Infection Control by Mary beth vogel , bsn , RN-c

1. Infection Controlby Mary bethvogel, bsn, RN-c

2. Useless (Useful) Facts! • Alcohol-based hand rubs take less time to use than h/w. In an 8hr shift, an estimated 1hr of an ICU nurse's time will be saved by using an alcohol-based handrub (CDC) • The CDC recently reported that in US hospitals, HAI account for @ 1.7 million infections and 99,000 associated deaths each year. Of these infections: • 32 % of all HAI infections are UTI’s • 22 % are surgical site infections • 15 % are pneumonias/VAP • 14 % are bloodstream infections

3. The Basics • Microorganism/microbe/non-pathogen • Pathogen • Non-pathogens • Normal flora • Colonization

4. Colonized or Infected:What’s the Difference? • Colonization: carry bacteria w/o evidence of infection • Infection can occur d/t coloniz • How?

5. Classifications of Microorganisms

6. 1. Bacteria • Single celled microorg • Tx w/ antibiotics • Resistant bacteria are cause of HAI • Categorization: • Size, shape, cellular arrangement • Growth req • Staining

7. Bacillus anthracis and WBC

8. a. Cocci • Round • Diplococci • Streptococci • Staphylococci • Ex: • MRSA • Strep throat • Pneumonia

9. Streptococci

10. Staphylococci

11. b. Bacilli • Rod shaped • Single, paired, chains • May contain flagella • May form spores • Ex: • TB • Tetanus • Pertussis • Botulism • C-diff

12. Tetanus

13. c. Spirilla • Spiral, comma or corkscrew shape • Ex: • Cholera • Syphilis • Lyme disease

14. Lyme Disease

15. d. Small bacteria • Round/oval • Obligate intracellular parasites • Ex: • Chlamydia • Rocky Mountain Spotted Fever • Typhus

16. e. Nosocomial infections: HAI • VRE: vancomycin resistant enterococcus • MRSA: methicillin resistant staphylococcus aureus • C-diff: clostridium difficile • Easily spread from pt to pt; by hosp staff/equipment • Requires PPE, isolation

17. Recovery of VRE from Hands and Environmental Surfaces • Up to 41% of HCW’s hands sampled (after patient care and before hand hygiene) were positive for VRE • VRE were recovered from a number of environmental surfaces in patient rooms • VRE survived on a countertop for up to 7 days

18. The Inanimate Environment Can Facilitate Transmission Xrepresents VRE culture positive sites

19. 2. Protozoa • One celled microorglgr than bac • Ex: Malaria • Tx: prevention and antiprotozoan agents

20. Malaria

21. 3. Fungi • Simple plant like microorg • Yeast, mold • Fungal/mycotic infections: • Ringworm, athletes foot • Topical tx

22. Ringworm

23. 4. Prions • “Proteinaceous infectious particle” • MISFOLDED PROTEINS • Pathogenic proteins • Rare • BSE (BOVINE SPONGIFORM ENCEPHALOPATHY) • vCJD (VARIANT CREUTZFELT- JAKOB DISEASE) Spongiform change in CJD Tonsil biopsy in CJD

24. 5. Pathogenic Animals • Roundworms, tapeworms • Mites, ticks, lice, insects, spiders

25. 6. Virus • Smallest microorg; particle • Nucleic acid w/ protein coat • Enters host cell, alters dna, replicates • Spread by body fluids • Difficult to tx • Incubation pd varies • Rhinovirus, mumps, varicella, influenza, hepatitis, HIV/AIDS, epstein-barr, HPV, herpes, measles

27. Hepatitis • Liver infection • Transmitted by blood/body fluids • Types: • Hepatitis A: food borne • HBV: Bloodbourne • HCV: bloodbourne • Hep D: occurs w/ B • Hepatitis E: uncommon, similar to A • ETOH, autoimmune, drug/toxin induced • Acute vs chronic

28. Hepatitis B

29. Hepatitis C

30. Infection • Invasion of pathogens causes local cellular inj, sec of toxins or antigen-antibody rxn in host • Risk: inadequate def/immun, increased environmental exp, malnutrition, meds, trauma

31. Body Defenses • Skin • Mucous memb • Cilia • Coughing/sneezing • Chemical inhibitors: tears, HCl • Normal flora • Fever • Inflammation • Immune system (WBC)

32. Categories of Infections/Diseases • 1. Endogenous • 2. Exogenous • 3. Nosocomial/HAI • 4. Opportunistic • 5. Acute vs chronic • 6. Self limiting • 7. Primary vs secondary • 8. Local vs Systemic

33. Chain of Infection • Conditions that allow for spread of infection • 6 parts: • 1. Causative agent • 2. Reservoir • 3. Portal of exit • 4. Mode of transmission • 5. Portal of entry • 6. Susceptible host

35. Asepsis and Aseptic Techniques • Asepsis • Sterile • Contaminated vs Clean • Aseptic Techniques in HC: • Hand hygiene, PPE, cleaning Equip/env • Ultrasonic and Disinfection • Sterilization

36. 2,000,000+ HAI occur annually in the US. HAI add @$5 billion in extended care and tx • HAI occur in about 7-10% of hospitalized patients and account for @ 90,000+ deaths per year (CDC) • Most HCW recognize the importance of H/W but routinely overestimate their own compliance (CDC)

37. Hand Hygiene • Aseptic technique to prevent HAI • Skin, nares colonization can be pathogenic to pts • Protects patients, HCWs, visitors • Observations in public restrooms: only 68% h/w before leaving • When should HCW wash their hands?

38. Arrival/Departure • Before/after all pt contact • Anytime contamination occurs • Before/after gloves/PPE • After picking anything up off floor • After bathroom use • After coughing, sneezing, blowing nose • Inbetween procedures to prevent cross contamination

39. After handling any specimen • After handling any contaminated/soiled items • Before/after any contact w/ mucous memb • Before eating • At least 30 seconds!

40. Efficacy of Hand Hygiene Preparations in Killing Bacteria Better Good Best Antimicrobial soap PlainSoap Alcohol-based handrub

41. Which hand hygiene method is best at killing bacteria? • Plain soap and water • Antimicrobial soap and water • Alcohol-based handrub

42. Plain soap and water • Antimicrobial soap and water • Alcohol-based handrub Which of the following hand hygiene agents is LEASTdrying to your skin?

43. Ability of Hand Hygiene Agents to Reduce Bacteria on Hands Time After Disinfection % log 0 60 180 minutes 99.9 3.0 99.0 2.0 Alcohol-based handrub (70% Isopropanol) Bacterial Reduction 90.0 1.0 Antimicrobial soap (4% Chlorhexidine) 0.0 0.0 Plain soap Baseline Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.

44. Waterless handrub: • Increases compliance • Reduces a greater number of bac • Must apply to all hand surfaces (CDC) • Handwashing: • Sudsy action, alkali content of soap, friction reduce pathogens • Use warm water, good lather, point fingertips down when rinsing • Use paper towel to turn on/off faucets

45. Time Spent Cleansing Hands:one nurse per 8 hour shift • Hand washing with soap and water: 56 minutes • Based on seven (60 second) handwashing episodes per hour • Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour Alcohol-based handrubs reduce time needed for hand disinfection .

46. Can a Fashion Statement Harm the Patient? ARTIFICIAL POLISHED NATURAL Avoid wearing artificial nails, keep natural nails <1/4 inch if caring for high risk patients (ICU, OR)

48. Standard Precautions • CDC regulations • All body fl/all pt are potential sources of inf • ALL HCW ALL THE TIME FOR ALL PT!! • Breaks the chain of inf

49. Standard Precautions Guidelines • Use anytime there is poss contact w/: body fl • Rules: • H/W guidelines • PPE where indicated • No jewelry • Do not reuse gloves

50. Masks must be changed q 30 min or if wet • Sharps disposal, no recapping • Spill/splash clean-up • Mouthpieces for resuscitation • Contaminated waste, linen handling • Exposures must be reported!