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Student Online Orientation Infection Control Exposure Control Plan Blood borne pathogen plan TB exposure control plan Isolation Exposure Control Plan Manual Found on Presence Health Intranet online – via POLICY and PROCEDURES – Under Infection Control category Pres-Net policy & procedures infection control 3 Blood Borne Pathogens What are Blood Borne Pathogens? Viruses and bacteria that require blood or body fluids to live – – – – – – HIV Hepatitis C Hepatitis B Delta Hepatitis Syphilis Malaria 5 HIV Hepatitis B, C and delta, syphilis and malaria can live in a variety of body fluids: Blood and blood products Cerebral spinal fluid Pleural fluid Pericardial fluid Peritoneal fluid Semen Vaginal fluid Amniotic fluid Synovial fluid 6 Blood Borne Pathogens are Spread by fluids entering the body through: Cuts, scrapes or other breaks in the skin Needle-stick injuries Splashes into the mouth nose or eyes Oral, vaginal or anal sex Using infected drug needles Pregnant women who are infected with these pathogens may pass them to their babies 7 How do you know if someone has one of these viruses? You Don’t! Patient with Hepatitis B or C may or may not have symptoms and will not be diagnosed unless they become jaundiced (yellow) – THEY ARE STILL CONTAGIOUS Signs and Symptoms of Hepatitis B and C – Loss of appetite – Tired feeling – Low grade temperature – Vague abdominal pain and discomfort – Diarrhea – vomiting – yellow skin or eyes 8 HIV Signs and Symptoms – Flu-like symptoms in the beginning – May have more frequent bouts of flu, and colds – Fever, diarrhea and fatigue Eventually Develop AIDS, and will be diagnosed – It can take up to 10 years or longer before a person is sick enough to be diagnosed with HIV, in the meantime they are contagious. 9 Standard precautions / universal precautions were developed by OSHA and the CDC to provide a means to protect health care workers Standard/ Universal Precaution – A system that outlines safeguards or barriers designed to protect healthcare workers • Personal protective equipment • Engineering control • Housekeeping • Work practice controls Personal Protective Equipment (PPE) – Located in every patient room in beige box on the wall (except Behavioral Health Unit) • • • • • • Gloves Gowns Masks Shielded masks Goggles Ambu bags 10 Standard / Universal Precautions require… Personal Protective Equipment FOR EACH AND EVERY PATIENT You will wear gloves – If there is a possibility that you are going to touch or come in contact with anyone’s blood, body fluids or mucous membranes You will wear a mask and goggles or a shielded mask – if there is a possibility of blood or body fluids splashing or coming in contact with your eyes, nose or mouth You will wear a gown – If there is a possibility that you might have your clothing soiled with someone’s blood or body fluids 11 Standard/ Universal precautions require… Engineering Controls Biohazard Labels Containers – Sharps Containers Safety Needles – Needless IV systems – Safety scalpels 12 Safety Equipment is only as good as the people who use it. When safety equipment is provided – Use it – Activate the safety mechanisms as soon as you are done with the procedure 13 Standard/Universal Precautions require… housekeeping Proper disposal of sharps and broken glass Never reach into trash Dispose of sharps containers when 2/3 full Clean up blood/ body fluids using the proper equipment and according to policy 14 Standard/ universal precautions require… work practice controls Never bend break or recap a needle Minimize splashing of fluids during collection or disposal Don’t eat or drink in work areas Wash you hands or skin after contact with body fluids or objects that might be contaminated 15 Hepatitis B Vaccine Hepatitis B is the only Blood Borne Pathogen we can protect against If you have not been vaccinated for Hepatitis B, we would encourage it due to potential exposure in a healthcare setting – See your personal physician or community health clinic 16 PSMH Blood Borne Pathogen Plan WHAT is an Exposure? – Anytime blood or body fluids come in contact with a worker's eyes, nose, mouth or skin through a needle stick, splash or other type of exposure 17 PSMH Blood Borne Pathogen Plan What should You do if you have an Exposure? – Wash the affected area thoroughly with warm water and soap at once! – For mouth or eye exposure thoroughly rinse out you mouth with water or mouthwash – Flush eyes with water or saline solutions Immediately House Operations Manager (HOM) notify your supervisor/institution to follow their specific protocol The source will be tested for HIV, Hep B and Hep C – You will be notified of results – Presence Health recommends you remain on site until rapid HIV is resulted – If source is HIV positive you will be sent for immediate care and consultation in the emergency department – . 18 PSMH Blood Borne Pathogen Plan For more information or further questions – Employee Health Nurse 815-937-2262 – Infection Control Coordinator 815-937-2235 19 Exposure Control Plan TB PSMH TB Exposure What is TB? – Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis – The bacteria usually attack the lungs, but can attack any part – It can be fatal if not treated properly How is TB Spread? – When an infectious person coughs, laughs, talks or sings and expels the small bacteria into the air and someone near by breaths it into their lungs 21 PSMH TB Exposure Control Plan Patients are screened when they enter the hospital for TB with the following questions: – – – – – – – Cough lasting longer than 2-3 weeks? Low grade temperature? Night sweats? Cough up blood? Unexplained weight loss? Loss of appetite? Feel weak? 22 PSMH TB Exposure Control Plan…. if the patient TB screen is positive: If Physician feels the TB screen is positive – Patient will be transferred to a “negative Pressure Isolation” – put on “Airborne Isolation” precautions • Requires room with special ventilation • Door kept shut at all times • Requires a N95 Particulate Filter Respirator Mask for persons entering the room, that has been fit tested. 23 PSMH TB exposure Control Plan TB Screening – 2 step PPD (Mantoux Testing) documentation is required prior to clinical rotation and anytime a healthcare worker or volunteer is exposed to MTB – Anyone who test positive for the first time is sent to the Kankakee County Health Department for evaluation, possible chest x-ray and treatment – Treatment is provided by the Kankakee County Health Department 24 PSMH TB Exposure control plan A POSITIVE TB Test (PPD, Mantoux)means: – You have come in contact with the TB germ – You are NOT infectious unless you have signs/ symptoms of TB – You cannot give TB to anyone at this stage 25 PSMH TB exposure Control Plan In 2015/ 2016 PSMH is considered at LOW risk for contact with Mycobacterium TB. A risk assessment is done annually. – Therefore yearly TB testing may or may not be required – Staff, Volunteers, and Students will be tested if they are exposed to a patient with active infectious TB 26 PSMH Infection Control Isolation Guidelines PSMH Isolation Guidelines How Do I know if a patient requires Isolation? – The first policy under Isolation in the exposure control manual is called Isolation Guidelines (also in the Infection Control Policy Manual Online) • Lists conditions and bacteria requiring isolation • Lists the type of isolation required • Lists the duration of isolation required 28 PSMH Isolation Guidelines 3 types of isolation used at PSMH – Airborne • Used for TB, Chickenpox(Varicella), disseminated herpes, Smallpox, SARS, or Avian Flu – Droplet • Used for whooping cough, (pertussis), influenza, pneumonic plague, diphtheria, mycoplasma pneumonia, mumps, rubella, haemophilus influenza type b, (pneumonia and sepsis) Bacterial Meningitis – Contact • Used for Diarrhea infection – Salmonella, shigella, hepatitis A, Toto Virus, Clostridium Difficile, and undiagnosed diarrhea • Respiratory Infection – RSV, enteroviral infections in infants/ children • Skin infections – Impetigo, scabies, zoster(chickenpox, Shingles) • Multidrug resistant organisms – MRSA, VRE, ESBL’s, C-Diff 29 AIRBORNE Isolation Requires a private room equipped with negative air flow, the door must remain closed. For TB : EVERYONE is required to wear an N95 particulate filter mask when entering room – For Chicken Pox, Disseminated Herpes(shingles in more than one nerve or in an immune-compromised patient): • If immune to chicken pox you may enter the room without a N95 particulate filter respirator mask • If you are not immune a N95 particulate filter respirator mask is required, and fit tested 30 DROPLET Isolation Standard precautions as well as the requirement of a surgical mask worn by everyone who enters the room 31 CONTACT Isolation Multi drug resistant Organisms – Requires GOWN and GLOVES be worn by EVERYONE upon entering the room EVERYTIME they enter the room. – Volunteers are not to enter any Isolation rooms 32 CONTACT Isolation for Clostridium Difficile: Hand Hygiene – USE soap and water – DO NOT use waterless alcohol hand sanitizers C-Diff is a spore forming bacteria – It is difficult to kill 33 PSMH Infection Control Hand Hygiene is the single most important thing you can do to protect your patients, yourself and your family! Hand Hygiene Saves lives -Washing hands with soap and water -Cleansing hands using an alcoholbased hand rub -Preventing the spread of germs and infections Hand Hygiene is the #1 way to prevent the spread of infections Wet hands with warm water and apply soap – A nickel or quarter sized amount of soap to your hands Rub hands together for 20 seconds – Rub all over the top of hands and in between fingers and under fingernails Rinse hands well under running water Dry your hands using a paper towel and use a paper towel to turn off the faucet and open the door if needed 36 Hand Hygiene Perform Hand Hygiene – – – – – – – – – – Before patient contact as you walk into patient room Before any invasive tasks Before starting your shift Before doing vital signs Before dispensing meds After contact with wounds, mucous membranes, blood and body fluids, secretions, excretions and other potentially infectious material After contact with equipment or surfaces that may be contaminated After removing gloves and other PPE After patient care After your shift before leaving work 37 All Equipment must be cleaned after use between patients Germicidal Wipes – Need to have a wet contact time of 2 minutes on the surface then be allowed to air dry to kill the bacteria and viruses • Lift equipment, glucometer, beside tables, stethoscopes BP cuffs, med pass areas, pill crushers, crash cart, counters, keyboards, mouse, telephone, pens, kitchen counter, microwave, refrigerator Bleach – Need to have a wet contact time of 4 minutes on the surface then be allowed to air dry to kill the bacteria and viruses • C-diff , and if patient has diarrhea use bleach to clean equipment and surfaces 38