Learn about the role of environment in disease transmission and how to implement standard and transmission-based precautions to prevent the spread of antibiotic resistant bacteria and other infections in your facility.
3.1 The Big Picture
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En provenance du cours de The University of North Carolina at Chapel Hill
Infection Prevention in Nursing Homes
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Safe Injection Practices
The goal of this module is to identify how to protect residents and staff using safe injection practices and safe diabetes care. To obtain CE Credit for this module: Take the Quiz and complete the evaluation at the end of the module, you will be directed to your course completion certificate.
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Evelyn CookAssociate Director
North Carolina Statewide Program for Infection Control and Epidemiology (SPICE)
In this module we will examine the unsafe injection practices that have led to large
outbreaks of blood borne pathogens.
Then we will examine the recommended best practices for safe injections and
blood glucose monitoring.
Followed by a review of some of the contributing factors
that lead to the misuse of injection equipment.
The consequences of these outbreaks are devastating.
Sometimes resulting in patient illness and deaths.
Outbreaks can also result in notifications of many potentially exposed patients.
Causing considerable psychological impacts including anxiety for patients and
their families, even if no actual transmission has occurred.
Outbreaks can also result in loss of licenses,
legal charges and malpractice suits, and criminal charges.
Additionally, these outbreaks erode confidence in our health care system.
These never events are entirely preventable.
Health care should never provide any avenue for
transmission of blood borne pathogens or micro organisms.
The number of outbreaks has grown substantially over the past decade.
Since 2001, the CDC has identified 48 outbreaks related to unsafe
injection practices during the delivery of injectable medications.
Just over 40% of the outbreaks were viral hepatitis infections,
and around 60% were bacterial infections, most of which were bloodstream infections.
We are seeing more and more outbreaks in outpatient settings
with an over-representation in pain management clinics, and oncology clinics.
These outbreaks have resulted in hundreds of infections.
In addition, to those infected during this period, there have been over 150,000
patients potentially exposed to infection as a result of poor practices.
These are patients who received letters or
phone calls telling them they should be tested for hepatitis, HIV or
other infections because of unsafe practices such as syringe reuse.
Outbreaks of Hepatitis B virus infection associated with assisted
blood glucose monitoring have been identified with increasing regularity.
Particularly in long term care settings, where residents often require assistance
with monitoring blood glucose levels and or insulin administration.
Since 2001,, there have been 23 recognized outbreaks
related to the assisted monitoring of blood glucose.
These outbreaks resulted in about 2,000 notifications and
over 170 incident infections.
Of all virus hepatitis outbreaks in long term care facilities, those
associated with the assisted monitoring of blood glucose accounted for about 90%.
Although the majority of these outbreaks have been reported in
long-term care settings, the risk of infection
is present in any setting where blood glucose monitoring equipment is shared.
Or those assisting with blood glucose monitoring and or
insulin administration failed to follow basic principles of infection control.
The big four causes that lead to these outbreaks are syringe reuse,
either directly or indirectly, inappropriate use of single-dose or
single-use vials, failure to use a septic technique.
A septic technique can be defined very broadly and
encompasses all of the big four.
But in this case, we're referring to contamination
of injection equipment from the nonsterile environment.
The fourth major cause is unsafe diabetes care.
Specifically, the assisted monitoring of blood glucose.
Outbreaks often involve more than one of these breaches.
[MUSIC]
>> 3 judges.
>> Show me the technique.
>> Contestants from around the country.
[MUSIC]
One great pride.
This seat on The Technique.
[MUSIC]
[APPLAUSE].
Welcome everyone.
I'm Rob Marino and welcome to The Technique.
After last season's record shattering finale, we're in for
a second stellar season on The Technique,
where contestants try to prove they've got the best injection safety and glucometer
care skills in their field to earn themselves the coveted McKnight trophy.
[MUSIC]
>> The McKnight trophy honors Evelyn McKnight Whose personal
experience motivated her to bring attention to and
advocate on behalf of safe injection practices.
Dr. McKnight was infected with Hepatitis C virus,
HCV while battling a reoccurrence of breast cancer in 2000.
In total 99 residents at the same oncology clinic became infected with HCV.
When their provider failed to follow safe injection practices.
For years, this was the largest known healthcare associated
outbreak of HCV in US history.
[MUSIC]
>> Let's not let that happen, again.
Judges, are we ready for our first contestants?
>> [MUSIC]
>> So, tell me Kim, what does it mean to you to be appearing on The Technique?
>> OMG!
I'm on television!
Okay.
Breathe, Kim, breathe.
>> [LAUGH] >> Okay.
[SOUND] Rob, it means everything to be on the technique.
My boyfriend and I drove in from Oklahoma to be here, and
I practiced my safe injection techniques on him the whole way in the car.
>> Wow, well if that isn't a dedicated boyfriend, I don't know what is.
So tell me, what's your specialty back in Oklahoma?
>> Well, to be honest.
I've been shadowing my mentors at the nursing home, and
I'm staying late at night post shift and learning the more unusual techniques.
And you know, getting my performance up to speed.
>> Well, let's see if Kim's night shifts have been paying off for her and
her boyfriend.
[MUSIC]
>> Let's pick out rising stars in the safe injection category.
>> Competence, energy, attitude, that is what I am looking for.
>> It looks like showmanship is really going to make a difference in today's
tryouts.
Gene, what are you looking for in our hopefuls?
>> Rob what we're really looking for today is safe injection practices, so
that's what I'm gonna make sure we're gonna focus on.
Now I'm not denying that energy and attitude aren't important,
but I'm looking for essential technical practices
that can make the difference between life and death.
>> Let's take a closer look at the judges criteria for our contestants here today.
>> CDC reminds healthcare personnel of the following practices that are critical for
resident safety.
Now, we will be looking for
strict adherence to these practices from our contestants today.
Never administer medications from the same syringe to more than one resident or
to the same resident at another time, even if the needle is changed or
you are injecting through an intervening link of IV tubing.
Needles and syringes are single use items.
Do not enter a medication vile, bag, or bottle with a used syringe or needle.
Never use medications packaged as single dose or
single use for more than one resident.
This includes ampoules, bags, and bottles of intravenous solutions.
Always, always use strict aseptic technique when preparing and
administering injections.
>> So there it is folks.
One needle, one syringe, one time use, and only one person.
>> So Kim from Oklahoma, what do you have in store for us today?
>> Hi Stefan, Minerva.
Well, today I am going to show you proper usage of a single use vial.
>> Let's bring out our residence for Kim.
They're beautiful.
>> She's carefully reading the order.
She sees the single dose vial.
She is doing great so far.
You can see she's really thinking through the steps before she performs.
Here she goes.
The hand hygiene looks good,
spending the appropriate amount of time with the hand sanitizer.
Product rubbing, now she's put on gloves, she's putting on the gloves next.
Yeah, here we go.
Now she's disinfecting the rubber septum with alcohol prior to piercing it.
Aseptic technique looks great.
She's preparing the clean needle and syringe.
That's appropriate entrance to the vial with the needle.
[MUSIC]
Okay she's administering the injection, very nice.
Looks like the judges agree too.
>> She smiling, she knows she nailed it.
>> And she's disposing of the injection equipment properly.
>> What is she doing?
>> [INAUDIBLE] >> Wait a minute,
she is keeping the syringe and setting up the same single dose vial?
Oh, no, manasteris.
[SOUND] >> Kim, I'm sorry, but
some rookie mistakes here.
Clearly, you intended on using the same syringe on the next resident and
you were intending on using the medicine from the same vial.
>> [COUGH] >> Yeah,
I'm gonna have to agree with Stephan on this one, I, unacceptable.
Huh, one needle, one syringe, only one time.
You do not have the technique.
>> Kim, you've got some great techniques down, but
you still have a lot of work ahead of you.
Now you must remember that after you use them, the syringe and
the needle are both contaminated and must be discarded.
You always use a new syringe and needle for each resident.
>> What a disappointing turn of events for Kim from Oklahoma.
But the road to the winner's circle is just beginning.
[MUSIC]
Cut, cut, cut, singing auditions are down the hall.
[MUSIC]
>> Perhaps I spoke too soon.
But I've got a great feeling about this next contestant.
Jennifer was actually at the auditions last year but
tripped and sprained her wrist on the way up to the stage.
>> [NOISE] >> Ever since that fateful moment when
I broke my wrist, I new that proper aseptic technique was going to
be the area I really scored well in.
Spending the correct amount of time washing and
then gloving properly, I have this competition in the bag.
[APPLAUSE] My name is Jennifer Abrams, and
I'm from Spring Lake Nursing Home in Charleston, South Carolina.
>> Jennifer, let's see what you've got.
[MUSIC]
Hand hygiene looks good, spending the appropriate amount of hand-rubbing.
Donning the gloves.
And her aseptic technique looks good.
[MUSIC]
She's now preparing the syringe and the needle.
[MUSIC]
>> I'm not sure if she's got the capability to use vial.
We've set that up for her, it's tricky trap.
>> Oh, the judges threw her a curve ball.
It's a multi dose vial, let's see how she handles it.
>> She didn't label it, it's too late.
>> Oh Jennifer, she just set that vile down without labeling it.
That's going to cost her.
Is it enough of an error though to keep her from advancing to round two?
>> Tell me, Jennifer, what type of vial you're using and
what should you have done after opening and assessing it the first time?
>> Oh Stefan, it's a multi-dose vial and
I should have used a 28 day beyond use date I can't
believe I forgot to do something so simple.
>> To be perfectly honest, you should have noticed that first thing.
But you did dispose of the injection equipment properly,
and the gloves, which shows you're no spring chicken to this in-house.
Stephan, you and your chickens can go back to Britian.
>> Whoa.
>> [LAUGH] >> You're right,
she had very good hand hygiene after disposing of the equipment.
I say, bravo Jennifer, love it.
>> But forgetting to label that vial is not something to overlook.
I mean it's important that she labels each multi use vial with a new expiration date.
She made an error right off the bat.
>> For anyone not familiar with labeling multi use vials,
the expiration date is 28 days from the date it was opened and
first accessed >> Unless a shorter time is specified by
the manufacturer.
It's kinda like my self-tanning lotion.
>> So, what do we think gang?
Is her failure to label the vile properly?
Enough to cost her advancement into round two?
>> I say, she passes.
Girfriend nursed herself back to health after a broken wrist,
and she's brought her A game.
Even if there was a slight oversight, which she recognized.
>> I hear what you're saying but an error is an error.
I have to say no.
>> True Gene, but I have to go with Minerva on this one.
My gut says advance.
Congratulations Jennifer, you're going on to round two.
>> [APPLAUSE] >> What do the judges have in
store for them next?
Find out tomorrow night as we continue with round one of The Technique.
>> [APPLAUSE]
>> [MUSIC].
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