Infection Control Programs Institutional Public Health

1
Infection Control Programs Institutional Public
Health

• Epidemiologically-based isolation and barrier
  strategies
• Patient-to-Patient transmission Eg. TB, C.
  difficile, MRSA, VRE and other MDR organisms
• Patient-to-Staff transmission Eg. Blood Borne
  Pathogens (BBP), TB, meningococcus, scabies
• Staff-to-Patient transmission (Semmelweis)
  outbreaks of rubella, varicella, influenza, HSV,
  viral keratoconjunctivitis

2
(No Transcript)
3
OSHA-speakPPE Personal Protective Equipment
4
Infection Control(Simplified)

• Anticipate a high-risk exposure with every
  procedure wear appropriate PPE to prevent
  sticks splashes
• All blood contains some blood borne pathogen
• All diarrhea contains some enteric pathogen HAV
• All skin has MRSA or scabies
• TB is an Equal Opportunity Pathogen
• Please dont come to work sick
• Wash your hands

5
Isolation Categories

• Contact
• Skin, mucous membranes, fluids, objects in
  hospital environment
• Wounds, diarrhea, vessicular/pustular rashes,
  drug-resistant organisms, SARS/Pandemic Flu
• Respiratory or Airborne
• Very small particles (sometimes for hours
• TB, primary varicella, rubeola, SARS/Pandemic Flu
• Droplet or Aerosol
• Wet droplets traveling a few feet 6 foot Rule
• Sneezing, coughing, suctioning, intubation
• N. meningitidis, influenza, SARS/Pandemic Flu

6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
Source Patient BBP Status - SFGH
10
Risk of Seroconversion from a Single Needle
StickRule of 3s

• HBV, e-antigen 30
• HCV 3
• HIV 0.3
• HIV splash

11
Risk Factors for Occupational BBP Transmission

• Deep injury ( 3mm)
• High inoculum volume x virus
• visible blood on injury-causing device
• hollow-bore needle suture (solid) needle
• high viral load (HBV, HIV, HCV)

12
Post Exposure Prophylaxis (PEP)Procedures for
HIV Exposure

• Basic regimen two nucleosides (NRTIs)
• For High Risk above protease inhibitor (PI)
• Initiate w/in 1 hr, continue for 28 d
• Surveillance serologies _at_ 6, 12, 24 wks
• SP heavily ARV-experienced, ?? VL or newly
  infected

13
Risk Reduction Strategies

• Learn how to do procedures safely
• Treat all procedures with equal respect
• Take your time
• Anticipate exposures, use PPE
• Remember eye protection!
• Safe devices are not intrinsically safer
• Injury rates actually rose when first introduced
• Learn how to use unfamiliar devices

14
24/7 Hotline Phone Numbers

• UCSF 719-3898
• SFGH VA 469-4411

15
Tuberculosis in San FranciscoDemographics - 2006

• 120 new cases in 2006 9 cf. 2005
• Incidence 14.9/100,000 (highest in Calif.)
• US average 4.8/100,000 (Europe11, Japan25)
• Healthy People 2010 1/100,000
• Demographics All Cases 2004
• Homeless 19 8
• ETOH 13 11
• IVDU 3 7
• HIV 9 12

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
Tuberculosis in San FranciscoDrug
Susceptibilities - 2006

• Fully Susceptible 87
• Any Resistance 8.3
• INH 2
• MDR (INHRIF) 1-3
• SF MDR (INHEMBStrep)

21
TB by Site - 2006

• UC/MZ (pulm extra pulm) 24
• SFGH (inpatient) 17
• VAMC (in/outpatient) 1

22
When to Think of TB

• History
• Close contact with active case
• Homeless, substance use, HIV risk factors, ETOH,
  recent incarceration, elderly, FB
• Symptoms for 2 weeks
• New productive cough, w/o hemoptysis
• Maybe fever, night sweats, weight loss

23
Doctor, Your Patient May Have Tuberculosis

• In the ER...
• Put surgical mask on patient before sending to
  lab and radiology (via elevators, etc.)
• Admit to Respiratory Isolation room
• Increased air exchanges
• Negative air pressure relative to corridor
• Designated exhaust ducting to outside
  non-recirculating
• Monitored
• On the Wards...
• Inform Infection Control Staff
• If smear notify TB Control (SFDPH) (415)
  648-8369

24
What the Patient Wears

• Whenever they are not in isolation status
• Going out of room
• Lab
• X-ray
• Visitors

25
What the HCW or Visitor Wears

• When in room
• When doing high-risk procedure
• Two Sizes
• Medium
• Small

26
What the HCW or Visitor Wears

• Usually better for small faces
• Two Sizes
• Medium
• Small

27
Hand Washing - 2007

• Soap water is necessary to clean hands
• Disinfectant soaps contains Triclosan, 0.5
• Bacteriostatic against gram positives gram
  negatives
• Reports of resistance appearing in literature
• Alcohol-based foams gels contain 60-65 EtOH
• Indicated for hand disinfection between patients
• Effective due to high user acceptance rates
• Also approved for OR
• C. difficile spores are not affected by alcohol
  soap water required
• Hand hygiene remains the single most important
  part of all infection control programs