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Infection Prevention

Infection Prevention. Topics to Cover. Infection Prevention / Control basics Hand Hygiene Respiratory / Cough Etiquette Blood borne pathogen exposure prevention Tuberculosis exposure prevention Influenza prevention Antibiotic stewardship. Goal: Prevent Transmission.

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Infection Prevention

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  1. Infection Prevention

  2. Topics to Cover • Infection Prevention / Control basics • Hand Hygiene • Respiratory / Cough Etiquette • Blood borne pathogen exposure prevention • Tuberculosis exposure prevention • Influenza prevention • Antibiotic stewardship

  3. Goal: Prevent Transmission • Patient-to-Patient: e.g. Clostridium difficile, drug resistant organisms • Healthcare worker-to-Patient: • e.g. influenza, pertussis • Patient-to-Healthcare worker: • e.g. blood borne pathogens (BBP), tuberculosis, meningococcus

  4. Infection Control • Standard Precautions: based on the principal that ALL blood and body fluids may contain an infectious pathogen • Hand hygiene before and after all patient encounters (and after removing gloves) • Gloves for potential hand contact with blood, fluid, mucous membranes, and non-intact skin • Gown, mask, eye protection/face shield for potential contact with secretions, blood, or fluid • Respiratory hygiene/cough etiquette – for all patients and visitors who may have respiratory infections • Key safety measure

  5. Hand Hygiene: When to Perform? • Gel in, gel out ORGel in, soap out … at a minimum – also need hand hygiene: • Before contact with patient when other activities performed first in patient room • After removing gloves • Before performing procedures • Moving from contaminated body site to clean site • After using the restroom • After touching your nose/eyes/mouth and blowing your nose

  6. Soap and Water vs. Alcohol Hand Gels? • On exiting room, use soap and water • If C. difficile known or suspected • If norovirus known or suspected • If hands are visibly soiled • Alcohol based hand rubs are otherwise preferred • Faster than hand washing • Less drying than hand washing • In general, greater decrease in number of organisms

  7. Right handprint on blood agar

  8. Right hand after alcohol-based hand gel

  9. Contact Precautions • Prevent spread of organisms by direct or indirect contact • Private room, gowns, gloves, dedicated patient equipment • Used, e.g., for certain drug-resistant organisms, C. difficile

  10. Droplet Precautions (Low level respiratory isolation at SFGH) • Prevent spread of organism through respiratory secretions • Large particle droplets generated by coughing, sneezing, suctioning • Private room (or physical separation in clinic), procedure mask for HCW, eye protection • Used, e.g., for N. meningitidis, influenza

  11. Airborne Precautions (High level respiratory isolation at SFGH) • Prevent spread of organisms in small particles (<5µ) suspended in air • Negative pressure, private room, N95 respirator for HCW • Used, e.g., for tuberculosis, measles, varicella, disseminated zoster

  12. If your patient may have TB… • For TB control, patient wears procedure mask • For discharges of suspected active tuberculosis patients, must notify TB Control (SFDPH): (415) 648-8369

  13. Culture of Safety: Personal Protective Equipment (PPE), Engineering Controls, and Safety Devices

  14. Risk of seroconversion from a needle stick or splash • “Rule of 3’s” • HBV, e-antigen+ ~30% • HCV+ ~3% (1.8%+) • HIV+ ~0.3% (0.2-0.5%) • HIV+ splash <0.1%

  15. Risk Reduction Strategies • Learn how to do procedures safely and treat all procedures with respect • Take your time • Anticipate exposures, use PPE • Remember eye protection • “Safe” devices are not always intrinsically safer • Some injury rates have risen when first introduced • Learn how to use unfamiliar devices

  16. 24/7 Hotline Phone Numbers for Blood Borne Pathogen Exposure First, wash area with soap and water (or flush eyes/mouth with water or saline). Then, call: • UCSF (415) 353-7842 [STIC] • SFGH & VA (415) 469-4411

  17. Influenza Prevention • Influenza vaccine required on annual basis for all employees OR sign a declination form and wear a mask during influenza season • Respiratory / cough etiquette • Remember eye protection • Appropriate room placement for suspected influenza or other respiratory viral illness • UCSF and VAMC: droplet precautions • SFGH: low level respiratory isolation

  18. Respiratory Etiquette: Protect Others -- Cover your Cough / Sneeze 18

  19. Antimicrobial Stewardship • Appropriate antimicrobial use measures: • On-call ID and ID pharmacist consultation • Tri-hospital guidelines (http://clinicalpharmacy.ucsf.edu/idmp/guide_home.htm) • Inpatient antibiotics reviewed and feedback given • Requirement for antibiotic approval

  20. Infection Control assistance is available at all sites • UCSF and Mt. Zion: 353-4343, pager 443-2644; http://infectioncontrol.ucsfmedicalcenter.org/html/index.html • SFGH: 206-8451, pager 443-1566 • VAMC: 221-4810, x3762 or x2728

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