PURPOSE & GOAL: The program is designed, implemented, and evaluated to prevent or reduce the incidence of infection among students and staff at HEC.

1. Responsibility
A. The Infection Control Coordinator is responsible for the activities associated with surveillance, prevention, and control of infections among students and staff. The Coordinator is also available for consultation to the EOC Committee regarding any infection related discussions.

B. The EOC Committee will be comprised of the following members, as appropriate:
Chairperson
Workers Compensation Coordinator/EOC Coordinator
Nursing Department Representatives
Maintenance Representatives
Housekeeping Representatives
Direct Care Representatives

In addition, Representatives from other areas are invited to meetings for discussion of issues specific to each of these departments. The EOC Committee meets bi-monthly at each site with the exception of the Intensive Treatment Unit where the EOC Committee meets bi-monthly.

C. The Infection Control Coordinator is responsible for the annual review of the Plan for Surveillance including:
1) Data collection method(s), quality control measures, reporting mechanisms.
2) Effectiveness of program and actions taken for the previous year(s), including data and trends
3) Effectiveness of control measures and actions taken by the EOC Committee
4) New or revised Local, State, and Federal Regulations
5) CDC Guidelines for infection control issues/programs
6) Information regarding Infection control in professional publications or as distributed by Local, State, and/or Federal Departments of Health
7) Review available HEC data presented annually, identify trends, recognize opportunities for improvement, propose actions, assign responsibility, implement and evaluate the effectiveness of actions taken.
8) Annual review and approval of infection control policies and procedures

D. Statement of Authority: Infection Control Coordinator
In the event of a threat to the public health of HEC students and personnel the ICC has the authority to take any steps deemed necessary to control the identified threat. The Medical Director will be contacted and informed of the potential health risk, prior to action being taken in such a situation. However, if the Medical Director can not be reached to make a timely decision the ICC may take definitive action. These actions may include, but are not limited to:
ordering lab work
restricting visitors
requiring the use of personal protective equipment
restricting entry into specific areas
ordering surveillance
further precautions as deemed appropriate by the ICC.

E. Infection Prevention: The Infection Control Coordinator (ICC) has the authority to institute any surveillance activities, control measures, or procedures to prevent infection or its spread among students, visitors, and staff. The ICC will consult appropriately with the EOC Committee and its Chairperson(s).
The Infection Control Coordinator is consulted by Department Heads on issues regarding Infection control, including the following:
1). The purchase of equipment associated with Sterilization, Disinfection, and/or Cleaning
2). Revision of Policies or Procedures relevant to infection control practices
3). The purchase of personal protection equipment and barriers
4). Infectious disease(s) in Staff or Students.

2. Scope of Care

The objective of the Infection Control program is to recognize the occurrence of preventable infections among students and staff along with understanding the prevention of these infectious diseases. The scope of care also includes those practices related to disinfection and cleaning of equipment as well as the necessary supplies. The areas/services which are included in the Scope of the program are:
Residential and Academic Buildings
Offices
Outpatient Services provided by Hillcrest Psychological Services
Food Services
Environmental Services:
Maintenance Services
Housekeeping Services

In addition, contract services are reviewed for appropriate infection control practices.

3. Important Aspects of Care:

A. Surveillance is focused on:
• Total agency surveillance including outpatient services for identification and investigation of preventable infections
• The incidence of blood/body fluid(s) exposure
• The identification of outbreaks of infectious diseases and the institution of appropriate precautions to prevent further spread
• Identification and reporting of those diseases, Reportable by Law to Local and/or State Departments of Health.

B. Review of the policies and procedures as they relate to infection control and/or environmental control issues, particularly those which address prevention and containment of infectious diseases.
4. Indicators

A. Criteria used to identify preventable infections:
• Signs, symptoms, and laboratory findings, that were present and/or incubating at the time of admission.
• For an unknown incubation period, an infection is considered from external sources if it develops 72 hours or more after admission or returning from LOA.
• Infection present at the time of admission, will be referred to the Physician and treated as indicated.
• Self report disclosed by outpatient clients

 
Flu recommendations and procedures

In view of the recent information regarding the swine influenza A (H1N1) the following procedures will be available for all HEC campuses. The best way to prevent the spread of flu illness should be noted and encouraged at every opportunity. These steps include:

• Cover your cough or sneezes into a tissue or inside of arm, not your hands, dispose of the tissue
• Avoid touching your eyes, nose and mouth
• Wash your hands frequently with soap and water or hand sanitizer
• Stay home if you are sick with fever over 100.4F
• Clean surfaces such as desks, tables, counters, and door knobs with antibacterial solutions

On the occasion that the flu reaches our students these procedures should be followed:

• All students will be observed for the following symptoms: fever above 100.4 F, cough, sore throat, body aches, headache, chills and fatigue
• When these symptoms occur, every effort will be made to isolate the student in their room or a designated infirmary area on campus (to be determined by PD and Head Nurse)
• Saff who are assigned to be with ill students will be provided with N95 masks, gloves and disinfectant wipes
• Observation of symptoms will continue. If the BMC diagnostic criteria for testing is fulfilled then a nasopharyngeal swab will be obtained and sent to BMC Lab
• BMC lab will test the swab for Influenza A virus (results available within 24 hours), if present, a repeat specimen will be obtained and submitted to the State lab for subtyping
• Dr. Dempsey will be notified at which time anti-viral treatment may be initiated according to his orders
• If the testing does not reveal type A flu, isolation is not necessary. However, bedrest may be indicated depending on current symptoms assessed by the nurse on duty.
• Symptomatic treatment by staff and nursing will continue throughout the illness. This may include: tylenol/ ibuprofen, fluids and rest.
• Documentation of information will be completed by nursing on the Student Isolation Log. This information will be used to follow isolation and testing processes. (see attached)
• Staff will use the Student Monitoring Sheet to record pertinent information for each student in the isolation room. (see attached)
• The Head Nurses at each campus will make daily decisions on the students entering and leaving the isolation infirmary area.
• Updates on available information will be relayed to staff in Community Meetings
• Decisions on limiting travel or visitation on and off campus will be made by the SMT

Supplies to have on hand:
Anti-bacterial wipes
N 95 Masks
Gloves
Tissues
Nasopharyngeal swabs
Ibuprofen/Tylenol
Ginger ale
Sports drink/ other clear fluids

Flu in outpatient areas:
Appointments may be cancelled if client reports active flu illlness
Appointments may be cancelled if the clinicain experiences active flu symptoms 
Indicators for outbreaks of infection are defined by the Infection Control Coordinator and/or EOC Committee

The ICC will monitor the occurrence of pathogens, drug resistance, and report concerns regarding these to the EOC Committee, and will authorize surveillance as appropriate.

Indicators for Employee Health:

a) Incidence of Measles, Rubella, or Chicken Pox and post-exposure follow-up
b) Blood/body fluid exposures and follow up per OSHA’s Bloodborne Pathogen Standard.

Indicators for Environmental Controls

Housekeeping – Cleaning Procedures: Prior to any change in products used or in manner of use, the Dept. Manager will submit to the EOC Committee ALL available written literature substantiating the efficacy of the change relative to infection control. (See, Housekeeping Department, Policies for Infection Control).

Maintenance: The importance of effective infection control including the Maintenance of the Facility(ies) is recognized and reflected in Dept. policies (See, Maintenance Department, Policies for Infection Control).

The Manager of the Maintenance Department will consult with the ICC relative to appropriate infection control measures put in place prior to, and during all, construction, reconstruction, or major renovation (constituting entering into walls and/or ceilings) to the facility(ies).

Indicators for Policies and Procedures

Review and Revision:

1) ALL infection control policy and procedures are reviewed and revised to reflect current standards at least every 2 years.
2) New policy and procedures are added as required by Local, State, or Federal Laws or Regulations
3) Each Department Manager will consult with the ICC prior to effecting any revisions of Department Policy or Procedure relative to infection control.

REPORTABLE DISEASES

REPORT IMMEDIATELY BY PHONE
This includes both suspected and confirmed cases.
All cases should be reported to your local health department.
If unavailable, call the Massachusetts Department of Health
Telephone (617) 983-6800 Confidential Fax (617) 983-6813

Any Case of an unusual illness thought to have public health implications.

Any Cluster/Outbreak of Illness (Including, but not limited to foodborne Illness)

• Anthrax
• Botulism
• Brucellosis
• Diphtheria
• Encephalitis, any case
• Haemophilus influenzae, invasive
• Hemoêytic uremic syndrome (also report dWectty.to MDPH: 617-983-6800).
• Hepatitis A (lgM+ only)
• Meningitis, baterial community acquired
• Meningococcal disease, invasive
• (N. meningitidis)
• Plague
• Polio
• Q Fever
• Rabies in humans
• Rubella
• Smallpox
• Tetanus
• Tularemia
• Viral hemorrhagic fevers

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REPORT PROMPTLY (WITHIN 1-2 BUSINESS DAYS)
This includes both suspected and confirmed cases.
All cases should be reported to your local health department.
If unavailable, call the Massachusetts Department of Health
Telephone (617) 983-6800 Confidential Fax (617) 983-6813

• Ehrlichiosis
• Creutzfekit-Jakob disease
• Food poisoning and toxicity (includes poisoning by
ciguatera, scombrotoxln, mushroom toxin, tetrodotoxin,
paralytic shellfish and amnesic shellfish)
• Guillain Barré syndrome
• Hansen’s disease (leprosy)
• Hantavirus infection HBsAg+ pregnant women
• Leptospirosis
• Lyme disease
• Meningitis, viral (aseptic), and other infectious (non-bacterial)
• Pertussis (Whooping Cough)
• Psattacosis
• Reye syndrome
• Rheumatic fever
• Rlckettsialpox
• Rocky Mountain spotted fever
• Toxic shock syndrome
• Trichinosis
• Varicella (chickenpox)

105 CMR 300000 Reportable Diseases and Isolation and Quarantine Requirements February 2003, Page 1 of 2
 
REPORT DIRECTLY TO THE MASSACHUSETTS DPH
DEPARTMENT OF PUBLIC HEALTH

HIV infection and AIDS (617) 983-6560

Sexually Transmitted Diseases (617) 983-6940

Chanchrold Ophthalmia neonatorum:
Chalamydial infections (genital) a. Gonoccocal
Genital Warts b. Other agents
Gonorrhea Pelvic Inflammatory disease
Granuloma inguinale a. Gonococcal
Herpes, neonatal (onset within 30 days b. Other agents
after birth)
Lymphogranuloma venereum Syphilis

Tuberculosis suspect and confirmed cases: Report within 24 hours to (617) 983-6989 or
Toll Free (1-888) MASS-MTB (627-7682) or
Confidential Fax (617) 983-6990

Latent tuberculosis infection: Confidential Fax (617) 983-6990 or
Mall report to:
Massachusetts Department of Public Health
Division of Tuberculosis Prevention and Control
305 South Street, Jamaica Plain, MA 02130

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REPORTABLE DISEASES PRIMARILY ASCERTAINED THROUGH LABORATORY REPORTING OF EVIDENCE OF INFECTION

Please work with the laboratories you utilize for diagnostic testing to assure complete reporting.

Amebiasis
Babesiosis
Calicvirus infection
Campylobacteriosis
Cholera
Cryptococcosis
Cryptosporidiosis
Cyclosporlasis
Dengue fever virus
Eastern equine encephahtis virus
E. coil 0157:H7
Enteroviruses (from CSF)
Giardiasis
Group A streptococcus, invasive infection
Group B streptococcus, invasive infection
Hepatitis B
Hepatitis C
Hepatitis – infectious, not otherwise specified
Evidence of human prion disease
Influenza
Legionellosis
Listeriosis
Malaria
Salmonellosis
Shiga toxin-producing organisms
Shigellosis
Streptococcus pneumoniae, invasive
infection /
Toxoplasmosis
West Nile virus
Yellow fever virus
Yersiniosis

105 CMR 300000 Reportable Diseases and Isolation and Quarantine Requirements February 2003, Page 2 of 2

COLLECTING AND ORGANIZING DATA

Data is collected, organized, and presented annually by the ICC and includes:

Incidence of all specific types of infections as well as anaylsis of campus location.

Indicators of environmental controls affecting this data are collected by the EOC Committee, who then notify the ICC of variances.

Communicable diseases are reported to the appropriate Department of Health, by the Medical Director, and reviewed by the ICC when appropriate, such as when further surveillance or action is necessary.

EVALUATION OF CARE

Data is trended and reviewed by the ICC and presented to the EOC Committee annually.

Analysis of data is done for the following reasons:
a) To identify problems
b) To determine the necessity for further data collection or further investigation
c) To quantify the problem and determine causes
d) To compare data to current issues in the professional infection control literature, with national or local data, or other appropriate benchmarks in order to evaluate efficacy of the infection control program
e) To review new CDC Guidelines, OSHA Regulations, state and local Laws to assure compliance
f) To coordinate efforts with Occupational Health to protect employees
g) To provide data to health care providers when appropriate, so that action can be taken to reduce known risks
h) To identify cases of significant epidemiological variation, in order to institute further investigation
 
ACTION TAKEN TO IMPROVE PROGRAM

The ICC and EOC Committee will take action to solve problems or reduce risk of infection, including the following:

1. Use of Knowledge:
a) Present annual infection control programs to all staff, to reinforce and broaden their knowledge base.
b) Orient new employees to accepted infection control procedures.
c) Integrate new procedures or practice recommendations into ongoing programs.
d) Present special programs to staff, relative to new practices, as this information becomes available.
e) Distribute information or current infection control issues at meetings and/or in writing.

2. Assessment of Behaviors
a) The ICC or EOC Committee may institute appropriate measures to modify staff practices necessary to assure compliance with current standards.
b) New policy and procedures as developed, and/or revised, should incorporate the following strategies:
i) Scientifically valid and pertinent information including CDC Guidelines and OSHA Regulations.
ii) Employee Health policies as they relate to infectious disease, prevention, and treatment.
iii) Methods used to reduce the risk of cross-infection between staff/staff, staff/student, and student/student. This may include review of universal precautions, as well as policies on disinfection and handwashing.

Assess Actions

Data Collection and Evaluation
A. The ICC will assess the effectiveness of actions taken by collecting and comparing data and noting any further trends.
B. If improvement is acceptable to ICC, no further action is taken unless specifically requested by the Medical Director.
C. In the event that further action is needed, as determined by Assessment or Request, there will be further data collection and evaluation by the ICC, who will then report this, as appropriate to the Medical Director.

Communicate Relevant Actions Taken

Surveillance Reports
A. The ICC will present pertinent infection control information at IOP Meetings.
B. The ICC will present pertinent infection control information to the EOC Committee quarterly.
C. The Annual Report will include a summary of surveillance data, trends, and actions taken.