SOW ATT - IC.2014.04 STANDARD PRECAUTIONS POLICY.pdf

DEPARTMENT OF HEALTH AND HUMAN SERVICES

INDIAN HEALTH SERVICE

WESTERN OREGON SERVICE UNIT

CHEMAWA INDIAN HEALTH CENTER

DEPARTMENT

INFECTION CONTROL

TOPIC:

STANDARD PRECAUTIONS POLICY

POLICY #

IC.2014.04

POLICY:

The employees of the Western Oregon Service Unit shall use basic Infection Control and Prevention Practices using Standard Precautions following the most current CDC and OSHA guidelines.

https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html

PURPOSE:

The Standard Precautions Policy (“Standard Precautions”) is designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection at the WOSU (Western Oregon Service Unit).

DEFINITIONS:

Standard Precautions are: (1) practices to reduce healthcare associated infections (2) used with ALL patients, regardless of diagnosis or isolation status, and (3) apply to interactions with blood, all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood, non-intact skin, or mucous membranes.

Standard Precautions are sufficient to interrupt the spread of most infectious agents and include:

1) Hand hygiene

2) PPE: Use of personal protective equipment (e.g., gloves, gowns, facemasks, shoe covers), depending on the anticipated exposure

3) Respiratory hygiene and cough etiquette

4) Safe injection practices

5) Sharps Precautions

6) Safe handling of potentially contaminated equipment or surfaces in the patient environment.

7) General Infection Control Practices HCW: Health Care Worker Donning: To put on Doffing: To take off OPIM: Other potentially infectious materials

STAFF GOVERNED BY THIS POLICY:

All personnel (staff, physicians, volunteers, students, etc.) at the Western Oregon Service Unit are responsible for understanding the principles of Infection Control and Standard Precautions, for assessing situations, and for implementing the Standard Precautions as noted in the practices below.

The Western Oregon Service Unit managers will ensure annual educational opportunities related to Infection Control and ensure that Standard Precautions are provided to all staff, visitors, and volunteers.

Effective Date:

4/17/14

New/Revised Date:

12/28/2017

Approved By:

AAAHC#: Chapter 7.I.F

STANDARD PRECAUTIONS:

Standard Precautions apply to all patients and all situations, regardless of diagnosis or presumed infection status. Because all patients can serve as reservoirs for infectious agents, adhering to Standard

Precautions during the care of ALL patients is essential to interrupting the transmission of microorganisms. Standard Precautions represent the minimum infection prevention measures that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. These evidence-based practices are designed to both protect healthcare personnel and prevent the spread of infections among patients. (Standard Precautions replaces earlier CDC guidelines relating to Universal Precautions and Body Substance Isolation).

1.0 Hand Hygiene (See Hand Hygiene Policy & Procedure (IC.2014.01)

1.1 Hand hygiene procedures include the use of alcohol-based hand rubs (containing 60-

95% alcohol) and handwashing with soap and water. Alcohol-based hand rub is the preferred method for decontaminating hands, except when hands are visibly soiled

(e.g., dirt, blood, body fluids), or after caring for patients with known or suspected infectious diarrhea (e.g., Clostridium difficile, norovirus), in which case soap and water should be used.

2.0 Personal Protective Equipment (PPE)

PPE is provided free of charge to all employees. OSHA’s Bloodborne Pathogens Standard (29 CFR

1910.1030) requires employers to protect workers who are occupationally or can reasonably be anticipated to come into contact with blood and other potentially infectious materials (OPIM).

Each employee is responsible for knowing where the equipment is kept in their department. The type of PPE used should be appropriate for the procedure being performed and the type of exposure anticipated. Refer to the PPE Donning/Doffing Poster from the CDC located at the end of this policy for instructions on the proper sequencing of Donning and Doffing PPE.

2.1 Gloves

Gloves should be worn whenever contact with blood, (ie venipuncture), blood products, body fluids, excretions, secretions, mucous membranes, or non-intact skin is anticipated. Gloves should also be worn when touching dressings or drainage tubes or when performing venipuncture or invasive procedures.

a. Change gloves:

Between each patient contact

Between tasks and procedures on the same patient after contact with material that may be contaminated

When holes or tears are noted or when the glove’s ability to function as a barrier is compromised

b. Remove gloves:

After each use

Before touching non-contaminated items and environmental surfaces

Before going to another patient

c. Reuse of gloves:

Single use gloves are not to be reused

Utility gloves may be decontaminated for re-use with an approved EPA-registered disinfectant if the integrity of the glove is not compromised

An approved hospital disinfectant is suitable for decontaminating utility gloves

Utility gloves must be discarded if they are cracked, peeling, torn, punctured, or exhibit any signs of deterioration

d. Selection of gloves:

Gloves should be chosen to fit hand size

Gloves should provide flexibility and tactile sensitivity needed during the procedure(s)

The need to follow sterile procedure (sterile versus non-sterile)

Potential for exposure to blood and body fluids during the procedure(s) both in terms of the amount and the length of time exposed

Exposure to other substances that break down glove material, such as disinfectants and solvents

The amount of stress placed on the glove during the procedure

2.2 Protective Face and Eyewear

Masks, goggles, or face shields must be worn to provide protection of the mucous membranes of the eyes, nose and mouth during procedures and patient care activities that are likely to generate droplets or splashing of blood, body fluids, secretions, or excretions.

Prescription glasses alone do not provide protection from splatter and splashes.

Removable side shields are needed to adequately protect healthcare workers from blood and body fluid exposures when they wear prescription glasses.

a. Selecting Masks:

Check the mask box for the mask’s filtering efficiency

Make sure that the mask will filter to the level of protection that is needed. For example, if the mask is intended to protect a HCW from TB, a NIOSH-approved respirator must be selected. See Respiratory Protection Policy (IC.2014.09).

Do not use adult masks on small children and infants

b. Wearing masks:

Adjust the mask so it fits snugly against the face, is secured along the sides of the face, and molded over the bridge of the nose; air should not enter around the mask edges

Keep beards groomed so that the mask fits as closely to the face as possible

Change the mask between patients

Change the mask if it gets wet

Remove the mask as soon as treatment is over

Do not leave the mask dangling around your neck

2.3 Gowns, Lab Coats, and Protective Apparel

Gowns are worn to prevent contamination of clothing and to protect the skin from blood and body fluid exposures. Gowns and other appropriate protective apparel must be worn when there is potential that an exposure (splashing with blood or body fluids) will occur. Various types of gowns and protective apparel are worn to provide barrier protection and reduce opportunities for transmission of microorganisms. Uniforms and scrubs do not provide adequate protection from blood and body fluid exposure.

a. Selecting gowns and protective apparel:

Protective garments should fit the HCW

Choose garments that prevent blood or other potentially infectious materials from passing through or reaching the HCW’s clothes or body

Select protective garments that are appropriate for the activity and amount of fluid likely to be encountered

Do not wear the same gown for the care of more than one patient

Remove gown and perform hand hygiene before leaving the patient’s environment (e.g., exam room)

b. If the uniforms or scrubs become soiled with blood or body fluids:

Glove and remove clothing immediately; handle clothing as little as possible

Do not rinse clothing

Wash contaminated skin with soap and water prior to changing into replacement scrubs

3.0 Respiratory Hygiene and Cough Etiquette (Refer to the Respiratory Hygiene and Cough

Etiquette Policy (IC.2014.03)

4.0 Safe Injection Practices (Refer to the Safe Injection Practices Policy (IC.2014.15)

5.0 Sharps Precautions

5.1 All staff that uses sharps and safety equipment will be oriented to safe practices to prevent injury to patients and themselves during orientation and annually or as needed thereafter.

5.2 Safer sharps devices will be used whenever commercially available as a substitute for a non-safety engineered device.

5.3 The safety device should be engaged before the device is placed into the sharps container.

5.4 Used needles will not be recapped, purposely bent or broken by hand, removed from disposable syringes or otherwise manipulated by hand.

5.5 Used sharps should be placed directly into impervious, rigid, leak-proof and puncture-resistant containers to eliminate the hazard of physical injury.

5.6 The sharps containers will be appropriately marked with the bio-hazard symbol.

5.7 Sharps containers will be placed in appropriate patient care areas, (ex. Exam rooms, Dental, Laboratory drawing station) which are locked and secure from tampering

5.8 Containers should be emptied when they are three-fourths full or are level with the containers line marked “full”.

5.9 Accidental needle stick “Sharps” Exposure

a. If an accidental needle stick “Sharps” exposure occurs, the employee should notify his or her supervisor immediately. Refer to Infection Control Policy

IC.2014.24, Blood and Body Fluid Exposure Plan on the Z: Drive.

6.0 Safe Handling of Patient-Care Equipment and Articles

6.1 All patient care equipment and articles that have become soiled or contaminated with infective material should be handled by employees wearing appropriate PPE.

6.2 The handling of patient care equipment and articles depends upon the type of item being handled.

a. Any disposable item that has become soiled or contaminated with infectious material should be disposed of in the appropriate biohazard container.

b. Reusable patient care equipment and articles that have been grossly soiled or contaminated with infectious material should be covered, handled, and decontaminated or sterilized according to the transmission-based isolation precautions, cleaning/disinfection, and sterilization policies.

7.0 General Infection Control Practices

7.1 Resuscitation Equipment

Mouthpieces or other ventilation devices are available in patient rooms and in the lab as alternatives for mouth to mouth resuscitation.

7.2 Linen and Laundry

a Linen that is soiled or contaminated with infective material should be handled by employees wearing appropriate PPE.

Soiled or contaminated linen should be placed directly into the provided impervious linen bags that line the linen hampers.

Linen bags should be closed and removed for transport to the laundering facility when two-thirds full.

Soiled linen should be handled as little as possible to prevent gross contamination of the environment and exposure of personnel handling the linen to organisms within the linen.

Double-bagging of linen from rooms is not necessary unless the bag’s integrity has been altered or the outer bag has become soiled with blood or body fluids.

b. Soiled laundry and linen should be picked up by an authorized laundry service

7.3 Routine and Terminal Cleaning

a. Routine and thorough cleaning and adequate disinfection of rooms, and shared patient equipment will be accomplished according to the Cleaning, Disinfection, and Sterilization Policy (IC.2014.12) and the Environmental Cleaning Policy

(IC.2014.14). Special attention should be given to items that have been in direct contact with the patient or in contact with the patient’s body fluids.

7.4 Regulated Medical Waste

a. All medical waste should be handled by employees wearing appropriate PPE based on potential exposure risks.

Waste should be bagged in impervious bags or containers.

Regulated medical waste shall be placed in an appropriately labeled or color coded bag according to state and local regulations.

An authorized waste disposal service should pick up Bio hazardous waste weekly at the Western Oregon Service Unit.

7.5 Lab Specimens

a. At the time of collection, all specimens must be placed in a labeled container which prevents leakage during collection, handling, processing, storage, transport, or shipping.

b. All specimens must be contained in a plastic biohazard lab specimen bag before leaving the collection area.

c. Some specimens may require special handling procedures. Contact your state and/or local health department or CDC to determine the proper category for shipment of specimens based on clinical history and risk assessment to obtain detailed shipping guidance and shipping documents.

7.6 Blood Spills

a. Gloves should be worn during cleaning and decontamination.

b. Spills of blood or other body fluids should be removed and the area decontaminated using an OSHA approved blood spill kit.

OSHA approved blood spill kits are located in the laboratory in a labeled cupboard.

The manufacturer’s directions should be followed for use of the product in cleaning and decontaminating spills.

The disinfectant should be EPA registered and have kill data against

Hepatitis B and HIV, Noroviruses, (non-enveloped viruses) and will be tuberculocidal.

7.7 Food and Drink

a. In patient care areas, staff can designate specific locations where drinks with lids are allowed.

These pre-approved locations must be separate from areas where lab specimens or contaminated equipment are handled.

Eating from utensils or drinking from open containers or coffee cups are prohibited at laboratory workstations or in areas where patient care occurs.

REFERENCES

United States Department of Labor, Occupational Safety and Health Administration. Occupational Safety and Health Standards, Toxic and Hazardous Substances, Bloodborne Pathogens. 29 CFR, 1910.1030.

Basic Infection Control and Prevention Plan for Outpatient Oncology Settings http://www.cdc.gov/HAI/settings/outpatient/basic-infection-control-prevention-plan-

2011/fundamental-of-infection-prevention.html

Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & the Healthcare Infection Control Practices

Advisory Committee. (2007). 2007 Guideline for Isolation Precautions: Preventing Transmission of

Infectious Agents in Healthcare Settings. Atlanta, Georgia: Centers for Disease Control and Prevention.

Guide to Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care https://www.cdc.gov/hai/pdfs/guidelines/ambulatory-carechecklist_508_11_2015.pdf http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 http://www.cdc.gov/hicpac/pdf/isolation/isolation2007.pdf http://www.cdc.gov/hicpac/pdf/isolation/isolation2007.pdf https://www.cdc.gov/hai/pdfs/guidelines/ambulatory-carechecklist_508_11_2015.pdf