Transcript INFECTION CONTROL - www.Clevelandvaresearch.org

7/17/2015
INFECTION CONTROL
Annual Review
Topics:
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OSHA Standards
Isolation Review
Multiply Resistant Organisms
Emerging Pathogens
JCAHO Patient Safety Goal #7
Bioterrorism
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OSHA STANDARDS
Bloodborne Pathogens
Tuberculosis
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Bloodborne Pathogens
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Hepatitis B
Hepatitis C
HIV
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Sharps Safety Devices
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Required by OSHA
Designed to prevent needlestick and sharps
exposures
May include retractable needles, resheathing devices, or cover shields
Selection of devices is partly based on input
from the user.
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Sharps Safety
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Always wear gloves when handling sharps.
Never bend, break or recap a needle.
Activate the safety feature before disposal.
Dispose of sharps into an approved
container immediately, as close to the point
of use as possible.
Never force items into the container.
EMS should replace the liner when 3/4 of
the way full.
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Types of Exposures
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Blood-to-blood contact through a sharps or
needlestick injury
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Splash exposure to mucous membrane or
non-intact skin
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Exposure Protocol
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Immediately wash affected area with soap
and water.
Notify your supervisor and report to
Employee Health ASAP.
Off tours and weekends:
Urgent Care (WP)
Nursing Supervisor (BV).
If known source, patient will be tested for
HBV, HCV and HIV (informed consent
required).
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Post-Exposure Prophylaxis
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Employee Health will evaluate the level of
risk and determine the need for postexposure prophylactic medication (PEP).
If employee is not immune to HBV, a dose
of vaccine or hepatitis B immune globulin
may be appropriate.
No PEP is indicated for Hepatitis C
exposure. Must follow-up with Employee
Health.
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Tuberculosis
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High-risk Groups
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HIV+
History of IV drug use
Close contacts of a person with active TB
Homeless people
Residents of long-term care facilities,
shelters, mental institutions, prisons
Chest x-ray consistent with TB
Immigrants or people born in highprevalence areas
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Medical Factors Increasing the
Risk of Active TB
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Diabetes Mellitus
Silicosis
>10% below ideal body weight
Chronic renal failure
Immunosuppressive therapy
Hematologic disorders
Other malignancies
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Symptoms of TB
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Fever and chills
Night sweats
Loss of appetite
Unexplained weight loss
Productive cough
Bloody sputum
Elevated WBC count
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How is TB Transmitted?
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Usually a pulmonary disease, transmitted
through the air by tiny particles called
droplet nuclei.
Can be spread when a person with active
disease coughs, sings, sneezes, laughs, etc.
Healthcare workers are at higher risk due to
possible exposure to sick patients.
Appropriate isolation precautions must be
followed.
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Airborne Isolation -TB
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Known or suspected cases should be placed in a
negative pressure room.
HCW must verify negative pressure
Some outpatient areas have portable HEPA filter
fans to be used prior to transfer.
Respiratory Hygiene and Cough Etiquette:
Instruct patient to cover his/her cough, or wear
surgical mask.
Employee must wear N-95 Particulate Respirator
(fit-testing required by OHSU)
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TB Screening
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PPD skin test is the preferred method of
screening.
Required annually of all Medical Center
employees.
Required upon admission and annually for
all long-term care patients.
RNs must be trained to administer and
interpret PPDs within the VA.
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Latent TB vs. Active TB
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A positive PPD skin test indicates that there
was an exposure to TB at one time.
Most cases of latent (inactive) TB never
progress to active disease, but the skin test
usually remains positive for life.
Prophylactic treatment may prevent active
TB from ever developing.
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Influenza
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Flu season is October through March.
Vaccination is strongly recommended.
No risk of getting the flu from the flu shot.
Available for patients 10/15/03
Available for employees 11/1/03
Refer to Flu Plan in public drive.
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Isolation Precautions
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Standard Precautions - Use for all patients.
All body fluids/substances considered
potentially infectious. Use appropriate
personal protective equipment (PPE).
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Personal Protective Equipment
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Gloves
Gowns
Masks
Goggles
Face Shield
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PPE - Gloves
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Wear gloves when contact with blood/body
fluids, mucous membranes, or non-intact
skin could occur.
Change gloves when moving from a
contaminated body site to a clean body site.
Remove gloves after caring for a patient.
Decontaminate your hands after gloves are
removed!
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PPE - cont.
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Don PPE prior to patient contact
Remove PPE at point of use, before leaving
the area
Observe proper technique to prevent
contamination
DECONTAMINATE hands after PPE
removal
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Isolation Precautions
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Transmission - Based Precautions
Airborne - TB, Chickenpox
Droplet - MRSA pneumonia
Contact - VRE, C. Difficile
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Contact Precautions
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Private room or cohort when possible.
Private or designated bathroom.
Wear gloves when entering room; other PPE
as needed.
Clean and disinfect all equipment before
use with another patient.
Hang stop sign outside door.
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Multiply Resistant Organisms
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MRSA
VRE
C. Difficile
Other resistant organisms
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MRO-cont.
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Contact isolation - private room or cohort if
necessary.
Be aware of environmental contamination
Target antibiotic therapy
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At your hospital, what percentage
of Staph aureus isolates are
resistant to methicillin?
1. <5%
2. 15%
3. 20%
4. 30%
5. >50%
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Colonized or Infected:
What is the Difference?
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People who carry bacteria without
evidence of infection (fever, increased
white blood cell count) are colonized
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If an infection develops, it is usually from
bacteria that colonize patients
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Bacteria that colonize patients can be
transmitted from one patient to another by
the hands of healthcare workers
~ Bacteria can be transmitted even if
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The Iceberg Effect
Infected
Colonized
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Vancomycin-Resistant
Enterococcus (VRE)
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Most often associated with antibiotic use.
Colonization is asymptomatic. Diagnosis
can only be made with a VRE culture.
Requires contact isolation and weekly
specimens until there are three consecutive
negative cultures.
History of VRE-isolate on admission .
No treatment for colonization.
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Recovery of VRE from Hands
and Environmental Surfaces
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Up to 41% of healthcare worker’s hands
sampled (after patient care and before
hand hygiene) were positive for VRE1
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VRE were recovered from a number of
environmental surfaces in patient rooms
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VRE survived on a countertop for up to 7
days2
1
Hayden MK, Clin Infect Diseases 2000;31:1058-1065.
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2 Noskin
G, Infect Control and Hosp Epidemi 1995;16:577-581.
The Inanimate Environment Can
Facilitate Transmission
X represents VRE culture positive sites
~ Contaminated surfaces increase cross-transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a
VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
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Clostridium Difficile (C. Diff.)
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Also associated with recent exposure to
antibiotics.
 Symptoms usually include diarrhea and
abdominal cramping.
 Recommended treatment is oral
metronidazole (Flagyl) x10 days.
 Requires contact isolation until symptoms
resolve (usually within a few days of
treatment).
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Emerging Pathogens
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SARS
West Nile
Smallpox
Monkeypox
To be announced…..
WWW.CDC.GOV
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JCAHO Patient Safety Goal #7
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Reduce the Risk of Health Care-Acquired
Infections
CDC Hand Hygiene Guidelines
Sentinel Events Related to Infections
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CDC Guideline for Hand Hygiene
in Health-Care Settings
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Published in October 2002
Provides recommendations for hand
hygiene among healthcare workers
Addresses alcohol-based hand rubs (gel,
foam, etc.)
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“Hand washing is generally considered
to be the most important measure in
preventing the spread of infection.”
“Hands should be washed before
significant contact with any patient and
after activities likely to cause
contamination.”
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So Why All the Fuss About Hand
Hygiene?
Most common mode of
transmission of pathogens is via
hands!
 Infections acquired in healthcare
 Spread of antimicrobial resistance
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Definitions
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Hand hygiene
• Performing handwashing, antiseptic handwash, alcoholbased handrub, surgical hand hygiene/antisepsis
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Handwashing
• Washing hands with plain soap and water
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Antiseptic handwash
• Washing hands with water and soap or other detergents
containing an antiseptic agent
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Alcohol-based handrub
• Rubbing hands with an alcohol-containing preparation
Guideline
for Hand Hygiene in Health-care Settings. MMWR 2002;
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vol. 51, no. RR-16.
Definitions
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Hand decontamination
• Performing handwashing using antiseptic
handwash, alcohol-based handrub, or surgical
hand hygiene/antisepsis
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Surgical hand hygiene/antisepsis
• Use antiseptic handwash or an alcohol-based
handrub with persistance before operations by
surgical personnel
Guideline
for Hand Hygiene in Health-care Settings. MMWR 2002;
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vol. 51, no. RR-16.
Indications for Hand
Hygiene
 When hands are visibly dirty,
contaminated, or soiled, wash with nonantimicrobial soap and follow with
decontamination using alcohol-based
handrub if situation dictates; or use
antimicrobial soap and water.
 If hands are not visibly soiled, use an
alcohol-based handrub for routinely
decontaminating hands.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol.7/17/2015
51, no. RR-16.
Specific Indications for
Hand Decontamination
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Before:
• Patient contact
• Donning gloves when inserting a CVC
• Inserting urinary catheters, peripheral vascular
catheters, or other invasive devices that don’t
require surgery
Guideline
7/17/2015for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.
Specific Indications for
Hand Decontamination
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After:
• Contact with a patient’s skin
• Contact with body fluids or excretions, nonintact skin, wound dressings
• Contact with the environment/equipment in
patient room/area
• Removing gloves
Guideline
7/17/2015for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.
Efficacy of Hand Hygiene
Preparations in Killing
Bacteria
Good
Better
Plain Soap
Antimicrobial
soap
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Best
Alcohol-based
handrub
Alcohol-Based Hand
Rubs
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Require less time
 Can be strategically placed
 Readily accessible
 Multiple sites
 All patient care areas
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Alcohol-Based Hand Foam
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Dispense a golf ball-sized
amount of foam, covering all
surfaces of both hands, and rub in
until dry.
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Preferred method of hand
hygiene when hands are not
visibly soiled.
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Time Spent Cleansing
Hands:
one nurse per 8 hour shift
 Hand washing with soap and water:
56 minutes
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Based on seven (60 second) handwashing
episodes per hour
 Alcohol-based handrub: 18 minutes
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Based on seven (20 second) handrub episodes per
hour
~ Alcohol-based handrubs reduce time
needed for hand disinfection ~
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Voss A and Widmer AF, Infect Control Hosp Epidemiol 1997:18;205-208.
Summary
Alcohol-Based Handrubs:
What benefits do they provide?
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Require less time
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More effective for standard
handwashing than soap
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More accessible than sinks
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Reduce bacterial counts on hands
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Improve skin condition
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Hand Washing (15 seconds of friction)
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Non-antimicrobial lotion soap: Use
only to wash if hands are soiled or
visbly dirty. FOLLOW WITH
ALCOHOL-BASED HANDRUB IF
HANDS NEED TO BE
DECONTAMINATED!
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Antimicrobial soap: Use to
decontaminate hands, clean hands
when visibly soiled, and when caring
for a patient with Clostridium difficile
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Routine Hand Wash
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Repeat procedures until hands are clean
Can a Fashion Statement
Harm the Patient?
% Recovery of gram
negative bacteria
40
Natural (n=31)
Artificial (n=27)
Polished (n=31)
35
30
ARTIFICIAL
20
10
10
0
5
POLISHED
NATURAL
p<0.05
Avoid wearing artificial nails, keep natural
nails <1/4 inch if caring for high risk patients
(ICU, OR)
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Edel et. al, Nursing Research 1998: 47;54-59
Artificial Nails
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Associated with outbreaks in healthcare due
to bacterial and fungal contamination.
Artificial nails are prohibited in high-risk
areas; strongly discouraged for anyone
providing patient care.
No chipped nail polish.
Natural nails should be kept less than 1/4
inch long.
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What is the Story on
Moisturizers and Lotions?
ONLY USE facility-approved and
supplied lotions
Because:
 Some lotions may make medicated
soaps less effective
 Some lotions cause breakdown of latex
gloves
 Lotions can become contaminated with
bacteria if dispensers are refilled
~ Do not refill lotion bottles ~
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Surveillance Activities
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Line-related bacteremias
Ventilator-associated pneumonia
Surgical wound infections
Resistant organisms- C. difficile
UTIs in nursing home
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Surveillance- cont.
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Notify Infection Control of any increased
incidence of infections.
If you are sick, report to Employee Health
before coming to work.
Report to Infection Control any adverse
patient outcomes related to infection.
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Sentinel Event
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All cases of unanticipated death or
permanent loss of function associated with a
health care-acquired infection.
Notify Infection Control if you are aware of
any cases.
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Bioterrorism
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All employees should be aware of the
Hospital Bioterrorism Plan.
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Significant agents of bioterrorism
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Anthrax
Smallpox
Plague
Tularemia
Viral Hemorrhagic Fevers
Botulism
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Anthrax
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Caused by bacillus anthracis bacteria
May cause inhalational, cutaneous or
gastrointestinal disease.
Transmitted by inhaling or handling spores,
but not transmitted person-to-person.
Antibiotic treatment is necessary.
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Smallpox
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Caused by variola virus
Last case identified in 1977; declared
eradicated in 1980.
Person-to-person transmission through
contact or airborne route is likely.
Smallpox vaccine is available, but only to
be used if there is an identified risk.
Treatment is supportive care.
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Smallpox Vaccine
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Made with vaccinia virus, another orthopox
virus similar to variola.
Causes the body to produce antibodies
which protect against all orthopox viruses.
This is a live virus vaccine, so the
vaccination site must be cared for to prevent
the virus from spreading.
Many contraindications.
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Plague
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Bacterial infection that causes bubonic or
pneumonic disease.
Most commonly transmitted through
infected fleas or infected animal tissues.
Antibiotic treatment effective when
administered early.
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Fortunately, most illnesses caused by
potential bioterrorist agents are treatable
when promptly diagnosed.
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Early recognition is the key!
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When you suspect bioterrorist activity,
immediately call the VA Police by dialing
2222!
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For more information on bioterrorism, see
the Bioterrorism Module located on the
public drive in the Infection Control
Education folder.
http://www.cdc.gov
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Questions?
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Contact Infection Control
Wade Park: ext 4791/4792
Brecksville: ext 6571
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