INFECTION CONTROL

THE INFECTION CONTROL THE INFECTION CONTROL STAFFSTAFF

INTEGRIS BAPTISTINTEGRIS BAPTIST INTEGRIS INTEGRIS SOUTHWESTSOUTHWEST• V. Ramgopal, M.D.,

Hospital Epidemiologist• Gwen Harington, RN, BSN,

CIC, Infection Control Specialist

• Kathy Knecht, RN, Surveillance Coordinator

• D. Chansolme, M.D., Hospital Epidemiologist

• Becky Lewis, RN, Infection Control Specialist

Who can Place a Patient in Who can Place a Patient in IsolationIsolation

• Attending MD to order isolation as indicated by the Centers for Disease Control Guidelines.

• Hospital Epidemiologist and Infection Control Specialist have authority to isolate and/or transfer any patient to a private room as indicated.

• By using CDC Guidelines, the licensed nurse responsible for the patient can institute isolation if notified that the patient has a positive culture for resistant organisms, i.e., MRSA, VRE, or Clostridium difficile.

• Physician order is necessary for the discontinuation of isolation.

Criteria for Placing Criteria for Placing IsolationIsolation

• Patients diagnosed with resistant organisms need to remain in the same location unless they are occupying a semi-private room, need to be transferred to an ICU bed, or need to be transferred from an ICU bed to a patient-care floor.

• Patients previously admitted with a positive culture of a resistant organisms should be placed in isolation immediately upon readmission.

• Reference: Policy #IC-112 Readmissions with Resistant Organisms.

PERSONAL PROTECTIVE PERSONAL PROTECTIVE EQUIPMENTEQUIPMENT

• This equipment is located in Barrier Boxes throughout each medical center and in the each patient room. The equipment is provided to protect employees against exposure to blood and body fluids.

BLOODBORNE EXPOSUREBLOODBORNE EXPOSURE

• Report IMMEDIATELY to your supervisor.

• Complete exposure incident report.

• Go to Employee Health Services ASAP. – If after hours or on

weekend, contact House Supervisor.

– If regular clinic hours and unable to go immediately, contact EHS by phone to report incident and begin patient testing.

BLOODBORNE PATHOGENS & BLOODBORNE PATHOGENS & TUBERCULOSIS EXPOSURE TUBERCULOSIS EXPOSURE

CONTROL PLANSCONTROL PLANS

• These plans are updated annually and are located in the following places:– Infection Control

Master Manual– Integris Intranet– Infection Control

website – The Public Folders

PATIENT PLACEMENT PATIENT PLACEMENT FOR TUBERCULOSISFOR TUBERCULOSIS

Any patient with positive AFB smear, probable or known Tuberculosis, must be placed in negative

pressure room.

• IBMC Negative pressure rooms

are located on East Tower floors 7, 8, 9, & 10 East; there are two rooms in 901 ICU. The only exception on the West Tower is in the 9West Cardiac suites; this area has one negative pressure room.

• ISMCNegative pressure rooms are on floors 6, 7, and 10 and in the ICU. Jim Thorpe Rehab Hospital has one isolation room on the 2nd and 3rd floors.

Contact Infection Control or Environmental Health and Safety for any problems or questions.

FIT TESTING OF FIT TESTING OF TUBERCULOSIS MASKSTUBERCULOSIS MASKS

• Must be fit-tested for mask when entering the room for patients with known or suspected Tuberculosis. All fit testing is done by employee health.

ISOLATION ISOLATION

PRECAUTIONSPRECAUTIONS

IN AIN A

NUTSHELLNUTSHELL

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS

• Use with ALL patients regardless of diagnosis or presumed infection. Use when there’s a chance of contact with:– blood– any body secretions

or excretions– broken skin– mucous membranes

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS• Hand WashingHand Washing

– BEFOREBEFORE and and AFTERAFTER patient patient contactcontact

– BEFOREBEFORE putting on or taking off putting on or taking off glovesgloves

– AFTERAFTER touching blood or other touching blood or other body substances, contaminated body substances, contaminated patient equipment, broken skin, or patient equipment, broken skin, or mucous membranesmucous membranes

– BETWEENBETWEEN different procedures on different procedures on the same patientthe same patient

– BEFOREBEFORE leaving the patient’s room leaving the patient’s room– WashWash your hands for your hands for 15 seconds if if

using soap and water.using soap and water.– When using When using alcohol foamalcohol foam rub your rub your

hands together hands together until handsuntil hands are are completely drycompletely dry..

– http://www.hhs.gov/ash/initiatives/hai/training/

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS

• Wearing GlovesWearing Gloves– BEFORE BEFORE any procedure that any procedure that

may involve contact with may involve contact with blood or other body blood or other body substances, broken skin, or substances, broken skin, or mucous membranes.mucous membranes.

– BEFORE BEFORE touching any touching any potentially contaminated potentially contaminated object.object.

– CHANGE CHANGE gloves after gloves after touching infective material touching infective material such as fecal material and such as fecal material and wound drainage.wound drainage.

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS

• Wearing Face and Wearing Face and Eye ProtectionEye Protection– Use a Use a maskmask and and

faceface and and eye eye protectionprotection when when the possibility exists the possibility exists that blood or other that blood or other body fluids may be body fluids may be splashed or sprayedsplashed or sprayed

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS

• Wearing GownsWearing Gowns– Use a gown if Use a gown if

splashing or splashing or spraying of spraying of blood, body blood, body fluids, fluids, secretions or secretions or excretions is excretions is possible.possible.

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS• Handling Patient-Care EquipmentHandling Patient-Care Equipment

– HandleHandle patient-care equipment that is soiled with patient-care equipment that is soiled with blood, other body fluids, secretions or excretions in a blood, other body fluids, secretions or excretions in a way that prevents contact with skin and mucous way that prevents contact with skin and mucous membranes.membranes.

– HandleHandle patient-care equipment in a way that prevents patient-care equipment in a way that prevents contamination of clothing and the spread of micro-contamination of clothing and the spread of micro-organisms to other patients and the environment.organisms to other patients and the environment.

– Appropriately Appropriately disposedispose of single-use equipment. of single-use equipment.

– SterilizeSterilize or or disinfectdisinfect reusable equipment according reusable equipment according to policy.to policy.

– Properly Properly cleanclean and and disinfectdisinfect equipment that is equipment that is shared by more than one patient.shared by more than one patient.

Standard Precautions

• Any piece of contaminated equipment that will not be immediately cleaned as part of room turnover should be covered with a blue bag labeled as “soiled”.

• Equipment that has been cleaned and decontaminated should be covered with a clear bag. Even if it will be used within a short time.

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS• SharpsSharps

– Never recap used Never recap used needlesneedles

– Deposit sharps in Deposit sharps in the sharps the sharps container container immediately after immediately after useuse

– Call Call housekeeping housekeeping to come and to come and replace the replace the sharps sharps container container when it is half when it is half fullfull

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS

• Handling LinenHandling Linen– Do not put linen on Do not put linen on

the floor. the floor. – Drape an open plastic Drape an open plastic

bag over a chair and bag over a chair and place dirty linen in the place dirty linen in the bag.bag.

– After removing bag After removing bag with dirty linen from a with dirty linen from a patient’s room place it patient’s room place it in the covered dirty in the covered dirty linen bin on your unit. linen bin on your unit.

3 CATEGORIES OF 3 CATEGORIES OF ISOLATION ISOLATION

PRECAUTIONSPRECAUTIONS

TO BE USED IN ADDITION TO BE USED IN ADDITION TO STANDARD TO STANDARD PRECAUTIONSPRECAUTIONS

CONTACT CONTACT PRECAUTIONSPRECAUTIONS

• This category is used for patients known to be infected or colonized with important microorganisms that can be transmitted by direct contact with the patient.

CONTACT PRECAUTIONSCONTACT PRECAUTIONSCommon Conditions That RequireCommon Conditions That Require

Contact Isolation:Contact Isolation:

MRSA (all body sites)

VRE (all body sites)

C. DIFFICILE LICE

MAJOR ABSCESSES SCABIES

CELLULITIS, DECUBITI RSV

CONTACT CONTACT PRECAUTIONSPRECAUTIONS

• Private room necessary.• Gloves MUST be worn when entering patient’s room.• Gown MUST be worn when entering patient’s room, if

you anticipate your clothing will have substantial contact with patient, environmental surfaces, or items in patient’s room.

• Transport: limit movement and transport of patient from the room for essential purposes only.

• Patient-Care Equipment: dedicate the use of non-critical patient-care equipment to a single patient to avoid sharing between patients. In unavoidable, clean and disinfect before using on another patient.

AIRBORNE AIRBORNE PRECAUTIONSPRECAUTIONS

• This category is used to prevent the spread of infectious small particles that remain suspended in the air and can be widely dispersed by air currents.

AIRBORNE AIRBORNE PRECAUTIONSPRECAUTIONS

Common Conditions That RequireCommon Conditions That RequireAirborne Isolation:Airborne Isolation:

TUBERCULOSISVARICELLA

(Chickenpox)

AIRBORNE AIRBORNE PRECAUTIONSPRECAUTIONS

• Private room with NEGATIVE air pressure. KEEP DOOR CLOSED.

• Wear respiratory protection when entering the room of those patients with known or suspected pulmonary tuberculosis. YOU MUST HAVE BEEN FIT-TESTED BEFORE YOU WEAR RESPIRATORY PROTECTION AND ENTER THE ROOM OF A PATIENT WITH KNOWN OR SUSPECTED PULMONARY TUBERCULOSIS.

• Patient transport: limit transport and movement to essential purposes only. If moving patient is necessary, place a SURGICAL MASK on the patient.

DROPLET PRECAUTIONSDROPLET PRECAUTIONS• This category is

used to prevent the spread of large particles that can be created by certain medical procedures or by coughing, sneezing, or talking.

DROPLET DROPLET PRECAUTIONSPRECAUTIONS

Common Diagnosis That RequireCommon Diagnosis That RequireDroplet Isolation:Droplet Isolation:

INFLUENZA PERTUSSIS

HAEMOPHILUS INFLUENZAE B

MENINGITIS, PNEUMONIA AND SEPSIS

NEISSERIA MENINGITIDIS MENINGITIS, PNEUMONIA

AND SEPSIS

DROPLET PRECAUTIONSDROPLET PRECAUTIONS

• Private room necessary• Mask MUST be worn when working within

3 feet of the patient• Patient transport: limit transport and

movement to essential purposes only. If moving patient is necessary, patient MUST wear a SURGICAL MASK

IF YOU HAVE ANY QUESTIONS, PLEASE CALL

INFECTION CONTROL

IBMC @949-3785

ISMC @ 636-7614