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INFECTION PREVENTION
Self-Study Packet (rev. 1.2015)
The following information will help familiarize you with some aspects of Infection Prevention
and some of the procedures used in the hospital to help prevent infections from occurring.
National Patient Safety Goal #7 from the Joint Commission is “Reduce the risk of health careassociated infections (HAI’S).
There are many things that can be done to limit the spread of microorganisms and infection and
everyone has a role and a responsibility in doing so.
Isolation Precautions
One thing that is done to help stop the spread of infection is to use Isolation Precautions.
Isolation Precautions are a series of recommendations that include using Personal Protective
Equipment (PPE) when working with patients that have certain diseases or organisms.
Standard Precautions
Standard Precautions say that PPE should be used when you may have contact with mucous
membranes, any body fluid and skin that is not intact. These precautions should be used for
ALL patients, even if you do not think they have an infectious disease, as well as when touching
objects that have been contaminated with body fluids. The type of PPE used should be based on
what the healthcare worker thinks they will come in contact with. Other aspects of Standard
Precautions include injection safety, hand hygiene, mask use for certain procedures, and
respiratory hygiene/cough etiquette.
Personal Protective Equipment
Personal Protective Equipment can include any of the following:
- Gloves
- Gown
- Mask – Procedure or Surgical
- Face shield or Goggles
- Respirator
There is a proper order in which to put on and remove PPE. This order applies to non-surgical
and non-aseptic settings.
Order for Donning (putting on) PPE
1.
2.
3.
4.
Gown
Mask or Respirator
Eye protection
Gloves
Order for Removing PPE
1. Gloves
2. Eye protection
3. Gown
4. Mask or Respirator
N-95 Respirators may be reused if not soiled, wet or damaged.
-
Peel glove off over first glove
Discard gloves in waste container
HAND HYGIENE SHOULD BE DONE IMMEDIATELY AFTER REMOVING ALL PPE
Hand Hygiene
Hand hygiene means cleaning of the hands using an alcohol rub or soap and water. In reducing
the spread of infectious pathogens hand hygiene may be the most important thing that you can
do.
It is recommended that you use alcohol rubs instead of soap and water, however soap and water
should still be used if your hands look dirty or if caring for a patient with c. difficile.
Make sure to actively rub hands together when using soap and water for a minimum of 15
seconds.
Hands needed to be rubbed together until dry when alcohol rub is used.
It is recommended that all aspects of the hands are cleansed and that the amount of soap or
alcohol rub you use follows the recommendation of the manufacturer.
Don’t turn off the water with your bare hands, but use a paper towel instead.
Figure II.1, p. 155 WHO
http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
Figure II.2, p 156 WHO
http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
It is also recommended that hands be cleaned after going to the bathroom or prior to eating.
When working with patients if moving to a clean area of the body from a dirty area of the body
hands should be cleaned, as well as after you take off gloves.
The following picture shows that cleaning your hands does make a difference. The plate on the
left is a handprint from a healthcare worker who had examined a patient that was colonized with
MRSA (Methicillin-resistant Staphylococcus aureus) before cleaning their hands. The one on
the right was done after using alcohol foam. The pink areas show growth of MRSA that came
from the healthcare worker’s hand.
Picture - Donskey and Eckstein. Cleveland Veterans Affairs Medical Center. From New England Journal of Medicine at
http://content.nejm.org/cgi/content/full/360/3/e3/F1
WASH YOUR HANDS!!!!
Fingernails and Jewelry
Fingernails tips should not be longer than ¼ of an inch. It is the policy of the hospital that if you
work with patients, artificial nails and nail jewelry are prohibited. Some hospitals prohibit the
wearing of nail polish as well. Check with your hospital regarding their policy on jewelry.
Transmission Based Precautions
Transmission based precautions are used based on what organism a patient has (or may have).
They include Airborne, Droplet, and Contact Precautions. A patient might require 2 or 3
isolation types used together depending on the organism and how it is spread. Standard
Precautions should STILL be used.
Airborne Precautions
There are some diseases, transmitted by very small particles that require Airborne Precautions.
These particles are small enough that others can breathe them in. These particles can also travel
long distances.
Some of the diseases that require Airborne Precautions include Tuberculosis, Smallpox (which
also requires contact isolation), Varicella (chickenpox), and Varicella Zoster (which also requires
contact isolation), and Measles.
When a patient is on Airborne Precautions they should be placed in an airborne infection
isolation room that has negative air pressure. The door should be closed and the air pressure
should be checked every day. The patient should be transferred if no airborne isolation room is
available.
California law requires at least an N-95 respirator to be worn when in the room of a patient with
Tuberculosis. Respirators are different than a regular mask. They filter a minimum of 95% of
particles in the air. It is required that a respirator be fit-tested before use. There are different
models of N 95 respirator so if you are unable to fit one type, others may be tried. Fit testing
will be done each year for those that require the use of a respirator. If a physical change
occurs that might change the fit of the respirator (such as cosmetic surgery, scarring of the face,
weight loss or gain, or dental changes) you must be re-fit tested. Gloves and gown should also
be worn if you may be touching things that have been contaminated with the patient’s secretions.
(Remember at Standard Precautions say you should be protected from any patient’s body fluids.)
This person is wearing an N 95
respirator, gloves, and a surgical
gown
Content providers - CDC/
Laura R. Zambuto; photo credit - James Gathany
When a patient on Airborne Isolation needs to be moved within the facility or to an outside
vehicle, they are to wear a surgical/procedure mask.
Aerosol Transmissible Disease Standards (ATD)
ATD standards address diseases requiring airborne infection isolation or droplet precautions,
developed in 2009 by Cal/OSHA to minimize the potential effects of a pandemic influenza.
Currently, these guidelines are to be in use for novel and unknown aerosol transmissible
pathogens. Employees who must enter areas in which people who are suspected, probable or
confirmed cases must wear N95 respirators or PAPR devices. If shortages of supplies occur,
alternative means of attaining worker protection and priority setting will occur. Consult the ATD
Exposure Control Plan for detailed actions required to avoid these occupational exposures in
your area of work.
Droplet Precautions
Droplet Precautions are required for patients with diseases that are transmitted by the droplet
route. Droplet transmission can occur when droplets from the respiratory tract land on mucous
membranes of another person. Examples of diseases requiring Droplet Precautions include
seasonal influenza, mumps, whooping cough, and meningitis caused by certain organisms.
If you will be within 3 feet of a patient on Droplet Precautions you should wear a regular mask
(NOT an N 95 respirator). If possible, these patients should be put into their own, single room.
The PATIENT should wear a mask if they are going to be moved outside their room and they
should follow cough etiquette and respiratory hygiene.
Note on masks: Some masks are regulated by the FDA (surgical masks that have fluid-resistant
characteristics) and some masks are not (isolation or procedure masks). The quality of the
second type of mask might not be as consistent as the quality of surgical masks. Check to see
that you are wearing the proper type of mask if you will be involved in surgical procedures.
Contact Precautions
Microorganisms can be transmitted by direct (person to person) or indirect (person » object (or
person) » person) contact. Examples of diseases requiring Contact Precautions include
Clostridium difficile (c. difficile), Vancomycin Resistant Enterococcus (VRE), Methicillinresistant Staphylococcus aureus (MRSA), and scabies. Contact Isolation is also used for less
common MDROs such as acinetobacter baumanii MDRO, and ESBL Klebsiella
pneumoniae/ESBL E. coli. MDRO pseudomonas and Carbipenem-Resistant Klebsiella
pneumonia (CRKP).
Gloves and a gown should be worn when caring for these patients or areas of their environment
that could be contaminated. Before leaving the patient’s room, remove and throw away PPE. If
possible, these patients should go into their own, single room.
The type of isolation needed is dictated by a CDC document – 2007 Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings and a
California law, Cal/OSHA Aerosol Transmissible Diseases, Title 8, Ch 4, Section 5199 for
Airborne and Droplet isolation. The California law takes precedence where any difference in
recommendation exists. Any questions as to whether a certain patient needs to be isolated can be
referred to the Infection Control Department.
Example from Guideline for Isolation Precautions
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf
Varicella Zoster (chickenpox)
The policy of WAMC requires that if you are not immune to chickenpox you should not take
care of, or go in the room of, a patient with chickenpox or shingles. Signs on the door should
read “Non-immune staff should not enter room.”
Placing a patient in Isolation
Patients should be placed in the proper isolation after:
- A culture has come back positive
- A physician makes a diagnosis of, or suspects an isolatable disease
- A patient has a known history of a multi drug-resistant organism. If they have been
in the facility before with an MDRO and they are readmitted, they should also be
placed in contact isolation until cleared
DISEASES REQUIRING TRANSMISSION BASED PRECAUTIONS
(LIMITED LIST – SEE 2007 ISOLATION GUIDELINES AND CAL/OSHA SECTION 5199 FOR COMPLETE LIST)
STANDARD PRECAUTIONS STILL APPLY
Contact Precautions Required
Abscess, draining, major
Bronchiolitis
C. difficile
Congenital rubella
Conjunctivitis, acute viral (acute hemorrhagic)
Cutaneous diphtheria
Furunculosis, staph in infants and young children
Rotavirus
Neonatal Herpes Simplex
Herpes Zoster – some (airborne also)
Impetigo
Lice
Monkeypox (airborne also)
Methicillin-resistant staphylococcus
aureus
Poliomyelitis
Respiratory syncytial virus (RSV)
Ritter’s disease
Scabies
SARS (droplet and airborne also)
Smallpox
Vancomycin-resistant enteroccocus
Varicella Zoster
Viral hemorrhagic fevers (such as
Ebola, Marburg) (droplet
also)
Droplet Precautions Required
Diphtheria, pharyngeal
Haemophilus influenzae type b epitglottitis
Influenza, seasonal
Meningitis – Haemophilus influenzae type b
Meningitis – Neisseria meningitides
Meningococcal disease
Mumps
Parvovirus B 19 (Erythema infectiosum)
Pertussis
Pneumonia – adenovirus, Haemophilus
influenzae in infants and children,
Meningococcal, Mycoplasma
Pneumonic plague
Streptococcus, group A
Rhinovirus
Rubella
SARS (contact and airborne also)
Some streptococcal disease
Viral hemorrhagic fevers (such as Ebola,
Marburg) (contact also)
DISEASES REQUIRING TRANSMISSION BASED PRECAUTIONS (CONT.)
Airborne Precautions Required
Anthrax
Avian Influenza
Herpes Zoster – some classifications (contact also)
Measles
Monkeypox (contact also)
Novel pathogens
SARS (droplet and contact also)
Smallpox (contact also)
Tuberculosis – pulmonary and extrapulmonary if
draining lesion
Varicella Zoster (contact also)
Respiratory Hygiene and Cough Etiquette
Patients should be informed of Respiratory Hygiene and Cough Etiquette and asked to follow
these guidelines while in the hospital. These guidelines include:
http://www.health.state.mn.us/divs/idepc/dtopics/infectioncontrol/cover/hcp/cycphceng.pdf
Signs such as these are placed in the hospital during flu season that explain respiratory hygiene.
Hand hygiene materials, tissues, and trash cans should be available for use by visitors and
patients. Also, while in waiting rooms or public areas, those with a respiratory disease or
symptoms of one should try and keep a distance of more than 3 feet away from others.
County of Los Angeles Department of Public Health
http://publichealth.lacounty.gov/acd/docs/Flu/Prevention%20Tips,%20Flu,%20HE%20Order%20form.pdf
Seasonal Influenza
In 2011, the CDC expanded their recommendation to include all people 6 months and older to
receive annual influenza vaccinations.
All employees are strongly encouraged to be vaccinated for influenza. Employee’s coming to
work sick will be sent home unless they can safely work wearing a mask and avoiding crosscontamination.
ALL EMPLOYEE’S ARE REQUIRED TO PROVIDE PROOF OF THE INFLUENZA
VACCINE/OR SIGN THE DECLINATION. A mask must be worn in patient-care areas if you
have not had a flu shot.You must maintain copies for other employers as well.
Free flu vaccines for employees are offered multiple times every year at WAMC during flu
season.
Transmission of Influenza Virus
-
Easily spread from person to person via respiratory droplets when an infected person
coughs or sneezes
Also spread when someone touches a surface contaminated with the virus
Airborne (droplet) transmission of the virus is possible, when an infected person is
talking
Why hospital employees should be vaccinated
Reduces risk of transmission to patients, coworkers and family members
Adults shed the infectious influenza virus at least 1 day before any symptoms appear
Then we continue to shed infectious virus for 5 to 10 days after symptoms begin.
Approximately 50% of influenza infections can have no symptoms at all.
Even without symptoms, we can be a source of infection to others, especially patients.
COMMON REASONS TO REFUSE VACCINATION
“I’ve had the flu, it’s not that bad”
Your influenza may be mild, but for your patients it could be fatal.
Protect the ones you serve - it’s not about you, it’s about patients.
“The flu shot does not work”
Overally, it is up to 80% effective
Getting vaccinated is the best protection
“I’ll wait a little longer”
Vaccine takes two weeks before fully effective
People exposed during that window may become sick
There is a high number of infected coworkers not showing symptoms who may be exposing you
Waiting results in needless exposure
Vaccine is a professional responsibility
Multi-Drug Resistant Organisms
Methicillin-resistant Staphylococcus aureus
MRSA
PHIL ID # 10045
Photo Credit: Janice Carr, Centers for Disease Control and Prevention; Content Providers - CDC/ Janice Carr; Jeff Hageman
http://www.cdc.gov/media/subtopic/library/diseases.htm accessed 1-22-10
MRSA stands for methicillin-resistant staphylococcus aureus. MRSA is a multi-drug resistant
organism, meaning that it is resistant to more than one antibiotic. Some of the antibiotics that
MRSA is resistant to are oxacillin, methicillin, amoxicillin, and penicillin. Infections with
staphylococcus occur more often in people that are in healthcare facilities and the hospital and
have an immune system that is weakened. Community associated infections with MRSA also
occur, usually as skin infections.
Photo credit: Gregory Moran, M.D.; Centers for Disease Control and Prevention, National Center for Preparedness, Detection, and Control of
Infectious Diseases (NCPDCID), Division of Healthcare Quality Promotion (DHQP);
http://www.cdc.gov/mrsa/mrsa_initiative/skin_infection/mrsa_phot_007.html
In healthcare settings MRSA is most commonly spread from patients that are colonized (have the
organism, but don’t have symptoms of infection) and those patients that have MRSA infections.
MRSA is often spread from people’s hands and, unfortunately, especially the hands of healthcare
workers.
MRSA screening when admitted to the hospital is required by California law (Senate Bill 1058)
for certain patients:
WAMC screens ALL patients admitted. When a positive result is identified the patient should be
placed on Contact Precautions. Patients are screened on discharge if the length of stay is seven
or more days, the patient is non-ambulatory and has no history of MRSA.
Vancomycin Resistant Enterococci (VRE)
VRE are enterococci bacteria that are resistant to the antibiotic vancomycin. Enteroccoci are
normally found in our intestines, the female genital tract, and the environment. If the bacteria
are living in someone, but not causing disease it means they are colonized. Some people have a
higher risk of VRE infection such as those who are colonized with VRE or those who have had
surgical procedures. Others with a higher risk of VRE infection include
- Those with devices like central lines or urinary catheters.
- Those whose immune system is weakened, for example patients the ICU
- Those in the hospital, especially if they have had antibiotics for long periods of time.
In fact, infections in hospitalized patients account for most VRE infections.
- Those that have been given vancomycin or other antibiotics
Patients with VRE should be placed on Contact Precautions.
Clostridium difficile
PHIL ID #9999; Photo Credit: Janice Haney Carr, Centers for Disease Control and Prevention; content providers - CDC/ Lois S.
Wiggs; http://www.cdc.gov/media/subtopic/library/diseases.htm accessed 1-22-10
Clostridium difficile is a bacteria that makes exotoxins and spores. It can cause diarrhea as well
as nausea, fever, pain in the abdomen, and loss of appetite. People who are sick from c. difficile
might still be colonized after the symptoms are gone. Certain people have a higher risk of
getting sick from c. difficile including older people and those who have had antibiotics. Those
who have had gastrointestinal surgery, those who are immune compromised or have serious
underlying medical illnesses, as well as those that have been in a healthcare facility for a long
time are also at higher risk.
Antibiotic-related diarrhea is the most common cause of diarrhea in the hospital. It is important
to properly assess the patients stools prior to requesting an order for c-difficile testing. At
minimum there should be 3-6 stools in a 24 hour period. Stools must be liquid, watery, profuse.
C. difficile spores must be released by the body after treatment, which may be delayed. No anti
diarrhea drugs should be given. ntibiotics that can be used to treat c. difficile include vancomycin
and metronidazole.
Patients with c. difficile should be put on Contact/Enteric Isolation. Alcohol hand rub may not
work well against the spores of c. difficile and hand hygiene with soap and water should be used.
Bleach solutions/wipes should be used when cleaning the room and equipment.
Acinetobacter
The most common species of acinetobacter that is implicated in infections is acinetobacter
baumanii. The risk of becoming infected with acinetobacter is higher if hospitalized, particularly
in certain populations (for example, those with open wounds). Certain people might be more
susceptible to acinetobacter infection - those with diabetes, a weak immune system, or chronic
lung disease. Infections that can be caused by acinetobacter include infections of wounds, the
blood, and pneumonia. Patients may be infected or colonized.
The environmental lifespan of acinetobacter might be several days. Proper environmental
cleaning should occur as well as hand washing. Acinetobacter is transmitted through contact.
WAMC places patients with acinetobacter MRO into contact isolation.
ESBL
ESBL stands for extended-spectrum beta-lactamase. There are many different types of betalactamases (26, 27), which are enzymes that bacteria make that cause some antibiotics not to work
(27)
. There are different types of bacteria that make these enzymes including E. coli, Klebsiella
pneumoniae, Klebsiella oxytoca, and Proteus mirabilis (26, 27). Patients can be infected or
colonized with ESBLs (26).
One way the bacteria are spread is healthcare workers who have these organisms on their hands.
There have also been instances where the bacteria were spread after being harbored in the
environment, such as on equipment. ESBLs have been brought to the hospital by patients coming
from nursing homes.
These types of organisms are a concern at WAMC, and Contact Precautions are required.. .
E. coli bacteria
PHIL ID # 10068; Photo Credit: Janice Haney Carr, Centers for Disease Control and Prevention; content providers - CDC/ National Escherichia,
Shigella, Vibrio Reference Unit at CDC; http://www.cdc.gov/media/subtopic/library/diseases.htm accessed 1-22-10
Carbapenem-resistant Klebsiella Pneumoniae (CRKP)
Some species of Klebsiella pneumoniae make carbapenemase, an enzyme, and are resistant to
carbapenem antibiotics. In fact, there are few antibiotics these bacteria are not resistant to. High
mortality and morbidity have been connected to infections of CRKP. Higher cost and longer
hospital stay have also been connected with these infections.
Patients may be infected or colonized. Patients with these bacteria should be placed on Contact
Precautions.
Preventing Transmission of MDROs
Everyone’s goal should be to prevent patients from acquiring an infection during their hospital
stay. Because patients are admitted with infections or colonization, efforts need to be made to
keep those organisms from being passed to other patients. The following apply to all patients
unless specified for those with an MDRO or in isolation.
Identification
We need to know which patients have an MDRO. This is done through routine admission
screening such as for MRSA and history. If a patient shows signs of infection during their stay
the physician may order cultures of blood, sputum, wounds etc.
Isolation
A patient that has been identified with an MDRO needs to be placed in isolation. This will
usually be Contact Isolation. All staff that enter the room need to comply with Isolation
Precautions. This includes nurses, physicians, respiratory therapists, physical therapists,
physician assistants, nurse practitioners, environmental services staff, engineering staff, and
laboratory personnel.
For any questionable patients, please check with the Infection Control Department.
Hand Hygiene
Hand hygiene should be performed any time before or after contact with a patient or after contact
with in the patient room. Even if gloves are worn, hands must be cleansed before apply gloves
and after taking gloves off.
Patient Placement/Transportation
If possible, patients with an MDRO should be placed in a single room. Cohorting can be
implemented if patients have the same organism and similar illness. For example,
- Patient A – MRSA; Patient B – MRSA – may cohort
- Patient A – MRSA, VRE; Patient B – VRE – may NOT cohort because Patient B
does not have MRSA
- Patient A – MRSA, VRE; Patient B – MRSA, VRE – may cohort
If patients are cohorted with the same organism you should still cleanse hands and put on new
PPE between working with these patients.
Contact the charge nurse or Infection Control before cohorting patients together.
If the patient on isolation will be moved in the hospital, isolation precautions still need to be in
place. You should wear PPE while getting the patient ready to go; remove, throw it away, and
wash your hands before moving through the hospital, and then put on new PPE when you arrive.
A mask should be worn by a patient on droplet or airborne isolation and Respiratory Hygiene
and Cough Etiquette should be followed if they are being moved. Cover up any other wounds or
areas that are colonized or infected. Any equipment used for transport or while the patient is out
of their room (wheelchair, x-ray table, etc.) should be properly disinfected after use according to
hospital policy. If there is a patient with an MDRO or on any type of isolation, they should be
moved throughout the hospital only if needed for medical reasons (i.e. the patient must go to
radiology for a CT scan). Try and do other procedures, such as an x-ray in the patient’s room if
possible and clean/disinfect contaminated equipment when done. Cannisters of antimicrobial
wipes are located inside of most patient rooms, and in strategic locations for this purpose.
Remember to use bleach wipes for C.diff patients.
Let the ambulance or other facilities receiving transferred patients know that the patient is in
isolation (done by Case Management as well).
Environmental Cleaning and Disinfection
The environment can be contaminated with microorganisms which the healthcare worker can
pass to a patient after contact with the surface.
Things such as blood sugar monitors, thermometers, and stethoscopes (typical things used for
patient care activities) must be cleaned and disinfected after they are used on a patient with an
MDRO if they will be used on another patient. Follow policies and procedures for cleaning
products/methods (i.e. sani wipes, bleach wipes etc.). When touching items that have been
contaminated (with body fluids/secretions, blood, or used by a patient with an MDRO) PPE
should be worn. For those in contact isolation, certain equipment (i.e. glucose meter) should be
used by only one patient for their whole stay if possible. This is called patient-dedicated
equipment. An alternative is to use equipment that can be thrown away after one use. Check to
see if patient-dedicated equipment should be used for those in other types of isolation.
Patient rooms are cleaned routinely by Environmental Services staff (EVS). More thorough
terminal cleaning is done after a patient is discharged. Proper disinfecting and cleaning products
should be used. Bleach solutions must be used for patients with confirmed or suspected c.
difficile. Cleaning product instructions should be followed including contact time (amount of
time the product is wet touching the surface before it dries) needed for effective cleaning.
It is everyone’s responsibility to keep the patient room clean throughout the day.
Products and procedures used for cleaning may vary based on department. You need to be
familiar with the policies for your work area. These can be found in the Policies and Procedures
Manual for each unit/area.
Typically the same processes and agents that are used for cleaning for non-isolated patients can
be used for those on Isolation Precautions if manufacturer’s instructions are followed. An
exception to this is a patient with c. difficile (bleach). Rooms of those on contact isolation
should be cleaned frequently. Surroundings close to the patient and often touched areas should
receive extra attention. Make sure to cover all surfaces and crevices and follow policies and
procedures for each type of cleaning.
NOTE: Patients with an MDRO should be scheduled as the last operative case of the day in the
specific OR suite if possible.
Keep an eye out for…
- Standing water/leaking faucets
- Wet towels/linens
- Doorways to the outside left open
-
Dust and debris
Any of these conditions, as well as evidence of insects/animals in the facility, should be reported
to the Infection Control Department.
Waste Disposal
Sharps (needles, glass, blades) are to be put into the RED Sharps containers for disposal. Sharps
containers should be emptied by appropriate personnel when the level has reached the fill line.
Any non-sharp that is contaminated with blood or body fluids should be disposed of in a RED
bag. Linens are sent out for re-processing. Handle linen carefully. Do NOT contaminate
uniform or shake used linens when working with waste/used linens appropriate PPE should be
worn.
Blood/Body Fluid Spill
Each hospital has a specific policy for cleaning of body fluid spills. Please be familiar with your
facility’s policy and appropriate products and procedures to follow.
Patient Hygiene
Specific facility policies regarding bathing, pericare, oral care, and changing of linens should be
followed as related to each discipline and job description. If you are asked to complete a task
and are unsure of the procedure or product to use, a senior staff member should be consulted.
Follow policies and procedures. Use hospital approved soaps/antiseptics and follow
manufacturer’s directions.
Staff should follow hospital policies regarding care of devices, IV sites, wounds, and surgical
sites.
Central Lines
- Proper equipment when inserting the catheter such as sterile gown and gloves use a
Central Line Insertion Pack if your facility carries these - A Central Line Insertion
Practices sheet be filled out when a central line is inserted.
- Disinfection of ports prior to access
- Observance of site for signs of infection
- Daily assessment for continued need Ventilators
- VAP Bundle including Oral care
o Perform every 4 hours
o Twice Daily
 Brush teeth and tongue
- Head of Bed should be elevated 30-45 degrees
- Daily weaning trial (can patient be removed from ventilator?) Observance for signs of
infection – increased suctioning/secretions, temperature etc.
Urinary Catheters
- Aseptic technique for insertion
- Take catheter out ASAP
- Observance for signs of infection like fever
To help prevent surgical site infections the following are Measures from the Surgical Care
Improvement Project:
“Infections Measures
- SCIP INF 1: Prophylactic antibiotic received within one hour prior to surgical
incision.
- SCIP INF 2: Prophylactic antibiotic selection for surgical patients.
- SCIP INF 3: Prophylactic antibiotics discontinued within 24 hours after surgery end
time (48 hours for cardiac patients).
- SCIP INF 4: Cardiac surgery patients with controlled 6 a.m. postoperative serum
glucose.
- SCIP INF 6: Surgery patients with appropriate hair removal.
- SCIP INF 7: Colorectal surgery patients with immediate postoperative
normothermia.”
http://www.qualitynet.org/dcs/ContentServer?c=MQParents&pagename=Medqic%2FMeasure%2FMeasuresHome&
cid=1089815967030&parentName=Topic
Patient Hygiene/Teaching
Patients can be involved in their own care and if reasonable, can be taught about infection
control measures. They should be informed about cough etiquette and respiratory hygiene and
hand hygiene. Patients with devices (and their family members) should be advised not to touch
central lines, surgical sites wounds, urinary catheters, and IV insertions to prevent contamination,
or they should clean their hands before doing so. They should also be instructed on proper care
of these sites and what they should do at home.
Patients should be advised to notify staff if they observe any signs of infection such as redness or
pain. Patients should also be encouraged to ask healthcare workers and staff if they have washed
their hands prior to taking care of them.
What To Do If You Are Sick - Recommendations for Restrictions
May Not Work With Patients
May Not Work At All
Disease
Return to Work
Disease
Return to Work
Pertussis – if been
After proper treatment Diphtheria
Have finished
exposed to pertussis
for at least 5 days
antibiotics AND 2
and has symptoms
cultures are negative
(second taken a
minimum of 24 hours
after first)
Scabies
After effectively
Neisseria
After 24 hours of
treated
meningitides infection proper treatment
Staph infection of
When they have been Hepatitis A
After one week has
draining lesion – may treated and infection
passed from jaundice
not handle food either is gone or staph ruled
onset
out
Conjunctivitis – may
When symptoms
Tuberculosis
Documentation from
not work in patient
resolve
medical provider
environment either
meeting certain
criteria
Acute
When symptoms are
Varicella
After lesions are dry
vomiting/diarrhea –
may not contact
patient environment
or handle food either
Streptococcal
infections – draining
lesions; no food
handling either
Herpes simplex on
hands or fingers
gone – unless health
regulations differ;
these employees
should be sure to
wash their hands
After proper treatment
for 24 hours or strep
is ruled out
and crusted. Other
restrictions may apply
pertaining to
exposure, reaction to
vaccine etc.
After lesions have
healed
Those that have recurrent orofacial herpes might need to be prohibited from working with highrisk patients. Those with orofacial lesions should not let contact occur between the lesions and
patients that have dermatitis, keep the lesions covered, and should wash their hands as needed.
Other restrictions may apply if exposed and not immune to mumps and/or rubella as well as
those not immune or with no evidence of immunity to measles
Don’t risk getting your patients sick - stay home when you are ill. Follow appropriate hand
hygiene and other guidelines.
Role of the Infection Preventionist (IP)
The Infection Preventionist is your resource for infection control measures. An IP conducts
surveillance for relevant MDROs and these data are reported to the Infection Control Committee.
The IP also conducts compliance rounds, reports certain diseases to the Public Health
Department. Employee Health is responsible for bloodborne pathogen or other exposure followup. The IP is involved in many areas of the hospital such as the nursing floor, environmental
services, engineering, and dietary.
Everyone Should Be Involved
Infection Prevention is everyone’s job and everyone has a part to play. Please participate in
infection control efforts and comply with policies and procedures. Questions or concerns can be
directed to the Infection Control Department.
Infection Preventionist: Sherry Marshall BSN,PHN,CIC
Phone 714-229-4095
Senate Bill 1058, Alquist, 2008
1. Cal/OSHA Aerosol Transmissible Diseases, Title 8, Ch 4, Section 5199
2. Cal/OSHA Subchapter 7. General Industry Safety Orders Group 16. Control of Hazardous Substances
Article 107. Dusts, Fumes, Mists, Vapors and Gases Section 5144, Respiratory Protection,
http://www.dir.ca.gov/Title8/5144.html accessed 1-25-10
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CDC Frequently Asked Questions Information for Healthcare Providers
http://www.cdc.gov/ncidod/dhqp/id_CdiffFAQ_HCP.htmlCDC, Frequently Asked Questions Information
for the public about VRE http://www.cdc.gov/ncidod/dhqp/at_VRE_publicFAQ.html#7
CDC, Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing
Enterobacteriaceae in Acute Care Facilities, Mobidity and Mortality Weekly Report March 20, 2009 /
58(10);256-260, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5810a4.htm accessed 1/25/10
CDC, MRSA in Healthcare Settings https://www.cdc.gov/ncidod/dhqp/ar_MRSA_spotlight_2006.html
CDC Overview of Drug-resistant Acinetobacter Infections in healthcare Settings
http://www.cdc.gov/ncidod/dhqp/ar_acinetobacter.html
CDC, Overview of Healthcare-associated MRSA http://www.cdc.gov/ncidod/dhqp/ar_MRSA.html
CDC Overview of Klebsiella pneumoniae (K. pneumoniae) http://www.cdc.gov/ncidod/dhqp/ar_kp.html
CDC PPE Poster http://www.cdc.gov/ncidod/dhqp/pdf/ppe/ppeposter1322.pdf
CDC Respiratory Hygiene/Cough Etiquette in Healthcare Settings
http://www.cdc.gov/flu/professionals/Infectioncontrol/resphygiene.htm
FAQs (frequently asked questions) about “Catheter-Associated Bloodstream Infections” (also known as
“Central Line-Associated Bloodstream Infections”), co-sponsored by SHEA, IDSA, AHA, APIC, CDC,
TJC
FAQs (frequently asked questions) about “Catheter-Associated Urinary Tract Infections,” co-sponsored by
SHEA, IDSA, AHA, APIC, CDC, TJC
FAQs (frequently asked questions) about “Ventilator-associated pneumonia,” co-sponsored by SHEA,
IDSA, AHA, APIC, CDC, TJC
FAQs (frequently asked questions) about “Surgical Site Infections,” co-sponsored by SHEA, IDSA, AHA,
APIC, CDC, TJC
Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 William A. Rutala, Ph.D.,
M.P.H.1,2, David J. Weber, M.D., M.P.H.1,2, and the Healthcare Infection Control Practices Advisory
Committee (HICPAC), accessed at
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf.
Guideline for Hand Hygiene in Health-Care Settings Recommendations of the Healthcare Infection Control
Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force, Mobidity
and Mortality Weekly Report October 25, 2002 / Vol. 51 / No. RR-16,
http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
Guideline for infection control in healthcare personnel, 1998. Elizabeth A. Bolyard, RN, MPH,a Ofelia C.
Tablan, MD, Walter W. Williams, MD, Michele L. Pearson, MD, Craig N. Shapiro, MD, Scott D.
Deitchman, MD, and The Hospital Infection Control Practices Advisory Committee
GUIDELINE FOR PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS
2009, Carolyn V. Gould, MD, MSCR; Craig A. Umscheid, MD, MSCE; Rajender K. Agarwal, MD, MPH;
Gretchen Kunzt, MSW, MSLIS; David A. Pegues, MD and the Healthcare Infection Control Practices
Advisory Committee (HICPAC),
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/CAUTI_Guideline2009final.pdf
Ideas from 2007 Infection Control Module by Jennifer Sanguinet, CIC, BSIS, MBA-HCM
Ideas from PowerPoint Presentation of Rosa Celera, RN, MHA
The Joint Commission http://www.jointcommission.org/NR/rdonlyres/868C9E07-037F-433D-88580D5FAA4322F2/0/RevisedChapter_HAP_NPSG_20090924.pdf, NPSG.07.03.01
Los Angeles County Department of Public Health Flu Prevention Tips,
http://publichealth.lacounty.gov/acd/docs/Flu/Prevention%20Tips,%20Flu,%20HE%20Order%20form.pdf
Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006, Jane D. Siegel, MD; Emily
Rhinehart, RN MPH CIC; Marguerite Jackson, PhD; Linda Chiarello, RN MS; the Healthcare Infection
Control Practices Advisory Committee
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http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource.html#sect1, accessed 1-25-10
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Raphael Dolin, M.D., Chapter 13 “Mechanisms of Antibiotic Resistance” Kenneth H. Mayer, Steven M.
Opal, Antone A. Medeiros
Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory
Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in
Healthcare Settings http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
Surgical Care Improvement Project,
http://www.qualitynet.org/dcs/ContentServer?c=MQParents&pagename=Medqic%2FMeasure%2FMeasure
sHome&cid=1089815967030&parentName=Topic
29. Ventilator-associated Pneumonia Event, CDC
http://www.cdc.gov/nhsn/PDFs/pscManual/6pscVAPcurrent.pdf