FUNCTION: Surveillance, Prevention, Control of Infection TITLE: Infection Control Plan - PACU _________________________________________________________________ PURPOSE: To provide guidelines for PACU for prevention of infection from diseases transmitted from blood, body fluids, tissues, excretions, and secretions during patient care. POLICY: 1. Personnel with an infectious process should not have patient contact. A physician's clearance will be required when the employee has been treated for the infectious process and returns to work. 2. Personnel are to wear scrub attire as specified in policy titled "Dress Code". 3. Protective gowns are to be worn by all personnel who enter the PACU that are not in scrub attire. Protective gowns are kept at the entrance of the PACU. Personnel who are not in protective apparel may be allowed in the desk area of the PACU, but should not proceed beyond this point until protective apparel is worn. 4. Handwashing is mandatory before and after patient contract. Gloves should be changed after contact with each patient. 5. Smoking or eating is not allowed in the patient care areas of the PACU. 6. Personnel will secure treatment through the Emergency Room when a percutaneous (i.e., needlesticks, cuts with sharp objects, and puncture wounds), mucous membrane (i.e., splashes in the eyes or mouth), or when non-intact skin exposures occur. Department Manager and Infection Control Employee Health Coordinator must be notified within twenty-four (24) hours after the exposure occurs. An occurrence report must be filled out. 7. AFTER EMPLOYEE EXPOSURE, the patient from whom the exposure occurred will be tested for the HIV antibody as well as for the Hepatitis B Surface Antigen. These reports are confidential and will be given to the Infection Control/Employee Health Coordinator and will not be a part of the patient's medical record nor the exposed employee's file. Should the patient's HIV and/or HBsAg be positive, the Infection Control/Employee Health Coordinator will contact the patient's physician to notify the patient of the results. The Infection Control Employee Health Coordinator will be available for informational/educational counseling at the request of the physician. 8. AFTER EMPLOYEE EXPOSURE, THE EMPLOYEE MAY BE TESTED FOR HIV only at the employee's request and after the employee has signed an informed consent. Consents may be obtained from the Infection Control/Employee Health Office or the Emergency Room. PATIENTS: 1. Every patient's blood, body fluids, excretions, secretions, and tissue must be treated as potentially infectious. 2. Contact of blood/body fluids with mucous membranes and breaks in the skin should be avoided. 3. GLOVES will be worn when caring for the patient to avoid contact with blood, specimens containing blood, body fluids, excretions or secretions, blood soiled items, body fluids, excretions and secretions, and the surfaces of objects exposed to these substances. Gloves are at bedside storage area. 4. GOWNS will be worn when there is to be direct contact with blood, body fluids, excretions and/or secretions. Gowns are located in the isolation area. 5. GOGGLES AND MASKS will be worn when there is potential for splatter of blood, body fluids, excretions, and/or secretions (e.g., suctioning a patient, during certain dental and surgical procedures, wound irrigations, post-mortem exams, and bronchoscopy). 6. Use good handwashing technique and wash hands before and after patient care, even though gloves have been worn. (See Handwashing Policy, Infection Control Manual). 7. Patients with known disorders requiring respiratory or strict isolation (radiation) are assigned to the Isolation Area of the PACU - Slot 8. Curtains will be kept closed at all times while a patient is in the Isolation Area. The staff member caring for the patient in the Isolation Area will not be assigned to other patients. When the recovery phase has been completed, the staff member will remove the protective gown, gloves, mask, etc., and dispose of these items properly in the isolation trash and linen containers (red-bagged) that are located in Slot 8. Disposable protective gowns, gloves, and masks will be kept in Slot 8 for use with contaminated cases. Housekeeping is to be called to do a thorough cleaning of the area and remove isolation bags after the patient is transferred to the floor. If Slot 8 is occupied, then patient will be recovered in the OR suite where the case was done by a qualified PACU RN. In Day surgery - infectious patients will be uncovered in the OR suite after the OR procedure is finished. 8. Ample distance between stretchers, 3 to 6 feet, will be observed. 9. Clean up blood/body fluid spills immediately with soap and water and a disinfectant solution such as household bleach (5.25% Sodium Hypochlorite) diluted with water (i.e., 1 part bleach to 10 parts water), or Wexcide. 10. PREGNANT AND IMMUNOSUPPRESSED individuals must take special precaution when caring for all patients as well as those with known communicable diseases. DO NOT RECAP NEEDLES AFTER USE ON THE PATIENT. Dispose of appropriately in the needle disposal unit located in each patient's slot and medication work area. DO NOT THROW SHARPS IN THE TRASH CONTAINERS OR LEAVE THEM LYING ON THE TABLES IN PATIENT AREA EQUIPMENT: 1. Respiratory Therapy equipment is disposed of or removed for terminal cleaning on a 24-hour basis. Nebulizers are disposable and replaced daily at 0700. 2. Wrights spirometers are gas sterilized on a weekly basis by the Sterile Processing Department. The spirometers are exchanged each Monday and the date of exchange labeled on tape on the spirometer case. A disposable (U/Adaptic T) adaptor is used with the spirometer for each intubated patient to prevent the possibility of cross contamination. If the spirometer is used on a patient in the Isolation Area, it is sterilized immediately after the patient is transferred out of the PACU. 3. Suction equipment is discarded after each patient use. Standard Nursing Policy regarding suctioning of patients will be followed. Face tents, masks, and nasal prongs, as well as aerosol tubing, are changed after each patient use. 4. Stretchers for OR/PACU patient transfer shall be kept in the PACU after disinfecting and application clean linen. Two stretchers will be stored in the OR corridor for emergency use. Following use of the OR/PACU stretcher, the linen and other miscellaneous items will be removed and the stretcher, pad, and safety straps (2) will be thoroughly cleaned with an approved germicidal cleaner. Clean linen will then be applied. Stretchers with any defective parts (i.e., broken rails, or straps, or torn mattresses) shall be sent to the Maintenance Department immediately, or be removed from use until the indicated repairs have been completed. 5. Equipment from Central Supply: If used, suction equipment will be discarded after each patient (i.e., bottle, tubing, and catheter). Instrument sets, Trach Tray, and/or Cutdown Tray will be cleaned after use and returned to C/S with a miscellaneous charge slip stamped with the patient's name. 6. Equipment obtained from Material Management (MM) will be picked up by MM personnel. OTHER: Any additional concerns regarding infection control can be referred to the Infection Control Committee through the Infection Control Coordinator. The PACU staff will review the Infection Control Manual or the unit specific policy, and this will be documented on an annual basis.