Download Infection Control the Handouts OBJECTIVES

Hospice Education Network - Infection Control
Infection Control
Linda Darbyshire MSN RN PMHCNS-BC
Consulting Coordinator
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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