Infection Prevention & Control
Student Orientation – 2010
Learning Objectives
Upon completion of this learning module, you should:
• recognize your role in preventing infection in the health care setting
• identify three (3) key strategies in preventing infection
• understand the types of transmission-based precautions (isolation)
used at Scott & White and general situations to which they apply
• know available resources at Scott & White to provide information
and guidance in preventing infection
• identify how to protect yourself from risks associated with common
bloodborne pathogens encountered in the health care setting
The Foundation of Infection
Prevention & Control is Hand Hygiene
• It is estimated that more than 2 million healthcare-associated infections occur annually,
leading to roughly 90,000 deaths each year
• At least one-third to one-half of healthcare-associated infections are preventable.
• Hand hygiene remains the most important method to prevent the spread of infection (although
estimates of healthcare personnel compliance rates in the United States remain around 40%)
Hand Hygiene – When ?
 Before & After each patient
encounter
 Before donning sterile gloves
 Before inserting invasive
devices
 After removing gloves
 After contact with objects and
equipment in the patient’s
environment
Hand Hygiene – How?
Alcohol Hand Sanitizer
 Apply to palm of one hand, rub hands
together covering all surfaces until dry
 Amount is based on manufacturer &
product
Hand-washing
 Wet hands with water, apply soap, rub
hands together for at least 15 seconds
 Wash all surfaces of hands
 Rinse and dry with disposable towel
 Use towel to turn off faucet
Soap & Water vs Alcohol Hand Sanitizer
Why is alcohol hand gel considered the better choice in most situations?
bacteria cultured from healthcare
employee’s hands after using alcohol
hand gel. . .
bacteria cultured from healthcare
employee’s hands after using soap &
water. . .
CLICK HERE for additional Hand Hygiene
Information from the Centers for Disease
Control & Prevention (CDC)
What are the 10 most common causes of infection?
Your fingers!
Clean your hands
before patient contact
(i.e. entering
the patient’s room), after
removing gloves &
after contact with patients
or contaminated materials
When must I use soap and water?
If alcohol hand gel is best, are there times I still should
use soap and water?
YES. . .
• whenever hands are visibly
soiled (including with blood,
body fluids or other
potentially infectious
material)
• before & after preparing food
• after using the restroom
• after contact with patients or
equipment contaminated with
a spore-forming organism
like Clostridium difficile (C
diff) or anthrax
More On Hand Hygiene
No artificial nails, extenders or tips they harbor bacteria & fungi
Natural nail length should
be ¼ inch or shorter
Wear only 1 ring per hand,
avoiding excessive grooves or
facets
Standard Precautions
• The way an organism is transmitted will determine the type of
precautions to be used
• ALWAYS use standard precautions on all patients, all the time
• protect yourself first, and in doing so, protect others
• use standard precautions for all patients, regardless of age, diagnosis
or overall health status
• assume everyone is potentially infectious – protect yourself from
human immunodeficiency virus (HIV), hepatitis B, hepatitis C and
other bloodborne diseases
Use personal protective equipment (PPE) as a
barrier to keep blood and body fluids off your
clothes, skin, eyes, nose and mouth. . .
Always clean your hands after removing PPE and
whenever you suspect contamination. . .
Standard Precautions protect you
from both known and unknown sources of infection
Standard Precautions
• apply to all blood, body fluids & other potentially infectious material
[OPIM] (including excretions, secretions, mucous membranes and nonintact skin) as well as contaminated equipment, linen, trash and supplies
• include the proper use of personal protective equipment (PPE) – gloves,
gown, mask, eye protection – appropriate to the specific task
• include selection of PPE based on the degree of anticipated
exposure
Along with
sharps injuries,
mucocutaneous
exposures are
of primary
significance
More on PPE. . .
Use GOOD JUDGMENT! Think about what you need to protect yourself before you
start any procedure. . .
 GLOVES – wear gloves if there is any chance you will touch blood or body fluids and
ALWAYS perform hand hygiene after you remove gloves
 FLUID RESISTANT GOWN – use gowns to prevent blood or body fluids from coming
into contact with clothing or skin
 PROTECTIVE EYEWEAR - use a face shield or goggles to protect your eyes from
splashing or spraying of blood or body fluids
 MASKS - use masks to protect your nose and mouth when splashing, spraying or
spattering of blood or body fluids might occur
 ONE-WAY VALVE RESUSCITATION MASK - use a resuscitation mask for rescue
breathing instead of direct mouth to mouth contact
Protecting yourself with appropriate PPE is essential – DO NOT fall into the trap of
thinking you do not have time to protect yourself!
Standard Precautions – Key Points
• Clean or wash hands before & after examining
patients & following any contact with blood,
body fluids or contaminated items
• Wear gloves for contact with blood, body
fluids, mucous membranes and non-intact skin
• Wear a mask, eye protection & gown if
splashes or sprays are possible or anticipated
Key Strategies in Preventing
Bloodborne Pathogen Exposure & the Spread of Infection
• avoid direct
contact with
contaminated
objects &
surfaces
• always wear
appropriate
personal
protective
equipment
(PPE)
• remove PPE
properly and
dispose in
appropriate
containers at
the point of
use
Examples of Engineering Controls &
Work Practice Controls
Engineering Controls
• devices or equipment made in a way to reduce or eliminate blood and body fluid exposure
• examples include needleless IV systems, puncture-proof sharps disposal containers, safety
scalpels and safety syringes with needles
Work Practice Controls
• never consume food or drinks, or apply cosmetics or lip balm, in patient care areas
• learn to use engineered safety devices correctly & always be aware of sharps in your immediate
environment
• never recap contaminated needles & always correctly activate or engage safety mechanisms
before further handling and disposal
• dispose of needles safely, promptly and only in approved sharps containers
• dispose of other sharps, including broken glass, only in approved sharps containers
• know policies, procedures and protocols to ensure the safety of staff, patients and visitors
Bloodborne Pathogens &
Occupational Exposure
• Splashes or sprays to the eyes, nose or mouth
• Through non-intact skin (cuts, abrasions, or rashes)
• Punctures or cuts from contaminated needles or other sharps
If you are exposed to blood, body fluids or OPIM, immediately
remove infectious material, wash the site of exposure and
notify your instructor and the unit supervisor
Also complete an Adverse Event Report to assist in our
ongoing evaluation of workplace safety
Regulated Medical Waste
• Proper disposal of regulated (biohazardous) waste must be observed at all
times
• place contaminated sharps (needles, scalpels, open ampules, broken
glass, etc) in designated, puncture-resistant containers at the point of use
• place items contaminated with blood or other potentially infectious materials
(OPIM) in designated red bins or tubs that are not accessible to the public
• all containers for disposal of regulated medical waste must be color-coded
(red) or contain the universal biohazard symbol (
)
• Cleaning blood & body fluid spills is done using a hospital approved germicide
• immediately contain the spill & block area from traffic
• clean small spills using an approved ‘spill kit’ or absorptive material and
disinfect the area using a hospital-approved germicidal agent
• never pick up broken glass with your hands
• notify Environmental Services for cleaning larger spills
OSHA’s Definition of
Regulated Waste
•
•
•
•
•
Liquid or semi-liquid blood or OPIM
Items contaminated with blood or OPIM and
which could release these substances in a
liquid or semi-liquid state if compressed
Items that are caked with dried blood or OPIM
and are capable of releasing these materials
during handling
Contaminated sharps
Pathological and microbiological wastes
containing blood or OPIM
What goes in a Red Bag ?
•
•
•
•
•
Blood & blood products
Anything caked, soaked or dripping with blood or OPIM
Tissue from biopsy, surgery or autopsy
Cultures and infectious agents, including discarded vaccines
Suction canisters (without an added disinfecting solidifier
agent), Hemovac and Pleurovac drainage devices
• Operating room waste saturated with body fluids (as defined by
OSHA)
• Puncture resistant containers with sharps, needles, scalpels
(including those attached to syringes & unused sharps)
• IV fluid containers & tubing
• Urinary catheter bags with no
visible blood
• Non bloody gloves
• Product packaging
• Waste soaked with urine, feces or
vomitus
• Regular trash (e.g. a pizza box,
paper towels)
Some Additional Points. . .
• Food and drink may not be kept in refrigerators, freezers, shelves,
cabinets or on countertops or bench tops where blood or OPIM are
actually or potentially present
• All procedures involving blood or OPIM must be performed in a
manner to minimize splashing, spraying, spattering and generation of
droplets of these substances
• Mouth pipetting/suctioning of blood or OPIM is strictly prohibited
• Talk with your instructor and refer to the Bloodborne Pathogen
Exposure Control Plan or contact Infection Prevention & Control or
Staff (Employee) Health for additional information
A patient room can be heavily contaminated!
~ Contaminated surfaces increase the chance to pick up organisms
and carry them to the next patient ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment.
Hayden M, ICAAC, 2001, Chicago, IL.
Other Sources of
Contamination. . .
. . . Staff uniforms,
hands & equipment
can also be a key
source of infectious
organisms
VRE – all three sites
contaminated 24% of the
time [Zachary, ICHE 2001;22:560-564]
31% of equipment surfaces
sampled were ocntaminated
37% of
uniforms or protective
gowns sampled were
contaminated
63% of workers’
gloves sampled were
contaminated
69% of white coats became contaminated with VRE or MRSA when gowns
were not worn after examining colonized/infected patients
(Boyce. 1998 SHEA abstract S74:52)
VRE or MRSA was transferred to hands after touching contaminated white
coats 27% of the time
(Boyce. 1998 SHEA abstract S74:52)
Transmission-Based (Isolation) Precautions
• CONTACT Precautions
• MRSA
• Diarrhea – enteric pathogens
• Rotavirus
•
•
•
•
Hepatitis A
RSV
Chickenpox (along with airborne isolation)
Viral Meningitis (only if stool incontinent)
Transmission-Based
Precautions are always
in addition to Standard
Precautions
Transmission-Based (Isolation) Precautions
MODIFIED CONTACT PRECAUTIONS
Used with VRE Infections or colonization
(Vancomycin-resistant Enterococcus species)
• Commonly found in the GI tract
• Easily transmitted by HCP on hands and clothing
• MUST wear gown and gloves!
Transmission-Based
Precautions are always
in addition to Standard
Precautions
Transmission-Based (Isolation) Precautions
EXTENDED CONTACT PRECAUTIONS
Used with C-DIFF Infectious Diarrhea
(Clostridium difficile)
• Spore forming bacteria
• ONLY washed off with soap and water!
• Alcohol hand sanitizers are NOT effective against
C diff
Transmission-Based
Precautions are always
in addition to Standard
Precautions
Transmission-Based (Isolation) Precautions
• DROPLET PRECAUTIONS
• Bacterial meningitis
• Neisseria meningitidis (meningococcal)
• Haemophilus influenzae
• Influenza
• Pertussis
• Rubella (German measles)
Transmission-Based
Precautions are always
in addition to Standard
Precautions
Transmission-Based (Isolation) Precautions
AIRBORNE PRECAUTIONS
• Tuberculosis – Active Disease or Rule Out
Transmission-Based
• Measles
Precautions are always
• Chicken Pox**
in addition to Standard
Precautions
• Varicella Zoster (Shingles)**
• with disseminated disease
• in an immune-compromised patient
**also, Contact Precautions if there are any lesions that have
not ruptured, dried and crusted over
AIRBORNE PRECAUTIONS
STOP
Nutrition & Food
Service Employees: May NOT
N95 or HEPA
Negative Air Pressure
Enter
HAND HYGIENE
HAND HYGIENE
Respirator Mask
Before Entering
After Exiting
REQUIRED
REQUIRED
Room
Room
To Enter Room
Keep Door Closed
Infection Prevention & Control –
Is Everyone’s Responsibility
Please contact us if you have any questions while at Scott & White . . .
The Infection Prevention & Control team is typically on-site at the Memorial Hospital Campus in Temple and UMC
Campus in Round Rock Monday through Friday, 8:00 am - 4:30 pm,
and can be reached by pager 24 hours a day, 7 days a week for consultation & assistance.
Staff (Employee) Health is open 7:00 am – 5:00pm, Monday through Friday and after-hours access to post-exposure
evaluation is available 24 hours a day, 7 days a week through the main hospital Nursing Supervisor (‘5-0’).
Policies are available on InSite (S&W Intranet)
Glen Jett, BSN, RN,BC, NE-BC
ext 4-6455
pager (254) 762-1188
System Director, Infection Prevention & Control and Staff (Employee) Health Programs
Infection Prevention & Control Staff
Karen Yates, RN, BSN, Infection Control Practitioner
ext 4-3241
pager (254) 762-0926
Angela Williams, RN, BSN, Infection Control Practitioner ext 4-4917
pager (254) 762-0408
Teresa Westbrook, RN, Infection Control Practitioner
ext 4-4519
pager (254) 762-1359
Callie Wilde, RN, BSN, Infection Control Practitioner
ext 4-8160
pager (254) 762-0082
Martha Land, RN, MPH, Infection Control Practitioner
ext 28-0405
pager (254) 762-0925
24 Hour Infection Prevention & Control ‘Task Pager’ (254) 762-0348
Staff (Employee) Health Staff
Rita Buro, RN, MSN, Employee Health Nurse
Kathleen Conley, RN, BSN, Employee Health Nurse
Martha Land, RN, MPH (Round Rock Campus)
ext 4-5520
ext 4-2935
ext 28-0405