Slide 1

In this presentation, we will be discussing issues related to infection prevention for HIV/AIDS healthcare providers as well as other caregivers in limited-resource settings.

Slide 2

The objectives of this presentation are to:

• Discuss the risk of acquiring HIV and other diseases such as hepatitis B and hepatitis C from needle stick injuries.
• Describe standard precaution strategies including: 
  • hand hygiene,
  • use of personal protective equipment or PPEs, and
  • handling and processing of instruments and other items.
• Describe methods for disposing of clinical waste in the hospital, the clinic or at home, and
• Discuss post-exposure care. What do you do after you have been exposed?
• Describe other ways to make the workplace safer for both staff and the patient, and
• Recommend infection prevention practices for taking care of the patient at home.

For the purpose of this presentation, I will refer to individuals seeking services or care as patients; however, many of these individuals may be clients seeking reproductive health services such as family planning or prenatal care. These infection prevention recommendations apply to both patients and clients equally.

Slide 3

What is the most common or frequent risk healthcare workers encounter while caring for patients in any setting?

Slide 4

Direct contact with blood and other body fluids is the most frequent and greatest risk healthcare workers encounter when taking care of patients.

Slide 5

Contact can occur when performing an examination... 

Slide 6

...or when processing instruments.

Slide 7

It can occur during a surgical procedure...

Slide 8

...or cleaning up after an operation.

Slide 9

It can occur when disposing of waste...

Slide 10

...or processing patient care items. 

This presentation will discuss ways that standard precautions can be used to prevent the spread of disease or infection from blood and other body fluids to the healthcare worker or anyone caring for the patient in any setting. 

Slide 11

Healthcare workers come in contact with many biological hazards while they work. Exposure or contact with these organisms can make you sick. While bacterial, fungal and parasitic infections can usually be cured, some infections caused by viruses such as HIV, hepatitis B and hepatitis C cannot.

In the past, we tried to prevent our patients from acquiring an infection after surgery or from a procedure while in the hospital or clinic. Now we need to teach healthcare workers how to protect themselves as well. Because we do not know by looking at people whether or not they are infected with one of these viruses, and because often we cannot test and wait for the results before treating, we need to protect ourselves at all times with every patient. Even if testing is done, it may be falsely negative if the person has been infected within 8-12 weeks.

Slide 12

How risky is working in the healthcare setting? Do you know how many of your friends or colleagues have been stuck by a needle or cut with a sharp during surgery? Do you know how many have been infected with HIV or hepatitis B virus or hepatitis C virus from working in healthcare? Maybe one? Maybe ten? How many of you do not know? Most people do not make that information public.

Do you know what the real risk is of contracting HIV after a needle stick from an HIV-positive patient?

Slide 13

The risk of acquiring HIV after being stuck with a needle from an HIV-positive patient is 0.4%. That is 4 in 1000. This is not as big a risk as many people might guess, but in areas where there is a high prevalence of HIV and poor infection prevention practices, it should be remembered that the risk of exposure is greater.

What is the risk of acquiring hepatitis B after being stuck with a needle from a hepatitis B-positive patient?

Slide 14

It is a much greater risk than most healthcare workers think. It is 27 to 37 percent, which is significantly greater than for HIV. This type of needle stick is particularly risky because chances are high that you will become positive after such an exposure if you are susceptible. 

Slide 15

With hepatitis B virus, as little as 10 to the minus 8 ml of hepatitis B-infected blood can transmit hepatitis B to a susceptible host. The risk is high and yet some people working in this area have never had the hepatitis B vaccine which has been available since 1982.

Even in the United States, the Centers for Disease Control and Prevention estimate that the number of chronically hepatitis B-positive people is one to one and a quarter million, with an estimated 200,000 to 300,000 new cases annually. Each year, approximately 10,000 healthcare providers acquire hepatitis. Of these, between 150 and 250 die of complications from this disease.

And now we need to be concerned about hepatitis C virus as well.

Slide 16

Globally, an estimated 170 million persons are chronically infected with hepatitis C and 3 to 4 million persons are newly infected each year. Hepatitis C virus or HCV is spread primarily by direct contact with blood or body fluids.

The risk of acquiring HCV after being stuck by a needle from a hepatitis C-positive patient is between 3 and 10 percent. The transmission of this infection is similar to hepatitis B, but hepatitis C is more likely to lead to cirrhosis, liver cancer and death. Currently, there is no vaccine for hepatitis C.

So, why do healthcare workers not use standard precautions with each and every patient? Maybe they do not believe the risk is real. 

Some areas of healthcare are more risky than others because there is more of a chance of coming in direct contact with blood and body fluids. Labor and delivery and the emergency room are two areas where people are frequently exposed to large quantities of blood and body fluids. We only need to look at healthcare workers’ glasses, their scrubs or their shoes for evidence of splashes or spills of blood or body fluids. The risk is very real.

Slide 17

Each year 800,000 needle stick injuries are reported by healthcare workers in the United States. However, when asked, most healthcare workers say they do not report all needle stick or other sharps injuries. Therefore, most researchers feel that this number is under reported. 

According to a study conducted in Tanzania, of 118 doctors and medical assistants interviewed, 1% had stuck themselves in the preceding week as had 9.2% of 623 nurses. In the preceding month, 22% of nurses working in operating theatres had stuck themselves and 25% of 50 laboratory technicians interviewed had been stuck. These healthcare workers are at risk. 

How many of you have been stuck by a needle at least once while working or have had a friend or colleague who has been stuck? 

Slide 18 

Many needle stick injuries occur at the bedside while giving an injection, drawing blood, during IV insertion or removal and many times while disposing of sharps. The needle sticks and sharps injuries that occur in the operating room are usually by a suture needle or by a scalpel.

Slide 19

Needle stick injuries are not the only way that healthcare workers can become exposed to blood and body fluids. 

You can have splashes to mucous membranes such as your eyes and mouth; or you can have splashes to intact skin such as your face or arms. HIV risk from mucocutaneous exposure is approximately 0.09%. Risk from skin exposure is poorly defined but thought to be significantly lower. 

You can also have exposure to nonintact skin. Most healthcare workers wash their hands so often that their hands become chapped and cracked. There can be holes in the gloves that you only discover when you remove them and find blood on your hands. 

These are all ways that you can be exposed to infections. Anytime the mucous membranes or nonintact skin come into direct contact with blood or body fluids is considered an exposure.

Slide 20

As of the last count in December 2001, there were 40 million people in the world living with HIV/AIDS. Do you know what percentage of these people live in your region or visit your clinics? 

Many of these people have tuberculosis as well, which is also a risk to healthcare workers. Tuberculosis or TB is the leading cause of death among those with HIV/AIDS throughout the world. 

Because we really do not know who is HIV-positive or who has tuberculosis, the best way to decrease the risk of exposure is to protect ourselves at all times by taking precautions each time we treat or care for a patient. 

Slide 21

For these precautions to be useful though, we need to remember:

• Most infectious agents are transmitted by contact with body substances such as blood, vaginal secretions, semen, feces, sputum, anything that is wet or moist, and
• Most infections are communicable for some period of time before symptoms are present or even when symptoms are absent.
• What can you do to protect yourself when you are working with patients?

Slide 22

...Use standard precautions.

You need to use standard precautions with each and every patient you take care of. 

Standard precautions (which used to be called barrier precautions or blood and body fluid precautions) were developed to reduce the risk of the transmission of microorganisms from both known and unknown sources of infection when caring for patients in any healthcare setting as well as at home.

Standard precautions, therefore, do apply to all blood and body secretions, excretions (except sweat), non-intact skin and mucous membranes for every person. Placing a physical, mechanical or a chemical barrier between you and the microorganisms can prevent the acquisition of disease.

In addition, transmission-based precautions are necessary for hospitalized patients who are known or highly suspected of being infected or colonized with pathogens transmitted by: 

• air (such as Zoster, tuberculosis, measles and chicken pox),
• droplet (such as meningitis, pertussis, and H. influenza), and 
• contact (such as Rotovirus, herpes, and hepatitis A and hepatitis E). 

These specific precautions are described in the document "Transmission-Based Precautions" on the Resources page.

Slide 23

Standard precautions include:

Washing your hands before and after patient care, before and after using gloves, and between patient contact

• Using personal protective equipment such as:
  • wearing gloves,
  • wearing goggles and a mask or face shield to protect eyes, nose and mouth, and
• Handling and processing instruments safely

Slide 24

Hand hygiene significantly reduces the number of disease-causing microorganisms on your hands and can minimize cross-contamination, such as from healthcare worker to patient. The indications for hand hygiene are well known, but guidelines for best practices continue to evolve. For example, the choice of plain or antiseptic soap, or use of an alcohol-based handrub, will depend on the degree of risk with patient contact such as routine medical procedure versus surgery. 

Depending on the circumstances, hand hygiene can be accomplished by:

• routine handwashing with soap and water,
• handwashing with an antiseptic agent and water, also called hand antisepsis, 
• using an antiseptic handrub with a waterless alcohol-based agent, and 
• performing a surgical scrub using an antiseptic agent.

Slide 25

The purpose of handwashing is to remove soil and debris from the skin and reduce the number of transient microorganisms. Handwashing with plain soap and water is as effective in cleaning hands and removing transient microorganisms as washing with antimicrobial soaps, and plain soap causes much less skin irritation.

Handwashing should be done:

• before and after patient care,
• before putting on gloves, and
• after taking off gloves. 

Hands should be washed after removing gloves because the gloves may have tiny holes or tears, and bacteria can rapidly multiply on gloved hands due to the moist, warm environment within the glove.

Most healthcare workers wash their hands 20 times or more each day. Therefore, you need to protect your hands from dryness. You can do this by using a petroleum-free cream or lotion. 

Organisms can hide in artificial nails and underneath nail wraps; so, it is important that nurses and physicians not use them while providing patient care. 

Research has shown that the area around the base of the nails contains the highest microbial count on the hand. In addition, several recent studies have shown that long nails may serve as a reservoir for gram-negative bacteria, yeast and other pathogens. So, it is recommended that nails be kept moderately short--not extend more than 3mm beyond the fingertip. 

Although there is no restriction on wearing nail polish, it is suggested that surgical team members and those staff working in specialty areas who use nail polish wear freshly applied, clear nail polish. Chipped nail polish supports the growth of larger numbers of organisms on fingernails compared to freshly polished or natural nails. Also, dark-colored nail polish may prevent dirt and debris under fingernails from being seen and removed.

Slide 26

The steps for routine handwashing are:

1. Thoroughly wet your hands.
2. Apply plain soap. An antiseptic agent is not necessary.
3. Vigorously rub together all areas of hands and fingers including the thumbs for at least 10-15 seconds, paying close attention to areas under fingernails and between fingers.
4. Rinse hands thoroughly using clean running water from a tap or bucket, and
5. Dry hands with a paper towel or a clean, dry towel, if available. If these are not available, air dry hands.
6. If you are lucky enough to have paper towels, use the paper towel to turn off the water to avoid recontaminating your hands.

Finally, not only can frequent handwashing reduce the spread of infection from the hands of healthcare workers, but from everyone else’s as well! For example, it is estimated that persuading people, especially young children, to wash their hands with soap and clean water after going to the toilet, handling or changing a dirty baby diaper, or doing other tasks that potentially contaminate hands (for example, cleaning vegetables or fresh meat or fish) can reduce diarrheal diseases by 45%--saving the lives of a million children a year. Moreover, in a large study, the US military found that when troops washed their hands five or more times daily, sniffles, coughs and common "colds" fell by 43%.

Slide 27

Because microorganisms grow and multiply in moisture and in standing water:

• When bar soap is used, provide small bars and soap racks that drain.
• Avoid dipping hands into basins containing standing water. Even with the addition of an antiseptic agent, such as Dettol or Savlon, microorganisms can survive and will multiply in these solutions.
• Do not add soap to a partially empty liquid soap dispenser. This practice of "topping off" dispensers may lead to bacterial contamination of the soap. The dispenser should be thoroughly washed before refilling. 
• When no running water is available, use a bucket with a tap that can be turned off while lathering hands and turned on again for rinsing; or use a bucket and a pitcher.

Slide 28

Hand antisepsis is similar to plain handwashing except that it involves use of an antimicrobial agent instead of plain soap or detergent. The goal of hand antisepsis is to remove soil and debris as well as to reduce both transient and resident flora. The technique for hand antisepsis is similar to that for plain handwashing. It consists of washing hands with water and soap or detergent containing an antiseptic agent such as chlorhexidine, iodophor or triclosan, instead of plain soap.

Hand antisepsis should be done:

• Before performing an invasive procedure, such as placement of an intravascular device,
• Before examining or caring for immunocompromised patients, such as patients with advanced AIDS, premature infants and elderly people, and
• On leaving the room of patients with diseases that are spread via direct contact, such as hepatitis A or hepatitis E, or on leaving the room of patients who have drug-resistant infections, such as methicillin-resistant staph aureus or vancomycin-resistant enterococci.

Slide 29

A waterless, alcohol-based handrub is a fast acting antiseptic that does not require use of water to remove transient flora, reduce resident organisms and protect the skin. These handrubs contain 60-90% alcohol, an emollient, and sometimes even an antiseptic that has residual action. 

Healthcare workers need to wash their hands very often. So, this waterless alcohol-based solution is very effective for use between patients in areas where soap and water is not readily available, such as in ambulances, out in the field, on patient rounds, or before mixing or distributing medications. The emollients prevent drying and cracking, so this type of handrub is also very effective in areas like intensive care units where nurses must wash their hands many times each day. Most importantly, because using a waterless alcohol-based handrub is easy and convenient, healthcare workers will use it more often.

To make the alcohol / glycerin solution, combine 100 cc alcohol with 2 cc glycerin. Then, for each application, use 3-5 cc of solution, approximately 1 teaspoon, and rub the solution vigorously onto the hands until dry.

If you cannot find glycerin in a pharmacy, you can usually find it in stores where cosmetics are found because glycerin is often used to soften skin.

Alcohol-based handrubs do not remove soil or organic matter. So, if hands are visibly soiled or contaminated with blood or body fluids, handwashing with soap and water should be done first. In addition, to reduce the "build-up" of emollients such as glycerin on the hands after repeated use of alcohol-based handrubs, washing hands with soap and water after every 5-10 applications is recommended. 

Slide 30

The purpose of surgical handscrub is to remove soil, debris, and transient microorganisms, and to reduce resident flora for the duration of surgery. The goal is to prevent wound contamination by microorganisms from the hands and arms of the surgeon and assistants.

In the past, preoperative scrubbing protocols required at least 10 minutes of vigorous scrubbing with a brush or sponge using soap containing an antiseptic agent such as chlorhexidine or an iodophor. This practice of scrubbing for 10 minutes, however, has been shown to damage the skin and can result in increased shedding of bacteria from the hands. 

Now, the steps for surgical scrub include:

1. Remove rings, watches and bracelets; do not wear any jewelry at all.
2. Thoroughly wash hands and forearms to the elbow with soap and water.
3. Clean fingernails with a stick.
4. Rinse with tap water.
5. Apply an antiseptic agent.
6. Vigorously wash all surfaces of hands, fingers and forearms for at least 2 minutes. If a brush is used, it should be clean and soft. If a soft brush is not available, use gauze or a sponge.
7. Rinse hands and arms thoroughly, holding the hands higher than the elbows. If available, use cooled, filtered, boiled water.
8. Keep hands up and away from the body; do not touch any surface or article. 
9. Dry hands with a clean, dry towel or air dry, and
10. Put on sterile or high-level disinfected surgical gloves.

Slide 31

If you are in an area where antiseptic soap is not available, the steps for surgical scrub are:

1. Wash hands and arms with soap or detergent and water.
2. Clean fingernails thoroughly.
3. Scrub with a soft brush or sponge and rinse.
4. Dry hands thoroughly.
5. Apply one teaspoon (5cc) of alcohol / glycerin handrub to the palm, then rub over your hands and forearms until dry.
6. Repeat this handrub two more times.

Slide 32

To protect skin, mucous membranes, and clothing when splashes or spills of blood and body fluids are likely, you need to use personal protective equipment. Again, this recommendation should be followed with every patient you take care of. 

• Use gloves when you are going to touch anything wet or moist;
• Use a mask, goggles, or face shield when you anticipate splashing (such as when you are washing instruments, starting an IV or during a delivery);
• Use a gown or apron to protect your clothing, and therefore the skin underneath, whenever you are going to be in contact with large amounts of blood or body fluid; and
• Wear closed shoes.

Everything you need to make personal protective equipment can be purchased or made from materials that are locally available. For example, the face shield in this picture can be made with an elastic band, a piece of foam and a piece of clear plastic. Plastic can be purchased in a bookstore, or a processed x-ray film can be used.

Slide 33

Gloves are necessary to protect your hands. There are different types of gloves for different jobs: 

• thick utility gloves for cleaning and washing instruments,
• latex, vinyl or nitral examination gloves for changing dressings, drawing blood, starting an IV, or performing pelvic exams, and
• latex or non-latex gloves for surgery.

Double gloving has been shown to reduce risks associated with sharps injuries due to the wipe-off effect of the latex glove. Many healthcare workers double glove for surgery. 

If you reprocess surgical gloves, double gloving is suggested because there is a greater chance that reprocessed gloves will have invisible holes or tears and the second glove will offer additional protection.

Slide 34

Masks, goggles and face shields protect you from splashes. If goggles are not available, you can purchase a pair of glasses with plain glass or plastic to protect the eyes from splashes, which is better than wearing nothing at all.

Aprons and gowns will protect you from large spills; for example, during a delivery or when you are washing instruments.

Slide 35

Do the sandals in this picture protect your feet? Obviously they do not, but many people take off their shoes and put on sandals to go into the operating room. Feet need protection from both sharps and splashes, so wear closed shoes.

Slide 36

Many immunizations are available to healthcare workers as well as to the public. Immunizations can protect you from acquiring a number of diseases, and it is important to take advantage of this opportunity for protection. Which of the immunizations above should every healthcare worker be required to get to prevent an infection from a blood or body fluid exposure? 

Slide 37

Correct, the Hepatitis B vaccine.

Slide 38

Another way that healthcare workers can protect themselves is to prevent injuries from sharps. When possible, limit the use of sharps and use oral antibiotics instead of injectables or IVs. You can also use a needleless or retractable injection system if it is available. For surgery, you can use blunt needles for suturing. 

Many injuries occur when disposing of sharps such as needles, scalpels, capillary tubes or biopsy glass. Use a system to dispose of the sharps immediately after use. A puncture-proof container, either cardboard or heavy plastic, should be available at the point of use.

Slide 39

Standard precautions recommend that when handling needles and sharps, healthcare workers should: 

• Discuss or agree on a plan for handling sharps before surgery begins;
• Use a safe or neutral zone for passing sharps;
• Know that even saying "pass" or "sharps" when passing sharps during surgery can prevent injuries. This is communicating effectively as a team.

Slide 40

Also, all healthcare workers should:

• Use a needle driver or holder--not your fingers--when suturing;
• Use blunt needles when available; and
• Never blind suture.

Slide 41

Prevent accidents by always removing blades with another instrument--not your fingers.

And, never use a scalpel blade without a handle.

Slide 42

Because needle stick accidents continue to be a problem in the clinic and the hospital, immediately after using a needle and syringe, place it into a puncture-proof container for disposal. 

If there is a possibility that someone else may come into contact with used needles and syringes, decontaminate them by flushing three times with a disinfectant before disposal (bleach is cheap). 

Do not bend, break or recap a needle before disposal. If, in some instances, it is absolutely necessary, recap the needle using the one-hand technique. 

Slide 43

After use, instruments and other items should be decontaminated by soaking them in a 0.5% bleach solution for 10 minutes. Decontamination will help protect the person who is cleaning the instruments. 

Then, physically wash the items until they are visibly clean. 

Finally, either sterilize or high-level disinfect the instruments. 

Slide 44

Other items you need to process are linens; either the scrubs from surgery or the sheets and towels from patient care. You want to handle them in a manner that prevents skin and mucous membrane exposure. When handling soiled linens, wear gloves, hold linens away from your body and do not shake them. Wash linens in hot, soapy water and dry. The procedures for handling linens are the same in either the hospital or at home.

Slide 45

No matter where you are disposing clinical waste, you want to put the waste and all other contaminated items into a leak-proof container and then either incinerate or bury the container. 

Slide 46

If you are taking care of patients or family members at home, remember that contaminated waste such as dressings or other items used by patients that have blood or body fluids can be buried or burned in an open pit or drum incinerator in the yard. 

Another item that needs proper disposal is the placenta. In many countries, the placenta is sent home from the hospital or midwives clinic with family members for burial. Regardless of where the baby is born, the placenta should be placed in a plastic bag or another leak-proof container and then incinerated or buried. If the family brings in a container, either place the plastic bag containing the placenta or the placenta directly into the container and cover it with a lid. The family should be instructed not to remove the placenta from the plastic bag or container before burial.

Slide 47

What do you do if you are exposed? If a splash or a spill occurs on the skin, wash immediately with soap and water. Do not use a caustic agent or bleach because that will irritate the skin and may increase your risk of exposure.

If you have a splash or a spill in the eyes, the nose or the mouth, or any mucous membrane contact, rinse with clean water for a minimum of 10 minutes.

If you are stuck by a needle or cut by an instrument, wash the area with soapy water, allow the wound to bleed freely and apply normal first aid. 

Slide 48

Exposure to blood, serum, semen, sputum, or vaginal secretions from an HIV-positive patient are considered high risk. The risk from exposure to body fluids or tissues other than blood such as amniotic fluid has not been clearly defined. The risk from fluids such as saliva, breastmilk and urine are considered low risk.

The level of risk also depends on the type of exposure.

For example, if you are drawing blood from an HIV-positive patient and you stick yourself with that needle, this would be considered the highest risk exposure. 

A mucous membrane splash or contact between nonintact skin with a high risk body fluid is considered less risky exposure. 

Contact between a high risk body fluid and intact skin is the least risky exposure.

Slide 49

If you do have an exposure, evaluation of the risk helps determine the need for post-exposure prophylaxis. 

First, evaluate the risk by determining the source of the fluid. Second, consider the type and severity of exposure. Consider whether it is percutaneous or needle stick, mucocutaneous, nonintact skin, or intact skin. Also, the severity of exposure; for example, quantity of blood and duration of contact. 

Finally, patients with more advanced HIV infection clinically, with lower CD4 cell counts or with higher viral loads, clinically are more infectious. 

If testing is available, healthcare workers should be tested for HIV after exposure as a baseline.

Slide 50

Most importantly, be aware that post-exposure prophylaxis has to be started within 1 to 2 hours after exposure. 

Decisions regarding which and how many antiretroviral agents to use are largely empiric.

Currently, the US Centers for Disease Control and Prevention recommends 2 to 3 drug combinations based on the level of risk and the possibility of drug resistance. 

For most HIV exposures, recommendations for HIV post-exposure prophylaxis include a basic 4-week regimen of two drugs, as listed on this slide.

For HIV exposures that pose an increased risk for transmission, an expanded regimen that includes the addition of a third drug from the protease inhibitor class of drugs is recommended. When the source virus is known or suspected to be resistant to one or more of the drugs considered for the post-exposure prophylaxis regimen, the selection of drugs to which the source person's virus is unlikely to be resistant is recommended. In this situation, consultation with an HIV expert is recommended.

The exposed healthcare worker should seek medical followup, and treatment should be continued for four weeks.

Slide 51

Throughout the world, there are two billion people with tuberculosis. There are eight million new cases of TB per year and two million deaths from TB. There are more than 40 million people living with HIV, most of these in sub-Saharan Africa. Many of them are also infected with TB. Tuberculosis is the leading cause of death related to HIV throughout the world and the tuberculosis epidemic has been made significantly worse by the HIV epidemic. 

To prevent the spread of TB in a hospital setting, patients with active TB should be placed in a private or single room with good ventilation and vented to the outside to lower the concentration of infectious particles in the air. Ideally, the room should also receive direct sunlight since the ultraviolet rays in sunlight kill the bacteria. When other people are present, the patient should wear a mask covering their nose and mouth until noninfectious. The patient should be instructed to always cover their mouth when coughing and to use sputum containers with lids. When healthcare workers and other visitors enter the room of a patient with TB, they should wear a mask covering their nose and mouth. Disposable surgical masks are acceptable. A single layer cloth or gauze mask will not protect the wearer from the infectious particles in the air.

Fortunately, once effective treatment is initiated, patients become noninfectious very quickly, within several days.

Slide 52

To make our workplace safer we can:

• identify risks and try to reduce them;
• use standard precautions with each and every patient we take care of;
• teach our patients it is okay to remind us to wash our hands and to use gloves if we forget; and
• actively role model the infection prevention practices we believe in. 

If the chiefs or senior staff (nurses and doctors) actively use personal protective equipment and actively support IP practices, then other healthcare workers will feel that it is the correct way to work and will actively copy them. For example, if healthcare workers see the chief of surgery wash his or her hands, then they will also wash their hands all the time -- not just when someone is looking.

Also patients coming into the hospital will see that the practices the healthcare workers use to protect themselves, protect the patient as well. 

Slide 53

How else can we make our workplace safer? 

We can get administrative support. Administration needs to make infection prevention a part of the healthcare worker’s performance evaluation. Administration also needs to make sure the necessary supplies are available.

Positive feedback from supervisors on individual behavior possibly with verbal praise or with other awards or incentives can help healthcare workers change their behavior.

Who do you think is responsible for providing the healthcare worker with personal protective equipment? Obviously administration--but if they cannot or will not, each person individually is responsible for his or her own safety. The next life you save may be your own.

Slide 54

Many times the safest place to care for the patient is at home. 

So, teach your patients and their families how to protect themselves while giving care at home.

Remember, any contact with blood and body fluids increases your risk of acquiring a disease. This is something you need to teach the family members.

Again, for infection prevention in the home, family members should use standard precautions:

• Wash your hands or use a waterless alcohol-based handrub.
• Use personal protective equipment when exposure to blood or body fluids (except sweat) is anticipated.
• Dishes and laundry should be washed in hot soapy water; nothing additional is necessary. 
• If the bed or bath linens have blood or body fluids on them, they should be handled and washed while wearing utility gloves. 
• Family members should not share toothbrushes or razors because these contain body fluids, and
• Teach patients and family members to wash their hands before and after giving care--just as we remind healthcare workers.

Slide 55

In summary:

• We can minimize and prevent exposure to infection by using standard precautions with every patient. 
• We must dispose of clinical waste properly.
• We should use post-exposure care when necessary and prophylaxis when available.
• We need to work together to make the workplace a safer place for both healthcare workers and patients.
• We need to teach patients and their families how to reduce their risk of exposure at home as well.

Each one of us can follow and support infection prevention practices while we are working. It decreases our risk and our patients’ risk of disease acquisition. We must continue to work together to protect each other. 

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