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Infection Control in Healthcare Facilities 200910 Influenza Season

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Respiratory hygiene / cough etiquette. Exclusion of ill ... and Cough Etiquette ... Sneeze or cough into tissue or elbow. Discard tissue immediately ... – PowerPoint PPT presentation

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Title: Infection Control in Healthcare Facilities 200910 Influenza Season


1
Infection Control in Healthcare
Facilities2009-10 Influenza Season
New York State Department of HealthBureau of
Healthcare Associated Infectionsicp_at_health.state
.ny.us
2
Infection Control in Healthcare Facilities
  • Basic Principles
  • Hand Hygiene
  • Respiratory hygiene / cough etiquette
  • Exclusion of ill staff and visitors
  • Transmission based precautions according to
    current guidance

3
Healthcare Continuum
  • Facility-specific measures
  • Hospitals
  • Long Term Care (Nursing Homes, Adult Homes, Home
    Health Care)
  • Ambulatory settings

4
Hand Hygiene
  • Reduction or removal of infectious agents to
    prevent spread
  • Alcohol-based Hand Rubs
  • Best at removing transient flora
  • Not appropriate for visibly soiled hands
  • Soap and Warm water
  • At least 15-20 seconds
  • Necessary if hands are visibly soiled

5
Respiratory Hygiene and Cough Etiquette
  • Mask symptomatic patients upon entry or when in
    common areas
  • Sneeze or cough into tissue or elbow
  • Discard tissue immediately
  • Perform hand hygiene

6
Exclusion of ill Staff
  • Not productive or useful to patients when staff
    work while ill
  • NYS Regulations 10NYCRR405.3(b)(10) (14)
  • Personnel includes all employees, members of the
    medical and dental staff, and volunteers
  • Must be free from a health impairment which is of
    potential risk to the patient
  • Facilities must assess employee health status and
    take appropriate measures to protect patients
  • Patient safety is a facilitys responsibility

7
Exclusion of ill Staff
  • Duration of exclusion
  • Clinical improvement and afebrile (off
    antipyretics) for at least 24 hours
  • Cough may persist for days to weeks
  • Employer considerations
  • Sick leave policy and compensation
  • Staff backup system
  • Do not require doctors note

8
Standard Precautions
  • Basic infection prevention and control strategies
    to care for all patients
  • Infectious agents may be found in
  • Blood
  • Body fluids
  • Secretions
  • Excretions except sweat
  • Nonintact skin
  • Mucous membranes

9
Standard Precautions
  • For ALL patients, ALWAYS
  • For blood borne pathogens, assume all patients
    infected
  • Hand hygiene prior to contact
  • Don appropriate personal protective equipment
    (PPE) for the task
  • Remove PPE and perform hand hygiene when done

10
Personal Protective Equipment
  • Dependent on task and likelihood of exposure to
    infectious material
  • Gloves
  • Mask or Respirator
  • Face shield or eye protection
  • Gown

11
Droplet Precautions
  • Agents that generate large respiratory droplets
  • Do not remain suspended in the air for prolonged
    period
  • Do not travel far and maintain infectivity
  • Mask when within 6 feet or upon room entry
  • Influenza
  • Pertussis

12
Airborne Precautions
  • Agents that are transmitted by small particles
  • Remain suspended and travel through air
  • Persist and remain infectious
  • Infect lower airway
  • N95 respirator or higher plus AIIR (Airborne
    Infection Isolation Room)
  • If no AIIR, then private room with door closed
  • If no AIIR or private room, then ensure spatial
    separation and pull curtain

13
Aerosol-Generating Procedures
  • Procedures during which small airborne particles
    may be generated
  • Airborne precautions for full protection
  • Procedures
  • Intubation
  • Extubation
  • Open tracheal suction
  • Bronchoscopy

14
CDC Recommendations
  • Seasonal influenza
  • Standard and Droplet Precautions
  • Routine care and aerosol-generating procedures
  • 2009 H1N1 Influenza
  • Airborne Precautions
  • Routine care and aerosol-generating procedures
  • Limited N95 Mask Supply
  • Allows for prioritization for aerosol-generating
    procedures

15
Hierarchy of Controls
  • Elimination of sources of infection
  • Engineering controls
  • Administrative controls
  • Personal protective equipment

16
2009 H1N1 Precautions Prioritized Use Mode
  • Routine care Standard plus Droplet
  • Large respiratory droplets
  • Infect upon contact with mucous membranes
  • Aerosol-Generating Procedures
  • Airborne precautions
  • Small airborne particles generated during
    aerosol-generating procedures
  • Intubation, extubation, open tracheal suction,
    bronchoscopy
  • Gloves and eye protection as per Standard
    precautions

17
Steps for 2009 H1N1 Season
  • Review and enhance existing respiratory
    protection plan
  • Hierarchy of controls
  • Assessment of N95 need and supply
  • How many needed for routine use, for prioritized
    use
  • Through May 2010
  • Determination of availability
  • Can adequate supply be obtained?
  • If no, go to Prioritized Use Mode

18
Duration of Isolation - Patients
  • Minimum of 7 days and afebrile for at least 24
    hours without antipyretics
  • ----or----
  • Until another diagnosis is made and influenza is
    ruled out
  • A negative RAT does not rule out H1N1 or
    influenza
  • Follow transmission-based precautions for new
    diagnosis

19
Preventing Transmission
  • Prevent exposure
  • Dont come to work if ill
  • Early appropriate action to isolate or exclude
    ill patients and staff
  • No ill visitors
  • Hyper-vigilance after known exposure

20
Cleaning
  • Routine measures
  • Enforce existing policies
  • Concentrating on high touch surfaces
  • Consider increasing frequency
  • Cleaning and disinfection
  • Clean visible soiling before disinfection
  • Use hospital-grade disinfectants according to
    manufacturers instructions
  • Dilute bleach acceptable

21
Nosocomial Outbreak
  • Definition
  • Single confirmed nosocomial case of influenza
  • 2 or more residents/patients and/or staff with
    ILI or confirmed influenza on the same unit
    within 7 days
  • Actions
  • Immediate implementation of transmission based
    precautions
  • Reinforcement of existing policies
  • Report to Public Health

22
Outbreak
  • Precautions
  • Low threshold for implementation
  • Affected and exposed patients
  • May need to include entire units
  • Treatment and Prophylaxis
  • Any exposed patient or HCW at high risk of
    complications
  • LTC Consider facility wide prophylaxis
  • Antiviral selection per surveillance data
  • Clinical judgment for all others

23
Outbreak
  • Testing and Confirmation
  • Local testing quickest
  • If available, prioritized for confirmation at
    Public Health Laboratory
  • Should NOT influence treatment decisions
  • Other considerations
  • Opportunity to vaccinate and educate
  • Staff prophylaxis if exposed and at high risk of
    complications

24
Hospital Considerations
  • Emergency Department
  • Waiting areas and ambulatory nature
  • Triage at point of entrance for febrile
    respiratory illness
  • Masking and/or distancing in waiting rooms
  • Tissues and trash receptacles
  • Readily accessible alcohol-based hand rubs

25
Hospital Considerations
  • All Units
  • Droplet precautions with any ILI until diagnosis
    is made
  • Restrict ill visitors from unit
  • Use supervisors to enforce ill staff exclusion
  • Coordinate management with Employee/ Occupational
    Health

26
Nursing Home Considerations
  • Residence
  • Limit interactive gatherings and activities
  • Contingency plans to avoid social isolation
  • Aggressive response to facility illness
  • Limit staff floating
  • Low threshold for precautions
  • Develop and enforce IC policies

27
Nursing Home Considerations
  • Chronic illness
  • Change in baseline rather than overt illness
  • Increased secretions, temperature instability
  • Low threshold to suspect influenza or other
    communicable disease

28
Transfers from Nursing Home to Hospital
  • Reserve ED for true emergencies only
  • Evaluate on site whenever possible
  • Based on patient assessment
  • Severity of illness
  • Not level of anxiety, community illness level,
    need for routine medical assessment
  • Advance notice
  • Notify EMS, ED, others of potentially infectious
    patient/resident

29
Home Health Considerations
  • Source control
  • Cover cough
  • Proper PPE
  • Early detection by caregivers
  • Monitor patients for symptoms
  • Early agency notification
  • Agency to monitor employees
  • Agency to report to LHD and medical provider

30
Adult Home Considerations
  • Congregate setting
  • Community mitigation strategies
  • Source control
  • Cover cough
  • Hand hygiene is critical
  • Early detection
  • Monitor residents for symptoms
  • Early notification
  • Report to LHD and medical provider

31
Ambulatory Considerations
  • Prior to visit to prevent exposures
  • Phone triage
  • Scheduling respiratory illness later in day
  • Hand sanitizer, masks, and tissues at entrances
  • Separation
  • In room as quickly as possible
  • Masks or physical distancing
  • Signage and education
  • For both staff and patients
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