General office number: 2-5790/2-6332 (6 a.m. – 4:30 p.m.)
RN, MS, CIC - Hospital Epidemiologist
Pager: (973) 312-4822 (24 hours/day)
Ř Cynthia Blackmon, RN, BSN - Infection Control Practitioner
Pager: (973) 312-5546 - During work hours: 6 a.m. - 1:45 p.m.
Ř Wilfredo Cruz, CIC - Infection Control Practitioner - Pager: (973) 312-4201
During work hours:
3:300 p.m.-7:30 p.m. Mon, Tues, Thurs, Friday and
Saturday 8 a.m-12:45 p.m.
Self Study Module
This module is designed to provide employees with education on accepted infection control practices and the infection control policies in place at University Hospital, including the bloodborne pathogens exposure control plan and tuberculosis control.
This module is to be used for annual update training and by an Infection Control Practitioner during new employee orientation. It is not to be used by new employees in lieu of attending the Infection Control portion of new employee orientation.
After completing the Infection Control self-study module, you will be able to:
· Describe how infections spread
· Explain Standard Precautions
· Name common infections transmitted by blood and other body fluids
· List types of protective work practices
· Explain and list the types of Personal Protective Equipment use at University Hospital
· Explain the steps involved in exposure reporting and follow up
· Name other types of precautions apart form Standard Precautions
· Explain how tuberculosis (TB) is transmitted
· Describe TB symptoms
· Explain the difference between TB infection and TB disease
· Describe protective steps used against TB exposure
· Describe TB skin test (TST) and where the TST is done.
GENERAL INFECTION CONTROL PRACTICES
Because of viruses such as HIV and the new drug-resistant super bacteria, such as MRSA and VRE, the risk of acquiring an infection in healthcare facilities has increased in recent years for both patients and staff. As a healthcare worker, you must recognize that these threats underscore the fundamental truth that using proper infection control practices is one of your most important job responsibilities.
Infection control practices are easy to ignore because they can be so elementary. Researchers at one hospital found that only 48 percent of staff in the intensive care units washed their hands before examining patients even though they knew they were being watched as part of a research project.
You must take time and make the effort required to consistently adhere to infection control procedures – because these procedures are crucial for protecting your patients and yourself from infection.
For infection to spread, three elements are required:
q A source of infectious microorganisms (germs)
q A susceptible host
q A means of transmission for the microorganism.
Unfortunately, healthcare facilities have several sources of infectious microorganisms including:
q Contaminated objects
People, including patients, staff members and visitors, can harbor a variety of infectious microorganisms such as bacteria, viruses, parasites, yeasts and fungi.
Although invisible, these microorganisms may be present in blood and other body fluids and secretions such as saliva, sputum, nasal and vaginal discharge, and wound drainage. They are also present in excrement and are often on the skin’s surface, especially the hands. A person doesn’t have to look or feel sick to be a source of infection. Patients can even infect themselves when microorganisms within their body multiply out of control.
Contaminated objects can also be sources of infection. Some objects especially prone to contamination include floors, bedpans, trash cans, medical equipment, invasive medical devices and dirty laundry.
To become a host, a person must be susceptible to the infectious organism. A person exposed to an infectious organism will not necessarily become a host because some people are immune to or able to resist the infection. Unfortunately, healthcare facilities have many different kind of patients that can become hosts. People particularly susceptible to infection include:
q Elderly patients
q Persons with weak or undeveloped immune systems
q Persons with cancer, multiple health problems or chronic diseases that require steroid therapy
q Patients with surgical incisions, catheters, breathing tubes and other medically induced pathways into the body that can allow infections to enter.
The longer a patient is in the hospital, the greater is his or her chance of acquiring an infection.
To be transmitted, microorganisms must enter the host’s body. Entrance may be gained through:
q The mouth, eyes, nose or other opening into the body
q A break in the host’s skin caused by cuts, nicks, skin abrasions or dermatitis
There are five main routes of transmission:
q Common vehicle
1. Contact Transmission—the most common route, can be either direct or indirect.
Indirect contact transmission—is when a source of infection contaminates an intermediate object, which then contacts a susceptible host. This can happen when contaminated gloves are not changed between patients or when a healthcare worker is stuck with a contaminated needle.
2. Droplet Transmission
Occurs when a source person produces tiny droplets containing infectious microorganisms. The droplets may be generated when the source person coughs, sneezes or talks, or during the performance of certain procedures such as bronchoscopy. The infectious droplets are propelled a short distance through the air and land in the host’s eyes, nose or mouth. Droplets do not remain suspended in the air.
3. Airborne Transmission—can occur over greater distances than droplet
transmission. The infectious microorganisms are carried by microscopic droplet nuclei or even dust particles that remain suspended in the air for long periods of time. The microorganisms can then be inhaled by a susceptible host in the same room, or they may be carried by air currents and infect people further away.
4. Common Vehicle Transmission —occurs when microorganisms are transmitted by contaminated items such as food, water, medications and equipment.
5. Vectorborne Transmission—occurs when mosquitoes, flies, rats and other vermin transmit microorganisms.
Common vehicle transmission and vectorborne transmission are both rare in U.S. healthcare facilities.
According to the Centers for Disease Control, effective infection control programs have two levels: Standard Precautions and Transmission-Based Precautions.
The Occupational Safety and Health Administration (OSHA) requires that employers protect employees with exposure to blood and body fluids from potential infection by organisms such as HIV, Hepatitis B (HBV), Hepatitis C (HCV) and syphilis, among others. University Hospital has an Exposure Control Plan which outlines the methods that are in place to minimize employee risk. These methods include the use of standard precautions, exposure reporting and follow up and offering of the Hepatitis B vaccine. The Exposure Control Plan is located in the Infection Control Policy and Procedure Manual.
Since there is no quick, surefire method of determining which patients may be carrying an infectious disease, Standard Precautions require that you treat all patients as though they may be infected. Standard Precautions combine the major features of:
q Universal Precautions—which reduce the risk of transmitting bloodborne pathogens.
q Body Substance Isolation—which reduces the risk of transmitting pathogens from moist body substances.
In other words, you must use Standard Precautions every time you anticipate contact with blood, all body fluids, secretions and excretions, nonintact skin and mucous membranes. Standard Precautions cover all healthcare workers whether they give direct patient care or work in support areas, like maintenance and housekeeping.
Standard Precautions outline a system of safeguards to help you protect yourself from infections such as hepatitis B, hepatitis C and HIV, while also protecting your patients from infectious organisms that are often transmitted from patient to patient by healthcare workers. University Hospital has developed policies using Standard Precautions, including:
q Protective work practices
q Use of personal protective equipment
q Protective Housekeeping
q Protection through the hepatitis B vaccination
q Exposure reporting.
You can decrease the spread of infection by using common sense and by practicing good hygiene.
HUMAN IMMUNODEFICIENCY VIRUS (HIV) the virus that causes AIDS.
is transmitted by:
INFECTION CONTROL EDUCATION POST-TEST
_______2. In droplet transmission, germs travel short distances through the air and land in
the host’s eyes, nose or mouth. True/False
_______ 3. Bloodborne pathogens include
b) Hepatitis B
c) Hepatitis C
e) All of the above
_______ 4. All of the following are examples of occupational exposure to bloodborne pathogens
a) A respiratory therapist is splashed with blood in the eye during an arterial puncture.
b) A nurse sustains a needlestick when discarding a needle use to draw blood from a patient.
c) A nursing assistant gets a drop of clear urine on his shoe while emptying urine from a Foley catheter.
d) A surgeon sustains a scalpel cut when making an abdominal incision on a patient.
_______ 5. Standard Precautions mean that blood and body fluid are treated as if potentially
_______ 6. Personal Protective Equipment (PPE) includes
a) Latex or vinyl disposable gloves
b) Fluid shield masks
c) Fluid resistant gowns
d) All of the above
_______ 7. Handwashing should be performed by using soap, running water and vigorous friction for
a) 5-7 seconds
b) 10-15 seconds
c) 3-4 seconds
d) Wetting the fingertips under running water for 2 seconds
_______ 8. Handwashing should be performed
a) After soiled gloves are removed
b) After patient contact
c) Before patient contact
d) All of the above
_______ 9. Sharps containers are available for the prompt disposal of all needles and other sharp
objects including broken glass. True/False
_______10. Items contaminated with blood or body fluids are placed into red bags.
_______11. The OSHA Bloodborne Pathogens Standards prohibit eating and drinking in areas where blood and body fluids are handled because these germs can be introduced into the body by contaminated hands and contaminated beverage containers. True/False
_______12. Items that are not contaminated with blood or body fluids are placed into clear bags.
_______13. As long as disposable gloves are not broken they could be washed and re-used.
______ 14. The Exposure Control Plan for Bloodborne Pathogens is located in the Infection Control Policy and Procedure Manual. True/False
_______16. TB is primarily transmitted by
a) Direct skin-to-skin contact
c) Airborne droplets
d) Blood splashes to the face
_______17. A patient with TB disease is infectious and must be put on Airborne Disease Isolation.
_______18. A person with TB Infection is not infectious. True/False
_______19. Negative Pressure means
a) Air flows in one direction from the patient's room into the hallway.
b) Air flows in one direction from the hallway into the patient's room.
c) Air flows back and forth from the patient's room into the hallway.
_______20. An N95 respirator must be worn by all staff members going into the room of a patient on Airborne Disease Isolation. True/False
_______21. TB skin testing is done every year for most employees with negative skin tests.
_______22. Some employees receive skin tests more often than once a year if they care for many TB
_______ 23. The precaution sign used for Airborne Disease isolation is
a) b) c) d)
_______ 24. Patients on Airborne Disease Isolation must wear a surgical mask when they are
transported out of their rooms. True/False
_______ 25. Symptoms of TB disease include
a) Night sweats
e) All the above