Guidelines for H1N1 flu

The CO Dept. of Health has issued updated guidelines for caring for pts with suspected or confirmed H1N1 flu.

These pts can be placed in Droplet Precautions (not negative pressure room) with the use of standard precautions UNLESS a procedure is being done that would cause secretions to be aerosolized (intubation, bronchoscopy, nebulizer treatments). If aerosolization may occur, staff should wear the N95 mask.

3W MDRO Precautions

As stated in an earlier post, 3W will be implementing formal isolation procedures for our pts with infections requiring protective isolation. May 18th is the day that these procedures will become official, so now is a good time to familiarize yourself with what you need to do.

• Isolation carts: The contents of the carts have all been standardized. A contents list is secured to the top of all carts. In the list you will find the ordering number for each item, should you need to replenish the stock. The staff discharging the pt is responsible for restocking the cart.
• Nurse servers: These must be closed and secured with "caution" tape whenever a pt is placed in isolation. Two old IV trays have been converted to stock items that are normally found in the nurse server. These supplies are additionally bagged in biohazard bags. Only bring into the room whatever supplies you actually need. Remember that everything that comes out of the room must be cleaned or disposed.
• Linen bags: You may still use these as usual. Clean linen should only be brought into the room on an as-needed basis.
• Room equipment: If a piece of equipment is not needed, remove it from the room before the pt arrives. Equipment that can be removed from the room (such as IV poles) will be tagged with the "Clean/In Use" tag. Items that stay in the room are not tagged. The person removing the equipment from the room is the one responsible for cleaning it. Keep walkers in the room until discharge; when they are no longer needed, clean them and store in the PT office. O2 tanks will be tagged; clean appropriately when removing from an isolation room. Equipment that is tagged and can be removed from the room will stay with the pt for their entire hospitalization.
• Tergo wipes: Keep an eye on these. If you find any with mold growing on them, place them in a garbage bag and place outside of Melissa's office. We should be checking the bin of Tergo wipes once a week or so to monitor for mold. Alert Melissa if you have any issues.

Please contact Melissa if you have any questions. More information will be coming soon!

Isolation Precautions

Melissa has posted educational posters about our 3 West Isolation Precautions/Procedures in the education room and the staff restroom. Here's what you need to know!

• Proper Identification of the Pt: Do they have a hx of MRSA/VRE? Is there Gram + cocci (GPCs) in clusters reported from the lab? Notify Infection Prevention @ ext. 2336 when pt identified.
• Proper Room Set Up: Equipment tag In Use, tape the nurse server closed (but use the linen bag as usual). Make sure there is disposable equipment in the room such as a thermometer, stethoscope, and BP cuff.
• Proper Education: Provide pt, family, and visitors with written information (found in Meditech under policies -> infection prevention, available in English and Spanish). Remind other staff (transporters, PT, OT, RT, etc.) as needed. Remind physicians of standards if you notice them not adhering to them (like taking the chart in the room).
• Proper Attire: Use shoe covers as needed. Make sure the isolation cart is well-stocked. Use MAR paper covers.
• Proper Discharge Procedure: Dispose of everything, strip bed linens, leave isolation signs on the door for EVS. Restock the isolation cart for the next pt.
• For all equipment like Dash monitors, walkers, O2 tanks, etc., clean with Tergo wipes (or spray/blue microfiber cloths for C. diff) between pt use.
  

Melissa is putting together a "tool box" to place on the nurse server for things that are usually accessed in the nurse server drawers. It will be minimally stocked with the basics like alcohol wipes and tele stickers, since most things will need to be disposed at discharge.

Infection Prevention Reminders

The flu in the news is a good reason to remember the basics when it comes to infection prevention.

• Wash your hands, wash your hands, wash your hands. It's the #1 way to prevent the spread of communicable disease.
  
• Cover your cough. All patients who have an active cough or upper respiratory symptoms must wear a surgical mask. The patient must also perform hand hygiene each time they sneeze or blow their nose.

The Infection Prevention department is keeping abreast on the developments with the H1N1 flu. If you have any questions or concerns, feel free to contact Beth @ ext. 2229 or Leslee @ ext. 2336.

Swine Flu public info sources

• Centers for Disease Control: www.cdc.gov/swineflu - This is a great resource, with pretty much everything you'd ever want to know. You can sign up for email updates through the CDC here.
• Boulder County Public Health: http://www.bouldercounty.org/health
• Colorado Dept. of Public Health: http://www.cdphe.state.co.us/

Click on the green box on the lower right hand side of the blog to link to the Dept. of HHS and CDC. More information will be posted that is specific to BCH when it becomes available.

Are you current on your N95 mask fit test? Call Employee Health to get your fit test completed.

Reminders

• We cannot secure O2 tanks to IV poles with tape. There are several IV poles with holders for O2 floating around the unit. Come to Melissa if you have questions about this.
  
• Don't forget to chart your pt's BMs. 'Nuff said about that...
• If you need to administer a medication that requires rotation of sites, please document the site the med was given.
  
• Check the alarm limits on your pt's tele monitor. This can be dangerous if not set properly. For example, a pt was in SR, but went into afib and the alarm never sounded when the HR was 165. It was soon discovered that someone on a previous shift had changed the HR alarm limit to 180!
  

Varicella Titers

Employee Health is sending out memos for everyone to provide proof of immunity to varicella. Please wait to receive this memo before you have a blood titer drawn. The lab requisition must accompany the blood specimen in order for it to be processed correctly.

From Infection Prevention Land...

If a pt is placed in Clostridium difficile precautions due to a positive C. diff toxin assay (different from a C. diff culture), they will remain in precautions for the remainder of their stay. A patient can only be removed from precautions during their stay if they have a negative C. diff culture. The catch? The C. diff cultures are not done in-house, they are sent to the lab at Mayo Clinic and usually take about 7 days. We cannot use a negative C. diff toxin assay to remove someone from precautions.

C. diff yucky equipment and other stuff is cleaned with the blue microfiber cloths and Sanimaster spray. The blue microfiber cloth literally picks up the C. diff spores (can you say "shamwow!"?) Use Tergo wipes for non-C. diff cleaning. Speaking of Tergo wipes...did you know that there have been a few instances in which mold was seen growing under the lid? Ew. We can prevent this by rinsing out the canister (after it has expired) with water and drying it with a blue microfiber cloth. Then refill as usual. Don't forget to write the expiration date...90 days from the fill date. Beth can answer your questions about any of this at ext. 2339.

New Employee Health Requirement

Employee health is now requiring all employees, physicians, and volunteers to provide proof of Varicella (chicken pox). Proof of immunity includes one of the following:

• 2 documented doses of Varicella vaccine
• A copy of a "positive" Varicella blood titer
• A copy of a signed statement from your physician stating you have had the chicken pox or shingles (edited 3/19/09 @ 8:40 pm).

Employee Health will be sending out memos and lab requisitions to everyone who does not have the above documentation in their file. The memo will give you instructions for obtaining the blood draw and charging it to Employee Health.

It will take a while to get everyone up-to-date, and memos will go out to employees throughout 2009. Once you receive the memo, you have 3 weeks to obtain documentation or blood test. The titer results become part of your Employee Health immunization record. You will be contacted by Employee Health only if you are not immune to Varicella.

Please call any member of the Employee Health Staff if you have any questions 3-441-0451.

Changes for isolation signs

If a patient has MRSA in their sputum, you would normally find 2 isolation signs posted on the door: a green "contact precautions" sign and a teal "additional precautions" sign (to protect your mucous membranes from contaminated sputum).

According to universal precautions, we should always protect our mucous membranes if we anticipate potential contact with a patient's body fluids (not just MRSA infections). Therefore, the teal "additional precautions" sign will no longer be used. If you have any questions, please call Beth in Infection Control at ext. 2339.