Patient Empowerment Education Campaign

1. Patient Empowerment Education Campaign • Patients will receive a hand hygiene brochure in their admission packet . • As you review the admitting pack and brochure with each patient , stress that we know patient safety is a topic in the media. We want them to know that it is important to us too. So, we are encouraging them to ask their healthcare workers when they enter their room: “Have you washed your hands?”

2. Health Care Worker Response When a patient asks you if you have washed your hands, what are some responses? “Yes, thank you for asking.” or “No, thank you for reminding me.” (go and wash)

3. Standard Precautions • For ALL patients • Does NOT mean do Nothing!!! • If it is wet and it’s not Yours ……., wear gloves. • If your patient has an undiagnosed rash, wear gloves. • If your patient is incontinent or has large open draining wounds, use contact precautions. • Do NOT reuse gowns, even for contact with the same pt. !!!!!! • Do NOT wear PPE (e.g., gown, gloves, mask – hanging around neck) outside of patient’s room. • During aerosol generating procedures (bronchoscopy, suctioning w/o in-line suction catheters, endotracheal intubation- wear face protection (goggles and mask or face shield). • Wear masks when placing a catheter or injecting material into the spinal canal or subdural space (i.e. myelograms, lumbar puncture, and spinal or epidural anesthesia.

4. Contact Isolation Precautions • If Indicator Screen is up, isolation is required. Call Infection Control Department to screen for deisolation. • Patients with Necrotizing fasciitis need contact isolation & masks worn during debridements. • Gloves and Gown required to enter the room to provide patient care • Door card to remain on door until room is cleaned. • If multi-use equipment is used, disinfect between patients. (e.g., EKG, BP cuffs)

5. Contact Precautions Sign

6. Modified Contact Precautions • Clostridium difficile infection: diarrheal disease from spore-forming bacteria • Hand washing with soap and water is necessary to remove spores from hands. • Do not use hand sanitizers!

7. Modified Contact Precautions Sign

8. 3M Air-Mate™ High Efficiency Powered Air Purifying Respirator (PAPR) • If patient has suspected or confirmed TB: • Obtain PAPR from equipment pool in addition to isolation cart. • A Fit Test is now required if you wear a N95 TB mask (orange duckbill) • Fit Check-each time mask is put on • Use a Powered Air Purifying Respirator (PAPR) to enter a room with a patient who has active pulmonary TB if not fit tested.

9. Airborne Precautions Sign

10. Airborne Isolation • Daily pressure checks need to be done on negative pressure rooms and documented. http://ozone.ohsu.edu/healthsystem/dept/infection/specialAirflowdocform.pdf • No ambulation allowed outside of room. • No admits to room for 1 hour after discharge. • Patients with extrapulmonary TB, who have infectious skin lesions or drains in place, must be placed on Airborne & Contact isolation.

11. Airborne Precaution Transportation • If procedure area does not have a negative pressure room: • Perform procedure in patient’s room if possible. • Postpone procedure until airborne precautions are not needed if possible or • Make patient the last case of the day if possible. • Patients cannot go to IRU or PACU, but must be recovered in a negative pressure isolation room.

12. Droplet • Mask-blue surgical • Attention to hand hygiene • No ambulation outside of room allowed.

13. Droplet Precautions Sign

14. Transportation of Isolated Patients • Notify receiving dept. of isolation requirement • Patients to go directly in exam/procedure room • Patients are not to be held in patient common waiting areas • Transportation staff should not need to wear isolation garb out of room to transport patients

15. Transportation of Isolated Patient • Droplet and Airborne Precautions: • Mask the patient & provide tissue for coughing, bag for tissues • Contact Precautions • Cover pt. with clean sheet • Cover/contain actively draining areas if possible • Best to use transportation vehicle other than bed • Wipe off bed rails, head and foot board of bed • Disinfect equipment used

16. Isolation Room Cleaning • Keep door card on room until cleaning is completed • No admits to negative pressure room for 1 hour post discharge of previously isolated TB patient. • Keep room door closed • Airborne isolation precautions must be followed if room is cleaned within 1 hour of discharge of patient.

17. Ambulation of Contact/Modified Contact Precautions Patients • Can have 3 supervised ambulations on unit with an MD order if: • Patient continent & wounds able to be contained • Patient follows directions, puts on a clean gown & washes hands. • Patient is NOT allowed to leave nursing unit or go in other patient’s rooms or common areas.