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Infection control for house officers at the Omaha VA Medical Center

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  1. Infection control for house officers at the Omaha VA Medical Center Infection Control Practitioner Pager 13-485 ext. 3319 MRSA Prevention Coordinator Pager 13-323 ext. 4226 Hospital Epidemiologist Ext. 5606

  2. Omaha VA uses • Standard and Transmission-Based Precautions • Based on current guideline of the Centers for Disease Control and Prevention (CDC)

  3. Standard Precautions Protective barriers for ALL potential contact with: • All body fluids • Blood • All secretions • All excretions (except sweat) • Mucus membranes • Non intact skin

  4. Follow CDC 2002 hand hygiene guideline • No artificial nails, no chipped nail polish • Natural nail no longer than 0.25 inch • Wash hands with antimicrobial soap and water if visibly soiled or after caring for Clostridium difficile patients • Hand hygiene before and after patient contact, including after removal of gloves. Generally use alcohol handrub.

  5. Personal Protective Equipment (PPE) • What is available for your use? • Surgical masks • N-95 respirators (must be fit tested) • Gloves • Gowns • Eye protection

  6. Alcohol dispensers often near sinks & in every patient room

  7. Purell alcohol handrub

  8. Transmission based Precautions • Contact • Enhanced contact • Airborne • Droplet

  9. Contact precautions • Examples of Diseases in this category: • Drug-resistant organisms (eg MRSA, VRE) • SARS (also needs airborne precautions, eye protection)

  10. Contact precautions includes • Gown • Gloves • Hand hygiene • Dedicated equipment in the room (including stethoscope, blood pressure cuff) • Terminally clean room on discharge of patient from the room

  11. Isolation Cart

  12. Find a gown in an isolation cart

  13. Remove gown from cart

  14. Put on the gown, fasten-ing it in back

  15. Remove it after seeing the patient, turning it inside-out

  16. Place the used gown in the trash can

  17. Enhanced contact precautions • Examples of diseases in this category: • Clostridium difficile • Norovirus

  18. Actions: Enhanced contact precautions • Disinfect hands with antimicrobial soap and water (rather than alcohol gel) • Housekeeping staff use special cleaning methods involving bleach

  19. Airborne precautions • Fit-tested N95 mask • Room with negative air flow • Door closed

  20. Airborne Precautions • Examples of Diseases in this category: • Tuberculosis • Varicella • Measles • SARS (also needs contact precautions and eye protection)

  21. Common questions on airborne precautions: PPD • Q. “My patient has a positive tuberculin skin test (PPD test). Is this an indication for airborne precautions?” • A. No, only patients suspected of having active tuberculosis or proven to have active tuberculosis need airborne precautions.

  22. Common questions on airborne precautions: AFB • Q. “My patient has a laboratory test showing acid-fast bacilli (AFB) in the sputum. Does this mean the patient has tuberculosis?” • A. Not always. So-called atypical mycobacteria that are not causing tuberculosis can result in a lab report of AFB in the sputum and isolation is not indicated.

  23. Rooms for airborne precautions • 8 rooms available (includes 2 each in Emergency, ICU, 6E, and 7E) • Specially equipped to maintain negative flow • Reduces risk of pathogens drifting in air currents from infected patient to other patient rooms

  24. Check alarm outside negative air flow room • Alarm should be off with the door closed • If not, contact nurse

  25. Droplet precautions • Regular mask • Door may be open or closed for known or suspected

  26. Droplet Precautions • Examples of disease in this category: • Influenza • Pertussis • Neisseria meningitidis

  27. Employee Health Issues • Blood and body fluid exposure • Immediately notify supervisor • Immediately call Occupational Health (5825) during day hours or go to Urgent Care area after hours • Do so immediately since post exposure prophylaxis for HIV should be started, ideally within an hour • FREE influenza vaccine provided for all • Tuberculin skin test annually at host institution: CUMC or UNMC • Hepatitis B vaccine at host institution

  28. All blood and body fluid exposures are important • Sharps Injuries • Needle stick • Scalpel cut • Pipette break • Any injury that breaks the skin in the presence of body fluids • Mucous membrane exposure

  29. If a Blood Exposure Occurs: • Clean the exposed area with soap and water. For exposed mucous membranes, flush with water. DO NOT use bleach or surface disinfectants. • Report incident to supervisor immediately. • Report to Employee Health or Urgent Care area as previously described. • Fill out an Incident Report via the electronic reporting system - ASISTS

  30. Follow-up of blood or body fluid exposure • Follow-up after initial visit to Urgent Care • Occupational health nurse practitioner • Call 3209 to schedule visit

  31. Safety needles can prevent some blood exposures Be sure to use these devices correctly.

  32. Sharps disposal containers in each room

  33. Needle/Sharps Disposal • DO activate safety device • DO locate the disposal container closest to your work area • DO look to be sure that the opening of the box is clear of sharps • Do NOT recap by hand • Do NOT bend, clip or break

  34. Check to be sure disposal box is not overfilled

  35. Aims of OSHA bloodborne pathogens standard • To protect employees from • Occupational exposure to blood or other potentially infectious materials • Transmission of bloodborne diseases

  36. Bloodborne diseases of concern • Human immunodeficiency virus (HIV) • Hepatitis B (HBV) • Hepatitis C (HCV)

  37. Transmission in the workplace occurs by: • Parenteral Exposure • Needle stick, blood transmission • Mucous Membrane Exposure • Mouth, eyes • In the community, they may be transmitted through IV drug use and from mother to baby.

  38. Human Immunodeficiency Virus (HIV) • Virus that causes AIDS • Attacks the immune system • May be no obvious signs of infection • Can transmit virus before illness known

  39. Hepatitis B (HBV) • Symptoms if liver damage develops: • Poor appetite • Fatigue • Abdominal discomfort • Jaundice • 125,000 people infected yearly in US • 5-10% become chronic carriers • 5-10% of those advance to liver disease • Hepatitis B Vaccine is available to prevent disease

  40. Hepatitis C (HCV) • Symptoms same as Hepatitis B • Antibodies may not provide immunity • Up to 85% will develop chronic hepatitis • 3.9 million chronically infected in US • Sexual transmission uncertain

  41. Respiratory etiquette to prevent transmission • Cover your cough or sneeze • Deposit tissues directly into the trash • Clean hands after use of tissues or cough/sneeze • Offer tissues or mask to others with coughing or sneezing • Remind them to clean hands

  42. Infection Control is Everyone’s Responsibility!