Transcript CLED41058-Reducing Hospital-Acquired

Infection Control
REDUCING/PREVENTING
HOSPITAL-ACQUIRED INFECTIONS—
IT’S EVERYONE’S JOB
Objectives
 Describe Standard and Isolation Precautions
 Describe transmission and control of MDROs
 Identify important infection control processes
 Identify risk factors for Hospital-Acquired Infections
(HAI)
Infection Control Web Page
The Infection Control Web Page can be reached by
going to:
 Kaleidascope
 Departments and Services
 Patient Care / Clinical
 Infection Control
Take your questions to the Experts!
Infection Control is Everyone’s
Business
Family/Visitors
CNA/PCA/CMA
Nutritionists
Child Life
Healthcare Associated Infections—Some sobering
statistics:
7-10%
patients
develop
HAI (This
increases
to 30% of
critically ill
patients)
1.7 million
HAI Occur
annually
across the
nation
More than
99,000
deaths are
attributed
in part to
hospital
acquired
infections
Prevention and Control Methods—
Quick, Easy and Simple
Use of Standard
Precautions
Practicing good
hand hygiene
Use of Personal
Protective
Equipment,
including gloves
Attention to
Environmental
Controls
Knowing when and
how to use
TransmissionBased Precautions
Transmission-Based Precautions:
CONTACT Precautions
Transmission Based
precautions:
 Contact Precautions
used for patients with
diagnosis of:
C.. Difficile
MRSA, VRE,
ESBL
Precautions include
Private room
Gloves
Hand hygiene
Gowns
Transmission-Based Precautions:
DROPLET Precautions
Communicable diseases are
passed on by droplet
dispersion. These include:




Upper respiratory infections
(cold and flu)
Neisseria meningitis
Pertussis or whooping cough
Adenovirus
Precautions to prevent spread
of droplet-borne diseases
include:
Private room
Hand hygiene
Use of surgical mask if within 6
feet of the patient.
Airborne Isolation is a means of protecting
against the spread of some diseases:
These diseases include:
Varicella Virus (Chicken pox, Disseminated
Shingles)Surgical Mask
M. tuberculosisN-95 respirator Mask
Pandemic Flu
Airborne Isolation
 Place in negative pressure room
 Wear respirator for TB, Pan flu
 Facilities Management (daily smoke test)
 Keep doors closed
 Mask patient for transport
 Communicate with other departments
 Instruct visitors: N-95 respirator use
 OSHA Reg’s-Fit testing Annually!
Transporting Patients
Transporting Patients on Special Precautions
Droplet/Airborne: mask patient
 Contact: cover open areas

Minimize travel off unit
 Off-unit procedures: last case of the day

Hand Hygiene
Culture plate showing growth of bacteria 24 hours after a nurse placed her hand on the plate
When to Wash Your Hands
Upon arriving
Entering patient room
Leaving patient room
Between patients in same room
After handling patient equipment
Before/after handling specimens
Before serving food
After toileting
Before donning gloves
After glove removal
Before leaving work
Are alcohol-based hand rubs really effective?
More than 20 published
studies have shown that
alcohol-based hand rubs
are more effective than
either plain soap or
antibacterial soaps in
reducing the number of
live bacteria on the
hands.
Advantages of cleaning hands with alcoholbased hand rubs
When compared to traditional soap and water hand washing,
alcohol hand rubs have the following advantages:
 take less time to use
 can be made more accessible than sinks
 cause less skin irritation and dryness
 are more effective in reducing the number of bacteria
on hands
Kaleida Health makes alcohol-based hand rubs readily
available to personnel
 has
led to improved hand hygiene practices
A 24-year-old man who had quadriplegia due to a traumatic spinal
cord injury was found on routine surveillance cultures to have
methicillin-resistant Staphylococcus aureus (MRSA) colonization of
his anterior nares. He had no history of MRSA infection or
colonization. To assess the potential implications of the patient's
MRSA carriage for infection control, an imprint of a health care
worker's ungloved hand was obtained for culture after the worker had
performed an abdominal examination of the patient. The MRSA
colonies grown from this handprint on the plate (CHROMagar Staph
aureus).
After the worker's hand had been cleaned with alcohol foam, another
hand imprint was obtained, and the resulting culture was negative for
MRSA (Panel B). These images illustrate the critical importance of
hand hygiene in caring for
patients, including those not known to carry antibiotic-resistant
pathogens.
This is the image…………………………
January 15, 2009
Image of before (A) and after (B) using Alcohol based hand
foam……
A. Before using hand foam
B. After using hand foam
When should you wash your
hands with soap and water?
Wash your hands with plain soap
and water, or with
antimicrobial soap and water
if:





your hands are visibly soiled
(dirty)
hands are visibly contaminated
with blood or body fluids
before eating
after using the restroom
after caring for patients with C diff
Multi-Drug Resistant Organisms and Clostridium Difficile
•C-DIFF
•MRSA
VRE
So What’s The Fuss All About ?
 Drug resistant Pathogens are a growing threat
 2 Million patients acquire a HAI
 90,000 patients die as result of a HAI
 50% -70% of S.aureus isolates are MRSA
 > 70% of bacteria that cause HAI’s are resistant to at
least one antibiotic used for treatment
Source: CDC
Financial Impact of MRSA
 Annual cost to treat MRSA patients in the U.S. between $
3.2 billion and $ 4.2 billion
 Extra cost associated:
a blood stream infection $ 17,422 (MSSA $ 9,661)
a surgical site infection $ 36,133 (MSSA $ 4,989)
Source:
Abramson,ICHE1999;20:408
Engelman et al. 2001;ICAAC
Cosgrove et al Clin Inf Dis 2003;36:53-59
Cosgrove et al. ICAAC 2001
Kaye et al. ICAAC 2002
International Society of Pharmacoeconomics Outcome Research, 5/05
Cheng, J Hosp. Inf. 1988; 12:91-101
Wakefield, AJIC 1988; 16: 185-192
The inanimate environment is a reservoir
of pathogens
~ 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.
Eating and Drinking
The
previous slide displayed why it is so
important not to eat or drink around the
patients.
OSHA
 Food
Regulation
and drink should not be consumed in patient
care areas or areas where contamination with blood
or other potentially infectious material could occur.
Environmental Surfaces
 Toys and playroom surfaces should be disinfected as
often as possible, but at least daily.
 Is someone designated to clean toys and surfaces on
each floor???
Personnel Health Guideline
The following are guidelines for personnel who have various diseases
Disease Entity
1. Strep Throat
2.
3.
Zoster
a)
Localized
b)
General
Viral Upper respiratory
infection
Staff restrictions
1. Restrict working until 24
hours after start of
antibiotics
Zoster
2.
a)
b)
3.
Cover lesions; restrict from
caring for high risk patients
Restrict from patient contact
until lesions are dry/crusted
Consider exclusion from
care of high risk patients
Personnel Health Guideline con’t
Disease Entity
4. Conjunctivitis
Staff Restrictions
4. Restrict from patient
care until discharge
ceases
5. HSV-1
a) Hand
5. HSV-1
a) Restrict until lesion(s)
healed
b) Evaluate worker for need
to be restricted from care
of certain patients
b)
Oro-facial
Questions
If you have any questions regarding how to prevent
Hospital Acquired Infections, please contact the
Infection Control Specialist at your own site.
Preventing infection is –
everyone’s job!