REQUIRED INSERVICES

INDEPENDENT LEARNING PACKET

MODULE III

INFECTION CONTROL

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 This section should be completed by all Carilion employees who may
be exposed to blood and/or body fluids. If you are unsure whether
you need to complete this section please check with your manager.

Objectives:

After reading this section, participants will be able to:

Basic Infection Control

• To be able to define a nosocomial infection

• Explain how infections are spread

• To describe proper hand washing/hand hygiene technique

• Describe how to prevent the spread of infections

Exposure Control Plan

• Understand the Exposure Control Plan for blood-borne pathogens

Respiratory Protection Plan

• Review facts about tuberculosis

Isolation Precautions
• Describe current guidelines for Isolation Precautions in hospitals

Employee Health
• Understand the return to work process

INTRODUCTION

Infection Control and Prevention is in your hands. All employees are responsible for:

• Following infection control practices (such as good handwashing).

• Reporting evidence of suspected infection (such as fever over 101 degrees or
wound drainage) to the Infection Control Department.
• Working with Infection Control Practitioners to educate patients, families and staff
on Infection Control practices.
• Following the Carilion Isolation Procedure Policy.

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 THE CHAIN OF INFECTION

A nosocomial infection or hospital-associated infection occurs after a patient is admitted to

the hospital. Like all infections, nosocomial infections put our patients’ health at risk. They
also can increase the length of the hospital stay and increase hospital costs.

Patients get infections many different ways. In order for an infection to occur, a chain of
events must take place:

1. Germs (bacteria, viruses, fungi and other microbes) are everywhere and on everyone.
Most of them don’t make us sick. However, some germs can cause infection.
2. Germs must have a place to grow and multiply. This is usually in or on a person or
animal, but can be in water and on equipment or other objects.
3. Germs don’t have legs, so they must have a way of spreading or getting away from
where they grow. For example, a cough, sneeze or shedding skin can help germs travel.
So can touching someone without washing your hands or consuming contaminated food
or water.
4. Germs must also have a way of entering a person's body. This can be through an IV
site, broken skin from a cut or surgery, through a urinary catheter or just by breathing.

HOW CAN THE CHAIN BE BROKEN?

The most important way to prevent the spread of infection is HANDWASHING.

Handwashing should be a habit, something you do without thinking. It is simple and
inexpensive.

SOAP

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 HANDWASHING CHALLENGE

Think you know how to wash your hands? Most people don’t wash their hands thoroughly
enough to get rid of germs. To make sure your hands are as clean as possible, follow these
directions.
• Use plenty of soap and warm (not hot) water. Hot water will dry your skin.
• Rub briskly for 10-15 seconds.
• Rubbing is the key to effective handwashing because it decreases the number of
bacteria on the skin.
• Dry your hands thoroughly with a paper towel.
• Use another clean, dry paper towel to turn off the faucet and open the door.

If hands are not visibly soiled, use an alcohol-based waterless antiseptic product to cleanse
hands.

HOW OFTEN SHOULD I WASH MY HANDS?

Often! Handwashing is one of the easiest, most inexpensive ways to help prevent
infections.
• At the beginning and end of your work shift.
• Before and after patient contact.
• After touching any contaminated object, such as bedding, trays or medical
equipment.
• Before and after putting on or taking off Personal Protective Equipment (PPE)
such as gloves, gowns, masks and eye protection.
• After blowing your nose, using the restroom, breaks, etc.
• Whenever your hands or nails are dirty.
• Before eating, drinking, smoking, applying make-up or touching your face or
mucous membranes (eyes, nose, mouth).

PERSONAL PROTECTIVE EQUIPMENT (PPE)

• Personal Protective Equipment (PPE) are items that reduce the risk of exposure to
infectious material.
• PPE may include gloves, gowns, face shields or masks, eye protection, pocket masks
and other protective gear. Scrubs are not considered PPE.
• If your hands may touch blood or other potentially infectious material or contaminated
surfaces, wear gloves.
• If you will be working near splashes, sprays, splatters or droplets of potential infectious
material, wear eye and mouth protection such as goggles, masks or glasses with solid
side shields.
• If your uniform or scrubs might become soiled with blood or body fluids, such as during
surgery or autopsies, wear gowns, aprons, surgical caps and shoe covers or boots.

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 SHOULD I WEAR PPE?

If you have direct exposure to blood and other potentially infectious materials, you may run
the risk of contracting blood-borne infections (such as Hepatitis B or Hepatitis C virus or
Human Immunodeficiency Virus, which causes AIDS). Using PPE can greatly reduce
potential exposure to blood-borne infections.

AVOIDING CONTAMINATION

Blood or other infectious materials must not come in contact with your work clothes, street
clothes, skin, eyes, mouth or other mucous membranes.

Exception: There is one exception to the requirement for PPE (Personal Protective
Equipment). An employee may choose, temporarily and briefly, under rare and
extraordinary circumstances, to forego the equipment. It must be the employee's
professional judgment that using the protective equipment would prevent the delivery
of healthcare or public safety services or would pose an increased hazard to the
safety of the worker or coworker. When one of these excepted situations occurs,
employers are to investigate and document the circumstances to determine if there
are ways to avoid it in the future.

DECONTAMINATION AND DISPOSAL OF PPE

Remove PPE before leaving the work area or when the PPE becomes contaminated. If your
PPE is wet or stained with blood or other potentially infectious material, remove it
immediately or as soon as possible.

Reusable contaminated PPE, such as faceshields, goggles, etc. must be cleaned or

disposed of properly and decontaminated prior to re-use.

OTHER WAYS TO KEEP GERMS FROM SPREADING

• If blood or body fluids come in contact with your skin or mucous membranes, wash with
soap and water and flush eyes for at least 15 minutes with water as soon as possible. In
addition, wash your hands immediately or as soon as possible after removing PPE.
• Don’t eat, drink, smoke, apply cosmetics or lip balm or handle contact lenses in patient
care areas and in areas where you may be exposed to blood or other potentially
infectious materials.
• Keep work areas clean and sanitary to reduce your risk of exposure to bloodborne
pathogens and other harmful germs.

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 REGULATED MEDICAL WASTE

• Regulated medical waste must be handled carefully. Containers used to store regulated
waste are marked with biohazard symbols. Regulated medical waste includes:
• Liquid or semi-liquid blood and other potentially infectious materials
• Items caked with these materials;
• Items that would release blood or other potentially infected materials if compressed or
squeezed, such as clothing or sponges;
• Pathological or microbiological wastes
• Sharps.

Examples of items to be placed in biohazard containers include contaminated dressings and

bloody gloves. If the outside of a container becomes contaminated, it must be placed within
a second suitable container. Regulated medical waste must be disposed of in accordance
with applicable state and local laws.

SHARPS

A sharp is any sharp item that may cause a puncture, cut or break in the skin. A needle
stick or a cut from a contaminated scalpel or other sharp instrument can lead to infection
such as hepatitis B or C or HIV.

PROMPT DISPOSAL

The best way to prevent cuts and sticks is to minimize contact with sharps by disposing of
them immediately after use. Puncture resistant containers must be readily available to hold
used sharps. Reuasble sharps must be decontaminated before re-use. When reprocessing
contaminated reusable sharps, do not reach into the holding container. Contaminated
sharps must never be sheared or broken.

Recapping, bending or removing needles is permissible only if there is no other alternative

or if required for a specific medical procedure such as blood gas analysis. If recapping,
bending or removal is necessary, either use a mechanical device or a one-handed
technique. If recapping is essential, for example, between multiple injections for the same
patient, avoid using both hands to recap. Recap with a one-handed "scoop" technique,
using the needle itself to pick up the cap, then pushing cap and sharp together against a
hard surface to ensure a tight fit. Tongs or forceps may be used to place the cap on the
needle.

HANDLING CONTAINERS

When you are ready to discard containers, first close the lids. If there is a chance of
leakage, use a second container that closes, is color-coded, is leak resistant and is labeled
as regulated medical waste.

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 EXPOSURES TO BLOOD / BLOODY BODY FLUIDS

An exposure is defined as an injury with a contaminated instrument (needles, blades or

other sharp instruments), mucous membrane contact with blood or body fluids or blood/body
fluid contact of an open wound or non-intact skin.

If an exposure occurs, cleanse the exposed area, notify your manager, fill out an Employee
Event Report form and report to your facility’s designated area for evaluation immediately.
Document details to include type and brand of sharp, and task you were performing when
injury occurred on the EER.

REMEMBER: The source patient's lab work must be ordered and drawn.

It is your responsibility to follow-up with Employee Health.

TUBERCULOSIS
POPULATIONS AT RISK FOR TUBERCULOSIS (TB)

People at risk for TB include anyone who has ever had contact with a person with infectious
TB. People at higher risk for TB infection may include:

• foreign-born people from areas with a high rate of TB

• residents and employees of long-term care or institutional settings, such as nursing
homes or prisons
• medically underserved populations, including the underprivileged, the homeless and
high-risk racial and ethnic minority groups
• injecting drug users
• people with other medical risk factors (such as diabetes, end-stage renal disease and
persons 10 percent or more below their ideal body weights)
• healthcare workers who care for patients with TB and/or participate in cough-inducing
procedures

HOW IS TB SPREAD?

TB is a germ that becomes airborne when a person with active disease coughs, sneezes,
sings or talks. TB can be spread when others breathe the germ into their lungs.

IDENTIFICATION OF PERSONS WITH TB INFECTION

Health care workers need to be tested on an annual basis.

A person exposed to an individual with infectious TB should be given a PPD (tuberculin skin
test). A chest x-ray will help rule out active TB or old/healed TB if the skin test result is
positive or if TB symptoms (productive and prolonged cough, fever, chills, loss of appetite,
weight loss, fatigue, night sweats) are present. Annual chest x-rays are not recommended
for know past - positive reactors.

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 WAYS YOU CAN HELP CONTROL INFECTION

Early identification of disease is essential. TB should be suspected in all people who have
symptoms of TB, especially inpatients with confirmed or suspected HIV infection. Take
precautions to prevent spreading the infection until TB is diagnosed and treated or ruled out.

Effective precautions include placing the patient in a private room that has monitored
negative air pressure flow, discharge of air outdoors or HEPA filtration (if re-
circulated). The door to the room should remain closed. After the patient is
discharged, only normal room cleaning is required. However, the room should
remain vacant for one hour before cleaning.

Your Responsibility:
If you have direct patient care contact and/or your job responsibilities require that you enter
a patient's room, you must undergo fit testing to identify a respirator that fits you. You will
receive fitting instructions that include demonstrations and practice in how the respirator
should be worn, how it should be adjusted, how to determine if it fits properly and how to
obtain replacement a mask.

You may not care for a patient with known or suspected tuberculosis until fit testing has
been performed by Employee Health or their designee.

HEPATITIS
WHAT IS HEPATITIS B?

About 300,000 children and adults become infected with Hepatitis B virus each year. More
that 10,000 need to be hospitalized.

Hepatitis B is a viral infection of the liver. It is one of several types of viruses that can cause
hepatitis. There is a vaccine that will prevent Hepatitis B infection. Hepatitis B virus
infection may occur in two phases, acute or chronic. The acute phase occurs right after a
person becomes infected and can last from a few weeks to several months. Some people
recover after the acute phase, but others remain infected for the rest of their lives. These
people enter into the chronic phase and become chronic carriers as the virus remains in
their liver and blood.

Acute Hepatitis B usually begins with symptoms such as loss of appetite, extreme tiredness,
nausea, vomiting and stomach pain. Dark urine and jaundice (yellow eyes and skin) are
also common. Skin rashes and joint pain can occur. Over half of the people who become
infected with Hepatitis B virus never become sick, but some may have long-term liver
disease later.

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 HOW DO YOU GET HEPATITIS B?

Hepatitis B is passed from one person to another in blood or body secretions. This may
occur during sexual relations or when sharing things like toothbrushes, razors, or needles.
A baby can get Hepatitis B at birth from its mother. A doctor or nurse may get Hepatitis B
through cuts or from an accidental needle stick after working with patients infected with
Hepatitis B.

People infected with Hepatitis B who are chronic carriers can spread the infection to others
throughout their lifetime. They can also develop cirrhosis or cancer of the liver.

The Hepatitis B vaccine prevents HBV infections in 85% - 95% of people who get all three
shots. Routine boosting is not recommended.

WHO SHOULD GET HEPATITIS B VACCINE?

Employees who may be exposed to blood and/or body fluids while performing their job
functions.

MRSA and VRE ---- WHAT ARE THEY?

Methicillin-resistant Staphylococcus Aureus (MRSA) is a strain of staphylococcus aureus

bacteria that is resistant to many antibiotics. Although MRSA is no more contagious than
other strains, few antibiotics are available to treat the infection – making this type of bacteria
more difficult to treat. The antibiotics that are used to treat MRSA are expensive and may
cause dangerous side effects.

Another example of an antibiotic-resistant organism is Vancomycin-resistant Enterococci

(VRE). Enterococci are normal bacteria found in the gastrointestinal tract of the human
digestive system.

Who is at Risk for These Antibiotic-Resistant Organisms?

Everyone is at risk. Persons at increased risk for antibiotic-resistant organism infection
include those with underlying disease, prior and/or prolonged hospitalizations, and those
who have been treated with numerous antibiotics.

How are Antibiotic Resistant Organisms Spread?

Bacteria can be spread through direct person-to-person contact or contaminated equipment
or surfaces. Patients are already weakened from surgery or disease are at high risk of
picking up antibiotic-resistant organisms.

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How Can the Spread of Antibiotic-Resistant Organisms be Prevented?
• Identify patients who might be infected with an antibiotic-resistant organism and follow all
hospital-recommended infection control procedures when dealing with these patients.
• Use appropriate precautions to prevent the spread of the bacteria to other patients in the
hospital, such as the use of gloves and gowns when patient care is given.
• Thorough and frequent hand washing is extremely important.

After the patient with MRSA is discharged, the patient's room should be cleaned via normal
post-discharge room cleaning procedures. After the patient with VRE is discharged, the
room should be cleaned using the bucket method/10 minute soak. There is no need to
keep the room vacant for any specific time after the completion of appropriate cleaning
method is performed.

ISOLATION PRECAUTIONS

Isolation Precaution signs are available from Duplicating Services.

Standard Precautions reduce the risk of transmission from both recognized and
unrecognized sources in hospitals. These precautions apply to all patients regardless of
diagnosis or presumed infection status. Standard Precautions apply to blood, all body fluids,
secretions, and excretions, non-intact skin and mucous membranes.

OTHER TYPES OF ISOLATION INCLUDE:

Transmission-based Precautions are used with patients who have known or suspected
infections that are highly contagious or more difficult to cure. Additional precautions beyond
Standard Precautions are needed to stop transmission in hospitals.
There are three types of Transmission-based Precautions:
• Contact Precautions
• Airborne Precautions
• Droplet Precautions

More than one type of precautions sign may be needed for diseases that have multiple
routes of transmission. Transmission-based precautions are always used in addition to
Standard Precautions.

Airborne Precautions (BLUE CARD) are designed to reduce the risk of airborne
transmission of infectious agents. Microorganisms can be widely dispersed by air currents.
Examples of such diseases are pulmonary tuberculosis, measles, or chickenpox. See an
example of the Airborne Precaution Card at the end of this section.

Droplet Precautions (GRAY CARD) are designed to reduce the risk of droplet transmission
of infectious agents. Droplet transmission involves close intimate contact with the eye or the
mucous membranes of the nose or mouth with droplets containing microorganisms.
Droplets are generated primarily during coughing, sneezing, or talking, and during the
performance of certain procedures such as CPR. Examples of such diseases are influenza,
Neisseria meningitis, mumps, and orpertussis. See an example of the Droplet Precaution
Card at the end of this section.

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Contact Precautions (ORANGE CARD) are designed to reduce the risk of transmission of
hard-to-cure microorganisms by direct or indirect contact. Direct contact transmission
involves skin-to-skin contact and physical transfer of microorganisms from an infected
person. This may occur, for example, when personnel turn a patient, give a bath, or perform
other patient care activities that require physical contact. Indirect contact transmission
involves contact with a contaminated object in the patient’s environment. Examples of such
diseases are scabies, viral conjunctivitis, impetigo, or major non-contained abscesses on a
patient’s skin. See an example of the contact Precaution Card at the end of this section.

Granulocytopenic Precautions (WHITE CARD) are designed to reduce the risk of staff,
patients, or visitors of spreading infection to the immunocompromised patient. These are
patients whose normal body defenses for fighting infection are impaired due to illness.
Infections such as the common cold can become an opportunistic infection (an infection
which normally does not cause disease in healthy persons) in the immunocompromised
patient. Patients with impaired immune systems are susceptible to infections spread via the
airborne, droplet, or contact route. An example of a condition requiring granulocytopenic
precautions is the cancer patient who has received radiation or chemotherapy. See an
example of the Granulocytopenic Card at the end of this section.

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 Examples of Precautions Cards

AIRBORNE PRECAUTIONS
(In addition to Standard Precautions)

Visitors - Report to Nurse’s Station Before Entering Room

Patient Placement’
Place patient in private room that has:
1. Monitored negative air pressure
2. Discharge of air outdoors or HEPA filtration if re-circulated
KEEP ROOM DOOR CLOSED AND THE PATIENT IN THE ROOM

Respirator Protection
1. Wear an approved particulate respirator mask for known or suspected AFB
disease.
2. Susceptible persons should not enter the room of patients with known or
suspected measles (rubella) or varicalla (chickenpox) if immune caregivers are
available. If susceptible persons must enter the room, wear appropriate mask.

Limit the movement/transport of patients from room for essential purposes only. During
transport, minimize the spread of droplet nuclei by placing a surgical mask on the
patient, if possible.

In addition to Standard Precautions, use Airborne Precautions for patients known or

suspected to have serious illnesses transmitted by airborne droplet nuclei.
Examples of such illnesses include:

Measles
Varilcella (including disseminated zoster)*
Tuberculosis

(May require more than one type of precaution

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 DROPLET PRECAUTIONS
(In addition to Standard Precautions)

Visitors – Report to Nurse’s Station Before Entering Room

Patient Placement
1. Place patient in private room, if possible
2. When private room is not available, cohort with patent(s) who have active infection with
same organism,
KEEP ROOM DOOR CLOSED AND PATIENT IN ROOM

Respiratory Protection
1. Wear a surgical mask when entering room

Limit the movement/transport of patients from room to essential purposes only. During transport
place surgical mask on the patient if possible.

In addition to Standard Precautions, use Droplet Precautions for a patient known or suspected
to be infected with microorganisms transmitted by large particle droplet that can be generated
by the patient during coughing, sneezing, talking, or the performance of such illnesses include:

Invasive Haemophilus influenza type b disease, including meningitis, pneumonia, epiglottis, and
sepsis
Invasive Neisserial meningitis disease, including meningitis, pneumonia and sepsis
Diphtheria (pharyngeal)
Mycoplasma pneumonia
Pertussis
Pneumonic plaque
Streptococcal pharyngitis, pneumonia, or scarlet fever in infants and young children
Adenovirus
Influenza
Mumps
Parvovirus B 19
Rubella

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 Contact Precautions
(In addition to Standard Precautions)

Visitors – Report to Nurse’s Station Before Entering Room

Patient Placement
1. Place patient in private room, if possible
2. When private room is not available, cohort with patent(s) who have active infection with same
microorganism
Wear Gloves
1. When entering room
2. Change gloves after contact with infectious material
3. Remove gloves before leaving patients room
Wash Hands
1. Immediately after glove removal with an Antimicrobial soap and before leaving patients room
Wear Gown
1. When entering room to protect clothes from items in patient’s room or if patient has any of the
following:
Incontinent, Diarrhea, Colostomy, Ileostomy, wound drainage not contained by dressing
2. Remove gown before leaving patient’s room
Patient Transport
1. Limit the movement/transport of patients from room to essential purposes only. During
transport ensure that all precautions are maintained at all times.

Patient-Care Equipment
1. Dedicate the use of non-critical equipment (i.e., stethoscope, sphygmomanometer, beside
commode, electronic rectal thermometer) to a single patient

In addition to Standard Precautions, use Droplet Precautions for a patient known or suspected to be
infected with microorganisms transmitted by large particle droplet that can be generated by the patient
during coughing, sneezing, talking, or the performance of such illnesses include:

Gastrointesintal, respiratory, skin or wound infections or colonization with multi-drug-resistant bacteria

judged by the infection control program to be a special clinical and epidmiologic significance.
Clostridium difficile infection
For diapered, incontinent patients – Enetrohemorrhagic Escherichia Coli 0157:H7,Shigella, Hepatitis A
rotavirus
Respiratory syncytial virus, parainfluenza virus, or enteroviral infections in infants and young children
Diphtheria (cutaneoua)
Herpes simplex virus (neonatal or mucosutaneous)
Impetigo
Major (non-contained) abscesses, cellulitis or decubiti
Pediculosis
Scabies,
Staphylococcal furunculosis in infants or young children
Zoster (disseminated or in the immunocompromised host
Viral/hemorrhagic conjunctivitis
Viral hemorrhagic infections (Ebola, Lassa or Margurg

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 GRANULOCYTOPENIC PRECAUTIONS

Visitors – Report to Nurse’s station before entering room

1. Private Room Preferred

2. No one with any infection may enter room
3. Hands must be washed with an antiseptic handwashing agent upon entering
room

RETURN TO WORK PROCESS

Prior to returning to work employees absent from work for more than three consecutive
workdays due to personal illness or injury must report to Employee Health Services with a
doctor's statement. Employee Health Services will verify the employee's ability to return to
normal job duties. Because Employee Health provides a variety of services, it is
recommended that the employee call in advance to schedule an appointment for a return to
work release.
When Employee Health offices are closed and an employee has a written release to return
to work without restrictions by his/her primary care physician, a manager may allow the
employee to begin work. The employee should be referred to Employee Health as soon as
possible for clearance.

Note: This process applies only to non-work related injuries or illnesses. Work related
injuries are handled through the Workers' Comp Representative.
(See HR policies: Attendance; Work with Non-Work Related Illness, Injury or Disability)

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 NOTE: To contact an Infection Control Practitioner at your hospital facility, contact the
hospital operator and ask for an Infection Control Practitioner. Or, if you are in a non-
hospital environment, call the operator at the nearest Carilion Hospital facility to reach an
Infection Control Practitioner.

Bedford Hospital 586-2441

Franklin Memorial Hospital 483-5277
Giles Memorial 921-6000
New River Valley Medical Center 731-2000
Roanoke Community 985-8000
Roanoke Memorial 981-7000
St. Albans 639-2481

For more information refer to the following policies on the CHS Intranet and/or CHS
Encyclopedia:
Bloodborne Pathogens Exposure Control Plan
Hand Hygiene
Infection Control and Employee Health
Isolation Guidelines
Respiratory Protection Plan
Tuberculosis Exposure Control Plan
Work With Non-Work Related Illness, Injury or Disability

This concludes the section on Infection Control - Continue to Corporate Compliance

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