Transcript Break the Chain - Greenville Health System

Infection Prevention and Control:
It’s a Lifesaver!
Part 1: Video
•
•
•
•
•
Chain of infection
Breaking the chain
Bloodborne pathogens
Exposure management
Modes of transmission / precautions
Chain of Infection
Chain of Infection
Becoming Infected Depends on 3 Variables
• Condition or health of susceptible host
• Virulence (strength) of the germ
• Amount of inoculum – how much did you
get?
Breaking the Chain: OSHA
• OSHA = Occupational Safety and Health
Administration
• Purpose: Regulate employers so your
workplace is SAFE
– Bloodborne Pathogen Standard
• GHS
– Exposure Control Plan
– Exposure Category I, II, III
Breaking the Chain:
Your Responsibilities
• Hand Hygiene
• Wear gloves, gowns, masks, and other
barriers
• Follow standard and expanded precautions
• Have appropriate vaccinations
• Disinfect/sterilize patient care equipment
and/or instruments
Breaking the Chain:
Your Responsibilities
• Completing the Infection Prevention
session during New Employee Orientation
• Completing annual Infection Prevention
updates as required
• Following/adhering to policies and
procedures established by GHS
• Reporting unsafe practices and hazards
• Reporting to Employee Health if you have a
disease transmitted by blood or body fluid
Breaking the Chain:
GHS Responsibilities
• Education during orientation, annually, and
special programs
• Personal protective equipment (PPE)
• Free vaccinations
• Policies/procedures in place for safe work
practices
• Documenting exposures on SREO
• GHS Infection Prevention Manual available
Bloodborne Pathogens
• Body fluids which can spread
• What’s a bloodborne
pathogens:
pathogen?
– Blood
– Any disease-producing
– Vaginal secretions
microorganism (germ) in
– Semen
the form of viruses or
– Wound Exudate
bacteria.
– Cerebrospinal fluid
– These pathogens can
– Pericardial fluid
be transmitted from one
– Pleural fluid
person to another.
–
–
–
–
Amniotic fluid
Peritoneal fluid
Synovial fluid
Any body fluid with visible blood
Bloodborne Pathogens:
Three Major Pathogens
HIV/AIDS
Hepatitis B
Hepatitis C
Bloodborne Pathogens:
Transmission
• Sexual Contact
• Blood Contact
– Percutaneous
– Transfusion
– Open wounds
• Perinatal
– Transplacental
– Breast milk
• Organ transplant
Standard Precautions are used to prevent transmission
Bloodborne Pathogens:
Comparison of HBV, HCV, & HIV
Feature
HBV
HCV
HIV
Cumulative Prevalence
(Total # Chronic Carriers)
# HCW Infections Per Year
~1-1.25
Million
≤400
~ 3.9
Million
??
~0.9-1.25
Million
~57
# HCW Deaths Per Year
Risk of HCW Infection After
Single Needlestick
Rare
~3-30% HBsAb(-)
~0% HBsAb(+)
??
1.8%
~1-2
~0.3%
2-6 months
2 weeks –
6 months
No
2 weeks –
6 months
Yes
Interferon
& Ribavirin
No
Antiviral
Drugs
No
Incubation Period
Post-Exposure Prophylaxis
(PEP)
Treatment
Pre-Exposure Prevention
Yes
Interferon
Yes
(cumulative)
(80% less if
PEP given)
Bloodborne Pathogens:
HCW Exposure
BODY FLUID
+ CONTACT =
EXPOSURE
•Blood
•Semen
•Vaginal Secretions
•Wound Exudate
•Cerebrospinal fluid
•Pericardial fluid
•Pleural fluid
•Amniotic fluid
•Peritoneal fluid
•Synovial fluid
•ANY body fluid with
visible blood
•Stick, cut, or scratch by needle
or other sharp object
•Splash into eyes, nose, or
mouth
•Into open wound, cut, or skin
lesion
•Onto broken skin (i.e., rash,
acne, torn cuticle, or abrasion)
•Large amount of skin exposed
•REVERSE EXPOSURE – human
bite
Bloodborne Pathogens:
Exposure Procedure
1. Perform first aid
•
•
Cleanse affected area with
soap & water OR
Irrigate eye(s) with normal
saline or water for 10-15
minutes
Bloodborne Pathogens:
Exposure Procedure
2. Report Exposure IMMEDIATELY!
Call phone number and follow instructions
• GMMC: 455-4209
• NGH: 455-9243
• GrMC: 797-8074
• HMH: 454-6196
• PMH: 797-1069
• LCMH: 833-9349 (starting Nov 1st)
• UMG and PIH: Call nearest hospital
ALL locations: If you have any difficulty reporting,
page (864) 345-6133.
Bloodborne Pathogens:
Exposure Procedure
3. Complete SREO
• Hard copy to supervisor / manager
• Remaining copies to Exposure RN
Modes of Transmission
Modes of Transmission:
Vector & Common Vehicle
• Vector
– Carried by plant or animal
• Common Vehicle
– Common carrier for the
germs, such as people, food,
animals, and contaminated
instruments
Modes of Transmission:
Contact
• Direct Contact
– Person-to-person spread
– Actual physical contact between source &
susceptible host
• Indirect Contact
– Susceptible host comes in contact
contaminated object
– Germ that is spread is on the item and
comes in contact with susceptible host
Modes of Transmission:
Contact
• Diseases spread by contact
– Antibiotic-resistant organisms
• MRSA
• VRE
• Pediculosis (lice)
• Scabies
Modes of Transmission:
Contact
• Private Room
• Gloves
• Gowns
• Use dedicated equipment
OR clean equipment
before leaving the room
Modes of Transmission:
Contact
• MUST wash your hands
with SOAP & WATER
• Private Room
• Gloves
• Gowns
• Use dedicated equipment
OR clean equipment
before leaving the room
Modes of Transmission:
Contact
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.
Modes of Transmission:
Contact
Transportation of the Patient
• Place a clean gown on the patient
• Use clean linens to cover patient / stretcher for
•
•
•
transport
Ensure all drainage is contained
Assist patient to perform hand hygiene
Wear gloves and gowns as indicated to assist
the patient onto a stretcher or wheelchair
If you are assisting with the transport of the patient, after you have moved the
patient to the stretcher, remove your PPE and clean your hands before leaving the
room.
Modes of Transmission:
Contact
Transportation of the Patient
• Additional steps are required if drainage can
NOT be contained
– 2 persons are required to transport the patient
– The one who has contact with the patient/bed may
wear PPE
– The other person is to open doors, push elevator
buttons and does NOT wear PPE
Modes of Transmission:
Droplet
• Large particles that rapidly settle out on flat
surfaces, like tables or trays
• Germs travel quickly through air (3 ft or less)
• Transmission involves contact with your eyes,
nose, or mouth
Modes of Transmission:
Droplet
• Disease spread by droplets
– Diphtheria
– Bacterial meningitis
– Mumps
– Rubella
Modes of Transmission:
Droplet
• Private Room
• Facial Protection
within 3 feet of the
patient
Modes of Transmission:
Airborne
• Contained within droplet or dust particles
• Suspended in air for extended period
– May spread through air ducts
• May involve varying distances between source
and susceptible host
Modes of Transmission:
Airborne
• Disease Spread by Airborne transmission
– Pulmonary tuberculosis
– Measles
Modes of Transmission:
Airborne
• Negative Pressure
Private Room
• N95 respirator or
PAPR hood
• Keep door closed at
ALL times
Pulmonary Tuberculosis
• Caused by Mycobacterium tuberculosis
• Symptoms:
–
–
–
–
–
–
–
Fatigue
Fever
Lethargy
Weakness
Night sweats
Weight loss
Persistent productive cough
Pulmonary Tuberculosis
• Outpatients presenting with cough
– Assess patient for symptoms
– If patient has cough & 2 or more symptoms:
• Immediately mask the patient
• Place in negative pressure room (if available) or private
room with the door closed
• If patient leaves the room, he needs to wear a mask
• MD to assess ASAP
– If MD suspects pulmonary TB:
• Notify Admitting Office to locate negative pressure room
• Patient wear mask during transport
• Inpatients assessed to have signs & symptoms of TB
– Place patient on Airborne Precautions
– Notify Infection Prevention Department
Modes of Transmission:
Multiple
• There are multiple diseases that can be
spread by more than one route of
transmission
– Pertussis (contact & droplet)
– RSV (contact & droplet)
– Chicken pox / disseminated herpes zoster
(contact & airborne)
Modes of Transmission:
Multiple
• Follow the sign for
correct PPE usage
• Clean your hands
BEFORE and AFTER
the removal of PPE
Break the Chain:
Communication of Expanded Precautions
• Initiating Expanded Precautions
– RN’s
– MD’s
– Infection Prevention Team
• If someone other than Infection Prevention
initiates precautions, they need to call the
Infection Prevention Department
Break the Chain:
Communication of Expanded Precautions
• Nursing Responsibilities
– Sign on door
– Sticker on front of chart
– Sticker in MD progress notes
• Include organism and site
– Educate patient/family
– Document patient/family education
– Document precautions every 24 hours
Break the Chain:
Communication of Expanded Precautions
• Discontinuing Precautions
– ONLY done by the Infection Prevention Team
– If an MD writes an order to discontinue
precautions, Infection Prevention MUST be
consulted to determine if precautions can be
discontinued
Continuum of Care
(Related to Antibiotic Resistance)
• The type of precautions required and extent of
the level of care a patient receives changes as
they move through the healthcare system
Ambulatory Care /
Physician Practice /
Outpatient Treatment
Acute Care
Long Term Care /
Subacute /
Rehab /
Home Care
Continuum of Care
(Related to Antibiotic Resistance)
Patient’s risk of contact transmission changes
related to:
•
•
•
•
Number of invasive devices
Activity level
Bowel/bladder control
Existence of body fluid drainage
Continuum of Care
(Related to Antibiotic Resistance)
• The level of precautions needed for a patient will
change related to the varying levels of risk
Ambulatory Care /
Physician Practice /
Outpatient Treatment
Standard Precautions
Acute Care
Contact Precautions
Long Term Care /
Subacute /
Rehab /
Home Care
Standard Precautions
Break the Chain:
Standard Precautions
GHS considers all blood, body substances and nonintact skin potentially infectious.
To minimize exposure follow:
• Work practice controls
– Hand hygiene
• Engineering controls
– PPE
These Controls and Barriers are STANDARD
PRECAUTIONS and are practiced AT ALL TIMES for
ALL PATIENTS and in ALL SITUATIONS.
Break the Chain:
Standard Precautions
• Treat every patient as if infectious.
• Wear Barriers appropriate for care being given.
For Example:
– Wear gloves when likely to touch body substances,
mucous membranes or non-intact skin.
– Wear gown when clothing is likely to become
soiled.
– Wear facial protection when likely to be splashed
with body fluids.
Break the Chain:
Standard Precautions
• Not sure what PPE is required for a
procedure in order to protect yourself?
– Section 8 of the Infection Prevention Manual
has a table that lists minimum requirements of
PPE
– The list is not all-inclusive, so use
professional judgment to assess the need for
additional barrier precautions
Are you
awake?
Break the Chain:
Hand Hygiene
HAND HYGIENE IS
A LIFESAVER
Break the Chain:
Hand Hygiene
When was the last time YOU cleaned your
hands?
Just because your hands
may look clean, doesn’t
mean they are clean.
Break the Chain:
Hand Hygiene
What’s on YOUR hands?
PCT BEFORE and AFTER hand hygiene
Break the Chain:
Hand Hygiene
• How?
– 15 second
handwash with
soap, water, and
friction
– Use of waterless
handrub. Spread
all over surfaces
of both hands
and allow to dry.
Break the Chain:
Hand Hygiene
When MUST you wash your hands with
soap and water?
• When your hands are visibly soiled
• When your hands are visibly contaminated
with blood and body fluids
• Before eating
• After using the restroom
• If the patient has a spore forming bacteria
such as C. difficile or Anthrax
Break the Chain:
Hand Hygiene
When CAN you use an alcohol-based hand
rub?
•
BEFORE having direct contact with a patient
• AFTER having direct contact with a patient or the
patient’s skin
• AFTER having contact with body fluids, wounds, or
broken skin if your hands are NOT visibly soiled
• AFTER touching equipment or furniture near the
patient
• BEFORE and AFTER removing gloves
My 5 Moments
of Hand Hygiene
Greenville Health System has adopted the 5 moments of Hand Hygiene as defined
by the World Health Organization as to when hand hygiene should be performed.
Break the Chain:
Hand Hygiene
Nail infections
Pseudomonas
Staph
•Outbreaks in Healthcare
Facilities have been associated
with Artificial nails.
•Nails don’t have to look this bad to
cause a problem. In events reported,
the nails looked “normal”.
Fungal
Break the Chain:
Hand Hygiene
Are Your Nails Clean?
Natural Nails
Break the Chain:
Hand Hygiene
Are Your Nails Clean?
False Nails
Break the Chain:
Hand Hygiene
REMEMBER: Everything you touch has
been touched by someone else!
• Clean your hands!
• Clean patient care equipment!
Break the Chain:
Cleaning of Equipment
After EACH patient use
• Glucometer
• Pulse Oximeter
• BP cuffs
EVERY shift
• Keyboards in clinical
•
•
•
settings (i.e. computer,
omnicell, pyxis
keyboards)
Phones in clinical areas
Dinamapp machines
Locator badges
Clorox hydrogen peroxide
wipes are hospital approved
to clean equipment
Don’t know when /
how to clean a
piece of
equipment?
Refer to the IP
Manual and/or your
department specific
IP Policy in the
front of your IP
manual
Break the Chain:
Infectious Waste
Classification of infectious waste and
recommendations for proper handling are found in
Section 8 of the Infection Prevention Manual
– Expanded precautions patients
• Waste from room of a patient in expanded precautions is handled
the same as for ALL patients
– Reusable Equipment / Trays
• DO NOT place reusable equipment/trays in red biohazard bags
• Use clear biohazard labeled bags
– Linen
• All linen is considered infectious
Break the Chain:
Infectious Waste
• Management of spills
– Follow procedure for management of spills found in
Section 8 of the Infection Prevention Manual
– Follow standard precautions when managing spills of
blood/body fluid
– Spill kits are available in the Omnicell and soiled utility
rooms
– Use shovel/scrapper if sharp objects. Use disposable
towels to clean up. Dispose of in biohazard container.
Other Resources:
Infection Prevention Manual
• Every department or at GHSNet
–
–
–
–
–
–
–
–
Disease Specific Table
Exposure Control Plan
TB Protection Plan
Infection Prevention & Control Precautions
Personal Protective Equipment Use
Animals in Healthcare
Sterilization
Cleaning patient care equipment
Other Resources:
Department Specific IP Policy
• If a clinical department has a department
specific infection control policy, it is found:
– FRONT of their IP Manual
– Infection Prevention Website
• Unit/department specific information
•
•
•
•
How to handle contaminated clothing
Cleaning of equipment
Location of PPE for your unit/department
Special infection control procedures or concerns
for your area
Other Resources:
Educational Materials
• Expanded Precautions Kit
(Every nurses’ station)
– Steps for initiating
precautions
– Precautions signs
– Precautions stickers
– Fact sheets
– How to reorder
precaution signs and
fact sheets
• Fact sheets
–
–
–
–
–
–
–
–
–
–
–
MRSA
Community acquired MRSA
VRE
C diff
Tuberculosis
Lice
Scabies
RSV
Meningitis
Bioterrorism agents
Influenza (seasonal &
pandemic flu)
– Disaster Family Plan
– Hand hygiene
– Pertussis
Other Resources:
IP Website
Infection Prevention:
It’s a Lifesaver!
•Protect Your Patient
•Protect Yourself
•Protect Your Family