Infection Prevention Its Everyones Responsibility ANNUAL INSERVICE and

“Infection Prevention” It’s Everyone’s Responsibility! ANNUAL INSERVICE and New Employee Orientation

INFECTION PREVENTION • What is the most important thing all staff can do to help prevent the spread of infection? • Hand hygiene!

HAND HYGIENE • • Most important defense against spreading infection Wash hands a minimum of 15 -20 sec with soap & warm water, using friction, getting in-between fingers and under nails. You can use alcohol gels/foams if hands are not visibly soiled; apply before entering a patient’s room or care area Perform hand hygiene before and after patient care, and Between procedures even when on the same patient, and Perform hand hygiene when changing bandage dressings on a patient. Remove soiled bandages, then perform hand hygiene, and apply clean gloves before applying fresh bandages Remove gloves when task is completed, and perform hand hygiene upon exiting the room

MICROORGANISMS • A microorganism is needed in order for an infection to occur. All of the following organisms have the potential of causing an infection:

• • • Bacteria Viruses Fungi Parasites All can cause infection

Who can get infections? • Anyone! • Most at risk: – Infants, and the very young – Elderly – Seriously Ill – Long-term care residents – Those who are in poor physical/nutritional health

How are infections spread? • • • Organism needed Carrier, i. e. can be a healthcare worker, patient, visitor, etc. Organism needs a way out, i. e. sneezing, coughing, talking, touching via contaminated hands Organism travels through respiratory droplets via air currents, via contaminated hands or contaminated environmental surfaces Organism needs a way in to the body, i. e. breathing, swallowing, break in the skin; mucosal membranes, i. e. eyes, nose, mouth The above chain of events all need to be present in order for an infection to take place. If this chain is broken and even one event doesn’t occur, an infection cannot take place. Standard Precautions are used to break that chain of infection! Whether an Infection occurs depends partially on the immune system

What precautions are used for everyone?

Standard Precautions • You don’t necessarily know who is infectious and who isn’t! • Standard Precautions are used for everyone! • Assess the situation you are in to determine use of PPE (personal protective equipment) as listed below: – Hand hygiene – Gloves – Masks – Goggles – Gowns

Respiratory hygiene/Cough etiquette • • • Another component of Standard Precautions Cough or sneeze into tissue; dispose of in waste basket Cough or sneeze into elbow, not hands! Wear mask or use a tissue to cover your cough or sneeze Wash hands or use alcohol gel Respiratory hygiene/cough etiquette is really stressed during influenza season

Safe Injection Practices • • • Another component of Standard Precautions Use 1 needle, 1 patient, each and every time Use single-dose vials whenever possible Do NOT re-cap needles! If using multi-dose vials, use a clean syringe, cannula, and needle every time!

Transmission-based precautions • Contact • Droplet • Airborne

DROPLET PRECAUTIONS Use in addition to Standard Precautions Organisms are spread through large respiratory droplets The organisms travel approx. 3 -6 ft. via air currents Always wear a mask! Isolate the patient. Place patient in a room by themselves or place patient with another patient who has the same type of infection. This is called “cohorting. ” • Place Droplet isolation sign on wall outside the patient’s room • If patients have RSV, influenza, as two examples, place in Droplet isolation. • • •

CONTACT PRECAUTIONS • • • Use in addition to Standard Precautions Isolate the patient in a single room or cohort with another patient who has the same type of infection Place Contact isolation sign on wall outside the patient’s room Use PPE (personal protective equipment) as situation dictates Place patient in Contact isolation if they have infections such as MRSA, VRE, C. DIFF, Rotavirus, RSV; Norovirus, draining wounds, cellulitis, uncontrolled diarrhea, as examples.

AIRBORNE PRECAUTIONS • • • Use in addition to Standard Precautions Set up a negative pressure room; use a HEPA UNIT, and roll into designated patient room ER is set up for negative pressure Employees need to wear N 95 masks; employees need to pass annual fit-testing Employees who have not been fit-tested or cannot pass the fit test, should not enter the patient care area If patient is transported out of the room, have the patient put on a regular mask or cover the mouth with a tissue Patient is placed in a Single room Door is to remain closed at all times AIRBORNE Isolation Sign is placed on wall outside the patient’s room Organisms are spread by small resp. droplets that remain suspended in the air and can travel for a long distance. Tuberculosis, chickenpox, measles are examples of infections where patients need to be placed in Airborne Isolation

Personal Protective Equipment (PPE) DON • Gown (fasten at neck and waist) • Mask (secure ties; fit wire piece to nose) • Goggles (adjust to fit) • Gloves (cover wrist of gown) REMOVE • Gloves • Goggles • Gown • Mask (grasp ties, not mask) • Perform hand hygiene

BLOODBORNE PATHOGENS • How do we protect ourselves from bloodborne pathogens? • Get hepatitis B vaccine. The hepatitis B vaccine is the BEST way to protect yourself. • In addition, use Standard Precautions! • This is available to ALL employees free of charge. Healthcare workers should all get the hepatitis B vaccine, especially those who work in direct patient care.

BLOODBORNE PATHOGENS • • • Bloodborne pathogens are spread through blood, body secretions, body fluids (bacteria, fungus, virus, parasites) Organisms enter the body through cuts, abrasions, mucous membranes such as the eyes, ears and nose. Use sharps containers for all sharps such as needles, broken glass, scalpels, lancets. Discard the sharps container when it is ¾ full. Do not overfill! Close the cover and lock it! Dispose of appropriately. This is biohazard waste and will be incinerated. Pick up broken glass by mechanical means such as a broom and dust pan Bloodborne Pathogen Policy must be made available w/in 15 days of the employees’ request New device evaluations must be performed by any staff who will use the device, not just the supervisors of that department.

Exposure incident. . who do you contact?

EXPOSURE INCIDENTS • If you have a needle stick, blood or body fluid exposure, perform first aid immediately by washing with soap and water, then flushing with copious amounts of water, then: • Contact risk manager, Paula Brown or Mel Johnson, or your immediate supervisor • Complete an incident report on the Healthcare Safety Portal Zone system • Get a medical exam by the Physician you selected • Determine if there is documented evidence that you responded to the hepatitis B vaccine; test source and employee for HIV, Hepatitis B, and hepatitis C per recommended guidelines.

Where are blood spill kits located?

BLOOD SPILL KITS • • Clinic-back room GSH-utility room across from nurses’ station Hospital-Lab & Housekeeping depts. Wellness Center – Contents: • Instructions for use • Absorbent material • Gloves • Goggles, mask • Biohazard bags • Disinfectant • Hand gel • Check expiration dates on contents! Replace the expired supply!

ENVIRONMENTAL CLEANING • Daily disinfect frequently touched areas. These are called “high touch” items: – – – – – Light switches Call lights Bedside rails Hallway rails Phones Toilet areas Bedside tables IV poles Divider curtains-replace upon patient discharge or when isolation has been discontinued

Where do you find instructions for kill time, how to use, etc for disinfectant products? • The Manufacturer’s Label! • • • Kill time: This is the time that it takes to kill the organisms that the manufacturer claims it will kill. The surface must remain wet for that amount of time, or the surface must be re-wet. Read the manufacturer’s label to determine if the product can be used as a concentrate, or if it needs to be diluted. Follow the instructions exactly! More is not better!! To effectively kill the organism, follow the instructions for each product. They are not all the same!

DISINFECTANTS • • • Disinfectant must be EPA-registered The disinfectant must be in a bottle that is labeled with the manufacturer’s label that is specific for that product. Bleach is the disinfectant that should be used for organisms such as the following as they may contain spores, and the EPA-registered disinfectants that are used throughout the facility are not effective against the spores: – C. difficile; Norovirus; Rotavirus – A 1: 10 dilution must be made fresh daily or you can use wipes that have been premoistened with a 1: 10 bleach solution that are very effective and convenient to use – C. diff, Norovirus, Rotavirus: Wash hands with soap & water! Alcohol gels or foams are not effective against the spores which these organisms can potentially have.

GLUCOMETER DISINFECTION • • • Glucometers must be cleaned after every use! Follow the manufacturer’s instructions on EACH glucometer. If there are no cleaning instructions for that glucometer, it must be used for one patient only…not used on multiple patients! Alcohol is NOT acceptable for disinfecting glucometers! It does not provide sustained antimicrobial activity. Use an EPA-registered disinfectant. The PDI Super Sani-Cloth wipes are an approved EPA-registered disinfectant, and can be used to clean and disinfect the glucometers.

KEYBOARD DISINFECTION • Keyboards-daily disinfection is recommended, and when visibly soiled • Disinfectant-alcohol removes bacteria but doesn’t provide sustained activity against organisms • Quaternary ammoniums-EPA-registered, PDI Sani-Cloth Wipes: provides sustained activity against even VRE, Pseudomonas up to 48 hours and is a good way to disinfect the keyboards. • Keyboard covers-disinfect same way with a disinfectant that is registered with the EPA. • Damage-Disinfectants do not damage keyboards

IMMUNIZATIONS These are the following immunizations that are recommended for healthcare workers: • • Hepatitis B vaccine Influenza vaccine Varicella vaccine MMR Tdap Childhood vaccine records Turn your vaccination records into HR

TUBERCULIN SKIN TEST (TST) • • A 2 -step TST is done at hire if there is no documented evidence of one being done w/in the last 12 months prior to hire. If you have a Positive TST, do the following: – See a Provider – Get a baseline chest x-ray – If it is determined that you have “Latent “ TB; you are NOT infectious, you are NOT ill or symptomatic, and you can still work, but treatment IS recommended as 1: 5 will develop TB in the future. This is to protect you! – If it is determined that you have “Active” TB, you ARE infectious, you ARE symptomatic, and you will need to be treated. You also will not be able to work until it has been determined by your Provider and through laboratory testing that you are no longer infectious. – Once you have a positive TST, you do not get tested again nor do you get repeat chest x-rays. Instead, complete a TB questionnaire annually which will help determine if you have become symptomatic or not.

TUBERCULOSIS • Contagious disease-bacteria is spread from person to person and travels on air currents via small respiratory droplets • Remains suspended for long time • Usually affects lungs • Can also affect, – Brain – Kidneys – Spine – Wounds

LATENT TB VS ACTIVE TB • Latent – Asymptomatic – Not contagious – Can work – Need 9 months INH preventative treatment • Active – Symptomatic – Contagious – Cannot work until you are determined to be noninfectious. – Need treatment

SUSCEPTIBILITY • The following have a higher incidence of contracting TB, – Medically underserved populations – Foreign-born – >/= 65 – Current or past prisoners – Homeless – Alcoholics – IV drug users, substance abusers

SIGNS & SYMPTOMS of TB • • • Bad cough > 3 weeks Coughing up blood, bloody sputum Pain in chest Fatigue Unexplained weight loss Loss of appetite Chills Fever Night sweats

What is your BEST line of defense against influenza? • Influenza vaccine!!! • EVERYONE, regardless of your department, should be vaccinated against influenza on an ANNUAL basis. • Virus strains change from year to year. • It is facility policy that you sign a declination form if you refuse the vaccine.

INFLUENZA • • • Influenza is a viral respiratory illness It is a reportable condition to the State Health Department If you have not been vaccinated, you must wear a mask during your entire shift throughout the entire influenza season. You are not allowed to work if you have influenza Influenza is very contagious – Symptoms • Generally comes on quickly • Cough • Sore throat • Runny nose • Body aches • Fever (generally > 100. 4 degrees F)

PERSONNEL • Employees are not allowed to work if, – Fever > 100. 4 degrees F (you must be 24 hrs without a fever AND without the use of fever-reducing meds) – Vomiting, diarrhea (stay home until you are asymptomatic) – Notify immediate Supervisor if you are ill – Managers-complete Infection Prevention form on Healthcare Safety Portal Zone System

NOROVIRUS • Contact Precautions-continue for a minimum of 48 hours after resolution of symptoms (employees need to stay home) • Suspend group activities, eating in dining room, etc. • Wash hands with soap & water. Alcohol gels and foams are not effective! • Put on gloves & gown prior to room entry • Cleaning and disinfecting: Use a 1: 10 BLEACH solution • Pre-diluted 1: 10 bleach wipes are effective and convenient!

What is a healthcare-associated infection (HAI)? • It is an infection that a patient/resident has acquired 48 -72 hours AFTER admission to a healthcare facility. They did not come into the facility with that infection and, – They are preventable! – Use Standard Precautions and be compliant with hand hygiene to help prevent transmission of infections.

REMEMBER!!! • Comply with hand hygiene BEFORE and AFTER ENTERING/LEAVING PATIENT CARE AREA! • Infection Prevention is EVERYONES’ Business!