Infection Prevention Topics to Cover Infection Prevention

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Infection Prevention
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Topics to Cover

• Infection Prevention / Control basics
• Hand Hygiene
• Respiratory/ Cough Etiquette
• Blood borne pathogen exposure prevention
• Tuberculosis exposure prevention
• Influenza prevention

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Goal Prevention Transmission

• Patient-to-Patient e.g.
  Clostridium difficile, drug resistant organisms
• Healthcare worker-to-Patient e.g. influenza,
  rubella
• Patient-to-Healthcare worker e.g. blood
  borne pathogens (BBP), tuberculosis, meningococcus

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Infection Control

• Standard Precautions based on the principal that
  ALL blood and body fluids may contain an
  infectious pathogen
• Hand hygiene before and after all patient
  encounters (and after removing gloves)
• Gloves for potential hand contact with blood,
  fluid, mucous membranes, and non-intact skin
• Gown, mask, eye protection/face shield for
  potential contact with secretions, blood, or
  fluid
• Respiratory hygiene/cough etiquette for all
  patients and visitors who may have respiratory
  infections
• Standard Precautions are a key safety measure for
  patients and healthcare workers

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HAND HYGIENE WHEN TO PERFORM?

• Before contact with patient
• After contact with patient or patients
  environment
• After removing gloves
• Before performing pt procedures
• Moving from contaminated body site to clean site
• Before eating and after using the restroom
• After touching your nose/eyes/mouth and blowing
  your nose

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Soap and Water vs. Alcohol Hand Gels?

• Use soap and water when hands are visibly soiled
• Hand hygiene of choice for C. difficile
• Alcohol based hand rubs
• Faster than hand washing
• Less drying than hand washing
• In general, greater decrease in number of
  organisms

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Right handprint on blood agar
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Right hand after alcohol-based hand gel
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Respiratory Etiquette Protect Others -- Cover
your Cough/ Sneeze
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Transmission Based Precautions

• Contact
• Prevent spread of organisms by direct or indirect
  contact
• Private room, gowns, gloves, dedicated patient
  equipment
• Used e.g. for certain drug-resistant organisms,
  C. difficile
• Droplet
• Prevent spread of organisms through respiratory
  secretions
• Large particle droplets generated by coughing,
  sneezing, suctioning
• Private room (physical separation), mask for
  healthcare worker
• Used e.g. for N. meningitidis, seasonal influenza
• Airborne
• Prevent spread of organisms in small particles (lt
  5m) suspended in air
• Negative pressure, private room, N95 respirator
  for healthcare worker
• Used e.g. for tuberculosis, smallpox

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Culture of Safety Personal Protective Equipment
(PPE), Engineering Controls, and Safety Devices
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Risk of seroconversion from a needle stick or
splashRule of 3s

• HBV, e-antigen 30
• HCV 3 (1.8)
• HIV 0.3 (0.2-0.5)
• HIV splash lt0.1

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Risk Reduction Strategies

• Learn how to do procedures safely and treat all
  procedures with respect
• Take your time
• Anticipate exposures, use PPE
• Remember eye protection
• Safe devices are not always intrinsically safer
• Some injury rates actually rose when first
  introduced
• Learn how to use unfamiliar devices

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24/7 Hotline Phone Numbers for Blood Borne
Pathogen Exposure

• First, wash area with soap and water (or flush
  eyes/mouth with water or saline). Then, call
• UCSF [phone] STIC
• SFGH VA [phone]

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Tuberculosis in San FranciscoDemographics - 2009

• 116 new cases active disease decrease of 1.7
  from 2008
• Incidence 14.2 cases/100,000
• US average 3.8 cases/100,000
• Demographics All Cases
• Foreign born (e.g. Asian/ PI) 76
• Homeless/marginally housed 13
• Alcohol abuse 9
• HIV 8
• Injection drug use 2

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When to think of TB

• History
• Close contact with active case
• Epidemiologic risk factors
• Symptoms for gt 2 weeks
• New productive cough
• Fever, night sweats, weight loss

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If your patient may have TB

• In the ED or clinic...
• Patients use surgical masks
• Healthcare workers use N95 respirators
• Move patient to respiratory isolation area, if
  available, or private room
• On the wards...
• Admit to Respiratory Isolation (SFGH) or
  Airborne/ AFB (Moffitt/ VA) room
• Healthcare workers use N95 respirators
• For discharges of active tuberculosis patients,
  must notify TB Control (SFDPH) [phone]

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For TB control patient wears surgical mask
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For TB control healthcare workers and visitors
wear N95 masks
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Influenza Prevention

• New policy Influenza vaccine required on annual
  basis for all employees OR sign a declination
  form and wear a mask during influenza season
• Respiratory/ cough etiquette
• Appropriate room placement (SFGH low level
  respiratory isolation UCSF droplet precautions)
  for suspected influenza/ respiratory viral
  illness

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UCSF Medical Center Seasonal Flu Shot Compliance
H1N1 vaccine compliance rate 75-85
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Infection Control assistance is available at all
sites

• UCSF and Mt. Zion 353-4343, pager
  443-2644 http//infectioncontrol.ucsfmedicalcente
  r.org/html/index.html
• SFGH 206-5466,
• pager 443-1566
• VAMC 221-4810, x3762 or x2728