ALABAMA DEPARTMENT OF PUBLIC HEALTH INFECTION PREVENTION GUIDELINES INFECTION PREVENTION SECTION BUREAU OF COMMUNICABLE DISEASE 334-206-5932 ADPH-DC-4IREV. 01-2010 Infection Prevention Manual Table of Contents Introduction ..........................................................................................................6 Hand Hygiene ......................................................................................................7 Disease Transmission .................................................... ...............................….. 9 Standard Precautions ………………………………………………………….. 10 Respiratory Hygiene/Cough Etiquette ………………………………………….11 Orientation of New Employees ..................................................................……12 Emergency Preparedness ………………………………………………………13 Severe Acute Respiratory Syndrome (SARS) ...………………………………14 SECTION I Recommendations for Vaccination and Tuberculin Skin Testing of Health Department Employees...................................................................................15 I. Guidelines for Vaccination ................................................................................15 A. Hepatitis B ............................................................................................... 15 B. Influenza ...................................................................................................16 C. Measles (Rubella) ..................................................................................... 16 D. Mumps .......................................................................................................16 E. Rubella .......................................................................................................16 F. Varicella (Chickenpox) ............................................................................. 17 G. Rabies .........................................................................................................17 II. Tuberculin Skin Testing ......................................................................................17 III. Protection of Immunocompromised Employees .................................................18 IV. HIV-Infected Persons ..........................................................................................18 V. Work Restrictions for Susceptible HCWs After Exposure .................................19 VI. Alabama Department of Public Health Employee Hepatitis B Vaccination Policy ..............................................................................................19 Alabama Department of Public Health Policy on Infected Healthcare Workers ......20 Infection Control Guidelines Manual January 2010 2 SECTION II Protection from Occupational Exposure to Blood and Body Fluids ...........................21 I. Bloodborne Pathogens Exposure Control Plan ...................................................21 II. Medical Waste Disposal Plans ............................................................................21 III. Disinfection and Sterilization - General Principles ............................................21 A. Definitions..................................................................................................21 B. Classification Scheme for Disinfection & Sterilization of Patient Care Items or Equipment .................................................................................. 22 C. Disinfection Solutions ............................................................................... 22 D. Disinfectants that Inactivate Hepatitis B (HBV) and HIV .........................23 E. Medical Equipment Disinfection ...............................................................23 SECTION III Recommendations for the Management of Percutaneous/ Permucosal Exposure to Blood or Other Body Fluids .................................................25 I. Introduction .........................................................................................................25 II. Management of Occupational Needlesticks and/or Exposure to Blood/Body Fluids ..........................................................................26 III. Recommendations for Management of Exposure to Hepatitis B Virus (HBV) ............................................................................... 26 IV. Recommendations for the Management of Exposure to Hepatitis C Virus (HCV) ................................................................................... 26 V. Recommendations for Management of Exposure to HIV ...................................27 SECTION IV Patient Care Procedures .................................................................................................28 I. Personal Protective Equipment (PPE) ................................................................28 II. Injections .............................................................................................................28 III. Specimen Collection ...........................................................................................29 IV. Storage of Supplies .............................................................................................29 SECTION V Recommendations for Isolation Area.............................................................................30 I. Establishment ......................................................................................................30 II. Use of the Isolation Room ..................................................................................30 III. Cleaning the Isolation Room ..............................................................................31 SECTION VI Infection Control Guidelines Manual January 2010 3 Guidelines for Prevention and Control of Antibiotic-Resistant ..................................32 I. Introduction .........................................................................................................32 II. Community Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) ..................................................................32 III. Background .........................................................................................................33 A. Methicillin-Resistant Staphylococcus aureus (MRSA) .............................33 B. Vancomycin-Resistant Enterococci (VRE) ...............................................33 IV. Colonization vs. Infection ...................................................................................33 A. Colonization ...............................................................................................33 B. Infection .....................................................................................................34 V. Epidemiology ......................................................................................................34 A. MRSA ....................................................................................................... 34 B. VRE............................................................................................................34 VI. Control Strategies ................................................................................................35 General Control Measures ..................................................................................35 VII. Setting Specific Control Measures. .....................................................................36 A. Clinics ........................................................................................................36 B. Home Healthcare .......................................................................................37 SECTION VII Home Care…. ...................................................................................................................38 I. Environmental Factors that may Increase Susceptibility to Infection ................38 II. Infection Control Principles that should be Taught ............................................38 III. Infection Reporting/Surveillance ........................................................................39 IV. Principles of Cleaning, Disinfecting, & Sterilizing ............................................39 V. Products Suitable for Disinfection in the Home .................................................39 VI. Storage of Medical Supplies ...............................................................................40 VII. Communicable and Infectious Disease Precautions ...........................................40 VIII. Waste Disposal within the Home ........................................................................41 IX. Soiled Linen ........................................................................................................41 X. Food Preparation .................................................................................................41 SECTION VIII Tuberculosis Infection Control Recommendations ......................................................42 I. Introduction .........................................................................................................42 II. Administrative Measures ....................................................................................42 III. Engineering Controls ..........................................................................................43 IV. Personal Respiratory Protective Equipment .......................................................43 V. Ultraviolet Germicidal Irradiation (UVGI) ........................................................ 43 VI. Sputum Induction ................................................................................................44