Infection Prevention and Control Annual Mandatory Education

Transcription

1 Infection Prevention and Control 2015 Annual Mandatory Education

2 Objectives Discuss procedures to prevent transmission of healthcare associated infections Outline isolation precaution procedures Discuss effective hand hygiene practices Identify and discuss personal protective equipment Discuss Clostridium difficile Discuss Influenza Discuss Tuberculosis transmission

3 Hand Hygiene Goal: To improve the overall knowledge of and compliance with hand hygiene practices and the consequences of lack of adherence (healthcare associated infection- HAI) It is an Administrative Policy: You must perform Hand Hygiene!

4 Mode of Transmission of Organisms Most Common Mode of Transmission of Organisms: Via the hands of healthcare workers (HCW s)

5 REMEMBER Objects in patient s rooms such as bed rails, bedside tables, monitors, IV pumps, ventilator equipment, etc. get colonized with the patient s bacteria. Thus, contamination of your hands and clothes occurs just by contact with those surfaces (even without touching the patient)

6 ALSO If you take clean equipment (computer on wheels, glucometer, blood pressure machine, stethoscopes, and thermometers) into a patient s room, you are contaminating that equipment. Therefore, you should disinfect it before taking it to the next patient s room

7 When To Practice Hand Hygiene? Before: Patient contact and/or entry into room Aseptic procedures (i.e. inserting urinary catheters, peripheral vascular catheters, and central lines) Donning gloves

8 When To Practice Hand Hygiene? After: Contact with patient s skin Contact with patient s environment (i.e. bed rails, side tables). Even without touching the patient Contact with body fluids, excretions or wound dressings Removing gloves (given that your hands will still get contaminated even with gloves)

9 Waterless Alcohol-Based Hand Rubs Is the preferred method when hands are not visibly soiled. Exceptions: For patients with C. difficile, use soap and water for a minimum of 15 seconds after contact with the patient or the environment When hands are visibly soiled

10 Other points Do not wear artificial nails, nail enhancements, or nail stickers (if you have any direct patient contact) Keep your nails less than 1/4 inch long Keep the area under the tip of the nails clean If used, nail polished should not be chipped

11 Key Points About Personal Protective Equipment (PPE) Don before entry into the room Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene NOTE: Occupational Safety & Health Administration (OSHA) requires that employer provides PPE for the safety of the employee

12 Face Protection Masks Protect nose and mouth Face shields Should fully cover nose, mouth, and eyes; prevent fluid penetration Cover forehead, extend below chin and wrap around side of face Goggles Should fit snuggly over and around eyes Personal glasses not a substitute for goggles. Anti-fog feature improves clarity

13 Sequence* for Donning PPE Hand Hygiene Gown Mask or respirator (if used) Goggles or face shield (if used) Gloves *Combination of PPE will affect sequence - be practical

14 Sequence for Removing PPE Gloves Gowns Face shield or goggles (if used) Mask or respirator (if used) Perform hand hygiene

15 Remember Work from clean to dirty Limit opportunities for touch contamination - protect yourself, others and environment Don t touch your face or adjust PPE with contaminated gloves Don t touch environmental surfaces except as necessary during patient care Don t touch your personal devices (i.e., pager, cell phones, ipads) Change gloves that are torn or soiled

16 Handling Regulated Waste Must be Placed in Closeable, Leak-Proof Containers Must be Covered When Transporting Must be in a Red Bag or Display a Biohazard Label Note: Refer to the JHS BBP Exposure Plan for additional information

17 Rationale for Isolation Precautions in Hospitals Prevents transmission of bacteria from healthcare workers to patients and from our patients to healthcare workers. Protects susceptible hosts

18 What are Infection Control Precautions Standard Precautions Respiratory Hygiene/Cough Etiquette Transmission Based Precautions/Isolation When Indicated Contact Precautions Droplet Precautions Airborne Infection Isolation Protective Environment

19 Standard Precautions Include Hand hygiene If anticipating exposure, then wear PPE Gloves, masks, aprons, impervious gowns, goggles, etc Clean and disinfect equipment and environment Safe sharp handling & disposal Respiratory etiquette

20 Respiratory Hygiene and Cough Etiquette

21 Influenza Influenza can be transmitted from healthcare workers to patients and from patients to healthcare workers You can protect yourself, patients, and your family by getting the flu vaccine each year Respiratory etiquette should be used at all times If you are sick, you should NOT be in contact with patients and other healthcare workers Do not allow sick visitors to enter patient care areas

22 Contact Precautions Multi-Drug Resistant Organisms, Lice, Scabies, Diarrhea until C. difficile is ruled out or maintain on Contact Precautions until no diarrhea x 2 days Private room Place sign on door or a highly visible area Hand hygiene Wear gown and gloves upon entry into room Hand Hygiene: alcohol-based hand rub (soap and water for C. difficile) Use disposable or dedicated patient care equipment

23 Clostridium difficile (C diff) Spore forming organisms that s resistant to many disinfectants Soap and water for hand hygiene (no alcohol as it does not kill the spores) Contact Precautions for patients with diarrhea Maintain on Contact Precautions until no diarrhea x 2 days Daily cleaning of patient rooms with bleach (other disinfectants do not kill the spores) Use soap and water

24 Droplet Precautions Influenza, pertussis, meningococcal meningitis Private room usually required Place sign on door or a highly visible area Hand hygiene Wear surgical mask on entry For patient transport, place surgical mask on patient

25 Airborne Infection Isolation Tuberculosis, Measles, Chickenpox, Smallpox, Viral Hemorrhagic Fever Private room with negative airflow (Airborne Infection Isolation Room) Post sign on door Keep door closed Hand hygiene Put on N-95 Particulate Respirator prior to entering room For patient transport, place a surgical mask on patient

26 A Simplified Description of TB Transmission

27 Think TB!!! Symptoms of Tuberculosis Unexplained cough > three weeks Unexplained cough > three weeks Unexplained cough with fever > three days Unexplained pleuritic chest pain, hemoptysis (coughing up blood) and/or dyspnea (difficulty breathing) Unexplained fever, night sweats, weight loss Individuals with the above symptoms should notify Occupational Health Services at Key Note: A positive TST (PPD) or TB blood test do not indicate active TB disease.

28 When to Call Tuberculosis Control Concern regarding proper isolation Possible or known exposures Information regarding past treatment Case management of TB patient Tuberculosis Control Contact Numbers Office: Pager:

29 Prevent Catheter Associated Bloodstream Infections (CLABSI) JHS has a Central Vascular Device policy The comprehensive strategy should include at least the following three components: Educating persons who insert and maintain catheters Use of maximal sterile barrier precautions Use of a >0.5% chlorhexidine preparation with alcohol for skin antisepsis during CVC insertion Use of a chlorhexidine patch at the site of catheter insertion In Pediatrics Scrub-the-Hub technique is practiced for hub care Every time you access a central line catheter port (hub) you are require to scrub the hub with chlorhexidine swabs for 15 seconds In the adult population a 70% isopropyl alcohol disinfecting cap is used on the ports This action decreases the contamination of the hubs and prevents bloodstream infections on your patients

30 Prevent Ventilator Associated Pneumonia (VAP) Patients on a mechanical ventilator are at risk of developing pneumonia The bundle to prevent this infection includes: Keeping the head of the bed elevated at 30 degrees Mouth care every 4 hours. Chlorhexidine mouthwash should be used additionally every 12 hours (age specific) Sedation holidays/ventilation weaning

31 Prevent Catheter Associated Urinary Tract Infections (CAUTI) Urinary catheter (Foley) increase the risk of your patients for catheter associated urinary tract infections The criteria for keeping a Foley catheter in place is in the JHS urinary catheter policy If the patient does not meet these criteria then the catheter can be removed by the nurse without an MD order Exceptions: pediatric cases, urology patients, spinal anesthesia

32 Infection Control Questions Call us: Jackson Memorial Hospital: Jackson South Community Hospital: ext Jackson North Medical Center: hour beeper for urgent matters after hours/weekends

33 November 2014