______________________________ Infection Control for New York Health Care Professionals ‒ 2024 Update
Personal Protective Equipment (PPE) Wearing gloves, gowns, masks, eye, and respiratory protec- tion can significantly reduce health risks for workers exposed to blood and other potentially infectious material. Detailed information, updated in 2023, on the selection and use of PPE in healthcare settings and the correct way to don and remove (doff) PPE is provided by the CDC and OSHA [22]: Adherence to PPE standards is multifaceted, with several components factoring into healthcare work- ers’ ability and desire to follow PPE guidelines. Areas of concern include workplace culture, availability of PPE, training, trust in PPE, and communication of hospital guidelines. Administrative teams are often responsible for ensuring the availability of PPE resources. Infection prevention teams that monitor and track hospital personal standard precaution use may increase compliance. Enhanced Barrier Precautions (EBP) Enhanced barrier precautions for skilled nursing facilities have recently been added to CDC guidelines and adopted by the New York State infection control training requirements that follow CDC directives [3]. New requirements include the use of gown and gloves during high-contact activities with residents to control transmission of MDRO. Eye protection may be indicated when spray and splash events are possible. According to the CDC [3]: The use of gown and gloves for high-contact resi- dent care activities is indicated, when Contact Pre- cautions do not otherwise apply, for nursing home residents with wounds and/or indwelling medical devices regardless of MDRO colonization as well as for residents with MDRO infection or colonization. Examples of high-contact resident care activities requiring gown and glove use for EBP include: • Dressing • Bathing/showering • Transferring • Providing hygiene • Changing linens • Changing briefs or assisting with toileting • Device care or use: Central line, urinary catheter, feed- ing tube, tracheostomy/ventilator • Wound care: Any skin opening requiring a dressing The CDC website provides further details on when to imple- ment EBP, PPE, and standard and contact precautions for residents infected or colonized with MDROs in nursing homes at https://www.cdc.gov/hai/containment/PPE-Nursing- Homes.html.
(CFU)/mL of one bacterial species. In addition to the aforementioned symptoms, patients with symp- tomatic UTI may generally present with chills, flank pain, altered mental status (if older than 65), hypo- tension, and evidence of systemic inflammatory response syndrome (SIRS). The most important risk factor for developing a catheter- associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should be used only for appro- priate indications and should be removed as soon as they are no longer needed. Exposure Control Plan and Recordkeeping The Occupational Safety and Health Administration provides their most recent information on basic requirements and forms that must be used to document injuries [17]: • Record all work-related needle-stick injuries and cuts from sharp objects that are contaminated with another person’s blood or other potentially infectious material (as defined by 29 CFR 1910.1030). You must enter the case on the OSHA 300 Log as an injury. To protect the employee’s privacy, you may not enter the employee’s name on the OSHA 300 Log – see the requirements for privacy cases in paragraphs 1904.29(b)(6) through 1904.29(b)(9). OSHA defines, “other potentially infec- tious material” as follows: ‒ Human bodily fluids, tissues, and organs, and other materials infected with the HIV or hepatitis B (HBV) virus, such as laboratory cultures or tis- sues from experimental animals. ELEMENT IV Selection and use of barriers and/or personal protective equip- ment for preventing patient and healthcare worker contact with potentially infectious material [1]. See Element IV Glossary. Content Outline I. Types of PPE/EBP barriers and criteria for selection. A. Gloves: 1. Types (sterile, non-sterile, utility); 2. Material (e.g., natural rubber latex, vinyl, nitrile). 3. Gloves are donned last B. Cover garb: 1. Types (gowns, aprons, laboratory coats); these are always put on first 2. Characteristics (fluid impervious, fluid resistant, permeable); C. Masks: 1. Donned after gown, followed by eyewear when required
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