Memorial Hospital of Rhode Island Department of Infection Control New Employee Orientation 2010

1. Memorial Hospital of Rhode IslandDepartment of Infection ControlNew Employee Orientation2010 YOU CAN MAKE A DIFFERENCE!

2. Infection Control Program2010 Annual Update • OSHA’s Blood Borne Pathogen Standard • Isolation Precautions • Personal Protective Equipment (PPE) • National Patient Safety Goal #7 • Multi-Drug Resistant Organisms • Tuberculosis and Respiratory Protection • Influenza (Seasonal and Swine Flu) • Employee Health

3. OSHA’s Bloodborne Pathogen Standard • A bloodborne pathogen is a microorganism that is transmitted in blood or blood products and is capable of causing disease. • All human blood and body fluids containing visible blood should be treated as potentially infectious. • Feces, nasal secretions, sputum, sweat, tears, urine, breast milk, saliva, and vomitus are not considered contagious unless blood is present.

4. How are BBP Spread? Bloodborne pathogens include HIV and Hepatitis B & C. • By injection, cuts, or sticks from contaminated sharps and needles • Contact between blood and open skin sources • Contact with other potential infectious material through the eyes, nose, and mouth (mucous membranes). • Sharing of needles during injecting/intravenous drug use • Sexual contact • Mother-To-Child-Transmission

5. HIV – Human Immunodeficiency Virus • Attacks the immune system, weakening it so that it can not fight other infections • Approx 55,000 new people are infected each year • Approx 1 million people living with HIV in the USA • Numbers probably higher as many who are infected are unaware

6. HIV – Human Immunodeficiency Virus • HIV is fragile and will not survive outside the body for a long time • Workplace infections are around 0.4%, typically via needlestick • Signs and Symptoms include flu-like syndrome, weakness, fever, sore throat, night sweats, white coating on tongue, weight loss, and swollen lymph nodes • IMPORTANT: Once infected with HIV, you are still able to transmit the virus to other people even though you have no symptoms

7. Hepatitis • Hepatitis is a general term for inflammation of the liver. There are several causes including: • Excessive use of alcohol • Illicit drug use • Prescription drug or OTC interactions • Viral infections including mononucleosis • Hepatitis A, B, C, D and others • Hepatitis B and C are transmitted primarily through blood and body fluids

8. Hepatitis B (HBV) • Infects liver and causes inflammation • Survives in dried blood for many days • Symptoms include flu-like syndrome, fatigue, stomach pain, loss of appetite, nausea, weakness, headache, fever, jaundice, liver cancer, cirrhosis, and death • Prevention: Hepatitis B Vaccine • No specific treatment for HBV

9. Hepatitis C (HCV) • 60-70% patients have no symptoms • Approx 4 million people in the USA have Hepatitis C • Complications include liver cancer, cirrhosis, death. • No vaccine • Treatment with peginterferon

10. Isolation Precautions • Standard Precautions • This is the practice of treating all blood and body fluid as if it is potentially infectious with a bloodborne or other pathogen.

11. Standard Precautions at MHRI • Hand washingbefore and after patient contact; • Using gloves when touching blood or body fluids, and contaminated patient items; • Using gloves, mask, eye protection, and gowns(Personal Protective Equipment) during procedures likely to generate splashes or sprays or exposure to blood or body fluids • **NEW**All equipment that is used on patients must be cleaned prior to use on other patients. • Respiratory Etiquette • “Cover Your Cough” Campaign • Cough/Sneeze into tissue or into your arm

12. Isolation Precautions • Transmission-Based Precautions • Patients who have an infectious and potentially communicable disease are placed into Isolation, and specific precautions are taken to reduce the transmission and acquisition of these infectious diseases • Isolation Signs on Patient Room Doors • Read the sign and DO what the sign says to do! • Ask a nurse if you have questions or confusion

13. Isolation Signs at MHRI

14. Personal Protective Equipment (PPE) “specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA)

15. Types of PPE Used at MHRI • Gloves – nitrile material: protect hands. • DO: Wash your hands BEFORE putting gloves on and AFTER taking gloves off. • DO: Change gloves • If torn and when heavily soiled (even during use on the same patient) • After use on each patient, and wash your hands! • DON’T: Wash or reuse disposable gloves

16. Types of PPE Used at MHRI, Cont’d • Gowns/aprons – protect skin and/or clothing, fit snugly around the waste, should not be used by staff as a warm-up jacket. • Goggles – protect eyes, personal glasses not a substitute for goggles. • Face shields – protect face, mouth, nose, and eyes. • Masks/respirators and PAPRs– protect mouth/nose and respiratory tract from airborne infectious agents (TB, Influenza, RSV).

17. Key Points About PPE • Perform hand hygiene before putting on PPE • Put on PPE before contact with the patient • Remove and discard PPE carefully, either at the doorway or immediately outside patient room • Immediately perform hand hygiene after removing PPE and/or patient contact • MHRI’s Policy is that PPE must also be used by family members and visitors of patients.

18. Needlestick Safety and Prevention Act, P.L. 106-430

19. Engineering Controls “… means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.”

20. Hypodermic syringes with “Self-Sheathing” safety feature Self-sheathed protected position

21. “Add-on” safety feature Attached to syringe needle Attached to blood tube holder

22. Retracting lancets with safety features Before During After Before During After In use After use

23. Exposure Control PlanIf you have an exposure: • Wash area with soap and water • If it is a Sharps exposure, save the device in a rigid container, take with you EH or ED • All exposures are to be reported to your supervisor • Incident report • Report to Employee Health (ext 2200) • After 4pm or weekends go to Emergency Room

24. The Joint Commission National Patient Safety Goals Goal # 7 Reduce the Risk of Healthcare Associated Infections

25. National Patient Safety Goal 7:Reduce the Risk of Healthcare-associated infections • HAND HYGIENE • Comply with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines. • Perform hand hygiene before and after every patient contact & before and after taking off gloves • Wash hands with soap and water or use an alcohol-based hand rub (Purell)

26. Hand Hygiene • Soap and water • Scrub for a minimum of 15 seconds • When hands a re visibly soiled • Contact CD (C. dificile) Precautions • After 4-5 alcohol-based cleanings • Alcohol-based hand rub all other times • NO artificial nails, tips, wraps, gels

27. Hand Hygiene Compliance • Hand Hygiene Compliance Rounds • JCAHO Requirement • Daily, on all shifts • Covertly, with opportunity for re-education • Don’t Be Afraid to Speak Up! Challenge your co-workers to wash their hands • Non-compliance with hand hygiene = corrective action discipline

28. National Patient Safety Goal 7:Reduce the Risk of Healthcare-associated infections • MDROs (Multidrug-Resistant Organisms) • Implement evidence-based practice to prevent health care associated infections due to multiple drug-resistant organisms in acute care hospitals • Patients are “coded” when identified with a MDRO, placed on contact precautions • High risk patients will be screened for MRSA/VRE as appropriate • Cleaning and disinfecting equipment and the patient’s environment between patients

29. National Patient Safety Goal 7:Reduce the Risk of Healthcare-associated infections • (07.03.01) MDROs, Cont’d • Continued education of staff on annual basis on hospital acquired infections, multi-drug resistant organisms and prevention strategies • Hospital educates patients, and their families who are infected or colonized with MDROs about health care associated infection strategies • Hospital policies and practices will be aimed at reducing the risk of transmitting multi-drug resistant organisms

30. Other Potential Exposures • Tuberculosis • Influenza, Seasonal and Swine • Multi-drug Resistant Organisms (MRSA, VRE, ESBLs) • Clostridium difficile • Varicella Zoster Virus (Chickenpox & Shingles)

31. Other Potential Exposures, Cont’d • Tuberculosis • Signs and Symptoms: • fatigue, cough>3 weeks, weight loss, night sweats, bloody sputum • Precautions: Airborne • N95 mask/PAPR • Negative Pressure Room • UV Light

32. Other Potential Exposures, Cont’d • Influenza (seasonal): • Signs and Symptoms: • Fever > 100˚ • Cough and Respiratory Symptoms • Headaches, bodyaches • Nausea, vomiting, diarrhea • Precautions: Droplet • Regular Surgical Masks • Handwashing, Handwashing, Handwashing

33. Other Potential Exposures, Cont’d • Influenza (H1N1 / swine flu): • Signs and Symptoms: • Fever > 100˚ *and* one of the following: • Cough and Respiratory Symptoms • Headaches, bodyaches • Nausea, vomiting, diarrhea • Precautions: Droplet (New Guidance 8/20/09) • Surgical Masks • Stay home if sick: 7 days from start of symptom onset or until 24 hours symptom free (without use of fever reducing medications; whichever is longer) • MHRI HR Sick Policy applies • Handwashing, Handwashing, Handwashing

34. Other Potential Exposures, Cont’d • Influenza (seasonal and swine flu): • Vaccine • Seasonal Flu • Typically available for distribution in early September • 2008 Flu Season: 58% DHCW vaccinated, 89% Non-DHCW vaccinated • 28% HCW who contracted flu rec’d it from co-workers • Influenza A: H1N1/Swine Flu • CDC New Guidelines for distribution: HCWs are priority • Pneumovax • See your PCP

35. Other Potential Exposures, Cont’d • Multidrug Resistant Organisms (MDROs) • MRSA -Methicillin Resistant Staphylococcus Aureus • Skin, Wound, Sputum, Urine, Blood Infections • Contact precautions (Gloves and Gowns) • VRE- Vancomycin Resistant Enterococcus • Stool, Sputum, Urine Infections • Contact Precautions (Gloves and Gowns)

36. Other Potential Exposures, Cont’d • Multidrug Resistant Organisms (MDROs) • ESBLs-Extended Spectrum Beta-Lactamases • Gram negative organisms • Enterobacteriaceae family • Examples include E. coli; Klebsiella pneumoniae; Enterobacter cloacae; Serratia marcescens; Enterobacter aerogenes • Resistant to penicillins and cephalosporins • Can be isolated from various sites including sputum, urine, wounds Skin, Wound, Sputum, Urine, Blood Infections • Precautions: Contact (Gloves and Gowns)

37. Other Potential Exposures • Clostridium difficile • Malodorous, Numerous (8+ stools/day), Foamy, Oily, Greasy appearance, Highly Contagious • Fever, Abdominal Pain, Dehydration, Flatulence • Precautions: Contact CD (gloves and gown) • Soap and Water ONLY for hand washing • Bleach for environmental cleaning

38. Varicella Zoster Virus (Chickenpox) • Varicella Zoster Virus (Chickenpox) • Member of the Herpes Family • Rash appears 10-21 days after exposure • Vesicles begin on head and quickly spread down the body • Prevention: Varicella Vaccine • Pregnant women should avoid contact with anyone with chickenpox • Airborne and Contact Precautions until lesions are dry and crusted over

39. Varicella Zoster Virus (Shingles) • Varicella Zoster Virus (Shingles) • Member of the Herpes Family • Reactivation of the Varicella Zoster Virus • Most common area of involvement is the trunk of the body, typically on one side of the body. Considered to be “more serious” if crosses the body or covers 2 or more dermatomes • Prevention: Varicella Vaccine • Pregnant women should avoid contact with anyone with shingles • Airborne and Contact Precautions until lesions are dry and crusted over

40. Employee Health Services • Location – Center for Primary Care / Internal Medicine Clinic • Hours – 8am-4pm M-F • Follow up on exposures • Immunizations / Annual PPD • Annual flu vaccine – declination statement • Fit testing for N95 respirator

41. Who is Responsible for Infection Control? EVERYONE

42. Infection Control • CONFIDENTIAL VOICE MAIL, Ext 2427 • Andrew Komensky, Program Manager • (Pgr: 872-0068) • Heidi Ahlquist, Infection Control Coordinator • (Pgr: 872-4847) • Marcia Carr Carvalho, Employee Health Nurse • (Ext 2200)

43. Questions??