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Infection control for house
officers at the Omaha VA
Medical Center
Infection Control Practitioner
Pager 13-485 ext. 3319
MRSA Prevention Coordinator
Pager 13-323 ext. 4226
Hospital Epidemiologist
Ext. 5606
Omaha VA uses
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Standard and Transmission-Based
Precautions
Based on current guideline of the
Centers for Disease Control and
Prevention (CDC)
Standard Precautions
Protective barriers for ALL potential
contact with:
 All body fluids
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Blood
All secretions
All excretions (except sweat)
Mucus membranes
Non intact skin
Follow CDC 2002 hand
hygiene guideline
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No artificial nails, no chipped nail polish
Natural nail no longer than 0.25 inch
Wash hands with antimicrobial soap and
water if visibly soiled or after caring for
Clostridium difficile patients
Hand hygiene before and after patient
contact, including after removal of
gloves. Generally use alcohol handrub.
Personal Protective Equipment
(PPE)
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What is available for your use?
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Surgical masks
N-95 respirators (must be fit tested)
Gloves
Gowns
Eye protection
Alcohol
dispensers
often near
sinks & in
every
patient
room
Purell
alcohol
handrub
Transmission based Precautions
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Contact
Enhanced contact
Airborne
Droplet
Contact precautions
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Examples of Diseases
in this category:
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Drug-resistant
organisms (eg MRSA,
VRE)
SARS (also needs
airborne precautions,
eye protection)
Contact precautions includes
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Gown
Gloves
Hand hygiene
Dedicated equipment in the room
(including stethoscope, blood pressure
cuff)
Terminally clean room on discharge of
patient from the room
Isolation
Cart
Find a
gown in
an
isolation
cart
Remove
gown from
cart
Put on
the
gown,
fastening it
in back
Remove it after
seeing the
patient, turning
it inside-out
Place
the used
gown in
the trash
can
Enhanced contact precautions

Examples of
diseases in this
category:
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Clostridium
difficile
Norovirus
Actions: Enhanced contact
precautions
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Disinfect hands with antimicrobial
soap and water (rather than alcohol
gel)
Housekeeping staff use special
cleaning methods involving bleach
Airborne precautions
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Fit-tested N95
mask
Room with
negative air flow
Door closed
Airborne Precautions
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Examples of Diseases in this category:
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Tuberculosis
Varicella
Measles
SARS (also needs contact precautions and eye
protection)
Common questions on
airborne precautions: PPD
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Q. “My patient has a positive tuberculin
skin test (PPD test). Is this an
indication for airborne precautions?”
A. No, only patients suspected of
having active tuberculosis or proven to
have active tuberculosis need airborne
precautions.
Common questions on
airborne precautions: AFB
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Q. “My patient has a laboratory test
showing acid-fast bacilli (AFB) in the
sputum. Does this mean the patient has
tuberculosis?”
A. Not always. So-called atypical
mycobacteria that are not causing
tuberculosis can result in a lab report of
AFB in the sputum and isolation is not
indicated.
Rooms for airborne
precautions
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8 rooms available (includes 2 each in
Emergency, ICU, 6E, and 7E)
Specially equipped to maintain negative
flow
Reduces risk of pathogens drifting in air
currents from infected patient to other
patient rooms
Check alarm
outside
negative air
flow room
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Alarm should be
off with the door
closed
If not, contact
nurse
Droplet precautions
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Regular mask
Door may be
open or closed
for known or
suspected
Droplet Precautions
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Examples of disease in this category:
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Influenza
Pertussis
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Neisseria meningitidis
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Employee Health Issues
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Blood and body fluid exposure
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Immediately notify supervisor
Immediately call Occupational Health (5825)
during day hours or go to Urgent Care area after
hours
Do so immediately since post exposure
prophylaxis for HIV should be started, ideally
within an hour
FREE influenza vaccine provided for all
Tuberculin skin test annually at host
institution: CUMC or UNMC
Hepatitis B vaccine at host institution
All blood and body fluid
exposures are important
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Sharps Injuries
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Needle stick
Scalpel cut
Pipette break
Any injury that breaks the skin in the
presence of body fluids
Mucous membrane exposure
If a Blood Exposure Occurs:
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Clean the exposed area with soap and water.
For exposed mucous membranes, flush with
water. DO NOT use bleach or surface
disinfectants.
Report incident to supervisor immediately.
Report to Employee Health or Urgent Care
area as previously described.
Fill out an Incident Report via the electronic
reporting system - ASISTS
Follow-up of blood or body
fluid exposure
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Follow-up after initial visit to Urgent
Care
Occupational health nurse practitioner
Call 3209 to schedule visit
Safety needles can prevent
some blood exposures
Be sure to use these devices
correctly.
Sharps disposal
containers in each
room
Needle/Sharps Disposal
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DO activate safety device
DO locate the disposal container closest
to your work area
DO look to be sure that the opening of
the box is clear of sharps
Do NOT recap by hand
Do NOT bend, clip or break
Check to be sure disposal box is
not overfilled
Aims of OSHA bloodborne
pathogens standard
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To protect employees from
 Occupational exposure to
blood or other potentially
infectious materials
 Transmission of bloodborne
diseases
Bloodborne diseases of
concern
Human immunodeficiency virus
(HIV)
 Hepatitis B (HBV)
 Hepatitis C (HCV)
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Transmission in the workplace
occurs by:
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Parenteral Exposure
Needle stick, blood transmission
 Mucous Membrane Exposure
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Mouth, eyes
In the community, they may be transmitted
through IV drug use and from mother to
baby.
Human Immunodeficiency
Virus (HIV)
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Virus that causes AIDS
Attacks the immune system
May be no obvious signs of infection
Can transmit virus before illness known
Hepatitis B (HBV)
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Symptoms if liver damage develops:
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Poor appetite
Fatigue
Abdominal discomfort
Jaundice
125,000 people infected yearly in US
5-10% become chronic carriers
5-10% of those advance to liver disease
Hepatitis B Vaccine is available to prevent
disease
Hepatitis C (HCV)
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Symptoms same as Hepatitis B
Antibodies may not provide immunity
Up to 85% will develop chronic hepatitis
3.9 million chronically infected in US
Sexual transmission uncertain
Respiratory etiquette to
prevent transmission
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Cover your cough or sneeze
Deposit tissues directly into the trash
Clean hands after use of tissues or
cough/sneeze
Offer tissues or mask to others with
coughing or sneezing
Remind them to clean hands
Infection Control is Everyone’s
Responsibility!