New Employee Orientation

Infection Control Course

INFECTION PREVENTION at it’s finest!

Purpose:

 Identify how infections are spread

 Understand how to protect patients and visitors
 Understand how to protect yourself
INFECTION PREVENTION at it’s finest!

 WHAT IS AN INFECTION?

 Condition resulting from the presence and invasion of

microorganisms.
 For infection to occur organism must:

 Enter the body

 Grow and multiply
 Cause a response
 Statistics of Hospital-Acquired Infections
(HAIs)

Statistics show that 1 in every 20 patients develops an infection

while in the hospital.

CDC Annual Estimates of Hospital Acquired Infections (HAI) in the

U.S.
• 12 million hospital-acquired infections
• 90,000 deaths associated with infections
 Multi-Drug Resistant Organisms
(MDRO)
A growing number of infections in hospitals are caused by Multi-
Drug Resistant Organisms (MDRO).
MDROs commonly seen at your hospital include:
• MRSA (Methicillin-Resistant Staph. aureus)
• VRE (Vancomycin-Resistant Enterococcus)
• ESBL (Extended-Spectrum Beta-Lactamase Producers)
• CRE (Carbepenem-Resistant Enterobacteriaceae)

All Patients with MDRO infection should be in ISOLATION

precautions when they are admitted to the hospital.
 Infections of Concern

Other infections may require specific isolation

precautions. Such infections may include:

Gastrointestinal infections:
 CDIFF (Clostridiodes difficile)

Emerging Infectious diseases:

 Candida auris
 Novel Coronavirus (2019-nCoV)
Germs can be spread

By:
 Contact:
 Direct – transmission occurs directly from one person to
another.
 Indirect – touching a contaminated surface or equipment
 Droplet:
 Transmission occurs by coughing or sneezing within 6 feet
 Airborne:
 Transmission occurs by coughing, talking, sneezing in a
patient room
Germs are all around

We know that:
 We should practice hand hygiene after touching
things that might be contaminated.
 We should regularly clean/disinfect potentially
contaminated surfaces and equipment
 We should cover our cough and sneezing

What we might not think about:

 Germs can live on surfaces for a long time
 Most surfaces and equipment are contaminated
 Potential Contaminated Surfaces
Germs are all around us, especially in healthcare facilities!
ALWAYS:
 Practice hand hygiene after touching surfaces in the patient room, common
work spaces, and even outside the clinical areas.
 Clean and disinfect these areas frequently.
Studies of patients’ rooms show that germs like MRSA and C. dif are on:
 most surfaces, including anything the patient might have touched
 anything that healthcare workers might have come in contact with after
touching the patient.
Prevention
YOU can help prevent hospital-acquired infections and
transmission of MDROs.
Practice STANDARD PRECAUTIONS, including:
• Always wash or sanitize hands before and after touching a patient
or patient’s environment.
• Ensure that equipment and work surfaces are cleaned and
disinfected frequently.

Follow ISOLATION PRECAUTIONS when indicated.

• Ensure that everyone entering the isolation room wears
appropriate PPE.
• Equipment and supplies brought into the isolation room should be
either: disposable, OR dedicated to use of the patient; OR
disinfected before re-use.
Hand Hygiene – Standard Precautions
The MOST IMPORTANT component of Standard Precautions is hand
hygiene.
It’s not just “hand washing” anymore. Hand washing has evolved to hand
hygiene, which means you have two options.
 Hand washing
 Hand Sanitizer

The World Health Organization study has shown good hand

hygiene practices prevent the spread of infection.

https://www.who.int/gpsc/5may/MDRO_literature-review.pdf
Hand Hygiene – Hand Sanitizer (Option 1)
Hand Hygiene – Hand Washing (Option 2)
 Hand Hygiene – Expectations

Sanitizer OR wash your hands

 Every time you enter a patient’s room (CLEAN IN)

 Every time you leave a patient’s room (CLEAN OUT)

 Using the “Your 5 Moments” guideline (CLEAN AGAIN)

Gloves are not a substitute for hand hygiene

 You should perform hand hygiene:
 Before putting gloves on
 After removing gloves

There are also 5 hand hygiene moments that can occur in a

patient room.
 Hand Hygiene – Nails and Lotions
Healthcare workers who work in patient care areas or handle
medications or food will:
 Keep nails clean, smooth, well-manicured and less than ¼ inch long
 Don’t wear artificial nails (acrylic or bonded nails, tips or wraps)
 Unchipped nail polish may be worn

 Use Only the approved lotion at your hospital because:

• Other commercially available products are oil-based or petroleum-based and
can interfere with hand hygiene products!
Culture of Hand Hygiene

 Hard-wire Hand Hygiene

‒ Like fastening your seat belt
‒ Like stopping at a stop sign

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 Hand Hygiene Monitor
SwipeSense Monitor System
 Staff wear badge (manager will distribute)
 Hand sanitizer sensor
 Location hub in patient room (do not unplug or remove)
 Communication hub (located at RN station)
 The system is at the two main acute care hospitals
 Hand Hygiene Monitor
SwipeSense Monitor System
 Dashboard
 Managers have access to view unit performance and individual performance
 Disinfectants and Cleaning
Clinical staff use hospital approved disinfectants to clean:
 work surfaces
 patient care equipment
 other items (keyboards, phones, etc.)

If there is visible soil, use one SaniCloth to wipe clean the surface and an second to disinfect it.
Allow surface to remain wet for the appropriate amount of time to kill germs most effectively.
Please refer to the product label on the container for the correct wet contact time.
Sani-cloth Super Sani-Cloth Bleach
needs to remain needs to remain
wet on surfaces wet on surfaces
for 2 minutes for 4 minutes
 Disinfectants and Cleaning
Housekeeping uses:
 Hospital approved disinfectants for cleaning of patient rooms.
 Targeted use of Xenex UV disinfection robot at Edward Hospital
 Targeted use of Altapure peracetic acid and hydrogen peroxide fog
at Elmhurst Hospital

IT’S EVERYONE’S RESPONSIBILITY!

Disinfect work surfaces and patient areas regularly.
Clean spills promptly.
 Blood/Body Fluid Spill Clean Up
To clean up a large quantity of blood or other bodily fluid
follow this procedure:

1. Put on PPE: at a minimum a pair of gloves, but you can add gown and
eye protection if needed.
2. Blot up the spill and dispose
appropriately.
3. Wipe the surface with a hospital approved
disinfectant to clean the surface.
4. Use additional hospital approved disinfectant
to disinfect the surface.

Call Housekeeping to clean a spill on fabric or carpet.

 Regular Trash vs. Biohazard Waste Container
OSHA’s standards of waste disposal are:
If an article is saturated with blood or body fluids to the
degree that you could wring it out, it is red-bag, biohazard waste.
 Dressings or other material Saturated with blood
 Paper towels or other absorbent material used to clean up large blood
spills

The Biohazard symbol (at right) means

potentially infectious substances are present.

Much of what we throw away every day can go into regular trash.
 Gloves
 Isolation gowns
 Articles with spots of blood or dried blood

Be mindful to use red biohazard bags only for medical waste.

Medical waste is expensive to dispose of therefore it should be used
appropriately.
 Using Sharps Safely

Working safely in a hospital also means

using and disposing of sharps safely.

 Use needle-less or safety devices whenever

possible
 NEVER recap dirty needles.
 Activate the safety mechanism to cover the needle.
 Dispose of sharps safely, in securely
mounted sharps containers.

Whenever a sharps container is more

than 2/3 full, it should be closed securely and replaced.
 Sharps Safety

Expectations for use of safety devices:

Ask about safety devices

Check safety device activation
Practice activating

Ultimately it is your responsibility to know how to use the

device safely.
 Bloodborne Pathogens

Bloodborne Pathogens are microorganisms that may be

present in blood and other body fluids, including:
 Hepatitis B Can cause Hepatitis,
 Hepatitis C a serious liver disease

 HIV Can cause AIDS,

which compromises immunity

 Healthcare workers MUST use safe work practices called

Standard Precautions.
 Treat all blood, body fluids, non-intact skin, and mucous
membranes as potentially infectious.
 OSHA’s Bloodborne Pathogens Standard makes these precautions
the law.
‒ Please locate the Exposure Control Plan and a link to OSHA’s Bloodborne
Pathogens Standard on your hospital Intranet.
 Bloodborne Pathogen Exposures
Bloodborne Pathogens are NOT easy to catch, even for healthcare workers.
You must have ‘exposure’ to blood or certain other body fluids that might
contain the virus. This does not include sweat, which does not transmit
these organisms, so casual contact cannot spread these diseases.
An exposure could be:
 Needle stick or cut with a used needle/scalpel
 Splash of blood/body fluid to eyes, nose, mouth
 Blood/body fluid getting into non-intact skin
In the event of an exposure, do the following:
1. If it is a needle stick or non-intact skin, clean the site.
If it is a splash to the eyes or mucous membranes, flush with water.
2. Notify your supervisor or charge person.
3. Go immediately to Occupational Health. If it is after hours, go to the
Emergency Department.
 Bloodborne Pathogen Exposure (cont’d)
You will receive a free, confidential evaluation,
including any required testing or treatment.

It’s important that you treat any exposure

(or any on-the-job injury) seriously. If you are exposed,
do not wait until the end of your shift or the next day
to be seen by Occupational Health.

The CDC (Centers for Disease Control) says that if

your exposure was to a patient carrying the HIV virus,
you need to receive treatment within hours of the
exposure.
If you wait a few days to be treated, it may be too late.

As quickly as possible, please report the exposure

following your hospital policy.
 Types of Isolation Precautions

Isolation precautions are used for patients with certain contagious

or dangerous diseases.
In these situations, Isolation Precautions are used in addition to
Standard Precautions. There are four categories of Isolation
Precautions:

 Contact
 Enteric/Contact Plus
 Droplet
 Airborne
 Isolation Precautions
Isolation precautions means everyone must follow the PPE
requirements on the posted isolation signs.
For Staff:
1. Put on PPE before entering an isolation room.
2. Remove the PPE:
- Gown and gloves before leaving room
- Eye protection and isolation mask right outside the room
3. Perform hand hygiene by washing
hands or using hand sanitizer before and after wearing PPE.
 Take only essential supplies into the isolation
room.
 Use disposable supplies and equipment for
isolation patients whenever possible.
 Disinfect any equipment taken from an isolation
room before it is used on another patient.
Elmhurst Hospital Isolation Signs
Edward Hospital Isolation Signs
Edward and Elmhurst Hospital Isolation
Signs
 Novel Coronavirus (COVID19)

The COVID19 pandemic has placed us in an unprecedented time.

Keeping our healthcare workers safe during the pandemic requires focus
on:
• Hand hygiene
• Cleaning
• PPE
• Isolation
• Universal masking
• Social distancing

*Please visit Esquared for the latest updates

https://employee.eehealth.org/covid19
 Novel Coronavirus (COVID19)
Signs and Symptoms:
• Fever >100.0ºF
• Cough EDW COVID Hotline: (630)527-2855
• Sore throat ELM COVID Hotline: (331)221-8820
• Shortness of Breath
• Chills
• Headache
• Fatigue
• New loss of taste and/or smell
• Nausea, Vomiting, Diarrhea or abdominal pain
• Runny nose
• Muscle pain
Before coming to work each day monitor yourself for the signs and
symptoms above.
‒ If you have a cough, fever or took medication to reduce a fever in
the past 24 hours, stay home and call your manager and the
Employee Covid Hotline.
‒ If you have two or more of the other above symptoms, stay home
and call your manager and the Employee Covid Hotline.
 Novel Coronavirus (COVID19)

When you get to work each day:

 Wear a cloth mask
 Go to the temperature kiosk and check your temperature
‒ If reading is >100.0ºF, go back to your car and call your manager
and the Employee Covid Hotline
‒ If reading is 99.0 to 99.9ºF, notify your manager and monitor your
temperature mid-shift
‒ If reading is <98.9ºF, proceed to your area
 On clinical units, replace your cloth mask with an isolation mask for
the day
 If you work in a non-clinical department and need to go to a clinical
area, replace the cloth mask with an isolation mask.
 During lunch, social distance from other staff while your mask is off to
eat your meal

EDW COVID Hotline: (630)527-2855

ELM COVID Hotline: (331)221-8820
 Tuberculosis
Tuberculosis is an infectious disease that is spread from person
to person through the air when a person with active TB disease
coughs, talks or sneezes.

Healthcare workers are at risk for exposure to TB. If you had

unprotected exposure to a TB patient, you might develop what is
called a latent infection.
 TB Infection vs. TB Disease

 Latent TB Infection:
 TB germ in the body
 Not sick
 Not contagious, so you would not put your family,
coworkers, or patients in danger
 Positive TB skin Test (TST) or blood test (Quantiferron)

 Active TB Disease:
 Positive chest xray
 Have symptoms of fever, cough, night sweats, unexplained
weight loss, coughing up blood
 Airborne Isolation Precautions
If a patient is identified with possible TB, we must take the following
precautions.

In the hospital:
 Airborne isolation precautions are initiated
 The patient is placed in a negative pressure room
 Staff wear N95 respirator in the room
 Enter the room from the ante room

In outpatient offices:
 Place an isolation mask on the patient
 Close the door to the exam room
 If patient needs to be transferred, notify
the receiving department
 N95 Respirators

There are a number of styles of N95 masks available to use for airborne
isolation. Wear the size and style that you were fit tested for.

You must be fit-tested for the N95 Respirators by Occupational Health

every year. You must also perform a fit-check every time you put on a
N95 respirator to ensure that you have a proper seal.

To perform a fit-check:
1. Put on the mask.
2. Seal it tightly around your face and the bridge of your nose.
3. Breathe in and out, feeling for air leakage around the edges of the
mask. If you feel air leaks, start the process over until you get a secure
fit.
 TB Mask-fit Annual Requirements
The annual TB mask-fit testing is done as an Occupational Health
Requirement for employees who take care of patients in airborne
isolation.
Noncompliance puts you at a great risk
for exposure to TB. Failure to comply
could lead to suspension and end in
your termination of employment.

Edward/Elmhurst Hospital take these measures of protection

seriously.
 TB Skin Testing Requirements
Background:
 Historically healthcare personnel (HCP) were at increased risk
of TB latent or active disease from worker related exposures.
 National TB rates have decreased by 73% since 1991.

Existing CDC guidelines:

 All HCP will have baseline TB testing done on hire.
 Post exposure testing for those with unprotected exposure
to a TB patient
Updated TB Skin Testing Requirements

Updated CDC guidelines:

NO annual TB testing for HCP!

 HCP with previous positive skin TST test

 Treatment for latent disease strongly encouraged
 May require yearly symptom evaluation if decline treatment
Vaccinations
Receiving the influenza and Hepatitis B vaccinations are two more
ways to further your protection from these illnesses.
Influenza Vaccine
• Is a condition of employment for all employees
• Vaccine must be re-administered every year

Hepatitis B Vaccine
• Offered to any employee with exposure risk
• A series of 3 vaccines given over 6 months
• Provides lifelong immunity
 Other Tips to Protect Yourself
NEVER eat or drink in patient care or clinical areas.
Remember:
 High risk of contaminating food or container and risk of exposure to YOU!
 Food should not be stored in clinical areas or refrigerators used
to store patient specimens.
 Do not apply makeup or handle contact lenses in these areas.

Ask yourself the following questions about work

areas to remind you of safe practices:
 How many people come and sit
here after seeing a patient?
 Did every one of them wash
their hands before sitting down?
 How many people have used the keyboard?
 Is EVERYONE cleaning surfaces in common areas and in patient
rooms?
Work Restriction Policy***
Hospital policy states that you must stay home if you have the
following:
• Strep throat (until after 24 hours of antibiotics)
• Chickenpox
• Measles
• Mumps
• Pertussis
• Tuberculosis
• COVID19

If you work with patients, within a patient’s environment, or with

their food, you must also stay home if you have the following:
• Conjunctivitis/Pinkeye (until the symptoms resolve)
• Diarrhea or vomiting with a fever greater than 100 degrees Fahrenheit
• Acute respiratory illness with a fever
 Water Management

 Hospitals are required to have water management plans

to protect patients from diseases that can spread through
water, such as Legionella.
 Cities treat the water with chlorine.
 Hospitals check for changes in water quality.
 Each EEH hospital (Edward, Elmhurst, Linden Oaks)
has a water management plan.
 If you want more information about the plan, please contact the
Facilities Department.

47
 Legionella

 Legionella grows in water that is:

 Not kept moving
 Not disinfected appropriately
 Between 77ºF-108ºF

 Legionella is commonly found

 Low levels in creeks, ponds, and streams

 Legionella grows and spreads in water systems

 Showers, faucets, cooling towers, decorative fountains,
hot tubs

48
 Legionnaires Disease

 Legionnaires disease is caused by breathing in small

droplets of water containing Legionella
 Causes respiratory illness including pneumonia
 Symptoms include:
 Fever
 Chills
 Cough
 Shortness of breath

 Some people need to be hospitalized with severe

symptoms
 Not spread from person to person

49
 High Risk items

 Water features such as decorative fountains

 Whirlpool bath tubs
 Hand held shower heads
 Fish tanks
 Humidifiers
 Misters
 Hot tubs
 Ice machine
 Eyewash stations
50
 Water Management Plans require:
 Monitoring chlorine levels in water
 Preventing water from becoming stagnant in plumbing
 Regularly run faucets and showers and flush toilets
 Ensure hand held shower heads are hanging down

Yes
 Identify and maintain equipment that uses water
 Use sterile water or other solutions (not tap water) for
clinical equipment and procedures
51
 Be Part of the Team

 Ensure shower heads in the patient bathrooms are

hanging down.
 If you have any equipment that uses water, follow the
manufacturers Instructions For Use and cleaning
instructions.
 Protect equipment and supplies from tap water
contamination by keeping these items away from sinks.

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Infection Control Commandments

1. Thou shall perform hand hygiene before going into a patient

room
2. Thou shall perform hand hygiene coming out of a patient room
3. Thou shall remind others to perform hand hygiene
4. Thou shall keep common areas clean
5. Thou shall clean surfaces down with Sanicloth wipes
6. Thou shall follow isolation precautions and wear the correct PPE
7. Thou shall put on the PPE before going into a patient room
8. Thou shall remind others to wear the PPE when they are not
9. Thou shall stay home when ill so the germs will stay home with thee

And above all else:

10. If thou follows the above commandments, the Infection Control team will
be happy
Your Infection
Control Team
Hand Hygiene is Supported
Throughout the System!
 Questions?

Contact:
Edward Hospital Infection Control Team (630)527-3060
Elmhurst Hospital Infection Control Team (331)221-3214