Download Hand Hygiene

HOSPITAL ORIENTATION 2010
June 22, 2010
Center for Health and Healing
ACGME Core Competencies
Dr. Donald Girard, Associate Dean of GME & CME
Dr. Andrea Cedfeldt, Assistant Dean for GME
Dr.Tana Grady-Weliky, Associate Dean of Undergraduate Medical Education
Patient Advocate
Susan Yoder, RN, BSN
Director, Department of Patient Relations
Administrator on Duty & Decedent Affairs Manager
Department of Patient Relations
Patient Advocacy
• Complaint Management
• Mediation & Conflict Resolution
• Accessing & Navigating Systems
Palliative Care Consult Service
Spiritual Support – Chaplaincy Services
Medical Ethics Consultation
Crisis Intervention & Debriefing for Staff
Administrator on Duty & Decedent Affairs
Administrator on Duty
•Front Line Hospital Administration
•“House Supervisor” (on steroids)
•Patient Placement/Access Management
•Bereavement & Requesting Organ/Tissue Donation
•Conflict Resolution/Crisis Intervention
•Resource to the Healthcare Team (policies, etc.)
Decedent Affairs
•Track documentation & location of deceased patient
•Work with providers, staff, ME, Funeral Directors & Loved
Ones for a smooth, compassionate process
Contacts:
Patient Relations for an Advocate X4-7959
Administrator on Duty (AOD) pager 12241 24X7
Decedent Affairs Coordinator pager 12813
(covered by AOD after hours)
Hospital Chaplain – Campus Operator
Susan Yoder pager 11405
Welcome to OHSU!
E*Value System
Christine Flores
Evaluations and Time Keeping
Sleep Deprivation in Residency
Dr. Holger Link
Sleep deprivation in residency
Epworth Scale
The Scope of the Problem
“… I always had a prior theory that when you
look up all the old sixties research how do you
brainwash someone? You sleep deprive
them. That’s number, two, and three. Sleep
deprive them. You feed them bad food and
you repeat things over and over again. It’s
like that kind of covers residency.”
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Epworth Sleepiness Scale
Sleepiness in residents is equivalent to that found in patients
with serious sleep disorders. Mustafa and Strohl, unpublished data. Papp, 2002
© American Academy of Sleep Medicine
Consequences of Insufficient Sleep
•
•
•
•
•
•
Increased medical errors
Impaired judgment
Impaired learning
Impaired physical health
Impaired mood and energy
Drowsy driving
Adapting to Sleep Loss
• Sleep need is genetically determined
• You can’t “adapt” to getting less sleep than
you need
• Performance may improve somewhat with
effort
• You can not achieve optimal performance!
Recovering from Sleep Loss
• Recovery from on-call sleep loss generally takes at
least 2 nights of extended sleep
• Most sleep debts can be paid off in 3-4 days!
Source: www.drowsydriving.org
Driving Home Post Call
Signs of Drowsy Driving
Trouble focusing on the road
Difficulty keeping your eyes open
Nodding
Yawning repeatedly
Drifting from your lane, missing signs or exits
Not remembering driving the last few miles
Closing your eyes at stoplights
Drowsy Driving:
What Doesn’t Work
 Turning up the radio
 Opening the car window
 Chewing gum
 Blowing cold air (water) on your face
 Slapping (pinching) yourself hard
 Promising yourself a reward for staying awake
4 second lapse = drowsy crash
Drive Smart and Safe
Do not drive drowsy!
 Take a 10-20 minute nap and/or drink a cup of coffee before
going home post-call
 Stop driving if you notice the warning signs of sleepiness
 Pull off the road at a safe place, take a short nap
 Get ride home, take taxi, or use public transportation
Napping
Benefit: Temporarily improves alertness
Types: Preventative (pre-call)
Operational (on the job)
Length:
Short naps: no longer than 20 minutes to avoid
grogginess
Long naps: 2 hours (range 30 to 180
minutes). Be aware of sleep-inertia.
Caffeine
 Strategic consumption is key
 Effects within 15 – 30 minutes; half-life 3 to 7 hours
 Use for temporary relief of sleepiness
 Cons:
 Disrupts subsequent sleep (more arousals)
 Tolerance may develop
 Diuretic effects
Library Services
Andrew Hamilton
Overview of the Library
OHSU Library
Library is here
Barcode
• You need one
• Where you can get
one
– Library circulation
desk
– Online at
www.ohsu.edu/xd/education/librar
y/services/forms/barcode.cfm
The Library Home Page
www.ohsu.edu/xd/education/library/
Get access from off-campus
Online
Catalog
Get
help
Databases
Electronic articles and journals are linked
from within databases.
Databases may include their own links to
full text, as well as the “Find It@OHSU
Library” link.
3 different ways to get to the article
Manage your citations
What if we don’t have it?
Summit Catalog
• Includes 36 college and university libraries in Oregon
and Washington
• You can request books, videos, CDs through Summit
and they will be sent to the OHSU Library for you to pick
up or will be sent directly to distance students
• Generally it takes less that 72 hours to get the book
• 95,000 titles at OHSU; 9.2 million titles in Summit
• IT’S FREE
• More information at
www.ohsu.edu/library/orbiscascade.shtml
Ways to get
help:
•Ask a Librarian
links
•Chat
•Email
•Phone
Infection Prevention & Control
Summer, 2010
Department of Infection
Prevention & Control:
Objectives
• How to contact our program
• Review resources that will be helpful when
caring for patients
• Review the OHSU isolation categories
• Organism – specific guidelines
• Employee Health topics
33
Department of Infection Prevention & Control
•
•
•
Phone: 494-6694 M-F 7:30AM - 5:00PM
– Contact AOD after hours
Physician Epidemiologists
– John Townes, MD Adult Infectious Diseases
– Judy Guzman-Cottrill, DO Pediatric Infectious Diseases
– Lynne Strasfeld, MD Transplant Infectious Diseases
Infection Control Program Manager
– Marjorie Underwood RN, CIC
Infection Control Specialists
– Linda Young RN, MSN, CIC
– Molly Hale MPH, CIC
– Emily Ackiss MPH, CIC
– Gail Carberry RN, MSN
VA Medical Center
Rita Tjoelker- 5-7143
Sherri Atherton-5-7144
Tom Ward, MD– Infectious Diseases
34
The IC Isolation Grid as a Resource
35
Isolatable Infections & Conditions
36
De-isolation Grid
37
EPIC VRE Alert Screen
38
Back to Basics:
Hand Hygiene
Cleaning your hands is
the most important
thing you can do to
prevent transmission of
infection
39
Hand Hygiene
Interrupts the chain of disease transmission
• Antibacterial Soap & Water
– Hand friction for 15 seconds
• Hand Sanitizer needs to dry
• Ensure all surfaces of hands, in between fingers
& nail beds are cleaned
WHO: “5 Moments of Hand Hygiene”
Hands Visibly Dirty?
Wash Your Hands with Soap and Water
 Turn on faucet
 Wet your hands with warm
water
 Apply soap
 Scrub your hands for at least
15 seconds
 Pay attention to fingernails
and areas around jewelry
(rings and watches)
 Dry hands completely with a
paper towel
 Use a paper towel to turn off
faucet
Hands Not Visibly Dirty?
Use alcohol-based waterless product
Apply enough to cover all surfaces of the hands, rub until
dry, about 15 seconds.
Resident Hand Hygiene Compliance
45
How do Residents Compare With Others?
46
Standard Precautions: Protect Yourself!
• 100% compliance with hand hygiene
• Gloves if touching non-intact skin or rash,
any body fluid or mucous membrane
• Gown if you may get it on you
• Mask/face protection if you may get
sprayed or splashed in the face
…Think about it before it happens!
Remember - if it is wet and it is not yoursuse a barrier!
Standard Precautions
Details you might not know…
• During aerosol generating procedures
(bronchs, suctioning, intubation, nasal wash,
NP cx, etc.) use face shield or mask &
goggles
• If pulmonary TB or other diseases requiring
airborne isolation is suspected, wear a fittested N95 masks or PAPR
• Wear masks for spinal procedures
(myelograms, LPs, spinal or epidural
anesthesia)
Respiratory Hygiene & Cough Etiquette
• YOU and your patients should
follow these rules!
• Wash hands after coughing
and using tissue
• Wear mask/eye protection if
close to coughing patient (if
contagious disease is
suspected, patient should be in
private room)
• Provide patients with tissues,
instruct them to cover their
coughs, have hand sanitizer
available
Isolation Precautions
(In addition to Standard Precautions)
1.
2.
3.
4.
Contact Precautions
Modified Contact Precautions
Droplet Precautions
Airborne Precautions
Isolation categories may be used in combination, if needed
– Example: Chickenpox (airborne + contact)
51
Contact Precautions
Examples
– Diarrhea - if incontinent, diapered,
or contaminating the room
– Norovirus until 72 hours after last
diarrhea episode
– Multi-drug resistant organisms (MDRO)
– Draining wounds or body substances not contained
– Nasty rashes that may be contagious
•
Scabies, secondary syphilis
MRSA and VRE
& Other Multi-drug Resistant Organisms (MDRO)
• For colonized and actively infected pts
• Contact Precautions
– You must wear gloves and gowns every time
you go into the patient room
– Even if you are not touching patient or
environment!
• Patient’s room & equipment contaminated
• Hand Hygiene after gloves come off
53
“De-isolation” for MDRO
• Usually occurs in the ambulatory setting,
because patient must be clinically well
• Rule of 3’s:
– 3 months since last positive result (cx or PCR)
– Must be off abx for 3 weeks
– Obtain 3 screening tests 1 week apart
• Contact Infection Control Dept for
additional guidance or for EPIC alert
screen removal
54
Modified Contact Precautions
• Same as Contact Precautions with the exception
that traditional handwashing with antimicrobial
soap and water must be used
• NO hand sanitizer
• Use for patients with positive, symptomatic C.
difficile diarrhea or high clinical index of suspicion
• Isolate until Rx complete and 72 hr symptom free
• Rooms cleaned with bleach to kill C. diff spore
Droplet Precautions
•
Used for pts known or suspected to be
colonized or infected with microorganisms
transmitted by large-particle respiratory droplets
•
Conditions that may require Droplet Precautions
–
–
–
–
–
Any symptomatic respiratory viral illness, even if
pathogen unknown
Haemophilus influenza type b (Hib)
Meningococcal disease
Mumps
Pertussis (Whooping Cough)
Contact + Droplet Precautions
•
•
When one set of precautions is not enough!
Conditions that may require Contact and
Droplet Precautions
–
–
–
–
–
–
Respiratory Syncytial Virus (RSV)
Adenovirus pneumonia
Parainfluenza
Influenza A &B
All pediatric bronchiolitis (even if culture negative)
All immunocompromised hosts with respiratory
viral infection
How do YOU take off YOUR gloves,
mask and gown?
Airborne Precautions
• Small droplet nuclei stay suspended in the air for
prolonged periods of time
• Room Requirements:
– Private room
– Negative pressure airflow with ante-room
– Doors always closed except for entry/exit
• Personal Protective Equipment:
– Fit-tested N-95 Mask or PAPR
• Diseases requiring airborne precautions:
– Pulmonary or laryngeal tuberculosis
– Measles
– Chicken Pox (Varicella) or disseminated zoster
N95 Respirator or PAPR
• A Fit Test is now required if
you wear an N95 TB mask
(orange duckbill)
– Fit-check each time mask is put
on
• If you cannot or have not
been fit tested for N95 mask:
– Use a Powered Air Purifying Respirator
(PAPR) to enter a room with a patient who
has active pulmonary TB
– Disinfect the PAPR on the inside of the
hood and then on the outside in between
use.
Tuberculosis
• Airborne Precautions in negative airflow room
– Rule out pulmonary TB (work up in progress)
– Confirmed pulmonary TB
– Laryngeal TB
• Patients need to be restricted to their rooms other
than medically necessary procedures (no
smoking!)
• OR cases- Should be the last case of day, unless
emergent
• Discontinue Isolation
– 3 negative AFB-smear sputum samples
– ADEQUATE SPUTUM SAMPLES
Reportable Infections
(Case Reporting to the Health Department)
• If disease confirmed by a lab test, OHSU lab
automatically reports cases to the health
department
• Clinicians required to report to county of
patient’s residence for clinically suspected
cases or culture-negative cases
– Toxic shock syndrome, hemolytic uremic syndrome
• Call Infection Control Program for assistance
Spotlight on Infection Prevention:
Central Line-Associated Bloodstream Infections
(CLABSI)
• Evidence-based guidelines must be followed
(CLABSI Bundle) every time






Hand hygiene
Maximum sterile barrier precautions
Chlorhexidine skin antisepsis
Choosing best anatomical site for insertion
Use of an Insertion Checklist
Remove line ASAP
• Mandatory CLABSI Educational Module (Big
Brain) for all house staff
• Rates are publicly reported in Oregon
Sani Cloth® Plus
• Use on computers: keyboard, mouse
and screen
• Patient care equipment: wheelchair,
gurney, BP cuff, stethoscope, etc.
• Use 2 wipes
(1) Clean off debris, gross contaminants
(2) Disinfection
• Allow 5 minutes to dry (“contact time”)
69
Avoiding Exposure to
Bloodborne Pathogens
• Minimize or eliminate splash, spray,
splatter, and droplet/aerosol generation
• Do not bend or recap sharps or needles
• Contain specimens during transport
• Proper use/laundering of scrubs, etc
• No food/drink near blood or other
potentially infectious material
– No food/drink in patient care areas!!!
Protect Yourself!
Use Standard Precautions every
time you care for a patient
or handle blood & other
specimens
Safety goggles are available
through Logistics
What to do if you have a blood or
body fluid exposure
1.
2.
3.
4.
5.
Wash the area well with soap and water
Flush eyes well with water if splashed
Immediately report accident to your supervisor
Call Employee Health for low risk exposure advice Monday-Friday
Report to the Emergency Department for high risk exposures or
those occurring after hours, or on weekends
6. Bring patient name, medical record number, and any known HIV risk
factors
• Complete confidential and free baseline & follow
up lab testing and counseling
2009 OHSU Bloodborne Pathogen Exposures
• 368 exposures in 2009
– 150 hollow needles
– 133 solid sharps
– 78 splashes
– 7 Bites & Scratches
• Source Patient
– 2% HIV +
– 16% HCV+
– 0.3% HBV+
• No Conversions
Employee Health Program
• Main phone number is 4-5271
• TST is required on hire and ANNUALLY
• Exposure follow up
– Bloodborne pathogens
– Communicable diseases
• Immunization history and vaccines
– Annual Influenza vaccine
– Tdap
INFECTION PREVENTION & CONTROL
We are here to assist you!
• Call us when you
have questions or
need clarification
• Call if a patient needs
an MDRO alert
screen placed
• We like to be involved
earlier rather than
later…
Phone: 4-6694
Email: [email protected]
76
Interpreter Services
Samia Saad
Resources and Legal Requirements
If you talk to a man in a language he
understands, that goes to his head.
If you talk to him in his language,
that goes to his heart.
-Nelson Mandela
OHSU
Medical Interpreter Services
Mission Statement
“Our goal as Medical Interpreters is to provide
communication support for the healthcare professional
and the patient. Our support gives strength the
interpersonal relationship between the hospital staff
and the patient, and therefore enhances the quality of
patient care. We are committed to service excellence
by our dedication to all parties who need our services.”
OHSU Medical Interpreter Services
• MIS Department was established 30 years ago. It
is located on OHSU campus.
• Interpreter Services Department serves all OHSU
patients in all OHSU departments.
• MIS department serves all languages in person,
via telephone, and video.
• Interpreter operation at OHSU is 24 hours a day, 7
days a week.
Why does OHSU Provide Medical Interpreters?
• Communication is the very heart of health care. It is a process that leads to
the development of trust between a patient and a provider.
• Growing diversification of the U.S. population brings a necessity to provide
equal access to health care for people who have limited English Proficiency
(LEP) or the deaf and hearing impaired.
• It is the policy of OHSU to provide equal access and equal participation in
health care activities for persons who are deaf or hearing impaired, and for
persons with Limited English proficiency as governed by Title VI of the Civil
Rights Act of 1964.
• All recipients of federal funds must comply with these requirements at no
cost to the patient or to the healthcare professional. The function of a
medical interpreter in this process is to facilitate the implementation of this
policy.
Top 20 Languages used July 2009- Feb 2010
Spanish
Russian
Vietnamese
Cantonese
Sign Language
Mandarin
Somalia
Arabic
Korean
Farsi
Burmese
Cambodian
Bosnian
Nepalese
Japanese
Romanian
Ukrainian
Mien
Laotian
Kirundi
10%
76%
4%
3%
1%
1%
1%
1%
1%
0% 0% 1% 1%
0% 0% 0%
0%
0%
0%
0%
Who are the OHSU professional health care interpreters?
• OHSU Medical Interpreters are native speakers and linguist
professionals. They have been certified by the OHSU Translation &
Interpreter Dept as Medical interpreters after successfully passing a
written and oral examination for medical interpreters developed and
administered by the OHSU Translation & Interpreter Services
Department.
• They are fluent and proficient in English and the target language
• They possess vast knowledge of medical terminology
• Medical Interpreters are professionally trained to interpret in consecutive
mode of interpretation and are able to do sight translations
• They comply with The National Standards of Practices and The Code of
Ethics for Interpreters in Health Care, established in this industry
Scope of Service:
•
Medical Interpreter Services is able to provide the following specific
services:
•
Telephone interpretation (about 80% of the total volume)
•
Face-to-Face interpretation
•
Videoconferencing (VIP) At CHH
•
Limited translation services are available for discharge instructions, letters
to patients, directions to the medical facilities and instructions on taking
medications. Any complex or lengthy materials will be referred to the
contract translation agency
•
A selection of translated documents is available on the OHSU Translation
Web Site at http://ozone.ohsu.edu/healthsystem/PED
OHSU MEDICAL INTERPRETER SERVICES
Business hours are:
Monday through Friday
7:30am to 5:30pm
INTERPRETING SERVICES ARE AVAILABLE AT
ALL TIMES, EVERY DAY 24 HOURS A DAY.
Our main telephone number is
503-494-2800 option 1
For scheduling
For interpreting and translation questions
For language competency exams
For any question pertaining to interpreting services
Direct telephone numbers to specific languages for
phone interpreting:
Spanish is 503-494-8900
Russian is 503-494-8922
Vietnamese 503-494-8989
Chinese 503-494-4914
DURING BUSINESS HOURS WE COUNT ON:
1 Chinese interpreter
3 Russian interpreters
1 Vietnamese interpreter
11 Spanish interpreters
4 language agencies
AFTERHOURS:
Call OHSU Operators at 503-494-8311
They can connect you to any language interpreter for phone interpreting
and assist you in getting a face to face interpreter if the need arises.
There is a Spanish interpreter at OHSU Monday to Friday until 11:30pm.
On Saturdays, Sundays and Holidays, there is Spanish interpreter on
campus from 8am to 6pm.
FOR FACE TO FACE INTERPRETING
Call the dispatcher at 503-494-2800
option 1
How to schedule interpreters?
For clinic appointments:
 Language indicator in Epic has to be present in RED. This automatically
schedules a phone interpreter for all appointments.
 We have to rely on phone interpreting because DEMAND FOR OUR
SERVICES IS MUCH GREATER THAN INTERPRETER THE AVAILABILITY
 While phone interpreting may seem less than ideal, our experience has
shown that many encounters can successfully and effectively done with a
phone interpreter.
 Given our limitation of resources, we have to be very judicious about
scheduling face to face interpreters, hence you will probably be asked why you
need an interpreter in person versus by telephone
 There are encounters are much more effectively done with a face to face
interpreter
 If in doubt, please call us
Bilingual Assessment Tests for all OHSU employees
•
MIS Department provides free bilingual assessment tests for all OHSU employees for all languages.
•
The exam consists of a written part, and an oral part. Passing score should be at 80% or more for both
exams in order for employee to be certified by MIS.
•
The exams were developed by MIS Department to enable employees to use their language skills with patients
or customers at OHSU.
•
Bilingual exams available:
1. Professional Interpreters Exam (Employees who would work as Medical interpreters)
2. Language Proficiency for Medical Staff- Doctors, Nurses or any staff members who use medical terminology in
their scope of work
3. Language Proficiency Exam for Non- Medical Staff- Registration people, case workers, schedulers etc.
Call Samia Saad, or Monica Serrano at 4-2800 to schedule time for the exam.
Testing are done between 8:30am and 3pm Monday-Friday.
Questions?
‫أي سؤال‬
Вопросы?
¿PREGUNTAS?
Safety/Environment of Care
Nina Wolf
Ben Richards
Environment of Care
The Joint Commission
Environment of Care
Standards in OHSU Hospitals and
Clinics
Environment of Care
Committee
503/494-7795
Why?
Goal: “Provide a safe, functional, supportive,
and effective environment for patients,
staff, and visitors.”
Test:
What do you expect if YOU are a patient?
Patients are being taught to look for, and
empowered to ask about safety issues.
General Safety
• Ergonomics
– Adjustable furniture (including CIMs) and
assessment help
• Incident Reports
• Patient Lifting
– Page the Lift Team… ask your nurses
• Tobacco Free Campus
• Waste Handling
– Trash, Medical (Red Bags), Pathological, etc.
Hazardous Materials Safety
• Know what you are working with
• Labels
–Manufacturer containers
–Secondary containers
• Material Safety Data Sheet (MSDS)
• Spill Response Team
Personal Protective Equipment (PPE)
Types: mask, gloves, face mask, gown, lab
coats (sometimes), eye protection, etc.
N95 – requires medical certification and fit
test (annual event)
Use: whenever there is a potential or
actual exposure risk
Limitations: soak through, single use, etc.
Fire Response
• RACE:
–
–
–
–
Rescue anyone in danger
Activate the Alarm
Confine the fire (close doors and windows)
Evacuate – if ordered
• Moving around
– Avoid the elevators - Some are safe, but reserve them
for people who can’t use the stairs
– You CAN go through fire doors…
just make sure they close after you
– Move to another compartment
if instructed (marked by flame decal)
• Listen for instructions from area leadership
Medical Equipment
• Train before use and document your training
• Clinical Technology Services checks all equipment
prior to use around patients
Preventative
Maintenance
– Inspection and
Done _________ By
____________
Periodic Maintenance
Due __________ CE#
___________
• Lasers, X-ray, Fluoroscopy, others
– Training? Tests? Badges?
• Department specific requirements
• Cell phones and other devices
– Settings can be changed when used close to
medical equipment
• Malfunction? Clinical intervention & report!
Utility Problems
• What do you do?
• Clinical intervention
• Refer to Emergency Resource Book! to
call the right people

Emergency power: red plugs

Critical equipment only
4-8054
Public Safety
• Photo Identification – always!
• Security Sensitive Areas - ED, Pharmacy, Pediatric
areas, L&D, Mother Baby, inpatient psych, etc.
• Emergency? – 4-4444
• “Dr. Strong”
• Forensic Patients – orientation handout to
officers, safety considerations
• Code Pink – your role
• Clinical Violence Alert Symbol
Emergency Preparedness
and Response
• Emergency Resource Books and Manuals
• Prioritize your personal safety
• Assess your area for safety hazards,
injuries, damage, utilities
• Report to area supervisor
• Defer to staff expertise
• Incident Command System
– NOT normal operations
• Incident Information Hotline 503 494-9021
Resources
• Printed: ERBs, badge backers,
yellow phone stickers, etc.
• OHSU Faculty, Staff & Students
• Great O-Zone sites
• Environmental Health & Radiation
Safety (4-7795)
• Public Safety (4-7744)
•
: (4-4444)
Injury, Fire, Chemical Spill
15 Minute Break