RHJ INFECTION CONTROL Program Infection Control at the

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RHJ INFECTION CONTROL Program

RHJ INFECTION CONTROL Program

Infection Control at the VAMC About the Infection Control Program: The Infection Control Program

Infection Control at the VAMC About the Infection Control Program: The Infection Control Program is a Center wide discipline that develops effective measures to prevent, identify, and control infections acquired in the Medical Center or brought into the Medical Center from the community.

The Infection Control Team Dr. Preston Church -Chief of Infection Control/Infectious Diseases Dr. Heather

The Infection Control Team Dr. Preston Church -Chief of Infection Control/Infectious Diseases Dr. Heather Hughes, MPH -Hospital Epidemiologist & ID Physician Infection Control Nurse Monica Mc. Crackin, RN MSN CIC- MDRO Prevention Coordinator Kate Pleasants, Pharm. D-Antimicrobial Stewardship Pharmacist Cynthia Follis-Program Support Assistant Last but not least YOU !!! Infection Prevention is Everybody’s Job. Protect our patients, protect your family, protect yourself.

IC Program Annual Plan (Available on the T-drive►Infection Control Guideline Folder►Annual IC Program Plan

IC Program Annual Plan (Available on the T-drive►Infection Control Guideline Folder►Annual IC Program Plan & Review Folder)

Activities of Infection Control Identifying/monitoring/reporting of infections Monitoring for compliance with IC policies &

Activities of Infection Control Identifying/monitoring/reporting of infections Monitoring for compliance with IC policies & guidelines Research of national IC standards and evidenced-based practices to write, revise, and/or review facility policies and guidelines Trending/analysis of data to find areas in need of improvement. Plan and implement activities to improve. Evaluate products and equipment to ensure it meets IC standards (i. e. disinfection, reduces needle stick injuries, etc. ) Risk assessments to identify vulnerabilities in the hospital related to potential infection control & prevention issues Construction and Renovation activities Environment of care Staff/patient education and consultation

Hand Hygiene The single, most effective means of reducing healthcare-associated infections. Alcohol hand sanitizer

Hand Hygiene The single, most effective means of reducing healthcare-associated infections. Alcohol hand sanitizer is best. Effects last longer, it’s quicker, and it’s better for skin.

Hand Hygiene, cont’d Washing with soap and water is recommended 1) when hands are

Hand Hygiene, cont’d Washing with soap and water is recommended 1) when hands are visibly soiled 2) when caring for a patient with any diarrheal type illness such as clostridium difficile (c. dif) due to spores that may not be killed by alcohol hand gel. 3) after using the restroom and after eating Wash hands for at least 15 -20 seconds with soap and water and be sure to cover all surfaces of the hands. Use a paper towel to turn off the faucet.

 • Avoid artificial fingernails and long nails for direct care providers • If

• Avoid artificial fingernails and long nails for direct care providers • If you see someone not washing their hands, you should politely remind them to wash their hands. • Emphasize a culture where hand hygiene is the norm and failure to perform hand hygiene is unacceptable

Standard Precautions Formerly know as universal precautions Treat every person as potentially infectious Includes

Standard Precautions Formerly know as universal precautions Treat every person as potentially infectious Includes the use of ◦ Good hand washing ◦ Use of gloves, gowns and other personal protective equipment (PPE) when exposure to body fluids is possible ◦ Knowledge and familiarity with equipment and it’s uses

Transmission-Based Precautions • Contact • Droplet • Airborne USED IN ADDITION TO STANDARD PRECAUTIONS

Transmission-Based Precautions • Contact • Droplet • Airborne USED IN ADDITION TO STANDARD PRECAUTIONS

Contact Isolation Used for any illness spread by direct contact with patients or indirect

Contact Isolation Used for any illness spread by direct contact with patients or indirect contact with contaminated surfaces in the environment. Also used when infectious body fluids cannot be contained (i. e. wound drainage, urine, drains, stool, etc. ) Most common reason for contact isolation is colonization or infection with multidrug-resistant organisms (MDROs)

MDROs Organisms that are resistant to one or more classes of antimicrobial agents meaning

MDROs Organisms that are resistant to one or more classes of antimicrobial agents meaning infections are harder to treat. Can survive on environmental surfaces for long periods of time Includes Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), and some gram negative bacteria (e. g. Klebsiella pneumoniae, Pseudomonas, e. Coli). Patients colonized or infected with an MDRO require contact isolation when admitted to the hospital. Standard precautions are used for outpatients with an emphasis on environmental cleaning between patients. Infection Control Guideline #88 further addresses

Risk Factors for MDROs Chronic illness, immunocompromised, frequent hospitalizations Long term antibiotic use Residents

Risk Factors for MDROs Chronic illness, immunocompromised, frequent hospitalizations Long term antibiotic use Residents of nursing homes Exposure to persons colonized/infected with MDROs Recent surgery Presence of Indwelling medical devices

Contact Isolation Precautions Private room when available but cohorting may be necessary PPE on

Contact Isolation Precautions Private room when available but cohorting may be necessary PPE on entrance to room and removal before exiting. PPE should not be worn in the halls. Equipment should be disposable but if that is not possible, it should be cleaned with Cavi. Wipes® or other approved disinfectant or sent to SPS for cleaning PPE = Personal Protective Equipment

Contact Isolation cabinet will be located on the door All PPE should be available

Contact Isolation cabinet will be located on the door All PPE should be available in the cabinet including Cavi Wipes for equipment cleaning Patients identified by green contact precautions sign

Droplet Precautions Used for patients with known or suspected agents transmitted by large droplet

Droplet Precautions Used for patients with known or suspected agents transmitted by large droplet method (>5 microns) for example. influenza, meningitis, meningococcal pneumonia, etc Wear a surgical mask when entering the room Identified by an orange sign outside the patient’s room.

Airborne Isolation Used for patients with suspected or known conditions that are transmitted via

Airborne Isolation Used for patients with suspected or known conditions that are transmitted via airborne route such as pulmonary tuberculosis • Patient must be in a negative pressure room: 3 BN 4 BN/4 BS MICU SICU • Identified by a pink sign outside the patient’s room.

Tuberculosis �Most common reason for airborne isolation. �If a patient is being ruled out

Tuberculosis �Most common reason for airborne isolation. �If a patient is being ruled out for or confirmed to have active Tuberculosis, they must be on airborne isolation. �Always determine if your patient has signs or symptoms of Tuberculosis and place a surgical mask on patient until they can be properly placed in a negative pressure room. �Symptoms: cough, weakness,

Airborne Isolation, cont’d N 95 respirator or PAPR must be worn by all staff

Airborne Isolation, cont’d N 95 respirator or PAPR must be worn by all staff when entering the room. Annual fit test is required. Only trained, fit-tested staff can wear a respirator. Patients/visitors/volunteers surgical mask require a

Transport of Isolation Patients � PPE used to prepare patient for transport but not

Transport of Isolation Patients � PPE used to prepare patient for transport but not transporting the patient. Patient will need a surgical mask in place if he/she is droplet or airborne isolation. � Clean stretcher or wheelchair, with clean pajamas, and a clean sheet covering patient to minimize bacterial contamination � Educated and assisted patients with hand hygiene prior to exiting their room � All drainage should be contained (i. e. urine, wounds) � Notify the receiving area of patient’s isolation status � ALL PPE MUST BE TAKEN OFF BEFORE LEAVING THE AREA

JC National Patient Safety Goals Implement policies/practices to minimize the risk of healthcareassociated infections

JC National Patient Safety Goals Implement policies/practices to minimize the risk of healthcareassociated infections including those with MDROs, those associated with surgical procedures, and those associated with medical devices. Hand hygiene is the most important thing we can do to minimize the risk of infection to our patients Ensure medical devices such as indwelling urinary catheters and central lines are only inserted when medically necessary and removed as soon as possible. When devices are necessary, an order is required indicating the need for the device and the continued need should be assessed daily Follow insertion bundle checklists which include hand hygiene, aseptic technique, and proper skin prep. Ensure proper maintenance of devices and patient education Infection Control Guidelines to address urinary catheters, vascular devices, dressing changes, skin prep, OR, etc. can be found on the T-drive in the Infection Control Guidelines Folder

Antimicrobial Stewardship “Coordinated effort to optimize antimicrobial usage with the goal of improving patient

Antimicrobial Stewardship “Coordinated effort to optimize antimicrobial usage with the goal of improving patient outcomes, reducing antimicrobial resistance, and decreasing health care costs. ” Am J Infect Control. 2006; 34(1): S 55 – 63.

Antimicrobial Stewardship at RHJ VAMC Team led by Infectious Disease physician and Infectious Disease

Antimicrobial Stewardship at RHJ VAMC Team led by Infectious Disease physician and Infectious Disease Pharmacist Annual Antibiogram Guidelines for Providers ◦ Antimicrobial Duration of Therapy ◦ UTI Treatment ◦ Surgical Site Prophylaxis Dosing ◦ Clostridium difficile Treatment Microbiology Laboratory Technology Feedback, Drug Restrictions, Evaluation, Education

Bloodborne Pathogens Most common are Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and

Bloodborne Pathogens Most common are Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV) These pathogens can be spread by exposure to infected blood or body fluids All direct-health care providers should be vaccinated for Hepatitis B

Prevent Exposure to Bloodborne Pathogens �Use safe work practices (i. e. good handwashing, do

Prevent Exposure to Bloodborne Pathogens �Use safe work practices (i. e. good handwashing, do not recap needles, use PPE as needed when exposure to body fluids is anticipated, be familiar with equipment and safety devices, do not rush through procedures, etc. ) �Keep breaks in the skin covered as skin is a defense against pathogens �Don’t eat or drink in patient care areas �Don’t apply lip balm, cosmetics, or contact lenses in patient care areas

If exposure happens Wash the area immediately Report the exposure to your supervisor right

If exposure happens Wash the area immediately Report the exposure to your supervisor right away Follow up with Occupational Health or the Emergency Department after hours Work with your supervisor to complete accident report forms Call the Infection Control Office with any questions or concerns: x 7469 or

Proper Waste Disposal Biohazard waste is any waste containing infectious materials or potentially infectious

Proper Waste Disposal Biohazard waste is any waste containing infectious materials or potentially infectious substances such as blood. Of special concern are sharps waste (i. e. needles, blades, glass pipettes) which may cause injury during handling All biohazard waste including sharps must be properly disposed in approved containers. Sharps containers are

What waste goes where? Sharps containers-Needles, lancets, surgical staples, rods, pins, intravenous catheters, protected

What waste goes where? Sharps containers-Needles, lancets, surgical staples, rods, pins, intravenous catheters, protected sharps, syringes with needles, scalpels, scissors, guide wires, etc. Also, lab/medical glass such as slides, ampules, test tubes, pipettes, specimen vials, capillary tubes, broken glass. Red Bag Container-blood bags and tubing, dialysis tubing, IV tubing with visible blood, foley catheters/bags with blood, human tissue, used Pleurovacs, Hemovacs, suction canisters, Wound vac canisters, culture

Items Not Considered Biohazard Waste � Urine unless it is visibly bloody � Gauzes

Items Not Considered Biohazard Waste � Urine unless it is visibly bloody � Gauzes or dressings, unless saturated with blood or body fluids that can be released when compressed. � Used sanitary napkins or tampons, diapers without blood � PPE used in isolation rooms � IV tubing and bags that do not have blood or sharps � Ventilator tubing � Emptied containers (urine/stool cups, bedpans, urinals, emesis basins, unbroken glass, etc. ) All of these items are considered regular trash!

Disposal Cont. Know where your sharps containers are located. Never overfill the containers as

Disposal Cont. Know where your sharps containers are located. Never overfill the containers as this may result in injury. Notify EMS if full. Know where your red bags for biohazard waste are located Liquid human waste (blood, urine, feces, etc. ) should be disposed of in an approved sink or toilet using splash precautions

Other Information �Contact Infection Control for any questions you have concerning the isolation of

Other Information �Contact Infection Control for any questions you have concerning the isolation of patients �Contact Infectious Disease Department for any questions you have concerning the treatment of infection, especially those with MDROs. �Remember to communicate a patient’s isolation status �Work with EMS to keep your area clean �Don’t wear PPE in the hallway �Get Vaccinated �Cover your cough and sneezes and encourage others to do so �WASH YOUR HANDS!!!! Remind Others to Wash!

Guidelines & Policies �You are responsible for viewing and following policies and procedure guidelines

Guidelines & Policies �You are responsible for viewing and following policies and procedure guidelines related to your area. Infection Control Guidelines can be found on: T-Drive. Infection Control

Review Questions: What do the letters PPE stand for? List three main types of

Review Questions: What do the letters PPE stand for? List three main types of PPE. List the main type of precaution we use for every patient. List the three types of Transmission-based Precautions. Who can wear a surgical Mask? Who can wear a Respirator(N 95 or PAPR) When should you use soap & water instead of alcohol to clean your hands? List the first three things you should do if you have a bloodborne exposure incidents.

Continued: What do the letters MDRO stand for? What type of patient would you

Continued: What do the letters MDRO stand for? What type of patient would you put in Airborne negative pressure room? When should a sharps container be changed? All PPE should be removed before moving to another area of the medical center. True or False What is the purpose of wearing paper shoe covers? Who should you call when you have questions about infection issues?

Infection Control Resources Monica Mc. Crackin, MSN RN CIC Infection Control Nurse 843 -789

Infection Control Resources Monica Mc. Crackin, MSN RN CIC Infection Control Nurse 843 -789 -7649 or ext. 7649 monica. mccrackin@va. gov The Infection Control Department is located in Room BB 225 on the 2 nd floor behind Dialysis. Dr. Preston Church Chief of Infection Control/Infectious Diseases 843 -789 -7714 preston. church@va. gov The extension to the IC Office is x 7397 Dr. Heather Hughes, MPH Hospital Epidemiologist 843 -789 -7397 heather. hughes@va. gov The Infectious Disease Clinics are in the Specialty Clinic on the first floor. x 7578 for scheduling or x 7043 to contact the nurse for ID clinic. Kate Pleasants, Pharm. D Antimicrobial Stewardship Pharmacist 843 -789 -7706 katherine. pleasants@va. gov