JHSCC

Infection Control Education

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 INSTRUCTIONS
Welcome, you are about to participate in an infection control educational
module.

This module contains information and questions.

You must answer every question correctly in order to continue to the

next slide and complete this module and receive your certificate.

You will be directed to the slide containing the information if a

question is answered incorrectly . There is no time limit.

You will be asked for your identifying information at the end of the
session so that you can receive credit for taking this module.

If you have questions about any of the information contained in this

educational module please call Infection Control Department at
(312) 864-4581.

Click the image button below to start and enjoy.

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Review of General Infection
Control Practices

3
Standard Precautions include the following:

1.
1 Gloves when handling blood/body
fluids
2.
2 Gown, mask and eye protection
when a splash/spray is anticipated
3
3. Replacing sharps containers when
they are ¾ full
4.
4
All of the above

4
Wrong Answer !

Try
Again!

5
 Standard (Universal) Precautions
• Based on the premise that transmission of
disease occurs when healthcare workers are
exposed to persons with undiagnosed
infectious diseases

• Routinely use personal protective equipment

(PPE), engineering controls, and safe work
practices to prevent direct contact with blood,
body fluids/substances, mucous membranes,
non-intact skin, and surfaces contaminated
with blood and body fluids/ substances
6
Examples of PPE and Engineering
Controls
PPE Engineering Controls
• Gowns • Sharps Containers
• Gloves • Centrifuge
covers/splash shields
• Eye/Face Protection
• Needleless or blunt
• Masks cannula systems
• Sharps with
engineered sharp
injury protection

7
 Safe Work Practices
• Activities you can control to make the
environment safe for everyone

• Eating, drinking, applying cosmetics or

manipulating contact lenses should be
performed ONLY in areas where there is
NO risk for contact with blood/body fluids
(Occupational Safety and Health Administration)

8
When placing a hand on a patient’s beside
table, the hand can be contaminated with a
multi-drug resistant organism e.g. MRSA,
C-difficile, or VRE.

True

False

9
 Recovery of VRE from Hands and
Environmental Surfaces
• Up to 41% of HCWs hands sampled (after
patient care and before hand hygiene)
were positive for VRE1
• VRE has been recovered from a number
of environmental surfaces in patient
rooms
• VRE can survive on a countertop for up to
7 days2
1
Hayden, Clinical Infectious Diseases 2000;31:1058-65
2
Noskin, Infection Control and Hospital Epidemiology 1995;16:577-581 10
The Inanimate Environment Can Facilitate Transmission
X represents VRE culture positive sites

~ Contaminated surfaces increase cross-transmission ~

MK Hayden, The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. ICAAC 2001.
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Where do you find the contact time
information for the surface disinfectant used
at JSHCC ?

Material Safety Data Sheet (MSDS)

Environmental Service Department
Product Label
Infection Control Department

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 SURFACE DISINFECTION

 A quaternary ammonium (QUAT) + isopropyl

alcohol product is used for surface disinfection
throughout the hospital.

 It is a ready to use (RTU) formulation available

for use by all staff.

 The contact time (stated on the product label) is

required in order to be effective.

 Wet the surface to be disinfected and allow to air

dry. DO NOT WIPE DRY.

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 Transfer of Patient in Isolation
From sending department
– Hand-off communication : Verbally communicate with the
receiving department about patient’s isolation status; ascertain
Personal Protective Equipment (PPE) is available
– Perform hand hygiene, don required PPE , place clean sheet on
gurney/wheelchair, transfer patient to gurney/wheelchair
– Remove PPE and perform hand hygiene before leaving the room
During transport
Staff should not wear any PPE in hallway or elevator (CDC
Guideline for Isolation, 2007), except when:
 patient is intubated
 there is non-contained blood or body fluids
 instructed by Infection Control

At receiving department
1. Don required PPE.
2. Transfer the patient to bed or examination table.
3. Remove PPE and perform hand hygiene before exiting the room.
4. Wipe gurney or wheelchair with hospital approved surface
disinfectant and allow to air dry.

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The following items should be placed in a
red plastic bag for disposal:
A used diaper or attends
A blood soaked gauze
A newspaper used by a patient on
Airborne Precautions
All of the above

15
Potentially Infectious Medical Waste
Include:

 All blood/body fluids, or disposable items

contaminated with blood or body fluids
that are not contained and may leak or
drip
 All laboratory waste that has not been
rendered non-infectious
 Contaminated sharps

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 Think Before You Dispose of Waste
White Red
 Tissue Paper  Blood soaked gauze
 Newspaper  Blood bag and tubing
 Sterile Tray Wrapper  Lab specimens and
 IV Tubing without culture plates
visible blood  Bloody OR drapes
 Disposable patient  19¢/pound of red
care items if not bag waste
saturated or caked
with blood/body fluids
 3.5¢/pound of regular
waste

17
 A hospital the size of JSH is expected to
generate 1.4 million pounds of red bag waste
per year. How many pounds of red bag
waste does JSH average per year?

One million pounds

Three million pounds
Two million pounds
1.5 million pounds

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 Red Bag Waste
 According to Environmental Services,
JSH generates an average of 2
million pounds of red bag waste each
year. The actual cost per year is
approximately $380,000.

 Theexcess 600,000 pounds of red

bag waste costs JSH an extra
$114,000 per year!

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 Point of Use Disposal
The sharps disposal container must be
used for:
– Needles
– Blades
– Scalpels
– Any sharp object that might penetrate
the trash bag
* Never place anything on top of the sharps disposal cabinet.
It may obstruct safe disposal and result in an exposure.
* Replace the sharps disposal liner when ¾ full and NEVER
force a sharp into the liner.

20
 When prepping the skin prior to
drawing blood for a blood culture,
one should:

1 Use chlorhexidine to disinfect the skin

Disinfect the diaphragms of the blood

2 culture bottles with alcohol

3 Collect 8-10 ml of blood

All of the above

4

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 Blood Culture Collection
 With circular motion , disinfect skin
with Chlorhexidine.

 Disinfect ports with alcohol.

 Disinfect diaphragm of blood culture
bottles with alcohol .

 Use sterile Vacutainer Safety-Lok®

blood collection set.

 Do not use blood culture bottles that

are missing its “pop-off” cap.

 TWO SETS (2 bottles/set) OF

BLOOD CULTURES ARE
MANDATORY approximately 5-15
minutes apart from 2 separate sites.

 Keep blood culture bottles in upright

position; label the blood culture
bottle to make sure 8-10 ml of
blood sample is collected.
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Laboratory specimens can be placed directly
into the pneumatic tube for transportation to
the lab.

1. True
2. False

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1 3

Specimen Container Translogic Zip N’ Fold Bag

Never place a specimen DIRECTLY in
2 the carrier!
4

Plastic Carrier
Specimen Bag
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The following pathogens require
Contact Precautions:

Clostridium difficile
MRSA (Methicillin Resistant Staphylococcus
aureus)
VRE (Vancomycin Resistant Enterococcus)
ESBL positive organisms (Extended
Spectrum Beta Lactamase)
All of the above

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 Example:
Example: MRSA, VRE
TB

John H. Stroger, Jr. Hospital of Cook County

NEUTROPENIC PRECAUTIONS Example:
1. ROOM: patients must be segregated in private room if Meningitis,
available or single bed cubicle.
Example: 2. GLOVES: must be worn by all personnel having any patient Whooping
contact.
Severely 3. HANDS: must be washed before and after delivery of cough
patient care; and after removing gloves.
immuno- 4. MASKS: must be worn by any personnel with colds, coughs
and other respiratory infections coming in contact with
compromised patient.
patients 5. Fresh fruits, vegetables and plants should not be left in
patients’ room. 26
P-800
Does every ICU patient get screened for
MRSA?

True
False

27
Patients colonized or infected with MRSA
require contact precautions. Which of the
following must a healthcare worker do to
prevent transmission?
Perform hand hygiene before and after
patient or environmental contact.
Wear gown and gloves before entering
the room.
Remove gown and gloves before leaving
the room.
All of the above.

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 MRSA/MDRO Legislation
 MRSA-stands for Methicillin (Oxacillin)-Resistant
Staphylococcus aureus.
– Staphylococcus aureus is a bacteria found on the skin or in noses Of
healthy people.
– MRSA is a type of Staphylococcus aureus infection that is resistant to
antibiotics making it more difficult to treat.
 Public Act 095-0312-MRSA Screening and Reporting Act
– requires active surveillance testing for MRSA of all patients in
intensive care units and other at-risk patients.
– requires isolation of MRSA-colonized or infected patients.
– requires monitoring and strict enforcement of hand hygiene.
– requires reporting of the total number of MRSA infections.
 Public 095-0282- Section 10.5 -Prevention and Control of
Multidrug- Resistant Organisms (MDRO)
– requires facilities to implement comprehensive interventions
to prevent and control and report MDRO.
– requires enforcement of hand hygiene requirements.

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 John H. Stroger Jr Hospital of Cook County
Critical Care Units
MRSA Surveillance Compliance and MRSA Positive Rate
January 2009 to December 2009
% Compliance % Positive
Mean (Compliance)=97.2%
100
95
90
85
80
75
70
65
Percentage

60
55
50
45
40
35
30
25
20 Mean (Positive)4.4
15 9.7
10 5.8 6.3 3.9 5.7 3.4
5
2.0 0.5
0
NeuroICU NICU MICU A & B BICU TICU CCU PICU SICU
Units

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 MultiDrugResistantOrganisms
Transmission: once introduced into the
hospital, transmission & persistence is
determined by:
– vulnerable patients
– antimicrobial use
– the number of colonized & infected
patients
– implementation & adherence to
prevention efforts

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 MultiDrugResistantOrganisms
Microorganisms seen at Stroger Hospital
 Gram negatives:
Acinetobacter baumannii—
direct, indirect &
environmental contact
E. Coli —GI tract, fecal
contamination of equipment
VRE—found everywhere,
opportunistic infections
Pseudomonas—contaminated
water & fluids and equipment
KPC/ESBLs—long staying pts.,
ICUs, central lines, antibiotics
 Gram positives:
MRSA—found everywhere,
unwashed hands,
contaminated equipment

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MultiDrugResistantOrganisms
▬Transmission Prevention▬
The Joint Commission-2010 National Patient Safety Goal, 07.03.01-
requires hospitals to implement evidence-based practices to prevent
healthcare-associated infections due to MDRO.

 Hand Hygiene is mandatory before entering and

after exiting a patient’s room.
 Follow contact precautions
 A single room is preferred.
 A gown & gloves are don prior to entering the room.
 Discard PPE before exiting the room. Never reuse a
yellow cover gown.
 Educate patients and families about hospital
acquired infections, MDRO, and prevention
strategies

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 MultiDrugResistantOrganisms
▬Transmission Prevention▬
 Environmental
Measures:
 Use dedicated non-critical equipment
 Thoroughly clean and disinfect
frequently touched surfaces (e.g.
bedrails, charts, bedside commodes,
doorknobs, etc.)
 Environmental contamination is
commonly found when there is a lack of
adherence to facility cleaning &
disinfection procedures
 Use a hospital approved disinfectant to
clean patient care equipment

Cleaning agents containing bleach maybe used to disinfect the

environment of patients with Clostridium difficile only at the
direction of Infection Control Department.

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 Surgical Site Infection Prevention
The Joint Commission- 2010 National Patient Safety Goal, 07.05.01-
requires hospitals to implement evidence-based practices for
preventing surgical site infections.

 If necessary to remove hair, use clippers—NO

RAZORS
 Control blood glucose level for all postop patients
particularly open heart patients
 Use Chlorhexidine bath prior to surgery when
appropriate

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Surgical Site Infection Prevention
 Administer
antimicrobial
prophylaxis in
accordance with your
department guidelines
(see Cerner Intranet)

36
Healthcare workers are considered at high
risk and should receive Influenza vaccine on
an annual basis.

True
False

37
 Healthcare Workers and Influenza Vaccine
 The Advisory Committee on Immunizations recommends
annual Influenza immunization for healthcare workers.
 A 2002 CDC survey determined that only 38% of
healthcare workers were vaccinated
 During the 2009-2010 flu season, 2304 employees
received seasonal influenza vaccine and 4413 employees
received H1N1 vaccine (as 1/9/10) from JSHCC Employee
Health Service.
 Influenza vaccination of healthcare workers has been
associated with reduced work absenteeism and fewer
deaths among nursing home patients
 Influenza outbreaks in hospitals have resulted from low
vaccination rates among healthcare providers.

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 Protect Yourself – Protect Others
Get Your Flu Shot!
 Influenza Vaccine
Influenza vaccination can prevent you from giving the flu to your
patients, your colleagues and your family.
It prevents illness in 70-90% of healthy adults under 65 when
the vaccine and the circulating strain match.

 Vaccinate Your Patients

The flu vaccine is the best way to prevent influenza
hospitalizations and death.
Influenza causes an average of 36,000 deaths and 200,000
hospitalizations per year in the U. S. (CDC data, September 2005

 Protect Your Community

Promote the flu vaccine throughout the influenza season.
October and November are the best months to vaccinate, but the
vaccine can be given as early as September and can be given in
December and throughout the flu season.

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All Influenza is the Same
True

False

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 US Infectious Disease Mortality:
The Impact of Spanish Flu Outbreak of 1918
Spanish flu outbreak of 1918

AIDS

The Spanish Flu pandemic of 1918 had a much more deadly impact than the AIDS
epidemic of the 1980s
Armstrong. JAMA 1999;281:61
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 Flu Terms Defined
 Seasonal (or common) flu is a respiratory illness that can be
transmitted person to person. Most people have some
immunity and a vaccine is available.

 Novel Influenza A H1N1( previously swine) is a respiratory

disease of pigs caused by Novel Influenza Type A H1N1.
Human cases have been identified throughout the world
(pandemic) including the United States. The virus is spread
from person-to-person by exposure to infected droplets
expelled by coughing or sneezing that can be inhaled, or that
can contaminated hands or surfaces.

 Avian (or bird) flu is caused by influenza viruses that occur

naturally among wild birds. The H5N1 variant is deadly to
domestic fowl and can be transmitted from birds to humans.
There is no human immunity and no vaccine is available.

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 John H. Stroger Hospital of Cook County
Weekly Novel Influenza A H1N1 Cases by Culture Date
April 27, 2009- March 31, 2010

<1 y. o. 1-4 y.o. 5-19 y.o. 20-65 y.o. >65 y.o.

45
44
43
42
41
40
Last positive case
39
38
37
3/22/10
36
35
34
33
32
31
30
First positive case
29
28 4/27/09
# of Cases

27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0

Week
Total Cases=295 ( Inpatient=145, Outpatient=131, EHS=11, No records=8)

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Novel Influenza A H1N1
• The World Health Organization (WHO) declared Novel Influenza A H1N1
a pandemic on June 11, 2009 based on increased human to human
transmission around the world. This labeling does not indicate severity of
the diseases, which, overall has been mild.
• Declaring Novel Influenza A H1N1 a pandemic triggers additional efforts
towards controlling the spread of the disease.

• Stay vigilant for Influenza. Identify and treat patients at high risk for
Influenza A H1N1. A nasopahryngeal swab is required for diagnostic
testing.

• Any employee with Influenza-Like-Illness (ILI)-defined as fever (100ºF or

37.8ºC and a cough and /or sore throat must inform supervisor, wear a
mask, and seek medical care immediately.

• Employees who have been away from work due to ILI must have medical
clearance from Employee Health Service before returning to work.
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Avian Influenza (H5N1)

 Outbreaks have occurred in poultry since 1977 mostly in Asia.

 As of August 2006, there have been 241 laboratory confirmed

human cases of avian influenza worldwide. Of those cases,
141 have died.

 There is concern that the virus will mutate in a way that

allows it to spread form person to person.

 Early identification of all patients with respiratory symptoms

will decrease the risk of transmission of all diseases that
transmit through the air by droplets.

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Acute Infectious Respiratory Illness Protocol (AIRIP)
 Patients presenting with a fever and respiratory illness must
be screened at the point of entry to care.
 They should be asked the following:
Do you have a new/worse cough or shortness of breath?
Are you feeling feverish or do you have a temperature?
 If the patient is symptomatic, they must be moved to a
negative pressure isolation room when available or a private
room with a HEPA filter when not available.
 Staff must:
Wear an N95 respirator, gloves and gown
Follow Airborne and Contact Isolation Precautions

John H. Stroger Jr. Hospital Infection Control Policy 07-07-16. Acute Infectious Respiratory Illness
Protocol (ARIP) and Fever and Rash Illness Protocol (FRIP)

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Which of the Following is Considered a
Category A Bioterrorism Agent?
Anthrax
Botulism
Plague
Smallpox
Tularemia
Viral hemorrhagic fever
All of the above

47
 CDC Category A Bioterrorism Agent
Infection Control
Patient Laboratory
Disease
Isolation Precautions Containment
Smallpox Airborne & Contact Yes

Plague Airborne & Droplet Yes

VHF Airborne & Contact Yes

Anthrax Standard No

Botulism Standard No

Tularemia Standard Yes

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Control of Transmission of Infectious Rash Illness

Patients presenting with a fever and a rash of

unknown origin must be:
•Instructed to wear a surgical mask
•Triaged to a private negative pressure isolation
room.

Staff must:
•Wear an N95 respirator, gloves and gown
•Follow Airborne and Contact Isolation Precautions

John H. Stroger Jr. Hospital Infection Control Policy 07-07-16. Acute Infectious
Respiratory Illness Protocol (ARIP) and Fever and Rash Illness Protocol (FRIP)

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Bloodborne Pathogens

50
All on-the-job injuries/exposures involving
blood or other potentially infectious
materials should be reported to:
The first physician encountered in your area or unit

Your own primary care physician

The Emergency Department

Inform your Supervisor, then go to Employee Health

Service during regular work hours (8am to 4pm) and
the Emergency Department during off-shift hours
(4pm to 8am)

51
 Factors Considered by EHS when
Evaluating if Post Exposure Prophylaxis (PEP) is needed
Source Material
Blood, body fluids, OPIM*, instruments
Type of Exposure
Percutaneous, mucous membrane, or compromised skin
Volume
Small/large, few drops/major splash
Severity
Solid needle vs. large hollow-bore, deep puncture, visible blood on
device
HIV status of source
CD4 count, AIDS, viral load

*OPIM (Other Potentially Infectious Material): semen, vaginal,

CSF, synovial, pleural, peritoneal, pericardial, amniotic, tissue
~ Report ALL Exposures in a timely manner ~

52
What is the single most effective
measure to prevent Hepatitis B Virus
(HBV) infection?
Avoid blood and body fluid exposures

Receive 2 doses of HB vaccine

Receive 3 doses of HB vaccine

Get tested for HBV antibody yearly

Wear gloves for any anticipated contact with

blood 53
Comparative Risks of Bloodborne
Pathogen Transmission from
Percutaneous Injury
(Rule of “3s”)

 HIV– 0.3%
 Hepatitis C – 3%
 Hepatitis B –
30%
Hepatitis B Carries Greatest Risk!

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Airborne Pathogens

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 Airborne Infection Isolation (AII)

Type of Patient Employee Examples of

Definition
isolation placement protection organisms
Airborne Organism 1- Negative N-95 mask TB
transmitted pressure isolation when Measles
by room entering Chickenpox
respiratory 2- Outside of patient room
droplet room place
nuclei (<0.5 surgical mask on
um in size) patient

56
Which of the following diseases require Airborne
Isolation?
TB
Measles
Chickenpox
Smallpox
SARS
All of the above

57
Which patient symptoms would make you suspect
pulmonary tuberculosis?
Chronic cough (> 2 weeks)

History of TB exposure

Unexplained weight loss (e.g., 20 lbs in 4

months)

History of a positive TB skin test

All of the above 58

Signs and Symptoms of Tuberculosis
 Cough
 Bloody Sputum
 Fever
 Chills
 Night Sweats
 Loss of Appetite
 Unintentional Weight Loss
 Easy Fatigability
 Abnormal Chest X-ray

It is the responsibility of the triage nurse in the ED to screen

all patients for the above symptoms. Patients should have a
surgical mask placed on them and have an expedited CXR.
They shall be placed in the negative pressure isolation room.

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 Sputum Specimen Collection
 Must have at least 3 consecutive sputum
specimen collected in 8-24 hours interval.
 At least 1 sputum must be an early
morning specimen.
 Sputum specimen must be collected in an
Airborne Infection Isolation (AII) Room or
Sputum Induction Booth.

60
What action should a HCW take before
entering an Airborne Infection Isolation (AII)
room?
Wear an N95 respirator
Perform a fit check
Check the mechanical monitor
All of the above

61
 Monitor

Sign
Mask

62
 Protect Yourself from Exposure to TB!
 HCWs (and visitors) put on
an N95 respirator and
perform a fit check before N95
entering the room
Surgical
 Check the mechanical mask
monitor to assure the
room is under negative
pressure

 Place a surgical mask on

patients when they are out
of the Airborne Infection
Isolation (AII) Room.
Notify receiving
department. Mechanical Monitor

63
When transporting a TB patient on an
elevator, the following persons should
be masked:
Patient transporter
Patient
Both transporter and patient
Everyone BUT the transporter and
the patient

64
Medical Evaluation Following a Positive
Tuberculin Skin Test
The medical evaluation is performed
by the Employee Health Service and
may include the following:
 Health Evaluation
 Chest X-Ray
 Sputum cultures
 Medication

65
The 2009 Tuberculin (PPD) skin testing performed
on HCWs at Stroger Hospital revealed a
conversion rate of:

5%
3%
0% (no conversions)
Less than 1%

66
 Stroger Hospital
2009 PPD Conversion Rate
• The risk of occupational
tuberculosis at Stroger
15 Conversions is low.
• Most employees at risk for
4,338 PPDs Placed exposure are tested
every 12 months.
• A few groups of employees
Conversion Rate = 0.3%
at high risk for exposure
are tested every 6 months.

67
From 1997 to 2009, the number of TB
cases seen at Stroger Hospital has:

Increased
Decreased
Remained about the same

68
 Tuberculosis Cases in Illinois, the City of
Chicago and Stroger Hospital 1997 – 2009
Illinois Chicago Stroger

974
1000
850
825
743
750 707
Number of Cases

680
633
599 569 596 569
521
473 463 469
500 418
400 378 382
339 333
308 292
259
214 202
250
112 95 92 97 91 93 89
83 80 72 73 60 39

0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year

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