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Did You Wash Your Hands? Fighting the Spread of Infection By Judith R. Owen, RN, MSN Teresa D. Johnson, BS
Preventing the spread of infectious disease should be a concern for all workers in adult day services. It is critical that all center workers understand the reasoning for infection control policies and how to carry out procedures to effectively reduce exposure. Policies and procedures must be established to meet the requirements of the regulatory bodies to which adult day centers report. Consider carefully the areas presented in this article in developing or evaluating your center’s infection control policies. (This article should not be considered inclusive of all policies or procedures necessary to comply with all federal, state or local regulations.)
Writing it down The purpose of any infection control policy should be: · To prevent exposure of infectious illness to those individuals in the care of the adult day center; · To aid in the identification of infectious processes as they occur; · To protect staff (including volunteers) from exposure.¹
It is imperative that adult day centers identify risk factors and develop a plan to address them, no matter how many staff are employed by the center.² The plan should include 1. A list of all job responsibilities in which employees have any risk of exposure to blood or other potentially infectious materials (as if persomal protective equipment were not being used); 2. The employees performing those tasks; 3. Procedures for reducing risk of infection before and after exposure to germs, blood or other potentially infectious materials.
Acquiring Protective Equipment Some tasks in adult day centers require the use of protective equipment to reduce risk of exposure, e.g. gloves, gowns, resuscitation devices, masks, etc. Personal protective equipment should be provided in appropriate sizes and accessible locations. Training should be given as to what equipment to use, where it is kept and how it is properly used. Hypoallergenic gloves, glove liners, powderless gloves or other alternatives should be provided for employees who are allergic to the gloves normally provided.
Disposable gloves, made of vinyl or latex, should be standard equipment for use in situations when contact with blood or body fluids containing visible blood may occur. They are not to be washed and/or re-used. General purpose utility gloves can be used for housekeeping chores as long as they are not cracked, peeling, torn or punctured. General utility gloves should be decontaminated after each use.
Ventilation devices for resuscitation should be readily accessible to staff who can reasonably be expected to resuscitate participants.
Disposable sharps should be disposed of as close as possible to where the sharps are used, in containers which are kept upright and are replaced routinely to prevent overfilling. Containers should be puncture-resistant material, closable, leak-proof on the sides and bottom and labeled or color-coded in accordance with the blood borne pathogen standard.
Avoiding Infectious Materials Common potentially infectious materials that pose risks in adult day centers are human body fluids such as blood, saliva, semen and vaginal secretions. Although OSHA regulations require strict procedures to dispose of regulated waste (products contaminated with blood), OSHA does not generally consider discarded feminine hygiene products to fall within the definition of regulated waste. The intended function of products such as sanitary napkins is to absorb and contain blood, and would, under most circumstances, prevent the release of liquid or semi-liquid blood or the flaking off of dried blood. OSHA expects the waste containers into which soiled feminine hygiene products are discarded, however, to be lined with a plastic or wax paper bag. Persons removing the garbage should do so wearing gloves.
Training Staff and Participants Effective training helps to ensure that staff understand the hazards, modes of transmission, procedures to reduce and respond to exposure, personal protective equipment, etc. Training should be given at the educational level and in the language primarily used by the persons being trained. Training should be provided at the time of initial employment and annually after that. When a worker’s job is changed to include different ways to do tasks or procedures, or when new tasks or procedures are added which affect the person’s exposure, additional training should be given.
Participants should also receive education regarding measures to prevent the spread of infections. Emphasize covering the mouth when coughing or sneezing, proper disposal of used tissues, personal hygiene, clean clothes, keeping hands away from mouth and nose and frequent handwashing.
Training must be documented in writing. The following information should be included at a minimum: · The dates of the training session · The contents or a summary of the training session · The names and qualifications of persons conducting the training · The names and job titles of all persons attending the training sessions. Training records should be maintained for at least three years from the date on which the training occurred.
Practicing Prevention: Hand washing Hand washing is the single most important way to prevent the spread of germs. Establish and maintain good hand washing practices for all staff. It is imperative that hands are washed immediately after contact with body fluids, whether or not gloves were worn. (Refer to “In Touch” in this issue for specific tips on how and when to wash hands.)
Hand washing facilities—sinks, soap dispensers and disposable towels—must be readily accessible to staff and participants. The spread of germs can be reduced when staff and participants do not have to travel long distances—or through doorways and stairs—to wash their hands. When hand washing facilities are not immediately available, antiseptic hand cleaners or antiseptic towelettes should be used until hand washing facilities are accessible.
Environmental Considerations Staff should ensure that the center is maintained in a clean and sanitary condition. Create a written schedule for cleaning and “decontaminating” the furnishings and equipment of the facility—including vehicles. Care must be taken to store cleaning supplies out of the reach of participants to prevent accidents. Potentially harmful chemicals should be kept under lock and key. Material Safety Data Sheets should be maintained on site for all chemicals, detergents and cleaners used.
Work surfaces should be sanitized on a routine basis. Bathroom surfaces, tabletops and floors should be cleaned and disinfected at least daily or when soiled. Don’t overlook door handles, telephones, computer keyboards, faucet handles and toilet seats. Time and technique are of the essence. The Center for Disease Control states that Hepatitis B Virus can survive for at least one week in dried blood on work surfaces or on contaminated needles and instruments.
All spills should be promptly cleaned up using an EPA approved disinfectant which kills bacteria, viruses and parasitic organisms or a 1:10 dilution of bleach in water while wearing gloves. Fresh bleach solution should be made daily. Cleaning all visible fluid from the spill area with paper towels before using the disinfectant will enhance the effectiveness of the disinfectant. When using commercial disinfectants, consult the label or the manufacturer to determine whether it will be effective and to determine what strength of solution is necessary to use in your situation.
Laundry of participants’ soiled clothing can be done at the adult day center as long as other regulations regarding storage and handling of contaminated laundry are followed. Normal washing with a standard washing machine and dryer using laundry detergent and warm water should be sufficient to decontaminate clothing. Staff whose duties include laundering must be provided protection with the hepatitis B vaccine, must wear gloves and other appropriate personal protective equipment and be trained in proper handling techniques. Soiled personal items should be transported to the participant’s caregiver in a leak proof package.
Garbage cans should be readily accessible and lined with plastic such that staff do not handle the contents. Storing an extra unfolded bag in the bottom of garbage cans will ensure easy access to additional bags should the garbage overflow. Persons emptying garbage containers should always wear gloves and wash their hands after removing the gloves.
Food Handling If food is served or prepared at the center, local sanitation regulations must be followed. Careful hand washing should always be conducted with everyone involved in cooking activities. Consideration should especially be given to storage of food at the proper temperatures and procedures for disposal of dated items.
Avoiding Contagious Diseases Provide each participant’s caregiver with information about your policies, procedures and disease prevention guidelines. Explain the infection control policies and procedures which are in effect in your center. Ask caregivers to keep you informed about the participant’s diagnosis of or exposures to contagious diseases outside the center, e.g. bacterial meningitis, hepatitis, pneumonia. Adult day center staff should take preventive measures to protect the other participants in the center.
Participants and staff should remain at home or distance themselves from others if they suspect an infectious illness. Receiving the annual flu vaccine may be strongly encouraged unless there is a documented medical reason for not receiving it. Proof of recent negative tuberculosis testing is often required.
It should not be necessary for the director to know if a participant is known to be HIV positive because Universal Precautions protect the staff and routine infection control procedures protect the participants.³ However, the reason adult day center staff should know if a participant is HIV positive is for the protection of the participant. Exposure to some contagious diseases requires immediate treatment for that participant.
Should the staff be told if a participant is HIV positive, it is imperative that full confidentiality for the participant be maintained. In some states, unlawful disclosure of HIV-related confidential information is a misdemeanor.
Adult day centers should seriously consider their role in preventing infectious illnesses. The services and needs of the participants and staff of each center vary. However, the proverb “an ounce of prevention is worth a pound of cure” holds great truth. It would be tragic for an outbreak of an infectious illness to force an adult day center to close for a period to decrease the likelihood of further spread when it all might have been prevented by something as simple as handwashing!
¹Guidelines for Infection Control in Adult Day Centers, NADSA. January 1995, Washington, DC. ²A Guide to Bloodborne Pathogens, Division of OSHA, NC Dept of Labor, May 1999, Raleigh, NC. ³Handbook for Child Care Center Directors, GA Division of Public Health. Http://www.ph.dhr.state.ga.us/epi/manuals/childcare/VII.htm.
Reprinted from The Information Source for Adult Day Centers®, February 2001 |