Infection Control and Hand Washing Manual

for Kindred Hospital

Table of Contents iii

Table of Contents

Table of Contents ........................................................................................................................... iii

Introduction ..................................................................................................................................... v

Chapter 1: The Chain of Infection .................................................................................................. 9

What is the Chain of Infection?................................................................................................... 9

How the chain of infection works ............................................................................................... 9

Who is susceptible? ................................................................................................................... 10

Antibiotic-Resistant Infections ..................................................................................................... 13

What is VRE? ............................................................................................................................ 13

Who is susceptible? ............................................................................................................... 13

What are the infection control measures for VRE? ............................................................... 13

What is MDR-TB? .................................................................................................................... 14

How is MDR-TB Transmitted? ............................................................................................. 14

What are the infection control measures for MDR-TB? ....................................................... 14

Chapter 3: The Importance of Hand Washing .............................................................................. 17

Why is hand washing important? .............................................................................................. 17

When should I wash my hands? ................................................................................................ 17

Hand sanitizing v. Hand washing .......................................................................................... 18

How do I properly wash my hands? .......................................................................................... 19

Chapter 4: Ways to Prevent Infections ......................................................................................... 21

How do I lessen my chances of spreading Infections?.............................................................. 21

How can gloves spread infections? ........................................................................................... 21

When to wear gloves: ............................................................................................................ 21

How to safely remove gloves: ............................................................................................... 21

How can scrubs spread infections? ........................................................................................... 22

Chapter 5: Ways to Maintain a Sanitized Environment Environment ................................ 24

How should I handle and dispose of sharp objects? .................................................................. 24

How should I handle and dispose clean and soiled linens? ....................................................... 24

iv Infection Control and Hand Washing Manual

Chapter 6: Precautions .................................................................................................................. 26

What is a contact precaution?.................................................................................................... 26

What is a droplet precaution? .................................................................................................... 27

What is an airborne precaution? ................................................................................................ 28

Introduction v

Introduction Two hundred and seventy-one. This is the number of causalities of one airplane crash. This is also the number of lives taken every day as a result of nosocomial infections. A nosocomial infection is an infection a patient acquires in the duration of their stay in a hospital that did not initially have upon admission. Hospital-acquired infections are the fourth leading cause of death in the United States. This means out of the approximately 1.8 million people suffering from a nosocomial each year, 99,000 will die. Methicillin-resistant staphylococcus aureus(MRSA)and vancomycin-resistant enterococci(VRE), the most commonly found bacterium in healthcare facilities, are usually harmless to those who are healthy. In fact, one out of every three people have the bacteria MRSA present in their nose and the bacteria VRE lives on the skin and intestinal tract. However, patients who are ill and immune systems are compromised these bacterium could lead to fatal results. Nearly a third of a patient’s room will be contaminated with MRSA and VRE and since this infections are virtually everywhere we must take special precautions to make sure the patients in our care have limited contact with these bacterium. The patient always comes first and it is our job as workers at Kindred to keep them as safe as possible on their road to recovery. This manual should be used as a reference on how to keep the patient, visitors and Kindred staff safe and sanitized from infections and disease.

Fly Chapter 1

Chapter 1: The Chain of Infection

What is the Chain of Infection?

The chain of infection is a way of gathering information to prevent an epidemic or spread of a disease. The chain consist of six links

• The organism • The reservoir • The portal of exit • The mode of transmission • The portal of entry • The vulnerable host

All of these links must be favorable in order for the organism to continue the epidemic. Any disruption in the chain would be a disruption in the epidemic.

How the chain of infection works

1. The Organism: There must be a contagious organism. The type of organism could be a bacteria, virus, protest, parasite, or fungi.

2. The Reservoir: The reservoir is where the organism is found between outbreaks. This could be environmental, the water supply, a living organism such as a rat or bird, or in this case the hospital.

3. The Portal of Exist: This is how the organism leaves the reservoir. The portal of exist could be through bodily floods such as blood or feces. Contaminated water could also be a portal of exist.

4. The Mode of Transmission- This is how the organism is passed from on host to the next. It could be passed from person to person through droplets, the air, or direct contact.

5. The Portal of Entry- This fifth step in the chain of infection has to do with how the organism enter the body. It could be through a break in the skin, an insect bite, contaminated food, or inhalation.

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This step is very important because it tells us what kind of personal protective equipment to use when entering the patients room.

6. The Vulnerable Host- This step tells us who is the most vulnerable to this organism. The most common vulnerable hosts are young children and the elderly. Those who have compromised immune system are also at high risk of contracting an infection.

Who is susceptible?

There are various factors that make people more or less susceptible to infection. Younger children and elderly are the highest at risk for contracting an infection. Chronic diseases such as HIV, diabetes, and asthma could also cause the person to be more susceptible as well as medications that the individual is taking.

Fly Chapter 2

Antibiotic-Resistant Infections

What is VRE?

VRE is an acronym for vancomycin-resistant enterococcus. The most common way of transmission of VRE within the hospital is through contact of health care workers hands. This is usually a direct result of inadequate hand washing.

Who is susceptible?

Patients who are at higher risk for VRE infections are:

• Patients in the Intensive Care Unit(ICU) • Patients undergoing chemotherapy • Patients undergoing a transplant • Patients who have had intra-abdominal • Patients who have had cardiothoracic procedures • Patients who have recently received antibiotic therapy • Patients who have received vancomycin orally or intravenously

What are the infection control measures for VRE?

Infection control measures include standard precautions in addition to contact precautions for VRE.

• All who enter the patient’s room should follow standard and contact precautions.

• The patient’s room must be cleaned daily • Patients should have their own patient care items

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What is MDR-TB?

Tuberculosis affects one third of the world’s population. The rise of multidrug-resistant tuberculosis is a pressing concern. Both Isoniazid and Rifampicin, the two most effective drugs, are both ineffective drugs against tuberculosis. Healthcare workers must receive annual TB screening.

How is MDR-TB Transmitted?

MDR-TB can be spread:

• through airborne and droplet interaction from people suffering from pulmonary or laryngeal disease

• by prolonged and closed contact with patients with MDR-TB

Those working in areas such as radiology units, bronchoscopy units, or tuberculosis laboratories are at higher risk of occupational exposure.

What are the infection control measures for MDR-TB?

• Early detection • Rapid implementation of infection control precautions • Diagnosis and treatment of TB • Patients should always be wearing a surgical mask while being

transported • Healthcare staff, and visitors should use standard as well as droplet

precautions upon entering a patient’s room

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Fly Chapter 3

Chapter 3: The Importance of Hand Washing

Why is hand washing important?

In society we are very inter-connected among each other and we may not notice how the smallest interactions can have the biggest impacts. Washing your hands is easy to do and it is one of the most effective methods used to prevent the spread of many types of infectious pathogens that can spread in your home and work place. When you have clean hands you can stop germs from spreading from one person to another, thus, stopping the spread of illness. Take a moment and think about the last door knob you touched when entering a community facility like a school, store or business. When interactions like this take place your hands accumulate all the bacteria that were present on all the other people’s hands who touched that same knob. Now to place these interactions in retrospect, it can also occur on a small scale, for example, when you exchange money, touch hands, and use small items (i.e pens and computer mice) In order to minimize the outspread of germs, washing your hands can significantly help kill germs before you have a chance to spread them further.

When should I wash my hands?

According to the U.S Centers for Disease Control and Prevention, you should wash your hands frequently throughout the day including:

• Before and after you prepare food • During food preparation when transitioning between different steps

(i.e. from handling meats to chopping veggies) • Before you eat

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• Before and after you care for someone who is sick and/or has an open wound

• After you exit the bathroom • After you change a baby’s diaper • After you sneeze cough or blow your nose • After handling garbage, animals or unsanitary materials • After you leave common places (i.e. classrooms, office spaces and

daycare facilities) • After you make physical contact with another person (i.e.

handshakes) • After playing/exploring outdoors • Before and after changing your contact lenses

Hand sanitizing v. Hand washing

Washing your hands with soap and water is the best way to reduce the number of germs that is present on your hands. In most situations soap and water are available in your nearest restroom, but if soap and water are not available, use and alcohol-based hand sanitizer. Alcohol-based hand sanitizers can quickly eliminated the number of germs that are present, but it does not eliminate all types of germs that soap does. Under no circumstance should sanitizer be used as a substitution or replacement to soap and water if it is available. Hand sanitizers my not be as effective if hands are moderate to extremely dirty, greasy or grimy. However the combination of both an alcohol-based sanitizer after you properly wash your hands with soap and water can be effective as well. How to properly sanitize:

• Apply the alcohol-based sanitizer to the palm of one hand (you should read the label to apply the correct amount)

• Rub the product over all surfaces of your hands from finger tips to wrist

• Rub your hands together until sanitizer is completely rubbed in

How do I properly wash my hands?

1. Wet your hands with clean warm or cold running water for at least 10 seconds. Apply a dime-size drop of soap to the inside of your palm.

2. Lather your hands by rubbing them together ensuring that the soap full covers all parts of your hands (from finger tips to wrist). Be sure to lather between your fingers and under your finger nails to ensure maximum coverage.

3. Scrub your hands for at least 20-30 seconds. This is the same amount of time is takes you to sing the “ABC song”. Make sure to apply some pressure between your hands while you scrub to clean the inside the ridges that are on the inside of your palms.

4. Rinse hands under clean running water until all the soap is removed.

5. Dry your hands to air dry or pat them with a clean towel. DO NOT rub your hands on your clothing or wipe them on any other surface.

6. Turn off the faucet with a towel.

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Fly Chapter 4

Index 21

Chapter 4: Ways to Prevent Infections

How do I lessen my chances of spreading Infections?

They are many ways to lessen the chances of spreading infections such as

• Nails should be short. No longer than 3 mm or past the fingertips • No artificial nails should be worn • Nail polish should not be worn longer than 3 days • Jewelry of any kind should be worn on the wrist or hands • Watches must be removed before work • Long sleeves should be pushed back • Long sleeves should never become wet or soiled

How can gloves spread infections?

After working with bodily fluids, gloves are covered with live pathogens. This pathogens can endanger the patient and cause infections.

When to wear gloves:

• Wear gloves whenever you may come into contact with all bodily fluids except for sweat

• Wear gloves when touching possibly contaminated objects

How to safely remove gloves:

In order to remove gloves without spreading pathogens, you must never touch your skin with the contaminated outside of wither glove.

• Grasp the palm of one glove close to the wrist • Pull the glove of with caution, turning it inside out • Hold the removed glove in the other hand

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• Place two fingers under the wrist of the still-gloved hand • Pull the glove off • Dispose of gloves • Wash hands with soap and water • Never leave a room with gloves still on.

How can scrubs spread infections?

In a recent study one-third of medical staff confessed they didn’t wash their scrubs before wearing them to work. 65% admitted they changed their lab coat less than once a week, despite known contamination. The scrubs we wear while in the hospital can be the culprit of many nosocomial infections. Think about the last time you were in a patient’s room. Was it possible you may have leaned on something or pulled down your shirt with your contaminated glove? As you make your rounds of the day you are spreading bacteria from your scrubs onto everything you come into contact with. This is why we must be careful and follow strict procedure on how and when to wash hospital uniforms.

• Take scrubs off as soon as you are home. • Wash scrubs in hot water • Wash scrubs daily • Wash lab coats daily • Tuck in scrub top • Make sure scrub pants do not touch the floor

Index 23

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Chapter 5: Ways to Maintain a Sanitized

Environment Environment

How should I handle and dispose of sharp objects? Knowing how to handle and dispose of sharp objects is very important. One must take special precautions each time. Without looking at the patient’s medical records, we do not know what they may have. Patients could be infected with various diseases such as HIV, Hepatitis, or other deadly illness. You must follow the correct procedures every time you use sharp objects such as razors or needles.

• Always wear gloves • Never recap a used needle • Never reach into sharp or waste containers • Dispose of sharp objects in the red biohazard bin • Clean the area you were in • Dispose of gloves properly in trash can • Wash hands

How should I handle and dispose clean and soiled linens? Both MRSA and VRE can survive for days in contaminated linens. In order to prevent the spread of infection through bed sheet, comforters, and towels:

• Hold soiled linen away from body • Never shake out soiled linen • Never place clean linen near the patients pillow • Dirty linen should be placed either on the foot of the bed or on the top of the

trashcan until disposed properly • Dirty linen should be disposed of in the yellow bins labeled “Linens”

Index 25

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Chapter 6: Precautions

What is a contact precaution?

Contact precautions should be taken for illness such as:

• Methicillin resistant Staphylococcus aurea (MRSA) • Extended spectrum beta-lactamase (ESBL) • Penicillin resistant Streptococcus oeumoniae (PRSP) • Multi-drug resistant Pseudomonas aeruginosa (MDRP) • Scabies • Herpes Zoster (Shingles) • Diarrhea

Appropriate procedures for patients with contact precautions:

• Wash patient’s hands with warm water and soap before transporting

• Give the patient a surgical or procedure mask and gown when transporting

• Notify the receiving area that the patient is being transported • Keep Negative Pressure Isolation Rooms closed

Before entering the patient’s room:

• Wash hand with soap and water • Wear gloves

Index 27

• Wear gown • Avoid touching own face or body

After leaving the patient’s room:

• Remove gown • Remove gloves • Wash hands with soap and water • Leave the patient’s door either cracked or closed

What is a droplet precaution? Droplet precautions should be taken for illness such as:

• Pertussis • Meningitis • Influenza • Mumps • Rubella • Tuberculosis • Streptococcus • Bronchitis • Croup • Pharyngitis • Pneumonia • Asthma • Anytime a red sign is placed on patient’s room door indicating

droplet precautions should be taken

The appropriate procedures for patients with droplet precautions:

• Maintain 2 mm distance from patients room • Disinfect equipment before and after use such as:

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Stethoscope Thermometer

Before entering the patient’s room:

• Wash hands • Put on surgical/procedure mask • Put on disposable gloves • Put PPE gown • PPE reusable googles are not required but are recommended

Before leaving the patient’s room:

• Dispose of gown • Dispose of mask • Dispose of gloves • Wash hands

What is an airborne precaution? Airborne precautions are procedures to protect against pathogens transmission through the air. Pathogens carried by airborne transmission can be dispersed widely by air currents. They can then be inhaled by the vulnerable host.

• Airborne precautions mimic droplet precautions. Follow the same steps in the case of an airborne precaution.

Index 29

Index

airborne, iv, 14, 28 chain of infection, iii, 9 contact, iv, v, 9, 13, 14, 18, 21, 22, 26 current, 14, 15

droplet, iv, 14, 27, 28 galleries, 15 MDR-TB, iii, 14 VRE, iii, v, 13, 24