Healthcare Epidemiology Department

BASIC INFECTION
CONTROL
2013
September 4, 2013
Infection Control is in your Hands.

Healthcare Epidemiology Department

Healthcare Epidemiology
Susan V. Donelan, M.D., Medical Director
Department
Francina Singh, RN, BScN, MPH, CIC, Director
Terrie Gardiner, BS, Administrative Assistant
Department Telephone Number: 444-7430
Department Fax Number: 444-8875

Infection Control Practitioners: (with phone extension & beeper)

Fran Edwards, RN,MSN, CIC 4-2760 / 3-861-3435
Bob Garcia, BS, MT(ASCP), CIC, 4-8204/ 3-861-2379
Barbara Kranz, LPN, CIC, 4-8087/ 3-861-9876
Allison Ward, RN, CMSRN, ICP 4-9122 / 3-861-2395

Infection Control is in your Hands.

Healthcare Epidemiology Department

Breaking the Chain of

Infection

Infection Control is in your Hands.

Healthcare Epidemiology Department

Infectious Agent

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Healthcare Epidemiology Department

Reservoirs

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Portal of Exit

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Healthcare Epidemiology Department

Means of Transmission

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Healthcare Epidemiology Department

Portal of Entry

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Susceptible Host

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Healthcare Epidemiology Department

Principal Risk Factors for

Transmission
Inadequate education of personnel

Failure to recognize a potentially infected patient or

susceptible host
Absent / inappropriate barriers
Lack of adequate hand washing
Unrestricted infected healthcare workers ( HCW )
Inadequate disinfection / sterilization of instruments /
equipment
Infection Control is in your Hands.

Healthcare Epidemiology Department

Goals of Infection Control

Minimize development of infections in patients and HCWs
Prevent cross transmission :
- Patient Patient
- Patient HCW

Infection Control is in your Hands.

Healthcare Epidemiology Department

Transmission by Contact Route

Direct Routes
Hands of healthcare workers

Indirect Routes
Invasive and non-invasive equipment

Droplet Route
Meningitis
Influenza
RSV

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Healthcare Epidemiology Department

Direct Transmission
Hands of Healthcare
workers
Respiratory infx
Enteroviral infx
Coxsackie, echo, polio
Hepatitis A, E
Diarrheal diseases
viral, parasitic, bacterial
Response
avoid pt - pt contact
use barriers, wash hands
Infection Control is in your Hands.

Healthcare Epidemiology Department

Indirect / Fomite
Transmission

Invasive & non invasive equipment

Hands of HCWs spread organisms
Organisms can also be carried on inanimate objects
Contamination can occur after only brief contact
Infection Control is in your Hands.

Healthcare Epidemiology Department

Aerosol (Droplet) Transmission

Falls to floor within 1-3 feet
Most respiratory viruses
RSV / influenza
most childhood exanthemas
strep pharyngeal infections

Response
single room
mask within 3 feet
e.g: Meningitis, Influenza, RSV
Infection Control is in your Hands.

Healthcare Epidemiology Department

Airborne Transmission
Droplet nuclei remain suspended
in air
TB, measles, VZV
Response:
negative pressure room
surgical mask on pt. for travel
seropositive HCW
respirator on HCW when
indicated
Eg: Pulmonary TB, Varicella
(chicken pox, disseminated
Zoster), Measles (Rubeola)
Negative pressure room
required

Infection Control is in your Hands.

Healthcare Epidemiology Department

Transmission by Vehicle Rout e

Salmonella
Hepatitis A
Hepatitis B
Hepatitis C
HIV

Infection Control is in your Hands.

Healthcare Epidemiology Department

Vector Borne
Transmission
Lyme disease
Malaria
Rabies
Rocky Mt. Spotted Fever

Infection Control is in your Hands.

Healthcare Epidemiology Department

Definitions
Infection:
Is the state in which the body is
invaded by an infectious agent
which under favorable conditions,
multiplies and produces injurious
effects.

Colonization:
Is the presence of a micro-organism
in/or on a host with growth and
multiplication of the microorganism, without any overt
clinical expression at the time it is
isolated, which can be
transferred to others.
Infection Control is in your Hands.

Healthcare Epidemiology Department

System of Isolation at SBUH

Combination of:
Universal Precautions and
Disease Specific Precautions
Universal precautions
( to be used in the care of all patients)
History & rational
Personal protection cabinets
Protective barrier materials
Gowns, gloves, surgical masks, face shields & / goggles

Safety devices
Disposal of sharps

Infection Control is in your Hands.

Healthcare Epidemiology Department

System of Isolation at SBUH

Disease Specific Isolation:

Isolation codes
Isolation cards & carts
Yellow cards, chart binders & stethoscopes
MRO cards

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Healthcare Epidemiology Department

Isolation Card (front)

Infection Control is in your Hands.

Healthcare Epidemiology Department

Isolation Card (back)

DO NOT WRITE ANY RESULTS ON THE CARD
CIRCLE THE APROPRIATE CODE

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Healthcare Epidemiology Department

Explanation of Codes
A = Measles, Varicella (Chicken Pox)
B = MRSA / VRE
C = Combination of multiply resistant organisms not coded elsewhere
D = Meningitis, Mumps, Influenza, Rubella, Pertussis
E = Clostridium difficile, Salmonella, Shigella, Campylobacter, E.coli, Rotavirus
H = Other Blood Born Pathogens
I = VISA/VRSA--Vancomycin-intermediate/-resistant Staphylococcus aureus
L = Long Island State Veterans Home
M = MRSA - Methicillin-resistant Staphylococcus aureus
N = Resistant Gram Negative
O = Other
P = PRSP - Penicillin-resistant Streptococcus pneumoniae
R = RSV - Respiratory Syncytial Virus
T = TB - Mycobacterium tuberculosis
V = VRE - Vancomycin-resistant Enterococci
Z = Herpes zoster (Shingles)
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Healthcare Epidemiology Department

Explanation of Procedures
A = Negative Pressure Room, Immune Healthcare Worker (HCW)
B = Single Room, Gown/Gloves To Enter Room
C = Single Room, Gown/Gloves To Enter Room, Surgical Mask Within 3 Feet
D = Single Room, Surgical Mask Within 3 Feet, Immune HCW If Applicable
E = Single or double Room, Shared bathroom (use toilet seat cover as barrier)
H = Standard Precautions
I = NOTIFY HEALTHCARE EPIDEMIOLOGY (HED) IMMEDIATELY (See Help)
L = Surveillance C/S on Admission to R/O MRSA, Standard Room Placement
Pending C/S
M N V = Single Room, Gown/Gloves To Enter Room
O = Double Room, Standard Precautions Contact HED (See Help)
P = Single Room, Surgical Mask Within 3 Feet
R = Single Room, Gloves To Enter Room, Gown/Gloves/Face Shield For All
Patient Contact
T = Negative Pressure Room, Fit-Tested Respirator To Enter Room
Z = Negative Pressure Room If Disseminated Zoster, Immune HCW (See Help)
Infection Control is in your Hands.

Healthcare Epidemiology Department

National Patient Safety Goal

Integrating Patient Safety

Goal #7

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Healthcare Epidemiology Department

National Patient Safety Goal #

7
Reduce
the risk of health care - acquired infections
(HAI)
Requirements:
1.Comply with current WHO or CDC hand- hygiene
guidelines to reduce the transmission by staff to patients of
infectious agents, thereby decreasing the incidence of HAI.
2.Manage as sentinel events all identified cases of
unanticipated death or major permanent loss of function
related to a HAI.

Infection Control is in your Hands.

Healthcare Epidemiology Department

National Patient Safety Goal

Reduce
# 7 the risk of health care - acquired infections (HAI)
Requirements (continued):
3. Implement evidence-based practices to prevent HAI due
to multidrug-resistant organisms in acute care hospitals.
4. Implement best practices or evidence-based guidelines to
prevent central-line associated bloodstream infections.
5. Implement best practices for preventing surgical site
infections.
6. Implement best practices for preventing catheter
associated urinary tract infections.
Infection Control is in your Hands.

Healthcare Epidemiology Department

Facts on Nosocomial
Infections

2 million nosocomial infections / year in USA

90,000 deaths associated with nosocomial infections
70 % of the bacterial infections are caused by bacteria
resistant to 1 drug commonly used to treat
Some bacteria are resistant to all approved drugs
Some require treatment with experimental & toxic drugs
$ 122 million - cost associated with treating antimicrobial
resistance among single pathogen

Infection Control is in your Hands.

Healthcare Epidemiology Department

Emergence of Resistance

1980 Staphylococcus aureus - methicillin & penicillin

preparations
1980 K pneumoniae - 3rd generation cephalosporins,
ceftazidime
1990 Enterococcus to vancomycin
1992 Mycobacterium tuberculosis to multiple drugs

Infection Control is in your Hands.

Healthcare Epidemiology Department

Multiplyresistant Organisms
SBUH
Methicillin resistant staphylococcus aureus
MRSA ( M )

Vancomycin resistant enterococcus

VRE

(V)

Penicillin resistant streptococcus

PRSP

(P)

Resistant gram negative rods

RGNR

(N)

Vancomycin resistant staphylococcus aureus

VRSA

(I)

Vancomycin intermediate susceptible

staphylococcus aureus

VISA/ GISA

(I)

All ESBL producing organisms ( extended spectrum beta lactamase )

Infection Control is in your Hands.

Healthcare Epidemiology Department

Patient Risk Factors

Antimicrobial usage - frequent, intermittent,
infrequent & prolonged
Surgical procedure
Invasive devices
Exfoliative dermatitis
Procedures by-passing natural defenses

Infection Control is in your Hands.

Healthcare Epidemiology Department

Survival Time for

Bacteria:
Pathogens
MRSA
VRE
C. difficile

180 days
30 days
Years (spore forming)

Viruses:
Influenza A &
B
RSV
Rotavirus
Hepatitis B

18 hours
6 hours
10 days
30 days (dried blood)

Infection Control is in your Hands.

Healthcare Epidemiology Department

Hand Hygiene
Hands of HCWs spread
organisms
Organisms can also be
carried on inanimate
objects
Contamination can occur
after only a brief contact

Infection Control is in your Hands.

Healthcare Epidemiology Department

Principles of Handwashing
Running water
Adequate amount of soap to create
lather
Friction and thoroughness
Time spent = 10 15 seconds
When ?
- Before and after every patient contact

Infection Control is in your Hands.

Healthcare Epidemiology Department

Hand Hygiene
Using Alcohol-based Hand gel/foam
May be used as a substitute:
When hands are not visibly soiled
Hands must be washed with soap and water after
5-6 applications of gel / foam.
DO NOT use when patient is on isolation for
clostridium difficile diarrhea (not reliably effective
in destroying spores)
Infection Control is in your Hands.

Healthcare Epidemiology Department

Hand Hygiene Process

Using Alcohol-based Hand gel/foam
Apply 1.5 3.0 ml of gel/foam to the palm of one
hand and rub hands together.
Cover all surfaces of hands and fingers including
areas in between fingers, around and under
fingernails.
Continue rubbing hands together until alcohol
dries.
Infection Control is in your Hands.

Healthcare Epidemiology Department

These are BANNED in all direct

and indirect healthcare workers!
[per the CDC]

Infection Control is in your Hands.

Healthcare Epidemiology Department

And this is
why.

And this is why.

Infection Control is in your Hands.

Healthcare Epidemiology Department

Occupational Safety and Health

Administration
OSHA Bloodborne Pathogen

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Healthcare Epidemiology Department

OSHA STANDARD
The
Occupational
Safety
and
Health
Administration (OSHA) has issued a
standard to prevent the transmission of
Bloodborne Pathogen that is designed to
protect you. It was finalized on December 6,
1991, Amended October 2002.

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Healthcare Epidemiology Department

OSHA Standard (cont.)

It details ways employees and employer can
work together to reduce your risk of
contracting a bloodborne pathogen on the job.
All employees are covered by the standard if it is
reasonably anticipated they could be exposed
to bloodborne pathogen as a result of job
duties.

Infection Control is in your Hands.

Healthcare Epidemiology Department

OSHA Standard (cont.)

OSHA requires all employers have available to
employees an Occupational Exposure Control
plan.
The exposure control plan also contains a copy of
the Regulatory Text of the standard and job
categorization.
All training records must be held for three years.

Infection Control is in your Hands.

Healthcare Epidemiology Department

SBUH Exposure Control Plan

Available to all employees 24x7
o Chemistry Lab
o ADNs office

Infection Control is in your Hands.

Healthcare Epidemiology Department

Training Requirements
All employees with a potential risk of exposure to
bloodborne pathogens be trained in preventive
measures:
At initial hire
Annually

Infection Control is in your Hands.

Healthcare Epidemiology Department

What To Do If Exposed
Clean affected area immediately.
Notify your supervisor immediately.
Complete an Incident/Accident form (to be signed by
supervisory).
Immediately report to Employee Health Service.
Mon-Fri 8 a.m.-4 p.m. (4-7767)
All other times, report to the Emergency Room (42465).

Infection Control is in your Hands.

Healthcare Epidemiology Department

Infection Control is in your Hands.

Healthcare Epidemiology Department

Blood Borne Pathogen Exposure (Needlestick)

BBP 2009 guidelines
Slideshow for BPP guidelines
Needlestick Exposed

Injury/Illness Reporting Form (for Hospital Employees)

Injury/Illness Reporting Form (for RF Employees)

Sharps Injury Log

ADN Files

ADN Role in BBP

ADN Checklist

HCP Checklist

Source Packet

Source Charting
Source Checklist

Resources

HIV Consent Part A and B

2005 HIV PEP guidelines

Needlestick Resources References

PEP Card

Truvada

Kaletra

Infection Control is in your Hands.

Healthcare Epidemiology Department

SBUH Exposure Control Plan

Key Points
1.

2.

3.

All non-HIV testing counseling and prophylaxis will be

administered by the Department having first contact with
employee.
The Employee Health & Wellness (EH&W) / Emergency
Department (ED) will determine if HIV exposure may
have occurred or cannot be excluded.
Should HIV counseling and post-exposure prophylaxis
(PEP) be required or desired by the employee, it will be
administered as per CDC recommendations
Infection Control is in your Hands.

Healthcare Epidemiology Department

Key Points (cont.)

4. a) The blood/body fluid form must be completed at initial
visit.
If first contact is with the ED, then the completed
form must be forwarded to the EH&W.
b) The employees will be referred to EH&W for HIV
counseling and testing on the next weekday.

Infection Control is in your Hands.

Healthcare Epidemiology Department

Infection Control is in your Hands.