Transcript Document 7135551

Basic Infection Prevention
Training
CIP Consulting LLC
Basic Infection Prevention Training
ROLE OF THE ICP
Father of Hand Hygiene:
Dr. Ignaz Semmelweis
Role of the ICP
• Infection Prevention and control expert
• Mentor staff
• Role model for Infection Prevention and
Control
• Resource for the staff
• Design and implement effective programs
Role of the ICP
•
•
•
•
•
•
Liaison to public health
Liaison in emergency preparedness
Promote zero tolerance for HAIs
Collect and analyze infection data
Develop and review policies
Consult on infection risk assessments,
prevention and control strategies
Role of the ICP
– Educate and direct interventions to reduce
infection risk
– Implement change mandated by regulatory bodies
– Evaluate Product changes
– Evaluate Chemical changes
– Development of IC Surveillance plan and annual
evaluation (review and discuss a sample infection
control surveillance plan with the group)
Basic Infection Prevention Training
MICROBIOLOGY REVIEW
Stain…. will identify
•
To visualize microbes the lab can stain them using two
common staining methods.
1. Gram stain
Gram + Purple
Gram – Red
Gram Stain – allows identification of four basic groups of
bacteria, and provide early suggestion of empiric
antibiotics to use and possible initiation of isolation
precautions.
2. Acid-fast stain
Stains….
•
Acid-fast stain – The cells of some bacteria
and parasites are impervious to crystal violet
and other dyes, so heat or detergents are
used to force dye into this type of cell.
• If smear +, look closely at the patient to
determine if airborne isolation is needed.
1. S/S of TB?
2. Look at most recent chest x-ray.
How are microbes cultured?
• Nutrient – type of plate
• Optimal temperature - 35 – 37 degrees C.
• Atmosphere – does the microbe need oxygen
or carbon dioxide?
• Collection – (Do you have a specimen
collection policy? Check with lab, and educate
your people)
• Tissue culture – Some viral pathogens are
more difficult to grow than bacteria, so non
culture methods are used for their
identification.
MIC
•
The zone sites are looked up on a
standardized chart to give a result of
1. Sensitive
2. Intermediate
3. Resistant
The charts have a corresponding column which
gives the minimum inhibitory concentration
for that drug.
MIC studies (Minimum inhibitory
concentration studies)
• MIC studies help determine antimicrobial
susceptibility to antibiotics.
• The lowest concentration of an antimicrobial
that will inhibit the visible growth of a
microorganism after incubation.
R, I, S, designations
For instance this culture report – the Ampicillin zone of inhibition was > 32,
according to the CLSI guidelines that the lab uses, that zone of inhibition should be
reported as “R”
Antibiogram
• Done annually by the Microbiology lab.
• Helps guide antibiotic usage, very specific to
the facility.
Multi-drug resistant organisms - MDRO
• CDC MDRO definition
Bacteria that is resistant to one or more classes
of antibiotics
• Discuss annual MDRO risk assessment (calculation of MDRO rates
discussed in “data and analysis”)
• Past and current hospital surveillance data is the core of the MRSA risk
assessment.
• MRSA risk assessment is developed annually, whenever there is a change
based on continuing surveillance, and when change of populations or
services occurs.
• Information from the MRSA risk assessment drives improvement
processes.
MDRO
• Prevention is key!
a. Use contact isolation (gowns and gloves before
entering room, remove before leaving the room)
b. Educate the patients and family members with
hospital MDRO literature (kept on each unit)
c. Hand washing before and after patient care
d. Wipe down equipment shared between patients
with hospital approved disinfectant.
Fungi – Some are well adapted human pathogens, but most
are accidental pathogens that we acquire through decaying
organic matter or airborne spores.
• Two groups
1. Yeasts – i.e. Candida species, Cryptococcus
2. Molds – i.e. Aspergillus species, histoplasma
capsulatum
What type of host plays an important part!
Construction on an oncology ward higher risk than
construction on a medical surgical unit.
Review ICRA with the group
Viruses – cannot multiply on their own, need
living cells to live and grow
•
1.
2.
3.
4.
5.
Multiplication occurs in 5 steps
Attachment
Penetration
Replication
Maturation
Release
Parasites
• Vary in size and complexity, i.e. may be single
celled microscopic protozoa or complex
worms over 10 feet in length!
• Flukes, tapeworms, roundworms, and
ectoparasites such as lice and scabies.
Direct antigen testing
• In addition to traditional culturing methods,
there are non-culture methods to detect
microbes.
• EIA (Enzyme immunoassay) This procedure
uses known specific antibodies which are
reacted with a patient specimen. If the
unknown patient antigen reacts with the
antibody, a visible result can be observed by
an enzymatic reaction. (i.e., Influenza A virus
antibody, HIV, Strep kit)
• Advantage – rapid testing, agents that are
difficult to grow, very specific identification.
DNA Probes – another non-culturing
method
• Matches DNA from an unknown agent, with
nucleic acid segments from a known agent.
• Lab frequently uses this method for genital
specimens to detect Neisseria gonorrhoeae
and Chlamydia.
PCR – Polymerase Chain Reaction - another nonculture detection method.
• PCR enzymatically enhances the number of
nucleic acid molecules to the point that they
can be detected.
• Used to detect Toxoplasmosis, Enteroviruses,
RSV, Pneumocystic carinii, and MTB.
• Disadvantage – does not allow the testing of
antimicrobial susceptibility testing.
Pulse field Gel Electrophoresis
• PFGE technique can be used with remarkable
precision to determine relatedness of isolates
from an outbreak…
Infection VS Colonization with normal flora
• Colonization – presence of microorganisms
with multiplication but without tissue invasion
or damage. (urine culture E-coli < 20,000 cfu,
patient with no symptoms)
• Infection – entry and multiplication of an
infectious agent in the tissues of a host. (urine
culture E-coli >100,000 cfu, patient has fever,
frequency, dysuria)
Exogenous VS Endogenous
• Exogenous organisms are those that come
from outside the host.
• Endogenous organisms are those that come
from the host’s own flora.
Environmental testing
• “Can we culture the ice machine, I don’t think
they clean them, and I see some black sludge
on the dispenser”
• Microbiological environmental testing is not
generally recommended. In most cases no
standards for comparison exist, so what are
you going to do with the information?
• Just clean the ice machine and make sure that
there is a scheduled cleaning procedure.
Staphylococcus aureus – most frequently seen
microbe in human infections.
• Gram positive cocci, easily grown in the microlab.
• Normal flora on skin.
• Common pathogen – possesses numerous
invasive enzymes which aid its pathogenicity.
• Frequently resistant to the penicillin group of
antibiotics, including the oxacillin-like agents
(methicillin)
Staphylococcus aureus – most frequently seen
microbe in human infections
• Commonly seen as “R” to Oxacillin on the culture report.
• MRSA – cannot be taken lightly!
• MRSA was first isolated in the United States in 1968. By the early 1990s,
MRSA accounted for 20%-25% of Staphylococcus aureus isolates from
hospitalized patients.
• 1999, MRSA accounted for >50% of S. aureus isolates from patients in
ICUs in the (NNIS) system.
• in 2003, 59.5% of S. aureus isolates in NNIS ICUs were MRSA.
Pseudomonas aeruginosa
•
•
•
•
Gram negative bacilli.
Most commonly associated with water.
Frequently a colonizing organism in patients.
“Opportunistic pathogen”, takes advantage of
lowered defense systems of the host.
• Can be commonly resistant to multiple
antimicrobial agents.
• Associated with outbreaks on healthcare
systems.
Mycobacterium Tuberculosis
• Referred to as an acid fast bacillus.
• Slow growing (can take 4-6 weeks to grow)
• Spread by the airborne route – so if + acid fast
smear +, consider negative airflow.
• If smear +, reportable to Oklahoma State
health department.
Herpes Simplex Virus
• Not seen by gram staining – it is a virus.
• Requires tissue culture to grow.
• Can a Healthcare worker (HCW) with a herpes
lesion on their lip work?
• What if they work in the NICU or oncology?
• What if the HCW has a herpetic whitlow?
• How do you find the answers? (CDC
healthcare worker guidelines)
WBC count and differential
•
•
Normal WBC count is 5,000 – 10,000
White blood cells originate in the bone
marrow.
• Types of WBC
1. Phagocytic – ingest and destroy bacteria,
protozoa, cells and cellular debris. (neutrophils,
eosinophils, basophils, monocytes, and macrophages)
2. Non-phagocytic – important to immune
function and produce antibody. (T and B
lymphocytes)
Meningitis – Cerebral spinal fluid
• Lumbar puncture – The results of the CSF
fluid; WBC count, protein, and glucose are
important in diagnosis between Bacterial
(septic) and Viral (aseptic) meningitis
CSF
Normal CSF
Bacterial
Aseptic
WBC
<5
> 1,000
5 – 500
Protein
< 50
> 100
30 –150
Glucose
2/3 serum
glucose
< 40
< 30 - 70
Meningitis Overview
Inflammation of the meninges, which surrounds the brain and spinal cord.
The inflammation may have infectious or non-infectious causes.
Presentation – both viral and bacterial present the same (fever, neck
stiffness, altered mental status, headache photophobia, nausea, skin rash
in meningococcal meningitis).
• Bacterial – often called septic meningitis, it has an identified
bacterial cause. (Streptococcus, Neisseria, Haemophilus, Listeria)
• Viral – often called aseptic meningitis, which refers to all non bacterial
causes of the meningitis, such as viruses, fungi, parasitic, medication
related, and malignancies.
Diagnostic Tests
•
•
•
•
CSF Culture
Blood Cultures
CSF and Blood Cultures take time.
Antigen Testing (Serology) Main advantage is
speed. The quicker the appropriate antibiotics
are given for bacterial meningitis the better!
Basic Infection Prevention Training
COMPONENTS OF SURVEILLANCE
Components of Surveillance
• Surveillance Methods
1.
2.
3.
4.
Facility wide
Periodic (Quarterly)
Targeted
Outbreak Thresholds
• CDC/NHSN definitions of HAI and criteria for
specific types of infections in the acute care
setting. (introduction to the CDC document, more
intense review in intermediate and advance
courses)
Surveillance
•
•
•
•
Collecting Relevant Data
Managing Data
Analyzing and Interpreting Data
Communicating Results
Reports
– Announcements that need to be recorded in the
minutes
– News related to Infection Prevention
– Updates from any construction projects
– Reports from regular surveillance
– Reports from Employee Health
– Reports from Dialysis water cultures
– Reports from IC Rounding
Annual Review
• Evaluate program annually
– Highlight accomplishments
– Evaluate goals
– Set new goals based on risk assessment
• Review a sample program evaluation
MRSA incidence
Incidence = the number of new cases (1st lab ID specimen) of a
given disease in a given time period.
Analysis –
“Past and current
hospital surveillance
data is the core of the
MRSA risk
assessment”.
Healthcare associated MRSA
CDC definition – Lab ID specimen collected > 3 days after
admission to the facility (i.e. on or after day 4)
Analysis – Based on
annual data, HA
MRSA goal is < 1 per
1000 patient days.
Healthcare associated VRE
Healthcare associated C-difficile
Breakdown of SSI cultures
December 2010 – January 2010
Annual TB risk assessment
• Oklahoma county TB rate
• State TB rate
• National TB rate
2009
3.3
2.8
3.8
2010 (rates per 100,000)
3.8
2.3
3.6
In 2011, The hospital continues to be low risk according to the CDC risk
classification of inpatient hospitals with < 200 beds, and outpatient
clinics (both must have < 3 confirmed TB patients per year)
Issues found during risk assessment and 11/2010 state health visit.
1. Only 1 ICP got immediate notification via email when PPD placed –
this was fixed and now both ICP’s get immediate notification, so
that prompt assessment can be made regarding negative airflow.
TB Risk assessment
2. ACH in negative airflow rooms now checked quarterly and reported to EOC
committee. Recommended ACH is 12.
3. Noted that compliance for annual fit testing not 100% as stated in TB
control plan – Employee Health working on compliance issue.
4. “TB reference book” placed in nurse house supervisor office. This book has
the list of “fit tested” team members and provides reference to reading
TBST’s, discontinuation of airborne isolation and references TB control
plan.
Basic Infection Prevention Training
INFECTION CONTROL RISK
ASSESSMENTS
ICRA
•
•
•
•
Multi-disciplinary Risk Assessment
Construction Risk Assessment
TB Risk assessment
Multi-drug resistant Risk Assessment
Basic Infection Prevention Training
DISEASE TRANSMISSION AND
ISOLATION
Reportable Diseases in Oklahoma
• Discuss Oklahoma Reportable Diseases
• Review PHIDDO system (open OSDH website
to review with the group)
• How do I get access to the system to report?
http://www.ok.gov/health/Disease,_Prevention,
_Preparedness/Acute_Disease_Service/Diseas
e_Reporting/What_to_Report/index.html
Infectious Disease Process
• Exposure
• Incubation Period (time from exposure to
onset of symptoms)
• Onset of symptoms/clinical disease
• Recovery, disability or death
Chain of Infection
•
•
•
•
•
•
Infectious agent
Reservoir
Portal of Exit
Means of Transmission
Portal of entry
Susceptible Host
Transmission Based Isolation
• The spread of infection requires 3
elements:
–Source
–Susceptible host
–Transmission
Standard Precautions
• Apply standard precautions to all:
–Patients
–Contaminated equipment, surfaces &
materials
• Use judgement to determine when personal
protective equipment is necessary
Standard Precautions
Wear face mask with eye shield
or mask & eye protection during
patient care activities that may
generate splashes or sprays of
blood or body fluids
Standard Precautions
Prevent injury when using & disposing of
needles or other contaminated sharp
instruments
Immediately dispose of used sharps in
puncture-resistant container
Do not recap using two-handed technique
Standard Precautions
Keep work area clean
Minimize the splashing or
spraying of blood or body fluids
performing procedures
while
Clean up spills of blood or body fluids
promptly using gloves & approved
disinfectant
Standard Precautions
• Remove gloves, gown, mask, eye
protection before leaving work area
• Gloves, gown, mask are not worn in halls,
elevators, cafeteria, or gift shop
Standard Precautions
Clean re-useable equipment
between patients to prevent
transfer of microorganisms to
other patients, staff
or environment
Standard Precautions
• Use:
–Mouthpieces
–Resuscitation bags
–Ventilatory device
• As an alternative to mouth-to-mouth
resuscitation methods
Contact Isolation Standard Precautions
Patients infected or colonized with:
–Epidemiologically important microorganisms
–Transmitted by direct contact with the
patient
–Indirect contact with room surfaces or
patient care items
Contact Isolation Standard Precautions
Patient may have:
• Incontinence
• Diarrhea
• Ileostomy
• Colostomy
• Wound drainage not contained by
dressings
Contact Isolation
Standard Precautions
• Wear gloves and gown before entering room
• Change gloves after contact with infective material
• Remove gloves before leaving room & wash hands
• Avoid contact with contaminated surfaces while
leaving room
Contact Isolation
Standard Precautions
• Limit transport to essential purposes
• Communicate precautions to appropriate
departments
• Maintain Contact Isolation
Contact Isolation
Standard Precautions
• Dedicate non-critical equipment to Contact
Isolation patient
• Clean & disinfect equipment between
patients to avoid spread of microorganisms to
other patients, staff, or environment
Droplet Isolation
Standard Precautions
Patients infected or colonized
with
• Microorganisms
• Transmitted by droplet from coughing,
sneezing, talking, or performing
procedures
Droplet Isolation
Standard Precautions
• Wear mask when working within three feet
of patient
• Limit transport to essential purposes
• Minimize dispersal of droplets by masking
patient if possible during transport
Airborne Isolation
Standard Precautions
Patients infected with:
• Pulmonary tuberculosis (TB)
• Rubeola (measles)
• Varicella (chicken pox)
Airborne Isolation
Standard Precautions
• Place patient in a negative air-flow
isolation room
• Keep room doors closed & patient in
room
• Limit transport to essential purposes &
minimize dispersal of droplets by
masking patient
Airborne Isolation
Standard Precautions
• Tuberculosis - wear particulate respirator to
enter room
• Varicella & Rubeola - susceptible care givers
not to enter room if immune caregivers are
available
– Susceptible = mask
– Immune persons = no mask
CDC - Management of Multidrug-Resistant Organisms In
Healthcare Settings, 2006
• General recommendations for all healthcare
settings independent of the prevalence of
multidrug resistant organism (MDRO)
infections or the population served.
• Administrative measures
– Make MDRO prevention and control an
organizational patient safety priority.
CDC - Management of Multidrug-Resistant Organisms
(MDRO’s) In Healthcare Settings, 2006
In healthcare organizations that outsource
microbiology laboratory services (e.g.,
ambulatory care, home care, LTCFs, smaller
acute care hospitals), specify by contract that
the laboratory provide either facility-specific
susceptibility data or local or regional
aggregate susceptibility data in order to
identify prevalent MDROs and trends in the
geographic area served.(363) Category II
MDRO’s
• In ambulatory settings, use Standard
Precautions for patients known to be
– infected or colonized with target MDROs, making
sure that gloves and gowns are used for contact
with uncontrolled secretions, pressure ulcers,
draining wounds, stool incontinence, and ostomy
tubes and bags. Category II
MDRO’s
• Discontinuation of Contact Precautions. No
recommendation can be made regarding
when to discontinue Contact Precautions.
Unresolved issue
• Discussion
MDRO’s
•
Intensified interventions to prevent MDRO
transmission.
List combinations of control elements that
were selected and have been shown to
reduced MDRO transmission rates in a
variety of healthcare settings.
•
–
–
Active surveillance cultures
Decolonization
Appendix A, Isolation guideline
• In packet, it is an A-Z reference that details
what type of isolation is needed for specific
diseases and conditions.
• Scabies
• Lice
• Influenza
• C-diff
• TB
Scabies
• You identify this burrow like rash as Scabies and place the
patient on Contact Isolation until 24 hours after the patient is
treated for the scabies.
• Notify the Dr., and obtain an order for Lindane (Kwell) Follow
directions on the bottle.
• The patients belongings need to be bagged and sent home.
How will you tell the family to treat the belongings. Do the
family members need to be treated?
Scabies
Diagnosis – definitive diagnosis of scabies infestation can be
made by a skin scraping of the burrow.
Transmission – Prolonged direct skin to skin contact. Mites can
burrow under the skin in 2.5 minutes.
Incubation – 2-6 weeks after exposure OR 1-4 days in people
previously infected.
Lice (Pediculosis)
Lice
• Contact Isolation until 24 hours after treatment. Call
Physician for Rx treatment.
• Apply Prescription lice medicine, according to the label
instructions. , re-treatment in 7-10 days is not necessary
unless crawling bugs are seen.
• After treatment, use the nit comb to remove nits and dead
lice from the hair shaft.
• All of the patient belongings should be bagged and sent home
for laundering or bagged for 2 weeks
Lice
• Do family members need to be treated?
• Mode of transmission – Direct contact with an infested
person, and objects used by them.
• Incubation – 7-15 days.
C- difficile
• A spore forming anaerobic gram positive
bacilli which are particularly virulent because
of the toxins they produce.
• On April 11, 2005 at the annual meeting of the
Society for Healthcare Epidemiology of
America (SHEA) infectious disease experts
presented information concerning a new
highly toxic strain of C- Diff.
C – Diff Prevention
• Hand Hygiene – soap, water, and friction.
Alcohol hand foam is not effective in killing
the spores of C – Diff.
• Contact Isolation – gloves and gowns when
entering the room of patient with c-diff. The
spores can be transmitted from person to
person, as well as by persons touching objects
(side rails, nurse call light) contaminated with
the spores.
C – Diff Prevention
• Use of hypochlorite disinfectant (bleach) has
been found to be more effective in killing the
C-diff spores upon patient discharge.
• Educate Health Care Workers
• Prudent Antibiotic use.
TUBERCULOSIS
• Infectious disease caused by bacteria.
• Usually affects lungs.
• Other body parts can be affected.
TRANSMISSION
• Spread through air (droplet nuclei).
• Sneezing, coughing, speaking, singing by
individual with TB disease.
• Sharing the same air space with persons with
infectious TB disease.
SYMPTOMS OF TB
•
•
•
•
•
•
•
Weak
Weight loss
Fever
Night sweats
Cough
Chest pain
Coughing up blood
TB INFECTION VS. TB DISEASE
• Have the organism in
their body.
• Have symptoms.
• No symptom.
• Are sick.
• Bacteria is inactive.
• Bacteria is active and
multiplying.
MULTI DRUG RESISTANT TB (MDR TB)
• One or more drugs can no longer kill TB
bacteria.
• High risk persons for MDR TB:
– Persons who did not take their TB meds.
– Immunocompromised persons, i.e. cancer, HIV
infection.
– Persons previously treated for TB with an
ineffective regimen of drugs.
TREATMENT FOR TB
• TB drugs for TB disease.
• If infected may need to take TB drugs to
prevent TB disease.
• TB drugs are taken for 6-12 months.
Basic Infection Prevention Training
FEDERAL AND STATE REGULATIONS
State Health Regulations for Hospitals
Chapter 667
• Employee and/or worker Health examinations
chapter 667-5-4
– Pre employment exams for
• Each employee full or part-time with or without patient care
responsibilities
• Physicians
• Emergency medical personnel
• Students
• Lab and pharmacy workers
• Volunteers and administrative staff
• Food service workers
Chapter 667
The pre employment health exam will include but not be limited to:
Immunization History
 Born before 1957
 Born in 1957 or later
 Serologic screening
Tb Skin Testing
2-step Testing
BCG
Hepatitis B
Chapter 667









(e) Annual influenza vaccination program. Each hospital shall have an annual influenza vaccination
program consistent with the recommendations of the Centers for Disease Control and Prevention
Advisory Committee on Immunization Practices that shall include at least the following:
(1) The offer of influenza vaccination onsite, at no charge to all employees and/or workers in the
hospital or acceptance of documented
evidence of current season vaccination from another vaccine source or hospital;
(2) Documentation of vaccination for each employee and/or worker or a signed declination statement
on record from each individual who
refuses the influenza vaccination for other than medical contraindications; and
(3) Education of all employees and/or workers about the following:
 (A) Influenza vaccination;
 (B) Non-vaccine influenza control measures; and
 (C) The symptoms, transmission, and potential impact of influenza.
(4) Each hospital influenza vaccination program shall conduct an annual evaluation of the program
including the reasons for nonparticipation.
(5) The requirements to complete vaccinations or declination statements for each employee and/or
worker may be suspended by the
hospital's medical staff executive in the event of a shortage of vaccine as recognized by the
Commissioner of Health.
Chapter 667
• TB Skin Test
– Based on annual TB risk assessment
• Communicable Diseases
Chapter 667
• A file shall be maintained for each employee
containing the results of the evaluations and
examinations and the dates of illness related
to employment.
Chapter 667
• These are for Credentialed non-employees
(physicians/mid-level providers)
– Such workers provide evidence of immunization
history and TB skin test consistent with the TB
Control Program. It is in the form of a signed
attestation statement.
Chapter 667
• 667-13-1 Infection Control Program
– Provide a sanitary environment
– Avoid sources and transmission of infection
– Provide written policies and procedures for:
• identifying, reporting, evaluating, and maintaining records of
infection among patients and personnel.
• Ongoing review and evaluation of all aseptic, isolation and
sanitation techniques employed in the hospital
• Development and coordination of training programs in infection
control for all hospital personnel.
Chapter 667
• 667-13-2 Infection Control Committee
– Shall meet at least quarterly
– Attendees – at least one person with appropriate
background who can speak for the relevant
department(s) attends the meeting or is
consulted.
Chapter 667
• 667-13-3 Policies and Procedures
– The infection control committee shall evaluate,
revise, and approve the type and scope of
surveillance activities at least annually
– Policies and Procedures shall be reviewed
periodically and revised as necessary
Chapter 667
• 667-13-4 Policy and Procedure content
– Record of all reported infections generated by
surveillance activities
– Handling and disposal of biomedical waste
– Related to admixture and drug reconstitution
– Indications for and type of isolation for each
specific disease
– A definition for nosocomial infection
– Designation of an Infection Control officer
Chapter 667
– A program of orientation of new employees and
other workers including physicians
– A program of continuing education concerning
infection control
CMS Regulations (State Operations
Manual)
• 482.42 Infection Control
– Provide Sanitary environment to avoid sources
and transmissions of infections and communicable
diseases.
– Must have active program for the prevention and
control and investigation of infections and
diseases.
– A person or persons must be designated as the
Infection Control officer
CMS Regulations
• Log of incidents related to infections and
communicable diseases (review sample log)
• The CEO, medical staff and director of nursing
MUST ensure that there are hospital programs
and training related to infection control and they
are responsible for the implementation of
successful corrective action in problem areas
• Review the 16 page CMS IC surveyor audit tool.
OSHA
• Requires Bloodborne Pathogens Exposure
Control Plan that must include the following:
– Purpose
– Scope
– Definitions
– Exposure determination
OSHA
– Control Measures
• Engineering Controls
• Work Practice Controls
• PPE (personal protective equipment)
– Hepatitis B vaccination
– Post exposure evaluation and follow-up
– Sharps Injury log
– Training and Education
– Recordkeeping
OSHA
• Bloodborne pathogens 1910.1030 29CFR
• www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDAR
DS&p_id=10051
• 1910.1030(c)(1)(iv)(B) Document annually consideration and
implementation of appropriate commercially available and effective safer
medical devices designed to eliminate or minimize occupational exposure.
• 1910.1030(c)(1)(v) An employer, who is required to establish an Exposure
Control Plan shall solicit input from non-managerial employees
responsible for direct patient care who are potentially exposed to injuries
from contaminated sharps in the identification, evaluation, and selection
of effective engineering and work practice controls and shall document
the solicitation in the Exposure Control Plan.
OSHA
• TB Control plan and Risk Assessment
• http://www.cdc.gov/tb/pubs/mmwr/Maj_guide/
Control_Elim.htm
• Risk Assessment Appendix B must be done
annually.
– Low
– Medium
– High
• Contact Investigation
The Joint Commission
I. Planning
a.
b.
c.
d.
e.
f.
Responsibility
Resources
Risks
Goals
Activities
Influx
II. Implementation
a.
b.
c.
d.
Activities
Medical Equipment, devices, supplies
Transmission of Infections
Influenza Vaccinations
III. Evaluation and Improvement
Other regulatory bodies…
• DNV