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 Champion
Dr. Marc J. La Riviere, Infectious Disease
Infection Preventionists
Theresa Caughlin, RN, BS, CIC, Director
Leslie Budrick, RN, CIC
Hala Nashed, M.B.B.Ch, MPH, CIC
Reddy Munagala, Ph. D., CIC
Leonard 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)
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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 soiled
WHO? 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 CONTACT
EVERY TIME
IF IT’S WET
AND
NOT YOURS…DO NOT TOUCH IT
DO 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
MASK
GOWNS
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
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•
•
•
•
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
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Standard Precautions
Hep B vaccine at no cost
Hand Hygiene
Safer Sharp devices
Biohazardous labeling
In case of exposure…
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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