Infection Control

This material is the private property of Chesapeake Medical Staffing.

Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited.

Infection Control

JCAHO MandatoryAnnual CompetencyChesapeake Medical Staffing



IntroductionInfection control is a critical concern for patients, healthcare workers, facility administrators, and government agencies. Infection control measures are designed to combat everything from the spread of colds and flu to hepatitis B and C, SARS, HIV/AIDs, and other potentially life threatening diseases. Appropriate infection control measures may range from something as simple as following proper hand washing hygiene to coordinated policies involving worker health screening, immunization, and treatment. All of these measures should be incorporated into synchronized, organization-wide infection control programs at healthcare facilities of all sizes and types.



Current Statistics

More than 2 million hospital patients each year get an infection while being treated for another illness or injury and 90,000 of them die as a direct or indirect cause of their infection. Healthcare-associated infections not only inflict suffering and death but also cost the United States in excess of $5 billion each year due to the extra days or weeks of hospitalization needed to treat the infection (Rutala et al., 2006).



Goals of Infection Control Training

• Ensure that health professionals understand how bloodborne and other pathogens can be transmitted in the work environment: patient to healthcare worker, healthcare worker to patient, and patient to patient

• Apply current scientifically accepted infection control principles as appropriate for the specific work environment

• Minimize opportunity for transmission of pathogens to patients and healthcare workers



CDC Recommendations

This section is based on the CDC Recommendations for Isolation Precautions in Hospitals, which is available at http://www.cdc.gov/ncidod/dhqp/gl_isolation.html.

The Centers for Disease Control (CDC) describe four types of precautions, based on the mode of transmission of the organism known or suspected to be present. CDC Guidelines are not regulations, but they are evidence-based recommendations. These guidelines were developed for hospitalized inpatients, and the principles can be applied in outpatient settings.



Standard Precautions

Standard Precautions are to be used with all patients, regardless of diagnosis. Standard Precautions, formerly known as Universal Precautions, were initially designed to minimize risk to staff from unknown carriers of bloodborne pathogens, such as hepatitis B, hepatitis C, or HIV. In addition to protecting staff, Standard Precautions also protect patients from organisms shed in the body fluids of other patients. Standard Precautions are required by by federal law and the OSHA Bloodborne Pathogens Standards.

*A complete description of Standard Precautions may be found at http://www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html. Source: CDC, 2006.



Ten Standard Precautions

The following slides will review the ten Standard Precautions recommended by the CDC for health care workers. Chesapeake Medical Staffing encourages all employees to follow these recommendations to reduce your risk of occupational hazards.



Hand Hygiene

Hand hygiene is still the single most importantprocedure for preventing the spread of infection! This is because healthcare facilities bring many reservoirs (the patients and staff) into close contact with many susceptible hosts (the patients and staff). We cannot eliminate the reservoirs and susceptible hosts, so we must eliminate the mode of transmission.

We must not carrygerms from reservoir to susceptible host!



#1: Handwashing

Wash hands with plain soap or waterless antiseptic agent (alcohol-based product) after touching blood, body fluids, and contaminated items, whether or not gloves are worn. Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross-contamination of different

body sites.



Hand Hygiene ProductsHand hygiene includes both using alcohol-based hand hygiene products and washing with soap and water. Alcohol-based hand hygiene products are preferred over soap and water when hands are not visibly soiled. Alcohol-based products are better in three ways: • they kill the germs better • they leave skin in better condition• they are quicker and easier to use, so people use them

more Use hand hygiene products only on dry hands. Use enough of the product so that hands are dry again in 15 seconds, and rub hands together until they are completely dry.



HandwashingHand washing should be done at all of the followingtimes: • When hands are visibly dirty or are visibly soiled

with blood or other body fluids, wash hands with soap and water

• If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations

• Before having direct contact with patients• Before donning sterile gloves for any invasive

procedure• After contact with a patient's intact skin (taking a

pulse or blood pressure, lifting a patient)



Handwashing (cont)• After contact with body fluids or excretions, mucous

membranes, nonintact skin, and wound dressings• If moving from a contaminated body site to a clean

body site• After contact with contaminated items or

environments• After removing gloves• Before eating and after using a restroom, wash

hands with soap and water• Wash hands with soap and water if exposure to

Bacillus anthracis (anthrax) is suspected or proven. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.



CDC: No Acrylic NailsThe CDC Hand Hygiene Guideline specifies "Do not wear artificial fingernails or extenders when having direct contact with patients at high risk.“ Nails should be unpolished and less than one-quarter inch long. Chipped nail polish, long nails, artificial fingernails, or nail extenders may tear gloves and can harbor pathogens, even after careful handwashing or the use of surgical scrubs. CMS endorses the CDC Hand Hygiene Guideline.No artificial nails or extenders are permitted.

* The complete CDC Guidelines on hand hygiene may be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm.Source: CDC, 2006.



#2: Gloves

Wear clean gloves when touching blood, body fluids, and contaminated items. Put on clean gloves just before touching mucous membranes and non-intact skin. Change gloves between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces, and before going to another patient, and wash hands

immediately.



#3: Mask, Eye Protection, Face Shield

Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during activities that are likely to generate splashes or sprays of blood or body fluids(such as suctioning, irrigation, or delivery of the newborn).



#4: Gown

Wear a gown to protect skin and to prevent soiling of clothing during activities that are likely to generate splashes or sprays of blood or body fluids. Select a gown that is appropriate for the amount of fluid likely to be encountered. Remove the soiled gown as promptly as possible and wash hands .



# 5: Patient-care Equipment

Handle used patient-care equipment soiled with blood or body fluids in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. Clean or reprocess reusable equipment before using it for the care of another patient. Ensure that single-use items are discarded properly.



#6: Environmental Control

Follow hospital procedures for the routine care, cleaning, and disinfection of environmental surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces.



#7: Linen

Handle, transport, and process used linen soiled with blood or body fluids in a manner that prevents skin and mucous membrane exposures and contamination of clothing and that avoids transfer of microorganisms to other patients and environments.



#8: Sharps

Take care to prevent injuries when using or disposing of needles, scalpels, and other sharp instruments or devices. Never recap used needles using both hands or use any other technique that involves directing the point of a needle toward any part of the body. Do not manipulate used needles by hand. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers that are located as close as practical to the area in which the items were used.



#9: Ventilation Devices

Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable.



#10: Patient Placement

Place a patient who contaminates the environment or who does not assist in maintaining appropriate hygiene (children, patients with altered mental status) in a private room. If a private room is not available, consult with infection control professionals regarding patient placement or other alternatives. If it is necessary for an infected patient to share a room with a noninfected patient, it is important that roommates are selected carefully and that patients, personnel, and visitors take

precautions to prevent the spread of infection.



Transmission Based Precautions

In addition to Standard Precautions, which are used with all patients, some patients require additional precautions, known as Transmission-Based Precautions. There are three types of transmission-based precautions:

• contact • droplet • airborne



Contact Precautions

Contact Precautions are designed to minimize transmission of organisms that are easily spread by contact with hands or objects. Thefollowing five actions are recommended when caring for patients with contact isolation.



Contact Precaution #1: Patient Placement

Place the patient in a private room. When a private room is not available, place the patient in a room with a patient(s) who has active infection with the same microorganism but with no other infection (cohorting ). Consultation with infection control professionals is advised before cohorting.



Contact Precaution #2: Gloves and Handwashing

In addition to wearing gloves, as outlined under Standard Precautions, wear gloves when entering the room. Change gloves after contact with infective material that may contain high concentrations of microorganisms, such as fecal material or wound drainage. Do not soil the environment with used gloves. Remove gloves before leaving the patient's room and wash hands immediately. After glove removal and handwashing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patient's room.



Contact Precaution #3: Gown

Wear a gown when entering the room if you anticipate that your clothing will have substantial contact with the patient, environmental surfaces, or items in the patient's room, or if the patient is incontinent or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing.Remove the gown before leaving the patient's environment. After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces.



Contact Precaution #4: Patient Transport

• Appropriate barriers (eg, masks, impervious dressings) should be worn or used by the patient to reduce transmission of infection to other patients, personnel, and visitors, and to avoid contamination of the environment.

• Personnel in the area to which the patient is to be taken should be notified of the impending arrival of the patient and precautions to be used to reduce the risk of transmission.

• Patients are informed of ways in which they can assist in preventing the transmission of their infection to others.



Contact Precaution #5: Patient-care Equipment

When possible, dedicate the use of non-critical patient-care equipment (stethoscope,BP cuff, thermometer, etc.) to a single patient or cohort of patients to avoid sharing among patients. Clean and disinfect any equipment that must be brought out of the room before use with others.



Airborne PrecautionsAirborne Precautions are designed to prevent transmission of diseases spread by the true airborne route. These organisms are released from the patient in respiratory droplets, which evaporate shortly after release. Most organisms die when they dry out, but the organisms of these few diseases—tuberculosis, chickenpox, measles, SARS, and smallpox—can survive drying out. The droplet nuclei (small-particle residue of evaporated droplets) remain suspended in the air and can be dispersed widely by air currents within a room or even over a long distance. Airborne Precautions are the only type that requires a negative-pressure room

with door kept closed and use of an N-95 respirator.



Recommendations

The following three precautions arerecommended when caring for patients with contact isolation:

1. Patient Placement2. Respiratory Protection3. Patient Transport



Airborne Precaution #1: Patient Placement

Place the patient in a designated negativepressure room. Keep the room door closed and the patient in the room, as feasible.



Airborne Precaution #2: Respiratory Protection Wear an N95 respirator when entering the room of a patient with known or suspected infectious pulmonary tuberculosis. Susceptible persons should not enter the room of patients known or suspected to have measles or chickenpox if immune caregivers are available. If susceptible persons must enter the room of a patientwith measles or chickenpox, they should wear anN95 respirator. Persons immune to measles orchickenpox do not need to wear respiratory protection.



N-95 RespiratorsN-95 respirators are required for staff sharing

air space with the patient in Airborne Precautions. They must make a tight seal against the face, and must be fit tested. This type of respirator protects the person wearing it from possible pathogens in the air of the room, protecting their portal of entry. Some N-95 respirators have an exhalation valve, and these do not prevent contamination of a sterile field and so should not be worn alone in the OR.



Airborne Precaution #3: Patient Transport

Limit the movement and transport of the patient from the room to essential purposes only. If transport or movement is necessary, place a surgical mask on the patient, if possible. Notify the receiving department of precautions prior to transport.

* A complete description of Airborne Precautions may be found at http://www.cdc.gov/ncidod/dhqp/gl_isolation_airborne.html.Source: CDC, 2006.



Respiratory HygieneRespiratory Hygiene is a relatively new concept, which recommends use of Droplet Precautions by healthcare workers when providing care to any patient with symptoms of respiratory infection, such as coughing. In addition, signs are posted asking patients to cover their nose and mouth with a tissue when coughing or sneezing or to wear a surgical mask. Patients are also asked to perform hand hygiene after contact with

their own secretions.

Complete details on Respiratory Hygiene may be found at http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene. htm.



Engineering ControlsEngineering controls include equipment, devices or instruments that remove or isolate (contain) a hazard. For example, the puncture-resistant containers required by Standard Precautions for the disposal and transport of needles and other sharps are an engineering control. Splatter shields on medical equipment associated with risk-prone procedures, such as locking centrifuge lids, isolate or contain the hazard. Hand hygiene is also an engineering control, since it removes the microorganisms from the workplace.



Engineering Control of Airborne Infections

Engineering controls used to prevent transmission of airborne infections include:

Isolation rooms with appropriate air exchanges (negative pressure or direct exhaust)

HEPA filtration Ultraviolet irradiation



Sharps Safety

Safety sharps devices and containers are another type of engineering control, since they isolate or contain the hazard—used sharps. OSHA requires the use of safety sharps when feasible. Healthcare workers may be exposed percutaneously (through the skin) by sharps or needle sticks to HIV, hepatitis B and C, and other bloodborne pathogens. When using a safety sharp device, be sure to activate the safety feature before discarding. The stick you prevent may be your own!



Specific Practices to Avoid Exposure and Injury

• Avoiding unnecessary use of needles and other sharps• Using care in the handling and disposal of needles and

other sharps • Not recapping unless absolutely medically necessary and

then using one-hand technique or safety device to recap • Passing sharp instruments by use of designated "safe

zones" • Disassembling sharp equipment by using forceps or other

devices • Closing and replacing sharps containers when they are full

(rather than overfilling) according to the manufacturer's instructions



Exposure Incident If you experience a needle stick or other sharps injury orare exposed to the blood or other body fluids of a patientduring the course of your work, immediately follow these steps: • Wash needle sticks and cuts with soap and water. • Flush splashes to the nose, mouth, or skin with water. • If your eyes were involved in the exposure, irrigate your

eyes with clean water, saline, or sterile irrigation solution. • Report the incident to a supervisor—including how, when,

where, and who, describing the events in as much detail as possible.

• Immediately seek medical treatment. • Notify CMS as soon as possible (410-321-4267) and

complete a CMS Incident Sheet



Work Practice Controls

Work practice controls are modifications in technique that reduce or eliminate the likelihood of exposure by altering the manner in which a task is performed. These are the workplace procedures that tell you how to do the job safely.



Work Practice Recommendations

Work practices recommendations include: • proper and timely hand washing• spraying of any potentially infectious material • proper decontamination and sterilization of equipment

and supplies • cleanup, care, and maintenance of supplies and

equipment • no eating, drinking, smoking, applying cosmetics or lip

balm, or handling contact lenses where there is a risk of contamination minimize splashing

• proper disposal of used supplies and equipment • keeping all food and drink away from areas where

blood or potentially infectious materials are present.



Environmental Control Measures

Environmental control measures also helpprevent the transmission of infection. These measures include:

• Environmental cleaning (housekeeping) • Waste management • Linens (textiles) and laundry management



Personal protective equipment (PPE)PPE is specialized clothing or equipment wornby a healthcare worker for protection against a hazard. OSHA guidelines state that PPE will be considered "appropriate" only if it does not permit blood or other potentially infectious materials to pass through or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.



PPE

Personal protective equipment includes: gloves cover garb (gowns, aprons, fluid-resistant

laboratory coats, foot covers) face shields masks eye protection caps and hoods



Use of PPE

Use of PPE is built into the descriptions of all four kinds of isolation precautions (Standard, Contact, Droplet, and Airborne) described by the CDC. Use appropriate barriers and/or PPE whenever you may have contact with the blood or body fluids of any patient and to prevent exposure to the droplets of patients with respiratory symptoms.



Barriers and PPE

Barriers and PPE are most effective whenappropriately selected, properly fitted, worn according to manufacturer's instructions, inspected frequently to verify integrity of the barrier and changed between patients. The cost of barriers and PPE are far less than the cost of treating preventable infections of patients and personnel.



Types of PPE Selected

The type of PPE selected should be based onthe procedure and reasonably anticipatedevents such as:

blood or body fluid splash contact with minimal bleeding/drainage/body

substance contact with large volume

bleeding/drainage/body substance that is likely to soak through the contact area

respiratory droplet pathogens airborne pathogens



Prevention of Infectious or Communicable Diseases in Healthcare workers.

Protecting health care workers from disease is accomplished in many ways, including:

• use of Standard Precautions with all patients • use of additional isolation precautions to protect

HCWs as well as patients • influenza vaccine



ConclusionYou have a professional responsibility toyourself and to your patients regardinginfection control. It takes diligence and effort on your part to follow the recommendations of the CDC to maintain safe clinical practices and reduce occupational hazards.

Infection Control

Health & Medicine

introduction infection

infection rutala

disease control cdc

healthcare workers

healthcare facilities

cdc recommendations

cdc guidelines

evidencebased recommendations