to inform some sort of information about infection prevention

1. Infection control for house
officers at the Omaha VA
Medical Center
Infection Control Practitioner
Pager 13-485 ext. 3319
MRSA Prevention Coordinator
Pager 13-323 ext. 4226
Hospital Epidemiologist
Ext. 5606

2. Omaha VA uses
 Standard and Transmission-Based
Precautions
 Based on current guideline of the
Centers for Disease Control and
Prevention (CDC)

3. Standard Precautions
Protective barriers for ALL potential
contact with:
 All body fluids
 Blood
 All secretions
 All excretions (except sweat)
 Mucus membranes
 Non intact skin

4. Follow CDC 2002 hand
hygiene guideline
 No artificial nails, no chipped nail polish
 Natural nail no longer than 0.25 inch
 Wash hands with antimicrobial soap and
water if visibly soiled or after caring for
Clostridium difficile patients
 Hand hygiene before and after patient
contact, including after removal of
gloves. Generally use alcohol handrub.

5. Personal Protective Equipment
(PPE)
 What is available for your use?
 Surgical masks
 N-95 respirators (must be fit tested)
 Gloves
 Gowns
 Eye protection

6. Alcohol
dispensers
often near
sinks & in
every
patient
room

7. Purell
alcohol
handrub

8. Transmission based Precautions
 Contact
 Enhanced contact
 Airborne
 Droplet

9. Contact precautions
 Examples of Diseases
in this category:
 Drug-resistant
organisms (eg MRSA,
VRE)
 SARS (also needs
airborne precautions,
eye protection)

10. Contact precautions includes
 Gown
 Gloves
 Hand hygiene
 Dedicated equipment in the room
(including stethoscope, blood pressure
cuff)
 Terminally clean room on discharge of
patient from the room

11. Isolation
Cart

12. Find a
gown in
an
isolation
cart

13. Remove
gown from
cart

14. Put on
the
gown,
fasten-
ing it
in back

15. Remove it after
seeing the
patient, turning
it inside-out

16. Place
the used
gown in
the trash
can

17. Enhanced contact precautions
 Examples of
diseases in this
category:
 Clostridium
difficile
 Norovirus

18. Actions: Enhanced contact
precautions
 Disinfect hands with antimicrobial
soap and water (rather than alcohol
gel)
 Housekeeping staff use special
cleaning methods involving bleach

19. Airborne precautions
 Fit-tested N95
mask
 Room with
negative air flow
 Door closed

20. Airborne Precautions
 Examples of Diseases in this category:
 Tuberculosis
 Varicella
 Measles
 SARS (also needs contact precautions and eye
protection)

21. Common questions on
airborne precautions: PPD
 Q. “My patient has a positive tuberculin
skin test (PPD test). Is this an
indication for airborne precautions?”
 A. No, only patients suspected of
having active tuberculosis or proven to
have active tuberculosis need airborne
precautions.

22. Common questions on
airborne precautions: AFB
 Q. “My patient has a laboratory test
showing acid-fast bacilli (AFB) in the
sputum. Does this mean the patient has
tuberculosis?”
 A. Not always. So-called atypical
mycobacteria that are not causing
tuberculosis can result in a lab report of
AFB in the sputum and isolation is not
indicated.

23. Rooms for airborne
precautions
 8 rooms available (includes 2 each in
Emergency, ICU, 6E, and 7E)
 Specially equipped to maintain negative
flow
 Reduces risk of pathogens drifting in air
currents from infected patient to other
patient rooms

24. Check alarm
outside
negative air
flow room
 Alarm should be
off with the door
closed
 If not, contact
nurse

25. Droplet precautions
 Regular mask
 Door may be
open or closed
for known or
suspected

26. Droplet Precautions
 Examples of disease in this category:
 Influenza
 Pertussis
 Neisseria meningitidis

27. Employee Health Issues
 Blood and body fluid exposure
 Immediately notify supervisor
 Immediately call Occupational Health (5825)
during day hours or go to Urgent Care area after
hours
 Do so immediately since post exposure
prophylaxis for HIV should be started, ideally
within an hour
 FREE influenza vaccine provided for all
 Tuberculin skin test annually at host
institution: CUMC or UNMC
 Hepatitis B vaccine at host institution

28. All blood and body fluid
exposures are important
 Sharps Injuries
 Needle stick
 Scalpel cut
 Pipette break
 Any injury that breaks the skin in the
presence of body fluids
 Mucous membrane exposure

29. If a Blood Exposure Occurs:
 Clean the exposed area with soap and water.
For exposed mucous membranes, flush with
water. DO NOT use bleach or surface
disinfectants.
 Report incident to supervisor immediately.
 Report to Employee Health or Urgent Care
area as previously described.
 Fill out an Incident Report via the electronic
reporting system - ASISTS

30. Follow-up of blood or body
fluid exposure
 Follow-up after initial visit to Urgent
Care
 Occupational health nurse practitioner
 Call 3209 to schedule visit

31. Safety needles can prevent
some blood exposures
Be sure to use these devices
correctly.

32. Sharps disposal
containers in each
room

33. Needle/Sharps Disposal
 DO activate safety device
 DO locate the disposal container closest
to your work area
 DO look to be sure that the opening of
the box is clear of sharps
 Do NOT recap by hand
 Do NOT bend, clip or break

34. Check to be sure disposal box is
not overfilled

35. Aims of OSHA bloodborne
pathogens standard
 To protect employees from
 Occupational exposure to
blood or other potentially
infectious materials
 Transmission of bloodborne
diseases

36. Bloodborne diseases of
concern
 Human immunodeficiency virus
(HIV)
 Hepatitis B (HBV)
 Hepatitis C (HCV)

37. Transmission in the workplace
occurs by:
 Parenteral Exposure
 Needle stick, blood transmission
 Mucous Membrane Exposure
 Mouth, eyes
 In the community, they may be transmitted
through IV drug use and from mother to
baby.

38. Human Immunodeficiency
Virus (HIV)
 Virus that causes AIDS
 Attacks the immune system
 May be no obvious signs of infection
 Can transmit virus before illness known

39. Hepatitis B (HBV)
 Symptoms if liver damage develops:
 Poor appetite
 Fatigue
 Abdominal discomfort
 Jaundice
 125,000 people infected yearly in US
 5-10% become chronic carriers
 5-10% of those advance to liver disease
 Hepatitis B Vaccine is available to prevent
disease

40. Hepatitis C (HCV)
 Symptoms same as Hepatitis B
 Antibodies may not provide immunity
 Up to 85% will develop chronic hepatitis
 3.9 million chronically infected in US
 Sexual transmission uncertain

41. Respiratory etiquette to
prevent transmission
 Cover your cough or sneeze
 Deposit tissues directly into the trash
 Clean hands after use of tissues or
cough/sneeze
 Offer tissues or mask to others with
coughing or sneezing
 Remind them to clean hands

42. Infection Control is Everyone’s
Responsibility!