Orientation Education

1. Orientation Education Mission Statement Cartersville Medical Center is committed to treating all of our patients with compassion, kindness, and dignity. We will collaborate with our stakeholders to continuously improve patient care, evaluate and establish services beneficial to our community, and position our hospital as the preferred health care provider and a desirable business partner.

2. 960 Joe Frank Harris Parkway Cartersville, GA 30120 (770) 382-1530 Hospital opened September 1, 1985 112 Total Beds 14 Intensive Care 88 Med/Surg 10 OB/Maternity beds 31 Beds in the Emergency Department 8 Operating Rooms Personnel 750 Employees 300 Physicians An Overview of Cartersville Medical Center Volume (FY 2015) 7,157 Admissions 57,501 ER Visits 9,198 Surgeries 919 Births 37,328 Outpatient Visits

3. Jan Tidwell, Associate Administrator Ed Moyer, Chief Nursing Officer Robbie Tatum, VP of Human Resources Keith Sandlin, Chief Executive Officer Benny McDonald, Chief Financial Officer Lori Rakes, Chief Operating Officer Phoebe Stieber, VP of Quality Resources Cartersville Medical CenterExecutive Management Team

4. Customer Service and HCAHPS • Increase awareness of HCAHPS and its impact on facility • Discuss how patient loyalty impacts satisfaction • Apply HCAHPS initiatives in your work setting to help “move the bar” on current results Objectives

5. Hospital Consumer Assessment of Healthcare Providers and Systems • The nation’s first standardized, publicly reported survey of patients’ perspectives of hospital care. Cliff Notes: It’s what our patients think about us after they leave our hospital. What is HCAHPS?

6. The HCAHPS survey asks patients who have stayed at our hospital (inpatients) 27 questions, including 18 items about key aspects of their hospital experience. These are broken down into the following domains: • Communication with nurses and doctors • The responsiveness of hospital staff • Cleanliness and quietness of hospital environment • Pain management • Communication about medicine • Discharge information • Overall rating of the hospital • And recommendation of the hospital Why is HCAHPS Important?

7. Our collective acts of all hospital staff have important consequences for patients, and directly affect their perceptions of the quality of care they received. Caring BehaviorsIt’s all about the things we do

8. A – Acknowledge Say hello to patients, visitors and co-workers • I – Introduce Provide your name and info about your skills/training • D – Duration Describe how long an event will take • E – Explain Provide important details about the procedure/situation • T – Thanks Thank patients for choosing CMC AIDET

9. Diversity • Describe the impact of the multi-language workplace on our facility • Identify your responsibility to respect different cultures in our organization and patient base • Identify your responsibility in ensuring that we do not exclude others just because English is not their first language • Describe how to apply a commonsense approach for addressing situations in which language might tend to exclude others • Identify other ways in which our behaviors might exclude others and strategies for demonstrating respectful, inclusive behaviors LearningObjectives

10. Core Concepts and Definitions

11. Core Concepts and Definitions

12. Cartersville and HCA have a comprehensive, values based Ethics and Compliance Program, which is a vital part of the way we conduct ourselves. Because the Program rests on our Mission and Values, it has easily become incorporated into our daily activities and supports our tradition of caring – for our patients, our communities, and our colleagues. We strive to deliver healthcare compassionately and to act with absolute integrity in the way we do our work and the way we live our lives. All work must be done in an ethical and legal manner. It is your responsibility and your obligation to follow the code of conduct and maintain the highest standards of ethics and compliance. Ethics and Compliance

13. If you have questions or encounter any situation which you believe violates the provisions of the code of conduct or the corporate integrity agreement, you should immediately consult your supervisor, another member of the management team, the VP of HR (Robbie Tatum ext 1141), the Ethics and Compliance Officer (Jan Tidwell ext 1070), or the HCA Ethics Line (1-800-455-1996). • Each employee and volunteer is required to attend two hours of initial code of conduct training and a one hour annual refresher training session. Leaders and individuals in key jobs have additional annual education requirements. Ethics and Compliance

14. There is a federal False Claims Act, and there are also Georgia laws that address fraud and abuse in the Georgia Medicaid program. • Any person or entity that knowingly submits a false or fraudulent claim for payment of funds is liable for significant penalties and fines. • The False Claims Act has a “qui tam” or “whistleblower” provision. This allows a private person with knowledge of a false claim to bring a civil action on behalf of the US Government. If the claim is successful, the whistleblower may be awarded a percentage of the funds recovered. • For additional information please see the Georgia False Claims Statutes Policy. Georgia False Claims Laws

15. Our goal is to identify and reduce risks of healthcare associated infections in patients, visitors, and healthcare workers • Hand hygiene is the single most effective way to prevent the spread of infection. • Hand hygiene with an alcohol based products is preferred as long as hands are not visibly soiled. Rub hands together for 15-20 seconds, covering all surfaces of the hands. • Hand hygiene with soap and water is required if hands are visibly soiled. Wet hands with water, add soap, and rub vigorously for 15-20 seconds, covering all surfaces of the hand. Rinse under running water, and turn the faucet off with a paper towel Infection Prevention

16. Indications for hand hygiene with an alcohol-based hand rub (unless hands are visibly soiled): GEL IN – GEL OUT! • Before having direct contact with patients, including between patient contacts. • Before donning sterile gloves when inserting a central intravascular catheter. • Before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure. • After contact with a patient’s intact skin (e.g. when taking a pulse or blood pressure, and lifting a patient). • After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings. • If moving from a contaminated body site to a clean body site during patient care. • After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient. • After removing gloves and/or other personal protective equipment. • After handling trash and/or infectious waste. Hand Hygiene

17. Indications for hand hygiene with plain soap and water, or antimicrobial soap and water: • If hands are visibly dirty, contaminated with proteinaceous material or visibly soiled with blood or other body fluids. • Before eating. • After using a restroom. • After covering the nose and mouth when coughing and sneezing. • If exposure to Bacillus anthracis (anthrax) spores is suspected or proven. This is because alcohol hand rubs have poor activity against spores and the action of washing and rinsing hands is needed to physically remove spores from the hands. Hand Hygiene

18. Infection Prevention champions monitor hand hygiene in our facility. The use of gloves does not eliminate the need for good hand hygiene. • Patients have the right to ask if you performed hand hygiene before you take care of them. • Our goal for hand hygiene is 100% Hand Hygiene Compliance

19. All healthcare workers must perform hand hygiene before and after contact with the patient • Appropriate patient skin preparation • Clipping of hair instead of shaving • Timely administration of antibiotics • Surgical team wears masks, cap, gown, and gloves during surgery • Surgical hand scrubs before procedure Prevention of Surgical Site Infections

20. Insert central lines only when necessary using sterile technique, follow “central line insertion bundle” which includes special skin prep, inserter wearing gown, mask, sterile gloves, patient fully draped, choose safest site for insertion. • Central line maintenance: • Perform hand hygiene prior to touching line or giving medication through the line • “Scrub the hub” using purposeful friction for 15-20 seconds. • Sterile dressing changes and tubing changes per hospital policy. • Remove line when no longer necessary. Prevention of Bloodstream Infections

21. Hand hygiene before and after patient contact • Gown and glove when caring for patients under contact and special contact precautions. Gowns and gloves required for entry into rooms of patients on these precautions. • Patients are placed in private rooms whenever possible. • Certain patients are screened for MRSA upon admission. • Meticulous cleaning of hospital equipment. • Patients are educated regarding disease transmission. Prevention of Multi-Drug Resistant Organisms

22. Methicillin Resistant Staph aureus (MRSA) • Staph aureus are commonly found in nose and on skin of healthy people. • MRSA can be present without causing disease. This is called colonization. If MRSA is causing disease (e.g. fever, pneumonia), it is called infection. • MRSA is spread by contact; therefore, “Contact” precautions are used. • Hand hygiene is the best prevention for spread of MRSA. • Clostridium difficile • Causes severe diarrhea • Spread by contact; requires “Special Contact” precautions • “Special” refers to additional requirements for environmental services for cleaning the room • Hand hygiene is the best prevention for spread. • Vancomycin Resistant Enterococci (VRE) • VRE can be present without causing disease. This is called colonization. If VRE is causing disease, it is called infection. • VRE is spread by contact; therefore, “Contact” precautions are used. Examples of Multi-Drug Resistant Organisms (MDROs)

23. Hand hygiene prior to inserting a Foley catheter. • Catheters are inserted only when medically necessary following established indications. • Inserted with sterile technique • Skin prep with antiseptic prior to insertion • Maintenance • Involves daily perineal care, catheter securement, Foley bag below level of bladder, no kinks in tubing, aseptic collection of specimen • Prompt removal of Foley when no longer medically indicated. Prevention of Urinary Tract Infections Related to Foley Catheters

24. Hand hygiene prior to care • Mouth care every two hours • Head of bed at 30 degrees unless contraindicated • Daily evaluation of readiness to remove from ventilator • Peptic ulcer disease prophylaxis • Deep venous thrombosis prophylaxis Prevention of Ventilator Associated Events, Including Pneumonia

25. Personal protective equipment (PPE) is provided at no cost. • PPE includes, but is not limited to: gloves, gowns, masks, N95 respirators, and goggles. Appropriate PPE is available in each department. • At a minimum, gloves must be worn when it can be reasonably anticipated that there may be hand contact with blood, body fluids, mucous membranes (e.g. eyes, nose, mouth), non-intact skin, or contacted with contaminated items or surfaces. Replace gloves if torn or punctured or if their ability to function as a barrier is compromised. Disposable gloves are single patient use only. • Other PPE must also be worn as appropriate. Personal Protective Equipment

26. Wear appropriate face and eye protection when splashes, sprays, splatters, or droplets of blood or body fluids may pose a hazard to the eye, nose, or mouth. • Any garment contaminated with blood or body fluids must be removed immediately or as soon as feasible. • PPE must be removed prior to leaving the patient’s room. Hand hygiene must be performed after glove (and other PPE) removal. • PPE may be disposed of in the regular trash unless contaminated with blood. If contaminated, they must be disposed of in red biohazard bags. Personal Protective Equipment

27. Standard Precautions means that we assume every patient is potentially infected or colonized with an organism (germ) that could be transmitted in the healthcare setting and requires the application of standard infection prevention practices during the delivery of healthcare. • Standard Precautions applies to blood, all body fluids, secretions, and excretions, mucous membranes, non-intact skin. • By using standard precautions, you will substantially reduce your risk of acquiring an infection from a patient. Standard Precautions

28. Used for patients known or suspected to be infected or colonized with highly transmissible or epidemiologically important microorganisms (germs) for which additional precautions are needed to prevent transmission. • Used in ADDITION to Standard Precautions • 5 categories (patients may need more than 1 category): • Contact • Special Contact • Droplet • Airborne • Protective Isolation Precautions

29. Transmission occurs by direct contact or by contact with a contaminated environment. • Patient placed in private room. • Requires gown and gloves for entering room. • Patients should wear an isolation gown and perform hand hygiene prior to leaving the room. Contact Precautions and Special Contact Precautions

30. Transmission occurs when droplets are generated from the infected patient primarily through coughing, sneezing, talking, and during certain procedures like bronchoscopy. • Droplets are propelled a short distance and are infectious if they enter the eyes, nose, or mouth. Can also occur if you touch a surface recently contaminated with droplets and then touch your eyes, nose, mouth. • Short distance = usually 3 feet or less • Patient placed in private room. • Requires standard procedure mask to enter. • Patients must wear a standard procedure mask if they need to leave the room. Droplet Precautions

31. Transmission occurs by dissemination of airborne droplet nuclei (5 micron or smaller) that remain suspended in the air for long periods of time. Can be dispersed by air currents over long distances and be inhaled by others. • Patient in private room with special ventilation (negative air flow). • N95 required to enter room. • Requires fit test in advance • Patient to wear a standard procedure mask if they must leave the room for medical purposes. • Persons not immune to Rubella (German Measles) or Mumps should not enter if other immune caregivers are available. Pregnant women who are not immune should not care for patients with Rubella. Airborne Precautions

32. Used for patients who are immuno-compromised (e.g. leukemia, lymphoma, severe burns, organ transplants, low white blood cell count). • Patient placed in private room. • If ill, should not enter room. • Patient should wear a standard procedure mask if they need to leave the room. Protective Precautions

33. Use disposable equipment (e.g. BP cuffs, stethoscopes, tourniquets) as much as possible. • Any equipment taken into the room must be disinfected prior to removing it from the room • Receiving departments must be notified that patient is on precautions. • Procedures should be scheduled when there are fewer patients in the area. • When leaving the room, patients should wear a clean gown and perform hand hygiene prior to leaving the room. For all MRDOs

34. TB is spread from person to person through air droplets from someone who has TB. • Symptoms of TB include: cough greater than 3 weeks, unexplained fever, weight loss, night sweats, coughing up blood. • TB infection: a positive PPD skin test, no illness. Germ is in body, but not causing disease. Cannot spread to others, but there is a risk if untreated that can progress to TB disease. • TB disease: signs and symptoms of disease. May be contagious. Tuberculosis (TB)

35. Upon hire, associates are required to have a PPD skin unless they have ever had a positive skin test. • Cartersville Medical Center is a “low risk” facility for TB. This means that an annual PPD test is not required. Our risk is re-evaluated yearly and can change. • Associates with active TB are not allowed to work until they are cleared as no longer being infectious and are healthy enough to perform their work duties. Tuberculosis (TB)

36. Patients suspected of having active TB are placed on “Airborne” precautions in a private room with negative air flow. The door must remain closed at all times except when entering and exiting the room. • Anyone entering the room is required to wear an N95 respirator. • A “fit check” must be done each time the mask is put on. If mask doesn’t fit, contact Occupational Medicine for a repeat fit test. Tuberculosis (TB)

37. The hospital is prepared should there be an influx of infectious patients. • We would activate our emergency preparedness plan. • This plan addresses staffing, supplies, and other issues that might occur as a result of increased patient load. Influx of Infectious Patients

38. Bloodborne pathogens are germs that are present in blood that can cause disease. • Includes, but it not limited to: HIV, Hepatitis B, and Hepatitis C • The hospital has a written plan that explains what bloodborne pathogens are, how to minimize risk of exposure, and what steps to take should an exposure occur. • A copy is available to all associates . BloodbornePathogens

39. The following body fluids are considered to be potentially infectious for bloodborne pathogens: • Blood or any other body fluid containing visible blood • Other potentially infectious materials • Semen, vaginal secretions, cerebrospinal fluid, synovial fluid, peritoneal fluid, pericardial fluid, amniotic fluid, pleural fluid, saliva in dental procedures, all body fluids where it is difficult or impossible to differentiate between body fluids, any unfixed tissue or organ (other than intact skin) from a human (living or dead), cell or tissue cultures, organ cultures, and culture medium or other solutions which may contain bloodborne pathogens, HIV-containing cell or tissue cultures, organ cultures, and HIV or HBV containing culture medium or other solutions, and blood, organs, or other tissues from experimental animals infected with HIV or HBV Bloodborne Pathogens

40. Occupational modes of transmission of bloodborne pathogens: • Percutaneous exposure (needlesticks or other sharp object injuries) to infected blood or other potentially infectious materials • Mucous membrane (eyes, nose, mouth) exposure to infected blood or other potentially infectious materials. • Open lesion exposure to infected blood or other potentially infectious materials • Intact skin exposure to infected blood or other potentially infectious materials if it involves an extensive area or is prolonged. Bloodborne Pathogens

41. Human Immunodeficiency Virus (HIV) is the virus that causes the disease Acquired Immune Deficiency Syndrome (AIDS). • HIV damages the immune system and makes a person more likely to get serious infections and other diseases. • To become infected with HIV, the virus must get into your body and enter your bloodstream. • Many people who have HIV do not have symptoms for years. Persons who are HIV positive or have AIDS can spread the disease to others. • Currently, there is no vaccine to prevent HIV infection. What is HIV?

42. Hepatitis is a disease of the liver. • Hepatitis B virus (HBV) is just one of many things that can cause liver disease. • Symptoms include jaundice, fatigue, fever, nausea, and abdominal pain. • A vaccine is available that is very effective in preventing Hepatitis B infection. What is Hepatitis B?

43. Hepatitis is a disease of the liver. • Hepatitis C virus (HCV) is just one of many things that can cause liver disease. • Many people with Hepatitis C do not have any symptoms. If there are symptoms, they are very similar to those of Hepatitis B infection. • Currently, there is no vaccine to prevent Hepatitis C virus infection. What is Hepatitis C?

44. Use Universal Precautions when caring for ALL patients. This means that we assume every patient that we are caring for has a bloodborne illness and take the same reasonable precautions to prevent exposure to infectious materials. • Use engineering controls (controls that remove the risk from the workplace). These include sharp safety devices, sharps disposal containers, and biohazard waste cans, for example. • Observe good work practice controls such as never recapping needles, performing hand hygiene, no eating or drinking or applying cosmetics or lip balm where there is a potential for exposure. • Use appropriate personal protective equipment. • Know the job tasks in your department that may involve exposure to blood or other potentially infectious materials. How to Reduce the Risk of Exposure to Bloodborne Pathogens

45. If your skin is exposed to blood or other potentially infectious materials, wash the area with soap and water as soon as possible (even if the exposure was a needlestick). If mucous membranes are exposed, flush with large volumes of water. • If the injury is serious, go immediately to the Emergency Department. Otherwise, notify your immediate supervisor of the exposure. You will be provided information on appropriate follow up procedures. Post Exposure to Blood or Other Potentially Infectious Materials

46. Risk varies based on pathogen involved, type of exposure, amount of blood/body fluid involved in the exposure, the amount of virus present in the patient’s blood at the time of exposure. • The following factors are associated with an increased risk of getting HIV from an exposure from an infected patient: • Deep injury • Visible blood on device that caused the injury • Device was in the infected patient’s vein or artery • The patient is end-stage AIDS Risk of Acquiring a Bloodborne Pathogen from an Exposure

47. If patient is HIV+: • The average risk of infection is 0.3%. • If patient is HBV+: • If you have completed the series of Hepatitis B vaccine and developed immunity, you are at virtually no risk for infection. • If you are unvaccinated, the risk if 6-30%. • If patient is HCV+ • The average risk of infection after a needlestick is about 3%. Risk of Acquiring a Bloodborne Pathogen from an Exposure

48. HIV: • Treatment involves starting anti-HIV medications as soon as possible after the exposure. • HBV: • Treatment involves starting the Hepatitis B vaccine or receiving “HBIG”. • HCV: • There is no vaccine and no recommended treatment after exposure. • Following infection prevention practices and preventing exposure is imperative. Post-Exposure Treatment

49. Receive appropriate training on using the sharps safety devices available to you. • Keep the exposed sharp in view. • Keep you hands behind the sharp/needle at all times. • Be aware of people around you. Stop if you feel rushed or distracted. • Focus on your task. • Avoid hand-passing or sharps (e.g. use a tray) and use verbal alerts when moving sharps. • Watch for sharps in linen, beds, on the floor, or in waste containers. • Don’t recap used needles. • Do not use a needle with a needleless IV system. • Activate safety mechanism immediately after use. • Never remove the safety feature. • Never force an item into a sharps container. • Do not overfill a sharps container; they are to be replaced when they are ¾ full. • Do not reach by hand into containers where sharps are placed. • If you identify a sharp item without a safety device, discuss this with your supervisor, Employee Health, or Infection Prevention. Preventing Sharp Object Injuries

50. Latex allergies pose a serious problem for nurses, other health care workers, and for 1% to 6% of the general population. Anaphylactic reactions to latex can be fatal. • Health care workers’ exposure to latex has increased dramatically since universal precautions against blood borne pathogens were mandated in 1987. Latex can trigger three types of reactions: irritant contact dermatitis, allergic contact dermatitis, and immediate hypersensitivity. • Many medical devices contain latex that might trigger serious systemic reactions by cutaneous (skin) exposure, (i.e. ECG electrodes, masks, bandages, catheters, gloves, and tape.) There are some diagnostic tests to determine if a person has an allergy to latex. If a patient tells you they are allergic to latex, notify Materials Management and they will provide a cart with latex-free products. Need more information? Contact the Nursing House Supervisor at ext. 6910. For associates with latex allergies, contact Employee Health Services ext. 2129. Latex Allergies