Safety, Infection Control & Patient Interaction

8/14/2019 Safety, Infection Control & Patient Interaction

1/73

Safety, Infection ControlSafety, Infection Control

& Patient Interaction& Patient Interaction

Colette SchrankColette Schrank

Lecture #1Lecture #1


2/73

Learning Objectives

1.1. Define the following terms/abbreviations: OSHA,

biohazard, universal precautions, nosocomial infection,

pathologist, medical technologist, medical laboratory

technician, phlebotomist, basal state, Patients Bill ofRights.

1.2. Define OSHAs Bloodborne Pathogen Standard

as it relates to blood specimen collection.


3/73

Learning Objectives, cont.

1.4. Relate handwashing techniques to thespread of nosocomial infections.

1.5. Identify infection control equipmentrequired when performing routinevenipuncture, including gowns and gloves.

1.6. Identify appropriate waste


4/73


.7. List the steps in proper needle disposal toprevent the spread of bloodborne pathogens.

1.8. List the steps in the appropriate method ofdisinfecting a site following a blood or bodyfluid spill.

1.9. Identify the appropriate course of action a

phlebotomist should follow after accidental


5/73


1.10. Identify the following categories ofisolation: strict, contact, respiratory, AFB,drainage-secretion, enteric.

1.11. Identify the color of sign that may appearon a patients door for each isolation category

listed above.

1.12. Identify the appropriate protective


6/73


1.13. Relate the Patients Bill of Rights to thefollowing situations: patient refusal,confidentiality, patient inquiry regarding test

results. 1.14. Approach the patient in a professional

manner, consistent with the Patients Bill of

Rights. 1.15. Identify the patient, following the two-


7/73


1.16. Discuss the importance of proper

patient identification (and specimen

labeling) for quality laboratory results.

1.17. Discuss at least two possible legal

ramifications of misidentifying a patientprior to collecting a specimen for


8/73


9/73

Professionalism

Meticulous adherenceMeticulous adherence to:

undeviating courtesy, honesty, and

responsibility in one's dealings withpatients (clients)patients (clients) and colleaguescolleagues, plus

A level of excellencelevel of excellence that exceeds the

standard of care and legalrequirements.


10/73


11/73

Safety

Mandated by OSHA (1970) Occupational Safety and Health Administration

Implementation of policies and procedures totoensure safe work practicesensure safe work practices for all employeesall employees

Employers must eliminate or minimizeeliminate or minimize

occupational riskoccupational risk Safety policies may vary from place to place


12/73

OSHA Laws re: lab safety

Hazardous CommunicationHazardous Communication 29 CFR 1910.1200

Bloodborne Pathogen StandardBloodborne Pathogen Standard 29 CFR 1910.1030

Needlestick Safety and Prevention ActNeedlestick Safety and Prevention Act 29 CFR 1910.1030


13/73

Hazard Communication StandardHazard Communication Standard

November, 1983

Evaluate hazards of all chemicals used

in workplace Employee training

Share information about chemicals is

with employees


14/73

Haz Com Outcomes

Label all chemicalsLabel all chemicals

Use NFPA labelUse NFPA label

Identify hazard (0-4)Identify hazard (0-4)..flammabilit

combustibilit , instabilithealth

..radiation, water reactivit , other


15/73


16/73


17/73

Exposure Control Plan

Implementation and complianceImplementation and compliance PPEPPE

EngineeringEngineering controls

Work practiceWork practice controls Cleaning and disinfectingCleaning and disinfecting WasteWaste disposal HBV vaccinevaccine Post exposurePost exposure follow-up; records Training and educationTraining and education


18/73

Lab Safety Practices

Wear PPE

Dispose of sharps Dispose of biohazardous materials

Dispose of non-biohazardous waste Wash hands


19/73

Waste Removal

Biohazardous sharpsBiohazardous sharps

lancets, needles, butterfly needles,

syringes, glass slides anything that can tear plastic

Biohazardous materialBiohazardous material

Contaminated with blood/body fluid Non-biohazardous wasteNon-biohazardous waste


20/73

Personal Protective Equipment

Protection fromProtection from parenteral, mucous

membrane and non-intact skin contact

exposure to BBPexposure to BBP Examples:


21/73

Needlestick Safety andNeedlestick Safety and

20012001

Safer needle devicesSafer needle devices

Employees to participate in choosingEmployees to participate in choosingequipmentequipment


22/73

Accidental Exposure follow-up

Flush siteFlush site (mucus membrane 10 min.)

Decontaminate areaDecontaminate area (iodine for 30sec.)

Report incidentReport incident


23/73

Be directed to employee healthdirected to employee health (medical

treatment, evaluation, and counseling)

Employee tested for HIV/HBVEmployee tested for HIV/HBV

Source tested for HIV, HBV, HCVSource tested for HIV, HBV, HCV

If source is positive for HIV or HBV,evaluation takes place at following intervals: 6

weeks, 12 weeks, 6 months

ZT administration & HBIG (there isno HCV prophylaxis)

I source is ositi e or HCV base ine


24/73

Universal Precautions

Mandated by OSHAOSHA for HCW

Assumes that blood and certain bodyblood and certain body

fluids of all patients are contaminatedfluids of all patients are contaminated HBV, HCV, HIVHBV, HCV, HIV infections of

greatest concern to HCW

Disease transmissionDisease transmission through contact

with blood and certain body fluids


25/73


26/73


27/73

Standard Precautions

Apply to bloodblood and all body fluidsall body fluids,

except sweatexcept sweat

Apply to non-intact skinnon-intact skin Apply to mucous membranesmucous membranes


28/73


29/73


30/73

Transmission-based: Airborne


31/73

Transmission-based: Droplet


32/73

Transmission-based: Contact


33/73


34/73

What constitutes Infection

Invasion of a bodyInvasion of a body by a microorganism,usually a pathogen, resulting in injury ordisease

Micro-organisms include: bacteria, viruses,bacteria, viruses,fungi, protozoafungi, protozoa

Could be caused by non-pathogenCould be caused by non-pathogen if

systemic conditions are favorable to infection Could be localCould be local: restricted to a small area of

the body


35/73

Infection

Source:Source: pathogen or infectious microbe Mode of transmission:Mode of transmission: a way for the microbe

to get from one place to another

Susceptible hostSusceptible host Infants

Elderly

Immunocompromised

Overmedicated


36/73

Source

Escherichia coli, E. coli


37/73

Mode of transmission

Fecal/oral (unwashed fruit)


38/73

Susceptible Host

Most at risk: infants, children and

elderly

Immunocompromised patients

Surgical pts

Debilitated pts

Overmedicated patients


39/73


40/73


41/73

Nosocomial Infection

Where acquired?Where acquired? in a healthcare facility How Many?How Many? infecting ~10% of hospital

patients DeathsDeaths - 20,000 patients/year Sites:Sites: Urinary tract, surgical, respiratory Etiologic agents:Etiologic agents:

Enterococcus E. coli Pseudomonassp.


42/73

Staphylococcus aureus

Normal skin flora

Can cause serious infection

Surgical wounds, respiratory infections


43/73

Methicillin Resistant Staphylococcus aureus:

super staphsuper staph

commonly on skin

pathogenic when it becomes systemic

more virulent strains in places of poor

hygiene

Tx: vancomycin, teicoplanin and Rifampin


44/73

Vancomycin-intermediate Staphylococcus aureus:

VISA

UncommonUncommon but emerging nosocomial

problem

Treatment varies; may be susceptible togentamicin, tetracycline, and

quinupristin-dalfopristin


45/73

Vancomycin resistant staphylococcus aureus:

VRSA Specific type of antimicrobial staph

Not successfully treated with

vancomycin VISA and VRSA uncommon rare atuncommon rare at

this timethis time

Best prevention: handwashing Tx: trimethoprim/sulphmethoxazole,

minoc cline linezolid uinu ristin-


46/73

Clostridium difficile: C diff

gram positive anaerobic bacteria

major cause if dysenterymajor cause if dysentery

one of the most common world-widenosocomial infections

susceptible: extended hospitalizedsusceptible: extended hospitalizedpatients, patients on antibiotic therapypatients, patients on antibiotic therapyor immunocompromisedor immunocompromised

treatment is vancomycin or metronidazole


47/73


48/73


49/73

Disinfectants

used to remove or killremove or kill pathogenicmicroorganisms- should be used on surfaces andsurfaces and

instruments, inanimate objectsinstruments, inanimate objects- examples:bleach (10%)bleach (10%)

formaldehyde (lab)formaldehyde (lab)glutaraldehyde (equipment)glutaraldehyde (equipment)ethylene oxide (sterilant)ethylene oxide (sterilant)henolshenols


50/73

Fomites


51/73

Infection Control

a policy to separate the patient fromthe mainstream

procedures designed to protectpatients, or healthcare workers, fromother patients that have a transmissibledisease

types of isolation: 3 basic typesrecommended by the CDC


52/73

Types of isolation

Category specific

Disease specific

Standard precautions and Transmission-

based precautions


53/73

Category specific

Drainage/ secretion-skin infections, openwounds, burn victims, sometimes followingsurgery, * requires: masks, gowns, if warranted

Enteric-intestinal infections that could betransmitted fecal/oral, *requires: gloves, masksand gowns if warranted

Blood and Body Fluid- patients with diseasethat can be transmitted through contact withpatients blood, body fluid; * requires: gloves,


54/73

Category specific

Strict ( AKA Complete)- highly contagiousdisease, requires: gowns, gloves, mask

Contact isolation-spread by direct patient

contact, * requires: gloves, gowns if needed, i.e.Flu, antibiotic resistant bacteria

Respiratory-spread via droplet nuclei, throughthe air, * requires: masks, if come within closecontact, i.e. H. influenza

AFB- active TB, * requires: masks or particulate


55/73

Disease specific

a specific isolation procedure based

upon the mode of transmission for a

common disease. Each certain diseasemay correspond to a specific precaution

needed, i.e. Chickenpox.


56/73

Modes of transmission

Contact transmission

Airborne transmission (less than 5 um)

Droplet transmission (larger than 5 um) Vector transmission (mosquito, tick,

animal)

Vehicle transmission (food, water)


57/73

Standard precautions and

airborne precautions reduce spread fromairborne droplet transmission of agents, i.e.rubeola (measles), varicella (chickenpox),Mycobacterium tuberculosis(TB).

droplet precautions reduce transmission ofdiseases such as pertussis (Bordetellapertussis), meningitis, pneumonia and Germanmeasles (rubella)

contact precautions reduce transmission ofdiseases as respiratory syncytial virus (RSV),herpes simplex, wound infections and othersthrough direct and indirect contact


58/73

Additional types of isolation

Reverse-(also called protective) used on patients that arehighly susceptible to disease/ infection, the protection isgiven to the patient, * requires: mask, i.e. this could be abone marrow recipient that was completely irradiatedprior to transplant

Radiation-allow exposure to patients in short increments,pregnant employees should not enter i.e. radiation implantpatients

Creutzfeld/ Jacob Disease-(human equivalent to Mad Cowdisease)- a genetic disorder that causes prion proteins inthe brain to mutate * re uires: loves i.e. isolation is


59/73

Other precautions

Doublebagging

putting contaminated material(s)

into a bag and sealing it;

then, placing the sealed bag (before leaving

the isolation room) into another bag after

leaving the room;

must be labeled BIOHAZARD).


60/73

l h d


61/73

Isolation techniques and

Wash hands

Wear gowns or lab coats

Wear gloves Wear mask, eye protection, face shield

Patient care equipment (PCE)

Environmental control- routine cleaning

i


62/73

During Clinical Experience

No eating, drinking, smoking, gum chewing

Use specific refrigerators

Dress conservatively, no clumsy jewelry,and dont apply make-up

Always wear lab coat, keep hair groomed

and tied back, keep fingernails short Always use PPE, close-toed, non-skid, non-


63/73

Safety Videos

Fire Extinguisher and Lab Safety


64/73

Patient Approach and Contact

Enter patients room-

knock lightly, introduce yourself and explain

purpose

Watch for signs-

look for special instruction posted on door

(isolation), above the bed (right arm drawonly), DNR (do not resuscitate)


65/73

Patient IdentificationPatient Identification

Identify yourself-

state your name and who you are, Hi Im

Jennifer, Im from the lab and Im here to

draw your blood; and your name is?


66/73

Special situations

Patient is sleeping:

Gently awaken them, explaining purpose,

never draw while still asleep.

Patient is unconscious:

Ask for help and explain purpose, patientmay still move.


67/73

Special situations

Patient is with doctor or clergy:

plan to come back later since time with

these individuals is limited unless a timed

test or stat then ask permission to obtain

sample.


68/73

Special situations

Patient not in room: Attempt to find the patient, especially timed

tests or stat must be searched out if possible

or document. Patient refusal:

even though the patient has the right to

refuse, gentle persuasion may possibly achievecooperation; explain importance of the laborder, ask a nurse or doctor explain; if unable


69/73


70/73

Preparation for testing

Bedside manner- gain patient trust and

respect

Handling difficult patient- remain calmand professional, treat patient w/ care

and respect

Explain procedure- give briefexplanation. If language barrier exist,


71/73

Handling inquiries- refer patient to

doctor.

Refusal, see above, try to convince

patient but never force them.

Verify restrictions, diet, movement,requirements for med (i.e. Digoxin-6hrs

post dose).

Proceed with collection.


72/73


73/73

Safety, Infection Control & Patient Interaction

Documents

Transcript of Safety, Infection Control & Patient Interaction