Infection Prevention and Control in the Workplace

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Infection Prevention and Control in the Workplace

• Sue Sebazco RN, BS, CIC
• Infection Control/Employee Health Director
• Arlington, TX

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Objectives

• Discuss how infection is spread.
• Discuss infectious agents and diseases of
  interest in the workplace.
• Identify practices that prevent spread.

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The Spread of Infection

• Source
• Mode of Transmission
• Susceptible Host

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Source

• People
• Inanimate objects

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Mode of Transmission

• Contact
• Direct
• Indirect
• droplet
• Airborne
• Vehicle
• Vectorborne

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Susceptible Host

• Immunocompromised
• Cancer, elderly, diabetics, HIV positive
• Invasive procedures
• Surgical procedures, diagnostic procedures
• Instrumentation
• Urinary catheters, intravascular devices

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WHAT IS COLONIZATION?

• Colonization means that an organism is present
  and growing.

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WHAT IS INFECTION?

• Infection means that an organism is present and
  growing and an immune response is present.

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Basic Principles

• Microorganisms are capable of causing illness in
  humans
• Microorganisms harmful to humans can be
  transmitted by direct and indirect contact
• Illness caused by microorganisms can be prevented
  by interrupting the transmission of
  microorganisms from source to susceptible host

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Hand Hygiene

• A general term that applies to either
  handwashing, antiseptic handwash, antiseptic
  handrub, or surgical hand antisepsis
• Single most effective way to prevent spread of
  infections.

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Standard Precautions

• Recommended for use when caring for all
  individuals at all times
• Worker assesses task
• Worker determines work practices or personal
  protective equipment(PPE) needed to provide
  barrier and reduce the risk of infection
  transmission

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Respiratory HygieneCough Etiquette

• Offer a mask to a person who is coughing
• Instruct to cover cough and cough into a tissue
  (if unable to tolerate a mask)
• Discard the tissue immediately into a trash
  container
• Hand hygiene

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Droplet Precautions

• Use for patients who have pneumonia, influenza or
  flu-like illness, febrile respiratory disease
  (FRI), productive cough
• Private room, if available
• Wear procedure mask if within 3 feet of the
  patients oropharynx

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Contact Precautions

• Use for multi-drug resistant organisms (MDROs)
• Private Room
• Use gown and gloves when entering the pts room
  or zone
• Use dedicated equipment when at all possible

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Housekeeping

• Clean all spills immediately
• Do not pick up broken glass or sharps with hands
• Clean thoroughly between each person
• Keep work areas clean

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Methicillin-resistant Staphylococcus aureus (MRSA)

• Bacteria
• Staphylococcus aureus
• Resistant to Methicillin
• antibiotic commonly used to treat most Staph
  infections

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MRSA TRANSMISSION

• Enters healthcare facility though an infected or
  colonized pt or HCW
• Mainly transmitted via hands of workers

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MRSACOMMON CARRIER SITES

• Nares
• Pharynx
• Wounds
• Skin (axilla, perineum, hands, dermatitis)

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Healthcare-associated MRSA

• Associated with the immunocompromised,
  hospitalization, instrumentation, antibiotic
  therapy
• Usually resistant in vitro to multiple classes of
  antimicrobial agents

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Expected Targets
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Unexpected Target
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Why MRSA Awareness?

• Ricky Lannetti graduated from Father Judge in
  2000
• Ricky was a student-athlete at Lycoming College
• Ricky Lannetti died from MRSA

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Community-associated MRSA

• Persons who have not been recently (within the
  past year) hospitalized or had a medical
  procedure
• Skin and Soft tissue infections
• spider bite
• Can lead to necrotizing pneumonia,
  osteomyelitis, bacteremia, death

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This 2005 scanning electron micrograph (SEM)
depicted numerous clumps of methicillin-resistant
Staphylococcus aureus bacteria CDC Pubic
Health Image Library
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a cutaneous abscess located on the hip of a
prison inmate CDC Public Health Image
Library
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Community-associated MRSA

• Transmission
• Inmates in correctional facilities
• Competitive sports participants
• Military recruits
• Day care attendees
• Men who have sex with men
• Native Americans

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Community-associated MRSA

• Factors that facilitate transmission
• Crowding
• Frequent skin-to-skin contact
• Participation in activities that result in
  compromised skin surfaces
• Sharing of personal items that may become
  contaminated with wound drainage
• Challenges in maintaining personal cleanliness
  and hygiene

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Professional Football Players

• Sept 1 through Dec 1, 2003
• Eight MRSA infections in 5 of 58 players
• Offensive and defensive linemen, one linebacker
• Skin abrasions on elbows, forearms, knees
• Progressed rapidly to large abscesses
• Kazakova SV et al. NEJM 2005 352

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A Clone of Methicillin-Resistant Staphylococcus
aureus among Professional Football Players
Sophia V. Kazakova, M.D., M.P.H., Ph.D., Jeffrey
C. Hageman, M.H.S., Matthew Matava, M.D., Arjun
Srinivasan, M.D., Larry Phelan, B.S., B.A.,
Bernard Garfinkel, M.D., Thomas Boo, M.D., Sigrid
McAllister, B.S., M.T.(A.S.C.P.), Jim Anderson,
B.S., A.T.C., Bette Jensen, M.M.Sc., Doug Dodson,
B.S., David Lonsway, M.M.Sc., Linda K. McDougal,
M.S., Matthew Arduino, Dr.P.H., Victoria J.
Fraser, M.D., George Killgore, Dr.P.H., Fred C.
Tenover, Ph.D., Sara Cody, M.D. and Daniel B.
Jernigan, M.D., M.P.H.
N Engl J Med Volume 3525468-475 February 3, 2005
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Study Overview

• During the 2003 football season, large skin
  abscesses due to methicillin-resistant
  Staphylococcus aureus (MRSA) developed in five
  players on a professional football team
• All the infections involved the same clone of
  MRSA, which appears to be widely distributed in
  the community

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Epidemic-Curve Graph (Top) and Field Position
Diagram (Bottom) of Cases of MRSA Infection among
St. Louis Rams Professional Football Players in
2003
Kazakova, S. et al. N Engl J Med 2005352468-475
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Remember to

• Shower and wash with soap after all practices and
  competitions
• Wash hands regularly with soap and hot water
• Dont share towels, razors, water bottles and
  athletic gear
• Wash athletic gear regularly

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Remember to

• Cover all cuts and abrasions
• Report any and all skin lesions
• Avoid picking, squeezing or scratching scabs,
  abrasions, bumps or rashes
• Remove all jewelry in practice or competition to
  avoid scratches

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Remember to

• Be aware!
• Check your skin!
• Wash your hands often
• Dont share equipment or towels

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Recommendations

• Awareness of emergence in community of MRSA with
  distinct microbiologic and epidemiologic
  characteristics
• Early Identification and targeted treatment
• Drain abscesses
• Wounds covered, clean and dry dressings
• Educate infected persons

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Influenza in the Workplace
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Annual Seasonal Influenza

• Influenza infection is a serious illness causing
  significant morbidity and mortality adversely
  affecting the public health on an annual basis.
• 6th leading cause of death among adults
• Related to 1 of 20 deaths gt65 years
• Estimated annual direct cost between 3 and 5
  billion dollars

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Influenza

• Contagious acute respiratory illness
• Caused by influenza viruses
• Global importance
• Mild to severe disease, even death
• Causes epidemics and pandemics

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Symptoms

• fever (usually high)
• headache
• extreme tiredness
• dry cough
• sore throat

• runny or stuffy nose
• muscle aches
• Stomach symptoms, such as nausea, vomiting, and
  diarrhea, also can occur but are more common in
  children than adults

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Influenza

• 250,000500,000 deaths worldwide annually
• Spread from person to person, coughing,
  sneezing, touching something with influenza
  viruses then their mouth or nose
• Prevention Pre-exposure immunization

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Influenza

• Influenza-infected workers can transmit this
  virus to their co-workers
• Studies show workers continue to work despite
  being ill
• Spreads when both symptomatic and asymptomatic

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Influenza Vaccine

• Influenza Vaccination of workers saves money for
  employees and employers and prevents workplace
  disruption.
• 25 fewer URIs
• 44 fewer Dr visits
• 43 fewer sick days off
• Average savings of 47 per person annually
• Staffing shortages during peak influenza epidemic

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Influenza Vaccine Recommendations

• Increased for complications
• Children 6-23 months old
• Adults gt 65 years old
• Persons with chronic medical conditions
• Persons aged 60-64
• Persons who can transmit influenza to those at
  high risk
• All healthcare personnel

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Immunization Requirements

• Immunization requirements are effective and work
  in increasing vaccination rates.
• Mandatory school-entry immunization requirements
• Mandatory Hepatitis B Vaccine
• Measle, Mumps, Rubella Vaccine, Varicella and
  annual TB Screenings

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Prevention Good Health Habits

• Avoid close contact.
• Stay home when you are sick.
• Cover your mouth and nose.
• Hand Hygiene.
• Avoid touching your eyes, nose or mouth.
• Practice other good health habits.

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Tuberculosis (TB)

• Disease caused by germs that are spread from
  person to person through the air
• TB usually affects the lungs
• Can also affect other parts of the body
• Brain, kidneys, spine.

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Tuberculosis

• Symptoms
• Cough gt3 weeks
• Loss of appetite
• Unexplained weight loss
• Blood in sputum
• Fever
• Night sweats

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Tuberculosis

• Most likely to spread the germs to people they
  spend time with every day
• such as family members or coworkers.
• If you have been around someone who has TB
  disease, you should go to your doctor or your
  local health department for tests.

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What is meningitis

• an infection of the fluid of a person's spinal
  cord and the fluid that surrounds the brain.
• sometimes referred to as spinal meningitis.
• usually caused by a viral or bacterial infection

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Meningitis

• Viral/Aseptic
• Bacterial meningitis
• usually more severe than the viral meningitis
• may have serious after-effects, such as brain
  damage, hearing loss, limb amputation, or
  learning disabilities
• leading causes
• Streptococcus pneumoniae
• Neisseria meningitidis (usually referred to as
  "meningococcus" and the disease it causes as
  meningococcal disease)

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Meningitis Signs and Symptoms

• high fever, headache, and stiff neck in anyone
  over the age of 2 years.
• can develop over several hours, or they may take
  1 to 2 days

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Meningitis How is it spread?

• Direct contact with large droplet respiratory
  secretions (coughing, sneezing, kissing,
  mouth-to-mouth resuscitation).
• Close household contacts of persons with
  meningococcal disease are at greatly increased
  risk of infection.

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Meningitis Prevention

• Vaccination
• Age 11-12 years
• Previously unvaccinated at high school entry
• Previously unvaccinated college freshmen living
  in dormitories
• Medication after exposure

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Scabies

• Skin infestation by a mite,Sarcoptes scabiei
• Transmitted by direct contact with infested
  person
• Burrow-like pruritic lesions
• Hands, webs of fingers, outer surfaces of feet,
  armpits, buttocks, waist

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Scabies

• Incubation period -- 3 to 6 weeks
• Cannot survive longer than 2 to 10 days on
  fomites
• Intimate articles of clothing, bedding washed by
  machine in hot cycle ( 122 degeees F) or bagged
  for 10 days

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Lice(Pediculosis)

• Skin infestation by a louse, a visible wingless
  parasite
• Three kinds
• Head, body, pubic
• Transmitted by close, direct, physical contact

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Lice(Pediculosis)

• Family members/close contacts examined
• Disinfect fomites
• Isolation of persons not necessary

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Pertussis

• Highly communicable
• Vaccine-preventable disease
• Lasts many weeks
• Typically manifested in children with paroxysmal
  spasms of severe coughing, whooping, and
  posttussive vomiting
• Incidence of pertussis has increased steadily
  since the 1980s

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PertussisMode of Transmission

• Large aerosol droplets
• Contact with respiratory secretions

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PertussisInfection Prevention

• Early diagnosis and treatment
• Implement Droplet Precautions (until 5 days after
  start of appropriate therapy)
• Post exposure prophylaxis
• Tetanus, diptheria, pertussis vaccine (Adacel)

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Objectives

• Discuss how infection is spread.
• Discuss infectious agents and diseases of
  interest in the workplace.
• Identify practices that prevent spread.

62
Questions?