EXPOSURE CONTROL PLAN

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EXPOSURE CONTROL PLAN

• BLOODBORNE PATHOGEN PLAN
• TB EXPOSURE CONTROL PLAN
• ISOLATION

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• An Exposure Control Plan Manual
• can be found on every department at PSMH
• or via the
• Dovenet policy procedures infection
  control

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BLOODBORNE PATHOGEN PLAN
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• WHAT ARE BLOODBORNE PATHOGENS?
• viruses and bacteria that require blood
• or body fluids to live

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PSMH Bloodborne Pathogen Plan

• WHAT BACTERIA AND VIRUSES ARE
• WE TALKING ABOUT?
• HIV, HEPATITIS C, SYPHILIS, DELTA HEPATITIS,
• B HEPATITIS, AND MALARIA
• WE are MAINLY CONCERNED with
• HIV, HEPATITIS B AND C.

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These bacteria viruses can live in these BLOOD
BODY FLUIDS

• P BLOOD AND BLOOD PRODUCTS
• P CEREBRAL SPINAL FLUID
• P PLEURAL FLUID
• P PERICARDIAL FLUID
• P PERITONEAL FLUID
• P SEMEN, VAGINAL FLUID
• P AMNIOTIC FLUID
• P SYNOVIAL FLUID

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How are Bloodborne Pathogen spread?

• When infected fluids enter the body through
• Cuts, scrapes or other breaks in the skin
• Needle-stick injuries
• Splashes into the mouth, nose or eyes
• Oral, vaginal or anal sex
• Using infected drug needles
• Pregnant women who are infected with these
  pathogens may pass them to their babies.

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HOW DO YOU KNOW IF SOMEONE HAS ONE OF THESE
VIRSUS?

• YOU DONT!
• SIGNES AND SYMPTOMS OF HEPATITIS B HEPATITIS
  C (Flu like)
• Loss of Appetite, Tired feeling
• Low grade temperature
• Vague abdominal pain and discomfort
• Diarrhea or vomiting
• Yellow skin or eyes
• Patients with Hepatitis B or C may or may not
  have symptoms and will not be diagnosed unless
  they become jaundiced (yellow) BUT THEY ARE
  STILL CONTAGIOUS!

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Signs Symptoms of HIV

• Flu-like symptoms in the beginning
• May have more frequent bouts of flu, colds
• Eventually develop AIDS and will be diagnosed
• Fever, diarrhea and fatigue (tired feeling)
• It can take up to 10 years or longer before
• a person is sick enough to be diagnosed
• with HIV. In the mean time they are
• contagious!

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WHAT CAN WE DO TO PROTECTHEALTHCARE WORKERS?

• STANDARD PRECAUTIONS/UNIVERSAL PRECAUTIONS WERE
  DEVELOPED BY OSHA AND CDC.

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PSMH Bloodborne Pathogen Plan

• STANDARD/UNIVERSAL PRECAUTIONS
• A SYSTEM THAT OUTLINES SAFEGUARDS OR BARRIERS
  DESIGNED TO PROTECT HEALTHCARE WORKERS
• Personal Protective Equipment
• Engineering control
• Housekeeping
• Work Practice Controls

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PSMH Bloodborne Pathogen Plan

• STANDARD/UNIVERSAL PRECAUTIONS REQUIRE
• PERSONAL PROTECTIVE EQUIPMENT
• FOR EACH AND EVERY PATIENT
• If there is a possibility that you are going to
  touch or come in contact with anyone's blood,
  body fluids or mucous membranes
• YOU WILL WEAR GLOVES
• If there is a possibility of blood or body fluids
  splashing or coming in contact with your eyes
  nose or mouth
• YOU WILL WEAR A MASK GOGGLES OR A SHIELDED
  MASK

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PSMH Bloodborne Pathogen Plan

• STANDARD/UNIVERSAL PRECAUTIONS REQUIRE
• PERSONAL PROTECTIVE EQUIPMENT
• FOR EACH AND EVERY PATIENT
• If there is a possibility that you might have
  your clothing soiled with someone's blood or body
  fluids
• YOU WILL WEAR A GOWN
• Personal Protective Equipment (PPE) is located in
  each and every patient room (except in the
  Psychiatric Unit, 2E) in a beige BSI Box on the
  wall (gloves, gowns, masks, shielded masks,
  goggles and AMBU BAGS)
• When you use this equipment REPLACE IT
  IMMEDIATELY!

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PSMH Bloodborne Pathogen Plan

• 
  STANARD/UNIVERSAL PRECAUTONS REQUIRE
  
• 
  ENGINEERING CONTROLS
• Biohazard Labels and containers
• Safety Needles
• Needless IV Systems
• Sharps containers
• Safety scalpels
• Safety equipment is only as good as the
• people who use it!
• When safety equipment is provided use it
• activate the safety mechanisms as soon as
• you are done with the procedure.

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PSMH Bloodborne Pathogen Plan

• STANDARD/UNIVERSAL PRECAUTONS REQUIRE
• HOUSEKEEPING
• Proper disposal of SHARPS and broken glass
• Never reach into trash
• Dispose of sharps containers when 2/3 full
• Clean up Blood/Body Fluids using the proper
  equipment and according to policy

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PSMH Bloodborne Pathogen Plan

• STANDARD/UNIVERSAL PRECAUTONS REQUIRE
• WORK PRACTICE CONTROLS
• NEVER bend, break, or RECAP a Needle
• Minimize splashing of fluids during collection or
  disposal
• Dont eat or drink in work areas
• Wash your hands or skin after contact with body
  fluids or objects that might be contaminated

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PSMH Bloodborne Pathogen Plan

• HEPATITIS B VACCINE
• Hepatitis B is the only Bloodborne Pathogen we
  can protect against!
• IF YOU HAVE NOT BEEN VACCINATED FOR HEPATISIS B
  WE WILL GIVE THE VACCINE FREE OF CHARGE!
• See the Employee Health Nurse Brenda Dearth

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PSMH Bloodborne Pathogen Plan

• HEPATITS B VACCINE
• CONSISTS OF 3 INJECTIONS
• 1- now
• 1- one month later
• 1- five months after the second
• A TITER DRAWN BY THE LABORATORY 2 MONTHS AFTER
  COMPLETION OF THE SERIES.
• If you are not immune after the vaccination
  series you will be offered a repeat vaccine
  series if you are not immune after the second
  vaccination series you will not become immune.
  IF you are exposed to Hepatitis B you can be
  given Immune Globulin that will give you
  temporary immunity for 3 to 6 months

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PSMH Bloodborne Pathogen Plan

• WHAT IS AN EXPOSURE?
• Its any time blood or body fluids come in
  contact with a workers eyes, nose, mouth or skin
  through a needlestick, splash, or other type of
  exposure

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PSMH Bloodborne Pathogen Plan

• WHAT SHOULD YOU DO IF YOU HAVE AN EXPOSURE?
• FIRST
• WASH THE AFFECTED AREA THROUGHLY WITH WARM WATER
  AND SOAP AT ONCE!
• FOR MOUTH OR EYE EXPOSURE THROUGHLY RINSE OUT
  YOUR MOUTH WITH WATER OR MOUTHWASH FLUSH EYES
  WITH WARM WATER OR A SALINE SOLUTIONS.

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PSMH Bloodborne Pathogen Plan

• SECOND
• NOTIFY YOUR IMMEDIATE SUPERVISOR
• THEY WILL CALL THE HOUSE OPERATIONS MANAGER (HOM)
• THE HOM WILL TEST THE SOURCE FOR HIV, HEPATITS B
  AND HEPATITIS C.
• NOTIFY YOU OF THE HIV TEST RESULTS WITH IN ONE
  HOUR.
• THE HOM WILL FILL OUT A EXPOSURE FORM AND AN
  EMPLOYEE INJURY FORM

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PSMH Bloodborne Pathogen Plan

• IF THE PATIENT IS KNOWN TO BE HIV POSITIVE OR
  TESTS HIV POSITIVE.
• You will be sent to the ED or the Occupational
  Health Office for follow-up IMMEDIATELY. And the
  Infectious Disease Physician will consult with
  you about your exposure.
• If it is a significant exposure and you need
  medication to help prevent you from turning
  positive to HIV it will be provided to you
  immediately.
• IN ORDER TO PROVIDE YOU WITH THE BEST
• TREATMENT AVAILABLE IT IS VERY
• IMPORTANT THAT ALL EXPOSURES ARE
• REPORTED IMMEDIATLEY.

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PSMH Bloodborne Pathogen Plan

• THIRD
• CONTACT THE EMPLOYEE HEALTH NURSE FOR FOLLOW-UP
• The Employee Health Nurse will do base line
  testing on you this is for your benefit. She
  will do a HIV, Hepatitis Profile and a Hepatitis
  B Titer if you have been vaccinated.
• If your Hepatitis B titer is below 10 she will
  offer to revaccinate you. If you do not become
  immune after the second vaccination
• The Employee Health Nurse will provide follow-up
  on the source testing HIV, Hepatitis B and
  Hepatitis C.
• The Employee Health Nurse will provide you with a
  written consultation, and follow-up testing as
  required.

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• ANY TIME YOU HAVE ANY QUESTONS
• PLEASE CONTACT THE INFECTION
• CONTROL COORDINATOR
• Paula Pourchot RN
• INFECTION CONTROL DEPARTMENT
• PHONE [phone]
• PAGER 815-279-0561
• (Available 24 hours a day on pager or through the
• HOM. Pager number also available on answering
  machine)

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TB EXPOSURE CONTROL PLAN
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PSMH TB Exposure Control Plan

• WHAT IS TB?
• Tuberculosis (TB) is a disease caused by
  bacteria called Mycobacterium tuberculosis.
• The bacteria usually attack the lungs. But, TB
  bacteria can attack any part of the body such as
  the kidney, spine, and brain.
• If not treated properly, TB disease can be
  fatal.
• TB disease was once the leading cause of
  death in the United States.

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PSMH TB Exposure Control Plan

• HOW IS TB SPEAD?
• TB is spread when a person with active TB, who is
  infectious (sick with TB) coughs, laughs, talks
  or sings and expels the small bacteria (particle)
  into the air and someone near by breaths it into
  their lungs
• This bacteria (particle) is so small it can stay
  in the air for up to 90 minutes.

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PSMH TB Exposure Control Plan

• Patients are screened when they enter the
  hospital for TB by asking them if they have any
  signs of Infectious TB.
• Cough lasting longer than 2-3 weeks
• Low grade temperature
• Night Sweats
• Cough up blood
• Unexplained weight loss
• Loss of appetite
• Feel weak

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PSMH TB Exposure Control Plan

• When these signs and symptoms are present the
  patients chest x-ray is checked and their doctor
  is called and ask if the patient could possible
  have TB.
• If the Doctor feels this patient may have TB or
  there is a cavitations in their lungs they are
  transferred to a Negative Pressure Isolation and
  placed in AIRBORNE ISOLATION

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PSMH TB Exposure Control Plan

• Airborne Isolation requires a room with special
  ventilation
• The air in the room exit the room through a
  special filter or directly outside. It is not
  recirculated.
• The Door is kept shut at all times (except when
  entering or leaving the room.)
• Health care workers, visitors and Doctors who
  enter the room MUST wear an N95 Particulate
  Filter Respirator Mask.
• Healthcare workers MUST be fit tested and passed
  the fit test in order to wear the mask.
• Visitors must be taught how to put the mask on
  and fit checked by staff before entering the
  room.

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PSMH TB Exposure Control Plan

• TB SCREENING
• PPD (Mantoux Testing) is done on hire and anytime
  a healthcare worker or volunteer is exposed to
  MTB.
• Anyone who tests positive for the first time is
  sent to the Kankakee County Health Department for
  evaluation and possible treatment
• Treatment is provided Free by the Kankakee County
  Health Department.

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PSMH Bloodborne Pathogen Plan

• A POSITIVE TB TEST (PPD, Mantoux Test) means
• You have come in contact with the TB germ
• You are not infectious unless you have
  signs/symptoms of TB
• You cannot give TB to anyone at this stage.

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PSMH TB Exposure Control Plan

• If you come in contact with someone who is
  infectious in the hospital what happens?
• When a patient is placed in Airborne Isolation
• the doctor will order 3 AFB Sputum Tests
• If the test comes back positive for AFB the
  patient will be placed on treatment
• The specimen is then cultured and if the
  results are positive for TB you will be
  contacted and a PPD test will be done
  approximately 3 months after your exposure

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PSMH TB Exposure Control Plan

• PSMH is considered at LOW Risk for contact with
  Mycobacterium TB
• Therefore we do not do annual TB testing
• Staff/Volunteers will be tested if they are
• exposed to a patient with active infectious TB.

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• PROVENA ST. MARYS HOSPITAL
• ISOLATION GUIDELINES

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PSMH Isolation Guidelines

• How do I know if a patient requires ISOLATION?
• The first policy under ISOLATION in the Exposure
  Control Manual is called ISOLATION GUIDELINES
• This policy lists all the conditions and bacteria
  requiring Isolation
• The type of Isolation required
• The duration of Isolation
• This policy is also in the Infection Control
  Policy manual on line.

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PSMH Isolation Guidelines

• There are Three different types of
• Isolation are used at PSMH
• AIRBORNE
• DROPLET
• CONTACT

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PSMH Isolation Guidelines

• Airborne Isolation
• Airborne Isolation is used for TB, Chickenpox
  (Varicella) and Disseminated Herpes
• If or When we see Smallpox, SARS, or Avian Flu it
  will be used for these also.

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PSMH Isolation Guidelines

• Airborne Isolation
• For TB requires EVERYONE entering the room to
  wear an N95 Particulate Filter Mask, HealthCare
  Workers must be fit tested and have passed the
  fit test.
• Visitors must be fit checked to wear the mask.

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PSMH Isolation Guidelines

• Airborne Isolation
• For Chicken Pox (Varicella) and Disseminated
  Herpes (Shingles in more than one nerve) or
  Shingles in an immune -compromised patient)
• If you are immune to chicken pox you may enter
  
• the room without a N95 Particulate Filter
• Respirator Mask.
• If you are not immune have someone who is
• immune go in the room or wear an N95
  Particulate
• Filter Respirator Mask for which you have
  been fit
• tested and passed

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PSMH Isolation Guidelines

• Droplet Isolation
• Used for respiratory infections
• Pertusses (Whooping Cough)
• Influenza
• Pneumonic plague
• Diptheria
• Mycoplasma Pneumonia
• Mumps
• Rubella
• Haemophilus influenza type b (pneumonia and
  sepsis
• Bacterial Meningitis

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PSMH Isolation Guidelines

• Airborne Isolation
• Requires a private room equipped with negative
  air flow. (MICU 346, SICU Rooms 5 6, Peds room
  225-226, Recovery Room and Room 8 in OR.)
• The DOOR MUST REMAINED CLOSED.
• Dedicate equipment to the patient (thermometer,
  B/P Cuff, etc.) use disposable equipment whenever
  possible
• Any equipment used for the patient and taken out
  of the room must be thoroughly disinfected before
  it is used again.

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PSMH Isolation Guidelines

• Droplet Isolation
• Requires that a surgical mask be worn by EVERYONE
  who enters the room.
• This is in addition to Standard Precautions

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PSMH Isolation Guidelines

• Contact Isolation
• Is used for
• Diarrhea infection
• Salmonella, Shigella,
• Hepatitis A, Roto virus
• Clostridium difficile Undiagnosed diarrhea
• Respiratory Infections
• RSV (Respiratory Synovial Virus)
• Enterovial infections in infants/children
• Skin Infections
• Impetigo Zoster (chicken Pox, Shingles)
• Scabies

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PSMH Isolation Guidelines

• Contact Isolation
• Is used for
• Multidrug Resistant Organisms
• - MRSA
• - VRE
• - ESBLs
• - Clostridium difficile

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PSMH Isolation Guidelines

• Hand Hygiene when caring for a patient with
  Clostridium difficile requiring Contact Isolation
• DO NOT USE WATERLESS ALCOHOL HAND SANITIZER!
• DO USE SOAP AND WATER!

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PSMH Isolation Guidelines

• Clostridium difficile is called a spore forming
  bacteria it develops a hard coat to prevent
  alcohol or disinfectants to enter it so it is
  very difficult to kill.
• The only way to make sure it is not on your hands
  when you leave a patient who has this bacteria is
  to wash your hands with soap and water.

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Contact Isolation for Clostridium
difficile

• PLACE A SIGN ON THE ALCOHOL DISPENSER IN THE
  PATIENTS ROOM THAT SAYS
• PLEASE USE SOAP AND WATER FOR HAND HYGIENE. DO
  NOT USE ALCOHOL GEL!!!

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PSMH Isolation Guidelines

• Contact Isolation
• Requires Gown, and gloves be worn
• by
• EVERYONE upon entering the room
• EVERY TIME they enter the room!
• Healthcare workers
• Visitors, family members
• Doctors
• Volunteers are not to enter any Isolation Room
• Isolation Education must be documented for all
  patients and visitors.

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• HAND HYGIENE IS THE SINGLE MOST IMPORTANT THING
  YOU CAN DO TO PROTECT YOUR PATIENTS, YOURSELF AND
  YOUR FAMILY!
• YOU CANNOT REMEMBER WHERE YOUR HANDS WERE FIVE
  MINUTES AGO AND YOU DO NOT KNOW WHERE THEY WILL
  BE FIVE MINUTES FROM NOW!!!!

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HAND HYGIENE

• Perform Hand Hygiene
• Before patient contact as you walk into the
  patients room
• Before doing invasive tasks (Starting IV s)
• Before taking care of newborn, touching all
  wounds, touching non intact skin or mucous
  membranes, starting your shift,
• Before doing vital signs
• Before dispensing oral or IV medications and
  nutritional substances

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HAND HYGIENE

• Perform Hand Hygiene
• After contact with wounds, mucous membranes,
  blood and body fluids, secretions and excretions
  and other potentially infectious material
• After contact with equipment, inanimate objects,
  or surfaces that are likely to be contaminated
  (over bed table, phone, chart, TV, Call light,
  IV, Door handle, etc.)
• After leaving an isolation room
• After removing gloves and other Personal
  Protective Equipment
• After giving patients Medications or feeding
  them
• As you leave the patients room
• After your shift before leaving work

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All equipment must be cleaned after use between
patients.

• Germicidal Wipes
• need to have wet contact time of 2 minutes on the
  surface, then be allowed to air dry to kill the
  bacteria and viruses
• Clorox
• - need to have wet contact time of 3 minutes
  on the surface, then be allowed to air dry to
  kill the bacteria and viruses
• If patient has diarrhea use Clorox wipes on
  equipment and surfaces

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use a germicidal wipe to

• Clean equipment after patient use (lift
  equipment, glucometer)
• Clean room (bedside tables etc.)
• Clean Stethoscopes, blood pressure cuffs and data
  scopes
• Clean medication pass area prior to preparing
  medication
• Clean pill crushers
• Clean crash cart
• Clean counters, keyboards, mouse
• Clean telephone, pens and highlighters at nurses
  station
• Clean patient kitchen, counter, microwave,
  refrigerator
• Clean isolation binders

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For questions please contact

• Paula Pourchot RN
• Infection Control Preventionist
• Phone [phone]
• Pager 815-279-0561