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Infection Control Training for Home Health and Hospice Settings, 2014

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Title: Infection Control Training for Home Health and Hospice Settings, 2014


1
Infection Control Training for Home Health
and Hospice Settings, 2014
  • Meeting the requirements of 10A NCAC 41A .0206
    Infection Prevention healthcare Settings

2
Patients deserve effective infection control
wherever they receive healthcare.
Adapted from Jarvis WR Emerg Infect Dis.
20017170-3. Macedo de Olivera et al. Annals
of Int Med. 2005, 11
3
Modules
  • Module A - North Carolina Laws Concerning
    Infection Prevention in Outpatient settings
  • Module B Complying with OSHA Bloodborne
    Pathogen Rule
  • Module C - Epidemiology and Risk of Infection in
    Home Health and Hospice Settings
  • Module D - Outbreaks and Safe Injection Practices
  • Module E - Sources of Infection and Disinfection
    and Sterilization in Home Care and hospice
    Settings
  • Module F Medical Asepsis, Hand Hygiene, and
    Patient Care Practices

4
NC Laws Concerning Infection Prevention in Home
Health and Hospice Settings
Module A
  • Statewide Program for Infection Control and
    Epidemiology (SPICE)
  • UNC School of Medicine

5
Module A Objectives North Carolina infection
control laws and regulations
  • Describe pertinent rules for infection prevention
  • Discuss control measures for Human
    Immunodeficiency Virus (HIV), hepatitis B and
    hepatitis C
  • Explain NC communicable disease reporting rules
  • Review medical waste rules

6
Background
  • 1990 CDC becomes aware of a possible
    transmission of HIV from a dentist to 6 patients
    (Kimberly Bergalis case)
  • July 1991 CDC publishes Recommendations for
    Preventing Transmission of HIV and hepatitis B
    Virus to Patients During Exposure-Prone Invasive
    Procedures
  • October 1991 Congress passes Public Law
    102-141, requiring states to adopt CDC Guidelines
    or equivalent guidelines drafted by the state

7
10A NCAC 41A .0207HIV and hepatitis B Infected
HCP
  • All healthcare providers who perform or assist in
    surgical or obstetrical procedures or dental
    procedures and who know themselves to be infected
    with HIV or hepatitis B shall notify the NC State
    Health Director

8
10A NCAC 41A .0207NC State Health Director
Responsibilities
  • Investigate practice
  • Reported needle sticks, types of procedures
    performed, practice during procedures
  • Evaluate clinical condition
  • Viral loads and antigen levels
  • Determine risk of transmission to patients
  • Based on clinical activities, viral burden
  • Convene expert panel
  • Issue isolation order pursuant to findings of the
    investigation and/or recommendations of the panel
  • Can occur prior to expert panel hearing if there
    is imminent risk to the public health

9
10A NCAC 41A .0206
  • Each healthcare organization in which invasive
    procedures are performed must
  • Implement a written infection control policy
  • Designate one on-site staff member to direct
    infection control activities
  • Designated staff member must complete a State
    approved course in infection control
  • On the job training is not sufficient
  • Must have certificate documenting course
    completion

10
10A NCAC 41A .0206 Infection Prevention in
healthcare Settings
  • (1) "healthcare organization" means a hospital
    clinic physician, dentist, podiatrist,
    optometrist, or chiropractic office home care
    agency nursing home local health department
    community health center mental health facility
    hospice ambulatory surgical facility urgent
    care center emergency room Emergency Medical
    Service (EMS) agency pharmacies where a health
    practitioner offers clinical services or any
    other organization that provides clinical care.

11
10A NCAC 41A .0206 Infection Prevention in
healthcare Settings
  • (2) "Invasive procedure" means entry into
    tissues, cavities, or organs or repair of
    traumatic injuries. The term includes the use of
    needles to puncture skin, vaginal and cesarean
    deliveries, surgery, and dental procedures during
    which bleeding occurs or the potential for
    bleeding exists.

12
Changes to 10A NCAC 41A .0206
  1. Adds safe injection practices to list of topics
    covered in state-approved courses
  2. Explicitly addresses hepatitis C and other
    bloodborne pathogens in addition to HBV and HIV
  3. Requires one designated staff member for each
    noncontiguous healthcare facility

non-contiguous defined as two facilities that
are not physically connected.
13
healthcare provider with Exudative Lesions or
Dermatitis on hands/wrists
  • Shall refrain from
  • Handling patient care equipment
  • Handling devices used for invasive procedures
  • All direct care activities likely to have contact
    with lesion

14
Infection Control Training of Employees
  • Infection control and OSHA Bloodborne Pathogen
    (BBP) training can be combined, but must include
  • Sterilization and disinfection
  • Include sterilizer monitoring and maintenance
  • Sanitation of rooms and equipment
  • Appropriate agents, procedures and frequencies
  • Accessibility of infection control devices and
    supplies
  • Personal protective equipment (PPE), sharp safety
    devices, etc.

15
Knowledge Check
  • Which of the following is not required by .0206
    rule for healthcare organizations that do
    invasive procedures of any type?
  • Have a written infection control policy
  • Conduct infection control training for healthcare
    providers
  • Monitor compliance with infection control
    requirements
  • Investigate needlesticks and other exposures to
    bloodborne pathogens (BBP)
  • Update policy as needed to prevent transmission
    of BBP

16
Module A Objectives North Carolina infection
control laws and regulations
  • Describe pertinent rules for Infection Prevention
  • Discuss control measures for Human
    Immunodeficiency Virus (HIV), hepatitis B and
    hepatitis C
  • 10A NCAC 41A .0202, .0203, and .0214
  • Explain NC communicable disease reporting rules
  • Review medical waste rules

17
Exposure
  • A needlestick
  • Non-sexual contact that
  • Exposes non-intact skin or mucous membranes to
    blood and potentially contaminated body fluids
    of a patient, AND
  • Poses a significant risk of transmission of HIV,
    hepatitis B, or Hepatitis C if source was
    infected with those viruses

Potentially contaminated body fluids include
cerebrospinal, pericardial, joint, peritoneal,
pleural, amniotic, vaginal secretions, semen, and
any fluid with visible blood. Sweat, tears,
saliva, respiratory tract secretions, vomitus,
stool, and urine (unless contaminated with blood)
are NOT potentially contaminated body fluids.
18
Source and Exposed Person
  • Source Person
  • Person who contributes blood or potentially
    contaminated body fluids to the exposure incident
  • Exposed Person
  • Individual who has needlestick or non-sexual
    exposure to blood and potentially contaminated
    body fluids

19
Control Measures HIV, HBV, HCV10A NCAC 41A
.0202, .0203, and .0214
  • Determine if exposure constitutes significant
    risk
  • Needlesticks
  • For all other exposures must consider
  • Type of body fluid or tissue
  • Volume of body fluid or tissue
  • Concentration of pathogen
  • Infectiousness or virulence of pathogen
  • Route of exposure - percutaneousgtmucous
    membranesgtnon-intact skingtintact skin

20
Control Measures HIV, HBV, HCV10A NCAC 41A
.0202, .0203, and .0214
  • Required Follow-up Measures
  • Known Source
  • Exposed persons attending physician or
    occupational healthcare provider must notify
    source persons attending physician.
  • Source persons physician must test source for
    HIV, HBV, and HCV and notify exposed persons
    physician of results.
  • Exposed persons physician offers follow-up in
    accordance with the rules and CDC guidelines (per
    OSHA).

21
Control Measures HIV, HBV, HCV10A NCAC 41A
.0202, .0203, and .0214
  • Required Follow-up Measures
  • Unknown Source
  • Offer HIV testing to exposed person
  • Determine whether exposed person has been
    vaccinated for hepatitis B
  • Vaccinate for hepatitis B if indicated
  • Offer hepatitis C testing to exposed person

22
Confidentiality
  • The attending physician of the exposed person
    shall instruct the exposed person regarding the
    necessity for protecting confidentiality.
    Exposed persons are instructed to maintain this
    confidentiality.

23
Knowledge Check
  • True or False You have to know or suspect a
    source person has HIV, hepatitis B or hepatitis C
    for the control measures rules to apply?
  • False.

24
Knowledge Check
  • True or False A source person must give informed
    consent before being tested?
  • No.

25
Module A Objectives North Carolina infection
control laws and regulations
  • Describe pertinent rules for Infection Prevention
  • Discuss control measures for Human
    Immunodeficiency Virus (HIV), hepatitis B and
    hepatitis C
  • Explain communicable disease reporting rules
  • Review medical waste rules

26
GS 130A-135
  • A physician licensed to practice medicine who
    has reason to suspect that a person about whom
    the physician has been consulted professionally
    has a communicable disease or condition declared
    by the Commission to be reported, shall report
    information required by the Commission to the
    local health director

27
Mandatory Communicable disease (CD)Reports in NC
  • Routine
  • Only if ordered
  • Physicians, labs specified others must report
    CDs designated reportable by NC Commission for
    Public Health
  • 71diseases/conditions
  • 10A NCAC 41A .0101
  • Timeframe for report varies (7 days, 24 hours, or
    immediately)
  • NC State Health Director may issue order
    requiring HCP to report symptoms, diseases,
    conditions, trends in use of services, other
    information needed to investigate a potential
    outbreak
  • Order must specify who must report what and may
    not exceed 90 days

28
Diseases and Conditions Reportable in North
Carolina
29
What about HIPAA?
  • HIPAA section 164.512(a) Can disclose
    information when required by law
  • Mandatory reporting laws are examples of laws
    requiring disclosure.
  • HIPAA section 164.512(b) Can disclose
    information to public health authorities that are
    authorized by law to receive it for purposes
    including disease control, surveillance, etc.
  • Sometimes have voluntary reporting covered by
    this section if public health authority is
    authorized by law to receive the information
  • GS 130A-142 provides immunity from liability for
    persons who make reports in good faith.
  • This immunity applies not only to physicians, but
    to all the other reporters as well

30
Confidentiality of records (GS 130A-143)
  • General rule Written consent is required to
    disclose any information that identifies a person
    who has or may have a reportable communicable
    disease or condition, including HIV.
  • Exceptions More limited than HIPAA, but allow
    for
  • Disclosures for treatment purposes
  • Disclosures required or allowed by the NC
    communicable disease laws and rules
  • A few other purposes

31
Communicable Disease Investigation
  • NC law supports access to information as part of
    an investigation - GS 130A-144(b)
  • Medical facilities, labs, physicians shall
    provide access to and copies of medical or other
    records that pertain to
  • Diagnosis, treatment, or prevention of a
    communicable disease for a person known to be, or
    reasonably suspected of being, infected or
    exposed
  • Investigation of known or reasonably suspected
    outbreak

32
Control Measures
  • Public health endeavors geared at controlling
    communicable disease
  • Sanitation
  • Immunizations
  • Screening or diagnostic tests
  • Partner notification
  • Treatment regimens
  • Isolation and quarantine
  • Etc.
  • May be population-based or directed to individuals

33
Control measures
  • In NC, all persons must comply with communicable
    disease control measures established by the
    Commission for Public Health. GS 130A-144(f).
  • Commission adopts rules establishing control
    measures and publishes them in the NC
    Administrative Code. 10A NCAC 41A.0200.

34
What are the control measures?
  • NC rules specify the control measures for HIV,
    hepatitis B, hepatitis C, sexually transmitted
    infections, tuberculosis, smallpox/vaccinia, and
    SARS
  • For all other communicable diseases, NC rules
    incorporate control measures specified in
  • CDC guidelines and recommended guidelines, if
    available
  • APHAs Control of Communicable Diseases Manual

35
Communicable disease Law Enforcement
  • Two Approaches
  • Civil enforcement
  • The health director can ask a superior court
    judge for a court order directing a person to
    comply with the law. GS 130A-18. A person who
    refuses to comply with a court order could be
    held in contempt of court.
  • Criminal enforcement
  • A person who violates a public health law can be
    charged with a misdemeanor. GS 130A-25.

36
Where to find Communicable diseaseLaws and Rules
  • General Statutes are available through NC General
    Assemblys website
  • http//www.ncga.state.nc.us
  • Click on General Statutes
  • Under Look up type in 130A
  • The NC Administrative Code is found online
  • http//www.reports.oah.state.nc.us/ncac.asp
  • Click on Title 10A
  • Click on Chapter 41
  • Click on .0206, .0207, .0202, .0203, .0214

37
Knowledge Check
  • True or False HIPAA prohibits physicians from
    making Communicable Disease reports?
  • False

38
Knowledge Check
  • True or False A physician must wait for lab
    reports confirming the Communicable
    Disease/Communicable Condition before making the
    report?
  • False

39
Module A Objectives North Carolina infection
control laws and regulations
  • Describe pertinent rules for Infection Prevention
  • Discuss control measures for Human
    Immunodeficiency Virus (HIV), hepatitis B and
    hepatitis C
  • Explain communicable disease reporting rules
  • Review medical waste rules
  • 15A NCAC 13B .1200

40
There are two types of medical waste!
  • Medical Waste
  • Regulated Medical Waste
  • Any solid waste generated in the diagnosis,
    treatment, or immunization of human beings or
    animals
  • Cost 0.55/lb to dispose
  • Any blood or body fluids in individual containers
    gt20ml (about size of test tube)
  • Microbiological waste
  • Pathological waste
  • Must be treated prior to disposal
  • Cost 1.75/lb to dispose of

Adapted from Medical Waste Presentation by Bill
Patrakis, NC DENR, Division of Solid Waste
Management. http//portal.ncdenr.org/web/wm/sw/med
icalwaste
41
Blood and Body Fluids
  • Liquid blood, serum, plasma, other blood
    products, emulsified human tissue, spinal fluids,
    and pleural and peritoneal fluids
  • Dialysates, urine, and feces are NOT blood or
    body fluids under this definition
  • Possible methods of treatment dispose of in
    commode, incineration, steam sterilization.

42
Microbiological Waste
  • Cultures and stocks of infectious agents (e.g.
    Microbiology laboratory)
  • Possible methods of treatment incineration,
    autoclaved, or chemical disinfectants (bleach 15)

43
Pathological Waste
  • Human tissues, organs, and body parts removed
    during surgery or autopsy
  • Only method of treatment - incineration

44
Disposal of Sharps
  • Rules do not require treatment before disposal
  • Must be packaged in a container that is rigid,
    leak-proof when upright, and puncture resistant
  • Can be disposed of with general solid waste
  • Some landfills do not accept sharps

Sharps Needles, Needles with syringes,
Needles with vacationers, blades (scalpels),
contaminated broken glassware
45
Not Defined as Regulated Medical Waste
  • Dressings and bandages (even blood soaked),
    sponges, disposable instruments, used gloves, and
    tubing
  • Disposed of as general solid waste
  • Household waste including injections administered
    at home is not included in medical waste rules.

46
Occupational Health and safety administration
  • OSHA specifies certain features of the regulated
    waste containers, including appropriate tagging
    meant to protect waste industry workers.
  • OSHA rules are intended to minimize employee
    exposure to bloodborne pathogens. OSHA does not
    address disposal.
  • OSHA definition of regulated waste may include
    waste such as bloody gauze, blood saturated
    dressings, used gloves, or tubing.

47
by Bill Patrakis, NC DENR, Division of Waste
Management.
48
Knowledge Check
  • Which of the following is NOT classified as
    Regulated medical waste in the NC Medical Waste
    Rules?
  • Microbiological
  • Isolation Precautions room waste
  • Pathological
  • Blood in quantities of 20 ml per a single unit
    vessel

49
Knowledge Check
  • What do the NC Medical Waste Rules require for
    disposal of sharps?
  • Container for sharps is rigid, puncture resistant
    and leak proof when in an upright position.
  • Closed sharps container may be disposed of with
    general solid waste.
  • Contained sharps shall not be compacted prior to
    off-site transportation.
  • All of the above

50
Questions?
51
References
  • Schaefer M. et al. Infection Control Assessment
    of Ambulatory Surgical Centers. JAMA. 2010303
    (22) 2273-2279.
  • Jarvis WR. Infection control and changing
    health-care delivery systems. Emerg Infect
    Dis20017170-173.
  • de Oliveira M. et al. An outbreak of hepatitis C
    virus infections among outpatients at a
    hematology/oncology clinic. Annals of Internal
    Medicine, 2005 June 7, 142(11)898-902.
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