1. What are some measures used to prevent transmission of infectious diseases to staff and to patients?
Isolation precautions may be instituted by the nursing staff without a physician’s order. AAMC’s mandatory immunization program protects both staff and patients. Environmental cleaning has become increasingly important in the fight against transmission, particularly with
antibiotic-resistant organisms. Hand hygiene remains the single most important factor in preventing the spread of infectious diseases.
2. When should hand hygiene be performed?
Hand hygiene (washing hands or use of alcohol-based handrub) should be performed before and after touching a patient or any equipment that touches a patient. Wash your hands with soap and water when hands are
visibly soiled/contaminated, before eating, after using the restroom, and whenever caring for a patient with Clostridium difficile (Cdiff). AAMC follows Centers for Disease Control and Prevention (CDC) guidelines.
3. How is hand hygiene monitored and promoted at AAMC?
Hand hygiene is monitored through audits conducted by “secret shoppers”
on every patient unit and the Emergency Department. Compliance is compared housewide, per patient unit, and per type of healthcare worker role. AAMC is a member of the Maryland Hand Hygiene Collaborative in order to foster improved hand hygiene by healthcare workers, patients, and visitors. Alcohol-based handrub, hand wipes on food trays, hand hygiene education in the patient handbook, and housewide signage are only some of the examples of how hand hygiene is promoted at AAMC. Be prepared to discuss the most current data on hand hygiene compliance for the hospital
Fingernails are to be short (less than ¼ inch in length); if nail polish is used, it should be clear and intact. Persons involved in patient care or handling linen, patient supplies, food, etc. are not allowed to wear artificial nails.
4. What are the steps to placing a patient in isolation?
> Identify the appropriate isolation and hang an isolation sign on entry to the patient room.
> Order isolation in the computer (physician’s order is not required).
> Gather the correct personal protective equipment (PPE) and place at entry to patient room.
> Educate patient/family members on need for isolation and expectations of them to maintain isolation. Use handouts located on intranet to assist with education.
> Perform hand hygiene and put on PPE prior to entry. Dispose of PPE in room upon exit and perform hand hygiene.
> With patient transfer or discharge, leave the isolation sign posted for environmental services (EVS) to remove following cleaning of room.
5. What infection control and prevention education is important to provide to your patient/patient’s family?
Any time a patient is diagnosed with an infectious disease or is about to undergo a procedure there is an opportunity for infection prevention education. Upon admission and throughout a patient stay, hand hygiene is emphasized. The Joint Commission emphasizes the need for education of patients and family members, and looks for documentation of education for the following conditions/situations:
> Identification of multidrug-resistant organisms (MDROs), such as MRSA, VRE, etc., and Clostridium difficile (Cdiff)
> Placement in isolation
> Prior to insertion of a central line (central line-associated bloodstream infection (BSI) prevention)
> Prior to surgery (surgical site infection (SSI) prevention)
6. What infection prevention strategies are used during the insertion of a central line (central venous catheter)?
Remember the central line insertion checklist (make sure to document):
> Have proper hand hygiene
> Use a sterile drape to cover patient (maximum barrier precautions)
> PPE: sterile gloves, cap, gown, mask, eye protection for
inserter/assistant; mask with eye shield for everyone else in the room
> Chlorhexidine skin prep or alternative if allergic
> Avoid femoral vein unless there are no other options.
7. How long does a disinfectant wipe or solution need to make contact
in order to kill bacteria and other microorganisms?
Germicidal wipes or bleach-impregnated wipes are used to wipe down equipment, including IV pumps, stethoscopes and keyboards between patient use. Sometimes staff will also use germicidal solution (for example, Virex), used mostly by environmental service (EVS) staff for cleaning rooms, for bigger items, such as stretchers. Whatever used, you are expected to know how long the equipment needs to stay wet (contact/kill time) in
Remember: Germicidal PDI AF3 (grey top) Wipes = 3 minutes Bleach Wipes (for example, Dispatch) = 5 minutes Virex Spray Solution = 10 minutes
8. How are employees exposed to bloodborne pathogens reported?
Exposures are reported by the exposed employee to their supervisor.
Employees exposed to bloodborne pathogens must be evaluated in Employee Health Monday to Friday 7:30am to 4pm and in the Emergency Department at all other times. This evaluation must occur immediately as the window for giving antiviral medications, if needed, is two hours.
9. How are communicable diseases reported at AAMC?
The Infection Control Department has the responsibility for reporting communicable diseases to the local and state health departments.
Physicians may also report as needed. The laboratory also reports any test results regarding communicable diseases.
10. How are infection control concerns reported?
Infection control concerns may be reported to Infection Control at x6446 or the 4PTS hotline at x4787. Immediate concerns can also be addressed by paging the hospital epidemiologist and/or director of Infection Control.
11. Where does staff receive education on infection control?
All staff receive infection control education in orientation and annually on Healthstream. Also, infection control practices are integrated into competencies. Infection control programs are also offered in specific departments as issues and concerns are identified. Infection Control personnel may be contacted for questions or consultation. Resources are
12. What are some of the monitors in AAMC’s Infection Control program?
The Infection Control program does surveillance of surgical site infections in high risk, high volume surgeries, central line-associated bloodstream infections, ventilator-associated pneumonias, urinary catheter-associated urinary tract infections, blood culture contamination rates and other high risk indicators. Surveillance also includes incidence of hospital-acquired multidrug-resistant organisms (MDROs) and Clostridium difficile (Cdiff) and other organisms. Environmental testing, such as water testing for Legionella, is coordinated through engineering and monitored by Infection Control. Infection Control Risk Assessments (ICRAs) are conducted prior to construction projects.
13. How is selection of surveillance/monitoring determined by Infection Control?
Selection of what surveillance/monitors are conducted is dependent on the level of risk associated with patients, staff, and visitors. Periodic and as needed risk assessments are performed in order to prioritize needs for surveillance/monitoring. Annually, the risk assessments are used to determine priorities; goals for the coming year are determined based on the risk assessment and listed in the Infection Control Plan, available for review on the Infection Control section of the hospital intranet.
14. How are data from the Infection Control activities reported?
All reports are presented at the monthly Infection Control Committee; data for specific patient populations are reported at service line and nursing quality councils, critical care committee, and shared at staff meetings.
Nursing Quality indicators (NDNQI) include unit-based infections data. Be aware of the infections data which relates to your area of service.