This document provides guidelines for infection control practices at the Omaha VA Medical Center. It outlines the use of standard and transmission-based precautions according to CDC guidelines. It describes personal protective equipment, hand hygiene practices, and protocols for contact, droplet and airborne precautions. It also addresses employee health issues such as exposure reporting procedures and safety measures to prevent needlestick injuries and bloodborne pathogen transmission.

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!