Transcript Infection Control

EXPOSURE CONTROL PLAN
BLOODBORNE PATHOGEN PLAN
TB EXPOSURE CONTROL PLAN
ISOLATION
An Exposure Control Plan Manual
can be found on every department at
PSMH
or via the
Dovenet policy & procedures infection
control
BLOODBORNE
PATHOGEN PLAN
WHAT ARE BLOODBORNE
PATHOGENS?
viruses and bacteria that require blood
or body fluids to live
PSMH BLOODBORNE PATHOGEN PLAN
WHAT BACTERIA AND VIRUSES ARE
WE TALKING ABOUT?
HIV, HEPATITIS C, SYPHILIS, DELTA
HEPATITIS,
B HEPATITIS, AND MALARIA
WE are MAINLY CONCERNED with
HIV, HEPATITIS B AND C.
THESE BACTERIA & VIRUSES CAN LIVE IN
THESE
BLOOD & BODY FLUIDS
P
P
P
P
P
P
P
P
BLOOD AND BLOOD PRODUCTS
CEREBRAL SPINAL FLUID
PLEURAL FLUID
PERICARDIAL FLUID
PERITONEAL FLUID
SEMEN, VAGINAL FLUID
AMNIOTIC FLUID
SYNOVIAL FLUID
HOW ARE BLOODBORNE PATHOGEN SPREAD?
When infected fluids enter the body through:
Cuts, scrapes or other breaks in the skin
Needle-stick injuries
Splashes into the mouth, nose or eyes
Oral, vaginal or anal sex
Using infected drug needles
Pregnant women who are infected with these
pathogens may pass them to their babies.
HOW DO YOU KNOW IF SOMEONE HAS ONE OF
THESE VIRSUS?
YOU DON’T!
SIGNES AND SYMPTOMS OF HEPATITIS B & HEPATITIS C: (Flu like)
Loss of Appetite, Tired feeling
Low grade temperature
Vague abdominal pain and discomfort
Diarrhea or vomiting
Yellow skin or eyes
Patients with Hepatitis B or C may or may not have symptoms and will not be
diagnosed unless they become jaundiced (yellow) – BUT THEY ARE STILL
CONTAGIOUS!
SIGNS & SYMPTOMS OF HIV:
 Flu-like symptoms in the beginning
May have more frequent bouts of flu, colds
Eventually develop AIDS and will be diagnosed
Fever, diarrhea and fatigue (tired feeling)
It can take up to 10 years or longer before
a person is sick enough to be diagnosed
with HIV. In the mean time they are
contagious!
WHAT CAN WE DO TO PROTECT
HEALTHCARE WORKERS?
STANDARD PRECAUTIONS/UNIVERSAL
PRECAUTIONS WERE DEVELOPED
BY OSHA AND CDC.
PSMH BLOODBORNE PATHOGEN PLAN
STANDARD/UNIVERSAL PRECAUTIONS:
A SYSTEM THAT OUTLINES SAFEGUARDS OR BARRIERS
DESIGNED TO PROTECT HEALTHCARE WORKERS
Personal Protective Equipment
Engineering control
Housekeeping
Work Practice Controls
PSMH BLOODBORNE PATHOGEN PLAN
STANDARD/UNIVERSAL PRECAUTIONS REQUIRE
PERSONAL PROTECTIVE EQUIPMENT
FOR EACH AND EVERY PATIENT
 If there is a possibility that you are going to touch or come in contact with anyone's blood, body fluids or
mucous membranes:
YOU WILL WEAR GLOVES
 If there is a possibility of blood or body fluids splashing or coming in contact with your eyes nose or mouth
YOU WILL WEAR A MASK & GOGGLES OR A SHIELDED MASK
PSMH BLOODBORNE PATHOGEN PLAN
STANDARD/UNIVERSAL PRECAUTIONS REQUIRE
PERSONAL PROTECTIVE EQUIPMENT
FOR EACH AND EVERY PATIENT
If there is a possibility that you might have your clothing soiled with someone's blood or body
fluids
YOU WILL WEAR A GOWN
 Personal Protective Equipment (PPE) is located in each and every patient room (except in the
Psychiatric Unit, 2E) in a beige BSI Box on the wall (gloves, gowns, masks, shielded masks, goggles
and AMBU BAGS)
 When you use this equipment – REPLACE IT IMMEDIATELY!
PSMH BLOODBORNE PATHOGEN PLAN
STANARD/UNIVERSAL PRECAUTONS
REQUIRE
ENGINEERING CONTROLS
Biohazard Labels and containers
Safety Needles
 Needless IV Systems
 Sharps containers
 Safety scalpels
Safety equipment is only as good as the
people who use it!
When safety equipment is provided use it
activate the safety mechanisms as soon as
you are done with the procedure.
PSMH BLOODBORNE PATHOGEN PLAN
STANDARD/UNIVERSAL PRECAUTONS REQUIRE
HOUSEKEEPING:
 Proper disposal of SHARPS and broken glass
 Never reach into trash
 Dispose of sharps containers when 2/3 full
 Clean up Blood/Body Fluids using the proper equipment and
according to policy
PSMH BLOODBORNE PATHOGEN PLAN
STANDARD/UNIVERSAL PRECAUTONS REQUIRE
WORK PRACTICE CONTROLS:
NEVER bend, break, or RECAP a Needle
Minimize splashing of fluids during collection or disposal
Don’t eat or drink in work areas
Wash your hands or skin after contact with body fluids or
objects that might be contaminated
PSMH BLOODBORNE PATHOGEN PLAN
HEPATITIS B VACCINE:
 Hepatitis B is the only Bloodborne Pathogen we can
protect against!
 IF YOU HAVE NOT BEEN VACCINATED FOR
HEPATISIS B WE WILL GIVE THE VACCINE FREE
OF CHARGE!
 See the Employee Health Nurse – Brenda Dearth
PSMH BLOODBORNE PATHOGEN PLAN
HEPATITS B VACCINE
CONSISTS OF 3 INJECTIONS
 1- now
 1- one month later
 1- five months after the second
 A TITER DRAWN BY THE LABORATORY 2 MONTHS AFTER COMPLETION
OF THE SERIES.
If you are not immune after the vaccination series you will be offered a repeat
vaccine series – if you are not immune after the second vaccination series you will
not become immune. IF you are exposed to Hepatitis B you can be given Immune
Globulin that will give you temporary immunity for 3 to 6 months
PSMH BLOODBORNE PATHOGEN PLAN
WHAT IS AN EXPOSURE?
It’s any time blood or body fluids come in
contact with a worker’s eyes, nose, mouth or
skin through a needlestick, splash, or other
type of exposure
PSMH BLOODBORNE PATHOGEN PLAN
WHAT SHOULD YOU DO IF YOU HAVE AN
EXPOSURE?
FIRST:
WASH THE AFFECTED AREA THROUGHLY WITH WARM
WATER AND SOAP AT ONCE!
FOR MOUTH OR EYE EXPOSURE THROUGHLY RINSE
OUT YOUR MOUTH WITH WATER OR MOUTHWASH:
FLUSH EYES WITH WARM WATER OR A SALINE
SOLUTIONS.
PSMH BLOODBORNE PATHOGEN PLAN
SECOND:
NOTIFY YOUR IMMEDIATE SUPERVISOR
THEY WILL CALL THE HOUSE OPERATIONS
MANAGER (HOM)
THE HOM WILL TEST THE SOURCE FOR HIV,
HEPATITS B AND HEPATITIS C.
NOTIFY YOU OF THE HIV TEST RESULTS
WITH IN ONE HOUR.
THE HOM WILL FILL OUT A EXPOSURE FORM
AND AN EMPLOYEE INJURY FORM
PSMH BLOODBORNE PATHOGEN PLAN
IF THE PATIENT IS KNOWN TO BE HIV
POSITIVE OR TESTS HIV POSITIVE.
 You will be sent to the ED or the Occupational Health Office
for follow-up IMMEDIATELY. And the Infectious Disease
Physician will consult with you about your exposure.
 If it is a significant exposure and you need medication to help
prevent you from turning positive to HIV it will be provided to you
immediately.
IN ORDER TO PROVIDE YOU WITH THE BEST
TREATMENT AVAILABLE IT IS VERY
IMPORTANT THAT ALL EXPOSURES ARE
REPORTED IMMEDIATLEY.
PSMH BLOODBORNE PATHOGEN PLAN
THIRD:
CONTACT THE EMPLOYEE HEALTH NURSE FOR
FOLLOW-UP
 The Employee Health Nurse will do base line testing on you – this is
for your benefit. She will do a HIV, Hepatitis Profile and a Hepatitis
B Titer if you have been vaccinated.
 If your Hepatitis B titer is below 10 she will offer to revaccinate you. If
you do not become immune after the second vaccination
 The Employee Health Nurse will provide follow-up on the source
testing – HIV, Hepatitis B and Hepatitis C.
 The Employee Health Nurse will provide you with a written
consultation, and follow-up testing as required.
ANY TIME YOU HAVE ANY QUESTONS
PLEASE CONTACT THE INFECTION
CONTROL COORDINATOR
Paula Pourchot RN
INFECTION CONTROL DEPARTMENT
PHONE 815-937-2235
PAGER 815-279-0561
(Available 24 hours a day on pager or through the
HOM. Pager number also available on answering machine)
TB EXPOSURE
CONTROL PLAN
PSMH TB EXPOSURE CONTROL PLAN
WHAT IS TB?
Tuberculosis (TB) is a disease caused by bacteria called
Mycobacterium tuberculosis.
The bacteria usually attack the lungs. But, TB bacteria can attack any
part of the body such as the kidney, spine, and brain.
If not treated properly, TB disease can be fatal.
TB disease was once the leading cause
States.
of death in the United
PSMH TB EXPOSURE CONTROL PLAN
HOW IS TB SPEAD?
TB is spread when a person with active TB, who is infectious
(sick with TB) coughs, laughs, talks or sings and expels the small
bacteria (particle) into the air and someone near by breaths it into
their lungs
This bacteria (particle) is so small it can stay in the air for up to 90
minutes.
PSMH TB EXPOSURE CONTROL PLAN
Patients are screened when they enter the hospital
for TB by asking them if they have any signs of
Infectious TB.
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Cough lasting longer than 2-3 weeks
Low grade temperature
Night Sweats
Cough up blood
Unexplained weight loss
Loss of appetite
Feel weak
PSMH TB EXPOSURE CONTROL PLAN
When these signs and symptoms are present the
patients chest x-ray is checked and their doctor
is called and ask if the patient could possible
have TB.
If the Doctor feels this patient may have TB or
there is a cavitations in their lungs they are
transferred to a “Negative Pressure Isolation
and placed in “AIRBORNE ISOLATION”
PSMH TB EXPOSURE CONTROL PLAN
Airborne Isolation requires a room with special ventilation:
 The air in the room exit the room through a special filter or directly
outside. It is not recirculated.
 The Door is kept shut at all times (except when entering or leaving
the room.)
 Health care workers, visitors and Doctors who enter the room MUST
wear an N95 Particulate Filter Respirator Mask.
- Healthcare workers MUST be fit tested and passed the fit test in order to wear the
mask.
- Visitors must be taught how to put the mask on and fit checked by staff before
entering the room.
PSMH TB EXPOSURE CONTROL PLAN
TB SCREENING:
 PPD (Mantoux Testing) is done on hire and anytime a healthcare worker
or volunteer is exposed to MTB.
 Anyone who tests positive for the first time is sent to the Kankakee
County Health Department for evaluation and possible treatment
 Treatment is provided Free by the Kankakee County Health Department.
PSMH BLOODBORNE PATHOGEN PLAN
A POSITIVE TB TEST (PPD, Mantoux
Test) means:
 You have come in contact with the TB germ
 You are not infectious unless you have
signs/symptoms of TB
 You cannot give TB to anyone at this stage.
PSMH TB EXPOSURE CONTROL PLAN
If you come in contact with someone who is infectious in the
hospital what happens?
When a patient is placed in Airborne Isolation
 the doctor will order 3 AFB Sputum Tests
 If the test comes back positive for AFB the patient will be placed
on treatment
 The specimen is then cultured and if the results are positive for TB
you will be contacted and a PPD test will be done
approximately 3 months after your exposure
PSMH TB EXPOSURE CONTROL PLAN
PSMH is considered at LOW Risk for
contact with Mycobacterium TB:
 Therefore we do not do annual TB testing
 Staff/Volunteers will be tested if they are
exposed to a patient with active infectious
TB.
P R O V E N A S T. M A RY ’ S
H O S P I TA L
I S O L AT I O N G U I D E L I N E S
PSMH ISOLATION GUIDELINES
How do I know if a patient requires ISOLATION?
The first policy under ISOLATION in the Exposure Control Manual is called
“ISOLATION GUIDELINES”
This policy lists all the conditions and bacteria
requiring Isolation
The type of Isolation required
The duration of Isolation
This policy is also in the Infection Control Policy
manual on line.
PSMH ISOLATION GUIDELINES
There are Three different types of
Isolation are used at PSMH
1.
2.
3.
AIRBORNE
DROPLET
CONTACT
PSMH ISOLATION GUIDELINES
Airborne Isolation
Airborne Isolation is used for TB, Chickenpox
(Varicella) and Disseminated Herpes
If or When we see Smallpox, SARS, or Avian Flu it
will be used for these also.
PSMH ISOLATION GUIDELINES
Airborne Isolation
For TB – requires EVERYONE entering the room to
wear an N95 Particulate Filter Mask, HealthCare
Workers must be fit tested and have passed the fit test.
Visitors must be fit checked to wear the mask.
PSMH ISOLATION GUIDELINES
Airborne Isolation
For Chicken Pox (Varicella) and Disseminated Herpes (Shingles in more
than one nerve) or Shingles in an immune -compromised patient)
 If you are immune to chicken pox you may enter
the room without a N95 Particulate Filter
Respirator Mask.
 If you are not immune have someone who is
immune go in the room or wear an N95 Particulate
Filter Respirator Mask for which you have been fit
tested and passed
PSMH ISOLATION GUIDELINES
Droplet Isolation:
 Used for respiratory infections:
 Pertusses (Whooping Cough)
 Influenza
 Pneumonic plague
 Diptheria
 Mycoplasma Pneumonia
 Mumps
 Rubella
 Haemophilus influenza type b (pneumonia and sepsis
 Bacterial Meningitis
PSMH ISOLATION GUIDELINES
Airborne Isolation:
 Requires a private room equipped with negative air flow.
(MICU 346, SICU Rooms 5 & 6, Peds room 225-226,
Recovery Room and Room 8 in OR.)
 The DOOR MUST REMAINED CLOSED.
 Dedicate equipment to the patient (thermometer, B/P Cuff, etc.)
use disposable equipment whenever possible
 Any equipment used for the patient and taken out of the room
must be thoroughly disinfected before it is used again.
PSMH ISOLATION GUIDELINES
Droplet Isolation
Requires that a surgical mask be worn by
EVERYONE who enters the room.
This is in addition to Standard Precautions
PSMH ISOLATION GUIDELINES
Contact Isolation
Is used for
 Diarrhea infection
 Salmonella,
 Hepatitis A,
 Clostridium difficile
Shigella,
Roto virus
Undiagnosed diarrhea
 Respiratory Infections
 RSV (Respiratory Synovial Virus)
 Enterovial infections in infants/children
 Skin Infections
 Impetigo
 Scabies
Zoster (chicken Pox, Shingles)
PSMH ISOLATION GUIDELINES
Contact Isolation
Is used for:
 Multidrug Resistant Organisms:
- MRSA
- VRE
- ESBL’s
- Clostridium difficile
PSMH ISOLATION GUIDELINES
Hand Hygiene when caring for a patient with
Clostridium difficile requiring Contact
Isolation
DO NOT USE WATERLESS ALCOHOL HAND
SANITIZER!
DO USE SOAP AND WATER!
PSMH ISOLATION GUIDELINES
Clostridium difficile is called a spore forming
bacteria – it develops a hard coat to prevent
alcohol or disinfectants to enter it – so it is very
difficult to kill.
The only way to make sure it is not on your hands
when you leave a patient who has this bacteria is
to wash your hands with soap and water.
CONTACT ISOLATION FOR
CLOSTRIDIUM DIFFICILE:
PLACE A SIGN ON THE ALCOHOL
DISPENSER IN THE PATIENTS ROOM THAT
SAYS:
“PLEASE USE SOAP AND WATER FOR
HAND HYGIENE. DO NOT USE ALCOHOL GEL!!!”
PSMH ISOLATION GUIDELINES
Contact Isolation:
Requires Gown, and gloves be worn
by
EVERYONE upon entering the room
EVERY TIME they enter the room!
Healthcare workers
Visitors, family members
Doctors
Volunteers are not to enter any Isolation Room
Isolation Education must be documented for all patients and visitors.
HAND HYGIENE IS THE SINGLE MOST
IMPORTANT THING YOU CAN DO TO
PROTECT YOUR PATIENTS,
YOURSELF AND YOUR FAMILY!
YOU CANNOT REMEMBER WHERE YOUR
HANDS WERE FIVE MINUTES AGO AND
YOU DO NOT KNOW WHERE THEY WILL
BE FIVE MINUTES FROM NOW!!!!
HAND HYGIENE
Perform Hand Hygiene:
Before patient contact as you walk into the patients’ room
Before doing invasive tasks (Starting IV s)
Before taking care of newborn, touching all wounds, touching non
intact skin or mucous membranes, starting your shift,
Before doing vital signs
 Before dispensing oral or IV medications and nutritional substances
HAND HYGIENE
Perform Hand Hygiene:
After contact with wounds, mucous membranes, blood and body fluids,
secretions and excretions and other potentially infectious material
After contact with equipment, inanimate objects, or surfaces that are likely
to be contaminated (over bed table, phone, chart, TV, Call light, IV, Door
handle, etc.)
 After leaving an isolation room
After removing gloves and other Personal Protective Equipment
After giving patient’s Medications or feeding them
As you leave the patient’s room
After your shift before leaving work
ALL EQUIPMENT MUST BE CLEANED AFTER
USE BETWEEN PATIENTS.
Germicidal Wipes
- need to have wet contact time of 2
minutes on the surface, then be allowed to
air dry to kill the bacteria and viruses
Clorox
- need to have wet contact time of 3 minutes
on the surface, then be allowed to air
dry to kill the bacteria and viruses
If patient has diarrhea use Clorox wipes on
equipment and surfaces
USE A GERMICIDAL WIPE TO:
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Clean equipment after patient use (lift equipment, glucometer)
Clean room (bedside tables etc.)
Clean Stethoscopes, blood pressure cuffs and data scopes
Clean medication pass area prior to preparing medication
Clean pill crushers
Clean crash cart
Clean counters, keyboards, mouse
Clean telephone, pens and highlighters at nurses station
Clean patient kitchen, counter, microwave, refrigerator
Clean isolation binders
FOR QUESTIONS PLEASE CONTACT:
Paula Pourchot RN
Infection Control Preventionist
Phone 815-937-2235
Pager 815-279-0561