Special Edition on Infection Prevention & Control | Page 28

on activities being performed; minimizing Potential Exposures (e.g. respiratory hygiene and cough etiquette); and reprocessing of reusable medical equipment between each patient and when soiled. Standard Precautions are the basic practices that apply to all patient care, regardless of the patient’s suspected or confirmed infectious state, and apply to all settings where care is delivered. These practices protect healthcare personnel and prevent healthcare personnel or the environment from transmitting infections to other patients. 6. Transmission-Based Precautions ● Implement additional precautions (i.e., Contact, Droplet, and/or Airborne Precautions) for patients with documented or suspected diagnoses where contact with the patient, their body fluids, or their environment presents a substantial transmission risk despite adherence to Standard Precautions. ● Adapt transmission-based precautions to the specific healthcare setting, the facility design characteristics, and the type of patient interaction. ● Implement transmission-based precautions based on the patient’s clinical presentation and likely infection diagnoses (e.g., syndromes suggestive of transmissible infections such as diarrhea, meningitis, fever and rash, respiratory infection) as soon as possible after the patient enters the healthcare facility (including reception or triage areas in emergency departments, ambulatory clinics or physicians’ offices) then adjust or discontinue precautions when more clinical information becomes available (e.g., confirmatory laboratory results). ● To the extent possible, place patients who may need transmission-based precautions into a single-patient room while awaiting clinical assessment. ● Notify accepting facilities and the transporting agency about suspected infections and the need for transmission-based precautions when patients are transferred. ● Implementation of Transmission-Based Precautions may differ depending on the patient care settings (e.g., inpatient, outpatient, long-term care), the facility design characteristics, and the type of patient interaction, and should be adapted to the specific healthcare setting. 7. Temporary invasive Medical Devices for Clinical Management ● During each healthcare encounter, assess the medical necessity of any invasive medical device (e.g., vascular catheter, indwelling urinary catheter, feeding tubes, ventilator, surgical drain) to identify the earliest opportunity for safe removal. ● Ensure that healthcare personnel adhere to recommended insertion and maintenance practices. ● Early and prompt removal of invasive devices should be part of the plan of care and included in regular assessment. Healthcare personnel should be knowledgeable regarding risks of the device and infection prevention interventions associated with the individual device and should advocate for the patient by working toward removal of the device as soon as possible. 8. Occupational Health ● Ensure that healthcare personnel either receive immunizations or have documented evidence of immunity against vaccine-preventable diseases as recommended by the CDC, CDC’s Advisory Committee on Immunization Practices (ACIP) and required by federal, state or local authorities. ● Implement processes and sick leave policies to encourage healthcare personnel to stay home when they develop signs or symptoms of acute infectious illness (e.g. fever, cough, diarrhea, vomiting, or draining skin lesions) to prevent spreading their infections to patients and other healthcare personnel. ● Implement a system for healthcare personnel to report signs, symptoms, and diagnosed illnesses that may represent a risk to their patients and coworkers to their supervisor or healthcare facility staff who are responsible for occupational health. ● Adhere to federal and state standards and directives applicable to protecting healthcare workers against transmission of infectious agents including OSHA’s Bloodborne Pathogens Standard, Personal Protective Equipment Standard, Respiratory Protection standard and TB compliance directive. ● It is the professional responsibility of all healthcare organizations and individual personnel to ensure adherence to federal, state and local requirements concerning immunizations; work policies that support safety of healthcare personnel; timely reporting of illness by employees to employers when that illness may represent a risk to patients and other healthcare personnel; and notification to public health authorities when the illness has public health implications or is required to be reported. STRIVE Program The STRIVE curriculum was developed by national infection prevention experts led by the Health Research & Educational Trust (HRET), which recruited 462 hospitals in 28 states and the District of Columbia, with 443 hospitals completing the 12-month program. One of the most comprehensive sources of information for infection prevention programs is contained in a repository of resources known as the STRIVE (States Targeting Reduction in Infections via Engagement) program, which uses the HAI National Action Plan goals from the Centers for Disease Control and Prevention (CDC). STRIVE, which was conducted from 2015 to 2018, focused on improving infection control practices and strengthening key stakeholder relationships to improve infection control efforts at the hospital and statewide levels. The STRIVE curriculum was developed by national infection prevention experts led by the Health Research & Educational Trust (HRET), which recruited 462 hospitals in 28 states and the District of Columbia, with 443 hospitals completing the 12-month program. STRIVE used evidence-based HAI reduction strategies and relationship-based methods to address infection rates in hospitals with a high cumulative attributable difference rate in Clostridioides difficile and at least one other HAI (central line-associated bloodstream infection, catheter-associated urinary tract infection, or methicillin-resistant Staphylococcus aureus infection). As Bhatt and Collier (2019) explain, “The curriculum emphasized horizontal (called ‘foundational’) infection prevention strategies, such as hand hygiene and environmental cleaning, that cut across all HAIs, as well as socio-adaptive solutions, such as team-building and leadership engagement, to address 28 IP&C Special Edition June 2020 • www.healthcarehygienemagazine.com