BLOOD BORNE PATHOGENS/INFECTION CONTROL TRAINING
WorkAbilities, Inc.
PROCEDURES FOR INFECTION CONTROL AND PREVENTION-
BLOOD BORNE PATHOGENS TRAINING
PURPOSE
A. The goal of all infection control procedures is to minimize the transmission of communicable disease and prevent infection when possible, helping to insure optimum health for all clients and staff.
B. Objectives:
1. To prevent episodes of communicable disease.
2. To prevent infection.
3. To prevent the transmission of communicable disease.
4. To insure prompt detection of communicable disease.
5. To insure compliance with the implementation of infection control procedures.
6. To limit occupational exposure to blood and other potentially infectious materials.
C. Infection control procedures will include the following components:
SURVEILLANCE is the on-going monitoring of all illness and disease among clients and staff, and the monitoring of compliance to procedures.
REPORTING is the method of communicating information about the existence of communicable disease.
CONTROL involves the ongoing activities used to reduce the spread of disease and minimize the effects of existing illness.
PREVENTION involves the passive and active methods used to eliminate the risk of contracting diseases.
D. The Infection Control procedures are designed to meet compliance with the OSHA standards for Occupational Exposure to Blood-Borne Pathogens. Refer to the OSHA standards included for details or clarification as necessary.
E. Infection control procedures follow Universal Precaution guidelines.
F. Infection control procedures will be followed for all instances of illness, injury, and communicable disease in the facility.
COMMUNICABLE DISEASE TRANSMISSION
A. Contact transmission occurs directly through person to person contact or indirectly by a person coming in contact with a contaminated surface or object. This is the most common means of disease transmission.
B. Airborne transmission occurs by “droplet infection” via breathing, talking, coughing, or through contaminated dust. These can be the most difficult to control.
C. Blood-borne transmission occurs through contact with blood, semen, vaginal secretions, or body fluids visibly contaminated with blood. (These substances are also known as infectious materials.) Generally these diseases are transmitted through skin, eyes, damaged skin, or mucous membranes (mouth, vaginal, or rectal tissue). This mode of transmission includes, but is not limited to, Hepatitis B virus (HBV) and human immuno deficiency virus (HIV).
IMMUNIZATIONS AND SCREENINGS
A. Employees with occupational exposure will be offered Hepatitis B immunizations per OSHA regulations.
B. Blood screenings to identify immunity status or presence of communicable diseases will occur per physician recommendation. If consent is required for the screening, it will be obtained.
IV. UNIVERSAL PRECAUTIONS
A. Universal Precautions have been established to reduce the occurrence of blood-borne transmission. AIDS and Hepatitis B are two communicable diseases which require the use of universal precautions.
B. Since medical history and examination can not reliably identify all clients infected with HIV (AIDS), or HBV (Hepatitis B), or other blood-borne pathogens, blood and body fluid precautions should consistently be used for all clients.
C. Universal precautions require that all human blood and certain body fluids are treated as if they are known to be infectious with HIV, HBV, and other blood-borne pathogens.
D. Universal Precautions is an approach to infection control that applies to the following infectious materials: blood; bodily fluids visibly contaminated with blood; semen; and vaginal secretions. (It also includes synovial fluid, pleura fluid, peritoneal fluids, amniotic fluid, and body tissues. Exposure to these in a facility is unlikely.)
E. Universal Precautions do not apply to feces, nasal secretions. Sputum, sweat, tears, urine, vomit or saliva, unless they are contaminated with visible blood.
F. Universal Precautions require:
1. hand washing (See hand washing procedure)
2. use of gloves when in contact with blood or other infectious materials. (See glove procedure)
3. use of other personal protective equipment as determined necessary. (See personal protective equipment procedures)
4. bagging contaminated laundry. (See laundry procedure)
5. cleaning and disinfecting procedures for contaminated surfaces. (See cleaning procedure)
6. disposal of sharps, without recapping, into a special container. (See sharps procedure)
7. specimens of blood or other potentially infectious materials shall be handled with gloves, placed in a container which prevents leakage during storage and transport, and labeled with the client’s name and type of specimen.
HANDWASHING PROCEDURE
A. Hand washing is the single most important procedure for preventing the spread of common infections. Thus, proper hand washing shall be expected as part of the regular routine, even in the absence of recognized disease.
B. In general hand washing must occur each time the hands come in contact with someone who is ill, after contact with blood or infectious materials, and with an object that is potentially contaminated. This includes, but is not limited to the following times:
• After removal of gloves or other protective equipment
• Before and after medication administration
• After going to the bathroom
• After assisting a client to use the bathroom and/or changing their briefs
• After contact with an ill client or objects that the client has touched
• Before meal preparation and eating
• Immediately after any contact with blood, semen, vaginal secretions, or any body fluid visibly contaminated with blood.
C. Supplies needed for Hand washing:
Running water Wastebasket
Disposable paper towels Hand lotion (water based)
Soap – keep bar soap on a rack that allows for drainage of water
D. Standard Handwashing Procedure:
1. Turn on and adjust water temperature.
2. Wet hands and lather completely.
3. Rub hands together, vigorously for at least 15 seconds.
4. Rinse hands under running water.
5. Repeat process.
6. Dry hands thoroughly using a paper towel.
7. Take a clean, dry paper towel and use it to turn off running water so that the clean hands do not touch the dirty water controls.
8. Dispose of paper towels in wastebasket as used.
9. Dry, rough hands may carry infection, so use water based hand lotion after drying hands as indicated.
10. Keep fingernails trimmed frequently.
E. In the event hand washing must be done in an area that does not have immediate access to running water, ISA gel may be used.
Procedure for use of ISA gel:
1. Place small amount in palm of hand.
2. Massage, covering hands completely.
3. Rub lightly until dry, do not rinse.
4. Wash hands with water and soap after 8-10 applications of ISA gel.
5. If ISA gel is used after exposure to blood or infectious materials, hands must be washed as soon as possible.
PERSONAL PROTECTIVE EQUIPMENT PROCEDURES
A. Personal protective equipment is specialized clothing or equipment worn by an employee for protection against a hazard. Personal protective equipment used to limit occupational exposure to blood-borne pathogens may include:
1. Gloves must be used when an employee’s hands may come in contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin.
2. Masks, in combination with eye protection devices (such as goggles or glasses with solid shields) must be worn whenever splashes, spray, splatter or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated.
3. Aprons or other protective body clothes must be worn whenever a medical procedure is performed with anticipated exposure to blood or infectious materials. This will depend on the task and degree of exposure anticipated.
B. The goal in using personal protective equipment is to prevent blood or other infectious materials from having contact with an employee’s clothes, skin, eyes, mouth, or other mucous membranes.
C. It is the responsibility of a health professional to determine which personal protective equipment is appropriate to the facility and to write a procedure for use of each item of personal protective equipment determined necessary. This procedure will include when to use the protective equipment, how to use it, how to dispose or clean it, repair or replacement tasks, and where it is located.
D. It is the responsibility of the employer to provide any recommended personal protective equipment.
E. The only acceptable reason for not using protective equipment is when an employee makes a judgment that use of protective equipment would cause a delay in an emergency situation that would threaten a client’s life. All such cases will be investigated and documented to determine whether changes could be instituted to prevent such occurrences in the future.
GLOVE USE PROCEDURE
A. Gloves can be used as a barrier between hands and a potential source of infection. Gloves must be used whenever there is contact with blood, body fluid visibly contaminated with blood, semen, or vaginal secretions.
This includes the following situations:
• Administering first aid treatment to a cut or wound.
• Removing and disposing of wound dressing.
• Brushing or flossing a client’s teeth.
• Cleaning contaminated surfaces.
• Handling contaminated laundry.
• Assisting with menstrual hygiene.
• Completing medical procedures in which there may be contact with blood or body fluid.
B. While universal precautions do not require gloves to be used when in contact with vomit, feces, nasal secretions, and urine unless they are visibly contaminated with blood, it is recommended that gloves be worn when:
• cleaning up vomit, feces, or urine.
• after assisting a client to use the bathroom and/or changing their briefs
• cleaning equipment used for treatment of any body area.
• disposing of tissues contaminated with thick mucus or pus draining from the eye or nose.
C. Procedure for Glove Use:
1. Gather together materials needed prior to putting on gloves.
2. Remove gloves from box or package touching only the wrist edge of the glove.
3. Place glove on hand minimizing contact with finger and palm areas.
4. Remove gloves prior to leaving the work area and/or if task is interrupted.
5. Fresh gloves must be used for each client involved and for each procedure.
6. If gloves become torn, punctured, cracked or peeling, remove and discard them immediately.
7. Remove and replace contaminated gloves as soon as practical.
8. Remove gloves pulling wrist area over fingertips to avoid contact with potentially contaminated areas.
9. Discard disposable gloves into a plastic-lined wastebasket.
10. Wash hands thoroughly after gloves are removed.
D. Disposable gloves will be located:
__ in the facility first aid kit
__ in the facility vehicle first aid kit
__ in the medication cabinet/area
__ other:___________________________________________________
E. The supply of disposable gloves will be replenished by the employer on an as needed basis.
CLEANING PROCEDURES
A. Objects or surfaces in the environment may be a source of disease transmission.
B. Employers shall insure that the facility environment is maintained in a clean and sanitary manner. Standard housekeeping practices are adequate for routine cleaning. Contamination with blood or body fluids requires special cleaning and decontamination procedures. These procedures are listed below.
C. Objects or surfaces contaminated with blood or any body fluids (this includes vomit, feces, semen, vaginal secretions, and urine) must be cleaned immediately after contamination following on of the procedures listed below.
D. Utility gloves are recommended for use in cleaning procedures. Clean the gloves after use by following hard surface cleaning procedures.
Hard surface cleaning procedure for blood and body fluids
1. Place gloves on both hands.
2. Remove excess fluids with paper towels.
3. Clean area with detergent and warm water.
4. Wash down or spray area with a freshly prepared solution of 10 parts water to 1 part bleach.
5. Do not rinse.
6. Allow to air dry.
F. Food contact surface area cleaning procedure for blood and body fluids
1. Place gloves on both hands.
2. Remove excess fluids with paper towels.
3. Clean area with detergent and warm water.
4. Wash down or spray area with freshly prepared solution of 10 parts water
to 1 part bleach.
5. All to air dry for 30 minutes.
6. Then wash area with water.
G. Fabric or carpeted surfaces contaminated with blood or body fluids should be laundered or dry cleaned whenever possible. If this is not possible, the following procedure shall be used:
1. Place gloves on both hands.
2. Remove excess fluid with paper towels.
3. Clean area with soap and cold water.
4. A fabric or carpet cleaning product may be used.
5. Spray with Lysol following cleaning.
H. Procedure for cleaning up broken glassware contaminated with blood
1. Do not use hands to pick up contaminated broken glassware.
2. Use mechanical devise to pick up glass, and dispose of glass immediately.
I. Waste basket Procedures
1. All wastebaskets shall be lined with plastic bags and shall be emptied regularly and not allowed to overflow.
2. Infectious material such as paper toweling used for blood clean up, dressings, gloves, and menstrual supplies shall be placed in a plastic bag, tied securely, checked for leakage and placed in a plastic lined waste basket.
J. Procedures for cleaning medical equipment will be determined via a health professional’s recommendations or per manufacturer’s instructions. These procedures will include cleaning and decontaminating instructions and a schedule for cleaning.
IX. LAUNDRY PROCEDURES
A. All laundry contaminated with blood, body fluids visibly contaminated with blood, semen, and vaginal secretions will be handled with gloves.
B. Laundry must be handled as little as possible and with a minimum of agitation to prevent exposure to the person handling the laundry.
C. Laundry soiled with blood or body fluids visibly contaminated with blood, semen, and vaginal secretions should be bagged at the location where it was used.
D. All contaminated laundry that can not be laundered immediately will be placed in a red plastic bag and fastened securely. The bag will be checked to make sure no leakage occurs. This red plastic bag will signify to others that this laundry is contaminated and laundry procedures must be followed.
E. Contaminated Laundry Washing Procedure
1. Use gloves when handling unwashed contaminated laundry.
2. Wash contaminated laundry separate from other laundry.
3. Pre-soak in cold water if needed for stain removal.
4. Use a cold water cycle for at least 10 minutes with detergent.
5. One-half cup Clorox bleach may be added per load of laundry if allowable according to clothing manufacturer’s recommendations.
6. Laundry will be dried in a clothes dryer whenever clothing manufacturer’s recommendation permits.
F. If it is necessary that contaminated laundry be sent out of the facility for cleaning, the laundry transfer procedure must be followed.
G. Contaminated Laundry Transfer Procedure
1. Use gloves.
2. Place contaminated laundry in a red plastic bag and fasten securely. Double bag if necessary to insure no leakage occurs.
3. Label with client’s name and type of stain (blood, semen, etc.)
X. CONTROL AND REPRORTING OF COMMUNICABLE DISEASES
A. Staff will report any signs of possible infections or symptoms of communicable
diseases that a person receiving services is experiencing to the Group Manager
who will notify the care giver and the nurse.
B. When a person receiving services has been exposed to a diagnosed communicable
disease their care giver will be notified.
XI. GENERAL GUIDELINES FOR RESTRICTED ACTIVITY and CLIENT WORK RESTRICTIONS
A. Restriction of activities of daily living may be required for persons who cannot be taught to follow general infection control guidelines. Such restrictions may include:
No food preparation
No sexual contact (this includes kissing and may include hugging).
Restriction from group activities
Restriction from community activities
Restriction from day placement, work, or school.
If a client shows evidence or is suspected of having an untreated serious illnesss/communicable disease, a physician examination may be required and/or the client may be required to present a statement from a physician that permits their return to work.
B. RESTRICTION GUIDELINES FOR MINOR COMMUNICABLE DISEASES:
1. Athletes Foot (Tinea Pedis)
A. Early Symptoms: Peeling, cracked skin between toes, itching.
B. Attendance restriction: Exclusion from showers, swimming, and going without shoes.
2. Common Cold
A. Early Symptoms: Watery eyes, runny nose, slight fever, sneezing, general malaise.
B. Attendance restriction: Restrict during acute states as needed, if fever is present, or if person cannot take care of discharges in sanitary manner.
3. Flu (Influenza)
A. Early Symptoms: Starts quickly with fever, body aches, headache, cough, runny nose, sore throat, chills. Illness lasts at least three days. People may develop ear infections, pneumonia, or croup as a result of influenza infection.
B. Attendance restriction: Until fever, vomiting, and/or diarrhea is gone and the individual is well enough to participate in routine activities.
4. Head Lice (Pediculosis)
A. Early Symptoms: Itchy scalp, small light gray insects, eggs or nits at base of hairs.
B. Attendance restriction: Until head lice are removed.
5. Impetigo
A. Early Symptoms: Blistered lesions, may be crusted with pus. Found on skin surfaces, usually on face.
B. Attendance restriction: Until all lesions are healed.
6. Pin Worm Infection
A. Early Symptoms: Anal area itching, restlessness and irritability.
B. Attendance restriction: As determined by a physician.
7. Pink Eye (Conjunctivitis)
A. Early Symptoms: Redness and swelling of eye membranes with burning, itching, light sensitivity and discharge.
B. Attendance restriction: Until secretion or discharge is clear or absent.
8. Scabies
A. Early Symptoms: Itchy skin, rash or small red bumps. Prone to protected parts of body such as between fingers, under arms, etc. Usually would not appear on face.
B. Attendance restriction: Until determined by physician.
9. Scalp Ringworm (Tinea Capitis)
A. Early Symptoms: Round, scaly patches with short, broken off hairs.
B. Attendance restriction: Until determined by physician.
10. Trench Mouth
A. Early Symptoms: Pain, especially on swallowing, gums with bleeding ulcers.
B. Attendance restriction: Until determined by physician or dentist.
11. Whooping Cough (Pertussis)
A. Early Symptoms: Cold symptoms which gradually becomes worse in 1-2 weeks. Incubation period is 7-21 days.
B. Attendance restriction: Minimum of 5 weeks from onset.
C. ATTENDANCE GUIDELINES FOR MAJOR COMMUNICABLE DISEASES.
Major communicable diseases generally require specific treatment and activity restrictions as directed by a physician. General guidelines are noted below. Physician orders will supersede any of the following recommendations.
1. Chicken Pox
A. Early Symptoms: Slight fever, general malaise, rash with scabs appearing after 3-5 days. Incubation period is 2-3 weeks.
B. Attendance restriction: Minimum of 7 days and until vesicles are dry.
2. German Measles (Rubella)
A. Early Symptoms: Inflamed eyes, enlarged lymph nodes, rash low-grade fever. Incubation period is 14-21 days.
B. Attendance restriction: At least 3 days after rash appears.
3. Measles (Rubeola)
A. Early Symptoms: Fever, inflammation of mucous membranes in eyes, nose and throat, eruption in mouth, rash. Incubation period is 10-15 days.
B. Attendance restriction: At least 4 days after rash appears.
4. Meningitis
A. Early Symptoms: Fever, headache, nausea, vomiting. Incubation period is 2-10 days.
B. Attendance restriction: None for Viral Meningitis; physician may determine. At least 24 hours following the initiation of antibiotic treatment for bacterial meningitis.
5. Mumps
A. Early Symptoms: Fever, swelling and tenderness of glands located on each side of neck below ears. Incubation period is 12-26 days.
B. Attendance restriction: Until temperature is normal and swelling had disappeared.
6. Roseola Infantum
A. Early Symptoms: Sudden high fever, slight red throat, after 3-4 days fever leaves and rash appears. Incubation period is not specifically known - may be 5-7 days.
B. Attendance restriction: During time of high fever and rash. Rash must be gone before readmittance.
7. Scarlet Fever (Scarlatine)
A. Early Symptoms: Irritability, fever, sore throat, vomiting. Followed by the bright red spots and rash usually in neck, chest, back areas.
B. Attendance restriction: 7 days after onset of illness or until physician gives permission.
8. Strep Throat
A. Early Symptoms: Fever, sore throat. Incubation period 2-5 days.
B. Attendance restriction: 24 hours following the initiation of antibiotic treatment.
9. Hepatitis A
A. Early Symptoms: Fever, nausea, vomiting, headache, jaundice. Incubation period is 10-40 days.
B. Attendance restriction: At least 7 days or until clinically well, as determined by physician.
10. Hepatitis B
A. Early Symptoms: Nausea, vomiting, headache, may be jaundiced. May appear flu-like or be asymptomatic.
B. Attendance restriction: During the time of active infection or as determined by physician.
C. HEPATITIS B CARRIER POLICIES:
1. No exclusions are necessary unless infected individual
Exhibits biting behavior, has open sores that can not be covered, or as determined by physician.
2. All clients who are identified Hepatitis B carriers must have any open wounds or open lesions covered.
11. Herpes (Oral or genital)
A. Early Symptoms: Open lesions, generally appearing on mouth or genitals.
B. Attendance restriction: As determined by nurse consultant or physician based on the client's ability to demonstrate responsible behavior. When client is known to have an open lesion, restriction of physical contact, including sexual contact will be required.
C. Strict adherence to the regular infection control guidelines is required.
D. Nurse consultant will discuss with the physician and/or the Minnesota Department of Health the need for any additional infection control procedures. If required, these procedures will be documented in the client’s health care plan. Staff will be instructed in these procedures.
12. Shingles (Zoster)
A. Early Symptoms: Severe pain and numbness along certain
Nerve pathways, commonly around the midline (trunk) or on the face. Ten to 14 days later, clusters of blisters appear in crops, usually on one side of the body and closer together than in chickenpox.
B. Attendance restriction: If lesions can be covered by clothing or a bandage, no exclusion is needed. If lesions cannot be covered, people should be excluded until the sores have crusted.
13. AIDS (Acquired Immune Deficiency Syndrome)
A. County/facility policies will be followed with regard to placement of individuals with AIDS.
B. Based on current data, regular infection control guidelines are adequate in preventing the transmission of AIDS in anything other than intimate sexual contact involving the exchange of body fluids.
C. Since information on the control and prevention of AIDS is rapidly changing, the physician and the Minnesota Department of Health should be contacted for further information as needed.
|PPM 407 Procedures for Infection Control and Prevention/Blood Borne Pathogens Training 3/08 *Copyright 1992 Health Counseling Services |
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