Infection Control-6-2 1 PDF

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Self-Learning Module

Basic Infection Control And Bloodborne Pathogen Training For Clinical Staf

Program Objectives

The learner will: 1. Describe how micro-organisms are transmitted in healthcare settings. 2. Demonstrate standard and transmission based precautions for all patient contact. 3. Describe occupational health practices that protect the healthcare worker from acquiring infection. 4. Describe occupational health practices that prevent the healthcare worker from transmitting infection to a patient. 5. Demonstrate ability to problem solve and apply knowledge to recognize, contain and prevent infection transmission. 6. Describe the different bloodborne pathogens. 7. Demonstrate safe work practices to protect against exposure to bloodborne pathogens.

The Chain of Infection All infections are spread by a process called the Chain of Infection. If you break any link in this chain you can prevent transmission. There are six links in the chain.

1. 2. 3. 4. 5. 6.

Presence of a pathogen Reservoir Portal of exit from reservoir Mode of transmission Portal of entry Susceptible host

Pathogens include: Bacteria, Virus, Fungus and Parasites Common hospital acquired pathogens include Staph aureus, Pseudomonas, Klebsiella spc., Proteus spc.,

Reservoir: A reservoir is a place where the pathogen is stored and can survive and replicate. There are three common reservoirs: humans, animals and environment. Reservoirs associated with hospital acquired infections (HAI) include patients, healthcare personnel, equipment and the environment. Portal of Exit: This is the path the pathogen takes to leave the reservoir and include the respiratory tract, GU tract, GI tract, blood and skin/mucous membranes. Mode of Transmission: The method by which the pathogen reaches the susceptible host is the mode of transmission. These methods include: -

Direct/indirect contact via hands or equipment Droplet via coughing, sneezing Airborne from the respiratory tract Vehicle would include contaminated food and water Vector such as ticks, mosquito’s, flea’s

Portal of Entry: The portal of entry is where the pathogen enters the susceptible host. These would include the respiratory tract, GI tract, GU tract, skin/mucous membranes, blood or trans-placental. Susceptible Host: This would be an individual who is not immune to the pathogen. Risk factors include the elderly, children, immune-compromised individuals, non-intact skin and indwelling devices.

Hand Hygiene

The single most effective method to prevent the spread of infection is the simple act of practicing hand hygiene with either soap and water, or an alcohol based hand rub. Use soap and water to wash your hands after contact with blood, body fluid or mucous membranes. After glove use and after contact with patient who has C-diff. Wash hands for 15 seconds. Pay attention to nail beds and in between the fingers. Make sure the water is of a comfortable temperature. Water that is too hot will remove the natural skin oils and contribute to dry/cracked skin Use alcohol gel hand cleansers for all other patient care activities. Rub the hand sanitizer onto your hands until it evaporates. Artificial nails are porous and bacteria will adhere to the surface. As such it is hospital policy that artificial nails are not to be worn. When to cleanse your hands: -

Before and after patient care Before and after glove use After contact with contaminated surfaces After touching blood or body fluids After contact with a patient’s bedside or equipment Before and after meals After toileting

Standard Precautions

These are the measures taken to protect the healthcare worker from exposure to potentially infectious material. Standard Precautions are used with all patients regardless of their diagnosis or infectious status.

Use the appropriate barriers or personal protective equipment (PPE) for contact with blood, body fluid, non-intact or mucous membranes. PPE Includes: - Gloves - Cover Garb (gowns, bibs) - Masks/Eye Protection Gloves are worn when there is the potential to touch blood, body fluid, non-intact skin or mucous membranes. Gloves are single use and must be discarded. Gloves should be changed if contaminated or torn. Remember gloves are worn to protect both the patient and healthcare worker. They should be applied just prior to patient care. Gowns are worn if the clothing is likely to be splattered with blood or body fluids. Masks and eye protection are worn if there is the potential to splash or spray the eyes, nose or mouth with blood or body fluid. It is appropriate to wear a mask with a face shield while suctioning or working with a child who is coughing and cannot cover their mouth.

Transmission Based Precautions In addition to Standard Precautions, there are three additional categories of precautions for specific infectious diseases. - Airborne Precautions - Droplet Precautions - Contact Precautions Airborne Precautions: These isolation precautions are used for those diseases where virus/bacteria are disseminated via air currents. There are three diseases that require this type of isolation. 1. Tuberculosis 2. Varicella (chickenpox) 3. Measles These microbes are small particles and can remain suspended in the air and travel on air currents. A negative pressure room is required for these patients. Healthcare personnel must wear an N95 respirator mask upon entry into the room. Yearly fit testing for this mask is necessary. An Airborne Precaution sign is placed at the entrance to the room. Droplet Precautions: This respiratory isolation is utilized for diseases that are spread by droplets generated by coughing, sneezing, talking or suctioning. These are large particle droplets and fall out of the air within 3 feet of an individual. Transmission occurs with contact of the conjunctivae or mucous membranes of the nose and or mouth.

These patients require a private room. Patients with the same diagnosis may be chorded. Masks are required upon entry into the room. Diseases that require this category of isolation include: Pertussis, Influenza, strep throat, parvovirus and H flu pneumonia in small children. A Droplet Precaution sign is placed at the entrance to the room. Contact Precautions: Contact transmission requires direct skin to skin contact and physical transfer of micro-organisms to a susceptible host from an infected or colonized person. Transmission can be patient to patient, staff to patient, or contaminated object to patient. Contact Precautions are used for patients with MDRO’s, Cdiff, infectious diarrhea and RSV. There should be dedicated patient equipment. Equipment that cannot be dedicated must be cleaned with a sani-cloth prior to re-use on another patient. Gloves and gowns are worn for all close contact with the patient or the patient’s bedside and equipment. A Contact Precaution sign is placed at the entrance to the room and at the patient’s bedside in a semi-private room.

Multidrug Resistant Organisms Multidrug resistant organisms (MDRO’s) are bacteria that have become resistant to many or specific antibiotics. They are not any more communicable than non-resistant bacteria and their method of transmission is the same as sensitive organisms. They are however, more difficult to treat since the choice of antibiotic is limited.

Infections with MDRO’s can increase a patient’s length of stay and cost of care.

Some common MDRO’s include: 1. 2. 3. 4.

Methicillin Resistant Staph aureus (MRSA) Vancomycin Resistant Enterococcus (VRE) Extended Spectrum Beta-lactamases (ESBL) Carbapenem Resistant Gram negative Organisms

MRSA is the most commonly identified MDRO. It is now frequently seen in the community as well as the hospital setting. This organism was first isolated in 1968. MRSA nasal colonization’s can be found in approximately 8-10% of individuals with nasal colonization of Staph aureus. VRE first emerged in the early 1990’s. Enterococcus is a bowel flora. A rectal swab screening test should be done to determine colonization with this MDRO in those patients with past infection. Infections are most commonly found in urine, blood and wounds. ESBL’s are gram negative bacteria, mainly Klebsiella and E. coli. These organisms produce an enzyme which inactivates the Betalactam antibiotics (penicillin and cephalosporin). Clostridium difficile C-diff is a gram positive, spore forming bacteria responsible for antibiotic associated diarrhea and pseudo-membranous colitis. The bacterial spores are difficult to kill. They can survive on environmental surfaces for extended periods of time and heavily contaminate a patient’s environment. Symptoms of Cdiff infection include frequent loose watery stools, leukocytosis, fever, abdominal pain and tenderness. Predisposing factors include antimicrobial and proton pump inhibitor administration. Testing for

Cdiff should not be performed on formed stools or on patients who do not exhibit symptoms. Patients with suspected or confirmed Cdiff will be placed on Contact Precautions. The patient’s environment must be cleaned with bleach. Hand hygiene must be performed with soap and water. Alcohol gel hand sanitizer will not inactivate the bacterial spores. Colonization versus Infection Some individuals may develop colonization’s with either sensitive or multi-drug resistant organisms. Colonization is defined as the presence of an organism that does not cause symptoms of disease or infection. Conversely, infection occurs when an organism is present and multiplying. The host exhibits signs of infection such as hyperthermia, leukocytosis, increased quantity and a change in the quality of secretions. Influenza The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccine each year. Flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose. Symptoms of the flu include: fever, sore throat, cough, muscle aches and pains, headache and fatigue. Certain people are at greater risk for serious complications if they get the flu. This includes older people, young children, pregnant

women and people with certain health conditions such as asthma, diabetes, or heart disease. Patients with suspected or confirmed flu are placed on Droplet Precautions.

BLOODBORNE PATHOGEN TRAINING OSHA Regulations In 1992, 29 CFR part 1910 was passed into law. This law addresses occupational exposure to bloodborne pathogens. You are covered by this standard if it is reasonably anticipated that exposure to bloodborne pathogens can result during the performance of your job. Bloodborne Pathogens Include: 1. Human Immunodeficiency Virus (HIV) 2. Hepatitis B Virus (HBV) 3. Hepatitis C Virus (HCV) HIV HIV attacks a person’s immune system. It is spread through sexual contact or contact with blood or other potentially infectious material (OPIM). The virus will attack the WBC’s the infected person and over time the body will produce fewer WBC’s. Virus has been isolated in the lymphocytes, macrophages and plasma in blood. All body fluids with the exception of sweat have been known to carry HIV. According to the CDC, as many as 900,000 people in the US are infected with the virus. The number of infected people who develop serious disease, AIDS, has decreased with the success of chemo therapeutic agents. There is no cure for HIV infection.

All information related to HIV is confidential. Written consent is required for testing and release of this information. HIV information can be released to federal and state regulatory agencies.

HBV HBV is the most common disease caused by contact with blood or OPIM. The CDC reports about 1.25 million people are infected with HBV. HBV attacks the liver and over time may cause scarring of the liver. Signs and symptoms of HBV usually occur 12 weeks after exposure and include: enlarged liver, jaundice, loss of appetite, nausea and abdominal pain. Many people infected do not have any symptoms, however, the virus can be spread to others. About 10% of those individuals infected with HBV develop chronic infection. HBV can be transmitted sexually, from needlesticks or perinatally from mother to baby. HBV poses a greater risk to healthcare workers that HIV or HCV and can be prevented with HBV vaccine. HCV HCV also attacks the liver. Seventy percent of those individuals infected are asymptomatic. The virus can remain in the body for a long period of time, up to 30 years, before symptoms appear. These symptoms include: fatigue, loss of appetite and abdominal pain. HCV is a leading cause of liver transplant. Many individuals with HIV also have HCV co-infection. Transmission can occur from needlesticks, perinatally or percutaneous such as IV drug use, or tattooing.

Blood/Body Fluid Exposure An exposure is defined as a needle stick or splatter of blood or OPIM to non-intact skin, eyes, nose, mouth or mucous membranes. It is important to report any exposure to your supervisor and to Employee Health Services. If an exposure occurs: - non-intact skin: wash area with soap and water - needle-stick: promote bleeding. Wash area with soap and water - eyes, nose, mouth: rinse with copious amount of water

Exposure Control Plan Blythedale Children’s Hospital has an exposure control plan. The plan defines the measures and procedures taken to prevent exposure to bloodborne pathogens. Employees are separated into two categories by job description and patient contact. The plan also defines engineering and work practice controls to prevent exposure. Engineering Controls These are physical or mechanical systems provided by the hospital to eliminate hazards. Examples of engineering controls include: - Needleless systems - SHARPS disposal containers - Protective devices for sharps

Work Practice Controls These are procedures you perform to protect yourself from exposure and include hand hygiene, appropriate use of PPE and proper SHARPS disposal. Hand Hygiene: This practice keeps you from transferring contamination from your hands to other areas of your body, environmental surfaces and other individuals. Remember to wash your hands with soap and water after gloves removed and after contact with blood, body fluids or OPIM. PPE: Protects you from contact with blood and OPIM. Choose PPE appropriate to the task being performed. Gloves are worn when touching blood, body fluids or mucous membranes. Always follow safe practices when removing gloves. Peal one glove off from the inside, tucking the first glove inside the second. Dispose the entire bundle and wash your hands. Remove gloves if they become contaminated or torn. Gowns are worn if there is the potential to splatter clothing with blood or OPIM. Make sure the gown is properly tied. Masks/Eye shields are worn if there is the potential to splatter blood or OPIM into your eyes, nose or mouth. For example, while suctioning.

Regulated Medical Waste Hospital garbage that contains potentially infectious material is considered regulated medical waste. These include SHARPS and items that are saturated with blood/body fluid. All sharps must be discarded into the impervious SHARPS containers. Needles are

never clipped or bent. Red bags are available for blood soaked items....