Infection Prevention

Self-directed
Learning Module
For Non-Clinical
Personnel
Infection Prevention/Epidemiology Department
Epidemiology Office
Telephone: 562-933-0387
M-F 6:30-4:00
 Call the office Monday through Friday
 Messages left will be answered on the
next business day.

For urgent or emergency issues after hours, utilize

phone tree – details on website
 Infection
Prevention/Epidemiology Dept

• Access the Infection Prevention Epidemiology

Department Website from

• It contains links to resources: e.g., Policies, Guidelines,

Bundles
• Current Infectious Disease Updates
• Isolation Quick Reference Guides
• Infection Prevention Policies link
• Education
Infectious Disease Transmission
For an infectious disease to be transmitted from one person to another, there must be a “chain”
of three things happening;

1. RESERVOIR or Source
A place for the organism (bacteria, virus, fungus, etc.) to live, grow and multiply.
It can be a person, animal, insect or an inanimate object.

2. MODE OF TRANSMISSION
Way for the organism to move from the reservoir (person) to the individual who
is likely to acquire the infection.
Common modes of transmission: direct contact with blood or body fluids;
indirect contact with a contaminated instrument or surface;
contact of mucosa of the eyes, nose or mouth with droplets or spatter;
inhalation of airborne microorganisms.

3. SUSCEPTIBLE HOST
A person who is susceptible to the organism. This may be an elderly person,
a very young child or infant, or an employee who has little resistance because
of illness or medication.

o The occurrence of all these events is considered the “chain” of infection.

o Effective infection control strategies prevent disease transmission by

interrupting one or more links in the chain of infection.
Hand Hygiene
Hand Hygiene means cleaning your hands by using either
 handwashing (washing hands with soap and water),
 antimicrobial hand wash,
 antimicrobial hand rub (i.e. alcohol-based hand sanitizer including foam or gel),
 or antimicrobial surgical hand wash

• Alcohol-based hand sanitizers with at least 60% alcohol can inactivate many types
of microbes very effectively when used correctly – Make sure you use a large enough
volume of the sanitizer and let it dry – NO wiping it off.
• Clostridium difficile spores are not killed by alcohol based hand sanitizers – use
soap and water for hand hygiene

Hand hygiene is required when crossing the threshold*

*Thresholds:
• Private rooms: Door sweep = the threshold
• Semi-private rooms: Door sweep or Curtain track = threshold
• Critical care units/ ED /Bay rooms: Sliding doors or curtain
track/ privacy curtains = threshold
• Hand Hygiene required when both feet past the threshold
Hand Hygiene, cont
Where are the thresholds in the rooms?

6
Hand Hygiene
It is important TO DO IT CORRECTLY
When using Soap and Water:

Wash with Soap and Water:

When hands are visibly soiled

After caring for a person with known or suspected

infectious diarrhea
After known or suspected exposure to spores
(e.g., B.anthracis, C.difficile outbreaks)
After caring for a person with known or suspected
C. auris
Facts about Nails
When using Soap and Water:
• Wet your hands with clean running water, (warm or cold) and
• Germs can live under artificial fingernails
both before and after using an alcohol-based
apply soap hand sanitizer and handwashing
• Lather your hands by rubbing them together with the soap.
• Scrub all surfaces of your hands, including the palms, backs, • Artificial nails (acrylic, gel, tips, overlays, gel
fingers, between your fingers, and under your nails. Keep polish)or extenders are not to be worn by any
scrubbing for 20 seconds. healthcare worker providing direct patient care
• Rinse your hands under clean running water
• Dry your hands using a clean towel or air dry them.
• Keep natural nail tips less than ¼ inch long
• Use towel to turn off the faucet. • Nail polish may be worn, but should be
removed when chipped
Hand hygiene
It is important - DO IT CORRECTLY
Use an Alcohol-Based Hand Sanitizer:
When crossing the threshold and/or before touching a patient
Before preforming an aseptic task (e.g., placing an indwelling
device) or handling invasive medical devices
Before moving from work on a soiled body site to a clean body
site on the same patient
After touching a patient or the patient’s immediate environment

Immediately after glove removal

When using alcohol-based hand sanitizer:

• APPLY. Put enough product on hands to cover all surfaces
• Rub hands together, until hands feel dry
• This should take around 20 seconds

Note: Do not rinse or wipe off the hand sanitizer before it’s dry;
it may not work well against germs.
Hand Hygiene OBSERVATIONS
MEMORIALCARE Bold Goal: Achieve 100% Hand Hygiene Compliance
Hand Hygiene Champions
• Observe hand hygiene (or not when should have) and record their compliance in the audit software tool.
• On-the-spot education is completed with educational cards available to congratulate, reinforce or correct behaviors.
• Compliance rates can by monitored by hospital, department, position, method used and other variables.
Hand Hygiene Measure Indicators:
Hand Hygiene is measured for full compliance or no compliance. If someone is found to be non-compliant, then
the reason for non-compliance are noted to determine how to improve.

Compliance Total No
2022 Rate audits Full Compliance Compliance
LBMC 93% 17465 16222 1242
MCH 98% 7198 7060 139

Our hand hygiene compliance and protocol is reported to Leap Frog and is publicly
reported. The number of audits is also important in this metric. Participation in the
Leapfrog Hospital Survey gives hospitals the opportunity to report additional
information about their safety measures.

The Leapfrog Hospital Safety Grade, Leapfrog's other main initiative, assigns letter
grades to hospitals based on their record of patient safety, helping consumers
protect themselves and their families from errors, injuries, accidents, and infections.
Cleaning of Equipment
2
After EACH patient use:
minute
• Glucometer
wet
• Pulse Oximeter
contact
• BP machine (for isolation)
time
Frequently: 4
• Keyboards in clinical settings (e.g., computer, minute
omnicell, keyboards) wet
• Phones in clinical areas
contact
• Desktops
time
Don’t know when / how to clean a piece of equipment?
Refer to the Epidemiology Infection Prevention Policy: IP-
14.2 Cleaning/Decontamination of In-Patient Care
Equipment
Ask your supervisor
Refer to manufacturer’s instructions
Standard Precautions
Standard Precautions applies to all patients regardless of suspected or confirmed diagnosis
or presumed infection status, are based on the principle that all blood, body fluids,
secretions, excretions, etc. may contain transmissible infectious agents.
You observe Standard Precautions by doing the following:
 Treat all human blood, secretions, and excretions as if they are known to be infectious.

 Treat all used needles, other sharps, and chemotherapeutic agents as if they are
contaminated

 Wash hands or use hospital-approved alcohol sanitizer before and after every contact
with patients, their secretions and excretions, or their environment.

 Protect yourself with the use of gloves, gowns, masks, face shields when anticipating
any potential contamination with blood or body fluids or contact with a contaminate
surface.
 If you put on a mask over your mouth and nose, be sure to also
protect your eyes!!!
 Equipment or items in the patient environment likely to have been contaminated with
infectious organisms must be handled in a manner to prevent transmission of
infectious agents, (e.g. wear gloves for equipment handling, contain (bag) heavily soiled
equipment, clean and disinfect or sterilize reusable equipment before use on another patient).
Transmission based Isolation Precautions
The concept of transmission based isolation relates to the manner in which the organisms is transmitted. Each
isolation precaution category dictates what personal protective equipment (PPE) is required to stop the transmission
of the organism.

Contact Transmission
 Gowns and gloves for contact with patient or environment of care
• Direct - Direct transmission occurs when microorganisms are transferred from one infected
person to another person
• Indirect - Indirect transmission involves the transfer of an infectious agent through a
contaminated intermediate object or person
• Examples requiring Contact precautions – Covid-19, C. difficile, ESBL E. coli, MDR-Acinetobacter,
Resistant Pseudomonas, Candida auris

• Isolation for specific cases that do not required isolation:

 MRSA in nares, blood and urine do not required isolation
 VRE in feces/rectal swab, blood and urine do not required isolation
 MRSA/VRE in any other site requires isolation precautions
In LBMC only:
 ESBL in blood or urine is no longer isolated
 ESBL in any other site requires isolation precautions
In MCWHLB:
• All ESBL continue to be placed in contact precautions!!!
• In NICU – all MDROs are placed in isolation precautions
 Droplet Transmission – Surgical masks within 6 feet
of patient
• Particulates in air (>0.5 microns)
• Examples requiring Droplet precautions
COVID (N95 mask), Influenza, Bacterial meningitis, Pertussis
• Hand hygiene, mask when with-in 6 feet of the patient and/or the
environment of care.

• If present during the performance of aerosol-generating procedures on

patients that are known or suspected to be infected with ATPs – wear an N95
mask or a CAPR.

All masks must be worn correctly

• Not under your chin
• Your nose must be covered
They must be changed between patient care
Discard when soiled or wet.
Isolation Precautions Contact / Droplet Isolation Precautions
Airborne Isolation Precautions

Contact/Droplet transmission - precautions are used when the mode of

transmission is either direct or indirect contact, in addition to, droplet.
Examples of infectious agents that are transmitted via the contact/droplet route include
COVID-19, RSV, Adenovirus, Enterovirus/Rhinovirus.

Disposable gowns are to be worn one time per patient

encounter and then discarded inside the patient’s room.

Airborne Transmission- N95 mask, negative

pressure room
• Tiny particulates (<0.5microns)
• Examples requiring Airborne precautions
TB, Chickenpox, Measles
• An airborne infection isolation room is a single-patient
room that is equipped with negative pressure ventilation.
• Hand hygiene, N95 mask when in contact with patient
and/or the environment of care.
Transmission based Isolation Precautions, cont

Access the Infection

Prevention/Epidemiology Department
Website via the
Isolation guideline chart available on the Epidemiology MHS Intranet
Website on the for questions!
Intranet!
It contains Policies, Guidelines, Bundles and
resources that can be utilized easily:
• Isolation Information & Changes
• Isolation Quick Reference Guides
• Infection Prevention Policies link
• Education
• Bundles
• Hand Hygiene
• FAQs
Transmission based Isolation Precautions, cont

Always look for any signage outside of a patient’s room before you enter

The isolation stethoscope

located in the isolation cart
is to be used in the isolation
room and maintained
during that admission.
It is to be discarded
after the patient is
discharged.
Disposable gowns are to
be worn one time
per patient
encounter
and then
discarded.
 While Standard
Precautions generally
apply to the practices
of healthcare
personnel during
patient care,
Respiratory
Hygiene/Cough
Etiquette applies to all
persons who enter a
healthcare setting
including healthcare
personnel, patients,
and visitors

Additional Isolation Precautions are based upon the mode of transmission

of a specific organism.
All Isolation Precautions are to be used in addition to Standard Precautions.
17
Isolation Precautions
Standard and Transmission based Isolation Precautions
Use gloves, gowns, masks, & face shields when anticipating any
potential contamination with blood or body fluids or contact with a
contaminated surface.

CDC-recommended donning (left) and doffing (right) procedures. Image from CDC.
 Aerosol Transmissible Diseases1 (ATD Standard), Title 8
California Code of Regulations (CCR) §5199, which protects
employees in health care and other higher risk environments.

• ATD: An aerosol transmissible disease is a disease that can be transmitted by either

1) inhaling particles/droplets; or 2) direct contact between particles/droplets and
mucous membranes in the respiratory tract or eyes.
• ATP: An aerosol transmissible pathogen, means a pathogen that, when present in
an aerosol and with sufficient exposure, may result in disease transmission.

ATD Exposure Control Plan:

• Required to have a full ATD Exposure Control Plan (Plan) covers all healthcare
workers who have or could have exposure to ATP. It contains protections in
procedures, engineering and work practice controls, personal protective
equipment, and respirators including Power Air Purifying Respirators (PAPR).
• List of all ATD and ADP covered by plan including Novel organisms
• Novel is a new or unknown organism or disease, having recently come into
existence or newly identified
 Aerosol Transmissible Diseases1 (ATD Standard), Title 8
California Code of Regulations (CCR) §5199, which protects
employees in health care and other higher risk environments.

• Patients with suspect or confirmed case of any ATD are placed in negative pressure room.
• Patients must wear a surgical mask when outside their room or in an ambulatory care/emergency room setting
• Notify Epidemiology Department (by phone, on call phone, or leave message if no answer)
• The N95 particulate respirator is to be used when caring for patients in Airborne/Negative Pressure
Precautions
• A CAPR must be worn by an employee performing a high hazard procedure on potentially infected with any ATP

Appendix A – (ATD Standard)

Examples of Diseases/Pathogens Requiring Airborne Infection Isolation per ADT Standard, e.g.,
Anthrax/Bacillus anthracis
Avian influenza/Avian influenza A viruses (strains capable of causing serious disease in humans)
Varicella disease (chickenpox, shingles)/Varicella zoster and Herpes zoster viruses, disseminated disease in any patient. Localized
disease in immunocompromised patient until disseminated infection is ruled out.
Measles (rubeola)/Measles virus
Monkeypox/Monkeypox virus
Novel or unknown pathogens
Smallpox (variola)/Varioloa virus

Examples of Diseases/Pathogens Requiring Droplet Precautions, e.g.,

Diphtheria pharyngeal
Mumps (infectious parotitis)/Mumps virus
Mycoplasmal pneumonia
Pneumonic plague/Yersinia pestis
Rubella virus infection (German measles)/Rubella virus
Severe acute respiratory syndrome (SARS)

This list is not inclusive- see policy for complete list

 Aerosol Transmissible Diseases1 (ATD Standard), Title 8
California Code of Regulations (CCR) §5199, which protects
employees in health care and other higher risk environments.

The ATD Standard requires employers to provide and

ensure that employees use respiratory
protection (respirators) whenever an employee:

•Enters an Airborne Infection Isolation Room (AIIR) or area in use for AII
•Is in an area or residence where patients known
or suspected of having an Airborne Infectious Disease (AirID) are or have
been recently
•Repairs, replaces, or maintains air systems or equipment that may contain or
generate aerosolized pathogens
•Is present during the performance of aerosol-generating procedures on
cadavers that are known or suspected to be infected with ATPs
 M-Connect Intranet

 Important Ways to Slow the Spread

• Wear a mask to protect yourself and others and stop the
spread of COVID-19

• Avoid crowds. The more people you are in contact with,

the more likely you are to be exposed to COVID-19.
 In Healthcare Settings
• All Patients should also be screened for symptoms of COVID-19 upon
entry into a health care setting.
• Universal masking is required for all patients, visitors, and HCWs

Healthcare Providers
• COVID-19 isolation includes Contact/Droplet precautions
• Standard PPE* for patients with suspected or confirmed COVID-19 includes the use of a
gown, gloves, a respirator or medical mask, and eye or face protection
• A respirator (e.g., N95 or other respirators that offer a higher level of protection) is to be
worn instead of a medical mask for care of suspected or positive COVID patients*
• All COVID-19 positive patients will be treated as any other transmission-based isolation
precautions with its own specific requirements.
• Unmasking in breakrooms is a major source of spread for COVID-19. Your co-workers
may feel like family, but you become exposed to everyone that they have encountered.
• Being Vaccinated for COVID-19 does not mean you can’t get COVID, that you can remove
your mask or that you can’t spread the disease to others.
 • Tuberculosis (TB) is a serious disease that is
spread from person to person through the air.
TB usually affects the lungs.
• The germs are put into the air when a person
with TB of the lung coughs, sneezes, laughs,
or sings.
• TB can also affect other parts of the body,
such as the brain, the kidneys, or the spine.

TB Transmission and the Development of TB Disease

• If another person inhales air that contains TB droplet nuclei,
they may become infected. However, not every person that is
exposed to TB becomes infected with M. tuberculosis.
• Not everyone infected with M. tuberculosis becomes sick.
People who are infected but not sick have latent TB infection.
• Some people with latent TB infection go on to develop TB
disease.
• About 5 to 10% of persons with normal immune systems will
develop TB disease at some point in their lives. The risk of
developing TB disease is the highest in the first 2 years after
infection.
 Symptoms of TB
• Feeling weak or sick, weight loss, fever, and/or night
sweats.
• Persistent cough, chest pain, and/or coughing up
blood.
• Other symptoms depend on the particular part of the
body that is affected.

How is TB disease treated?

• Treatment benefits both the patient by preventing
disability and restoring health & it benefits the
community by preventing the spread of TB

• TB can almost always be treated & cured with

appropriate treatment and management.

• Treating TB disease with several drugs is more

effective & helps prevent drug resistance.

• TB traditionally lasts at least 6 to 9 months, but in

some cases, Treatment can last much longer, for
example, multidrug-resistant TB (MDR TB).
Healthcare Worker Protection
Prior to caring for patients or entering the room of suspected or
diagnosed tuberculosis, all staff is required to:
 Receive a respiratory health screen.
 Be fit-tested with the N95 PARTICULATE RESPIRATOR by Employee
Health Service
 The particulate respirator can be used more than once for a single
patient as long as it continues to form an adequate seal and has
not been contaminated.

By LAW, Patients with M. Tb CANNOT be discharged without

Public Health Department approval.
Discharge is coordinated with the Epidemiology
Department.
 • C. difficile infects approximately half a million
Americans each year.
• 29,000 patients had fatal outcomes within a
month of the initial diagnosis
• Recent studies have revealed that
approximately 41% of the infections caused
by C. difficile are community-acquired
C. difficile causes life-threatening diarrhea • 30% to 50% of antibiotics prescribed are
and colitis (an inflammation of the colon), unnecessary or incorrect. According to CDC
mostly in people who have had both recent estimates, up to $3.8 billion in medical costs
medical care and antibiotics. could be saved over 5 years.
• NIH May 2022
Transmission of C. difficile
• Clostridioides difficile is shed in feces; survives on any surface, device, or
material; and can live for long periods of time
• C. difficile spores are transferred to patients mainly via the hands of
healthcare personnel who have touched a contaminated surface or item.
 LBM and MCWHLB performs periodic
risk assessments to identify the risk of acquisition
and transmission of
Multi-Drug Resistant Organisms (MDRO).

The following MDRO s were identified to be of epidemiologic

significance:
• MRSA (methicillin resistant Staphylococcus aureus)
• VRE (vancomycin resistant Enterococcus)
• CDI (Clostridioides difficiles – formerly Clostridium difficile)
• CRE (carbapenemase-producing CRE).
• ESBL (Extended Spectrum Beta lactamase) which can be but aren’t
limited to E. coli, Klebsiella, Enterobacter, Pseudomonas
• Candida Aurus
 The Centers for Disease Control (CDC) and Prevention and the Occupational Safety
and Health Administration (OSHA) have written guidelines and regulations for
protection of workers in healthcare facilities when in contact with blood or body fluids.
A written “Exposure Control Plan for Bloodborne Pathogens” is available for all
healthcare workers (HCW) to review on the Intranet, Epidemiology/Infection Control.
The plan is designed to:
– 1) Identify workers at risk for occupational exposure to blood or other potentially
infectious diseases
– 2) Provide and document education for HCWs about their risk
– 3) Provide strategies for risk reduction and
– 4) Define and monitor compliance with the plan.

Exposure Control & Post-exposure Prophylaxis

Systems have been put in place to prevent inadvertent exposure or injury from
equipment, patient’s blood or other excretions (i.e. sharps containers, medical waste
management).
Both CDC and OSHA have written guidelines for prevention and given guidance if an
exposure were to occur.
The policy and procedure for post-exposure response is found on the Intranet,
Epidemiology/Infection Control.
Personal Protective Equipment (PPE)
These protective devices include gloves, masks, fluid resistant and non-fluid resistant gowns and eye
or face shields. As your employer, LBM/MCWHLB, is responsible for providing and maintaining
personal protective equipment (PPE) for you.

Gloves
Protective gloves should be worn whenever there is a risk of touching or handling blood,
secretions or excretions of a patient. Gloves should also be worn to prevent broken skin
transmission of infections. Wash your hands after using protective gloves. These gloves
are disposable and should be discarded after each use.
 Protective gloves should NOT be worn outside of the area where patient care is being done,
such as in the hallway and elevators.

Face Mask and Protective Eyewear

Facemask (surgical) and protective eyewear are used to protect the mucous membranes
of the eyes, nose and mouth when care activities seem likely to generate splashes or
sprays of blood, body fluids, secretions, or excretions.
The N95 particulate respirator is worn (after fit testing) for tuberculosis and similar
airborne infections only.

Gowns
Gowns or aprons must be worn when splashes of infectious materials are anticipated.
 Disposable gowns are to be worn one time per patient encounter and then thrown away. Gowns should
NOT be worn in hallways or elevators.
 Handling Sharps
•Contaminated needles and other sharps must be handled carefully to avoid puncture wounds.
•An approved engineered sharps device must protect all sharps.
•Needles should not be recapped unless a recapping device is used. Departments using
recapping devices must have a policy to cover this practice. If necessary, a one handed scoop
methods should be utilized.
•After use, all needles and sharps should be placed in the point-of-use needle container.
•This container must be kept clear of any clutter on top of it.
•Only sharps and pharmaceutical waste can be placed in this container.
•All engineered sharps are to be disposed of as medical waste.

Decontamination Procedure
Any blood spill should be decontaminated using a spill kit, appropriate protective
clothing and disinfectant. Environmental Services (EVS) should be called for
assistance after the spill is contained.

Engineering Controls
According to regulations, hospitals must implement the following practices:
 Needleless Systems - Needleless systems shall be used for:
• Withdrawal of body fluids after initial venous or arterial access
is established
• Administration of medications or fluids
• Any other procedure involving the potential for an exposure incident for which a
needleless system is available as an alternative to the use of needle devices
 Engineering Controls (con’t)
Needle Devices - If needleless systems are not used, needles with
engineered sharps injury protection shall be used for:
•Withdrawal of body fluids;
•Accessing a vein or artery;
•Administration of medications or fluids; and
•Any other procedure involving the potential for an exposure
incident for which a needle device with engineered sharps
injury protection is available.

Non-Needle Sharps - If sharps other than needle devices are used,

these items shall include engineered sharps injury protection.

LBM/MCWHLB has implemented these Engineering Controls and

the staff is expected to use them for their safety and the safety of If any of these
the patient. exceptions occur the
information should be
Exceptions to implementing the engineering control rules exist if no discussed with
safety device exists for a particular sharps device, if using the device Epidemiology, so that
jeopardizes patient safety or the success of a medical, dental or the information can be
nursing procedure or if certain circumstances exist related to the presented to the
safety performance of a device. Product Evaluation and
If a department is unable to use an engineering device provided by Implementation Team
the medical center and the reason qualifies as outlined in the and appropriately
exceptions, the exception must be documented in the department documented
specific policy.
Exposure Incident – All MUST be reported to EHS
This may be defined as an injury or exposure that involves contact with blood or other
potentially infectious materials (OPIM). Specifically, California OSHA’s definition is “a
specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact
with blood or other potentially infectious materials that results from the performance
of an employee’s duties.”

Post-exposure Response
• What should be done after an exposure? If you suffer a puncture wound with a used
needle or other sharp instrument, if you experience broken skin, or mucous
membrane contact with potentially infectious body fluids you should do the following:

1. Wash the exposed area immediately. Flood the exposed area with water
and clean any wound with soap and water or a skin disinfectant if available.
This may help prevent the pathogens from entering your body.

2. Complete an Injury & Illness form(INI) Obtain your supervisor’s signature

and go to Employee Health Services. After hours call the House Supervisor.
– Report to EHS (7am-3:30pm) or after hours to the House Supervisor
– A post-exposure confidential evaluation and follow-up will be done by EHS.
 Potential Sources of Infection
A potential source of bloodborne pathogen
transmission includes any body fluid that may contain
enough of the virus to transmit infection.

The three most common bloodborne pathogens

(BBPs) are human immunodeficiency virus (HIV),
hepatitis B virus (HBV), and hepatitis C virus (HCV).
Additional follow-up:
Sources include:
 Test of the source individual’s blood, when  Blood
feasible, to see if the body fluid that you  Body fluids that contain blood
were in contact is infectious. This should  Body fluids in situations where it is
be done with the source individual’s difficult or impossible to
consent and knowledge. The source differentiate between body fluids
individuals attending physician must be  Semen
notified.  Vaginal secretions
 Fluid from around the unborn
 You will be asked to undergo a blood test infant (amniotic fluid)
to determine if you have been infected.  Fluid from the spine joints
(Not mandatory, but highly recommended) (synovial fluid)
 Body tissue

Post-Exposure Prophylaxis
•If medically indicated, you are entitled to post-exposure prophylaxis.
•You will get medical counseling about your risk of infection and your risk of infecting others
from the Employee Health Services staff.
•All of your records regarding any incident and medical condition will be kept in strictest
confidence. All laboratory reports are coded to maintain confidentiality.
Also included in the evaluation and follow-up for an
exposure is documentation of the incident

OSHArequires
OSHA requiresdocumentation
documentationof
ofthe
the
following:
following:
–
• Date and time of exposure.
Documentation of the incident.
– • Type
Date andandtimebrand of sharp involved.
of exposure.
– • A and
Type description
brand ofofsharp
the exposure
involved. incident which
– must include:
A description of the exposure incident which
must *Your opinion about whether the injury
include:
could• have
Yourbeen
opinion about whether
prevented the of
by the use injury
other
couldcontrols,
engineering have been prevented by theor
administrative use of
work
practiceother engineering controls, administrative
controls.
or work practice controls.
*Your job classification.
• Your job classification.
*Work
• Work areaarea where
where thethe incident
incident occurred.
occurred.
• The*The procedure
procedure that
that waswas being
being performed
performed
when the exposure occurred
when the exposure occurred..
Medical Waste Management
There are five types of medical waste:
– solid – Recognizable fluid blood, fluid blood products.
– hazardous – Blood and/or body fluid filled containers, e.g., suction
container.
– chemotherapeutic – Laboratory Waste: specimen cultures; cultures and
– biohazardous (medical) stocks.
– and pharmaceutical. – Waste product of bacteria, viruses, discarded live &
attenuated vaccines, culture dishes.
– Pathological specimens.
– Artificial kidneys & blood lines for dialysis.
– Chemotherapy Waste.
– Animal parts, tissues, fluids, or carcasses suspected of
being contaminated with infectious agents known to be
contagious to humans.
– Pharmaceutical Waste.

All medical waste should be placed in a red biohazardous waste bag at the point-of-use, contained in a biohazard
waste container.
• The container must have “biohazard” labels on all visible sides and on the cover.
• All waste needs to be completely inside the container with the lid closed.
• Nothing can be stored on top of any medical waste container, no matter how small.
• All containers must be easily accessible, nothing blocking their easy use.
 Employee Health Services
562 933-1600
Mon-Fri 7am-3:30pm
Afterhours/Weekends Contact House Supervisor

During Flu Season employees and

physicians who are unvaccinated
for FLU will be required to war a
mask while at work.

How does the Flu Spread?

• The flu spreads mainly droplets
made when people with flu cough,
sneeze, or talk.
• People occasionally may become
infected by touching a surface or
object that has flu virus on it and
then touching their mouth, nose, or
eyes.
• You should stay home if sick.
Always cover your nose and
mouth with a tissue when
you cough or sneeze.
VACCINES IMPORTANT FOR YOU AS A HEALTHCARE PROVIDER
Vaccines are provided free of charge for all employees and physicians by Employee Health Services. It is
important that you take advantage of this service.
A bill became effective July 1, 2007 in California that requires all healthcare personnel to be offered the
influenza vaccine; if the individual does not wish the vaccine, they must sign a statement of declination
As of 2009 annual influenza vaccination is mandatory in all Memorial Healthcare hospitals.
Contact EHS if you have questions regarding any of the vaccines. (ex.31600)
Vaccines offered by Employee Health:
Diphtheria Mumps*
Hepatitis A Rubella (German measles)*
Hepatitis B Tdap
Influenza (flu) Tetanus
Measles* Varicella (Chickenpox)
*You do not need the measles, mumps, rubella vaccine (MMR) if:
oYou have blood tests that show you are immune to measles, mumps, and rubella.
oYou have laboratory proof of Measles
oYou have had 2 MMR vaccines on or after your 1st birthday and at least 28 days apart.
 Vaccines
Vaccination is one of the best ways parents can protect infants, children, and teens from 16 potentially harmful diseases.

https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Antimicrobial Stewardship
What is it?
• Antimicrobial stewardship describes actions or interventions that promote:
• Optimal selection of antibiotic or antimicrobial regimen
• For the appropriate duration
• At the correct dose and route of administration
• Hospital antimicrobial stewardship programs are required or recommended
by:
• California law (Senate Bills 739, 1311)
• Presidential Executive Order
• The Joint Commission
• Centers for Medicare and Medicaid Services

• Antimicrobial overuse causes organisms to become more

resistant to existing drugs, making infection harder to treat.
• With antimicrobial overuse, patients are also at greater risk of
getting unwanted side effects and other infections such as C.
difficile.
Consider these CDC statements:
• About 30% of antibiotics prescribed in U.S. acute care
hospitals are either unnecessary or inappropriate
• Each year, there are over 2.8 million infections caused
by bacteria resistant to antibiotics
LBMMC and MCWH Antimicrobial Stewardship Program
Interventions

• To guide which mediation to use, there are:

• Order sets and clinical pathways, such as the sepsis order set
• Antibiogram, to determine what drugs are most likely to work for various organisms
• Pharmacist review of specific antimicrobial therapies
• To promote correct dosing, route and administration:
• Dosing guidelines based on kidney function
• Program to convert IV drugs to oral if able
• Policies that outline how to use various antimicrobials correctly
• To assist clinicians in monitoring of antimicrobial therapy:
• Required documentation of indications for antimicrobial drugs on order entry
• Process for physician to re-evaluate antimicrobial therapy at 48 – 72 hours after start of
antimicrobial regimen (48 – 72 hour time out)
• To preserve future use of special medications:
• Restrictions on who can order targeted antimicrobials (example: broad-spectrum agents)
• Education is provided to prescribers and staff through department meetings, continuing education
programs, YouLearn module, huddles, etc.
What everyone can do daily to help
Antimicrobial Stewardship efforts

Everyone should:
• Practice good infection control practices to prevent
spread of organisms that can cause infections
• Wash hands
• Follow hospital policies for isolation, handling of patients
and equipment

• Be familiar with how to obtain more information about

the control and treatment of resistant pathogens
• Visit the Epidemiology /Infection Prevention department
page from the intranet.
• Visit the Antimicrobial Stewardship Teams department
page from the intranet
45