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Making Safe Choices

  • This module provides critical information/steps needed to ensure that our patients consistently receive safe care. It is your responsibility to notify your supervisor/educator if you have questions about the information in this module, or if you are unable to complete the steps as described.
  • Not following these steps may cause harm to our patients, ourselves or others and is called at-risk behavior. You should expect to be coached if you misstep, or drift, from the described procedures.
  • Should you choose to not follow this procedure (after being coached on the correct procedure) that may be considered reckless behavior and may result in punitive action.

Precautions in use at Beaumont Hospitals

  • Standard Precautions
  • Airborne Precautions
  • Droplet Precautions
  • Contact Precautions
  • Enhanced Contact Precautions

Standard Precautions

  • Hand hygiene is performed before and after each and every patient contact
  • Gloves are worn for contact with blood, body fluids, mucous membranes and non-intact skin
  • Gown and face protection are worn if splashing or spraying of body fluids is anticipated
  • Beaumont Pledge “Foam In Foam Out”  use an alcohol foam or soap and water upon entry and exiting all patient rooms

Beaumont Pledge

Bloodborne Pathogens (BBP)

  • Bloodborne pathogens such as HIV and hepatitis may be transmitted to HCWs by:
    • Puncture with a contaminated sharp instrument
    • Splash of blood/body fluid into eyes, nose or mouth
    • Blood/body fluid contact with non-intact skin
  • If you are exposed to BBP
    • Provide immediate care to exposure site:
    • Wash wound with soap and water
    • Flush mucous membranes with water
    • Fill out the online employee injury/illness form and please include the following:
    • the source patient’s name and
    • medical record number
    • Go to the Emergency Department for immediate follow-up
  • Employee Injury/Illness Form
    • The online employee injury/illness form can be found on Inside Beaumont online, under Departments:
    • Click on Occupational Health, Management Resources and link to Employee Injury Illness Form
  • Exposure follow-up
    • Assessment and treatment of injury
    • Update TdaP (or Td) if indicated
    • Exposed HCW is tested for Hepatitis B antibody
    • Source patient is tested for HIV, Hepatitis B surface antigen, and Hepatitis C antibody
      o Results of source patient rapid HIV test are usually available within 1 hour of blood reaching the lab
      o Call OHS at 248-733-7300 to set up your follow up appointment
  • If source patient is HIV positive:
    • Post-exposure chemoprophylaxis (PEP) is offered to exposed HCW in the EC
    • PEP should be started as soon as possible after exposure
    • Counseling will be provided and a referral with an Infectious Diseases specialist will be made for you
  • Airborne Precautions
    • Patients suspected of having any of the following diseases are placed in Airborne Precautions:
      • Chickenpox (Varicella)
      • Measles
      • Disseminated Shingles
      • Tuberculosis
    • Patient must be placed in an airborne (negative pressure) isolation room
    • Negative pressure monitor must be turned on
    • Door(s) must remain closed
    • HCWs entering the room must wear a N-95 respirator (mask)
  • Droplet Precautions are used for the following diseases:
    • Bacterial Meningitis
    • Pertussis (Whooping Cough)
    • Influenza
    • Diphtheria
    • Mumps
    • Rubella
    • Other infection as identified
      • Patient may be placed in a private room or may be cohorted with another
        patient with the same symptoms, who requires droplet precautions
        (patients should be placed at least 3 feet apart)
      • Door to the room may remain open
      • A surgical (or isolation) mask must be worn within 3 feet of the patient
      • Eye protection within 3 feet of the patient
  • Contact Precautions are used for:
    • Patients with known resistant organisms (such as MRSA or multi-drug resistant gram negative rods)
    • Patient may be placed in a private room or cohorted with another patient who has the same organism (but no other resistant organisms)
    • Door to the room may remain open.
    • Gown and gloves must be worn when providing care to the patient
  • Enhanced Contact Precautions are used for:
    • Patients suspected of having a resistant organism (such as patients admitted from another facility with an open wound, tracheostomy or diarrheao C. difficile
    • Vancomycin Resistant Enterococcus (VRE)
    • Staph. aureus resistant or intermediate to vancomycin (VRSA, VISA)
    • Extensively drug resistant organisms, such as XDR Acinetobacter and those producing an ESBL or Carbapenemase enzyme
    • Serious emerging resistant organisms
      • Patient may be placed in a private room, or cohorted with another patient with the same organism
      • Gown and gloves must be worn when entering the room
      • Gown and gloves are removed before leaving the room, and hand hygiene performed
  • Screening for MRSA and VRE
    • Upon admission to Beaumont Hospitals “high risk” patients (those admitted from an ECF or other long-term or acute facility, and dialysis patients) are cultured for MRSA (nasal specimen) and VRE (stool specimen)
  • Screening for XDR Acinetobacter
    • Patients admitted from another facility who have an open wound, a tracheostomy, or those on a ventilator are cultured for XDR Acinetobacter, and placed in Contact Precautions until the culture is complete
    • They are placed in Enhanced Contact Precautions if positive for XDR-ACB, and removed from precautions if culture negative
  • Duration of Precautions
    • Airborne, Droplet, and C. difficile precautions are visit-specific, and are discontinued when patients are no longer infectious
    • Contact and Enhanced Contact precautions remain in the patient’s medical record, and the patient is placed in precautions on each subsequent admission until culture negative per IC policy # 2.20
  • Medical Waste
    • The following medical waste must be disposed of in sharps boxes or biohazard bins:
      • Sharps such as syringes, lancets, scalpels
      • Blood soaked material that would release blood / body fluid (BBF) if compressed
      • Items caked with dried BBF that could release this material while handling
      • Tissues, organs, body parts other than teeth
    • Liquid Human Waste may be flushed down a sanitary sewer (hopper or toilet)
    • Blood-stained items such as gauze may be discarded in regular trash
  • For Additional Information:
    • Call your Department of Epidemiology:
      • Grosse Pointe @ 313-473-1715
      • Royal Oak @ 248-551-4040
      • Troy @ 248-964-7144

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