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INFECTION CONTROL

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Title: INFECTION CONTROL


1
INFECTION CONTROL
  • Annual Review

2
Topics
  • OSHA Standards
  • Isolation Review
  • Multiply Resistant Organisms
  • Emerging Pathogens
  • JCAHO Patient Safety Goal 7
  • Bioterrorism

3
OSHA STANDARDS Bloodborne Pathogens Tuberculosis
4
Bloodborne Pathogens
  • Hepatitis B
  • Hepatitis C
  • HIV

5
Sharps Safety Devices
  • Required by OSHA
  • Designed to prevent needlestick and sharps
    exposures
  • May include retractable needles, re-sheathing
    devices, or cover shields
  • Selection of devices is partly based on input
    from the user.

6
Sharps Safety
  • Always wear gloves when handling sharps.
  • Never bend, break or recap a needle.
  • Activate the safety feature before disposal.
  • Dispose of sharps into an approved container
    immediately, as close to the point of use as
    possible.
  • Never force items into the container.
  • EMS should replace the liner when 3/4 of the way
    full.

7
Types of Exposures
  • Blood-to-blood contact through a sharps or
    needlestick injury
  • Splash exposure to mucous membrane or non-intact
    skin

8
Exposure Protocol
  • Immediately wash affected area with soap and
    water.
  • Notify your supervisor and report to Employee
    Health ASAP.
  • Off tours and weekends Urgent Care (WP)
    Nursing Supervisor (BV).
  • If known source, patient will be tested for HBV,
    HCV and HIV (informed consent required).

9
Post-Exposure Prophylaxis
  • Employee Health will evaluate the level of risk
    and determine the need for post-exposure
    prophylactic medication (PEP).
  • If employee is not immune to HBV, a dose of
    vaccine or hepatitis B immune globulin may be
    appropriate.
  • No PEP is indicated for Hepatitis C exposure.
    Must follow-up with Employee Health.

10
Tuberculosis
11
High-risk Groups
  • HIV
  • History of IV drug use
  • Close contacts of a person with active TB
  • Homeless people
  • Residents of long-term care facilities, shelters,
    mental institutions, prisons
  • Chest x-ray consistent with TB
  • Immigrants or people born in high-prevalence
    areas

12
Medical Factors Increasing the Risk of Active TB
  • Diabetes Mellitus
  • Silicosis
  • gt10 below ideal body weight
  • Chronic renal failure
  • Immunosuppressive therapy
  • Hematologic disorders
  • Other malignancies

13
Symptoms of TB
  • Fever and chills
  • Night sweats
  • Loss of appetite
  • Unexplained weight loss
  • Productive cough
  • Bloody sputum
  • Elevated WBC count

14
How is TB Transmitted?
  • Usually a pulmonary disease, transmitted through
    the air by tiny particles called droplet nuclei.
  • Can be spread when a person with active disease
    coughs, sings, sneezes, laughs, etc.
  • Healthcare workers are at higher risk due to
    possible exposure to sick patients.
  • Appropriate isolation precautions must be
    followed.

15
Airborne Isolation -TB
  • Known or suspected cases should be placed in a
    negative pressure room.
  • HCW must verify negative pressure
  • Some outpatient areas have portable HEPA filter
    fans to be used prior to transfer.
  • Respiratory Hygiene and Cough Etiquette
    Instruct patient to cover his/her cough, or wear
    surgical mask.
  • Employee must wear N-95 Particulate Respirator
    (fit-testing required by OHSU)

16
TB Screening
  • PPD skin test is the preferred method of
    screening.
  • Required annually of all Medical Center
    employees.
  • Required upon admission and annually for all
    long-term care patients.
  • RNs must be trained to administer and interpret
    PPDs within the VA.

17
Latent TB vs. Active TB
  • A positive PPD skin test indicates that there was
    an exposure to TB at one time.
  • Most cases of latent (inactive) TB never progress
    to active disease, but the skin test usually
    remains positive for life.
  • Prophylactic treatment may prevent active TB from
    ever developing.

18
Influenza
  • Flu season is October through March.
  • Vaccination is strongly recommended.
  • No risk of getting the flu from the flu shot.
  • Available for patients 10/15/03
  • Available for employees 11/1/03
  • Refer to Flu Plan in public drive.

19
Isolation Precautions
  • Standard Precautions - Use for all patients. All
    body fluids/substances considered potentially
    infectious. Use appropriate personal protective
    equipment (PPE).

20
Personal Protective Equipment
  • Gloves
  • Gowns
  • Masks
  • Goggles
  • Face Shield

21
PPE - Gloves
  • Wear gloves when contact with blood/body fluids,
    mucous membranes, or non-intact skin could occur.
  • Change gloves when moving from a contaminated
    body site to a clean body site.
  • Remove gloves after caring for a patient.
  • Decontaminate your hands after gloves are removed!

22
PPE - cont.
  • Don PPE prior to patient contact
  • Remove PPE at point of use, before leaving the
    area
  • Observe proper technique to prevent contamination
  • DECONTAMINATE hands after PPE removal

23
Isolation Precautions
  • Transmission - Based Precautions Airborne -
    TB, Chickenpox Droplet - MRSA
    pneumonia Contact - VRE, C. Difficile

24
Contact Precautions
  • Private room or cohort when possible.
  • Private or designated bathroom.
  • Wear gloves when entering room other PPE as
    needed.
  • Clean and disinfect all equipment before use with
    another patient.
  • Hang stop sign outside door.

25
Multiply Resistant Organisms
  • MRSA
  • VRE
  • C. Difficile
  • Other resistant organisms

26
MRO-cont.
  • Contact isolation - private room or cohort if
    necessary.
  • Be aware of environmental contamination
  • Target antibiotic therapy

27
At your hospital, what percentage of Staph aureus
isolates are resistant to methicillin?
  1. lt5
  2. 15
  3. 20
  4. 30
  5. gt50

28
Colonized or InfectedWhat is the Difference?
  • People who carry bacteria without evidence of
    infection (fever, increased white blood cell
    count) are colonized
  • If an infection develops, it is usually from
    bacteria that colonize patients
  • Bacteria that colonize patients can be
    transmitted from one patient to another by the
    hands of healthcare workers

Bacteria can be transmitted even if the patient
is not infected
29
The Iceberg Effect
30
Vancomycin-Resistant Enterococcus (VRE)
  • Most often associated with antibiotic use.
  • Colonization is asymptomatic. Diagnosis can only
    be made with a VRE culture.
  • Requires contact isolation and weekly specimens
    until there are three consecutive negative
    cultures.
  • History of VRE-isolate on admission .
  • No treatment for colonization.

31
Recovery of VRE from Hands and Environmental
Surfaces
  • Up to 41 of healthcare workers hands sampled
    (after patient care and before hand hygiene) were
    positive for VRE1
  • VRE were recovered from a number of environmental
    surfaces in patient rooms
  • VRE survived on a countertop for up to 7 days2

1 Hayden MK, Clin Infect Diseases
2000311058-1065. 2 Noskin G, Infect Control and
Hosp Epidemi 199516577-581.
32
The Inanimate Environment Can Facilitate
Transmission
X represents VRE culture positive sites
Contaminated surfaces increase
cross-transmission Abstract The Risk of Hand
and Glove Contamination after Contact with a VRE
() Patient Environment. Hayden M, ICAAC, 2001,
Chicago, IL.
33
Clostridium Difficile (C. Diff.)
  • Also associated with recent exposure to
    antibiotics.
  • Symptoms usually include diarrhea and abdominal
    cramping.
  • Recommended treatment is oral metronidazole
    (Flagyl) x10 days.
  • Requires contact isolation until symptoms resolve
    (usually within a few days of treatment).

34
Emerging Pathogens
  • SARS
  • West Nile
  • Smallpox
  • Monkeypox
  • To be announced.. WWW.CDC.GOV

35
JCAHO Patient Safety Goal 7
  • Reduce the Risk of Health Care-Acquired
    Infections
  • CDC Hand Hygiene Guidelines
  • Sentinel Events Related to Infections

36
CDC Guideline for Hand Hygiene in Health-Care
Settings
  • Published in October 2002
  • Provides recommendations for hand hygiene among
    healthcare workers
  • Addresses alcohol-based hand rubs (gel, foam,
    etc.)

37
  • Hand washing is generally considered to be the
    most important measure in preventing the spread
    of infection.
  • Hands should be washed before significant
    contact with any patient and after activities
    likely to cause contamination.

38
So Why All the Fuss About Hand Hygiene?
  • Most common mode of transmission of pathogens is
    via hands!
  • Infections acquired in healthcare
  • Spread of antimicrobial resistance

39
Definitions
  • Hand hygiene
  • Performing handwashing, antiseptic handwash,
    alcohol-based handrub, surgical hand
    hygiene/antisepsis
  • Handwashing
  • Washing hands with plain soap and water
  • Antiseptic handwash
  • Washing hands with water and soap or other
    detergents containing an antiseptic agent
  • Alcohol-based handrub
  • Rubbing hands with an alcohol-containing
    preparation

Guideline for Hand Hygiene in Health-care
Settings. MMWR 2002 vol. 51, no. RR-16.
40
Definitions
  • Hand decontamination
  • Performing handwashing using antiseptic handwash,
    alcohol-based handrub, or surgical hand
    hygiene/antisepsis
  • Surgical hand hygiene/antisepsis
  • Use antiseptic handwash or an alcohol-based
    handrub with persistance before operations by
    surgical personnel

Guideline for Hand Hygiene in Health-care
Settings. MMWR 2002 vol. 51, no. RR-16.
41
Indications for Hand Hygiene
  • When hands are visibly dirty, contaminated, or
    soiled, wash with non-antimicrobial soap and
    follow with decontamination using alcohol-based
    handrub if situation dictates or use
    antimicrobial soap and water.
  • If hands are not visibly soiled, use an
    alcohol-based handrub for routinely
    decontaminating hands.

Guideline for Hand Hygiene in Health-care
Settings. MMWR 2002 vol. 51, no. RR-16.
42
Specific Indications for Hand Decontamination
  • Before
  • Patient contact
  • Donning gloves when inserting a CVC
  • Inserting urinary catheters, peripheral vascular
    catheters, or other invasive devices that dont
    require surgery

Guideline for Hand Hygiene in Health-care
Settings. MMWR 2002 vol. 51, no. RR-16.
43
Specific Indications for Hand Decontamination
  • After
  • Contact with a patients skin
  • Contact with body fluids or excretions,
    non-intact skin, wound dressings
  • Contact with the environment/equipment in patient
    room/area
  • Removing gloves

Guideline for Hand Hygiene in Health-care
Settings. MMWR 2002 vol. 51, no. RR-16.
44
Efficacy of Hand Hygiene Preparations in Killing
Bacteria
Better
Good
Best
Antimicrobial soap
Alcohol-based handrub
Plain Soap
45
Alcohol-Based Hand Rubs
  • Require less time
  • Can be strategically placed
  • Readily accessible
  • Multiple sites
  • All patient care areas

46
Alcohol-Based Hand Foam
  • Dispense a golf ball-sized amount of foam,
    covering all surfaces of both hands, and rub in
    until dry.
  • Preferred method of hand hygiene when hands are
    not visibly soiled.

47
Time Spent Cleansing Handsone nurse per 8 hour
shift
  • Hand washing with soap and water 56 minutes
  • Based on seven (60 second) handwashing episodes
    per hour
  • Alcohol-based handrub 18 minutes
  • Based on seven (20 second) handrub episodes per
    hour

Alcohol-based handrubs reduce time needed for
hand disinfection
Voss A and Widmer AF, Infect Control Hosp
Epidemiol 199718205-208.
48
SummaryAlcohol-Based Handrubs What benefits do
they provide?
  • Require less time
  • More effective for standard handwashing than soap
  • More accessible than sinks
  • Reduce bacterial counts on hands
  • Improve skin condition

49
Hand Washing (15 seconds of friction)
  • Non-antimicrobial lotion soap Use only to wash
    if hands are soiled or visbly dirty. FOLLOW WITH
    ALCOHOL-BASED HANDRUB IF HANDS NEED TO BE
    DECONTAMINATED!
  • Antimicrobial soap Use to decontaminate hands,
    clean hands when visibly soiled, and when caring
    for a patient with Clostridium difficile

50
Routine Hand Wash
Repeat procedures until hands are clean
51
Can a Fashion Statement Harm the Patient?
ARTIFICIAL
POLISHED
NATURAL
Avoid wearing artificial nails, keep natural
nails lt1/4 inch if caring for high risk patients
(ICU, OR)
Edel et. al, Nursing Research 1998 4754-59
52
Artificial Nails
  • Associated with outbreaks in healthcare due to
    bacterial and fungal contamination.
  • Artificial nails are prohibited in high-risk
    areas strongly discouraged for anyone providing
    patient care.
  • No chipped nail polish.
  • Natural nails should be kept less than 1/4 inch
    long.

53
What is the Story on Moisturizers and Lotions?
  • ONLY USE facility-approved and supplied lotions
  • Because
  • Some lotions may make medicated soaps less
    effective
  • Some lotions cause breakdown of latex gloves
  • Lotions can become contaminated with bacteria if
    dispensers are refilled

Do not refill lotion bottles
54
Surveillance Activities
  • Line-related bacteremias
  • Ventilator-associated pneumonia
  • Surgical wound infections
  • Resistant organisms- C. difficile
  • UTIs in nursing home

55
Surveillance- cont.
  • Notify Infection Control of any increased
    incidence of infections.
  • If you are sick, report to Employee Health before
    coming to work.
  • Report to Infection Control any adverse patient
    outcomes related to infection.

56
Sentinel Event
  • All cases of unanticipated death or permanent
    loss of function associated with a health
    care-acquired infection.
  • Notify Infection Control if you are aware of any
    cases.

57
Bioterrorism
58
All employees should be aware of the Hospital
Bioterrorism Plan.
59
Significant agents of bioterrorism
  • Anthrax
  • Smallpox
  • Plague
  • Tularemia
  • Viral Hemorrhagic Fevers
  • Botulism

60
Anthrax
  • Caused by bacillus anthracis bacteria
  • May cause inhalational, cutaneous or
    gastrointestinal disease.
  • Transmitted by inhaling or handling spores, but
    not transmitted person-to-person.
  • Antibiotic treatment is necessary.

61
Smallpox
  • Caused by variola virus
  • Last case identified in 1977 declared eradicated
    in 1980.
  • Person-to-person transmission through contact or
    airborne route is likely.
  • Smallpox vaccine is available, but only to be
    used if there is an identified risk.
  • Treatment is supportive care.

62
Smallpox Vaccine
  • Made with vaccinia virus, another orthopox virus
    similar to variola.
  • Causes the body to produce antibodies which
    protect against all orthopox viruses.
  • This is a live virus vaccine, so the vaccination
    site must be cared for to prevent the virus from
    spreading.
  • Many contraindications.

63
Plague
  • Bacterial infection that causes bubonic or
    pneumonic disease.
  • Most commonly transmitted through infected fleas
    or infected animal tissues.
  • Antibiotic treatment effective when administered
    early.

64
  • Fortunately, most illnesses caused by potential
    bioterrorist agents are treatable when promptly
    diagnosed.
  • Early recognition is the key!

65
  • When you suspect bioterrorist activity,
    immediately call the VA Police by dialing 2222!

66
  • For more information on bioterrorism, see the
    Bioterrorism Module located on the public drive
    in the Infection Control Education folder.
  • http//www.cdc.gov

67
Questions?
  • Contact Infection Control
  • Wade Park ext 4791/4792
  • Brecksville ext 6571
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