party name, address, and telephone number

SECTION 2: Hazards identification

Hazardous classification (such as “flammable liquid”)

Signal word

Hazard Statement(s) Pictograms

2.3 Other hazards

For a mixture that contains an ingredient with unknown toxicity, percentage of how much of the mixture consists of ingredient(s) with unknown toxicity

2.1 Classification of the substance or mixture

identification Signal Word Hazard Statement(s) Pictograms Precautionary Statement(s) Description of any hazards not otherwise classified For a mixture that contains an ingredient with unknown toxicity, percentage of how much of the mixture consists of ingredient(s) with unknown toxicity 3 Composition/ For substances: information on Chemical name ingredients Common name and synonyms Chemical abstracts Impurities/stabilizing additives For mixtures: Same information as required for substances Chemical name and concentration (such as exact percentage) of all ingredients classified as a health hazard HC: 10 SECTION TOPIC DESCRIPTION 4 First-aid measures Necessary first-aid instructions by relevant routes of exposure (such as what to do in the event of inhalation, skin and eye contact, ingestion) Description of the most important symptoms or effects, and any symptoms that are acute or delayed Recommendations for immediate medical care and special treatment needed, when necessary 5 Firefighting Recommendations of suitable extinguishing equipment, and measures information about extinguishing equipment that is not appropriate for a particular situation Advice on specific hazards that develop from the chemical during the hazardous combustion products created when the chemical burns Recommendations on special protective equipment or precautions for firefighters 6 Accidental release Use of personal precautions (such as removal of ignition sources or measures providing sufficient ventilation) and protective equipment to prevent the contamination of skin, eyes, and clothing Emergency procedures, including instructions for evacuations, consulting experts when needed, and appropriate protective clothing Methods and materials used for containment (such as covering drains and capping procedures) Cleanup procedures (such as appropriate techniques for neutralization, decontamination, cleaning/vacuuming, adsorbent materials; and/or equipment required for containment/cleanup) 7 Handling and Precautions for safe handling, including recommendations for storage handling incompatible chemicals, minimizing the release of the chemical into the environment, and providing advice on general hygiene practices (such as stating that eating or drinking in work areas is prohibited) Recommendations on the conditions of safe storage and incompatibilities, as well as specific storage requirements (such as ventilation requirements) 8 Exposure Exposure limits as used or recommended by agency (OSHA, etc.), controls/personal chemical manufacturer, importer, or employer, where available protection Appropriate engineering controls Personal protective measures to prevent illness or injury from exposure to chemicals, such as personal protective equipment (PPE) HC: 11 SECTION TOPIC DESCRIPTION 9 Physical and Minimum required information (as applicable/available) consists chemical of: Appearance (physical state, color, etc.), Odor, Odor threshold, properties pH, Melting point/freezing point, Initial boiling point/range, Flash Point, Evaporation rate, Flammability (solid, gas), Upper/lower flammability/explosive limits, Vapor pressure/density, Relative density, Solubility(ies), Partition coefficient (n-octanol/water), Auto-ignition temperature, Decomposition temperature, and Viscosity 10 Stability and Reactivity: Description of the specific test data such as class or reactivity family of the chemicals Chemical Stability: Indication of whether the chemical is stable or unstable 11 Toxicological Information on the likely routes of exposure (such as inhalation, information skin, eye contact) Description of delayed, immediate, or chronic effects from short- term and long-term exposure Numerical measures of toxicity Description of symptoms Indication of whether the chemical is listed in the National Toxicology Program (NTP) Report on Carcinogens, or has been found to be a potential carcinogen by International Agency for Research on Cancer (IARC) Monographs or by OSHA 12 Ecological This section provides information to evaluate the environmental information impact of the chemical (non-mandatory) 13 Disposal This section provides guidance on proper disposal practices, considerations recycling, or reclamation of the chemical(s) or its container, and (non-mandatory) safe handling practices (refer to Section 8 of the SDS for information on Exposure Controls/Personal Protection) 14 Transport This section provides guidance on classification information for information shipping and transporting of hazardous chemical(s) by road, air, (non-mandatory) rail, or sea 15 Regulatory This section identifies the safety, health, and environmental information regulations specific for the product that is not indicated anywhere (non-mandatory) else on the SDS 16 Other information This section indicates when the SDS was prepared or when the last known revision was made HC: 12 DEALING WITH HAZARDOUS SPILLS Your facility will have specific clean-up policies for various types of hazardous spills. Please consult with your supervisor in the event you encounter a hazardous spill in an area in which you are working. In general, you should respond to a hazardous spill by: • Protecting your safety and the safety of others • Isolating the scene and denying entry to it • Notifying the individual or department responsible for cleaning up hazardous spills HC: 13 CONCLUSION Hazardous chemical communication is a valuable way to ensure everyone benefits from the same safety warnings. But it can protect you only if you: 1. Read labels and SDS 2. Know where to find information about the chemicals you work with 3. Follow warnings and instructions 4. Use and store chemicals safely 5. Use the correct protective clothing and equipment when handling hazardous substances 6. Learn emergency procedures in the event of a spill or exposure 7. Practice sensible, safe work habits REFERENCES: • Hazard Communication Standard: Labels and Pictograms. United States Department of Labor, Occupational Safety and Health Administration. Available at: https://www.osha.gov/Publications/OSHA3636.pdf. Accessed October 13, 2016. • Hazard Communication Standard: Safety Data Sheets. United States Department of Labor, Occupational Safety and Health Administration. Available at: https://www.osha.gov/Publications/OSHA3514.pdf. Accessed October 13, 2016. • Hazard Communication. United States Department of Labor, Occupational Safety and Health Administration. Available at: https://www.osha.gov/dsg/hazcom/index.html. Accessed October 13, 2016. HI IPAA A H Healt th Ins suran nce Po ortab bility and Acc count tabili ity Ac ct HIPAA . ..................... ..................... ...................... ..................... ..................... ... HI: 1 1. Introduction ... ....................... ....................... ....................... ....................... HI: 1 2. Purpose ......... ....................... ....................... ....................... ....................... HI: 1 3. Overall Goal .. ....................... ....................... ....................... ....................... HI: 1 4. Who Must Com mply With HIP PAA? ............. ....................... ....................... HI: 2 5. What is Protec cted Health Inf formation (PHI I)? ................... ....................... HI: 3 6. How Should P PHI Be Used an nd Disclosed? ....................... ....................... HI: 4 7. HIPAA Privac cy and Security y Rules ........... ....................... ....................... HI: 5 8. How PHI Can Be Compromi ised ................ ....................... ....................... HI: 6 9. PHI Access an nd Disclosure .. ....................... ....................... ....................... HI: 7 10 0. HIPAA Viola ations .............. ....................... ....................... ....................... HI: 8 11 . Penalties for HIPAA Violat tions ............... ....................... ....................... HI: 9 12 . Recommenda ations for Care egivers ............ ....................... ....................... HI: 10 13 . HITECH Act t Regarding El ectronic Health h Records ....... ....................... HI: 11 14 4. Conclusion .. ....................... ....................... ....................... ....................... HI: 12 © Copyright t Clinical Assessmen A nts by Prop phecy, a Di ivision of A Advanced Practice St trategies HI: 1 H IPAA: H Health I nsuran ce Port tability an nd Acco ountabil lity Act INTRO DUCTION N Healthcar re workers an nd organizatio ons rely heavi ily on the sha aring of patien nt informatio n. As the indu ustry continues s to move tow ward electron ic sharing of patient recor rds, protectin ng the privacy y of health informatio on becomes m more of a cha allenge. The Healt th Insurance P Portability an d Accountabi ility Act of 19 996 (HIPAA), P Public Law 10 04-191, was enacted in n 1996 to add dress these co oncerns. HIPAA est tablishes stan ndards for the e fast and acc curate exchan nge of health information d data, while maintaini ng the securi ty of that info ormation. PURPO OSE/OVER RALL GOA AL This modu ule outlines w what you as a healthcare w worker need t to know abou ut Protected H Health Informati on (PHI) and HIPAA rules a and regulatio ns concerning g patient priv vacy and the c confidentialit ty of health inf formation. The goal o of this modul e is to provid e the informa ation you nee ed to comply with HIPAA p privacy and security r ules at all tim mes. COURS SE OBJECT TIVES After com mpleting this m module, the le earner should d be able to: 1. D escribe the im mportance of f complying w with HIPAA ru les and regul ation 2. D efine Protect ted Health Inf formation (PH HI) 3. D escribe how PHI can beco me comprom mised 4. Ex xplain what t o do in the ev vent of a HIPA AA violation 5. D escribe the p penalties for H HIPAA violatio ons HI: 2 WHO M MUST CO OMPLY W WITH HIPA AA? HIPAA’s m main goal is to o assure that a person’s he ealth informa ation is prope rly protected d – while still allowing the t flow of he ealth informa tion needed t to provide hig gh-quality he ealthcare and to protect th he public's h ealth and we ll-being. According g to HIPAA, al l “Covered En ntities” must comply with privacy and s security rules s. “Covered Entities” incl ude: 1. H ealthcare pro oviders (inclu ding doctors, , nurses, hosp pitals, dentist ts, nursing ho mes, and p harmacies). U Under HIPAA, a healthcare e provider is d defined as: o Any perso n or organiza tion that furn nishes, bills, o or is paid for h healthcare se ervices in the normal co urse of busin ess, and tran smits and sto ores that heal lthcare inform mation o A person o or organizatio on that engag es a third par rty to process s, transmit, a nd store claim ms 2. H ealth plans (i nsurance com mpanies) 3. H ealthcare cle aringhouses, which are en ntities that pr rocess certain n information , such as: o Billing serv vices o Repricing c companies o Communit ty health man nagement info ormation syst tems As a healt thcare worke r, you are par rt of the “hea althcare provi ider” network k and therefo ore are requir red comply with w HIPAA rul es and regula ations regard ing Protected d Health Infor rmation (PHI) ). HI: 3 WHAT IS PROTE ECTED HE EALTH IN FORMAT TION (PHI I)? Protected d Health Infor rmation (PHI) is: • In ndividually ide entifiable hea alth informati ion • In nformation th hat is linked to o a patient PHI relate es to: • A person’s pas st, present, or r future physi ical or menta l health or co ondition • Th he provision o of healthcare e to a person • Th he past, prese ent, or future e payment for r the provisio on of healthca are to the per rson Individual lly identifiable e health infor rmation is eit her: • H ealth informa ation that spe ecifically iden ntifies a perso on, or • In nformation th hat could reas sonably be ex xpected to ide entify a perso on, even if tha at person is n not n amed An examp ple of Protect ted Health In formation (P PHI): Mary Smi th is the only y 50-year-old patient with a diagnosis o f lung cancer r at XYZ Hospi ital. The follow wing stateme nt DOES NOT T provide indi vidually ident tifiable health h information n about Mary y Smith and d is therefore NOT PHI: • Th here are pres sently 7 perso ons of all ages s with a diagn nosis of lung c cancer at XYZ Z Hospital. The follow wing stateme nt DOES prov vide individua ally identifiab le health info ormation: • Th here is a 50-y year-old wom man with lung cancer at XYZ Z Hospital. Though th he second sta atement does s not mention n Mary Smith by name, it is s PHI because e Mary Smith h is the only person p who fi ts the descrip ption. Many diff ferent types o of information n can identify y an individua al's PHI under r HIPAA, inclu uding but not limited to o: • Pa atient’s name e • Pa atient’s addre ess • D ates directly related to a person, p such a as birth date, , admission d ate, discharg e date, death h date • Te elephone num mber, fax num mber, email a address • So ocial security number, me dical record n number, acco ount number • Th he individual' 's e-mail, URL L, or IP addres ss • H ealth plan be eneficiary num mber (insuran nce number) • C ertificate/lice ense number • V ehicle identif fier and serial l number, inc luding license e plate numb ber • B iometric iden ntifier, includi ng fingerprin nts and voice prints • Fu ull-face photo ographs and a any comparab ble images • A ny other uniq que identifyin ng number, ch haracteristic, or code HI: 4 HOW S SHOULD PHI BE US SED AND D DISCLOS SED? HIPAA pro otects the pri vacy of Perso onal Health In nformation (P PHI). Here are e some import tant facts to keep in mind: • A s a healthcar e worker, if y you are involv ved in the gat hering, storin ng, and transm mission of pa tient in nformation, y ou MUST com mply with HIP PAA. • Fa ailure to follo ow HIPAA reg ulations could d result in fin nes for you an nd/or your em mployer. • H owever, PHI can be used a and disclosed d without a sig gned or verba al authorizati on from the p atient when it i is a necessa ary part of tre eatment, paym ment, or hea lthcare opera ations. HIPAA allo ows the use o or disclosure o of PHI for the e following re easons: 1. Fo or treatment 2. Fo or payment 3. Fo or healthcare e operations 4. W When authoriz zed by the ind dividual 5. W When required d by law About the e Minimum N Necessary Sta andard Rule The Minim mum Necessa ary Standard Rule states th hat only the in nformation n eeded to get t the job done e should be e provided. • H ealthcare org ganizations M MUST obtain p permission or r authorizatio on from a pati ient for the p urpose of ma arketing, adve ertising, and o other purpose es. • H ealthcare org ganizations m must establish written priva acy policies a nd procedure es regarding p rotected hea lth informatio on. • C aregivers sho ould refer to t their facility’s health inform mation policie es and proced dures regardi ing th he use and dis sclosure of PH HI. The Minim mum Necessa ary Standard Rule does NO OT apply to th he following: 1. D isclosures to or requests b by a healthca re provider fo or treatment purposes (su uch as co ommunicatio n hand-offs) 2. D isclosures to the patient 3. U ses or disclos sures made w with a patient’ ’s authorizati on 4. U ses or disclos sures required d for complia ance with HIP AA Rules 5. D isclosures to the U.S. Depa artment of H ealth and Hu man Services s when disclo sure of in nformation is required und der HIPAA for r enforcemen t purposes 6. U ses or disclos sures that are e required by other laws HI: 5 HIPAA PRIVACY Y AND SE CURITY R RULES The Priva cy Rule Under HIP PAA, the Priva acy Rule prot ects the priva acy of all Prot tected Health h Information (PHI), which is individual lly identifiable e health infor rmation that is gathered, s stored, or tra nsmitted on paper, orally, , or by electro onic or any ot ther media. It is impor rtant to know w that the HIP PAA Privacy R ule requirem ents: • A pply to most healthcare p roviders • Se et a federal st tandard for p protecting ind dividually iden ntifiable healt th informatio on across all m mediums (elec ctronic, paper r, and oral) • Li imit how Cov ered Entities may use and disclose indi vidually ident tifiable health h information n they re eceive or crea ate • G ive individua ls rights with respect to th heir PHI, inclu uding: o The rig ght to examin ne and obtain n a copy of inf formation in t their medical l records o The rig ght to ask Cov vered Entities s to amend th heir medical r record if infor rmation is inaccu urate or incom mplete • Im mpose admin istrative requ uirements for r Covered Ent tities; and est ablish civil pe enalties Under the e HIPAA Priva acy Rule: • A ll patients MU UST receive a healthcare o organization’s s Notice of Pr rivacy Practice es. • Pa atients may g give a verbal authorization a n to provide P PHI to family m members and d friends. • Pa atients are no otified of thei ir rights to co omplain about t an organiza tion’s compli iance with the e P rivacy Rule. • Pa atients have t the right to a ccess and am mend their ow wn Personal H Health Inform ation. The Secur rity Rule The Secur rity Rule estab blishes nation nal standards s to protect ce ertain health information that is held o or transferre ed in electron nic form. The Secur rity Rule requ uires appropri iate safeguard ds to ensure t the confident tiality, integri ity, and secur rity of electronic c Protected H ealth Informa ation (PHI). The U.S. O Office of Civil Rights, in con njunction wit h the federal Department of Justice, is responsible f for enforcing this rule and d imposing cri minal penalti ies of impriso onment and f ines for HIPA AA violations involving PHI. HI: 6 HOW P PHI CAN B BE COMP PROMISE D In order t o understand d how a careg giver can safe guard Protec cted Health In nformation (P PHI), it is impo ortant to unders stand how PH I can be com promised. Here are w ways in which h PHI could b e compromis sed: • Fa ace-to-face co onversations • Te elephone or dictated d conv versations • O On unprotecte ed computer h hard drives o r on copy ma achines • V ia fax transm issions • Th hrough mobi le devices, lap ptops, flash d drives, CDs • V ia cell phones s or PDAs (pe ersonal digital l assistants th hat function a as electronic o organizers) • Th hrough email l, text messag ges, or social media posts • By y disposing P HI in the tras h • H aving unsecu ured PHI (no d data encryptio on, unsecured d networks, u unlocked file cabinets) • Th hrough inapp propriate acce ess, such as a caregiver acc cessing the P HI of a patien nt they are no ot ca aring for An examp ple of how Pr rotected Hea lth Informati on (PHI) can be comprom mised: A caregive er is in a hallw way talking on n a cell phone e about a pat tient, and som meone passin g by overhea rs the conve ersation. This is a violation of HIPAA rul es. Conversat tions of this n nature should d be in a priva ate location w where confide entiality of PH HI cannot be comprom mised. As a he ealthcare wor rker, you are responsible f for the privacy y and security y of patients’ health inf formation. HI: 7 PHI AC CCESS AN D DISCLO OSURE Under HIP PAA, patients s have certain n rights regard ding their Pro otected Healt h Information n (PHI). • Pa atients have t the right to re equest, inspe ect, and receiv ve a copy of t their own PH I, including e lectronic reco ords. • A response to such a reque st must be m made within 30 0 days. An ex xception of th his would be ps sychotherapy y notes and in nformation th hat has been g gathered in a anticipation o of civil, crimin al, or ad dministrative e action. • Pa atients also h have the right t to amend th heir Protected d Health Infor rmation. An o organization c can re equire that th hese requests s are in writin g and that th e individual e explains the r reason for the e ch hange. • Pa atients also h have a right to o know the id dentities of in dividuals or a agencies that have accesse ed th heir PHI for th he past six ye ars. Special Ci ircumstances s Protecting g public healt th – such as th hrough public c health surve eillance, prog gram evaluati ion, terrorism m preparedn ness, outbrea ak investigatio ons, and othe er public heal th activities – often requir res access to or the repor ting of Protec cted Health In nformation. HIPAA pe rmits Covered d Entities to d disclose prote ected health i information w without autho orization for specified public health purposes. There ma y be more rig gorous state l aws regardin g special circ umstances, s so it is import ant for you a s a healthcar e worker to k know about th he policies an nd procedure s in place for your organiz zation. HI: 8 HIPAA VIOLATI ONS A HIPAA v violation is th e use or discl osure of Prot tected Health h Information n (PHI) in a wa ay that comprom mises an indivi dual’s right to o privacy or s security and p poses a signif icant risk of f financial, reputatio nal, or other harm. The HIPAA A Breach Not ification Rule e requires Cov vered Entities s to promptly y notify the af ffected perso n as well as th e U.S. Secreta ary of Health and Human Services S of th he loss, theft, or certain ot ther impermis ssible uses or di sclosures of P PHI. As a healt thcare worke r, you must re eport any kno owledge of po otential or ac ctual violation ns immediate ely to your supe ervisor. An examp ple of a HIPAA A violation: A well-kno own actress i s being treate ed at your ho ospital, and th here is much e excitement a mong the sta aff. The fact t hat she has b been hospitali ized has not b been made kn nown or repo orted in the m media. This actre ess is a favori te of your be st friend, so y you text your r friend to say y that the cele ebrity is a pat tient at your fa cility. You do n’t disclose t he reason; on nly the fact th hat she is the re. This is a H HIPAA breach that could le ave you and y your employe er open to pe enalties that m may include f fines and impri sonment. HI: 9 PENAL LTIES FOR R HIPAA V VIOLATIO ONS All health care workers s must follow their organiz zation’s health h information n privacy and security poli cies and proce edures manda ated under H IPAA. Workers w who violate t hese policies could place t themselves an nd their orga nization at ris sk for investig gative or enforce ement action s by the U.S. Department of Health and d Human Serv vices. In addi tion, there m may be penalties imposed by t their respecti ve state and professional licensing boa ards. The U.S. D Department o of Health and Human Serv ices’ Office fo or Civil Rights s (OCR): • Is s responsible for administe ering and enfo orcing the HIP PAA Privacy a and Security R Rules • C onducts asso ciated compl aint investiga ations, compl iance review s, and audits • M May impose fi nes on covere ed providers for failure to comply with the HIPAA R ules The State Attorney Ge neral may als so enforce pro ovisions of th he HIPAA Rule es. Failure to comply with the HIPAA R ules can resu lt in the follo wing civil and d criminal pen nalties: Civil M Monetary P Penalties u under HIPA AA Violation Category Per Violation n (Minimum) ) M Maximum Civi l Monetary Pe enalties for V Violations Did not kn now (and by exercising e $100 per vio olation, with a an $5 50,000 per vio olation, with an reasonab le diligence w would not annual maxi mum of $25,0 000 for an nnual maximu um of $1.5 m illion have know wn) that he/s she repeat violat tions violated H HIPAA Reasonab ble cause (not t due to $1,000 per v violation, with h an $5 50,000 per vio olation, with an willful neg glect) annual maxi mum of $100 0,000 an nnual maximu um of $1.5 m illion for repeat vi olations HIPAA vio olation due to o willful $10,000 per violation, wit th an $5 50,000 per vio olation, with an neglect bu ut violation is s corrected annual maxi mum of $250 0,000 an nnual maximu um of $1.5 m illion (within re equired time p period) for repeat vi olations HIPAA vio olation is due to willful $50,000 per violation, wit th an $5 50,000 per vio olation, with an neglect (n not corrected ) annual maxi mum of $1.5 million an nnual maximu um of $1.5 m illion Cri iminal Pen nalties und der HIPAA • U p to $50,000 and 1 year in n prison for im mproperly ob tained or disc closed PHI • U p to $100,00 0 and up to 5 years in pris on for offens ses committe d in obtaining g PHI under f alse p retenses • U p to $250,00 0 and up to 1 10 years in pri ison for offen nses committ ed in disclosi ng PHI with t he in ntent to sell, t transfer, or us se this inform mation for com mmercial adv vantage, perso onal gain, or m malicious harm m HI: 10 RECOM MMENDA ATIONS FO OR CAREG GIVERS As a healt thcare worke r, here are re ecommendati ons to help y you follow HIP PAA rules and d regulations regarding g patient conf identiality: En nsure conver sations regar rding patients s, such as han nd-off commu unications, ar e done in a co onfidential ar rea. A void discussin ng a patient's s condition in front of othe er patients, vi isitors, or fam mily members s in a h allway. Lo ower your vo ice when disc cussing patien nt informatio on in person a and/or over th he phone. A void having c conversations s about patien nts in public p places, such a as elevators, p public hallwa ys, or th he cafeteria. En nsure that pa atient-related information is not visible to the public c, such as on c computer scr reens. Si ign off of com mputers when n not in use. U se passwords s on desktop and portable e media devic es, and chang ge them as of ften as your o rganization’s policy allows s. N ever share yo our password d. En nsure data-en ncrypted com mputers are u sed for Prote ected Health I nformation ( PHI). Use these e precautions to protect PH HI from accid ental disclosu ure: A void sending PHI by email if at all possi ble. D o not post pa atient informa ation or phot os on social m media (such a as Facebook, Twitter, In nstagram, etc .). U se a fax cove r sheet when n faxing PHI an nd double-ch heck the fax n number to be sure it is corr rect. HI: 11 HITECH H ACT REG GARDING G ELECTR ONIC HEA ALTH REC CORDS The Healt th Informatio n Technology y for Economi ic and Clinica l Health Act ( HITECH Act) w was created i in 2009 to st timulate the a adoption of e electronic hea alth records ( EHR) while ad ddressing the e privacy and security o of electronica lly transmitte ed health info ormation. An EHR is an electronic c version of a patient’s me edical history and is mainta ained by the provider. The e EHR is a mean s to automat e access to pe ersonal healt h information n and improv ve clinical wor rkflow proces sses. The EHR m may include c clinical data su uch as: • D emographics s • P rogress notes s • P roblems • M Medications • V ital signs • Pa ast medical h history • Im mmunizations s • La aboratory dat ta • R adiology repo orts The HITEC CH Act is an a mendment to o HIPAA that provides incr reased respon nsibility for th he protection n of Protected d Health Infor rmation (PHI) in electronic form. It is es ssential for yo ou as a health hcare worker to understan nd how the H ITECH Act aff fects you in th he workplace e setting. The HITEC CH Act require es: • In ncreased deve elopment and d use of EHR in the workpl lace • In ncreased deve elopment and d monitoring of EHR secur rity in the wor rkplace; in ot ther words, w who is ac ccessing EHR and do they have a “need d to know” • Im mmediate rep porting of any y and all EHR security brea aches • In ncreased pena alties for HIPA AA breaches • Pe eriodic audits s by the U.S. D Department o of Health and d Human Serv vices • M Mandatory pe nalties impos sed for “willfu ul neglect” HI: 12 CONCL LUSION For health hcare worker s, it is crucial to know how w to balance p patient confid dentiality with h the need fo or effective c communicati on to ensure quality patie nt care. Understan nding HIPAA rules and reg gulations, as w well as your fa acility’s polici ies and proce edures, can en nsure that Prote ected Health Information ( (PHI) remains s safeguarded d and in the h hands of only the individua als who have e a need and a right to kno ow it. REFERENC CES: • A ccounting an d Tracking Di sclosures of P Protected He alth Informat tion (2001). A American Hea alth In nformation M Management A Association. A Available at: ht ttp://library.a ahima.org/xp pedio/groups/ /public/docum ments/ahima a/bok1_00946 68.hcsp?dDo cNam e= =bok1_00946 68. Accessed October 20, 2 2016. • B reach Notific ation Rule. U nited States D Department o of Health and d Human Serv vices. Availab le at: ht ttp://www.hh hs.gov/ocr/pr rivacy/hipaa/ /administrativ ve/breachnot tificationrule. . Accessed O October 20, 20 016. • C overed Entiti es and Busine ess Associate s. United Stat tes Departme ent of Health and Human Se ervices. Avail able at: http: //www.hhs.g gov/hipaa/for r-professiona ls/privacy/law ws- re egulations/ind dex.html. Acc cessed Octob er 20, 2016. • El lectronic Hea lth Records. United States s Centers for Medicare & M Medicaid Serv vices. Availab ble at: ht ttps://www.c cms.gov/Med dicare/E- H ealth/EHealt hRecords/ind dex.html?redi irect=/ehealt hrecords. Acc cessed Octob ber 20, 2016. • El lectronic Hea lth Records. United States s Centers for Medicare & M Medicaid. Ava ailable at: ht ttps://www.c cms.gov/Med dicare/E- H ealth/EHealt hRecords/ind dex.html?redi irect=/ehealt hrecords. Acc cessed Octob ber 20, 2016. • Fe ederal Registe er Part II. Uni ited States De epartment of f Health and H Human Servic ces. Available at: ht ttp://www.hh hs.gov/sites/d default/files/ /ocr/privacy/h hipaa/admini istrative/secu urityrule/secu urityr u lepdf.pdf. Acc cessed Octob ber 20, 2016. • G uidance Rega arding Metho ods for De-ide entification of f Protected H ealth Informa ation in A ccordance wi ith the Health h Insurance P ortability and d Accountabil lity Act (HIPA AA) Privacy Ru ule. U nited States Department o of Health and d Human Serv vices . Availab ble at: ht ttp://www.hh hs.gov/ocr/pr rivacy/hipaa/ /understandin ng/covereden ntities/De- id dentification/ guidance.htm ml. Accessed O October 20, 2 2016 • H ealth Informa ation Privacy. . United State es Departmen nt of Health a and Human Se ervices. Avail able at t: http://www w.hhs.gov/oc r/privacy/hip paa/understan nding/covere edentities/ind dex.html. Acce essed O October 20, 20 016. • H IPAA Adminis strative Simp lification. Uni ited States De epartment of f Health and H Human Servic ces, O Office for Civil Rights. Availa able at: http:/ //www.hhs.g gov/sites/defa ault/files/hipa aa-simplificat tion- 20 01303.pdf. Ac ccessed Octo ber 20, 2016 . • H IPAA Privacy, , Security, and d Breach Not ification Aud it Program. U United States Department of H ealth and Hu man Services s. Available at t: http://www w.hhs.gov/hip paa/for- p rofessionals/ compliance-e enforcement/ /audit. Access sed October 2 20, 2016. • H ITECH Act (He ealth Informa ation Technol logy for Econ omic and Clin nical Health A Act). Available e at: ht ttp://searchh healthit.techt arget.com/de efinition/HITE ECH-Act. Acce essed Octobe er 20, 2016. HI: 13 • In ndex for Exce rpts from the e American Re ecovery and R Reinvestment t Act of 2009 (ARRA). Avai lable at t: https://ww ww.healthit.go ov/sites/defa ult/files/hitec ch_act_excer rpt_from_arra a_with_index x.pdf. A ccessed Octo ober 20, 2016 . • M Minimum Nec essary Requir rement. Unite ed States Dep partment of H Health and Hu uman Service es. A vailable at: ht ttp://www.hh hs.gov/ocr/pr rivacy/hipaa/ /understandin ng/covereden ntities/minim mumnecessary y.htm l. Accessed Oct tober 20, 201 16. • Se elect Portions s of the HITEC CH Act and Re elationship to o ONC Work. Available at: ht ttps://www.h healthit.gov/p policy-researc chers-implem menters/selec ct-portions-hi tech-act-and - re elationship-on nc-work. Acce essed Octobe er 20, 2016. • Su ummary of th he HIPAA Priv vacy Rule. Uni ited States De epartment of f Health and H Human Servic ces. A vailable at: ht ttp://www.h hs.gov/hipaa/ /for-professio onals/privacy y/laws-regula tions/index.h html. A ccessed Octo ober 20, 2016 . • Th he Security R ule. United St tates Departm ment of Healt th and Huma n Services. Av vailable at: ht ttp://www.hh hs.gov/hipaa/ /for-professio onals/security y/index.html . Accessed Oc ctober 20, 20 016. Infection Control/ Bloodborne Pathogens Infection Control/Bloodborne Pathogens ..................... IC: 1 1. Introduction ........................................................................................ IC: 1 2. Purpose/Overall Goal ......................................................................... IC: 1 3. Course Objectives .............................................................................. IC: 1 4. Hand Hygiene .................................................................................... IC: 2 5. Gloves ................................................................................................ IC: 3 6. Gowns, Masks, Eye Protection .......................................................... IC: 4 7. Safe Injection Practices ...................................................................... IC: 5 8. Respiratory Infections/Cough Etiquette ............................................. IC: 6 9. Bloodborne Pathogens ....................................................................... IC: 7 10. Hepatitis ........................................................................................... IC: 8 11. HIV/AIDS ........................................................................................ IC: 9 12. Transmission-Based Precautions ..................................................... IC: 10 13. Multidrug-Resistant Organisms (MDROs) ...................................... IC: 12 14. Tuberculosis ..................................................................................... IC: 13 15. Ebola ................................................................................................ IC: 14 16. Handling and Disposal of Infectious Waste ..................................... IC: 18 17. Conclusion ....................................................................................... IC: 19 © Copyright Clinical Assessments by Prophecy, a Division of Advanced Practice Strategies IC: 1 Infection Control/Bloodborne Pathogens INTRODUCTION Infectious diseases are caused by microscopic organisms that penetrate the body’s natural barriers and multiply. They create symptoms that can range from mild to fatal. The U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization, and other agencies have established guidelines to help protect patients and healthcare workers from exposure to potential infections. These guidelines establish policies for hand-washing, the use of Personal Protective Equipment (PPE), safe injection practices, cough etiquette, and more. Following Standard Precautions is a requirement, not an option. It will reduce your risk of cross contamination from infected patients to yourself and others, as well as from yourself to patients. Standard Precautions must be used for all patients, at all times, by all healthcare workers. PURPOSE/OVERALL GOAL This module outlines procedures for healthcare workers to avoid personal exposure to infections and bloodborne pathogens, and to keep infections from spreading to patients, visitors, and other workers. The goal of this module is to instruct you on how to stay safe from infection as you go about your work at your facility. COURSE OBJECTIVES After completing this module, the learner should be able to: 1. Explain the importance of standard infection-control precautions 2. Explain how to protect themselves and others from infection 3. Define Personal Protection Equipment and how to use it 4. Describe precautions to take for patients with serious infections 5. Describe how to handle and dispose of infectious waste IC: 2 HAND HYGIENE Hand-washing is considered the single most important procedure for preventing nosocomial (hospital - acquired) infections. Any healthcare worker involved in direct or indirect patient care must know how and when to perform proper hand hygiene. The World Health Organization states that hands must always be properly washed: 1. Before patient contact 2. Before performing an aseptic procedure (a procedure that must be free from bacteria and other microorganisms) 3. After exposure to any body fluids 4. After patient contact 5. After contact with patient surroundings (touching items in the immediate patient care environment, even if you don’t touch the patient) If your hands are not visibly soiled, you may use an alcohol-based rub: 1. Apply the product to the palm of one hand. 2. Rub your hands together, covering all surfaces of hands and fingers. 3. Rub until your hands are dry. If your hands are soiled, wash with soap and water following these procedures: 1. Wet your hands first with water. 2. Apply soap; liquid, bar, or powdered forms of plain soap are acceptable. 3. Rub your hands together vigorously for at least 15 seconds, covering all surfaces of your hands and fingers. 4. Rinse your hands with water and dry thoroughly with a disposable towel. 5. Use the towel to turn off the faucet. 6. Avoid using very hot water, since repeated exposure to hot water may increase the risk of dermatitis. If you use hand lotion:  You should have your own container; shared bottles can easily become contaminated.  Use only water-based products and only those that are hospital-approved. Just because a product washes off with water does not mean it is water-based.  Using lanolin or oil-based lotions before donning gloves will seriously weaken the gloves, increasing the risk that germs will pass through the gloves. Fingernails:  Numerous studies have been conducted on artificial nails, the nail hygiene of healthcare personnel, and the transmission of healthcare-associated infections to patients.  The U.S. Centers for Disease Control and Prevention (CDC) states that nail tips should be less than one-quarter inch long.  The CDC and the World Health Organization state that those who have direct contact with patients at high risk should not have artificial fingernails or extenders. IC: 3 GLOVES Personal Protective Equipment (PPE) is specialized clothing or equipment designed for your protection against infection. Gloves are a type of PPE. Gloves MUST be worn when there is a possibility of contact with: 1. Blood and/or body fluids 2. Mucous membranes 3. Non-intact (broken) skin 4. Contact with contaminated items Keep these important facts in mind regarding gloves:  Wear gloves that fit properly.  Do not wear the same pair of gloves for the care of more than one patient.  Do not wash gloves so that you can reuse them.  Remove and/or change gloves after you complete your task and whenever the gloves become soiled or damaged.  Turn the gloves inside out when removing them, and dispose of them in the proper receptacle.  Clean your hands before putting gloves on and also immediately after removing them.  Never wear multiple layers of gloves in order to “peel off” layers between tasks.  Always wear the right gloves for the job: o Wear heavy work gloves for cleaning. o Never wear latex gloves when caring for a patient with a latex allergy; instead, wear a synthetic glove such as vinyl. Latex Allergies Latex is contained in a variety of products such as gloves, catheters, adhesive bandages and tape, and more. It is also present in a variety of household items such as rubber bands, balloons, condoms, and dental dams. Allergic reactions to latex range from skin irritation and itching to life-threatening episodes of anaphylactic shock. It is the responsibility of healthcare workers to protect themselves, coworkers and patients from unnecessary exposure to latex. Some important points to remember about latex allergies:  Ask patients questions about allergies, including latex allergies, in terms that they understand.  Document findings in the patient chart.  All latex products, including gloves, MUST be kept away from allergic patients and staff.  Latex products release latex allergens into the air, and these allergens may cause reactions in latex-allergic persons.  Glove powder from latex gloves may carry enough latex allergen through the air to cause reactions in allergic persons.  If you suspect that you have a latex allergy, contact Employee Health for an appointment to rule out this allergy. IC: 4 GOWNS, MASKS, EYE PROTECTION Other types of Personal Protective Equipment (PPE) include gowns, masks, and eye protection. Wear a gown that is appropriate to your task, to protect your skin and prevent soiling or contamination of your clothing during procedures or activities when you are likely to come in contact with blood, body fluids, excretions, or secretions.  Do not wear the same gown for the care of more than one patient.  Remove a soiled gown as soon as possible.  Practice hand hygiene after removal of gown. Wear a mask and eye protection or a face shield to protect the mucous membranes of your eyes, nose, and mouth during procedures or activities when you are likely to come in contact with blood, body fluids, excretions, or secretions. To protect your respiratory tract from airborne infectious agent such as tuberculosis (TB), use a respirator (commonly called the “N95 mask”) when necessary. IC: 5 SAFE INJECTION PRACTICES According to the U.S. Centers for Disease Control and Prevention (CDC), improper use of syringes, needles, and medication vials during routine healthcare procedures have resulted in transmission of bloodborne viruses such as hepatitis and human immunodeficiency virus (HIV). Recommendations by the CDC for safe injection practices include:  Follow proper infection control practices.  Maintain Aseptic Technique when preparing and administering injected medications (follow hand-washing guidelines and maintain a sterile field).  Never administer medications from the same syringe to more than one patient, even if the needle is changed.  Never enter a vial with a used syringe or needle.  Do not use medications packaged as single-dose or single-use for more than one patient.  Do not use bags of intravenous solution as a common source of supply for more than one patient.  Limit the use of multi-dose vials and dedicate them to a single patient whenever possible.  Always use facemasks when injected material or inserting a catheter into the epidural or subdural space. IC: 6 RESPIRATORY INFECTIONS/COUGH ETIQUETTE Coughs and sneezes produce droplets that can be inhaled by people nearby, spreading viruses. Following simple “cough etiquette” procedures can help protect you as a healthcare worker as well as patients and visitors at your facility.  Cover your mouth and nose when you cough or sneeze, with a tissue if at all possible.  Throw used tissues away immediately.  Use a surgical mask for patients who are coughing, if tolerated and appropriate.  Use a surgical mask yourself if you are coughing.  Clean your hands after contact with respiratory secretions.  Stay at least three feet away, if possible, from people with respiratory infections. IC: 7 BLOODBORNE PATHOGENS Bloodborne pathogens are infectious microorganisms in human blood that can cause disease. Examples are hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV, the virus that causes AIDS). Healthcare workers are at risk for exposure through needle sticks or other sharps related injuries. All used sharps are considered contaminated. It is essential to follow these guidelines:  Never bend or break needles and other used sharps after use.  Never recap contaminated needles.  Always use needle-based safety devices when available.  Never carry a used sharp in a pocket.  Dispose of sharps in designated sharps disposal containers.  Sharps disposal containers should be sealed and removed when three-quarters full to avoid overflow.  Do not attempt to remove anything from a sharps disposal container.  Properly dispose of all sharp objects, such as syringes with needles and scalpels, after use. The U.S. Occupational Safety and Health Administration requires employers to:  Establish an exposure control plan and update it annually  Implement the use of Standard Precautions (treating all blood and other potentially infectious material as if known to be infectious for bloodborne pathogens)  Identify and use engineering controls (sharps disposal containers, self-sheathing needles, and safer medical devices such as needleless systems)  Identify and ensure the use of work practice controls (appropriate practices for handling and disposing of contaminated sharps, handling specimens, handling laundry, and cleaning contaminated surfaces and items)  Provide Personal Protective Equipment (PPE)  Make hepatitis B vaccinations available to all workers with occupational exposure  Make post-exposure evaluation and follow-up available to any occupationally exposed worker who experiences an exposure incident  Use labels and signs to communicate hazards  Provide information and training to workers, and maintain worker medical and training records IC: 8 HEPATITIS Hepatitis is a serious disease of the liver, an organ necessary for life. Hepatitis B (HBV) and hepatitis C (HCV), the two most serious kinds of hepatitis, are similar kinds of liver infections caused by different viruses. Although there are fewer new hepatitis C infections each year compared with hepatitis B, there are more deaths in the long term due to hepatitis C. About 50% of hepatitis B infections and 75% of hepatitis C infections cause no initial symptoms. When symptoms do occur, they include:  Jaundice (yellowing of skin and eyes)  Loss of appetite  Dark urine  Nausea and vomiting  Fever  Fatigue  Clay-colored bowel movements  Joint pain  Abdominal pain Hepatitis B and hepatitis C viruses are transmitted through blood and body fluids. Methods of bloodborne transmission of HBV and HCV that you should be aware of include:  Blood splashes from minor cuts and nosebleeds  Procedures that involve blood  Hemodialysis  Sharing personal items like nail clippers, razors, and toothbrushes  Sharing needles for intravenous drug use  Body piercing and tattoos Precautions for Healthcare Workers Although it is rare, healthcare workers are at risk of becoming infected with hepatitis. Even exposure to a small amount of blood from an infected person can cause hepatitis. Here are guidelines to follow:  Assume that blood and other body fluids from all patients are potentially infectious.  Routinely use Personal Protective Equipment (PPE) such as goggles and masks if you might come in contact with blood or body fluids  Immediately wash your hands and other skin surfaces after contact with blood and body fluids.  Carefully handle and dispose of sharp instruments during and after use.  The CDC’s Advisory Committee on Immunization Practices recommends that all healthcare workers at risk for exposure to blood or blood-contaminated body fluids receive the hepatitis B vaccination. IC: 9 HIV/AIDS HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV weakens a person’s immune system by gradually destroying the body’s CD4 cells, which fight disease and infection. This makes a person more likely to get other infections or infection-related cancers. AIDS is considered to be the last stage of HIV infection. Currently, no effective cure exists for HIV or AIDS. With antiretroviral therapy (ART), people can be treated before HIV progresses and have a nearly normal life expectancy. However, ART treatment is a lifetime therapy and must be strictly followed. Many people infected with HIV may not feel sick or even know they have the virus for many years. During that time, the virus, a bloodborne pathogen, can infect other people – including healthcare workers. To prevent the transmission of HIV, implement Standard Precautions (treating all blood and other potentially infectious material as if known to be infectious for bloodborne pathogens). IC: 10 TRANSMISSION-BASED PRECAUTIONS As a healthcare worker, you should be aware of the three specific Transmission-Based Precautions that are used for patients when there is a risk of the spread of infection by direct or indirect contact: 1. Contact Precautions 2. Droplet Precautions 3. Airborne Precautions Contact Precautions Contact Precautions are used for:  Patients infected with multidrug-resistant organisms (MDROs)  Situations where excessive wound drainage, fecal incontinence (may include patients with norovirus, rotavirus, or C. difficile), or other discharges from the body suggest an increased risk of transmission Healthcare workers caring for patients on Contact Precautions should:  Wear appropriate Personal Protective Equipment (PPE) such as gown and gloves when entering the patient’s room  Discard the PPE before exiting the patient’s room to contain the pathogens  Place those patients in a single room when possible Droplet Precautions Droplet Precautions are used in cases where respiratory secretions (saliva, mucus) could spread an infection. These patients may not need special air handling and ventilation in their room, but a single room is preferred. Droplet Precautions may be used for patients with:  Influenza (the flu)  Whooping cough (pertussis)  Adenovirus, which can cause bronchitis, pneumonia, diarrhea, and pink eye  Group A streptococcus, which can cause strep throat Healthcare personnel caring for patients on Droplet Precautions should:  Wear a mask (a respirator is not necessary) for close contact with the patient  Put the mask on as soon as they enter the patient’s room  Put a mask on the patient, if tolerated, when transporting the patient outside the room IC: 11 Airborne Precautions Airborne Precautions are used for patients with pathogens that remain infectious over long distances when suspended in the air. This includes:  Measles  Chickenpox (varicella)  Tuberculosis  Smallpox When Airborne Precautions are necessary:  An airborne infection isolation room (AIIR), which is a room with special air handling and ventilation equipment, is preferred.  Healthcare personnel caring for patients on Airborne Precautions should wear a mask or respirator, depending on the disease-specific recommendations, which is donned prior to room entry.  Whenever possible, non-immune healthcare workers should not care for patients with vaccine- preventable airborne diseases (measles, chickenpox, smallpox). IC: 12 MULTIDRUG-RESISTANT ORGANISMS (MDRO) Multidrug-resistant organisms (MDROs) are microorganisms, primarily bacteria, that are resistant to antimicrobial agents and therefore can be difficult to treat. Common MDROs are VRE and MRSA. VRE (Vancomycin-Resistant Enterococci) Vancomycin-resistant enterococci (VRE) are bacterial strains of the genus Enterococcus that are resistant to the antibiotic vancomycin. Enterococci are organisms found normally in the intestinal tract and, in females, in the vaginal tract. People at higher risk for VRE are those who have been ill and have been taking many antibiotics or have weakened immune systems due to illness or age. VRE:  Are found most often in the stool  Can also be found in the blood, urine, and wounds, or wherever it can be carried by blood  Can be spread to other people by contact between persons VRE are hardy organisms. They can survive on hard surfaces for 7 to 10 days and on hands for hours. But it is easy to kill them with hand-washing and the proper use of disinfectants. Healthcare workers treating VRE patients must follow these rules:  Gloves MUST be worn before or upon entry to patient’s room.  Hands MUST be washed after glove removal and before leaving the room.  Gowns MUST be worn by anyone having contact with VRE patients or items that the patient may have come in contact with.  A standard surgical mask is necessary if the organism is in the respiratory tract for close contact with the patient, which is defined as being within 2 to 3 feet. MRSA (Methicillin-Resistant Staphylococcus Aureus) MRSA is a strain of the germ Staphylococcus aureus that has developed resistance to most of the antibiotics commonly used to treat staph infections. MRSA is passed from person to person through contact.  A person who is infected with MRSA may have it in their nose as well as on their hands – so whenever they touch others, they can pass the germ along.  MRSA can be transmitted from someone in contact with a MRSA patient to another patient. Healthcare workers treating MRSA patients must follow these rules:  Use Personal Protective Equipment (PPE), including gloves and gowns, if it can be reasonably anticipated that contact with blood or other potentially infectious materials may occur.  Hands must be washed after touching blood, body fluids, secretions, excretions, and contaminated items. Also wash hands after glove removal and before leaving the room.  A standard surgical mask is necessary if the organism is in the respiratory tract and close contact with the patient is required, which is defined as being within 2 to 3 feet. IC: 13 TUBERCULOSIS Tuberculosis (TB) is a disease that is caused by bacteria that are carried through the air by tiny droplets. TB mainly attacks the lungs, but any part of the body can be affected, including the kidneys, spine, and brain. With long-term medication, tuberculosis can be cured. Symptoms of TB include:  Chest pain  Prolonged productive cough (3 weeks or longer)  Coughing up of blood or sputum  Fever, chills, night sweats  Weight loss, lack of appetite  Weakness or fatigue TB transmission:  TB is transmitted through the air when a person with TB in the lungs or throat coughs, sneezes, or speaks, infecting those nearby if they inhale the infectious airborne droplets.  According to the U.S. Centers for Disease Control and Prevention (CDC), TB is NOT spread by shaking someone’s hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes, or kissing. There are two types of tests for TB – a skin test or TB blood test. People working in healthcare settings should receive an initial TB skin test upon hire, and then annual tests depending on the type of setting. Special precautions for healthcare workers regarding TB patients:  TB patients should be in private rooms with their door kept closed.  Pulmonary TB patients should be in a negative pressure ventilated room or an AIIR (airborne infection isolation room).  Healthcare workers should wear a special “fit-tested” mask such as an N-95 or greater to provide at least 95% efficiency, and receive training on proper fitting and how to wear it correctly.  The N-95 or greater efficiency mask should be worn when entering the patient’s room and while in the room.  Patients should be kept in their rooms as much as possible; if transportation is necessary, patient MUST wear a high-efficiency mask (if medically feasible).  Patients should be encouraged to cough or sneeze directly into tissues and to dispose of them.  HANDS MUST BE WASHED after touching the patient or potentially contaminated articles, and after taking off gloves, mask, and/or gown. IC: 14 EBOLA Ebola is a rare and deadly disease that first occurred in remote villages in central Africa but has affected people in other countries around the world. Symptoms of Ebola may appear between 2 and 21 days after exposure and include:  Fever  Muscle pain  Weakness  Vomiting  Fatigue  Severe headache  Diarrhea  Abdominal pain  Internal or external bleeding (from skin, eyes, gums) It is difficult to diagnose a person in the first few days of contracting Ebola, mainly because the early symptoms are often seen in many other illnesses. The screening process includes taking a recent travel history. Confirmation of Ebola virus infection is with blood tests. How Ebola is Transmitted Ebola can infect humans and other mammals, including bats, monkeys, and apes. Human-to-human transmission occurs through direct contact with blood or body fluids of an infected person. Healthcare providers caring for Ebola patients, as well as the family and friends in close contact with Ebola patients, are at the highest risk of contracting Ebola because they are more likely to come into contact with their blood or body fluids. The virus also can be spread through contact with objects that have been contaminated with the virus, such as:  Clothes  Bedding  Needles  Syringes/sharps  Medical equipment Currently there is no FDA-approved vaccine or medicine available for Ebola. These basic interventions, when used early, can significantly improve the chances of survival:  Providing intravenous (IV) fluids and electrolytes  Maintaining oxygen status and blood pressure  Treating other infections that may occur IC: 15 Caring for a Suspected Ebola Patient If a patient has met the criteria for Ebola:  Healthcare providers should implement Standard, Contact, and Droplet Precautions using appropriate Personal Protective Equipment (PPE).  The patient should be placed in isolation in a single patient room with a private bathroom.  The patient’s door(s) should be kept closed.  A log should be maintained of all persons entering the patient's room.  Public health officials should be notified. Special Precautions for Healthcare Workers Here are recommendations from the U.S. Centers for Disease Control and Prevention (CDC) for healthcare workers in close contact with patients who have suspected or known Ebola infection: 1. ALL body parts should be completely covered when putting on Personal Protective Equipment (PPE). 2. Impermeable garment should be: o Single-use (disposable) fluid-resistant or impermeable gown that extends to at least mid- calf, OR o Coverall without integrated hood 3. Respiratory protection should be: o PAPR (powered air purifying respirator), a hooded respirator with a full-face shield, helmet, or headpiece. Any reusable helmet or headpiece must be covered with a single-use hood that extends to the shoulders and fully covers the neck and is compatible with the selected PAPR, OR o A single-use N95 respirator in combination with single-use surgical hood extending to the shoulders and single-use full-face shield. 4. Single-use boot covers that are waterproof and go to at least mid-calf 5. Single-use examination gloves with extended cuffs, using double-glove technique (sterile for some procedures) 6. Single-use apron that is waterproof and covers the torso to the level of the mid-calf should be used if Ebola patients have vomiting or diarrhea Healthcare workers should receive rigorous and repeated training to ensure they are knowledgeable and proficient in putting on (donning) and taking off (doffing) PPE prior to managing an Ebola patient. The sequence for donning and doffing are critical to avoiding exposure. A clear layout and separation between clean and potentially contaminated areas is critical to prevent contamination and exposure. Non-dedicated, non-disposable equipment used for patient care should be immediately cleaned and disinfected according to manufacturer’s instructions and hospital policies. IC: 16 Additional Infection Control Practices for Ebola 1. Limit the use of needles and other sharps as much as possible. 2. All needle and sharps should be handled with extreme care. 3. Dispose of all needles and sharps in puncture-proof, sealed containers. 4. Keep hands away from the face. 5. Limit touching surfaces and body fluids. 6. Immediately disinfect any visibly contaminated PPE surfaces, equipment, or patient care area surfaces using an EPA-registered disinfectant wipe. 7. Perform regular cleaning and disinfection of patient care surfaces, even if visible contamination is not seen. 8. Perform frequent disinfection of gloved hands using an alcohol-based hand rub, particularly after handling body fluids. Aerosol Generating Procedures (AGP’s) It has not been established that Ebola can be contracted through airborne transmission; however, there may be some patients with severe pulmonary involvement or who during certain invasive procedures can potentially produce aerosols. Aerosol Generating Procedures (AGPs) include:  Airway suctioning  Aerosolized or nebulized medication administration  Bronchoscopy  Endotracheal intubation and extubation  Positive pressure ventilation via face mask In these instances, facilities may choose to adhere to the following CDC recommendations:  Visitors should not be present.  Limit number of individuals entering room.  Only pertinent healthcare personnel needed for procedure are present.  Conduct the procedure in a private room or ideally, when possible, in an airborne infection isolation room (AIIR).  All doors should be kept closed; entry and exit should be limited or eliminated if possible during the procedure.  Use strict PPE recommendations for these procedures. Environmental Cleaning & Control The CDC recommends the following environmental cleaning practices for any care areas of known or suspected Ebola virus patients. This especially applies to Environmental Services staff but is also for anyone who would be performing cleaning tasks.  Wear Ebola PPE during cleaning procedures, and follow Ebola donning and doffing procedures.  Use an EPA-registered hospital disinfectant with a label claim for a non-enveloped virus (norovirus, rotavirus, adenovirus, poliovirus).  Avoid contamination of reusable porous surfaces that cannot be made single use.  Use disposable cleaning cloths, mop cloths, and wipes, and dispose of these in leak-proof bags.  Use a rigid waste receptacle designed to support the bag to help minimize contamination of the bag’s exterior. IC: 17 Keep these cleaning facts in mind in cases of diagnosed or suspected Ebola:  Daily cleaning and disinfection of hard, non-porous surfaces (high-touch surfaces such as bed rails and over bed tables, housekeeping surfaces such as floors and counters) should be done.  Remove all upholstered furniture and decorative curtains from patient rooms before use.  Mattresses and pillows should have plastic covers or other protective covering to prevent fluids from leaking through.  Patient rooms should not be carpeted.  Basic principles for blood or body substance spill management should be followed as outlined by OSHA’s Bloodborne Pathogen.  Ebola-associated waste that has been appropriately incinerated, autoclaved, or otherwise inactivated is not infectious, does not pose a health risk, and is not considered to be regulated medical waste or a hazardous material under federal law.  Waste items transported offsite for disposal that is contaminated or suspected of being contaminated with Ebola virus must be packaged and transported in accordance with the Department of Transportation’s (DOT) Hazardous Materials Regulations. This includes: o Medical equipment o Sharps o Linens o Used healthcare products (such as soiled absorbent pads or dressings, kidney-shaped emesis pans, portable toilets, or byproducts of cleaning) o Used Personal Protection Equipment (gowns, masks, gloves, goggles, face shields, respirators, booties, etc.) If You Are Exposed to Ebola If you are exposed to the blood, other body fluids, secretions, or excretions of an Ebola patient:  Stop working and immediately wash the affected skin surfaces with soap and water. Eyes should be irrigated with copious amounts of water or eyewash solution.  Immediately contact your occupational health/supervisor for assessment and access to post- exposure management services. If you develop sudden fever, intense weakness or muscle pains, vomiting, diarrhea, or any signs of hemorrhage after exposure to an Ebola patient, you should:  Not report to work or should immediately stop working  Notify your supervisor  Seek prompt medical evaluation and testing  Notify local and state health departments  Comply with work exclusion until it is established that you are no longer infectious to others Post-Mortem Care for Ebola Patients Unfortunately, there will be Ebola-related deaths. Healthcare workers who will provide post-mortem care for these patients must know and understand their organization’s policies and procedures related to providing post-mortem care for Ebola patients. IC: 18 HANDLING AND DISPOSAL OF INFECTIOUS WASTES Remember these simple steps when dealing with infectious materials or waste (such as blood and body fluids, human tissue, sharps, needles, scalpels, IV tubing): 1. Infectious waste should be placed in closable leak-proof containers – color-coded, labeled, or tagged with the biohazard symbol. 2. Waste MUST be separated into appropriate containers. 3. Biohazard bags should be used for contaminated materials that are saturated with blood or other potentially infectious material. 4. Sharps MUST NOT be recapped. 5. Sharps MUST be placed in approved puncture-resistant biohazard sharps container, only up to the three-quarters-full mark. 6. Fluids MUST be emptied into the sanitary sewer system. 7. Fluid-filled container that cannot be emptied prior to disposal MUST be placed in biohazard receptacle. 8. Always protect yourself by wearing Personal Protective Equipment (PPE) when handling infectious waste. When handling specimens: 1. Laboratory specimens from all patients should be handled with equal care. 2. All non-blood specimen containers MUST be securely closed before transport. 3. Blood specimens and other glass containers MUST be transported in a manner that reduces the risk of breakage. 4. Specimens with visible soiling on their containers MUST be properly cleaned before transport to the lab. 5. If the lab tag becomes visibly soiled, issue a replacement tag for the specimen. 6. Workers transporting specimens should wash their hands after delivering them to the lab. A glove may be worn on the hand used to carry the specimen, leaving the ungloved hand free for opening doors, pushing elevator buttons, etc. A tray or box can make it easier to transport multiple specimens. IC: 19 CONCLUSION In the healthcare setting, infections are a major threat. As a healthcare worker, you are an important part of infection prevention at your facility. Understanding ways to protect yourself and others, particularly when exposed to a patient with a serious transmittable infection, is crucial. By observing certain precautions and following certain procedures, you can reduce the risk that an infection will spread. REFERENCES:  2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. U.S. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf. Accessed October 25, 2016.  Basic TB Facts. U.S. Centers for Disease Control and Prevention. Healthcare-associated Infections (HAI). U.S. Centers for Disease Control and Prevention. Available at: Available at: www.cdc.gov/tb/topic/basics/default.htm. Accessed October 25, 2016.  Ebola virus disease. World Health Organization. Available at: http://www.who.int/mediacentre/factsheets/fs103/en. Accessed October 25, 2016.  Ebola. U.S. Occupational Health and Safety Administration. Available at: https://www.osha.gov/SLTC/ebola/medical_info.html. Accessed October 25, 2016.  Frequently Asked Questions (FAQs) Regarding Safe Practices For Medical Injections. U.S. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/injectionsafety/PDF/FAQs-Safe-Practices-for-Medical-Injections.pdf. Accessed October 25, 2016.  HAI Data and Statistics. U.S. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/hai/surveillance/index.html. Accessed October 25, 2016.  Hand Hygiene: Why, How & When? World Health Organization. Available at: http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf. Accessed October 25, 2016.  Healthcare-associated infections (HAI). U.S. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed October 25, 2016.  Hepatitis B FAQs for Health Professionals. U.S. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#treatment. Accessed October 25, 2016.  HIV/AIDS. U.S. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/hiv/default.html. Accessed October 25, 2016.  Infection Prevention and Control (IC) (Ambulatory Health Care / Ambulatory Health Care). The Joint Commission. Available at: https://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFAQId=12 03&StandardsFAQChapterId=6&ProgramId=0&ChapterId=0&IsFeatured=False&IsNew=False&Ke yword=. Accessed October 25, 2016. IC: 20  Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S. Hospitals. U.S. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/vhf/ebola/healthcare- us/hospitals/infection-control.html. Accessed October 25, 2016.  Medical Waste. U.S. Environmental Protection Agency. Available at: https://www.epa.gov/rcra/medical-waste. Accessed October 25, 2016.  OSHA’s Bloodborne Pathogens Standard. U.S. Occupational Health & Safety Administration. Available at: https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf. Accessed October 25, 2016.  Viral Hepatitis. U.S. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/hepatitis/index.htm. Accessed October 25, 2016.  WHO best practices for injections and related procedures toolkit. World Health Organizations. Available at: http://apps.who.int/iris/bitstream/10665/44298/1/9789241599252_eng.pdf. Accessed October 25, 2016.