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Infection Prevention
for Patient Care Services
2013
Isolation and Precautions
Bloodborne Pathogen Standard
TB Control Plan
Multidrug Resistant Organisms
Objectives
• Understand the different types of transmission
based precautions and isolation
• Understand the Bloodborne Pathogen Standard
• Understand the TB Control Plan
• Know what services are available through
Occupation Health Services
• Understand what MDR-organisms are and how
to prevent transmission
• Understand contact time with regards to
disinfection
Mandatory Requirements that
keep our staff and patients safe
• Infection Control Education is a Mandatory Annual
Requirement as stated in:
• OSHA Bloodborne Pathogens Standard 1910.1030
April, 2001 and
• Guidelines for Preventing the Transmission of
Mycobacterium tuberculosis in Healthcare Facilities,
2005.
Isolation and Precautions
- More Safety Activities
• Along with good hand hygiene, Standard Precautions
and disease specific precautions help prevent the
transmission of organisms. There are 6 types of
precautions used at Karmanos:
1. Standard Precautions
2. Contact Precautions
3. Contact Precautions with Special Cleaning
4. Droplet Precautions
5. AFB Isolation
6. Airborne Precautions
Standard Precautions
• Standard Precautions – is used with
all patients and assumes that all patients are
infectious.
• Protective barriers called Personal Protective
Equipment (PPE) includes gloves,
goggles/eye shields, masks and gowns are
used to prevent contact with patients’ blood or
body fluids.
• The type of activity or task determines the amount
and type of PPE to be used. The greater the risk
of coming in contact or being splashed with the
patients’ blood or body fluids, the more protection
is needed.
Standard Precautions
Personal Protective Equipment (PPE) -Masks
•Masks, eyewear and face shields protect your eyes, nose and mouth.
from splashes or splatters of blood and body fluids
•Make sure to choose PPE that will protect your eyes, nose and mouth
if there is any chance of splash.
•Examples of tasks when you should wear such PPE include:
Suctioning
Irrigating wounds
Cleaning contaminated equipment
•Place disposable PPE into general waste container after use.
Standard Precautions
Personal Protective Equipment (PPE) - Gloves
•Gloves keep potentially infectious materials away from your hands
during contact with patient’s blood, body fluids, mucous
membranes, or broken skin.
•Gloves also protect you from contact with infectious materials when
handling contaminated equipment, surfaces, linen or waste.
•Remove gloves immediately after the task is done. Dispose gloves
into a general waste container.
•Perform hand hygiene after removing and disposing gloves.
•NEVER wash gloved hands. NEVER reuse disposable gloves.
•Change gloves after each procedure; even if performing more than
one procedure on the same patient.
•Standard exam gloves are latex-free.
Standard Precautions
Personal Protective Equipment (PPE) –
Gowns
• Fluid-resistant gowns prevent blood and body fluids that
splash or spray from soaking through to your clothes and skin.
• Dispose gowns after use in general waste container, NOT
medical waste biohazard container.
• Some situations that may require wearing a gown include:
Irrigating a wound
Performing tracheostomy care
Any time blood or body fluid contamination to your
clothes skin is likely
Airborne Precautions
• Place patients in Airborne
Precautions if they have a disease
that is transmitted by the
airborne route (except
Tuberculosis).
• These diseases include:
• Chicken Pox/Varicella
• Measles
• Disseminated Herpes Zoster
(Shingles)
AFB Isolation
• AFB Isolation is required for all
patients with or suspected of having
Tuberculosis (TB). TB is spread by
the airborne route.
• ALL AFB Isolation cases require:
- A private, negative air pressure
room where the air is exchanged 6-12
times per hour and exhausted to the
outside of the hospital.
- All healthcare workers must wear a
N-95 particulate respirator (N-95 PR)
to enter the room. Refer to policy IC
125.
NOTE: This is a special mask that
must be fitted to each individual. Always fitcheck your mask before entering the room.
Make sure you know what size N-95 you wear.
AFB Isolation
• If you are not able to wear a N-95 mask because you
couldn’t be fit tested, you may be trained on the use of a
PAPR-Powered Air Purifying Respirator. The PAPR is
worn when entering an AFB isolation room. There are
PAPR’s on 10WN, 5WN and Radiation Oncology Center.
• Refer to policy IC 152 or CLN 152 for additional
information.
Contact Precautions
Required to prevent transmission of
infectious agents such as Multidrug resistant organisms (i.e.
Acinetobacter, Pseudomonas,
KPC), and Rotavirus, which are
spread by direct or indirect
contact with the patient or the
patient’s environment.
Gown and gloves upon entry to room.
Discard PPE before exiting room.
Change gown and gloves after
preparing patient for transfer out
of room and perform hand
hygiene. Don new PPE to assist
with patient transfer outside of
room.
Contact Precautions with
Special Cleaning
This is signage for our
patients that have C.difficile
disease. Contact
Precautions are followed
PLUS the signage is on
the door to remind our
Environmental Services
staff to use a bleach
detergent when cleaning
the surfaces in the room.
Droplet Precautions
•
Used in the care of patients with
suspected or confirmed infections
such as Pertussis, Influenza,
Rhinovirus, Neisseria
meningitidis and RSV which are
transmitted primarily by droplet
route.
•
Surgical mask is required upon
entry to room
Latex Sensitive Patient
• Patients identified as allergic or at risk of latex
allergy are to have the following Latex Allergy
Precautions implemented:
• A purple allergy band is placed on patient.
• Patient’s chart is marked “Latex Precautions”.
• “Latex Sensitive” sign is placed on the patient’s
door.
• Latex-free supplies from Central Sterile Processing
are used for patient care.
• Refer to policy CLN 210 on the KCC policy web
site.
Bloodborne Pathogen
Standard
• Hospitals are required by the Bloodborne Pathogen
Standard of MI/OSHA to protect all healthcare
workers (HCWs) from exposure to bloodborne
pathogens, while on the job.
• Assume that all patients could have organisms
that are transmitted by contact with their blood
and/or body fluids. Follow Standard Precautions.
• The MIOSHA Blood Borne Pathogen Exposure
Control Plan is the policy that describes protection
measures for staff and patients.
Refer to policy IC 110
Bloodborne Pathogen Standard
Epidemiology of Bloodborne Pathogens:
• Important bloodborne pathogens (disease-causing organisms)
that may be present in human blood could include:
• Hepatitis B Virus (HBV)
• Hepatitis C Virus (HCV)
• Human Immunodeficiency Virus (HIV)
• These same bloodborne pathogens may also be found in other
body fluids, including:
• Semen
• Vaginal fluids
• Fluids around the brain, spine, heart, lungs, abdomen and joints
• Bloody saliva during certain dental procedures
• Bloodborne pathogens are NOT found in tears, urine, stool,
sweat or saliva unless these body fluids are visibly bloody.
Bloodborne Pathogen Standard
Exposure to Bloodborne Pathogens:
• HCWs may be exposed to bloodborne pathogens by:
• Your skin being punctured with a contaminated needle or cut by a
contaminated sharp device, such as a lancet or scalpel.
• Blood or body fluids getting on skin that has cuts, cracks, rashes
or burns.
• Being splashed or sprayed with blood or body fluids into your
eyes, nose or mouth.
• Certain HCWs have a higher risk of exposure to bloodborne
pathogens while on the job.
• Nurses and Patient Care Staff
• Physicians
• Lab Staff
• Environmental Services Staff who handle Regulated Medical Waste
• Dental Staff
Bloodborne Pathogen Standard
Symptoms of Blood Borne Diseases
Symptoms of Hepatitis B, C and HIV may include:
•
•
•
•
•
•
•
•
•
•
•
•
•
Fever
Fatigue
Flu-like illness
Nausea
Vomiting
Diarrhea
Loss of Appetite
Weight loss
Jaundice
Itchy skin
Night Sweats
Swollen Lymph Glands
Pneumonia
Bloodborne Pathogen
Standard
• Standard Precautions requires HCWs to treat all blood
and body fluids as if they are infected with diseasecausing organisms.
• ALWAYS using Standard Precautions will prevent the
spread of disease to yourself, co-workers, patients and
visitors.
Your protection and Safety is important. Know where to
find PPE in your department.
How to Manage a Blood or
Body Fluid Spill
• Small spills that can be contained by a paper towel
will be cleaned and disinfected by the department. The
Small Spill Procedure is:
• Put on PPE
• Contain and absorb spill with paper towels
• Dispose of the paper towels
• Add approved disinfectant to the spill site
• Dispose of used supplies in general waste container
• Remove gloves and perform hand hygiene
• Large spills will be contained by the department with a
barrier pad and then disinfected by Environmental
Services. See Blood and Body Fluid Spill policy IC 134
on the KCC Policy Web Site.
How is KCC keeping you safe?
• By evaluating and implementing safer sharps devices.
• The Infection Control Practitioners and the nurse
educators meet regularly with the Safer Sharps
committee at Harper Hospital . This group
• Investigates new, safer sharps devices
• Coordinate new product trials
• Develop safe work practices for work settings
• Trains staff about sharps safety
• Monitor injury data after implementation of new devices
Call 576-8083 if you have any concerns about sharps or know of new
products we may want to look at.
Common Causes of Sharps
and Splash Exposure
• Staff not activating safety device
• Sudden patient movement
• Unnecessary manipulation of sharp device by hand
• Improper disposal into sharps container
• Mislaid sharp in environment such as bed, table,
trash, etc.
• Performing procedure too quickly
• Not wearing appropriate PPE during procedures
Always remember to wear mask and goggles or face
shield when an aerosol or splash is likely.
• Passing sharps to others
Bloodborne Pathogen Standard
Safe Sharps Disposal
• Locate sharps container close to point of use.
• After use, immediately activate safety feature,
if appropriate, then dispose sharp into an
approved puncture-resistant container.
• NEVER leave sharps for someone else to
clean up.
• Observe container opening. If sharps are
protruding, do not put your hands near it.
• NEVER overfill sharps containers.
• Replace sharps containers when they are ¾
full.
• Lock sharps containers before moving or
replacing them.
Bloodborne Pathogen Standard
Safety Devices
• Safety devices available for staff to use:
• Needleless IV system
• Safety butterfly phlebotomy device
• Safety lancets
• Safety blood gas syringe
• Safety IV catheter
• Safety syringe and needle
• Safety huber needle
• Blood transfer safety device
• Hemodialysis safety fistulas
• Safety scalpels utilized outside the
operating room
REMEMBER: Safety devices
will protect you only if you
activate the safety feature
after use.
• Evaluations and implementation of safer devices is an ongoing
KCC commitment.
Waste disposal
• Regulated Medical Waste is waste
that may contain disease-causing
organisms.
• Michigan law requires health care
waste to be segregated properly. Please
do not use these red containers for your
regular trash.
• Regulated Medical Waste must be
placed into closeable, leak-proof
containers that are lined with a red bag
and labeled with the biohazard symbol.
Bloodborne Pathogen Standard
What is Regulated Medical Waste?
Regulated Medical Waste : Throw these away in the Red Biohazard container
• Tissue and other pathology lab waste
• Lab specimens (not urine)
• Bulk blood and body fluids
• Blood and blood-product bags
• Dressings soaked with blood
• PPE soaked with blood
General Waste: Throw these away in the regular trash
• Urinary catheters and collection bags
• Empty drainage containers such as
suction canisters
• Dressings stained with blood
• PPE stained with blood
• Diapers
• Sanitary napkins
Tuberculosis (TB) Control Plan
What is TB?
TB is a contagious disease caused by the bacteria
named Mycobacterium tuberculosis. TB infects
primarily the lungs. Signs and symptoms of TB
include:
• Fever
• Weight loss
• Night sweats
• Fatigue, weakness
• Prolonged cough (cough > 3 weeks) and/or blood-tinged sputum
TB is spread when infected people cough or sneeze
the bacteria into the air and others inhale the bacteria.
Tuberculosis (TB) Control Plan
Protecting Health Care Workers
MI/OSHA requires that all health care facilities have a TB
Control Plan (refer to policy IC 124) to protect health care
workers from exposure to TB while on the job.
Proper AFB Isolation is a key part of the TB Control Plan.
ALWAYS follow AFB/Airborne Isolation policy IC 101 on the
KCC policy web site.
• NEVER enter an AFB Isolation room if you have not been fit
tested for the N-95 respirator. Staff that have been trained on
the use of the PAPR may use it to enter AFB isolation rooms.
• ALWAYS fit-check your N-95 respirator before entering an AFB
Isolation room.
Infection Control &
Occupational Health Services
• KCC manages exposures to infected persons by:
• Investigating exposure situations.
• Referring exposed employees to Occupational Health
Services (OHS).
• Your manager or supervisor will allow immediate release
of exposed employee to OHS for follow-up.
• Providing prophylaxis to prevent infection when
appropriate (refer to policy CLN 209 Post Exposure
Prophylaxis). This would also include the availability of
free Hepatitis B vaccination through OHS.
Providing follow up Management after a
Blood or body fluid exposure
•Clean the area with soap and water; flush eyes with
water.
•Notify your supervisor.
•IMMEDIATELY report to Occupational Health
Services for care. After hours report to DRH ED.
•Treatment options, if necessary will be discussed
with you.
•You and the source patient will be tested for Hepatitis
B, Hepatitis C and HIV, if indicated.
•You will be counseled about your risk of contracting
an infection with a bloodborne pathogen.
Multidrug Resistant OrganismsMDRO
MDRO’s are organisms, usually bacteria, that are
resistant to at least two classes of antibiotics,
but may be resistant to many antibiotics.
Treatment options for infections caused by
MDRO’s are often extremely limited, which
poses a safety risk to our patients.
MDRO infections increase length of stay, costs,
and mortality.
There is evidence that MDRO’s are carried from
one person to another on the hands of
healthcare workers.
MDRO’s
Some examples of MDRO’s are:
•Resistant Acinetobacter baumanii,
sometimes called ACBA
•KPC, a term used for certain
resistant Klebsiella pneumoniae, or
E. coli
•Multidrug resistant Pseudomonas
aeruginosa
Why all the fuss?
Because…
• Cancer patients are at greater risk of acquiring a
resistant organisms
• Cancer patients have indwelling devices like central
lines and foley catheters that make them more
vulnerable to all organisms
• Cancer patients tend to be on antibiotics for long
periods of time which causes the patient to be more
susceptible to these organisms
• Patients admitted from long term acute care centers
(LTAC) or nursing homes are at higher risk of acquiring
these organisms too
• When a patient is admitted from a nursing home or
LTAC a pathogen screen is ordered to make sure the
patient is not colonized with the highly infectious KPC
What else do you I need to know?
• Healthcare associated infections
(HAI’s) are the 5th leading cause of
death in U.S.
• HAI's are the most common
complications affecting
hospitalized patients
• There are simple steps that can be
followed to prevent HAI’s
Interventions
• Maintain isolation precautions as
recommended by Infection Control staff.
(Policy #101)
• Patients will be in Contact Precautions for the
duration of their illness.
• Patients with a KPC may be in isolation for up
to one year. So every time the patient is
readmitted to the hospital they will be placed in
Contact Precautions. Admitting staff and the
Infection Control staff keep an updated list of
all patients with KPC isolates.
What else can I do?
• Practice hand hygiene at every opportunity.
Unclean hands will promote the spread of
infectious organisms.
• Teach your patient to ask healthcare workers
(HCW’s) to clean their hands before they are
being examined or any time a HCW comes in
contact with them. PERFORM HAND HYGIENE
AS YOU ENTER THE ROOM.
• Educate your patient and their family on
proper precautions.
Disinfection in the Patient
Care Environment
• Always use approved disinfectant
• Always follow manufacturers’ guidelines
for disinfecting patient care equipment
• Always follow manufacturers’ required
contact times for disinfection-Contact time
indicates how long the surface must remain wet with disinfectant.
References:
• CDC, Guidelines for Disinfection and Sterilization in Healthcare
Facilities, 2008.
• CDC, Guidelines for Environmental Infection Control in Healthcare
Facilities, 2003.
• CDC, Guidelines for Hand Hygiene in Healthcare Settings, 2002.
• CDC, Guidelines for Isolation Precautions in Healthcare Settings,
2007.
• CDC, Guidelines for Preventing the Transmission of Mycobacterium
tuberculosis in Healthcare Facilities, 2005.
• CDC, Management of Multidrug Resistant Organisms in Healthcare
Setting, 2006.
• OSHA Bloodborne Pathogen Standards, 1910.1030, April 2001.
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