Download Nursing Tips for April 2006 - LCCC-LPN

Nursing Tips for April 2006
(This information can be found @: http://www.osha.gov/SLTC/etools/hospital/hazards/univprec/univ.html)
Hospital eTool - HealthCare Wide Hazards Module
(Lack of) Universal Precautions
Potential Hazard
Employee exposure to bloodborne pathogens from
blood and Other Potentially Infectious Materials (OPIM)
because employees are not using Universal Precautions.

Bloodborne pathogens are pathogenic
microorganisms that are present in human blood
and can cause disease in humans.

Some infections that can be transmitted through
contact with blood and body fluids include:
o
HIV, Hepatitis A, B, C, Staph and Strep
infections, Gastroenteritis-salmonella, and
shigella, Pneumonia, Syphilis, TB, Malaria,
Measles, Chicken Pox, Herpes, Urinary tract
infections, and Blood infections. The
greatest risks are from HIV and Hepatitis B
and C.
Possible Solutions
Use Universal Precautions. Universal precautions is an approach to infection control to
treat all human blood and certain human body fluids as if they were known to be
infectious for HIV, HBV and other bloodborne pathogens, (Bloodborne Pathogens
Standard 1910.1030(b) definitions).

Bloodborne Pathogen Standard 1910.1030(d)(1) requires:
o
Employees to observe Universal Precautions to prevent contact with blood
or other potentially infectious materials (OPIM).
o
Under circumstances in which differentiation between body fluid types is
difficult or impossible, all body fluids shall be considered potentially
infectious materials.
o
Treat all blood and other potentially infectious materials with appropriate
precautions such as:

Use gloves, masks, and gowns if blood or OPIM exposure is
anticipated.

Use engineering and work practice controls to limit exposure.
OPIM is defined in 1910.1030(b) as:

The following human body fluids: semen, vaginal secretions, cerebrospinal fluid,
synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva
in dental procedures, any body fluid that is visibly contaminated with blood, and
all body fluids in situations where it is difficult or impossible to differentiate
between body fluids;

Any unfixed tissue or organ (other than intact skin) from a human (living or
dead); and

HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing
culture medium or other solutions; and blood, organs, or other tissues from
experimental animals infected with HIV or HBV.
The Bloodborne Pathogens Standard allows for hospitals to use acceptable alternatives
[OSHA Directive CPL 2-2.69] to universal precautions:

Alternative concepts in infection control are called Body Substance Isolation (BSI)
and Standard Precautions. These methods define all body fluids and substances
as infectious. These methods incorporate not only the fluids and materials
covered by the Bloodborne Pathogens Standard but expands coverage to include
all body fluids and substances.

These concepts are acceptable alternatives to universal precautions, provided that
facilities utilizing them adhere to all other provisions of the standard.

For compliance with OSHA Standards, the use of either Universal Precautions or
Standard Precautions are acceptable.
The CDC recommends Standard Precautions for the care of all patients, regardless of
their diagnosis or presumed infection status.

Standard Precautions apply to 1) blood; 2) all body fluids, secretions, and
excretions, except sweat, regardless of whether or not they contain visible blood;
3) non-intact skin; and 4) mucous membranes. Standard precautions are
designed to reduce the risk of transmission of microorganisms from both
recognized and unrecognized sources of infection in hospitals.
o

Standard precautions includes the use of: hand washing, appropriate
personal protective equipment such as gloves, gowns, masks, whenever
touching or exposure to patients' body fluids is anticipated.
Transmission-Based Precautions (i.e., Airborne Precautions, Droplet
Precautions, and Contact Precautions), are recommended to provide additional
precautions beyond Standard Precautions to interrupt transmission of pathogens
in hospitals.
o
o
Transmission-based precautions can be used for patients with known or
suspected to be infected or colonized with epidemiologically important
pathogens that can be transmitted by airborne or droplet transmission or
by contact with dry skin or contaminated surfaces. These precautions
should be used in addition to standard precautions.

Airborne Precautions used for infections spread in small particles
in the air such as chicken pox.

Droplet Precautions used for infections spread in large droplets
by coughing, talking, or sneezing such as influenza.

Contact Precautions used for infections spread by skin to skin
contact or contact with other surfaces such as herpes simplex
virus.
Airborne Precautions, Droplet Precautions, and Contact Precautions. May
be combined for diseases that have multiple routes of transmission. When
used either singularly or in combination, they are to be used in addition to
Standard Precautions.
Additional information on hand washing can be found at:
http://www.cdc.gov/handhygiene/materials.htm
Methicillin-Resistant Staph aureus (MRSA)
(This information can be found @:
http://www.charmeck.org/Departments/Health+Department/Top+News/MRSA.htm )
What is MRSA?
MRSA is a type of infection caused by the bacteria Staphylococcus aureus (or S. aureus).
Staphylococcus aureus, often referred to simply as "Staph," are bacteria commonly carried on the
skin or in the nose of healthy people. Some strains of S. aureus are resistant to a class of
antibiotics frequently used to treat Staph infections such as methicillin (which is a synthetic form
of penicillin)—and thus are called Methicillin-Resistant Staph aureus (or MRSA).
Who gets MRSA?
S. aureus (or Staph) including MRSA can be spread among people having close contact with an
infected person. MRSA is almost always spread by direct physical contact and not through the
air. However, spread may also occur through indirect contact by touching objects (e.g., towels,
sheets, wound dressings, clothes, workout areas, or sports equipment) contaminated with Staph
bacteria or MRSA.
Staph bacteria can live on the skin or in the nose of healthy individuals without causing any
symptoms of disease. This is known as colonization and MRSA can also be carried in this way.
However, injury to the skin (e.g. scrape or cut) can allow an opportunity for bacteria to enter the
skin and cause an infection.
Infections caused by Staph or MRSA are usually mild, limited to the surface of the skin, and can
be treated successfully with proper hygiene and antibiotics. In rare cases, if left untreated or not
recognized early, MRSA infections can be difficult to treat and can progress to life-threatening
blood or bone infections because there are fewer effective antibiotics available for treatment.
MRSA infections occur most commonly among persons in hospitals and healthcare facilities.
However, MRSA can cause illness in persons outside of hospitals and healthcare facilities as
well. Cases of MRSA infection in the community setting (e.g. day care centers, schools, prisons)
are called Community-Associated Methicillin Resistant Staphylococcus aureus (or CA-MRSA)
and have been associated with recent antibiotic use, sharing contaminated personal items,
reoccurring skin infections, and living in crowded settings.
C-Diff
(Interesting article on c-diff can be found @:
http://www.cbsnews.com/stories/2005/12/02/ap/health/mainD8E7P5U00.shtml )
Deadly Bacterial Illness May Be Spreading
ATLANTA, Dec. 2, 2005
(AP) A deadly bacterial illness commonly seen in people on antibiotics appears to be growing
more common _ even in patients not taking such drugs, according to a report published Thursday
in a federal health journal.
In another article in the New England Journal of Medicine, health officials said samples of the
same bacterium taken from eight U.S. hospitals show it is mutating to become even more
resistant to antibiotics.
"I don't want to scare people away from using antibiotics. ... But it's concerning, and we need to
respond," said Dr. L. Clifford McDonald, an author of both articles and an epidemiologist at the
federal Centers for Disease Control and Prevention.
"Hospitals need to be conducting surveillance and implementing control measures. And all of us
need to realize the risk of antibiotic use may be increasing" as the bacteria continue to mutate,
McDonald said.
The bacterium is Clostridium difficile, also known as C-diff. The germ is becoming a regular
menace in hospitals and nursing homes, and last year it was blamed for 100 deaths over 18
months at a hospital in Quebec, Canada.
"What exactly has made C-diff act up right now, we don't know," McDonald said.
The article published in the CDC's Morbidity and Mortality Weekly Report focused on cases
involving 33 otherwise healthy people that were reported since 2003 in Pennsylvania, Ohio, New
Jersey and New Hampshire.
Most of the 33 hadn't been in a hospital within three months of getting sick, and eight said they
hadn't taken any antibiotics in that span.
C-diff is found in the colon and can cause diarrhea and a more serious intestinal condition known
as colitis. It is spread by spores in feces.
The spores are difficult to kill with most conventional household cleaners. Even washing your
hands with an antibacterial soap doesn't eliminate all the germs.
C-diff has grown resistant to certain antibiotics that work against other colon bacteria. The result:
When patients take those antibiotics, particularly clindamycin, competing bacteria die off and Cdiff explodes.
One of the 33 patients in the report died _ a 31-year-old Pennsylvania woman who was 14 weeks
pregnant with twins when she first went to the emergency room with symptoms. Despite
treatment with antibiotics considered effective against C-diff, she lost the fetuses and then died.
Ten of the 33 were otherwise healthy pregnant women or women who had recently given birth
who had had brief hospital stays. The rest were people in the Philadelphia area who had not been
in a hospital in the three months before their illness.
The New England Journal of Medicine article looked at C-diff samples taken between 2000 and
2003 from eight hospitals in six states _ Georgia, Illinois, Maine, New Jersey, Oregon and
Pennsylvania.
The researchers found that a virulent strain of C-diff rarely seen before 2000 accounted for more
than half of the samples taken in the hospitals. What's more, the BI strain _ as it is called _
seems to have built resistance to two of the newest antibiotics in the fluoroquinolones class
commonly used in hospitals.
Much of the data was presented at a scientific meeting in Boston last year, McDonald said.
Another NEJM article looked at the occurrence of C-diff in 12 hospitals in Quebec. Researchers
counted 1,703 patients with C-diff illnesses, and 422 died within 30 days of diagnosis.
Exposure to fluoroquinolones and other antibiotics was clearly a risk for patients, according to the
Canadian researchers who wrote the article.
Doctors watching for C-diff in hospitals and nursing home patients need to look for it in other
patients as well, McDonald said.
Patients need to be wary too. "If you have severe diarrhea, seek attention from a physician," he
said.