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Download Infection Control the Handouts OBJECTIVES
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Hospice Education Network - Infection Control Infection Control Linda Darbyshire MSN RN PMHCNS-BC Consulting Coordinator Download the Handouts • Click on the “Links” button to download the handouts • Handouts are in PDF format • You can save it and/or print it OBJECTIVES At the end of this session, participants will be able to: 1. List at least 3 ways germs are spread 2. Identify 3 ways to prevent the spread of infection 3. Verbalize what to do if exposed to blood or body fluids 4. Identify the effective handwashing technique when your patient has C-difficile Hospice Education Network (c) 2010 Hospice Education Network - Infection Control Limitations of this Presentation • This presentation is based on 2010 Center for Disease Control recommendations • Infection Control data can change quickly, so please check the resource websites at the end of this presentation for updates • State regulations may vary, so please check your state department of public health to ensure compliance with regulations specific to your location CoP Requirements for Hospice 418.60 • Develop an effective, up-to-date Infection Control program, based on accepted standards of practice • Develop Policies and Procedures on Infection Control • Provide education on Infection Control to patients/families and hospice staff • Develop processes for the monitoring, surveillance, identification, prevention and control of known or suspected infections • Collect data related to personnel & patient infections • Incorporate that data into QAPI (Quality Assessment Performance Improvement) Five Ways Germs are Spread 1. CONTACT: from person to person OR from contaminated objects to person 2. RESPIRATORY: from breathing germs in the air 3. VECTOR: from insects that carry diseases 4. FOOD and/or WATER: from contaminated food or water 5. BLOOD or BODY FLUIDS: from contact with blood borne pathogens Hospice Education Network (c) 2010 Hospice Education Network - Infection Control Prevention of Infection • PROPER HANDWASHING! • Proper handling and disposal of potentially contaminated material • Use of vaccines and annual testing • Eliminating the use of artificial nails for direct care staff • Keep natural nail tips no longer than ¼ inch long • Wear gloves when you are in contact with body fluids and non-intact skin Hand Hygiene • If hands are visibly soiled, wash with soap and water for 15 seconds • Otherwise, use an alcohol-based hand rub EXCEPTION TO ALCOHOL-BASED HAND RUB • **If your patient has a C-difficile infection, you must wash your hands with soap and water rather than use the alcohol-based hand rub, as it is the friction from hand washing that kills the microorganism** When do you wash your hands? • Prior to ANY direct patient contact • After contact with blood, body fluid, mucous membranes or non-intact skin • Before you enter your bag • After removing gloves • After using the toilet, blowing your nose, or covering a sneeze • When moving from a contaminated body site to a clean body site, during patient care • Before you leave the patient’s home Hospice Education Network (c) 2010 Hospice Education Network - Infection Control Cover Your Sneeze! To help stop the spread of germs: • Cover your mouth and nose with a tissue when you cough or sneeze • Put your used tissue in the waste basket • If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands • You may be asked to put on a facemask to protect others Bag Technique • Theoretically, the outside of your bag is considered “dirty” and the inside is considered “clean” • Wash your hands whenever you enter your bag • Check the policy of your hospice. You may be able to place your bag on a clean, hard surface OR use a barrier (newspaper/paper towel) between your bag and the surface • Use the barrier once and then dispose of it • Never, ever, place your bag on the floor • Bag technique and your car Personal Protective Equipment (PPE) • Personal Protective Equipment includes: gloves, gowns, aprons, masks, etc. It must be available to protect staff and patients from infection • The type of PPE used with each patient will vary • Latex free gloves should be available for staff • Gloves should be worn whenever there is potential for contact with body fluids (changing bed linens, bed baths, dressing changes, etc.) • Change gloves and wash hands once the gloves have become contaminated Hospice Education Network (c) 2010 Hospice Education Network - Infection Control Infection Control and Equipment • Individual hospices have their own policies and procedures regarding infection control and equipment. Please familiarize yourself with your own policy • It is recommended that cell phones be cleaned with an approved antiseptic wipe at the beginning and end of each workday • If you bring a laptop or other electronic device into the home, it should be cleaned with an approved antiseptic wipe between patients • Stethoscopes and other equipment should be cleaned before and after use with each patient • Bags should be washed periodically Disposal of Hazardous Waste • Please check your state health department regulations for specifics for the approved manner of disposal of soiled dressings • Some states allow double-bagging of soiled dressings, then disposal in the regular trash • You may be required to add a capful of a 10% bleach solution to an infectious or saturated dressing, prior to double-bagging Laundry: Washing Infected Material • Although soiled linen may harbor large numbers of microorganisms, the risk of disease transmission from soiled linen is negligible • Soiled linen should be handled as little as possible • Gloves should always be worn when handling linen • In the home, normal washing and drying cycles including “hot” or “cold” cycles are adequate to ensure patient safety Hospice Education Network (c) 2010 Hospice Education Network - Infection Control Tracking of Infections • Hospices are required to collect and track data on specific patient infections, as well as infections of personnel • As part of its Infection Control program, the hospice incorporates this data into its QAPI program Multidrug-Resistant Organisms • MRSA: Methicillin-resistant Staphylococcus aureus • VRE: Vancomycin-resistant enterococci • PRSP: Penicillin-resistant Strptococcus pneumoniae • ESBLs: extended spectrum beta-lactamases (which are resistant to cphalosporins & monobactams Multidrug-Resistant Organisms Precautions • Good hand hygiene is essential • The type of personal protective equipment (PPE) healthcare providers require will depend on where the infection is located: – Gloves are required – If the infection is respiratory, then healthcare providers need to wear masks – If the infection is located in a wound, then gloves and an apron are appropriate – If the infection is in the urine, then anyone draining the catheter should wear an apron and a face shield (or goggles & mask) to protect against a splash Hospice Education Network (c) 2010 Hospice Education Network - Infection Control Clostridium difficile • C. difficile is a spore-forming, gram positive anaerobic bacillus • It is a common cause of antibiotic-associated diarrhea • Symptoms include: – – – – – Watery diarrhea Fever Loss of appetite Nausea Abdominal pain C. difficile continued • C. difficile is shed in feces • C. difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface/item • Good hand hygiene for C. difficile requires soap and water with vigorous rubbing. It is the friction of hand washing that destroys the spores • The latest data from CDC indicates that C. difficile is more prevalent than MRSA Sharps • Sharps containers should be provided to clinicians for disposal of needles or other sharps • Patients who create their own sharps (self injections or the use of lancets) should be taught proper disposal of sharps. The department of health in some states provides patients with sharps containers; or families can be taught to use empty liquid laundry detergent bottles Hospice Education Network (c) 2010 Hospice Education Network - Infection Control Standard Precautions • “Universal Precautions” and “Body Substance Isolation” have been combined, and are now known as “Standard Precautions” • With Standard Precautions, barrier precautions are used with all patients, regardless of diagnosis, for contact with blood, body fluids, secretions, excretions, mucous membranes and non-intact skin • Treat the blood and body fluids of every patient as infectious at all times Blood Borne Pathogens • Blood borne pathogens include, but are not limited to, the Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) • They can be transmitted through contact with blood or body fluids • It is recommended that healthcare workers receive the Hepatitis B vaccine Hepatitis • Hepatitis B: – Blood Borne Pathogen transmitted via blood or body fluids – Acute Hepatitis B may cause inflammation, vomiting and jaundice – Chronic Hepatitis B eventually causes liver cirrhosis, liver cancer, possibly death – Prevention through vaccine, standard precautions, safe sex, no shared needles • Hepatitis C: – Blood Borne Pathogen transmitted via blood or body fluids – Often asymptomatic – Acute Hepatitis C may cause fatigue, abdominal pain, jaundice, itching, and flu-like symptoms – Chronic Hepatitis C may cause cirrhosis, liver cancer, possibly death – Liver transplant may be helpful initially – NO VACCINE – Prevention though standard precautions, safe sex, no shared needles Hospice Education Network (c) 2010 Hospice Education Network - Infection Control Human Immunodeficiency Virus (HIV) • Blood Borne Pathogen • HIV is found in blood, semen, vaginal fluid and breast milk • Usually transmitted through unprotected sex, sharing needles, breast milk, and from an infected mother to her child at birth • Prevention through standard precautions & safe sex • Through much improved treatments, patients with HIV are living much longer • A course of antiretroviral treatments administered immediately after exposure, post exposure prophylaxis, is believed to reduce the risk of infection Exposure to Blood or Body Fluids • Wash and flush the area immediately for at least 15 seconds • Do not squeeze punctured skin from a needle stick to make it bleed • Notify your supervisor immediately; follow the policy of your hospice • You will likely be told to go to the nearest Emergency Center for treatment immediately – treatment for a high risk HIV exposure requires treatment within two hours of the event • If you are determined to be at high risk for a blood borne pathogen, you’ll be treated and monitored confidentially Tuberculosis (TB) • Tuberculosis is an airborne infection spread by: – – – – Sneezing Coughing Laughing Singing • Symptoms of Tuberculosis include: – – – – – Fever and night sweats Persistent cough lasting more than 3 weeks Coughing up blood Loss of appetite and weight loss Fatigue Hospice Education Network (c) 2010 Hospice Education Network - Infection Control High Risk Populations for TB • Residents of: correctional facilities, long-term care facilities, nursing homes, and mental health facilities • Persons infected with HIV • Medically underserved, low-income populations • IV drug abusers • Anyone sharing a household or having close contact with an individual with TB • Anyone who has spent time in a country with high TB prevalence TB Prevention • TB testing upon hire and every 12 months afterward • Employees who were born in other countries may have been given a BCG, a live TB vaccine, at birth, or when they began a career as in healthcare • If you are caring for a patient with TB, you must wear a NIOSH approved mask – You must be fitted for the mask to ensure that you are protected – The mask must be put on before you enter the patient’s home and not removed until you are out of the home – Patients with suspected TB should be isolated Infection Control Resources • Association for Professionals in Infection Control and Epidemiology (APIC): www.apic.org • Center for Disease Control and Prevention (CDC): www.cdc.gov • Occupational Safety and Health Administration (OSHA): www.osha.gov • Infectious Disease Society of America (IDSA): www.idsociety.org • Society for Healthcare Epidemiology (SHEA): www.shea-online.org • Your local county and state health departments Hospice Education Network (c) 2010 Hospice Education Network - Infection Control THANK YOU Linda Darbyshire RN MSN PMHCNSPMHCNS-BC Consulting Coordinator www.weatherbeeresources.com Hospice Education Network (c) 2010