Pathogens and Disease

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.

Differentiate between communicable and chronic diseases. Communicable diseases are spread by pathogens (bacteria, viruses, fungi, and parasites). They may be spread through the air (Hantavirus, tuberculosis), food (salmonella, Ecoli), or water (SARS, polio). Some diseases are spread by insects. The bite of a tick may result in Lyme disease or Rocky Mountain Spotted Fever; mosquitoes spread malaria. The bite of a warm-blooded animal can cause rabies. Some communicable diseases are spread directly from person to person, such as the childhood illnesses: measles, mumps, and chicken pox. Sexually transmitted diseases are passed only through intimate contact. The most common STDs are caused by bacteria (Chlamydia, gonorrhea, syphilis) and viruses (herpes, HIV, human papilloma virus). Methods of preventing communicable diseases include avoiding pathogens, cleanliness, the use of barriers and prophylactics, abstinence from risky behaviors, and staying away from those infected. Chronic diseases involve the degeneration of body organs.

B5 Diseases, pathogens, symptoms and treatments

Orchard / fruit trees Importance of fruit trees • Fruit trees are important for the following uses: They are a source of food, they produce fruits Some are used for making medicines Others provide shade and can also act as wind breakers. Those with beautiful flowers are very decorative. They contain vitamins which means they have nutritional value. Classification of fruit trees • Fruit trees are classified as indigenous and exotic. Indigenous fruit trees • are those that natural grow in a country. • They take longer to grow. • Examples of indigenous fruit trees are: English name Shona Name Snot apple Water berry Red ivory Fig Monkey orange Wild custard apple Mobola fruit Exotic fruit trees • These are trees that were brought from other countries. • They are commercially grown in orchards. • Common exotic fruit trees include: • Exotic fruit trees grow faster than indigenous. Ornamental horticulture • It deals with the growing of decorative plants. • Decorative plants are collectively called ornamental plants. • They include trees, shrubs, flowers and lawn grasses. Importance of ornamental plants They beautify the environment. Flowers often produce a pleasing fragrance. Flowers attract insects like bees that are responsible for pollination. Plants produce oxygen that we need for breathing. • Some are used for making medicines. • Lawn grasses prevent soil erosion. • Plants provide shelter for birds and insects. Classification of ornamental plants • There are four classes of ornamental plants. Trees Shrubs Flowers Lawn Trees: • Ornamental trees are very useful as decorative plants. • This is because most of these trees produce beautiful flowers and some are ever green. • Examples of decorative trees include flamboyant, jacaranda, pines, Cyprus. Shrubs: • A shrub is a woody plant with many branches but smaller than a tree. • Some of them are ornamentals because they produce beautiful flowers. • Others can be cut into decorative shapes. • The golden duranta is good example because it can be cut into nice shapes. • The bougainvillea is another example of a decorative plant because: It can act as a climbing plant. It produces decorative flowers. It can also be cut into any shape using a hedge shear. Flowers: • Flowers have the following functions: They are used for decorations at weddings, hotels and parties. They are used as an expression of love and appreciation such as valentine’s day and get well soon messages. They are useful in bee farming called apiculture as they are a source of nectar used for making honey. Flowers produce a pleasant fragrance used in the production of soaps and scents for perfumes, deodorant and lotions. Lawn: • A lawn is an area of grass that is kept cut short and is usually part of someone's garden or backyard, or part of a park. • Some lawn grasses grown in Zimbabwe are Durban, kikuyu, couch and buffalo lawn. • They prevent soil erosion. • They also provide a comfortable outdoor resting place. Forestry Importance of trees • Trees are important to us and animals. • The Forestry Commission is responsible for taking care of trees in Zimbabwe. • Trees are also important to the environment because: They are a source of fuel in the form of firewood. They are used for making most of the furniture we use. Most medicines come from both exotic and indigenous trees, for example pine trees and gum trees are used for making cough medicines. Trees provide browsing animals like the kudu and giraffe with food. Fruits from both exotic and indigenous fruit trees are a rich source of vitamins Trees give out oxygen which we need for breathing. Trees provide timber that can be used for roofing. • Trees are grouped according to where they come from. • The groups are indigenous and exotic. 1 . Indigenous trees : • These are local trees that have always been grown in their country. Shona name English name Mutohwe Snot apple Mususu Yellow wood Mubvamaropa Blood wood Muuyu Baobab Muonde Fig tree Musasa msasa Characteristics of indigenous trees  take longer to mature  Do not produce straight poles  Grow on their own  Hard wood 2 .Exotic trees : • These are trees that have been brought from another country to be grown in Zimbabwe. Characteristics of exotic trees  They are brought in a country from another country. Grow very fast.  Have soft woods  Usually grow straight  Usually grown in orchards and plantations Common exotic trees in Zimbabwe are: Gum trees Pine trees Wattle Cyprus Date palm Mango Apple pawpaw Causes of plant damage • plant damage is when cultivated crops are kept from normal growth that leads to reduced yields. • plant damage is caused by both living and non living things. • Some of the common causes of crop damage are: (a)Pests • These are living organisms that cause physical damage to crops. • Examples of pests are weevils, army worm, aphids, cutworms and locusts. (b) Diseases • Plant diseases are caused by living organisms called pathogens. • These pathogens infest the plant and take away nutrients. • Fruit rot and bacteria spot are some of the examples of plant diseases. (c) Weeds • these are plant which grow where they are not wanted. • For example if black jack grows in a groundnut field, it is a weed. • Weeds compete for nutrients with cultivated plants. (d) Very high temperatures • High temperatures may cause crops to wither. • High temperatures may also lead to lightning and fires. • This can burn up crops. ( e) Frost • Frost damages crops in winter. • Tomatoes, potatoes, and beans are easily damaged by frost. (f) Drought • drought is when there is no rainfall in a season where it supposed to be raining. • It is one of the most serious forms of crop damage. • Plants wither and die if there is no rainfall. ( g) Animals • Wild animals like baboons often eat maize crops before they mature. • Birds also are a problem to crops like sorghum. Signs of plant damage • There are various signs that show plant damage. • Some can be corrected but some lead to total loss. • Some signs of plant damage include: Lodged plants Flowers and small fruits blown to the ground Dull leaf color Wilted plants Stunted growth

Pathogens and Immunity

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.

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.

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: __________________________

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