Infection Control

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Infection Control

• Some policies and procedures may be facility
  specific.

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Nosocomial InfectionsHealth Care Acquired
Infections

• Nosocomial Infections are infections that
  patients obtain while in the hospital
• There are 40 million hospital admissions annually
• 2 million patients develop hospital acquired
  infections and 88,000 die
• Hospital acquired infections cost 4.5 billion
  annually
• 60 of Nosocomial Infections are caused by Drug
  Resistant Organisms

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Chain of Events

• Three Elements must be present for an infection
  to spread to hospital patients
• Source of Pathogen Causative Agent
• Susceptible Host Patients and/or Care Providers
• Mode of Transmission - Transmission route for
  microorganisms from person to person or object to
  person

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Chain of Infection

Causative Agent
Susceptible Host
Reservoir
Portal of Exit
Portal of Entry
Mode of Transmission
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Breaking The Chain

• Infection control policies exist to help break
  the chain of events that leads to the spread of
  infection.
• Infection Control Activities Include
• Handwashing
• Isolation Techniques
• Use of Personnel Protective Equipment
• Occupational Exposure Plan

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HANDWASHING

• Handwashing is the most important activity you
  can do to prevent the spread of infection.
• 15-20 seconds of friction
• Rinse from wrist to fingertips
• Turn faucet off with paper towel
• Wash before and after each patient contact
• Wash after removing gloves
• Wash after using the restroom
• Wash before eating
• Alcohol handrinse should be used if hands are not
  visibly soiled

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Artificial Nails

• CDC advisory do not wear artificial nails,
  tips, overlays or decorations on nails for
  healthcare workers who have direct contact with
  patients
• Do not wear old or chipped nail polish
• Keep nails short-no longer than ¼ of an inch
• Scientific studies indicate increased fungal and
  bacterial colonization in healthcare workers with
  artificial nails

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Isolation Precautions

• Currently there are two types of Isolation
  Precautions
• Standard Precautions Used when caring for all
  patients, also known as Universal Precautions
• Transmission Based Precautions Used in addition
  to standard precautions for specific disease
  processes.
• Contact
• Droplet
• Airborne
• Protective

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Standard or Universal Precautions

• The Key Principle
• Treat all Blood, Body Fluid, Secretions and
  Excretions as if potentially infectious for HIV
  (the virus that causes AIDS), Hepatitis B,
• Hepatitis C, or other blood borne pathogens

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BloodBorne Pathogens

• Hepatitis B, Hepatitis C and Human
  Immunodeficiency Virus (HIV) are the most
  commonly known bloodborne pathogens.
• The main ways to become infected with these
  pathogens is through sexual contact and contact
  with blood and other body fluids.
• Since we cant look at a person and tell if they
  have HIV or HBV, we have to treat everyone as if
  they are infected, and follow standard
  precautions at all times.
• The average risk of infection after accidental
  exposure is
• HIV 0.3
• HBV-5-30 - There is a HBV vaccine series that is
  available to reduce healthcare workers risk of
  infection.

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Standard Precautions

• Wash hands between patient contact
• Use Alcohol hand gel when hands are not visibly
  soiled
• Use proper Personal Protective Equipment (PPE)
• Clean up spills with proper technique and
  disinfectants
• Never re-cap needles using two hands
• Discard Sharps in approved puncture resistant
  containers only
• Keep food away from possible infectious materials
• Never pick up glass with bare hands
• Identify places in your work area for eye and
  face washing if contamination occurs

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Personal Protective EquipmentPPE

• PPE is specialized clothing or equipment used to
  prevent exposure to health and safety hazards
• Gloves should be worn anytime you could
  potentially come in contact with blood, body
  fluids or other potentially infectious materials
• Gowns, Masks, Face Shield / Eyewear should be
  worn anytime a splash of body fluids is possible
• Any contaminated PPE should be disposed of
  properly in biohazard waste containers
• PPE is supplied by the hospitals
• PPE should be in the correct size
• You should know where PPE is located
• Gloves - latex free and powder free are available

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• Handling of Needles
• Never recap needles using 2 hands
• Never bend or break needles
• Dispose of all needles in nearest sharps
  disposal container
• Replace sharps containers when 2/3 3/4 full
• Must use safety devices when available

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Cleaning Bloodspills

• PPE Wear gloves. Also gown and eye goggles if
  a large spill
• Contain spill with paper towels or cover clean
  with 110 fresh bleach / water solution, or EPA
  approved germicidal cleaner then place in red bag
• Disinfect by applying 110 bleach / water
  solution let air dry

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• All used linens are to be put in soiled linen
  containers / bags without separating

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The biohazard symbol should be used to identify
anything or any area that may present possible
exposure to Blood and Body Fluids
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Transmission Based Isolation Precautions

• Contact Precautions Used to reduce transmission
  of microorganisms via the contact route.
  Examples include Antibiotic Resistant Organisms
• Droplet Precautions Used to reduce transmission
  of microorganisms by coughing, sneezing and
  talking. Examples include Bacterial Meningitis,
  Flu, Mumps and Rubella.
• Airborne Precautions Used to reduce
  transmission via the airborne route. Examples
  include TB, Smallpox, SARS and Chicken Pox Do
  not allow non-immune to go in this room
• Protective Precautions For immune-compromised
  patients with less than 1000 white blood cells.

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Contact Precautions

• Follow Standard Precautions .
• Follow instructions posted on the door.
• Always wear gloves when entering the room.
• Always wear gown when entering the room.
• Patients with MRSA and Entercoccus are examples
  of patients who should be placed in Contact
  Isolation.
• Students must be supervised by their preceptor
  the first time they enter a Contact Precautions
  room.

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MRSA(Methicillin Resistant Staph Aureus)

• MRSA is transmitted via direct contact between
  people or contaminated objects.
• S. aureus produces an ENZYME, betalactamase,
  which allows it to become RESISTANT to
  penicillins
• In 1960, Methicillin became available for
  treating penicillin resistant S. aureus
• S. aureus developed strains resistant to
  Methicillin and by the mid 1970s MRSA became a
  problem
• MRSA are resistant to many antibiotics, but can
  be treated with Vancomycin, some VRSA (Vancomycin
  Resistant Staph Aureus) are now being reported

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ENTEROCOCCUS

• Located in normal flora of the GI and female
  reproductive tract, also transmitted via the
  contact route.
• Third most common cause of hospital acquired
  infections.
• Infection occurs in urinary tract, wounds,
  central lines
• VRE Enterococcus has acquired vancomycin
  resistance
• VRE 70 from urinary site nursing home
  residents
• VRE Reportable to state from sterile body sites

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Risk Factors for Developing Antibiotic Resistance

• ICU Patients
• Patients with extended length of stay
• Patients with previous admissions
• Overuse and misuse of antibiotics
• Nursing home residents

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Preventing The Spread of Drug Resistant Organisms

• Wash hands between each patient contact
• Place patient in Contact Isolation Precautions
• Use and dispose of PPE correctly
• Follow strict isolation technique
• Use antibiotics appropriately

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Droplet Precautions

• Follow Standard Precautions.
• Follow Instructions Posted on the Door.
• Wear an Isolation Mask if coming within 3-6
  feet of the patient.
• Some hospitals may require a mask upon entering
  the patient room.
• Patients with the flu should be placed in Droplet
  Precautions.
• Students must be supervised by their preceptor
  the first time they enter a Droplet Precautions
  room.

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Influenza

• 10 to 20 of U.S. population will get the flu
• 36,000 will die, 114,000 will be hospitalized
• Most who die will be over 65, but children
  younger that 2 will be as likely as elderly to be
  hospitalized
• Healthcare employee vaccination rate has been
  about 35, CDC goal is over 80
• Recommendation for flu vaccine
• Elderly gt65
• Young children lt2 (6 months or younger not
  eligible)
• Immunocompromised and/or with chronic disease
• Healthcare worker taking care of or living with
  above
• Per CDC current data

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Airborne Precautions

• Standard Precautions should be followed
• Place patient in a negative pressure room
• Door remains closed
• Personnel entering room must wear an N95
  Particulate Respirator
• Employees must be medically screened and fit
  tested to wear the respirator.
• Due to the fit test requirement, students are not
  to enter the room of patients in TB isolation.
• Visitors/Family are encouraged to refrain from
  entry to the TB patients room. If entry is
  elected these individuals are strongly encouraged
  to wear an approved dust-mist mask, supplied by
  the hospital.
• Students have not been screened and fit tested
  and will not be allowed to care for patients in
  Airborne Precautions.

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Airborne Pathogens

• TB
• Chicken Pox
• Measles
• Disseminated Herpes Zoster
• Smallpox
• SARS (Severe Acute Respiratory Syndrome)

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TB

• Mycobacterium tuberculosis
• One third of the world has been infected with TB
• TB Infection Body holds the germ in check, but
  PPD is positive
• TB Disease 10 of persons infected will develop
  active disease, half within 2 years of exposure
• Active disease is defined as having the bacteria,
  being contagious, and symptomatic. A person can
  be infected with TB but not be symptomatic or
  contagious.
• 40-50 of TB patients have a delayed diagnosis an
  average of 6 days resulting in exposure of 25-45
  workers for each undiagnosed patient
• Health Care Workers should have annual PPD
  testing done

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QUESTIONS to detect TB

• Have you been coughing for over 3 weeks?
• Have you been coughing at all and have any of the
  following
• a. Coughing up blood?
• b. Sweats at night?
• c. Loss of weight without trying?
• d. Persistent fever?

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Exposure Control Plan

• OSHA requires that all hospitals develop an
  Exposure Control Plan designed to
• Reduce your risk of exposure to blood and body
  fluids
• Provide the use of PPE (Personal Protective
  Equipment)
• Provide the use of Engineering Controls ex.
  Negative pressure rooms for TB patients, sharps
  disposal containers
• Provide a Hepatitis B vaccine program
• The plan is located in the Epidemiology Manual
  (Infection Control) in your area

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Needlestick or Blood ExposureActions to Take if
Exposure Occurs

• First Aid thoroughly wash area
• If your eyes get splashed, flush them with water
• Notify supervisor immediately
• Notify Occupational/Employee Health
• Complete Needlestick/Exposure forms- this will
  allow for testing of the source patient
• Counseling
• HIV source - begin post -exposure prophylaxis
  within 2 hours