New Employee Orientation Infection Prevention and Control

Topics

Hand Hygiene

Standard Precautions

Transmission-Based Precautions

Personal Protective Equipment (PPE)

Multiple Drug Resistant Organisms (MDRO)

Bloodborne Pathogens

Aerosol Transmissible Diseases (ATD) Exposure Control Plan

Infection Prevention and Control Team

Physician ChampionDr. Marc J. La Riviere, Infectious Disease

Infection Preventionists

Theresa Caughlin, RN, BS, CIC, DirectorLeslie Budrick, RN, CIC

Hala Nashed, M.B.B.Ch, MPH, CICReddy Munagala, Ph. D., CICLeonard De la Cruz, RN, BSN, MPH, CIC, CPHQ

Sharron Martinez, Project Manager

Office: (323) 783-8398 24 hr Pager (323) 279-0610

Coverage

Los Angeles Medical Center Medical Office Buildings (MOBs)

East Los Angeles Glendale Glendale Orange Pasadena Mental Health Center

PURPOSE OF THE INFECTION PREVENTION AND CONTROL PROGRAM

• Improve patient safety via PREVENTION, IDENTIFICATION, and CONTROL of infections & communicable diseases

• Prevent hospital acquired infections• Minimize occupational health risk to

healthcare workers

Starting with the basics……

HAND HYGIENE: Key to Preventing Infection

WHAT? A general term that applies to either handwashing, antiseptic handwash/handrub, or surgical hand antisepsis

WHEN? Before and after ALL patient interactions; before using and after removing gloves

HOW? Rub hands vigorously for 15 seconds WHICH? Soap and water or alcohol-based hand gel if hands

are not visibly soiledWHO? All healthcare providers, patients, family

EVERY PATIENT - EVERY TIME

STOP the bugs! Clean hands = patient safety

Culture of a hand before disinfection

Culture of a hand after disinfection

Photos by John M. Boyce, M.D.

WHAT CAN YOU DO?

Remember the 5 moments of hand hygiene

Commitment to 15 second hand wash or routine use of alcohol-based hand rub

Gloves: Not a substitute for Hand Hygiene

STANDARD PRECAUTIONS

Previously called Universal Precautions

Assumes blood and body fluid of ANY patient could be infectious

Includes Respiratory Hygiene/Cough Etiquette

Hand hygiene

Every patient – every time

Respiratory Hygiene/Cough Etiquette

• Component of Standard Precautions• Prevent transmission of all respiratory

infections• Targeted for all individuals with signs of

respiratory illness including cough, congestion, rhinorrhea, or increased production of respiratory secretions when entering a healthcare facility

Elements of Respiratory Hygiene/Cough Etiquette

Education of staff, patients, and visitors

Visual alerts/posted signs

Source control measures

Hand hygiene after contact with respiratory secretions

Spatial separation

STANDARD PRECAUTIONS

FOR EVERY PATIENT CONTACTEVERY TIME

IF IT’S WET AND

NOT YOURS…DO NOT TOUCH ITDO NOT LET IT TOUCH YOU WITHOUT

PPE

Personal Protective Equipment (PPE)

WHAT? A variety of barriers and respirators used to protect from contact with infectious agents

WHY? To protect susceptible patients from inadvertent colonization and subsequent development of health care associated infections (HAI)

WHEN? As part of standard precautions and transmission-based precautions depending on anticipated exposure

WHO? All healthcare providers

PPE

GLOVES

GOWNS

MASK

GOGGLES

Transmission-based Precautions

Contact Precautions

• For infections spread by direct or indirect contact with patients or patient-care environment (e.g. MRSA, VRE, ESBL)

• PPE• Hand hygiene• Educate patient and family and document

in Health Connect

Contact Plus Precautions

• Use Contact Plus Precautions for confirmed or suspected cases of C. difficile, Norovirus, unexplained/infectious diarrhea

• Use soap and water to wash hands for 15 seconds after all patient care

• Use bleach wipes for routine cleaning of patient equipment and high touch surfaces

Droplet Precautions

• For infections spread by large droplets generated by coughs, sneezes (e.g. Neisseria meningitis, pertussis, seasonal influenza, MRSA pneumonia)

• Use surgical mask (not N-95) • Patient should wear a surgical mask outside of

the patient room• Negative pressure room is not needed• Educate patient and family and document in

Health Connect

Airborne Precautions

• For infections spread by particles that remain suspended in the air (TB, measles, varicella, disseminated herpes zoster)

• Negative pressure room• N-95 mask for personnel inside negative pressure room• Patient should wear surgical mask outside of the room • Educate patient and family and document in Health

Connect

It is your responsibility…

• To know where to locate PPE in your department

• To don PPE when appropriate• To do hand hygiene as the final step after

removing and disposing PPE

Multi-drug resistant organisms (MDROs)

• Organisms that have developed resistance to antimicrobial drugs

• Growing threat to public health

Examples of MDRO

• Methicillin Resistant Staphylococcus Aureus (MRSA)

• Vancomycin Resistant Enterococcus (VRE)• Extended spectrum beta lactamase (ESBL)

i.e. Klebsiella, E. Coli• Multi-drug resistant Acinetobacter

Modes of transmission of MDROs

• Unwashed hands• Gloves worn from patient to patient• Contaminated environmental surfaces• Inadequately cleaned and disinfected

equipment• Inadequate, inappropriate or prolonged use of

antibiotic agents

Preventing Transmission of MDRO’s

• Hand hygiene is the BEST way to prevent transmission

• Use of Contact precautions: gloves and gowns; dedicated equipment and supplies

• Proper cleaning and disinfection of the room• Education of staff and patients• Prompt identification, treatment and notification • Antimicrobial stewardship

Bloodborne Pathogens (BBP)

Hepatitis B virus (HBV)

Hepatitis C virus (HCV)

Human immunodeficiency virus (HIV)

Bloodborne Pathogen

3 Modes of BBP transmission

1. Needle sticks and punctures

2. Splashes to the eyes or mucous membranes

3. Cuts or non-intact skin

BBP Exposure Control Plan

• Standard Precautions• Hep B vaccine at no cost• Hand Hygiene• Safer Sharp devices• Biohazardous labeling

In case of exposure…

• Wash area• Notify supervisor immediately• Fill out appropriate forms• See a health care professional within 1-2

hours of exposure

BBP

BBP Awareness Training in KP Learn

http://learn.kp.org/

No Food or Drinks at the Nursing Station

The OSHA Bloodborne Pathogen Standard prohibits food and drink in areas where contamination is likely.

“This regulation prohibits the consumption of food and drink in areas in which work involving exposure or potential exposure to blood or other potentially infectious material exists, or where the potential for contamination of work surfaces exists. The prohibition against eating and drinking in such work area is consistent with other OSHA standards and is good industrial

hygiene practice”

Aerosol Transmissible Diseases (ATD)

• ATD Exposure Control Plan• Exposure Prevention and Hierarchy of

Controls• TB Surveillance/Screening• Fit testing

ATD Exposure Control Plan

• Cal OSHA ATD Standard • Preventing the transmission of various ATD

including Tuberculosis• Collaboration with Employee Health Services

(EHS) and Environmental Health and Safety (EH&S) in the implementation and management of program

ATD Exposure Prevention

• Prompt identification of suspect and confirmed ATD cases

• Respiratory etiquette practices• Patients wearing surgical mask during

transport or in waiting rooms• PPE during provision of care• Use of airborne infection isolation rooms

(AIIR) for suspect or confirmed cases

TB Surveillance and Screening

• TB screening: new hire and annually• Fit testing• Exposure Control and Follow-up

Tuberculosis (TB)

• Is infectious and potentially life-threatening• Can involve any body organ or tissue, not just lungs• Contagious. Spread through coughing, sneezing,

singing, talking loudly• Reportable to Department of Health and Human

Services• Must have care plan approved by Department of

Health prior to discharge from the hospital. Contact your Case Manager/Discharge Planner

Infection Prevention

It’s everyone’s business

Thank you