The Infection Prevention and Control Program at OISC is designed to reduce the risk of acquiring and transmitting infections and communicable diseases and includes patients, visitors, employees, allied health professionals, and physicians.
The components of the program are based on pertinent evidence based guidelines from the Centers for Disease Control (CDC). Supportive guidelines include the Association of Perioperative Registered Nurses (AORN), the American Association of Orthopedic Surgeons (AAOS), the Association for the Advancement of Medical Instrumentation (AAMI), the Association of Professionals in Infection Control and Edidemiology (APIC), and the Minnesota Ambulatory Surgery Center Association (MNASCA).
It is the responsibility of all employees and healthcare personnel to follow practices that minimize the spread of infection.
This course is designed to meet AAAHC and CMS regulatory requirements for infection prevention education and the OSHA bloodborne pathogen standard and employee right to know standard for infectious hazards.
- Review the Chain of Infection.
- Review key elements of Standard Precautions including hand hygiene, personal protective equipment, safe injection practices, safe handling of potentially contaminated equipment and surfaces in the patient environment, and respiratory hygiene.
- Know how to manage patients with multi-drug resistant organisms at OISC.
- Review the most common bloodborne pathogens that can be transmitted in healthcare settings, ways to prevent exposure/illness, how to respond/report exposures, and the OISC Exposure Control Plan to meet the requirements of OSHA Bloodborne Pathogen Training
- Provide tuberculosis education and understand required employee testing and the risk of transmission at OISC.
- Review influenza symptoms, ways to prevent influenza, and annual influenza vaccination reporting requirements.
- Understand what illnesses/infections/conditions and exposures need to be reported for possible work restrictions.
Chain of Infection
The transmission of infection depends on six elements which link together like a chain. By breaking any link in the chain of infection, healthcare professionals can prevent the occurrence of new infection. Infection prevention measures are designed to break the links and thereby prevent new infections. The chain of infection is the foundation of infection prevention.
Standard Precautions are the minimum infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status of the patient. These practices are designed to both protect healthcare providers and prevent healthcare providers from spreading infections among patients.
Standard Precautions include:
- Hand hygiene
- Personal Protective Equipment (PPE)
- Safe injection practices
- Safe handling of potentially contaminated equipment and surfaces in the patient environment
- Respiratory hygiene/cough etiquette
Most infection transmission occurs through direct hand contact. Hand hygiene is considered the single most important practice in preventing the spread of infection in healthcare settings.
All healthcare workers are expected to follow the OISC hand hygiene policy and use only facility approved hand hygiene products.
Alcohol Based Hand Rubs
- Is more effective at killing potentially deadly germs on hands than soap
- Requires less time
- Is more accessible than handwashing sinks
- Produces reduced bacterial counts on hands, and
- Improves skin condition with less irritation and dryness than soap and water
These areas are most often missed by healthcare providers when using alcohol based hand rubs:
- Between fingers
|Wash with soap and water||Use an alcohol based hand rub|
|•When hands are visibly dirty|
•After using the restroom
•To remove build-up of alcohol based hand rub
|•For everything else|
Basic Hand Hygiene Expectations
1. Before each patient contact or encounter
- Perform on room entry even if direct patient contact is not anticipated
- If the door threshold is crossed, hand hygiene is expected. This includes either passing beyond the swing of a door OR passing
over the threshold of a sliding door.
2. Before a clean/aseptic procedure or task
- Before donning gloves and after glove removal
- When moving from a contaminated body site to a clean body site during the care of the same patient
- Before preparing or handling sterile packages and parenterals
3. After body fluid exposure risk
- After contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings
- After handling/cleaning contaminated equipment
- After removing gloves and other PPE
4. After touching the patient environment
- After contact with surfaces or objects in the patient’s room
5. After each patient contact or encounter
- Perform hand hygiene on exit from the patient room or procedure room/area
Hand hygiene audits are conducted by designated staff in patient care areas to verify practice using entry/exit measurement.
All staff and providers are observed.
Maintaining Good Skin Health
The primary function of our skin is to act as a barrier and is the first line of defense against the external environment.
Repeated exposure to hand washing and alcohol based hand rubs may cause irritant hand dermatitis, characterized by dryness, irritation, itching, cracking and bleeding.
Facility approved hand lotion should be used 3-5 times per day. DO NOT USE lotions from home as they may not be compatible with antiseptic products and gloves.
Individuals providing direct patient care are not allowed to wear artificial nails.
Any fingernail enhancement or resin bonding product is considered artificial and includes:
- Fingernail extensions or tips
- Gels and acrylic overlays
- Resin wraps
- Acrylic fingernails
Personal Protective Equipment (PPE)
PPE refers to wearable equipment that is intended to protect healthcare providers from exposure to or contact with infectious blood and body fluids and includes gloves, gowns, face masks, respirators, goggles and face shields.
Select PPE based on anticipated exposure to blood, body fluids, or infectious agents.
- Use of gloves in situations involving possible contact with blood or body fluids (i.e., starting an IV).
- Use of a gown to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated
- Use of mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids
Click the following button to reviw how to Don and Remove PPE.
Injection safety includes practices intended to prevent the transmission of infectious diseases between one patient and another, or between a patient and healthcare provider during preparation and administration of parenteral medications.
Injection Safety Guidelines from the CDC
- Never administer medications from the same syringe to more than one patient, even if the needle is changed.
- Always use a new sterile syringe and needle for each patient
2. After a syringe or needle has been used to enter or connect to a patient’s IV, it is contaminated and should not be used on another patient or to enter a medication vial
3. Never use medications packaged as single-dose or single-use for more than one patient. This includes vials, ampoules, bags and bottles of intravenous solutions
- Even if a single-dose or single-use medication appears to contain multiple doses or contains more medication than is needed for a single patient, it CANNOT be used for more than one patient or stored for future use
- Single-dose or single-use medications must be discarded at the end of the case/procedure for which they were used
- If a multi-dose vial is accessed in an immediate patient care area (OR, Procedure Room, Patient Bay), it must be dedicated to that patient and discarded after use
NOTE: OISC still purchases multi-dose vials for some medications as they are less expensive than a single-dose vial.
5. Do not use bags or bottles of intravenous solutions as a common source of supply for more than one patient.
6. Do not combine (pool) leftover contents of single-dose vials or store single-use vials for later use.
7. Follow proper infection control practices and always use aseptic technique during the preparation and administration of injected medications. This includes:
- Performing hand hygiene before accessing supplies, handling vials and IV solutions, and preparing or administering medications
- Storing, accessing, and preparing medications and supplies in a clean area or on a clean surface
- Avoiding having non-sterile contact with sterile areas of devices, containers, and drugs
- Disinfecting the rubber stopper/diaphragm of medication vials with a sterile alcohol prep pad before inserting a needle, EVEN AFTER INITIALLY REMOVING THE CAP OF A NEW, UNUSED VIAL
- Disinfecting the neck of glass ampoules with a sterile alcohol prep pad before inserting a needle or breaking the ampoule
- Disinfecting injection ports on bags or bottles, administration sets, needleless connectors, and the hub of a catheter itself with a sterile alcohol prep pad before accessing. Hubs, connections, and ports are a potential portal of entry for infection
- Allowing alcohol to dry before entry
Labeling and Administrating Timing
All medications that are not immediately administered must be labeled with the date and time of draw, initials of the person drawing, medication name, strength, and beyond-use date and time (CMS).
Medications should always be prepared as close as possible to time of administration. The United States Pharmacopeia (USP) requires a 1 hour limit from completing medication preparation (IV bags or syringes) until beginning administration to patients.
Note: The rationale is that the 1-hour limit is expected to preclude microbial population increase when accidental contamination of such drugs occurs with small quantities of microorganisms. Once microbial contamination occurs, the organism replication can begin within 1 to 4 hours with exponential growth occurring rapidly afterward.
Consider all used linen contaminated. Wear gloves when handling used linen.
Remove bed/cart/recliner linen gently by rolling toward center of bed in such a way to contain blood or other potentially infectious materials.
Hold soiled linen away from your body at all times.
Used linen should be bagged at the location it was used (bedside) and removed from the room after the patient is transferred from the operating/procedure room or discharged from the facility.
Clean linen can be stored in patient or procedure rooms/areas, in drawers, cupboards, carts or shelves. Limit the amount of clean linen stored in patient or procedure rooms.
Clean linen should be kept covered (in plastic bags) if left in an unsecured area.
Keep clean linen separate from used equipment and supplies.
If clean linen comes in contact with the floor or other contaminated surface, dispose of it in soiled linen.
Clean and disinfect environmental surfaces when contaminated with blood or body fluids and between patients, focusing on frequently touched surfaces that are most likely to be contaminated.
Disinfectants should be used following the manufacturer’s instructions for amount, dilution and contact time.
- Oxivir Tb Wipes (purple) – Surface must remain visibly wet for 1 minute for disinfection and allowed to air dry
- PDI Sani-Cloth AF3 (gray) – Surface must remain visibly wet for 3 minutes for disinfection and allowed to air dry
All reusable equipment should be cleaned/disinfected and/or sterilized (as appropriate) between use on different patients.
Equipment contaminated by contact with contaminated surfaces, such as the floor, must be cleaned and disinfected before reusing on patient.
If the equipment cannot be adequately cleaned and disinfected, the item must be replaced.
Infectious Waste Disposal
Infectious waste is defined as the following:
- Items saturated with regulated body fluids
- Items with significant amount of caked or dried regulated body fluids
- Pathological and microbiological waste
Infectious waste must be disposed of in red bags, cans, or bins labeled with a biohazard label.
Place sharps in sharps containers.
Click the following button to view the Infectious Waste Disposal Algorithm.
Respiratory Hygiene/Cough Etiquette
The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection.
- Cover mouth/nose when coughing or sneezing
- Promptly dispose of used tissues in nearest waste receptacle after use
- Perform hand hygiene after contact with respiratory secretions
- If you feel well enough to work but have a frequent cough, a mask should be worn.
Transmission Based Precautions
Transmission based precautions are additional precautions to practice when a patient is suspected of having an illness that spreads easily and is based on how the infection is spread (i.e., contact, droplet, airborne, and enteric).
Acceptable patient populations at OISC are those that present no risk to other patients, visitors, employees and HCPs, and can be appropriately isolated. Patients that require transmission based precautions are not candidates for surgery at OISC (i.e, active Tuberculosis, Clostridium difficile, active MRSA infection).
Patients suspected of having any of, but not limited to, the following diseases on admission will be given a procedural mask and placed in a private room with the door closed until transfer for additional treatment/evaluation can be done.
- Bacterial meningitis
Patients are screened prior to admission for infectious diseases. They are advised to contact the surgery center or their surgeon’s office prior to day of surgery with any illnesses or changes in their health.
Multi-Drug Resistant Organisms (MDRO)
Patients with a history of a MDRO (i.e., MRSA, VRE, CRE) may be a candidate for surgery at OISC if the following criteria is met:
- No evidence of ongoing transmission (i.e., current infection/antibiotic treatment)
- No open wounds with excessive drainage
- No uncontrolled discharges from the body (i.e., secretions, stool incontinence)
Standard Precautions will be used for patients with a history of a MDRO. PPE should be worn based on anticipated exposure to blood and body fluids and removed prior to room exit as per PPE guidelines previously reviewed.
Bloodborne pathogens are infectious microorganisms in human blood that can cause disease in humans. Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) are three of the most common bloodborne pathogens from which health care workers are at risk. Health care workers are potentially exposed to these diseases in one of two ways:
- A percutaneous injury in which a health care worker is injured by a sharp object, or
- Contact of mucous membrane or non-intact skin with blood, tissue, or other potentially infectious bodily fluids.
Exposure Prevention and Sharps Safety
- use safety needles/sharps when available; activate the safety device immediately following use
- use appropriate PPE
- clean spills appropriately (i.e., wearing PPE, using forceps for sharps)
- avoid the recapping of needles
- place sharps in sharps container immediately after use
- don’t use a sharps container that is too full; change the container when the fill line is reached. Close/lock the container and store in Decontamination room for pick up by contracted service.
- place items saturated with blood or body fluids in infectious waste containers
- handle contaminated laundry as little as possible and bag at the bedside
- point sharp ends away from users when passing sharps
- use a neutral zone for sharps
- use a safe technique when loading sharps
- don’t use fingers to point to sharps when counting
Hepatitis B Vaccination
The hepatitis B (HBV) vaccine is HIGHLY RECOMMENDED for all employees who have contact with blood and body fluids of patients who might be infected with HBV, or who are at ongoing risk for injuries with sharp instruments or needlesticks. After three intramuscular doses of hepatitis B vaccine, more than 90% of healthy adults develop adequate antibody responses.
Responding to Exposure
1. Immediate Exposure Instructions:
- For needlesticks, cuts or contamination of skin – wash with soap and water
- For splashes to eyes, nose or mouth – rinse with water (eyewash station is located in the decontamination room)
- Report as soon as possible to the Administrator, Infection Specialist or other staff member to assist with post-exposure reporting
- Call Employee Occupational Health (EOH) at ANW or complete the post-exposure packet and fax to EOH
- If indicated, the patient’s blood will be drawn for HIV, HBV, and HCV
- EOH will contact you to inform you of patient lab results, and any treatment recommendations.
OISC has an Exposure Control Plan to eliminate or minimize occupational exposure to bloodborne pathogens. The Exposure Control Plan is located in the OISC Policy and Procedure Manual located in Phase 1 Recovery.
Click on the following button to review the OISC Exposure Control Plan.
Influenza (also known as the flu) is a contagious respiratory illness caused by flu viruses. It can cause mild to severe illness, and at times can lead to death. The flu is different from a cold. The flu usually comes on suddenly. People who have the flu often feel some or all of these symptoms:
- Fever (100°F or higher) or feeling feverish/chills
- Sore throat
- Runny or stuffy nose
- Muscle or body aches
- Fatigue (tiredness)
- Some people may have vomiting and diarrhea, though this is more common in children than adults.
During Influenza Season:
- Get vaccinated!
- Take steps in your daily life to help protect you from getting the flu.
- Wash your hands often with soap and water or an alcohol-based hand rub.
- Avoid touching your eyes, nose, or mouth.
- Try to avoid close contact with sick people.
- Practice good health habits. Get plenty of sleep and exercise, manage your stress, drink plenty of fluids, and eat healthy food.
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone without the use of fever-reducing medicine. If you have ongoing respiratory symptoms, you may need to be evaluated by your primary care provider to determine appropriateness of contact with patients.
An annual influenza consent or declination is required to be completed for all employees and non-employees who work in the facility from October 1st through March 31st. The consent/decline form is available online via the Allina Knowledge Network.
The following illnesses/infections/conditions or exposures to the following should be reported to the Administrator to determine if work restrictions are necessary.
- Chicken Pox or Shingles
- Measles, Mumps, and Rubella
- Non-allergic skin rashes
- Hand or forearm lesions
- Open or draining wounds
- Diarrhea ≥ 3 days or bloody diarrhea
- Cough > 14 days if no recent upper respiratory infection or cough; < 14 days if known exposure to pertussis
- By request of the Administrator and/or infection prevention & control in response to an outbreak or concern about infectivity to patients or staff
A physician assessment/treatment may be required as appropriate.
Mode of Transmission
- Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis or M. tuberculosis.
- It is spread from person to person through the air.
- When a person with infectious TB disease (TB that can spread) coughs, sneezes, speaks, or sings, tiny particles containing the bacteria may be expelled into the air.
- Infection occurs when a susceptible person inhales air that contains the bacteria.
Phases of TB
Not everyone infected with M. tuberculosis develops TB disease.
There are two TB related conditions:
- Latent TB infection (LTBI)
- TB disease
Risk Factors for Developing TB Disease
Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later, when their immune system becomes weak for another reason.
Overall, about 5 to 10% of infected persons who do not receive treatment for latent TB infection will develop TB disease at some time in their lives. For persons whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for persons with normal immune systems.
Generally, persons at high risk for developing TB disease fall into two categories:
- Persons who have been recently infected with TB bacteria
- Persons with medical conditions that weaken the immune system
Sites of TB Disease
- Occurs in the lungs
- Most cases of TB are pulmonary
- Occurs in places other than the lungs (larynx, lymph nodes, membrane surrounding the lung, brain, kidneys, and bones/joints)
- Occurs most often in immunocompromised persons or young children
- Most types are not considered infectious
- Occurs when TB bacteria enter the bloodstream and are carried to all parts of the body, where they grow and cause disease in multiple sites
- Very rare, but serious
Symptoms of TB Disease
Pulmonary TB disease usually causes one or more of the following symptoms:
- cough (lasting for 3 or more weeks)
- chest pain when breathing or coughing
- night sweats
- weight loss
- appetite loss
If you have symptoms of TB disease, consult with your primary care provider.
Testing for TB Infection
There are 2 tests available to determine if a person is infected with M. tuberculosis:
- Mantoux tuberculin skin test (TST)
- QuantiFERON TB Gold test (QFT-G)
- A small amount of fluid called tuberculin is injected under the skin in the lower part of the arm.
- Most people with TB infection will have a reaction to tuberculin at the injection site.
- The basis of reading the skin test is the presence or absence of induration, which is a hard, dense, raised formation. This is the area that is measured.
- Reactions to the tuberculin test at the injection site can range from no induration to a large, well-defined induration.
- The induration is measured in millimeters (mm). A measurement of 0-4 mm of induration is interpreted as negative. A measurement of 5 mm and above may be interpreted as positive depending on multiple factors (i.e., medical history, age, occupation, contact with infected persons, etc.)
- Blood test that measures a person’s immune reactivity to M. tuberculosis.
- May be used in place of a TST.
**Medical evaluation and additional testing are needed to confirm the diagnosis of LTBI or TB disease for a positive TST or QFT-G.
Tuberculosis Cases in Minnesota and United States
- There were 172 reported cases of active TB disease in Minnesota in 2018 (a rate of 3.1 per 100,000 population).
- This represents a 3% decrease in the number of cases compared to 2017.
- The majority of cases occurred in the metropolitan area, primarily in Hennepin and Ramsey Counties.
- Despite the higher TB case counts and rates in Minnesota recently, the TB case count has decreased 28% since 2007.
- There were 9,025 TB cases reported in the US in 2018 (a rate of 2.98cases per 100,000 population).
- This represents a 0.7% decrease from 2017.
- In 2018, a total of 70.2% of reported TB cases in the United States occurred among non-U.S.-born people.
Risk of Transmission at OISC
- An annual TB risk assessment is conducted to monitor and evaluate the quality of the TB Infection Control Program and determine the types of controls needed.
- OISC is a low risk setting, meaning persons with TB disease are not expected to be encountered and exposure to M. tuberculosis is unlikely.
- The primary TB risk to employees and healthcare workers is when they come in contact with patients who have undiagnosed or unsuspected TB disease.
- Even though patients with suspected TB or TB disease are not expected to be encountered at OISC, and transmission is unlikely, protocols are followed for the recognition of TB, patient isolation and transfer.
- Baseline testing for M. tuberculosis infection is required for all newly hired employees included in the TB Infection Control Program. TB documention for credentialed providers is facilitated by Allina CVO.
- Effective June 10, 2019, annual screening is no longer required for Minnesota Department of Health licensed health care setttings, including ASCs, regardless of setting risk level classification. Annual testing is not required at OISC.
Click on the following button to view the OISC Tuberculosis Control Plan policy.
All employees and providers are responsible for preventing and minimizing the risk of infection for patients, coworkers, visitors, and self.
Employee and provider responsibilities include:
- Following OISC infection prevention and control policies and procedures
- Using proper aseptic technique when indicated
- Maintaining a clean and sanitary work environment
- Using personal protective barriers and engineering controls to prevent exposure to infectious agents
- Reporting exposures to the Administrator and/or Infection Specialist
- Following the facility guidelines for HCWs “exposed to” and HCWs “with” communicable diseases
- Participating in investigations of employee/patient exposures to communicable diseases
- Participating/completing infection control training within 30 days of hire at OISC and annually thereafter
- Be familiar with the contents of the OISC Bloodborne Pathogen Exposure Control Plan and be able to locate the plan
- Collaborating with the Administrator and Infection Control Specialist and others as appropriate with the investigation of infection rates and other significant findings which exceed thresholds; develop and/or implement actions to minimize the infection risk
- Notifying the Administrator or Infection Control Specialist of any known or suspected infection control problems.
Thank you for completing the infection prevention and control education module! Complete the following attestation form.
CDC. Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html
CDC. Hand Hygiene in Healthcare Facilities. https://www.cdc.gov/handhygiene/
CDC. Management of Multi-drug Resistant Organisms in Healthcare Settings 2006. http://www.cdc.gov/hicpac/pdf/guidelines/MDROGuideline2006.pdf
CDC. Tuberculosis. http://www.cdc.gov/tb/
CDC. Influenza (Flu). Information for Health Professionals. http://www.cdc.gov/flu/professionals/
CDC, Workplace Safety, Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C. http://www.cdc.gov/niosh/topics/bbp/