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INFECTION CONTROL DEPARTMENT

INFECTION CONTROL PROGRAM

The goal of the Infection Control Program is to prevent and control the spread of infection among patients, personnel, students and visitors. The Infection Control Practitioners:

• perform surveillance for nosocomial infections
• work in collaboration with OHS to provide follow-up of occupational exposures
• investigate clusters/outbreaks or other unusual infection occurrences
• provide consultation concerning any process and/or environmental issues relating to infection control

The following Infection Control information is a sample of what is available electronically.
At BWH and DFCI, it is found on the Partners intranet at www.bwhpikenotes.org/GeneralClinicalResources/InfectionControl/InfectionControl.asp.

At MGH it is found at the website http://phsweb3/icu or via the MGH homepage as above.]

• AIDS information
• SARS information
• Fact Sheets for C. difficile, MRSA, VRE, and TB
• Manual of Precautions for specific disease/illness
• Negative air pressure rooms
• Protection for patients and health care workers
• Standard Precautions
• Transmission-based precautions: Airborne, Contact and Droplet
• Exposure protocol
• OSHA Exposure Control Plan
• Masks/Respirators
• Needle Safety

STANDARD PRECAUTIONS

1. Blood and all body fluids, moist body surfaces, mucous membranes non-intact skin, secretions, excretions and contaminated equipment must be considered reservoirs for infection in all patients regardless of their diagnosis or condition. Standard Precautions require clinical judgment in determining the selection of personal protective equipment (PPE) such as faceshields, goggles and masks, protective gowns and/or gloves, based on the degree of exposure anticipated during patient
care activities. Routinely do the following: Disinfect hands before and after all patient contacts.

2. Use gloves when there is potential contact with blood and/or any body fluids, secretions, excretions, contaminated equipment, mucous membranes and non-intact skin. Change gloves when they become soiled (even during the care of the same patient). Always remove gloves AND disinfect hands with an alcohol based gel. If hands are visibly soiled wash hands with soap and water, dry, then use an alcohol based gel. NEVER use the same gloves for more than one patient.

3. Wear a fluid-resistant gown when blood, body fluids, secretions, excretions, non-intact skin, or contaminated equipment may come in contact with skin and/or clothing. Never use the same gown for more than one patient.

4. Wear a mask and goggles or a faceshield when droplets or aerosols of blood or body fluids, secretions, or excretions might contact your face.

5. USE SAFETY NEEDLES INSTEAD OF REGULAR NEEDLES WHENEVER POSSIBLE: e.g. safety IV catheters, sheathed butterfly needles, sheathed syringes, sheathed needles, recessed needles, safety devices for transfer of blood into blood culture bottles and blood collection tube, and a vacutainer with a safety sheath.

6. Never recap needles (unless a safe recapping device is used).

7. Never throw any needles or sharps into a wastebasket; dispose of all uncapped needles and other sharps in puncture-resistant sharp containers.

8. Dispose of bloody waste or pooled fluids in special hazardous waste containers.

9. Wear gloves and a gown, if necessary when handling linen soiled with blood, body fluids, secretions, or excretions. Linen that is visibly soiled does not have to be bagged separately (all used linen is handled according to standard precautions by linen services).

10. At BWH: All departments have individualized task sheets which list the personal protective equipment (PPE) required during a given procedure. Locate and review the guidelines for your department.

OTHER PRECAUTIONS.

Three types of transmission-based precautions are used: Airborne Precautions, Droplet Precautions and Contact Precautions.

Information regarding the details of Standard Precautions and transmission-based precautions may be found at each hospital. At BWH, it is available on the Infection Control websites. At BWH : www.bwhpikenotes.org/GeneralClinicalResources/InfectionControl/InfectionControl.asp. At MGH, it is available at the Infection Control website through the MGH home page under Departments and Programs (or http://phsweb3/icu). This information is also available at MGH in the Infection Control Manual located in all patient care areas.

EXPOSURES TO BLOODBORNE PATHOGENS
Exposure follow-up: If you are exposed to blood or visibly bloody fluids by needle stick, cut with a sharp instrument and/or splashed in the eyes or mouth or in open areas on your skin, take the following steps as soon as possible. These procedures are also outlined on the red badges at BWH issued with your hospital identification badge.

• Wash the affected area with soap and water
• Flush eyes and mouth with water, if exposed
• Notify your supervisor
• Report to Occupational Health Service (OHS) (or Emergency Dept.) as soon as possible after exposure
• Complete an Employee Incident Report

It is very important to report an exposure immediately. Depending on the risk assessment, you may be eligible for anti-viral therapy, which should be administered as soon as possible, ideally within one to two hours.

Partners policy requires that ALL occupational exposures be reported to OHS or Emergency Department. If you are seen in the ED, you still must report to OHS. Follow-up of the exposed individual and the exposure source are confidential and must be performed through OHS.

At BWH: Page the STIK Beeper: #3-STIK (37845).
Go to OHS located on the PBB MID-CAMPUS ground (x28501). OHS hours are Monday - Friday, 7:00 am - 4:30 pm. During other hours, weekends and holidays report to the Emergency Department (ED).

At MGH: OHS is located on Clinics 3. OHS hours are Monday – Friday, 7:00 am - 4:30 pm. During off hours, page the OHS Nurse Practitioner via the page operator. There is a nurse practitioner on call at all times to manage health care worker exposures.

GUIDELINES FOR INTRAVASCULAR DEVICE USE
Qualified physicians may perform insertion of an intravascular catheter, as may members of the IV team, physician’s assistants, and registered nurses with demonstrated competence. Resident physicians and/or medical students may perform procedures only under the direction and guidance of a qualified physician. All intravascular devices are inserted and manipulated using aseptic technique. See Guidelines for the Prevention of Intravascular Catheter Infections on the MGH Infection Control Website.

1 Site Prep -BWH- 2-4% aqueous CHG or 10% povidone iodine (1% titratable iodine) or 70% isopropyl alcohol MGH- Please Refer to infection control guidelines

2 Guidewire-assisted catheter replacement is acceptable (in the absence of evidence of catheter site infection) for replacing a malfunctioning catheter, to aid in diagnosis of catheter-related infection, to provide an unviolated dedicated port for TPN, or to replace a CVC at a former PAC site when invasive monitoring is no longer needed.

TPN MUST be given through a dedicated port.
TPN should not be given through a pulmonary arterial catheter unless previously approved by Metabolic Support Service physician. Contact Metabolic Support Services at BWH or Nutritional Support Services at MGH.
CXR or Fluoroscopy required s/p CVC and PICC placement.

TUBERCULOSIS
Patients with active Tuberculosis or a “rule-out” diagnosis must be placed on Airborne Precautions in a negative-pressure isolation room. Health care workers entering the room must wear N95 respirators or PAPRs (purified air-powered respirators). Medical clearance and fit-testing for particulate respirators is coordinated by the Occupational Health Service and the Safety Office.

Inpatients with Tuberculosis should be reported to the Infection Control Unit for immediate notification to the MDPH Division of TB Control. Outpatients should be reported by the health care provider. Call the MDPH Division of TB Control (617-983-6989).

OCCUPATIONAL HEALTH
It is required that all interns and residents be cleared by OHS prior to beginning training. Specifically interns and residents must show acceptable evidence of immunity for rubella and measles, must have a TB screening test at least annually, and be screened for Varicella.

Varicella vaccine, Hepatitis B vaccine, and Influenza vaccine are all available through OHS.

Contact OHS:

1. If you are ill with: Varicella (chicken pox) or Zoster (shingles), tuberculosis,conjunctivitis, diarrhea lasting more than 3 days, any unexplained rash, jaundice, an unexplained cough>2 weeks, a severe sore throat, draining skin lesions, or meningitis.

2. If you come in contact with someone who has: Varicella, measles, tuberculosis, Pertussis, or meningitis.

3. If you are exposed to blood or other potentially infectious material.

REPORTABLE COMMUNICABLE DISEASES
Massachusetts law requires that all patients confirmed as having a communicable disease be reported to the Massachusetts Department of Public Health (MDPH) by the physician or his/her designee. All patients with a reportable disease diagnosed during an inpatient stay will be reported to the MDPH by the Infection Control department. Reports on outpatients remain the responsibility of the physician. The regulations distinguish diseases reportable through local boards of health from those reportable directly to MDPH. Reporting forms available on MGH Infection Control Website. See attached MDPH Guidelines effective 2/03.
Reporting forms are available online at www.bphc.org. Reporting may be done online.

Animal bites: Use an “Animal Bite/Rabies Prophylaxis” form or call the CDC Program (404-639-1050 business hours, 404-639-2888 other hours) or MDPH (617-983-6800). For emergency animal follow up, contact the Animal Inspector for the City of Boston by phone (617-426-9170; 24 hours a day) or by fax (617-426-3028; 24 hours a day).

Communicable and Other Infectious Diseases Reportable in Massachusetts by Healthcare Providers*

*The list of reportable diseases is not limited to those designated below. This list includes only those which are primarily reportable by
clinical providers. Reports of additional diseases and information may be required by MDPH and local boards of health from time to
time.

A full list of reportable diseases in Massachusetts is detailed in 105 CMR 300.100.

REPORT IMMEDIATELY BY PHONE!
This includes both suspect and confirmed cases.
All cases should be reported to your local health department;
if unavailable, call the Massachusetts Department of Public Health:
Telephone: (617) 983-6800 Confidential Fax: (617) 983-6813

• Any Case of an Unusual Illness thought to have public health implications
• Any Cluster/Outbreak of Illness (including, but not limited to foodborne illness)
• Anthrax
• Botulism
• Brucellosis
• Diphtheria
• Encephalitis, any case
• Haemophilus influenzae, invasive
• Hemolytic uremic syndrome (also report directly to MDPH: 617-983-6800)
• Hepatitis A (IgM+ only)
• Measles
• Meningitis, bacterial, community acquired
• Meningococcal disease, invasive (N. meningitidis)
• Plague
• Polio
• Q Fever
• Rabies in humans
• Rubella
• Smallpox
• Tetanus
• Tularemia
• Viral hemorrhagic fevers

Animal bites should be reported immediately to the designated local authority.

REPORT PROMPTLY (WITHIN 1-2 B U S I N E SS DAYS)
This includes both suspect and confirmed cases.
All cases should be reported to your local health department ,
if unavailable, call the Massachusetts Department of Public Health:
Telephone: (617) 983-6800 Confidential Fax: (617) 983-6813

• Ehrlichiosis
• Creutzfeldt-Jakob disease
• Food poisoning and toxicity (includes poisoning by ciguatera, scombrotoxin, mushroom toxin, tetrodotoxin, paralytic shellfish and amnesic shellfish)
• Guillain Barré syndrome
• Hansen’s disease (leprosy)
• Hantavirus infection
• HBsAg+ pregnant women
• Leptospirosis
• Lyme disease
• Meningitis, viral (aseptic), and other infectious (non-bacterial)
• Mumps
• Pertussis (Whooping Cough)
• Psittacosis
• Reye syndrome
• Rheumatic fever
• Rickettsialpox
• Rocky Mountain spotted fever
• Toxic shock syndrome
• Trichinosis
• Varicella (chickenpox)
  

MDPH, its authorized agents, and local boards of health have the authority to collect pertinent information on all reportable diseases, including those not listed above, as part of epidemiological investigations (M.G.L. c. 111, s. 7).

Communicable and Other Infectious Diseases Reportable in Massachusetts by Healthcare Providers*

*The list of reportable diseases is not limited to those designated below. This list includes only those which are primarily reportable by
clinical providers. Reports of additional diseases and information may be required by MDPH and local boards of health from time to
time.

A full list of reportable diseases in Massachusetts is detailed in 105 CMR 300.100.

Report Directly to the Massachusetts Department of Public Health

• HIV infection and AIDS (617) 983-6560
• Sexually Transmitted Diseases (617) 983-6940
  • Chanchroid
    Chalamydial infections (genital)
    Genital Warts
    Gonorrhea
    Granuloma inguinale
    Herpes, neonatal (onset within 30 days after birth)
    Lymphogranuloma venereum
  • Ophthalmia neonatorum:
    a. Gonoccocal
    b. Other agents
  • Pelvic Inflammatory disease
    a. Gonococcal
    b. Other agents
  • Syphilis
    
• Tuberculosis suspect and confirmed cases:

  Report within 24 hours to (617) 983-6989 or
  Toll Free (1-888) MASS-MTB (627-7682) or
  Confidential Fax (617) 983-6990

• Latent tuberculosis infection:

  Confidential Fax (617) 983-6990 or
  Mail report to:
  Massachusetts Department of Public Health
  Division of Tuberculosis Prevention and Control
  305 South Street, Jamaica Plain, MA 02130

Reportable Diseases Primarily Ascertained Through Laboratory Reporting of Evidence of Infection

Please work with the laboratories you utilize for diagnostic testing to assure complete reporting.

• Amebiasis
• Babesiosis
• Calicivirus infection
• Campylobacteriosis
• Cholera
• Cryptococcosis
• Cryptosporidiosis
• Cyclosporiasis
• Dengue fever virus
• Eastern equine encephalitis virus
• E. coli O157:H7
• Enteroviruses (from CSF)
• Giardiasis
• Group A streptococcus, invasive infection
• Group B streptococcus, invasive infection
• Hepatitis B
• Hepatitis C
• Hepatitis – infectious, not otherwisespecified
• Evidence of human prion disease
• Influenza
• Legionellosis
• Listeriosis
• Malaria
• Salmonellosis
• Shiga toxin-producing organisms
• Shigellosis
• Streptococcus pneumoniae, invasive infection
• Toxoplasmosis
• West Nile virus
• Yellow fever virus
• Yersiniosis