* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Infection Control - Professional Pediatric Home Care
Diseases of poverty wikipedia , lookup
Eradication of infectious diseases wikipedia , lookup
Focal infection theory wikipedia , lookup
Public health genomics wikipedia , lookup
Compartmental models in epidemiology wikipedia , lookup
Marburg virus disease wikipedia , lookup
Patient safety wikipedia , lookup
Hygiene hypothesis wikipedia , lookup
Table of Contents Infection Control POLICIES Infection Tracking System ...................................................................................................... 3.1 Infection Control Plan ............................................................................................................. 3.2 Exposure Control Plan: OSHA Regulations ........................................................................... 3.3 Specific Procedures for Employee and Patient Infection Control Training ........................... 3.4 Standard Precautions ............................................................................................................... 3.5 Hand Hygiene / Hand Washing / Hand Cleansing.................................................................. 3.6 Housekeeping Requirements for Bloodborne Pathogens ....................................................... 3.7 Employee Infectious Diseases ................................................................................................ 3.8 Employee Epidemiological Illnesses ...................................................................................... 3.9 Reporting of Epidemiological Illnesses .................................................................................. 3.10 Bloodborne Pathogens Standard ............................................................................................. 3.11 Airborne Pathogens Standard ................................................................................................. 3.12 Supply Maintenance................................................................................................................ 3.13 Occupational Exposure to Tuberculosis/Prevention of Transmission of TB Plan ................. 3.14 Patient Education of Infection Precautions and Infection Control Practices .......................... 3.15 Influenza Immunization of Home Healthcare Workers .......................................................... 3.16 Appropriate Safeguards to Prevent Drug Contamination ....................................................... 3.17 Fingernails............................................................................................................................... 3.18 FORMS/ATTACHMENTS Infection Log: Patients ............................................................................................................ 3.1A Infection Log: Employees ....................................................................................................... 3.1B Infection Log Annual Data Aggregation and Analysis: Patients and Employees ..................................................................................................... 3.1C Annual Infection Control Program Evaluation ...................................................................... 3.2A Employee Infection Control Training ..................................................................................... 3.3A Health Guidelines for Employees with Infectious Diseases ................................................... 3.8A Communicable Diseases: Definitions and Modes of Transmission ........................................ 3.10A Communicable/Infectious Disease Information Table............................................................ 3.10B Colorado Department of Health Conditions Reportable ........................................................ 3.10C Employee Information Sheet: Hepatitis B and Hepatitis B Vaccine....................................... 3.11A Hepatitis B Vaccination Waiver Form ................................................................................... 3.11B Personal Protective Equipment .............................................................................................. 3.11C Recommendations for Follow-Up after Significant Exposure ................................................ 3.11D Employee TB Screening .......................................................................................................... 3.14A State Tuberculosis Cases by County ....................................................................................... 3.14B Employee Information Sheet: Influenza Immunization .......................................................... 3.16A Influenza Vaccination Consent/Waiver Form ......................................................................... 3.16B Professional Pediatric Home Care December 2012 Contents – Chapter 3 ACHC Standard HH7-1A.01 Infection Tracking System ______________________ POLICY The Agency will implement an infection tracking system for patients and staff. The definition of infections is based on the most common infections prevalent to Agency’s services that are high volume, frequent infectious complications and/or have an increased risk for negative patient outcomes. ______________________ PURPOSE To define infection tracking system for patients and staff. ______________________ REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies ______________________ RELATED DOCUMENTS “Infection Log: Patients,” “Infection Log: Employees,” and “Infection Log Annual Data Aggregation and Analysis: Patients and Employees” forms ______________________ PROCEDURE 1. The Agency will provide an infection and safety risk management control program that meets the CDC, Health Department, APIC (Association for Professionals in Infection Control Epidemiology) and OSHA standards addressing: General infection control measures appropriate for care/service provided Hand washing. Use of standard precautions and personal protective equipment. Needle-stick prevention and sharps safety. Appropriate cleaning/disinfecting procedures. Infection surveillance, monitoring and reporting of employees and patients. Disposal and transportation of regulated waste, if applicable. Precautions to protect immune-compromised patients. Employee health conditions limiting their activities. Assessment and utilization of data obtained about infections and the infection control program. Protocols for addressing patient care issues and prevention of infection related to infusion therapy, urinary tract care, respiratory tract care, and wound care. Guidelines on caring for patients with multi-drug resistant organisms. Professional Pediatric Home Care December 2012 3.1 ACHC Standard HH7-1A.01 Policies on protecting patients and personnel from blood borne or airborne pathogens. Monitoring staff for compliance with HHA policies and procedures related to infection control. Protocols for educating patient and personnel in standard precautions and the prevention and control of infection. 2. Agency will track targeted infections as follows: Patient infections to be reported at time of admission: chicken pox, german measles, hepatitis B, MRSA, VRE, small pox, TB, or any reportable communicable disease (as defined by local health department). Patient infections to be reported while patient is on service: wound infections that develop 30 days or greater after admission which require an antibiotic or identified by lab test or MD that may or may not require an antibiotic; IV site infections that develop 10 days after admission or at any time if IV cannula was inserted by Agency staff; device related infections such as urinary catheters; and all infections that are identified as infections to be reported at admission. Employee infections to be reported if an employee develops or has a known exposure to: conjunctivitis, MRSA, VRE, boils, jaundice, infected wounds, vomiting, diarrhea, acute respiratory infections and any reportable communicable disease as defined by the local health department. 3. Written reporting of infections will occur through documentation on the infection log. 4. At least quarterly, the Administrator/Director of Clinical Services and infection control and PI committees will review and assess the infection log. Data will be aggregated and analyzed on the Infection Log Annual Data Aggregation and Analysis: Patients and Employees form. 5. Problems and/or undesirable trends in infections will be identified, including potential significant Agency acquired and/or community acquired infections. If such problems or undesirable trends are identified, the Administrator/Director of Clinical Services and infection control and PI committees will identify any common factors that could have led to the transmission of the infection(s). 6. The committees will make recommendations for and implement improvement activities. Professional Pediatric Home Care December 2012 3.1 ACHC Standard HH7-1A.01 INFECTION LOG: PATIENTS Date Pt ID# Infection MD Notified Antibiotic Tx Community Acquired Agency Acquired Infections to be Reported upon Admission: Infections to be Reported while on Service: 1. Chicken pox 2. German measles 3. Hepatitis B 4. MRSA 5. VRE 6. Small pox 7. TB 8. Any other reportable communicable disease as defined by the local health department. 1. Wound infections that develop 30 days or greater after admission which require an antibiotic or identified by lab test or MD that may or may not require antibiotic. 2. IV site infections that develop 10 days or greater after admission or at any time if IV cannula was inserted by Agency staff. 3. Device related infections such as urinary catheters. 4. All infections identified on the “Infections to be reported upon Admission” listing. Professional Pediatric Home Care December 2012 3.1A ACHC Standard HH7-1A.01 INFECTION LOG: EMPLOYEES Date Pt ID# Infections to be Reported: 1. Chicken pox 2. German measles 3. Hepatitis B 4. MRSA 5. VRE 6. Small pox 7. TB Professional Pediatric Home Care Infection MD Notified Antibiotic Tx Community Acquired 8. Boils 9. Jaundice 10. Infected wounds 11. Vomiting 12. Diarrhea 13. Acute respiratory infections 14. Any other reportable communicable disease as defined by the local health department. December 2012 3.1B Agency Acquired ACHC Standard HH7-1A.01 INFECTION LOG ANNUAL DATA AGGREGATION AND ANALYSIS: Patients and Employees Quarter: _______________________ I. Date reported to PI Committee: Patient Infections: A. Total number infections reported: B. Types of infections: # Wound Infections _________/ per 1000 wound days. # IV Site Infections _________/ per 1000 device days. Other Infections: C. Number of Community Acquired: _______ Number of Agency Acquired: D. Trends: YES _____ NO _____ If YES, describe: E. PI committee recommendations for improvement opportunities: II. Employee Infections: A. Total number infections and/or exposures reported: B. Types of infections/exposures: C. Number of Community Acquired: _______ Number of Agency Acquired: D. Volume (#) of Alcohol-Based Hand Rubs Used _______/_______ visits/month. E. Clinical staff adhering to artificial nail policy: YES _____ No _____ If No, recommendations: F. Trends in findings: YES _____ NO _____ If, YES, describe: G. PI committee recommendations for improvement opportunities: _________________________________________________ Signature/Title Professional Pediatric Home Care December 2012 3.1C Date ACHC Standard HH7-1A.01 Infection Control Plan ______________________ POLICY The Agency has developed, and implemented infection control practices that conform to OSHA regulations, CDC guidelines, state and local regulations and currently accepted standards of practice. ______________________ PURPOSE To prevent or decrease the exposure of patients and employees to communicable diseases. ______________________ REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies ______________________ RELATED DOCUMENTS “Communicable Diseases: Definitions and Modes of Transmission” form ______________________ PROCEDURE 1. The Agency Infection Control Plan conforms to OSHA regulations, CDC guidelines, the state and local regulations and currently accepted standards of practice. 2. The Plan meets or exceeds the standards established by the Department of Labor Occupational Safety and Health Administration (OSHA) (1910.1020) on bloodborne pathogens, including HIV and HBV. 3. The Infection Control Plan establishes and implements policies and procedures for controlling employee exposure to fluids, tissues or other potentially infectious material. These policies/procedures include: Identifies all those employees at risk of exposure to communicable diseases. Establishes procedures for the evaluation of circumstances surrounding exposure incidents. Makes provision for Hepatitis B vaccine to be administered to all employees at risk in accordance with standard medical practice. Establishes a training program upon employment which: o Educates employees in the infection control program. o Advises employees of any revisions or when changes occur. Provides record keeping in accordance with regulations. Professional Pediatric Home Care December 2012 3.2 ACHC Standard HH7-1A.01 Ensures that provisions of equipment and supplies necessary to minimize the risk of infection with bloodborne pathogens or other potentially infectious materials are available to all employees at risk of exposure. Establishes a process for educating patient/caregivers/families regarding infection control policies/ procedures. Establishes a tracking system for infections acquired in home health care. Reviews the program’s effectiveness annually and revises as necessary. Establishes policies/procedures that will reduce the spread of infections to employees and patients. Monitors staff adherence to recommended policies, procedures and protective measures. When monitoring reveals a failure to follow recommended precautions: o Counseling, education and/or retraining will be provided. o If necessary, appropriate disciplinary action will be taken. Screens staff for exposure and/or immunity to infectious diseases that staff may come in contact with. Refers staff who are exposed to or who potentially have an infectious disease to physicians for assessment, testing, prophylaxis treatment, counseling and/or immunization. 4. Goals for the infection control program include: To reduce the risk of acquisition and transmission of infections. To limit unprotected exposure to pathogens throughout the organization by implementing current CDC and OSHA guidelines. To enhance hand hygiene. To minimize the risk of transmitting infections associated with the use of procedures, medical equipment and medical devices. 5. Emergency management planning for infectious disease outbreak includes: The agency will be prepared to respond to an influx, or the risk of an influx, of infectious patients. Such planning includes implementation of the emergency management plan phases of preparation and response (see plan). Depending on the severity and potential numbers of infectious patients, existing patients may be prioritized and services rendered to the highest priority patients. In order to manage an ongoing influx of potentially infectious patients over an extended time, the Agency will consider suspension of patient admissions and early discharge of existing stable patients after physician consultation. The Agency has established processes and procedures for information management during an infectious disease outbreak. o The Agency will keep abreast of current information through communication with hospitals, local and state health departments, offices of emergency management and departments of homeland security, and local media (e.g., television, radio and newspapers). o Critical information will be disseminated to staff, key practitioners and leaders through e-mail, voicemail, telephone and staff meetings. o Community resources for obtaining additional information include local and state health departments, offices of emergency management and departments of homeland security as well as local hospitals. Professional Pediatric Home Care December 2012 3.2 ACHC Standard HH7-1A.01 6. The Agency will perform a risk analysis to identify risks for the transmission and acquisition of infectious agents based on: Geographic location and community served. Results of analysis of infection prevention and control data. Care provided. 7. The risk analysis defines the current surveillance activities and will be reviewed annually or whenever significant changes occur. 8. The Agency formally evaluates the infection control program and goals annually or whenever risks significantly change. 9. The Director of Clinical Services is responsible for infection control program management, unless another staff member is assigned by the Administrator/DCS. The assigned individual will be qualified for such responsibilities based on education, additional training and/or experience. The individual coordinates all activities and assures appropriate data collection, aggregation, analysis, monitoring of the effectiveness of the program and staff education. The individual meets regularly with leaders, managers and staff (as appropriate) to: o Develop strategies. o Review and react (as appropriate) to data. o Assess successes and failures of program. o Review and revise program. o Perform annual infection control program evaluation. Professional Pediatric Home Care December 2012 3.2 ACHC Standard HH7-1A.01 Annual Infection Control Program Evaluation Area of Review Yes No Describe 1. Goals reviewed and are relevant. 2. New services or sites have been introduced with resulting changes in the scope of the program. 3. Risk analysis has changed. 4. Emerging and/or reemerging problems in the health care community that potentially affected our organization occurred. 5. Describe successes or failures of interventions in preventing or controlling infections: a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ d. _____________________________________________________________________ 6. Describe responses to concerns raised by leadership and others within organization: a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ 7. Describe evolution of relevant infection prevention and control guidelines that are based on evidence or, in the absence of evidence, expert consensus: a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ d. _____________________________________________________________________ _____________________________________________ Signature Professional Pediatric Home Care December 2012 3.2A ________________________ Date ACHC Standard HH6-6A.01, HH7-1A.01, HH7-6A.01, HH7-7A.01 Exposure Control Plan: OSHA Regulations ______________________ POLICY The Agency will develop, implement and maintain infection control policies and procedures for patients diagnosed with infections and/or contagious diseases and for the protection of employees caring for such patients. Policies and procedures will reflect OSHA regulations and accepted standards of care along with state and federal guidelines. ______________________ PURPOSE To prevent and control the exposure of home care staff and patient/caregivers to infections and hazardous products. ______________________ RELATED DOCUMENTS “Employee Infection Control Training” and “Employee TB Screening” forms ______________________ PROCEDURE General Information – Infection Control and Standard Precautions 1. The use of standard precautions in the workplace is considered effective preventive methodology in the care of patients with suspected or diagnosed bloodborne pathogen infections and/or immuno-compromised patients and caregivers. Standard precautions should be implemented as outlined in “Standard Precautions” (see Policy 3.5). As applicable, isolation precautions will be implemented on as-needed basis for protection of immuno-compromised patients and caregivers. The attending physician will be consulted as applicable for additional guidelines. 2. The use of combined interventions will be practiced in the care of patient’s diagnosed with infection by multidrug resistant organisms (MDRO). These include hand hygiene, use of Contact Precautions until patients are culture-negative for a target MDRO, active surveillance cultures, education, enhanced environmental cleaning, and improvements in communication about patients with MDROs within and between healthcare facilities. 3. Blood, body fluids and tissues of all patients are presumed infectious. 4. If questions arise concerning a particular technique or policies of infection control, they should be directed to the Administrator/Director of Clinical Services. 5. Refrigerate food promptly and keep in a refrigerator separate from medications and biologicals. Medications and biologicals are also stored separately. Professional Pediatric Home Care December 2012 3.3 ACHC Standard HH6-6A.01, HH7-1A.01, HH7-6A.01, HH7-7A.01 6. Maintain a clean patient environment with emphasis on the bathroom and kitchen cleanliness. 7. Keep supplies off the floor and out of reach of children. 8. Eating, drinking, smoking, applying cosmetics or lip balm and handling contact lenses are prohibited in the work environment where there is a chance of occupational exposure. 9. Use aseptic technique for all invasive procedures including, but not limited to: Urinary catheterization. Gastrostomy tube changes. Tracheostomy tube care. Nasotracheal suction. Venipuncture. Injections. Care of intravenous devices. Wound care. Hand washing Hand washing is the most important procedure in the prevention of infections. Hand washing will be performed by all staff according to established Hand Hygiene / Hand washing / Hand Cleansing Policy. Disposal of Infectious Waste 1. Infectious waste may include soiled dressings, used disposable instruments, used internal devices such as urinary catheters, gastrostomy tubes, and suction catheters, vaccines, and intravenous equipment. Contaminated sharps, e.g., needles and lancets, will not be recapped: Agency provides in all devices for staff use. Contaminated sharps will not be bent, broken, or removed from disposable syringes. Immediately after use, contaminated sharps will be dropped into a rigid, puncture resistant container. Puncture resistant containers are available and include: o Rigid plastic sharps containers: Agency will provide for staff use. Staff will return rigid plastic sharps containers to Agency for disposal. o Patient/caregivers will be educated to dispose of sharps by placing in: - Metal cans with reinforced lid to improve the puncture resistance. - Hard plastic jugs. - All containers will be located close to the work area. When the container is ¾ full, it will be securely sealed and placed in household trash, unless Agency provided sharps container (which will be picked up by staff for proper disposal when ¾ full). Materials without the risk of puncturing, e.g., gauze dressings, catheters, tubing, gloves, etc., will be placed in leak-proof plastic bags, then securely fastened and disposed of in the patient’s household trash. Professional Pediatric Home Care December 2012 3.3 ACHC Standard HH6-6A.01, HH7-1A.01, HH7-6A.01, HH7-7A.01 Nurse and other Staff Bags 1. Bags used by nurses and other staff which contain equipment, e.g., a thermometer, stethoscope, blood pressure cuff, etc., and are brought into the home are classified as clean on the inside. The outside of the bag, because it is exposed to all environments, is considered “soiled.” The inside and outside of the bag will be cleaned when visibly soiled. A barrier under the bag is not required but may be used if needed to protect the patient’s environment or equipment bag. Methods of Disinfection 1. Reusable articles in the patient’s home contaminated with blood or body fluids, e.g., feces, pus, mucous or other organic matter, will be washed with soap and water. If a danger of contamination of body parts or adjacent areas exists, items will be washed in a specific container for that purpose and the subsequent solution discarded into the toilet bowl. Full strength disinfectant will be used to clean toilet bowl and seat. 2. Whenever it is necessary to use equipment which must be disinfected after use and which will be used by or for a patient over a period of time, e.g., bedpans, urinals, bedside commodes, etc., the nurse will instruct the family to provide this equipment or will assist them in obtaining it. 3. Blood glucose monitors are cleaned when visibly soiled or according to manufacturers’ recommendations. 4. All solutions will be checked for expiration date prior to patient use. When the patient no longer needs the treatment, all opened solutions and supplies will be discarded. Other disposable supplies, e.g., irrigation trays, syringes, suture removal sets, solution containers, etc., will be discarded after use. 5. Thermometers will be wiped with alcohol pad after each use. The effectiveness of this technique is dependent on vigorous friction. Allow to air dry. Thermometers with disposable shields are to be cleaned with alcohol pad after disposal of shield. 6. Stethoscopes and blood pressure cuffs not provided by the patient/family will be cleaned when visibly soiled by the employee who has possession of the equipment. The chance of transmission of infection through use of blood pressure cuff or stethoscope is small, therefore wiping with disinfectant when visibly soiled is adequate. 7. All patient dirty laundry is to be handled minimally and not shaken or placed against the employee’s clothing or body. Laundry will be placed immediately in the patient’s laundry area or washing machine to minimize employee and family exposure. 8. Broken glassware, e.g., contaminated blood collection tubes, will not be picked up directly by hand. Professional Pediatric Home Care December 2012 3.3 ACHC Standard HH6-6A.01, HH7-1A.01, HH7-6A.01, HH7-7A.01 Use the contents of the spill kit by sprinkling the spill with the absorbent material. Wear gloves to scoop up the absorbed spill and broken glass. Dispose in container and place container into a contaminated garbage bag. Wear gloves to scoop up the absorbed spill and broken glass. Dispose in container and place container into a contaminated garbage bag. Nursing Bag Technique 1. Before entering the home, make sure the bag is stocked with bacteriostatic foam/ liquid/wipes and plastic trash bags (preferable in a side pocket). 2. Upon entering the home, place the bag on a clean surface; paper towels or plastic bag may be used to create a clean area if indicated. Open the bag near the care area and, if possible, near the water supply. Wash hands thoroughly with bacteriostatic foam/liquid/wipes. Remove all items which will be needed for the visit. o Place items on a firm clean surface. Close the bag and give the patient care. o If additional items are needed after care has started, wash hands before re-entering bag. o Clean any visibly soiled items, which will be returned to the bag. o Wash hands and return equipment to the bag; close bag. o Tidy up the work area disposing of wastes. Professional Pediatric Home Care December 2012 3.3 ACHC Standard HH7-1A.01 EMPLOYEE INFECTION CONTROL TRAINING Employees will receive education and training during orientation and at least annually (see Specific Procedures for Employee and Patient Infection Control Training). 1. Standard Precautions Hand washing Gloves Gowns/aprons Masks Protective eyewear and shoe covers CPR resusci-masks Disinfection Linens Eating utensils Needles, scalpels and other sharp instruments or devices: disposal 2. Employee Health Requirements Pre-employment physical evaluations are not required. Pre-employment physical evaluations may be required on a case-by-case basis per Administrator/Director of Clinical Services discretion. TB test – chest x-ray, per CDC guidelines HBV vaccine or declination Infections or illness to be reported to supervisor. 3. Hygiene Personal hygiene (handwashing) Agency uniform requirements 4. List of Reportable Communicable Diseases Disease information Disease/infection mode of transmission Vaccine availability: signs and symptoms 5. Transmitted Infections Wound infections IV site infections Hepatitis, AIDS MRSA, VRE Other reportable communicable diseases 6. Infectious Waste Disposal 7. Cleaning and Disinfection of Equipment Thermometer Stethoscope Professional Pediatric Home Care December 2012 3.3A ACHC Standard HH7-1A.01 Sphygmomanometer Clinician bag Ultrasound (head) 8. OSHA Regulations Exposure Control Plan Standard Precautions Engineering controls Work practice controls Personal protective equipment (PPE) Orientation and training Labels and signs Hepatitis B Vaccination Post-exposure plans TB/Airborne Exposure Control Plan 9. Procedures Requiring Special Techniques Dressing changes Wound or decubitus care Intravenous therapy Respiratory care Urinary care Foot care Other aseptic procedures Employees will be evaluated for compliance with agency infection control policies and procedures during periodic infection control in-service training and by direct observation during supervised home visits. Professional Pediatric Home Care December 2012 3.3A ACHC Standard HH7-1A.01 Specific Procedures for Employee and Patient Infection Control Training ______________________ POLICY To ensure that all Agency staff are educated and understand specific procedures regarding infection control. ______________________ PURPOSE All Agency employees are educated and understand proper infection control precautions. ______________________ RELATED DOCUMENTS “Incident/Occurrence Report: Patient or Employee” form ______________________ PROCEDURE Staff 1. All employees who come into contact with blood, body fluids, tissue, solids or any moist body part or substance of any patient will use the following specific procedures in compliance with Standard Precautions procedures: Apply gloves before contact with any moist body site, fluids or solids, including mucous membranes, e.g., when providing personal care for patients with bleeding or open lesions, large abrasions or dermatitis, and when handling items soiled with body fluids or substances. Wear gloves for all patient care if employee’s hands are chapped or if employee has any open skin areas on hands. Wear gloves when changing soiled linens. Wash hands before and after wearing gloves. Change gloves and wash hands between patients. 2. Wear an apron or gown and protective eyewear if danger of body fluid splash is present. Bag all soiled dressings in plastic and close the bag securely before placing into the patient’s trash container. 3. Any piece of disposable equipment which has been in contact with blood/body fluids or moist body substances must be disposed of in a plastic bag. Place the plastic bag in the patient’s covered trash receptacle. 4. Handle all lab specimens, body secretions/tissue, lab tubes and syringes used in specimen collection as if contaminated. Label blood specimen tubes. After venipuncture, place tubes in plastic bag with biohazard label. Professional Pediatric Home Care December 2012 3.4 ACHC Standard HH7-1A.01 5. Place the biohazard bag with the blood specimen tubes in a rigid, impervious container for transport to lab. When a needlestick or body fluid splash/exposure occurs, wash the area thoroughly and report the incident to the Administrator/Director of Clinical Services. Complete an Incident/Occurrence Report: Patient or Employee. Patient Education 1. Instruct in all basic principles of Standard Precautions and any other procedures as applicable to the patient’s care. 2. Instruct in modes of transmission of all possible contaminants and specific organisms, if known. 3. Instruct regarding disposal of all infectious wastes. 4. Instruct to report any contaminated needlestick or exposure to a physician immediately. 5. Instruct to make a 10% bleach solution for cleaning equipment and decontamination. Add 9 parts of water to 1 part of household bleach. Once mixed, the solution must be discarded after 24 hours. Instruct to clean contaminated surfaces with the bleach solution. 6. Instruct to run one (1) cup of bleach through the washing machine for laundering contaminated linens and clothing. 7. Patients who have Hepatitis, Staph, TB, MRSA, VRE or enterobacterium should use separate dishes. Wash first in a plastic basin and rinse in 10% bleach solution followed by a cold rinse. Rinse the basin with bleach solution after use. 8. Food leftovers from infectious patients should be bagged before discarding. 9. Bathrooms should be cleaned with a 10% bleach solution. 10. Instruct patient/caregivers to cover the nose and mouth when coughing or sneezing. 11. Contact infection control specialists at a local hospital or the local health department for procedures regarding specific organisms, when known. 12. The patient/caregiver should demonstrate understanding following teaching. Evaluate and record patient/caregiver compliance in the nurses’ notes periodically. Professional Pediatric Home Care December 2012 3.4 ACHC Standard HH7-1A.01 Standard Precautions ______________________ POLICY Blood and body fluid precautions will be followed for all patients. ______________________ PURPOSE To prevent transmission of communicable diseases. ______________________ PROCEDURE 1. The concept of body substance isolation encompasses all the principles of Standard Precautions/blood and body fluid precaution, and extends to all moist body parts/tissues/ surfaces, including fluids, solids, tissue and moist areas, e.g., mucous membranes. 2. The principles of Standard Precautions are to be followed by all employees when contacting any such substances or areas. Standard Precautions include the following procedures: All health care workers will routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any patient is anticipated. o Gloves will be worn before touching blood and body fluids, mucous membranes or non-intact skin of all patients; for handling items or surfaces soiled with blood or body fluids; and for performing venipuncture and other vascular access procedures. o Gloves will be changed and hands washed after contact with each patient. o Masks and protective eyewear or face shields will be worn during procedures that are likely to generate droplets of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose and eyes. o Gowns or aprons and shoe covers will be worn during procedures that are likely to generate splashes of blood or other body fluids. o CPR resusci-masks will be used when rendering resuscitation. For the staff that is CPR certified, the masks are to be carried at all times while rendering care. 3. Hands and other skin surfaces will be washed immediately and thoroughly if contaminated with blood or other body fluids. 4. All health care workers will take precautions to prevent injuries caused: Needles, scalpels, and other sharp instruments or devices during procedures. When cleaning used equipment. During disposal of used needles. When handling sharp instruments after procedures. 5. To prevent needlestick injuries, contaminated needles will not be recapped, purposely bent or broken by hand, removed from disposable syringes or otherwise manipulated by hand. The Agency provides all safe devices for staff use. Professional Pediatric Home Care December 2012 3.5 ACHC Standard HH7-1A.01 6. After use, disposable syringes and needles, scalpel blades, and other sharp items will be placed in puncture-resistant containers. These containers should be: Practical to the use area. Be leak-proof on the sides and bottom. Be kept closed. Not overfilled. 7. Standard Precautions will be followed for all patients. Isolation precautions will be used as necessary if specific conditions, e.g., infectious diarrhea or tuberculosis, are diagnosed or suspected. Professional Pediatric Home Care December 2012 3.5 ACHC Standard HH7-1A.01 Hand Hygiene / Hand Washing / Hand Cleansing ______________________ POLICY Hand Hygiene / Hand Washing / Hand Cleansing will be done by all employees to reduce the transfer of microbes to patients and to prevent the growth of microorganisms on the nails, hands and forearms. ______________________ PURPOSE To prevent transfer of germs and transmission of infections to patients and caregivers. ______________________ REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies ______________________ EQUIPMENT Alcohol based gel. Sink with running water. Soap – preferably liquid. Paper Towels. Disposable plastic bag or waste can. ______________________ PROCEDURE 1. Indications for Hand Hygiene / Hand Washing / Hand Cleansing are: Before and after direct patient care. Before and after each procedure. After using the bathroom. After blowing or wiping the nose. Before and after eating and drinking. Before and after collecting specimen. When hands are soiled. After any contact with contaminated materials. Before entering clinician’s bag or patient’s clean supplies. 2. All employees are responsible for implementing Hand Hygiene / Hand Washing / Hand Cleansing procedures in an on-going attempt to prevent and/or contain infectious processes and communicable diseases. 3. Alcohol based gels are the preferable Hand Hygiene / Hand Washing / Hand Cleansing method. When using alcohol based gel, the procedure is a follows: Place adequate amount of foam or liquid on hands. Professional Pediatric Home Care December 2012 3.6 ACHC Standard HH7-1A.01 Using friction, clean between fingers, around and under nails, palms and backs of hands. Apply friction to hands until the foam or liquid has dried on the skin surface. Alcohol based gels are not to be used for hand hygiene when hands are visibly soiled, in this instance hand washing with soap and water is required. 4. The proper procedure for hand washing when using soap and water is as follows: Turn water to a comfortable warm temperature. Hold hands under running water so they get completely wet. Lather hands well with soap: use friction for a minimum of 15 seconds; wash between fingers, wash area around and under nails. Using a clean, dry towel, dry hands thoroughly. Turn off water faucet using clean, dry towel. Discard paper towels in a disposable bag or waste can. 5. Staff competence with use of alcohol based gel and hand washing will be evaluated at time of hire and annually. Professional Pediatric Home Care December 2012 3.6 ACHC Standard HH7-1A.01 Housekeeping Requirements for Bloodborne Pathogens ______________________ POLICY The Agency will encourage employees to use good housekeeping techniques in both the patients’ homes and the Agency office. ______________________ PURPOSE To maintain a clean and sanitary working environment. ______________________ PROCEDURE 1. All equipment, environmental and working surfaces will be cleaned and decontaminated after contact with blood or other potentially infectious materials. Work surfaces will be decontaminated with an appropriate disinfectant: After completion of care. Immediately, or as soon as feasible, when surfaces are overtly contaminated. After any spill of blood or other potentially infectious materials. 2. Protective covers used to cover equipment and environmental surfaces, e.g., plastic wrap, aluminum foil or imperviously backed absorbent paper, will be removed and replaced as soon as possible when they become overtly contaminated. 3. All bins, pails, cans and similar receptacles intended for reuse which have a reasonable likelihood of becoming contaminated with blood or other potentially infectious materials will be inspected and decontaminated immediately, or as soon as feasible upon visible contamination. 4. Broken glassware which may be contaminated will not be picked up directly with the hands. It will be cleaned by using mechanical means such as a brush, dust pan, tongs or forceps. 5. When moving containers of contaminated sharps from the area, the container will be: Closeable. Constructed to contain all contents and prevent leakage during handling, storage, transport or shipping. Closed prior to removal to prevent spillage. Labeled and color coded as biohazardous waste. 6. Disposal of all regulated waste will be in accordance with applicable laws/regulations, both state and federal. Regulated waste will be placed in containers which are: Closeable. Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping. Professional Pediatric Home Care December 2012 3.7 ACHC Standard HH7-1A.01 Labeled and color coded as biohazardous waste. Closed prior to removal to prevent spillage. 7. If outside contamination of waste containers occurs, the container will be placed in a second container. The second container will be: Closeable. Constructed to contain all contents and prevent leakage during handling, storage, transport or shipping. Labeled and color coded as biohazardous waste. Closed prior to removal to prevent spillage or protrusion of contents. 8. Blood spills will be wiped up and decontaminated with diluted bleach solution or commercial germicide. A spill kit will be used, as appropriate. 9. Transportation of hazardous waste: Hazardous waste shall be transported off site by a biomedical waste transporter. (This does not include the transport of the sharps containers back to the Agency from the patient’s home.) Hazardous waste shall be contained in an onsite storage area prior to offsite transport in such a manner that no discharge or release of any waste may occur. Storage of hazardous waste shall not exceed 30 days beginning on the day the waste is collected. All packages containing hazardous waste shall be visibly identified with the international biological hazard symbol sign and a “Biomedical Waste” sign. Outer container/off site transported container shall be labeled with transporter’s name, address, registration number, and 24 hour telephone number. All labels must be legible, written in indelible ink and securely attached or permanently printed on each bag. Hazardous waste containers/packages shall be transferred in a manner that does not impair the integrity of the packaging. Packages shall not be compacted. Bags shall be prepared for offsite transport by enclosing in a rigid type container. The Agency will contract with a hazardous waste management company. Contractor responsibilities include the transportation and treatment of all Agency hazardous wastes. In the event the contractor is unable to fulfill the contracted duties/responsibilities, the Agency will contact another hazardous waste management company as soon as the Agency becomes aware of the problem. Professional Pediatric Home Care December 2012 3.7 ACHC Standard HH7-1A.01 Employee Infectious Diseases ______________________ POLICY The Agency will determine the work status of an employee diagnosed with certain infectious diseases. ______________________ PURPOSE To prevent the spread of infectious diseases to patients and other employees. ______________________ REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies CDC Personnel Health Guideline ______________________ RELATED DOCUMENTS “Health Guidelines for Employees with Infectious Diseases” ______________________ PROCEDURE 1. Work status of employees with infectious diseases will be determined by consultation with the Administrator/Director of Clinical Services or Supervisor and the employee’s physician, if applicable. 2. Recommendations will be based on guidelines from CDC, current practice and state law. Professional Pediatric Home Care December 2012 3.8 ACHC Standard HH7-1A.01 HEALTH GUIDELINES FOR EMPLOYEES WITH INFECTIOUS DISEASES The following guidelines are to be followed regarding the work status and any restrictions for employees with infectious diseases. Illness/Disease Abscesses, boils or lesionsdraining AIDS, HIV Positive, ARC Disease Work Status No direct patient care contact Restrictions Until drainage stops May work unless other infections prohibit from work Conjunctivitis Diarrhea or enteric infections May not work May not work Fungus: hands German Measles (Rubella) May not work May not work Gonorrhea Hepatitis - A, B, and non A, non B Herpes Simplex: May work May not work Not to provide care to immune suppressed or severely ill patient Until symptoms subside Until symptoms resolve - See MD if severe or persistent. No care for immune suppressed or severely ill patients Until lesions are healed Until rash is cleared – minimum 5 days None Until MD permits to work a. Genital May work b. Oral/facial May work Herpes Zoster Impetigo Influenza Jaundice May not work May not work May not work May work Lice May not work Meningitis – active Meningocele Meningitis exposure May not work Professional Pediatric Home Care May work December 2012 3.8A Use good handwashing technique No contacts with immune suppressed or severely ill patients Until lesions have crusted Until lesions have crusted Until acute symptoms resolve Limit physical exertion, allow frequent rest periods Until MD permits return to work Until MD permits return to work None ACHC Standard HH7-1A.01 Illness/Disease Mononucleosis Infectious Work Status May not work Mumps – active May not work Pertussis May not work PPD – positive conversion May not work Salmonella, Shigella No direct patient care Scabies May not work Strep Throat by culture May not work Upper Respiratory Infection with coughing & sneezing Varicella - active (Chicken Pox) Vomiting No direct patient care Wound Infection May work May not work May not work Restrictions Until MD permits return to work Until 9 days after onset of parotitis Until 7 days after start of treatment Until MD permits return to work May not return to direct patient care until 48 hrs after anti-microbials are D/C'd & 2 successive negative cultures from fecal samples or rectal swabs & MD permits return to work Until MD permits return to work Until 24 hours after adequate treatment started Until coughing & sneezing subside; should be afebrile Until MD permits return to work Until acute symptoms resolve - See MD if severe or persistent. No care for immune suppressed or severely ill patients Wound must be receiving adequate treatment, wound must be covered with intact, waterproof dressing **NOTE: For any other infectious illnesses and/or communicable diseases not listed, the employee's physician will be consulted regarding work status and any work restrictions and durations. Professional Pediatric Home Care December 2012 3.8A ACHC Standard HH7-1A.01 Employee Epidemiological Illnesses ______________________ POLICY Any employee who has an exposure to or is diagnosed with a reportable communicable disease will not be allowed to work. Notification will be made of exposure or diagnosis to all contacts. The patient’s physician will be notified, as appropriate. ______________________ PURPOSE To establish a procedure when an employee is exposed to or diagnosed with a reportable communicable disease that could possibly be transmitted to other staff or patients. ______________________ PROCEDURE 1. If an employee is diagnosed with or has an exposure to a reportable communicable disease, the employee will be suspended from work. The employee will be required to report to his/her physician. 2. To return to work, the employee must present a written statement from employee’s physician indicating physician’s permission to return to work with no restrictions. 3. Reportable communicable diseases are defined by local health departments. Professional Pediatric Home Care December 2012 3.9 ACHC Standard HH7-1A.01 Reporting of Epidemiological Illnesses ______________________ POLICY Unless previously reported, patients and employees with known or suspected reportable communicable diseases will be reported to the Colorado Department of Public Health and Environment. ______________________ PURPOSE To comply with state and federal regulations regarding reporting requirements applicable to communicable diseases. ______________________ RELATED DOCUMENTS “Communicable Diseases: Definitions and Modes of Transmission,” “Communicable/Infectious Disease Information Table,” and “Colorado Department of Health Conditions Reportable” forms ______________________ PROCEDURE 1. All reportable communicable diseases will be reported to the state department of health, according to guidelines established by the Colorado Department of Public Health and Environment. 2. Patients will be encouraged to report any reportable communicable diseases to the office and to the Colorado Department of Public Health and Environment. 3. Records will be kept to identify any patterns or trends of communicable diseases. Data regarding communicable diseases will be reviewed and analyzed on an ongoing basis to identify any trends. Professional Pediatric Home Care December 2012 3.10 ACHC Standard HH7-1A.01 COMMUNICABLE DISEASES: DEFINITIONS AND MODES OF TRANSMISSION Definitions: An infectious disease results from the invasion of a host by disease-producing organisms, such as bacteria, viruses, fungi or parasites. Example: Salmonella is a highly infectious disease usually transmitted from poorly prepared foods contaminated with salmonella bacteria and is not contagious. A communicable (or contagious) disease is one that can be transmitted from one person to another. Not all infectious diseases are communicable. Example: chickenpox is an infectious disease which is also communicable and can be easily transmitted from one person to another. Modes of Transmission: Communicable disease can be spread through contact, droplet, or airborne routes. . Contact transmission, includes direct and indirect transmission, and includes bloodborne transmission. Direct transmission occurs through direct contact with the blood or other body substances of an infected individual. Indirect transmission occurs without person-to-person contact. The disease-producing organism passes from the infected individual to an inanimate object. (Person comes into contact with a contaminated object and comes down with the disease.) Bloodborne diseases are spread by direct contact with the blood or other body substances of an infected person. (Bloodborne diseases of most concern include Human Immunodeficiency Virus [HIV], Hepatitis B and Hepatitis.) Droplet transmission occurs when respiratory droplets carrying infectious pathogens make contact with the mucosal surfaces of the recipient, generally over short distances. This can be caused by a productive cough, sneeze, or talking. Influenza, SARS, group A streptococcus, adenovirus, and Mycoplasma pnuemoniae can be transmitted by this route. Airborne transmission occurs by dissemination of either airborne droplet nuclei or small particles that contain infectious agents that remain infective over time and distance (e.g., Aspergillus, Mycobacterium tuberculosis.) Exposure to Bloodborne Pathogens: Human “exposure” is defined as contact with blood or other body fluids to which Standard Precautions apply. Exposure can occur via percutaneous inoculation (needlestick, laceration or bite), contact with an open wound, non-intact skin or mucous membrane (ocular or permucosal) during the performance of normal job duties. Professional Pediatric Home Care December 2012 3.10A ACHC Standard HH7-1A.01 Body Fluids Exposure: “Body fluids” exposures are those identified by the CDC to which Standard Precautions apply including, without limitation, the following body fluids: blood, semen, vaginal secretions, CSF, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid, laboratory specimens that contain HIV or other body fluids which contain visible blood, such as vomitus or urine. Professional Pediatric Home Care December 2012 3.10A ACHC Standard HH7-1A.01 COMMUNICABLE/INFECTIOUS DISEASE INFORMATION TABLE Disease/ Infection Mode of Transmission Is Vaccine Available? AIDS/HIV (Human Immunodeficiency Virus) Needlesticks, blood splashes into mucous membranes (e.g., eye or mouth) or blood contact with open wounds Cutaneous: spores enter open areas Pulmonary: inhalation of spores NO Fever, night sweats, weight loss, cough YES Anthrax Signs and Symptoms Respiratory secretions and contact with moist vesicles Fecal/oral YES NO Cutaneous: pustules, lesions, edema Pulmonary: fever, fatigue, headache, rapid onset of acute respiratory distress Fever, rash, cutaneous vesicles (blisters) Loose, watery stools Respiratory droplets & contact with respiratory secretions Fecal/oral YES Fever, rash YES Needlestick, blood splashes into mucous membranes (e.g., eye or mouth) or blood contact with open wound Possible exposure during mouthto-mouth resuscitation Same as Hepatitis B Same as Hepatitis B; dependent on HBV (past or present) to cause infection YES Fever, loss of appetite, fatigue, jaundice. Incubation period is 15-50 days (avg of 28) Fever, fatigue, loss of appetite, nausea, headache, jaundice. Incubation period is 45-160 days (avg of 120) Other non-A, non-B Hepatitis Several viruses with different modes of transmission (These are called “non-A, non-B” because there are no specific tests to identify them) NO Herpes Simplex (Cold Sores) Contact of mucous membrane with moist lesions Fingers are at particular risk for becoming infected Contact with moist lesions NO Skin lesions located around the mouth area NO Skin lesions Airborne YES Fever, fatigue, loss of appetite, nausea, headache Chickenpox Diarrhea: Campylobactor, Cryptosporidium, Giardia Salmonella, Shigella Viral, Yersinia German Measles (Rubella) Hepatitis A (Infectious Hepatitis) Hepatitis B (Serum Hepatitis) Hepatitis C Hepatitis D Herpes Zoster (Shingles) localized disseminated (See Chickenpox) Influenza Professional Pediatric Home Care December 2012 3.10B NO NO Same as Hepatitis B A complication of HBV infection & can increase the severity of HBV infection Fever, headache, fatigue, jaundice ACHC Standard HH7-1A.01 Disease/ Infection Mode of Transmission Is Vaccine Available? Signs and Symptoms Lice: Head, Body, Pubic Close head to head contact. Both body & pubic lice require intimate contact (usually sexual) or sharing of intimate clothing NO Measles Respiratory droplets & contact with nasal or throat secretions Highly communicable Contact with respiratory secretions YES Severe itching and scratching, often with secondary infection. Scalp & hairy portions of body may be affected. Eggs of head lice (nits) attach to hairs as small, round, gray lumps Fever, rash, bronchitis NO Fever, severe headache, stiff neck, sore throat Hemophilus Influenza Contact with respiratory secretions YES (Same) Viral Meningitis NO (Same) NO Fever, sore throat, fatigue Mumps (infectious parotitis) Salmonellosis Contact with respiratory secretions Contact with respiratory secretions or saliva, such as with mouth-to-mouth resuscitation Respiratory droplets & contact with saliva Foodborne YES Scabies Close body contact NO Small Pox Respiratory droplets & contact with nasal or throat secretions Direct contact with pustules Highly communicable YES Syphilis Primarily sexual contact; rarely through blood transfusion NO Tuberculosis, pulmonary Airborne NO Whooping cough (pertussis) Airborne, direct contact with oral secretions YES Fever, swelling of salivary glands (parotid) Sudden onset of fever, abdominal pain, diarrhea, nausea & frequent vomiting Itching, tiny linear burrows or “tracks,” vesicles – particularly around fingers, wrists, elbows & skin folds Severe headache, chills, high fever, vomiting, convulsions, rash of small red pustules that become blisters Genital & cutaneous lesions, nerve degeneration (late) Fever, night sweats, weight loss, cough Violent cough at night, whooping sound when cough subsides Meningitis: Meningococcal Mononucleosis NO *NOTE: Obtain list and guidelines from local health department for other state-specific reportable, communicable diseases. Professional Pediatric Home Care December 2012 3.10B ACHC Standard HH7-1A.01 COLORADO BOARD OF HEALTH CONDITIONS REPORTABLE BY ALL PHYSICIANS AND HEALTH CARE PROVIDERS IN COLORADO The list below applies to physicians and health care providers. Laboratories have separate reporting requirements. A case must be reported to the state or local health department following diagnosis within the timeframe indicated. The State Health Department recommends reporting all suspected cases, whether or not supporting laboratory data are available. 24 - Hour Reportables Animal bites by dogs, cats, bats, skunks or other wild carnivores Anthrax Botulism Cholera Diphtheria Group Outbreaks - known or suspected of all types: including foodborne, waterborne or other illness Vaccine-Preventable Diseases Influenza - associated death if <18 years (7d) Mumps (7d) Foodborne and Enteric Diseases Giardiasis (7d) Hemolytic uremic syndrome if <18 years (7d) Listeriosis (7d) Hepatitis B (7d) Influenza - associated hospitalization (7d) Campylobacteriosis (7d) Cryptosporidiosis (7d) Cyclospora (7d) E. coli 0157:H7 & shiga toxin producing E. coli (7d) Sexually Transmitted Diseases Gonorrhea, any site (7d) AIDS and HIV infection (7d) Chancroid (7d) Zoonotic Diseases Psittacosis (7d) Q Fever (7d) Relapsing Fever (7d) Meningitis/Encephalitis & Invasive Disease Aseptic meningitis (7d) Brucellosis (7d) Hantavirus (7d) Lyme Disease (7d) Encephalitis (7d) encephalopathy (7d) Hepatitis C, acute (7d) Hepatitis, other viral (7d) Kawasaki Syndrome (7d) Haemophilus influenzae invasive disease Hepatitis A Human Rabies (suspected) Measles Neisseria meningitidis invasive disease Pertussis Plague Poliomyelitis Rubella SARS Smallpox Syphilis, early (1o, 2o, early latent) Tuberculosis (active disease) Typhoid Fever Rubella, congenital (7d) Tetanus (7d) Varicella (7d) Salmonellosis (7d) Shigellosis (7d) Trichinosis (7d) Lymphogranuloma venereum (7d) Rocky Mountain Spotted Fever (7d) Tularemia (7d) Transmissible spongiform Other Important Reportable Diseases Legionellosis (7d) Toxic Shock Syndrome (7d) Leprosy (7d) Positive TB skin test in workers Malaria (7d) exposed to active disease (7d) Environmental, Occupational, and Chronic Conditions Fetal Alcohol Syndrome if <10 years Muscular Dystrophy (120d)+ old (30d) Spinal cord injuries (120d)+ Head injuries (hospitalized or fatal) (120d)+ Autism spectrum disorders <10 years old (30d)+ Birth defects, developmental disabilities and risk factors (pregnancy to 3rd birthday) (120d)+ (+) only hospitals required to report ~ Immediate reporting by phone is required of any illness suspected to be caused by biologic, chemical, or radioactive terrorism ~ ALL REPORTS MUST INCLUDE: TO REPORT A CASE / REQUEST FORMS, CONTACT: 1. The disease or condition being reported The Local Health Department or 2. Patient's name, date of birth, sex, race, Colorado Department of Public Health and Environment ethnicity, address (including city, Division of Disease Control & Environmental Epidemiology county, and phone number) 4300 Cherry Creek Drive South, A3 3. Physician's name, address and Denver, Colorado 80246-1530 www.cdphe.state.co.us/dc/index.html telephone number Denver Metro Telephone: 303-692-2700 Denver Metro Fax: (303) 782-0338 Outside Denver / Toll Free Telephone: 1-800-866-2759 Outside Denver / Toll Free Fax: 1-800-811-7263 For a Rapid Response / 24-Hour Reportable Conditions call: 303-370-9395 (after hours and weekends) Professional Pediatric Home Care December 2012 3.10C ACHC Standard HH4-2D.01, HH7-1A.01 Bloodborne Pathogens Standard ______________________ POLICY Current OSHA standards are followed to reduce the risk of occupational exposure to bloodborne pathogens. ______________________ PURPOSE To follow procedures established in the OSHA standards to reduce the risk of occupational exposure to bloodborne pathogens. ______________________ RELATED DOCUMENTS “OSHA Directive No. CPL 02-02-069 (November 27, 2001), Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens,” “Employee Information Sheet: Hepatitis B and Hepatitis B Vaccine,” “Hepatitis B Vaccination Form,” and “Personal Protective Equipment” ______________________ DEFINITIONS Bloodborne pathogens are those that are transmitted through blood, semen, vaginal secretions, tissues, cerebrospinal fluid, pleural fluid, synovial fluid, peritoneal fluid, pericardial fluid, amniotic fluid and any other body fluids that can reasonably be expected to contain visible blood. Nasal secretions, sputum, and vomitus are included in this category if they contain visible blood. Parenteral (needlestick/mucous membrane) exposure is defined as exposure to blood, body fluids or tissue involving puncture wound, splash, spill, etc., or cutaneous (skin contact) exposure involving large amounts of blood/body fluids or prolonged contact with blood/body fluids. ______________________ PROCEDURE 1. Any employee who will be in direct patient contact and accepts employment with Agency is required upon employment to be notified of the Hepatitis B vaccination that is offered to the employee by the Agency. An information sheet will be given to all new employees. The employee can either accept the vaccine or decline and sign the waiver form that will be placed in the employee’s health file. If at any time during employment an employee is exposed to Hepatitis B, the employer will offer the vaccine. Employees must sign a declination statement for the Hepatitis B vaccination within 10 days of employment it they chose not to become vaccinated. 2. Agency will provide to the employees at no cost the following engineering and work place controls: All safe devices for needles. Puncture-resistant containers for used needles. Professional Pediatric Home Care December 2012 3.11 ACHC Standard HH4-2D.01, HH7-1A.01 Biohazardous waste containers for disposal of biohazardous waste. Hand washing capability with alcohol based gel to reduce contamination. Gloves when contact with blood, body fluid, mucous membranes or non-intact skin of patients is anticipated and/or when contact with contaminated surfaces is anticipated. Gowns or plastic aprons if blood splattering is likely. Masks and protective eyewear and shoe covers if aerosolization or splattering is likely to occur. CPR resusci-masks for those employees who are CPR certified and may be required to render CPR. Biohazard-labeled plastic bags and rigid, impervious containers for transportation of lab specimens. Employee infection control policies and procedures. Cleaning procedures for all equipment and work surfaces. 3. The following Job Classification/Tasks Performed positions are defined as Category I employees who are exposed occupationally to blood and body secretions: Nurses (RN/LPN): dressing changes, wound care, foley catheter changes, venipuncture, IV administration, IV access devices, enema administration, medication administration, personal care (bathing, etc.), patient assessment, suctioning, tracheostomy care and all direct (hands-on) patient care. Therapists (Physical/Speech Language/Occupational): dysphagia teaching, ambulation/gait training, ADL's, ultrasound, paraffin treatments and all direct (handson) patient care procedures. 4. The following employee positions are defined as Category II positions that are occasionally exposed to blood and body secretions: Social Workers: Usually provide no direct (hands-on) patient care, but may be occupationally exposed by virtue of performing home visits. 5. The Agency provides orientation to each of its employees at the time of initial employment and annual training thereafter. Additional training will be provided when there is a modification in tasks or procedures or with the institution of new tasks or procedures. Each employee will receive the Employee Information Sheet: Hepatitis B and Hepatitis B Vaccine as part of the training program (information sheet contains materials appropriate in content and vocabulary to education level, literacy and language of employees). 6. The program consists of identification of modes of transmission; knowledge of the exposure control plan; understanding of engineering controls and work practices to safeguard the employees; the importance of personal protective equipment; an understanding by the employee of hazards associated with bloodborne disease; and understanding of CDC's Standard Precautions. 7. Each employee will inform the Agency of his/her individual status regarding the HBV vaccine. Agency will make the HBV vaccination series available to all employees who have occupational exposure (Category I and Category II employees) after those employees have received appropriate training. Professional Pediatric Home Care December 2012 3.11 ACHC Standard HH4-2D.01, HH7-1A.01 If employee does not want to receive the vaccine, the Hepatitis B Vaccination Waiver Form must be signed. The recommended dosage and administration of Hepatitis B vaccine is a series of three 1ml doses (initial injection, one month and six months) given intramuscularly in the deltoid muscle. The Agency will make provision for Hepatitis B vaccine to be administered. The vaccine will be administered unless the employee has previously received the complete Hepatitis B vaccination series, antibody testing has revealed that the employee is immune, employee refuses (signs waiver) or the vaccine is contraindicated for medical reasons. 8. The Administrator/Director of Clinical Services is responsible for: development, implementation and overall management of the infection control plan; staff education; record keeping; evaluation of exposure incidents; annually reviewing the plan; updating the plan whenever changes in the work environment or job task assignments so dictate; etc. 9. The Agency will make available post-exposure follow up for all employees with an occupational exposure incident at no cost to the employee. All medical evaluations and procedures will be performed by or under the supervision of a licensed physician at no cost to the employee. Agency will provide all necessary personal protective equipment to employees whose tasks, procedures and/or positions may lead to an occupational bloodborne exposure. 10. Each employee has the responsibility to report any contaminated needlesticks or any direct blood or body fluid exposures to eyes, skin, mouth, nose, open wound or abrasion. Employee must notify Administrator, Director of Clinical Services or Supervisor of any open wounds or abrasions that might allow disease transmission before initiating work activities involving bloodborne pathogens. Employee will properly wear all personal protective equipment as described in this plan. Failure to comply with Standard Precautions is a serious violation and will be treated as such. Employee will report to the Administrator, Director of Clinical Services or Supervisor immediately all accidents, incidents or near occurrences. 11. Employee records are confidential and will be kept for the following durations: Inservice (training) records will be maintained for a minimum of three (3) years from the date of the training. Medical records for any employee with an occupational exposure will be kept for the duration of his/her employment plus thirty years and will be kept confidential. Health records for exposed employees will contain a copy of their Hepatitis B vaccination status, results of examination, medical testing and follow-up procedures. Each health record will include the name and social security number of each employee. - A copy of each employee's Hepatitis B vaccination record will be maintained in the employee's health record. - A copy of the Hepatitis B Vaccination Waiver Form will be maintained in each employee's health record that does not elect to receive the HBV vaccine. Professional Pediatric Home Care December 2012 3.11 ACHC Standard HH4-2D.01, HH7-1A.01 All records will be made available upon request to the Assistant Secretary and Director of OSHA for examination and copying. Employee inservice records will be provided upon request for examination to employees, employee representatives and the Assistant Secretary of OSHA. Employee health records and inservice records relevant to the Bloodborne Pathogen Standards will be provided upon request for examination and copying to the subject employee, to anyone having written consent of the subject employee and to the Assistant Secretary of OSHA. 12. If the Agency ceases to do business and there is no successor, the Agency will notify the Director of OSHA at least three months prior to ceasing business to transmit records, if required by the Director of OSHA and to do so during that three month period. 13. Transmission of Hepatitis B virus and HIV virus occur through contact with infected blood and/or body fluids. It is not always possible to know the HBV or HIV status of a patient. For the safety and/or protection of employees, work-related tasks may require the use of appropriate precautions. As defined by the Department of Labor, work related tasks may be divided into three exposure categories: Category I: Tasks that involve exposure to blood, body fluids or tissues. Category II: Tasks that involve no exposure to blood, body fluids or tissues, but employee's job may require performing unplanned Category I tasks. Category III: Tasks that involve no exposure to blood, body fluids or tissues, and Category I tasks are not a condition of employment, e.g., secretarial and billing staff. 14. Staff will utilize appropriate precautions (Standard Precautions) for all unanticipated blood/body fluid exposures utilizing CDC guidelines for Standard Precautions and incorporating barriers. Patient care staff will have readily available barriers at all times for potential blood/body fluid exposures, such as handwashing, gloves, masks, gowns and goggles. 15. The following items will be readily available and utilized for the Category I and II tasks: Gloves: Disposable gloves are to be worn with any anticipated exposure to blood, body fluids or when providing direct care for a patient with an open wound/lesions, fecal or urinary incontinence, vomiting or any other type of drainage of bodily fluids. Masks: Masks will be worn when the splattering of blood and/or body fluids is likely to occur. For those employees who are required to be CPR certified as a condition of job assignment, these employees will carry a CPR resusci-mask with them at all times while performing home visits and will use the mask when rendering CPR. Goggles: Goggles will be worn when the splattering of blood or body fluids is likely to occur. Gowns and Shoe Covers: Gowns and shoe covers will be worn if the soiling of an employee's clothing or shoes with blood or body fluids is likely to occur. 16. If an exposure should occur, the Agency will file an Incident/Occurrence Report: Patient or Employee and make it available to the affected employee. The report will contain: Documentation of the routes of exposure including source individual(s), if known, and the circumstances surrounding the event. Professional Pediatric Home Care December 2012 3.11 ACHC Standard HH4-2D.01, HH7-1A.01 Results from the collection of and testing of source patient blood (if determined and permission given) to determine the presence of HBV and/or HIV infection. Results from antibody or antigen testing of victim's blood or serum sample (sample to be collected as soon as possible after the exposure). Follow up results on the testing, counseling, illness reported and post exposure prophylaxis. 17. The Agency will provide the following information to the evaluating physician: A description of the affected employee's duties as they relate to the occupational exposure. Documentation of the routes of exposure and circumstances under which the exposure occurred. Results of the source individual's blood testing, if available. All medical records relevant to the appropriate treatment of the employee including vaccination status. 18. The Agency will obtain and provide the employee with a copy of the evaluating physician's opinion within 15 working days of the completion of the evaluation. 19. When an exposure occurs, the employee will immediately notify the Administrator, Director of Clinical Services or Supervisor for instructions for post-exposure health care. The affected area will be cleansed immediately by flushing area(s) under a steady stream of running hot water and soap. Treatment should minimally consist of the taking of a baseline serum or blood sample and a HBV booster or equivalent as soon as feasible. 20. The affected employee and the Administrator, Director of Clinical Services or Supervisor will file an initial incident report detailing the circumstances of the incident. The report will include: The name of the individual affected. The date and time of the incident. Task being performed at the time of the incident. Suspected cause of the incident. Any mitigating circumstances surrounding the incident. The immediate responses and actions of all individuals involved in the incident (including patient, caregivers, bystanders, witnesses, etc.). 21. A copy of the report will be filed in the employee's health record and the original sent to the Administrator/Director of Clinical Services for review. 22. The exposed employee will be tested as follows: Initial tests: HBV and HIV. 6 weeks post-exposure: HBV and HIV. 3 months post-exposure: HIV. 6 months post-exposure: HIV. 12 months post-exposure: HIV. Professional Pediatric Home Care December 2012 3.11 ACHC Standard HH4-2D.01, HH7-1A.01 INFORMATION SHEET Hepatitis B and Hepatitis B Vaccine Hepatitis B, a viral infection of the liver, is caused by the Hepatitis B virus (HBV). In the United States, some 300,000 persons are newly infected with HBV each year. Occupational work related acquisition of HBV occurs through a needlestick, mucous membrane or non-intact skin exposure to blood and other body fluids containing the HBV. The risk of contracting Hepatitis B from a single contaminated needlestick ranges from 6% to 30%. Each year approximately 12,000 healthcare workers (HCW) contract work-related Hepatitis B. Three hundred of these will ultimately die from Hepatitis B related complications. Healthcare workers are 20 times more likely to contract HBV infection than the general public. There is a 15% to 30% prevalence of Hepatitis B markers in physicians and HCWs indicating prior exposure to the virus. Since 1970, 20 reported cases of HBV infection from HCWs to patients have been reported. Although HBV is an unpredictable disease that may incapacitate a person for weeks or months and lead to complications, most people develop antibody to the virus and recover completely. However, 5% to 10% of infected persons become chronic carriers of HBV and never develop antibodies. One in 200 persons in the United States is chronic HBV carriers. It is estimated that 1% to 2% of all hospital admissions are Hepatitis B antigen positive. A carrier is infectious to others and has an increased risk of developing long-term complications, such as chronic active hepatitis, cirrhosis of the liver and primary carcinoma of the liver. Carriers have a risk 273 times greater than that of the general population of contracting liver cancer. A vaccine is available for the prevention of Hepatitis B infection. It is a non-infectious genetically engineered recombinant DNA vaccine. No substances of human origin are used in its manufacture. The vaccine is administered in the deltoid area in a series of 3 doses over a 6month period. The second dose is given one month after the first and the third dose 5 months after the second or 6 months after the first dose. Protective antibody titers are achieved in 95% of those vaccinated. The incidence of side effects, both local and general, has been minimal among recipients of the vaccine. Broad use of the vaccine could have adverse reactions not observed during clinical trails. The most common adverse reaction is local soreness at the injection site. Less common reactions include erythema, swelling and warmth or induration of the injection site which is generally well tolerated and usually subsides within 48 hours. Low grade fever (101) occurs occasionally; fever over 102 is uncommon. Systemic complaints, including fatigue, malaise, nausea, vomiting, headache, myalgia and arthralgia are infrequent. Rash has rarely been reported. There has been no cause and effect relationship established between the vaccine and neurological disorders. This vaccine is contraindicated in persons allergic to yeast. HBV vaccine would not be expected to be harmful to a developing fetus; however, its safety for the fetus has not yet been demonstrated. Accordingly, HBV vaccine is not generally recommended for pregnant women or nursing mothers. If you have a medical condition, allergies, are pregnant or breastfeeding, please consult your physician for direction prior to receiving the vaccine. Professional Pediatric Home Care December 2012 3.11A ACHC Standard HH4-2D.01, HH7-1A.01 HEPATITIS B VACCINATION WAIVER FORM I understand that due to my occupational exposure to blood or other potentially infectious material, I am at risk of acquiring HBV (Hepatitis B Virus) infection. I have read the Information Sheet: Hepatitis B and Hepatitis B Vaccine and have had an opportunity to ask questions and understand the risks and benefits of the HBV vaccine. I have been given the opportunity to be vaccinated at no charge to myself. Having been so informed, I decline to take the HBV vaccine at this time. I understand that by declining the vaccine, I continue to be at risk of acquiring hepatitis. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and want to be vaccinated, I can receive the vaccination series at no charge to me. NAME (Print): ________________________________________________________________ SS#: ________________________ AGENCY: ______________________________________ EMPLOYEE SIGNATURE: _________________________________ DATE: ______________ SUPERVISOR: ___________________________________________ DATE: ______________ Professional Pediatric Home Care December 2012 3.11B ACHC Standard HH7-1A.01 PERSONAL PROTECTIVE EQUIPMENT Procedures that may Involve Exposure to Blood or Other Potentially Infectious Materials Key: X = Required O = Use if soiling or splattering likely Procedures Gloves Venipuncture Fingerstick Blood Sample Dressing Change Wound Irrigation Cleaning Equipment Suctioning Enemas Vaginal Douche Sputum Collection/ Aerosol Admin Foley Catheter Insertion Foley Catheter Care Foley Catheter Removal Condom Catheter Applica/Care IM, SQ, Intradermal Injection CPR NG Tube Insertion Tube Feeding Bath Oral Care Colostomy Care Assist with Toileting Changing Soiled Linens Disposal of Soiled Trash Handling Specimens Administration of Suppository Taking Rectal Temperature Specimen Collection Nail Clipping X X X X X X X X X X X X X X X X X X X X X X X X X X X X Professional Pediatric Home Care December 2012 3.11C Gowns Faceshield Eye Cover O O O O O O O O O O O O + TB mask Pocket ResusciMask X O O O O O O ACHC Standard HH4-2D.01, HH7-1A.01 RECOMMENDATIONS FOR FOLLOW-UP AFTER SIGNIFICANT EXPOSURE Treatment when source patient is found to be: Exposed Person Obtain baseline and f/u HIV titers *4, *5. HIV Status Unknown or Source Patient Unknown Request to obtain HIV testing on source patient *6. Offer AZT or current medication per protocol Offer AZT or current education per protocol HIV Positive Employee Obtain baseline and f/u HIV titers on employee *4, *5. *4 *5 *6 Obtain employee f/u titers at 6 weeks, 3 months & 6 months. Employee may elect to have blood stored for 90 days if he declines immediate testing. If source patient refuses HIV testing, employee must have HIV testing or provide proof of negative results done within the last 6 months. Any blood on hold in the lab from the source patient may then be tested for HIV. Chickenpox (Varicella) If the history is questionable, or the exposed employee has never had chickenpox or shingles, a titer should be drawn with the results documented in the employee’s file. Exposed susceptible employees will be placed on work restrictions as indicated. Hepatitis A (Post-Exposure or Acute Disease) Hepatitis A is primarily transmitted by person-to-person contact, generally through fecal contamination or oral ingestion. Employees who have had direct exposure to Viral Hepatitis, Type A, should report to Agency office and to their physician to be given immune serum globulin (IgG) intramuscularly, if indicated. The recommended dose if 0.02 ml/kg of body weight. Refer to insert in product package. IgG should be given as soon as possible after last exposure (Giving IgG more than two weeks after exposure is not indicated.) Transmission of Hepatitis A is primarily through oral/fecal route. Good personal hygiene and practicing good handwashing at all times is strongly recommended. Employees who have had Hepatitis A (or Hepatitis B) and are in the convalescent state will not be allowed to return to duty until blood levels are: Total Bilirubin not above 3 mg/ml AST not above 150 units ALT not above 150 units Any employee who has been released by his/her private physician following illness of Hepatitis A or B must present current laboratory reports as listed above. The laboratory results will be reviewed by the Administrator/Director of Clinical Services. If results are not within acceptable levels, the employee will not be allowed to return until the standard is met. Professional Pediatric Home Care December 2012 3.11D ACHC Standard HH4-2D.01, HH7-1A.01 Laboratory studies, Total Bilirubin, AST and ALT will be done on each employee, if deemed necessary by the Administrator/Director of Clinical Services. Any variation in this policy will be at the discretion of the Administrator/Director of Clinical Services. Hepatitis B (Employee with Active, Acute or Chronic Disease or Post-Exposure) All employees who have a positive Hepatitis B surface antigen will be given a written statement which reviews techniques and precautions that are to be observed. This statement will be signed by the employee, witnessed and filed in his/her health records. Certain work restrictions may apply. Follow-up lab work (AST and ALT) may be requested by the Agency on employees every six (6) months. The Administrator/Director of Clinical Services will be responsible for employee’s work technique and placement. Subsequent Hepatitis B surface antibody (HBsAB) will be done on any employee who requests one. This test will be done one (1) month after the final injection. If HBsAB is not present, a fourth injection will be given. Employees who decline the vaccine must sign the Hepatitis B Vaccination Waiver Form indicating they have had three (3) doses of vaccine, have positive antibody tests or have medical contraindications for the vaccine. Records of the Hepatitis B immunization dates are kept by the Agency. For accidental percutaneous (needlestick, laceration or bite) or permucosal (ocular or mucous membrane) exposure to blood, the decision to provide prophylaxis must consider: 1) Whether the source of the blood is available; 2) The HBsAB status of the source; 3) The Hepatitis B vaccination and vaccine response status of the exposed person. Once an exposure has occurred, a blood sample should be drawn and tested for HBsAB from the exposed individual. Local laws regarding consent for testing source individuals should be followed. CDC recommendations for Hepatitis B prophylaxis are followed. Hepatitis B Virus Prophylaxis CDC recommendations for Hepatitis B prophylaxis following percutaneous or permucosal exposure are: Exposed Person HBsAB-Positive HBsAB-Negative Unvaccinated HBIG x 1 * and indicate Initiate HB vaccine HB vaccine + Previously vaccinated Test exposed for HBs. No treatment responder 1. If adequate, no treatment 2. If inadequate, HB vaccine booster dose Known nonresponders HBIG x 2 or HBIG x * No treatment 1 dose HB vaccine Professional Pediatric Home Care December 2012 3.11D Source not tested or unknown Initiate HB vaccine + No treatment If known high-risk source, may treat as HBsAB-positive ACHC Standard HH4-2D.01, HH7-1A.01 Exposed Person Response unknown HBsAB-Positive Test exposed for HBs 1. If inadequate, HBIG x 1 # Hepatitis-B vaccine booster dose. 2. If adequate, no treatment. HBsAB-Negative No treatment Source not tested or unknown Test exposed for HBs 1. If inadequate, Hepatitis vaccine booster dose. 2. If adequate, no treatment. * HBIG dose 0.06 ml/kg IM ASAP after exposure within 24 hours if possible. + HB vaccine dose per the recommended three (3) doses. Given IM at a separate site and can be given simultaneously with HBIG or within seven (7) days of exposure. # Adequate anti-HBs is >10 SRU by RIA or positive EIA. Measles, Mumps, Rubella (MMR) Titers will be required on exposed susceptible employees who are exposed to an active case of MMR before proper precautions are instituted. If the titers indicate no immunity, the exposed employee will be placed on work restriction as indicated. Meningococcal Meningitis A person having intimate contact, e.g., mouth-to-mouth resuscitation, with a patient who has meningitis prior to 24 hours of subsequent treatment with effective antibiotics may be treated with prophylaxis antibiotics. If this decision is made, treatment will not await laboratory confirmation. Medication will be prescribed by the employee’s physician. Professional Pediatric Home Care December 2012 3.11D ACHC Standard HH7-1A.01 Airborne Pathogens Standard ______________________ POLICY Current CDC standards are followed to reduce the risk of occupational exposure to airborne pathogens. ______________________ PURPOSE To follow procedures established in the CDC standards to reduce the risk of occupational exposure to airborne pathogens. ______________________ RELATED DOCUMENTS CDC 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings ______________________ DEFINITIONS Airborne pathogens include Mycobacterium tuberculosis, rubeola virus (measles), and varicellazoster virus (chickenpox). Additionally, consideration is given to influenza, rhinovirus and some gastrointestinal viruses (e.g., norovirus and rotavirus). Airborne transmission occurs by dissemination of either airborne droplet nuclei or small particles in the respirable size range containing infectious agents that remain infective over time and distance (e.g., spores of Aspergillus spp, and Mycobacterium tuberculosis). Microorganisms carried in this manner may be dispersed over long distances by air currents and may be inhaled by susceptible individuals who have not had face-to-face contact with (or been in the same room with) the infectious individual. ______________________ PROCEDURE 1. Standard precautions will be observed for patients with known or suspected infection with an airborne pathogen. 2. In settings where Airborne Isolation Precautions cannot be implemented due to limited engineering resources (e.g., the home setting), masking the patient, placing the patient in a private room with the door closed, and providing N95 or higher level respirators or masks if respirators are not available for healthcare personnel will reduce the likelihood of airborne transmission. 3. Healthcare personnel caring for patients on Airborne Precautions will wear a mask or respirator, depending on the disease-specific recommendations, that is donned prior to room entry. Whenever possible, non-immune health care workers should not care for patients with vaccine-preventable airborne diseases (e.g., measles, chickenpox, and smallpox). 4. Clinical staff will be educated on preventing transmission of infectious agents associated with healthcare during orientation and during ongoing education programs. Documentation of training will be retained for the specific staff positions. Professional Pediatric Home Care December 2012 3.12 ACHC Standard HH7-1A.01 Supply Maintenance ______________________ POLICY The Agency maintains and delivers supplies according to applicable federal/state laws and regulations. ______________________ PURPOSE To assure that the supplies used by Agency staff and/or patients are sanitary and appropriate for use. ______________________ PROCEDURE At the Agency Site(s) 1. All medical supplies, especially sterile items, will be properly stored in a clean, dry area and handled in a sanitary manner protected from potential contamination as indicated by the manufacturer. 2. Supply packaging will remain intact while stored. If outer package is damaged or opened, supply will be removed and discarded. 3. Supplies will be checked for expiration date prior to use. If outdated, the supplies will be immediately removed from stock and discarded. 4. New medical supplies will be stored behind older supplies to assist in a timely rotation of supplies. 5. Staff will inspect packages of sterile items for evidence of interruption or exposure to liquid prior to use. 6. Staff using sterile medical supplies will handle items in a manner to protect sterility and prevent contamination. If supplies are taken from the Agency to the patient’s environment, staff assures appropriate and safe delivery of supplies. Supplies will be placed in a plastic or paper bag and placed in a clean area of the car for transport. In the Patient’s Home 1. Staff will assess the home environment for appropriate location for storage of supplies. 2. Staff will request that patient/caregiver allocate one area, e.g., shelf, drawer counter top, as the designated area for supply storage and maintenance. 3. Staff will instruct the patient/caregiver on proper storage of medical supplies and maintenance of an optimal clean environment for supplies. 4. Items will be stored according to vendor/manufacturer’s recommendations, e.g., refrigeration if necessary. 5. The patient/caregiver will be instructed on principles of safe handling of clean supplies, equipment, medication and solutions. 6. The patient/caregiver will be instructed on proper disposal and handling of utilized supplies. 7. The Agency is responsible for obtaining and delivering only those supplies routinely stocked in the supply room, e.g., dressings, catheter supplies. 8. The patient/caregiver is responsible for obtaining other supplies and medications with the appropriate assistance from staff. 9. Supplies issued to a patient will not be returned from the patient’s home. Professional Pediatric Home Care December 2012 3.13 ACHC Standard HH4-2C.01, HH7-1A.01 Occupational Exposure to Tuberculosis/ Prevention of Transmission of TB Plan ______________________ POLICY This Agency will comply with the current OSHA Enforcement Policy and Procedure for Occupational Exposure to Tuberculosis (TB) as well as Centers for Disease Control (CDC) guidelines. ______________________ PURPOSE To protect exposed employees against TB. ______________________ PROCEDURE 1. Responsibility for the TB infection control program is assigned to the Administrator/Director of Clinical Services. The Administrator/Director of Clinical Services is given the authority to implement and enforce TB infection control policies and procedures. 2. The Administrator/Director of Clinical Services will perform annual and ongoing risk assessment surveillance for the Agency. According to the Annual TB Surveillance Report for CO 2011, the overall case rate for TB is 1.4 per 100,000 (March 2012 TB Report/CDC). There have been no documented cases of TB or suspected TB in the PPHC client or family population in the past year. For this reason, PPHC clients/families and care providers are considered at very low risk for TB infection and/or transmission. Regardless of the risk level, the management of patients with known or suspected infectious TB will not vary. Risk definitions include: Very low risk: Applies to an entire facility in which patients with active TB are not admitted to inpatient areas but may receive initial assessment and diagnostic evaluation or outpatient management in outpatient areas. Patients who may have active TB and need inpatient care are promptly referred to an appropriate facility. Low risk: Areas or groups in which the PPD test conversion rate is not greater than that for areas or groups in which occupational exposure to TB is unlikely or than previous conversion rates for the same area or group. No clusters of PPD test conversions have occurred. Person-to-person transmission of TB has not been detected, and fewer than six (6) TB patients have been treated per year. Intermediate risk: Same as low risk, except that six (6) or more TB patients are treated per year. High risk: Areas or occupational groups in which the PPD test conversion rate is significantly greater than for areas or groups in which occupational exposure to TB is unlikely or than previous conversion rates for the same area or group and epidemiologic evaluation suggest nosocomial transmission. An epidemiologic evaluation suggests nosocomial transmission of TB. Possible person-to-person transmission of TB has been detected. Professional Pediatric Home Care December 2012 3.14 ACHC Standard HH4-2C.01, HH7-1A.01 3. The occurrence of drug-resistant TB in the patient population served or a relatively high prevalence of HIV infections among patients served or employees may increase the concern about the transmission of TB and may influence the decision regarding which protocol to follow, e.g., high risk classification may be selected. 4. The Agency may have a combination of risk areas at any given time. The appropriate protocol will be implemented for each area or group. 5. A diagnosis of TB may be considered for any patient who has a persistent cough, e.g., a cough lasting 3 weeks or longer, unexplained weight loss, night sweats and/or other signs/symptoms suggestive of active TB. The home management of those patients with suspected or confirmed infections includes: Implementation of precautions to prevent exposure until communicability has been eliminated by drugs including: o Instructing patients to cover coughs and sneezes. o Instructing patients who are on TB medications about the importance of taking medications as prescribed (unless adverse effects are seen). o Employee use of NIOSH-approved high efficiency particulate air respirator (the minimally acceptable level of respiratory protection) in the following circumstances: 1) When employees enter the homes or rooms of individuals with suspected or confirmed infectious TB disease. 2) When employees perform high risk procedures on individuals who have suspected or confirmed TB disease including, but not limited to: aerosolized medication (e.g., pentamidine), sputum induction, endotracheal procedures and/or suctioning procedures. Performance of cough-inducing procedures in a well-ventilated area away from other persons. o A cough-inducing procedure performed on patients who have infectious TB should not be done in the patient’s home unless absolutely necessary. o When medically necessary to be performed in the home, procedure should be performed in a well-ventilated area away from other persons. o Employee should consider opening a window to improve ventilation or collecting the specimen while outside the dwelling. o The employee collecting the specimen must wear respiratory protection during the procedure. To the extent possible, isolation of the patient away from other residents in an area with the maximum possible ventilation. o If agreeable with the patient, placement of a warning sign outside the room or home: 1) “Special Respiratory Isolation” or 2) A description of the necessary precautions. o Precautions may be discontinued when patient is no longer infectious. 6. 7. Respiratory protective devices should meet recommended performance criteria. These include: Ability to filter particles 1mm in size in the unloaded state (not loaded with dust) with a filter efficiency of greater than or equal to 95% (NIOSH = 95 or greater). Professional Pediatric Home Care December 2012 3.14 ACHC Standard HH4-2C.01, HH7-1A.01 Ability to be qualitatively or quantitatively fit tested in a reliable way to obtain a faceseal leakage of less than or equal to 10%. Ability to fit different facial sizes and characteristics of employees. Ability to be checked for face piece fit, in accordance with OSHA and good industrial hygiene practice, by employees each time respirators are used. CDC guidelines reference OSHA requirements for use of respiratory protective devices which are certified by NIOSH. 8. Respiratory protection should be used: By employees entering homes in which patients with known or suspected infectious TB are living. Employees when performing cough-inducing or aerosol-generating procedures on such patients. Where administrative and engineering controls are not likely to protect employee from inhaling infectious airborne droplet nuclei. 9. Patients suspected of having TB should wear surgical masks when not in TB isolation rooms to reduce the expulsion of droplet nuclei into the air. NOTE: These patients do not need to wear particulate respirators which are designed to filter the air before it is inhaled by the person wearing the respirator. 10. All employees will receive education regarding TB that is relevant to their particular occupational group, before initial assignment and annually. The program will include the following elements: Basic concepts of transmission, pathogenesis and diagnosis, including the difference between latent and active TB infection, the signs and symptoms of TB and the possibility of re-infection. Potential for occupational exposure. Principles and practices of infection control that reduce risk for transmission. Purpose of TB screening and the importance of participating in the screening program. Principles of preventive therapy for latent TB. Employee’s responsibility to seek prompt medical evaluation if a PPD test conversion develops or if symptoms develop that could be caused by TB. Principles of drug therapy for active TB. Importance of notifying the Agency if the employee is diagnosed with active TB. Responsibility of the Agency to maintain the confidentiality of the employee while ensuring that the employee who has TB receives therapy. High risks associated with TB infection in persons who have HIV infection or other causes of severely impaired cell-mediated immunity. Potential development of cutaneous anergy as immune functions decline. Information regarding the efficacy and safety of BCG vaccination and the principles of PPD screening among BCG recipients. Agency’s policy on voluntary work reassignment options for immunocompromised employees. 11. Employees will be counseled regarding: Professional Pediatric Home Care December 2012 3.14 ACHC Standard HH4-2C.01, HH7-1A.01 The need to follow existing recommendations for infection control to minimize the risk for exposure to infectious agents. The potential risks to severely immunocompromised persons associated with caring for patients who have some infectious diseases including TB. Making reasonable accommodations for employees who have health conditions that compromise cell-mediated immunity and who work in settings where they may be exposed to Mycobacterium tuberculosis. Immunocompromised employees will be referred to health professionals who can individually counsel the employees regarding their risk for TB. Agency will offer, but not compel, a work setting in which the immunocompromised employee wound have the lowest possible risk for occupational exposure to M. tuberculosis, including consideration of the provisions of the “Americans with Disabilities Act of 1990.” Immunosuppressed employees should have appropriate follow up and screening for infectious diseases, including TB. Employees who are known to be HIV infected or otherwise severely immunosuppressed should be tested for cutaneous anergy at the time of PPD testing. Consideration will be given to retesting at least every 6 months, those immunocompromised employees who are potentially exposed to M. tuberculosis because of the high risk for rapid progression to active TB if they become infected. Information provided by employees regarding their immune status will be treated confidentially. If the employee requests voluntary job reassignment, confidentiality will be maintained. 12. Any employee who has a persistent cough (lasting greater than or equal to 3 weeks), especially in the presence of other signs or symptoms compatible with active TB, should be evaluated for TB. The employee should not return to the workplace until a diagnosis of TB has been excluded or until the employee is on therapy and a determination has been made that the employee is noninfectious. 13. New Employees/Contractors will produce recent (within 12 months) evidence of a negative PPD or chest x-ray prior to working with PPHC clients. Employees who have a documented history of a positive PPD test, adequate treatment for disease or adequate preventive therapy for infection will be exempt from further PPD screening unless they develop signs of symptoms suggestive of TB. PPD negative employees need not obtain ongoing PPD screening, unless they have come in contact with any of the following high risk groups: • • • • • • • • • • persons with HIV infection/AIDS recent close contacts to persons with infectious pulmonary TB disease persons with fibrotic lesions on chest x-ray consistent with healed TB persons who inject drugs or use other high risk substances, such as crack cocaine, and alcoholics persons with medical conditions which increase the risk of TB disease residents and employees of high risk congregate settings such as correctional institutions, long-term residential care facilities (nursing homes, mental institutions, etc.), hospitals and other health care facilities, and homeless shelters. health care workers and volunteers who serve high risk clients who undergo employment screening and cannot provide documentation of a previous TST or information about appropriate follow-up for a “positive” skin test mycobacteriology laboratory personnel foreign-born persons who have arrived within five years from countries that have a high TB incidence or prevalence (most countries in Africa, Asia, Latin America, Eastern Professional Pediatric Home Care December 2012 3.14 ACHC Standard HH4-2C.01, HH7-1A.01 • • Europe, and Russia) children less than 4 years of age, or children and adolescents exposed to adults in high risk categories • adult contacts to children with TB • persons with a history of inadequately treated TB (State of Colorado Rules and Regulations Pertaining to Epidemic and Communicable Disease Control {6 CCR-1009-1}. Regulation 4: Treatment and Control of Tuberculosis) Care Providers will receive annual education regarding signs/symptoms of exposure, high risk groups and where to obtain screening. Employees/Contractors will notify the Clinical Director and/or Administrator if they believe they have been in contact with a potentially infectious client or family. PPD test results will be filed confidentially in the individual employee health record. 14. Employees who have positive TB screening results will be referred to their physician for evaluation. The employee will be removed from patient contact until permission to work is granted by the physician in writing. If an employee’s PPD test result converts to positive, a history of confirmed or suspected TB exposure will be obtained in an attempt to determine the potential source. When the source of exposure is known, the drug susceptibility of M. tuberculosis from the source should be determined and recorded in the employee’s health record, where it will be available if the employee subsequently develops active TB and needs therapy. Employees with pulmonary or laryngeal TB will be excluded from the workplace until they are noninfectious. Before the employee who has TB can return to the workplace, the Agency must have documentation from the health care provider that the employee is receiving adequate therapy, cough has resolved and the employee has had three consecutive negative sputum smears collected on different days. After work duties are resumed and while the employee remains on therapy, Agency must receive periodic documentation from the health care provider that the employee is being maintained on effective drug therapy for the recommended time period and that the sputum AFB smears continue to be negative. Employees with active laryngeal or pulmonary TB who discontinue treatment before they are cured will be evaluated promptly for infectiousness. If it is determined that they are still infectious, they will be excluded from the workplace until treatment has been resumed, an adequate response has been documented and three or more consecutive AFB smears collected on different days have been negative. Employees who have TB at sites other than the lung or larynx usually do not need to be excluded from the workplace, if a diagnosis of concurrent pulmonary TB has been ruled out. Employees receiving preventive treatment for latent TB will not be restricted from their usual work activities. Employees with latent TB who cannot take or who do not accept or complete a full course of preventive therapy will not be excluded from the workplace. They will be counseled about the risk for developing active TB and instructed regularly to seek prompt evaluation if signs and symptoms develop that could be caused by TB. 15. As soon as a patient or employee is known or suspected to have active TB, the patient or employee should be reported to the public health department so that appropriate follow Professional Pediatric Home Care December 2012 3.14 ACHC Standard HH4-2C.01, HH7-1A.01 up can be arranged and a community contact investigation can be performed. The public health department will protect the confidentiality of the patient or employee in accordance with state and local laws. 16. The Agency and health department will coordinate their efforts to perform appropriate contact investigations on patients and employees who have active TB. 17. In accordance with state and local laws and regulations, results of all AFB positive sputum smears, cultures positive for M. tuberculosis and drug susceptibility results will be reported to the public health department as soon as these results are available. 18. Public health department may be able to assist the Agency with planning and implementing various aspects of a TB infection control program, e.g., surveillance, screening activities and outbreak investigations. 19. All reports (exposure/medical) of an employee are confidential and may be accessed when the record is within the regulation definition. A record of TB skin testing results and medical evaluations and treatment is an employee medical record within the regulation definitions. Records must be handled in compliance with the regulations. 20. TB infections (positive TB Mantoux skin test or PPDs and TB disease) will be recorded on the “Infection Log: Employees.” A positive skin test for TB, even on baseline testing (except if positive on pre-employment screening), is recordable on the log because there is a presumption of work-relatedness. 21. If an employee’s TB infection which was recorded on the log progresses to TB disease during the five year maintenance period, the original log entry must be updated to reflect the new information. Because it is clinically difficult to determine if TB disease resulted from the source indicated by the skin test conversion or from subsequent exposures, only one case should be entered to avoid double counting. Professional Pediatric Home Care December 2012 3.14 ACHC Standard HH4-2C.01, HH7-1A.01 Employee TB Screening 1. Are you from or have you lived for two months or more in Africa, Asia, Central or South America, or Eastern Europe? � No � Yes If yes, list countries: ________________________________________________ 2. Have you been diagnosed with a chronic condition that may impair your immune system? � No � Yes If yes, check all that apply: � Chronic steroid use � Gastrectomy/intestinal bypass � Diabetes mellitus � HIV infection � Crohn’s disease � Dialysis/Renal failure � Cancer of the head or neck � Rheumatoid arthritis � Chronic malabsorption syndromes � Silicosis � Use of TNF-α antagonist � Low body weight � Leukemia � Lymphoma � Hodgkin’s Disease � Other _______________________________________________________ 3. Have you ever resided, worked or volunteered in any of the following facilities? � No � Yes If yes, check all that apply: � Prison � Hospital � Nursing home � Homeless shelter � Other long term treatment center _____________________________________ 4. Do you currently have any of the following symptoms? � No � Yes If yes, check all that apply: � Cough > 3 weeks � Productive cough � Coughing up blood � Unexplained fever � Night sweats � Unexplained wt. loss � Chest pain � Shortness of breath � Fatigue � Chills � Loss of appetite � Weakness 5. Have you ever had contact with a person known to have active tuberculosis? � No � Yes 6. Have you ever used injection drugs? � No � Yes 7. Have you had a tuberculin skin test before? � No � Yes If yes, list where given ___________________ Date __________ (attach results) 8. Have you had a chest x-ray? � No � Yes If yes, list where given ___________________ Date __________ (attach results) The information above is true and complete to the best of my knowledge, and I am aware that deliberate misrepresentation may jeopardize my health. I understand that this information is confidential and will not be released without my knowledge and written permission. _____________________________________________ Applicant / Employee Signature ______________________________ Date -------------------------------------------------------------------------------A “yes” answer to 1-6 above may require the employee be referred to a provider for further evaluation, unless the applicant/employee can provide documentation of negative skin test in the last 12 months or negative chest x-ray. If referred, applicant/employee will be eligible to work only when cleared by physician. Referred to MD? � No � Yes If yes, cleared to work? � No � Yes Date __________ (attach documentation) _____________________________________________ Administrator / Supervisor Signature Professional Pediatric Home Care ______________________________ Date December 2012 3.14A ACHC Standard HH7-1A.01 TB in Colorado: Cases by County and Year of Report 2002-2011 County Adams Alamosa Arapahoe Archuleta Bent Boulder Broomfield Chaffee Clear Creek Conejos Costilla Crowley Delta Denver Douglas Eagle El Paso Elbert Fremont Garfield Grand Gunnison Huerfano Jefferson Kit Carson La Plata Lake Larimer Las Animas Lincoln Logan Mesa Moffat Montezuma Montrose Morgan Otero Phillips Pitkin Pueblo Rio Blanco Rio Grande Routt Saguache Sedgwick Summit Teller Weld Yuma TOTAL 2002 11 0 20 0 0 5 0 0 0 0 0 0 0 38 2 1 5 0 0 1 0 0 0 4 0 1 0 3 0 0 0 2 0 0 0 1 0 0 0 6 0 0 0 0 0 0 0 4 0 104 2003 9 0 20 1 0 13 0 1 0 1 0 0 0 38 0 2 4 1 2 0 0 0 0 7 0 0 0 3 0 0 0 2 0 0 0 1 0 0 0 2 1 0 0 0 0 0 0 2 1 111 2004 13 0 18 0 0 2 0 0 0 0 0 1 0 47 3 0 9 0 0 0 2 0 0 10 0 1 0 2 0 0 0 0 0 2 0 1 0 0 0 3 1 0 0 0 1 2 0 9 0 127 2005 6 1 17 0 0 3 1 0 0 0 0 0 0 42 0 1 9 0 1 0 1 0 0 5 0 0 0 2 0 0 1 0 1 0 0 2 0 1 1 3 0 0 0 0 0 0 0 3 0 101 2006 17 0 22 0 0 7 0 0 0 1 0 0 0 40 1 0 10 0 0 2 2 0 0 5 0 0 0 4 0 0 0 0 0 0 0 0 1 0 2 2 0 0 0 0 0 1 0 5 2 124 2007 14 0 17 0 1 5 0 0 0 0 0 0 1 37 2 0 7 0 1 2 0 0 0 9 0 0 1 2 2 0 0 0 0 1 0 2 0 0 0 4 0 1 0 0 0 0 0 1 1 111 Note: Only counties reporting an active case of TB (2002-2011) are included. Source: CDPHE Annual Tuberculosis Surveillance Report Colorado 2011 Professional Pediatric Home Care December 2012 3.14B 2008 14 0 14 0 0 7 0 0 0 2 0 0 0 24 3 1 10 0 0 1 0 0 0 12 0 0 1 3 1 0 1 0 0 0 0 1 1 0 0 3 0 0 0 1 0 0 0 3 0 103 2009 4 0 11 0 0 3 0 0 1 0 0 0 1 29 4 2 7 0 1 2 0 2 0 8 0 0 0 2 2 0 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 2 0 85 2010 6 0 17 0 0 0 1 0 0 0 0 0 0 24 1 0 8 0 1 0 0 0 1 0 1 0 0 5 0 0 0 0 0 0 0 0 0 0 0 2 0 1 0 0 0 1 0 2 0 71 2011 10 0 5 0 0 5 0 0 0 0 0 0 0 23 2 0 7 0 0 0 0 0 0 8 0 0 0 2 0 0 0 1 0 0 0 2 0 0 0 1 0 0 0 0 0 0 0 4 0 70 ACHC Standard HH7-1A.01 Patient Education of Infection Precautions and Infection Control Practices ______________________ POLICY Agency will assure that patients/caregivers are informed of any infection precautions or control precautions. ______________________ PURPOSE The Agency will educate the patient/caregiver/family regarding any precautions to be taken to prevent and/or control any infection. ______________________ PROCEDURE 1. Appropriate Agency staff members will provide to the patient/caregiver/family any information/education regarding infection prevention or control precautions to be taken, such as Standard or barrier precautions. The patient/caregiver will also be instructed regarding any observations to be reported to Agency staff. 2. Education will occur at time of admission and on an ongoing basis. 3. As appropriate to the care and services which the patient is receiving, education may include such precautions as: Appropriate hand hygiene/handwashing. Use of gloves and/or protective clothing. Dressing changes with disposal of soiled dressings. Personal care. Equipment cleaning. Handling patient’s personal items, e.g., laundry and dishes. Professional Pediatric Home Care December 2012 3.15 ACHC Standard HH7-1A.01 Influenza Immunization of Home Healthcare Workers ______________________ POLICY All employees who have direct contact with patients will be offered the influenza vaccine annually to encourage and promote the benefits associated with vaccinations against influenza. The Agency shall provide employees with pertinent information regarding benefits and availability of immunization and importance of adhering to standard precautions. ______________________ PURPOSE To follow procedures established in the CDPHE standards to reduce the risk of occupational exposure to influenza. ______________________ REFERENCE Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 2 – General Licensure Standards, Part 10 ______________________ RELATED DOCUMENTS “Employee Information Sheet: Influenza Immunization” form ______________________ DEFINITIONS “Influenza Season" means November 1 through March 31 of the following year, or as otherwise defined by the CDPHE epidemiology and flu surveillance team. "Influenza Vaccine" means a currently licensed FDA approved vaccine product. "Proof of Immunization" means a written statement from a licensed healthcare provider who has administered an influenza vaccine to a healthcare worker, specifying the vaccine administered and the date it was administered or electronic entry in the Colorado Immunization Information System (CIIS). ______________________ PROCEDURE 1. The Agency will perform and document an initial assessment to assist in the development of a written policy regarding influenza transmission from its healthcare workers to its patients and/or consumers. The assessment shall, at a minimum, consider the following criteria: The number of healthcare workers at the agency; Professional Pediatric Home Care July 2012 3.16 ACHC Standard HH7-1A.01 The number of patients and/or consumers served by the agency; Whether the agency has an ongoing employee wellness program that offers annual influenza vaccinations; Whether influenza transmission from healthcare workers is addressed in the agency’s infection control policy; What precautions are taken to prevent the transmission of influenza from unvaccinated healthcare workers; and What type of educational material is utilized by the agency to promote influenza immunization for its healthcare workers. 2. Between October 1st and March 31st each year, the influenza vaccine shall be offered to all Agency employees who have direct contact with patients, unless the vaccination is medically contraindicated or the employee has already been immunized, has declined or is exempted. An employee is considered exempted when they provide a medical exemption signed by a physician, physician’s assistant, advanced practice nurse or nurse midwife licensed in the State of Colorado stating that the influenza vaccination for that individual is medically contraindicated as described in the product labeling approved by the United States Food and Drug Administration. Agency will have the vaccine available on-site and provide to the employee at a cost determined by the Agency to include the vaccine and supplies required for administration. Employees will be permitted to obtain the vaccine elsewhere and must provide proof of receipt of the vaccine within two (2) business days of immunization. 3. Agency employees without proof of immunization are not required to wear surgical or procedure masks when providing care to patients in their homes during the flu season. In the event Agency employees without proof of immunization provide patient care in facilities that require the use of surgical or procedure masks (hospitals, hospital units, ambulatory surgical centers and long-term care facilities (nursing homes)), the Agency will coordinate with the facility and provide the required personal protective equipment to the employee(s). 4. Agency will maintain record of each employee’s annual immunization or declination / exemption. 5. Agency will track annual influenza vaccination rate for its employees through December 31st of each year and report to Department of Public Health & Environment by March 31st of following year, in the form and manner specified by CDPHE. Professional Pediatric Home Care July 2012 3.16 ACHC Standard HH7-1A.01 Employee Information Sheet: Influenza Immunization Healthcare entities and healthcare workers have a shared responsibility to prevent the spread of infection and avoid causing harm to their patients by taking reasonable precautions to prevent the transmission of vaccine-preventable diseases. Vaccine programs are, therefore, an essential part of infection prevention and control for slowing or stopping the transmission of seasonal influenza viruses from adversely affecting those individuals who are most susceptible. Influenza is primarily a community-based infection that is transmitted in households and community settings. Each year, 5% to 20% of U.S. residents acquire an influenza virus infection, and many will seek medical care in ambulatory healthcare. In addition, more than 200,000 persons, on average, are hospitalized each year for influenza-related complications. Healthcare-associated influenza infections can occur in any healthcare setting and are most common when influenza is also circulating in the community. Uncomplicated influenza illness is characterized by the abrupt onset of constitutional and respiratory signs and symptoms (e.g., fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis). Preventing transmission of influenza virus and other infectious agents within healthcare settings requires a multi-faceted approach. Spread of influenza virus can occur among patients, health care providers, and visitors; in addition, health care providers may acquire influenza from persons in their household or community. The most effective strategy for preventing influenza is annual vaccination. Achieving high influenza vaccination rates of health care providers and patients is a critical step in preventing healthcare transmission of influenza from health care providers to patients and from patients to health care providers. According to current national guidelines, unless contraindicated, vaccination is recommended for all people aged 6 months and older, including health care providers, patients and residents of long-term care facilities. During the care of any patient, all health care providers in every healthcare setting should adhere to standard precautions, which are the foundation for preventing transmission of infectious agents in all healthcare settings. Standard precautions assume that every person is potentially infected or colonized with a pathogen that could be transmitted in the healthcare setting. Elements of standard precautions that apply to patients with respiratory infections, including those caused by the influenza virus include, but are not limited to: Frequent hand hygiene, including before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of personal protective equipment, including gloves. Wearing gloves for any contact with potentially infectious material. Remove gloves after contact, followed by hand hygiene. Wearing gowns for any patient-care activity when contact with potentially infectious material (including respiratory) is anticipated. Remove gown and perform hand hygiene before leaving the patient's environment. Droplet precautions should be implemented for patients with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and Professional Pediatric Home Care July 2012 3.16A ACHC Standard HH7-1A.01 respiratory symptoms, whichever is longer. In some cases, agencies may choose to apply droplet precautions for longer periods based on clinical judgment, such as in the case of young children or severely immuno-compromised patients, who may shed influenza virus for longer periods of time. Health care providers at higher risk for complications from influenza infection include pregnant women and women up to 2 weeks postpartum, persons 65 years old and older, and persons with chronic diseases such as asthma, heart disease, diabetes, diseases that suppress the immune system, certain other chronic medical conditions, and morbid obesity. Vaccination and early treatment with antiviral medications are very important for HCP at higher risk for influenza complications because they can decrease the risk of hospitalizations and deaths. HCP at higher risk for complications should check with their healthcare provider if they become ill so that they can receive early treatment. The influenza vaccine has the potential to cause serious problems, such as severe allergic reactions. The risk of the vaccine causing serious harm, or death, is extremely small. Serious problems from influenza vaccine are very rare. The virus is inactivated, preventing transmission of influenza from the vaccine. Mild reactions: o soreness, redness, or swelling at the injection site o fever o aches o If these problems occur, they usually begin soon after the shot and last 1-2 days Severe reactions: o Life-threatening allergic reactions are very rare. If they do occur, it is usually within a few minutes to a few hours after the injection. o In 1976, a type of influenza (swine flu) vaccine was associated with Guillain-Barre Syndrome (GBS). Since then, flu vaccines have not been clearly linked to GBS. However, if there is a risk of GBS from current flu vaccines, it would be no more than 1 or 2 cases per million people vaccinated. This is much lower than the risk of severe influenza, which can be prevented by vaccination. Between October 1st and March 31st each year, the influenza vaccine is available all Agency employees who have direct contact with patients. If you have a medical condition, allergies, are pregnant or breastfeeding, please consult your physician for direction prior to receiving the vaccine. Professional Pediatric Home Care July 2012 3.16A ACHC Standard HH7-1A.01 INFLUENZA VACCINATION CONSENT / WAIVER FORM Do not accept the influenza vaccine if: You have had a previous allergic and/or serious reaction to the vaccine You currently have moderate to severe acute illness with fever The following information is required: 1. 2. 3. 4. 5. 6. The date of your last influenza vaccine: Are you allergic to eggs? Have you ever had a serious reaction to a flu shot? Are you sick with a fever? Have you ever had Guillain-Barre Syndrome? Are you pregnant or breastfeeding? ____________________ Yes No Yes No Yes No Yes No Yes No I understand that due to my occupational exposure to potentially infectious material, I am at risk of acquiring influenza infection. I have read the Employee Information Sheet: Influenza Immunization and have had an opportunity to ask questions which were answered to my satisfaction. I understand the risks and benefits and have been given the opportunity to be vaccinated. Having been so informed: I give my consent to receive the influenza vaccine I have received the influenza vaccine from another provider and will provide proof of immunization within two (2) business days of this notice I will be receiving the influenza vaccine from another provider and will provide proof of immunization within two (2) business days of receipt of the vaccination I decline the influenza vaccine Employee Name Employee Signature Date Manufacturer: Dose: Lot Number: Site: Deltoid Expiration Date: Signature of administering health care professional Professional Pediatric Home Care December 2012 3.16B Date administered R L ACHC Standard HH7-1A.01 Appropriate Safeguards to Prevent Drug Contamination ______________________ POLICY Agency staff will implement appropriate safeguards in administering medications and in teaching patients/caregivers to administer medications. ______________________ PURPOSE To prevent drug contamination. ______________________ PROCEDURE 1. Medications will be properly stored in the patient’s home according to any cautionary statements included in the prescription label (e.g., “keep refrigerated”). 2. Patients/caregivers will be educated regarding proper disposal of unused or expired medications. 3. Patients/caregivers will be educated regarding protecting medications from contamination. 4. Staff will implement appropriate aseptic technique when compounding and preparing medications. Patients/caregivers will be educated regarding use of aseptic technique when compounding and preparing medications. 5. Staff and patients/caregivers will keep work surfaces clean for preparing medications. 6. Medications will be prepared according to any directions. 7. Prior to administration, medications will be visually inspected for microbial contamination, inappropriate particulate matter and/or signs of deterioration. 8. Medications will be prepared in the patient’s home only when the stability of such medications is required. Professional Pediatric Home Care December 2012 3.17 ACHC Standard HH7-1A.01 Fingernails ______________________ POLICY The Agency will follow CDC recommended hand hygiene guidelines for fingernails. ______________________ PURPOSE To reduce the risk to patients of Agency acquired infections. ______________________ RELATED DOCUMENTS CDC Media Relations: Press Release – “Fact Sheet: Hand Hygiene Guidelines Fact Sheet” ______________________ PROCEDURE 1. Fingernails of staff should be clean and well cared for. Professional Pediatric Home Care December 2012 3.18