Student Orientation

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2. Instructions/requirementsAll students must provide a copy of their immunization record. Including evidence of a two-step TST and evidence of immunity to , MMR, hepatitis B, and varicella as well as a tetanus booster with in 10 years. All students must provide evidence of yearly flu vaccine.

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Student Orientation

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1. 1 Student Orientation Self-directed student orientation packet- 2011

2. 2 Instructions/requirements All students must provide a copy of their immunization record. Including evidence of a two-step TST and evidence of immunity to , MMR, hepatitis B, and varicella as well as a tetanus booster with in 10 years. All students must provide evidence of yearly flu vaccine. In accordance with the student affiliation agreement the college or school must submit a letter stating that a CORI check was completed on each student and was returned with a result of "no record" All students will complete orientation by viewing the orientation presentation. After completion of this presentation, call the Office of Student Affiliations at 774-442-5701 for an appointment to complete the required test and final requirements for clinical clearance. Pharmacy, nursing groups, and other groups of students coming for clinical will take the test on the first day. Final clearance will be granted during this appointment, providing all paperwork is complete Student will then contact the preceptor or supervisor for a start date and schedule In preparation for your upcoming clinical rotation at UMass Memorial Medical Center, (University, Memorial ,and Hahnemann campuses) the following documents and requirements must be met prior to your start date. Please review both modules # 1 and #2 .

3. 3 Welcome to UMMMC online student self-directed orientation program. Please review all the content. You are responsible for this content and will be expected to use this information throughout your clinical experience. All students will be expected to complete an orientation quiz with a passing grade of 80%. One make-up quiz will be allowed. All wrong answers will be reviewed.

4. 4 Welcome to UMMMC Mission, Vision, Values Our Mission, Vision and Values Our Vision The vision of UMass Memorial Medical Center is to be one of the top 10 academic medical centers in the United States.   Our Mission UMass Memorial Medical Center is committed to improving the health of the people of Central New England through excellence in clinical care, service, teaching and research.

5. 5 Mission, Vision, Values Our Values Members of UMass Memorial Medical Center are committed to: Excelling at patient-centered care: Achieving patient-focused excellence through the highest standards of quality care, patient safety and patient satisfaction. Acting with integrity: Dealing honestly, fairly and responsibly with each other. Respecting one another: Valuing the contributions, ideas and opinions of our coworkers, colleagues, patients and partners. Contributing to the community: Partnering with the community at large and with other health care and social agencies in meeting the health needs of the community. Improving through teamwork and systems thinking: Working to continuously improve ourselves, our processes and our patient services through cooperation and thinking as an integrated health care system. Embracing accountability: Holding ourselves, our coworkers and our leaders to the highest standards of performance.

6. 6 PATIENT RIGHTS Patient Rights Every patient of UMass Memorial Medical Center has the right: 1. To freedom of his or her selection of a physician except in the case of emergency medical treatment provided that the physician is able to accommodate the patient 2. Upon request, to receive an itemized bill reflecting charges from the physician and/or the facility including laboratory charges, pharmaceutical charges, and third party credits and charges 3. Upon request, to obtain the name and specialty of the physician or other person responsible for his or her care or coordination of care 4. To confidentiality of all records and communication to the extent provided by law 5. To have all reasonable requests responded to promptly and adequately within the capabilities of this facility

7. 7 PATIENT RIGHTS Continued 6. Upon request, to obtain an explanation as to the relationship, if any, of UMass Memorial to any other health care facility or educational institution insofar as it relates to his or her care or treatment 7. Upon request, to receive any information which this facility has available relative to financial assistance and free care 8. Upon request, to inspect his or her medical records and to receive a copy for a fee determined by the current rate of copying expenses 9. To refuse to be examined, observed, or treated by students or any other staff member without jeopardizing access to psychiatric, psychological or other medical care and attention 10. To refuse to serve as a research subject and to refuse any care or examination when the primary purpose is educational or informational rather than therapeutic. 11. To privacy during medical treatment or care within the capacity of UMass Memorial Medical Center 12. To prompt lifesaving treatment in an emergency without discrimination because of source of payment or delay due to discussions of source of payment 13. To informed consent to the extent provided for by law 14. To appropriate assessment and management of pain

8. 8 PATIENT RIGHTS Continued Voicing Concerns Patients have the right to voice concerns or complaints regarding the quality of care or services received. Voicing a concern or a complaint in no way compromises access to care or to treatment. Contacts include: • Department of Patient Care Services, UMass Memorial Medical Center • The Commonwealth of Massachusetts, Board of Registration in Medicine • Massachusetts Department of Public Health, Patient Advocacy and Complaint Unit ? Joint Commission, Office of Quality Monitoring

9. 9 Occurrence Reporting Objectives Understand the role of Risk Management Understand the purposes and definition of Occurrence Reporting Understand the procedure for reporting an “Occurrence”

10. 10 Occurrence Reporting Purpose and Definition Occurrence Reporting: Assists in identifying care or safety conditions that may result in an injury to a patient, visitor or other Assists in monitoring frequency and severity of occurrences, identifying opportunities for quality improvement and/or potential legal liability and implementing corrective action. Assists in complying with voluntary and mandatory regulatory reporting requirements such as the MA Department of Public Health (DPH), the Joint Commission, and MA Board of Registration in Medicine (BORM). If, after following this or other applicable UMMMC policies and procedures, an employee feels that there are unresolved concerns about safety or quality of care provided in the hospital, that employee may report these concerns to the Joint Commission.

11. 11 Occurrence Reporting Definition: An “occurrence” is any event or situation that: Falls outside of routine care and treatment Results in an actual or potential adverse outcome for a patient or visitor Results in damage to UMMMCMC property

12. 12 Occurrence Reporting Examples of occurrence types (inpatient, outpatient, visitors) include but are not limited to: All cases of unanticipated death or major permanent loss of function associated with healthcare acquired (nosocomial) infection. Death in the course of, or resulting from, elective ambulatory procedures. Death intraoperatively or immediately post op in an ASA 1 Class patient. Any event related to the use of contaminated drugs, devices or biologics. Includes research studies. Any actual or potential invasive diagnostic and/or surgical procedure performed on the wrong patient, side/site, organ, extremity or body part, regardless of the magnitude of the procedure or injury. Any patient identification related errors (includes wristbands, medical records, registration, etc.).

13. 13 Occurrence Reporting Examples of occurrence types (inpatient, outpatient, visitors) include but are not limited to: All falls or other injury (patient or visitor). Death of a pregnant woman during any stage of gestation, labor or delivery, or the death of a woman within 90 days of delivery or termination of pregnancy regardless of the cause of death. Death or major/permanent impairment of bodily function not ordinarily expected as a result of the patient’s condition on presentation. ANY death of a fetus/infant; includes heath/serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates. Any medication, IV fluid, blood, blood products – related occurrences. Includes any blood transfusion errors (e.g. wrong type, outdated blood, not given when ordered, given to wrong patient, HIV seropositive transfusion) with potential serious complications.

14. 14 Occurrence Reporting Report Types There are 3 types of UMMMC Occurrence Report forms (paper and electronic) Falls (for fall related occurrence) Medication Related (for any medication-related occurrence or near miss, including IV fluids and blood products) General (all other types of patient/visitor occurrences) Occurrence Report forms are available in individual departments. Completed reports (paper) should be sent to the Risk Management Department (only) via interoffice mail, marked “Confidential”. Reports generated via the electronic system will go directly to Risk Management. In Conclusion Occurrences that result in injury should be reported to the Risk Manager on call immediately via pager 7475, The Risk Management Department will follow up on individual and/or trended reports as appropriate. Occurrence Reports should be completed FACTUALLY and without opinion or blame. Occurrence Reports are internal, confidential peer review documents and should not be copied, distributed or placed in the medical record.

15. 15 Reporting Incidents This lesson has focused on guidelines and best practices for ensuring staff and patient safety. However, mistakes and problems can happen. A breach in safety is referred to as an incident. Common examples of incidents have been mentioned in this lesson: Equipment malfunction Back injury Slip, trip or fall Exposure to hazardous chemicals Workplace violence All incidents should be reported immediately. Check with your supervisor if you are not familiar with facility procedures for reporting incidents. Utility Safety Electrical and Emergency Power The Facility will have emergency power to the building in the event of a power failure or outage. The RED outlets located throughout the Facility have emergency power. Always plug life support equipment into RED outlets. There is an uninterrupted supply of electricity to emergency outlets and emergency lighting. General Safety and Infection Control

16. 16 General Safety This course has been designed for healthcare staff / student to review and update your knowledge of: Safety Emergency preparedness Infection Control Welcome to the lesson on safety. This lesson covers: General safety Fire safety Electrical safety Ergonomics Back Safety Slips, trips, and falls Hazard communication Security and workplace violence Reporting incidents Utility Safety Medical Equipment Latex Allergy

17. 17 General Safety Healthcare facilities have many potential hazards OSHA separates these hazards into five categories: Biological Chemical Psychological Physical Environmental/mechanical As shown in the table on the next screen, take appropriate measures to: Eliminate as many of these hazards as possible. Safeguard against exposure to the hazards that cannot be eliminated. Note: Many of the hazards mentioned in the table are addressed in greater detail later. General Safety and Infection Control

18. 18 General Safety and Infection Control

19. 19 Fire Safety: Safeguards in the Event of Fire Not all fires can be prevented. Therefore, your facility has fire safety features. These features include: Fire alarm systems Fire extinguishers Emergency exit routes and doors Smoke and fire doors and partitions A fire plan Be familiar with the location and use of each of these and keep access clear at all times. Items in corridors must be in use (accessed within 30 minutes) and on one side General Safety and Infection Control

20. 20 General Safety and Infection Control Fire Safety: Prevention Corridors Exceptions: crash carts and infection control carts are considered in use. Items in use must be kept on one side, not blocking doors or fire safety systems, etc. Fire Safety: Prevention Prevention is the best defense against fire. To help prevent fires related to the common cause of smoking: Follow your facility’s smoking policy To help prevent fires related to the common cause of electrical malfunction: Remove damaged or faulty equipment from service Submit malfunctioning equipment for repair. To help prevent fires related to the common cause of equipment misuse: Do not use any piece of equipment before being trained. NEVER leave food cooking in toasters or microwave ovens unattended. Space heaters are prohibited.

21. 21 General Safety and Infection Control Fire Safety – R A C E Emergency Response R Rescue A Alarm C Contain/Confine E Evacuate ( as required * )/Extinguish( if trained) NOTE: Employees are not required to use fire extinguishers unless trained to do so. * HOSPITALS & HAHNEMANN – PROTECT IN PLACE * OFFICE BUILDINGS & AMBULATORY CLINICS - EVACUATE BUILDING Always evacuate horizontally first, second vertically down – Training is key to fire prevention & fire safety All staff & employees must participate during drills Danger - Do not use elevators during alarms!

22. 22 Electrical Safety Most equipment in the healthcare setting is electric. This means there is risk of electric shock Electric shock can cause: Burns Muscle spasms Ventricular fibrillation Respiratory arrest Death Electrical Safety: Preventing Accidents To help prevent electrical accidents in your facility: Remove and report electrical hazards Use electrical equipment properly Maintain, test, and inspect equipment General Safety and Infection Control

23. 23 Radiation Safety Exposure to radiation can increase the risk of cancer Therefore, it is important to protect against exposure. The three key factors for limiting exposure are: Time: Minimize the amount of time that you are exposed Distance. Maximize your distance from the radiation source. Shielding. Use appropriate shielding to absorb the energy of radioactive particles. The goal is to keep your radiation exposure As Low As Reasonably Achievable (ALARA) General Safety and Infection Control

24. 24 General Safety and Infection Control Hazardous Materials & Waste Hazard Communication also called: “Right to Know” For All Chemicals Used Documented Training Required MSDS – Material Safety Data Sheets Readily Available 24-7-365 by calling 3E Company at (800)451-8346 or Department Supervisor or Environmental Health & Safety x63985 PPE – Personal Protective Equipment Required for all Hazards Emergency Spill University- x63292 Memorial/Hahnemann- x12345

25. 25 General Safety and Infection Control

26. 26 Slips, Trips, and Falls: Preventing Slips To help prevent slips: Keep floors clean and dry Increase the friction of floors with abrasive coatings, non-skid strips, or rubber mats. Secure rugs with ski-resistant backing. Choose slip-resistant shoes. Look for: Soft rubber soles A large amount of surface area in contact with the floor (no high heels!) Patterned soles that increase friction Post safety signs around slip hazards (icy sidewalks, wet floors, etc.) Report slippery or icy surfaces General Safety and Infection Control

27. 27 Security and Workplace Violence Workplace violence is any violence in a work setting To help keep your workplace safe from violence: Recognize aggressive behavior and warning signs of potential violence Respond appropriately to the level of aggressive behavior (see graphic). Report all unsafe situations immediately For a listing of emergency phone numbers, proceed to the next slide General Safety and Infection Control

28. 28 General Safety and Infection Control

29. 29 General Safety and Infection Control Emergency Numbers Memorial/Hahnemann Emergency 12345 University Campus Emergency 911

30. 30 Emergency Phone Numbers- Dial 911 THEN

31. 31 Medical Equipment Safety Proper Training -- documented Assure Competency Check Inspection Date prior to use Log Visual & Operating Inspections Emergency Outlets for Life-Support Equipment Keep battery operated equipment plugged-in / charged when not in use Remove, Secure, Tag, notify Risk Management Report Defective Equipment to Clinical Engineering Department, X41111 Report Patient Occurrence

32. 32 Medical Equipment Safety Medical Equipment Safety: Inspection, Testing & Maintenance In the event a piece of equipment is defective, do the following: Remove from service any equipment that is defective or not operating correctly. Secure and tag equipment so that it is unable to be used by mistake. Defective equipment CANNOT be used even if there is no other equipment available or while waiting for a loaner. Report all defective equipment to Clinical Engineering. If a piece of equipment becomes defective while being used on a patient. Report this incident on an Occurrence/Incident Report and send to Risk Management. Discontinue use of the equipment and follow the steps outlined above.

33. 33 Communications In the event of a phone failure, use designated phones located throughout the facility. Cell phones are not permitted to be used within 3 feet (1 meter –arm’s length) of any operating medical device. Utility Safety Medical Gas/Vacuum In the event of an emergency requiring the shut off of an oxygen zone valve, the ONLY personnel that have authority to do this is the Nursing Supervisor and operations Engineering In the event of a medical gas alarm, contact Operations Engineering. Do not shut off medical gas zone valves, unless instructed to do so by the Nursing Supervisor and Operations Engineer. General Safety

34. 34 Ergonomics Ergonomics best practices are: Avoid fixed or awkward postures. Avoid lifting without using proper devices or equipment. Avoid highly repetitive tasks. Use properposture and body mechanics when sitting, standing, or lifting. Avoid reaching, twisting, and bending for items. Use supportive equipment. Respond promptly to aches and pains. General Safety

35. 35 Be willing to make changes that reduce your risk of injury. Ask for help. Talk to your supervisor to develop a plan to re duce risk of injury. If you are injured at work, report your injury to your supervisor. Complete a “ First Report of Employee Injury “ form. If needed , seek immediate medical attention. Contact Workers Compensation at x 41355 or Employee Health Services at x 508-793-6400 for further instructions.

36. 36 AGE SPECIFIC COMPETENCIES Growth and development are continuous All humans follow the same pattern of growth and development although the length of each stage and it’s effects vary. There are many theories that address growth and development. Age is a factor to be considered in how we provide care and services.

37. 37 Age Specific Competencies Infants (up to age 1) Toddlers (age 1-3) Preschool age children (age 4-5) School age children (age 6-12) Young Adults (age 13-17) Adults (age 18-60) Older Adults (age 61+) Note: Numeric ages come from a blending of some of the most well noted researchers in the development field so these ranges are guidelines. Exercise Method #1: Assign each table an age group (can have multiple tables doing the same age group if a large session or can have tables do more than one age group if it is a small session). Tables need to pick a scribe and a spokesperson and list the things that they think are important to keep in mind for the age group(s) in the following categories: Key characteristics of the age group: 1. Pain – how do you know this age group is feeling pain/how do they show pain 2. Communication – what is important to say/not say; who do you speak to; how does this age group take in information; how to you give this age group advice 3. Privacy – is it important and in what ways Age related concerns that may impact delivery of care or how you work with customers in this age group Method #2: You facilitate a discussion with the entire group, asking for participation as you go through each of the following categories: Key characteristics of the age group 1. Pain – how do you know this age group is feeling pain/how do they show pain 2. Communication – what is important to say/not say; who do you speak to; how does this age group take in information; how to you give this age group advice 3. Privacy – is it important and in what ways Age related concerns that may impact delivery of care or how you work with customers in this age group Exercise Method #1: Assign each table an age group (can have multiple tables doing the same age group if a large session or can have tables do more than one age group if it is a small session). Tables need to pick a scribe and a spokesperson and list the things that they think are important to keep in mind for the age group(s) in the following categories: Key characteristics of the age group: 1. Pain – how do you know this age group is feeling pain/how do they show pain 2. Communication – what is important to say/not say; who do you speak to; how does this age group take in information; how to you give this age group advice 3. Privacy – is it important and in what ways Age related concerns that may impact delivery of care or how you work with customers in this age group Method #2: You facilitate a discussion with the entire group, asking for participation as you go through each of the following categories: Key characteristics of the age group 1. Pain – how do you know this age group is feeling pain/how do they show pain 2. Communication – what is important to say/not say; who do you speak to; how does this age group take in information; how to you give this age group advice 3. Privacy – is it important and in what ways Age related concerns that may impact delivery of care or how you work with customers in this age group

38. 38 Different Age Groups Infants (up to age 1) During this stage, infants are entirely dependent on others for their care and basic needs. When their needs are met they will develop trust. Inconsistent care can lead to crying and unrest. Crying is the infants of communicating that something is wrong. Physical growth, muscle building and development are rapid this first year. The goal in providing care to an infant is to maintain TRUST. Providing love and nourishment is the key to maintaining TRUST. Some ways to provide care to the infant include: Not leaving the infant unattended Cuddle an upset child Offer age appropriate toys Hold and rock the infant after an invasive procedure Age Specific Competency

39. 39 Toddlers (1 to 3 Years) At this stage, the toddler can walk, talk, feed themselves and is learning about their world. The parent helps the child to make decisions. If a toddler is shamed, they will not be confident in themselves. It is important to give position feedback to a toddler in order for them to gain self control and strengthen the toddler’s attempt at independence. The goal in providing care to a toddler is to maintain AUTONOMY. In order to maintain AUTONOMY it is important to first assess the patient’s level of independence. This would include potty training, ability to feed themselves and dressing. Some of the age specific care that is appropriate for a toddler is: Involve the parents in the care of the child Explain procedures to child in simple terms Allow time for the child to ask questions Let the child touch the equipment Demonstrate the procedure on a doll or stuff animal Incorporate home rituals (bedtime stories, favorite toy/blanket) Age Specific Competency

40. 40 Age Specific Competency Preschool age children (age 4-5) At this stage, the child is beginning to develop a conscience. They are aware of other’s feelings. They know right from wrong and are very creative. They are good with using their hands. They may have imaginary friends. The young child is beginning to develop a sense of privacy. They ask lots of questions and enjoy conversations. They like stories and make believe. They have some fears, especially being separated from their parents. When providing care to a pre-schooler, the goal is to PREVENT EXAGGERATED IDEAS. Interventions In order to prevent exaggeration of ideas, explain the procedure just before it will be performed, using a doll Sometimes they may feel like it is their fault for being sick and in the hospital. Abolish the guilt of being in the hospital. It is not their fault for being sick. Reassure the young child that the procedure is not a punishment. Incorporate daily rituals, like reading a book. Encourage the parents to stay with the child and to bring a security object (blanket or doll). Try to foster initiative, not guilt.

41. 41 School Age (age 6 to 12 years) At this stage, growth continues at a slower pace until a spurt occurs at puberty. Older children can do a lot of activities, like sports and crafts. They can accept rules and responsibilities. Completing tasks help to build self-esteem. Older children like doing things with friends and they want more privacy. They enjoy playing games. They have a better understanding of time. The goal in providing age specific care to the older child is to maintain INDUSTRY. The type of care that is appropriate for the school age child includes: Ask about their friends, interests, accomplishments, concerns Explain procedure and equipment in advance Be honest about what will and will not hurt Respect privacy Give the child the opportunity to help and do things on their own Let the child be involved in his/her own care Praise cooperative behavior Keep them busy…keep a journal…create a schedule Age Specific Competency

42. 42 Young Adults (age 13-18) During adolescence the child is developing a sense of identity that is marked by puberty. Sexual features begin to develop. They can be self conscious of their body changes. They may feel awkward. Fashion and looks are becoming more of an issue. The adolescent begins to separate from his/her parents and develop a sense of loyalty to others. Privacy is very important at this stage. The goal in providing care to the adolescent is to preserve IDENTITY. In order to provide appropriate care for the adolescent you need to assess their feelings, their attitude and their activities. Some of the age specific care includes: Avoid giving advice…Instead provide encouragement Explain in detail what will be happening Be an active listener Provide privacy for procedures and teaching Encourage involvement in care and decisions Encourage contact with friends and family…explain visiting hours Teach them about healthy habits, avoiding pregnancy and STD’s Age Specific Competency

43. 43 Age Specific Competency Adults (19-60) Young adults reach sexual maturity and their adult height and weight during this stage. They are comfortable with their body image. They develop a personal identity and self-reliance. They may experience sexual intimacy, choose a mate and raise a family. They will establish a career. Young adults reflect on changes in their bodies, their lives and look at problems from a different point of view. They establish values and use them to make life decisions. Education, work, economic status and commitment to the opposite sex or partner are important to the young adult. They become committed to life (socially, occupationally and sexually). The goal in providing care to the young adult is to address COMMITMENTS.

44. 44 Adults (age 19-60) At around 40, the adult begins to experience physical changes, such as a decreased endurance and women experience menopause. An illness or injury can interfere with plans. A chronic illness may develop. There is an economic status. This can become stressful if the expectations are not realistic. The goal is providing age specific care to the middle age adult is to evaluate EXPECTATIONS. It is important to first assess the middle adult patients family, work and leisure concerns. Based on their concerns, the following care should be provided: Encourage delegation Lessen their concerns for work Help the patient to prioritize work Listen to patients advice…they may have a good idea Encourage as much self care as possible Start teaching about advance medical directives Age Specific Competency

45. 45 Age Specific Competency Older Adults (61+) During this stage, the older adult has achieved a sense of integrity. They begin to evaluate the choices that they made during their life, as well as their family relations and economic status. If they find satisfaction with their choices then they will have a sense of distinction and honor for a life well lived. If not, they may see their life as a waste of time and end life with a sense of hopelessness. The goal is providing care to the elderly adult is to assess INTEGRITY. Providing care to the older adult begins with assessing how hopeful the patient is and how positive they are about their past. Also, evaluate the family structure …be a good listener. Ask open-ended questions about their family. Discuss concerns for health maintenance, including personal, financial and spiritual. The older adult may have a reduced attention span and will need more time to learn. Use large print, enough light and give the information in short segments. Assist with end of life planning.

46. 46 Infection Control Nails: Short and well-trimmed nails are necessary to reduce reservoirs of microorganisms that may be harbored under the long natural nail having the opportunity to be transmitted to patients. Long natural nails have been linked to surgical infections in patients. Prohibiting the use of artificial nails, wraps, and tips is essential to eliminate a reservoir of microorganisms that cannot be effectively removed with hand washing or surgical scrubs. Nails are to be short and well trimmed. Nail polish, if used, should be freshly applied and free of chipping. None in clinical areas. Artificial fingernails, tips, wraps and nail jewelry are prohibited for direct care providers. Individual departments may have more restrictive policies for artificial fingernails, tips and wraps for non direct care providers. See Hand Hygiene Policy # 5009

47. 47 Standard Precautions Is a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed diagnosis or presumed infection status. Standard Precautions is based on the principle that all blood, body fluids, secretions, excretions except sweat, all non-intact skin, and mucous membranes may contain transmissible infectious agents. Standard Precautions includes hand hygiene, and depending on the anticipated exposure, use of gloves, gown, mask, eye protection, or face shield. Also, equipment or items in the patient environment likely to have been contaminated with infectious fluids must be handled in a manner to prevent transmission of infectious agents,

48. 48 Standard Precautions Standard Precautions is an outgrowth of Universal Precautions. Universal Precautions was first recommended in 1987 to prevent the transmission of bloodborne pathogens to healthcare personnel. In 1996, the application of the concept was expanded and renamed “Standard Precautions.” Standard Precautions is intended to prevent the transmission of common infectious agents to healthcare personnel, patients and visitors in any healthcare setting. During care for any patient, one should assume that an infectious agent could be present in the patient’s blood or body fluids, including all secretions and excretions except tears and sweat. Therefore appropriate precautions, including use of PPE, must be taken. Whether PPE is needed, and if so, which type, is determined by the type of clinical interaction with the patient and the degree of blood and body fluid contact that can be reasonably anticipated and by whether the patient has been placed on isolation precautions such as Contact or Droplet Precautions or Airborne Infection Isolation. Standard Precautions is an outgrowth of Universal Precautions. Universal Precautions was first recommended in 1987 to prevent the transmission of bloodborne pathogens to healthcare personnel. In 1996, the application of the concept was expanded and renamed “Standard Precautions.” Standard Precautions is intended to prevent the transmission of common infectious agents to healthcare personnel, patients and visitors in any healthcare setting. During care for any patient, one should assume that an infectious agent could be present in the patient’s blood or body fluids, including all secretions and excretions except tears and sweat. Therefore appropriate precautions, including use of PPE, must be taken. Whether PPE is needed, and if so, which type, is determined by the type of clinical interaction with the patient and the degree of blood and body fluid contact that can be reasonably anticipated and by whether the patient has been placed on isolation precautions such as Contact or Droplet Precautions or Airborne Infection Isolation.

49. 49 Controlling the Spread of Infection Introduction Welcome to the lesson on infection control. This lesson covers: Healthcare-associated infection (HAI) Hand hygiene Antibiotic resistance The Bloodborne Pathogens Standard Airborne pathogens Personal responsibility Healthcare-Associated Infection: Impact Healthcare-associated infection (HAI) is an infection that develops after contact with the healthcare system. HAI can be very costly, in terms of: Patient life and health Healthcare dollars Infection Control

50. 50 Hand Hygiene: When and What The single most important factor for preventing the spread of infection is proper hand hygiene Hands should be washed or decontaminated before and after each direct patient contact. Current CDC guidelines recommend the use of: Soap and water for washing visibly soiled hands Alcohol-based hand rubs for routine decontamination of hands between patient contacts, when hands are not visibly soiled Always Foam in and Foam out! Environmental Hygiene Best practices for environmental hygiene: Maintain a clean environment. There should be no visible dust or soiling. Clean, disinfect, or sterilize medical equipment after each use. Dispose safely of clinical waste. Launder used and infected linens safely and effectively. Follow appropriate guidelines for kitchen and food hygiene. Maintain an adequate pest-control program. Infection Control

51. 51 Bloodborne Pathogens Bloodborne diseases area spread from person to person as a result of unprotected exposure to: Infected blood Certain other body fluids and tissues Non-intact skin Moist body tissues Important bloodborne diseases include: AIDS Hepatitis B Hepatitis C Infection Control

52. 52 Bloodborne Pathogens The Bloodborne Pathogen Standard helps protect workers from bloodborne diseases. One of the key parts of the Bloodborne Pathogens Standard is the use of Standard Precautions. Standard Precautions protect healthcare workers from exposure to patient: Blood Body fluids, secretions, and excretions (except sweat) Non-intact skin Mucous membranes Standard Precautions must be used in the care of all patients. Infection Control

53. 53 Infection Control

54. 54 Airborne Pathogens: Background Airborne diseases are transmitted from person to person via tiny particles. These particles: Are produced when an infected person sneezes, coughs, or talks Can remain suspended in the air for long periods of time Can travel long distances on air currents Transmission occurs when a healthy person inhales an infectious particle. Infection and disease symptoms then may occur. Airborne Pathogens: Diseases Important airborne (or potentially airborne) diseases include: Chickenpox and shingles Measles Tuberculosis (TB) Severe Acute Respiratory Syndrome (SARS) Smallpox Infection Control

55. 55 Infection Control

56. 56 Infection Control Airborne Precautions: Tuberculosis TB is an airborne disease. Therefore, Airborne Precautions apply. In addition, both the CDC and OSHA have specific guidelines for preventing transmission of TB in the healthcare setting. CDC Guidelines OSHA TB Enforcement Policy If you would like to request a copy of these pdf files, please call (508)334-5063

57. 57 Personal Responsibility As a healthcare worker, you have personal responsibilities for infection control in your facility. Maintain immunity to vaccine-preventable diseases such as: Hepatitis B Measles Varicella (chickenpox) Rubella Mumps Report all unprotected exposures, such as accidental needlesticks or blood body fluid splashes to the eyes and mouth by paging the BUGS beeper (2847) Stay home from work when you are sick. Patients who register through UMass Memorial Healthcare system for a medical appointment and who are coughing need to be provided a surgical mask to be worn in order to protect other patients and healthcare workers with whom they come into contact. Infection Control

58. 58 Contact Precautions: Background Contact transmission of disease occurs via direct or indirect person-to-person contact. This form of transmission is the most important and common cause of HAI. Contact Precautions: Diseases Examples of contact diseases are: Hepatitis A Respiratory syncytial virus infection Impetigo Conjunctivitis Clostridium difficile (Cdif) diarrhea Viral hemorrhagic infections Resistant organisms Many others Infection Control

59. 59 Infection Control

60. 60 Droplet Precautions: Background Droplet transmission happens via large respiratory droplets. These droplets: Are generated during coughing, sneezing, talking, etc. Travel a short distance through the air (up to three feet) Droplets may land on the mucous membranes of a nearby person’s eyes, nose, or mouth Disease transmission then may occur. Droplet Precautions: Diseases Examples of droplet diseases are: Mumps Rubella Influenza Meningococcal Meningitis Pertussis Many others Infection Control

61. 61 Personal Protective Equipment Personal protective equipment (PPE) is an important component of infection control. PPE helps to prevent the spread of microorganisms both: From patient to healthcare worker From healthcare worker to patient Review the screens describing Standard Precautions, Airborne Precautions, Contact Precautions, and Droplet Precautions for appropriate use of key items of PPE. Note the use of: Gloves Masks Goggles Gowns Respirators Infection Control

62. 62 Infection Control Antibiotic Use: Antibiotic Resistance Widespread use of antibiotics began in the 1940’s. Penicillin and other antibiotics were hailed as miracle drugs. They were able to cure previously untreatable bacterial illnesses. However, bacteria are very adaptable. They have the ability to change genetically to resist the effects of antibiotics. The more antibiotics are used, the more common resistant strains of bacteria become. Antibiotic Use: Impact of Resistance Antibiotic resistance is a significant health problem It affects: Drug choice Patient health The healthcare system

63. 63 Infection Control Drug Choice When an infection is resistant to the antibiotic of choice, other antibiotics must be used instead. These second-choice drugs are typically: Less effective against the bacteria More toxic to the patient More expensive Patient Health Patients with resistant infections tend to have: Lengthier illness Higher medical bills Greater risk of death The healthcare system Antibiotic-resistant strains contribute significantly to HAI. More than 70% of all bacteria that cause HAI are found to be resistant to one or more commonly used antibiotics

64. 64 CONTACT PRECAUTIONS

65. 65 New Practices for patients with MRSA and VRE Effective Nov 1, 2010 all patients with MRSA and VRE will be on STANDARD PRECAUTIONS unless these patients meet the criteria for CONTACT PRECAUTIONS. No private rooms are indicated under standard precautions Use PPE like you would for any patient

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