To prevent the spread of infections, CDC recommends that ALL STAFF USE Standard Precautions with EVERY patient contact. HMC is adopting the CDC Isolation Precautions of Standard, and Expanded Precautions.
Elements of Standard Precautions | What’s New and Noteworthy at HMC in 2008 | Points of Emphasis |
Hand hygiene | Visitors and staff may audit if staff wash their hands before leaving the room. | Patients should also wash their hands (with soap and water) prior to meals, after toileting and before leaving their room. |
Cleaning equipment | FDA alerts noted that too much liquid dripping into open circuits has caused fires and damaged equipment. Electronic equipment and cords should have their keyboards, face plates and vented surfaces wiped with Sani-Wipes to avoid damaging equipment. | As a general rule, non-electronic equipment should first be cleaned to remove all visible dirt, then disinfected with rags soaked with Quat ammonium cleaner. IV poles, carts, stretcher boards, beds, tables, surfaces, door and sink handles should be cleaned in this way. |
Immunizations | MRSA infection, coupled with influenza, is an increasing cause of severe illness and death in children and young adults. | HMC’s goal in 2008 is that 90% of staff will comply with the immunization policy to protect themselves and their patients. |
Personal Protective Equipment | To reduce risk of colonization with MRSA, staff should routinely wear masks with eye protection when suctioning, intubating and providing trach care to patients. | Due to risks documented in CDC’s outbreak investigations, staff should wear masks to protect patients during lumbar punctures and epidural access. |
Respiratory Hygiene | Staff should ask visitors with coughs and signs of upper respiratory illnesses to cover their cough and wash their hands. | Patients with coughs or infectious respiratory illnesses should wear a surgical mask, if tolerated. when in public areas, |
Cleaning the Environment | Charge nurses should ensure that the EVS supervisor is aware of patients with C. difficile or norovirus infections. Sups. will give EVS staff chlorine containing detergent (Bru-Clean). | Infection Control faxes and e-mails the Isolation Precautions list of patients reported to them who need isolation and whose rooms need special cleaning. Notify IC if new patients are placed isolation. |
Laundry | To help clean equipment in rooms with Contact Precautions, staff may take in rags soaked with Bru-Clean, which contains chlorine. Put these rags in a laundry bag after use. | The Bru-Clean solution is made daily as needed by housekeeping (1 gallon to one tablet). It is the equivalent of 1: 50 bleach to water concentration. |
Safe Injections | CDC notes that hepatitis continues to be spread through the use of multi-dose vials accessed with used syringes. | HMC will avoid the use of multi-dose vials whenever possible, and ensure that syringes with incremental dosing are discarded after use on one patient. |
Patient Placement : | In 2008, the ICUs will place patients with MRSA into Contact Precautions. | In 2008, the Acute Care units will pilot measures to reduce the spread of MRSA between patients and staff. Contact Precautions for MRSA in Acute care may be modified due to the large number of patients admitted with community acquired MRSA. |
Elements of Expanded Precautions
| What's New and Noteworthy at HMC in 2008
| Points of Emphasis
|
Contact Precautions
| Contact Precautions replaced BSI + in 2007 | Staff use gowns and gloves to reduce diseases spread by contact |
| Most commonly used at HMC for multiple drug resistant organisms and C. difficile | HMC does not reculture patients prior to discontinuing Precautions for C. difficile; but DOES reculture for ESBL, VRE, MRSA, R-ACIN |
Droplet Precautions
| Droplet Precautions replaces Airborne Precautions. Use a mask, and a private room, or place the patient with an immune roommate | Droplet Precautions is most commonly used at HMC for Influenza, mumps, and untreated Neisseria meningititis. |
Airborne Precautions
| Airborne Precautions replaces « Airborne 2 » | Most commonly used for TB and rule out TB patients. |
| In 2008, rule out TB patients should routinely have 3 negative AFB smears before DC'ing Precautions. | Staff wear PAPRs and place patients in rooms with negative pressure. Transport patients with masks. |
Airborne and Contact Precautions
| This replaces Airborne 3. Staff use PAPR, gowns, gloves, face and eye protection. For zoster, and varicella, staff can wear a surgical masks or PAPR.
| Used for varicella and disseminated zoster in immunocompromised patients. It is also used for emerging infectious still poorly understood,or diseases transmitted by multiple routes : SARS, Viral hemorrhagic fevers, and smallpox. |
- HMC had 32 lab confirmed TB patients in 2006.
- HMC staff do not restrain TB patients to keep them in the isolation room or to prevent them from leaving.
Call PH-Seattle & King County if a TB patient leaves against medical advice or poses a danger to others.
To prevent exposure to TB:
- Place patients with a cough greater than 3 weeks in a private, negative pressure room if TB is being ruled out.
- Post the Airborne Precautions sign on the door.
- Wear PAPRs to enter the room.
- Mask the patient if the patient MUST leave the room.
Annual TB screening is required for ALL personnel working in patient care areas. Your screen must be in 2007 to be valid.
- If your skin test has not reacted in the past, you will need a PPD skin test. The test must be evaluated between 48 and 72 hours after placement and reported to Employee Health Service.
- If your skin test has reacted, and we have evidence of a negative chest x-ray, you must complete an annual TB symptoms questionnaire.
TB screening is available through Employee Health Services, located at 7EC room 02 during the following times: 7:15 a.m. to 4:30 p.m. M, W, Th, and F. 7:15 a.m. to 12:00 p.m. on Tuesday.
HMC uses Powered Air Purifying Respirators (PAPR) with High Efficiency Particulate Air (HEPA) filters. Employees must be trained for respirator wear.?The following steps shall be followed every time the respirator is used.
1. Step One 2. Step Two 3.Step Three
Step One: Inspect the respirator unit, air tube and hood for damage. Only use if all pieces are intact and in good working order. Immediately take malfunctioning equipment out of service and contact Clinical Engineering.
Step Two: Test air flow with unit ON. The airflow indicator must float above the lower band on the test cup.
Step Three: Put on the hood. There should be good airflow over the face, exiting below the chin. You are now ready to enter the isolation area. When finished, exit the room.
Step Four: Remove hood and turn off unit outside of contaminated area. Inspect equipment, clean if necessary.
Step Five: Return power unit to charger, and?your personal?hood to the storage area. Hoods used by more than one individual must be cleaned after use.
Helpful Numbers Regarding PAPRs
To report equipment failures, call Clinical Engineering at 4-3496.
To purchase hoods or checkout PAPR units, call Medical Stores at 4-8384.
To report exposures or concerns at any time, call Employee Health at 4-3081, or Epidemiology/Infection Control?at 4-9560.
We are continuously analyzing what devices and procedures are involved in exposures. The Product Evaluation Committee evaluates new devices. If you know of a device you would like evaluated:
- Wash area immediately.
- Seek care within 2 hours at Employee Health or the Emergency Department.
- Verbally report the exposure to Employee Health at 4-3081.
- Document the incident with your supervisor.
- Following employee exposure, patient consent for testing can be obtained and arranged by Employee Health or the Emergency Department. Counseling is also available.
- Hepatitis B, Hepatitis C, and HIV can ONLY be tested for after consent is obtained.
Patients at HMC with suspected avian influenza ("bird flu") or SARS are immediately placed in a private, negative pressure isolation room. All persons entering the room must sign in and wear gowns, gloves and PAPRs.
Infection Control must be notified immediately.
A Level 3 Airborne & High Level Containment Isolation Sign is posted for the following:
- Avian influenza
- SARS
- Smallpox, Vaccinia, Monkeypox
- Viral hemorrhagic fevers <>
HMC has a Plan for Control of Dangerous Pathogens which includes avian influenze, SARS, smallpox, and other emerging infectious diseases that are natural or intentional events.
For pandemic avian influenza, special plans are being developed for handling a surge of patients.
The plan can be found online at http://depts.washington.edu/ictrain or on the HMC intranet under Emergency Preparedness.
Other HMC Resources include the Infection Control staff headed by Dr. Dellit of Infectious Diseases and the Employee Health Service.
During construction and renovations, there could be conditions that might lead to infection problems in patients. These conditions include:
- Uncontained dust
- Air blowing out from a construction zone
- Water leaks
- Water soaked walls growing mold
If you see any of these during construction and renovation projects, please contact your manager, the shift engineer, or Infection Control.
You can learn more about infection control at HMC by linking to http://depts.washington.edu/ictrain/ and through the HMC intranet.
Epidemiology/Infection Control office: 744-9560
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Next, click on "Take the Quiz" at the bottom of this screen.
Once you are finished with the quiz, you will be directed to Module 4.
Last modified: 3/24/2008 9:10 AM