The first step of getting sharp injury or exposure to body fluids is

Do first aids and inform ward supervisor

Report to infection control department

Infection Control in Health Care Setting

7.018 Safe Injection Practices (Refer to 7.07 Safe Injection Policy) Environment of Care: Active participation with all identified projects to assess compliance with infection control standards. . Surveillance, Control, and Reporting includes: Baseline information about the frequency and type of nosocomial infections. Identification of patients and/or staff with communicable or potentially communicable infections. Patients identified with a communicable disease will be isolated from other patients in the facility or, if this is not possible, they will be transferred to a local hospital for care or rescheduled. Identification of clusters of microorganisms or significant deviations from endemic level. Reporting to committees and outside agencies, when required. Investigation of infections as needed. Immediate implementation of corrective and preventive measures that result in improvements. The Infection Control nurse or designated staff member will perform facility audits and report results to the QI committee and Board of Managers. EVALUATION Evaluation and improvement of the infection prevention and control activities are important steps in the Center’s efforts to control and prevent infection. Infection prevention and control practices should become a routine part of the care, treatment, or services the center provides to patients. Patients expect and deserve hygienic and safe care even if their contact with the Center does not extend beyond a single visit. Continuous review of the goals, activities, and outcomes of the Center’s initiative are therefore followed by improvement activities that are realistic in expectation and, above all, effective. Evaluation of the plan shall include but not be limited to: Evaluation of the infection prevention and control activities annually and whenever risks significantly change. The evaluation includes a review of the following: The infection prevention and control prioritized risks The infection prevention and control goals. Implementation of infection prevention and control Outcomes of infection prevention and control activities. Findings from the evaluation are communicated at least annually to the Quality Management Committee References: http://oneandonlycampaign.org/content/what-are-they-why-follow-them. Centers for Disease Control and Prevention (CDC). (2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved January 29, 2015 from www.cdc.gov/niosh/topics/bbp/sharps.html. Centers for Disease Control and Prevention (CDC). (2003). Guidelines for Environmental Infection Control in Health-Care Facilities 52(RR10);1-42. Retrieved January 29, 2015 from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm. Centers for Disease Control and Prevention (CDC). (2002). Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR. 51(RR-16). Retrieved January 29, 2015 from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm. Centers for Disease Control and Prevention (CDC). (2008). Sharps Safety Workbook. Retrieved April 24 2014 from http://www.cdc.gov/sharpssafety/pdf/workbookcomplete.pdf. Guideline for Infection Control in Healthcare Personnnel available at: Guideline for Infection Control in Healthcare Personnel available at: http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf Immunization of HealthCare Personnel, guidance available at: http://www.cdc.gov/vaccines/spec-grps/hcw.htm Occupational Safety & Health Administration (OSHA) Bloodborne Pathogens and Needlestick Prevention Standards available at: http://www.osha.gov/SLTC/bloodbornepathogens/index.html Sax H, et al. (2007). My five moments for hand hygiene: A user-centered design approach to understand, train, monitor and report hand hygiene. For the World Health Organization. J Hosp Infect 67(1):9–21. World Health Organization (WHO). (2005). World Alliance for Patient Safety. WHO Guidelines on Hand Hygiene in Health Care. Retrieved January 29 , 2015 from http://www.who.int/patientsafety/events/05/HH_en.pdf.

7.012 Employee Health The Center provides a safe working environment for all employees through a collaborative effort with them and the organization’s infection control program to identify infectious conditions that may put staff, patients and visitors at risk. Health evaluations, immunity testing for measles, mumps rubella and chickenpox, tuberculosis screening and immunity testing for hepatitis B and if not immune either signs declination form or accepts 3 dose vaccine series. (Rrefer to the Employee and Occupational Health Section policy Chapter 3.21) It is the center’s policy to monitor Health Care Associated Infections (HAI) in patients and personnel working in the Center as part of its ongoing program in Infection Prevention and Control. Staff should be encouraged to stay home when they have signs and symptoms of an infectious disease. If a staff develops signs and symptoms while at work, the person of other personnel and patients who may have been exposed to a staff member with a communicable disease should be taken into consideration. Patients and personnel can be told that they were exposed to a certain disease without disclosing the index case’s identity. In addition we work together to provide an annual influenza vaccination program that includes all staff who have patient contact, and licensed independent practitioners. Environmental Rounds - Environmental rounds are performed daily by assigned staff members, ie. “safety officer”. Feedback on opportunities for improvement is given to the Infection Control Coordinator and QAPI committee and then reported to the board Education – Employee education includes: General information about infections Techniques for prevention, surveillance, investigation and control Review of policies and procedures related to infection control: (See attachment B, policy and procedure reference list) Employee health practices; refer to Administration 3.16 Orientation and Training Offer of Hepatitis B vaccination & post exposure evaluations Annual TB skin testing Provides access to influenza vaccinations. Educates staff and licensed independent practitioners about influenza vaccination; non-vaccine infection control measures (such as the use of Droplet Precautions); and diagnosis, transmission, and potential impact of influenza. Annually evaluates vaccination participation and non-participation in the influenza immunization program and reports to Department of Health.

7.03 Patients with Infectious Disease The center adheres to infection control policies to ensure the safety of patients, physicians, and staff members. Patients who are currently being treated for an infectious disease or condition that is transmitted via the contact route may not be treated at the center. Patients with disease spread via droplet (e.g. influenza) or airborne (e.g. tuberculosis, measles) routes will reschedule their procedures in consultation with their physicians. The infection control nurse, in consultation with the infection control consultant, will determine whether the patient requires isolation or other additional precautions. If a patient with current Clostridium difficile-associated diarrhea is treated at the center, all rooms where the patient was housed, even briefly, should be cleaned by housekeeping under supervision of the staff at the center. Physicians must document relevant information in their pre-admission documentation. Standard Precautions will be followed in the care of all patients. Cigarroa Interventional Institute establishes policies to ensure compliance with infection control policies for the care of patients with drug-resistant organisms. The physician will screen patients through the medical history review prior to scheduling a patient at the center. During the pre-operative (pre-op) phone call or interview, a pre-op screening of the patient will be conducted. Strict isolation policies are required to treat patients with active MRSA, VRSA, or tuberculosis. Since this facility has no provisions for strict isolation, those patients with active infections will be referred elsewhere for treatment. Patients who are undergoing or completed a course of antibiotic therapy, are colonized and/or are not actively infected may be treated at the center. Patients with active infections requiring transmission-based precautions are not appropriate candidates for this facility and will be referred to another facility or rescheduled. Procedures cannot be scheduled for patients currently undergoing an infection with transmission based precautions. The patient must finish the course, and they will be rescheduled. Definitions and Standards: The following definitions and standards are provided for informational purposes only: Airborne Transmission and Precautions: This mode of transmission occurs by the spreading of either airborne droplet nuclei (small particle residue of 5 microns or smaller), of evaporated droplets which contain microorganisms that remain suspended in the air for long periods of time) or dust particles containing microorganisms. Patients must be isolated in private rooms with special air handling and ventilation, and the door must remain closed. Patient transport should be restricted to essential transport only. Respiratory precautions must be taken when in the presence of patients with active tuberculosis, including respiratory masks. Droplet Transmission and Precautions: Droplets are transmitted from the host source by coughing, sneezing, talking, or during procedures such as suctioning or bronchoscopy. Patients must be isolated, and a distance of 3 feet maintained between the infected patient and others. Caregivers within 3 feet of the patient should wear a mask. Patient transport should be minimized. Contact Transmission and Precautions: Direct contact transmission involves direct body surface to body surface contact with physical transfer of microorganisms between a susceptible host and an infected person. Indirect contact transmission involves contact with an intermediate object (usually inanimate) and a susceptible host. Patients should be isolated as much as possible. Gloves and hand washing are essential for all contact with the patient and contact with objects, which come in contact with the patient. Gloves should be changed after each contact. Reportable Condition If the patient is determined to have a reportable condition at any time during pre-admission, the Director of Operations/Nurse Manager will be notified. The procedural physician will be contacted and the case will be canceled. The Department of Health will also be notified the same day following state regulations regarding Reportable Communicable Diseases. To report a disease or condition, contact: The City of Laredo Epidemiology 24/7 Reporting Line: (956) 763-2915, if unable to report locally, call The Texas Departmrent of Health Services epidemiology program: 24/7Number for Immediately Reportable – 1-800-705-8868

Introduction to Infection Control in Healthcare - Starter Quiz

7.015 Hand Hygiene: Practice observation of hand hygiene compliance via the use of a hand hygiene survey tool to be reviewed quarterly at the QAPI committee. (Chapter 10.14 Handwashing & Surgical Antisepsis) Continue infection control education through ongoing orientation to center staff routinely and annual mandatory in-service. Continue to promote hand hygiene awareness for patients and staff by means of educational materials placed throughout the center which references the CDC/WHO guidelines. Needle-stick Injuries: (Refer to Exposure Control Plan) Use of designated safety engineered needles for injections (safety glide needles for injection and autoguard IV catheters) and blood draw. New employee and annual clinical competency for injections will be provided to all staff. The staff will be trained yearly on OSHA, blood borne pathogens and PPE. 7.016 Hand Hygiene Quality in the ASCs: based on AORN (Association of periOperative Registered Nurses) Standards and guidelines Policy: All ASC staff, including physicians, nurses, and other healthcare workers, are required to perform hand hygiene before and after any direct contact with patients, before and after any procedure, and after any contact with potentially contaminated items or surfaces. Hand hygiene must be performed using either an alcohol-based hand rub or soap and water. The alcohol-based hand rub must contain at least 60% alcohol. Staff members must ensure that their hands are free of debris and visible dirt before performing hand hygiene. Hand hygiene must be performed for a minimum of 20 seconds, and hands must be dried thoroughly after washing. Staff members must be trained on proper hand hygiene techniques and will be educated on a regular basis to ensure compliance with this policy. All staff members must comply with this policy and demonstrate compliance during inspections by ASC management and regulatory agencies. Any staff member who fails to comply with this policy will be subject to disciplinary action. ASC management will monitor compliance with this policy through regular inspections and audits and will take appropriate action to address any noncompliance issues. The ASC will maintain records of staff compliance with this policy as part of its infection control program. The ASC will review and update this policy on an annual basis or more frequently as needed to ensure that it remains current with the latest guidelines and standards for hand hygiene quality.

Policy for Bloodborne Pathogen Exposure Incident as per OSHA regulation (29 CFR 1910.1030) Purpose: To ensure that ASC staff members are protected against potential exposure to bloodborne pathogens per OSHA regulations (29 CFR 1910.1030). Scope: This policy applies to all ASC staff members who may be exposed to blood or other potentially infectious materials during their duties. Policy: An exposure incident is defined as a specific eye, mouth, other mucous membranes, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties. Any spill or accident that results in an exposure incident must be immediately reported to the Infection Control Nurse, first-line leader, or another responsible person. The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure and post-exposure evaluation and follow-up to all employees who have had an exposure incident. The employer shall provide a confidential medical evaluation and follow-up for the exposed employee, which shall include at least the following elements: • Documentation of the route(s) of exposure and the circumstances under which the exposure incident occurred. • Identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law. The source individual's blood shall be tested as soon as feasible and after consent is obtained to determine HBV and HIV infectivity. • Collection and testing of blood for HBV and HIV serological status. • If the employee consents to baseline blood collection but does not consent to HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible • Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service. • Counseling. • Evaluation of reported illnesses. The employer shall ensure that the healthcare professional evaluating an employee after an exposure incident is provided with the following: A copy of OSHA regulation 1910.1030 A description of the exposed employee's duties as they relate to the exposure incident Documentation of the route(s) of exposure and circumstances under which exposure occurred Results of the source individual's blood testing, if available. All medical records are relevant to the appropriate treatment of the employee, including vaccination status, which is the employer's responsibility to maintain. The employer shall obtain and provide the employee with a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of the evaluation. The healthcare professional's written opinion for Hepatitis B vaccination shall include the following: Whether it is indicated for the employee If the employee has received such a vaccination The healthcare professional's written opinion for post-exposure evaluation and follow-up shall include the following: That the employee has been informed of the results of the evaluation That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment All other findings or diagnoses shall remain confidential and not be included in the written report. An employer must establish and maintain accurate medical records for each employee with occupational exposure. Records should include the employee's Name, hepatitis B vaccination status and dates, results of medical testing and follow-up procedures, healthcare professional's written opinion, and information provided to the healthcare professional. Records must be kept confidential and not disclosed without the employee's written consent, except as required by law. Records must be kept for at least the duration of the employee's employment plus 30 years. Form 7.041 Employee Consent Form for Testing for HBV and HIV Serological Status Following Accidental Exposure I, __________________________, understand that I have been involved in an accidental exposure incident and may be at risk for contracting Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) under 29 CFR 1910.1030. Therefore, following OSHA standards, I am being offered the opportunity to be tested for these viruses. I understand that the testing will involve a blood sample and that the results will be kept confidential and will only be shared with authorized personnel. I also understand that testing is voluntary and that I have the right to refuse to test. By signing this form, I consent to be tested for HBV and HIV following the accidental exposure incident. Signed: __________________________ Patient's Name: __________________________ Form 7.042 Patient Consent Form for Testing for HBV and HIV Serological Status Following Accidental Exposure I, __________________________, understand that a staff member involved in an accidental exposure incident may be at risk for contracting Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) following 29 CFR 1910.1030. Therefore, by OSHA standards, the staff member may be offered the opportunity to be tested for these viruses. I also understand that testing of my blood is necessary to determine if I am infected with HBV and HIV. The results will be kept confidential and only shared with authorized personnel. I understand that testing is voluntary and that I have the right to refuse to test. By signing this form, I consent to the staff member being tested for HBV and HIV and to my blood testing following the accidental exposure incident. Signed: __________________________ Form7.043 Refusal of Testing Patient/Employee (Circle One) I,_____________________________________, understand that I have the right to refuse testing for Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) following an accidental exposure incident per 29 CFR 1910.1030. I understand that if I refuse to test, it may impact my ability to receive appropriate medical treatment and the healthcare facility's power to respond to the exposure incident. Following 29 CFR 1910.1030, The source individual's blood shall be tested as soon as feasible and after consent is obtained to determine HBV and HIV infectivity. The employer shall establish that legally required consent cannot be obtained if permission is not obtained. When the source individual's consent is not required by law, the source individual's blood, if available, shall be tested, and the results documented. Signed: __________________________

7.017 Fingernail Policy for ASC Personnel with Direct Patient Contact The surgical center applies this policy equitably and inclusively, and management expects staff to do so in good faith. Purpose: To prevent infection by ensuring proper hand and nail hygiene among ASC staff with direct patient contact. Policy: All ASC staff with direct patient contact must maintain clean and well-groomed fingernails and a healthy hand skin condition. Artificial Nails The ASC defines Artificial nails as press-on, extenders, studs, stones, or other objects positioned on top of the natural nail that are elevated and irregular. These are not allowed as they can be a potential source of infection and can also inhibit proper hand hygiene. Nail Enhancements The ASC defines Nail enhancements as nail paint, gel, and shellac. These are allowed, as evidence against them is weak/moderate and inconsistent, as long as they are undamaged, free of chipping, adequately maintained, and do not interfere with proper hand hygiene, job performance, or glove integrity. Staff must ensure that their nails are trimmed, clean, rounded, and at a length that does not inhibit them from performing their duties or putting themselves or their patient at risk for exposure. Staff must wash their hands with soap and water or use an alcohol-based hand rub before and after each patient encounter and after any activity that may contaminate the hands. Staff must report any cuts, sores, or other skin conditions that may prevent them from maintaining proper hand hygiene to the supervisor. Implementation: The infection Control Nurse or designee will educate staff on hand and nail hygiene, proper hand-washing techniques, and alcohol-based rubs. Supervisors will monitor staff compliance with the policy and provide corrective action as needed. The ASC will provide hand hygiene products and education materials for staff. Evaluation: The infection Control Nurse or designee will evaluate the effectiveness of this policy annually and through regular staff education and monitoring of staff compliance. Nurses are reminded of the standards of nursing practice specified in 22 Texas Administrative Code Rule 217.11 (B)(O), which includes Implementing measures to promote a safe environment for clients and others and Implementing measures to prevent exposure to infectious pathogens and communicable conditions. Reference: AORN INC. (2022). Guidelines for perioperative practice.

When Europeans met American Indians in the late 15th century, the people of two continents exchanged many beneficial customs and goods. Europeans received New World crops such as potatoes and corn. American Indians acquired cloth and horses. However, besides the beneficial exchanges, Europeans and American Indians often traded deadly germs–bacteria and viruses–for which they had no immunity. Smallpox and Indians Image 1: Smallpox epidemics helped Europeans conquer the Aztec and Incan Empires of Mexico and South America. North American Indians quickly concluded that contact with Europeans often resulted in devastating diseases that caused widespread death. This drawing, made in the 1500s in Mexico, shows how the disease was passed from a European to an American Indian through simple contact. Many of the diseases that were common in Europe were entirely new to the peoples of North America. Diseases such as tuberculosis and measles could be fatal, but Europeans had developed resistance to the disease, so many people survived. However, when European diseases infected American Indians with no previous exposure, the people suffered terribly. The most devastating of these diseases was smallpox which is caused by a virus (Variola major). Smallpox, like many other diseases, had a latent period of about one week between the time the person was exposed to the disease and the time when signs of the disease became apparent. During this time, the sick person might begin a journey and carry the germs along with him. Anyone the person met would be exposed to smallpox. Anything the victim touched including clothing, bedding, or unwashed dishes carried living germs of smallpox. Cotton Mather Image 2: Cotton Mather was a Boston minister. When smallpox threatened Boston, he remembered reading about how the Turks inoculated people with dried material from smallpox blisters. The inoculation usually gave the person a mild case of the disease and future immunity. The procedure was highly controversial, but it helped save the lives of 274 people who were inoculated during the Boston smallpox epidemic of 1721. Symptoms of the disease began with fever, chills, and aches. The fever might raise a person’s temperature from the normal 98.6o to a dangerous 106o. After four days of misery, the victim entered the second stage when large pustules (fluid-filled bumps) appeared on the body. The rash made the person feel as if their skin were on fire. After suffering with the rash for nine days, the victim entered a new stage-if he or she had survived this long. The pustules opened and dried up. Each pustule formed a scab that turned into a scar that marked the person’s face for the rest of his or her life. Complications of smallpox for those who survived might include loss of vision or damage to the lungs, heart, or liver. Waterhouse Image 3: Dr. Benjamin Waterhouse of Harvard University brought Jenner’s smallpox preventative to the United States. It was called vaccination and used cowpox as the infective material. This much milder form of pox gave immunity to smallpox with fewer complications. Dr. Waterhouse encouraged President-elect Thomas Jefferson to promote vaccination. Jefferson responded, “Every friend of humanity must look with pleasure on this discovery, by which one evil more is withdrawn from the condition of man.” (T. Jefferson 12/25/1800 to Benjamin Waterhouse, December 25, 1800) Historians have found evidence of smallpox as far back as 1157 B.C. when the Egyptian pharaoh Ramses V apparently died of smallpox. From Egypt, where scientists believe smallpox began, the disease spread to Asia. Europeans began to experience periodic epidemics of smallpox in the14th century when Crusaders returning from the Middle East brought smallpox to Europe. People who survived the disease were immune and could not get smallpox again. This fact explains why epidemics struck periodically and the disease was not a constant threat to European societies. Smallpox Vaccination 1803 Image 4: Dr. Edward Jenner’s new smallpox vaccination (from cowpox) was widely accepted. This medical image was published by a Spanish physician to teach colonial doctors how to apply the vaccine to native Mexicans. The scratches were supposed to go through several stages of development as evidence that the vaccine had given the patient immunity. Vaccination was very effective in preventing smallpox epidemics among those who received the vaccine. In 1520, while Cortés was trying to conquer the Aztecs, smallpox broke out among the Spaniards and was transferred to the Aztecs. By 1527, the disease had migrated through Central America to Peru where it helped Pizarro conquer the Incas. (See Image 1.) In 1633, smallpox infected American Indians living near the English colony of Plymouth, Massachusetts. The disease traveled very quickly to tribes living far inland from the English colonies. In 1721, a smallpox epidemic threatened the English colonists of Boston. (See Image 2.) Cotton Mather, a Boston minister, wanted to inoculate people against the disease. He knew that Turkish healers took material from a dried smallpox scab and injected it into the body of a healthy person by scratching the surface of the skin. The patients developed a mild form of the disease from which they recovered. The procedure was highly controversial in Boston where about 280 Bostonians accepted inoculation. The epidemic infected more than half of the people living in Boston at the time. About 15% of those who got sick died of the disease. Among those who were inoculated, only six (2%) died of smallpox. The practice of inoculation spread to other English colonies, but not to the American Indian tribes living near the colonies. Late in the 18th century, British doctor Edward Jenner recognized that people who milked cows never came down with smallpox. They had already been infected with cowpox, a similar, but much milder disease that gave them immunity to smallpox. In 1796, Jenner inoculated a young man with cowpox virus he had collected from a milkmaid. The young man had a mild infection for less than 24 hours and recovered. Jenner’s efforts resulted in a widespread acceptance of vaccination (vaccine comes from Latin words meaning “taken from a cow”). By 1800, many Americans were receiving smallpox vaccinations. (See Image 3.) President Thomas Jefferson supported and encouraged the vaccination program in major American cities. (See Image 4.) By the middle of the 19th century, smallpox was under control, but broke out from time to time among unvaccinated people. Bismarck, Dakota Territory, experienced a small outbreak of smallpox in 1882. American Indians, however, were still subject to the disease in its most dangerous form.

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