New York State Mandatory Infection Control Training

• Dental hygienists
• Dentists
• Licensed practical nurses
• Optometrists
• Physicians
• Physician assistants
• Podiatrists
• Registered professional nurses
• Specialist assistants

The Patient Safety Act was passed in 2008 and that law added requirements that the following professionals must also complete the training:

• Medical students
• Interns and residents

Beginning in September 2008, courses must address specified updates for Elements III and V. These updates primarily concern injection techniques and equipment reprocessing updates.

There are six core elements that must be included in the infection control training; they will be covered in this course. After the initial infection control education is completed, a course including the six core elements (as originally developed and as revised in the legislation of 2008) or education specific to the professional?s practice will satisfy the mandatory requirement each four years thereafter. The training must be provided by an organization specifically approved by the New York State Education Department or New York State Department of Health to do so.

Provider Approval

CEU4U is approved as a provider (OH-218/10/01/2009) of continuing nursing education by the Ohio Nurses Association which is accredited by the American Nurses Credentialing Center's (ANCC) Commission on Accreditation.

All ANCC accredited organizations' contact hours are recognized by all other ANCC accredited organizations. Most states with mandatory continuing education requirements recognize the ANCC accreditation/approval system. Questions about the acceptance of ANCC contact hours to meet mandatory regulations should be directed to the professional licensing board within that state.

CEU4U has been granted provider status by the Florida State Board of Nursing as a provider of continuing education in nursing and is listed with CEBroker (Provider Provider # 50-3388-1).

Introduction

In addition to public exposures, there are also many reports about the dangers of contacting infections in hospitals, long term care facilities, and medical offices. Lay media and professional publications stress the value of using infection control practices to reduce the spread of these infections. Both anecdotes and research demonstrate that the most effective way to prevent infection in patients, workers, and visitors is to utilize infection control practices consistently and completely. There are standards in place to identify risks, monitor compliance, and quantify infection rates. Research clearly identifies relationships and demonstrates that the most effective way to prevent nosocomial infections and occupationally acquired infections is to use sound implement infection control procedures.

Scarcely a day goes by without some news item about "hospitals killing patients." The general public is inundated with stories about the spread of infection caused by improper procedures or carelessness demonstrated by healthcare workers. For instance, the January 2007 issue of the AARP Bulletin headlined its article, "Dirty Hospitals." That article claimed that two million patients are infected in hospitals each year and more than 90,000 die. While stories may be exaggerations in many cases, there is no doubt that nosocomial infections do occur, do cause pain, suffering, even death, and cost millions of dollars. It is also important to note that the spread of infections and communicable diseases among the workers themselves is of great concern, too. The same knowledge and practices that protect patients will protect the workers! So what can be done? How can each healthcare worker protect him or her self and their patients?

None of this is new ? and the need for healthcare professionals to do all they can to prevent and reduce the spread of infection is not new either! As stated earlier, New York State legislators enacted Chapter 786 of the Laws of 1992 and established a requirement that licensed healthcare professionals practicing in New York had to complete infection control training by July 1994 and every four years thereafter. The Patient Safety Act of 2008 revised the training curriculum somewhat and added medical students, interns, and residents to the list of health care professionals required to complete the training.

The overall goals of the infection control training were specified in the law.

1. Assure that licensed, registered, or certified healthcare professionals understand how bloodborne pathogens are transmitted patient to healthcare worker, healthcare worker to patient, and patient to patient.
2. Apply current scientifically accepted infection control principles as appropriate for the workplace.
3. Minimize opportunity for transmission of pathogens to patients and workers.
4. Familiarize professionals with the law requiring this training and the professional misconduct charges that may be applicable for not complying with the law.

There are six core elements that must be included in the NYS mandatory training. These core elements provide essential information and facts that form the basis of infection control and disease prevention.

Element I - Professional Responsibility to Adhere to Infection Control Practices

New York State Standards and Authorities

1. Medicine
2. Physician?s assistant
3. Specialist?s assistant
4. Dentistry
5. Dental hygiene
6. Podiatry
7. Optometry
8. Registered professional nurse
9. Licensed practical nurse

"Failing to use scientifically accepted infection prevention techniques appropriate to each profession for the cleaning and sterilization or disinfection of instruments, devices, materials and work surfaces, utilization of protective garb, use of covers for contamination-prone equipment and the handling of sharp instruments. Such techniques shall include but not be limited to:
1. Wearing of appropriate protective gloves at all times when touching blood, saliva, other body fluids or secretions, mucous membranes, non-intact skin, blood-soiled items or bodily fluid-soiled items, contaminated surfaces, and sterile body areas, and during instrument cleaning and decontamination procedures;

2. Discarding gloves used following treatment of a patient and changing to new gloves if torn or damaged during treatment of a patient; washing hands and donning new gloves prior to performing services for another patient; and washing hands and other skin surfaces immediately if contaminated with blood or other body fluids;

3. Wearing of appropriate masks, gowns or aprons, and protective eyewear or chin-length plastic face shields whenever splashing or spattering of blood or other body fluids is likely to occur;

4. Sterilizing equipment and devices that enter the patient's vascular system or other normally sterile areas of the body;

5. Sterilizing equipment and devices that touch intact mucous membranes but do not penetrate the patient's body or using high-level disinfection for equipment and devices which cannot be sterilized prior to use for a patient;

6. Using appropriate agents, including but not limited to detergents for cleaning all equipment and devices prior a sterilization or disinfection;

7. Cleaning, by the use of appropriate agents, including but not limited to detergents, equipment and devices which do not touch the patient or that only touch the intact skin of the patient;

8. Maintaining equipment and devices used for sterilization according to the manufacturer's instructions;

9. Adequately monitoring the performance of all personnel, licensed or unlicensed, for whom the licensee is responsible regarding infection control techniques;

10. Placing disposable used syringes, needles, scalpel blades, and other sharp instruments in appropriate puncture-resistant containers for disposal; and placing reusable needles, scalpel blades, and other sharp instruments in appropriate puncture-resistant containers until appropriately cleaned and sterilized;

11. Maintaining appropriate ventilation devices to minimize the need for emergency mouth-to-mouth resuscitation;

12. Refraining from all direct patient care and handling of patient care equipment when the healthcare professional has exudative lesions or weeping dermatitis and the condition has not been medically evaluated and determined to be safe or capable of being safely protected against in providing direct patient care or in handling patient care equipment; and

13. Placing all specimens of blood and body fluids in well-constructed containers with secure lids to prevent leaking; and cleaning any spill of blood or other body fluid with an appropriate detergent and appropriate chemical germicide."

Any patient or employee complaint regarding lax infection control practices in a private medical or dental office will prompt an investigation by the Departments of Health and/or Education. Substantiated lapses in infection control in a private practice setting may result in charges of professional misconduct against any licensed professional in the practice who was directly involved, was aware of the violation, or who has responsibility for ensuring that office staff is adequately trained and follow patient protection measures.

Codes, Rules, and Regulations of New York Title 10 (Health)

"For physicians, registered physician assistants, and specialist assistants, the definition of unprofessional conduct shall include the failure to use scientifically accepted infection control practices to prevent transmission of disease pathogens from patient to patient, physician to patient, registered physician assistant or specialist assistant to patient, employee to patient, and patient to employee, as appropriate to physicians, registered physician assistants and specialist assistants. Such practices include:

1. Adherence to scientifically accepted standards for: hand washing; aseptic technique; use of gloves and other barriers for preventing bi-directional contact with blood and body fluids; thorough cleaning following sterilization or disinfection of medical devices; disposal of non-reusable materials and equipment; and cleaning between patients of objects that are visibly contaminated or subject to touch contamination with blood or body fluids;

2. Use of scientifically accepted injury prevention techniques or engineering controls to reduce the opportunity for patient and employee exposure; and

3. Performance monitoring of all personnel, licensed or unlicensed, for whom the licensee is responsible regarding infection control techniques.

New York Standards for Hospitals State Health Code regulates all article 28 facilities licensed by New York. Part 405 prescribes health standards such as infection control.

New York State Department of Health Guidelines relate to infection control, prevention of transmission of HIV and HBV, immunizations for prevention of communicable diseases, and infection control training.

Professional and National Infection Control Standards

• Healthcare outcomes,
• Outbreaks in healthcare settings,
• Emerging antimicrobial-resistant infections,
• Efficacy of new interventions for patient safety,
• Clinical microbiology laboratory quality,
• Water quality in healthcare settings,
• Cost effectiveness of prevention interventions,
• Promotion of implementation and evaluation of prevention interventions,
• Development of infection control guidelines and policies.

DHQP is organized into three main components: the Epidemiology and Laboratory Branch, the Prevention and Evaluation Branch, and the Healthcare Outcomes Branch.

The Epidemiology and Laboratory Branch (ELB) provides epidemiologic and laboratory assistance when investigating outbreaks of disease and other adverse events that occur in healthcare settings. ELB is a reference laboratory for U.S. hospitals and other healthcare facilities for the identification of staphylococci and their toxins, anaerobic bacteria, and enteric bacteria. ELB confirms and characterizes unusual antimicrobial resistance patterns and delineates the mechanism of resistance. ELB?s environmental microbiology team is developing optimum methods to detect and decontaminate healthcare surfaces and water that may be contaminated with Category A and B bacterial agents in a bioterrorism event. The epidemiology section responds to outbreaks of new or emerging infectious diseases and other adverse outcomes associated with the delivery of healthcare. Examples of such responses include the first-ever description of rabies transmission associated with organ transplantation, investigation of nationwide outbreaks associated with contaminated medications and devices, investigation of a nationwide epidemic of Clostridium difficile-associated disease, and responding to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) outside healthcare facilities, including increasing rates of MRSA skin and soft tissue disease.

The Prevention and Evaluation Branch (PEB) develops and promotes the implementation of evidence-based guidelines, recommendations, and other interventions to prevent healthcare-associated infections and antimicrobial resistance, related adverse events, and medical errors; evaluates the effectiveness of novel and proven interventions for prevention of healthcare-associated infections and antimicrobial resistance, related adverse events, and medical errors; and develops, disseminates, and evaluates training and other health communications tools designed to protect patients and healthcare personnel and to promote quality healthcare.

The Healthcare Outcomes Branch (HOB) conducts surveillance, research, and demonstration projects to measure the impact of healthcare-associated infections, adverse drug events, and other complications of healthcare. HOB staff work closely with healthcare practitioners and healthcare facilities and with partners in other federal agencies, accrediting bodies, and professional groups. A major initiative currently underway in HOB is the launch of the National Healthcare Safety Network (NHSN), a web-based system for monitoring healthcare-associated adverse events.

"APIC?s mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. The Association?s more than 11,000 members have primary responsibility for infection prevention, control and hospital epidemiology in health care settings around the globe, and include nurses, epidemiologists, physicians, microbiologists, clinical pathologists, laboratory technologists and public health practitioners. APIC advances its mission through education, research, collaboration, practice guidance and credentialing.

APIC was conceived in 1972 in recognition of the need for an organized, systematic approach to the "control" of infections acquired as a result of hospitalization. Originally called The Association for Practitioners in Infection Control, the name was changed to the Association for Professionals in Infection Control and Epidemiology, Inc. in 1994 to recognize the organization's maturation and evolution into the broader context of health care delivery in this country. This includes the study of non-infectious adverse outcomes and the movement of care outside the traditional health care system, specifically the hospital."

The Society for Healthcare Epidemiology of America (SHEA)

"The Society for Healthcare Epidemiology of America (SHEA) was organized in 1980 to foster the development and application of the science of healthcare epidemiology.