One of the most important educational tools in Long-term Care is a planned, annual, general infection control in-service for all staff. A lecture does not have the impact that a visual interpretation of Infection Prevention Guidelines does. For this reason investing in a good quality, comprehensive and current video for presentation is very worthwhile.
A good Infection Prevention educational video stresses how to “Break The Chain of Infection” by reviewing Standard and Transmission Based Precautions along with Airborne, Droplet and Contact Isolation Guidelines. Proper hand washing technique, the use of alcohol sanitizers, and recommendations for finger nail hygiene are also stressed. A visual demonstrations of how best to don and remove Personal Protective Equipment (PPE) such as gloves, masks, gowns and goggles, stressing where, how, and in what sequence, helps to make the process a visual experience. Employee health, work restrictions, vaccines for seasonal and H1N1 influenza and PPD testing of staff and residents for Tuberculosis should also be covered. At the end of the presentation the health care worker should be familiar with all of the above.
The second annual educational event to plan for is a mandatory review of the OSHA Blood Borne Pathogens Standard for all staff. This includes the role of the employer in providing a safe environment for health Care Workers on the job along with those likely to be exposed to patient blood and body fluids which have the potential to contain pathogens such as Hepatitis B and C, and HIV/AIDS. A review of employer sponsored Hepatitis B Vaccine programs is reviewed explaining the vaccine is not necessary for all employees but is intended to protect those expected to come in contact with blood and body fluids.
Once again a visual educational experience is more likely to leave a lasting impression on all staff then is a lecture without a “How to” component. These videos are available for purchase from APIC, the CDC, and leading Health Care Video manufacturers. They usually run between 15 and 30 minutes, can be shown to all shifts, and are appropriate for all levels of education.
The Preventionist should develop a lesson plan and handouts to accompany each in-service and retain them for future reference. Educating staff is the basis for every component of an effective Infection Prevention program. The process may seem somewhat daunting initially but will soon become second nature, with a little experience.
Next: Antibiotic Resistance
Friday, December 4, 2009
Friday, November 27, 2009
Breaking the Chain of Infection
The last post briefly explained the roles of both the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) and their influence on Universal, Standard, and Transmission Based Precautions, also known as Isolation Precautions. Isolation Precautions are needed in many situations but there are those where they are not really indicated.
Thinking in terms of interrupting transmission of infectious agents in everyday situations is known as Breaking the Chain of Infection. This term uses a metaphor to create a visual interpretation; each link depends on the last and the next, in order to continue. Break one link and there is no longer a connection.
An example might be:
The 1st link is the pathogen, let’s use MRSA.
The 2nd link is the reservoir or house the pathogen lives in. In this case it’s living in the nares (nose) of a nurse but not causing any clinical signs of infection.
The 3rd link is the portal of exit (the nurse rubs her nose, now the pathogen is on her hands).
The 4th link is the mode of transmission, the nurses hands.
The 5th link is the new host, her patient.
The 6th link is the portal of entry. The nurse does not take time to wash her hands and transmits the MRSA to her patient’s skin while taking her blood pressure.
The patient is a susceptible host because her immune status is impaired by her chronic medical conditions and diabetes. Her arm itches, she scratches it and places the MRSA she picked up from the nurse, directly into her open skin (portal of entry) and develops an MRSA wound infection.
Looking back we see any one of the links could have been broken at any time, preventing transmission from nurse to patient. Barriers were not indicated, simple, effective hand washing or the use of an alcohol sanitizer could have prevented transmission at each and every link. Had the nurse washed her hands after touching her nose and before touching her patient, she'd have Broken the Chain of Infection.
Next: Annual Infection Control and Bloodborne pathogens In-service
Thinking in terms of interrupting transmission of infectious agents in everyday situations is known as Breaking the Chain of Infection. This term uses a metaphor to create a visual interpretation; each link depends on the last and the next, in order to continue. Break one link and there is no longer a connection.
An example might be:
The 1st link is the pathogen, let’s use MRSA.
The 2nd link is the reservoir or house the pathogen lives in. In this case it’s living in the nares (nose) of a nurse but not causing any clinical signs of infection.
The 3rd link is the portal of exit (the nurse rubs her nose, now the pathogen is on her hands).
The 4th link is the mode of transmission, the nurses hands.
The 5th link is the new host, her patient.
The 6th link is the portal of entry. The nurse does not take time to wash her hands and transmits the MRSA to her patient’s skin while taking her blood pressure.
The patient is a susceptible host because her immune status is impaired by her chronic medical conditions and diabetes. Her arm itches, she scratches it and places the MRSA she picked up from the nurse, directly into her open skin (portal of entry) and develops an MRSA wound infection.
Looking back we see any one of the links could have been broken at any time, preventing transmission from nurse to patient. Barriers were not indicated, simple, effective hand washing or the use of an alcohol sanitizer could have prevented transmission at each and every link. Had the nurse washed her hands after touching her nose and before touching her patient, she'd have Broken the Chain of Infection.
Next: Annual Infection Control and Bloodborne pathogens In-service
Saturday, November 21, 2009
Universal, Standard and Transmission Based Precautions
What is OSHA?
OSHA is the acronym for the Occupational Safety and Health Administration, an agency of the Federal Government created by Congress in 1970 under The Department of Labor. OSHA mandates compliance with standards set for employee safety in the workplace. In 1991 OSHA developed the Bloodborne Pathogens Standard to protect workers from the risk associated with sharps injuries, HIV/AIDS, and Hepatitis B & C. Congress developed The Needlestick Safety and Prevention Act in 2000 and OSHA revised Standard to include the modifications in 2001.
OSHA developed Universal Precautions to prevent health care workers from coming in contact with all potentially infected blood or body fluids during the course of patient care. These precautions includes hand washing and the use of barriers such as gloves, gowns and masks.
What is the CDC?
CDC is the acronym for the Centers for Disease Control and Prevention, an agency of the Federal Government under the Department of Health and Human Services. The CDC is concerned with Public Health, safety and the prevention and control of disease.
Based on the fact that we cannot know a patient’s status with certainty, The CDC recommends Standard Precautions for the care of all patients no matter their diagnosis.
Standard Precautions include the use of Personal Protective Equipment (PPE) to provide a barrier to blood and body fluids. PPE consists of gloves, gowns, masks and face shields, as indicated.
Hand washing and alcohol hand sanitizers are used appropriately before and after contact with each patient, before and after donning gloves, passing medications, using the restroom, eating, inserting contacts or applying makeup.
In addition to Standard Precautions, Transmission Based Precautions are recommended when there is a confirmed or suspected pathogen of significance. These precautions are based on body site, type of pathogen and mode of transmission. They include:
Airborne Precautions for pathogens that travel through small particles in the air such as Tuberculosis. Airborne Precautions usually require the use of N-95 respirators and negative pressure rooms for patient care, options not normally available in Long-term Care.
Droplet Precautions are indicated for pathogens traveling on large droplet’s propelled in the air through respiratory secretions while sneezing, coughing or talking. These droplets travel about 3 feet; if it is expected the worker will come within 3 feet of the patient they wear a mask, conversley if the patient is transported from the room, they must wear a mask. Examples of droplet isolation include the influenza viruses, Pneumonias, and Meningitis. (See Appendix A of The CDC Guidelines for Isolation Precautions 2007 for a complete list.
Contact Precautions are used for infectious pathogens that are transmitted from skin to skin and by contact with a contaminated environment. Examples are C. Difficile, Noro Viruses, MRSA, and VRE.
Next: Breaking the Chain of Infection
OSHA is the acronym for the Occupational Safety and Health Administration, an agency of the Federal Government created by Congress in 1970 under The Department of Labor. OSHA mandates compliance with standards set for employee safety in the workplace. In 1991 OSHA developed the Bloodborne Pathogens Standard to protect workers from the risk associated with sharps injuries, HIV/AIDS, and Hepatitis B & C. Congress developed The Needlestick Safety and Prevention Act in 2000 and OSHA revised Standard to include the modifications in 2001.
OSHA developed Universal Precautions to prevent health care workers from coming in contact with all potentially infected blood or body fluids during the course of patient care. These precautions includes hand washing and the use of barriers such as gloves, gowns and masks.
What is the CDC?
CDC is the acronym for the Centers for Disease Control and Prevention, an agency of the Federal Government under the Department of Health and Human Services. The CDC is concerned with Public Health, safety and the prevention and control of disease.
Based on the fact that we cannot know a patient’s status with certainty, The CDC recommends Standard Precautions for the care of all patients no matter their diagnosis.
Standard Precautions include the use of Personal Protective Equipment (PPE) to provide a barrier to blood and body fluids. PPE consists of gloves, gowns, masks and face shields, as indicated.
Hand washing and alcohol hand sanitizers are used appropriately before and after contact with each patient, before and after donning gloves, passing medications, using the restroom, eating, inserting contacts or applying makeup.
In addition to Standard Precautions, Transmission Based Precautions are recommended when there is a confirmed or suspected pathogen of significance. These precautions are based on body site, type of pathogen and mode of transmission. They include:
Airborne Precautions for pathogens that travel through small particles in the air such as Tuberculosis. Airborne Precautions usually require the use of N-95 respirators and negative pressure rooms for patient care, options not normally available in Long-term Care.
Droplet Precautions are indicated for pathogens traveling on large droplet’s propelled in the air through respiratory secretions while sneezing, coughing or talking. These droplets travel about 3 feet; if it is expected the worker will come within 3 feet of the patient they wear a mask, conversley if the patient is transported from the room, they must wear a mask. Examples of droplet isolation include the influenza viruses, Pneumonias, and Meningitis. (See Appendix A of The CDC Guidelines for Isolation Precautions 2007 for a complete list.
Contact Precautions are used for infectious pathogens that are transmitted from skin to skin and by contact with a contaminated environment. Examples are C. Difficile, Noro Viruses, MRSA, and VRE.
Next: Breaking the Chain of Infection
Tuesday, November 17, 2009
The Surveillance Program
The acronym ICP (Infection Control Practitioner) is typically used to refer to the Infection Control Nurse in long-term care.
In the past, the term Nosocomial Infections was used to describe facility acquired infections; the newer term, Healthcare-associated Infections (HAI) is in use by Preventionists now.
In our last post we discussed many of the duties assigned to the ICP. One of the most important responsibilities is the Surveillance Program, which is a means of collecting patient data as it pertains to infection prevention and control.
Pertinent information about newly diagnosed infections, the clinical signs and symptoms supporting the diagnosis, and new orders for antibiotic treatments are reported on surveillance logs and then analyzed.
APIC and McGeer defines a Healthcare-Associated Infection (HAI) as one that develops more than 48 hours after admission.
Conversely, a Community–Associated Infection is one that was present on admission or developed with-in 48 hours of admission.
A Chronic Infection is one present at the same site from 1-3 months. These are monitored by the ICP and nursing staff as are all other infections, but for the purposes of statistical reporting they are referred to as Chronic rather than Healthcare-Associated Infections.
For statistical reporting McGeer’s Definitions of Infection for Surveillance in Long-term Care Facilities are generally recommended as a resource for analyzing and quantifying patient’s signs and symptoms. This information, in combination with reviewing of cultures and sensitivities, drug resistant organisms and anti-biotic usage, is recommended for monitoring and reporting infection rates.
Next: Standard Precautions and Transmission Based Precautions.
In the past, the term Nosocomial Infections was used to describe facility acquired infections; the newer term, Healthcare-associated Infections (HAI) is in use by Preventionists now.
In our last post we discussed many of the duties assigned to the ICP. One of the most important responsibilities is the Surveillance Program, which is a means of collecting patient data as it pertains to infection prevention and control.
Pertinent information about newly diagnosed infections, the clinical signs and symptoms supporting the diagnosis, and new orders for antibiotic treatments are reported on surveillance logs and then analyzed.
APIC and McGeer defines a Healthcare-Associated Infection (HAI) as one that develops more than 48 hours after admission.
Conversely, a Community–Associated Infection is one that was present on admission or developed with-in 48 hours of admission.
A Chronic Infection is one present at the same site from 1-3 months. These are monitored by the ICP and nursing staff as are all other infections, but for the purposes of statistical reporting they are referred to as Chronic rather than Healthcare-Associated Infections.
For statistical reporting McGeer’s Definitions of Infection for Surveillance in Long-term Care Facilities are generally recommended as a resource for analyzing and quantifying patient’s signs and symptoms. This information, in combination with reviewing of cultures and sensitivities, drug resistant organisms and anti-biotic usage, is recommended for monitoring and reporting infection rates.
Next: Standard Precautions and Transmission Based Precautions.
Wednesday, November 11, 2009
Typical Duties of The Infection Preventionist
Typical Duties of The Infection Preventionist in Long-Term Care
An Infection Control professional ICP), more recently referred to as an Infection Preventionist, is usually required to be a licensed Registered or Vocational Nurse, depending on state regulations.
Some of the duties of the Infection Preventionist may include:
Surveillance: In infection control, surveillance is the term used to describe the function of observing, gathering, investigating and reviewing information about the patient as it pertains to infection prevention and control.
Patient Assessment: Accurately reporting signs, symptoms, and changes in condition and initiating isolation precautions as indicated.
Tracking and Trending: Tracking and trending information from surveillance; Practicing outbreak prevention and investigation, monitoring rates of infection and communicating findings in the form of verbal and written reports.
Orientation and Staff Education: Educating staff, patients and families to Infection Prevention. Monitoring staff compliance with basic infection control principles such as; hand washing, isolation, transmission based precautions, and use of personal protective equipment (PPE).
Monitor Antibiotic Usage: Reviewing and reporting antibiotic usage and trends of antibiotic resistance reported in antibiograms.
Revise Policies and Procedures: Participates in updating policies and procedures needed to maintain compliance with current recommendations from agencies of the federal and local government such as; OSHA, the CDC, state and local departments of health.
Environmental Rounds: Monitoring department compliance with Infection Control guidelines; conducting environmental rounds and consultation as needed.
Monitor Employee Health: This may or may not be the direct responsibility of the Infection Preventionist. Responsibilities include annual physicals and tuberculosis screening for new hires and employees, offering influenza and Hepatitis B. vaccines, keeping accurate employee records, initiating workplace restrictions if indicated, becoming familiar with OSHA regulations and educating staff to Infection Control and Blood Borne Pathogens standards.
Each facility should create their own policies and procedures regarding the expectations of the Infection Control Designee. Responsibilities may be shared and hopefully, the nurse will be given the support and autonomy needed to sucessfully integrate the major components of an effective Infection Prevention Program.
Next: The Surveillance Program.
An Infection Control professional ICP), more recently referred to as an Infection Preventionist, is usually required to be a licensed Registered or Vocational Nurse, depending on state regulations.
Some of the duties of the Infection Preventionist may include:
Surveillance: In infection control, surveillance is the term used to describe the function of observing, gathering, investigating and reviewing information about the patient as it pertains to infection prevention and control.
Patient Assessment: Accurately reporting signs, symptoms, and changes in condition and initiating isolation precautions as indicated.
Tracking and Trending: Tracking and trending information from surveillance; Practicing outbreak prevention and investigation, monitoring rates of infection and communicating findings in the form of verbal and written reports.
Orientation and Staff Education: Educating staff, patients and families to Infection Prevention. Monitoring staff compliance with basic infection control principles such as; hand washing, isolation, transmission based precautions, and use of personal protective equipment (PPE).
Monitor Antibiotic Usage: Reviewing and reporting antibiotic usage and trends of antibiotic resistance reported in antibiograms.
Revise Policies and Procedures: Participates in updating policies and procedures needed to maintain compliance with current recommendations from agencies of the federal and local government such as; OSHA, the CDC, state and local departments of health.
Environmental Rounds: Monitoring department compliance with Infection Control guidelines; conducting environmental rounds and consultation as needed.
Monitor Employee Health: This may or may not be the direct responsibility of the Infection Preventionist. Responsibilities include annual physicals and tuberculosis screening for new hires and employees, offering influenza and Hepatitis B. vaccines, keeping accurate employee records, initiating workplace restrictions if indicated, becoming familiar with OSHA regulations and educating staff to Infection Control and Blood Borne Pathogens standards.
Each facility should create their own policies and procedures regarding the expectations of the Infection Control Designee. Responsibilities may be shared and hopefully, the nurse will be given the support and autonomy needed to sucessfully integrate the major components of an effective Infection Prevention Program.
Next: The Surveillance Program.
Sunday, November 8, 2009
You are an Infection Preventionist. I am a What?
Posted by C. Lyn Walter, RN, BSN CIC November 8, 2009
Infection Prevention and Control is not a new specialty but it is one that has gained attention locally, nationally and globally, in light of the emergence of the H1N1 Influenza Pandemic. Nurses are familiar with basic Infection Control principles whether they work in acute care settings, long-term care, home health, clinics or physician’s offices. The term Infection Control has recently been changed to Infection Prevention and Control with an emphasis on prevention. It follows that nurses and other medical professionals who work closely in the specialty, are now referred to as Infection Preventionists. After all, preventing health care associated infections should be the primary concern. Controlling them implies there is already a problem.
Infection Prevention and Control in Long-term Care begins with developing a strong Infection Prevention and Control program designed to prevent transmission of infection from resident to staff, staff to patient and patient to patient. In Long-term Care the job typically, but not always, falls to the Staff Developer. Often times there is a sudden vacancy, for whatever reason, and an urgent assignment is made to a nurse who may have no measurable experience in the specialty. Before the appointee begins to feel overwhelmed, it is very important that the Infection Preventionist have the support of physicians, nursing, administration and ancillary services.
To those nurses who find themselves feeling unprepared for the new role suddenly thrust upon them, there are professional organizations such as the Association for Professionals in Infection Control and Epidemiology. This organization provides classes, seminars, videos, podcasts, manuals, books, magazines and even certification in Infection Control. A visit to the website is well worthwhile. APIC
The Preventionist is dedicated to facilitating information and links to resources for Nurses who have an interest in developing their skills in Infection Prevention and Control in Long-term Care.
Next: Typical Duties of the Infection Preventionist in Long-term Care
Infection Prevention and Control is not a new specialty but it is one that has gained attention locally, nationally and globally, in light of the emergence of the H1N1 Influenza Pandemic. Nurses are familiar with basic Infection Control principles whether they work in acute care settings, long-term care, home health, clinics or physician’s offices. The term Infection Control has recently been changed to Infection Prevention and Control with an emphasis on prevention. It follows that nurses and other medical professionals who work closely in the specialty, are now referred to as Infection Preventionists. After all, preventing health care associated infections should be the primary concern. Controlling them implies there is already a problem.
Infection Prevention and Control in Long-term Care begins with developing a strong Infection Prevention and Control program designed to prevent transmission of infection from resident to staff, staff to patient and patient to patient. In Long-term Care the job typically, but not always, falls to the Staff Developer. Often times there is a sudden vacancy, for whatever reason, and an urgent assignment is made to a nurse who may have no measurable experience in the specialty. Before the appointee begins to feel overwhelmed, it is very important that the Infection Preventionist have the support of physicians, nursing, administration and ancillary services.
To those nurses who find themselves feeling unprepared for the new role suddenly thrust upon them, there are professional organizations such as the Association for Professionals in Infection Control and Epidemiology. This organization provides classes, seminars, videos, podcasts, manuals, books, magazines and even certification in Infection Control. A visit to the website is well worthwhile. APIC
The Preventionist is dedicated to facilitating information and links to resources for Nurses who have an interest in developing their skills in Infection Prevention and Control in Long-term Care.
Next: Typical Duties of the Infection Preventionist in Long-term Care
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