Download Infection Prevention Clinical

Annual Continuing Education Modules
Infection Prevention means preventing healthcare
associated infections and reducing the likelihood
teammates, patients, or visitors will be exposed to
germs in a healthcare facility. This self-directed
learning module contains information you are expected
to know to protect yourself, our patients, and our guests.
Content Experts:
Infection Prevention
Target Audience: All Clinical Areas’ Teammates
Contents
Instructions ........................................................2
Learning Objectives...........................................2
Module Content .................................................3
Posttest .............................................................18
Carolinas HealthCare System
Instructions:
The material in this module is an introduction to important general information and
procedures regarding Infection Prevention precautions. After completing this module,
contact your immediate supervisor to obtain additional information specific to your
department.
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Read this module.
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If you have any questions about the material, ask your supervisor.
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Complete the online posttest for this module.
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The Job Aid on page 18 should be customized to fit your department’s policies
and procedures and then used as a quick reference guide.
Learning Objectives:
When you finish this module, you will be able to:
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Describe why hand hygiene is important to prevent the spread of infection.
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Define Standard Precautions and discuss when and how to use them.
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Describe Personal Protective Equipment used to prevent the spread of
infection.
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Describe Isolation Precautions used to prevent the spread of infection.
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State how to obtain more information about Infection Prevention practices.
• Identify Multidrug Resistant Organisms and ways to prevent transmission.
• Identify Healthcare Associated Infections and preventive measures.
• Describe correct respiratory hygiene measures to prevent infection.
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Who Should Be Concerned about Infections?
Everyday, people are exposed to germs that may make them sick. People who work in
healthcare, such as: nurses, laboratory technologists, and environmental service
workers, have a greater risk of exposure in the workplace.
Patients may also be exposed to germs found in healthcare facilities. When a patient
gets an infection while in a healthcare facility, it is called a healthcare associated
infection (HAI).
People working in healthcare facilities frequently have questions about preventing the
spread of infection between staff and patients. Many of these questions will be
answered in this module.
What does Infection Prevention mean?
Infection Prevention means preventing healthcare associated infections and reducing
the likelihood teammates, patients, or visitors will be exposed to germs in a healthcare
facility. Education should be provided to the patient and all visitors regarding the
reasons for isolation and the importance of preventing the spread of infection. All patient
and visitor education should be documented.
Where can I learn more?
Your supervisor and/or preceptor will review basic Infection Prevention principles with
you during your departmental orientation. If you have questions about specific
departmental or area Infection Prevention measures, or high-risk patients or
procedures, be sure to ask about these issues before beginning work.
Additional resources include:
• Infection Prevention Manual
• Exposure Control Plans & Bloodborne Pathogen Policy
• Safety Management Program Manual
• Departmental policies and procedures
• Infection Prevention
• Employee Health
• Corporate Safety
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What is my role in Infection Prevention?
1. Stay healthy
It is very important for you to stay healthy, so you do not infect anyone with
germs that may make them sick. If you become sick with an infectious illness,
such as pink eye or GI symptoms, stay home so you do not infect others.
2. Help keep others healthy
Many diseases are easily spread to others, and some people are very
susceptible to germs. Some germs are much harder to contain or kill than others.
In these difficult situations, special precautions must be used.
Routine measures that may help protect you and your patients include:
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Performing hand hygiene according to approved guidelines
Using Standard Precautions for patient care
• Using Isolation Precautions when needed
• Utilize the cleaning grid to appropriately disinfect patient equipment.
HAND HYGIENE
Who?
Everyone is responsible for performing proper hand hygiene.
What?
In most settings, a liquid soap is provided at each sink and alcohol based hand
rubs are available in each department.
When?
People who work in healthcare facilities should perform hand hygiene often.
Use an alcohol based hand rub:
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Before each patient encounter.
After having direct contact with the patient or their environment.
Before donning sterile gloves for performing an invasive procedure such as
inserting a central intravascular catheter.
Before inserting any invasive device such as an indwelling catheter,
peripheral vascular catheter, or any other device which does not require a
surgical procedure.
After contact with body fluids or excretions, mucus membranes, non-intact
skin, and wound dressings if hands are not visibly soiled.
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After coming in contact with a patient’s intact skin such as taking a blood
pressure, pulse, or moving a patient.
When moving from a contaminated body site to a clean body site during
patient care.
After contact with inanimate objects (including medical equipment) in the
immediate vicinity of the patient.
After removing gloves.
Before leaving the job site.
How?
1. Place enough alcohol hand rub in the palm of your hand to saturate all
surfaces of the hands
2. Rub hands together, covering all surfaces of your hands and fingers until
hands are dry.
3. Do not “dry” hands with paper towels, rub it in.
4. Be sure hands are dry before touching any electrical equipment.
Wash your hands with soap and water:
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After personal activities such as using the restroom, sneezing, or blowing
your nose.
Before eating, preparing and/or serving food.
When your hands are visibly dirty.
Anytime alcohol hand rubs are not recommended i.e. when caring for a
patient with Clostridium difficile.
How?
1. Rinse hands, from fingertips to wrist, under warm running water.
2. Spread soap on your hands using circular motion and friction for at least 15
seconds making sure to clean between fingers and under fingernails and
jewelry.
3. Rinse hands thoroughly under running water.
4. Use a paper towel to blot your hands dry. Turn off the faucet using a clean
paper towel to prevent contaminating your hands.
Artificial nails have been implicated in the transmission of infection. All
healthcare workers providing direct patient care are restricted from wearing
artificial nails/gels/wraps/overlays. Natural nails should not extend > ¼” beyond
tip of fingers.
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RESPIRATORY HYGIENE / COUGH ETIQUETTE
Healthcare personnel will be aware of the importance of source prevention measures to
contain respiratory secretions to prevent droplet transmission and environmental
contamination with respiratory pathogens.
Inpatient and outpatient departments and clinics will implement the following measures
to contain respiratory secretions in patients and accompanying individuals who have
signs and symptoms of a respiratory infection:
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Signs will be posted at entrances and in strategic places within the facilities with
instructions to patients and other persons with symptoms of a respiratory
infection to cover their mouths/noses when coughing or sneezing, use and
dispose of tissues, and perform hand hygiene after hands have been in contact
with respiratory secretions.
Tissues and no-touch receptacles for disposal of tissues will be provided.
Instructions for performing hand hygiene and appropriate supplies will be
provided in or near waiting areas.
During periods of increased prevalence of respiratory infections in the
community, masks will be offered to coughing patients and other symptomatic
persons upon entry into the facility. Symptomatic persons will be encouraged to
maintain spatial separation, ideally a distance of at least 3 feet, from others in
common waiting areas.
In addition to Standard precautions, Droplet precautions (wear a surgical mask)
should be observed when providing care to a patient with signs and symptoms of
a potentially infectious respiratory infection.
STANDARD PRECAUTIONS
Many people carry bloodborne infections without even knowing it, so it is difficult to
identify patients who may transmit infection.
Standard Precautions requires you to treat all human blood and body fluids as if they
are infected with a bloodborne pathogen.
Use Standard Precautions to Protect Yourself from Exposure to Blood and Body
Fluids.
Treat all blood and other body substances as if they could spread infection.
Depending on the task, use appropriate PPE including:
o gowns and/or aprons
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o masks and/or face shields or N-95 respirators
o eye wear such as special glasses, goggles, or face shields
o gloves
ISOLATION PRECAUTIONS
Isolation Precautions mean the patient has an illness that may not be contained by
using Standard Precautions alone. Additional prevention measures are needed to
prevent the spread of infection.
Acute care facilities will identify special precautions by placing a sign outside the patient
room.
Examples of Signs
There are five Isolation categories:
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Contact Precautions
Contact Precautions Enteric
Droplet Precautions
Airborne Precautions
Protective Precautions
The Isolation Precautions policy is located in the Infection Prevention Manual.
The Isolation Precautions policy includes additional information on the different isolation
categories. The policy, “Conditions and Organisms Requiring Isolation
Precautions” lists infections alphabetically, the type of isolation required for each
infection, the length of time a patient should remain on isolation, and other special
considerations.
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Patients with suspected or known communicable diseases must not wait in
common areas and must be placed in isolation as soon as the infection is
suspected.
When isolation is ordered, nursing personnel must do the following:
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Place the appropriate sign on the outside of the patient's door. A patient may be
on more than one category of isolation (combination signs are available).
Enter the isolation category in the computer. This will help to alert receiving
departments who will not see a sign on the patient's door and risk possible
exposure.
Notify receiving departments when transporting a patient on Isolation
Precautions, so all employees may be protected, and contagious patients are not
placed in waiting rooms.
Explain the reason for isolation and how to prevent the spread of infection to
others by using patient education.
Document all teaching on ETR in the Infection Control tab.
To discontinue isolation refer to the policy “Conditions and Organisms requiring
isolation precautions.”
Patients who have positive cultures for MRSA, VRE, CRE and other Multidrug
Resistant Organisms will be flagged in the computer system by Infection
Prevention.
When a patient, whose medical record is flagged in the computer system (MRSA, VRE,
CRE, or HR-MDRO), is re-admitted, the physician or nurse will place the patient on
Contact Precautions as part of the admission process.
The admitting nurse will check the Diagnosis and Problems section on Cerner to
determine if patient requires contact precautions based on a history of MRSA, VRE,
CRE, or HR-MDRO that is active. The nurse will place the patient on Contact
Precautions as part of the admission process if history is active.
The unit isolation report prints routinely. This report should be reviewed by staff when it
is printed to make sure all applicable patients on the list are on appropriate isolation
precautions.
Contact Precautions
Contact Precautions means a patient may have a germ that may be spread by the
hands of workers or visitors. These germs may be spread by touching the patient or his
belongings, equipment, etc.
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Common conditions requiring Contact Precautions:
• MRSA (Methicillin Resistant Staph aureus)
• VRE (Vancomycin Resistant Enterococcus)
• CRE (Carbapenem resistant Enterobacteriaciae)
• ESBL (Extended spectrum beta lactamase)
• Multi-drug resistant organisms
• Highly Resistant Multi-drug resistant organisms
• Chicken pox*
• Shingles (Disseminated and/or immunocompromised patient)*
• RSV (Respiratory Syncytial Virus)
• Lice
• Scabies
(*) Indicates also requires Airborne Precautions.
Special considerations:
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Always wear gown & gloves when entering patient room.
Practice good hand hygiene at all times.
Encourage visitors to clean hands and wear gowns and gloves while in patient’s
room.
Assist patient with handwashing.
The following patient dedicated equipment should be kept in patient's room:
o disposable thermometer
o disposable blood pressure cuff
o disposable stethoscope
Note: If disposable equipment is not available, use a barrier between
the patient and equipment. Clean the equipment after use with an
appropriate disinfectant.
Educate patient and family members about contact precautions using patient
educations sheets. Document in ETR in the Infection Control tab.
Notify the receiving department when transporting the patient.
At discharge, discard disposable patient equipment.
CONTACT P RECAUTIONS ARE REQUIRED FOR:
MDRO’s (Multi-drug Resistant Organisms)
HR- MDRO’s (Highly Resistant – MDRO’s)
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MDRO’s- Multi-drug Resistant Organisms include:
MRSA and VRE
MRSA (Methicillin resistant staphylococcus aureus) and VRE
(Vancomycin resistant Enterococcus) are two multi-drug resistant
organisms. Methicillin and vancomycin are antibiotics used to treat
infections. Germs, that cause the infections, have become resistant to
the antibiotics normally used to kill them. When germs become resistant
to antibiotics, it is harder to cure the infection.
HR- MDRO’s – Highly Resistant – MDRO’s include:
CRE and ESBL
Another group of organisms to remember in the list of multi-drug resistant organisms
include gram negative bacteria. CRE (Carbapenem resistant Enterobacteriaciae)
affects the sickest patients and secretes an enzyme that inactivates the carbepenems.
That means that the medications that would normally treat the infection will not work.
ESBL’s (extended spectrum beta lactamase) are rapidly increasing and patients
often carry this bacterium in the lower digestive tract.
Prevention is KEY! Few new medications are in production to treat these organisms.
Patient / visitor education on MDRO’s should be performed anytime you have a patient
with a confirmed or suspected diagnosis. Infection Prevention approved patient
education sheets are available. Document when education is provided on ETR in the
Infection Control tab.
Contact Precautions Enteric
Contact Precautions Enteric is required when a patient may have certain enteric
organisms, such as Clostridium difficile.
Common conditions requiring Contact Precautions Enteric:
• Clostridium difficile (C. difficile, C. diff)
• Acute diarrhea with unknown etiology
• Norovirus
• Rotavirus
Special Considerations:
• Staff should wash their hands with soap and water when leaving the room.
• Always wear gown and gloves when entering the patient room.
• The following patient dedicated equipment should be kept in the patient’s room:
o disposable thermometer
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o disposable blood pressure cuff
o disposable stethoscope
Note: If disposable equipment is not available, use a barrier between the
patient and equipment. Clean the equipment after use with bleach wipes.
At discharge, discard of disposable patient equipment.
Placement of a patient on Contact Precautions Enteric in a private room is
optimal. When a private room is not available, cohorting of patients with the same
microorganism is appropriate. Consult Infection Prevention for difficult triage
situations.
Document all patient and family education on the ETR in the Infection Control
tab.
Notify the receiving department when transporting the patient.
For discontinuation of isolation, refer the policy “Conditions and Organisms
Requiring Isolation.”
Droplet Precautions
Droplet Precautions are required when a patient may have an infectious disease that
is spread by droplets in the air when the patient coughs, sneezes, talks, or when a
splash is produced during a procedure such as suctioning.
Common conditions requiring Droplet Precautions:
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Influenza
Mumps
Bacterial meningitis
Strep throat during the first 24 hours of treatment
Pertussis (whooping cough)
Special considerations:
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Healthcare personnel wear a surgical mask when entering a patient room or
within 3 to 6 feet of a patient in a cubicle.
Place surgical mask on patient while transporting through the facility.
Notify the receiving department when transporting the patient.
Make sure the patient is in a private room
A negative airflow room is not required.
Patient door may remain open.
Airborne Precautions
Airborne Precautions means the patient may have an infectious disease that may be
spread through the air.
Conditions requiring Airborne Isolation Precautions include:
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• Chickenpox*
• Measles
• Disseminated shingles*
• Shingles in an immunocompromised patient*
• Tuberculosis
(*) Indicates also requires Contact Precautions
Special considerations:
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Place patient in a negative pressure room. Negative pressure must be checked
and documented daily.
If a negative pressure room is not available, place patient in a private room with a
portable HEPA machine as a temporary measure.
Educate patient and family members about airborne precautions using patient
educations sheets. Document in ETR in the Infection Control tab.
In an ambulatory clinic setting, the patient must wear a surgical mask and be
placed in a private room with the door closed.
Keep patient’s door and windows closed at all times to maintain negative airflow.
Personnel must wear N95 respirators. These respirators require FIT TESTING.
For those staff members that cannot wear a N95 respirator, a PAPR unit is
available.
The N95 respirator is not removed until the teammate / visitor leaves the room.
The N95 respirator may be used for an entire shift unless visibly soiled.
Staff and visitors nonimmune to chickenpox by history or vaccine should not
enter room. Other immune caregivers should assume care.
Place surgical mask on patient when transporting through facility.
Notify the receiving department prior to transporting the patient.
Minimize the need for the patient to be transported within the facility by
performing procedures in the patient’s room whenever possible.
Isolation for tuberculosis may be discontinued by a physician order according to
the policy “Conditions and Organisms Requiring Isolation Precautions.”
Protective Precautions
Protective Precautions is used for patients with decreased ability to fight infection and
may be easily infected.
High risk patients may include:
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Any disorder/therapy which compromises immune function (e.g. lymphoma,
AIDS).
Chemotherapy or radiation therapy patients
Stem cell transplant patients.
Solid organ transplant patients
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Chronic / high dose steroid patients
Special considerations:
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Screen visitors or ask patient to receive only healthy visitors.
Caregivers who participate in the care of the immunocompromised patient must
be healthy (free of colds, etc.).
Use a private room, if available.
Minimize travel through the facility to other departments.
Other Efforts to Reduce Healthcare Associated Infections
Partner with your patients to reduce infections using patient education.
Prevention of Central Line Associated bloodstream infections
(CLABSI)
Central line associated blood stream infections (CLABSI) can lead to poor patient
outcomes. Evidence based standards and guidelines are utilized to prevent these
infections and meet the National Patient Safety Goals. These include:
• Patients, and as appropriate their families, are educated about central line
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associated blood stream infection prevention. Use patient education sheets and
document on the ETR.
Perform hand hygiene with alcohol based hand rub prior to catheter insertion or
manipulation
Properly disinfect catheter hubs and injection ports before accessing per policy.
Use of the “Central Line Insertion Checklist” to standardize practice.
Use of standardized supply cart or kit that is all inclusive for insertion.
Prevention of Catheter Associated Urinary Tract Infections (CAUTI)
There are also efforts in place to reduce CATHETER ASSOCIATED URINARY TRACT
INFECTIONS. Included in the measures are:
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Educate patients using patient education sheets on Nursing Portal and document
on ETR.
Daily assessment of need and proper care and maintenance.
Contact physician if urinary catheter does not meet criteria.
Goal is to remove as soon as no longer necessary.
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Prevention of Ventilator Associated Pneumonia (VAP)
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Care of the patient on a ventilator is standardized to provide the safest care and
reduce the risk of a healthcare associated infection.
Follow ventilator associated pneumonia prevention bundle and document.
Use patient education sheets in Infection Prevention Manual and document on
ETR.
Prevention of Surgical Site Infections (SSI’s)
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Educate patient / families on prevention of SSI’s and document on ETR.
Pre-operative Chlorhexidine baths and skin antisepsis
Appropriate skin preparations (no shaving)
Appropriately timed antibiotics (pre and post operative)
Glucose Management
Proper hand hygiene when manipulating dressings or providing wound care
Comply with SCIP (Surgical Care Improvement Project) Measures
Prevention of Multi-drug Resistant Organisms (MDRO’s)
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Isolate patients appropriately. Dedicate medical equipment.
Educate patient / families when a patient is identified with a MDRO. Education
should include reason for isolation and appropriate PPE required. Document in
the ETR.
Flag patients identified with a MDRO in the computer system to enable isolation
upon readmission.
Antibiotic Stewardship
Reporting Communicable Diseases
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Physicians are responsible for notifying the county health department of
reportable communicable diseases.
This can be done by phone or by completing a communicable disease report
form.
The reporting of communicable diseases should not be delayed for laboratory
confirmation when a reportable disease is suspected.
The following are examples of reportable communicable diseases:
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Whooping Cough (pertussis)
Tuberculosis
Meningococcal Disease
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Salmonella
Shigellosis
Hemolytic Uremic Syndrome (HUS)
Use of Equipment and Supplies
Items used for patient care must be clean and, in some cases, sterile. When using any
equipment, supplies, or products:
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Make sure the package has no holes, tears, or small openings.
Check for an expiration date (if applicable). Do not use expired products.
Do not use an item if it is damaged, wet, or soiled, or if the packaging is
damaged, wet, or soiled.
Keep clean equipment and supplies separate from dirty / used equipment and
supplies.
Do not use one patient's supplies or equipment for another patient; this action
may transfer germs and cause infection.
Clean / disinfect glucometers between each patient use with the appropriate
disinfectant.
Clean / disinfect equipment between patients and after use in a contact isolation
room.
The Cleaning Grid is a policy to clarify procedures for cleaning of equipment that
remains in the department. It is located in the Infection Prevention Manual.
Follow contact times suggested by the cleaning grid. Contact time=Wet time.
This is the amount of time that the surface must stay wet in order for the product
to effectively disinfect the surface.
Infection Prevention and Construction
It is important to prevent and control infections that could be caused by construction or
renovation projects. The dust that occurs during construction can contain spores or
other bacteria that can be harmful to some people.
Aspergillus
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Is a fungus (mold) that occurs in nature
Can be found in decaying leaves, plaster and drywall
and settled dust
Who may be harmed by aspergillus and other fungus?
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Premature babies
Transplant patients
Cancer patients
Immunocompromised patients
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One way to control dust during construction is through the use of barriers. It is
important to maintain the integrity of these barriers by keeping doors or barriers closed
and not walking through construction areas. Please report to Infection Prevention any
concerns about construction dust, open ceiling tiles, or mold growth that could put
patients at risk.
Moisture Management
Molds occur all around us in nature. The presence of mold does not necessarily create
a hazard. Mold does not adversely affect the health of all individuals. Pre-existing
health conditions, such as allergies, can be exacerbated or aggravated by the presence
of molds. This is the most common response to mold. Molds can cause serious
infections in people who are immunocompromised, such as those with cancer, organ
transplants, AIDS, or on steroid type medications.
Mold growth can occur within 48 hours of a water leak or moisture accumulation.
What should you do when you find water leaks, water damage or mold?
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Clean-up spills or leaks promptly
Notify Plant Operations Maintenance (POM) and Infection Prevention.
Report these promptly to your supervisor, maintenance or property manager, or
your safety officer.
Assist as needed with drying and repairs to prevent the growth of mold.
Avoid disturbing the mold – do not pull wallpaper back, or lift ceiling tiles. This
may release thousands of mold spores.
Should I come to work if I am sick?
Some infections may be readily transmitted to patients, family
members, and others. If you suspect you have an infection or have
been exposed to an infection or infectious illness, call your
manager so that they can report this to Employee Health before
coming to work.
The following are examples of infectious illnesses or exposures to
report to Employee Health:
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Conjunctivitis (pink eye)
Viral hepatitis
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Herpes Whitlow (herpes of the fingers)
HIV
Meningococcal meningitis
Varicella (chicken pox)
Pertussis (whooping cough)
Tuberculosis (TB)
Salmonella
Shigella
Influenza
Health Screening
Employee Health will assess your health to make sure you are not infectious to others.
Your supervisor may also help if you are ill. Remember! You may do more harm than
good if you do not have your own illness checked or treated. You may place patients,
co-workers, and family members at risk of catching your illness.
To avoid becoming ill, take the following precautions:
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keep immunizations up-to-date
maintain a healthy lifestyle
exercise
eat fruits and vegetables
practice good personal hygiene
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Posttest
Name: _____________________________________________
Date: ______________________________________________
Circle the correct answer.
1. Alcohol based hand rub should be used to clean your hand in which of the
following situations?
a. After contact with a patient
b. After contact with a patient’s environment
c. Before each patient encounter
d. After caring for a patient with C. difficile
e. a, b, and c
2. Donning the appropriate personal protective equipment (PPE) to protect you from
exposure to bloodborne pathogens is an important aspect of Standard
Precautions. What PPE may be needed when providing care to a recent trauma
victim in emergency department?
a. Gown
b. Gloves
c. Face shield
d. All of the above
3. Which of the following PPE should be worn when caring for a patient with a
potentially infectious respiratory infection?
a. Gown
b. Gloves
c. Surgical cap
d. Surgical mask
e. c and d
4. Which Infection Prevention policy contains an alphabetical list of conditions along
with the type of isolation required for each?
a. Transmission Based Precautions
b. Conditions and Organisms Requiring Isolation Precautions
c. Exposure Control Plan
d. Discontinuation of MRSA, VRE, and Known or Suspected TB
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5. Key points to remember when implementing airborne precautions include:
a. Wear a surgical mask to enter room
b. Wear gown and gloves to enter room
c. Wear a N95 mask to enter room
d. Make sure room is negative pressure
e. c and d
6. Which of the following organisms require Contact Precautions?
a. MRSA (Methicillin Resistant Staphylococcus)
b. CRE (Carbopenem Resistant Enterobacteriaciae)
c. VRE (Vancomycin Resistant Enterococcus)
d. ESBL (Extended Spectrum Beta Lactamase)
e. All of the above
7. National Patient Safety Goals require that healthcare workers educate
patients/families about which of the following?
a. Preventing surgical site infections (SSI)
b. Preventing central line associated bloodstream infections (CLABSI)
c. Hand hygiene
d. Multidrug resistant organisms (MDRO’s)
e. All of the above
8. An important aspect of droplet precautions includes:
a. Wearing a N95 mask to enter the room
b. Donning a surgical mask when within 3 feet of a patient in patient room
c. Wearing a surgical mask upon entering a patient room
d. Wearing a gown, gloves, and surgical mask upon entering a patient room
9. An important aspect of Contact precautions includes:
a. Wearing a gown and gloves upon entry to the patient room.
b. Wearing a N95 mask to enter the room.
c. Wearing a surgical mask upon entering a patient room.
d. Wearing gloves always and gown only if in contact with the patient.
10. Contact time refers to which of the following?
a. The amount of time to rub the surface.
b. The amount of time to blow on the surface to dry it.
c. The amount of time that the surface must remain wet with the product.
d. The amount of time that the patient was in contact with the surface.
e. None of the above
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