infections before they arise. Infection control measures are put into place, guided by the recommendations of the CDC, OSHA, CMS and other regulatory bodies.

3 Standard Precautions Used for EVERY PATIENT, EVERY DAY, and EVERY TIME there is any contact with the patient or the potential for exposure to blood/body fluid, secretions, excretions, mucous membranes, skin wounds, wound drainage or broken skin.

4 When should hand hygiene be used? When hands are visibly dirty or soiled, wash hands with soap and water. Before patient contact. Before donning gloves for invasive procedures. Before eating. After contact with non-intact skin, blood & B/F, inanimate objects in the patient s environment, using the restroom,& after removing gloves.

5 Recommended Hand Hygiene Techniques Alcohol-based hand rubs: Apply to the palm of one hand, rub hands together covering all surfaces until dry. These are effective against MDROs. Do not use when hands are visibly soiled or if patient has C. difficile.

6 Recommended Hand Hygiene Techniques Wet hands with water, apply soap, rub hands together strongly for at least 15 seconds; cover all surfaces of the hands and fingers. Rinse hands with warm water and dry with paper towel. Use paper towel to turn off faucet.

7 Fingernail Policy Based upon 2002 CDC recommendations artificial nails are not to be worn by direct care givers or anyone who prepares items for patient use. Natural nails should be well groomed and < ¼ inch in length. If nail polish is worn, it must be in good repair.

8 Donning and Removing (doffing) PPE Gown, Glove and Mask Technique Policy #908.4 Poster in all isolation carts All PPE should be removed inside the patient room/area except for N-95 masks Correct order for removal when no visible contamination is noted: gloves, googles/face shields, gown, mask/ N-95

9 Respiratory Hygiene/Cough Etiquette Another important element in Standard Precautions is: Place visual alerts at all points of entry and common waiting areas. Have masks, tissues and alcohol rubs available. When examining a patient with fever and respiratory symptoms healthcare personnel should observe Droplet Precautions (i.e., wearing a surgical or procedure mask for close contact), in addition to Standard Precautions.

10 Spinal Procedures The use of a surgical mask for the individual placing a catheter or injecting material into the spinal or epidural space (i.e., myelograms, lumbar punctures, spinal or epidural anesthesia, etc) is required. If a staff member assists the physician with the above procedures and they are close to the sterile field, they too will require the use of a surgical mask.

11 Management of Blood & Body Fluid Spills Use Gloves and other PPE as needed Clean Gross Soiling Immediately Disinfect Area Blood Spill Kits are available for large spillage

12 Bagging Technique Soiled Linen place in blue bags Chemo linen goes in yellow bags Precautions for 48hrs all excreta Infectious Waste that is grossly saturated in RED bags Always carry linen and or trash bags away from the body!

13 Injection Safety ALWAYS use a safety needle when available. Plan ahead for disposal of an unsafe sharp instrument BEFORE use. DON T put sharps in trash containers! Sharps containers need to be replaced when ¾ full.

14 Injection Safety Any injection equipment is one time use only Do not change needle and re-use syringe Scrub the hub seconds Do not bulk spike IVF or pull up IV meds ahead of time Multi-use vials (good for 28 days) Must label with discard date A single-dose vial should be used for one patient only

15 Care of the Immunocompromised Patients Strict Hand washing. Pay close attention to how patients are assigned. Discourage visitors who are unwell from visiting patient. No reverse isolation standard- MD specific.

16 Sanitation/ disinfection All used patient care equipment should be considered potentially infectious. Patient care equipment must be properly cleaned between patients and single use items discarded. COWs should be cleaned each shift.

17 Sanitation/Disinfection Sani Wipes: use one towel to pre-clean and then a second towel to disinfect Allow to remain wet for the appropriate contact time Discard each wipe before moving on to the next item Tagged before storing.

18 Transmission Based Precautions Used for pts with either suspected or confirmed transmissible infections or diseases and in addition to Standard Precautions. Three types: 1. Contact 2. Droplet 3. Airborne

19 Contact Isolation Infections/diseases that are spread via direct contact with skin, body fluid, blood, or by indirect contact with contaminated objects in the environment. Gloves and Gowns should be worn when entering the room. Some examples are: all Multidrug-resistant organisms (MDROs), most GI tract infections, scabies..&

20 Methicillin Resistant Staph Aureus (MRSA) Staphylococcus aureus, often referred to simply as staph, is a bacteria. Occasionally, staph can get into the body and cause an infection. This infection can be minor, such as boils, or serious such as blood infections (sepsis) or pneumonia. Some of these bacteria have developed resistance to Methicillin and can no longer be killed by this antibiotic. These resistant bacteria are called MRSA.

21 MRSA AST Active Surveillance Screening: Hemodialysis patients Transfers from other hospitals Long term care patients Patient with known hx of MRSA in the past 2 years Pre-operative total & partial hip and knee* Must be done within 24 of admit, do not isolate until results are known. *For elective cases done during the PAT visit.

22 MRSA Nasal Specimen Collection Use the special MRSA swab; insert ¾ inch into nose Culture both anterior nares utilizing one swab Rotate swab in each nare 2 to 5 times in a clockwise & counter clockwise motion

23 Vancomycin Resistant Enterococci (VRE) Enterococci are bacteria that are normally found in human intestines, the female genital tract, and are often found in the environment. Infections caused by enterococcci are most often treated with an antibiotic called Vancomycin. However, in some instances enterococci have become resistant to this drug and are called Vancomycin-resistant enterococci (VRE).

24 Clostridium Difficile Clostridium Difficile is a spore forming bacillus of the intestines that is responsible for the development of antibiotic-associated diarrhea and colitis. No alcohol hand rubs!!! Place sign over alcohol foam dispenser. Place yellow isolation sign on door.

25 ESBL positive gram negative bacteria Extended-spectrum beta-lactamase Enzyme produced by certain bacteria making them resistant to Penicillin, Carbapenems and 3 rd generation Cephalosporins These antibiotics have a common element in their molecular structure: a 4 atom ring known as beta-lactam Usually seen with E. Coli and Klebsiella

26 Carbapenem-resistant Enterobacteriacea -CRE Enterbacteriace are a large family of gram negatives, normal part of the human digestive system. Developed high levels of resistance to most antibiotics. High mortality~ 50% Transfer their antibiotic fighting ability to other kinds of germs.

27 Antibiotic Stewardship Antimicrobial resistance is one of our most serious health threats. Only 5 new ABY were approved from When first-line and then second-line antibiotic treatment options are limited by resistance or are unavailable, we are forced to use antibiotics that may be more toxic, more expensive and less effective Patients should be instructed to complete all antibiotic therapy as ordered by their physician.

28 Droplet Precautions Infectious organisms come into direct contact with another person s eyes, mouth or nasal passage when an infected person coughs or sneezes. Large droplets. A regular procedure mask should be worn when entering the room. Some examples: flu, pertussis, rubella

29 Meningitis Meningitis is a clinical syndrome in which the meninges become inflamed. Meningitis is usually caused by a viral or bacterial infection. Knowing whether meningitis is caused by a virus or bacterium is important because the severity of illness and the treatment differ. Must be in Droplet Isolation for 24 hours after start of appropriate antibiotic. Droplet precautions for all until patients until known if viral or bacterial.

30 Airborne Infection Isolation Patients have an infection that is spread by pathogens that are suspended in the air. A special mask (n-95) must be worn. Patient must be placed in a negative pressure airborne isolation room. Plant Operations to be notified; House Supervisor on weekends. Some examples: measles, chicken pox, disseminated shingles &..

31 Tuberculosis TB is caused by mycobacterium tuberculosis. Classic signs/symptoms are: coughing that continues for more than 3 weeks, coughing up blood, weight loss, night sweats, fatigue, SOB & chest pain.

32 Isolation Sign Put on door promptly. Place sign based upon what type of isolation needed. Housekeeping will remove when patient is d/c or transferred.

33 Disease Specific Isolation For other disease specific information please look in the Isolation Manual under tab D.

34 During our TJC or HFAP (AOA) survey you may be asked how our EMR is flagged or tagged for patients with a history of a MDRO or C. Difficile. In Cerner: Hx of any MDRO diagnosed at this facility is recorded in the chart under the Problems and Diagnoses Band in IView.