INFECTION PREVENTION Part 1

1. INFECTION PREVENTION Part 1

2. National Patient Safety Goal#7 PREVENTION OF HEALTHCARE ASSOCIATED INFECTIONS • Comply with hand hygiene guidelines by either • Centers for Disease Control and Prevention (CDC) OR • World Health Organization (WHO) • Healthcare facilities must implement evidence based practices for the prevention of • Multi-drug resistant organisms (MDRO) • Central Line Associated Blood Stream Infections (CLABSI) • Surgical Site Infections (SSI) • Catheter Associated Urinary Tract Infections (CAUTI) • HAIs causing death or permanent loss of function are managed as sentinel events

3. Surgical Site Infection (SSI) Ventilator Associated Event (VAE) HAI Catheter Associated Urinary Tract Infection (CAUTI) Central Line Associated Blood Stream Infection (CLABSI)

4. Healthcare Associated Infections (HAI) • An infection not present or incubating on admission • Related to a previous hospitalization (within 30 days) • May be associated with a procedure performed at a healthcare facility

5. HAND HYGIENE THE MOST EFFECTIVE WAY TO PREVENT THE SPREAD OF INFECTION

6. Most Frequently Missed Frequently Missed  Less Frequently Missed

7. Hand Hygiene Practice Before and after contact with a patient or contaminated surfaces: • Antibacterial soap and water when hands are: • Visibly soiled • Had contact with blood or body fluid • If C. dif. is suspected or confirmed Alcohol gel hand rub on any other occasion • Use friction • Cover all surfaces of hands SING HAPPY BIRTHDAY! To ensure you have washed long enough • Don’t forget to keep nails ¼ inch in length to decrease accumulation of bacteria

8. Skin Care An important part of hand hygiene. Hands that are chapped and dry not only present an exposure risk, but healthcare workers are less likely to wash when skin integrity is impaired. Maintain good skin health with a hospital grade lotion. Hospital grade lotions are compatible with alcohol gel. Other lotion will decrease the efficacy of alcohol based gel.

9. DRUG RESISTANT ORGANISMS VRE MRSA ESBL KLEBSIELLA ACINETOBACTER

10. Multi-drug Resistant Organisms (MDRO) • Microorganisms that are resistant to • one or more classes of antimicrobial • agents . • Antibiotics fight off disease when • patient’s immune system cannot. • But what happens when a patient • (in a weakened state) acquires an • infection that is resistant to • antibiotics?

11. 07.03.01 EP# 8&9 Laboratory-Based Alert System for MDRO Why identify patients who have a history of drug resistance? Patients with a history of MDRO pose a risk to the inpatient population because they may remain colonized with the infectious bacteria even after treatment. Identification of these patients on admission allows us to protect other patients and staff.

12. Those aren’t flammin’ hot Cheetos!

13. Universal Identifier for C.difficile Clostridium difficile (C.dif) while not technically a drug resistant organism is considered epidemiologically important due to: • A propensity for transmission within healthcare facilities. • Patients may develop as a result of antibiotic use. • General association with serious disease and increased morbidity /mortality. Place a black square magnet on the Patient Census board (white board) next to the name of any patient who is suspected or confirmed to have C.difficile Purpose: identifies any transmission risk to other patients and staff 1. alerts healthcare personnel to wash with soap and water 2. alerts EVS that a 2 step terminal cleaning process is indicated

14. Use Proper Technique During Specimen Collection to Avoid… Wrong Diagnosis False positive or negative result Wrong treatment Antibiotic prescribed when not needed will delay or prevent the appropriate treatment Poor Outcomes Antibiotic resistance C.difficile colitis Drug allergies …..AND public reporting of erroneous rates by the IP

15. That’s no banana smoothie

16. HAI Report to the Stakeholders 07.03.01 EP#6 ▬07.04.01 EP#5 ▬07.05.01 EP#6 • Report of identified acquired infections within the facility • Posted in designated areas for staff to review • Includes a brief analysis with suggested strategies for improvement Analysis: 1 VRE, 5/27DX Sepsis & Sacral Abscessè 5/28 intra-operative Cultures are negative è 6/9 wound Cultures test + VRE Risks Factors: multiple co-morbidities, multiple transfers during visit, bowel prep when patient has sacral wound Action Plan: Opportunities for improvement are use of rectal tube if indicated, wound care consult, limit transfers.

17. PROTECTIVE MEASURES

18. Standard Precautions • Otherwise known as Universal Precautions • Assumes blood and body fluid of any patient is infectious • Type of PPE used is determined by type of clinical interaction with patient

19. Personal Protective Equipment (PPE) • Gloves • Gowns • Masks • Respirators • Aprons • Eye shields

20. References Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007. Jane D. Siegel, MD; Emily Rhinehart, RN MPH CIC; Marguerite Jackson, PhD; Linda Chiarello, RN MS; the Healthcare Infection Control Practices Advisory Committee. http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf Chiarello L, Jackson M, Rhinehart E, Siegel JD, and the Healthcare Infection Control Practices Advisory Committee (HICPAC) (2006). Management of Multidrug-Resistant Organisms In Healthcare Settings. http://www.cdc.gov/hicpac/pdf/MDRO/MDROGuideline2006.pdf William A. Rutala, Ph.D., M.P.H., David J. Weber, M.D., M.P.H., and the Healthcare Infection Control Practices Advisory Committee (HICPAC) (2008) Guideline for Disinfection and Sterilization in Healthcare Facilities, Centers for Disease Control and Prevention. http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf Lynne Sehulster, Ph.D., Raymond Y.W. Chinn, M.D., Center for Disease Control and Prevention / Healthcare Infection Control Practices Advisory Committee (HICPAC) (2003), Guidelines for Environmental Infection Control in Health-Care Facilities http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm