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Customize Your Infection Control Manual. James Marx, RN, MS, CIC Broad Street Solutions May 2006. What Infection Control Manual?. Regulatory Title 22 Federal Conditions of Participation JCAHO OSHA. Establish your practice. Many practices are not specified in law Isolation practice

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customize your infection control manual

Customize Your Infection Control Manual

James Marx, RN, MS, CIC

Broad Street Solutions

May 2006

what infection control manual
What Infection Control Manual?
  • Regulatory
    • Title 22
    • Federal Conditions of Participation
    • JCAHO
    • OSHA
establish your practice
Establish your practice
  • Many practices are not specified in law
    • Isolation practice
    • Surveillance methods and definitions
    • Outbreak identification and followup
  • “Its our policy to ….”
    • Not to isolate residents
    • Do two step TST for new admissions
critical policies
Critical policies
  • Surveillance system
    • Definition of infection
    • Case finding methods
    • Reporting schedule
  • Isolation system
    • When to start and stop isolation precautions
  • Employee health
    • Required vaccines
  • Infection Control Risk Assessment (ICRA)
    • Describe your unique resident population
    • Describe your unique staff population
    • How limited are your resources
  • What current trends will effect IC practice
essential elements
Essential Elements
  • Program description
  • Job description
  • Surveillance System
  • Isolation System
  • Hand Hygiene
  • Outbreak Management
  • Employee Health
  • Tuberculosis Control Program
  • Bloodborne Pathogens Program
  • Reportable Diseases
program description
Program description
  • Broad policies that are used throughout the facility
  • Department specific policies
    • Nursing
    • Housekeeping and Laundry
    • Facilities
    • Activities
    • Therapies
    • Food Services
job description
Job description
  • What is expected?
  • What training is provided? Initial? On-going?
  • What support is available?
  • What written resources are available?
  • How do you keep up with changes?
surveillance system
Surveillance System
  • Infection Prevention Risk Assessment
  • Definition of infection
  • Analysis of the information
  • Comparing the data
  • Creating reports
  • Quarterly meeting
isolation system
Isolation System
  • New guideline from CDC expected 2006
    • Will include information for LTC
  • Last guideline published 1996
    • Needs to be modified for LTC
  • California guideline on Antibiotic Resistant Microorganisms
  • Local county based guidelines
1996 cdc isolation guideline
1996 CDC Isolation Guideline
  • Standard Precautions
  • Transmission Precautions
    • Airborne
    • Droplet
    • Contact
airborne precautions
Airborne Precautions

Tuberculosis, Chickenpox, Measles

  • Requires a negative pressure room
  • Requires 6-12 air exchanges per hour
  • Requires the use of N95 respirators
    • Requires fit testing program
  • Modify policy to address each disease
  • Use 2005 CDC guideline for Prevention and Control of TB
  • Perform annual risk assessment
  • Define a suspect TB cases
    • Positive AFB smear
    • Suspicious chest x-ray with symptoms
  • Pre-plan for transfer of suspect cases
  • Screen all healthcare workers (100%)
  • Check blood titer of potential non-immune workers (8-10 %)
  • Vaccinate susceptible workers (1-2%)
  • Generally not a problem in adult LTC populations
  • Vaccine is recommended for any adult who does have history or vaccination
droplet precautions
Droplet Precautions
  • Influenza
    • Standard surgical mask
    • Advise staff, physicians, residents and family
    • Suspend socialization (activities/dining, visitation)
    • Consider antiviral therapy
    • Room door may remain open
    • Annual resident and staff vaccination program is critical to prevent and contain an outbreak
    • Consider mandatory vaccination/declination program
contact precautions
Contact Precautions
  • Need to modify 1996 CDC guideline
  • Socialization during activities
  • Dining room
  • Degree of Precautions
    • Colonization and infection
    • Infection only
    • Standard Precautions only
antibiotic resistant bacteria
Antibiotic Resistant Bacteria
  • Colonized residents
    • MRSa- 25% for 3months to 3 years
    • VRE- 25-67% for 3-4 months
    • GNR- 22% for 2 months
  • Methicillin Resistant Staphylococcus aureus
  • Can be normal skin flora
  • An undesirable side effect of antibiotic use
  • Regular hand hygiene indicated
  • Routine cleaning of the environment
  • Cleaning of multi-use resident care equipment
    • Blood pressure cuff
    • Stethoscope
    • Thermometer
  • Vancomycin Resistant Enterococcus
  • Can be normal bowel flora
  • An undesirable side effect of antibiotic use
  • Routine cleaning of the environment
  • Special attention to items with stool contact
    • Eliminate electronic rectal thermometers
    • Develop a system to disinfect bedpans after use
    • Dispose enema equipment after use
    • Disinfect shower chairs between use
common questions about isolation in skilled nursing
Common questions about isolation in skilled nursing
  • Can we use isolation signs?
  • Should we do Admission/Periodic surveillance cultures?
  • When do we discontinue isolation? How many negative cultures are needed?
    • MRSA, VRE, C. diff
  • How should isolation be documented in the medical record? Care Plan?
  • Should we use masks with MRSa?
  • Is antibacterial soap required?
hand hygiene
Hand Hygiene
  • CDC guideline- 2002
    • Alcohol hand sanitizer in all clinical situations
    • Soap and water when hands are visibly soiled, before eating and after using the bathroom
  • Decide placement of containers
  • Conform to local fire laws
cleaning and disinfection
Cleaning and Disinfection
  • Identify surface to be cleaned
  • Use according to Direction for Use
  • Create a cleaning schedule
  • Assign responsibility for cleaning
  • Decide on the supplies needed to clean
storage of sterile items
Storage of sterile items
  • Identify area storage area
    • Clean, cool, no sunlight, dry
  • Establish a schedule to rotate stock
  • Insure that outdates are monitored
  • Assign responsibility
outbreak management
Outbreak Management
  • Define an outbreak
  • Define a case
  • Find additional cases
  • Institute control measures
  • Formulate a hypothesis
  • Communicate findings
employee health
Employee Health
  • Initial and annual TB screen
    • Two step TST for employees who have not been tested in past year
    • Include volunteers with > 10 hours per week
  • Initial health examination
  • Annual health examination
    • Can be done by questionnaire only with RN review (need Program Flexibility)
  • Vaccine Preventable Diseases screen
    • Measles, Mumps, Rubella, Varicella, Hepatitis B, Influenza (Oct-March), Tetnus/diphtheria/pertussis
tuberculosis control program
Tuberculosis Control Program
  • Resident screening
    • Initial tuberculin skin test (TST)- required
    • Annual screening (determine your policy)
      • Not required by Title 22 or Federal COP
      • Not recommended by the CDC
      • Recommended by California TB Controllers Association and DHS
  • Employee screening
bloodborne pathogens program
Bloodborne Pathogens Program
  • Identify staff at exposure risk
  • Identify techniques and devices that reduce the risk of exposure
  • Provide education
  • Implement hepatitis B vaccination program
    • Include required post vaccine titers
  • Define exposure follow up protocol
reportable conditions
Reportable Conditions
  • Contact local county/city health department
  • Conditions like Alzhiemer Disease and lapse of consciousness
index and table of contents
Index and Table of Contents
  • Have electronic version of policies
  • Some software will create and index for you
  • Different color pages
    • Isolation Table
  • Principles of Infection Control and Epidemiology- APIC 2003
references and resources
References and Resources
  • James Marx, RN, MS, CIC

P.O. Box 16557, San Diego, CA 92176

619-656-7887 Voice/Fax

references and resources1
References and Resources
  • National Immunization Program at the Centers for Disease Control and Prevention
  • S Bradley, Prevention of Influenza in Long-Term Care Facilities, ICHE, September 1999
  • Adult Immunization Programs in Nontraditional Settings and Use of Standing Orders Programs to Increase Adult Vaccination Rates, MMRW, March 24, 2000
essential elements exercise
Essential Elements Exercise
  • Seasonal Influenza
  • Isolation Systems
  • Hepatitis B vaccination
influenza planning exercise
Influenza planning exercise
  • Seasonal influenza
    • Vaccination planning and promotion
    • Early detection
    • Reducing transmission
  • Pandemic influenza
    • Bed capacity
    • Staffing capabilities
    • Supplies- masks, medications, vaccine, tissues
    • Temporary morgue
hepatitis b vaccination
Hepatitis B vaccination
  • Determine who should be vaccinated
  • How will they be educated?
  • How will they get vaccinated? Describe process of the three vaccine series
  • How will post- vaccine titer be done?
James Marx, RN, MS, CIC

Broad Street Solutions

P.O. Box 16557

San Diego, CA 92176

619-656-7887 Voice/Fax