Keep staff focused on infection control

Rehab facility’s program is comprehensive

As the 21st century ushers in a time of unprecedented antibiotic drug resistance in pneumococcal and other common bacterial infections, rehab facilities need to renew efforts to improve infection control. This could mean further training and competency testing for staff.

Gundersen Lutheran Medical Center in La Crosse, WI, has about 150 employees, including therapists and other rehab staff, who are associate infection control practitioners (AICP), specially trained in standard precautions and other infection control measures. (See role specification for AICP.)

Role Specification for Associate Infection Control Practitioner

Gundersen Lutheran Medical Center in La Crosse, WI, designates certain staff as associate infection control practitioners. Employees desiring to receive this designation must attend a four-day education program, offered one day a month for four months.

Here is an outline of what the role requires:

1. Position Title: Associate Infection Control Practitioner

2. Responsible to: Unit Manager

3. Hours and Schedule: To be determined

4. Role Summary: A health care professional, specifically designated and educated to serve as a resource person and work cooperatively with all involved members of the health care team, including the patient and family to prevent nosocomial infections.

5. Background Experience: Staff person with at least one year clinical experience. A minimum of six months experience on the nursing unit/ department for which person will be acting as associate infection control practitioner.

6. Duties and Responsibilities:

A.	Responsibilities — general
	1. Act as liaison between the unit/department and infection control.
	2. Serve as a resource person for all infection control-related practices on the unit/department, such as standard precautions, patient placement, and prevention of nosocomial infections.
	3. Participate on the infection control committee when appropriate.
	4. Attend infection control inservices and conferences.
	5. Participate in development, review, and revision of unit policies.
	6. Facilitate communication to other nursing units or departments.
	7. Participate in surveillance activities as needed.

B.	Responsibilities — patient-related
	1. Implement infection control precautions and work practice controls to prevent the spread of infectious disease.
	2. Promote practice of standard precautions for all patient care activities.
	3. Assist with problem solving and follow-up for specific unit infection problems.
	4. Guide staff to instruct patients and families regarding infection control and prevention.
	5. Assist in planning care regarding infection problems or isolation.
	6. Promote community health through monitoring immunization records; control of communicable diseases; and teaching related to waste management, sanitation issues, and hygiene.

C.	Responsibilities to unit staff
	1. Orient new staff in relation to infection hazards and prevention.
	2. Educate staff as needed.
	3. Promote aseptic technique for all patient care.
	4. Assist personnel with the surveillance interpretation of microbiology lab results.
	5. Monitor compliance to standard precautions.
	6. Report findings from epidemiologic investigations.

D.	Responsibilities for equipment
	1. Be knowledgeable about the equipment used in the unit as it relates to infection hazards, cleaning, and storage or disposal.
	2. Advise staff regarding the proper handling and care of equipment.
	3. Monitor cleanliness of patient rooms, utility and med rooms, bathrooms, kitchens, etc.

"We have to attend a four-day orientation program that covers everything about infectious diseases," says Marguerite Costigan, PT, AICP, staff physical therapist for the 20-bed rehab unit within the 282-bed hospital.

AICP staff meet monthly

Staff certified as AICPs meet every other month to discuss infectious disease problems that have arisen and how to solve them. They also report how their individual departments are following standard precautions and other procedures. For example, they address questions such as, "Is the temperature in the refrigerator being checked every day and logged?"

The AICP staff also hold one-hour, public educational sessions open to the entire hospital staff. Once a year, there is a community and hospital-wide educational seminar, held over a two day period. It covers different topics through posterboard and other types of presentations.

Previous topics have included rabies, tick bites, how to keep food safe at picnics, and other information about preventing infections. The staff must attend and are required to sign in with employee numbers and complete a one-page evaluation form.

Infection control staff also collect data on nosocomial infections. They assess whether antibiotics are being administered correctly and keep track of each department’s infectious disease rate.

The goal is to ensure that the entire staff follows standard precaution measures at all times. The assessment includes a written test and observation of the employee at work. (See standard precaution assessment test.)

Assessment Test

Here’s a sample standard precaution assessment test given to rehab staff.

Gundersen Lutheran Medical Center in La Crosse, WI, promotes strict attention to infection control among its entire staff, including rehab employees. The hospital’s efforts include a written assessment of infection control techniques.

Employee Name ________________________________________
Unit _________________________________________________
Employee Number ______________________________________

(True or False)
1. Standard precautions are designed for the care of all individuals regardless of their diagnosis or presumed infectious status and apply to: blood, all body fluids, secretions and excretions regardless of whether they contain visible blood, nonintact skin and mucous membranes.

A. True	B. False

(Select the best response)

2. Personal protective equipment (PPE) used in practicing standard precautions includes:

A. Gowns	D. Goggles
B. Gloves	E. CPR Mask
C. Masks	F. All of the above

3. Personal protective equipment should be found:

A. In the locker room.
B. In the patient care areas (i.e., nurse’s station, standard precautions basket, personal protective equipment cabinets).
C. In the employee health & safety office.

4. Personal protective equipment should be used when there is contact with:

A. Urine	C. Any body fluid
B. Blood

5. Match the color of the isolation signs with the precaution/isolation categories. (All four need to be correct to receive credit.)

Color	Category
A. Green	___ Contact
B. Yellow	___ Droplet
C. Orange	___ Airborne
D. Pink	___ AFB

Answers: 1. a, 2. f, 3. b, 4. c, 5. c,b,a,d

For example, the rehab staff are assessed annually on how they wash their hands.

"Every employee goes through a test, and I watch people wash their hands to see if they’re doing it appropriately," Costigan says. "Do they do at least 10 seconds of scrubbing of the hands themselves?"

Other competency points are:

• Do employees use a paper towel to turn off the faucet instead of touching the faucet with the hands they just washed?

• Do employees use soap each time they wash their hands?

• Are employees washing hands between each patient contact?

• Are they using personal protective equipment for whatever procedure they’re doing?"

• Are the employees working on wound or debridement wearing a mask and gloves and protective jackets or gowns?

• Are employees recapping needles properly and disposing of them safely in sharps containers? (See sharps disposal and handwashing checklists.)

Sharps Disposal Checklist

Gundersen Lutheran Medical Center in La Crosse, WI, created this simple checklist to make sure staff dispose of sharps correctly.

Completed by: ________________________________________

Unit: ____________________________________

Policy Statement for Sharps Disposal

A. Syringes, needles, and other sharp objects are placed in a rigid, plastic, leakproof, closable sharps container.

B. Used needles should not be broken off, purposely bent, or recapped before disposal. Exception: If procedure requires the contaminated needle to be recapped and no alternative is feasible, the only acceptable method is a one-handed scoop technique.

C. Needles must not be removed from syringes by hand.

D. Sharps containers should be sealed when two-thirds full.

E. Broken glass should not be picked up with bare hands but swept up with a broom. If a small amount, place in sharps container. If a large amount, page janitor.

*Were sharps disposed of according to policy statement?*
Yes ___	No ___

Assistants observe staff’s handwashing

"It’s my job to get the assessment done," Costigan says. "We designate two rehab assistants to observe people handwashing throughout the day to make sure they washed them for 10 seconds and that they did all the steps they were supposed to do."

The hands-on competency test is scored objectively. It applies to every employee who comes into the rehab department, and the hospital’s goal is to have the staff score 100%, Costigan says.

Handwashing Checklist

Gundersen Lutheran Medical Center of La Crosse, WI, made this checklist to assess whether staff are correctly following infection control measures with regard to handwashing:

Job Category:
MD ___	Resp Care___
Res/Intern ___	Lab ___
Nurse ___	Other ___

1. Hands cleansed after patient contact, using gloves, contact with contaminated items, and before caring for immunodeficient patients.	Y / N

2. Technique with soap and water:
A. Used soap from dispenser.	Y / N
B. Greater than or equal to 10 seconds of friction.	Y / N
C. Patted hands dry with paper towel.	Y / N
D. Toweling used to turn off water (not applicable if sink with foot controls is used).	Y / N

3. Alcohol gel used as a handwash substitute.	Y / N

4. Greater than or equal to 15-second period of friction (hands must be thoroughly wet).	Y / N

Recent infection control results in the rehab department were a 100% on handwashing, 100% on proper use of masks and eyewear, 92.3% on proper use of gowns, and 87.8% on proper use of gloves.

Need More Information?

Marguerite Costigan, PT, AICP, Staff Physical Therapist, Gundersen Lutheran Medical Center, 1910 South Ave., Health Science Library, La Crosse, WI 54601-5400. Telephone: (608) 782-7300.