Infection Control in Healthcare Facilities 200910 Influenza Season - PowerPoint PPT Presentation


PPT – Infection Control in Healthcare Facilities 200910 Influenza Season PowerPoint presentation | free to view - id: 19fbfa-ZDc1Z


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

Infection Control in Healthcare Facilities 200910 Influenza Season


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

Number of Views:68
Avg rating:3.0/5.0
Slides: 32
Provided by: jks6


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Infection Control in Healthcare Facilities 200910 Influenza Season

Infection Control in Healthcare
Facilities2009-10 Influenza Season
New York State Department of HealthBureau of
Healthcare Associated Infectionsicp_at_health.state
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

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

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

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

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

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

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

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

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

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

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

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

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

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

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,
  • Gloves and eye protection as per Standard

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
  • Through May 2010
  • Determination of availability
  • Can adequate supply be obtained?
  • If no, go to Prioritized Use Mode

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
  • Follow transmission-based precautions for new

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

  • 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

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
  • Reinforcement of existing policies
  • Report to Public Health

  • 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
  • LTC Consider facility wide prophylaxis
  • Antiviral selection per surveillance data
  • Clinical judgment for all others

  • 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

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

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

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

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

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

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

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

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