INFECTION PREVENTION MANUAL FOR

LONG TERM CARE

AUTHOR: Gail Bennett, RN, MSN, CIC

ICP Associates Consultation in Prevention and Control of Healthcare-Associated Infections 1304 North Broad St. Rome, Georgia 30161

706/235-1167 [email protected]

www.icpassociates.com

Infection Prevention Manual for Long Term Care

Page 2 © 2012 ICP Associates, Inc.

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Infection Prevention Manual for Long Term Care

TABLE OF CONTENTS Manual Approval Form

TOC-10

Section 1: INFECTION PREVENTION PROGRAM Infection Prevention Program Overview............................................................................ 5 Infection Prevention Plan................................................................................................... 8 Form: Infection Prevention Plan/Risk Assessment Worksheet ................................... 9 Surveillance Plan ....................................................................................................... 12 Job Description – Infection Preventionist ........................................................................ 13 Infection Prevention Competency Assessment .......................................................... 16 Infection Prevention Committee ...................................................................................... 19 Sample Quarterly Agenda - Infection Prevention Committee Meeting ..................... 20 Authority of the Infection Prevention Committee ..................................................... 21 Sample Minutes Form...................................................................................................... 22

Section 2: SURVEILLANCE Infection Prevention Surveillance ...................................................................................... 5 Surveillance Forms ............................................................................................................ 6 Healthcare-Associated Infection Summary Report by Resident Days (Excel Spreadsheet) ..................................................................................................... 6 Monthly Infection Rates by Site (Excel Spreadsheet) ................................................. 7 Infections by Device Days ........................................................................................... 8 Line Listing of Resident Infections.............................................................................. 9 Definitions of Infections for Surveillance Activities ....................................................... 10 Reportable Diseases ......................................................................................................... 19 Outbreak Investigation ..................................................................................................... 20

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Infection Prevention Manual for Long Term Care Outbreak Investigation Form ..................................................................................... 22 Healthcare-Associated Infections and Sentinel Events.................................................... 26 Form: Healthcare-Associated Infections Reviewed as Sentinel Events..................... 27 Influx of People with Infectious Diseases........................................................................ 28

Section 3: INFECTION PREVENTION EDUCATION Employee Education Forms ............................................................................................... 5 Educational Needs Assessment Tool - Infection Prevention ....................................... 5 Education Course Attendance Sign-in Sheet ............................................................... 6 Evaluation Form - Infection Prevention Training........................................................ 7 Infection Prevention Orientation and Inservices ................................................................ 8 Infection Prevention Orientation Outline..................................................................... 9 Orientation Checklist – Infection Prevention for Clinical Staff ................................ 11 OSHA Bloodborne Pathogens Standard Employee Training Outline ............................. 12 Tuberculosis Employee Training Outline ........................................................................ 14 Resident and Family Education for Infection Prevention and Infectious Diseases .................................................................................................... 17 Educational Resources for Infection Prevention.............................................................. 18

Section 4: ISOLATION Isolation Precautions .......................................................................................................... 5 Standard Precautions.................................................................................................... 5 Respiratory Hygiene/Cough Etiquette in Healthcare Settings ............................... 8 Poster: “Cover Your Cough” ..................................................................................... 10 Contact Precautions ................................................................................................... 11 Donning PPE........................................................................................................ 13 Removing PPE ..................................................................................................... 14 Droplet Precautions.................................................................................................... 15 Page 4 © 2012 ICP Associates, Inc.

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Infection Prevention Manual for Long Term Care Multi-Drug Resistant Organisms (MDROs) .................................................................... 16 Compliance ...................................................................................................................... 18 Compliance Monitoring ............................................................................................. 18 Staff Self-Evaluation of Infection Prevention Practices ............................................ 19 Monitoring Compliance with Infection Prevention Policies by Observation ............ 20 Glove Use......................................................................................................................... 21 Handling and/or Disposing of Used Needles ................................................................... 23 Transfer Form (Inter-facility) for Infection Prevention.................................................... 24 Table: Type and Duration of Precautions Needed for Selected Infections and Conditions.................................................................................. 25

Section 5: OCCUPATIONAL HEALTH Assessment of New Hires .................................................................................................. 5 Health Assessment ...................................................................................................... 5 Infectious Disease and Immunization History ............................................................. 6 Bloodborne Pathogens ....................................................................................................... 7 Hepatitis B Immunization Program ............................................................................. 7 Information on Hepatitis B and the Vaccine................................................................ 8 Hepatitis B Vaccine Information Statement ................................................................ 9 Hepatitis B Immunization Consent or Declination .................................................... 11 Blood and Body Fluid Exposure Report .................................................................... 12 Blood and Body Fluid Exposure Report Form .......................................................... 13 Bloodborne Pathogens Post-Exposure Evaluation and Follow-Up ........................... 19 Bloodborne Pathogens Post-Exposure Evaluation and Follow-up Form................... 21 Bloodborne Pathogens Post-Exposure Evaluation/ Healthcare Professional’s Written Opinion ............................................................... 24 Recommended Postexposure Prophylaxis for Exposure to Hepatitis B virus ........... 25 Potential HIV Exposure ............................................................................................. 26

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Infection Prevention Manual for Long Term Care Table: Recommended HIV postexposure prophylaxis (PEP) for percutaneous injuries............................................................................................ 27 Table: Recommended HIV postexposure prophylaxis (PEP) for mucous membrane exposures and nonintact skin exposures ............................... 28 Consent for HIV Antibody Blood Test and Release of Information.......................... 29 Employee Infections......................................................................................................... 30 Reporting Employee Infections.................................................................................. 30 Employee Infection Record........................................................................................ 31 Summary of Important Recommendations and Work Restrictions for Personnel with Infectious Diseases........................................ 32 Exposures to Communicable Diseases ............................................................................ 37 Criteria for Determining Exposure to Communicable Disease ................................. 37 Management of Accidental Exposure to Communicable Diseases ........................... 39 Pregnant Personnel Occupational Exposures............................................................. 42 Influenza Immunization ................................................................................................... 43 Influenza Vaccine and Healthcare Personnel............................................................. 43 Employee Influenza Immunization Summary form................................................... 44 Consent to Influenza Vaccination .............................................................................. 45 Declination of Influenza Vaccination ........................................................................ 46 Tuberculosis ..................................................................................................................... 47 Tuberculosis Screening for Employee ....................................................................... 47 Annual Tuberculosis Assessment (for use with staff who are TST positive)............ 52 Frequently Asked Questions: Tuberculosis and the Tuberculin Skin Test ................ 53 Vaccine Recommendations.............................................................................................. 55 Healthcare Personnel Vaccine Recommendations..................................................... 55

Section 6: RESIDENT CARE POLICIES Animals in the Long Term Care Facility .......................................................................... 5 Artificial Nails.................................................................................................................... 7 Bed Bug Management........................................................................................................ 8 Page 6 © 2012 ICP Associates, Inc.

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Infection Prevention Manual for Long Term Care Periodic Bed Bug Inspection Checklist by Unit......................................................... 12 Assessment of Pest Control Agent for Bed Bugs ...................................................... 13 Catheter Associated Urinary Tract Infection (CAUTI) Prevention ................................. 14 Table: Examples of Appropriate Indications for Indwelling Urethral Catheter Use . 16 Catheter Related Bloodstream Infection (CRBSI) Prevention......................................... 17 Cleaning, Disinfection and Sterilization .......................................................................... 20 Collection of Specimens .................................................................................................. 23 Environmental Sampling.................................................................................................. 24 Glucometer Decontamination .......................................................................................... 25 Hand Hygiene................................................................................................................... 26 Ice Chests and Ice Machines ............................................................................................ 27 Immunizations.................................................................................................................. 28 Influenza (Flu) Vaccination of Residents, Staff, and Volunteers............................................................................ 28 Standing Orders for Administering Influenza Vaccine to Adults .............................. 30 Standing Orders for Administering Pneumococcal Vaccination to Adults ............... 32 Medical Management of Vaccine Reactions in Adult Patients.................................. 34 Nasogastric/Gastrostomy Tube Feeding .......................................................................... 36 Oxygen Use...................................................................................................................... 37 Pediculosis (Lice) Care .................................................................................................... 38 Personal Hygiene ............................................................................................................. 42 Pest Control...................................................................................................................... 43 Regulated Medical Waste Management........................................................................... 44 Safe Injection Practices .................................................................................................... 46 Scabies Care..................................................................................................................... 48 Thermometer Use............................................................................................................. 50 Tracheostomy Suctioning and Care ................................................................................. 51 Tube Feeding Syringes..................................................................................................... 52 Visitors ............................................................................................................................. 53 Wound Infection Prevention ............................................................................................ 54

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Infection Prevention Manual for Long Term Care Wound Care/Treatment Guidelines ........................................................................... 55 Wound Care Procedure for Major Wounds ................................................... 56

Section 7: DEPARTMENT POLICIES Beautician/Barber Services ................................................................................................ 5 Dietary Services ................................................................................................................. 6 Housekeeping Services .................................................................................................... 11 Environmental Checklist for Monitoring Terminal Cleaning.................................... 14 Laundry Services.............................................................................................................. 15 Maintenance Department ................................................................................................. 17 Vending Room (Canteen) ................................................................................................ 19

Section 8: BLOODBORNE PATHOGENS Bloodborne Pathogens Model Exposure Control Plan (ECP) ........................................... 5 Program Administration............................................................................................... 6 Employee Exposure Determination ............................................................................. 6 Methods of Implementation and Control ........................................................................... 7 Standard Precautions.................................................................................................... 7 Exposure Control Plan ................................................................................................. 7 Engineering Controls and Work Practices ................................................................... 7 Personal Protective Equipment .................................................................................... 8 Housekeeping............................................................................................................... 9 Laundry ........................................................................................................................ 9 Labels ......................................................................................................................... 10 Hepatitis B Vaccination ................................................................................................... 10 Post-Exposure Evaluation and Follow-up........................................................................ 10 Administration of Post-Exposure Evaluation and Follow-up .......................................... 11

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Infection Prevention Manual for Long Term Care Procedures for Evaluating the Circumstances Surrounding an Exposure Incident.......... 11 Employee Training........................................................................................................... 12 Recordkeeping ................................................................................................................. 13 Training Records........................................................................................................ 13 Medical Records ........................................................................................................ 13 OSHA Recordkeeping................................................................................................ 13 Sharps Injury Log....................................................................................................... 13 Sample Sharps Injury Log (Form).................................................................................... 14 Employee Input about Engineering and Work Practice Controls .................................... 15

Section 9: TUBERCULOSIS Tuberculosis Control Plan.................................................................................................. 5 Administrative Controls............................................................................................... 5 Risk Assessment .......................................................................................................... 5 Admissions................................................................................................................... 6 Prospective Employees ................................................................................................ 7 Annual Personnel Screening ........................................................................................ 8 Exposure Incidents....................................................................................................... 8 Documentation of Occupational Exposure .................................................................. 8 Resident Care ............................................................................................................... 9 Information and Training ............................................................................................. 9 Engineering Controls ................................................................................................. 10 Table I: Factors affecting treatment decisions during the medical and diagnostic evaluation, by tuberculin skin test (TST) ................................... 11 Table II: Indications for two-step tuberculin skin tests (TSTs)........................................ 12 Appendix A: Tuberculosis Risk Assessment worksheet.................................................. 13 Appendix B: Risk Classifications .................................................................................... 15 Appendix C: Quality control (QC) procedural observation checklists ............................ 16 Annual Tuberculosis Assessment (for use with staff who are TST-positive).................. 18 Page 9 © 2012 ICP Associates, Inc.

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Infection Prevention Manual for Long Term Care Employee Tuberculin Skin Testing Summary ................................................................. 19 Immunization and TB Skin Testing Record..................................................................... 20 Annual Tuberculosis Assessment (for use with all residents) ......................................... 21

Section 10: INFECTIOUS DISEASES Introduction ........................................................................................................................ 5 Acinetobacter baumannii (resistant) .................................................................................. 6 Bed Bugs (Cimex lectularius) ............................................................................................ 7 Clostridium difficile ........................................................................................................... 8 Creutzfeldt-Jakob Disease (CJD)....................................................................................... 9 Dengue ............................................................................................................................. 10 Extended-Spectrum Beta Lactamases (ESBLs) ............................................................... 11 Hepatitis A ....................................................................................................................... 12 Hepatitis B, Hepatitis C, HIV .......................................................................................... 13 Influenza........................................................................................................................... 14 Klebsiella pneumoniae Carbapenemase (KPC) ............................................................... 15 Legionnaires’ Disease ..................................................................................................... 16 Lice .................................................................................................................................. 17 Methicillin-Resistant Staphylococcus aureus (MRSA) ................................................... 18 Norovirus Gastroenteritis................................................................................................. 19 Pneumoccocal Infections (pneumonia, meningitis) ......................................................... 20 Salmonellosis ................................................................................................................... 21 Scabies ............................................................................................................................. 22 Vancomycin-Resistant Enterococcus (VRE) ................................................................... 23

Section 11: PERFORMANCE IMPROVEMENT Supervisory Review ........................................................................................................... 5

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Infection Prevention Manual for Long Term Care Environmental Checklist for Terminal Cleaning ............................................................... 6 Hand Hygiene and Glove Use Monitoring Form ............................................................... 7 Infection Prevention Assessment of Facility...................................................................... 9 Compliance Rounds Forms.............................................................................................. 12 Cleanliness and Sanitation ......................................................................................... 12 Documentation of Infections...................................................................................... 13 Dressings/Wound Care .............................................................................................. 14 Indwelling Catheters .................................................................................................. 15 Laundry and Linen Handling ..................................................................................... 16 Oxygen Concentrator ................................................................................................. 17 Precautions................................................................................................................. 18 Standard Precautions............................................................................................ 18 Contact Precautions.............................................................................................. 19 Droplet Precautions.............................................................................................. 20 Cough Etiquette.................................................................................................... 21 Safer Sharps and Sharps Disposal.............................................................................. 22 Tube Feeding.............................................................................................................. 23

Appendix: BIOTERRORISM READINESS PLAN Introduction ........................................................................................................................ 5 Section I: General Recommendations for a Bioterrorism Event........................................ 6 Section II: Agent-Specific Recommendations ................................................................. 16 Anthrax ................................................................................................................ 16 Botulism............................................................................................................... 21 Plague................................................................................................................... 24 Smallpox .............................................................................................................. 29 Tularemia ............................................................................................................. 35 Viral Hemorrhagic Fevers.................................................................................... 41 Appendix 1: Federal Bureau of Investigation (FBI) Field Offices................................... 45 Page 11 © 2012 ICP Associates, Inc.

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Infection Prevention Manual for Long Term Care Appendix 2: Telephone Directory of State and Territorial Public Health Directors ....... 46 Appendix 3: CDC’s Biological Diseases/Agents Listing ................................................ 50 Appendix 4: Smallpox Immunization Procedure............................................................. 51 Appendix 6: Websites Relevant to Bioterrorism Readiness ............................................ 53 Appendix 7: Other Sources of Information...................................................................... 53

References

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Infection Prevention Manual for Long Term Care

INFECTION PREVENTION MANUAL APPROVED BY:

PRESIDENT

ADMINISTRATOR

MEDICAL DIRECTOR

DIRECTOR OF NURSING

DATE

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