For infections to be transmitted from one place or person to another, the Chain of Infection must exist. Infection Control exists to prevent hospital acquired or nosocomial infections by breaking this chain. The causative agent must be capable of causing disease. There are many such organisms everywhere but especially in hospitals. It must have a place to live or reservoir. It must have a way of getting out of the reservoir or a portal of exit. It must have a mode of transmission or a way of moving from where it is to another person or place. There must be a way for it to get into a person. The person must be susceptible to the organism (i.e.- immunocompromised, surgical patient, transplant or cancer patient or neonate).
Standard Precautions: Standard Precautions are the cornerstone of Infection Control practice. It combines two systems developed by the CDC, Body Substance Isolation and Universal Precautions. Standard Precautions is based on the premise that everyone we encounter may have an infection/ communicable disease. Therefore, if we treat everyone the same, we will protect not only ourselves, but also our patients. Standard Precautions include, but are not limited to the following:
3 The most important thing - washing our hands. This is a simple yet powerful tool we have at our disposal to stop the spread of infectious disease whether at work or at home, yet we do not use it often enough. So, when in doubt- wash your hands. Hand washing: Before- eating putting on gloves changing your contacts leaving work at the end of your shift After eating taking off your gloves using the restroom arriving at work at the beginning of your shift covering your mouth to sneeze or cough
Implementation of CDC Hand Hygiene Guidelines has been added as the seventh JCAHO National Patient Safety Goal for 2004. The guidelines have been implemented and include the use of an alcohol based hand rub instead of soap and water in certain situations. The hand rubs can not be used if there is gross contamination on your hands with blood, body fluids or potentially infectious material.
4 . Use the appropriate Personal Protective Equipment (PPE): Gloves When you come into contact with non-intact skin / or open wounds When you come into contact with blood, body fluids or infectious material When you are cleaning in the hospital environment or dealing with contaminated supplies or equipment (includes dishes, surgical instruments and etc) Gowns When you come into contact with non-intact skin / or open wounds When you come into contact with blood or body fluids When a patient is incontinent of stool or urine with resulting contamination of the environment When there is risk of being splashed with blood, body fluids or infectious material Eye Protection When there is risk of being splashed with blood, body fluids or infectious material Masks When there is risk of being splashed with blood, body fluids or infectious material Patients are coughing or sneezing and you will be within 3 feet of them.
5 . Use safety engineered sharps whenever possible. . Correctly dispose of sharps in appropriately labeled, red sharps containers. . Correctly dispose of biohazardous waste in the “red bag” trash. . Appropriate patient placement (placing patients with potentially communicable diseases in private rooms). . Appropriate staff assignments (separation of surgical and medical patients etc) . Do not eat,drink, change contacts etc in work areas. These essential components of Standard Precautions provide the basis for a safe, clean environment for our patients, visitors and staff. They are used 24 hours/day, seven days/week.
6 Transmission Based Precautions: In addition to Standard Precautions, Transmission-based precautions are used in certain circumstances. They are required for communicable diseases that are transmitted via airborne, droplet and contact modes. Standard Precautions are always used, these three transmission based precautions are simply added to the Standard Precautions VISITORS MUST FOLLOW THE SAME PROCEDURES AS STAFF.
7 Airborne Precautions: Indications: Tuberculosis (TB), Chickenpox, measles, disseminated Herpes Zoster (shingles) in an immunocompromised patient PPE: N95 Respirator mask for staff. Duckbill mask for visitors or for patient if the patient must be transported out of their room for tests. Special considerations: Private room with negative pressure required. All doors and windows must be kept closed to maintain negative pressure. Call engineering immediately when airborne precautions are implemented so they can monitor the pressures per policy. Patient should not leave room unless absolutely necessary. As noted above, patient should wear duckbill mask and staff wears N95 respirator.
8 Droplet Precautions: Indications: include but are not limited to Meningitis, Mumps, Influenza, and Pertussis PPE: Simple surgical mask for staff, visitors and patient if the patient must be transported out of their room for tests. Special Considerations: Private room preferred, but may cohort patients with like illness if necessary. Patient should not leave room unless necessary. As noted above, patient should wear simple surgical mask if transported out of the room.
9 Contact Precautions: Indications: include but are not limited to Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococcus (VRE), Lice, Scabies, C. difficile, and chickenpox(airborne also required for chickenpox). PPE: gowns, gloves, and masks if indicated based on the organism culture site. Special Considerations: Private room preferred, but may cohort patients with like illness if necessary. MRSA/ VRE patients should not leave room, however may ambulate in the hall with PT if ordered by physician as part of the treatment regimen. Patient should wash hands well immediately before leaving room, wear a cover gown and immediately return to the room after ambulating. Contact with the environment outside the room should be minimized (i.e. touching the rails, walls, etc).
10 OSHA Regulations: Bloodborne Pathogens and Tuberculosis Exposure Control Plans SPUH and ZLUH meet two very important staff safety needs through compliance with OSHA requirements for bloodborne pathogens and tuberculosis. Education in both areas is provided to employees on hire, and on an annual basis thereafter. A general review for those areas that have not changed in the past year is provided in a self-study format. A “live” inservice is provided for those areas of the requirements that have changed in the past year. The inservice education format provides employees the opportunity to immediately clarify any questions they may have regarding the new regulations.
11 Bloodborne Pathogens Exposure Control Plan: St. Paul and Zale Lipshy University Hospitals have a Bloodborne Pathogens Exposure Control Plan to decrease employee risk of exposure to Hepatitis B, Hepatitis C and HIV as well as other bloodborne pathogens. Essential components include but are not limited to: PPE: Use of PPE provides barrier protection when worn during procedures that place employees at risk for exposure to blood, body fluids or infectious waste. Before completing a procedure, staff assess their risk and wear the appropriate PPE to protect them. PPE may include gowns, gloves, masks, eye protection and shoe covers. Waste Stream Management: Risk of exposure is decreased through appropriate disposal of trash and other waste stream management activities: Red Bag trash : Any trash contaminated or possibly contaminated by blood, body fluids, or infectious waste Linen : yellow bag Sharps : sharp containers Clear plastic bag : anything else not listed above Hepatitis B Vaccination Program: All employees at risk for exposure to bloodborne pathogens are offered and encouraged to receive the series of three Hepatitis B vaccinations. Safety Engineered Sharp Devices Safety Engineered Sharp Devices are provided by SPUH/ZLUH with the expectation that staff will use them unless patient outcome would be adversely affected. Staff are actively involved in product evaluation and selection through annual product evaluations and ongoing search for new products with final approval through the Value Analysis Team. Monitoring of Employee Sharps Injuries Employee reporting enhanced to include brand/type of sharp involved in injuries for trending purposes. Those products with increased injuries will be identified as priorities for replacement products.
Chain of Infection Causative Agent Reservoir Portal of exit Mode of Transmission Mode of entry Susceptible Host