1 Injection Safety Alana Cilwick, MPH Injection Safety Coordinator
2 Objectives Demonstrate the importance of safe injection practices Define what constitutes a safe injection Single-Dose vs. Multi-Dose Vials Insulin pens and point of care testing Identify the health education One & Only Campaign and access resources and information on injection safety
3 The One & Only Campaign
4 Why Unsafe Injection Practices are Unacceptable Injection safety is part of Standard Precautions Healthcare practices should not provide a pathway for transmission of life-threatening infections Patient protections regarding injection safety should be on par with healthcare worker safety
5 Fast Facts: Unsafe Injection Practices Between , more than 150,000 patients in the United States have been advised to get tested for bloodborne pathogens (BBP). The documented number of patients affected by unsafe injections likely represents only the tip of the iceberg. Consequences include: infection transmission to patients, notification of thousands of patients of possible exposure to bloodborne pathogens, referral of providers to licensing boards for disciplinary action, and malpractice suits filed by patients.
7 Fast Facts: Unsafe Injection Practices The following practices are dangerous and have resulted in disease transmission: Using the same syringe to administer medication to more than one patient, even if the needle was changed or the injection was administered through an intervening length of intravenous (IV) tubing. Accessing medication with a syringe that has already been used to administer medication to a patient, then reusing the contaminated medication for another patient. Using medications packaged as single-dose for more than one patient. Failing to use aseptic technique when preparing and administering injections.
8 Examples of Unsafe Injection Practices in Colorado
9 Evelyn McKnight s Story Dr. Evelyn McKnight, was battling breast cancer and was infected with hepatitis C during treatment because of syringe reuse to access saline flush solution. A total of 99 cancer patients were infected in what was one of the largest outbreaks of hepatitis C in American healthcare history. Evelyn co-founded HONOReform, a foundation dedicated to improving America s injection safety practices, and was the catalyst of the formation of the Safe Injection Practices Coalition.
10 One needle, one syringe, only one time? A survey of physician and nurse knowledge, attitudes, and practices around injection safety A panel of physicians (n=370) and nurses (n=320) 12.4% of physicians and 3% of nurses indicated reuse of syringes for >1 patient occurs in their workplace 5% of physicians indicated this practice usually or always occurs Higher proportion of oncologists reported unsafe practices occurring in their workplace One needle, one syringe, only one time? A survey of physician and nurse knowledge, attitudes, and practices around injection safety Kossover-Smith, Rachel A. et al American Journal of Infection Control, Volume 45, Issue 9,
11 Medication Preparation
12 One Needle, One Syringe, Only One Time Always use a new sterile syringe and needle to draw up medications Proper hand hygiene should be performed before handling medications Parenteral medications and injection equipment should be accessed in an aseptic manner
13 Single-Dose Vials A single-dose vial (SDV) is approved for used on a SINGLE person for a SINGLE procedure or injection SDV s typically lack an antimicrobial preservative. Do not save left over medication from these vials. Harmful bacteria can grow and infect a patient. Discard after every use!
14 Multiple-Dose Vials A multiple-dose vial (MDV) is recognized by it s FDA-approved label. Although MDV s can be used for more than one patient,ideally even MDV s are used for only one patient. MDV s typically contain an antimicrobial preservative to help limit the growth of bacteria. Preservatives have no affect on bloodborne viruses Discard MDV s when the beyond-use date has been reached, when doses are drawn in a patient treatment area, or any time the sterility of the vial is in question!
15 Las Vegas, Nevada Outbreak, 2008 Cluster of three acute HCV infections identified in Las Vegas All three patients underwent procedures at the same endoscopy clinic during the incubation period Two breaches contributed to transmission: Re-entering vials with used syringes Using contents from these single-dose vials on more than one patient
16 Las Vegas, Nevada Outbreak, 2008
17 Medications Prepared in a Clean Dedicated Area Medications should be drawn up in a designated clean medication preparation area In general, any item that could have come in contact with blood or body fluids should be kept separate Use single-use vials whenever possible Use a new sterile needle and syringe for each injection, even if for the same patient A needle, or needless device should never be inserted into a vial septum for multiple uses When in doubt throw it out!
18 Dangerous Misperceptions Examples of dangerous misperceptions about safe injection practices Myth Single-dose vials with large volumes that appear to contain multiple doses can be used for more than one patient. Truth Single-dose vials should not be used for more than one patient regardless of the vial size. Size doesn t matter!!
19 Insulin Pen Safety Designed to be used multiple times for a single patient using a new needle with each injection. Should never be used for more than one patient. Regurgitation of blood into the insulin cartridge can occur after injection, creating a risk of pathogen transmission if the pen is used for more than one person, bioburden was present 58% of the time.
20 Insulin Pen Reuse Incidents Reuse of insulin pens for multiple patients, reportedly after changing needles has resulted in large notifications NY hospital, 2008: 185 patients notified TX hospital, 2009: 2,114 patients notified WI hospital and outpatient clinic, 2011: 2,401 patients notified Infection Prevention during Blood Glucose Monitoring and Insulin Administration (2012)
21 Insulin Pen Safety: 60 Second Check
22 Assisted Blood Glucose Monitoring Outbreaks of HBV associated with glucose monitoring have been identified Particularly in long-term care settings, such as nursing homes and assisted living facilities where residents often require assistance with monitoring. Last 10 years, there have been at least 15 outbreaks of HBV associated ABGM.
23 Assisted Monitoring of Blood Glucose (AMBG) AMBG is performed for a patient with diabetes by a health care provider or other caregiver. In many instances, the equipment and processes that are appropriate for an individual performing SMBG are not appropriate in an AMBG setting. Most blood glucose monitoring equipment has been designed for self-use, focused on : device design, comfort, convenience, and portability not the ability to properly decontaminate.
24 Blood Glucose Meters Whenever possible, blood glucose meters should be assigned to an individual person and not be shared. If shared, the device should be cleaned and disinfected after every use. Follow manufacturer s instructions for use, if the manufacturer does not specify how to clean and disinfect the device, then it should not be shared.
25 Blood Glucose Meter Safety 60 Second Check
26 Fingerstick Lancing Device Safety Auto-disabling single-use fingerstick devices are intended for onetime use Re-usable lancing devices are NOT intended to be used on more than one person, even if disinfected and the lancet is changed Treat fingerstick devices as personal items
27 Monitoring Injection Safety and Point of Care Testing
28 Elements to be Assessed A. The facility has a policy on injection safety which includes protocols for performing finger sticks and point of care testing (e.g., assisted blood glucose monitoring, or AMBG) B. Personnel who perform point of care testing (e.g., AMBG) receive training and competency validation on injection safety procedures at time of employment. C. Personnel who perform point of care testing (e.g., AMBG) receive training and competency validation on injection safety procedures within the past 12 months. D. The facility routinely audits (monitors and documents) adherence to injection safety procedures during point of care testing.
29 Elements to be Assessed (cont.) E. The facility provides feedback to personnel regarding their adherence to injection safety procedures during point of care testing. F. Supplies necessary for adherence to safe injection practices (e.g., single-use, auto-disabling lancets, sharps containers) are readily accessible in resident care areas (i.e., nursing units). G. The facility has policies and procedures to track personnel access to controlled substances to prevent narcotics theft/drug diversion. Note: If services are performed by contract personnel, facility should verify that training is provided by contracting company
30 Examples of Unsafe Injection Practices
34 What can we do?
35 A Call to Action Injection practices should not provide a pathway for transmission of life-threatening infections Injection safety is every provider s responsibility Safe injection practices should be discussed and review frequently among colleagues
36 How do we impact a positive change? Educate HCW s and QMAP s and ensure in long term training efforts Develop Partnerships with a variety of organizations Positive Change For Resident Safety Develop Tools and other resources to support sustained change Develop Focused Efforts with achievable goals Promote Evidenced Based Prevention such as vaccination for diabetics
37 Additional Resources
38 References Blood Glucose Monitoring Bloodborne Pathogen Standards Infection Prevention in Outpatient Settings Mayo Proceedings
Injection Safety! Every Providerʼs Responsibility! Outline! Safe Injection Practices" The ONE and ONLY Campaign" Outbreak History" Mistaken Beliefs" A Call to Action" Resources and Information" Why Unsafe
SAFE INJECTION PRACTICES Barbara J Connell MS,MT(ASCP)SH VP Clinical Services Medline Industries, Inc. DISCLOSURES»Employee of Medline Industries, Inc.»Opinions expressed are my own and not necessarily
Slide 1 Safe Patient Care Keeping our Residents Safe Safe injection practices sharps management Fiona Barry 2016 at ALL times #safepatientcare Slide 2 Learning outcomes What is injection safety Safe injection
Module D OUTBREAKS AND SAFE INJECTION PRACTICES IN DENTAL SETTINGS OBJECTIVES 1. The Big Picture 2. Outbreaks and best practices 3. Beyond the outbreaks 4. Resources 1 THE BIG PICTURE THE BIG PICTURE 2
INJECTIONS WITHOUT INFECTIONS: SAFE INJECTION PRACTICES ONE NEEDLE, ONE SYRINGE, ONLY ONE TIME Patsy Kelso, PhD State Epidemiologist for Infectious Disease Vermont Department of Health INJECTIONS & INFUSIONS
Module D Outline Outbreaks and Safe Injection Practices in outpatient Settings 1. The big picture 2. Outbreaks and best practices 3. Beyond the outbreaks 4. Resources THE BIG PICTURE The Big Picture Unsafe
Topics of Concern: Infection Control in LTC Settings in North Dakota Bonnie M. Barnard, MPH, CIC 1 Objectives List three mechanisms of transmission for bloodborne pathogens in long term care settings (Assisted)
Script for Podcast on Injection Safety MB: Hi, I m Mary Beth Wenger, of the New York One & Only Campaign. New York is a partner state in the national One & Only Campaign which is a public health campaign
Injection Safety: Every Provider s Responsibility! Patsy Kelso, PhD State Epidemiologist for Infectious Disease Transmission of Hepatitis B and C Viruses in Outpatient Settings MMWR 2003 52:901 Endoscopy
SOURCES OF INFECTION IN LONG-TERM CARE FACILITY - ENVIRONMENTAL ISSUES Slides provided by: William A. Rutala, PhD, MPH Director, Hospital Epidemiology, Occupational Health and Safety at UNC Health Care;
Infection Prevention and Control A Foundation Course SAFE INJECTION PRACTICES AND SHARPS MANAGEMENT Fiona Barry IPCN Mercy University Hospital, Cork 2014 Links to CDC Materials http://www.youtube.com/watch%3fv%3d6d0stmoz80k
Health Alert Network Tri-County Health Department Serving Adams, Arapahoe and Douglas Counties Phone 303/220-9200 Fax 303/741-4173 www.tchd.org Richard L. Vogt, M.D. Executive Director The pages that follow
Hepatitis B and C Overview, Outbreaks, and Recommendations Elizabeth Lawlor, MS Healthy Kansans living in safe and sustainable environments. Viral Hepatitis Language Acute infection is when the infection
Injections Without Infections: Basic Patient Safety Joseph Perz, DrPH Team Leader, Ambulatory and Long-Term Care Prevention and Response Branch Division of Healthcare Quality Promotion Centers for Disease
Healthcare-Related Outbreaks of Hepatitis B and C in the United States Ian T. Williams, PhD, MS Epidemiology Branch Division of Viral Hepatitis National Center for Infectious Diseases Centers for Disease
Preventing Transmission of Bloodborne Pathogens in Healthcare Settings Joshua K. Schaffzin, MD, PhD Healthcare Epidemiology and Infection Control Program Bureau of Healthcare Associated Infections Outline
Pharmaceuticals and Ambulatory Surgery Centers Tom Simpleman Consultant Pharmacist 2014 Rocky Mountain Ambulatory Surgery Center Educational Conference April 10, 2014 Pharmaceuticals and Ambulatory Surgery
Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion Single-dose/Single-use Vial Position and Messages May 2,
A "Never" Event: Unsafe Injection Practices Joseph Perz DrPH MA Arjun Srinivasan MD Priti Patel MD MPH Prevention and Response Branch Division of Healthcare Quality Promotion Centers for Disease Control
Ambulatory Surgery Outbreaks, Los Angeles County Kelsey OYong, MPH Acute Communicable Disease Control Program June 3, 2016 Objectives Review recent outbreaks in ambulatory surgery centers (ASCs) Describe
How Pathogens Spread in the Healthcare Setting: Understanding the Basics Healthcare-Associated Infections: A Practice-Oriented Update Tom Talbot, MD MPH Assistant Professor of Medicine and Preventive Medicine
Hepatitis C STRATEGIES TO PREVENT SPREAD OF HEPATITIS C IN THE WORKPLACE NORMA GOMEZ, MBA, MSN, RN, CNE It does happen! "A recent publication describes a dialysis facility where an outbreak of HCV continued
Bloodborne Pathogens Montclair Kimberley Academy 1 Introduction! Approximately 5.6 million workers in health care and other facilities are at risk of exposure to bloodborne pathogens such as human immunodeficiency
Risk Management Lessons for Dentists Infection Prevention Strategies Dentists Required to Comply with Regulations as a Condition of Licensure Chadwick v. Board of Registration in Dentistry, 461 Mass. 77;
MAKE SMART INJECTION CHOICES INJECTION PROVIDERS GUIDE FOR SAFE INJECTIONS MAKE SMART INJECTION CHOICES WHO recommends syringes with re-use prevention (RUP) features for all injections. RUP syringes with
Infection Control Assessment and Response (ICAR) in Long-term Care Carol Genese, MBA ICAR Infection Preventionist Communicable Disease Service New Jersey Department of Health Agenda ICAR Introduction ICAR
Memo To: Lawrence Sands, DO, MPH From: Southern Nevada Health District Outbreak Investigation Team Date: 3/28/2008 Re: Interim report on the Endoscopy Center of Southern Nevada Hepatitis C Investigation
Lapsing into Consciousness: Learning From IPAC lapses Presentation to IPAC SWO Laura Farrell, CPHI(C), CIC, Program IPAC Specialist May 2017 Acknowledgements to Isabelle Guerreiro, Program IPAC Specialist
IMSN Conference 18 th Oct 2013 Insulin pens; cross-contamination risks Eileen Relihan, PhD Practice of Pharmacy, Medication Safety Facilitator, St. James s Hospital Insulin Pen Devices 2 basic types: reusable
Infection Prevention and Control Annual Education 2017 Authored by: Infection Prevention and Control Department Objectives After you complete this Computer-Based Learning (CBL) module, you should be able
COMMUNICABLE DISEASE OUTBREAK MANUAL New Jersey s Public Health Response APPENDIX T2: EXTENDED GUIDANCE Outbreak Investigation Guidance for Healthcare-Associated Infections CURRENT HAI CONTEXT AND GOALS
Toronto Public Health HCV Outbreak Investigation Ontario Endoscopy Clinic 1315 Finch Avenue West, Suite 302, Toronto Final Report April 24, 2015 Initial Case Identification On May 24, 2013, a 60 year old
Self-Instructional Packet (SIP) Advanced Infection Prevention and Control Training Module 1 Intro to Infection Prevention Control February 11, 2013 Page 1 Learning Objectives Module One Introduction to
This webinar begins at 11 a.m., Eastern. You will not hear anything over your telephone line until the program starts. If the system did not prompt you to enter your phone number and receive a call back,
Occupational exposure to bloodborne pathogens Dr. Sadeghniiat Professor of Tehran University of Medical Sciences Director of Iranian Occupational Medicine Association Head of Imam Khomeini complex hospital
LEARNING MODULE: INFECTION CONTROL BLOODBORNE PATHOGENS ISOLATION PRECAUTIONS PHARMACEUTICAL WASTE For Residents & Instructors ggbha.org Updated 6/18/2018 This learning module must be reviewed by residents
Bloodborne Pathogens and Universal Precautions Parkway School District 2012-2013 Revised 9/19/2012 What Are Bloodborne Pathogens(BBPs) Bloodborne pathogens (BBPs) are disease causing microorganisms carried
Policy Title: Sterilization and Disinfection of Patient-Care Items Policy Number: 11 6.2.2. Examples of useful items to maintain in the office sterilization log are as following: o Date and time of cycle
Drug Diversion and Safe Injections: Risks, Recommendations, & Resources Oregon Public Health Division Healthcare-Associated Infections HAI Program Drug diversion can lead to infection Hepatitis C virus
Bloodborne Pathogens At School Introduction What are bloodborne pathogens? What diseases do they cause? How do you protect yourself from being exposed? With a little knowledge, you can guard your health
2018 Ascension Infection Prevention 1. Course 1.1 Infection Prevention 1.2 Main Objectives Additional Objectives Understand the purpose of the Corporate Responsibility Program State examples of expected
Bloodborne Pathogens Training July 26, 2012 Introduction As sure as the sun comes up every day, children end up with scraped knees, cuts, and bruises. Students of all ages hurt themselves on the playground,
Page 1 of 8 Weekly March 11, 2005 / 54(09);220-223 Transmission of Hepatitis B Virus Among Persons Undergoing Blood Glucose Monitoring in Long-Term--Care Facilities --- Mississippi, North Carolina, and
Slide 1 Bloodborne Pathogens LVHN s Annual Safety Course Nucleus Medical Media (2010). Blood Carries Nutrients. Smart Imagebase. Lehigh Valley Health Network cares about your safety especially about protecting
Lesson Plan 6080a This training session outline is designed to follow the accompanying booklet, OSHA s Bloodborne Pathogens Standard. The booklet reviews what employees who are potentially exposed to the
Bloodborne Pathogens Session Objectives Identify bloodborne pathogens (BBPs) Understand how diseases are transmitted Risk of exposure Protecting yourself from exposure through prevention Responding appropriately
1 of 10 Purpose Scope University of Alaska Anchorage departments will develop plans and procedures to limit occupational exposure to blood and other potentially infectious materials (PIM) in compliance
Zambia infection prevention guidelines & application in health care facilities MANOFF GROUP INC. Answell Chipukuma BCC Specialist 17/04/2008 1 Introduction to Infection Prevention Key Concepts you will
NEEDLESTICK PREVENTION Ever since the rapid increase in the number of cases of HIV/AIDS and other bloodborne infections such as hepatitis B and C, there has been tremendous interest in the healthcare community
Revision Preparation: Safety Mgr Authority: President Issuing Dept: Safety Page: Page 1 of 15 INTRODUCTION The Occupational Safety and Health Administration (OSHA) has a variety of regulations that all
All Personnel BP 4119.43 UNIVERSAL PRECAUTIONS 4319.43 In order to protect employees from contact with potentially infectious blood or other body fluids, the Governing Board requires that universal precautions
Welcome to Bloodborne Pathogens Update BIO 311 Ouch, That Hurts! Needlestick injuries not only hurt and are dangerous, they cost money. It is estimated that 384,000 health care workers sustain a needlestick
Orion ISO Universal Precautions Employee Training Module Pathogens are disease-causing microorganisms. Bloodborne pathogens are viruses or bacteria present in human blood and body fluids which can infect
Bloodborne Pathogens Exposure Procedure Background: Bloodborne pathogens are infectious microorganisms present in blood that can cause disease in humans. These pathogens include, but are not limited to,
Mohawk Valley Health System Infection Prevention Annual Mandatory Education Infection Prevention is Everyone s Responsibility Here are some steps that you can take to help prevent healthcare acquired infections
Appendix C. RECOMMENDATIONS FOR INFECTION CONTROL IN THE HEALTHCARE SETTING Infection Control Principles for Preventing the Spread of Influenza The following infection control principles apply in any setting
Transmission/Prevention Section Three Transmission/Prevention Hepatitis C is transmitted by blood-to-blood contact. Any break in the skin may allow HCV to enter the body, even if no blood is visible. The
1 The BBP Standard applies to all employers with employees with reasonably anticipated occupational exposure to blood or OPIM. It applies, not just in healthcare, but in general industry as well (e.g.,
BLOODBORNEPATHOGENS CAP Safety Meetings Revision: 10-2011 2011 Copyright - PEC/Premier Safety Management, Inc. All Rights Reserved Revision: [10-2011] 1 THEBLOODBORNEPATHOGENSSTANDARD The Bloodborne Pathogens
Bloodborne Pathogens General Session Objectives Identify bloodborne pathogens (BBPs) Understand how diseases are transmitted Determine your risk of exposure Protect yourself from exposure through prevention
Clinical Bag Technique COMPETENCY STATEMENT: Demonstrates the proper bag technique according to APIC and CDC guidelines Disciplines Involved: Clinicians Demonstrates knowledge of infection control as it
Bloodborne Pathogens Training OSHA S Bloodborne Pathogen Standard 29CFR 1910.1030 Employers must: Develop an Exposure Control Plan (ECP) that details their Bloodborne Pathogens (BBP) Program Provide employees
Policy 1016 Elk Grove Police Department 1016.1 PURPOSE AND SCOPE This policy provides general guidelines to assist in minimizing the risk of department members contracting and/or spreading communicable
Colgate University Bloodborne Pathogens Exposure Control Plan COLGATE UNIVERSITY BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN I. STATEMENT OF POLICY It is the policy of Colgate University (CU) to limit or
IC3:0100 Canadian Council on Health Services Accreditation (CCHSA) Standards 1.0 PURPOSE CCHSA standards were included in this document as guidelines for the development of an infection control program.
1 Bloodborne Pathogens Exposure Control Plan Policy The Department Bloodborne Pathogens Exposure Control Plan is designed to comply with the requirements of the OSHA Bloodborne Pathogens Standard, 29 CFR
Chapter 13 Preventing Infection Copyright 2019 by Elsevier, Inc. All rights reserved. Lesson 13.1 Define the key terms and key abbreviations in this chapter. Identify what microbes need to live and grow.
Christopher M. Dembny R.Ph. Dembny Pharmacy Consultants LLC email@example.com Learning Objectives Rule Compliance is Stimulating 1 Biography 2 3 This is a broad and confusing issue for many centers. Information
Life Threatening Vocational Hazards Diseases and Toxins INTRODUCTION What is the blood-borne pathogens standard? 29CFR 1910.1030 Who needs blood-borne pathogens (BBP) training? What content needs to be
Chapter 11 PREVENTING INFECTION Infection is a major safety and health hazard. The health team follows certain practices and procedures to protect patients, residents, visitors, and staff from infection.
Bloodborne Pathogens Training for School Staff Insert Nurse Name, Credentials Here Insert Organization Here This presentation was adapted from the Ohio Department of Health, School and Adolescent Health
What are Universal Precautions? What employees should know about UNIVERSAL PRECAUTIONS They re work practices that help prevent contact with blood and certain other body fluids. Universal precautions are:
BLOODBORNE PATHOGENS IN THE WORKPLACE Purpose In the event of an emergency, are you prepared to lend a helping hand? Workplace accidents, automobile accidents, injuries at home or during recreation can
Controlling Infection Madeleine Myers FNP-BC Core Curriculum Elements Professional Responsibilities Infection Cycle Barriers and PPE Safe Client Care Environment Work Practice Controls Prevention and Control
Influenza Control Program Frequently Asked Questions Influenza Vaccine Influenza or the flu can be a serious contagious disease, which is spread by droplet transmission through close contact with an infected
Page 1 of 6 BLOODBORNE PATHOGEN PROGRAM INTRODUCTION The intended purpose of this document is to comply with OSHA s Occupational Exposures to Bloodborne Pathogens in Title 29 Code of Federal Regulations
BLOODBORNE PATHOGENS PROGRAM I. PURPOSE The SHSU Bloodborne Pathogens program ensures SHSU compliance with Occupational Safety and Health (OSHA) Standard, 29 CFR 1910.1030, Blood Borne Pathogens. II. SCOPE
DHSR/HCPR/CARE NAT I Curriculum - July 2013 1 N.C. Nurse Aide I Curriculum MODULE B Infection Prevention Objectives Relate the chain of infection to the work of a nurse aide in long-term care facilities.
Chapter 12 Preventing Infection Infection Infection is a major safety and health hazard. The health team follows certain practices and procedures to protect patients, residents, visitors, and staff from
CDC s Role in Outbreak Investigations in Dental Settings Jennifer L. Cleveland, DDS, MPH Division of Oral Health OSAP June 14, 2013 National Center for Chronic Disease Prevention and Health Promotion Division
Your Best Shot: Training Your Staff to Give Safe Injections Emily Lutterloh, MD, MPH Director, Bureau of Healthcare Associated Infections, NYSDOH and Ernest J. Clement, RN, MSN, CIC Epidemiologist/Infection
Background: Bloodborne pathogens are viruses present in human blood and body fluids that can cause disease in humans. Diseases like the hepatitis B virus (HBV), human immunodeficiency virus (HIV) and others
IV Link Staff Infection Prevention & Control A Learning Package for IV Link Staff Purpose This learning package provides key infection prevention messages and direction for knowledge that you require as