Huron Medical Center 2012 Annual Mandatory Review Infection - - PDF document

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DIRECTIONS: At the end of this section/module, please complete the quiz

• nline with the corresponding topic. Results will be available to you at the

conclusion of each quiz. Please review, and if needed, arrange to meet with your manager to discuss any questions you may have. Huron Medical Center has an Education Policy that gives us guidance when developing and updating this Publication. The Purpose of this policy and the Edu- cation Grid is to help us ensure you have the information and competency need- ed to perform your job functions safely and assure Huron Medical Center is com- pliant with regulatory requirements. Each department also has department specific education needs. Please re- view any departmental policies and procedures specific to your area for any top- ics covered in this newsletter. Thank you for your time and energy in completing the annual requirements! If you have any questions regarding anything that you have read, please refer them to your Manager. If they are unable to answer your question, they will help you find someone who can.

Thank you for reading this information! Your participation in the Annual Mandatory Safety Education is important for your safety and the safety of others at HMC.

Huron Medical Center 2012 Annual Mandatory Review Infection Control/Employee Health

December 2012

Proper hand hygiene is necessary to decrease the risk of infection. It is con- sidered to be the single, most important procedure to prevent healthcare-related infections today. Huron Medical Center follows the CDC Category I recommen- dations; set forth by the following proce- dures: INDICATIONS FOR HANDWASHING AND HAND ANTISEPSIS: When entering or leaving the patient care environment. When hands are visibly dirty or con- taminated with blood or body fluids. Wash hands with either a non- antimicrobial or antimicrobial soap and water If hands are not visibly soiled, use an alcohol-based hand rub. Before direct patient contact and be- fore donning sterile gloves for proce- dures. After contact with a patient’s intact or non-intact skin. When moving from a contaminated body site to a clean body site. After removing glove Before eating, and before and after using the restroom. If exposed to suspected or proven Bacillus anthracis or Clostridium dif- ficile. WHAT’S THE PROPER WAY TO WASH MY HANDS? Turn on the water to a comfortable, warm temperature, and moisten hands with soap and water until they reach a heavy lather Wash well under running water for a minimum of 15 seconds Rinse hands well, dry with paper towel, and immediately discard. Turn off the running faucet with a clean paper towel and discard. IS IT OKAY TO USE HAND LOTION? Hand lotion that is approved by the In- fection Prevention Committee as com- patible for use with hand hygiene prod- ucts and gloves will be provided. Hand lotions should not be allowed to be brought from home. Contaminated hand lotions have been implicated in

• utbreaks of diseases.

WHEN SHOULD I USE ALCOHOL- BASED HAND RUBS? An alcohol-based hand rub is the pre- ferred method for hand hygiene in all situations, except for when your hands are visibly dirty or contaminated. When using an alcohol-based hand rub, ap- ply to the palm of one hand and rub to- gether; covering all surfaces of hands and fingers until dry. The Infection Prevention (IP) policies are available on HMC’s Intranet in PolicyStat under the Infection Control

• section. The IP Program is compre-

hensive in that it addresses detec- tion, prevention, and control of infec- tions among patients and personnel.

Source: http://www.cdc.gov/handhygiene/

This module is our way of helping you meet your annual safety training requirements. The safety of our employees, patients and visitors is very important to all of us. Please read this entire module, & complete the corresponding quiz online.

Remember: Safety is everyone’s job!

We’re on the Web: www.huronmedicalcenter.org

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2012 Huron Medical Center Annual Mandatory Module

WHAT ABOUT MY FINGERNAILS? Keep your natural fingernails short to about ¼ inch Do not wear artificial nails when having direct contact with patients

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2012 Huron Medical Center Annual Mandatory Module

Personal Protective Equipment (PPE) is used when exposure to blood, body fluids, excretions, secretions (except sweat), mucous membranes, or non-intact skin is anticipated. The type of protective barrier(s) should be appropriate for the procedure being performed and the type of ex- posure anticipated.

GOWN

Fully cover torso from neck to knees, arms to end of wrist, and wrap around the back Fasten in back at neck and waist

MASK OR RESPIRATOR

Secure ties or elastic band at middle of head and neck Fit flexible band to nose bridge Fit snug to face and below chin Fit-check respirator

GOGGLES/FACE SHIELD

Put over face and eyes and ad- just to fit

GLOVES

Extend to cover wrist of isolation gown

WHAT IS THE CORRECT WAY TO PUT ON (DONNING PPE) PPE?

SAFE WORK PRACTICES

Keep hands away from face Limit surfaces touched Change PPE torn or heavily contaminated Perform hand hygiene

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WHAT IS THE CORRECT WAY TO TAKE OFF (DOFFING) PPE?

Remove PPE at doorway before leaving patient room or in anteroom; remove respirator outside of room

HAND HYGIENE Perform immediately after removing all PPE

GLOVES

Outside of gloves are contaminated! Grasp outside of glove with opposite gloved hand; peel off Hold removed glove in gloved hand Slide fingers of ungloved hand under re- maining glove at wrist

GOGGLES/FACE SHIELD

Outside of goggles or face shield are contaminated! To remove, handle by ―clean‖ head band

• r ear pieces

Place in designated receptacle for repro- cessing or in waste container

GOWN

Gown front and sleeves are contaminat- ed! Unfasten neck, the waist ties Remove gown using a peeling motion; pull gown from each shoulder toward the same hand Gown will turn inside out Hold removed gown away from body, roll into a bundle and discard into waste or linen receptacle

MASK OR RESPIRATOR

Front of mask/respirator is contaminated – DO NOT TOUCH! Grasp bottom then top ties/elastics and remove Discard in waste container

Flu is a serious contagious disease that can lead to hospitalization and even death. CDC urges you to take the following actions to protect yourself and others from influenza (the flu):

Take time to get a flu vaccine.

CDC recommends a yearly flu vaccine, to everyone 6 months of age and older, as the first and most important step in protecting against flu viruses. Note-Children younger than 6 months are at high risk of serious flu illness, but are too young to be vaccinated. People who care for them should be vaccinated instead.

Take everyday preventive actions to stop the spread of germs.

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub. Avoid touching your eyes, nose and mouth. Germs spread this way. Try to avoid close contact with sick people. If you are sick with flu–like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) While sick, limit contact with others as much as possible to keep from infecting them.

Take flu antiviral drugs if your doctor prescribes them.

If you get the flu, antiviral drugs can treat your

• illness. Antiviral drugs can make illness mild-

er and shorten the time you are sick. They may also prevent serious flu complications.

CDC Says “Take 3” Actions To Fight The Flu

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Additional CDC Recommendations for healthcare professionals (HCP):

• 1. Promote and administer seasonal influen-

za vaccine: Employees are encouraged to get vaccinated-offered free of charge.

• 2. Monitor and manage ill healthcare person-

nel: HCP who develop fever and respiratory symptoms Should not report to work, or if at work; stop patient care activities, don a face mask, and promptly notify their director/supervisor. Staff are reminded that adherence to respira- tory hygiene and cough etiquette after return- ing to work is always important. If symptoms such as cough and sneezing are still present, HCP should wear a facemask during patient care activities. Hand hygiene should be rein- forced.

• 4. Adhere to standard and droplet precaution:

During the care of any patient, all HCP in every healthcare setting should adhere to standard precautions, which are the foundation for pre- venting transmission of infectious agents in all healthcare settings. Droplet precautions should be implemented for patients with suspected or confirmed influ- enza for 7days after illness onset or until 24 hours after the resolution of fever and respira- tory symptoms (whichever is longer), while a patient is in a healthcare facility. HCP should don a face mask when entering the room of a patient with suspected or con- firmed influenza. Remove the face mask when leav- ing the patient’s room, dispose of the face mask in a waste container, and perform hand hygiene.

• 5. Use caution when performing aerosol-

generating procedures: Some procedures per- formed on patients with suspected or confirmed influenza infection may be more likely to generate higher concentrations of infectious respiratory aerosols than coughing, sneezing, talking, or

• breathing. These procedures potentially put HCP

at an increased risk for influenza exposure. Addi- tional precautions should be used when such procedures are performed; such as bronchosco- py, sputum induction, intubation/extubation, as well as CPR and open suctioning of airways. Pre- cautions for aerosol-generating procedures include: Only performing these procedures on patients with suspected or confirmed influenza if they are medically necessary and cannot be postponed. Limiting the number of HCP present for a proce- dure to only those essential for patient care and support. Conducting the procedures in an airborne infec- tion isolation room (AIIR) when feasible. Consider use of portable HEPA filtration units to further reduce the concentration of air contami- nants. HCP should adhere to standard precautions and wear proper PPE. HCP should wear respiratory protection equiva- lent to a fitted N95 filtering face piece respirator during aerosol-generating procedures or when required in an occupational setting. A compre- hensive respiratory protection program for fit- testing and training is required under OSHA’s Respiratory Protection Standard (29 CFR 1910.134) Unprotected HCP should not be allowed in a room where an aerosol-generating procedure has been performed until sufficient time has elapsed to remove potentially infectious parti- cles.

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• 6. Manage visitor access and movement within

the facility: Limit visitors for patients in isolation for influenza to persons who are necessary for the patient’s well being and care. Visitors who have been in contact with the patient before and during hospitalization are a possible source of influenza for other patients, visitors, and staff.

• 7. Implement environmental infection control:

Standard cleaning and disinfection procedures are adequate for environmental control of the influenza virus in all settings within the healthcare

• facility. These include patient care areas in which

aerosol-generating procedures are performed. Management of laundry, food service utensils, and medical waste should also be performed in accordance with standard procedures. Source: http://www.cdc.gov/flu

Did you know: Vaccine preventable diseases are on the rise? According to the CDC, the following vaccines might be indicated for Healthcare Personnel, based on medical and other factors?

• 1. Influenza Vaccination

Annual vaccinations against influenza is recommended for all persons aged 6 months and older, including adults.

• 2. Tetanus, Diptheria, and Acellular Pertussis (Td/

Tdap) Vaccination: Healthcare personnel who have not or are unsure if they have previously received a dose of Tdap should receive a

• ne-time dose of Tdap as soon as feasible, without re-

gard to the interval since the previous dose of Td. Then,

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They should receive Td boosters every 10 years there- after.

• 3. Varicella Vaccination

It is recommended that all health care personnel (HCP) be immune to varicella. Evidence of immunity in HCP includes documentation of 2 doses of varicella given at least 28 days apart, history of varicella or herpes zoster based on physician diagnosis, laboratory evidence of immunity, or laboratory confirmation of disease.

• 4. Measles, Mumps, Rubella (MMR) Vaccination

Health care personnel (HCP) who work in medical facil- ities should be immune to measles, mumps, and rubel-

• la. HCP born in 1957 or later generally are considered

immune to measles and mumps. All adults born in 1957

• r later should have documentation of one or more dos-

es of MMR vaccine, unless they have a medical contra- indication to the vaccine, laboratory evidence of immun- ity to each of the three diseases, or documentation of provider-diagnosed measles or mumps disease

• 5. Hepatitis B Vaccination

Health care personnel (HCP) who perform tasks that may involve exposure to blood or body fluids should receive a 3-dose series of hepatitis B vaccine and then tested for hepatitis B surface antibody. HCP who are non-responders should receive the complete series a second time. Website: http://www.vaccineinformation.org

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The links in the Chain of Infection necessary for an infection to take place include:

• 1. Infectious agent
• 2. Reservoir (a place for the bacteria

to grow)

• 3. Portal of exit from the reservoir
• 4. Mode of Transmission
• 5. Portal of entry
• 6. Susceptible host

Modes of Transmission include: Contact Transmission Direct contact is body surface to body surface Indirect contact is transmission from intermediate

• bject, i.e. contaminated instruments

Droplet Transmission: Generated by coughing, sneezing, talking, and suctioning. Droplets are pro- pelled up to 3 feet through the air and deposited on the mucous membranes (eyes, nose or mouth). Airborne Transmission: Very small particles con- taining the infectious agent remain suspended in the air for long periods of time. This requires special air handling and ventilation to prevent transmission (Negative Pressure Rooms). Microorganisms trans- mitted by the airborne route include Mycobacterium tuberculosis, rubeola, smallpox and chickenpox. Vehicle Transmission Microorganisms are transmitted by such items as food, water, medications, devices and equipment as well as the hands of healthcare workers and the population in general. Vector Transmission Microorganisms are transmitted by vectors such as mosquitoes (West Nile Virus), flies, rats Pathways for infection include:

• 1. Respiratory (Chickenpox, mea-

sles, anthrax)

• 2. Gastrointestinal (In food or water)
• 3. Skin (Through breaks in the skin)
• 4. Mucous Membranes (Eyes, mouth)

EVERY EMPLOYEE IS RESPONSIBLE FOR INFECTION CONTROL

Healthcare-associated infections (HAIs) are infec- tions caused by a wide variety of common and unu- sual bacteria, fungi, and viruses during the course of receiving medical care. Medical advances have brought lifesaving care to patients in need, yet many of those advances come with a risk HAI. These infections related to medical care can be devastating and even deadly. As our ability to prevent HAIs grows, these infections are increasingly unacceptable. Recent successes in HAI elimination have been very encouraging. Examples include sustained reduction in central line-associated bloodstream infections (CLABSIs) by 70% simply by ensuring adherence to available guidelines. Reductions have been demon- strated for other HAIs as well, but, much more re- mains to be done. Wherever patient care is provided, adherence to infection prevention guidelines is need- ed to ensure that all care is safe. Huron Medical Cen- ter uses the Center for Disease Control & Prevention (CDC)/National Healthcare Safety Network (NHSN) Patient Safety Component Protocol in identifying healthcare associated infections. Source: ww.cdc.gov/hai/

INFECTION CONTROL IS REQUIRED BY MDCH, MEDICAID AND OTHER THIRD PARTY PAYERS

―Universal Precautions‖ is the Occupational Safety and Health Administration (OSHA) regulation for preventing transmission of bloodborne infections such as HIV, HBV, and HCV in the workplace. Universal Precautions are based on the concept that human blood and certain body fluids are treated as if they are known to be infectious for bloodborne pathogens.

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"Safety First" is "Safety Always" ~Charles M. Hayes Out of this nettle, danger, we pluck this flower, safety. ~William Shakespeare Accidents hurt - safety doesn't. ~Author Unknown

The Centers for Disease Control and Prevention (CDC) developed ―Standard Precautions‖. What are Standard Precau- tions? According to the CDC, Standard Pre- cautions are a set of infection control prac- tices that healthcare personnel use to re- duce transmission of microorganisms from both recognized and unrecognized sources

• f infection in healthcare settings. Standard

Precautions protect both healthcare person- nel and patients from contact with infectious

• agents. Standard Precautions include:

Hand Hygiene (handwashing with soap and water or use of an alcohol-based hand sanitizer) before and after patient contact and after contact with the imme- diate patient care environment. Personal protective equipment (PPE) when exposure to blood, body fluids, ex- cretions, secretions (except sweat), mu- cous membranes or non-intact skin is

• anticipated. PPE includes gloves, gowns,

masks, face shields, eye protection and resuscitation devices. When should you use Standard Precau- tions? Healthcare personnel caring for pa- tients should use Standard Precautions re- gardless of the patient’s diagnosis and whether or not the patient is known to have a communicable infection. In other words, Standard Precautions should be used for all patients, all the time. It is the intent of HMC that all patient blood and body fluids will be considered potential- ly infectious, and standard precautions will be used for all patients. (In addition to Standard Precautions, Isolation and Trans- mission Based Precautions [i.e. Airborne, Contact, Droplet, Protective Environment, Multi-Drug Resistant Organisms] will be uti- lized to interrupt disease transmission, see individual sections that follow. All personnel, physicians, contracted workers, students, volunteers, and observers are responsible for complying with Standard, Isolation, and Transmission based precautions as appro- priate. Gloves—gloves should be worn when- ever exposure to the following is planned

• r anticipated: Blood/blood products/

body fluids with visible blood, excretions, secretions, Urine, Feces, Saliva, Mucous membranes, Wound drainage, Drainage tubes, Non-intact skin, Amniotic, cerebral spinal, pericardial, pleural, peritoneal, synovial fluids, Performing venipuncture

• r invasive procedures

Masks and eyewear (or face shields)— should be worn during procedures that are likely to generate droplets/splashing

• f blood/body fluids.

Gowns/Aprons (fluid resistant) — should be worn when there is potential for soiling clothing with blood/body fluids. Eyewear—protection

• ver

the eyes should be worn during procedures that are likely to generate droplets of blood/ body fluids. Private room— consider when patient hygiene is poor or in cases where blood/ body fluids cannot be contained. Hand hygiene—Handwashing frequently is the single most important measure to reduce the risks of transmitting organ- isms from one person to another or from

• ne site to another on the same patient,

refer to hand hygiene procedures. Water- less products are encouraged for use and are placed in strategic locations. R e s u s c i t a t i o n e q u i p m e n t — mouthpieces or other ventilation devices should be available as alternatives for mouth to mouth resuscitation. Sharps precautions—safer sharps should be used and used sharps should be placed in an appropriately labeled puncture resistant container. Container are placed so that healthcare workers

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can easily see the opening and reach across hori- zontally to use, whenever possible. As a general rule needles are not to be recapped. Lab specimens—are placed in a container that pre- vents leakage during collection, handling, pro- cessing, storage, transport, or shipping and should be labeled with biohazard symbol. If outside con- tamination of the primary container occurs, it should be placed within a second container. Blood spills—spills of blood or other body fluids should be removed and the area decontaminated using the HMC approved blood spill kit. Gloves should be worn during cleaning and decontamina-

• tion. The manufacturer’s directions will be followed

for use of the product in cleaning and decontaminat- ing spills. The disinfectant should be EPA registered and have kill data against Hepatitis B and HIV or should be tuberculocidal. Linen—soiled linen should be handled as little as

• possible. Gloves should be worn to handle soiled/

wet linen. Linen will be bagged in an impervious bag

• r placed in a container lined with an impervious

lining. General waste—waste should be bagged in imper- vious bags in regular waste containers. Biomedical waste – refer to biomedical waste policy. Personal Protective Equipment (PPE)— Personal protective equipment (PPE) is used when exposure to blood, body fluids, excretions, secretions (except sweat), mucous membranes, or non-intact skin is anticipated. PPE is provided to all associates. Each associate is responsible for knowing where the equipment is kept in the department. The type of protective barrier(s) should be appropri- ate for the procedure being performed and the type

• f exposure anticipated. PPE available includes

gloves, gowns or aprons, masks, eye protection, and resuscitation devices. See ―Donning and Removing PPE‖; page 3 and 4. RESPIRATORY HYGIENE See Respiratory Hygiene/Cough Etiquette in Healthcare Settings. When are Droplet Precautions Used? Droplet precautions shall be used in addition to Stand- ard Precautions for patients with infections that can be transmitted by droplets (large-particle droplets, larger than 5 um in size). Droplet transmission involves con- tact of the conjunctiva or mucous membranes of the nose or mouth of a susceptible person with large- particle droplets containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. Droplets may be generat- ed by the patient's coughing, sneezing, talking, or dur- ing the performance of procedures, e.g., suctioning. PATIENT PLACEMENT Patient may be placed in a private room. If a private room is not necessary/not available, the patient may be placed in a room with a patient who has an active infection with the same organism but with no other infection (cohorting). When a private room is not available and cohort- ing is not an option, maintain spatial separation of at least 3 feet between the infected patient and

• ther patients and visitors. Special air handling

and ventilation are not necessary and the door may remain open. Droplet Isolation sign and isolation door hanger shall be placed on the door, and dedicated equip- ment should be used for that patient. MASKS A mask should be worn to enter the room or cubicle. See ―Donning & Doffing of PPE‖ page 3 and 4.

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When are Contact Precautions Used? Contact precautions in addition to standard precau- tions shall be used for patients known or suspected to have serious illnesses easily transmitted by direct pa- tient contact or by contact with items in the patient’s environment. BARRIERS INDICATED FOR CONTACT PRECAU- TIONS There are two types of contact transmission:

• 1. Direct Contact Transmission – microorganisms

are transmitted directly from person to person.

• 2. Indirect Contact Transmission – transfer of the

infectious agent through a contaminated intermedi- ate object or person. PATIENT PLACEMENT Patient may be placed in a private room. If a pri- vate room is not needed/not available, the patient may be placed in a room with a patient(s) who has an active infection with the same organism but with no other infection. Examples of patients who may require a private room include patients with re- sistant organisms who have copious drainage from a wound, patients with poor hygiene and whose behavior cannot be positively influenced, etc. Contact Isolation sign and isolation door hanger shall be placed on the door, and dedicated equip- ment should be used for that patient. GLOVES AND HAND HYGIENE Hand hygiene should be completed prior to don- ning gloves. Gloves should be worn when entering the room and while providing care for the patient. Gloves should be changed after having contact with infective material (e.g., fecal material and wound drainage). Gloves should be removed before leaving the pa- tient’s room and hand hygiene should be per- formed immediately. After glove removal and hand hygiene, hands should not touch potentially contaminated environ- mental surfaces or items. See ―Donning & Doffing of PPE‖ page 3 and 4. GOWNS A gown should be donned prior to entering the room or patient’s cubicle. The gown should be removed before leaving the patient’s room. After removal of the gown, clothing should not contact potentially contaminated environmental surfaces. See ―Donning & Doffing of PPE‖ page 3 and 4. PATIENT TRANSPORT Activities of the patient may need to be limited. This will be determined on a case-by-case basis. If the patient leaves the room, precautions should be maintained to minimize the risk of transmission

• f microorganisms to other patients and contamina-

tion of environmental surfaces or equipment. PATIENT CARE EQUIPMENT Dedicated patient-care equipment should be con- sidered for the patient. If use of common equipment or items is unavoida- ble, the items should be adequately cleaned and/or disinfected, according to HMC policy, before use for another patient. TRANSPORT Limit the movement and transport of the patient. If transport is necessary, masking the patient may mini- mize dispersal of droplets. DISEASES Examples of diseases in which droplet precautions may be considered include: Influenza, Mycoplasma pneumonia, Neisseria Meningitis, Strep Pharyngitis or

• Pneumonia. Refer to the IP manual located on the

intranet for complete listing.

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DISEASES Examples of diseases in which contact precautions may be considered include: Multi-drug resistant or- ganisms (e.g., MRSA, VRE, ESBLs, KPC- see fact sheets for these organisms in the IP Manual), scabies, Clostridium difficile, diarrhea, incontinence, and uncontained draining wounds. Refer to the IP manual located on the intra- net for complete listing. When are Airborne Precautions Used? Airborne precautions will be used in addition to stand- ard precautions for patients known or suspected to be infected with a disease spread by very small droplet nuclei (5 um or smaller). These particles may be spread through the air and may be carried on air cur- rents or inhaled by another person. Special air han- dling/ventilation is needed. Note: The following negative pressure options/rooms are available for use:

• 1. Emergency Department– Room #3
• 2. Cardio Pulmonary has a negative pressure tent to

be placed over bed

• 3. Plant Operations can set up the portable negative

pressure unit in a patient room

• 4. Obstetrics Department– Labor and Deliver Room #1
• 5. Obstetrics Department- Protective Nursery
• 6. Surgical Services– Operating Room #3

Staff is required to be fit tested for N95 masks prior to entering rooms where airborne precautions have been initiated.

• I. PATIENT PLACEMENT

A negative-pressure Airborne Infection Isolation Room (AIIR) is necessary. Airborne Isolation sign and isolation door hanger shall be placed on the door, and dedicated equip- ment should be used for that patient. Door must remain closed to ensure negative pres- sure. Patients with same diseases may be placed togeth- er.

• II. MASKS

A N95 respirator shall be worn when entering the room (annual fit testing is required). Respirator masks can be worn indefinitely until

• ne of the following conditions occurs: the mask

becomes contaminated, gets wet, loses its shape and efficacy or breathing becomes increasingly difficult. Susceptible persons should not enter the room of patients known or suspected to have measles (rubeola) or varicella (chickenpox) if other immune caregivers are available. TRANSPORT Limit the movement and transport of the patient from the room to essential purposes only. If movement or transport is necessary, patients shall wear a surgical mask if possible. DISEASES Examples of diseases in which airborne precau- tions may be considered include: TB, SARS, Chickenpox, Disseminated Zoster, Measles, Hemorrhagic fevers (Ebola, Lassa, Marburg). Re- fer to the IP manual for complete listing.

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The Infection Prevention (IP) policies are availa- ble on HMC’s Intranet in PolicyStat under the In- fection Control section. Infection prevention and control measures are re- quired both by law and professional standards. Participation in the Infection Prevention Program is an ―Unwritten‖ part of everyone’s job description. The purpose of the IP manual is to help our hospital achieve the best possible infection prevention and control for the protection of our patients, physicians, visitors and healthcare workers. The goals of the IP program are to: Decrease the risk of infection to patients and per- sonnel Monitor for occurrence of infection and implement appropriate control measures Identify and correct problems relating to infection prevention practices Limit unprotected exposure to pathogens through-

• ut the hospital.

Minimize the risk associated with procedures, medical devices, and medical equipment. Maintain compliance with state and federal regu- lations relating to infection prevention. Each employee must be aware of: The use of personal protective equipment (PPE) appropriately. Knowing and following the IP policies and proce- dures. Following hand hygiene and cough etiquette guidelines. Teaching patients and visitors infection preven- tion/control such as hand hygiene and cough eti- quette. Safe handling of sharps. Staying home from work when ill.

MIOSHA Michigan Occupational Safety and Health Administration

This is Michigan’s government agency that develops and enforces standards for workplace safety and health. MIOSHA, may either adopt or modify OSHA rules. Michigan did modify OSHA’s rules on Bloodborne patho- gens and titled them: ―Bloodborne Infectious Diseases‖ rules. MIOSHA may levy fines if their rules are not followed.

OSHA Occupational Safety and Health Administration

This is the U.S. government agency that develops and enforces standards for workplace safety and health. These standards may be based on CDC (Center for Disease Control) recommendations.

CDC Centers for Disease Control and Prevention

This is the U.S. agency that tracks the spread of diseases. It developed the original Universal Precautions recommendations for controlling HBV and HIV in the workplace. Later, the CDC developed the Standard Pre- cautions recommendations.

2012 Huron Medical Center Annual Mandatory Module

Bloodborne pathogens are disease-causing agents found in the blood. Potential sources of Bloodborne Pathogens include: Some of the Bloodborne infections caused by these Bloodborne pathogens include: HIV Infection (Can progress to AIDS) caused by HIV (Human Immunodeficiency Virus) which affects the immune system and limits the body’s ability to fight

• infection. HIV infection can progress to AIDS

(Acquired Immunodeficiency Syndrome). A person with HIV infection may display no symptoms at all. There are drugs that may delay the onset of symp- toms of AIDS, but there is no cure and there is no vaccine to prevent HIV infection. The occupational risk for AIDS is small. However, the incidence of HIV in the population is growing. Once a person is infected with HIV, they are a carrier for life. Hepatitis B caused by HBV (Hepatitis B Virus) which is a viral infection of the liver caused by the hepatitis B virus. Potential symptoms of Hepatitis B may in- clude: mild flu-like illness, nausea, abdominal pain, fatigue, yellow skin and eyes, dark urine, rash, joint pain, fever or no symptoms at all. The occupational risk is more significant for HBV than for HIV. Because more health care workers are getting im- munized against Hepatitis B, these numbers are coming down. Hepatitis C caused by HCV (Hepatitis C Virus) is a viral infection of the liver caused by the Hepatitis C

• virus. It is the most common chronic

bloodborne infection in the U.S. There are no vaccine or immune globulin products available to pre- vent transmission of Hepatitis C. Modes of transmission are ways blood or fluids con- taining bloodborne pathogens get inside the body. Transmission in Health Care Workers are usually from: Needle sticks and punctures with instruments that contain or have blood or body fluids on the needle or instrument. Splash of blood or body fluids into mucous mem- branes (eyes, nose, mouth) Spill of blood or body fluids onto nonintact skin, i.e. open dermatitis, small cuts on the hands. You can protect yourself by: Following Universal or Standard Precautions against exposure to bloodborne pathogens. Following OSHA rules and Huron Medical Center’s Exposure Control Plan. Prevent exposures to bloodborne pathogens by following these safety rules: Treat all blood and body fluids as if they are infect- ed. Always wear gloves or other personal protective equipment (PPE). Always wash hands thoroughly after removing personal protective equipment (PPE). If soap and water is not available, use antiseptic hand cleaners. Dispose of needles, scalpels or other sharps im- mediately after use in properly marked containers. No eating, drinking, applying cosmetics, lip balm

• r handling contact lenses in patient care areas.

Utilize good cleaning and disinfecting procedures.

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Blood Body fluids that con- tain blood Semen Vaginal secretions

Fluid from around an unborn baby

Spinal fluid

Fluid from around the heart Fluid from around the lungs

Fluid around joints Tissue removed from the body All body fluids where it is difficult or impossible to differentiate between body fluids

2012 Huron Medical Center Annual Mandatory Module

Health care workers have to protect their own health, as well as that of patients. One risk that affects people in a wide range of health care jobs is exposure to bloodborne pathogens. Relatively few people contract bloodborne illness on the

• job. But no one wants to take a chance with HIV,

the virus that causes AIDS, HBV, the hepatitis B virus, or HBC, the hepatitis C virus. These illnesses are transmitted by infected blood and

• ther potentially infectious body
• fluids. They're a small but serious risk for people

in patient care, emergency response, and house-

• keeping. You also need protection if you handle

patient linens or waste (including sharps), or perform lab work that involves blood or bodily fluids.

To assure you of these protections, the Occupational Safety and Health Administration (OSHA) developed a detailed regulation called the Bloodborne Pathogens Standard. Which requires: ▪ A written Exposure Control Plan ▪ Engineering and work practice controls (ECP) ▪ Personal Protective Equipment (PPE) ▪ Training ▪ Medical Surveillance ▪ Free Hepatitis B Vaccination (Category A Employees only) ▪ Signs and Labels indicating hazard

Employees have responsibilities, too. To avoid expo- sure to bloodborne pathogens, they must make full use of all the training, procedures, and protections that employers provide.

Huron Medical Center (HMC) is committed to providing a safe and healthful work environment for

• ur entire staff. Because of this the ECP applies to all

HMC personnel who are permanent, temporary, casu- al, contracted, physicians, volunteer workers, and stu- dents who may anticipate risk of occupational expo- sure to blood or other potentially infectious material. The ECP is a key document to assist our facility in implementing and ensuring compliance with the standard, thereby protecting our employees. HMC’s Exposure Control Plan includes the fol- lowing (complete policies located on PolicyStat):

• 1. Determination of employee expo-

sure

• 2. Methods of Implementation and

Control including:

• A. Standard precautions
• B. Engineering controls
• C. Work practice controls
• D. Personal protective equipment
• E. Housekeeping
• F. Laundry
• G. Labels
• H. Hepatitis B Vaccination
• 3. Post Exposure Management
• 4. Employee Training
• 5. Recordkeeping
• 6. Sharps Injury Protection Plan

Page 15

2012 Huron Medical Center Annual Mandatory Module

• 1. TO DETERMINE POTENTIAL FOR EMPLOY-

EE EXPOSURES TO BLOOD OR OTHER POTEN- TIALLY INFECTIOUS MATERIAL (OPIM)

• 2. ECP-METHODS OF IMPLEMENTATION

AND CONTROL

Methods of Implementation and Control include:

• A. Standard precautions
• B. Engineering controls
• C. Work practice controls
• D. Personal protective equipment
• E. Housekeeping
• F. Laundry
• G. Labels
• H. Hepatitis B Vaccination
• A. STANDARD PRECAUTIONS

All employees will utilize standard precautions (refer to Standard Precautions Policy).

• B. ENGINEERING CONTROLS

Engineering Controls (e.g., needleless devices, shielded needle devices and etc.) will be used in combination with work practice controls to minimize or eliminate employee exposure to blood and other potentially infectious material.

Exposure determination will be made without regard to the use

• f personal protective equipment (PPE). Routine and reasonably

anticipated tasks and procedures to determine if there is an actual

• r reasonably anticipated employee exposure to blood or other

potentially infectious material (OPIM). Based on this evaluation employees will be categorized into category A or B as follows: CATEGORY A - Category A consists of occu-

pations that require procedures or other occupa- tion- related tasks that involve exposure or rea- sonably anticipated exposures to blood or body fluids or that involve likelihood for spills or splashes of blood or body fluids. This includes procedures or tasks conducted in non-routine situ- ations as a condition of employment.

(Those employees who are determined to have occupational exposure to blood or other potentially infectious materials (OPIM) must comply with the procedures and work practic- es outlined in this ECP)

CATEGORY B- Category B consists of occupa- tions that do not require tasks that involve expo- sure to blood or body fluids on routine or non- routine bases as a condition of employment. Em- ployees in this category do not perform or assist in emergency medical care or first aid and are not reasonably anticipated to be exposed in any way. 2012 Huron Medical Center Annual Mandatory Module

Page 16

• C. WORK PRACTICE CONTROLS

Work practice controls are used to further reduce or eliminate employee exposure to blood and other potentially infectious materials (OPIM). Department Directors/Supervisors are re- sponsible for overseeing the Work Practice Controls in their de- partments.

Work Practice Controls used are as listed:

Handwashing – Handwashing facilities must be readily

• accessible. If they are not, waterless hand cleaner will be
• provided. Hands shall be washed under the following con-

ditions and according to the Hand Hygiene policy:

• A. Immediately or as soon as feasible after the

removal of PPE.

• B. Following contact with blood or body fluids.
• C. Any other skin or mucous membranes that have

contact with these materials shall be washed as soon as feasible. Sharps Handling - Contaminated needles and other con- taminated sharps shall not be sheared, bent, or broken and shall not be recapped or resheathed (Refer to Sharps Dis- posal policy). Sharps disposal – Contaminated sharps shall be discard- ed immediately, or as soon as possible, in a sharps disposal

• container. The sharps disposal containers must never be
• verfilled. They are to be replaced when they are 2/3 full by
• housekeeping. (Refer to Sharps Disposal policy).

Reusable sharps – immediately or as soon as possible after use, contaminated reusable sharps shall be placed in appropriate containers until properly reprocessed. Food and drink – shall not be stored in refrigerators, freezers, shelves, cabinets or on countertops where blood or

• ther potentially infectious material is present or in areas of

possible contamination. Eating, Drinking, smoking, apply- ing cosmetics or lip balm, or handling contact lenses is pro- hibited in work areas where there is a reasonable likelihood

• f occupational exposure.

Mouth pipetting or suctioning - of blood and body fluids is prohibited. Procedures - involving blood or body fluids shall be per- formed in a manner that minimizes splashing, spraying and aerosolization. Specimen handling – specimens of blood or body fluids shall be placed in a container which prevents leakage dur- ing collection, handling, processing, storage, transport or shipping. Contaminated medical equipment – All equipment which may become contaminated during use shall be exam- ined prior to servicing or shipping and shall be decontami- nated as necessary, with hospital approved disinfectant. When decontamination of equipment or portions of such equipment is not feasible the parts that are contaminated must be labeled with a biohazard symbol stating which por- tions may be contaminated.

• D. PERSONAL PROTECTIVE EQUIPMENT (PPE)

When there is a risk of occupational exposures, personal protec- tive equipment (PPE) such as, but not limited to gloves, gowns, face shields, masks, or respirators, will be provided at no cost to

• employees. PPE will be chosen based on the anticipated expo-

sure to blood or body fluids. The protective equipment will be considered appropriate only if it prevents blood or other poten- tially infectious material from passing through or reaching work- er’s clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used. All employees using PPE must be aware of the following: Training- Is provided by department Directors/designee in the use of the appropriate PPE for the department tasks or proce- dures employees will perform. Use of PPE – All personnel who may have occupational expo- sure are required to use PPE (such as, but not limited to gloves, gowns, masks, face shields, goggles, glasses, surgical caps, shoe covers, and resuscitation masks) when they have reasonable an- ticipation of an exposure. Accessibility – Appropriate PPE in proper sizes shall be readi- ly accessible at the worksite or issued to employees.

• It is the responsibility of the employee to inform the

Director/Supervisor of difficulty or inability to obtain/ use specific PPE so that an alternative solution may be determined. 4. Cleaning, laundering and disposal – PPE shall be pro- vided, replaced, cleaned, repaired, laundered, and/or dis- posed of at no cost to employees.

2012 Huron Medical Center Annual Mandatory Module

Page 17

• E. HOUSEKEEPING

This includes, but is not limited to, utilizing approved cleaners and disinfectants, picking up broken glass by mechanical means

• nly, cleaning work areas, proper handling of regulated waste,

and changing sharps containers according to policy.

• F. LAUNDRY (refer to Laundry Service Policy)

Laundry that is contaminated will be:

• Handled as little as possible.
• Shall be bagged at the location where it was

used.

• Will not be sorted or rinsed at the location of

use. Contaminated wet laundry will be contained or placed in a leak-proof plastic bag prior to transport

• G. LABELS

Labeling with the biohazard symbol or the use of red bags or containers is used to warn employees of poten- tial hazards. The universal biohazard symbol must al- ways be used in conjunction with the word “biohazard”. The warning labels must be fluorescent orange or red in color. The following must be labeled appropriately as biohazard: ♦ Contaminated equipment ♦ Containers of regulated waste ♦ Refrigerators and freezers used to store blood or

• ther potentially infectious material

♦ Sharps disposal containers ♦ Containers used to store, transport, or ship blood

• r other potentially infectious materials (e.g., blood

drawing trays) ♦ Containers used to transport items contaminated with blood or other potentially infectious materials (e.g., basins)

Employees are to notify department Directors if they discover regulated waste containers, refrigera- tors containing blood or body fluids, contaminated equipment, etc., without proper labels.

• H. HEPATITIS B VACCINATION- The Hepatitis B vaccina-

tion is offered at no cost to employees in Category A.

Post-Exposure Evaluation and Follow-up

The following steps are to be taken by the healthcare worker when there is an exposure to blood or body fluids. Immediately following an exposure to blood or body fluids: ♦ Wash needlesticks and cuts with soap and water ♦ Flush splashes to the nose, mouth, or skin with water ♦ Irrigate eyes with clean water, saline, or sterile irrigate. All personnel who have an exposure to a patient’s blood/body fluids will immediately report to their Director/designee for treatment and testing as war- ranted per policy. Typical routes of exposure transmission for Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) in the healthcare setting are: ♦ Needlestick injuries ♦ Blood contact with preexisting portal of entry (such as scratch or cut) ♦ Blood fluid contact with a mucous mem brane (mouth, nose, eyes) ♦ Similar contact with other potentially in- fectious materials (OPIM) or regulated waste can also result in exposure to HIV, HBV, or HBC. In the event an exposure incident should occur, the director/employee will contact the HR Health Co-

• rdinator/IP or the on duty Clinical Manager for

post-exposure management. An immediately available confidential medical evaluation and follow-up will be conducted by Em- ployee Health (EH) Physician/Emergency Depart- ment Physician in coordination with the HR Health Coordinator/IP or Clinical Manager.

2012 Huron Medical Center Annual Mandatory Module

Page 18

Recordkeeping

Bloodborne pathogens (BBP) and other potential infectious material (OPIM) training and exposures are documented in accordance with OSHA standard 29 CFR 1910.1030. An exposure incident is evaluated to determine whether the case meets OSHA’s Recordkeeping Requirements (29 CFR 1904). In addition to the 29CFR 1904 recordkeeping require- ments, all percutaneous injuries from contaminated sharps are also recorded in the sharps injury log. A number will be used to identify each entry on the sharps injury log to protect the identity and confidentiality of the injured em-

• ployee. All incidences must include at

least: the date of the injury the type and brand of the device involved the department or work area where the incident occurred an explanation of how the incident

• ccurred

Training

Information and training on occu- pational hazards and required PPE is all new employees at General Orientation and to Category A em- ployees annually. Department specific orientation will include job specific training prior to beginning activities that may place employees at risk of occupational exposure. All employees who have occupa- tional exposure to bloodborne path-

• gens receive training on the epide-

miology, symptoms, and transmis- sion of bloodborne pathogen dis- eases. 2012 Huron Medical Center Annual Mandatory Module

Page 19

Page 20

All regulated waste shall be placed in closable, leak proof containers or bags that are color-coded or la- beled with a biohazard label. If the outside of the con- tainer of bag becomes contaminated then the contami- nated container or bag shall be placed in a second leak proof container or bag that is closable and labeled

• r color-coded. All specimens that are transported

within the hospital must be placed in an approved bio- hazard bag or container before transport. Large or multiple items are to be transported on a cart to mini- mize the chance of a spill. What is Regulated Medical Waste? Regulated Medical Waste may also be referred to as Potentially Infections Waste, Bio-Hazardous Waste, or Red Bag Waste. It includes: Liquid or semi-liquid blood or other potentially infec- tious materials (OPIM). OPIM – semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental pro- cedures, any other fluid that is visibly contaminated with blood. Contaminated items that could release blood or OPIM. Items caked with dried blood or OPIM capable of releasing these materials during handling. Contaminated sharps. Trace chemotherapy waste. Pathological waste – human organs, tissues, and body parts other than teeth. Sharps, but is not limited to – blades, broken glass (slides & Pipettes), capillary tubes, carpules, vessel dilators, endodontic files, reamers, guide wires, in- troducers, IV tubing with needle attached, lancets, needles, ortho wire, scalpels, scissors, disposable sharp instruments, staples, stylet, syringes. Cultures and stocks – Infectious agents and associ- ated biologicals, biological production waste, dis- carded live and attenuated vaccines, culture dishes and related devices. All of the above items should be placed in the Regulat- ed Medical Waste Containers. Examples of items that do go into the Sharps container: Needles Syringes with needles attached Scalpels IV tubing with needles attached Blood vials Broken/Contaminated glassware (e.g., specimen tubes, flasks, beakers, pipettes) Examples of items that do go into the RED bag: Visibly Bloody Gloves *Saturated Bandages Visibly Bloody Plastic Tubing Blood/Body Fluid Saturated Items Visibly Contaminated PPE Culture Petri Dishes *Saturated Gauze Potentially Infectious Materials Examples of items that do go into the regular garbage container: Garbage Alcohol Prep Pads Gauze/Bandages that are not saturated in blood and/or body fluids Gloves not visibly contaminated with blood Urine containers after the contents have been dumped down the drain Empty IV bags after the contents have been drained *Contaminated items that release blood or other poten- tially infectious materials in a liquid or semi-liquid state if compressed are considered saturated.

Page 20

Precautions must be taken when: Handling Sharps Working with Lab Materials Decontaminating Care Areas and Equipment Handling Laundry Disposing of Regulated Waste

2012 Huron Medical Center Annual Mandatory Module

Page 21

What is TB? Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the

• spine. A person with TB can die if they do not get treat-

ment. What Are the Symptoms of TB? The general symptoms of TB disease include feelings

• f sickness or weakness, weight loss, fever, and night
• sweats. The symptoms of TB disease of the lungs also

include coughing, chest pain, and the coughing up of

• blood. Symptoms of TB disease in other parts of the

body depend on the area affected. How is TB Spread? TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs can stay in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB germs can become infected; this is called latent TB infection. What is the Difference Between Latent TB Infection and TB Disease? People with latent TB infection have TB germs in their bodies, but they are not sick because the germs are not

• active. These people do not have symptoms of TB dis-

ease, and they cannot spread the germs to others. However, they may develop TB disease in the future. They are often prescribed treatment to prevent them from developing TB disease. People with TB disease are sick from TB germs that are active, meaning that they are multiplying and de- stroying tissue in their body. They usually have symp- toms of TB disease. People with TB disease of the lungs or throat are capable of spreading germs to oth-

• ers. They are prescribed drugs that can treat TB dis-

ease. What Should I Do if I Have Been Exposed to Some-

• ne with TB Disease?

People with TB disease are most likely to spread the germs to people they spend time with every day, such as family members or coworkers. If you have been exposed to someone with active TB disease, you should report to the HR Health Coordinator/IP who will arrange for an evaluation with the Employee Health Physician. In addition, the county health de- partment must be notified and will conduct the fol- low-up investigation. Why is Latent TB Infection Treated? If you have latent TB infection but not TB disease, your doctor may want you to take a drug to kill the TB germs and prevent you from developing TB disease. The deci- sion about taking treatment for latent infection will be based on your chances of developing TB disease. Some people are more likely than others to develop TB disease once they have TB infection. This includes people with HIV infection, people who were recently exposed to someone with TB disease, and people with certain medical conditions. How is TB Disease Treated? TB disease can be treated by taking several drugs for 6 to 12 months. It is very important that people who have TB disease finish the medicine, and take the drugs ex- actly as prescribed. If they stop taking the drugs too soon, they can become sick again; if they do not take the drugs correctly, the germs that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat.

Huron Medical Center (HMC) has adopted and will enforce the latest recommenda- tions of the Centers for Disease Control and Prevention (CDC) regarding preven- tion of occupational transmission of TB among its employees and volunteers. Based on the guidelines, a risk assess- ment will be conducted initially and annu- ally to assess HMC’s risk for transmission

• f TB and to direct the TB control

measures to be implemented. 2012 Huron Medical Center Annual Mandatory Module

Page 22 Page 22

Nine steps to avoiding needle sticks

• 1. Avoid the use of needles

where safe and effective alternatives are available.

• 2. Help your employer select

and evaluate devices with safety features.

• 3. Use devices with safety fea-

tures provided by your em- ployer.

• 4. Avoid recapping, bending or

removing used needles.

• 5. Plan safe handling and dis-

posal before beginning any procedure using needles.

• 6. Dispose of used needle de-

vices promptly in appropriate sharps disposal containers.

• 7. Report all needlestick and
• ther sharps-related injuries

promptly.

• 8. Tell your employer about

hazards from needles that you observe in your work environment.

• 9. Participate in bloodborne

pathogen training and follow recommended infection pre- vention practices, including hepatitis B vaccination.

Airborne Isolation-A private, negative-pressure airborne infection isolation room is necessary with monitored negative air

pressure relative to the other areas. Door must remain closed. All healthcare personnel entering the room must wear

appropriate personal protective equipment (PPE), with special emphasis on the use of the N95 respirator. If an employee is unable to be fit tested for the N95, the employee must wear a powered air-purifying respira- tor (PAPR). Training is required for both the N95 mask and the PAPR (see respirator mask fit test-

2012 Huron Medical Center Annual Mandatory Module

Safer medical devices can be of two types:

• 1. The first are ―sharps with engineered sharps injury protections.‖

These are non-needle sharps, or needle devices used for withdrawing body fluids, administering meds or other body fluids, or accessing a vein or artery with a build in safety feature or mechanism that effective- ly reduces the risk of an exposure incident.

• 2. The second are ―needleless systems.‖ A needleless system is de-

fined as, ―a device that does not use needles for the collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established, the administration of medication or fluids, or any other pro- cedure involving the potential for occupational exposure to Bloodborne Pathogens due to percutaneous injury from contaminated sharps. When evaluating and selecting a safer medical device, em- ployers must consult those who use sharps regularly on the job; including getting input from non-managerial employees responsible for providing direct patient care.

Page 23

Air purifying respirator masks are designed for employee use to re- duce employee exposures against inhaled particles which could harm

• them. Not all res-

pirators are the

• same. Some res-

pirators are de- signed to filter dusts and respira- tory airborne/ droplet trans- ferred infections while others are designed to protect employees from fumes, gases and vapors. An employee must know the condi- tions they are working in and use the appropriate protection. Examples of infections that respira- tor masks can help prevent are measles, smallpox, tuberculosis, anthrax, and SARS Why should you fit test a respi- rator? Getting a good fit with a respira- tor is essential to protect em- ployees against respiratory haz- ards. If the face piece doesn’t fit tight- ly on the employee’s face, the employee could be exposed to the very hazards the respiratory is designed to protect against. Inhalation is one of the most common ways hazardous sub- stances enter the body to do their damage. Fit testing is required in OSHA’s respiratory protection standard (29 CFR 1910.134[f]. Huron Medical Center uses the Qualitative Fit Test, which relies on the employee’s senses of smell and taste to determine if the respi- rator fits tightly. If the employee doesn’t smell or taste the test agent during the test, then the fit is good. HMC follows the current CDC rec-

• mmendations to determine who

needs to be fit-tested. Fit-testing is required before an employee can wear an N-95 in an area where exposure is possible. If an employee cannot be fit tested with an N-95, they can wear a PAPR (Powered Air Purifying Res- pirator) which requires special

• training. If an employee cannot tol-

erate any mask/hood, due to claus- trophobic or medical reasons, they need to remove themselves from the area of potential exposure. The respirator mask should be in- spected monthly by the employee for any breaks, tears, and/or loss of elasticity. Respirators should be stored in a plastic bag in a secure place. The bag should not be sealed totally air

• tight. The employee should write

their initials on the bottom strap and name on a white sticker label placed on the outside of the plastic bag. Fit Testing must be done when one

• f the following conditions occur:

Increase or loss of weight of 20#

• r more

Change in facial structure Change in facial hair Significant dental changes Change in the model of respirator Negative fit checks must be per- formed annually and before each

• use. All employees are encour-

aged to perform periodic fit checks

• f their N-95 mask according to the

negative fit check procedure. No employee should wear a respi- rator if facial hair interferes with the seal of the mask. Respirator masks can be worn in- definitely until one of the following conditions occur: The mask gets wet Breathing becomes increasingly difficult The mask loses it’s shape, and efficacy from damage or improp- er care The mask gets contaminated i.e., enters airborne isolation room) Please review the Respiratory Pro- tection Program in the Infection Prevention Policy Manual

• n

HMC’s Intranet.

2012 Huron Medical Center Annual Mandatory Module

Page 24

Anytime you or your patient is injured by a medical device, you should: Stop the equipment and remove from service Give any necessary emergency first aid Call the physician Call Plant Operations to pick up the equipment Notify Risk Management or the on-call administrator immediately Wellness is more than just the absence of disease. It encompasses the whole person, including physical, emotional and spiritual aspects of the individual’s life. People who do not take time to attend to aspects of wellness in each of these interconnected dynamic spheres will soon be taking time to deal with illness. The physical dimension of wellness promotes taking care of your body for optimal health and functioning. Physical health is attained through exercise, healthy eating, sleeping and resting according to our body

• needs. Important health tips include:

Don’t Smoke / Quit Smoking Maintain a physically healthy weight Exercise regularly Eat healthy foods Drink alcohol in moderation Our Spiritual selves allow us to find inner calm and peace to deal with whatever life brings. It is in our spiritual selves where we find meaning in life, com- fort, the ability to be compassionate, and to find beauty in what surrounds us. Signs of spiritual well- ness include: Having dreams/goals for your life Caring about what happens to your fellow man Identifying meaning in events of your life Having a clear sense of right and wrong Being able to explain why you believe what you believe Essential components of Emotional Wellness include self-acceptance and self-confidence, as well as the ability to share our feelings. It is impossible to pre- vent emotions (feelings) from happening, So it is im- portant to be able to cope in both an effective and healthy way. It is important to take care of yourself so that you are able to deal with the stresses of life and job. This means getting enough sleep, eating healthy foods, exercising, making time for things you enjoy, and having at least one person you can con- fide in. Signs of emotional health include: You are happy much of the time You feel good about who you are You have people in your life who care about you; those you can call when you need to You can say ―NO‖ when needed without guilt You can talk with someone about your concerns

2012 Huron Medical Center Annual Mandatory Module

Back injuries are the second leading cause of ab- senteeism from the work place and low back pain affects 80% of the population at some time in their

• lifetime. Back injuries make up more than half of the

injury claims among people who work in hospitals. Workers compensation premium is reduced when staff consistently use the available assistive devices to move patients. Proper lifting in all situations is critical to decrease the chance you could be injured . Three factors that increase risk of back injury: Repetition: Be aware of tasks that you repeat mul- tiple times through the day Awkward posture: i.e. Bending down to do a bed bath, reaching under a shelf to get a box, transfers of patient from bed to cart. Force: How heavy is the object you are moving? How far do you have to carry it? Are you in good enough physical condition to do your job? You can reduce the risk of injury by staying in good physical shape. The greater the strength, endurance and flexibility you have, the better you are able to meet the demands of your job. Stress can also in- crease your chance of injury. Stress relief, as well as building both strength and endurance will reduce your chance of injury. Consider starting an exercise program if you do not have one at this time and be sure you continue if you exercise on a regular basis now. So how do you lift properly? Plan ahead Check your surroundings to avoid obstacles and allow a clear path. Assess the load to make sure it is not too heavy

• r awkward.

Ask for help if you are not sure you can safely lift the object.

Use the available assistive devices consistently.

Use proper technique Lift with your legs by bending your knees. Keep abs tight and keep a natural curve of the spine. Keep the object close to your body with your cen- ter of gravity within the base of support. Do not twist but step through with your feet. Do not hold your breath. (If you have to hold your breath the load is too heavy.)

Page 25

Any time an employee is injured on the job, he/she must immediately report it to his/her supervisor or manager and an Incident Report must be completed. If the injury is non-emergent (meaning the employee can still perform the essential functions of the job), the employee is not required to be seen by an employee health physician, except in the case of an exposure to blood or body fluids. If the employee needs to be seen by the Employee Health physician, the Human Resource Health Coordinator must be contacted to coordinate. During nights and weekends, the Nursing Supervisor will determine if the employee needs to be seen by a physician, and will refer the employee to the ER as needed. In the case of a serious injury, the employee is immediately sent to the Emer- gency Room and the Human Resource Health Coordinator/Nursing Supervisor is notified to follow up. The incident report is completed by the manager and forwarded to Human Resources. In the event of an exposure to blood or body fluids, the employee must immediately report to his/her manager or Health Coordinator/Nursing Supervisor so that timely follow up may be done. A Doctors slip is ob- tained for an illness that results in being

• ff work 3 or more

consecutive days. The slip must contain date seen by a physi- cian, dates of total or partial disability, and any physical limita- tions and the physi- cian signature. The slip must be given to your supervisor be- fore returning to work.

2012 Huron Medical Center Annual Mandatory Module

Page 26

Your back is your foundation... it supports your entire body. Your back holds up your body, but it needs your help in order to do its job. Just one wrong move can cause back injury and serious pain. That pain may return again and again for the rest of your life. The best way to avoid back problems is to strengthen your back and abdominal muscles and learn to sit, stand, lift, and move correctly. Good back care does more than pre- vent injury. It’s an important part of keeping your body strong and flexible so you can continue to enjoy an active life.

Your Back Holds Up Your Body.

The spinal column, which is an s-shaped group of bones called vertebrae, bears most of the body’s weight. Cartilage pads called discs separate and cushion vertebrae. Ligaments connect the vertebrae. Muscles attached to the spine, plus the stomach muscles, keep the spinal column in place and the back strong.

One Wrong Move or Built-Up Stress on Weak Muscles Can Injure the Back.

Strain results from overused or overstretched mus- cles. Sprain occurs when sudden movements stretch/ twist ligaments. Muscle spasm can result from tension or stress. Slipped or herniated disc occurs when tears, fluid leakage, or other damage makes the disc lose its cushioning effect. That puts painful pressure on spinal nerves.

Be Aware of Acts and Habits That Strain or Weaken the Back.

Posture: Poor sitting or standing posture puts pain- ful stress on the back. Physical condition: Regular exercise keeps back and abdominal muscles strong and flexible enough to hold up your back and let it move properly. Weight: The more you weigh, the more your back has to hold up. A potbelly puts special strain on the back. Stress: Tension makes your muscles tense up. Overdoing: Lifting or otherwise taking on more than you can safely handle makes injury more likely. Staying in one position: It strains the back when you sit or stand for too long in one position. Awkward movements: Reaching, bending, or twist- ing forces your body, including your back, into un- natural positions.

Stand and Move in Ways That Protect Your Back.

Stand tall and straight, but not stiff. Keep your shoulders even and back, head up, and pelvis for- ward. Let your muscles do the work and reduce strain on the vertebrae in your lower back. Stand on a ladder or platform to reach items above your head. Keep your feet flat and spread slightly, back straight, and head up but not back. Don’t stand in one position too long; change posi- tion or walk around. Sit Properly to Reduce Strain on Your Back. Sit straight, with feet flat on the floor and knees bent. Lean your back against a supportive chair. If nec- essary, use a cushion or rolled-up towel for added back support. Keep your chair close to the desk or work surface. Adjust its height and support as needed. Turn with your whole body; don’t twist your trunk. Hold paperwork upright; don’t lean over to read. Adjust your workstation height if you can. Arrange your work area so you don’t have to reach

• r bend.

Place your computer monitor with the screen top slightly below eye level. Change positions and move around regularly.

Lift to Reduce Strain on Your Back.

If there is any doubt about your ability to lift some- thing without strain, get help from a mechanical aid

• r another person.

Let your legs, not your back, do the work with a wide stance.

2012 Huron Medical Center Annual Mandatory Module

Page 27

Squat close to pick up supplies or other loads. Keep your back straight, knees bent, and stomach muscles tight. Stand up slowly with your back straight; let your legs do the lifting. Grip loads firmly, with both entire hands, not just fingers. Carry loads close to your body; center your weight

• ver your feet.

Move slowly, with load no higher than your waist. Move your feet to change direction. Don’t twist; it’s a major cause of injury. Falls Are Another Cause of Back Injuries. Wet floors should be marked, spills cleaned up promptly, passageways cleaned one side at a time. Ladders must be in condition and used properly. Stairways must be well-lit and free of obstructions. A Healthy Lifestyle Helps Your Back. Take off extra pounds and take pressure off your back. Reduce stress. Learn to relax and unwind. Get enough rest. Sleep on a firm mattress, or place a board between the mattress and box spring. The best sleeping position is on your side, with legs slightly bent. Drive in a position far enough forward to avoid stretching toward the pedals or wheel. Stop at least hourly for a walk during long trips. Stretch before you begin lifting. Practice regular exercises to strengthen your back, abdomen and legs. (But check with a doctor first.) If your back hurts, stop what you’re doing. Rest. Summary

• 1. Your back—made up of vertebrae, discs, liga-

ments, and muscles—holds up your body.

• 2. Injuries like strains, sprains, and disc problems

can result from one wrong move or built-up stress

• n weak muscles.
• 3. Poor physical health can harm your back.
• 4. Don’t try to force your body into unnatural posi-

tions or do more than you can handle safely.

• 5. Stand tall and straight, shoulders even and back,

head up and pelvis forward.

• 6. Don’t stand in one position too long.
• 7. Sit straight, with your feet flat on the floor, knees

bent, back against a chair back, and chair close to the desk.

• 8. When you sit, avoid awkward reaching and bend-

ing and turn with your whole body.

• 9. Avoid manual lifting when possible. If you have to

lift, let your legs do the work—not your back.

2012 Huron Medical Center Annual Mandatory Module

Moving patients safely is much different than moving a compact box or crate. Patients come in different shapes and sizes and can be unpredictable. They can be cooperative one moment and combative the next. Patients can resist movement and be heavier than they

• appear. Other factors such as the

number of times the patients need to be moved throughout the day and the type of transfer being performed (bed to stretcher, w/c to bed, etc.) should be considered when determining the best and safest way to move the patient. Using an appropriate assistive de- vice consistently throughout the day, will allow you to use less force and be in a better posture to keep you, the caregiver, and the patient safe from injury or harm. Assistive Devices for Transfers HMC has many assistive devices available to use to help assist with movement of a patient. Purple sheet/ black roller sheets can be used to reposition a patient in bed or help transfer from bed to cart by reducing the amount of fric- tion. Sara lift can be used with patients up to 400 lbs. who are alert and can understand directions. Patients must be able to bear weight on at least one leg. Patients must also have good grip strength and ade- quate shoulder range of motion. Arjo lift can be used with non- weight bearing patients up to 500lbs. It can be used with patients who are

• n the floor and cannot get up.

Gait belts should be used with any patient who has the potential of los- ing their balance. Gait belts offer more control of the patient who is falling than grabbing the patient’s arm would. A gait belt can be used

• n a patient that has had abdominal

surgery by placing the gait belt around the chest. Hover mat can be inflated for easy movement and repositioning of pa- tients up to 600 lbs, Moving Patients Safely Prepare the Room Get everything out of the way Have the proper equipment and staff available (i.e. Gait belt, non-skid slippers, transfer sheet, mechanical lift, additional staff) Prepare the Patient Know the patient’s ability and if you are not sure, have someone help. Raise or lower the bed to appropri- ate height. Explain what you are going to do, giving clear instructions to the pa- tient and anyone helping you. Check all IV’s, catheter and other tubing that might get caught. Transfer the Patient Encourage the patient to help as much as they can. Keep the patient close. Do not lift the patient by the arms or

• shoulders. (Especially people with

arthritic shoulders.) Use an assistive device. Use proper lifting techniques. Get help if you are not sure of the patient’s ability or have any hesita- tion about having a safe transfer. Proper Posture for Patient Care Follow proper ergonomic principles for all patient care. Bring the bed to proper height so you do not have to bend too far. Keep the natural curve of your back as much as possible. Use an assistive device for bed mo- bility . Do not twist. Keep your task as close to you as you can. (Move the patient closer to the edge of the bed if you can.)

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Maintain the natural curve of the spine. Do not bend at the waist Exercise can help reduce the risk of back pain.

2012 Huron Medical Center Annual Mandatory Module

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CDC HMC HAZCOM Program False Claims Act Johns Hopkins FEMA MIOSHA HIPAA Privacy Law MHA HIPAA Security Law OIG Compliance Guidance HMC Bloodborne Pathogens Plan Oklahoma State University HMC Emergency Preparedness Plan OSHA

Resources

Hospital Education/Community Outreach: Terry Atwell, Becky Forster and Heidi Walker Diagnostic Imaging: Matt Rick Human Resource Health Coordinator/Infection Preventionist: Michelle Hammond Rehabilitation Services: Matt Rick & Denise War- czinsky Quality and Risk Management, Compliance, Priva- cy: Carrie Franzel Safety Officer, Plant Operations: Dave Eilers and Jason Talaski Pharmacy: Martha VanBelle

Module Contributors

“Huron Medical Center is committed to providing excellence in healthcare to our communities in a caring, compassionate manner.”

2012 Huron Medical Center Annual Mandatory Module

The Infection Prevention Committee is a multidisciplinary consisting of the IP and representatives from medical staff (as required by the bylaws), Administration, Cardiopulmonary services, Plant Operations, Laboratory, Nursing, Patholo- gy, Pharmacy, Quality/Risk Management, Surgical Services, and representatives from appropriate departments, as ap- proved by the committee. Consulting representatives may be requested from other disciplines or local health as necessary. The Committee meets every other month.